Public Health, Welfare and Labor Committee- Senate and House
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okay good morning everybody calling the public health committee meeting to order I'm excited to have my our house vice chair representative Josh Miller here chairing the committee with me today um representative johnson is not able to be here i think he's probably working an er shift
so i appreciate everybody being here the only comments that i have is um we are pending approval of the speaker um but we do have meetings scheduled for fort smith june 4th and 5th but again if uh hopefully the that will get approval from the speaker so that the house can uh house committee can have those with us in June, June 4th and 5th in Fort Smith. So Ms. Steele will send out details about those as well.
I know that we have several people that are out of town from the agencies that are out of town today from different rules. And so as those come up, if we have major, major questions or concerns, you know, we can always have the option of holding a rule over for further discussion if members have questions that aren't uh answered so um no big deal um we'll just do our work and proceed as we go forward you have any comments no comments okay all right with that we will go ahead and get
started so um i need to have a motion to approve the minutes from the april 30th meeting and second those in favor say aye aye when opposed ayes have it uh the meeting minutes are approved All right, we will go to item C, and we have staff here, someone here. It's not Caleb, but we'll let you go ahead and proceed with us. It's Mr. McAllister.
Yes, if you'll just introduce yourself for the record, we will start with item
Speaker 8
2:16
C, exhibit C, in your handout. Good morning, Madam Chair and committee members. I'm Michael McAllister. I'm the managing attorney at the Department of Energy and Environment. I'm here before you this morning to present some revisions to Pollution Control and Ecology Commission Rule 12 that deals with regulated petroleum storage tanks.
This was a simple update to the rule that was required to make it comply with acts passed by the General Assembly, particularly Act 442 of 2023. And that act raised the cap of reimbursable expenses for reimbursement of releases from a million and a half dollars to $2 million.
So we needed to update the rule to reflect that rule change. And while we were in there, we also updated it to address some issues regarding licensing and lapsed license and reinstatements and reciprocity for licenses to make that comply with some previous acts of the General Assembly. So it was a pretty straightforward update to the rule. Nothing else was changed.
This was an industry-supported rule. The regulated community wanted to have this cap increased due to the increased expenses of doing this kind of work. Everything costs more these days. It hadn't been raised in a long time, and this was their initiative that was approved in the act. The rule was updated to reflect that. It went before the Pollution Control and Ecology Commission to initiate the rulemaking, went through public comment,
Speaker 10
4:18
and the commission approved it at their last meeting, so we're here before you for review. I'll be glad to answer any questions. All
right. Are there any questions from members of the committees? All right. Seeing none, I appreciate it very much, and without objection, this rule will be reviewed.
Thank you. Thank you so much. Next item D, Department of Health.
Speaker 19
4:48
Good morning, Madam Chair and committee. Good morning. I'm David Dawson. I'm general counsel with the Board of Nursing. I'm
Speaker 20
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Sue Tethford, Executive Director of the Board of Nursing,
Speaker 22
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and on behalf of Matt, he will not be able to be here today, so we
will miss him. No, I appreciate that very much. Mr. Gilmore's not able to be with us today, so
Speaker 23
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just everybody keep him in your prayers. Thanks. Please proceed.
Speaker 19
5:36
All right. I'll start with your Exhibit D. Do you want me to do all of them? Yeah, we'll just go one at a
time, starting with Exhibit D. I spoke with you, right, about, I think, most of these a couple months ago, I think.
Right, right. But go ahead and we'll just start with Exhibit D, and then if any questions
Speaker 19
6:00
at the end of each. Okay. Under the proposed copy under your Exhibit D is Chapter 1 of the rules under page 1-4. Let me direct members to,
we have a handout here, if you'll look, members, there's a handout that's kind of a summary, is that fair to say, from the Department of Health of all the different rule changes, the public comments, do you want to just describe this handout real quick before we get started so that people can, so that members can use
Speaker 34
6:37
Okay. Are you talking about this handout,
Speaker 32
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the memorandum that we got? Thank you. Okay. The summary
Speaker 21
6:57
of the changes, what I'm going to describe or under each
Speaker 19
7:03
paragraph here of the rules. Right.
