ALC-Administrative Rules

All right members if you'll take your seats please I just wanna remind those that wish to come in our rule to go ahead and sign and be sure to specify the rule of which you wish to come in and we'll be taking up those signing sheets momentarily first sort of business if you look at your agenda is reports from the executive subcommittee concerning emergency roles we have three reports from the executive subcommittee concerning its review and approval of merchant rules and those reports of course you're in your package and I would ask her there any questions regarding the executive committee and the emergency rules. Then without objection these reports will be failed next on your agenda is item see a reports from alc subcommittees concerned their view the rules this month we have two reports in your package. From other ALC subcommittees concerning their review of rules well we will take those two rolls up under item eat today anybody having questions regarding that. And without objection these reports will also be failed on to d which is reports on the administrative directives percent to act twelve fifty eight of two thousand fifteen for the quarter indian march thirty first twenty twenty four we have these quarterly reports on the administrative direct yourself i'd like to call department corrections to the table and they'll be making doc will be presenting on both of these reports of your would please come forward and name entitled for the record please and your recognition to present. In good morning. Good morning you'll have a pretty long list in front of you today and we had some change over and administration of the department so there's been a little flurry of administrative directive uh amendments so I apologize in advance and i'm gonna kind of get through these as quickly as I can end if you'll have questions I will do my best to answer them. So there were no secretarial directives issued for the first quarter and the first administrative directive could could interrupt you from it i'm sure I may miss it but I didn't hear your name and total fully record i'm so sorry tony rall chief legal counsel good morning go here no secretarial directives were issued for the first quarter next is the division of correction directives the first of which is a brain new directive and this was set at two provide guidelines for the inmate field ministry program there is a seminary program they are working on expanding at the barner unit and effectively this gets the inmates post secondary education in ministry and they are able to be. I am sent out to other units to kind of help with chaplancy services and what night and. The next policy is an amendment to restrict of housing with this primarily dead was amended to set out that um individuals who were in restrictive housing for purposes other than their own protection and do not earn good time they can't have good time restored and. And just clarify that. Initial unit of assignment is twenty twenty four dash oh three this just clarifies where prea vulnerable individuals go end under eighteen year old individuals go. The inmate disciplinary manual and assignments to varner supermarks behave your modification and send a levels and those following the same band as the restrictive housing policy and set out that if you're in restrictive housing if you're in that partner behavior modification you're not going to earn good time you're not eligible to have good time restored. Uhm if it's okay with everybody i'm gonna skip the first in mate visitation because it's amended a second time on this report. And so i'm going to move to twenty twenty four dash o seven which is transportation in a scoring event mates outside of units this was primarily updated to a penned a guidelines checklist on the back. Uhm and clarifies that arkansas state police will be advised of any route that we're taking on high security high risk in high profile transfers. Twenty twenty four dash oh eight sets out rules for volunteer internet student services again this is another place where the big change was that some additional documentation was appended on the back end and and it did take out some steps that are no longer necessary. Temperature settings was amended to provide that temperature checks in living quarters are being done every day this has been done for a while i'm it's just in the policy now. Twenty twenty four dash ten movement of pregnant women primarily was updated to provide for the extended post pardon period provided for the protect arkansas act and also required that if there are restraints used during labor those are reported to the division director secretary corrections and then the board of directions and attorney general are also notified and in mate visitation has been modified a lot of technical clean up in the swine and as you saw earlier this was modified actually twice in this quarter. First of all set out that visitation appointments need to be set up online and then there were some changes we had a secretarial directive on access to facilities by attorneys and also in administrative directive just to ensure that there weren't any conflicts between the two you know in between changes everything about attorneys is stricken and it just references to the secretarial directive on attorney access and visitation. Er moving on to the vision of community correction administrative directives weapons and security equipment has been updated to provide for a portable firearm lock boxes to put in vehicles for community supervision officers it also provides for armory audits this was the legislative audit finding. I think two years ago and this just sets out some guidelines by which the armory's will be audited for inventory. Use a four s provides for twelve cancelling sessions per year with a licensed counselor that's found in the checklist in the back use of restraints in a similar van to the movement of private network and provides that if a pregnant woman is in restraints during labor that has to be reported to the secretary of corrections for the corrections division directory and the attorney general and terroristic threats provides um effectively that we have some higher level policies we have a secretarial directive on incident notification and serve department of emergency management policies and it just references that so that is the report fine the secretarial directives and individual correction and community correction administrative directives okay let's ship to parcel before you go to the next one cheap a membership questions and they'd be senator urban first. Just to be a clarification on the restraints being used during labor date was that not addressed legislatively. And so it updates it to match the legislation I think that legislation was either twenty nineteen or twenty twenty one it just posts that into the policy to make sure that we're lighted up with legislation. But we still have a policy that restraints can be used during labor yes in in very limited circumstances. Okay if you don't mind I mean I really. I. What what was the if you will just remind me what what was the what were the limited circumstances and why. Do we have to create the limited circumstances so I can get more detail on that for you I believe that the exemption in the law is if it's for the safety of them baby m we do have some inmates who could be a potential risk to the child if they were not restrained okay yes but I can get more information yeah if you don't mind I just I wanted to make sure that we get this as a narrow as we possibly can of course and I can also check and see if it's even been done that I would that was my second question is can we check to see how often that's the case or. How often that has been done thank you mr chair welcome coach. Thank you mister chair agree with senator urban added and remember there being any limitations on them being able to be used in any kind of circumstance so I can car with her that we need that information on. How many times it's been used and what the circumstances are behind why they were used because I remember like she das there was legislation random restricted it from being used at all okay thank you. Mr chair I would ask that we would hold this one out until we get all the information that we need thank you okay let me ask you a question about the weapons and security equipment that was a big issue when that all it came out said said time. Other than what may have been reported in audit or not are there any situations where ammunition has come up missing or that you know historically is that fixed it now i'm not aware of anything um I do think that they are working on finding early the best solution for making sure that we're doing you know really robust audits of that immunity there has been some conversation about using quick books they are utilizing assess to do the firearms but you know bullets are held in a such high quantity that they're they're a little difficult to track an asus but there have not been any situations that i'm aware of okay what we're going to go to. Seat sixty one i'm not sure who that is so who ever since seat sixty one you're recognized thank you mister right senator love I wanted to go back to the tower senator urban touched on so without currently usaver will try to update the rule so the match was in the legislation so I as of right now what a week what are we doing how we made any any changes since this rule hasn't advanced. Are you speaking about the pregnant women yes so. I mean like what practices are we using now since we don't have a rule in place and if this was supposed to take. I've think back in twenty nineteen to twenty twenty one what what of the current practices so this is actually an administrative directive and not a full administrative rule so this is already in effect right now okay so it's already in effect. But you just say it stated that in limit its circumstances. Then yes and I can get more information I can look and yeah II just want to know what practice we have in place now since this rule since this administrative rule hasn't been passed the immediate so this is an administrative directive and it is already in effect there is not a rule that's part of this report. Open to department of corrections has some legislation that requires us to report on directive switch your account at that level below rule making for us. Mr sharon still i'm a little bit confused so I just wait for the report to come back thank you cochair representative thank you mister chair I do have a question if I remember correctly in the prison reform legislation I thought there was something to do with a mental on behavioral health service is being provided within the prison system but I don't see a directive here for that can you explain why are you talking about the protect arkansas yes okay because that's in process of being developed okay that's we've got we've got drafts that are in front of the secretary and those are in process of being developed so I have we began to provide those services because from what I understand we've not began. Providing those services to those inmates so i'm wondering are you speaking specifically about pregnant inmates. Yes so we have existing support services for the pregnant inmates we are in the process of looking kind of comprehensively at what we're doing for pregnant in mates you know with potentially trying to come up with one solution for those who were at the community correction center in the division of correction we've got some outside contractors who provide support there and I don't know exactly the status of where that's at just that they are really looking at it to try to come up with one solution for you know the division of correction and division of community correction thank you you welcome. Came members any other questions. Alright so this is a report as understand that this is a report that no action is actually required but here's one one ask you to do because of the questions regarding the restraints might ask you to come back next month and be prepared to answer senator irving and representative questions if you would I think it'd be better than just sending an email that way there can be open dialog about it okay alright. Then without objections that will be filed and you're going to give the report also on the post prison transfer board is that correct yesterday okay go his please well this one's a lot shorter and the post present transfer work has not issued any directives this quarter. Okay members any questions on that the objection then the report be considered reviewed and final thank you all right members will go on to e and the first one up is department of agriculture and it's gonna be on page one of your packet rules governing poultry feeding operation regiration and if you would sir come forward and name a tow for the record and you recognize to present. Fewer death that you could receive to general counsel for the arguments all department of agriculture and first director left argument good morning i'll go hit please thank sir six hundred of twenty twenty three transfer responsibilities for the registration of poltry pitting operations from the arts on natural resources commission the arts all department of agriculture. The rule before this body they reflects the change of responsibility of that registration program to the department of agriculture. The. Many questions members. The. All right then without objection this rule is reviewed in approved thank you. And you get you got the next one to on the posting of paint rule yes sir thank you. Orders are called annotated section eighteen eleven four zero four directed the arts on department of agriculture's forced commission to prescribe rules governing the top and color of paint to be used by owners or less ease of force land when posting the property against trash basing. This rule sets are actually fulfills and requirements of the statute it sets a standard for the color and type of accepted paint to be used requires the forestry division to maintain samples and formulas of approved posting paint and also to make samples available upon request. Are a questions for members senator. Has this has been a problem and it's changed from the purple then it but we just put it in statute that is correct so that was always going to be the purple on that young would have to be able to provide simples yes okay and that's available to anybody in the public correct is there a cost of your happened to provide paint to people. Pain itself for the paint samples no cost for the samples thank you and everything know the interest question but this is just for clarification by being in law somebody has caught trustpassing this gives the full weight to be able to charge them because there's not discrepancy in the color there's been uses that part of the intent behind yes okay and then one ish one of the question this came up from a constituent some asking. If you have a no trust person signed posted. Is it law that those letters have to be a certain dimension in order for it to be enforceable or do you know the editor that question if you don't could you get back with me yesterday I believe that is correct. I'm sorry for each year sir. Show every letter on that sign has to be a minimum before itches no trespassing what about the wording under it is at the no trust passing that is supposed to be the four letters and that if there's wording underneath it. Is that required by law too sir i'm not sure I have to get back with you on that if you would get back I had a considerate who had an issue that because it wasn't a certain size uhm they had trouble enforcing i'd like to know about that please. Right members then on the on this role without objection the rule is reviewed and approved and I think we're on two three which you're still at the table on this one to get away. At sixty one and arts are quite annotated seventeen one or one two oh three and also section seventeen one one three nineteen required the arts all our stock and poetry commission to create rules for submitting applications for this initial certification of veterinary technician specialists and applications from clabbard of practice agreements between veterinary technician specialists and veterinarians the proposed rule fulfils the requirements from these code sections it says the standard for requirements of initial certification