Joint Public Health: Jan. 7, 2026

Representative Jeff Wardlaw Representative Steimel, you might open us up with prayer. [Prayer] Members, do I have a motion to approve the minutes from the December 8 meeting? I have a motion. A second. All those in favor, say aye. All opposed? Ayes have it. 

Members, Item C, we typically refer these ISPs to the subcommittees. We have referred Item C1 and C2 to Labor and Environment subcommittee. Do I have a motion to adopt them and accept the recommendations of the chair? I have a motion. I have a second. All those in favor say aye. All opposed? Ayes have it. Item C will be referred, both items, to Labor and Environment subcommittee. 

With that, we’ll move on to Item D. Be looking for Jay Hill and Melissa Weatherton and Deborah Inman. If you guys would introduce yourself for the committee, you are recognized to present your rule. 

Deborah Inman Hi, my name is Deborah Inman. I’m an assistant director of Aging at the Arkansas Department of Human Services. It’s nice to meet you all. 

Melissa Weatherton Hey, good afternoon, Melissa Weatherton, Director of Medicaid Specialty Populations at Department of Human Services. 

Personal Care eligibility process

Jay Hill And Jay Hill, division director for Aging and Adult Behavior Health Services at DHS. Thank you, Mr. Chairman. We are presenting to you today revisions for two manuals at the agency, the state plan personal care manual and then the state’s Arkansas independent assessment manual or the ARIA manual. You may have– apologies, can you hear me okay now? 

We are presenting to you to revise two manuals, the Arkansas state plan personal care manual and our Arkansas independent assessment manual, the ARIA manual. This rule will repeal the current manuals and issue new simplified, streamlined versions. And I’ll very briefly, very quickly kind of go over the changes, the additions for you, and then certainly gladly take questions.

Primarily, we are removing overlapping language with other manuals, clarifying what we’ve got and restricting it to a specific program. For instance, in the personal care manual, we will be removing references to other programs and making references or inserting links to other manuals where necessary.

Representative Jeff Wardlaw So I didn’t do my homework and read the agenda and notice that this was a personal care item. Since I work and have worked in the personal care field, I’m going to let Representative Wooldridge chair this meeting from here. 

Jay Hill Thank you, sir. Secondly, the revision of the personal care manual will implement Act 853 of the previous general session, 2025, which will move licensure and certification from the Department of Human Services for personal care agencies, private care agencies to the Arkansas Department of Health. 

Very quickly and briefly to summarize the updated manual for our state plan personal care, the changes will be, this will reintegrate PCPs into the eligibility and assessment process for individuals that will be entering the program or making application to enter into the program for state plan personal care. 

It will transition from a single assessment tool, which we currently use our Optum contractor to perform the Arkansas independent assessment, and replacing it with a more functional assessment tool. It will remove the independent assessment contractor from that process, as I mentioned, and reassign this task to personal care agency registered nurses. 

And so an individual agency that would be selected to provide those services will be the conducting entity for that assessment piece with a prospective beneficiary. It will also lengthen the prior authorization process, which is currently at six months. So every six months we are issuing a new PA for an agency to able to bill or to file claims against services for a beneficiary. 

Our intentions are to lengthen that to one year. This will also save the agency funds by only having to pay for that service, that function, one time annually. It will maintain the current cap of 64 hours per month of services, which is what has been traditional under our state plan. Our revisions to the Arkansas independent assessment manual will remove references to state plan personal care. 

So as I mentioned, a big component of this is to make these manuals more user-friendly, to make them easier to read and easier to understand, and remove references to multiple programs, which can be very confusing to, whether it’s a provider or a beneficiary, any entity that read those. We are seeking to clarify assessments may be conducted in person or through telehealth. 

Again, keep in mind this is for our ARIA manual, our independent assessment manual. It will delete language inconsistent with our current processes and create new sections to detail current processes related to referral, tiering, and outcomes in the Arkansas PASSE program that align with the current PASSE manual. 

So it is to seek to align those two manuals. It will remove references to the Battelle development screening process, and it will add additional sections, new sections, regarding assessments and tier logic for other programs, specifically the AR Choices program, the Living Choices Program– these are two HCBS waiver services,– and the PACE Program, Program for All-Inclusive Care for the Elderly, which do run out of the Aging Division. With that, happy to take any questions. 

Melissa Weatherton And if I could just add, Representative Wooldridge, a few Items, it’s been pretty– 

Representative Jeremy Wooldridge If you will recognize yourself for the record if you’ve not already. 

Melissa Weatherton I’m sorry. Melissa Weatherton. Just a few things that I think are pertinent to the conversation. We have had several investigations into the personal care space over the past several years. This is a service that we provide through Medicaid, but it’s also a service that’s paid for by the PASSEs. 

