Transcript Highlights:

• Cms will score the rule factors.
• the same as if there's any on obligated funds by CMS.
• This is what this will be review subjectively by CMS staff and CMS analysts who they choose to bring
• So that's what CMS is going to use.
• quickly with CMS here at this time.

Transcript Highlights:

• That's the crux of the issue with CMS.
• But that is the third option that CMS offered.
• And that bill had two distinct issues per CMS.
• CMS doesn’t have an issue?
• Lab services are a mandatory service by CMS.

Summary: The Administrative Rules Subcommittee of the Arkansas Legislative Council reviewed several agency rules and requests. The Insurance Department’s amendment to its holding company system rule was reviewed and approved, as were two State Board of Election Commissioners rules: one clarifying poll watcher conduct, vote challenges, and provisional voting, and another increasing pay for certified election monitors and defining training, observation, and report-writing compensation. The Arkansas Financial Education Commission also had its rule reviewed and approved after removing membership requirements tied to DEI language to comply with Act 938. The committee held over the Department of Education’s request to be excluded from reporting requirements for one month to allow further discussion about who should write or implement the rules. A major portion of the meeting focused on the Department of Human Services’ request to be excluded from reporting requirements for Acts 567, 568, 967, and 1025. DHS said CMS had raised comparability and other federal approval concerns, especially for the dental and diagnostic lab provisions, and that it might not be able to meet the acts’ effective dates. DHS described several possible paths forward, including broader benefit changes, waivers, or splitting the dental provisions so the pediatric rate increase could move separately from the special-needs adult cap increase. The Arkansas State Dental Association disputed DHS’s conclusion that the acts could not be implemented as written, argued that Act 1025 is workable, and urged DHS to continue pursuing implementation and preserve the September 1 effective date where possible. Public testimony also supported expanded dental access for adults with disabilities and special needs. After discussion, the committee voted not to exclude DHS from reporting requirements for those acts. The committee then reviewed the Division of Higher Education’s Act 781 report. The division said it has 32 rules in effect, asked to repeal three rules—two replaced by new rules and one no longer supported by authority or current law—and to continue the remaining 29 rules. The committee approved that request, with the repeals effective upon adjournment of the Legislative Council meeting on January 16, 2026. The meeting concluded with no questions on the remaining written rulemaking updates from prior and current sessions, which were filed without further action.

Transcript Highlights:

• We may move it forward to CMS.
• So, Donna, when you say CMS, is this a board or is it a person? Who is CMS exactly?
• CMS won't allow us in order to execute that contract.
• If there is something they had not thought of in their application to CMS, CMS can also allow them to
• Then I will draw it down from CMS.

Keywords: 908, all

Summary: The Appropriations Division met in a work session on the draft Rural Health Transformation appropriations bill, 25.1392.01000, with no public testimony taken. Legislative Council and the Department of Health and Human Services walked through the bill, which would appropriate about $397.8 million in federal grant funds over two federal fiscal years, provide transfer authority, allow certain federal funds to be used for salaries and wages without counting against existing transfer limits, and authorize OMB to adjust other agencies’ spending authority if they receive grant awards through HHS. The bill also includes several temporary statutory exemptions to help implement the program, plus recipient acknowledgement/reporting requirements, periodic reports to Legislative Management, and an immediate effective date upon filing. Committee discussion focused heavily on how the federal rural health transformation money can be used and administered. Department officials explained that CMS will review projects for allowability and sustainability, that the state has flexibility to move funds among categories, and that the grant is limited to 10% administrative costs. Members asked about whether the funding could support renovations, equipment, ambulances, bulk purchasing, food distribution, and other rural health ideas, and were told many details will depend on CMS approval and the eventual applications. Questions also addressed cash flow, timing of obligations and reimbursements, FTE funding, and whether grant recipients should be told the program will not continue beyond the federal period; officials said the language is meant to prevent expectations of automatic continuation, not to bar future legislative action. The committee also discussed the bill’s use of a two-year appropriation amount, with staff explaining that the state must appropriate enough authority to cover the federal grant cycle and that unused authority would lapse if the full amount is not received or spent. Members raised concerns about whether the bill’s language could limit creativity or future program design, but department officials and several members emphasized the need for flexibility because CMS may reject overly specific directives. After discussion, the committee voted to recommend the bill draft to the full committee; the motion carried on a roll call vote, and the chair said the full Joint Appropriations Committee would take up the bill at the special session next week.

