Arkansas Session 2019

The AR Legislative session has been going on a few weeks. They will be making important decisions that affect us. Here are some resources to help you stay up-to-date no matter where you live.

See the bills that have been filed:

The boxes are check for 2019. Just click Submit to see the latest list.

http://www.arkleg.state.ar.us/SearchCenter/Pages/historicalbil.aspx

See today’s calendar to decide which committees you want to watch.

Public Health, Welfare, & Labor are committees for both Senate and House that discuss bills that affect Medicaid. Each meeting has an agenda, so you can see if the bill you care about is on the list for today.

http://www.arkleg.state.ar.us/assembly/2019/2019R/Pages/Home.aspx

Watch what’s going on right now:

(Business hours)

http://sg001-harmony.sliq.net/00316/Harmony/en/View/UpcomingEvents/20190208/-1

Watch previous sessions and committees:

Bills travel to different committees, to the House, and Senate before they hit the Governor’s desk. You might want to go back to see how your legislators voted or if they discussed your concerns in the meetings.

http://sg001-harmony.sliq.net/00316/Harmony/en/View/RecentEnded/20190208/-1

AR Choices Update

Here’s an AR Choices update from our friends at Legal Aid Arkansas:


Latest ARChoices update. Last Monday (12/10), the first legislative committee–which didn’t have the power to say no–reviewed the proposed changes to the ARChoices program and sent them on to a second legislative committee, which is called the Rules and Regulations committee. This second committee has the power to say no to the rules (in some circumstances).

THE SECOND COMMITTEE MEETS on Tuesday, 12/18, at 1 p.m. in Room A of the MAC Building in Little Rock. Members of the public have the right to speak. People were limited to two or three minutes at the first committee and were pressured to get straight to the point.

Based on what DHS said at the meeting, media reports, and questions I’ve received from clients, here’s some important information.

(1) ACTUAL CARE HOURS. Our clients’ main concern is getting enough care. Almost 90% of the people on ARChoices use agencies for their care. The remaining people hire their own caregivers (it’s called “self-directing” care; you know you self-direct if you go through Palco; self-directing people may be able to get more hours). For everyone who uses agencies, the absolute maximum number of hours you can get under the new rules is 6.5 hours per day (46 per week) based on the hard budget limit of $30,000 per person per year. We know that is not enough for many of our clients.

6.5 hours per day (46 per week) is the best-case scenario. From experience, we know that the best-case scenario isn’t usually what happens. There are several things that can take away from this.

(A) The first thing that can take away hours is the new Task and Hour Standards, which will allocate a set amount of time for each activity of daily living you need done. Using algorithms, DHS will assign you a severity score in each key ADL. Then, based on that severity score, you can get a certain number of minutes for each activity. For example, if you score a 3 on bathing (3 is the most severe), the DHS nurse can give you between 35 and 45 minutes. DHS does that for each ADL (food prep, eating, dressing, grooming, cleaning, etc.) and then adds it all up. If this comes out lower than 6.5 hours per day, you can only get the number of hours the Task and Hour Standards allows. If that comes out higher than 6.5 hours per day, you can still only get the 6.5 that your budget allows.

(B) The second is if you use other services like home-delivered meals, the personal emergency response system, or respite care. The cost of these things comes out of your budget. IF YOU GET ONE MEAL FIVE DAYS PER WEEK AND HAVE THE EMERGENCY RESPONSE SYSTEM, YOU WILL LOSE ABOUT TWO HOURS OF CARE PER WEEK. And, every hour of respite care you choose means a loss of one hour of attendant care.

(C) The third is if you do not get placed in the budget category of $30,000 per year. There are two other budget categories–one with a $20,000 limit per year and one with a $5,000 limit per year. People in the $20,000 category will only be able to get up to 5 hours per day (36 hours per week). People in the $5,000 category will only be able to get up to 3 hours per day (20 hours per week). Algorithms will determine budget placement.