The PASSEs went to a very similar system to what we’re trying to set up now, which is reinserting physician and APRN, PCP engagement to try to control what we were seeing on the PASSE side and they are seeing great success in this. We also work very closely with the Department of Education. T

he independent assessment has been a thorn in their side for school-aged children that receive personal care in schools since the moment we set it up. They’re very excited that we are moving away from that. It has been delaying some care for kids when they start a school year under their IEPs. So they were very excited about the new process. 

And then I would also add that we did work with other agencies as well as extensive stakeholder engagement since June of ’24, which is when we started floating the draft of these rules was in June of ’24. So this has been a long time coming. The current process we have in place is not controlling utilization. 

So the Optum Independent Assessment, the percentage of approvals is 95%. So it is not weeding people out from being eligible for this service. Likewise, we have a prior authorization on this. For adults, it’s an extremely high approval rate for a prior authorization. So we have seen a significant increase in personal care spend year over year. 

We pulled the number this morning and we’re spending over $212 million dollars annually on this service for about 17,000 people. We believe that putting the new process in place with very strict evaluation forms and prescription forms for physicians and PCP offices will significantly assist us in ensuring that the people who need personal care are the ones getting personal care. 

Those forms, we no longer have to promulgate those forms. But I did bring the forms. I’m happy to share the forms. Lastly, what I just want to mention is, our plan is to implement this– like, to come today and then go before ALC in February with a delayed implementation date. Because we do understand this is a very different change in how we are doing personal care, and we need to properly train physician offices to make sure they understand so that we don’t have any kind of delay in service. 

So right now we’re asking for these rules to be effective in April. But we actually talked this morning, our timeline has been extended longer than we thought. And so we are open to the idea of even implementing those later in the summer if we need to allow more physician training. So with that, like Jay said, we’re happy to answer questions. 

Representative Jeremy Wooldridge Thank you, ma’am. I appreciate you all being here. Thank you for that explanation. I think that I do have a couple of questions and then we’ve got some questions in the queue. So obviously we’ve had conversations about independent assessments across the board. 

There are some that are required because of the waiver process and then there are some that are not. And apparently this is one that is not. But I guess my question would be, either independent assessments work or they don’t. So it sounded to me like– I don’t want to put words in your mouth– but it sounded to me like that you believe that they’re not working or not controlling costs in this instance. 

So I guess I could assume that they are not controlling costs in other instances also. But it sounds to me like we’re admitting that there is somewhat of a problem in this field with the growing costs. So other than saving the cost of the contract, how else are we saving cost or controlling cost in a growing field? 

Melissa Weatherton So I would say, yes, I do think that if it initially was controlling costs in the personal care field using the Optum Independent Assessment that we’re no longer seeing the cost effectiveness of that tool. For this population, it’s required right now under Optum contract that we use a registered nurse, which is highly expensive. We’re paying about $497 per assessment. They are receiving those annually. 

And like I mentioned earlier, the percentage of people who go through it, 95 percent are approved for the service. So we’re looking at an arsenal of different things. One of them is brought to you today, but we’re also rewriting right now how we do our utilization management contract. 

Right now, we’re using Acentra, but a new RFP has been out on the street and it’s going to be awarded. In that, we are asking for a lot more detail in how they are looking at retrospectively reviewing our providers, including personal care providers so that we can see that everyone is following the rules correctly. 

So we’re coming at this from a few different angles. But for state-planned personal care, Representative Wooldridge is correct. There’s a federal reg that requires that an independent third party that has no financial incentive at all assess clients who are on our waiver programs. But it’s not required for a state plan. And it’s highly expensive. And we’re no longer seeing the benefit of utilizing that cost. 

Representative Jeremy Wooldridge I appreciate that. I don’t want to cut you off. But I think the point that I’m trying to make is, we either agree with the process or we don’t. But I kind of subscribe to that defending exceptions becomes difficult. So either we believe in the independent assessment process as a cost control measure and it holds down that or it doesn’t work. 

And I understand that some things are out of your control. This is one where you can make that change. But from a consistency standpoint, I guess what I’m saying is that doesn’t seem to make sense to me initially. I’d like to have some more information on how that will control some costs, how that will make sure that there’s still a quality of care.

Because I think that we all agree we want to make sure that there’s a quality of service, Arkansas are getting exactly what they need. But we do want some mechanism in place to make sure that the services are needed and assessed appropriately. So thank you for that. And we’re going to go– I want to recognize the Senate chair of Public Health. 

Senator Missy Irvin Thank you. Sorry I was late. Appreciate it. Yeah, I think for me, I need to understand, again, when was the decision made to do this, not through waiver, but through state plan? Has it always been that way? 

Melissa Weatherton Yeah, it’s been that way since I’ve been there. 

Senator Missy Irvin Okay, but at one time we did study this through the Healthcare Reform Task Force, correct? 

Melissa Weatherton I believe it was in the aging– yeah, when we looked at all the aging programs, as well as behavioral health. 

