Joint Public Health

November 7, 2022

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• Minority Health Commission 2022 report
• Medicaid electronic visits update
• PANDAS report
• Recycling nuclear fuel rods report
• Mental health report
• Volunteer healthcare rules report

Sen Bledsoe: Ladies and gentlemen of the committee, if you would please take your seats, we’re going to get started. All right. Mr. Chair, do you have any comments? All right, we’re going to go ahead. I need a motion to approve the September 6 minutes. Do I have a motion to approve the minutes? All right, second. All those in favor, say aye. All those against. Thank you. The minutes passed. All right. Let’s go down to number D, item D. And we have Ms. Eddings from the Arkansas Minority Health Commission. If you’d come to the table, please. All right. And ladies and gentlemen of the committee, there is a report on your desk. It looks like this. All right. Please introduce yourselves for the record. And you may begin.

 

Minority Health Commission 2022 report

 

Eddings (ADH): Good morning. Kenya Eddings, director of Arkansas Minority Health Commission.

 

Gilmore (ADH): Matt Gilmore, Department of Health.

 

Mondragon (AHD): Beatrice Mondragon, Arkansas Minority Health Commission.

 

Frazier (ADH): And Este Frazier, Arkansas Minority Health Commission.

 

Sen Bledsoe: Okay. You are recognized.

 

Eddings (ADH): Thank you. Good morning. My name is Kenya Eddings, and I am the new director of the Arkansas Minority Health Commission. Thank you for the opportunity to review our fiscal Year 2022 report with you. The mission of the Arkansas Minority Health Commission is to assure all minority Arkansans equitable access to preventive healthcare and to seek ways to promote health and prevent diseases and conditions that are prevalent among minority populations. Our vision is that minority Arkansans and underserved communities of color have equal opportunity and access to health, healthcare, and preventive well care. To summarize the commission’s work for fiscal year 2022, we continued the important work in creating, nurturing, and participating in programming that is steeped in our legislative mandate, vision, and mission. We focused on six goals, of which I’ll highlight a few of those efforts. The outcomes of those efforts are listed throughout the reports which you should have.

 

Eddings (ADH): Goal one was to increase the number of minority Arkansans obtaining screening for diseases that disproportionately impact minorities. Our team utilized our mobile health unit to provide free health screenings for chronic diseases like diabetes, hypertension, heart disease, and HIV/AIDS. We have also continued our partnership with Arkansas Human Development’s Hispanic Initiative to offer health education and screening to the Hispanic population in the state. We are fortunate to have partnerships with various statewide organizations like ARcare, DHS, Jefferson Comprehensive Care, and others to provide these preventive screenings. Goal two was to increase the number of minority Arkansans who receive education regarding diseases that disproportionately impact minorities. To accomplish this goal, our Bridge Magazine continued to be a trusted source of education to help reduce and/or prevent chronic diseases in minority populations in Arkansas and to also spotlight partnerships and collaborations around the state which are so important.

 

Eddings (ADH): Our website, the use of television, streaming and social media gave us the opportunity to reach people where they were with our educational messages. Our educational outreach programming through radio in Central Arkansas targeting the African American community through our partnership with Arkansas Medical Dental and Pharmaceutical Association, in Northwest Arkansas targeting the Marshallese community with Marshallese Physician Dr. Sheldon Ricklon was highly utilized. These two radio stations provide listeners with the opportunity to engage with physicians directly by calling in to get health-related questions and concerns addressed. Our two signature programmatic efforts, Southern Ain’t Fried Sundays and Camp I Can, also continue to be highly requested despite the pandemic. Southern Ain’t Fried Sundays is a 21-day meal replacement– meal enhancement program designed to encourage healthy eating and physical activity. Camp I Can is a three-day coed summer day camp for children ages 9 to 12 designed to promote healthy lifestyles, physical activity, and healthy self-esteem.

