Public Health, Welfare and Labor Committee - Senate
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Bills discussed (34)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
|
HB1543
Act 956
· 4 mentions in agenda, chapter, transcript
Matched: “…OF HUMAN SERVICES TO OBTAIN CERTAIN RECORDS WITHOUT CHARGE. HB1543 Burch TO CLARIFY THE LAW ON ELIGIBILITY FOR SERVICES PROVID…”
|
TO CLARIFY THE LAW ON ELIGIBILITY FOR SERVICES PROVIDED BY THE ADULT PROTECTIVE SERVICES UNIT … | Burch | Notification that HB1543 is now Act 956 |
|
HB1691
· 4 mentions in agenda, chapter, transcript
Matched: “…well Sen. Kim Hammer REGULAR AGENDA Number Sponsor Subtitle HB1691 M. Gray TO REQUIRE THE DIVISION OF DEVELOPMENTAL DISABILITI…”
|
TO REQUIRE THE DIVISION OF DEVELOPMENTAL DISABILITIES SERVICES OF THE DEPARTMENT OF HUMAN SERVICES TO … | M. Gray | Sine Die adjournment |
|
HB1904
· 3 mentions in agenda, transcript, chapter
Matched: “…WHO MAKE REPORTS TO THE CHILD ABUSE HOTLINE IN GOOD FAITH. HB1904 Della Rosa TO CREATE A STUDY OF PUBLIC NOTICE AND PARTICIPA…”
|
TO CREATE A STUDY OF PUBLIC NOTICE AND PARTICIPATION IN THE ENVIRONMENTAL PERMITTING PROCESS. | Della Rosa | Sine Die adjournment |
|
SB587
· 3 mentions in agenda, chapter, transcript
Matched: “…SSISTED LIVING WAIVER PROGRAM; AND TO DECLARE AN EMERGENCY. SB587 A. Clark TO CREATE THE CHILD MALTREATMENT INVESTIGATION BOD…”
|
TO CREATE THE CHILD MALTREATMENT INVESTIGATION BODY CAMERA PILOT PROGRAM. | A. Clark | Sine Die adjournment |
|
HB1521
· 2 mentions in chapter, agenda
Matched: “HB1521 M. Gray TO ESTABLISH RULES TO IMPROVE CONTRACTING AND SERVI…”
|
TO ESTABLISH RULES TO IMPROVE CONTRACTING AND SERVICE DELIVERY OF MEDICAID NONEMERGENCY TRANSPORTATION AND TO … | M. Gray | Sine Die adjournment |
|
HB1542
Act 955
· 2 mentions in chapter, transcript
Matched: “HB1542 Burch TO ALLOW THE DEPARTMENT OF HUMAN SERVICES TO OBTAIN C…”
|
TO ALLOW THE DEPARTMENT OF HUMAN SERVICES TO OBTAIN CERTAIN RECORDS WITHOUT CHARGE. | Burch | Notification that HB1542 is now Act 955 |
|
HB1664
Act 1036
· 2 mentions in chapter, agenda
Matched: “HB1664 Crawford TO ESTABLISH THE LIFE CHOICES LIFELINE PROGRAM.”
|
TO ESTABLISH THE LIFE CHOICES LIFELINE PROGRAM. | Crawford | Notification that HB1664 is now Act 1036 |
|
HB1711
Act 968
· 2 mentions in agenda, chapter
Matched: “…OTECTIVE SERVICES UNIT OF THE DEPARTMENT OF HUMAN SERVICES. HB1711 Burch TO AMEND THE LAW CONCERNING GUARDIANSHIP SUBSIDIES OF…”
|
TO AMEND THE LAW CONCERNING GUARDIANSHIP SUBSIDIES OFFERED BY THE DEPARTMENT OF HUMAN SERVICES. | Burch | Notification that HB1711 is now Act 968 |
|
HB1746
Act 970
· 2 mentions in agenda, chapter
Matched: “…64 Crawford TO ESTABLISH THE LIFE CHOICES LIFELINE PROGRAM. HB1746 Kelly TO PROVIDE CIVIL AND CRIMINAL IMMUNITY FOR INDIVIDUAL…”
|
TO PROVIDE CIVIL AND CRIMINAL IMMUNITY FOR INDIVIDUALS WHO MAKE REPORTS TO THE CHILD ABUSE … | Kelly | Notification that HB1746 is now Act 970 |
|
HB1815
Act 975
· 2 mentions in agenda, chapter
Matched: “…estrictions designating areas as 'Members and Staff Only'. HB1815 Perry TO AMEND THE DEATH CERTIFICATE REGISTRATION PROCESS F…”
|
TO AMEND THE DEATH CERTIFICATE REGISTRATION PROCESS FOR THE SIGNATURE OF THE MEDICAL CERTIFICATE OF … | Perry | Notification that HB1815 is now Act 975 |
|
HB1821
· 2 mentions in agenda, chapter
Matched: “…AND PARTICIPATION IN THE ENVIRONMENTAL PERMITTING PROCESS. HB1821 Murdock TO PROVIDE FOR MEDICAID REIMBURSEMENT RATES THAT AD…”
|
TO PROVIDE FOR MEDICAID REIMBURSEMENT RATES THAT ADDRESS THE MINIMUM WAGE INCREASES; TO PROVIDE FOR … | Murdock | Sine Die adjournment |
|
SB441
Act 928
· 2 mentions in transcript
Matched: “concurring Senate Bill 441, so Senator Bledsoe, go ahead. So we need to pass out this…”
|
TO ADD RESTRICTIONS REGARDING ADVERTISING OF MEDICAL MARIJUANA AND USE OF CERTAIN SYMBOLS. | Bledsoe | Notification that SB441 is now Act 928 |
|
SB519
· 2 mentions in chapter, agenda
Matched: “SB519 K. Hammer TO AMEND THE LAWS CONCERNING FUNDING FOR COMMUNIT…”
|
TO AMEND THE LAWS CONCERNING FUNDING FOR COMMUNITY MENTAL HEALTH CENTERS. | K. Hammer | Sine Die adjournment |
|
HB1290
· 1 mention in agenda
Matched: “…RTMENT OF HEALTH. LAID ON THE TABLE Number Sponsor Subtitle HB1290 Pilkington TO AMEND THE PROVISIONS OF THE ARKANSAS CODE CON…”
|
TO AMEND THE PROVISIONS OF THE ARKANSAS CODE CONCERNING THE PRACTICE OF PHARMACY; AND TO … | Pilkington | Sine Die adjournment |
|
HB1687
· 1 mention in agenda
Matched: “…AWS CONCERNING FUNDING FOR COMMUNITY MENTAL HEALTH CENTERS. HB1687 M. Gray AN ACT TO AMEND THE DEPARTMENT OF WORKFORCE SERVICE…”
|
AN ACT TO AMEND THE DEPARTMENT OF WORKFORCE SERVICES LAW; AND TO AMEND AN EXCLUSION … | M. Gray | Read first time, rules suspended, read second time, … |
|
HB1717
· 1 mention in agenda
Matched: “…TRANSFER, AND EXPANSION OF CERTAIN FACILITIES AND SERVICES. HB1717 M. Gray TO INCREASE THE NUMBER OF PERSONS SERVED UNDER THE…”
|
TO INCREASE THE NUMBER OF PERSONS SERVED UNDER THE ASSISTED LIVING WAIVER PROGRAM; AND TO … | M. Gray | Sine Die adjournment |
|
HB1967
Act 1067
· 1 mention in chapter
Matched: “HB1967 Watson TO CREATE THE ENVIRONMETAL COMPLIANCE RESOURCE ACT.”
|
TO CREATE THE ENVIRONMENTAL COMPLIANCE RESOURCE ACT. | Watson | Notification that HB1967 is now Act 1067 |
|
SB115
· 1 mention in agenda
Matched: “…TROL ACT REGARDING VACCINATIONS AGAINST RABIES FOR ANIMALS. SB115 B. Ballinger TO PROVIDE EXCEPTIONS TO THE MINIMUM WAGE LAW;…”
|
TO PROVIDE EXCEPTIONS TO THE MINIMUM WAGE LAW; TO AMEND THE LAW IMPACTING INITIATED ACT … | B. Ballinger | Sine Die adjournment |
|
SB157
· 1 mention in agenda
Matched: “…CTING INITIATED ACT 5 OF 2018; AND TO DECLARE AN EMERGENCY. SB157 B. Ballinger TO REPEAL LICENSURE FOR ELECTROLOGISTS. SB189…”
|
TO REPEAL LICENSURE FOR ELECTROLOGISTS. | B. Ballinger | Sine Die adjournment |
|
SB16
· 1 mention in agenda
Matched: “…KFORCE SERVICES LAW. DEFERRED BILLS Number Sponsor Subtitle SB16 J. Cooper TO AMEND THE RABIES CONTROL ACT REGARDING VACCINA…”
|
TO AMEND THE RABIES CONTROL ACT REGARDING VACCINATIONS AGAINST RABIES FOR ANIMALS. | J. Cooper | Sine Die adjournment |
|
SB175
· 1 mention in agenda
Matched: “…ADVISORY COMMITTEE AND THE STATE BOARD OF BARBER EXAMINERS. SB175 J. Cooper TO REQUIRE DISCRETION IN REVIEWING CERTAIN FACTOR…”
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TO REQUIRE DISCRETION IN REVIEWING CERTAIN FACTORS BEFORE DISQUALIFYING AN APPLICANT FOR OCCUPATIONAL LICENSURE; AND … | J. Cooper | Sine Die adjournment |
|
SB189
· 1 mention in agenda
Matched: “…SB157 B. Ballinger TO REPEAL LICENSURE FOR ELECTROLOGISTS. SB189 D. Wallace TO REMOVE THE REQUIREMENT FOR A MANDATORY COLLAB…”
|
TO REMOVE THE REQUIREMENT FOR A MANDATORY COLLABORATIVE PRACTICE AGREEMENT FOR AN ADVANCED PRACTICE REGISTERED … | D. Wallace | Sine Die adjournment |
|
SB221
· 1 mention in agenda
Matched: “…D PRACTICE REGISTERED NURSE TO HAVE PRESCRIPTIVE AUTHORITY. SB221 K. Hammer TO CREATE THE AL HUNT ACT; AND TO MODERNIZE THE P…”
|
TO CREATE THE AL HUNT ACT; AND TO MODERNIZE THE PROVISIONS WITHIN THE ARKANSAS CODE … | K. Hammer | Sine Die adjournment |
|
SB264
· 1 mention in agenda
Matched: “…SICAL THERAPY SERVICES REGARDLESS OF CERTAIN CIRCUMSTANCES. SB264 T. Garner TO CREATE THE FRESH START ACT OF 2019; AND TO HEL…”
|
TO CREATE THE FRESH START ACT OF 2019; AND TO HELP INDIVIDUALS WITH CRIMINAL RECORDS … | T. Garner | Sine Die adjournment |
|
SB317
· 1 mention in agenda
Matched: “…OF LEGISLATIVE REVIEW AND APPROVAL OF STATE EMISSION PLANS. SB317 B. Davis TO PROHIBIT DISCRIMINATION AGAINST INDIVIDUALS WIT…”
|
TO PROHIBIT DISCRIMINATION AGAINST INDIVIDUALS WITH DISABILITIES REGARDING ACCESS TO ORGAN TRANSPLANTATION; TO REQUIRE COVERED … | B. Davis | Sine Die adjournment |
|
SB395
· 1 mention in agenda
Matched: “…KFORCE AND STAY OUT OF PRISON; AND TO DECLARE AN EMERGENCY. SB395 Rapert CONCERNING THE PLACEMENT OF A CHILD IN A FOSTER HOME…”
|
CONCERNING THE PLACEMENT OF A CHILD IN A FOSTER HOME BY A CHILD WELFARE AGENCY. | Rapert | Sine Die adjournment |
|
SB567
· 1 mention in agenda
Matched: “…TO THE TERMS "MENTAL RETARDATION" AND "MENTALLY RETARDED". SB567 J. Cooper TO COMBINE THE COSMETOLOGY TECHNICAL ADVISORY COM…”
|
TO COMBINE THE COSMETOLOGY TECHNICAL ADVISORY COMMITTEE AND THE STATE BOARD OF BARBER EXAMINERS. | J. Cooper | Sine Die adjournment |
|
SB604
· 1 mention in agenda
Matched: “…CKGROUND CHECKS BEFORE APPLYING FOR OCCUPATIONAL LICENSURE. SB604 B. Ballinger TO MODIFY THE DEFINITION OF "WATER SYSTEM" WIT…”
|
TO MODIFY THE DEFINITION OF "WATER SYSTEM" WITHIN THE STATEWIDE FLUORIDATION PROGRAM; AND TO REDUCE … | B. Ballinger | Sine Die adjournment |
|
SB626
· 1 mention in agenda
Matched: “…CHILD MALTREATMENT INVESTIGATION BODY CAMERA PILOT PROGRAM. SB626 K. Hammer TO MODIFY THE TIME AN EMPLOYER HAS TO RESPOND TO…”
|
TO MODIFY THE TIME AN EMPLOYER HAS TO RESPOND TO AN APPLICATION FOR UNEMPLOYMENT BENEFITS. | K. Hammer | Sine Die adjournment |
|
SB639
· 1 mention in agenda
Matched: “…MODIFICATIONS; AND TO PROVIDE AUXILIARY AIDS AND SERVICES. SB639 B. Davis TO REQUIRE THE ARKANSAS MEDICAID PROGRAM TO COVER…”
|
TO REQUIRE THE ARKANSAS MEDICAID PROGRAM TO COVER PHYSICAL THERAPY SERVICES REGARDLESS OF CERTAIN CIRCUMSTANCES. | B. Davis | Sine Die adjournment |
|
SB644
· 1 mention in agenda
Matched: “…IZE OF WATER SYSTEMS REQUIRED TO MAINTAIN FLUORIDE CONTENT. SB644 B. Ballinger TO AMEND THE LAW REGARDING STATE EMISSION PLAN…”
|
TO AMEND THE LAW REGARDING STATE EMISSION PLANS FOR FOSSIL FUEL-FIRED ELECTRIC GENERATING UNITS; AND … | B. Ballinger | Sine Die adjournment |
|
SB648
· 1 mention in agenda
Matched: “…HAS TO RESPOND TO AN APPLICATION FOR UNEMPLOYMENT BENEFITS. SB648 Irvin TO AMEND THE REGULATION OF BODY PIERCING, BRANDING, A…”
|
TO AMEND THE REGULATION OF BODY PIERCING, BRANDING, AND TATTOOING BY GRANTING ALL AUTHORITY OF … | Irvin | Sine Die adjournment |
|
SB655
· 1 mention in agenda
Matched: “…CATION STANDARDS FOR LICENSING TO THE DEPARTMENT OF HEALTH. SB655 G. Leding TO CREATE THE RIGHT TO KNOW YOUR PAY ACT. HB1542…”
|
TO CREATE THE RIGHT TO KNOW YOUR PAY ACT. | G. Leding | Sine Die adjournment |
|
SB673
· 1 mention in agenda