such as written application. Showing that the applicant has active certification is completed specific set of education on training requirements also require submission of any collaborative practice agreements to the commission and to know if I the commission of the termination of such agreement if that happens within seven days. All right a questions from members. And just for the record and if you know which signed up to speak for against them i'm going to say that every time just note that nobody's signed up to speak for against the rule until we get one where they are any questions for members. They without objection is rules reviewed and approved and were onto the next one. This rule as well as the next one is a companion to the vendor technician specialist rule also require back one sixty one of twenty twenty three was a directive for the laugh stock and poetry commission to create rules regarding the contingent continuing education requirements for veterinary and technician specialist license renewal and this rule a men's a cart rule to include an additional eight hours required scoting the great education for veterinary technician specialists in accordance with the act. Any questions remember. Then without objection these this rules reviewed and approved c. The third rule regarding better medical sort veterinary technician specialists as regarding fees the proposed rule implements a fee schedule for veterinary technician specialists that mirrors the existing fee schedule for technicians and technologists which is an application fee of forty dollars with an annual renewal fee of twenty five dollars it also includes a provision that the fees are waived for service members veterans or spouses who hold similar license in good standing in another state territorial district of the united states. The. Any questions for members. The. You said this this mayors would. Is elsewhere did I understand you say that correct on the fees yes sir it did it did not create an additional fee for a veterinary technician specialist okay that's what I want to hear how questions from members without objection this rule is reviewed and approved and a d. At five ninety eight of twenty twenty three amended the arkansas egg marketing act by heading a provision regarding the direct delivery of eggs to consumers to address food safety and home grocery deliveries this amendment allows delivery of eggs as long as they are maintain at a temperature of forty five degrees or less so this amended rule will reflect that a minute to the act. Okay a questions from members. Senator right. Thank you is there another rule in here on a eggs that I had seen a couple days ago when I ran through this staff thanks that had to do with. I'm banking a home operation that somebody might be selling neighborhood it said that that less than two hundred chickens or something is is there another rule in the and i'm sure I think that's a part of the part of this yes at different step online and what i'm looking at here can you expand is this gonna care jenny. Hon people raising chickens at owner share eggs with their. Church friends or something nerve no sir. Okay where to me out that's not going to have. I'm sorry sir tell me how that's not going to have it actually it it provide allows for home delivery in a I guess in a more permissive manner than had been previously required the only requirement the main requirement being the temperature okay so but there is something in their i'm i'm degano a home grow was not going to have two hundred chicken so i'm just trying to make sure we're not kitchen. Some family stuff is. Impatriate first direct on poetry no sir that number was actually reduced to allow the smaller operations to do that it took him out of for the regulations in regards to food safety appreciate your claire by thank you. Although. Representative the thank you mister chair center as a kind of parked at my errors with his question but cars in reality people who do eggs at home for their neighbors or whatever they don't put a minor refrigerator. This. And now we're going to tell him it for them to deliver they have to be. Kept at forty five degrees. That's really for the retail alerts within that of retailers supplying delivery services or contracting the delivery services with put that language in there so that they don't have to maintain refrigeration but that purpose is for delivery from a retail. I wish it stated that a little bit better thank you would you would you put your michael closer number one and and never to which you defined delivery service maybe that will help clarify who we're talking about is that a commercial grower or could that be the marma park with you which definitely will be a retailer restaurant I mean grocery store. The. Okay so to be some idea license then that's great okay okay good any questions any other questions from members. But then with objection this rule is reviewed and approved and. But paying on second century. So I just I mean back to the point because what we've seen sometimes in the past is will pass a rule and then. Because it's been interpreted by somebody that's actually out enforcing the law it may be interpreted the differently I would just watch the just because if somebody is becomes in violation because they don't have a license or their that has happened and we've seen that all I will get caused from constituents and and then we'll have to go back and and clarify legislation or whatever so I just say that is a word of caution because there's a lot of folks that you know have a deliver eggs to their to their hut to people's hounds and a neighborhoods and things like that and and when it when these things become on the side of enforcement issues or somebody calls and reports them or complain makes a complaint whatever that's when we get phone calls and so II just don't want some way on who's been doing this then to get your side finder or whatever and because I don't have a license and that's what they're supposed to have so I just think we would like to look at that rule and look at the legislation if you could just then that to me just so that we can make sure we're avoiding when it gets down the line of enforcement you know actually night catching people kind of in a predicament if that makes sense cause I mean that's what lead to the whole cottage food industry was because you had at that time a health department that was incredibly sensitive and shut down a boy scout through from selling browning set of county fair and that lead to the whole cottage food industry legislation and and so on and so forth because the enforcement of it you know was a pretty intense so I don't know if this would apply for the specific situation but but I stand on the side of people that are farmers then. Wanting to be able to do this. And not have to go through grocery stores thank you members when representing pay you dropped off you. That we've already we've already passed this out with the objection but for the purpose of a little dialog i'm a represent recognized represent page speaking on the subject okay arguature I appreciate you explain to me. If if you guys were stating sitting there saying about retailers can you explain to me why you guys didn't put that in the rule. This is towards retailers to forty five degrees this world towards retailers and not for you know people like me that have home grown checking to do all over to the neighborhood if it's not for me and it's more towards the retailers than why didn't we make that rule specific. Cause this is pretty broad. The. And actually the main purpose of that was to allow for the smaller sales with the increase of books buying back your birds and wanting to share that between their neighbors that's that was the intent of that was to allow them to do that without having the better refrigeration or have a contract or have a license. Right members okay then as stated then with objection to the rules reviewed and approved but I would encourage out known what's been said okay thank you all right next. Alright next one to depermand commerce economic no we're not sure. Where are we weren't for all right for total too okay and then I think you're ready to get out of there is six ninety six ninety one of twenty twenty three were enacted. To make changes to the appointment election of conservation district directors at sixteen a when main changes to the appointment and election of conservation district war members. So these are this rule is being a minute to conform to changes in those two x. Members any questions on. Okay any any questions on this one. Then without objections rules reviewed and approved older seat of second representative. Yes I have a parliamentary procedure and I think so if we wanted as a representative painter and representative to a resenator irvine senator of rice we're talking about is there a way that we can hold that resend what we did for the one with the eggs and bring it back for it to be clarified more clear about it not being for. Is that a possibility okay so are you asking could we expensive by which it was approved yes that's my question i'm on a recognized emotion so i'll make a motion to expand that action on what was the number of that one yes ma'am okay expanding that action without review you're exponging right that's what I want to do that we got emotion we add a second and so everybody understand what motion second years. All right a discussion on the motion. All right nowhere discussion on the motion of every eye and you opposed. Alright her nobody but the eyes have it and so and then I need emotion to hold the rule I would like to make a motion to help the rule or we have emotion to hold the rules or second or I need a discussion to the motion. All favor ci and imposed. All right with that being the case we're on hold the role on the eggs arkansas egg marketing what I would suggest you give with members and see back term getting it getting the issues addressed hang on second. Yeah and just for clarification world held in here is not going back to committee I just encourage you give the member see if we get those issues addressed okay yes sir thanks for all right all right moving on members were on two six which is department commerce to take insurance department when get you out to the table please name a tower for the record any recognize to present number number five sorry. Page well. The. Yeah it's part of a commerce are solicited development commission. Good morning go would please name tail for the record please claim on executive director or can sell economic development commission. Alison happier cheaper staff commerce good morning all recognized your head. Thank you mister chairman adc was appropriate ten million dollars for the are console site development program by act five sixty one of two thousand twenty three this will provide communities with the opportunity to apply for grant funds to help offset the expense of improving available industrial sites to put us in a better position to compete for economic development projects a public comment period was held we received no comments. All members any questions. Refresh my marriage went through commedia day but as far as the funding for this what's the source of funding i'm sorry. Restricted reserve. I believe so message that that's right okay or any questions for members. Then without objection the rule is reviewed and approved thank you thank you all right want a six department commerce state insurance part of the please. One page sixteen members. And good morning if you would name and tell for the recommendation he recognized present amanda gibson council for the board. The proposed amendments are needed to implement twenty twenty three legislation and who make other misclaim yes changes. At one thirty seven of twenty twenty three a expanded act one thirty five of twenty twenty one by allowing the board to consider at national certifications toward initial licensing requirements for uniform service members at veterans in their spouses act one thirty seven further eliminates the one your limitation for discharged uniform service petrols to use service education training or certification toward initial licensing requirements and then act at four fifty seven of twenty twenty three requires the board to provide automatic license your to new arkansas residents who hold a license in another state and this legislation applies to all occupational licensing boards not just a sport. At three sixty eight of twenty twenty three s specific to this board and it allows licensees to renew their licences either on an annual or a biannial basis with no increase in fees and add so these are the minutes to this rule implement these ad this legislation throughout i'd be happy to answer and in questions members having questions liberty or nationwide quick question for one quick answer time to time funeral homes you know in the not doing the right thing in the end up you know disrespecting the remains. Do you guys go and do annual periodical inspections to make sure that we catch that sooner than later like we've seen in the news and pastors that on you to do that yes I don't know that at the inspectors may get to every single few home annually I understand there are I think about four hundred and fifty funeral establishments in the state of arkansas and the board only has two inspectors okay thank you for the information alright members any questions on the rule. Without objection as rules reviewed and approved thank you very much alright weren't to department correction border corrections. Good morning again if you would name a title for the record please good morning tony ral chief legal council department of corrections. And I have two rules and they really go hand in hand the first is what we promulgate it as a new rule act one thirty three of this past session required that instead of having a twenty day window in which county jails can submit a complete and accurate sentencing order in order to have payment back dated to the date of sentencing that kind of no matter when they got that complete inaccurate sentencing order that reimbursement that they get for holding state prisoners and for qualified medical expenses does back date to the date of sentencing. The portion that deals with reimbursement for cost of care did not require rule making am so what you have in front of you is remaking for just the medical care reimbursement portion of that we had an existing rule that applied only to the division of correction and didn't. Ditten really account for current process and procedure it was such a big revision that instead of amending that rule in making it apply to both we decided it was first to just repeal the initial rule and create a new one. And so effectively this provides that if we have an inmate in county jail who has some emergent medical need that's related to their incarceration and the division of correction is either going to reimburse them for them for their medical expenses or fast track then into the division of correction so that are medical contractor can take care of that. Uhm we have a process set out in the rule whereby they contact the medical services administrator for the department of correction and she makes a determination forward so that up to the division director to set out whether it's more cost effective for us to reimburse the county for that care or whether that individual just needs to be bright end to one of our facilities and I you know I think that that's pretty much covers what it does provides a little more protection for our counties as far as making sure that they can be reimbursed can you questions from members on this and cash spoke to both them but what's are there any questions on the the first one which is the medical expense reimburse. K. And then without objection in this rule be reviewed and approved any additional information you want to give on the second one you kind of spoke to it the repeal just that it's a repeal of a rule that's covered by the new one now but now so applies to both divisions okay i've got one quick question no other members have it show what if there's a what if there's a disagreement as far as the individual makes that choices are appeal processed for the county or house that resolved if the county thanks a disreally the sin make really need to go with the other person says no. And so if we down fast track that person