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 Works – 18K Lose Coverage

The news isn’t good for Arkansas Works. Reports are showing that over 18,000 people have lost coverage so far.

Check out the whole story.

People have to work or report some exemption as a reason that they can’t work, like if they have a disability or a kid at home. If they don’t report 80 hours of work a month, for 3 months in a year, they get kicked off.

What do you think about this? Let us know!

If you have lost coverage, you can contact Legal Aid of Arkansas for help! Call 870-732-6370 ext 2206.

What’s the PASSE Ombudsman?

The PASSE Ombudsman is supposed to be there to help us when our PASSE isn’t.

These are people employed by DHS, not by the PASSEs.

If you have a complaint against your PASSE, your care coordinator, your Independent Assessment Tier, or if something just isn’t getting solved, you might want to try calling the Ombudsman. Call 1-844-843-7351 if you need help.

Make an Impact with 2 Simple Words

This holiday season, you can make an impact with 2 simple words: Thank you.

Especially if you’re a Medicaid recipient, let the people in charge know that we need Medicaid, and let them know what it does for us. Tell them thank you, and ask them to keep directing funding to Medicaid. Send them a photo of the person who is helped by Medicaid.

This is what advocacy is. It’s so easy! Just speak up for what matters to you.

Here’s how:

Email DHS Director Gillespie

Email Governor Hutchinson:

other contact: governor.arkansas.gov/online-services/contact-us

Email any State Congressperson

Contact any Federal Congressman

Contact any elected official

ARChoices: Take Action

This is a long but important update from Kevin deLiban of Legal Aid of Arkansas on information about the NEW SYSTEM to determine hours for ARChoices that DHS will start using on January 1, 2019.

The public comment period is open until 11/7/18, and public meetings will be held from now until then.


(1) RUGs Update. Late Monday, the judge dissolved the injunction against RUGs, meaning that DHS will start allocating attendant care to new applicants for the program and will also re-assess people whose plans of care have expired. RUGs will only go back into effect for the next two-and-a-half months and then will be replaced by the new system described below. If anyone faces reductions because of RUGs during that time, they can call Legal Aid of Arkansas at 800-967-9224. We don’t anticipate more court challenges against RUGs (though that can always change), but we may be able to help with administrative appeal hearings.

Due to the hard work of people on the program, caregivers, attorneys (at Legal Aid of Arkansas, the Center for Arkansas Legal Services, and Disability Rights Arkansas), case managers, care agencies, journalists, and others, RUGs is definitely going away (DHS had no plans to switch to a new system before the litigation and public attention), about a thousand people avoided devastating RUGs-based cuts for several months (and at least couple dozen people kept their pre-RUGs hours for a year or longer), 150+ people with cerebral palsy are getting more hours than they otherwise would have due to discovery of a DHS software error, hundreds of people (including legislators and the wider public) have learned more about Medicaid home-care services and the importance of a fair system to determine hours, and a community of people are now activated around these issues. Justice only exists because people work to create it. Grateful for all of you who did so here. We lost along the way, too, and I think about the clients who passed away fearing or fighting cuts, clients who’ve been living with the cuts, and all the suffering we couldn’t stop. They keep me motivated.

(2) The New System. DHS finally released details of the new system it plans to use starting January 1, 2019. DHS’s own summary of the changes are attached. There is A LOT of information in here, so I’ll go through the major items.

New Assessment. Up to now, DHS was using the assessment tool known as ArPath, which had 286 questions. ArPath will be going away. The new assessment will be called ARIA and could have as many as 400 questions. It will be performed by a Registered Nurse who works for a private company named Optum. After the Optum RN comes out to do the assessment, the results will be sent to DHS for a determination about eligibility, the amount of hours someone gets, and what budget category someone fits in. This involves a separate visit by a DHS RN to do the care plan.

Questions/Unknowns:

~ Will people be given enough advance warning in order to get medical records or arrange for caregivers to be present so that the information in the assessment is accurate?

~ Will the new assessment take longer than the old assessment, which already took 60 to 120 minutes? Will the questions be understandable, relevant, and fair?