(2) POSSIBLE ALTERNATIVES. While Legal Aid does not advocate for specific policy fixes, we can analyze factual information and consider alternatives. Our clients’ main concern is getting enough care. We don’t have access to detailed DHS data that would allow for precise calculations, but we can make reasonable assumptions.

SCENARIO ONE. If DHS raised the $30,000 yearly cap to $36,000, it would give people a possibility of 1 more hour of care each day (so, 7.5 total per day, which is 53 per week) and would probably cost less than $1,500,000 total to the budget per year. Based on DHS’s estimates, about 260 people received services this year that cost more than the $30,000 cap. Those people will already be “grandfathered” into the new system and should be accounted for in DHS’s current budget. The extra cost of $1,500,000 assumes another 260 people will need services that cost more than $30,000 per year. This extra 260 people seems like a reasonable estimate. There could be people already on the program who face increased needs (DHS estimated 206 people this year required services that cost between $25,000 and $29,999, so some of them might need more as conditions worsen) or people who come onto the program with higher needs than the people they are replacing. There could also be a few of the grandfathered people who would get a slight bump under an incrased cap (147 people got services that cost between $30,000 and $34,999). And, that $1,500,000 assumes that all of the people who qualify for the increased budget cap will actually receive all $36,000 of services.

***REMEMBER, the increased budget doesn’t automatically mean more hours. The actual hours will be limited by the Task and Hour Standards.

SCENARIO TWO. If DHS raised the $30,000 yearly cap to $39,000, it would give people a possibility of 1.5 more hours of care each day (so, 8 total per day, which is 56 per week, which was the maximum under the system of nurse discretion that existed before RUGs) and would probably cost less than $2,340,000 total to the budget per year. Again, this assumes that 260 people will need services that cost more than $30,000. The 260 people could include some of the 206 people who received services costing between $25,000 and $29,999, some of the 147 people that got services costing between $30,000 and $34,999, some of the 74 people that got services costing between $35,000 and $39,999, and some new people.

***REMEMBER, the increased budget doesn’t automatically mean more hours. The actual hours will be limited by the Task and Hour Standards.

Even with higher budget limits, THE COST OF HOME-BASED CARE IS FAR LESS THAN THE COST OF NURSING HOME CARE. The $39,000 cap comes out to $3,250 per month, and the $36,000 cap comes out to $3,000 per month. By DHS’s own estimates, nursing home care costs around $5,500 per month.

(3) The Proposed System Still Uses ALGORITHMS That Will Be Hard for People to Understand. DHS is publicly saying that the proposed system doesn’t use computer algorithms. This is demonstrably false. DHS has to use algorithms to turn the answers to the 400+ questions on the assessment into placement in an eligibility tier, a budget category, and scores for the ADLs on the Task and Hour Standards. While the new algorithms will work differently than the RUGs algorithm, they are still algorithms. People will probably still have a hard time understanding why they get a particular amount of care.

(4) The Proposed System Could VIOLATE THE AMERICANS WITH DISABILITIES ACT. Some people have heard of the Olmstead case. It was a Supreme Court case that stands for the idea that a state discriminates against people with disabilities if the state’s actions put people at risk of institutionalization. Using a hard budget limit to deny services that are needed for people to be able to stay at home violates the ADA.

(5) The “Flexibility” DHS Has Proposed Doesn’t Address the Issue of Budget Caps. DHS will allow nurses some modest discretion in completing the Task and Hour Standards, but this DOES NOT allow nurses to adjust the hard budget cap. So, even if the nurse uses their discretion to say that you need 8 hours a day of care on the Task and Hour Standards, you cannot get that much if your budget doesn’t allow it. If you need more than $30,000 in services, there is a one-time exception possible for “exceptional, unexpected circumstances” like the death of a caregiver or drastic change in condition but not for people whose regular care requirements involve more than that (i.e. if you are relatively stable, no exception is possible). And, to get this limited exception, you have to go through a DHS review panel–it is NOT in the discretion of the nurse.