Senator Missy Irvin And the recommendation at that time was to tier it? 

Melissa Weatherton The recommendation at that time for personal care was to put an independent third party in place to determine eligibility. And that’s when we asked Optum to step in and do a tool to determine whether or not someone should get personal care. And that’s what we’ve been doing ever since. 

Senator Missy Irvin Okay. And so how many times has that Optum contract been up for RFP? 

Melissa Weatherton Goodness. I don’t know that we’ve hit our seven years on that contract. I don’t think it’s come back. I don’t think we’ve put out an RFP. I think the initial one was during the task force, and we have not hit our 7-year mark. 

Senator Missy Irvin And so you’re saying today there’s issues with that assessment? 

Melissa Weatherton I don’t know that there’s necessarily issues with the assessment. We do assessments for the aging waiver, for the IDD population, and for behavioral health. And we used to do it for the EIDTs. Remember when we took that away and gave that back to the physician offices when we weren’t seeing a benefit of paying for the service like now. This one’s a little different. 

This is a tool that they’re using to determine eligibility. In the DD space and the behavioral health space, we use it to develop a person-centered service plan. You’ve already been deemed eligible, right? So we’re kind of using it in different ways. What we’re seeing with this is it’s a very expensive part of that contract that we’re not seeing the benefit of. It doesn’t attempt to be controlling utilization like we were anticipating. 

And when we’re looking at the spend, it is just increasing year over year. And again, I mentioned at the very beginning, we also were seeing some significant issues and there’s been ongoing investigations in this space for our past clients getting personal care inappropriately. And so when that started happening, they moved to this method, back to requiring a doctor prescription. And they are seeing substantial improvements now that we’ve reinserted the PCP back into the process. 

Senator Missy Irvin Okay, so I just want to talk with you about that for a second. And I know we’ve got other people in the queue wanting questions. But requiring the doctor is a PCP. Family doctors are not social workers, okay? They provide healthcare, okay? So I can fully disclose I’m married to one. And he’s like, do not put me in the middle of this. I am not a social worker. It is not my job to do that, okay? 

And so that is my concern here, is because, who is educating the PCPs on them being the gatekeepers? If we’re trying to utilize the PCP’s as gatekeepers, who’s educating them about how we want them to be gatekeepers or how is this being determined? Because I can tell you what’s happening. 

What’s happening is they want to be able to be attentive to their patients and to those families who are beating their doors down going, Hey, I found out about this benefit that I have, and I want to be able take advantage of it, and I need you to diagnose my mom or dad or whatever with this so they qualify for it. They have to have a client base. They have have to patients return to them. And if they refuse that, guess what? They’re going to go right down the road to somebody else. 

I’m just laying the land of how it works in reality. I think it’s a good idea in theory. I just don’t know if it’s going to work. And I’m being honest with you, I think we do need to control utilization. Absolutely. I think that I am incredibly concerned by the enormous cost to state GR and the growth of this program. I think it’s good and appropriate for elderly people that want to stay in their homes. I see tremendous benefit for that. 

But I also see where you’re putting somebody kind of in the middle of something that they really don’t have a lot of knowledge about. And who’s going to educate them? And my fear is it’s either going to be the patient’s families that are pushing hard for it or the personal care providers who will be that, and that could be exploitative to the PCPs. And I am a little concerned about that. 

And so I’ve voiced those concerns to your agency offline that, absolutely, doctors need to be involved in their care. We just need to understand personal care is not nursing. It’s not home health. It’s not nursing care. They can’t even replace a Band-Aid on a person if the Band-Aid falls off. So, you know, it’s a completely different game. It’s a beast and a different animal. I think it’s absolutely great and necessary when it’s needed. T

he thing that we have to just figure out together, and I know that you’re working to do that– I really, really do. I’m just saying I don’t think that this is– this is not going to be the approach that’s really going to get us to where we need to go to. But I think we just have to rethink the process a little bit. And if this is a really costly part of the RFP, why not cancel that part of RFP, put out a specific RFP that’s more narrowed and specific and go that route first. Have y’all thought about that? 

Melissa Weatherton We did talk about that. The reason that we have gone this route is because this is a state plan service and we are treating it like we have been transforming our other state plan services. So it’s the exact same process we have set up for adult day treatment, early intervention day treatment, OT, PT speech. 

They’re all state plan services and we’re mimicking the exact same process. Again, so when we go out to trained physician offices that are already familiar with the forms, we’re doing an evaluation referral and a treatment referral so that it all looks familiar. Because for the rest of our state plan services, we’re utilizing the same process. 

Senator Missy Irvin Do you have any data– and this will be my last question. I’ll let you get to everybody else. But do you have data as it relates to therapy? Therapy is another thing that has exploded, in my opinion. So, do you have any data that says, No, this is denied by the PCPs? Do we have data that shows that the therapy has been denied? 