New Hour Determination System. RUGs used an algorithm that mixed a lot of different factors that didn’t seem to make obvious sense in order to place someone in a group with a fixed number of hours. The new system will be very different. It is called the “Task and Hour Standards.” Based on the ARIA assessment, an algorithm will rank each person from 0 to 3 in each key Activity of Daily Living (bathing, dressing, feeding, grooming, toileting, transferring, walking, cleaning, laundry, meal preparations, and shopping). Then, based on whether you get a 0, 1, 2, or 3, the DHS nurse (who comes in a separate visit from the Optum nurse) will determine how many minutes you get for that particular activity. For example, if you score a 3 on bathing, the DHS nurse can give you between 35 and 45 minutes. If you score a 2, the DHS nurse can give you between 15 and 30 minutes. If you score a 1, the DHS nurse can give you between 5 and 10 minutes. The DHS nurse will then figure out how many times per week you need to do a particular task. The DHS nurse will then add up all the minutes you get for each ADL and give you a monthly number of hours.

Questions/Unknowns:

~ DHS hasn’t said how the algorithm will figure out if you are a 1 or 2 or 3 for any particular ADL.

~ DHS hasn’t stated the frequency that certain tasks will be allowed. Is bathing a daily task? Do people get to be dressed twice per day (once into the day’s clothes; once into bedtime clothes)? Will the frequencies allowed match actual care needs?

~ DHS has said that the time given will be reduced by the amount of time that family, friends, or others do that same task voluntarily. It is not known how this will affect people with family caregivers.

~ DHS has said that no time will be given for the cleaning of shared spaces when the caregiver lives with the beneficiary. There could be other reductions for people who live with their caregiver.

~ DHS has said that nurses can request to go outside the amount of time allowed if there are “extenuating circumstances” and the nurse receives supervisor approval. For example, this means someone may be able to get 55 minutes for bathing even though the highest amount officially available is 45 minutes. BUT, these adjustments might not mean much because of the budget limits described below.

~ Even if you are allowed a particular amount of hours under the Task and Hour Standards, you might not actually get that number of hours because of the new overall budget limits described below.

• New Overall Budget Limits. DHS is doing something it has not done before in ARChoices, AAPD, or Elder Choices. It is setting a hard budget cap for services an individual on the program can receive, regardless of the amount of care DHS’s own Task and Hours Standards says someone needs. There are three budget categories–Intensive, Intermediate, and Preventative. An algorithm will use the answers to the assessment to put you into one these three groups. People in the Intensive group can get no more than $30,000 worth of services in a year ($2,500 in a month). People in the Intermediate group can get no more than $20,000 worth of services in a year ($1,667 per month). People in the Preventive group get $5,000 in a year ($417 per month).

So, even if the Task and Hours Standards states that you need 200 hours in a month, you cannot get those 200 hours if they cost more than is allowed by your budget limit. For example, your budget limit might only allow you to “buy” 150 hours per month (or some other number less than 200).

Questions/Unknowns:

~ DHS has not stated the actual price of the services so that you can predict the number of hours actually possible under the budget limits. However, if you take the standard attendant care rate of $18 per hour, the highest budget level (Intensive, which allows $2,500 per month), would only allow 139 hours per month. This would not be enough for many people. The next highest budget limit (Intermediate, $1,667 per month) would only allow 93 hours per month (at the rate of $18 per hour for attendant care).

~ DHS has stated to media that the cost of attendant care would be less for people who hire their own caregivers instead of using an agency (meaning they could possibly get more hours under the budget limit), but that would seem to give far fewer hours to people who use agencies than people who hire their own caregivers.

~ DHS has stated to media that up to 64 hours of personal care hours may be available apart from this, but that is not confirmed in policy and may still not be enough care for many people who have higher needs.

~ DHS’s process to arrive at these $30,000/$20,000/$5,000 categories has not been independently verified to be reliable. These amounts could be arbitrary. DHS says they are based on the cost of nursing home care, but DHS has given other figures that state nursing home care costs much more than $30,000 per year (these other DHS estimates have put the cost of nursing homes at more like $60,000 per year).