And I can refer you in the exhibits to what pages those are located on. Perfect. Perfect. Okay. Under Chapter 1, under the proposed copy section of the Exhibit D, under Page 1-4, clinical nurse specialist was added to the definition under full practice authority because when the Full Practice Authority Act was initially created,
it inadvertently left the clinical nurse specialist off, and that was added back in by Act 872 of 2023. On page 1-6, program outcomes was added to definitions. This was at the request of education programs because the education programs had been getting pushed from their accreditation organizations to include descriptions of program outcomes, and they wanted to be consistent with other programs, and so they asked for a definition to provide consistency.
What page is that on? That's 1-6. Okay, okay, got it. Of the proposed copy. And then on page 1-7 and 1-8, there were some fees that you can see were removed. These fees are no longer applicable. So that's
all the changes that were in Chapter 1. Okay. Are there any questions for members
of the committee? All right. Seeing none, this rule will stand reviewed. Now we'll move on to E, which is Chapter 2.
Speaker 29
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look at Chapter 2. Exhibit E. Under Chapter 2, if you
Speaker 19
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look at pages under the proposed copy 2-3 through 2-7, this is the nurse licensure compact rules and Arkansas is a member of the nurse licensure compact and those rules are periodically reviewed by the the Nurse Licensure Compact Commission, and Arkansas does have representation on that
commission, and those rules, there's a process that's in the statute of how that's supposed to be done, and these changes just reflect the rules that were most recently done. It's, they're,
Speaker 49
9:43
I don't think they change them every year, but they do a periodic review and make a
few changes. So, those look like just technical changes, is that correct? I'm looking at 2-3 and 2-4 that's underlined or stricken. There was only one
Speaker 22
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change that was not a technical correction.
Now, an individual is required to apply for licensure within 60 days of moving to a new primary state of residence. Originally, there was no time frame, and so they've added the 60 days
per application. Okay, what happens if they don't within
Speaker 22
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60 days? Nothing, really. They still have their license in their old primary state of residence, so they're covered by somebody's license and disciplinary action could take it. Okay. All right.
Are there any, let's see, Representative Richardson. You're recognized. Good morning.
Speaker 53
10:43
Thank you, Madam Chair. So, just a real quick question. I noticed that we've line item 407 has been removed from the proposed rules associated with the deactivation of a license with a potential disciplinary action. My question is, how do we receive notice of that
from a multi-licensed or compact of this nature? A person has some sort of event that occurs another state if this rule is removed how are we going to be notified that that event has occurred and therefore take appropriate action here we have a national data
Speaker 22
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bank that all disciplinary and all licensure for every state in the United States and territory participate in and that is put into the data bank and we are sent a speed memo notifying of the disciplinary action okay that and
And how often are those reviewed? They're reviewed generally on a weekly basis. Okay, thank you. And one other thing, just for just clarification, if another state puts your licensee under investigation, they notify you that they're under investigation.
Speaker 51
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So we know them from the start that they're under investigation and follow that also.
Thank you. All right, thank you. Any other questions? Are you finished with the
Speaker 19
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changes in this? There are a couple more in Chapter 2.
If you look on page 2-9, under Section I, about a fourth way down the page, we just changed the statutory reference. Several years ago, the criminal bar statute was centralized for all boards and commissions into one statute and we just inadvertently missed one of the areas where we needed to change that statutory reference so we're changing that in I and then L is similarly all the
requirements that are listed in L are now in 17-3-102 and so it's really not necessary have L as part of the rules okay and then on page 2-14 the you know legislature in 2017 passed automatic licensure for uniformed service members and spouses and veterans and those requirements are usually changed every legislative
session a little bit, and so this is in response to the latest change pursuant to Act 137 of 2023 to comply with the statute. Okay, I
have that on my page 2-13, but I see it. Licensure for uniformed service members, veterans, and spouses. Is that correct? Yes. Okay, got it. Okay, any other questions on the rest of this rule? All
right. Seeing none, this rule will be reviewed without
objection. Next chapter, which is Exhibit F. Yes, this is
Speaker 19
14:03
Chapter 6 of our rules, and if you'll Referred to the proposed copy, page 6-1. The, under A-1-2, on accreditation of health care organizations was removed because that is no longer part of the Joint Commission's name. It's just now referred to as the Joint Commission, so we removed that to comply, or to have the correct reference in there.