NOTE: If you currently receive more than $30,000 in services, you will be “grandfathered” into the new system and get to keep up to your current services next year (your current level will be your budget cap). However, your hours could still go down based on the Task and Hour Standards.

As always, please feel free to write or call me with any questions. 870-732-6370 x 2206.

ARChoices Update

Here’s the latest on what has been happening with ARChoices directly from our friends at Legal Aid:

(1) Second Legislative Hearing. When I last wrote, the Public Health committee of the legislature gave the RUGs algorithm an “unfavorable” review, meaning that the committee did not like it. The RUGs then went before the Rules and Regulations subcommittee. This subcommittee can only disapprove a regulation in narrow circumstances, so the RUGs was approved as a short-term measure to allow DHS to give attendant care to new applicants and to make new determinations for people up for reassessment. But, the chairperson said this:
The RUGs has not proven to be holistic in assessing the needs of the patients. Your presence here today has not fallen on deaf ears and, moving forward, because of your intense pressure, it is duly noted that RUGs is not the system we want serving the needs of Arkansans with disabilities. I believe it would be fair to say that you have the attention and the ears of the legislative branch to assure that your needs are moving forward. While we may not agree 100% on everything, the one thing we know is we can’t stay where we are. And while this process continues out after we do our duty today, then we will work to make sure that we don’t revisit this chapter again.
Even though RUGs was approved, the statement is great news for people hurt by the RUGs. Even if RUGs comes back in the short-term (it might not; see below for updates on the court case), it looks like the legislature won’t allow it to go on beyond December or early 2019. And, the public, media, and legislature will all take a close look at whatever new system DHS eventually comes up with. Personally, it was especially inspiring to see all the people most affected and their families come out and speak at the public forums or at the legislature, offer written comments, and lead the public effort (Legal Aid didn’t organize it).  And, this would not have happened without all the thoughtful and caring providers and other advocates who stepped up. It’s been wonderful to work with everyone.
(2) New System. DHS kept talking about a new system it would implement as of 1/1/19. DHS said that it would start the public comment process on 10/1/18. As of today, nothing has been published about it. Legal Aid will let everyone know when the official proposed rule comes out. The unofficial drafts we’ve seen suggest that it might be easier to understand than RUGs, but the unofficial drafts make it seem unlikely the new system will offer enough care hours for the patients with the highest needs.
(3) Court Case. Because the legislature approved the RUGs, DHS was going to start using it again as of yesterday. DHS asked the court to remove the injunction that stops them from doing that. DHS claims that it followed the proper process to adopt the rule. Today, Legal Aid, on behalf of our plaintiffs, filed an objection and asked the judge to keep the injunction in place (it is attached if you want to read the full legal document). DHS’s public comment process appears to be a sham. 43 different people criticized the RUGs for allowing inadequate care and not taking into account a nurse or doctor opinion in making hour determinations. They offered concrete ideas about alternatives. DHS didn’t even try to address the criticisms or alternatives, which the law requires it to do. Only 1 person was fully supportive of RUGs.
Our filing means that people who have applied for ARChoices services may be further delayed in getting them. DHS keeps saying that it has no lawful way to allocate attendant care, but we disagree and keep arguing that DHS can use the system of nurse discretion in place before RUGs. We are very sympathetic to the people who are waiting on services and understand they are caught up in this. However, Legal Aid has a duty to serve our clients. All of our plaintiffs (and many other clients) have been cut by the RUGs in the past. And, because DHS hasn’t been able to re-assess them for two years, they could be first in line for re-assessment. We tried to negotiate with DHS to get a formal, written agreement to ensure our clients would be safe, but DHS would not do anything formal. We had to file this objection to try to protect our plaintiffs. We have another legal case pending that could get the assessments and allocations started again with nurse discretion and will continue pursuing that option.

Contact:

Kevin De Liban, Attorney
Economic Justice Practice Group Leader
Legal Aid of Arkansas–West Memphis
310 Mid-Continent Plaza, Suite 420
West Memphis, AR 72301
Phone: (870) 732-6370 x. 2206

ARChoices: Update From Legal Aid

This is an update from Kevin De Liban from Legal Aid of Arkansas. He wants to help us understand the latest on ARChoices.


