Transcript Highlights:

• At this time, please present PCB HCB 25-01. Thank you very much, Chair.
• Members, PCB-HCB-25-01 is a conforming bill for health care, which provides the following.

Summary: The Health Care Budget Subcommittee began with a roll call confirming a quorum, then heard a presentation of the proposed health care budget. The chair said the overall health care budget would total $46.7 billion, a 2.1% decrease in total spending and a 3% increase in general revenue, while reducing 3,585 state FTE. He highlighted funding for Medicaid, KidCare, developmental disabilities services, opioid settlement spending, mental health facilities, senior services, school health nurses, veterans’ dental care, and veterans nursing home improvements. The chair also presented PCB HCB 25-01, a conforming bill that eliminates the Health Care Innovation Program, the Health Care Innovation Council, and the revolving loan program; makes changes to cancer research and graduate medical education provisions; and adjusts Medicaid rebate-related language. The conforming bill passed favorably after no questions, public testimony, or debate. The committee then considered CS/HB 47 on child care. The bill, as explained by Rep. McFarland, would reduce regulation for child care providers in good standing, speed background screening for child care workers, allow provisional hiring status in some cases, create license-exempt status for certain employer-provided child care facilities and DOD child care facilities, and remove outdated paperwork requirements such as the flu brochure. An amendment restored language protecting large family child care homes from being dropped by residential insurers and cleaned up statutory language; it was adopted. Members debated the bill at length, with supporters emphasizing common-sense deregulation and helping working parents, while some members raised concerns about safety, early learning quality, and the loss of informational reminders to parents. The bill was reported favorably. The subcommittee also heard HB 1553 on a uterine fibroid research database. Rep. Dunkley explained that the bill would require health care providers to submit identified fibroid data to DOH so it can be de-identified for a research database, after the department had been unable to use prior de-identified submissions reliably. An amendment removed the current appropriation and was adopted. Members spoke in strong support, noting the prevalence of fibroids and the value of better diagnosis and treatment data. The bill passed favorably. Finally, the committee heard HB 1529, which addresses the home health aide program for medically fragile children. Rep. Tremont said the bill would direct AHCA to seek a federal waiver so parents’ earnings from caring for their children would not count against Medicaid eligibility, and would revise training requirements and remove mandated annual program assessments. The bill drew supportive public testimony from home care stakeholders, had no debate, and was reported favorably. The meeting then adjourned.

Transcript Highlights:

• relationships are critical to evaluating the effectiveness of overall service delivery, including HCBS
• relationships are critical to evaluating the effectiveness of overall service delivery, including HCBS
• Every state in the country already uses remote service delivery in some way through their HCBS programs
• That includes the HCBS final rule, the electronic visit verification for those that it applies to, and
• And of the 17% that haven't met, I think 100% of them have met the HCBS rules. Correct.

Keywords: 987, senate, all

Summary: The subcommittee heard an overview of the governor’s IHSS budget proposals and then took public testimony from the administration, LAO, county representatives, labor, consumer advocates, and an aging/disability advocacy group. The administration described IHSS as a large Medi-Cal long-term services program serving more than 900,000 recipients and proposed three changes: shifting some growth costs tied to authorized hours per case to counties, eliminating the statewide backup provider system, and aligning IHSS terminations with Medi-Cal terminations. The administration also discussed the earlier CFCO reassessment penalty change for counties and said overdue reassessments had dropped significantly. LAO said the governor’s overall IHSS cost estimates appeared reasonable, but raised concerns about the hours-per-case cost shift, including unclear root causes for growth, limited county control over statewide averages, and uncertainty about the eventual savings. County Welfare Directors Association, SEIU, and consumer/advocacy witnesses opposed the hours cost shift, arguing counties use state tools, the proposal would pressure counties to cut services, and it could harm older adults and people with disabilities by increasing institutionalization and shifting costs elsewhere. The chair and members repeatedly questioned the rationale for the proposal, the lack of a defined baseline, and whether the current assessment tools or MOE structure should instead be revisited. On the backup provider system, the administration said the program is underused and costly to administer relative to service spending, while LAO suggested the Legislature consider whether administrative costs could be reduced instead of eliminating it. County, labor, and consumer witnesses opposed the cut, saying the system is a critical emergency safety net even if utilization is low, especially for rural areas and people with complex needs. Members also asked about data quality, county backup systems, and whether consumers know the program exists. On the Medi-Cal/IHSS alignment proposal, the administration said automation would stop General Fund-only spending when recipients lose Medi-Cal and restore IHSS automatically when Medi-Cal is regained; LAO and others noted the proposal had been rejected before and urged better notices and safeguards. Witnesses warned that automatic termination could create gaps in care and unpaid work for providers, while the department said counties already manually terminate in some cases and that automation is ready if approved. No votes were taken in the excerpt, and the chair indicated the committee would continue with public comment and later items before a hard adjournment time.

