Arkansas Tobacco Settlement Commission (ATSC)
Meeting Minutes
June 13, 2017
Commissioners Attending: Susan Hanrahan, Chair; Alex Johnston, Commissioner (AEDC Designee); Mary
Franklin, Commissioner (DHS Designee); Tara Smith, Commissioner (ADHE
Designee); Nate Smith, Commissioner
Staff Attending:Matt Gilmore,Executive Director; Larissa Liddell, Assistant;
Guests: Shannon Fleming, AAI; Amy Leigh Overton-McCoy, AAI; Clarke Sherrod; Bobby McGehee, ABI; Leslie Humphries, ABI;Liz Gates, COPH; Ashley McNatt, COPH; ShaRhonda Love, MHI; Louise Scott, MHI; Becky Hall, UAMS East; Stephanie Loveless, UAMS East; Debbie Rushing, TPCP; Representative Frederick Love; Charles Saunders, AG Office; Christopher Thompson, AG Office; Jake Windley, AG Law Clerk; Wes Manus, AG Law Clerk; Zack Trail,AG Law Clerk; Ed Powers, UCA; Emily Lane, UCA; Rhonda McClellan, UCA (by phone); Jacquie Rainey, UCA (by phone)
Minutes Recorder: Larissa Liddell
Agenda Item / Discussion / Action/Next StepsCall to order and introduction of attendees / Chair Hanrahan called the meeting to order at 10:00am. Attendees introduced themselves and gave their organizational affiliation. There was not a quorum established at that time.
Chair Hanrahan introduced State Representative Frederick Love, District 29 / State Representative Love gave a brief description of his diverse district in the Southwest portion of Little Rock from Arch street to the Saline County line. He has been on the House Public Health and Welfare committee for three terms and this regular session has been the most difficult so far in regards to public health.A major highlight was the passage was Act 50, which will use the funding from the tobacco settlement and decrease the number of people on the developmental disability waiting list.
Chair Hanrahan informed Representative Love that Governor Hutchinson actually attended the September 2016 meeting and made an appeal to the Commission on that issue.
Representative Love stressed he is a firm advocate of tobacco policy. He gave a brief overview ofthe Special Session, which involved two issues,Medicaid and the Healthy Century Trust Fund. The Healthy Century Trust Fund will be transferred to a long termfund so the state can get a better bond rating. There were some changes made to Medicaid that will move some individuals on to the federal exchange, helping lessen the amount the state pays. Representative Love statedthe Commission and its programs play a role in this change as well and asked the programshow they are working together for the betterment of Arkansas? What is the overall strategic long-term plan for the Tobacco Settlement Commission?
Representative Loveoffered to take questions.
Chair Hanrahan asked if there is any discussion around vaping.
Representative Love said yes but most individuals have said to let the market take care of itself. There was not any new legislation or tax initiatives passed concerning vaping this session.
Commissioner Nate Smith talked about bringing vaping under the same tax as tobacco and one attempt was to bring it under the Clean Indoor Act and neither was successful. T21was introduced and would have raised the age limit on tobacco salesto the same as alcohol. He thinks this will probably have a greater impact. A lot of kids gettobacco products from people between the ages of 18 to 21.
Chair Hanrahan askedthe programs representatives to talk about things that might be happening in the future or current program collaborations to share with Representative Love.
Bobby McGehee stated that ABI collaborates very strongly, not only with the five member institutes but other research attempts are madein-state as well as out of state. They are establishing a more formal relationship with Arkansas Center of Health Improvement (ACHI). Joe Thompson, the director, has some interesting investigator led research dealing with Public Health and Database Mining. Over the years a lot things have been created, but they are exploring the Health Data Initiative and the All Payers Claims Database (APCD). The Health Data Initiative isrepository data on Arkansans that comes from hospitals and healthcare providers. The All Payer Claims Database includes all of the insurance companies in the state that insure more than one thousand people. ABI and ACHI will open a new investigation with APCD. The Governor, Legislators, and hospitals support ACHI. ABI has a two hundred thousand dollar commitment for the next five years. If they get two extramural grants from this interaction that will help pay back the money that was used for this venture.
Shannon Fleming (AAI) statedthat Claudia Beverly will be stepping down at the end of June 2017 as the director of AAI. Dr. Wei will be the interim director of AAI. They are currently in transition and doing more collaboration and partnering with ATSC programs and other agencies to utilize funds the best way possible.
Chair Hanrahan told Representative Love that the programs do not rely totally upon the MSA funding and the Commission does encourage programs to engage in collaborations. In addition, many programs have been very successful in financially leveraging the funding they receive from the MSA.