On page 6-3, under 2F, it's section 1B2F. It was changed, the time period was changed from one year to two years, and that's to be consistent with other provisions where we have timing in our rules so we'd be consistent with the time periods in other sections.
Okay. On page 6-5 and 6-6, this is in response to changes required by the Nursing Earn-to-Learn program under Act 672 of 2023. The first reference there under F1A said preceptors shall not be utilized in foundation or introductory courses was removed because the statute does allow that now.
And when you go further down into section two, I'm
Speaker 19
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on my notes here. Removing the licensed and psychiatric technician nurses was removed because they do not serve as preceptors. and then in section three there previously they were not students were
not allowed to be reimbursed and of course you know from the title of the act they with earn to learn they are now allowed to have some pay okay so that was removed because of the statutory requirements and then on page 6-9 is where the earn-to-learn program is referenced in the rules and the these track the statutory requirements.
This rule section does. Okay. All right, Representative Lightyman, you're
Representative Jack Ladyman
Unverified
17:03
recognized for a question. Thank you, Madam Chair. I'm over here. I'll try to talk loud. Back on 6-3, page 6-3, where you change that from one year to two years. Two years is a long time, but if you read the rest of that,
it says to correct noncompliance deviation from the standards, and then it says unless determined by the board. So there is an option that you can look at that within the two-year period based on a determination from the board. Yes. If there's a problem or an issue. Yes, I
Speaker 22
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have a staff that totally monitors the programs. If there's any issue, she brings it to the board's attention. Okay, all right, thank
you. Okay, are there any other questions? Are you finished with the changes in this section?
Are there any other questions from members of the committee? Okay, seeing none, this item will stand reviewed. Next
Speaker 19
18:04
one, Exhibit G. Yes, this is Chapter 7, our rules. Okay. And if you'll refer to page 7-5, this is the rule regarding discipline, and the board has always had the ability to discipline a licensee if they had provided false information on an application for licensure.
we also have now we have where APRNs can apply for prescriptive authority and for full practice authority and under the full practice committee they can't really discipline the applicant their licensee for providing false information they can just simply deny the the application this gives the board the authority to actually discipline the license
if somebody does provide false information on that application. It adds it to the other applications that we
have. Okay. But if somebody provides false information on an application, are you saying, though, that gives them the right to discipline them but still approve them? No. Well, the committee
Speaker 21
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would make their own decision on whether or not they could be approved for full independent
Speaker 19
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practice, but they can't discipline the license.
The nursing board has the authority to discipline the license for providing
false information. Okay. I'm just not sure if I see where if somebody provides false information that they just should be denied. Like, why wouldn't they just be denied immediately? I mean, I understand the need
Speaker 19
19:58
for this, but... Right. Well, I think practically the committee probably will deny them if they provided false information.
But they still have flexibility to give them a license even if they provide false information. Well, I'd
Speaker 19
20:14
have to review the statute for the full independent practice committee, but I think they do maybe have that discretion. But in current practice, so far, the committee has not run across this, but kind of the feel of things are I don't think that they would approve anyone for independent
Speaker 82
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practice if they provided false information.
Speaker 55
20:37
Okay. I'm sure there's probably a level
of degree there. Right. Yeah. Okay. No, I know. This is fine. I just was trying, it just led to some questions that I had. Okay, any questions from members of the committee? Is that the only one on that change? Yes, ma'am. Okay, exhibit G. All
right, seeing no questions, this item will stand reviewed. All right, exhibit H.
Speaker 19
21:09
Yes, this is Chapter 8 of our rules regarding medication Assistant Certified Individuals under page 8-9 of the proposed changes. This is a statutory reference that was changed once again when the requirements under this previous statute were moved to a different statute, and so we had to change the statutory
reference. Under page 8-11, the Act 137 of 2023 dissolved several committees statewide because they were inactive and the Medication Assisted Certified Advisory Committee was one of those committees and so it no longer exists and so that's why that's deleted that's in section xv
and then the new section xv is the next one and that's the same thing that we that we did in a previous chapter um in response to act 137 of 2023 for the uniform Servicemembers, Veterans, and Spouses Act. Okay. And that's all we have for Chapter 8. Any questions from members of the committee?