Matched: “…EMENT RATES AND METHODOLOGIES; AND TO DECLARE AN EMERGENCY. SB673 Rapert TO AUTHORIZE A LIMITED PROGRAM OF AN OPTIONAL SYSTEM…”
|
TO AUTHORIZE A LIMITED PROGRAM OF AN OPTIONAL SYSTEM TO ALLOW AN EMPLOYER TO SECURE … | Rapert | Sine Die adjournment |
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Okay, we're going to start at the top, which is, we actually have two bills that we're able to hear. One is we're
concurring Senate Bill 441, so Senator Bledsoe, go ahead. So we need to pass out this bill. This is a Senate Bill 441. This was not on our agenda, but we were able to make a motion to allow it to hear tonight
because we are concurring with the House Amendment and Senate Bill 441, but we've already heard Senate Bill 441. So he's going to pass out the bill. Okay, here's the amendment and
amendment and the bill, but the amendment's engrossed in the bill. Is that correct? Yes, because it's concurrent.
we're going to pass that out. Okay. Senator Bledsoe, you're recognized to explain what the House amendment was so we can.
Senator Cecile Bledsoe
Unverified
1:37
All right. Thank you, Madam Chairman and members of committee. with the house amendment page two it says include at least one of the following statements and this was for the broadcasters of Arkansas they felt like there was a list like when you're watching tv and they're talking about a medicine they give you a list of all these things that you have to do
or don't do and so with being on the radio they felt like the list was too long so they just amended it to include at least one and so that's really all it is and if you want me to read that list I'd be glad
Senator Jimmy Hickey, Jr
Unverified
2:28
to. Okay are there members that are questions of the committee? Any questions on this House
Senator Cecile Bledsoe
Unverified
2:37
amendment. There is another part there, Madam Chairman, and it's page two, line 33,
and it deletes disease and and substitutes disease R. And that's from the House.
Okay. Any other questions? it's it's engrossed but they're just
giving you a copy of the amendment just to be helpful that was the house amendment that was put on any questions
yes okay motion to concur second those in favor say aye aye and opposed i have it thank you that bill is, we've
concurred. Senator Bledsoe, stay there. We're going to go to House Bill 1904. That is, you're handling that, I believe, for
Representative De La Rosa. Is that correct?
Senator Cecile Bledsoe
Unverified
3:47
Well, I think so. I think I passed it on to Bart, Senator Hester, but it is a study.
I don't even have a copy of the bill. I wasn't prepared to do that
one. Okay, sorry. That's all right. I'll give Representative De La Rosa the chance
Senator Cecile Bledsoe
Unverified
4:10
to get it heard. Thank you. Thank you very much. I don't know. I don't
think so. We had a situation in our area where there was a quarry that was started in a certain area of Lowell and none of the neighbors knew about it.
And so, as Representative De La Rosa tried to find out why they were not notified, she came up against a lot of problems with language and some of the laws. And so this is just a study about public notice
and participation in the environmental permitting process, and that's the gist of it.
That's the history of why we have it today, and that's just asking for a study to be done. I'm sorry. i guess
it would be basically an interim study to
create a study of public notice and participation in environmental permitting process i think she included
Senator Cecile Bledsoe
Unverified
5:31
the public health committee per se in that so so you're effectively just
trying to do an interim study on this subject
yeah i believe is that correct yeah adq you're in the room
you're good okay all right any questions
from the members of the committee all right all right it's the pleasure of the committee you've closed for your bill yes and i don't believe we have anybody signed up to speak for against the bill
Speaker 36
6:03
yeah okay yeah senator hickey just just one
Senator Jimmy Hickey, Jr
Unverified
6:07
thing and i want the committee to see this does require does require a meeting it won't be
at the call i guess it'll be at the
call a chair, but it does have to be one time every two months.
Speaker 42
6:20
So just making sure everybody sees that. On page 3, line 5. Thank
Senator Cecile Bledsoe
Unverified
6:28
you. Oh, I think her idea was to have the Public Health Committee meet on this and to ask the staff to come up with all the ramifications of the law that is already on the books
and then meet on that. Okay. Well, I mean... It's at the pleasure of
the committee. Yes, no, I... Okay. I don't... I mean, if we amend it, they'd have to go back.
Senator Jimmy Hickey, Jr
Unverified
7:07
And so... Okay. I have no problem with it
being an interim study. I think the part, yeah, that on page three requires us to meet one time
Senator Jimmy Hickey, Jr
Unverified
7:20
every two months on this issue.
Senator Cecile Bledsoe
Unverified
7:24
That's kind of a mandate on the committee. Let me ask you this. Is the committee meeting tomorrow? No. No. Okay. Okay. All right. That's the purpose of it.
Senator Cecile Bledsoe
Unverified
7:40
At this time of night, I totally understand that answer. But what I was thinking was that possibly I haven't done justice to. It's okay. I don't have a problem with the topic
of the bill, but I do have a problem with the mandate in the bill.
Senator Jimmy Hickey, Jr
Unverified
7:58
So I think, I mean, I will work with Representative Della Rosa on these issues. I don't have a problem with that.
but we can do an interim study but mandating our committee to meet um it says shall be held at least one time every two months right that may occur more often that that i'm not so anyway but we'll just maybe the bill
Senator Cecile Bledsoe
Unverified
8:24
needs to um go down and then we'll go to interim yeah i think that might
be a good that might be okay okay all
right thank you thank you thank you senator blood so okay senator
sample well no it's just not doing anything with it okay we'll just move on how about that let me
Senator Jimmy Hickey, Jr
Unverified
8:47
ask you this yep with what you said does it need to go
down do we need to vote it down for it to be referred to interim study or we can just do
that okay why don't we just make a motion to send it to interim study.
Okay. Motion. Second. Those in favor say aye. Aye. And
opposed. Ayes have it. Okay. Thank you. All right. We're going to start at the top of the list. Thank you, Senator Bledsoe. Good night. House Bill 1691. I believe Senator Caldwell, are you going to run that one for Representative Gray? I believe DHS. Are you here, DHS, that might want to explain the bill? I'm just starting at the top of the list and going down. I can tell you Senate
Bill 648 shouldn't be on here because that's my bill. Mark that one off your list because
yeah I did I did look no I did I looked yeah okay all right Melissa
Stone I believe hi House Bill 1691
Senator Ronald Caldwell
Unverified
10:09
We're on a call with Senator District 23.
Speaker 66
10:18
Melissa Stone, Director for the Division of Developmental Disability Services for DHS. So DDS is
Speaker 65
10:27
neutral on this bill. We have no problems as this bill is written.
Speaker 66
10:32
Sorry, state that again. DHS is neutral on this bill.
We've worked with Representative Gray, and we
have no problems with the way
Speaker 66
10:51
it's written. Okay. Can you just tell us a little bit about it real quick? All right, yes. So currently in statute, there is a moratorium on the ability to expand adult developmental day treatment programs and early intervention day treatment programs. And this would mandate that DHS add into their rules concerning when one of those programs closed, sold, or transferred to another provider.
Senator Jimmy Hickey, Jr
Unverified
11:26
Okay. All right. Are there any questions on the
bill? Nobody is here to speak for or against the bill. Signed up. Any questions?
Any questions? No? All right. What is the pleasure of the committee? Motion
do pass. Is there a second? Second. All
those in favor say aye. Aye. And opposed? Ayes have it. Bill passes. Thank you. Okay. Moving down. Let's see. I've got Representative Ballinger is here for only one bill
Speaker 77
12:39
Is that correct? I mean, I'm sorry, Senator Ballinger I'm going to
run those DHS bills Okay, Senator Clark Are you going to hear here too? Which bill
are you running? Oh, he's going to do You're
going to do House Bill Okay, so you don't have to do House Bill 1542 But you can go ahead
and sit down there and be ready Yeah, so actually we have Senator Ballinger and Senator Clark are going to start.
We're going to do House
Bill 1542, is that correct? Y'all have
got 1542, 1543, and 1711, and these are DHS bills, is
that correct? That's correct. Okay. Senator Ludding is not running Senate
Bill 655. Senator Clark, you're not running 587. Is that correct?
Senator Alan Clark
Unverified
13:43
Senate Bill 587. Hold on. I don't believe so. Madam Chair, we would like to invite Jerry Sherom with DHS to help us present House
Bill 1542. Okay. And these are for Representative Birch, who is at the Speaker's Ball. And so these gentlemen are standing in for Representative Birch, and I appreciate that.
And thank you also to Senator Caldwell
Speaker 91
14:25
for doing the same for Representative Gray. All right. State your name for the record, and you may proceed. Gerald Sherom, Senior General Counsel for the Department of Human Services. Thank you.
similar to DCFS for kids, this does maltreatment investigations for adults. Similarly, it would allow the Office of Public Guardian, which is a guardianship program in the department, to care for and provide guardianship services for adults in need. And that is essentially the bill. Okay.
Any questions on the bill? any there's nobody here to sign up to speak for against
Speaker 99
15:29
the bill is that correct okay any questions
All right, what's the pleasure of the committee? Motion to pass, second. Is there a second?