Just a quick update on yesterday’s meeting in the legislature. The Public Health committee gave the RUGs algorithm an unfavorable review, meaning that the committee thinks that DHS should not adopt the RUGs algorithm. At least 4 people on the ARChoices program were present and testified before the legislators, as well as parent caregivers, advocates, case managers, and care agencies. These voices–especially the people on the ARChoices program–let the legislators know the details about how the RUGs algorithm has hurt many beneficiaries. Here is a newspaper article about the meeting.

That is not the end of the process. The RUGs algorithm now goes to the Rules and Regulations Subcommittee on Tuesday, September 18, at 1 p.m. in Room A of the MAC Building. The agenda includes a list of the legislators on the committee as well as other details.

Public comment will be accepted at this meeting. If the Rules subcommittee votes against the RUGs algorithm, it should be the end of it. But, there are some technicalities involved, and I have no way of knowing what the likely outcome is. Whatever happens, it’s inspiring to see how all sorts of people in different situations have been working in their own ways for justice on this issue.


How to contact Kevin with concerns or questions:

Kevin De Liban, Attorney
Economic Justice Practice Group Leader
Legal Aid of Arkansas–West Memphis

310 Mid-Continent Plaza, Suite 420
West Memphis, AR 72301
Phone: (870) 732-6370 x. 2206
Fax: (870) 732-6373

How to Best Communicate with Legislators

read the artic

If you can’t see the graphic above, you can read the article.

AR Works: Update from Legal Aid

Legal Aid of Arkansas sent the following update and wants everyone to know this important information.


We’re writing to let you know the latest information on the work requirements in the Arkansas Works program. With the work requirements now in effect, Legal Aid is available to help beneficiaries understand how to comply and how to assert their legal rights. Anyone affected is welcome to call our special Medicaid line–(800) 967-9224 and press 4. 

Lawsuit: Because of the widespread loss of coverage these work requirements are likely to cause for our clients, Legal Aid of Arkansas has filed a federal lawsuit in Washington DC. While that lawsuit is moving along, we want to make sure people have all the information they need to give them the best chance of keeping their coverage.

Letters of Non-ComplianceMany beneficiaries will have already received notices for non-compliance for the month of July. The notices will have a date of August 6 on them. For some people, this is their second month of non-compliance, and they will be terminated as of September 1 if they do not report compliance in August. For others, this is just the first month of non-compliance, but that means their care is threatened for future months. DHS reported that 72% of people who had to go online in June did not do so. That’s about 7,400 people, and we expect similar numbers for July, which are set to come out later this week.

Resources for People AffectedAnyone who receives notices of non-compliance is welcome to call Legal Aid for information about the program and their legal rights. We have a special Medicaid line–just call (800) 967-9224 and press 4. If someone doesn’t answer right away, we’ll get back with them within a few business hours. You (or they) are also welcome to call me at x. 2206 or Trevor Hawkins at x. 6313.

Here are other ways you can spread the word about the changes: 

(1) Share the Facebook video. This explains the latest on the lawsuit and how to comply with the work requirements:  https://www.facebook.com/arlegalaid/videos/2110260212381560/

(2) Share the flyer

and this (Front/back) handout. 

(3)  Invite us to talk to  your group, community, staff, or clients. We can accommodate any form of participation (in-person, video, phone), various languages, and any time limitations.

Contact:

Kevin De Liban, Attorney

Economic Justice Practice Group Leader

Legal Aid of Arkansas–West Memphis

310 Mid-Continent Plaza, Suite 420

West Memphis, AR 72301

Phone: (870) 732-6370 x. 2206

Fax: (870) 732-6373

Facebook Twitter

Take Action: June Legislative Committee Meetings

Update (6/5/18): The rules were approved in the Public Health joint committee and will be next voted upon by the ALC Rules & Regulations Joint Committee on Tuesday, June 12 at 1pm in Little Rock. Contact the committee members. Read below to catch up if you wonder which issues are being voted upon.