Transcript Highlights:

• These are two HCBS waiver services and the PACE program, Program for All-Inclusive Care for the Elderly
• These are two HCBS Waiver Services and the PACE program, program for all-inclusive care for the elderly

Summary: The committee approved the December 8 minutes and referred items C1 and C2 to the labor and environment subcommittees, adopting the chair’s recommendations. The main substantive item was a DHS rule package revising the State Plan Personal Care Manual and the Arkansas Independent Assessment (ARIA) Manual. DHS said the revisions would repeal and replace the current manuals with streamlined versions, remove overlapping language, implement Act 853 by shifting licensure/certification for personal care agencies to the Department of Health, lengthen personal care prior authorizations from six months to one year, and keep the 64-hour monthly cap. For ARIA, DHS said it would remove references to state plan personal care, clarify telehealth and in-person assessments, and add/update sections for PASS, AR Choices, Living Choices, and PACE. DHS argued the current independent assessment process is costly and not controlling utilization, citing a 95% approval rate, annual spending of more than $212 million on personal care for about 17,000 people, and an estimated $6.173 million in savings from eliminating the Optum assessment and reducing prior-authorization frequency. Agency witnesses said the new process would reinsert primary care practitioner involvement, use standardized evaluation and prescription forms, and rely on personal care provider nurses for the assessment step, with training already available through an AFMC contract. Several members questioned whether PCPs should be used as gatekeepers, whether the change would delay services, and whether the savings estimate accounted for training or provider burden. Some members also raised concerns about conflicts of interest, the workload on physicians, and whether the agency had adequately worked with the existing vendor to improve the current system. The discussion became contentious, with Senator Irvin and others strongly opposing the proposal as inconsistent with the earlier independent-assessment approach and urging DHS to slow down and work with legislators. Other members asked for clarification on how the new process would work for new applicants and whether it would affect waiver or PASS participants; DHS said the rule would not apply to PASS and should not delay services. At the end of the hearing, the chair offered DHS the option to pull the rule down and work off-record with legislators on a revised proposal, and DHS agreed. The meeting then adjourned without further business or a final vote on the rule.

Transcript Highlights:

• let's say just supporting access and quality of care, working with our long-term care partners and our HCBS
• let's say just supporting access and quality of care, working with our long-term care partners and our HCBS

Summary: The Arkansas Alzheimer’s Disease and Dementia Advisory Council met to introduce members, adopt its rules and procedures, approve prior minutes, and authorize the co-chairs to approve special expenses. The main discussion focused on updating the Arkansas State Plan for Alzheimer’s disease and dementia, with David Cook of the Alzheimer’s Association outlining major changes in prevalence, caregiving burden, diagnostics, and treatment since the prior plan. He noted rising disease and caregiver numbers in Arkansas, the expansion of amyloid PET access, the growing use of blood-based biomarkers, and the availability of FDA-approved treatments such as Leqembi and Kisunla, while emphasizing that access, insurance coverage, and provider education remain major barriers. Members and presenters also discussed the need to better reach rural primary care providers, who may not be aware of new diagnostics and therapies, and the bottlenecks caused by limited specialists and infusion capacity. There was concern about overreliance on blood tests without confirmatory evaluation, and several members stressed the importance of collaboration, public education, and promoting brain health through exercise and diet. The council also heard about existing programs such as the dementia services coordinator, the BOLD grant, caregiver respite grants, workforce training, and a pilot dementia resource center with UAMS Centers on Aging. The council approved a new four-part outline for the next state plan: advancing risk reduction and brain health/early detection, strengthening family caregiver support, improving access to diagnostics and treatment, and supporting access and quality of care, including workforce and crisis response. Members also agreed to consider future agenda items on new treatments, brain health and lifestyle prevention, workforce training, and possible legislative changes to the enabling statute. The meeting ended with discussion of scheduling the next meeting, tentatively set for August 12 in Hot Springs, and adjournment.