in to the division of correction we're on the hook for providing reimbursement for what the county spends to take care of them for those emergent medical needs this isn't going to be really simple things like inhalers or you know we second medication for fluid or attention but if they have some severe medical need then it's really in the department's best interest or fast track them and get them on our medical contract okay any questions for members. And without objections rules reviewed approved thank you all right then that was on a tin so on to the department of health. Then we start off on page twenty members. And good morning all if you would please name and turn off for the record and your recognition to present. Morning chair and community members and david darson general council affordable nursing. Matt your more apartment. Good morning we have some changes in several chapters in some chapters have. More than one change would you like me to go through the entire chapter and then for each chapter I think so expeditiously would be great okay i'll refer to page numbers. I was using what was provided by blower on the website on. On proposed copy of the rules changes well I will first say that these rules were represented to the public health committee a week before last year let me interrupt you for a second the rules are on them on the web site so members want to take a look at those in group to the website and before you a further senate. Also they provided a really great hand out that was kind of a sinopsis and two s and public health i'm not sure if that's also posted on the website it should have been maybe under a hand out and for that public health committee but that was a very good. I guess I would just refer people back to that but and we can for that the chair and it for that over yeah yeah it would be helpful to have had today as well but but it was very very good and appreciated so we went through the use very very clearly but matt you think where you should know you could have messaged somebody get that sent to stare for a quote we'll try to push it out just give you all the younger copies yeah they'll be great. Okay thank you all right they've go ahead and go in short again okay thank you page one dash four in chapter one it and. It added clinical nurse specialist to the definition of four practice authority and this was in compliance with. Act eight seventy two of two thousand twenty three. Then the right clinical and are specialist to those being allowed to apply for full independent practice authority. On page. One day. Er added the definition of program outcomes this was known at the request of the educational programs because they're crediting agencies where requiring them to provide program outcomes as part of the credit decent process and the education facilities one that be consistent. And so they would know and can have some guidelines of what information they needed for right as a program outcome so this definition was added at their request. In the end pages one day seven to one dash a. These removed some fees that are no longer applicable. Members having questions on this one. Right then without objection this rule is going to be reviewed and approved in one two chapter two yes on chapter two pages two days three through two dash seven these are the nurse lasted your compact rules. These rules are part of the compact arkansas are so as a compact state there are forty other states in a few other states that are in the process of implementing the campaign currently and when you when you join the come back to agree to have joint rules to where every state is consistent and these rules are reviewed periodically by the. Commission nurse and arkansas has representation on the commission there's public comment there's discussion it's kind of a year long process to do this. And this is their most recent update so we're just incorporated the changes. A lot of a lot of things were were. Change just to can I update to modern practice the only sensitive change I think was there is a sixty day. The. It requires licensees if they have a multi state license you know you have to have a license in your primary state of residence then you can practice in other state on your multi state license if you move to another state then you're required to change your primary state of residence to that new state that you live in. And they actually have the license that states you live in now has the actual nursing license and so. And. They have to do that within sixty days if they moved to another state now. Aren't members having questions. Then without objections to rule is reviewed and approved and chapter six ok I think there were a couple of other in chapter two. This. On page two days and earn that was just a correction to the stats to reference the criminal bar statute was consolidated a few years ago and for all boards and commissions into one statute and we inadvertently did not change the reference in her rules and so. And her eye we've changed their to the correct state story reference and then under l that was removed because all of that information it's in there is now contained in the current states you seventeen days three days one or two so it's no longer necessary all right then regain questions. All right then with that objections rules reviewed. And approved. The. All right okay next the next one is chapter six. And on page six dash one the joint commission on a creditation of health care organizations has changed its name to and just shorned it to the joint commission so we we took that later poor the name out of there on six dash one. On page six s three. The conditional approval status was changed town from one year to two years in that's consistent with the timelines that we have for the institutions in other parts of the rules. The. Page six dash five and six test six the. Act six seventy two two thousand and twenty three established the nursing earned to learn program and an. And so these changes on on both of these pages were necessary in order to comply. With the earned a learn program primarily preceptors. Are allowed. To be utilized now and in also the under three c on dash six six it says that there's previously there shouldn't be any reimbursement to students for educational receptorship and the acts allows that now. Members any questions. N i'm sorry there is one other on page six dash nine that's where they earn to learn program kind of the meat of the statute is included in the rules and the requirements that you see there at staff the page. Or taken straight out of state okay. All right questions for members. The objection and rule is reviewed approved next next is chapter seven. This is the chapter regarding discipline so on page seven dash five you'll see at the very tap the term for one of them definitions for friday deceit. Is providing false implement information on an application when the rule was initially written the applications were for you know license applications now nurses also were able to apply for prescriptive authority and for a full practice authority in this just adds this to the definition. That if you're going to provide if you provide false information on any application you you might be subject to display. Okay any questions for members that objection rules reviewed approved next. Thank you chapter eight m these are being amended to land with the current stance. Act. Three sixty five of twenty twenty three year ballist many of the inactive state agency will only back up i'm sorry it's on page eight days nine. We just changed stats toward reference we noticed that the the the requirements that were in a previous statute were moved to a different statute. And so we were changing to make sure we have the correct statutory reference there in their own page eight dash eleven. Home act three six five twenty three abolish many inactive state entities there was previously a advantage committee. For. This advantage committee was a ballist by the acting at the last legislative session so this the rules regarding that have been removed in the in the last section on. Eight days eleven. Or the uniform service members in veterans and spouses of service members that we changed also when chapter two it's just the same exact changes here. Okay required by stats you are sorry a questions remembered then without objection the rule is reviewed and approved the next one right this rural here these rules are joint rules between the department of education and the nursing board and. Two years ago the these rails for were submitted and approved bad that probably education appeared at the at the meeting at their term I was under the impression that it was a joint that the girls are being submitted jointly a sense have found out that the only rules that were approved that day were department of education rules they're identical to these rules the same exact wording is these rules. And but when we were going to the the process when the code reviews and the uh BLR folks who were establishing the new code of archaeo rules they did our rules this past year and they looked at the history of these rules and they said there's these haven't been approved pursuant to the administrative procedures act and so we're doing it now. Um to make sure that we comply with administrative procedures act. A questions members. And without objection as rules reviewed and approved under ten in a tin and. In addition to licensing various levels of nursing archaeological nursing also provides. It monsters certifications profile certifications to medication assisted certified individuals in the legislature through act two thirty four of twenty twenty three. Change the statute for the alternative to discipline program that previously was. Was set up for nurses it also allows these medication assisted certified individuals to take advantage of the alternative to discipline program if they qualify and so all this language in here. In the entire chapter changes the wording to add. Certification in addition to license individuals are had any other questions for members. Objection rules reviewed and approved and checked her loan. Thank you and. Dear in the. Twenty twenty one let's slave session act for twelve was passed which permitted. Certified nurse practitioners to play for full independent practice. And here in a last legislative station the act was through vaz to. Include clinical nurse specialist in addition to. And so for a nurse practice is being able author as to a platform pin practice. In also the original act did not have a provision that allowed people who were. Practice in a state that already had independent practice to be able to transferred arkansas so the wording was changed to allow that it allowed people who had. Who practiced under a collaborative practice agreement in another state to to move to arkansas but not those individuals who were already practing in independent practice date and so. The changes you see in chapter eleven reflect the changes may be a state. Said urban. Actually it's not a question on this rule and just have a general question when we're done okay. Any any questions on this rule. Can you guess like in a minor lush do you have the ability to tell me where we are in the process of those that have applied through the independent practice and in the numbers where we are yes and. I don't know a lot but II did here assistant director over advanced practice mentioned to the board at the meeting and a couple of weeks ago that they are over four hundred people individuals now who have been granted independent practice they the committee and has been working very hard and you know because this is initial thing they they have lots of airports to review and their meetings are pretty long every time that they meet. There's they're better get on top of things I do kind of sitting in and listen to those meetings even though they have a separate legal council from the attorney general's office who help who assist them. And I think they're bad to get on top of the initial wave of initial applicants to wear they they can have less applicants in unfortunately they have getting into one discipline issue with someone in that person agreed to uh constant agreement to be able to withdraw their independent practice for a certain amount of time and then apply later once they do a few things okay good at eighteen no sir we smith or the report stopper would health committee I think those are email but we can share the most recent one with you asking if you'd like and yes gives the numbers and breakdown they'll be great thank you all right centers you might have come in after this but need questions on the rule. Then with objections rules reviewed improve senator urban you want a little just a quick question on the arkansas representation on the compact license your board how is that selected or who is that are consult representation it's the executor direct executive director and the board president. So the executive director of the nursing board mister okay miss okay some is temporarily the executive officer for each is the member of the commission and also the president of each board. Okay okay and as that base are statute or about theirs there are rules yeah the compact the compounds come nurse license or compare requirements okay thank you I just wanted to make sure I was clear about who that was thank you. Okay touch it for you to next department health state board. Health under nine rules for critical excess hospital thank you thank you for being here. And if you're would please name a town for the record when you take seat in your recognized proceed on page twenty nine members. Thank you mister chair members of the committee i'm lara su i'm general council for the department of health thank you holiday m section change the services for the architect department which are moan just a little close on the market please thank you and then you recognize to present. Thank you mister chair we first am have the rules for critical access hospitals in arkansas the rules are implementing seven acts from twenty twenty three it includes a provision for pharmacy you continuity of care under act who thirty three it requires posting at the written notice that attacking a health care worker professional as a felony under act three thirteen it requires hospitals in this act to comply with federal hospital pricing transparency regulations under act four eighty two it requires hospitals to comply with abortion right to know and see act under act five five nine it immense that no patient left alone act regarding clergy members under act seven sixteen and it amends the patient right to know regarding license of a health care provider under act eight thirty it also clarifies that the performance and of an abortion to save the life of a pregnant woman in a medical emergency may be performed only in a hospital or emergency room under act eight forty eight we may these amendments and at what health approved this rule at we have had a public commit period we received no public comments and this rule was reviewed by the public health committee last week then we're happy to take any questions in questions for members. With the objection of the rule is reviewed and approves are at next page thirty one. Thank you mr chair with the rules for hospitals and related institutions in arkansas these are implementing the exact same acts as a we stated for the critical access hospitals the seven max under twenty twenty three that we stated earlier we had a public hearing we received no public comments and we're happy to take any questions any questions members. Then without objections rules reviewed and approved the freestanding birthday center. Thank you mister chair the rules for free standing birthing centers in arkansas are implementing eight forty eight which were am amending to state that abortion can only be performed to save the life of a pregnant woman and may only be performed in a hospital or emergency room it also out of a requirement for written notice regarding the attacking of a healthcare professional under act three thirteen. And act eight thirty which out of the requirement regarding healthcare providers not misleading the public regarding their license or status we had a public comment period it expired and we received a no public comments and were happy to take any questions and questions members of that rejection