Transcript Highlights:

• CMS approved a lump sum.
• Since CMS had not even approved the budget, there was nothing beyond that that we believe CMS would approve
• with CMS on its budget.
• between the state and CMS.
• As specific as I can be, because CMS is still working on these things. >> And while you're on CMS, you

Keywords: Public Health and Welfare - Room 216, 4 June, 2026; 2:30 PM, 925, all

Transcript Highlights:

• And then we have our CMS award notice.
• And then we have our CMS Award notice.
• And we are at the mercy of CMS.
• And I think we've been... ...a great partner with CMS, and CMS has been a great partner for us in asking
• CMS being able to redistribute unobligated funds.

Keywords: 908, all

Summary: The Joint Policy Committee met to hear an overview of North Dakota’s Rural Health Transformation Program before taking up the related policy bills. Department of Health and Human Services staff explained that the state received a $198.9 million CMS award, with funding focused on four pillars: strengthening rural workforce, bringing care closer to home, connecting technology and data, and improving population health through prevention. They emphasized that the program is intended to benefit rural and frontier residents statewide, including areas near urban centers when the project serves rural patients, and that CMS approval, provider readiness, and sustainability will drive what can be funded. Committee members asked about how the program would treat border communities, frontier counties, urban providers serving rural patients, multilingual outreach, tribal consultation, and whether there would be information sessions for applicants. HHS said the website will include sign-up and translation features, more listening sessions and training will be offered, and a rural health tribal liaison will work alongside the existing Medicaid tribal liaison. Members also raised concerns about reimbursement timing, cash flow for providers, and whether projects in urban areas could qualify; HHS responded that urban projects may be eligible if they clearly benefit rural residents. The department then outlined the four policy bills tied to the grant scoring: nutrition continuing medical education for physicians, the presidential fitness test, the physician assistant compact, and pharmacist scope of practice. HHS said these policy actions were incentivized in the federal funding opportunity and that failure to pass them could reduce future funding. The committee did not take final action on the bills in this portion of the transcript and recessed for lunch before moving on.

Transcript Highlights:

• that the program be terminated and CMS that the program be terminated and CMS had<00:04:12.560><
• Um CMS has money from the state.
• ,<00:40:48.000> the and submit our response to CMS, the and submit our response to CMS, the
• Um CMS did contracts with counties.
• Um not it's not a uh CMS defines.

Bills: HF3379

Keywords: housing stabilization, disability services, predatory funding, provider requirements, housing accessibility, 1183, house

Transcript Highlights:

• CMS, again, as Pat stated, will be approving CMS, again, as Pat stated, will be approving every single
• We're still going to have to submit that to CMS for approval.
• So far, they've been very good to deal with, the CMS folks.
• The CMS folks have been very good to deal with.
• Sure we don't run afoul of the CMS rules and regulations.

Keywords: 908, all

Summary: The Rural Health Transformation Committee met to receive an extensive briefing from the Department of Health and Human Services on North Dakota’s federal Rural Health Transformation award. HHS leaders Pat Traynor, Donna Auckland, Jonathan Ollum, and Krista Freming described the $198.9 million award, the tight federal timelines for obligating and liquidating funds, and the need for rapid procurement, CMS approval, and technical assistance. They outlined broad funding priorities including connect tech/data, care closer to home, workforce recruitment and retention, and a “Make North Dakota Healthy Again” prevention initiative focused on chronic disease, movement, nutrition, behavioral health, and community connection. They also emphasized that the program cannot fund new buildings or supplant existing funding, and that sustainability will be a key requirement for all projects. The department previewed likely first-round grant opportunities, including recruitment and retention incentives, technical assistance and equipment grants for rural providers, financial analysis support for rural hospitals, and exploration of a unified electronic health record option. Freming also reviewed four policy bills tied to the award: a presidential fitness test, nutrition continuing medical education, the Physician Assistant Compact, and pharmacist scope-of-practice changes, explaining that these policy actions affect future scoring and funding. HHS said it will work with tribes, local public health, hospitals, medical and pharmacy associations, and other partners, and will use a website, listserv, listening sessions, and committee updates to communicate opportunities. Committee members raised concerns about how the money will reach rural residents, whether newspapers and existing local communication networks will be used, how “rural” and “frontier” will be defined, how faith communities might participate in behavioral health efforts, and how HHS will avoid CMS delays and supplanting issues. HHS responded that the focus will be on where the patient lives and on rural community need, that local public health units and existing structures will be part of outreach, and that technical assistance and template applications will help speed approvals. The committee approved the December 4, 2025 minutes, then recessed into divisions for further work on the appropriations bill and the four policy bills, with the full committee set to reconvene the next morning.