Melissa Weatherton I don’t have it, but I can totally pull that. 

Senator Missy Irvin Yeah, let’s look at that, because I want to see if that’s, No, this child does not need speech therapy; no, this child does not need occupational therapy; no, this child does not need physical therapy. I want to see how many times that’s actually been denied or if it’s been reduced by the PCP or changed in any way. 

Melissa Weatherton We could definitely pull that. We could pull the utilization when we have that developmental screen in place and then pull and we switch. Because that was a fear of the providers when we changed it for EIDT that they were going to tighten, the doctor was not going to sign them. 

Senator Missy Irvin Yeah, but the doctors are so busy during the day and they’re there to treat heart attacks. We just need to understand what people’s roles are. And I just don’t want to put somebody in a position where they’re just signing something and they’re not really– because they don’t have enough time in the day and they are not making enough. 

Family practice doctors are not making enough money for them to be able to spend that. I’m just telling you it’s an impossible situation. They’re seeing 40 patients a day just to cover overhead generally because they’re dealing with Medicaid. I can go down the whole rabbit hole, but I’m just saying we need to think through this a little bit. 

Representative Jeremy Wooldridge Thanks, Senator. All right, we do have several members in the queue. We’ll ask that you keep your questions concise and on topic. Representative Moore, you’re recognized.

Representative Kendra Moore Thank you, Mr. Chair. I just have a motion at the proper time. 

Representative Jeremy Wooldridge Okay, I’ll come back to you on your motion. Representative Bentley. 

Representative Mary Bentley Thank you, Chairman. Thank you all for being here today. So I distinctly remember getting multiple phone calls of people so frustrated when we moved to Optum. So I guess my red light’s going on. I haven’t had a phone call in a long time. Things are going smooth, so why do we want to change it? I guess that’s my heartache at this point. 

Because I remember so many phone calls of people being so frustrated. So can you just kind of clarify it for me real quick? So we’re going to go use the PCP in there during an office visit. Are we still going to have someone come out to the home? I’m sorry, can you go over the process for me again real quick? 

Melissa Weatherton Yes, ma’am. And  we still get frustration calls, Jay and I do for sure. More from providers because they feel like it’s having to schedule the Optum A and then the timeline for when they go out, and they think it’s delaying treatment for when the personal care providers can get in there. 

But I agree with you. It has died down substantially since we implemented it. It’s going to work just like– adult developmental day treatment is a good example. So going– oh, thank you. We have a PowerPoint on this as well. So, yeah, this is great. Okay, so DCO will still determine whether or not somebody meets Medicaid eligibility– that’s not changing at all, right– just like they do today. 

The beneficiary reaches out to a personal care provider as they do today, right, asking for the service. They will then need to discuss with their PCP and have the PCP complete the evaluation referral. And that evaluation referral, it goes back to the provider like it does for the ADT and then that provider sends out a registered nurse to do an assessment that’s routed back to the physician to determine whether or not a prescription is warranted. 

Representative Mary Bentley Okay, follow up if that’s okay, Chairman. So I guess I’m concerned there because I just know what it takes to get a physician’s appointment, right? So it could be three months before they even have time to be able to get in to see the physician to get that filled out. I guess that’s my concern there. 

And I appreciate you guys bringing before us so we can look at this today. So why are we moving it from you guys over to Department of Health? Can you answer that question for me? 

Melissa Weatherton That occurred during this session. Before this last session, you would go to Department of Health and you’d get a private care agency license, then you’d bring that over to our division of provider– DIPSQA– they would do a certification. It was overly burdensome and it needed to go one way or the other. And it went that way. 

Representative Mary Bentley Thank you for that. That’s all my questions for now, Chairman. 

Representative Jeremy Wooldridge So I do want to clarify something. So currently Optum is sending someone out to do that assessment, correct? 

Melissa Weatherton Yes. 

Representative Jeremy Wooldridge Okay. And they’re being paid for that through this contract. So if we refer that back to the PCP’s office, are they going to be able to bill to send a nurse to do that assessment? 

Melissa Weatherton So it’s not the PCP sending a nurse. The PCP will fill out the evaluation, which basically, it’s a primary diagnosis and suspected deficit, right? Like this person cannot walk, this person can not go to the bathroom on their own, things that will qualify you for personal care services. 

And this is sent back to the personal care provider. They send out one of their registered nurses. And we’ve developed a standardized required tool. So all the personal care providers are using the same assessment tool. So we’re actually mandating what’s utilized. 

Representative Jeremy Wooldridge Okay, so I just want to make sure I understand. Right now, an independent nurse is being sent out for an evaluation. If this rule goes into effect, the person that’s wanting to bill the service will send a nurse out to evaluate whether someone qualifies for their service? 

