OPINION Hearing may expose flaws on long term care

The devil is always in the details.

And in the case of new procedures for state managed care in Arkansas -- this devil is often revealed only when a committee member asks questions.

Count on some hard questions coming out this week from Legislative meetings down in Little Rock which will generate very little press coverage, but affect thousands of Arkansans.

In the June meeting of the Aging, Children and Youth, Military committee, State Rep. Charlene Fite, of House District 80 (which includes the western portion of Washington County) put DHS on notice that they would be reporting to the committee at its July meeting on how they are fixing this fiasco of the new system that evaluates residents/applicants for assisted living.

Assisted living has been in turmoil as many Arkansans have been notified they will soon lose these benefits and possibly be sent back to relatives or to fend for themselves -- in other words -- kicked out of assisted living facilities as the state evaluations may end direct care they no longer need or qualify for these services.

So far, Rep. Fite is the only legislator who has had an open meeting and invited the public to come and testify.

This open meeting could have been done in either the Public Health or State Agencies committees, but instead she had the hearing in Aging, Children and Youth, Military committee (which she is chairman).

Rep. Fite says she is, "glad my committee took it on."

At issue is The Optum group and the new evaluations on care, which are pretty new so that people didn't start getting notices that they no longer would qualify until recently.

There are problems with the new assessment tools, Fite says.

So many problems, in fact, she is asking any state clients that are told they are no longer eligible to please send her their contact information or give her personal number to their relatives.

That's a pretty bold move but she is taking it on to make sure the (clients) receive a new assessment.

Rep. Fite says she will be joined by others in the legislature, notably state Rep. Denise Garner of Fayetteville, a former nurse, in stating these clients being denied care should NOT be happening in our state.

"At the very least, the new assessment should be used for new patients, not those already in the system," Fite said.

Fite says some new direction on supplying Medicaid dollars in any location other than a nursing home, may become harder and harder to secure for clients.

"I have witnessed in the (legislative) sessions that our seniors are in for a rough few years, especially in the rural areas," Fite said. "What makes me sad is that providers were asked by the then Governor Mike Beebe and Herb Sanderson to grow Assisted Living out in the rural markets. To do that they wrote the 2001 statute, gave a tax credit set aside, brought in the waiver, etc. and we created a highly regulated assisted living industry, far above other states."

Now, Fite says what legislators are being told is Medicaid was never meant as a business model by the new managers in power to regulate assisted living dollars.

One recommendation would be that anyone already in assisted living be "grandfathered" and the assessment be done for new patients only.

Some of the startling reasons for cases to be denied have been such as officials:

• Not looking at medical records, or in most cases not allowing a caregiver to be present for the evaluation.

• The fact the provider, OPTUM, pays their RNs based on number of assessments completed, not a salary.

• In many cases the providers are contacting the resident directly for assessment times and not family or the facility.

• Some cases were set to be closed because three calls were made to a resident room and they never answered their phones.

• OPTUM has also sent out a determination letter(s) even though it is not the final determination. These letters come from OLTC (the Office of Long Term Care) which confuses everyone as they rarely stay the same.

The rate of denials for continued home care funding are now down to 50% or so, they were at one time running upwards of 85% of the cases denied.

Scary stuff for a committee room discussion. More than a few elected officials or the public were on hand to witness and hear these details, but those who were, apparently found their passion for righting these wrongs of in-home care for these Arkansans.

-- Maylon Rice is a former journalist who worked for several northwest Arkansas publications. He can be reached via email at [email protected]. The opinions expressed are those of the author.

Editorial on 07/17/2019