Transcript Highlights:

• As recently as last week, I've had conversations with CMS about this.
• So it does seem like there's a backlog in the federal CMS approval process.
• So CMS is making progress on clearing the backlog on a lot of these state-directed payments that were
• submitted to CMS.
• Yes, there are current fiscal year state-directed payments for 2025-26 that we're working with CMS to

Keywords: 999, senate, all

Transcript Highlights:

• Many of those are also reflected in the corrective action plan that we've submitted to CMS.
• I should note that was at the direction of CMS. Also enhancing prepayment review processes.
• Many of those are also reflected in the corrective action plan that we've submitted to CMS.
• I should note that was at the direction of CMS. Also enhancing prepayment review processes.
• CMS allows the state, and the state gives the commissioner the authority to do that.

Bills: HF3378

Keywords: human services, Optum reports, data privacy, transparency, legislative oversight, 1183, house

Transcript Highlights:

• So given these communication from CMS.
• , communications and requirements of CMS, communications and requirements of CMS, other<00:21:13.200
• It was in meetings with CMS.
• um expressed from leadership of CMS um expressed from leadership of CMS about<00:36:57.520> that
• And CMS came to the table rectified."

Keywords: 1187, senate, all

Transcript Highlights:

• specker Adam chair representative so CMS specker Adam chair representative so CMS dollars<01:36:
• yes they do see patients and you get CMS yes they do see patients and you get CMS dollars<01:36:
• So yes, there is some CMS funding there, as you can see.
• So yes, there is some CMS funding there, as you can see.
• So yes, there is some CMS funding there, as you can see.

Keywords: 1183, house

Transcript Highlights:

• They can complain to CMS, the Centers for Medicare and Medicaid, and they can come in and do a review
• Um they can complain to um CMS,<00:44:01.520> the<00:44:01.680> Centers<00:44:02.000>
• > for<00:44:02.160> Medicare<00:44:02.560> and CMS, the Centers for Medicare and CMS
• They had little things that were already tweaked by the time that they received the notice from CMS.
• With that, you have notice from CMS.

Bills: SF0023, SF0057

Keywords: mental health, involuntary hospitalization, examiners, public safety, Wyoming legislature, hospital pricing, healthcare transparency, public health, civil penalties, shoppable services, 916, all

Transcript Highlights:

• point in the out years based on CMS point in the out years based on CMS priorities<00:54:58.800>
• Um, I'll just helped us with CMS.
• Um, and CMS at the $200 million level.
• It is a collaborative with CMS.
• Um but as most CMS and all application.

Keywords: 1187, senate, all

Transcript Highlights:

• This is really a very significant opportunity from CMS to think differently.
• Think we have to remain aligned with what CMS has approved.
• really is the focus of CMS. really is the focus of CMS.
• but<01:02:13.880> our CMS only required three, but our CMS only required three, but our
• the approved application that CMS the approved application that CMS approved. approved. approved

Keywords: 958, all

Transcript Highlights:

• they are penalized twice, once by CMS and again by HHSC.
• Is CMS trying to overturn the MPRO decision?
• Well, if CMS changes it on the federal side, we have to make our state.
• And then as you said, CMS does what they do.
• If CMS decides to leave that in place, who is, who, who that that is not you, you're not the.

Bills: HB 2510, HB 3589, HB 4611, HB 4655, HB 4665, HB 4666, HB 4670, HB 4700, HB 4730, HB 4798, HB 4838, HB 5136, HB 5243, HB 5302, HB 5539

Keywords: assisted living, healthcare, licensing, criminal offense, personal assistance, group home, regulation, health and safety, inspections, resident care, criminal background checks, adoption, parental rights, registry, vital statistics, disclosure, counseling, foster care, independent living, financial literacy

Transcript Highlights:

• CMS subsequently expanded the availability of these waivers to include serious mental conditions.
• So the tool that CMS has used to waive...
• So the tool that CMS has used to waive the IMD exclusion is Section 1115 of the Medicaid Act.
• And then there are a couple of analyses that have been conducted by CMS.
• Conducted by CMS.