the rule is reviewed and approved private care agencies thank you mr chair with the rules for private care agencies in arkansas there were implementing three acts including act seventy which means the promulgation excuse me the rule to add a training requirements to include alzheimer's disease and dementia training under actory thirteen it requires the posting of the written notice and am also act eight thirty which amended the patient right to know act and we had a public comment period and we received no public comments and were happy to take any questions in questions members. Then with that objection this rule is reviewed and approved rules for home health with the rules for home health we added a the amendments to the rules for at three thirteen at eight thirty and act seventy we had a public comment period and we received no comments and were happy to take any questions any questions members. Then without objections rule is reviewed and approved and rules for hospitals and finally with the rules for hospitals in arkansas we added four acts the requirement for the written notice under actually thirteen the requirement for healthcare providers not misleading the public regarding their license or under act eight thirty and adding the training requirements for alzheimer's disease and dimension for hospital's aids under act seventy and also amending to address the clergy member visitation under act seven sixteen of twenty twenty three we had a public commit period and we received no public comments and this was also reviewed by public health and and we are happy to take any questions questions members. And without objections rule is reviewed and approved thank you very much green here today are run out of the department human services on the division medical services if we can get the former come up and before you give your name and total and recognize present members understand or probably be a lot of discussion on this one just to establish how the chair intends to handle discussion more recognize members of the committee first and will recognize members that are not members of the committee after that and we'll chairs going to allow little attitude as far as the amount of questions and also discussion or take place by members but if I see the queue gets lined up before I may ask you to go to bottom of the and we do have people signed up to speak for against his three allies staff just check the list make sure if there's anybody else or may be very done that if you would just check the let's see if anybody else is saying to speak up for against this okay and with that as girl to keep your action name and title for the record police good morning elizabeth pittman director for division of medical services good morning janet man DHS metro stupid staff dhs okay you're recognized present the first role is our role on continuously chris monitors and diabetics supplies and being offered through the pharmacy it is in it is to implement at three ninety three of the general session of twenty twenty three um dhs has interpreted that that act to require us to do two things once he make a cgms available in pharmacies with a prescription and then the second to be eligible for rebates as a pharmacy benefiting in order to accomplish both pieces of that act we have a we are proposing to implement the following rule which does allow both durable medical equipment providers in pharmacists to provide cgms and diabetics supplies. Through our point of sale pharmacy billing system and they are paid at a wholesale acquisition cost. I'm under this proposal and with that happy to take any questions. Members having questioned. The. Seat b six sender right. Thank you could you address the comments that are read and land to the public posting people concerned about. That. Those who are not able to access I know what I had to be the older population you could have. Uh young people on each month in thanks but would you address they look like so ever a car means only at my concern. That he has been not use this but. Overall hold the steps were taking to reform for good reason we're trying to save money. But and we'll say it again publicly. We're giving. Governmental. Bureaucrats and agency had increases because there's inflation. Why do we do it out here. For. Providers vendors. And the public. To help them keep up with inflation and if we're taking services away from both that have to go sixty mile round triumph to a farmer see. If they have another option and i'm told there is another option. Would you address that that i'm pretty simply stick here but he knows that but i'm talking about the common people that don't have access to saying it has seen more and more staff were making it harder for them to be sir. Appreciate you yesterday i'll attempt a as best I can to address the concerns they raised and they are concerns were regarding members not being able or beneficiaries not being able to access cgms through a durable medical equipment provider in our initial form of the rule we did only allow pharmacies to provide it after receiving own initial round of comments and speaking with cms we change the rule to allow the terrible medical equipment providers in pharmacists to provide it but it is through a pharmacy so when we initially got those comments to be quite honest we were very confused as to why we why that was happening and why we were getting those so we met with the durable medical equipment providers. And it learns a little bit more about how this works. So won't we have come to understand is one of the manufacturers and that is involved in this one of the primary ones has two pricing systems that's that's prioritarian I can't tell you the prices II don't even know them really off the type of my head and but they give them a discount for doing it through what they call the government program that discount goes away when we move it over to pharmacy there they're then required to pay what's called the acquisition price what pharmacists would pay for it which is what we ultimately then reimburse them the wholesale acquisition cost even though our actual reimbursement is going up by about a hundred dollars their cost is also going up and so they are they're not making as much money off the product as they were before that is what we've come to understand and therefore what they would make is what we pay as a dispensing fee which right now is ten dollars and fifty cents per prescription. Generational. Okay. Thank you and II know we've talked about this I think for me walked me through the way I read this act which II supported opening a. I support my intention was to support it opening the serve through pharmacies but not to replace and move it from dme to pharmacy that was never my internet that doesn't open access such as ships from one to the other so explained to me why if it says that they we've written the rule to make this eligible to be eligible as a pharmacy benefit but the legislation doesn't mandate that it has to be a pharmacy benefit it could be both a medical benefit and a pharmacy benefit because the legislation does not dictate that that was your interpretation in the way that you wrote the rule. And I understand that the rebate follows the pharmacy benefit understand that as well but could you is there not a rebate through the medical device. But we don't make that determination. So I mean we don't make the determination whether the rebate through the medical device option. That's determined at the federal level through cms but just like with our work requirement we can ask for that and also meet the letter that legislation. Oh i'll I will start an elizabeth will follow up if at. Miss a speaker don't completely answer our understanding with working with cms the only way to obtain the rebate is through the pharmacy pricing which is the wholesale acquisition cost so we am moving it to the pharmacy and allowing dme and pharmacy to bill for that through the wholesale acquisition cost does open it up to be able to obtain the rebate at this time i'm i'm not aware of a way to obtain a benefit through the death of rebate excuse me through medical billing honored on the dme side. That's my understanding as well I asked our contractor we spoke with cms and i've spoken with my pharmacy program numerous times about whether or not we could claim the rebate on the medical side and the issue is the wholesale acquisition cost as well as on the medical side the way we bill you bill the claim adjudicates and we pay a week later you bill after you provide the service you can't prevail for a claim so once you've sent off that cgn then you come into our billing system in bill for pharmacy as soon as I elizabeth show up at the pharmacy and get a cgm they put that in the system realize i'm eligible for it it automatically adjudicates that claim has been determined paid that the requirement is to get the rebate that it'd be done on that automatic real time point of sale system. That's the other issue when at an and I know that we'll have people testifying and not have questions for them later but but but because of that you're increasing the administrative burden now on dmeas because they're going to have to maintain to different separate billing portals that's administrative burden and cost on them and then number two years said that it was specific to one drug manufacturer. Who is that. The one that has the separate pricing is dexcomacom is the company that has a separate pricing what about the other cgms they do not have separate pricing so so they learned let me just emphasize to our knowledge they don't in depth conversations with other vendors just I don't want to mislead one thank you that's thank you. There was any questions. See thirty six years. Representative richardson. Thank you mister so one expound on that just a little bit you said that the current reimbursement rate is ten dollars ninety five cents for a pharmacy pharmacy's cost associated with that are or of course the equipment itself and they're a little bit of overhead associate electricity whatever according to the pharmacy when we're dealing with it the direct delivery those individuals have other costs right there to share up there all of those other items that associated with their packaging time effort whatever are we reimbursing for that cost in addition to the ten dollars ninety five cents or is that considered all inclusive so let me clarify what I would I said earlier and what we reimburse a pharmacist is went the wholesale acquisition costs which is the cost of the drug so we do reimburse the pharmacist for the drug itself i'm at that wholesale acquisition costs if they are able to get the drug less than that then they they still keep the wholesale acquisition cost and then we additionally give them a dispensing speed which is ten dollars and fifty cents and for the drugs and for that supplies and question I that is account that accounts for whatever went into the rate study to do that dispensing fee and I don't know how long that's been and so that is to account for the cost of dispensing the drug at the pharmacy. Set so there's no way for the direct delivery to receive compensation reimbursement for the additional cost of providing these through a mail order environment is that what you're saying I would say that their dispensing fee that we haven't placed now doesn't account for that because that wasn't allowed under the methodology used. Ok and these are these are actually medical equipment not. Pharmacy where I thought it's a differentiator yesterday these are considered durable medical equipment so why doesn't the rule provide for the opportunity to ship this equipment and therefore provide reimbursement for that it dies allow for that the main issue is the pricing so there's no reimbursement you can ship it if you want to but it's going to be at your own cost. Essentially that is with a durable medical equipment providers are saying that is what is happening yesterday but it will raise the price by about a hundred dollars so that had to be brought to our attention when all of this case so pharmacies have the ability to ship these and i'm sure a lot of pharmacies out there do ship direct to individuals for certain types of equipment whatever but they're also absorbing the cost of the shipping. Internally right we don't reimburse them for that we would really only reimburse them what I said which would account for any of the cost associated would be that ten dollars and fifty cents yesterday so just the ten dollars but he since shipping a hundred pounds worth of equipment costume thousand backs week we give them ten dollars ok appreciate that that makes sense the other question that I have that still revolves and consultantly back around to I guess earlier conversations why are we not providing both mechanisms I know the rebates and we're letting the the vendors dictate to us how we are going to perform this and I understand the rebates but do we can we not just provide dual methods and just collect rebates on the ones that go through the pharmacy system and it allow the dmeast that direct medical equipment providers to to continue doing the way that they're doing we have the technical ability to do that with our system there are several issues with that from a but it seemed point and that i'm happy to discuss with it discuss here i'm one of them is what I just mentioned about the timing of the way we pay claims so i'm in essence because of the way we pay claims the dme providers are always kind of going to be the second to the door not because they're slow or anything like that just by the nature of how the services are provided and paid for um and so if we do set up edits in our system to say you can only receive one cgm and a durable medical equipment provider provides went to someone who already received one in a pharmacy without knowing that because our systems don't talk to each other in real time then they are not going to be able to get paid at all for that so that was one of our concerns in one of the reasons the other is because our systems don't talk to each other in real time it becomes very difficult to on it so I have my it team looking to see if there's anything we can do about that but our systems just have not historically been able to communicate that quickly with each other so that's one issue and that there is as we stated before we were we interpreted the rules to require us to attempt to collect the rebate the only way we could do that was to move it to the pharmacy. So the rebate that the interpretation sorry want one more mischief that them i'll put thanks in so the rebate is the driver for this the what I see from that is that whoever that does vendors are there driving. What we're going to choose to do in the state of arkansas based on the rules that you're creating we're allowing them to say this is how we're going to do it so we're not allowing for that extra mechanism right. Because of that that is one of the reasons because of the way the statute was written that's how we have read the statute that you know you guys can tell us reading differently but we have discussed with added sponsored poking representative pocking ten and and this is our interpretation of the statute based on those discussions thank you thank you mister represented painter thank you mister chair would this rule what is the per patient per month are cost to the state under the the whack pricing per patient per month I don't know that we have it broken down like that but we can definitely get it for you please get that to thank you. Going to ask up questions and we'll represent war golf thought by senator davis. First question is is this rural favouring one provider and making exclusive to one provider while excluding any other provider that could offer these services as well. We do not believe so we believe we're allowing both pharmacist interactive medical equipment providers to provide the rural and that the only to provide the service that has been our goal and intent all along we understand there are some concerns from the durable medical equipment equipment providers but it is not our intention or what we believe to be happening and also I would add that there is more than one vendor that does supply coast monitors that probably would have been the better question not provider vendor is this rule allowing. For one vendor exclusive or other vendors going to be