Melissa Weatherton So right now, Optum sends a nurse out and they bill us for that. And they determine whether or not they’re eligible. It goes to the personal care provider. They then, too, send a nurse out to do their own assessment. And so you’re eliminating the Optum assessment that’s determining eligibility and asking that the PCP be the gatekeeper for that function. 

Representative Jeremy Wooldridge Okay, I think that I would refer back to Senator Irvin’s comments earlier that I don’t know that they would have time to adequately do that. But we’ll move on through the queue. Representative Pilkington, you’re recognized for a question. 

Representative Aaron Pilkington Thank you. And that current discussion though, I just want to make sure I clarify. So we’re going from three assessments down to two assessments with the PCP being the gatekeeper. Is that right? Was I following that along correctly? 

Melissa Weatherton Yes, sir. 

Representative Aaron Pilkington So we are reducing some of the red tape. The other thing, and this is what I was curious about, just so I’m understanding this financial impact correctly. So we say next year we’ll save around $6 million, $3 million in general revenue, $3 million federal funds, and another $3 million, bringing a total of $9 million in municipal government, state, county. 

So we’ve got a total of $9 million next year in savings for the taxpayer if we pass this rule. Am I understanding that financial impact correctly or is that wrong? 

Melissa Weatherton The financial impact, we are estimating a projection that will save $6.173 million. And that’s just based on, again, eliminating this part of the Optum contract. And then also right now, we’re paying a vendor, Acentra, to do prior authorizations multiple times in a year. And we’re going to move it to 12 months. 

Representative Aaron Pilkington No, I see where I got confused. So it’s a $6 million savings around that. Okay, gotcha. I see where I double added a number. Okay. But if we do nothing, we’re still going to pay another $6 million next year, which will be no savings to the taxpayer if we did nothing on this rule and keeping the extra red tape on. So do I understand this correctly? 

Melissa Weatherton Yes. 

Representative Aaron Pilkington Okay. Thank you. 

Senator Missy Irvin Mr. Chair, there’s a difference between red tape and a personal care agency sending their own nurse out to do an assessment for a service that they’re going to get paid for. You are letting the personal care agency nurse send out, go out to do the assessment. And you don’t see a problem with that? 

That’s not eliminating red tape. That’s an independent assessment. So that is the fox guarding the hen house. I mean, that’s the way I see that. And so I see that you’re saying that there’s going to be savings in the Optum contract. I get that. And prior authorization, whatever. 

But I don’t know why you can’t go ahead and have done that already and streamline your current process with your own contracted vendor. I don’t understand why you’re having to have a complete rule change when you have a contract with a vendor. And if it’s not working, why didn’t you go to the vendor and say– you have the ability to do that because I have been all through procurement. 

You have the ability to do that with your vendor and say, This isn’t working, we need to find cost savings and we need to redo this process within this contract. You have the ability to do that. Why didn’t you do that? You could have canceled that part of the contract and you could have said, we’re going to create a new process that eliminates this and save us money and continue to have an independent process assessment with a new RFP. Why didn’t you do that? 

Melissa Weatherton Yes. Well, a couple of reasons. Number one, it’s not federally required and the current one is not doing what we anticipate it doing. And again, trying to align it with how we are performing our other services outside of our waivers and our PASSE program. We’re mimicking the same process with this iteration. That was just the route that we went to try to streamline our state plan services and how we try to operationalize them the same way. 

Senator Missy Irvin I will accept that as your answer. I don’t agree with it. Because I think that we could have been a little bit more thinking forward and change what we were doing and maintaining independent assessment. The healthcare reform task force worked incredibly hard to get us to an independent assessment approach. 

And it feels like today we are throwing all of that work out the window. And I was here for that. And we spent a lot of time trying to figure out, to get savings through the Medicaid program and savings to state general revenue. And so I’m not willing– I don’t think that that’s appropriate and the right thing to do. 

And I think you’re taking advantage of PCPs and you’re exploiting them and you are turning them into social workers, which they are not, and they don’t have the time to do that. And they don’t get paid to do this extra work for you to be gatekeepers. They don’t get paid for that. They get paid according to your billing of Medicaid for what they come in for, RSV, a cough, a cold, whatever it is. That’s all they get paid for. 

And you’re putting these people in the middle of something, a nurse practitioner or a physician that has no business doing that. And, yes, they have a business treating them in healthcare. But again, personal care is completely different. They are not the appropriate person to pursue that or to be that gatekeeper. They just are not. And I think that you’re exploiting them and you’re putting them in the middle of something. And I, for one, am not for that. And I think you’ve got to rethink your approach here. 

Representative Jeremy Wooldridge Thank you, Senator. Senator Sullivan, you’re recognized for a question. 

Senator Dan Sullivan Thank you, Mr. Chair. And Chair Irvin, I appreciate those comments. They were spot on. It seems like in my years with this, we have bounced back and forth between PCPs, internal audits, internal approval. We try one and then it doesn’t work. We try something else, and none of them seem to work. So how much confidence do you have, if this goes forward today, that this is going to work, even though we’ve tried this before. 