Summary: The meeting focused heavily on behavioral health and substance use treatment, especially the IMD exclusion and whether North Dakota should pursue a Section 1115 waiver to allow Medicaid reimbursement for services in institutions for mental diseases for adults ages 21 to 64. Turtle Mountain representatives described major local needs, including limited access to care, high syphilis rates, and the importance of timely public health data. They also discussed the tribe’s recovery center, which opened the prior year, now operating five levels of care with 16 beds, and the desire to expand capacity, possibly through an IMD waiver or related policy changes. Committee members also raised related issues such as rural health transformation funding, telehealth, workforce retention, and the need for better coordination between tribal and state public health systems. A central issue was Turtle Mountain Public Health’s long-running effort to secure a data use agreement with the state so it can receive surveillance data and respond directly to infectious disease cases among tribal members. Speakers said the tribe had a successful COVID-era agreement that allowed faster contact tracing and case management, but that agreement ended with the pandemic. They argued that current delays in sharing data, especially for sexually transmitted infections, leave the tribe unable to respond quickly, while the state and county epidemiology workload is too distant and stretched to be effective. Committee members expressed support and said they would look into the issue, noting that other tribes have secured similar agreements. The committee also heard a detailed presentation from the National Health Law Program on the IMD exclusion. The presenter explained that federal Medicaid law generally bars payment for care in facilities with more than 16 beds, but that states can use other tools such as state plan amendments, managed care arrangements, telehealth, and community-based services. He said IMD waivers are administratively complex, time-limited, and have shown mixed results in other states, with some gains in residential treatment access but limited evidence of improved overdose outcomes or stronger community-based care. He urged the committee to consider broader continuum-of-care solutions and cautioned that waivers alone are not a cure-all. No final vote was taken on the bill draft during the portion shown, but the committee discussed the proposal to appropriate $49,000 and one FTE to HHS to pursue an IMD waiver and report back in the next interim. Members also debated the policy rationale for the 16-bed limit, the role of the state versus tribal sovereignty, and whether the bill should move through the Health Care or Human Services committee in the future.

Transcript Highlights:

• also have the three big waivers for, we call them waivers because that's the policy mechanism with CMS
• So there are products and there are vendors that CMS has actually said, here's a short list.
• These vendors have what CMS calls MVP, minimum viable product.
• So for CMS, it is kind of our surveying agency and entity.
• CMS has a target of just under a 16-month interval. But all of our surveys are unannounced.

Keywords: House Room C, General Assembly Building, 976, house, all

Transcript Highlights:

• I believe that said that CMS had no additional authority other than what was in statute. Thank you.
• like issues that CMS wouldn't approve. like issues that CMS wouldn't approve.
• Um, and I think both of approved by CMS.
• In other words, CMS. Yeah. Federal law. Yeah. I mean, inclusive statute and rule. federal law.
• In other words, CMS. CMS. CMS.

Keywords: 1189, house, all

Transcript Highlights:

• So, in the CMS space, So, in the CMS space, um<00:26:32.280> there<00:26:32.480> is
• He said that on July 3 it was sent to CMS, and on July 4 the HR1 bill was signed.
• was sent in to CMS. was sent in to CMS.
• They CMS has interpreted HR 1 program.
• <01:04:44.200> that<01:04:44.440> may from CMS that may from CMS that may be<01:04:

Keywords: 1187, senate, all

Transcript Highlights:

• CMS got involved over month.
• And there are things that CMS CMS CMS has<00:49:53.119> to<00:49:53.280> look<00:49:53.440
• That's like CMS is going to say to you, well, we're following the rules of CMS, but that's the wrong
• That's like CMS is going to say to you, well, we're following the rules of CMS, but that's the wrong
• That's like CMS is going to say to you, well, we're following the rules of CMS, but that's the wrong

Keywords: 1187, senate, all

Transcript Highlights:

• , His leadership has been essential, stabilizing the hospital, restoring CMS compliance, making tough
• We regained CMS compliance around October 2025, and then regained it again in January. Yeah.
• And this was in response to the CMS and Joint Commission findings.
• In September of '25, CMS re-surveyed us again.
• And I'm glad that you have slides about meeting the bare minimum requirements of CMS.