ShaRhonda Love (MHI) stated that they have been in contact with several tobacco initiatives, written letters of support for COPH, two grants for the Aging Initiative and been talking with UAMS East Regional Campusabout another grant opportunity.
Becky Hall (UAMS East Regional Campus) stated that they have been engaged in over one hundred local collaborations over the years with churches and other entities. Their Cooking Matters class is funded by Kathy Webb with Arkansas Hunger Alliance. These classes are for kids, diabetics, and senior citizens. They also received a ninety thousand dollar grant from Greater Delta Health Alliance, which is an alliance of several hospitals in the Southern region.
Debbie Rushing (TPCP) added that everyone isworking towards the reduction of tobacco usage. They count on everyone taking on the charge to help achieve the goal of having a healthier Arkansas. The smoking prevalence in 2016 is 23.6%which is down from 24.9%. Cessation, prevention, and reduction need to be a top priority, or we will not be able to achieve the goal of having a healthier Arkansas.
Mary Franklin (TS-MEP) stated that the new fourth population will be individuals onthe developmental disability waiting list. This increases the funding support for individuals on the list beyond regular Medicaid and helps them remain in their homes and communities. The other three groups are: expanded coverage for pregnant women at 133% to 200% of the federal poverty level; the ARSeniors program assistsindividuals age sixty-five and older at 80% of the poverty level and allows them to receive full Medicaid; and the last is expanded benefits fornineteen to sixty-four year olds, allowing them toreceive Medicaid to cover hospitalization coverage for three more days and reduce the amount of out of pocket co-pays.
Commissioner Nate Smith states that there are very diverse activities provided by Tobacco Settlement Funding. Arkansas is not a wealthy state and deals with additional economic challenges due to higher healthcare costs. The cohesive plan is to keep healthy people healthy. The national average adult smoking rate is 15% and the rate in Arkansas is 25%.This translates into higher healthcare cost for Arkansas, so the strategic nature of the plan is to try to keep healthy people healthy and create new ways to do so.
Chair Hanrahan introduces Attorney General Representative Charles Saunders
/ Charles Saundersgave an update on the Master Settlement Agreement (MSA). MSA funding does not end in twenty-five years. The amount of the payment is based on the volume of cigarettes sold and 80% of the market is Phillip Morrison and Reynolds. What happens if one does not pay or one goes bankrupt? Certain mechanics in the MSA increases and decreases the funding. One thing that everyone should be interested in is the volume adjustment.Over the years the number of smokers and amounts of cigarettes sold has decreased. This brings down the obligation. The funding increased this year due to an end of certain credits owed to the major tobacco companies. There are two payments: Main (C1) and Strategic (C2).Arkansas’ share of the main paymentwas .8% and strategic was .7%.This will end next year and will be only .8%.
Bobby McGehee (ABI) welcomed Charles to come visit any of the ABI programs.
Chair Hanrahan informed everyone if they ever have any questions or issues to please call Charlesand he will assist in any way he can.
Charles Saunders asked had anyone heard of a new product that is called “Heated Tobacco” and Debbie Rushing (TPCP) gave a brief description of the new tobacco device called Heat-No-Burn Cigarettes which is tobacco heated at a high temperature. This is currently on the market in the UK. A new HUD Rule is a federal law that states that all HUD property must be smoke free.This came out in February this year and will be officially in place next year. This new form of tobacco may not apply to this rule.
Review/Approval of March Minutes / Chair Hanrahan stated that a quorum exists. Motion to approve the minutes was made by Commissioner Franklin and seconded by Commissioner Tara Smith. The March minutes were approved.
Director’s Report / Director Gilmore discussed the financials for ATSC for the last quarter that included salaries, operating budget and professional service fees. The ATSC account, funded from interest as of May, is $391,448.26.The ATSC account will also receiveapproximately $151,499.62 from interest off of CD’s and the total for this year will be at least $542,947.88which is about 200k more than FY16.
Director Gilmore discussed the changes that were made in Professionals Fees and Grants and Aids that will go into effect on July 1, 2017. He also went over the MSA disbursement and the annual report by UCA and contract renewal. After the edits are made and the final report is out, the Commission will have a meeting by conference call to approve the annual report to be submitted to the legislature.
Chair Hanrahan asked Jacquie Rainey (UCA) or Rhonda McClellan (UCA) if they had anything to add to the discussion and if that was a good timeline for their report.
Director Gilmore stated that some programs have indicator changes and asked them each to explain them.
Ed Powers (UCA) stated that some of the indicators for AAI were dated and that he felt it was time to update several. The first change was to the funding amount that the agency leverages per year.