 

Eddings (ADH): Goal three was to establish a collaborative network of stakeholders to address workforce diversity and education of healthcare professionals. We continued our partnership with Tri County Rural Health Network based in Phillips County to utilize trained community health workers who are boots on the ground helping to educate and disseminate educational materials. Additionally, we cosponsored the Pathways Academy at UAMS’ Diversity, Equity, and Inclusion department to expose low-income K-12 students to career opportunities in STEM and healthcare disciplines. Our healthcare workforce diversity scholarships provided a source of needed funding for minority students pursuing higher education to help address the shortage of health professionals and the underrepresentation of minorities in healthcare fields. To that end, we awarded 38 scholarships in the fall of 2021 and 45 scholarships in spring of 2022.

 

Eddings (ADH): Goal four was to establish a network of coordination and collaboration with other agencies and organizations addressing the health of minority populations. Our partnerships and collaborations with state and federal agencies helped to address minority health in Arkansas. We’re grateful for the Arkansas Department of Health Center for Health Protection branch for the partnership to help with COVID-19 vaccination equity for minorities and underserved Arkansans. Additionally, we are thankful for the partnership with ADH and CDC Paul Coverdale National Acute Stroke Program Prevention Grant to help address stroke in the state. We also continued our partnerships with agencies like Legacy Initiatives in Sevier County to provide prostate cancer screenings and other preventive healthcare screenings for the Hispanic community.

 

Eddings (ADH): Goal five was to establish a constituency of individuals, community-based organizations, and communities committed to the mission and goals of AMHC. In the spring, we partnered with the Arkansas Cancer Coalition to help present its 23rd Annual Arkansas Virtual Cancer Summit to help educate attendees about cancer and tobacco control. We look forward to a continued partnership with organizations like Arkansas Cancer Coalition and others to educate minority and underserved communities in the state. The wisdom and guidance of our commission board continued to be important to the Arkansas Minority Health Commission staff. Yet COVID-19 continued to hamper in-person meetings of our commission board in fiscal year 2022. As a result, our quarterly commissioners meetings were held virtually.

 

Eddings (ADH): Goal six was to advocate for a policy that will promote the health of minority Arkansans by identifying gaps in data addressing the health status in minority groups and develop with partners a plan for filling those gaps. Our seventh Biennial Minority Health Summit focused solely on mental health in minority and underserved populations in Arkansas. We were pleased to host a panel dealing with mental health in children and also one with adults. The panels were led by mental health professionals from around the state and was hosted both in-person and virtually. The Arkansas Minority Health Commission team will continue to work toward decreasing health disparities that exist in Arkansas through a variety of avenues like community outreach, prevention and intervention strategies, advocacy, and collaborative research and health screening efforts and more.

 

Eddings (ADH): A few of those plan strategies we have to meet the need include expanding our programmatic efforts with Camp I Can and Southern Ain’t Fried Sundays resuming in-person community health forums in each congressional district, expanding our Ask the Doctor radio series, hosting our Arkansas Minority Health Luncheon and more. On behalf of the Arkansas Minority Health Commission team and its Board of Commissioners, thank you for your continued support in helping to advance the mission and vision of the Arkansas Minority Health Commission. Thank you.

 

Sen Bledsoe: All right. We have Representative Ladyman with a comment.

 

Rep Ladyman: Thank you for that report. I’m glad to hear that mental health is one of your goals, to work with individuals on mental health, because that’s a problem across the board. So I’m glad that you are all working on that. Thank you.

 

Eddings (ADH): Thank you.

 

Sen Bledsoe: All right. Representative Boyd, do you have a question? Who’s sitting in– Okay. All right. Okay, Allen.

 

Rep Allen: Thank you, Madam Chairman. Thank you all for coming, and thank you for your report today. This is very interesting about all the screenings that you all are doing. Can you tell me have you all ramped up your efforts in cancer screening?