All right. All those in favor, say aye. Aye. And opposed? Ayes have
Speaker 101
16:13
it. Congratulations, you've passed your bill. House Bill 1543. Thank you, Madam Chair. Thank you, committee.
Speaker 91
16:21
Again, we're going to ask Mr. Sherham to help us present House Bill 1543. HB 1543 is a bill regarding the eligibility for services provided by APS.
It clarifies eligibility standards for services provided by APS to maltreated adults that are in APS custody including custody itself and related services to ensure that APS is able to protect all Arkansans regardless of their financial circumstances. the bill requires courts to resolve over income and over resource issues to ensure that an adult can become Medicaid eligible where needed. Under current law, a strict reading of the statute would lead you to conclude that an adult who does not meet Medicaid eligibility standards is not
eligible for protective services from the department. And this clarifies that courts can enter orders to allow an adult to be made Medicaid eligible by spending down the resources for their care, just like anyone else who would need to be, become Medicaid eligible if they have too many resources. And that
Speaker 95
17:21
is essentially the bill. Okay, are there any questions?
Any questions from the members of the committee? There's nobody here to speak for or against this bill that's signed up. Any questions from members of the committee?
pleasure of the committee you've closed for your bill we're closed we appreciate a good vote what's the pleasure
of the committee is there a motion motion do pass is there a second is there a second anyone okay those in favor say aye and opposed i have it okay
Speaker 101
18:56
house bill 1711 and again madam chair we're going to ask uh mr sharon to help us present Although, with the committee's enthusiasm, we may jump in to help. Go
Speaker 91
19:16
ahead. Thank you, Madam Chair. Committee, Gerald Cheram, Senior General Counsel for the Department of Human Services. HB 1711 is a law to allow guardianship subsidies to be offered to fictive kin as well as relatives.
Under current law, guardianship subsidies, which are subsidies that provide assistance going forward after the guardianship is entered, to be provided only to relatives. This allows kids to have guardianship by those who have a good relationship with the family, with that child. And that is essentially the bill. Okay, are there any questions?
Senator Jimmy Hickey, Jr
Unverified
19:59
1711. Senator Hickey. I see we say relative or fictive kin. What was it, fictive kin, what
Speaker 91
20:21
was it before this bill? Senator, before this bill, it was only relatives. This allows guardianship subsidies to be offered for fictive kin, and this just expands the permanency options for kids.
If there's not an appropriate relative, maybe to have a person who has that good relationship with that
Senator Jimmy Hickey, Jr
Unverified
20:39
child. And I know that we've dealt with that word before. How do you determine that? I mean, is it just who they're living with at that time? I mean, how do
Speaker 91
20:48
you determine fictive kin? Well, it's defined by statute to include someone who has that good relationship with the child or that family. Just exactly
Speaker 117
20:56
what you just said. Exactly, exactly that. It's almost verbatim. Fair enough. Thank you, sir. Okay.
Okay, any other questions from members of the committee?
You've closed. Nobody's here to speak for or against this bill. What's the pleasure of the committee?
Move to pass. Move to pass. Second. Is there a second? Second. All right. All those in favor say aye. Aye. And opposed? Ayes have it. Congratulations. You've passed your bills. All right. Senator Ballinger, you're up. Is that correct? Y'all are finished. Is that correct?
Yes. Senator Clark, are you finished? I have one more. Oh, okay. I'm sorry.
Speaker 123
21:36
No, no, no. That's okay. I don't know. You're not ready? Well, I mean, you can hear your question. What's the
Speaker 125
21:45
number? What's the number? SB 587. We've already done that.
I'm sorry. What number is it? SB 587. 587.
Senator Alan Clark
Unverified
22:01
587. And Madam Chair, this is one I asked you to run for me.
Gave you some instructions on. I would ask that the committee not spend too much time on this bill. Okay. It's an act to create the Child Miltreatment Investigation Body Camera Pilot Program. And that's what it does. I believe that it, uh, 10, uh, body cameras, uh, within either, and it's been a day or two since I read it, but, uh, either within DCFS or CACD, a pilot program to see how
it works. And, uh, we have created, we're very late in the session, we have created no funding for it. But the fiscal impact, I'll go ahead and tell you before somebody else does, came back as a million dollars over five years, which I have to go back in, which I guess that's $100,000 per camera. So I guess if we did the pilot camera, Senator Hickey did the pilot program,
we certainly couldn't afford to do it at $100,000 a camera across the state. But I'm going to have to apologize to a couple of sheriff's departments and police departments that I helped get body cams for with GIF funds because I probably bankrupted them if it's costing $100,000 a year per camera. So anyway, with my sarcastic remarks, I'm open for questions. Are there any questions?
No questions? All right. They, uh, we have three people signed up to speak against the bill. Okay. Proper motion. Which one do you want first? We have a motion. Okay.
Are you going to withdraw your motion? Okay. Motion for immediate consideration. All those in favor say aye.
Speaker 136
24:11
Great. Motion for immediate consideration.
Speaker 103
24:15
Okay, yes, I'm sorry. You just voted against your own motion. Okay. Okay, motion for immediate consideration. All
those in favor say aye. And opposed. Ayes have it. All right. Is there a motion to pass the bill? There's no motion. The bill dies for lack of a motion. Thank you, Madam Chair. Thank you, committee.
Y'all have hurt my feelings. Well, it's okay. We've hurt a
few people's feelings, unfortunately. Okay. Representative, I mean, I'm sorry. Senator Ballinger. I do that
to me, too, so I'm not offended at all. Okay. You are doing
House Bill 1664. Senate Bill 673 there's somebody here
just one moment there's somebody here for Senate Bill 673 to speak against it that bill is not going to run and it will go to interim study Senate Bill 673 so if you're here you can go home alright you're
recognized to present House Bill 1664 Okay, this
Speaker 145
25:38
is an awesome bill that sets up a possibility of an awesome program that could save babies if the Department of Health can do it and find funding to do so. So if you look at it on line 25, page 1, right in the middle, it says the health department may implement.
So this is nothing mandatory at all. And then the gist of what this program would be would be a Life Choices Lifeline program that shall encourage healthy childbirth, support childbirth as an alternative to abortion, promote family formation, aid successful parenting, increase families, economic self-sufficiency. This is modeled off from a program that Texas has. The way Texas does is they contract out with an organization that actually does social media marketing, reaches out to people who are seeking things like abortion clinics,
health care, crisis pregnancy, that type of stuff, and they work with them. there is a possibility of maybe some federal funds that would would cover this but at this point all we're doing is setting up the framework for the possibility to implement it there's a little more information if you look at what will actually be included in that you know lines one through four but i don't want to belabor the point i'm happy to answer any questions
are there any questions from the members of the committee so this was amended to make it permissive for the health department's cool with it yep so okay
Speaker 145
26:59
no nobody's nobody's mad at it i don't think
Senator Jimmy Hickey, Jr
Unverified
27:02
okay are there questions from the members of the committee any questions
no questions all right you've closed for the bill nobody has signed up to speak for or against this bill i don't believe
Speaker 145
27:26
i am closed and i do uh request a good vote all right
what is the pleasure of the committee pleasure of the committee
motion do pass is there a second is there a second
no second are you seconding you're seconding okay all those in favor say aye and opposed ayes have it I don't blame you guys
Speaker 145
27:54
for being grumpy I'm grumpy too but I do appreciate you thank
you so much alright moving down that list House Bill 1746 House Bill 1746
senator hammer i think is handling this one thank
Senator Kim Hammer
Unverified
28:24
you madam chair may i have uh jerry uh shuram from dhs come to the table please madam chair i don't
think this is going to be a lengthy or heavy lift so
we'll try to respect the committee's time okay
if you'll just um state your name for the record and you can proceed.
Speaker 91
28:46
Thank you, Madam Chair, committee. My name is Gerald Sherham, Senior General Counsel for the Department of Human Services. Okay, proceed. Explain the bill. Yes, ma'am, thank you. So this bill should sound pretty familiar. There was a previous bill earlier this session that provided immunity from civil and criminal liability for good faith reports by mandated reporters. This one provides that same immunity for all reporters. This allows Arkansas to align with new requirements from the Federal Victims of Child Abuse Act authorization
that happened earlier this year in January, which amends the controlling federal provision to require immunity from civil and criminal liability for people who make good faith reports related to child abuse and neglect. And that is the bill. So
Speaker 104
29:33
basically it aligns federal law, right? All right. Are
Senator Jimmy Hickey, Jr
Unverified
29:37
there any questions? Yes, Senator Hickey. Just one. It
may sound stupid, but I want to make sure. What if somebody reports their CIF to this hotline? That wouldn't make them immune, would it?
Speaker 117
29:50
No, it would not. And why would that not be? So immunity for
Speaker 91
29:54
making the report is what they're talking about. Immunity from liability for criminally doing something wrong, making the report criminally wrong, as opposed to the underlying report itself. Like, if they committed the child maltreatment, this is nothing to protect them. Okay, that makes a lot of sense. Thank you, sir. Okay. Are there any other
questions on the bill? No questions? What's the pleasure of
the committee? There's nobody here to speak for against this bill, I don't believe.
Okay. What's the motion to pass? Is there a second? Second. Second. Thank you. All those in favor say aye. Aye. And opposed? Ayes have it. Bill passes. Thank
Speaker 160
30:33
you. Thank you, ma'am. Chair, members, committee.
Thank you. All right. All right. Senator Hammer, I know 1821 is a little controversial. I'm just, but we can go ahead and go for it.
Senator Kim Hammer
Unverified
30:52
Thank you, Madam Chair. Madam Chair, I've got a couple handouts, if I could, please,
for the committee. Okay, before we get started, you know, if you have signed up to speak against Senate Bill 587, obviously we
killed that bill, so you can go home. You don't have to stay here and speak against that bill.
Thank you for coming tonight. Madam Chair. um also i'm sorry just one moment house bill 1688 i do not believe will be running as well house bill 1688 it did not make it over here and i don't believe the sponsor is going
to run that bill so if you've signed up
Speaker 35
31:53
to speak against that bill you can go home too 587 we're
um go ahead and you may proceed house bill 1821 thank you madam chair
Senator Kim Hammer
Unverified
32:28
guests introduce themselves for the record please
Speaker 174
32:31
go ahead please i'm robert wright with the mitchell blacksock law firm
Speaker 177
32:39
okay you may proceed thank you thank you madam chair i'm
Senator Kim Hammer
Unverified
32:42
going to defer to mr wright if that's right because uh we want to be as expedient get into the meat of the questions if that's permissible
to the chair okay go ahead and proceed madam madam chairman members of the committee
Speaker 182
33:02
um house bill 1821 basically does uh two things the first thing that it does is provides for a rate increase on July 1st of 8.8% for a very specifically defined group of Medicaid services. Those are early intervention day treatment services, adult development day treatment services, personal care, attendant care and respite care under the ARC Choices waiver, and
substance abuse treatment services. The objective here is to try to bring some relief to these providers. In case of the DD providers who haven't had a rate increase in nine years, in the case of our choices in personal care, I've had one increase in ten years. These providers have a proportionately high number of employees who are affected by the minimum wage increases, both the ones that we've already experienced and
ones that are are yet to come. So the 8.8% increase would would help offset some of offset some of some of those costs. The other thing that the other thing that it does is sets up a process at the Department of Human Services, a requirement that rates and reimbursement methodologies for Medicaid be reviewed on a regular basis, rather than going nine years, for example, between getting rate increases
or only getting one rate increase in 10 years, what this bill would do is require DHS to set up a schedule whereby essentially every provider type would have their rates or reimbursement methodologies reviewed once every three years. there are requirements there are factors in here that dhs would have to consider there's no guarantee of a rate increase for any provider in any year it's it's the requirement for a review
and a report and there is a requirement for input from the public and there is a requirement for participation by providers in the process dhs's report which would include their recommendations and their responses to public comment and their responses to provider input would then go to the General Assembly, beginning with the Administrative Rules Committee, and essentially the process that's laid out here is the same process that rules go through for promulgation.