able to provide as well yes sir we put multiple vendors on our preferred provider list and so multiple vendors will be able to provide this service and then the second question is a lot of this is built around the rebate discussion if understand it right. How are you guaranteed. That you're actually going to get a rebate once this ship sales what what are the guarantees that you're actually going to get a rebate that is actually going to do what it is stated as the intent. We have been in preliminary discussions with our our contractor i'm magellan who actually does our rebate agreements for us i'm and they have discussed permanent preliminarily with the manufacturer so we do believe we will be able to insurance rebate agreements for these products and not just the dexcon products but other brands as well and that is you know of course has to happen after the rule passes and after we began putting it on her pdl but right now we haven't understanding with those spenders and with our manufacturers are with our vendor contractor a majority a lot of hit it and then we'll go to the member states boards like that but what guarantee I mean because once the same job here. And we not lost control for that discussion in what's to say that they would actually do that so are prefer drug list is how we we determine. We use our prefer drug less to help incident to eyes manufacturers to intervene to you at rebate agreements with I so the drug the products that get on our pdl or do you have rebate agreements with us primarily and so that's one way we can use that and two to help get those rebates in place or it will go to more go to represent more like sufficient member of the committee go ahead and represent word things chair it's been a couple months that we had this discussion in here. Someone go back to representative richardson's question about the reimbursement rate. You mentioned that that reimbursement rate is going up to approximately a hundred dollars plus where it sat today is that true. I believe it is about a dollar increase it's going up in its based off of. Need act pricing correct. So that would mean that the cost to the providers going up as well. And we I think all this has been hast out so i'm not trying to rehas and this makes your members that are here today understand what we hash out to months ago. So we would be using the wholesale acquisition cost and to be. Just is transparent i'm not sure how that relates to a narrow cost so I don't want to say thing I work with them something oh exact same day and we have a law in the state arks all that you have to reimburse above that costs and that's the reason you guys are having to raise that price because that cost is going up to that point. Hope mischer yield for anything else got saturdays thank you mister chair I just want to clarify a few things from representative richardson's questions saying that we're letting a vendor dictate what we're doing here but. I'm a little bit affected by that I was the senate sponsor of this bill and the reason for this bill was am to push policy that increased access for patience across the state that have diabetes that need access to continuous glutes monitors. This is a really big issue we've been dealing with it over the last several years looking at legislation to increase access and this was dressed one more way of doing that by allowing it to be a pharmacy benefit and not just that but to provide huge savings to the state I mean when we presented this the fiscal impact statement was about four and a half million dollars in savings to the state. So providing it this way is something that I think we all agreed on those at least who bettered for this legislation. That we should increase as access through a pharmacy benefit which we are doing and the dme still have access to so if people have a preference to still continue to get their cgm through their dme they can continue to do that what we're debating here is how much dmes will make vs how much pharmacies will make what we should be debating is increased access to children to adults to elderly across our state who need access to cgms in a different way besides just through the means but also need access through pharmacy which this rule provides for you can still have access through your dme and you can get access to your pharmacy which was exactly the legislative intent of this bill and it also provides a cost savings for the state in the millions of dollars annually so I want to sort of set the record straight and said the town because we're really going off track here through the line of questioning I can hear were trying to say that a vendor is dictating policy in the state and that we're trying to you know make it close to just excom and that certainly isn't the case and I certainly wouldn't hear your piece of legislation that did that this is about kids about elderly about people across our state who have diabetes that need access to c g m not just through their dme but through their pharmacy where a lot of them get their insulin so we're making it even more convenient and efficient for these families to when they drive through their pharmacy to pick up their insult and they can also pick up their cgm that's what this is about increased access to quality care savings to the state it's not about one vendor it's not about who's going to make more money and wear. So I would like to shift this conversation please and let it be what it's about which is the legislative intent to increase care to increase access to care and to save money for the state that's what this is I know because I sponsored the bill I understand my legislative intent representative pilking ten sponsored the bill he understands his legislative and ten we've been debating this for almost a year and a half now actually years and the making to increase access just in general to cgms but we've been debating this for over a year now and we're just chasing our tail in circles it's time for us. To review this rule let people across the state have access to cgms through pharmacies as a pharmacy benefit as well and save money for our state we debate that every day. Why are we arguing about saving millions of dollars for our state and providing better quality of care to people across arkansas. That's what this is about that's what this debate is about and people in this room are trying to change it to something else that it's not. Thank you sanity of a question in there. Would you agree thank you ma'am. All right i'm ungo to representative pilkington thank you just a few questions and be sure so currently if you're on your state employee do you receive your cgm through a pharmacy benefit are there a benefit at the state employee plan does it through a pharmacy benefit okay is that the policy of most private industry that we often time say we prefer the boy private sector does it over the waste state control does it. I can't speak to that necessarily but I know that the the reason we did it on the state plan side was to get those rebates and to increase access so if you're a member of the legislature you can get your faster because it's there a pharmacy benefit and it says the same money and we get rebates for it so we're only asking that those on medicaid. Are able to receive it the same way that we would have our state employees receive it. Correct and and I could say you know I have a cgu personally I get it through my pharmacy um yeah really I get it directly through my internalities and they direct me to who I need to go to the to get my suppliers so thank you that's it. Are them a good to send her gilmore who's extra fish your member the committee and representative richardson thank you mister I just want to follow up on rivers and pilgrims on a question I think the consultant signal that we hired identified the car savings associated with this for outcomes in the future yeah familiar with that and i'll speak to that if you are seeing those numbers yes we have that we have those numbers do you remember what they are i'm sorry we haven't seen the single number you got one of your need turn off your mic there for okay we have not seen the single numbers or at least we don't have them at the table with us just to be clear the four and a half four point three million dollars of savings that senator davis referred to you with our physical analysis that we prepared and provided to both committees during session last year it was based upon cgm clients if there were six thousand that savings could potentially be four point three that we also modeled it based on thirty five hundred clients five thousand in all the way up to ten thousand clients to show the variation of potential savings thank you. All right more of center urban as I mention them or go to members first then to non member so senator irving. Europe do you currently have any rebate agreements with any pharmaceutical manufacturers of cgms. Right now currently in the state are any of them. Not to my knowledge but I we can confirm with the pharmacy team I don't know you've so so so specifically there's one vendor that's offering a potential rebate that that's why we are down to one vendor like there's potentially one vendor. Is that the others do we know if we are getting rebates from the other things we had identified two vendors that we asking the pharmacy team to be communications with are about a rebate one in communicate out but but we don't currently never we do not currently have a rebate agreement for cgms right with this rule would allow us due to have those conversations about continue those conversations okay but currently that's not something that we use done in the past but okay but but we could have by put them on the preferred list and are current rule so without this legislation we actually could have done that worth current cgms via placing them on the prefer less without having a directive I mean we don't have a direct devine exactly you know blood pressure medication. We we we don't the only reason i'm i'm pausing is I would need to think that it think that through because. In the medicaid program cgms are listed as a home health benefit and they're reported that way which we have testified to you priviously in committee and the service delivery model in the reimbursement model that allows the rebate is through the pharmacy and through the house acquisition cost that the intriguers the ability to have the rebate set I don't know so so so use you said you said that they they follow a different rate schedule than the other stuff. So can you can you does can you elaborate on that yes so during the conversation when this rule was being drafted in communications with the dme providers and others we learned that there is a government fee schedule in a commercial fee schedule that was new information for us we learned that with one vendor I don't know that that does or does not exist with other vendors that lead to some of the discrepancies of the cost being higher on the wholesale acquisition cost of approximately a hundred dollars so and we know about it with with one vendor we don't know about it with any other and that's why we're trying to say this is there's a specific scenario for this one vendor because of the rate schedule they fall over that is different than the others yes and then and then the medicaid population is is very very different than the state employee population. Am I wait we have we acknowledge that through our policies and through our health care programs. The medicaid populations are are different it's a different population they require a different level of engagement and we have done that consistently with a lot of different programs I found it a little difficult to say that we can treat the medicaid population like everybody else when these are people that are struggling with a lot a lot of issues that are not as compliant generally speaking as you are sitting there at the time. I would not compete in and I i'm not trying to be. Difficult i'm not trying to be but i'm just saying there is a huge difference and we deal with the medicare population and those policies and those programs are vastly vastly different for a very good reasons because of trying to be sensitive and understanding to their situations of their economic situations and they're disabilities so they do require more of an engagement more of an assistance and so you know I have a great concern about treating everybody the same because they're just not and II think we have to be familiar and understanding of that or talking about medicaid population which is one of my big concerns with this rule and shifting shifting there's you know pricing some out a certain pricing providers out of being able to do what they have traditionally done for our medicaid population I have a problem with that so bit but that's that's me i'll i'll continue and have questions later thank you members senator and will give you a snapshot where we are I got four on the board so what i'm going to ask in some of these are repeat and then summer new member so and we've got three people that want to let testify and we still have rules to go and i'm not going to recess for lunch so here's what i'm i'm going to ask you i'm on and we'll come back and we'll go to the members first non members I don't have anybody else on the board and I think we've pretty well discussed this is much and I want to get to the witnesses and so if you will please just keep that in mind so going to the members on the board if you will kind of shorten it up at this point moving on and I want to go to representative and i'll tell you what to keep is going to represent it painter i've got center dismay that now has joined in represent first and yourself board not a member and then I got representative ward law is the last. Okay so here we go representative painter thank you mister chairman my questions just really short how many cgu medicaid patients are there in the state. Um I think yesterday to outlet me confirm but yesterday we were talking around fifteen hundred to two thousand I would say would they just recently changed medicare policy to increase who has access to a cgm through medicare and we will often follow that so we may see more a very similar all right thank you and senator dislike thank you in a imminent wish we were kind of debating a little bit more about where we're not following in time vs. You know following the law and i'll switch things but i'll just because we were talking about it mean what is the difference of access or whatever it may be for medicaid patient who cannot hurt a little bit there may be some downside depiviting to doing what we're talking about doing even though it's saving some money what what is the downside of what what is the negative benefit going to be to the medicaid recipient you know trying to get this good. So senator we we don't see one from our perspective we see this as opening access because we're inviting an entirely new provider type to offer the service through a pharmacy where a lot of people have to go anyway to receive their drugs and that they receive through medicaid so our position has been that now I know the dme providers believe that this is going to adversely affect them to the point where they may not be able to provide the service anymore and that could potentially limit access and they can speak more to why they fill that way but our position is that this is opening it up to an entirely new group of providers who can offer access to your beneficiaries in a new way that they don't already have a never can expand on that too it also to the point of savings the savings get spread out over the medicaid program so you know that that helps all of our beneficiaries as well and the route that we've chosen you know going through the point of sale system as opposed to having some kind of dual system that would open an app to fraud waste an abuse it limits that ability to have that fraud waste an abuse so those are all positive savings increased access reduced fraud waste and it reduces it does not eliminate you will never get rid of fraud wasting abuse I can say a pay i'll see you got cut off going thank you and in but. Instant i'm not so. Do these same medicaid patients to have to go to the pharmacy anyway to get their installment is that i'll direct shipment is at all through these other entities I mean how does that work are they having to go to the pharmacy