Original post: MSL has announced on Facebook that this committee meeting would be occurring on June 4th and that it was moved to Jonesboro. Here is some information to help you to understand what’s happening when, and what you need to do.

If you’re lost and need to catch up, you can watch a video we previously released on the subject.

Screen Shot 2018-06-03 at 10.01.07 PM

Several important issues are being discussed that affect children as well as adults:

Here is how you can contact the people of the Public Health Committee:

2018 Election Info

It’s election season! In fact, early voting for primaries has begun. That means it’s time for you to do some homework and make decisions about which issues are most important to you. Sometimes your values on different issues may clash, which is why it’s important to rank one of them as most important to you.

Medicaid is a hot topic. We’ve seen a lot of change, and depending on the officials we elect, we may see even more. That’s why it’s important to be informed about election deadlines, requirements, and the candidates.


Your first question might be:

Who’s running?

Click here to find out.


Next you’re probably asking:

What are the deadlines?

Elections for the office of Arkansas House of Representatives will take place soon!

  • candidate filing deadline – March 1, 2018.
  • primary election – May 22, 2018.
  • primary runoff election – June 19, 2018.
  • general election – November 6, 2018.

All 100 House seats are up for election in 2018. Arkansas state representatives serve two-year terms, with all seats up for election every two years.

Elections for the office of Arkansas State Senate are also happening soon.

  • candidate filing deadline – March 1, 2018,
  • primary election – May 22, 2018.
  • primary runoff election – June 19, 2018.
  • general election – November 6, 2018.

A total of 18 seats out of the chamber’s 35 seats are up for election in 2018.Arkansas state senators serve one two-year term and two four-year terms each decade.

Arkansas will also hold elections for Governor, Lieutenant Governor, Attorney General, Secretary of State, Auditor, and Treasurer on November 6, 2018. The candidate filing deadline was March 1, 2018.

The 2018 U.S. House of Representatives will hold elections

  • candidate filing deadline – March 1, 2018,
  • primary election – May 22, 2018.
  • general election – November 6, 2018.

Arkansans elect representatives to the U.S. House, one from each of the state’s four congressional districts.


How can I be informed about the candidates?

As candidates are campaigning, make sure you take every opportunity to inform yourself. Know what questions to ask!


Have I met the requirements to vote?

Voter Registration

To register to vote in Arkansas you should provide one of the following:

  • The Last Four Digits of your Social Security Number
  • Your Arkansas Driver’s License Number

If you do not have any of these IDs, you can provide a copy of one of the following with your registration application:

  • Current and Valid Photo ID
  • Government Issued Document that shows your current name and address
  • Utility Bill
  • Government Check
  • Bank Statement
  • Paycheck that Shows your current name and address

You can alternatively provide one of these documents when you vote to complete your registration.

Voting In-Person

In Arkansas, you need to show a valid ID to vote. You can use any ID from this list:

  • Paycheck that shows your Current Name and Address
  • Current and Valid Photo ID
  • Utility Bill
  • Bank Statement
  • Government Check
  • Government Issued Document that shows your Current Name and Address
  • Veteran Health ID Issued by US Department of Veterans Affairs

Where should I vote?

Find out.


Source 1

Source 2

Source 3

One Therapy Rule – Part 1

MSL has done some research on a change coming our way. You may have heard of it – the “One Therapy Rule,” formally known as the EIDT Program. Watch this video and stay tuned for your opportunity to take action.

Updated PASSE Information

Click the image below to receive comprehensive, updated information on the PASSE systems (as of October 2017). The deadlines have been updated, and if you were wondering what the purpose of the model is, here’s your chance to find out!

Screen Shot 2017-10-31 at 9.36.43 AM

Three PASSEs were officially certified on October 18: Arkansas Advanced Care, ARkansas Total Care and Empower Healthcare Solutions. Read more about them in the image below:

Screen Shot 2017-10-31 at 10.20.51 AM