 

Eddings (ADH): That is a great question, and thank you for asking that. We work with the Arkansas Cancer Coalition to provide cancer screenings, like colorectal cancer screening test kits that can be taken home. The sample can be provided and then mailed in. We also have a partnership with UAMS to increase colorectal cancer screening as well as our continued efforts with prostate screening and the like. Additionally, we continue to work with UAMS to provide mammographies around the states. Our program director and grants coordinator, Ms. Beatrice Mondragon, is here and can also add to that discussion. Do you have anything to add?

 

Mondragon (AHD): Thank you. Yes. So our efforts have increased. We have extended the invitation each and every time that we travel the state of Arkansas, sending in our outreach events to the Prostate Foundation as well as, she mentioned, the colorectal screening that we now have on board, along with the education. And yeah. Thank you.

 

Rep Allen: Okay.

 

Sen Bledsoe: All right.

 

Rep Allen: Follow-up.

 

Sen Bledsoe: All right, real quickly.

 

Rep Allen: Okay. Can you tell me if there are any efforts on y’all’s part to address healthcare deserts around the state of Arkansas?

 

Eddings (ADH): Thank you for that question. We have established a partnership with Shorter College in North Little Rock to help them create a health clinic for students, staff, and the community. We also are doing other outreach efforts as they become available, but I can do some additional research and report back to you on that.

 

Rep Allen: Thank you.

 

Eddings (ADH): Yes, sir.

 

Sen Bledsoe: All right. Is there a number 20? Okay. Representative Pilkington, you’re recognized for a question.

 

Rep Pilkington: Thank you, Chairman Bledsoe. Thank you for your work. One of the things I’m curious about is, obviously, due to the public health emergency, the rolls have expanded. As that goes away, we’re worried about people getting kicked off the rolls. I was curious, with the minority community in mind, are you all having any programs or anything in place to make sure that some of those who might get kicked off with a change of address or anything like that are able to get re-enrolled? Is there anything currently in the works to address that?

 

Gilmore (ADH): Representative Pilkington, Matt Gilmore, great question. I think we can coordinate with DHS and see if there’s ways to do that there. But I think, also, when they do their screenings, they connect them to a local healthcare professional, and they can help guide them and give them some advice and guidance through that process when you’re connecting them to a local professional. But we can work with DHS a little bit more.

 

Rep Pilkington: Okay. Thank you.

 

Sen Bledsoe: All right. Ladies and gentlemen, I don’t see any other questions. We thank you so very much. Okay. Representative, you were there, then you disappeared. You’re recognized.

 

Rep Bentley: Thank you, Chairman. Thank you all so much for the work you do. I really appreciate that. Looking forward on the new things that you wanted to do with maternal mortality, are we doing anything to increase breastfeeding among the minority populations? I know that’s really one thing that will improve their maternal mortality, increase the amount of women that are breastfeeding. So do you have anything on that avenue at all that you guys are looking at for the future?

 

Eddings (ADH): Thank you for that question. Prior to me coming to the Arkansas Minority Health Commission, I did a lot of work and continue to do a lot of work in the space of breastfeeding. And thank you, Representative Bentley, for the partnerships that you have had with us over the years with healthy, active Arkansas. We continue our breastfeeding efforts not only in the community, providing education, and helping the community understand the importance of breastfeeding, but also helping companies and businesses set up lactation accommodations for their breastfeeding employees. We have just finished a project with the Department of Insurance to help them create a lactation accommodation space for their employees. We’ve also done some extensive work with the Little Rock Air Force Base in helping them to provide lactation accommodations for their military personnel. So the work continues. The outreach efforts continue as well.

 

Sen Bledsoe: All right. Any other questions? All right. Seeing none, thank you so very much for that good report. Appreciate it. All right, ladies and gentlemen, the Public Health Committee has been invited to the rotunda to stand in opposition to marijuana. That’s Amendment 4. And so we’re going to flip the agenda. We’re going to go to the ISPs right now, and we’re going to batch them. And that’s what we plan to do right now. All right. Turn over– and it will be from Interim Study 1 all the way through 18. Any questions? All right. All those in favor of batching the ISPs today, say aye. All those opposed? All right. Thank you very much. Now all the ISPs go out. All right. Getting back to the regular agenda, we will go to E, Medicaid electronic visit verification update. And that is Elizabeth Pittman and Martina Smith. If you’d come forward, please. If you’ll introduce yourselves for the record.