Transcript Highlights:

• I've read the CMS homepage.
• I believe CMS.
• CMS to be able to engage.
• I am so sick of CMS right now it just makes me For years, CMS has sat idly by, looked at that payment
• And I don't think CMS has done that adequately.

Keywords: Michael Falkender, Deputy Secretary of the Treasury, IRS, taxpayer privacy, nomination process, committee hearing

Summary: The committee convened to discuss critical issues surrounding the nomination of Michael Falkender for the position of Deputy Secretary of the Treasury. This meeting included a series of remarks from committee members who expressed divergent views on Falkender's qualifications and the implications of his appointment. Senator Wyden voiced strong opposition, arguing that Falkender represents harmful policies expected to be perpetuated under the current administration, especially concerning taxpayer privacy and IRS tactics. Meanwhile, other members defended Falkender, noting his extensive experience, including a commitment to transparency in government operations if confirmed.

Transcript Highlights:

• It knocked her out of CMS. Thank you.
• And the federal CMS, and this is CMS under the Biden administration, has consistently erected barriers
• We never received a response back from CMS or acknowledgement of that.
• From CMS or acknowledgement of that.
• We never received a response back from CMS or acknowledgement of that.

Summary: The committee received a briefing from AHCA Deputy Secretary Brian Meyer and Florida Healthy Kids CMO Ashley Carr on implementation of HB 121, which was enacted in 2023 to expand Florida’s KidCare/CHIP eligibility from 200% to 300% of the federal poverty level and replace the sharp premium “benefits cliff” with a tiered premium glide path. Sponsor Rep. Bartleman described the bill as a bipartisan effort to help working families keep children insured while moving toward economic self-sufficiency. The presenters explained that the program remains a joint federal-state structure, with Medicaid unchanged and the bill affecting only the CHIP-related portions of KidCare. AHCA said implementation has been delayed by federal CMS actions. The agency reported that CMS first rejected a state plan amendment approach, then required revisions to the premium tiers under a new maintenance-of-effort interpretation, and later issued a new interpretation of continuous 12-month eligibility that would prevent disenrollment for nonpayment of premiums. AHCA said it submitted an 1115 waiver, but negotiations over special terms and conditions reached an impasse, and the state has filed litigation challenging CMS’s interpretation. Members asked about the cost of litigation, the effect on future bills, the review process for CMS documents, disenrollment and reenrollment rules, and whether any additional legislative action is needed; AHCA said no further state action is needed at this time and that the key issue is the pending federal litigation. Several members and the sponsor emphasized the need for immediate implementation and asked about possible interim relief. AHCA said current coverage remains in place under the preexisting program, that there is a 30-day grace period for premium payment, and that reenrollment does not require a penalty or back payment, though coverage is not active during lapsed periods. The committee also heard public comment from Nicholas Hessing of the Children’s Services Council of Broward County and the Florida Alliance of Children’s Councils and Trusts, who supported HB 121 and said the expansion could make about 17,600 additional children eligible in Broward County alone. The meeting ended with Rep. Bartleman thanking staff and expressing hope that the new federal administration would allow the program to move forward, and the chair adjourned the meeting.

Transcript Highlights:

• So as you can see, this is a very quick-moving program. by CMS.
• CMS came back and they clarified Arkansas can determine what is rural.
• So this is a CMS-funded project.
• Yes, that's prohibited by CMS.
• And CMS has said, you know, add to an existing footprint.