If the rate increases were not disapproved by the Administrative Rules Committee or by the legislative council, then they would go into effect the following July 1st. The bill also provides for a remedy that, again, a very limited remedy that would allow a Medicaid provider or beneficiary to bring a suit against DHS for equitable relief only.
In other words, no money damages, just a suit if the department failed to do the things that this law requires. Again, you wouldn't be able to sue because you don't like the rate. You wouldn't be able to sue because the rate's not enough. You wouldn't be able to sue to get money. The only thing you could sue for is if DHS didn't do the review that's required in this bill. And then finally, the last section, because we put this in at the recommendation of Representative Gray,
because right now the law provides that legislative committees can only disapprove of rules for three reasons. If it's inconsistent with state law, if it's inconsistent with federal law, or if it's inconsistent with legislative intent. And what we've done here is added a paragraph that says when you're reviewing these rates, you're not bound by those three reasons. You could review the rates and approve them or disapprove them for whatever reason that the legislature chose.
And that's what the bill does. Be happy to answer
any questions. All right. Thank you. Are there any questions? Any questions from members? Yes, Senator Hickey,
Senator Jimmy Hickey, Jr
Unverified
37:47
you're recognized. I've got a couple. I want to back up to the part you added where you're talking about the rules, and that's maybe to Senator Hammer. I guess the Bureau looked at that.
I thought that those rules were in place based on the constitutional amendment that we passed, that that was the only way that we could look at that. I don't... Can you give me a second? Yes, sir.
Senator Kim Hammer
Unverified
38:23
Senator, would you mind if I defer to Mr. Wright to answer that because he is an attorney? I think he could give us an attorney's perspective on that.
Speaker 182
38:30
Sure, sure, that'll be great. What's being provided here is a report from the Department of Human Services that's going to go through legislative review. Although the process will be very much like promulgation of a rule, it would not be exactly the same as a rule, and that's why we put the language in that section that otherwise would limit you in the reasons that you could reject the report.
We basically said in this paragraph, you're not limited when it comes to reviewing this report regarding reimbursement methodologies and rates. Okay. I'm not 100% sure about that, but may I
Senator Jimmy Hickey, Jr
Unverified
39:12
continue, Madam Chair? Yes, please do. Can you tell me where you are? Are you
on page six? I think we're on page six and seven, Madam Chair. Is
Senator Kim Hammer
Unverified
39:22
that right, Senator Hickey, isn't that where you are? Yes. Okay, thank you. I'm just trying to keep up.
Senator Jimmy Hickey, Jr
Unverified
39:29
Right. I guess the next thing, I'm just going to kind of cut straight to it here.
Of course, there's been tons of people out
here wanting me to vote for this, and of course, I'm for this, in theory. But here's the other thing. Didn't this thing have an appropriation? It had an appropriation that failed. Is that
Speaker 182
39:49
correct? There was an appropriation that failed in special language. Right.
Senator Jimmy Hickey, Jr
Unverified
39:52
And we, as far as the Senate, have looked at RSA, and that wasn't in RSA. So here's the thing. All these people out here in the public and everything, we passed this bill out,
and there's a lot of co-sponsors and all that on here. What is it for? I want to know how we're going to get the thing funded if I'm going to vote for this, because I don't want it just to be a look-good, feel-good type thing. And to be honest with you, that's exactly where it would be right now. Everybody in this room needs to understand that. There is not a funding mechanism in place for this right now. I want to know what we're going to do to go forward before I vote yes on this.
So, Senator Hammer, I don't know what we'd have to try to do or
how we're going to do it, but I want to know that before voting.
Senator Kim Hammer
Unverified
40:45
All right. I'm going to make a statement. And then if you don't care, Mr. Wright, make a tag
on to that. This bill started, I'm not sure of the file date on it. Well, I know it was after 3-13. So this thing's been in the hopper a long time coming down the line, and it's been gaining support as it's been coming down to us. So I think it would be interesting to get DHS to the table and ask why,
knowing that there was support for this bill, you know, why it wasn't included in the discussion. Of course, I understand it did fail in special language, so there was a platform there. But as with a lot of other bills down here, it starts, and then the process is always moving until we get to where we are right now. And I think that's what creates the tough choices we have to make. If this rises to the occasion that we feel that it is worthy of support before we vote RSA, we may have to take that up.
But if you don't mind, could Mr. Wright tag on to that? Yes, sir. Thank you. If the chair's permission, that
Speaker 182
41:49
is. Okay. Go ahead. Go ahead. Okay. Thank you, Senator Hickey. I rest assured the people who are sitting behind me don't want this to be a bill just for show either. And there are two issues involved. One, of course, is the appropriation that you mentioned. In the Division of Medical Services in the department, and let me just say, I'm an attorney with the Mitchell Blackside Law Firm.
Before I was an attorney, I worked in state government. And my last job was as chief financial officer of the Arkansas Medicaid program. The Arkansas Medicaid appropriation includes what is termed in the budget book that you guys start looking at in the fall, excess appropriation. That's appropriation that's not funded. There was $700 million that was originally included in the fiscal year 2020 appropriation.
During the hearing over in Big Mac back in the fall, there were some questions from legislators for DHS about why they had all of that excess appropriation. And there's reasons for it. There's for flexibility or if something comes along that they, you know, program they need to spend money on or whatever. but there's a lot. I've gone through the two appropriation bills. One of them has been signed by the governor. The other one is on the governor's desk. Looks like in the process, Joint Budget
Committee has taken about 100 of that away. So it looks like there's about $600 million in excess appropriation now. We estimate the annual cost of this to be about $40 million. So there is room within the appropriation it doesn't require it doesn't require a special or separate appropriation these are services that are already being provided and paid out of appropriations that exist the rates would just be the rates would just be higher so you don't you don't have to have
additional appropriation because you already have excess appropriation in the medicaid budget in terms of funding the department has and you guys get these on a regular basis The department has been providing for the last couple years a quarterly scorecard that goes all the way back to the legislative task force from a couple years ago. And those of you who are involved in that will remember that there was a general consensus that the trend that,
I'm going the right way from the way you guys are looking, the trend that Medicaid was on was something that was not affordable. and was something that the state couldn't maintain, number one, and certainly couldn't maintain its contribution to Arkansas Works if the Medicaid budget continued to grow like that. And so the task force set targets for the same providers plus others that are included in this bill.
And the department reports quarterly on the savings that they have achieved because what the governor and the legislature did was determine that there needed to be, over five years, $830 million in savings. $830 million less spending in the Medicaid program in order to be able to afford the Medicaid budget and pay for the state portion of Arkansas Works. When you look at what has actually happened, the department has overachieved, overperformed significantly in terms of the savings through the first two and a half years.
This chart that was passed out, if you look over on the left-hand side, the first two set of bars through December 31st of 2018, which was two and a half years into the five-year period that the savings were supposed to be accomplished. For DD, the projected savings were $47 million, that shorter bar. the actual savings were $113 million.
So there's been excess savings in that two and a half years of $66 million, which is over three times the amount, the annual cost of the DD part of the rate increase. If you go over a couple to LTSS, there the savings through two and a half years that were targeted were $90 million. The actual savings have been $148. That's $58 million in excess savings, which is, again, is about three times what is required for long-term care.
If you look all the way, I mean long-term support services and supports. If you look all the way over at the right, $316 million is the amount of savings that were targeted through December 31st of 2018. The actual savings have been $439 million. And again, that's just two and a half years in. And there's every reason to believe that those excess savings are going to continue. Number one, because they are getting larger every year, the amount of excess savings.
Number two, many of the initiatives that were included in that task force report actually got a late start, a late implementation. So you're seeing these kinds of additional savings, even though the program's got a slow start. So if you're seeing those savings during the ramp-up, once everything is totally implemented, you're going to see even greater savings. And then third, in that five-year plan that was put together,
there was an assumption of savings due to managed care or the passes. That was going to start in the fifth year, which is fiscal year 2021. Of course, as you know, the passes actually started last month. And the department started saving money as soon as the passes started getting capitation rate because there's savings built into that. So there is flexibility within the funding of about $1.3 billion in
in state general revenue for the $12 million or so that's required for the $12 million or so that's required for this rate increase. And we believe that can be accommodated both in the funding and in the appropriation. And just to give you an example, the department recently approved an increase in the rates for private duty nursing. That was effective January 1st of this year.
There was no appropriation increase that was provided for that rate increase, and there was no additional funding that was added to their budget for that rate increase. But the department was able to accommodate that rate increase within the Medicaid budget. We believe the same thing can happen with this increase.
May I continue? Yeah, yes, but I just want to, you know, stay on the bill, and
if we can, and you may continue, but I think DHS also will probably need to respond, so.
Senator Jimmy Hickey, Jr
Unverified
49:32
I'll tell you what, I'll just wait on DHS based on what he's, I want
to hear what they've got to say. Yeah, I think that would be fine. Okay, I just, you know,
are you, are you, I have some questions. I chair special language, and so I can confirm for the
members of the committee that the appropriation, the amendment to the Division of Medical Services appropriation did fail in special language. That was one of your questions.
So, yes, that did fail. So, there is no appropriation for this. That's correct. My other question, though, is are you familiar with all the other different savings and when they started in Medicaid? the ones I'm familiar with. All the different savings that started back since 2011. You had you had physician, you had providers, doctors, hospitals. You've had all these other people in the Medicaid space that started savings back in 2011. That's correct. And the only reason we
Speaker 182
50:35
didn't, the only reason we haven't included those is in the, in the savings calculations that we provided are, number one, those weren't part of the task force savings. No, I would disagree with you, but go ahead. Well, I mean, the five-year plan. They weren't part of the five-year plan that was in the final report for the Stephen Group, and also because those providers are not included in the rate increase in the bill. Our idea was that the people who were getting the benefit ought to be coming
up with the savings. And in fact, they do
match. So to be fair, there are doctors that started with savings in 2011 through the episodes of care, which I'm not a fan of. But those savings started in 2011.
Do you know how long they have had a rate increase? How long it's been for them since they've had a rate increase? I don't know
Speaker 182
51:33
exactly, but I know it's been a long time. The rates for doctors are governed by a consent decree from a court case from the 1990s.
There's a process where the department and the doctors are supposed to meet, representatives of physicians are supposed to meet every year to talk about rates. And my experience, that meeting generally doesn't even
happen. Does not happen. That's correct. What
Speaker 182
52:01
about hospitals? I mean, I'm just asking for rate increases. Hospitals rates are cost-based if they're below the cap. The cap was last increased to 7.25, I think, while I was there, or 7.75.
It may have been increased since then. I don't know for hospitals. But again, hospitals are not included either in this bill nor in the savings and anticipated savings. that we're looking at in the plan from the task
force. I understand. My point is there are a lot of other
people that contributed to savings for Medicaid before the task force even started.
Speaker 182
52:48
And that is an accurate statement. That's correct. And one of the positive aspects of this bill is every provider type would have their reimbursement mechanisms and rates reviewed on a three-year cycle if this bill were passed. So that meant doctors and hospitals and anybody else would be guaranteed that their reimbursement mechanism, their reimbursement structure, their rates would be looked at every three years.
Okay. And do you know if that's consistent with what the executive order from the governor has already?
Speaker 212
53:24
The executive order from the governor, I believe, called for four years with the first ones to be finished July
Speaker 182
53:30
1st, 2021. I believe that's what the executive order called for. All right. Thank you. DHS, will you come
to the table, please? Madam Chair, you want us to
Senator Kim Hammer
Unverified
53:39
clear out, or are we okay sitting here?
Yeah. Stay there. I'm fine. Senator Hickey, you're recognized.
Senator Jimmy Hickey, Jr
Unverified
53:51
If you could just state your name for the record and then we'll
Speaker 221
54:02
go to Senator Hickey and his questions. Kelly
Speaker 222
54:07
Link, Legislative Integral Mental Affairs at DHS. Dawn Staley, Deputy Director and Medicaid Director for DHS.
Speaker 224
54:13
Dennis Smith, Senior Advisor for Medicaid and Healthcare Reform. Okay.
Senator Jimmy Hickey, Jr
Unverified
54:17
I guess I'll do it in my simple way. according to this gentleman
here, you all have more than enough money now to pay for this.