All right, seeing none, this item stands reviewed.
Speaker 19
22:49
Chapter 9. Yes, in Chapter 9, these rules are joint rules between the Department of Education and the Nursing Board for insulin, glucagon, medication for adrenal insufficiency or adrenal crisis. And the previous legislative session, not last year, but the one before, actually changed this.
It was Act 1, Act 1050 of 2021. And we worked together with the Department of Education and promulgated the rules changes in response to the statute. And I came to the committee meeting whenever those rules were reviewed, and I thought that they were being reviewed jointly, but we found out when the code, the folks at Bureau of Legislative Research who were creating the new code of rules were looking at our rules.
they didn't see where the committee had actually approved the Board of Nursing rules. They only approved the Department of Education rules. They're the same exact rule. I mean, it's identical. So we're just running them through now
so we can comply with the Administrative
Procedures Act. All right. And this is in response to legislation? Yes. Okay. and so it's pretty extensive, but you're
on 9-1 is where it starts.
Speaker 19
24:29
Right. They added the medication for adrenal insufficiency or adrenal crisis provisions to where a family member can allow someone at school who has training to administer the
Speaker 82
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medication to their student okay are there any questions from members of
the committee on this chapter all right seeing none that one
will stand reviewed that item will stand reviewed
Speaker 19
25:08
exhibit J J is chapter 10 this This is our alternative to discipline roles, and in addition to licensing various levels of nursing, the Board of Nursing also is tasked with providing certifications for medication assisted certified individuals, and when the alternative program was created by the legislature,
all the references in the statute referred to licensed individuals and didn't make any mention of certified individuals and so these changes are being proposed in order to allow certified individuals who are regulated under the Board of Nursing to also participate in the alternative to discipline
program. Any questions from members of the committee about this one? Seeing
none, this item will stand reviewed item k
Speaker 19
26:08
okay this is our chapter living rules on full independent practice credentialing
committee and during the 2021 legislative session act 412 was passed which permitted certified nurse practitioners to apply for full independent practice it did not the statute statute inadvertently left out clinical nurse specialists, and so that was added back in in 2023 Act 872 of 2023. And then also the original statute did not have a mechanism for APRNs
from other states to apply for independent practice in Arkansas if the state they were coming from was already an independent practice state because it made reference to the necessity for a collaborative practice agreement and so that language was changed also in act 872 of 2023 so the rules in chapter 11 are to comply with that act okay
are there any questions from members of
the committee? All right. Seeing none, this rule will stand reviewed. And I think that's it for you guys. Good job. Thank you so much. Appreciate the handout.
That made it very easy to follow.
all right hi just introduce yourself for the record and then we will proceed thank you madam chair members of
Speaker 95
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the committee i'm laura shu and i'm general counsel for the department of health i'm
Speaker 98
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paula day i'm section chief for health facility health facility services with the Arkansas Department of Health. And I'm David Mitchum.