Keywords: 907, all

Summary: The joint Senate and House Behavioral Health committees held an informational meeting focused first on the Oregon State Hospital (OSH). OHA Director Sajal Hathi introduced the hospital’s incoming permanent superintendent, Sean Murphy, and praised interim superintendent Jim Deagle for stabilizing operations, restoring CMS compliance, and helping drive a culture change centered on safety, accountability, and transparency. Deagle and Chief Medical Officer Dr. Amit Bavon described OSH’s role as the state’s highest-level forensic psychiatric hospital, the patient populations it serves, its partnerships with courts, counties, jails, hospitals, and advocates, and recent leadership changes across the hospital. They also reported improved accreditation and regulatory status, including Joint Commission accreditation and CMS compliance, and said the hospital is now using daily safety huddles, incident review meetings, stronger escalation procedures, and revised seclusion/restraint practices to reduce risk and improve oversight. Members pressed hospital leaders on past seclusion practices, asking how prolonged seclusions could have occurred under federal standards. Leaders said they could not explain past decisions but emphasized that current leadership has changed processes, training, reporting, and oversight so that seclusion and restraint are reviewed in real time and cannot be normalized. Questions also covered staffing, falls, and future planning. OSH said it is generally staffed to budget, though it still has RN and mental health technician vacancies and is working on recruitment, training, and better staffing distribution. Hathi said the hospital is building a public dashboard with key performance and safety metrics, including workforce data, and described the long-term goal as a consistently safe, disciplined, high-functioning institution that responds quickly to mistakes and remains accountable to the public. The committee then shifted to an informational overview of civil commitment. Oregon Judicial Department representative Chanah Newell explained the civil commitment process, including who can initiate it, the role of community mental health providers and courts, the five-day timeline to hearing, and the standards for danger to self, danger to others, and inability to meet basic needs. She summarized changes made in House Bill 2005, including revised statutory language and new provisions allowing a second diversion period, but cautioned that the data are too early to show clear trends. Testimony from NAMI Oregon’s Chris Bonif and psychiatrist Dr. Stephanie Lopez argued that Oregon still relies too heavily on jails and state hospital commitments because the broader community system lacks enough treatment, housing, and less restrictive alternatives. They urged the legislature to focus on upstream services, supported housing, and possible outpatient commitment tools so people can receive treatment before reaching crisis. The meeting ended with acknowledgment that additional reports and follow-up discussions are expected, including on residential treatment capacity and related behavioral health system reforms.

Transcript Highlights:

• We regained CMS compliance around October 2025, and then regained it again in January. Yeah.
• We regain CMS compliance around October 2020-5-4, and then regained it again in January. Yeah.
• And this was in response to the CMS and Joint Commission findings.
• In September of '25, CMS re-surveyed us again.
• And I'm glad that you have slides about meeting the bare minimum requirements of CMS.

Keywords: 907, all

Summary: The joint Senate and House Behavioral Health committee met for informational presentations on the Oregon State Hospital and civil commitment, followed by a planned tour of the hospital. Oregon Health Authority and Oregon State Hospital leaders reported that Sean Murphy will become the next permanent superintendent on July 13, with Sarah Castle to follow as permanent chief nursing officer on July 20. They described recent leadership turnover, a major organizational restructure, and efforts to build a culture of safety, transparency, and accountability. Officials said the hospital regained Joint Commission accreditation and CMS compliance, and they highlighted daily safety huddles, incident review processes, stronger escalation procedures, and improved management of seclusion and restraint. Committee members pressed hospital leaders on past prolonged seclusion practices, falls, staffing, and the need for better public reporting; OHA said it is building a public dashboard of key safety and workforce metrics. The committee then heard a civil commitment overview from the Oregon Judicial Department. The presenter explained that civil commitment is a separate legal process from criminal cases, usually beginning with a hospital hold, investigation, court review, appointed counsel, and a hearing within five days. She summarized changes made in House Bill 2005, including revised standards for danger to self, danger to others, and basic-needs commitments, plus a second 14-day diversion option. She cautioned that the new law has only been in effect since January and that it is too early to draw firm conclusions from the data, though there has been a recent uptick in commitments and a decrease in diversions. Testimony from NAMI Oregon and a forensic psychiatrist emphasized that Oregon still relies too heavily on jails and state hospitals because community services, housing, and outpatient supports are insufficient. They argued that the state needs more less-restrictive alternatives, including better use of assisted outpatient treatment or outpatient civil commitment, and more supported housing so people do not cycle between homelessness, incarceration, and hospitalization. A family member described a relative remaining psychotic in jail for more than 120 days before ending up back at the state hospital, urging faster intervention and better collaboration among courts, counties, hospitals, and state agencies. Committee members and witnesses also discussed workforce shortages, the expansion of secure residential treatment beds, and the need for broader system reforms beyond the hospital itself.