Transcript Highlights:

• The bill requires AHCCCS to convene a stakeholder work group to solicit input and to provide HCBS comparable
• The bill allows HCBS to be delivered in any authorized residential setting for eligible individuals,
• and allows Access to adopt enhanced reimbursement rates for high-acuity SMI individuals receiving HCBS
• Chair, the six-page Angus Amendment dated February 20, 2026, at 1:58 p.m. modifies the HCBS for SMI program
• requires Access to continue pursuing approval if CMS denies or does not approve the implementation of the HCBS

Bills: SB1041, SB1050, SB1131, SB1138, SB1249, SB1267, SB1272, SB1317, SB1461, SB1488, SB1504, SB1517, SB1523, SB1580, SB1582, SB1584, SB1585, SB1602, SB1630, SB1654, SB1672, SB1673, SB1718, SB1761, SB1819, SB1826, SB1827

Keywords: electronic monitoring, nursing care, assisted living, resident rights, privacy, consent, surveillance, veterans, lifetime pass, state parks, Arizona, access, disabled veterans, cardiac arrest, defibrillators, school safety, emergency response, CPR training, Arizona education funding, automated license plate readers

Summary: The committee first considered Senate Bill 1630, which would direct AHCCCS to seek federal approval for a home- and community-based services program for adults determined to be seriously mentally ill, with quarterly implementation updates, stakeholder input, and a cap on enrollment. The sponsor and advocates from Arizona Mad Moms argued the bill would create an assisted-living-style Medicaid option for the most disabled SMI individuals, improve continuity of care, and reduce state general fund costs by shifting some expenses to federal Medicaid funding. Access testified neutral, estimating a total fiscal impact of $27.7 million, including $5.83 million general fund, and explained the need for CMS approval. The committee adopted an amendment reducing the initial cap to 250 members, changing reporting frequency, and adjusting eligibility and expansion conditions, then passed SB 1630 as amended on a 10-0 vote. The committee next heard Senate Bill 1131, which originally required school districts and charter schools to adopt cardiac emergency response plans and appropriated $1 million for implementation. An amendment replaced the mandate with a reporting requirement on AED counts, CPR/AED-trained staff, and whether schools have a plan, while keeping a grant component for AEDs and prioritizing rural schools. The American Heart Association supported the amended approach as a way to gather baseline data and target resources, and members discussed AED training, school preparedness, and whether the funding should favor rural or high-population schools. The committee adopted the amendment and passed SB 1131 as amended on a 9-1 vote, with Senator Kuby voting no and several members explaining concerns about funding and priorities. The committee then took up Senate Bill 1582, which concerned the school safety interoperability fund. An amendment shifted the appropriation from the Department of Education to the Department of Administration and allocated funds to specific county sheriff offices for continuing operation and maintenance of existing interoperability systems, while narrowing the program to public safety agencies and school districts and requiring twice-yearly testing. Sheriffs, a county school superintendent, and the Arizona Sheriffs Association described the systems as useful for drills and real emergencies, improving communication between schools and first responders; one speaker noted the program had been used in drills and at least one live deployment. Some members questioned the audit findings, the focus on rural counties, and whether the program was a good use of funds, while supporters emphasized its value for school safety. The committee adopted the amendment and passed SB 1582 as amended on a 6-4 vote. Finally, the committee began hearing Senate Bill 1504, which would change retirement rules for Tier 2 and Tier 3 public safety personnel by allowing earlier normal retirement and shortening the COLA waiting period, with an amendment exempting the changes from the statutory pre-funding requirement. Supporters from firefighter and police groups said the bill would improve recruitment and retention and let employees receive earned benefits sooner, while city, county, and taxpayer representatives warned it would add substantial unfunded liabilities and undermine the 2016 pension reforms. Actuarial testimony estimated significant costs, including tens of millions in annual or upfront impacts depending on how the change is funded, and members debated whether the amendment would shift costs onto future taxpayers or simply spread them over time. The transcript ends during continued testimony and discussion on SB 1504, before a final vote is reached.