Speaker 225
54:27
Is that true or not true? No, I would disagree with what Mr. Wright has said, both in terms of the amount of money that he is quoting that this would cost. Based on our estimates, we believe it's actually closer to $20 million of basically the state match that would have to be put up for a total of $65.5 million. So, I mean, that's, I think, one area that's important to clarify. And secondly, while we did talk about appropriation, that is just it. It's appropriation. It's not funding. So this
would be something that would have to be absorbed within the existing budget, which is not something that has been accounted for at
Senator Jimmy Hickey, Jr
Unverified
55:09
this point. Just because it hasn't been accounted for, though, do
you all, I mean, they've showed these savings here. Where is this at? Where is it going to?
Is it sitting in accounts? Where is it at? So
Speaker 225
55:26
that funding is not sitting at DHS. I think that's important to start with. In fact, we actually, and folks may have seen this, but
last state fiscal year compared to the previous one, we actually spent less for the first time in history, and we returned money actually back to the state. So we are by no means sitting on any kind of stockpile of money or savings that have resulted. We're certainly very happy and excited about the great work that providers and others have done to achieve those savings, but like I said, they're definitely not sitting in any account or anything at DHS. And I understand that. You're required to send that
Senator Jimmy Hickey, Jr
Unverified
56:00
back to the state. If you have those savings, those come back to the state every year, or they would, is
Speaker 225
56:08
that correct? At the end of the year, if there are funds left over, there is a mechanism for some portion of those to be swept into the Medicaid trust fund. But otherwise, those funds revert
Senator Jimmy Hickey, Jr
Unverified
56:20
back to the state. Okay. How much last year? You said that you sent
Speaker 238
56:24
money. How much money was sent? Is it $32 million? $32 million? Yeah. Somewhere around
Senator Jimmy Hickey, Jr
Unverified
56:28
in the – and I understand. Okay. so
if if we were to pass this bill what what what would you all need what would you all need to
fund this i mean if we don't have
an appropriation and i don't know what
senator hammer he alluded to something with rsa are you looking to try to amend are we looking to try to amend rsa is that what we're trying going to try
Senator Kim Hammer
Unverified
56:59
to do we are in that very fluid time of the session it depends what the will of the committee is regarding
this. I think that would force that discussion. And to me, I think, in my interpretation of where we are, it would force
us to have that discussion if this bill passes out. Okay. Could I ask DHS another question?
Senator Jimmy Hickey, Jr
Unverified
57:16
Yes, please. Okay. They're saying $12 million. You are saying $20 million. Any idea why there's a difference? Can
you tell us why you think the $20 million is a correct number? Based
Speaker 225
57:33
on our math, we have looked at this as it's an across-the-board rate increase. I know that providers and others may say that it's, you know, it's just for certain services, but the way that the bill reads, it is an across-the-board rate increase. So even for
services that, you know, like, for example, services that may be provided by a therapist or evaluation services that may be provided by a physician would all be impacted by this rate increase. Now, I can't speak to the numbers that have been provided, that the providers have come up with. We have talked to them about that in the past, but I have not seen their numbers, so I can't speak to how their figures compare to ours. What I can say, though, is that even the estimate that we put together is assuming that we would be able to draw down federal match. I think
something that's important for the committee to understand as well is that there's a lot of things in this bill that are not things that we could consider as part of a right study, and we've certainly, you know, have been through the experience before, as I know some of the senators within the room have, where if the law says we're required to pay for something, even if CMS doesn't allow us to do so, a lot of times those providers end up going through the Claims Commission and we have to pay for it anyway. So, again, that's part of our concern is there is the financial component, but there's also
the fact that the way this bill is written, it actually includes things that we could not consider and things that likely CMS would not allow us to do, meaning that there would be a significant share of the state's dollars that are on the hook if we were not able to get federal match.
Senator Jimmy Hickey, Jr
Unverified
59:09
Where exactly in the bill? Would you point that part out to me? Certainly. Where that part
Speaker 225
59:18
was giving you concerns? I'm just trying to pull up the page number basically. So on page five
it talks about what are the factors that would go into the proposed rate study. For example item number four the extent and amount of uncompensated care delivered by providers. That is not something that would be part of a rate review because again if we're asking CMS to provide funding for this uncompensated care is not a factor that would be considered. Similarly, number six talks about the capital infrastructure needs of Medicaid providers. With rare exception, Medicaid cannot pay for those
types of expenditures. So again, including things like the cost of a building or the cost for upkeep or maintenance is not something that would be included and eligible for federal match. And likewise, number 10, the availability of other non-Medicaid state or federal funding for the services provided. Again, since the purpose of this is to look at, you know, Medicaid funding, that would not be a factor that we could take into consideration and likely would not result in a study that we would be able to get federal funding for in terms of Medicaid match.
Speaker 224
1:00:28
Okay, I'll pause for a bit. If I may, there are two others that, again, are concerned. Number one, extent to which existing rates or reimbursement methodologies allow providers to operate on a solvent basis, and I would just throw in from my own experience previously in another state to where a group of investors came in and bought up a number of nursing homes and turned out to be a very bad business decision, but they turned around and expected the state
to basically build into our new rate-setting methodology to compensate them for bad business decisions. I don't think that that is really what would be intended. We have a catch-all phrase of any other factors that are relevant in reviewing Medicaid rates and reimbursement methodologies. Our concern is when you go through this process and then go to the end of the bill where there is the private right of action for an individual provider or a beneficiary to go to
court. Again, this has a four-year history. I don't want to go through all of that, but in Medicaid, a group of providers previously sued their state on rates. The U.S. Supreme Court determined that they did not have a private right of action on the outcome. So this private right of action is on the process. So again, we can make a majority of providers happy. We can make a supermajority of providers happy.
But if we have one provider out there, for example, that we did not, if the provider believes that we did not sufficiently consider their alternative to the rape methodology, they could still go to court. So again, not certain if this actually will speed up or slow down what we're trying to achieve. With the recent Supreme Court decision about
Senator Jimmy Hickey, Jr
Unverified
1:02:27
you all as a state, do you even think that it would be allowed that you would be sued?
Speaker 224
1:02:37
The court said that there is no right of action on rates, but this would be on the process. And again, we already have a process. We have Administrative Procedures Act, the way we promulgate on methodologies, the way it comes to the legislature for review. we already have those things in which the public interest is protected. This adds to that, and basically it says that public process is no longer sufficient.
Again, we go on the premise that writing something new into law, there's an expectation that it does confer a new right that does not presently exist. So we're moving from a public right to a private right. Thank you. Senator Caldwell, did you have a question? I have a
Senator Ronald Caldwell
Unverified
1:03:35
comment. I'm going to poke them in the eye. We talk about the nursing homes coming in and making bad business decisions,
and then they talk about protecting the public interest, and it always comes back to me of the computer contract that we made and spent millions of dollars on that we shouldn't and the contract that we were going to allow but the legislative council stopped that we were going to pay nine million dollars a year more for a contract than what we were paying that was over seven years 63 million dollars we were going to throw down a rat hole and so you know again uh if we can find savings and sir you may have some
some insight on the comments that DHS has made as far as savings to be made or not. I'd love to hear comments from you.
Speaker 182
1:04:34
All right. Let me try to respond. Number one, in terms of savings, what we've shown is savings that the department has reported in the past. As I said, I gave three different reasons why there's every reason to believe that those savings are going to be even greater in the future.
So that's what you're looking at in terms of the rate increase. The estimate of the cost of the rate increase, therapy services are not included. Early intervention, day treatment services, yes, those providers employ therapists. But the service that's being increased here is the day treatment service. So we have limited it to those services, specific services. The list of items that we've suggested that we've said that should be considered,
we have not, it does not say that any one of those things has to be entirely reimbursed, reimbursed at all. Those are simply things that should be looked at because they're part of the operation of a provider. I think you're going to hear from some providers later. And those are things that have an effect on a provider's ability to provide services with the reimbursement that is, with the reimbursement that's provided.
Suggestion that we already, we already have these things, we already have a process. Well, process it results in no rate increase in nine years. I'm not sure that's really a good process. And the department even said in the House committee that they agreed that this kind of review should happen. I've been in meetings with the department and three different provider groups who have asked about the minimum wage increase and how is the department going to deal with that or reflect that in reimbursement rates.
And the answer in every case has been that we are working on a department-wide strategy. We've yet to see a department-wide strategy of any kind. And so that's why we've put it in here. And again, back on the appropriation, even though there is not a specific appropriation for these rate increases, there is adequate appropriation in the Medicaid appropriation bill,
one of which has been signed by the governor and the other which is sitting on the governor's desk. There's more than enough to use for the spending authority for these increases. And in terms of the lawsuit, arguably you could sue the state even without this language in here. Essentially what we've done is put a limitation on what you can do. The only thing, you don't sue for money, all you can sue for is equitable relief
if the department doesn't do this review, it doesn't do the rate review process. Just one more. So
Senator Jimmy Hickey, Jr
Unverified
1:07:39
if the money's there in the current appropriation, and don't misunderstand what I'm saying on
how I'm going to vote here, if the money's there and they're willing to do it, we don't even need this bill, if they were willing
Speaker 182
1:07:55
to do it. Is that correct? If they were willing to do this or
Speaker 193
1:07:59
did this, this does not require legislation.
Right. But that's not been our experience.
Senator Jimmy Hickey, Jr
Unverified
1:08:05
And I'm well aware of that, but that's what I go back to my original statement. We can pass this bill, but if we don't have that funding mechanism that failed in special language, how are we going to make them do that? I don't want to mislead the public with this thing, because I don't want to pass something
out of here and them not understand, because from the public standpoint, they think whenever we pass this legislation that that's automatic, and it's not that way. You have to have the funding mechanism with it. If we have the funding mechanism with it today, I'm a yes today. I may be anyway. but I want there to be some direction whenever we vote or if I vote yes and you get a majority vote out of this committee, what we're going to do.
Speaker 182
1:09:05
Are we not back to you with what you just said about the appropriation? They just have to choose to do it. Again, there are hundreds of millions of dollars in excess appropriation in the Medicaid budget, and we have seen the savings halfway through the five-year period. The savings are getting bigger every quarter. That would indicate that there's going to be more than enough funding in the Medicaid budget to fund this increase
if you cost it out at the limited services that we've included in the bill.
Gerald Sherham
Unverified
1:09:43
Senator Hickey. DHS, I think, did you want to
Speaker 221
1:09:46
respond? Not necessarily a response, Madam Chair, but yes, ma'am. Also, I don't know if you've approved to pass out. I have.
Speaker 255
1:09:53
okay the executive order and then the other sheet as well but um as as was pointed out i did say in the house committee we agree there needs to be an a systematic review of everyone's rates there's
approximately 30 provider types in the state and as was pointed out earlier in the past however many years of dhs we've not had a systematic system review and and the governor has put it this executive order in which you have in your hands now that promises that we will do this the which is the latter part of this bill that we will do this systematically every four years and and if you think about there's roughly 30 provider types that means we're reviewing a provider type about every month and a half we will be in constant review of some provider type
in the state and this this executive order lays that out and assures that we'll be doing that in the future as we
Senator Ronald Caldwell
Unverified
1:10:53
should. Thank you. Senator Caldwell. When would a rate be changed? When would relief come
Speaker 255
1:10:58
to fruition? We've already, Don, if you want to speak to that, we've already started this process as far as trying to find the folks to do the
Speaker 225
1:11:10
reviews and that. Thank you. And yes, just to add to what Mr. Link was saying, within the governor's executive
of order, it does say that after the initial two-year review, which would include all of those 30 provider groups that Mr. Link mentioned, then there would be a cycle that would be set up so everyone would be reviewed no less than four years. I think something that's important to also emphasize is that within these first two years, as we're reviewing all the different groups, if we determine that a rate then needs to be set for an actuarial study, basically to say, let's actually see whether or not there's a significant increase in cost, and then to go ahead and then look at adjusting that rate,
that's something we're going to do right away. We're not going to wait for two years. We're not going to wait for four years. So as an example in this case, if we were to look at EIDT as a provider group, you know, within, at the beginning of this, we would then be in a position to be able to then have a rate increase, if that was ultimately what was decided, go into effect in January. So, I mean, we're talking about a pretty aggressive process, as Mr. Link said, in terms of within basically a month and a half to two months, we're going to be reviewing multiple provider
groups, and then if it's determined that there is a need for an adjustment, we're going to bring that forward to the legislature, as well as to CMS to get the federal and state approvals and
Senator Ronald Caldwell
Unverified
1:12:29
reviews necessary to go ahead and put that in place. In layman's term, when
Speaker 255
1:12:33
would relief come to fruition? January 1st, 2020. So in eight months, ten months, whatever that
Senator Jimmy Hickey, Jr
Unverified
1:12:44
is. Senator Hickey, did you have another question? I have a question for the providers or provider groups, and this was one thing that I asked
during ALC, which was, I know you referred to the minimum wage increase, correct?