(1) Revise the third indicator for the long-term objective that reads: “Long-term Objective: Improve the health status and decrease death rates of elderly Arkansans as well as obtain federal and philanthropic grant funding.” The third indicator originally stated:
Increase the amount of external funding to support AAI programs by the end of FY2015.
The proposed new wording is:
Increase the amount ofOn an annual basis, AAI will obtain external funding to support programs by the end of FY2015 in amounts equivalent to ATSC funding for that year.
Rationale: The original indicator was dated and it did not contain a benchmark amount specific enough to be helpful in evaluating the agency. The new indicator is aligned with the long-term objective, focuses on annual fundraising performance, and provides an aggressive but reasonable external funding goal for the agency to achieve.
Ed Powersstated that the Act requires the agency prioritize health issues and this new indicator below will help them accomplish that.
(2) Add a performance indicator for the following short-term objective: Prioritize the list of health problems and planned interventions for elderly Arkansans and increase the number of Arkansans participating in health improvement programs.
NEW indicator: On an annual basis, the AAI-Centers on Aging will develop a list of health problems that should be prioritized and education-related interventions that will be implemented for older Arkansans.
Rationale: There is currently no indicator to measure efforts related to prioritizing health problems and health interventions specific to older Arkansans. This is supposed to be a key function of the agency and it needs to be assessed and tracked.
Ed Powers stated that this indicator below is just a terminology change and provides some flexibility with the changes in healthcare providers and hospitals.
(3) Change terminology in the key performance indicator related to increasing “… the number of Arkansans participating in health improvement programs.” Change terminology from “partner hospitals” to “local healthcare providers” as follows:
Terminology change: Assist partner hospitalslocal healthcare providers in maintaining the maximum number of Senior Health clinic encounters through a continued positive relationship.
Rationale:Changes in the healthcare system have altered the array of services that might contribute to health improvement. As a result, the “partner hospital” terminology is too restrictive. The terminology “local healthcare providers” is more flexible and more accurately reflects the current healthcare system.
Ed Powers suggested that the indicator below should be eliminated due to AAI not having any control or authority over the staffing decisions at partner hospitals.
(4) Eliminate a performance indicator for the following short-term objective: Prioritize the list of health problems and planned interventions for elderly Arkansans and increase the number of Arkansans participating in health improvement programs.
Eliminate indicator: Partner hospitals will maintain a minimum of three provider Full Time Employees (FTEs) for Senior Health Clinics including a geriatrician, advanced practice nurse, and social worker.
Rationale: AAI has minimal influence and no direct control over staffing decisions of healthcare providers. This performance indicator is also not necessary to evaluate the objective.
Ed Powers stated that the last indicator change below is something that the agency has wanted to do for a while and will hopefully lead to less confusion and give a better description of what the agency’s mission is in the state.
(5) The Arkansas Aging Initiative requests a name change from AAI to UAMS Centers on Aging. There are multiple rationales for this request:
- UAMS Centers on Aging implies a distributed network of sites and this implication more accurately describes the agency. The agency consists of seven Centers on Aging located in various regions of the state. All the Centers are coordinated from the Donald W. Reynolds Institute on Aging at UAMS but each Center customizes its services to the needs of the geographic region it serves.
- UAMS Centers on Aging better aligns the name of the agency with the original wording of the Arkansas Settlement Funds Act of 2000. That wording states, “…satellite centers on aging will provide access to dependable healthcare, education, resource and support programs for the most rapidly growing segment of the State’s population.”
- UAMS Centers on Aging helps distinguish the agency from AAA (Area Agencies on Aging). Since the inception of AAI there have been constant confusions over what AAA is and what AAI is. The new name will help alleviate the confusion.
Director Gilmore briefly explained that the reason for the change in the indicator for Medicaid Expansion was to eliminate the old indicator for the population that is currently no longer served through tobacco settlement funding and then create an indicator that will show how many individuals are now being served through the funding for the Developmentally Disabled population.
(1) Eliminate the performance indicator for the following short-term objective:The Arkansas Department of Human Services will demonstrate an increase in the number of new Medicaid eligible persons participating in the expanded programs.
Eliminate Indicator: Increase the average number of persons enrolled in the ARHealthNetworks program, which provides a limited benefit package to low-income employed adults in the age range of 19-64 years.
New Indicator: To be used for the evaluation of the new Developmental Disabilities population for the Tobacco Settlement Medicaid Expansion Program (TS-MEP):
(1)The number of people on the waiting list at the beginning and end of each quarter.
(2) The number of adults receiving services each quarter by county.