Transcript Highlights:

• A couple key provisions of the rule include public payment reporting for HCBS.
• A couple key provisions of the rule include public payment reporting for HCBS, establishing an interested
• advocates, and implementing an electronic critical incident management system and a grievance system for HCBS

Summary: The committee first received an update on the effects of HR1 and related federal Medicaid and marketplace changes from Governor’s Office and Health Care Authority staff. Presenters said the most immediate coverage losses are expected in the individual market beginning in January, with premium increases and an estimated 80,000 people potentially unable to afford coverage. They warned that larger Medicaid impacts will follow over the next year and beyond, including tighter eligibility checks, work requirements, reduced retroactive coverage, limits on state-directed payments and provider taxes, new cost-sharing, and changes affecting certain non-citizen adults. They also said the state plans to seek a waiver or extension for work requirements and will continue to analyze impacts, including on rural providers and Planned Parenthood-related services. Members asked about the effect on nursing homes, rural hospitals, and how the state can help providers and enrollees navigate the new requirements; staff said timelines and a state-specific implementation chart are being developed. The committee then heard a report on the International Medical Graduate Work Group and Washington’s efforts to create pathways for internationally trained physicians. Testimony described the clinical experience license, the clinical evaluation assessment tool, grant funding for IMG support organizations, and a new hardship waiver process enacted this year. National presenters said many states have adopted similar pathways because of physician shortages, but Washington and Tennessee are among the few states that have actually issued licenses so far. They recommended clear guardrails, an employment offer before application, ECFMG certification, supervised practice, and data collection to avoid exploitation and protect patients. Members asked about state-to-state variation, retention of IMGs, and whether Washington should pursue dedicated residency or preceptorship options; presenters said the key next step is moving successful participants from supervised experience to a durable long-term license. The final topic was implementation of Washington’s Apple Health doula benefit and the statewide doula hub and referral system. Senator T’wina Nobles highlighted the state’s $3,500 per-birth Medicaid reimbursement rate for doulas and the importance of the hub for referrals, training, and billing. Health Care Authority staff said the benefit launched January 1, 2025, and covers prenatal intake, labor and delivery, postpartum visits, and telehealth-supported services. They reported 336 state-certified doulas, 134 enrolled in Apple Health, 287 unique clients served, and 641 claims paid so far. Testimony emphasized doulas’ role in improving birth outcomes, reducing unnecessary interventions, and addressing racial disparities in maternal health, while noting that implementation is still early and ongoing.

Bills: HF4438, HF4467, HF4379, SF3402, HF4349, HF4064, HF84, HF85, HF3804

Keywords: healthcare, WIC, community health, licensing, speech-language pathology, audiology, contract term limits, healthcare services, provider enrollment, disenrollment, premium payments, medical assistance, substance use disorders, mental health, children's mental health, early childhood, early intervention, consultation grants, Head Start, child care

Bills: HF2115, HF2276, HF1644, HF99, HF2068, HF2707, HF2704, HF2406, HF1674, HF1579

Keywords: human services, aging services, disability services, behavioral health, long-term care, nursing home, nursing facility, assisted living, waiver services, medical assistance, Medicaid, case mix reimbursement, PDPM, RUG, direct care and treatment, developmental disabilities, day services, positive support, guardian, conservator

Bills: HF2115, HF2276, HF1644, HF99, HF2068, HF2707, HF2704, HF2406, HF1674, HF1579

Keywords: human services, aging services, disability services, behavioral health, long-term care, nursing home, nursing facility, assisted living, waiver services, medical assistance, Medicaid, case mix reimbursement, PDPM, RUG, direct care and treatment, developmental disabilities, day services, positive support, guardian, conservator

Bills: HF2367, HF2319, HF2523, HF1742, HF671, HF2331, HF2722, HF2406, HF1674

Keywords: HF2367, Community First Services and Supports, CFSS, personal care assistance, PCA, consumer-directed community supports, CDCS, home and community-based services, HCBS, direct support professionals, direct care workers, caregivers, support workers, SEIU Healthcare Minnesota & Iowa, collective bargaining agreement, retention stipend, health care cost stipend, training stipend, orientation program, retirement trust

Transcript Highlights:

• Um, and then we've had a few other moratoriums and uh an HCBS licensing moratorium that was implemented
• <00:10:26.000> licensing moratoriums and uh an HCBS licensing moratoriums and uh an HCBS licensing
• It was established under<01:09:08.640> a<01:09:09.040> um<01:09:09.359> HCBS,<01
• a<01:09:10.480> home<01:09:10.640> and<01:09:10.799> community under a um HCBS
• , a home and community under a um HCBS, a home and community based<01:09:11.359> services<01:09