Okay, so my question during ALC to the different provider groups that have come before us asking for increases based on the minimum
wage increase that was voted on by the voters of the state of Arkansas, which was a citizen-led initiative. It was not an initiative that was sent from this body, the legislature, to the ballot. It was citizen-led. So I don't feel a responsibility to it just because it didn't come out of our body.
But did you or your organization or your provider group organize a campaign to try to defeat the minimum wage ballot initiative during
the fall election? I believe all the provider groups
Speaker 182
1:13:41
that have answered your question have said no, they haven't done that. Okay. But they have to live by the minimum wage increase no matter how it passed and by
whom. I understand that. However, I know that there were provider groups and I know
that there were organizations and groups that actually campaigned
and came together to try to defeat the minimum wage increase because they knew what it was going to do to
Senator Jimmy Hickey, Jr
Unverified
1:14:10
their businesses. So I just ask that question because I think people have a responsibility for outcomes of elections. And I think you'll
Speaker 212
1:14:19
hear from a couple of providers from the groups that will be able to address
that as well. Right, but you did not. Okay, thank you.
Are there other questions? Any other questions? Okay. Yes, Senator Caldwell. All right.
That is a proper motion. Madam Chair, I did not
Senator Kim Hammer
Unverified
1:14:49
hear what the motion was. I'm sorry. The motion
was immediate consideration. And we do have people signed up for and against this bill just for the committee to know that is a proper motion non-debatable those in favor say aye
and opposed no all right well i guess the nose have it okay yes may i
Senator Kim Hammer
Unverified
1:15:19
make a may i make a motion as a member of the committee Yes. I'd like to make a motion. We
limit debate. Ten minutes either side. That's a proper motion. Any discussion? All
those in favor say aye. Aye. And opposed? Ayes have it.
Senator Kim Hammer
Unverified
1:15:37
Thank you. Okay. Madam Chair? Yes? I do have the right for the
closing comments, all right? Yes, you do retain the right for a closing comment.
Thank you. Okay. All right. We have only one to speak against. No. Do we have any against? Okay, we have three that are four. So I
guess we'll, DHS, you're opposed to the bill, so we'll give you the opportunity to speak against the bill.
Is that okay? Since it's 10 minutes, both
sides. No, we'll go to the
four. If you can come to the table, I have Luke Mattingly, Stephanie Smith, and Janie Sexton.
Go ahead and state your name for the record,
Speaker 266
1:16:54
and then you're recognized. I'm Luke Mattingly, CEO of CareLink, and I'm representing the
Speaker 267
1:17:00
Area Agency on Aging Association. Okay. I'm Stephanie Smith. I'm with Easter Seals, Arkansas, and also with the Developmental Disability Providers Association, and here
Speaker 271
1:17:11
to answer any questions. I'm Janie Sexton. I'm representing the Developmental Disability Provider Association, also Executive Director for Building Bridges Development on Community Services,
serving Lone Oak Prairie, Arkansas County. Thank you for being here. I know it's late, but thank
Speaker 268
1:17:31
you for being here. Go ahead. Well, I'm going to skip some of this because I know
Speaker 266
1:17:36
time is of the essence, and I appreciate you folks' time. You know, with such long spans between rate increases, providers are always left struggling to keep the doors open and have to plead with the legislature to resolve the issue. And DHS kind of acts like this
is the first time they've seen this, but I personally contacted leadership at DHS when it looked like this thing was going to get on the ballot last spring. And then when it did get on the ballot, I contacted them. I said, look, this is going to be a real problem. We need to get planned for this in the budget. Then I contacted them when it actually passed. And then we had a meeting at DHS, Kelly Link, and the answer was no. So that's why I have to be here with you guys today, because they wouldn't include it in the normal budget allocation process. This bill does establish that periodic rate review.
Now, we haven't had one in almost four years. The one before that was eight years on the home and community-based services side. The minimum wage was $6.25 in 2008. Today, a little over a decade later, it's increased by $3, a 48% increase, and only increased by another $1.75 by 2021 for a total increase of 76% by 2008. Our rate increase in 2016 was 7.4% or $1.24 per hour. The requested 8.8 is an additional $1.58 per hour, still below the required minimum wage requirements.
Adjustments, and this does not totally solve our entire issue. Rate compression amongst more senior employees that now will be at minimum wage or at the same rate as a new hire is not addressed. Minimum wage is not the only contributing factor. The cost, of course, normal inflationary costs, software, additional administrative processing and billing costs, the Medicaid reform actions and office facility costs are also rising. Now, CareLink has been providing this service to seniors and we're in business for 40 years, so we're one of the entities with the most experience in the state.
And we believe in change, so we know that because Medicaid funding challenges we must be proactive, innovative, and pence pennies in order to continue serving the senior population, which is our passion and our agency and life mission.
Speaker 268
1:19:46
However, even as good as CareLink is, and we're great with such rapid labor and other cost increases, we're barely
Speaker 266
1:19:53
at break-even financially right now with personal care. We're not filling vacant positions for over a year. We've laid off five professional staff in November 2018 after this was passed. We're making other
expenditure reductions. And in the upcoming fiscal year, there's going to be some real cuts to aid holiday paid, deleting all their benefits and life insurance, except what is exceptionally statutory and mandatory. Like the state of Arkansas, we strive for a balanced budget and can't continue deficit spending. So even with these deep costs for efforts by fiscal year 2021, when that final one comes, I think it will probably be the death kill for our agency for this service. everyone agrees these are extraordinary circumstance and we're asking our
legislature from the great state of Arkansas to not only recognize that it's a problem but to take action I said earlier in the presentation that I have to come and plead with the legislature for rate changes so as I am humbled by the daily struggles of the people that we serve I'm here today pleading with you not for me or these agencies that are around me but for our older people your constituents they've worked all their lives and because of advanced age and health issues
they find themselves with depleted resources and they have to rely on these services to stay in their homes independent for as long as they possibly can which is where they want to be and for them please send
Speaker 276
1:21:20
this bill to the full senate for consideration and i would really appreciate that and thank you so
Speaker 267
1:21:27
much for allowing me to speak um i just want to um answer Madam Chairman's question as far as the vote. Easter Seals did not do an outreach to campaign against the minimum wage initiative,
but we also didn't campaign for it. The majority of our staff are these minimum wage staff people, and to campaign against something that would benefit our employees and the moms and dads of the children and adults we serve would be a very difficult position. But I can tell you, when I went to the polls to vote, I was very conflicted because I knew voting for it would be devastating for Easter Seals, but then voting against it would be devastating statewide for all of our employees that barely make it from paycheck to paycheck.
but I voted no. And I voted no because I knew our state had not prepared for this minimum wage increase or the three prior to it. So while this one puts us at a cumulative for, since our last rate increase of 27%, if we even take this one off the table, we're at 18% for the three that happened prior to it since 2010, since our last rate increase. And then that doesn't even take into account just the regular cost increases of doing business in the last 10 years, you know,
it's over 15% if you're just looking at general inflation. You know, for us, what it's going to mean, we did pass a deficit budget this past year. We didn't do annual increases. We did not fund our retirement match. In the prior years, we have taken benefits away. We've shifted all of our health insurance costs to our employees, any increases that we get. Reduce the number of days that we close, eliminated administrative and finance staff position.
Our overhead for the past fiscal year was 7.92%. We can't get any leaner. And so what it'll mean this next year as we're preparing for our budget is that we will be looking at closing programs. And if we close programs, not only does it mean children and Adults with disabilities will not get the services that they need, but one of those parents is going to have to stay home. And so that means we've got more people unemployed, less people contributing to the economies of our communities.
And we're doing a disservice, not only to the people that we serve and their families, but to the state. So I would appreciate a good vote. Thank you for your consideration. All
Speaker 271
1:24:12
right. I'm going to just briefly say I'm here to answer any questions, and I'm going to give you a specific impact. I'm a medium-sized program. I'll give you an impact. On January 1st, 2019, 48 employees were increased to 925. I only have a total of 175 employees.
In January 2020, there will be 55 employees that will be raised up to $10 per hour. Again, I have 175 employees. January 2021, 115 employees will increase to $11 per hour. It doesn't take really a good assumption to understand that there's no way we can support that. I already have a break-even budget. Many of the providers that you see here today have a break-even budget. but that's without even considering the minimum wage impact.
I mean, I would like to defer the rest of my time to Robert. Do you want to add anything else? Do you have anything else to add? Okay, I think if you have questions, I'll be glad to answer any questions, but I do ask you to pass this bill forward for the sake of the vulnerable people in the state. Thank you. Do you have
Senator Jimmy Hickey, Jr
Unverified
1:25:25
any questions? Senator Hagee. Just one. You heard my comments at the beginning. We passed this bill. There's no funding mechanism attached to it.
You all understand how that works? I want to make sure
that I do not want to mislead the public. Everybody gets excited. If it were to pass, it may fail. If that bill that was in special language had failed, that was the mechanism that you needed to get the money. If it would have passed, and it failed. So I know I've said that about three times, but I want to
make sure that all of you understand that.
So I may not like it, but it's reality. You know, just because a bill passes, if you don't have the funding mechanism, it's not worth the paper it's written on unless we figure out something else. And Senator Hammer may have some other ideas
that he's got in his pocket, so thank you. Yeah, yes, sir. All right. Thank you. All right. Thank you.
Thank you. All right. Thank you so much for your comments. All right. DHS, you want to come to the table since, please.
Speaker 225
1:26:46
You're recognized. Thank you. Again, I just want to reiterate that while we are opposed to this bill, we are very supportive of the concept of doing the right review as outlined the governor's executive order. And again, that is something that for all 30 provider groups, they will be reviewed within the next two years. So I think that's important. Again, we understand and appreciate the work of all the providers in this room and others that serve our clients each and every day. But again, we think this process should be one that is set up on a regular cycle
that allows us to look at all providers as opposed to looking at this particular group of providers and then having to then have an off cycle to then look at other providers because, you know, much to the discussion earlier, we have other groups such as physicians and others who have been tremendous supporters of the program and helped achieve significant savings and they have not received a rate increase. And so, again, you know, we are very supportive of the concept. In fact, we've worked with other members to be able to look at
Speaker 232
1:27:47
other legislation that would support these efforts.
But in the current form, this bill is
Speaker 224
1:27:56
not something that we can support. The rate review cycle itself absolutely should be established and ongoing, predictable, and stable. but it has to work in such a way in which you do those reviews up front and make the comparisons in the marketplace. Every single type of Medicaid provider is competing for the same pool
of entry-level talent and going up the scale. So this does not affect just a small group of providers. It affects all providers. And to be able to do that in a systematic way and one that is manageable and that it also coincides with the regular budgetary cycle of the General Assembly. We think that it would be, that it is imperative to be able to make recommendations prior to the
funding cycle so then the General Assembly had the ultimate power is the power of the purse and to be able to make certain that we are living within a budget that is stable and predictable and that you are willing to fund it again rather than an approach in which one group or another sort of gets to rush to the head of the line. All of these providers are under the same pressures for competing for the talent pool. All of them have concerns to be raised.