Summary: The committee first heard extensive public testimony from youth and advocates urging stronger restrictions on vaping. Speakers described vaping as a youth-targeted public health problem, citing flavored products, social media marketing, nicotine addiction, brain development concerns, school disruption, and exposure to harmful aerosol. They recommended prohibiting vaping in public indoor spaces and aligning vape rules with smoke-free laws. Committee members praised the speakers and encouraged them to continue building support for future legislation. The main presentation was on Arkansas’s Rural Health Transformation Program, administered through DFA. Secretary Jim Hudson and program director Brad Andi explained that Arkansas received about $209 million in the first year under the federal program, with potential for roughly $1 billion over five years if performance is strong. They emphasized that the program is meant for long-term rural health transformation, not general operating support, debt relief, or new construction. The state’s plan centers on four initiatives: HEART for prevention and community health, PACT for access and provider collaboration, RISE for workforce development, and THRIVE for technology and telehealth. Officials said applications will be handled through upcoming notices of funding opportunity, with a focus on local, shovel-ready projects, regional collaboration, and transparency. Committee members asked how the program would work for hospitals, clinics, nonprofits, schools, faith groups, and urban providers serving rural patients. Officials said eligibility is broad if applicants can show a connection to rural health, and that targeted renovations, mobile units, school-based clinics, farm-to-school or garden projects, EMS equipment, residency expansion, and behavioral health initiatives may fit if they align with the plan. They stressed that the program cannot fund working capital, routine maintenance, or new buildings, but can support repurposing space and collaborative networks. Members also raised concerns about protecting existing rural providers from being displaced, and officials said applications would be reviewed by a state committee with technical assistance and a reimbursement-based process. The committee then reviewed and took no objection to several DHS and Health Department rules. DHS presented a Medicaid/CHIP rule implementing federal requirements for incarcerated youth, including pre- and post-release coverage, care coordination, targeted case management, and screening services, with no public comments received. The Health Department also presented a licensing rule for audiology and speech pathology that implements recent acts and changes the renewal deadline; that rule was likewise reviewed without objection. The meeting adjourned after no further business.

Transcript Highlights:

• The only piece that transferred is the administration of the CMS managed care plan.
• There are two components of the CMS Children's Medical Services plan.
•   73 All providers previously credentialed with the CMS plan and the [questionable: "spender" CMS
• We are continuing to engage with CMS on this.
• So right now we're waiting for final approval from CMS.

Summary: The Health Facilities Subcommittee met to receive implementation updates from the Agency for Health Care Administration on three bills passed in prior sessions. First, Deputy Secretary Brian Meyer reported on the transfer of the Children’s Medical Services managed care plan from the Department of Health to AHCA under HB 1085. He said the move was administrative only, with no change to enrollment, providers, services, or clinical eligibility functions, and that it was intended to create efficiencies by aligning procurement and shifting staff resources between agencies. Members then questioned AHCA about reports of reductions in private duty nursing and therapy services for medically fragile children, including concerns about appeals, provider credentialing, and whether families were losing services or being transitioned appropriately. AHCA said it was reviewing denials, monitoring the plan, and using contractual remedies while focusing on maintaining access for members. The committee also reviewed implementation of a bill creating permanent Medicaid eligibility for individuals with permanent disabilities. AHCA staff explained that the agency had submitted a federal 1115 waiver request after public comment and stakeholder meetings, but CMS had indicated it did not anticipate approving the requested authority. Members pressed AHCA on why the waiver was submitted later than the bill’s directive date and on whether the delay was avoidable. AHCA said the waiver was complex and required review, drafting, and public input, and noted that DCF already has a specialized unit to help with redeterminations while the agencies work on operational changes. The committee discussed the practical impact on families who struggle with annual eligibility renewals and the need for clearer communication and faster follow-up from the agency. Finally, AHCA presented on the home health aide program for medically fragile children and related Medicaid eligibility changes. The agency described the 2023 law that created a family caregiver provider type and the 2025 changes that increased the hourly rate, expanded hours, reduced training requirements, and removed caregiver earnings from Medicaid eligibility calculations, subject to federal approval. AHCA said it had completed state public comment, submitted the waiver amendment to CMS, and was awaiting federal action. Members raised concerns that some families may have enrolled or begun work before the eligibility fix was in place and may have lost benefits, especially in Broward County. AHCA said it would work with affected families and plans, review outreach through DCF and the health plans, and continue rulemaking, system updates, and provider training. The meeting ended with the chair noting that the committee had received the updates and adjourned without objection.