Keywords: 1183, house

Transcript Highlights:

• staffing-related items for the Steps for Success program and some other program integrity pieces for HCBS
• :29:01.120> for other uh program integrity pieces for other uh program integrity pieces for HCBS
• <00:29:03.440> Um HCBS providers. Um HCBS providers.
• So this is a MDH governor's proposal to reduce the HCBS employee scholarship grants and loan forgiveness

Keywords: 1187, senate, all

Transcript Highlights:

• did recommend 500 new slots for Michelle P starting in '27, 250 in CL, and 500 new waiver slots in HCBS
• did recommend 500 new slots for Michelle P starting in '27, 250 in CL, and 500 new waiver slots in HCBS
• did recommend 500 new slots for Michelle P starting in '27, 250 in CL, and 500 new waiver slots in HCBS
• did recommend 500 new slots for Michelle P starting in '27, 250 in CL, and 500 new waiver slots in HCBS
• did recommend 500 new slots for Michelle P starting in '27, 250 in CL, and 500 new waiver slots in HCBS

Keywords: Meeting Start 00:00:00 Attendance Roll Call 00:00:36 Department for Medicaid Services 00:01:44, 958, all

Summary: The House Budget Review Subcommittee on Health and Family Services met for an overview of the Department for Medicaid Services budget. Commissioner Lisa Lee and CFO Steve Beal described Kentucky Medicaid enrollment at about 1.4 million members, including more than 600,000 children, and said the agency’s 2025 total budget was $20.6 billion. They reviewed enrollment trends before, during, and after the COVID-19 public health emergency, noting that redeterminations begun in 2023 reduced enrollment from its peak but that total membership remains above pre-COVID levels. They also explained the difference between the fee-for-service population, which includes long-term care and waiver members, and managed care members, and gave examples of the kinds of services and diagnoses seen in each group. A major focus was the governor’s recommended Medicaid budget and the department’s forecast process. Lee said the budget is split into benefits and administration, with benefits covering fee-for-service services, managed care capitation, transportation, and Medicare premiums, while administration covers contracts, personnel, operating costs, and IT-related advanced planning documents. She said the department uses a consensus forecasting group and actuary input, and that its forecasts have been within 1% of actual spending in recent years. The department also said the governor’s budget includes new waiver slots to address waiting lists, a 2% staff COLA, and a 10% phase-down on state-directed payments beginning in January 2028. Much of the discussion centered on House Resolution 1 and the funding needed to implement its Medicaid-related provisions, including community engagement requirements, six-month redeterminations, and future cost sharing. Lee said the department requested about $35 million in total funds for fiscal 2027, including about $8.2 million in general funds for system changes to the integrated eligibility system, claims processing, notices, and monitoring; and about $11 million in fiscal 2028 for ongoing maintenance, with about $1.6 million in general funds. She said the department expects to seek federal APD matching funds for the IT work. In response to questions, she explained that community engagement would apply to Medicaid expansion members, with qualifying activities including work, school, volunteering, or equivalent income, and that certain groups such as pregnant women, children, caretaker relatives, and some people with chronic disease or substance use disorder would be excluded. She said the department identified roughly 70,000 expansion members who could be subject to the requirement. No votes or formal actions were taken.

Transcript Highlights:

• HCBS does have some value-based payments, and I think it started in 2020, in the last year, maybe.
• But there are value-based payments for HCBS, too. Is that question about value-based payments?

Keywords: 962, all

Summary: The Complex Care Committee meeting focused first on a new Diabetes Caucus launched at the Capitol. Rep. Johnson described the caucus as a forum to educate people about type 1 and type 2 diabetes, genetic risk, early testing, pregnancy-related diabetes, and ways Medicaid policy might improve prevention and lower long-term costs. Members agreed the caucus could intersect with care management, and Carolyn Grandell of CHNCT offered to share information about current diabetes-related care management services at a future meeting. The committee then heard a detailed presentation from Alex Rigger of the Office of Health Strategy, who is moving to the Office of Policy and Management. He reviewed Connecticut health care benchmark data, including total health care expenditures, medical spending, and market-by-market trends. He said 2023 to 2024 per-capita spending grew more than 8.5% statewide and 14% in Medicaid, with long-term care accounting for about 46% of Medicaid spending and retail pharmacy also identified as a major cost driver. Members asked about enrollment changes, dual-eligible populations, Medicare Savings Program members, 340B drug pricing, and value-based payment models. Rigger explained that his office tracks alternate payment models and quality benchmarks, but does not separately capture 340B data. Discussion then shifted to Medicare Advantage, dual eligibles, and hospital discharge planning. Members said they want better data on how many Medicaid members are in Medicare Advantage plans and whether those plans shift costs back to Medicaid or affect access to care, especially for complex-care patients. Staff noted DSS does have some Medicare Advantage indicators and that CMS is developing encounter-data rules for states. Kathy Holt and others raised concerns about denials, nursing home stays, and the need to compare Medicaid spending for dual eligibles in Medicare Advantage versus traditional Medicare. The meeting ended with plans for follow-up data sharing, including Alex Rigger’s slides, the diabetes caucus materials, and a future discussion with DSS and other agencies; no formal votes were taken.