They should be dealt with, in my estimation, together in a systematic way. And then ultimately the General Assembly has the power of the purse and has that information in a way that is systematic so it's not on an ad hoc basis of which provider group gets to go first. Senator Sample, you had a question?
Senator Bill Sample
Unverified
1:30:04
Yes. How many of these providers do you think are going to be able to survive for two years? Because I don't think any of them are without this. I certainly appreciate the question, and I think it's
Speaker 225
1:30:24
helpful to clarify that while the review, the initial review will occur over two years, as we begin going through and looking at those groups, if it's determined that the rate needs to be increased, we're going to bring that forward.
So it wouldn't be that the provider group would have to wait two years if it's
Speaker 285
1:30:42
determined that in that initial review, we need to move
Senator Bill Sample
Unverified
1:30:47
forward with a rate increase. Madam Chair? Yes. So how long do you think that it's going to be before you review
Speaker 225
1:30:54
this? These folks can't live on hope. Certainly, certainly understand. And again, we have begun the process as outlined in the executive order. And at this point, you know, whatever rate increases that may result from the first review would go into effect January 1st.
Senator Bill Sample
Unverified
1:31:09
I don't think these folks can last until January 1st, just to be honest. I mean, I know what they're looking at. And so if we don't pass this, we are giving them a death sentence real quick. Thank you, Madam Chair. Are there any other questions?
All right, seeing none. Senator Hammer, you're recognized to close for your bill.
Senator Kim Hammer
Unverified
1:31:46
Madam Chair, if you'd allow, I will be as brief as I can, but I also want to be as deliberate as I can because of the sensitivity of the issue before us. And I want to speak a little bit from my heart, I want to speak a little bit from my emotions, and I want to speak a little bit from what I see as a factual situation. First of all, to Senator Hickey's question, we always find time and we always find resources for what's important around here. And just to be really blunt and direct, I got field dressed pretty good today.
But it's because we always come back around to the same discussions, and it cycles around, it seems like, every one to two years. We had John Steen come in and do a report and work and spend time extensively dealing with where we are health care-wise. After that report, DHS hired Millman to come in and do an analysis. I requested that John Stephen would be able to take a snapshot of one particular issue,
and that was not done as far as a comparison, so we're left here in this position that we're in. We seem to find time and we seem to find resources around here, even to tie up our bureau and our staff working on a 2,000-plus page bill that has pushed this to the last partially, not entirely, has pushed this subject matter, this bill, here in the late hours of the night for us to make a decision. We've been told that we're going to be here until next Friday. If this is important, I bet we can find a way if that's what we choose to do.
It's a debate. I'm a little bit at a disadvantage. I'm not on budget this time. I was on budget last time. You're smarter than I am when it comes to that. I'll admit it. Or Senator Samples. I'll give somebody here who's maybe a little bit smarter. But you heard somebody who used to be a state employee say that the appropriation is there. We're down to the debate of who do we believe. And if you've got to decide who you're going to believe, you've got to look at the history that goes into your decision-making process. And I do appreciate the work of DHS, but I also appreciate the work that these providers behind us do.
And we've been called into special sessions before. I want to draw your attention to now what is stated in fact in the bill, and it's on page 3, and it begins on line 29, and it goes down through line 34, and there's a key phrase. And this is legislating processes in place that in all probability should have been in place a long time ago. But what it says on line 29 is the department shall use best efforts to make the rate increases in subjection, a subsection of this section effective for services on or after July 1st, 2019.
The next one, the rate increases shall not be implemented until approval by the Centers for Medicare and Medicaid Services if federal approval is required. I do believe that clearly identifies that there are some safe steps in here leading up to that process. Senator Sample, you hit on a point right there, and that is that some of these folks may not hang on. Unfortunately, time will prove that out based on what we do here.
My final thoughts bringing it in is this. Providers have been through three minimum wage increases. The groups sitting behind me are probably the ones that have been impacted the most by that. Two more coming in 2020 and 2021, and yes, that was imposed upon us by the voters of the state of Arkansas, which now creates the position for us to have to make some tough decisions. Providers cannot factually continue to operate as wages and other costs go up without some increases.
And executive orders can be undone as well as they can be done. and here comes the executive order today, unless I'm mistaken, I didn't even see it. I didn't get a copy of it, but unless I'm mistaken, I don't know if that came on the House end or not, Madam Chair. I'm getting a little vulnerable here, but here it comes as a result of what? As a result of us having the providers come and just simply say, just make sure that it doesn't go away down the road. Madam Chair, with that, I'll respect the opinion of the committee.
i'm ready to make a motion unless the chair wants to entertain or direct
questions no i think you've closed for your bill and so we we're past the time of
Senator Jimmy Hickey, Jr
Unverified
1:36:27
questions um i am disclosing i do have a family member that works in this arena so i'm going to be abstaining from this vote because there would be a direct financial interest from a family
member motion do pass and there's a second those in favor say aye aye and opposed
no um it takes five votes and i'm abstaining i'll call for roll
Senator Kim Hammer
Unverified
1:36:55
call okay just for clarification on the record manager okay that there are not enough in the room okay thank you please call the Senator Sample. Senator Caldwell.
Speaker 295
1:37:18
Senator Hickey. Senator Hester. Senator Hester. Senator Filippo. Senator Filippo? Senator Hammer? Yes. Vice Chair Wallace? No. Okay.
Speaker 169
1:37:55
Okay. It has four ayes and one no. Motion fails. thank
you thank you all right next bill i
believe we have yes five minute recess okay
Speaker 294
1:39:27
you.
Yeah, that was going to be the time when it infects the whole crew. It's starting to feel bad. You started to feel bad? My ears are hurting. It'll
Speaker 294
1:39:54
I hope I never have that experience. Five times, don't do it. I don't ever drink the water now.
Speaker 312
1:42:32
I'm starting the president's program,
Speaker 294
1:42:35
so I'm very excited about it, so I think that's happening. We have a very, very little campus in the middle of our area, demographically, because we're very happy to serve.
Speaker 307
1:42:51
Great. That's a big deal. We're going to let you also apply expansion there, but take some fresh oil. Some fresh oil. Yeah.
Speaker 331
1:43:02
Yeah, you do. Yeah, you do. Yeah, you do. I'm about to
Speaker 332
1:43:13
present it. I called you back in a few years. Okay, thanks.
Speaker 293
1:43:19
You can mark your soul and your head in here. Nothing more you could have done. We need
Speaker 336
1:43:27
to start home tomorrow afternoon. We will. No, I mean you.
Speaker 338
1:43:32
I don't help them. I know, but it's not over
Speaker 126
1:43:48
until, you know, some of them come up and work. Let me not say credit, there's
Senator Kim Hammer
Unverified
1:43:52
that much money sitting there. Why is it just sitting there? Well, that's what I'm going to find out. Because on April 8th, we can extract the bills from the committee. Three days. All I got to do is get on the floor.
So that's what
Speaker 342
1:44:06
y'all need to do. Y'all need to light
If y'all can come back to your seats, Representative Watson is here and Senator Wallace, they have a bill, and we're going to go to him since he's already here, Representative Watson. This is
the bill, House Bill 1967, I believe, which is the ADEQ bill.
So if you guys can get down to the end of the
table and make this succinct, I would appreciate it. It's House Bill 1967. Do we have this bill in our packets? I just handed it out. Okay. House Bill 1967, you're recognized to present House Bill 1967. I don't have it on
Representative Danny Watson
Unverified
1:46:29
the mic. Thank you, Madam. Thank you, Madam Chairman. House Bill 1967 is in reference to environmental officer program.
This potential legislation was brought to me on behalf of the ADEQ. Just real quickly, this amends the Arkansas Code 816-2066-101, titled the Environmental Compliance Resource Act, and create the environmental investigative officer position for the Arkansas Department of Environmental Quality to improve environmental investigation outcomes and enhance program effectiveness. It allows, number two, it allows for certification of municipal and county environmental officers by amending Title VIII of the Arkansas Code.
Number three, again, it allows for the transfer of illegal dump control officers and all of the duties to become certified environmental officers. Number four, it removes the requirement that solid waste districts must have illegal dump control officers in order to assess fees. Anything for efficiency, more effectiveness, and not building up anything on an apartment that strives for compliance, something I have done for the last 31 years.
I have to be privy to look into this. And the young man sitting to the right, I'm going to have him identify himself. If there's any more questions, feel free to ask. Go
Speaker 349
1:47:51
ahead. Yeah, thank you very much, Mr. Watson. Michael Grappay, Arkansas Department of Environmental Quality. Okay, are there questions on
the bill? Are there any fee increases here? There are no physical impact.
Speaker 350
1:48:10
There are no fee increases or personnel hires. There's
no fiscal impact here. There's no, okay. This bill is simply
Speaker 349
1:48:16
to help the cities and the counties get people educated to help enforce the problems that they face every day. Okay. So the second part of the bill is just
repealing code. Okay. Any questions from members of the committee?
Seeing none, you recognize a close for your bill?
We have nobody here to speak for against
Representative Danny Watson
Unverified
1:48:46
this bill. Yes, thank you, Madam Chair. I appreciate a favorable vote. on this positive legislation. Thank you, and I'll close.
Okay. What's the pleasure of the committee? I'd like to pay it. Second? All those in favor say aye. Aye. And opposed? Ayes have it. Congratulations, and thank you, Representative, for coming back to us tonight. Thank you, Madam Chair. Okay, thank you. Senator Wallace, we do have three more bills, I believe.
That's it. But Senator Wallace, are you presenting House Bill 1815? House Bill 1815 is by Representative Perry.
House Bill 1815? Okay, Senator Wallace, you're recognized.
Senator David Wallace
Unverified
1:49:55
Thank you Senator Dave Wallace, District 22. This bill is written to give relief to bereaved families. They're still having an issue getting death certificates signed and death certificates back to the families. It's written with intent of putting a little bite
into the law as it stands now. As the law stands now, the medical certificate has to be completed and signed within two days. They're changing that three days in order to give the hospital or the physician more time to do it. The process from death is a medical surfer has two business days from date of death to complete the
medical information. That'll change to three. The medical staff will have an opportunity to put additional medical information and put it in an electronic form. That's three days. And then the medical certifier will certify the death case within two business days of death. And we've got cases now where individuals of bereaved families are not receiving the death certificate for weeks in some cases.
Senator Jimmy Hickey, Jr
Unverified
1:51:34
I'm sorry, Senator Hammer, you have a question? Thank
Senator Kim Hammer
Unverified
1:51:37
you, Madam Chair. Is the Department of Health here? Yes,
they are. Could we get them to the table, please? Yes, if you can come to
Speaker 364
1:51:54
the end of the table and you can say
Senator Kim Hammer
Unverified
1:51:58
your name. Laura Shue, General Counsel for the Department. You may proceed. Thank you, Madam Chair. Good evening. So, what's the Department
of Health's perspective or reason or views as far as the delayed turnaround time?
Because I know y'all are involved in receiving and issuing. Can you just give me a quick education? A lot of hospices
are doing electronic filing now and everything.
Speaker 366
1:52:21
So, can you put some light on this? Yes, sir. Thank you, Madam Chair, members of the committee. Senator Hammer, this is not our bill, and we are neutral on this bill. But as far as providing information about our electronic registration of Arkansas vital events, the e-RAVE system, this bill would mandate use of that electronic system.
And it's my understanding the intent is to increase the use of the electronic system to decrease
Speaker 33
1:52:48
the amount of time it takes to get the certificates to folks. All right. Senator Walsh, so
Senator Kim Hammer
Unverified
1:52:53
this is a mandate transitioning away from paper copies to electronic copies. Is that right? And I saw there's a pretty good fine for a physician who doesn't get it. We hear a lot of discussion around here about, you know, problems with people having access to the Internet and all that stuff.
That's been reasons before why, you know, bills have not gone through. So why would we
Senator David Wallace
Unverified
1:53:22
this bill? Well, written within this bill, and I'll find it, they've gone to the point of making it very reasonable. If, for example, a physician is older, maybe my age or older, they give them more time to do it.
if there is issues with internet, they'll have more time. Where's that stated in the
Speaker 367
1:53:56
bill? I'm looking for it. Now, I was giving this bill about... Oh, okay. Sorry. Yeah. Yeah, sorry. It's on page four. Page four. I'm sorry. You're carrying this... I'm sorry. Yeah. You're carrying for... I got this about You're good, man. 515. All right. I know. Thank you, Madam Chair. Sure. Yes, Senator Hickey, you have a
question? No. I was just saying it's on page four.