~ DHS did not include in the public documents anything about how the budget limits will actually affect people. How many people will be put into each category? How many people will face cuts because of placement in a particular category?

~ DHS has stated that ARChoices beneficiaries who were on the program in 2018 and who received more than $30,000 in services will not face a cut due to the budget limits the first year. Instead, their budget limit will be the cost of the services they received in 2018. This is known as “grandfathering” people into the program. So, people with higher needs may be able to keep what they got in 2018 if the Task and Hour Standards determination shows they need that many hours.

~ Apart from the “grandfathering,” DHS has stated that the budget limit can be temporarily adjusted upward for one year through an “exceptions process” for “exceptional, unexpected circumstances.” DHS stated that these “exceptional, unexpected circumstances” might include the death of a caregiver or recent release from a facility.

• Will the new system provide enough care? Compared to the system of nurse discretion, RUGs was harmful to our clients because it meant huge cuts in hours for so many people, especially people with the most severe needs. It is not clear if the new system will give people any more hours than RUGs did. It is not clear if the new system will give people enough hours to meet their actual care needs and keep individuals out of nursing homes. DHS has stated that the changes will cut Medicaid spending by about $10 million the first year and about $14 million the second year. If spending cuts are the goal, increased care may not be part of the plan.

• Is it understandable? RUGs involved 20 pages of computer code that didn’t make sense to our clients. The new system seems to be complicated in a different way. First, people will have to figure out how the 400-question assessment turns into a score for each ADL on the Task and Hour Standard (how many minutes you get for each ADL). And, we don’t know if that will make sense. Second, people will have to figure out how the assessment turns into a Budget Limit category. Some people may be qualified for hours under the Task and Hour Standard that they can’t actually get because of the Budget Limit category. These complications may mean that people on the program may not be able to fairly contest decisions about the care they are allotted.

(3) Public Comment. Anyone can participate in the public comment process. Comments can be sent by email to becky.murphy@dhs.arkansas.gov or by mail to Office of Policy Coordination and Promulgation, P.O. Box 1437, Slot S295, Little Rock, Arkansas 72203-1437. Comments must be submitted by 4:30 p.m. on November 7.

(4) Public Meetings. Public comment will also be accepted at public meetings. The meetings are at the following times and places. Some of these meeting places are different from the meetings about ARChoices that were held in summer.

Fort Smith, 10/15, 5 p.m., Arkansas College of Osteopathic Medicine, 7000 Chad Colley Blvd
Monticello, 10/18, 5 p.m., Drew Memorial Hospital Conf. A., 778 Scoggin Dr.
Hope, 10/22, 5 p.m., UA Hope Hempstead Hall, 2500 South Main St.
Little Rock, 10/29, 5 p.m., Arkansas Enterprises for the Developmentally Disabled, 105 E Roosevelt Rd
Jonesboro, 11/7, 5 p.m., St. Bernard’s Medical Center Auditorium, 225 E. Jackson Ave.

(5) Copy of the Full Materials. I could not cover all the changes being made. The full materials can be downloaded here. The full materials have information on other important changes being made to this program, Independent Choices, and the Assisted Living waiver program. For example, the rates of Assisted Living providers are facing significant cuts, which may mean that fewer people can get into an assisted living facility and more people may have to choose a nursing home instead.


This update was provided by Kevin De Liban of Legal Aid. If you have questions, please feel free to reach out to him:

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

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

ARWorks: Healthcare Options If You’ve Lost Your Coverage

The 2 graphics below are of a letter that is going out to ARWorks beneficiaries who had their coverage closed last week. It contains options for them going forward.

Also, DHS posted many of their notices and letters that have gone out here: https://ardhs.sharepointsite.net/ARWorks/Notice_Samples/Forms/AllItems.aspx

Screen Shot 2018-09-15 at 1.26.18 PMScreen Shot 2018-09-15 at 1.26.32 PM

Preferred Family Health Closure Update

This is a letter that went out to beneficiaries who received services at PFH to notify them of PFH’s closure. Some of you may be interested in this information as well as this link which lists the available providers. Please note the PDF is searchable!

PFH_LETTER

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.