Transcript Highlights:

• While the state considers long-term options to increase access to LTSS through things like the HCBS Roadmap
• Second, prioritize housing stability for low-income Medi-Cal beneficiaries receiving HCBS by standardizing
• And third, preserve coverage for Medi-Cal's HCBS, even in times of budgetary constraints that the state
• Research shows that cutting HCBS will lead to increased hospitalizations and institutionalization and

Summary: The joint Assembly Budget Subcommittee hearing focused first on long-term services and supports for older adults, especially the “forgotten/overlooked middle” who earn too much for Medi-Cal but cannot afford private long-term care. Administration witnesses from DHCS, the Department of Aging, and Social Services described Medicare’s limited long-term care coverage, Medi-Cal’s role, the elimination of the Medi-Cal asset test, and ongoing state studies and listening sessions on financing options. Testimony from advocates and researchers emphasized rising homelessness among older adults, the need for better navigation and coordination across health, aging, housing, and social service systems, and short-term policy steps such as share-of-cost reform, housing stability supports, and protecting home- and community-based services. Members highlighted the need for a coordinated, no-wrong-door approach and asked for the most impactful budget investments to address affordability and homelessness risk. The second major topic was the Community-Based Adult Services (CBAS) program. CDA reported that CBAS helps participants remain in the community, that 304 centers operate statewide serving about 42,000 people, and that demand is stable but access gaps remain in some regions. DHCS explained that a 2024 rate increase authorized by SB 159 became inoperative after Proposition 35, and that a separate 10% rate change on the fee schedule was the result of a DHCS system error; the department said it would not require recoupment, though managed care plans may act under their contracts. CBAS providers and advocates warned that reimbursement rates have not kept pace with costs, that several centers have closed, and that clawbacks could trigger more closures. They requested $74.8 million ongoing General Fund to close part of the rate gap and preserve the program, while members expressed concern about closures and the cost savings of keeping people out of more expensive institutional care. The hearing then moved to In-Home Supportive Services (IHSS) and statewide collective bargaining. CDSS reviewed provider recruitment and retention efforts, including electronic timesheets, direct deposit, and the now-completed IHSS Career Pathways program, which trained more than 59,000 providers. CDSS also summarized its AB 102 workgroup report on statewide versus regional bargaining, saying the final report would be sent to the Legislature soon and that statewide bargaining appeared more viable than regional bargaining, though it would require clear statutory scope and major fiscal changes. The department estimated that each $1 per hour statewide wage increase would cost at least $1.3 billion to $1.5 billion annually. Labor advocates argued that IHSS wages, benefits, and training are too inconsistent across counties and called for statewide bargaining, consumer participation, and ongoing state funding. County representatives supported stronger wages but cautioned that counties need protection from new costs and administrative burdens, and consumer advocates warned that moving bargaining to the state could weaken local consumer control and the program’s consumer-driven structure.

Transcript Highlights:

• transition to a location of their choice, whether that be another assisted living, back to another HCBS
• “Assisted living, back to another HCBS service, or to any other institution that is appropriate for their