Transcript Highlights:

• multiple requests to to CMS. multiple requests to to CMS.
• Um, that one is pending CMS review.
• Um, that one is pending CMS review.
• CMS approved and we've hospital.
• Um, in Some of it is CMS, though.

Keywords: 1187, senate, all

Transcript Highlights:

• CMS came back and clarified Arkansas can determine what is rural.
• So this is a CMS-funded project.
• So this is a CMS-funded project.
• Yes, that's prohibited by CMS.
• Does CMS allow that? How do you see that really working in this process?

Summary: The committee heard extensive public testimony from youth advocates and public health speakers urging action on vaping. Witnesses said flavored products and social media are driving youth use in Arkansas, described nicotine addiction and health harms, and asked lawmakers to prohibit vaping in public indoor spaces, align vape rules with smoke-free laws, and expand prevention efforts. Committee members thanked the speakers and encouraged them to continue building support for future legislation. The main presentation was an overview of Arkansas’s Rural Health Transformation Program, a five-year federal initiative funded through CMS. State officials said Arkansas received about $209 million for the first year and may receive roughly $1 billion over five years if performance is strong. They emphasized that the program is intended for targeted, locally driven transformation rather than general operating support, debt relief, or new construction, and outlined four initiatives: Heart, PACT, Rise, and Thrive, focused on prevention, access and coordination, workforce development, and technology. Officials said applications would open in the spring, with a reimbursement-based process and a goal of launching all four initiatives by June. Members asked detailed questions about eligibility, rural definitions, school gardens, faith-based and nonprofit partnerships, mobile clinics, EMS, behavioral health, residency slots, and whether urban providers serving rural patients could apply. Officials said the program would favor regional collaboration, could support targeted renovations and expansion of existing programs, and would allow residency growth and some equipment or infrastructure purchases, but not food purchases or permanent new construction. They also said a committee of state health and finance officials would review applications, with heavy technical assistance and an expectation of quick turnaround. The committee also reviewed two DHS/Health Department rules. One implemented Medicaid and CHIP coverage and care coordination for eligible incarcerated youth before and after release, including targeted case management and screening services, with no public comments received. The other updated audiology licensing rules to reflect recent acts expanding scope of practice and changing the renewal deadline. Both rules were reviewed without objection, and the committee adjourned.

Transcript Highlights:

• Our goal is to get approved and then after that, CMS will determine how much money we get.
• , the way that CMS is going to<00:04:44.800> administer<00:04:45.280> this,<00:04:45.520
• will determine how much after that, CMS will determine how much money<00:04:57.040> we<00:04:
• Additionally, in HR1, the bill that created this, they specifically said that CMS determinations were
• the uh the leadership over this CMS the uh the leadership over this CMS initiative,<00:09:21.120

Keywords: 958, all

Summary: The Medicaid Oversight and Advisory Board met on November 12, 2025, approved the October 22 minutes, and heard an update from Cabinet for Health and Family Services Secretary Steven Stack and Public Health Commissioner John Langfeld on Kentucky’s application for the federal rural health transformation grant. The presenters described the grant as a $50 billion, five-year program with annual CMS scoring and rescorings, no state appeal rights, and a December 31 deadline for CMS to announce awards. They said Kentucky submitted its application on November 3 and had gathered stakeholder comments earlier in the process. The testimony emphasized that the grant is intended to support new models of rural care rather than replace existing funding or pay for clinical services or lost hospital revenue. Officials said the state had to address at least three of five federal strategic goals, including prevention and chronic disease, sustainable access, workforce development, and care/technology innovation. They also reviewed restrictions such as no new building construction, no payment for monthly broadband costs, and a cap of 5% for electronic medical record-related spending. The presenters said CMS has been clear that funding should focus on innovation in care delivery, rural access, and related policy goals, and that the state’s award could vary year to year based on performance milestones. The meeting was interrupted by a building fire alarm and evacuation announcement before the presentation was completed.

