On Thursday, Arkansas Department of Human Services Director Cindy Gillespie announced an internal reorganization of the DHS that will shift 171 employees to a newly created division, impact more than 40 DHS contracts and streamline the agency’s oversight of thousands of Medicaid providers across the state.
The DHS is comprised of nine divisions that perform a wide range of functions, from managing the state’s foster care system to administering the Arkansas Works insurance program to inspecting daycares and nursing homes. As part of their duties, five of the DHS’ divisions oversee Medicaid funds and Medicaid providers; often, a single provider must answer to multiple divisions. For example, a child care facility that provides specialized care for children with autism would be subject to inspection from both the Division of Developmental Disabilities Services and the Division of Child Care and Early Childhood Education.
Gillespie said DHS administrators realized upon reviewing their requirements last fall that there was an “astounding” degree of redundancy and determined a need to “make this a more streamlined, effective operation.”
“They were each certifying, in many cases, the same provider groups. They each had separate policies ... We were actually duplicating what we were doing all over the place,” Gillespie said. A DHS working group recommended creating a new, centralized division that will certify, license, monitor and inspect all Medicaid providers for all of the DHS: the Division of Provider Services and Quality Assurance, or DPSQA. Legislation passed in the 2017 regular session of the Arkansas General Assembly paved the way for the change, which should be fully implemented by early 2018. The DHS hired a consultant, Leavitt Partners, to assist in designing the new division.
The change will be revenue neutral in the current fiscal year, Gillespie told reporters, and may save the state money in the future by increasing efficiency. By January, 171 DHS workers from the five divisions will be transferred to the newly created DPSQA. No employees will be laid off, although Gillespie said some positions eventually may be eliminated through attrition. The DHS will also review over 40 contracts this fall that will be transferred from the existing divisions to the new one.
The division will be headed by Craig Cloud, who previously served as director of the Division of Aging and Adult Services. The organizational change will not require approval from federal authorities that disburse Medicaid funds, Gillespie said.
Dawn Stehle, the DHS Deputy Director for Health and Medicaid, said providers would welcome the creation of a “one-stop shop” for compliance.
“Unfortunately, it’s not uncommon today where a provider, sometimes on the same day or the same week, can have multiple people from DHS on site actually inspecting those different programs and services,” Stehle said. “It’s not beneficial to us or to the provider to have six different people looking at that. … Let’s set up a structure where we have one team go out and look across multiple programs.”
Stehle said the change would also benefit Medicaid beneficiaries and their families “from a client and consumer choice perspective” by increasing transparency. Combining inspection and oversight of providers into a single division should “help provide information to parents and others [asking] ‘Is this a facility or a program where I want to have my child or loved one served?'”
The DPSQA should also allow for better quality control of providers, Gillespie said, by ensuring that information from surveys and inspections isn’t “siloed” within the various divisions of the DHS. “We have today an ad hoc system” regarding the sharing of data from provider inspections, she said. “By putting it together, we’re going to be able to do a much more effective job,” she said.
The new division will also be tasked with health care workforce development in Arkansas, which has a shortage of nurses and other medical professionals. Gillespie noted the long-term shift away from reliance on institutions such as nursing homes and toward home- and community-based services. “We do not have the workforce to meet needs for home- and community-based services,” she said. “This [new division] would be a perfect place to do that.”
Pathfinder, Inc., a Jacksonville-based nonprofit, is one Medicaid provider that would be affected by the change. Pathfinder provides a variety of services to children and disabled adults, including preschool for ages 0-5, adult developmental day treatment, in-home waiver services, group homes and outpatient mental health. CEO Mike McCreight said the nonprofit is currently subject to inspection and oversight by multiple DHS entities: the Division of Developmental Disabilities Services, the Division of Behavioral Health Services, the Division of Child Care and Early Childhood Education and the Office of Long Term Care.
“You can have two or three sets of standards that have gaps, redundancies or sometimes even conflicts,” McCreight said. Different divisions have different inspectors, different policies and different paperwork that must be filled out.
“It would be better if you didn’t have different licensure people coming in at different times,” he said. “It would be nice if that was all together.
McCreight, who was once director of the Division of Developmental Disabilities Services, said the creation of a new arm of the DHS would be a “logistical challenge” for the agency, but he praised the move as a positive one. “Of course, you have to see what the end product looks like, but it’s a great opportunity.”
This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.