 

Medicaid electronic visits update

 

Pittman (Medical Svcs): Good morning. Elizabeth Pittman, director for the Division of Medical Services.

 

Smith (Medical Svcs): Good morning. Martina Smith, division director, Provider Services and Quality Assurance.

 

Sen Bledsoe: All right. You’re recognized.

 

Pittman (Medical Svcs): We just have a few slides to go through, and then we’ll just take any questions that you might have. Just want to give an update on where we are on fully implementing the electronic visit verification. And let me see if I can make this work. There we go. Okay. Just a reminder of why we are doing the electronic visit verification. There was a federal mandate, the 21st Century Cures Act. It also avoids delays in potential non-payments. It is an effective management tool for providers. It allows them to monitor where their caregivers are and how often they are working, what time they’re arriving, what time they’re leaving, verifies that services were rendered, helps prevent any fraud or liability, and results in a higher percentage of paid claims. We are seeing through those claims that go through the EVV system known as AuthentiCare versus those that go directly through MMIS, we are seeing a higher percentage of paid claims through EVV. And then, again, because of that, it results in more efficient billing for the services we are currently using EVV for, which is personal care, attendant care under the ARChoices waiver, and respite.

 

Pittman (Medical Svcs): This is just a brief timeline. On September 30 of this year, we sent out an initial notification to all providers of our direct claim submission cut-off date. So we are going to stop allowing any direct claim submission on December 1. So in the beginning on November 1 of this month, we actually started suspending the claims for one week. So they will pay a week later, but we’re suspending them so that we can calculate who is still using direct care billing, why they’re still using it, and do some direct outreach to those providers. So throughout the month of October, we continue to do reminder emails. We did weekly calls with both the vendors who were doing third-party systems and with the providers. We did face-to-face outreach, and we also did some social media campaigning. And Martina– or Director Smith will talk more about the self-directed client outreach that we did. Again, on December 1, we will actually begin denying those claims. And so we are actually implementing a tactical response team. Right now, it is partially assembled. But when we begin fully denying those claims, it will be fully assembled. And that team will help those providers whose claims are denied to get them paid through the EVV system.

 

Pittman (Medical Svcs): Currently, we have 26 out of, I believe, over 100 provider agencies who are not using EVV. So we really have over the past year– I know it’s taken us a while to get here, but it’s been worth it. We’ve made a lot of progress in getting agencies to use it. We’ve been doing direct phone calls and direct communications. We’ve continued to have the technical calls available through several different phone lines, and we continue to have weekly calls with providers. So that’s how we’re doing that outreach. And I know you have somewhere to be, so I’m rushing through this a little bit, but please ask any questions that you might have. You’ll see here at the bottom where the EVV phone line is as well as our link. If you’re having any problems with EVV or you know of providers, please send them to these resources. And with that, I’m going to turn it over to Director Smith.

 

Smith (Medical Svcs): So EVV for self-direction clients actually began in the spring of 2021. During that time, we used emails. We utilized phone calls. We actually went to the homes and performed face-to-face visits with those individuals that would allow us to come into their homes to show them hands-on how to use the application. We also held training sessions at different times during the day to make sure that everyone had an opportunity to see and have training to use the application. We also placed tutorials on the DHS website as well as the contractor’s website. And then, again, we’ve done a lot of one-on-one outreach to those individuals, if they would allow us in their home. As of October 2022, we only have three individuals out of the 2,300 self-direction clients that are using the paper timesheets. So they have not began to use the application at all. We have emailed, mailed, called, offered in-person visits as well to show them how to use the application, so they will no longer use those paper timesheets. And at this point, we have 87 clients that have started the process of using EVV. So they are using the contractor’s website to log in those times that they are providing service or receiving service. However, they have not obtained a Medicaid PIN to complete the process. So actually, that number was at 109 on October 12. As you can see, we’ve gotten it down to 87. Still doing that outreach, calling them, visiting them, sending them letters. This week, we plan to send another letter to them in the mail to advise them that they must use EVV or risk losing their services. Thank you. Any questions?