Melissa Weatherton So I totally agree with you. Before we went into the utilizing the Optum IA, we had what was called the 618, which was a physician prescription. 

Senator Dan Sullivan Yeah, I’ve been through it all. I’m just asking you for a real simple answer. How much confidence do you have that this is going to work? 

Melissa Weatherton So I don’t think it’s just this rule today. I think I started with that. This is going to have to be a multifaceted approach to control the utilization of personal care. 

Senator Dan Sullivan All right, let me try one more time. It’s a multi-faceted approach, we all get it. It’s going to take multiple changes. If we continue down that timeline and that plan, how much confidence do you have that this is going to work? Even though we’ve done this before and tried it similar, how confidence do you have it’s going to work? 

Melissa Weatherton I believe it will control utilization. 

Senator Dan Sullivan Mr. Chair, I think the same thing. I’m really concerned about this PASSE effort. This is the same thing. Is this part of the PASSE? Are these groups part of the PASSE? 

Melissa Weatherton No, this isn’t the manual that would do people outside of the PASSE. 

Senator Dan Sullivan Okay. Well, Mr. Chair, I think PASSEs do the same deep dive to look about how effective it is. We’ve had it for years. The initial reason that we did it was very clear that we have an audit that says, yes, what we originally intended has achieved. I’d make that recommendation to the chair. I appreciate it. I’m not on the committee, but been involved in this for a number of years. Thank you. 

Representative Jeremy Wooldridge Thank you, Senator. I appreciate that. And I’ll reiterate and ask for that as well, an audit of that system just to see kind of that effectiveness that kind of goes back to the question that I was going to lead with after Senator Irvin’s question. 

To your point, this is a multifaceted approach. I think I want to better understand the methodical process that got us here today. So why this change? Where have we been? We now have identified that that’s not working. How did we identify that? And what are the processes that you’ve utilized, the steps that you have put in place to say that this is what’s going to solve that problem? 

Because I agree with Senator Sullivan and Senator Irvin in the fact that it seems like we have bounced back and forth. We’ve utilized PCPs. We’ve utilized an independent assessment. Now we’re going back to PCPs. Well, if it didn’t work the first time and we’re now bouncing back to that, what makes us think or what confidence can we have that it’s going to work this second time? 

So I think that’s a fair request. And I’d make that request of you and the agency as well to give us a snapshot or a look back at that to help us better understand why this is going to be a solution. Representative Ennett, you’re recognized for a question. 

Representative Denise Ennett Thank you, Mr. Chair. I have a question. So I’m confused. So I am a parent who has a son with an IDD and he’s on the waiver. And so I’m familiar with some of this. So how does this work for a parent that’s coming into the system? How would this affect them? 

Melissa Weatherton So Representative Ennett, so your son would be in a PASSE. And so these rules do not apply. They’re a managed care entity and they set up their own rules. They have a very similar process in place to what you have before where they’ve reinserted primary care practitioners into approving personal care under the PASSE program. 

Representative Denise Ennett Moving forward, the new rule change, how would that affect somebody that’s coming into the system?

Melissa Weatherton It won’t. I mean, you come in, you are deemed eligible in one of our various Medicaid eligibility categories, and then you’d have to show that you meet the medical criteria to get personal care, just like it is today. 

Representative Denise Ennett So with this new rule change, will it delay services? 

Melissa Weatherton We believe it will– no, we do not think it will delay services with this rule change. 

Representative Denise Ennett So I’m familiar with having to wait for a referral from the doctors and all this and that. So if I’m a new parent and I’m signing up for these programs, it’s not going to delay me getting a diagnosis for my child with the new rule changes? 

Melissa Weatherton It should not. 

Representative Denise Ennett Okay, thank you. 

Representative Jeremy Wooldridge Senator Payton, you’re recognized for a question. 

Representative John Payton Thank you Mr. Chair. So obviously, every time we have a rule change or something suggested, there’s pros and cons. And we’re trying to weigh the pros and the cons. I appreciate a lot of the questions and concerns. My question is, one of the most important pros and cons is the fiscal impact. 

And I look at the fiscal impact and it says that it will result in a reduction of cost. Total reduction of the cost is– and now, based on the questions, I question whether or not you took into consideration both sides of the equation when you stated these cost savings. So are these cost-savings stated in the financial impact solely based on the elimination of the contract? Or does it take into consideration, both of you mentioned training the PCPs? Is that money considered in the financial impact the money we’re going to spend training? 

Melissa Weatherton No, it’s not in here because we already have a contract with AFMC who does training for our PCPs. We were developing a training curriculum that falls under a current cost in a current contract. They already have to do that work for us. 

Representative John Payton Okay. And do we have any data on the financial impact to the PCPs, like Senator Irvin’s talking about? The PCP is going to send their own personnel, spend their own time trying to do the vetting here. Do we have any sense of what that financial impact is going to be? 