anyway into your point it's kind of a one start up for you on on how you you last so this roll actually moves all diabetics supplies and to that benefit so they would be able to get there in sline just the same way that they get their cgms and the restricts and all of that good stuff i'm so they have options there just as they do here what we're trying to present as options for a clients if they are on other prescription medicines that aren't related to insulin diabetic structures those types of things than yes they may have to go to the pharmacy to get this. Senator center gilmore's member rick me sir gilmore. Senator gilmore yeah so thank you sorry there were some conversation happening around me so I just kind of want to circle back to what's already been said by senators making senator davis. This rule meets the legislation attempt as used as you read it correct. Yes okay and the members here who ran the bill also state it meets legislative tent is that what i've heard but I think i've seen some headlights to that affair correct so I guess i'm just trying to figure out two with the discussion is because that's our job in this committee and i'm i'm happy to defer the character deemed otherwise but I think our job in this committee is determined whether or not the rules mean legislative intent which it sounds like it is so I just I just want to offer that so thank you for answering my questions alright we're going down to a more recognized school chair representative and then first and then more law i'm sorry richardson then word law thank you mister chair so my question is. Federally is this legal for us to do this yes ma'am and they approved the spar on march nineteenth I believe twenty eight and we have no federal issues. Nominal okay thank you representative richer and if you will just keep it reviewed to placer thank you absolutely I think for recording as me again miss chair I won't get circle back around to the numbers just just briefly can you tell me how many currently patience across the state are receiving these benefits through a direct male kind of situation how many are we going to impact. II don't know the number of the top of my head that are receiving a direct through male and we had some conversations yesterday with my south internally to answer some of the questions that we knew we were going to get today and my understanding as we have about. An fifteen hundred to two thousand beneficiaries who receive cgms in case of fifteen hundred to two thousand people will potentially be impacted and need to go to potentially depending on how shipping now that kind of step works out for direct providers could potentially have to change to provide to a pharmacy to be to receive these benefits. So we we don't believe that to be true like said earlier we believe we're opening access apps you allow options not worse would be fifteen hundred thousand thank you very much thank you represent morgan. So when you read a statute in the go off over served his main and senator gilmore slightly laid out. Do you guys interpret to step due to eliminate the dme option today. No we do not thank you and touch you'd say that if you got a line thirty four on page two section c. It says coverage for the continuous glue cost monday show allowable beneficiary to go to a pharmacy and must receive a benefit or can be eligible for benefit is exact words so why would you bring us a rule that shuts down the d and meet benefit which is what this rule nurse. If you see it as opening access and a new option one up bring a rule that open up that option but allow the deme option to stay the way it is. We don't believe this rough to be shutting down the dme benefit it's still allowing that to be provided by calls in the dme companies to be like a pharmacy in this rule and they're not a farmers you're requiring them to go to a mac pricing to a wholesale pricing you are taking away the current diameter benefit that you just said this law doesn't take away. And that's my issue with this rule is it does valid state law because you just in your own emission said it did not eliminate that benefit and I just read the law and looked over the law with one of the sponsors it now we're in this law did it in the language that it a stroke did it strike the current benefit. Nowhere in this rule or law does it say that dme cannot provide the benefit of lucas you're changing the method they provide correctly yes we are changing the delivery method and it says does the law say you have to change that method it well the law triggers the change when it says online thirty six and be eligible for a rebate as a pharmacy benefit so that's right there's a farms you benefit which this opens up a whole nother benefit that wasn't there correct. A whole nother benefit opens up the pharmacy benefit for cgfs. I think tap hopefully i'm answering your question if not apologize but the only way we could capture rebates was going through the point of sale pharmacy system so in order to comply with them so you're interpreting this as it has to be eligible for benefit in either option to move forward. In our conversations with cms we've brought this rule before your multiple time they have been here and so we pulled it down the first time through conversations with cms. And there was discussion about the fact that it is considered a home health benefit under the medicaid program at the federal level and can be delivered through the pharmacy benefit to increase access so working with cms and updating the rule it has to go through a point of sale with hostile acquisition costs cost reimbursement to be available for the rebate. We don't have a way to do a wholesale reacquisition cost through any other methodology to accept a point of sale system through the pharmacy. This. So that's why we interpreted it that it's not necessarily closing down dnmt it is asking to meet to participate but they would have to build differently where does it say that in the law it doesn't say it explicitly and it says to be eligible for the rebate if the only way we can obtain the rebate is through the pharmacy point of sale system and with the wholesale acquisition cost with that would have given cms approval that's how we interpreted it. All right. Still going i'm still taken I just don't I want to go back to their agreement that it did not cut out the dimmy benefit therefore and it does it say in section see that the damage benefit has to be eligible for rebate it says the pharmacy benefit has to be eligible for rebate. And I just found it hard to believe that this rule doesn't violate the law because it is absolutely changing the dme benefit and and i'd give you a chance to reply the way that i've read this and as dms for the ones obligated to put this into effect is the coverage is what has to be eligible for a rebate like a pharmacy benefit or as a pharmacy benefit that's how we read and interpreted the statute and and why we felt like it triggered us moving it towards the pharmacy program. As the way to deliver well and if I can add a point of distinction I think but I think you know yes we did move this to a pharmacy benefit to capture those pharmacy rebates we did not cut out suggiums but I think the distinction and I think this is what you're trying to get at we we are requiring that the me's to change the system that they use for cgouds and the reason we're doing that is to capture those rebates and that that is requiring a change on the dme's part but they are still able to provide cgms. They're through the way that we are implementing this rule. The. A pressure representative were law. If I could I have a motion at property here I got sent her urban center dismayne i'm cutting it off after that no disrespecting member senator urban if you will short your size to center dismay please thank you go ahead center urban yeah and and it in just a response on online thirty four when it says coverage for a continuous click as monitoring. Device. So so that's what's confusing me we don't say that it has to be for all. So you so you have it as a home health benefit correct under the federal walls from medicaid it is a home health benefit and I understand how you're saying it i'd still I still think this is written we're not written collect correctly that it says that the beneficiary receives a rebate not i've discussed that with your way that this is written to me that should have been instead of a sea it should have been at three under b instead of us a whole nother thought because I have a problem with the way this is written that it to me says that the beneficiaries the one that's should receive a rebate instead of the medicaid program which we know that that doesn't take place but that's a problem on the way this was written in my opinion but. But but that's what i'm trying to square is that you have a home health benefit legally it is a home health benefit under federal laws. Under the cms guidelines. Both but we are effectively taking that away because it will never no longer be a home health benefit for dme only a pharmacy benefit and that's where I don't see that language in here understand the rebate part of it but who's to say that you but that a rebate couldn't be established federally when it when that rule changes. And so so I don't understand why we we've cannot done this wholesale complete swap and not allowed for it to be considered legally federally as a home health benefit and legally considered as a pharmacy benefit at the same time which does not then create the incredible destruction potentially for two thousand people that are receiving that through deaths. With all that goes with that so that I guess that's an a and I guess it gets back to the I mean i'll let your respond i'll begin in others can join a think having a dual benefit opened up the agency and the medicaid program to fraud waste an abuse which we had testified previously that does cause us great consign it also causes as operational concerns of what elizabeth testified to earlier that if it's a pharmacy point of sale system so due to catered right at that moment its veiled and in its completed if the dme then completes it later and they've paid for it in and delivered the device in in good faith but because it's a duplication they medicaid agency can't pay for that and so that leads to natural conflict so trying to reduce operational inefficiencies and putting it in one location for the pharmacy benefit I believe opens of the access dme has the option to build through pharmacy using this rule we we feel I think at the base of this conversation I think the difference in the reimbursement is what has lead to a lot of this discussion in in concern that everyone has voiced we we have tried to look at bundling versus unbundling we have tried to look at different options but when cms gave us their feedback and their questions and said we needed to modify the rule we went with the wholesale acquisition cost in the dispensing fee and presented it and too I just overall I would I have great concerns with opening up a dual benefit and I don't think that I have I don't think the agency has removed dme from this process we've changed the way they bill it and. In and apparently that's lead to a lot of conversation. And if I can add to that I think one of your questions may be is why rebate is an allowed on the home health side or the dme side and and that's just that that's something we don't have any control over right now the system not our system right exactly and just like it well. It's not really I mean I think some of that is manufacturer control the not to cms control to cfr I think it's forty two cfr four forty seven point five oh nine that outlines the the pharmacy medicaid pharmacy drug rebate program I believe is the exact name of it that creates this opportunity and okay among those things display them we're going to get to test myself sir display thank you and i'm in our honestly feel like we just need to move on to the debate on whether or not this is falling legislative to internet it's where we are which is where we need to scan it stay a minute I guess my my comment to the chair would just be if we're going to get into a bunch of back and forth of whether or not this is a good idea a bad idea that that all settled itself out when the law was best and at this point we're just talking about internet if we're following into and I think we've already satisfied the fact that it's email says that you can do this and it's not conflicting with federal law. So my question really goes back to cause i'm now trying to read the bill and so I think if i'm understanding a right because we added to the definition. Of glucas monitors the requirement of a rebate that the only way that you can achieve a rebate is through making in a pharmacy benefit which means that this all has to change for everybody else it's involved in supplying the product is that fair yes and then my second question in this goes to intent and I haven't gotten a chance to see it here but when you are did you analysis and it was before us and we're looking at it and you're showing that there's going to be a savings that that contemplate a dual system order was it already understood that that means everyone one is moving to a to order to receive the rebate was moving to a pharmacy benefit. Because that speaks to me a lot about maybe that we didn't recognize what our intent was at the time but it was pretty explicitly laid out if that was in what you provided is you know to us and that's what I don't know so it how did you do your calculations with a dual or was it based purely on the fact that there was going to be a rebate allowed or required. We looked at whether or not a rebate would be required for anyone receiving the service regardless of who was providing it and so as much as I hate to say it or whatever I don't hate saving of this I mean it is much as it's just more I think the realization is like it's hard to argue that it didn't meet intent when there was a piece of paper put in front of his saying that everybody was going to be subject to rebate in the way that you can get a rebate. Is by being part of a pharmacy benefit. II just don't i'd like to I hope we move pretty quick because I think we're going to get into a bunch of back and forth it doesn't really fit the narrative of what were tasked to do because we're trying to relitigate a bill that has already passed me come law so thank you. Heard thank you and just as a reference and we're on call up the foreign against at the beginning of the discussion I made the comment that this is a knew it was going to be a lengthy debate we have to allow for reasonable opportunity for the public comment and it is a weighty matter so gave a little attitude but I made that statement before we began to debate on this bill at this point like two invite and we're gonna do because I have two against one for redo against ford against when I will white who signed up to speak against it comportant if you will please sir your comments direct into the point there will be opportunity for questions afterwards but let's keep it to what's been mentioned as far as the intent if you would please come forward and if you would state your name and who you represent please for the record. Yeah. I'm brad wine by share architect medically community providers president pity gene medical supply okay ergo it. Yeah. Ah. The. The. I just i'm going to keep it short I think there was a lot of wonderful comments. I think i. Before the association was founded I think the way the cause I think it does come down to intent. And the word allow I as my industry had our nose down work in really was a little bit of misdirection on where we thought maybe this was going because our heart has always been since we shared a meeting in proven access as part of the home health benefit dmease and the homes we see the impact that this has happened on our cansons and this is a generational impact for arkansas medicaid I mean the the diabetes the arkansas medicaid diabetes spend every year is tremendous and and this is a lot of this generational not behavior a health but eating habits and the way we cope with emotions here in arkansas and for me to see patiences are on sitting at third kitchen table I have seen them change the way they e with a cause they're getting the diagnostic information pushed to them on their phone where they're finally able to see what