 

Sen Bledsoe: All right. Any questions from the committee? All right. Seeing none, thank you so very much for that report.

 

Pittman (Medical Svcs): Thank you.

 

Sen Bledsoe: Going on to the next– I don’t think that Senator Hammer is here. We’ll just put him at the end. He’s over at–

 

Rep Ladyman: He’s here.

 

Sen Bledsoe: Oh, there you are. We’re ready for you. You want to go down to the table, Senator? Yes. We will have to go back to G, so maybe he can get over next door.

 

Sen Hammer: Thank you, Madam Chair. Kim Hammer, State Senator.

 

Sen Bledsoe: You’re recognized.

PANDAS report

 

Sen Hammer: Thank you, Madam Chair. Under legislation that was passed involving the subject matter of PAN and PANDAS, it was required to report to the Public Health Committee as far as the progress that we’ve made since the inception of this committee. You have a handout that outlines all the efforts that have been put forth into this. One of the reasons it’s beneficial to bring it to you this morning is because, through partnership with Children’s Hospital and UAMS, there’s information that’s being sent out to all the PCPs in the state informing them of what PAN and PANDAS is and how to receive treatment for it. I do have Mr. Ryan, Paul Ryan, who’s going to join us for a brief Zoom meeting. And what he is going to do is emphasize that we are participants– because of this effort of legislative branch and administrative branch, we are participants in a approximately $34 million pharma study that is involving treatment of PAN and PANDAS. And there are Arkansans that are involved in this. It’d be good for the members to know this in case they’re approached by a constituent, that they could get them to the center of excellence. And with that, Madam Chair, I’d like to recognize Mr. Ryan if the Chair would allow to join us by Zoom. He is the flagship for the certification of a center of excellence for PAN and PANDAS. And he’s going to give us just a brief update on the pharma and also just a progress of where we are, if the Chair would allow.

 

Sen Bledsoe: All right. He’s got to Zoom in. We don’t see him on the monitor.

 

Sen Hammer: I think he’s waiting to be added is what he told me, that he’s waiting to be authorized or to be joined in.

 

Sen Bledsoe: Just a minute.

 

Sen Hammer: Yes, ma’am.

 

Sen Bledsoe: We are going to have to call IT. So we could ask you to sit to the side, and we’ll go on with the next one. It may take a few minutes.

 

Sen Hammer: Madam Chair, may I make a suggestion?

 

Sen Bledsoe: Yes.

 

Sen Hammer: For the sake of time, what he’s going to share is that we are participants in a $34-million big pharma study and if members have patients or if they have constituents, that they can contact the center of UAMS. And maybe we could reschedule him to Zoom in at the next meeting for the sake of time.

 

Sen Bledsoe: That sounds even better.

 

Sen Hammer: I think we fulfilled the obligations of the legislative.

 

Sen Bledsoe: Oh, wait a minute. Somebody’s going to check and see if the Zoom is on. Okay. Yes, we’ll take your suggestion, Senator Hammer. We’ll come back again.

 

Sen Hammer: That’s fine. And I’ll let Mr. Ryan know.

 

Sen Bledsoe: Yes, please, and that we’re so sorry, but thank you very much for understanding. All right, ladies and gentlemen, we’re going to go back to F, and that’s Michael Grupay. And if Michael would come and start his discussion, please. And that’s number F, item F.

 

Grupay (E&E): Good morning. Michael Grupay, Department of Energy and Environment.

