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Arkansas DHS proposes to revise personal care manuals, to reintegrate PCPs and remove Optum assessments; lawmakers press for delay
Summary
The Arkansas Department of Human Services presented proposed rule changes to the State Plan Personal Care and ARIA manuals that would remove the Optum independent assessment contractor, reintegrate primary care providers into eligibility and shift assessment tasks to personal care agency RNs; legislators raised concerns about PCP burden, conflicts of interest and asked DHS to pull the rule and work with lawmakers.
The Arkansas Department of Human Services on the committee floor presented proposed revisions to two manuals governing state-plan personal care services, announcing plans to repeal the current Arkansas State Plan Personal Care Manual and the Arkansas Independent Assessment (ARIA) manual and issue streamlined replacements that would reintegrate primary care providers into eligibility and assessment processes.
Melissa Weatherton, director of Medicaid populations at the Department of Human Services, said the agency intends to remove the independent assessment contractor (Optum) from eligibility determinations, replace the Optum tool with a more functional assessment instrument, reassign the eligibility assessment task to registered nurses employed or contracted by personal care agencies and lengthen prior authorizations from six months to 12 months. "We're spending over $212,000,000 annually, on this service for about 17,000 people," Weatherton said, and the department believes the changes and standardized physician and evaluation forms will better target services.
Why it matters: The proposal changes who determines eligibility for personal care — a Medicaid-covered, non-nursing service used by older adults and others to remain at home — and could reduce state spending in the near term while raising concerns about provider incentives, the workload of PCPs and potential service delays.
Agency justification and fiscal numbers
DHS told lawmakers Optum assessments cost roughly $497 per assessment and that Optum's independent assessment currently approves about 95% of cases, which DHS said has not produced the anticipated utilization control. The agency projected about $6,173,000 in savings next year by removing the Optum assessment cost and moving prior authorizations to a 12-month cycle; DHS also said it is rewriting utilization management contracts and expects additional review and oversight through a forthcoming RFP.
Legislators' concerns and exchanges
Multiple legislators pressed DHS for data and questioned both the mechanics and the policy rationale. Several raised practical concerns that primary care physicians and nurse practitioners, who already face heavy patient loads, lack time to serve as gatekeepers and may sign forms under pressure from families or providers. One legislator, later identified in the record as Senator Sandra Irvin, characterized the proposal as allowing "the fox guarding the hen house," arguing that personal care agencies have a financial interest in approving services and that an independent assessment should remain to prevent fraud and misaligned incentives.
DHS response and next steps
DHS officials said they conducted stakeholder engagement beginning in June 2024, have collaborated with other agencies (including the Department of Education on school-age concerns) and plan to train PCP offices through an existing contract with AFMC. The agency acknowledged the proposal would be part of a multifaceted effort to control utilization rather than a single solution and told the committee it was open to delaying implementation to allow for physician training.
Following sustained objections and requests for further review and audits of past independent-assessment efforts, the committee chair offered the agency the option to "pull this down" and work with specified legislators off the record to refine the rule. DHS agreed to do so; the committee took no final vote on the rule and adjourned.
What was not decided
No formal vote on the rule occurred during the meeting. Earlier procedural motions on the agenda were approved (minutes and referral of Items C1 and C2 to Labor and Environment subcommittees), but the DHS rule itself was withdrawn for additional negotiation and review.
Next steps
DHS plans to return to the committee after further work with legislators and stakeholders. Committee members requested historical audits and utilization data that DHS agreed to produce to support the department's rationale for changing the assessment model.