Summary: The subcommittee met to review Department of Human Services hospital payments in Arkansas Medicaid, with DHS Secretary Janet Mann and Deputy Secretary Misty Eubanks presenting first, followed by Arkansas Hospital Association Executive Vice President Jody Ann Tritt and a brief comment from Arkansas Children’s. DHS outlined the main hospital payment streams: fee-for-service per diem payments, upper payment limit (UPL) supplemental payments, cost settlements, and smaller payments such as graduate medical education and disproportionate share hospital funds. Members asked for plain-language explanations of cost settlements, why per diem rates vary by hospital type, and why UPL applies to private hospitals. DHS said cost settlements and UPL are mechanisms to help offset Medicaid underpayment, with SFY 2025 hospital payments totaling hundreds of millions of dollars and no general revenue used for supplemental payments beyond the state share funded through hospital assessments and related financing structures. Committee members focused heavily on whether Arkansas hospitals are adequately reimbursed and why rural hospitals struggle. Tritt explained that critical access hospitals, rural emergency hospitals, PPS hospitals, and specialty hospitals operate under different federal and state rules, and said lower per diem rates for some facilities help with cash flow and later cost settlement adjustments. She said Arkansas hospitals are under financial strain, citing a negative patient services margin statewide and noting that Medicaid, Medicare, and commercial payers all contribute to the problem. She also said the association had just authorized a statewide survey of hospital finances and costs, which she expected would take about a year to complete. A major theme was commercial insurance reimbursement. Tritt argued Arkansas hospitals are paid far less than hospitals in neighboring states even though premiums are similar, and said administrative burdens, prior authorizations, and denials add to the problem. She said hospitals receive about 52 to 53 cents on the dollar for Medicaid costs without UPL and about 78 cents with UPL, still below cost. Members also discussed Medicare wage index issues, Medicare Advantage, and whether hospitals could use technology or alternative arrangements to improve finances. No votes were taken on the hospital presentation. At the end of the meeting, DHS provided a brief update on Living Choices and assisted living reimbursement. Officials said one assisted living facility, Pillars of the Community in Crossett, had announced closure, with nine waiver clients being transitioned to other settings. DHS said the current cost reporting period was underway and that a new rate study could be ready for review before the end of the fiscal year if reports were submitted on time. Members also asked about the broader waiver plan, and DHS said the next waiver iteration would likely be brought back to the committee in the summer.

Transcript Highlights:

• transition to a location of their choice, whether that be another assisted living, back to another HCBS
• transition to a location of their choice, whether that be another assisted living, back to another HCBS

Summary: The subcommittee met to review Arkansas DHS hospital spending and reimbursement methods, with Secretary Janet Mann and Deputy Secretary Misty Eubanks explaining Medicaid hospital payments. They described fee-for-service per diem payments, cost settlements, and the upper payment limit (UPL) program, noting that SFY 2025 hospital payments included $688 million in inpatient/outpatient claims, $473 million in UPL payments, $248 million in cost settlements, and about $47 million in other payments such as graduate medical education and disproportionate share hospital funds. Members asked about why per diem rates vary, how cost settlements work, why UPL applies mainly to private hospitals, and how assessment fees are structured and funded. DHS said the hospital assessment fee is broad-based and uniform, used as the state share to draw federal funds, and that supplemental hospital payments after federal match totaled $548 million with no general revenue used. The Arkansas Hospital Association’s Jody Ann Tritt then gave a broader overview of the hospital landscape, explaining the different hospital types in the state, including critical access hospitals, rural emergency hospitals, PPS hospitals, and specialty hospitals. She said Arkansas hospitals face financial strain, citing a negative 5.18% patient service margin statewide and lower reimbursement than surrounding states. She argued that Arkansas hospitals are paid less than hospitals in neighboring states for similar services, that commercial payer rates and administrative burdens are a major problem, and that Medicaid and Medicare rates remain below cost even with UPL support. She also said hospitals are the backbone of community care, provide emergency and public health functions, and are looking for ways to invest in technology and telehealth but often lack the revenue to do so. Members pressed for clearer data on hospital finances, reimbursement adequacy, and the impact of commercial insurers. Tritt said the association had just authorized a statewide survey to gather updated financial information from hospitals, which she said would take about a year to complete. She also explained that Medicaid pays weekly, Medicare and commercial plans can involve delays and denials, and that hospitals often spend significant resources on revenue cycle work. The discussion ended with a brief update on assisted living reimbursement: DHS said one facility, The Pillars of the Community in Crossett, had announced closure, nine Living Choices waiver clients were being transitioned, and the updated rate study would be available after cost reports are collected, likely before the end of the fiscal year. The meeting then adjourned.

Transcript Highlights:

• services not just for housing stabilization services, but they're interwoven through a whole number of HCBS
• They found the HCBS licenses. And they identified 22 at one single address, 20 at another address.

