Panel backs DHS rules for awarding care hours

A state legislative panel on Tuesday approved rules that state officials said would allow them to begin serving more than 1,800 disabled Medicaid recipients on a waiting list for help with daily living tasks, such as dressing and bathing.

The rules approved by the Legislative Council's Administrative Rules and Regulations subcommittee would allow the state to go back to using an algorithm to award hours of care under the ARChoices program, which serves about 8,800 people.

Pulaski County Circuit Judge Wendell Griffen in May barred the state from using the formula until rules allowing it had been "properly promulgated."

With no members objecting, Rep. Kim Hammer, a chairman of the subcommittee, on Tuesday declared the rules "reviewed and approved."

But he said legislators had taken note of testimony by disabled Medicaid recipients who said the algorithm, which assigns recipients to "resource utilization groups, or RUGs," had resulted in their hours being reduced to inadequate levels.

In response to the complaints, the House and Senate public health committees last week recommended against approving the rules.

"Your presence here today has not fallen on deaf ears," Hammer said. "Moving forward, because of your intense pressure, it is duly noted that [resource utilization groups] is not the system we want serving the needs of Arkansans with disabilities."

The rules will go Friday to the Legislative Council for final approval.

The state Department of Human Services had used the algorithm since 2016, when it combined two programs that served disabled Medicaid recipients into ARChoices.

Kevin De Liban, an attorney with Jonesboro-based Legal Aid of Arkansas, said the formula reduced most recipients to about five hours a day of care, compared with about eight hours before 2016.

The formula assigns recipients to groups based on their answers to questions about their needs. Previously nurses had discretion in awarding hours.

In a lawsuit filed by Legal Aid on behalf of several recipients, Griffen in May ruled that the department failed to give adequate public notice before it adopted rules allowing the use of the algorithm. That ruling ultimately led the department to hold five public hearings on the rules in July and present them to legislators this month.

Until the rules are approved, the department contends it has no approved way to assess the needs of new enrollees or conduct annual reassessments of those already on the program.

As of Aug. 31, it had accumulated a backlog of 1,869 new enrollees who have not been awarded care hours and 2,411 enrollees who were overdue for a reassessment.

In July, Legal Aid filed a second lawsuit, this time asking Griffen to force the department to go back to allowing nurses to use discretion in awarding hours.

The Human Services Department contends that federal officials won't allow it to use that method. But department officials said they are working on a new system for assigning hours that they hope to start using Jan. 1 instead of the algorithm.

Luke Mattingly, chief executive of Carelink, the Central Arkansas Area Agency on Aging, said he agrees with critics of the algorithm that it was wrong to cut the hours of people on ARChoices.

But he said the freeze on awarding care hours has prevented elderly people from getting the help that would allow them to live in their own homes instead of nursing homes.

"If you have zero hours right now, 30 hours still goes a long way," he said.

A Section on 09/19/2018

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