Transcript Highlights:

• and I'll just quote from one of those documents: Supplemental payments are expressly prohibited by CMS
• and I'll just quote from one of those documents: Supplemental payments are expressly prohibited by CMS
• under managed care prohibited by CMS under managed care medical<00:12:40.240> s<00:12:40.639>
• been doing it for some time with the CMS been doing it for some time with the CMS waivers. waivers
• typically a fiveyear window and and CMS typically a fiveyear window and and CMS with<00:13:38.480

Keywords: 928, house, all

Summary: The Committee to Study Long-Term Managed Care approved the prior meeting minutes as amended after correcting the first paragraph. The chair then outlined the committee’s plan to produce a preliminary report by October 1, with additional meetings to follow, since some questions remain about the federal One Big Beautiful Bill (OB3) and its effects on Medicaid financing and managed care. The main discussion focused on New Hampshire nursing home funding and how ProShare and MQUIP work. Members reviewed Medicaid rates, supplemental payments, intergovernmental transfers, and the role of federal matching funds. The chair and Mr. Litman concluded that OB3’s phase-down of payments above the Medicare rate likely would not directly eliminate ProShare or MQUIP in New Hampshire, but uncertainty remains about intergovernmental transfers and about how these payments would function if the state moved nursing facilities into managed care. Mr. Litman said managed care would likely require waivers for supplemental payments, and Texas was cited as an example of a state operating under such waivers. The committee also discussed dual eligibles, DNIP, PACE, and the possibility of carving out HCBS from nursing facility services. DHS said its managed care contract would allow the state to use MCOs for DNIP, with the goal of better coordination between Medicaid and Medicare, while PACE would likely require more study and might be more feasible in populated counties. Members also reviewed OB3’s new presumptive eligibility provisions and a state waiver request modeled on Washington’s approach, plus a separate grant for transitioning people from facilities back to the community. The rural health transformation fund was discussed as a possible source for workforce, telehealth, mobile integrated health, and other support investments, but not for direct construction or major building renovation. County representatives emphasized that any county role in PACE or DNIP would require significant vetting, infrastructure, capital investment, and a realistic timeline. The meeting ended with the chair saying the draft report would outline issues and possible alternatives, but not recommendations yet, and the committee adjourned without taking further action.

Transcript Highlights:

• so that was just this week that CMS so that was just this week that CMS approved<00:10:06.720>
• appreciate what Meredith did getting CMS appreciate what Meredith did getting CMS waiver.<00:10:
• you get very much for getting CMS you get very much for getting CMS approval<00:15:32.720> for
• we we require we're required to get CMS we we require we're required to get CMS approval<00:16:03.520
• Um CMS is is is these beneficiaries are.

Keywords: 912, senate, all

Summary: The Health and Human Services committee hearing opened with notice that the meeting was being streamed and could reconvene later if technical problems forced an abrupt end. The chair also announced a one-minute testimony limit and proceeded through several bills, taking mostly written and oral support testimony and asking limited questions. No votes were taken in the portion provided. HB 1626, relating to youth penalties, drew strong support from the Office of Hawaiian Affairs, youth advocates, the ACLU, the Department of Education, and others. Testifiers said financial sanctions on youth are ineffective, disproportionately burden Native Hawaiian youth, and function as poverty penalties; they urged replacing fines with community service, restorative practices, and ʻāina-based programs, and eliminating uncollectible legacy debt. The chair moved on after no member questions. HB 1643, relating to pharmacy, was discussed with support from the Hawaii Pharmacists Association, Kaiser, the Board of Pharmacy, independent pharmacies, and PBM representatives. Testimony focused on amendment language, audit procedures, HIPAA concerns, and the need for flexibility for small island pharmacies. HB 1668, relating to Medicaid, received broad support from disability advocates and the Department of Human Services; witnesses said CMS had already approved the underlying state plan amendment removing income and asset limits for certain workers with disabilities, but they wanted the protection codified in law to preserve it long term. The chair asked whether codification was necessary and was told it would not be harmful and would help ensure continuity if federal policy changed. The committee then heard HB 1550 on drug paraphernalia and syringe access, with support from Shipta and the Department of Health; testimony emphasized preserving flexibility for the statewide syringe access program to respond to emerging drugs like xylazine. HB 1974, relating to health, was presented as a planning measure for hearing loss; testifiers said Hawaii lacks a comprehensive hearing-loss plan and that the bill would fund a state planning process, not direct services. HB 1858 on vital statistics drew support from clinicians and medical organizations, who said better data on spontaneous fetal deaths is needed and that the term used in the bill is standard medical and CDC terminology. HB 1871 and HB 1966 also received support, with HB 1966’s EMS special fund prompting discussion about the cigarette-tax revenue source; the chair questioned the nexus to EMS, and the Department of Health said the revenue currently funds the special fund and there is no alternative funding stream.