 

Sen Bledsoe: You’re recognized.

Recycling nuclear fuel rods report

 

Grupay (E&E): So Act 292 that was passed in the last session required us to put together a report to determine if recycling nuclear fuel rods was viable. We have completed that report as required in the act, and I present it to the committee this morning for acceptance.

 

Sen Bledsoe: All right. Any questions?

 

Rep Ladyman: I have a comment.

 

Sen Bledsoe: All right. A comment, Representative Ladyman.

 

Rep Ladyman: Mr. Grupay, thank you for your work on this. You and Mr. Warmack worked very hard on this for a long time. I’m just glad you decided not to read that page per page, so. But I know you’ve got some suggestions moving forward into the next session in your report, and that looks very good. But thank you for your work on this.

 

Grupay (E&E): Thank you, sir.

 

Sen Bledsoe: Okay, thank you so much. All right. Going to item H. Representative Ladyman.

 

Mental health report

 

Rep Ladyman: Thank you, Madam Chair. Representative Vaught could not be here today, so I have a few comments about the report that’s due. I would ask the committee to allow the Health Services Subcommittee, which is meeting November the 14, to adopt the report of a study of mental and behavioral health and send it to ALC as required in Act 802 of 2021. I wanted to give you a few comments about the report and the work that Representative Vaught’s working group that met six times during the interim, and many subcommittees met as well. This group, composed of DHS personnel, mental health providers, public education personnel, and family members of persons with behavioral health issues, met for two to three hours at each of these meetings. They have come up with a series of recommendations to improve the system of providing help to persons with mental and behavioral health issues. Some of these recommendations only require administrative changes, and some will require legislation that she will introduce in January. The report is still being compiled and will be submitted to the Health Services Subcommittee on November 14. So without objection, the House and Senate Public Health Welfare and Labor Committee will allow the Health Services Subcommittee to submit this report to the Arkansas Legislative Council by December 1 as required in Act 802 of 2021.

 

Sen Bledsoe: All right. So moved. Thank you. Let’s go on.  Any objections? Thank you. All right. Let’s go down to I. This is the Arkansas Department of Health Center for Local Public Health review of rules. So if you would introduce yourselves for the record, we will–

 

Thompson (ADH): Charles Thompson– excuse me. Charles Thompson, attorney, Arkansas Department of Health.

 

C Smith (ADG): Craig Smith, attorney for Arkansas Department of Health.

 

Sen Bledsoe: Okay. You’re recognized.

 

Volunteer healthcare rules report

 

Thompson (ADH): Thank you, Madam Chair. Thank you, Co-Chair Ladyman. What we have before you is the update to rules for volunteer healthcare immunity. What this is is these laws were already on the books, and we already had rules on them. What it is is really combining them into one rule so that they’re easy to find and administer. The majority of it, as you look, is correction of grammatical errors and updating of language. The substantive portion is, in fact, the update in compliance with Act 968 of 2021, Representative Pilkington’s act. This added therapists, addiction specialists, and counselors to the volunteer healthcare program, and it bumped the CEUs that you could receive for providing volunteer or charitable care up from 8 to 32. We did have one public comment. The issue was we used the term ‘physician’s assistant.’ That was what is currently in the code for that code section. However, since then, ‘physician assistant’ code section for the profession itself is not in the possessive. So it’s ‘physician assistant.’ So that’s what we’ve updated to reflect that pursuant to the public comment. That was the only public comment we had. We’d be happy to take any questions.

 

Sen Bledsoe: All right. Thank you. Does anyone have a question? All right. Seeing none, thank you very much.

 

Thompson (ADH): Thank you.

 

Sen Bledsoe: This will go out as adopted without objection. Rule stands. Thank you. We’re still trying to decide about Senator Hammer and the expert that he had. So just hold on one minute. All right. I think we’re just going to let him do it the next meeting. So is there any more business to come before? All right. Seeing none, we are adjourned.