Transcript Highlights:

• and the opportunity to negotiate with CMS on the final budget and final action plan.
• So we submitted our application to CMS.
• CMS has informed states that each year, CMS will recalculate the workload funding amount for each budget
• And for noncompliance, CMS may withhold, reduce, or recover award payments.
• CMS may withhold, reduce, or recover award payments.

Keywords: 985, all

Transcript Highlights:

• And is CMS trying to overturn the MPRO decision? They can.
• CMS does have the ultimate authority on the federal level.
• overrides when there is a corresponding federal and state violation, if CMS...
• Well, if CMS...
• And then, as you said, CMS does what they do. Is it one inspector that's...

Bills: HB2510, HB3589, HB4611, HB4655, HB4665, HB4666, HB4670, HB4700, HB4730, HB4798, HB4838, HB5136, HB5243, HB5302, HB5539

Keywords: assisted living, healthcare, licensing, criminal offense, personal assistance, group home, regulation, health and safety, inspections, resident care, criminal background checks, adoption, parental rights, registry, vital statistics, disclosure, counseling, foster care, independent living, financial literacy

Transcript Highlights:

• I mean, there would be some sort of needs from CMS on this, it sounds like.
• We have actually had meetings with CMS, including the Department of Human Services and the Minnesota
• For context, CMS has approved 249 distinct directed payment programs in 40 different states.
• <01:10:02.960> has Medicaid providers for context CMS has Medicaid providers for context CMS
• c><01:12:32.960> has being both broad-based and fair CMS has being both broad-based and fair CMS

Keywords: 1183, house

Transcript Highlights:

• In November of 2024, we had calls with CMS, HHS, with In November of 2024, we had calls with CMS, HHS
• CMS subsequently expanded the availability of these waivers to include serious mental conditions.
• So the tool that CMS has used to waive the IMD exclusion is Section 1115 of the Medicaid Act.
• This is a very ambiguous policy from CMS that has really been shown to have no teeth in practice.
• And then there are a couple of analyses that have been conducted by CMS.

Keywords: 908, all

Transcript Highlights:

• The CMS-64 reports are quarterly expenditure reports that are filed by DHS with the federal grantor.
• United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, or CMS
• from Arkansas DHS, which document the resolution of these audit findings with the federal grantor, CMS
• It is a state and federal partnership, and we work with the CMS as described earlier to have a state
• CMS provides 75% of our funding, and so we are obviously bound to some of the federal regulations, and

Summary: The Medicaid Subcommittee of the Legislative Joint Auditing Committee met to adopt the November 2018 minutes and receive a primer on the subcommittee’s role and Medicaid oversight in Arkansas. Legislative audit staff reviewed the subcommittee’s history and explained that Medicaid is audited annually through the statewide single audit because it is a high-risk federal program. Staff summarized recent audit findings, including weaknesses in eligibility and data-matching controls, improper use of Medicaid funds for partially non-Medicaid work, issues with incarcerated juveniles’ coverage, the absence of a Medicaid recovery audit contractor program exception request, reporting problems involving MFCU recoveries, and provider eligibility documentation concerns. Staff also noted a DHS departmental audit finding involving employees who improperly received benefits, which was referred for further action. The Department of Human Services gave an overview of Medicaid’s structure, eligibility, delivery systems, and budget. DHS described Arkansas Medicaid as covering about 850,000 people through fee-for-service, managed care, and premium assistance for the expansion population, and outlined major spending categories such as institutional care, long-term services, pharmacy, capitated payments, and supplemental payments. DHS also explained the difference between state plan amendments and waivers, and said it has a beneficiary-fraud unit that refers cases to local prosecutors. The Office of Medicaid Inspector General described its role in detecting and preventing fraud, waste, and abuse, distinguishing between suspensions for credible allegations of fraud and recovery actions for mistakes or overpayments. OMIG said it works with DHS and law enforcement, issues quarterly and annual reports, and has increased recoveries in recent years. The Attorney General’s Medicaid Fraud Control Unit explained that it prosecutes provider fraud criminally and civilly, can also handle long-term care neglect, abuse, and exploitation cases, and works with local prosecutors as special deputies. Committee members asked about court venue, provider suspensions, beneficiary fraud, education of providers, and the status of Medicaid expansion work requirements; DHS said it is preparing to implement community engagement requirements under HR 1 and will begin with a soft launch before full enforcement. No formal votes were taken beyond adoption of the minutes, and the meeting adjourned after questions were answered.