Transcript Highlights:

• So that's the field slots. to ask CMS for the authority to add. um to ask CMS for the authority to add
• CM to CMS that but we have to ensure CM to CMS that they<00:54:40.720> have<00:54:40.800>
• So there we have CMS would approve.
• funds, our ARPA funds, and CMS funds, our ARPA funds, and CMS essentially<01:14:44.320> had
• >> Yeah, the process has been approved by CMS. The whole process is approved by CMS in the waiver.

Keywords: 958, all

Summary: The Medicaid Oversight Advisory Board’s fourth meeting focused primarily on a presentation from University of Kentucky and University of Louisville health leaders about the state university directed payment program. Mark Birdwhistle and Ken Marshall described the program as a long-running, value-based Medicaid arrangement that began in 2019, uses university-provided matching funds rather than provider taxes, and ties a portion of payments to quality outcomes. They said the program has improved measures such as tobacco cessation, diabetes control, depression screening, and cancer screening, while supporting access to specialty care, medical education, and workforce training. They also emphasized that Kentucky’s model is nationally notable and has helped improve health rankings and generate cost savings. A major topic was the federal reconciliation bill signed July 4, which the presenters said will reduce directed payments by 10% annually for 10 years beginning in 2028. UL Health estimated a first-year loss of about $75 million and a cumulative loss of about $600 million over the decade; UK estimated about $100 million in the first year, for a combined first-year impact of roughly $175 million. Both speakers warned the cuts could affect access to care, training capacity, and the sustainability of Kentucky’s value-based model, though they expressed hope that congressional action could alter or delay the changes. They also noted that 340B drug pricing changes could further strain already thin operating margins, but did not provide exact figures during the meeting. Committee members responded positively to the program’s reported outcomes and the institutions’ role in Kentucky health care. Senator Berg praised the quality of care and shared a personal example of being advised to stay at UofL for breast cancer treatment. Representative Moer highlighted Kentucky’s strong cancer-control score and asked for more explanation of the value-based payment structure; the presenters said the system is built around ongoing measurement, accountability, and collaboration with the Cabinet for Health and Family Services. No votes or formal actions were taken beyond approving the amended August 27 minutes by voice vote.

Transcript Highlights:

• We cannot pay the providers directly under the CMS rules. Okay.
• What did the CMS proposal read when it came to TIP 2.0?
• What did the CMS proposal read when it came to TIP 2.0?
• And I understand you have some... ...submitted to CMS related to TIP 2.0.
• How has Access engaged with CMS since the report was published?

Keywords: 1182, all

Summary: The Committee on Health and Human Services held another oversight hearing on Access, focusing on fee-for-service behavioral health management, prior authorization and claims processing, the Targeted Investment Program (TIP), and network adequacy. The chair and other members criticized Access for repeated transparency failures, including missing records related to the Covered Behavioral Health Services Guide, lack of public comment, unanswered questions about ARPA compliance, and concerns about ghost networks and delayed payments to providers, especially in Native communities and rural areas. Interim Director Roberta Harrison said Access had improved fraud controls after the sober living scheme crisis and acknowledged the need for modernization. She reported faster prior authorization processing, fewer denial codes, real-time dashboards, additional staffing, and claims processing under 30 days. She also said the agency wants more fraud referrals and is working to strengthen internal systems and communication. On the TIP program, Access officials explained that payments are delayed because of complex data validation and allocation across many provider sites; they said year one of TIP 2.0 was paid, but years two and three had not yet been distributed. The committee requested a formal plan within 30 days for paying the estimated $122 million in delayed TIP funds and asked for CMS-related documentation. Committee members also questioned Access about a direct contract with Constellation for claims processing, noting language in the proposal suggesting higher ROI from denying more claims; Access said that language was not part of the contract scope and was verbally rejected. On network adequacy, officials described time-and-distance standards, annual MCO reports, and internal review processes, but could not immediately confirm whether a fiscal year 2025 report had been submitted to CMS or whether any corrective action plans had been imposed. The chair concluded that Access’s improvements appeared to be driven by legislative pressure, said the committee would review the information received, and announced that Access would be sent detailed monthly reporting directions before the hearing adjourned.