the doctors been preaching for years and they're seeing what happens when you have to have twenties after lunch and what that does do their billing sugar and and how that begins to change their their eating habits not just how it's impact in their life but their kids sitting on the couch and their grandkids plan in the floor. I see how we can change the trade actory of our medicaid spend so when we talk about savings I think this is so much broader than a rebate savings and the mystery rebate savings then when we ask questions about it they say per prioritary or we won't give the answer and as we're talking about expanding access it really is down to one manufacturer this participating and whack wholesale acquisition cost pricing and you as we look at how do we expand access. But adding extra providers that can connect points for the community as we're talking about that expanded access it can't be a narrow exclusive conversation and that's what I see happening as it's one manufacturer out of california that way back when the original comment back in twenty twenty one for at six four three that first expanded the coverage for cgn. That manufacturer was already making comments trying to steer how arkansas was going to recharge public and how we how we were going to reach our medicaid population so I want to be open to any questions that I might be able to to answer for the representatives I think everyone here is is well intended and wants to see an increased excess i'm just here because I feel like that my industry is getting caught you know as as it was stated on you know the pricing methodology that was used was all based on price pharmacy pricing pharmacy delivery pharmacy outcomes and pharmacy rebate and it's not as simple to take a and act it says allow expansion to pharmacy to take dme and make us. You know act like a pharmacy bar like a pharmacy service like a farmers were just we're home health benefit and always have been are what what we do is a lot different than drive through. And there's patience that are driving to get their insurance which is the prescription but this is a diagnostic piece. Then I read that i'm seeing our nationally a credited requirements for monthly case management and our plan of service that we have to do it initial set up an education i'm seeing yet. Affect how a patient utilizes this diagnostic piece of equipment if you got to take your pill and it's empty oh I got a drive to the pharmacy to pick it up or i'm out of insulin. But this is a censure that a lot of times we have to call and see miss jones you got five more days and if you don't are you prepared if you don't plan now to let me go ahead and send this to you are you prepared to **** your finger so that you can stay on top of your physical physicians are diabetes protocol so there's a huge opportunity for arkansas to change the long term trajectory spend of medicaid and how bad expensive diabetes is the manage and I just don't want to see a stumble coming out of the cgn blacks because. There's a single manufacturer based on a california present in a rebate and that's gonna drag us into a more initially more expensive you know I think everything everything adds up perfectly except wholesale acquisition costs is actually more expensive. The drive through model is more expensive than deeming we've been doing this and the patience home and direct to the patient for twenty eight to thirty percent less on the front end we're a built in savings for the state on these fifteen hundred patients we're doing it cheaper today. I've enter shift to the pharmacy is going to increase the price you know there's a another manufacturer is windows to and that's right could you begin because i've got to send it or once ask your question please. Okay said this man alright and thank you and and so. I'm in the laws written the way the laws written in our job here is pretty limited minute it's either it follows legislative and ten or dozen or breaks federal law state law in some way and that's really were were limited to the debate for the bill and it was back during the session you know and I guess really my question is are you able what is the drawback for the industry if it has to go through as a pharmacy benefit or is it something you're able to do and just don't. You know what will be burdensome but we can still do it or is it just something we're not going to be do you able to do it all because I understand that there is a benefit to some medicaid beneficiaries to have someone in the home helping understand monitor whatever it may be. Is it something you're going to be able to do or not. Because I said the way that I read it it's read in the way that it's written and noticed don't see your I don't I don't see how you how we can in the we would have to break law to be able to do something differently. So. I don't know that a deem in arkansas while I know the dedeeming and arkansas never process claims that a pharmacy major in portal could even tell you what it looks like I don't want to fortune tail also knows that's never been done in the history of arkansas as far as the pricing my price goes up to match case it's part of the designed model of what pricing my colleague knows more than the numbers on this but our pricing goes up to match that acquisition cost and you live off what's called a dispensing fee and the methodology for that was completely formulated off of a pharmacy business model so in essence the only way I could live in zepara became a pharmacy. And and I had an employee asked me that can we not just become a pharmacy in this and it's an update simple so it answer is no dme as a health benefit cannot live in this environment it cuts us out. Okay. All right thank you sir next up is going to be for chambers for we'd please come and you're a name and who you represent if you would please keep comments directed toward the intent please. Thank you mister chair john borrow I am with capital advisors group re represent dexcom manufacturing. Appreciate your consideration today I think a lot of the points I was going to make remained by a sponsors and other legislators but I still wanted to speak because you know I think. Yet to the entire it's never easy sitting in your seats I think they're the hardest seats it's not easy they're probably not an easy seat in the building I think sometimes it's frustrating when people describe motives to actions without knowing and I try to never do that I don't know it's a lot of that standard but I try to encourage people and myself deliver up to that standard so of nothing else I wanted to speak today to say all the ascribing motive to force someone out of a market or something big that out of state company nothing could be further from the truth I think if I were ask all of you and it in a very general way where do you go to full prescription you'd say a pharmacy that needs nf I ask you should this if the state's gonna buy which it should they pay one price in the best price for that which is I think you'd say yes and in the end that's what this bill does it's what this rule does I do want to address a couple of specific points that senator is buying us a question about insulin on state medicaid you do have to be a proof a diagnosed diabetic to border type to to qualify for a cgum so you are already going to a pharmacy to get your ensure you are well and grained into a pharmacy channel that is where you go to get insulin and probably other things now you will be able to get your cgm with the same place you can absolutely still get it through a near me but the state is going to pay one price in the lowest price I think in the end this does come down to a concern about access I think if we if there was two public health hearings on this topic it was held at one it advanced that the other there is multiple providers there to speak in some submitted letters the head of intercollege was in regional submitted a letter to the committee at public health that talked about the problems in the delays that come when you have to give the cgl from a dme snow maybe no fault of their own assist the reality of the system versus being able to go to a pharmacy to pick it up when it's prescribed they are truly live saving devices my father has one it's kept in from passing out. The field for a third time no because my sugar got too low the easier to get the better their major cost avoidance for health plans which is my every single one of us in this room if we're prescribed to see to young will go to a pharmacy to get one it's what commercial plan to do it's what the state ebd does only medicaid and limits it to a dmba this rule correct that III think it's imported to bring it back to access and I think the rebate is secondary that that was a report on my dhs with the legislation it's been public for a year and a half I can't get in the you know some of the discussion around unit prices in this that whack in made act all those things I know that the the report my dhs was presented with the bill that senator does that was pointed out that stipulated the rebate which is where the car savings some from it's pretty rare that you can have a chance to make a product more accessible at a spot where the patients already going to save the state money and say the federal government money but but that's what this rule does I would say that if if the dmes want to run legislation that says that they should be paid more than a pharmacy obviously that something they can ask for but I think at this time in the setting the appropriate discussion is about legislative internet or violation of federal law and since has already approved this rule it's been active since april the law has been active since all last august we do not believe it violates legislative internet and I don't believe it is inconsistent with state or federal wall that has always been the standard in this committee and I would ask you to stick with that standard today but moving forward would be happy to be a part of any discussion that makes dabate supplies more available to our kansas because it's an important one and it should be ongoing and we're happy to participate in that but we would ask you to review the rule today or not map it answer the questions thank you those particular time to the german and there's no questions but thank you very much for being here on to the last which is against machi. I think that shown the courier machoy michel mccurry to a please come your speaker against I would ask you to speak to the intent also mindful of the thoughts have been expressed already that match what you are intending to say if you would just be mindful that we very heard those and please speak to the intent and the members were going to move after that. Thank you a name and who you represent for the record please good afternoon and shaun macquarie and the president of eclipse medical amounts of the president of the newly formed arkansas medical equipment providers association here in the state. Quick again I want to be respectful of everyone's time today and II think for us in and I want to come out of the gate saying that as a dme owner here in arkansas are as the president of the article medical equipment providers association and all of our membership there's no one in that membership that opposes act three ninety three we fully support what we considered the intent of act three ninety three to be which is broadening access by allowing pharmaceutics to now participate and provide cgn products the initial act which came into being a couple two and a half years ago which allowed the dmeast to build out this distribution channel to the medicaid population here in the state is what we have done is dme providers and we spoke the last two and a half for three years doing that and so I think that we fully support broading access and I also know that there is a way to achieve the goals of brought of broadening access allowing the pharmacies to participate in this product category allowing the state to receive rebates through the pharmacy and you can do that by a dual benefit there are states around the country that are doing this well states like ohio have a dual benefit program I know whether the concerns is fraud waste and abuse and has a demand you know we don't want to see that either one of the things that happens to us sometimes now is we make a claim that claim is also submitted to another supplier whoever gets that submission and first gets paid the other one is out the cost of goods. We don't like that so we try to run same or similar checks we try to do things it will prevent that we also believe very far only that there's a way for the state to do that through rule by having a dual benefit where claims can be adjudicated through the pharmacy side as proposed but they can also remain a home health benefit which they have been defined by CMS as we've always understood it to be a home health benefit we can run those through the dme side through the current system in place and we could have a form of a cross reference system where we use our current coating system are we we call a heckpics code we could run and cross verify that with another another number within the pharmacy portal to make sure that we're not double dipping as it were and creating fraud waste and abuse we would fully support that we would love to be involved in helping DHS you know come to come to a solution in that regard and so we look at an agent as as an association we want to be part of the process these architect medicaid patients need these products I think brad did a great job on on talking about that I will say very quickly we had AAA a young lady a girl a child who was a patient up in northwest side and saw she had a transplant surgery and ohio recently she spent a month in the hospital we had one of our staff mate members dedicated that patient who spent multiple hours coordinating with northwest are consult children's hospitals team coordinating with the staff in ohio where she had this surgery insuring that when she came out of that hospital she had the supplies she needed I think that mother's forever grateful and that didn't happen if the pharmacy level that's no knock on a pharmacy they're not designed to do that type of work but those are the types of things that we do is an organization so again I come back to internet we believe that intent was to broaden access open it up to multiple channels and I will say this sorry one last day. The wack proposed a pricing model raises our cost by two hundred dollars in it brings our cost up by two hundred dollars which is a equivalent to what the whack reimbursement rate is so the only money is that we could potentially realize is the dispensing fee we can't ship product for that so we're essentially by this proposed rule where price completely out none of the dmes and our association will be able to continue to provide those services moving ahead because we can't financially pay our patience to to do business with us that were essentially priced out under the proposed model. Take any questions happy to do so alright at this point I don't have any short thank you very much for being here okay thank you all right represent wardle earlier you had a motion at the properties this is it you still want to make it go ahead. And make a motion to hold this in evaluate a door benefit with DHS to establish a dme billing portal alongside the pharmacy portal to be. Applicable to this law. The. Sir second. All right you heard the motion in the second and discussion to motion center dismay. I guess my question be would there be anything even with passage of this rule that would prevent them from developing a deal model. The. Would you like to direct that to representative law to for further answer. There are that's only her sentence a representative I asked the department this morning could they suspend the rule when it came to dmes for the next six months till we got back to session to fix that and their answer was they didn't think they had the authority to do that and i'm looking at them because I know they can't commit since we're motion on the floor um so I did try to go down at avenues because II do want to see this move forward I understand the aggregation but also don't think it's fair to an industry has been doing this and doing it well to have to suffer because of a new benefit that's offered for new access point. Um. So I don't know that since