Melissa Weatherton That is not included in here. No, sir. 

Representative John Payton Would it be reasonable to think that it’s going to cost them as much as it does the state to perform the same duty? 

Melissa Weatherton Just to clarify, we’re not asking the PCP to do an assessment, an independent assessment in the client’s home. We’re asking them to specify that they think the client needs personal care because, again, they can’t go to the bathroom, where they can’t feed themselves, or they can’t walk. To say, Yes, there’s something wrong and they need this service that Medicaid pays for to help them. Then the assessment is outside of that office. It’s sent back to them for review. And then we would ask them to sign a 12-month prescription. 

Representative John Payton Okay, well, I thought I heard you say that somebody was going to send a registered nurse out there, a primary care nurse out there?

Melissa Weatherton So the personal care provider would be responsible for doing that. 

Representative John Payton Are they currently responsible for doing that? 

Melissa Weatherton They do. 

Representative John Payton So that’s not an added burden? 

Melissa Weatherton No, sir. 

Representative John Payton Okay, thank you. Thank you, Mr. Chair. 

Representative Jeremy Wooldridge Thank you, Senator. Representative Pilkington, you’re recognized for a question. 

Representative Aaron Pilkington Thank you. A little confused. There’s been so much mixing of metaphors here, I lost track. So on the one hand, I’m hearing we’re taking advantage of these poor PCPs and this is an undue burden. And then two seconds later, I hear that it’s the fox guarding the hen house. So which one is it? I mean, I’m confused about those statements. 

But the additional thing is why are we already– I guess my real question though, too, is why are we already paying for training of these providers with an AFMC contract if they’re not doing it right now? So I’m confused by that. So can you help me clarify? 

Melissa Weatherton Absolutely. So it’s my understanding that the contract today, they do lunch and learns for our PCPs on a monthly basis. And we get to share what topics we would like for AFMC to do in those lunch and learns. And we’re going to add this to their curriculum. So it’s ongoing training they already do with PCPs and then we get the opportunity through our contract to give suggestions and tell them what we want people trained on. 

Representative Aaron Pilkington Gotcha. And, okay, I appreciate that, and thank you for clarifying it. 

Representative Jeremy Wooldridge Thank you, sir. Representative Ladyman, you’re recognized for a question. 

Representative Jack Ladyman Thank you Mr. Chairman. Yeah, there’s been a lot of talk here. Some of it I don’t understand, but a lot of it comes from people that are in the business. I’m not in the business. So I’m outside the business, common person looking at this. So the savings, does that come from eliminating a step in the process? That’s where the savings come from? 

Melissa Weatherton Yes, sir. It comes for eliminating two steps or two things, not two steps. So it comes from removing it from the Optum contract, because, like I think I mentioned, we use, it’s like $497 and change that we pay them to determine whether or not someone’s eligible for personal care right now. And then second, right now, we pay Acentra, our utilization management vendor, to do a prior authorization every six months, which is different from how we do any other service. The rest of our services that have prior authorizations are 12 month prior authorization. 

Representative Jack Ladyman So we would be eliminating a process which would give us savings, which we’re always looking for. But we don’t want to reduce the service that’s needed. So we’re not putting any additional requirements on anyone, hard requirements. Is that right? 

Melissa Weatherton Well, the personal care providers would tell you that we are putting many additional requirements on them. 

Representative Jack Ladyman No, I’m not talking about the personal care. I’m talking about their opinion. In writing, we’re not requiring them to do anything else? Or are we? 

Melissa Weatherton So we’re significantly tightening who will– we want a very clear, this is the diagnosis of the individual, this is their deficit on why they should get personal care, and tie those two things together. Part of what we were seeing over the last couple of years, and many of you guys had conversations with us about this, was that we were seeing personal care being provided to people that did not have an ADL deficit, meaning they could walk, feed, shower, right? 

And the service was, in many cases, being kind of misused or filled in when it should have been something else. And so that was mainly happening under our PASSE program, and that’s when they went in and we worked with them to change their process. 

Representative Jack Ladyman So, I mean, if this is not working, if it’s not helping the current process, I don’t understand why we keep doing the same thing we’re doing. And why we would not make improvements? And in your opinion, you think this would be an improvement to the system? Is that right? 

Melissa Weatherton We do. 

Representative Jack Ladyman Okay, thank you. 

Senator Missy Irvin Could you get for me how many times that you’ve had conversations with Optum in the last six years about this independent assessment process and the PA process? I want to know how many times you tried to work with your vendor to change the process when you saw utilization continue to increase. 

Do you know how many times you’ve done that with Optum? How many conversations, negotiations have you had with them about changing the process when you’ve seen utilization increase? 