Speaker 99
28:21
I'm Program Manager with the Health Facility Services with the Arkansas Department
Speaker 95
28:29
We will proceed. Thank you, Madam Chair. Members of the committee, we have six rules before you today from the Board of Health instrumented and implemented by the Department of Health and Health Facility Services. The first one on the agenda is Item L. In Exhibit L, we'll show the rules for critical access hospitals in Arkansas. There were several 2023 acts that we are implementing. There are seven acts,
including Act 233, which provides for provision of pharmacy continuity of care, Act 313, which requires posting of the written notice that attacking a healthcare worker professional is a felony. It also requires hospitals in this state to comply with federal hospital pricing transparency regulations in Act 482. Act 559 requires hospitals to comply with the Abortion Right to Know and See Act. Act 716 amends the No Patient Left Alone Act regarding clergy members. Act 830 amends the
patient right to know regarding licensure of a health care provider. And Act 848 clarifies that the performance 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. We implemented these seven acts in the critical access hospital rules. We also changed the time frame for reappointment to medical staff from two years to three years as requested by the Arkansas Hospital Association. We clarified some of the reporting requirements in the rules. We had a public comment period that lasted from January 29th to
February 28th of 2024 we received no comments and we are standing before you for review today I'm happy to take any questions okay are there any questions from members of the committee right
seeing none item L will be reviewed
Speaker 95
30:29
without objection thank you madam chair moving on to item M and exhibit M we have similar acts that we're implementing in the rules for hospitals and related
institutions in Arkansas these are the seven acts that I mentioned previously acts 233 313 482 559 716 830 and 848 we made the exact same changes to the rules for hospitals as we did as mentioned before in critical access hospitals and we're happy to take any questions any questions from members
of committee if not all right Adam this rule will stand reviewed without objection exhibit in moving on to
Speaker 95
31:07
exhibit in these are the rules for
freestanding birthing centers in Arkansas and we made changes to implement acts from 2013 act 848 provides that state abortions could only be performed to save the life of a pregnant woman and only may only be performed in a hospital emergency room we also added the requirement for written notice regarding attacking a health care professional under Act 313, and we added a requirement regarding health care providers to not mislead the public regarding their licensure status provided for in Act 830.
We had a public comment period from January 29th to February 28th, and we received no comments, and we're happy to take any questions. Okay, any
questions from members of the committee? Seeing none, this item will stand reviewed without objection. Exhibit O. Moving on to exhibit O, we are going to
have another subject matter expert join us at the table. Thank you. Hello, my name is Kirk Gardner.
Kirk Gardner
Unverified
32:13
I am a program manager with Health Facility Services, a part of Arkansas Department of
Speaker 95
32:18
Health. Thank you. Thank you for being here. Thank you, Madam Chair, members of the committee. We have the rules for private care agencies and the purpose of this rule promulgation is to implement the Acts, Act 70, which provides for aid training requirements to include Alzheimer's disease and dementia. Act 313 requires the posting of the written notice that attacking a health care professional is a felony. And we also added the Act 830, amending the patient right to know.
We provided a public comment period from January 29th through February 28th. We received no public comments. and we're happy to take any questions that you
may have today. All right, any questions from members of the committee? All right, seeing none,
this item will stand reviewed without objection.
Speaker 95
33:11
Item P. Moving to Item P, Exhibit P, we have the Rules for Home Health Agencies in Arkansas. We are implementing Acts 313, 830, and Act 70 to provide for the written notice
and add the requirement regarding health care providers not misleading the public and also to add the training requirements for Alzheimer's disease and dementia. We had a public comment period from January 29th through February 28th, and we received no comments, and we're happy to take any
questions that you may have today. All right, any questions from members of the committee? Seeing none, this item will stand reviewed,
Speaker 95
33:50
without objection, and Exhibit Q. Our last rule before you today are the rules for hospice in Arkansas. We're implementing four acts from 2023, including the requirement for written notice for attacking a healthcare professional under Act 313, adding the requirement regarding healthcare providers not misleading the public regarding their licensure under Act 830, and also adding the training requirements for Alzheimer's under Act 70, and amending the rule to address clergy member visitation under Act 716.
And we had a public comment period from January 29th through February 28th, and we received no comments. We're happy to take any questions that you
may have today. All right. Any questions, members
of the committee? Seeing none, this item will stand reviewed. Thank you so much. Thank you. All right, members, anything else to come before this committee? All right. Seeing none, we got our work done. thank you agency folks for we really appreciate you and your due diligence and implementing our
acts thank you for that and with that we are adjourned Thank you.
Agenda
No agenda available.
Documents
Speakers
Senator Missy Irvin Chair
Unverified
Speaker 8
Speaker 10
Speaker 19
Speaker 20
Speaker 22
Speaker 23
Speaker 32
Speaker 34
Speaker 21
Speaker 47
Speaker 29
Speaker 49
Speaker 53
Speaker 51
Speaker 17
Representative Jack Ladyman
Unverified
Speaker 82
Speaker 55
Speaker 95
Speaker 98
Speaker 99
Speaker 100
Kirk Gardner
Unverified