it is main but I would be very open to that if the department could establish that. So just mean that any follow up to their new questions. Sarah does mine you done okay. All right subject to me being. Corrected as our sale will get emotional second on floor if the motion passes that will be the action moving forward if it's fails then what we're gonna move on to is without objection to rule be reviewed and approved my correct on itself. Okay just want to roll on same page here so you heard the motion second any questions to the motion a discussion to the motion hearing known then. All they ever say I opposed. The. I share. Yeah. We have a roll call division of the chamber does see three hands. About three hands alright. So we're gonna have a roll call on that vote and we've already established forms of president so I can recognize. Hang out sick. Yes step consolidate staff I was advised that yes and the division and because i'm a senate chairman start on the senate side first so we'll call the senate first and if you are well please keep the conversations down so staff can hear. Senator dismang. No center english. Yeah. So english. Center hickey. Senator hecky. Senator hester. Senator hester going to the first alternate senator d. Senator davis. Senator hill. Senator hill votes now senator gilmore send it a center of your more about now. Senator rice. Senator rice votes yes senator urban. Senator urban votes yes. This. Of the second please. Cheer votes now. Staff consulting paying. The. The. Motion failed round no other motion sunday table then the rule without objection is review objection objection noted. Rules reviewed and approved. Well key I also have they have been wrong you can do that area just hold. My apologies if a member of jackson ruled a member of much make a motion. Two take a vote to not approve the rule. If you if you would go in lied up so I can have it please thank you go ahead I object and I make a motion not to approve the rule alright here we go senator but I don't have a center dismay raymouth. Motion most include one or two bases that the rules inconsistent with state of federal law or that the law is inconsistent with legislative intent. And I have emotion. Do I have a second. Have a second. I have nobody lived up on the board. Said her display which speak to what a thought. There has been a reason given yes previous statement I think that's all right yes sir thank you center urban you want to speak as to your defense with motion on the basis of the two reasons yes I believe that this rule does not follow the legislative intent because it effectively requires an entire industry to change their business model and that is not stated clearly in this bill in a while for this to be considered a pharmacy benefit nowhere in the legislation does it state that it has to be a pharmacy benefit instead are they home health benefit in for I believe that it does not fall the rule does not follow the legislative intent which was to increase access. And so therefore I do not believe that the rule follows the legislative intent and therefore I have to make a motion not to approve this rule. Yeah. Alright and is that your second representative war low. Okay discussion to the motion into the second. Okay members are make sure i'll on same page make sure i'm on the same page i'm a recognized senator davis I mean we vote by a division. A big pardon motion yet substant motion that we vote by division is that it I mean if that's the proper motion you go to hang out because all I make sure step right okay so request you I have to make a motion three hands. I got three hands okay. Alright shall run up when take the motion or where we're gonna take the vote by a diversion that was your that was your request right center dave's make sure all right so I want to make sure every listen carefully because this is where you get almost cycle backwards if emotion receives a second which should have a vote is then taken on the motion. To take a vote to not approve the rule. A yes vote or vote in favor of the motion is to proceed with a vote on not approving the rule. A no vote or a vote opposed to the motion is to allow the rule to be reviewed and approved any any questions. Clear right. I'm soon urban you have a question away okay all right okay pretty good so here we are we got this motion second you've heard the statement as to the intent of of the of the votion and we have a request to divide the chambers we have the three hands for that and so with that as I stated earlier most people stay consistent as the senate chair today i'm going to go to the senate first for the vote alright. Senator does may play sick up if you would dismay both now send it or english. Senator english senator hickey senator hickey senator hester. Senator history going to the first alternate senator d's senator days vets now. Senator davis. Excuse me senator davis voted no senator hill voted now senator gilmore. Sinner girl more about now said it arise. Is that a rice foot yes senator urban senator urban votes yes. Cheer votes now said our hammer votes now. This. Yeah. Yeah. The. Okay members the motion failed and so the next the appears then without objection to review is or the most the rule is reviewed and approved with objection. Alright. Thank you for your patience and thank you for your dial open as I mentioned it's been well better. I'll move in on and we're down to child's ever could see center fund on the right page and members thanks for sticking it out. Hi if you would name and told it for the record again please hello elizabeth pittman DHS jane at me and DHS. Mrs d h. You'll go ahead. I will good afternoon now I believe the second role is for a child advocacy centers to be able to perform at sexual at fault examinations and physical abuse examinations and receive medicaid reimbursement for it that has historically not been allowed we worked with and the child advocacy centers decreased this rule and it has been approved by cms and we most of the comments we received were clarifying about how billing would occur and we were able to work through this and happy to take any questions and questions members cave that objections rule is reviewed and proved thank you over a month alright we're on to department labor in licensing or so manufactured home commission. We all get here if you would please name a town for the record. And then you recognize to proceed. Thank you mister chair at least the courts are council for the department of labor and licensing. Good morning committee aaron howard manufacturing commission director. Are your recognized go here. In accordance with act through ninety one of the twenty twenty three legislative session the proposed rule changes. Adjust the civil penalties to meet state administrative agencies state plan a requirements provides for a future per violation and per year maximums to be identical to the inflation adjusted amount. And are also implemented three thousand three ninety one's clarification that a civil penalty is not abated. But a subsequent suspension ravocation surrender or failure or refusal to renew license no public comment in approved other commission in questions for members. Here in earn the road reviewed approved thank you very much permanently we're licensing professional bale bond company. The. The. Please show name and total for the record rainy murray arkansas professional bill by licensing board director recognized. We hear about rule and the basic deals we hit some clean up technical clean up in the rules in the second thing is of the rule is we added to the opinions. Um in reference to x six fifty nine center bill four ninety five or the. The. Ten percent rules what we call it for collecting collecting the bailbone companies collecting ten percent of the bail. Um so there has been a. There's been an addition to a pindics a of the rule it's an effort david for premium deposit. In basically it's just an effort david. Let's the bonds of men and the bank company are firm to the fact that they did collect in percent being cash or property. Any questions for members. Harry known with objections rule is reviewed approved thank you all very much the department transformation shirt services. Upside department military. You'll get away partment military. And afternoon german if you would please name a total for the record. Jeff would cheaper staff. Good afternoon mischairman committee michael henderson director of joint staff arks on national gore could have you gentlemen if you would please. This rule implements an assistance program to encourage members of the architect national guard and better and engaged in enlisting an inserting new soldiers into the arkansas national gord the rural provider monetary incentive for members. And better. Who provide leads to recruiters assisting resulting in in the list my initiation in larks on national gord the department of military will pay a thousand dollars for a lead that in list into the guard and ships to initial training upon completion of the terms and conditions of the assistance agreement. The program requires an assistance agreement in lisbon verification and certification and request repayment priority any funds being dispersed. These forms are allowed and a rule. Be happy to answer any questions and questions from members. Then without objections rules reviewed improved and we do appreciate you appreciate service and thank you for just protect our freedom thank you sir thank you all right we're on to the transportation and share services please. Afternoon payment time for the record please right great wallace a director employee benefits division this is the rule in response to act five thirty three of twenty twenty three and is overseeing the administration and procurement of voluntary products that is done by or see in these voluntary products would be like your cancer policies you're accidental death extended life benefits things of on those natures this is four state employees. This is been reviewed by the ebd oversight committee or the ebd advisory commission the stateboard of finance and the ebd oversight alc committee are there was some pub public comment those have been incorporated just clarifying that it is only impacting state employees and there were no objections and questions for members. Then without objections rule is reviewed and approved thank you. Department transmission chaired services procurement. Afternoon to police name entitled through the record. Good afternoon just compatible send director of the officer state requirement. The. Agree thank you this role is promulgating pursuit to act five fifty six twenty twenty three the purpose of the rules to clarify the extent of the states authority that they sent of the states authority under act five fifty six up to a twenty twenty three and we also wanted to include some examples of what was promised for under it the you were always in public has was published and the public comment period expired on february twenty seventh no comments were received and no changes were made we request your approval of this rule. Any questions for members. And without objections reviewed improved thank you very much state board of election commissioners. Good afternoon in a few weeks please name telephone record. Good morning a good afternoon my name is chris matter some director from state board of election commissioners and with me as well and cooper general council or turning for the same water like semesters okay you'll go here please. So first rule we have as the rules on this is under sixteen a we have rules on poll watchers vote challenges and this was changes based on the act three twenty nine and act for forty four in some minor changes or BLR compliance purposes and questions members. Without objection to rules reviewed and approved and assistance complaint their rules are procedured for citizens complaints was amended percent to act to ninety five and then also we wanted to clean up some of our procedures for a complaint process we had some confusion confusing sections and there would claim that up and then also against them be a lot clean up related to definitions in terms any questions for members. With our objections rules reviewed and approved next one. The next one's rules for reimbursement expenses for state funded elections and this was impacted about act three fifty act seven forty three and act three fifty six. The act through fifty and seven forty three related to countings that selected to go to hand count uh paper ballots and how the state would reimburse costs on that then actually fifty six was related to cbc pay the county board of much questions pay we do adjust the rule on that and I mean I forgot to mention earlier we had received no public comments on any of these rules so there was no public comments to address in it again to monitor bill are tweaks just a comply with their definitions a questions on it. Per membership rules reviewed and approved them with our objection here. The next rule is the rule for verification of a registration and the modifications were done percent to act for forty one it was adopted in. It was to include the term trade schools as a qualifying incident provide photo identification for verification about a registration okay in question members. Because I objection rules reviewed approved lash one at one ninety four governs the changes that we have in rules of practice and procedure functionality we deleted an entire section related to the stateboard's review of the initiative ballot titles because that has now been switched back to the attorney general's office and again there were some minor tweaks to for BLR language. Any questions members. Without objection and the rule is reviewed to prove that our question for you get away from table you're now allowed to audit fifteen counties how many of the fifteen have you got to so far quick point of information please. Fab we we have completed five this for and they'll attend you that could be completed by when the plan is to have them done by the end of june you know there's two that may be over into lock as we've had to rearrange their schedule but charlie warson office the coordinator is working on line and those up in his goal was haven't done by the individual of the five are you hundred percent on the acre you've found anything thank you all right thank you very much being here that you would next members next time on the general include in person update from department education as outstanding real making twenty twenty one regular session and feel come on up and. Brief would be good if you could please. The. And name and california recompletion good morning chair members of the media money must understand the chief legal council for the permanent of education dead yourselves deploy council department of education alright thank you chair and on this report there's one rule the rule governing professional development that rules currently undergoing a second round of public comment that public comment period will end on june tenth we will promptly take that to the state board and then bring it to you for your review and questions members. Okay thanks for your parents and update today thank you and then a last one the item is we got a submission of the april may monthly written updates page and cease concern roommate can result in from twenty twenty three year ago session he's updated in your package they were having questions. The. So urban. Yep mr chair I just in the report i'd like it reflected that there was great objection to the one rule and that there was a lot of discussion and I think that should be included in the report please it will be. Thank you. All right then without objection will you file the april may written reports members next month will take back up act seventy one consideration group two rules report reviews which for speed straight into the package for last mean also just so you're wear and show the monthly written updates like we just filed on the twenty twenty three romaking the time has come that we will be hearing and personal dates from agencies on their upsetting twenty twenty three role making next month much like we just heard from the department of education twenty twenty one and with no other business for the committee thank you all for stick around being here to the end for those of you that are and without any business before the committee we are a journal.