Melissa Weatherton  I will be completely honest. No, we are not having conversations. We have not had conversations about them doing something different with the tool for personal care. Our entire direction since probably the summer of ’24 has been developing a process outside of them completely. I mean, I’ll be completely frank, we have never asked them to change.

Senator Missy Irvin That’s the problem. You were in a contract. And for six years you saw utilization increase, and you had zero conversation with the vendor about how to change the process or the independent assessment of what they were doing when you had the ability to manage that contract and that RFP and utilize the independent assessment to provide savings. 

I know for a fact, because I have talked to Optum several times over the last six years about different things. I know for a fact that they would have absolutely gone and engaged with you on that, and that they had savings, because they shared them with me. So that’s what I don’t understand. And that’s where I find this is not appropriate. I’m not willing to go forward and do a complete wholesale change when that never occurred. Because that should have been part of the thinking. 

That should have been part of the process with DHS in your office. You have a contract. You have an independent assessment. The healthcare reform task force was adamant about independent assessment at that time. We were adamant about that: Nobody with a financial interest making the assessment. That’s why that was put in place. If the personal care agency, they have a financial interest, they’re doing the assessment, how is that not a conflict of interest? There is. 

That’s why the healthcare reform task force said independent assessment should absolutely be utilized. And in that process, if you see, we’ve put in an independent process assessment through this contract. But in six years, you never had a conversation with them about, well, something seems to not be working here. Let’s figure this out because the legislature was adamant for independent assessment. This isn’t working maybe the way it needs to be working. What do we need to do differently here? 

You never had that conversation with them. And so that’s where my frustration is, is because I absolutely– and people can say whatever they want to say. I live with a family practice physician. I know how many patients they see. And somehow I’ve explained this to DHS and you don’t listen to me. And that’s fine, you don’t have to listen to me. But I am telling you, my husband’s not going to deny a patient and his family to sign off on a form when the personal care agency’s telling them which diagnostic code that they need to fill in. That is happening. 

Because they don’t have the time to go and do their own assessment, and that’s their name that they’re signing to this, okay? Put apart however much money they’re not going to be able to recoup on the administrative part of all of that. Maybe that’s not important, but their name is important. And when they’re signing something, they want to make sure that they are signing off on something that’s true, and that is not fraudulent. You know how many teachers say, Bring your kid to the doctor because Johnny can’t sit in his seat all day long, needs ADHD medicine? 

You know the amount of pressure that’s put on that PCP from the parents and the teachers and everything because this little boy just can’t sit still for five, eight hours a day? And they’re pushing for medication, pushing for medications, and guess what? If doctor so-and-so doesn’t prescribe it, they’re just going to go to this doctor. 

And so, there’s gotta be some understanding of reality here of what is actually happening with PCPs in the state of Arkansas and how they interact with patients. And y’all don’t seem to understand that. And you don’t see to listen to us. And you do not seem to listen to the legislature when we spent so much time in the Healthcare Reform Task Force. I’ve asked you to slow down on this. Weeks ago, I asked you to do that and get back with me. You didn’t do it. 

Melissa Weatherton Senator–. 

Senator Missy Irvin I’ve asked for that. 

Melissa Weatherton I apologize. I did not–

Senator Missy Irvin So today I am upset. Because I thought we were at a point where my input was like, we could sit down and talk through this and figure out what the right approach is before we got to here today. But we’re not here. 

Melissa Weatherton I apologize–

Senator Missy Irvin I would like for y’all to pull this down and let’s work on this with the legislature so that we have a good plan and a good approach going forward where we can do all these things, where we could save money for the state of Arkansas, where we provide appropriate personal care services for individuals, where we make sure people are not put in a bad position to sign something that could be fraudulent because it’s being completed and filled out by the personal care agencies and it’s just put in front of them. 

And they’re seeing 40 patients, and three of them that came in this morning are all having cardiac arrest and they come to the clinic instead of to the ER. Because that shit happens right now every day. And you’re not thinking about the PCPs. You’re not thinking about these nurse practitioners. We had a nurse practitioner that sent me a picture and said, What do I do; a patient presented with an incredible tumor in the palate of their mouth. 

Are they going to spend their time trying to make sure that this person doesn’t have an incredible life-threatening event because of a tumor that’s in the hard palate of their mouth and that they’ve sent to another doctor for help? Or are they going to be a gatekeeper for personal care service so that we can hire somebody to come and clean their home for them? I’m very frustrated. And I’m going to stop right here. My suggestion to the chair is that we not proceed. 

Representative Jeremy Wooldridge Thanks, senator. I’m going to give the agency an option. Do you want to pull this down, work with Senator Irvin, Senator Wallace, Representative Wardlaw and myself off record, and let’s see if we can get a rule back that everyone agrees on? 

Melissa Weatherton Of course. And thank you for the opportunity to do so. 

Representative Jeremy Wooldridge That sounds good. Thank you very much. If there’s no further business, with that, we’re adjourned.