Transcript Highlights:

• and when we get the approval from CMS. and when we get the approval from CMS.
• things verbally in conversation with CMS things verbally in conversation with CMS in<00:47:48.600
• That is still under appeal within the administrative process within CMS, and CMS is now building their
• I think largely the things that CMS I think largely the things that CMS cited<01:10:51.640> in
• understanding of conversations with CMS understanding of conversations with CMS of<01:13:00.320>

Bills: HF3526, HF3375, HF3469

Keywords: home care, licensing, fines, advisory council, grant program, client safety, healthcare regulation, HF3375, Minnesota disability waiver, waiver rate system, human services, individualized home supports, individualized home supports with training, individualized home supports with family training, positive support services, employment support services, employment development services, employment exploration services, billing limits, service authorization year

Transcript Highlights:

• That was submitted as a SPA and approved by CMS.
• We did submit that to CMS.
• That was submitted as a SPA and approved by CMS.
• We did submit that to CMS.
• And I guess through CMS is really the question.

Summary: The Arkansas Administrative Rules Subcommittee met to review a large set of agency rules and reports. Early items were routine filings: emergency-rule reports, subcommittee review reports, and administrative directive reports were filed without objection. One rule from the Department of Agriculture on maternal health providers and remote monitoring was noted as pulled by the agency and not considered. The committee then reviewed and approved several Agriculture rules, including repeal of equine ID-chip rules after Act 703 of 2025, updates to finance rules adding a new water and sewer treatment facilities grant and consolidating revolving-fund rules, and a pesticide rule creating a Class J pesticide category for feral hog toxicant use. It also approved a Commerce/Insurance rule removing duplicative workers’ compensation plan provisions, and a Corrections rule creating a unified visitation rule for correctional facilities and community correction centers. A member asked about prison visitation hours during COVID, and staff said they would check on that. The committee next approved multiple Department of Human Services rules. These included marketing rules for provider-led organizations under Act 301 of 2025, a comprehensive revision of the DCFS policy manual, changes to Medicaid eligibility to include fictive kin placements and to expand ABLE account eligibility under Act 875, presumptive eligibility changes for pregnant women to align with federal rules, and a follow-up SNAP/TEA/Work Pays rule with updated work requirements, mandatory employment and training, alien eligibility changes, and job-search requirements for certain applicants. DHS also presented a rule implementing federal coverage for certain incarcerated youth before and after release, and the committee approved it. Another DHS rule updated nurse aide training requirements to match federal CNA hour standards and moved criminal-records-check procedures to the agency website. The most extended discussion involved DHS Division of Medical Services’ dental rate rule under Act 1025. The agency explained that it was increasing pediatric dental rates and certain oral-surgery-related rates, but not orthodontic rates or a broader special-needs benefit limit because CMS would not approve a diagnosis-based limit. Members debated whether the statutory language was intended to cover general dentists performing oral surgery procedures, with legislators, the Dental Association, and DHS discussing legislative intent, fiscal impact, and whether a future fix or emergency rule might be needed. Despite the disagreement, the committee approved the rule. The committee also approved other DHS medical rules: adverse-decision appeal changes and prior-authorization posting requirements, an increased RSV administration fee for children, expanded emergency treat/triage/transport ambulance authority, and clinic-based physical and occupational therapy coverage. Later, the committee approved permanent rules for the new state insurance program under Shared Administrative Services, procurement rule revisions recommended after an ACASO review, and commodity-management rule updates including a new revenue distribution model. Under Act 595 of 2021, the committee granted two Department of Commerce/Insurance requests to be excluded from rulemaking requirements: one for Act 772 on forced organ harvesting, and one for restorative reproductive medicine, with the department saying it would promulgate rules later when clinical guidelines are available. Finally, the committee accepted a recommendation to keep and extend the Department of Education, Division of Career and Technical Education rules, filed outstanding rulemaking updates, and adjourned without further business.