Transcript Highlights:

• budgeting, where we did not include the rate increase or the projected increase in utilization for HCBS
• That is that HCBS cost to continue line. Okay.

Keywords: 908, all

Summary: The Senate Appropriations HR Division met with all members present to review the medical services portion of the HHS budget. Sarah Aker, Executive Director of Medical Services, walked the committee through several budget items, including HCBS cost-to-continue adjustments, the DD bed assessment, expansion of value-based purchasing, targeted rate increases for home health and QSP services, and the cross-disability waiver. Members generally supported the targeted increases for home health and QSP, and Aker explained that the cross-disability waiver funding would support startup work, service design, and infrastructure ahead of a planned July 1, 2028 implementation. The committee spent significant time on rate-setting and provider payment issues. Members discussed ambulance rate rebasing, with several senators expressing concern that the proposed increase was too high relative to peer states; the committee ultimately moved toward reducing that item to $1 million rather than zero so it could be revisited in conference committee. They also discussed a House-added critical access hospital networking grant and similarly leaned toward reducing it to $1 million. Aker explained the department’s value-based purchasing plans, including use of a vendor selected through RFP, and clarified how the department’s existing Medicaid managed care and hospital value-based programs work. A major portion of the meeting focused on long-term care and basic care payments, including a House-added extension of the $5 per day basic care add-on and a proposed shift in nursing facility incentive grants toward a withhold-based model. Senator Mathern indicated he would bring an amendment to delay or modify the withhold change, and Aker said the department would prefer language that directly addresses whether a withhold may be implemented. Members also discussed 1915(i) services, FMAP changes, the Medicaid legacy system modernization carryover, and a House-added legislative intent section on medical assistance. The committee adjourned for the morning with plans to return later to continue Human Services budget work and revisit unresolved items in conference committee.

Transcript Highlights:

• The Medicaid HCB waiver is designed to keep that person out of the nursing home by providing personal
• And also the clarification and streamlining of HCBS and adult daycare waiver services to reduce duplication
• It's the HCB waiver primarily that covers adult day healthcare. >> There's no particular way it's under
• It's the HCB<00:39:43.119> waiver<00:39:44.000> primarily<00:39:44.640> that<00:
• 39:44.960> covers<00:39:45.359> adult HCB waiver primarily that covers adult HCB waiver

Keywords: 958, all

Summary: The Medicaid Oversight and Advisory Board reconvened and heard a presentation from the Attorney General’s Office Medicaid Fraud and Abuse Control unit. AG staff described the unit’s structure and work: it investigates and prosecutes Medicaid provider fraud, and also handles abuse, neglect, and exploitation cases involving vulnerable adults in facility settings when asked to assist. They said the office has prosecutors, detectives, auditors, and support staff, works with federal partners, Commonwealth’s attorneys, CHFS, DMS, OIG, and MCOs, and uses a hotline and referral line for complaints. They also explained the MCO referral process, including monthly meetings, stand-down lists, and review of referrals for a “credible allegation of fraud” before the AG office decides whether to open a criminal or civil investigation. The presentation focused heavily on current fraud trends. Staff said behavioral health is a major concern, along with participant-directed waiver services, medically assisted treatment, cash billing for services, controlled-substance billing, and vision and dental fraud. They gave examples such as duplicate time sheets for family caregivers, questionable Suboxone counseling and urine drug screening practices, and a prior optometry case involving false claims for children’s glasses. They also discussed CMS’s estimate that about 5% of Medicaid payments are improper, noted that most improper payments are at the fee-for-service level, and said there is no reliable overall fraud-rate estimate. They highlighted a sharp shift in behavioral health billing after the cabinet’s November 1, 2024 policy changes, saying individual psychotherapy spending dropped while group billing increased, suggesting providers may have moved billing to different codes. Members asked about the scale and timing of cases, how MCO referrals are screened, and whether the data reflected more people being served or just higher spending. The AG office said investigations can take years, with some federal cases still awaiting sentencing from 2018 and 2019 matters, and that they currently had nine individuals awaiting sentencing in federal court. They also reported 58 hotline reports during the referenced period, six cases opened from MCO referrals, and four additional MCO referrals not accepted for active cases. Several members raised concerns about home-based services and the risk of abuse or fraud when family members are reimbursed, and asked whether the process could be streamlined; the AG office said it had no immediate recommendations but would be willing to return with suggestions after further review.