Senator Jimmy Hickey, Jr
Unverified
1:54:19
Oh, I'm sorry. Okay. Thank you. Any other questions? All
Senator David Wallace
Unverified
1:54:26
right. Thank you. I'm sorry. Go ahead. Yeah, and thank you, Senator Hickey. If you look at line six on page four, that will show some of the waivers
that they'll process to help out individuals that are
having issues with this. Okay. Thank you. All right. We
do have somebody who signed up
Speaker 371
1:54:56
to speak against the bill. If you can come to the end of the table and state your name. I'm here today to speak out against this bill.
There are multiple problems inside of this bill, and unfortunately there wasn't a collaboration of stakeholders to actually create a comprehensive measure initially this bill at its fundamental level makes a lot of sense the problem is not all funeral homes are required to use the e-rave system in fact some funeral homes that we interact with specifically tell us not to use the e-rave system that we need to use paper additionally colleagues have had problems using the e-rave system describing it as inefficient and even archaic it there
are multiple health, multiple electronic systems that physicians are having to use. Outpatient health records, inpatient electronic health records, the Arkansas PDMP, and now this brings in another system. And unfortunately, the eRAVE system doesn't have an interface with the electronic health system, electronic health record systems that are mostly in use today, including the Cerner and the Epic systems, which are mostly used in Arkansas. So we, there's not adequate interfacing.
One of the things that is very disturbing about this is it's very physician punitive. If physicians go into eRAVE, but the information hasn't been added, we're actually the ones who wind up getting penalized for this. And definitely getting death certificates in a timely manner from funeral homes have been a problem on the Baptist palliative care side. I actually have to review all of those cases, and that's been a problem consistently. Quite frankly, if Senator Irvin and her husband go out of town on a vacation and they come back from a five-day vacation, they could be coming home to a $250 fine from
the Arkansas State Medical Board because this information wasn't in any grave in a timely manner. Additionally, no medical group has actually put their support behind this bill, including the Arkansas Medical Society and the American Hospital Association. The AHA actually recommended amendments to this bill that were not done to provide 24 hour a day seven day a week tech support so if I'm doing what's called my pajama time part of my life which is where I go home and spend an hour and a
half working on electronic health records and I can't I can't accomplish something an era like we had trouble with last week with one of my colleagues we can't get anybody on the phone to help us that can turn into a $250 fine very quickly. Again, I think the idea of the bill is fantastic, but the actual crafting of it needs to involve all stakeholders to come up with a better bill that's comprehensive and to have funeral homes partner by using the e-rave system as well. Additionally,
I know that families want death certificates faster. My uncle passed away, and I have experienced this personally, but it actually was very quickly, and I can tell you the largest health system in Arkansas, I have to review all those cases, and we actually don't have a problem with this. What we do have a problem with, sadly, is physicians are afraid to take care of people at the end of their lives. Physicians are afraid of death. They're afraid of being sued. They're afraid of being seen as failures, even though we can't give in mortality. And a highly punitive
bill against physicians like this is going to encourage physicians to play hot potato with the dying patient, to see who can jump away from the patient's care and who can pass it off the fastest to who gets stuck with the hot potato of running the risk of getting a fine from the state medical board for taking too long, just a couple of days to do a death certificate. Therefore, I appreciate a vote against this physician punitive bill, and I will take any questions that you have at this time.
Senator Kim Hammer
Unverified
1:58:58
Senator Hammer. am i mistaken but funeral homes can't issue death certificates right it's it's hospice physicians coroners but but the funeral homes can't issue the death certificate right so
Speaker 334
1:59:15
what happens is the funeral homes provide provide the death certificates tried to
Speaker 371
1:59:20
fill out deserts the certifier the certifier certifies the death certificate and sends it back to the funeral home which is the paper form and make and please understand this bill does not eliminate an
inefficient system in fact there are so many people who are still going to be using the paper system if the paper system was so dreadful this isn't taking care of the problem because we're still going to be using most a lot of people are still going to be using the
Senator Kim Hammer
Unverified
1:59:50
paper system with it i just didn't see anything punitive to
the funeral home in here and i know senator walsh You're doing the yeoman's work on this at the last minute. I appreciate it. Unless I miss it, I just want to point out to other members, I don't see anything punitive to the funeral home. If it falls on the funeral home, that the delay is actually occurring.
Senator David Wallace
Unverified
2:00:08
Unless I missed it. I agree with the senator. This is a very one-sided bill. Okay. Any other questions? Madam Chair, if I may, I would recommend that I pull this bill down and give the sponsor the opportunity to come in. It's his
bill. Well, it passed by a lopsided vote in the House, but
I'm not as knowledgeable as he would be. Sure. Sure. Okay. Well, we'll give, I mean, Senator Hickey, go ahead. We're not meeting again.
Yeah, that's the only problem. I mean, yes. I think, I think, is it fair to say with the health department here, maybe the best is
to try to maybe put it in towards an interim study like we did with the other bill? I'm just throwing that out as a suggestion. There are clear issues in here that need to be addressed. But what's the pleasure of the committee? Senator Wallace, you want to just pull it down?
I'll pull it down. Okay. Thank you. Senator Hickey? Okay. Okay.
Speaker 371
2:01:19
Thank you. Thank you for being here so late.
Senator Jimmy Hickey, Jr
Unverified
2:01:24
Thank you. I appreciate your time and
service. Okay. Thank you. All right. There, I only have two more bills. I believe House Bill 1521, DHS. Do you want to come and present that bill? Because I don't know anything about it. 1521. There's this one and then Senator Hammer, you have 519. Is
that correct? Okay. All right. House Bill 1521,
If you don't mind, I will put my, I'll give Senator Wallace the chair, but 1521. Catherine Silva, Division of Medical
Speaker 378
2:02:00
Services at the Department of Human Services. So I'm presenting this on behalf
Speaker 379
2:02:04
of Representative Gray, who's not able to be here tonight, but the department has worked with her on this bill. It's been amended once or twice. and the goal is really to address the situation we had earlier this year in implementing new
non-emergency transportation contracts. As you'll recall I think there was some several missed rides and there were some readiness issues and so we worked on some various approaches to address that and decided that in order to really get to our shared goal of making it smoother for future contract transitions, we needed some more time to transition plan. And so we've already had some initial conversations at the department about what that might look like in terms of phasing in the
transition of services and other approaches so we can minimize the disruption to beneficiaries. So this bill instructs the department to make rules to ensure that that is a smoother transition process. And also section C there would require and reinforce our need to comply with federal regulations in this area that require us to look at broker experience, performance, references, resources, qualifications, and costs. I think there were some concerns that there was too much
of an emphasis on cost. And so this is just to reinforce that we're obligated to look at all of those factors. And with that, I'm happy to take
Senator Ronald Caldwell
Unverified
2:03:36
questions. Senator Caldwell. Why do you have to have a bill to tell you
Speaker 379
2:03:43
all to go do your job? Senator, that's a good question. I don't know that we have
Senator Ronald Caldwell
Unverified
2:03:48
to have it. I think the goal- Why have you not been doing your job? I'm not poking on you. Kelly was up here. I'd poke on him a little bit. Yeah, thanks, Kelly. But I mean,
This is some of the things we've been talking about. I'm in my seventh year up here, and I know I've been talking about
Speaker 379
2:04:05
it for seven years. Right, Senator, I appreciate that. And I have been at the department since November, and one of my first duties was to implement these contracts. So I cannot speak as much to the procurement process, but I understand that there were sort of multiple attempts at different agencies to get it right, and it has historically been a difficult area for us. And we think that's unacceptable because of the impact on the beneficiaries.
And so I think Representative Gray's goal with this bill was to put our feet to the fire in terms of rulemaking, to think ahead and plan ahead for the next time we transition.
Senator Ronald Caldwell
Unverified
2:04:42
Yeah, I mean, we just went through the bill on the disability providers that y'all are going to put into place. And again, I'm not poking you and I, but I want it to go on public record. that y'all are going to now go about the way of trying to find them a review process.
The bill failed, so you don't have to have a bill to have the review process, and they're going to put it into place. And now we're coming in here, you know, that we've had these problems with transportation, and we threatened with the bill again, and now we're going to put the processes in place. And, you know, with y'all's budget, the processes should be in place and should be working. That's my statement for the record. Again, I'm not poking
Senator Kim Hammer
Unverified
2:05:31
you an eye. Thank you. Senator Hammer.
Speaker 379
2:05:35
What's the financial impact on this? I don't believe that we have a financial impact on it because it just instructs us to make rules for
Senator Kim Hammer
Unverified
2:05:51
transition. So it will depend on those rules. So is there a projected, we're having a mandate now, and is there not going to be an increase in the cost by the implementation of this bill above what is being done now?
Speaker 379
2:06:08
Senator, as I read the bill and understand the bill, the cost will pertain to the transition of the contracts, which I think can go as long as seven years with various extensions. So there's no added cost to the current contract. This speaks to managing future transitions. So we would look at the cost of how we do that as part of the rulemaking process. Is this the
Senator Kim Hammer
Unverified
2:06:34
issue that Senator Rice had a big challenge over, or am I confused?
Do you remember the where? Yes. I believe Senator Rice had some issues because people weren't getting picked up. Is
that correct, Senator Caldwell? People were not getting picked up. It was a huge problem. So how is this
Senator Kim Hammer
Unverified
2:06:53
bill going to fix that? I just need to connect the dots. How is this going to fix Senator Rice's? He was a champion on that, so how is
that going to fix it? or maybe somebody else was too,
Speaker 379
2:07:07
but I remember him. Sorry. Right. Senator, I heard most feedback
at the initial part of the beginning of this year from Senator Irvin and Representative Gray from that particular region of the state, which is sort of the north central area, was where we saw the most problems. And this will force DHS to make rules and do an actual transition plan. And one idea, like I mentioned, we've talked about is instead of moving from one broker to another on January 1, say, we may move certain services January 1, others January 15th, a phase-in
or something to ensure readiness, or do other sort of checks on our brokers prior to implementation. Okay, last thing, and I
Senator Kim Hammer
Unverified
2:07:52
want to apologize, Madam Chair, I didn't mean to direct it all to Senator Rice. my apologies to you
because I know this is sensitive and important to you and you had a lot to do. My apology. No, Senator Rice did too. Okay. Thank you. Um, I guess what I struggle with is y'all don't mind being mandated on this issue, but you just fought me on the other issue, which is not relevant to this bill other than you just fought on the other one. And what's the difference
other than you contend the other one was going to cost money, but you're contending on this one. it's not going to be an increase to the budget, because I have a hard time going along with being mandated for one thing, but you fight being mandated on something else, and that's what I'm trying to rationalize in
Speaker 221
2:08:38
my mind. Kelly Link, legislative manager, goodwill affairs, Madam Chair, if I may. So, Senator Hammer,
Speaker 255
2:08:44
first off, this is not a bill that we're bringing forward. This is a bill that Representative Gray and Senator Irvin wanted to put something in place,
So we didn't have the rough transition we had with the provider that we later dismissed because they simply weren't able to do the job. And so we talked with the senator and the representative to say, we understand, we don't ever want that to happen again. And so they brought forward some language. We didn't particularly like that language, and we worked with them to get to a point where, you know, as Senator Caldwell says,
you know, why are you putting in place language, a bill to do our job? And to be fair, we did transition well as just with a bad company in the past circumstance. What this would do was have us, we'll say transition earlier so that if it is a company that's not able to do the job, we'll recognize that before they take over the districts. At least we hope they'll recognize, we'll recognize that before they take over the districts. So again, Senator Hammer, not, not our bill, but we don't see any fiscal impact in this at all.
And that's the difference between this and the previous bill that you presented. But
Senator Jimmy Hickey, Jr
Unverified
2:10:11
you're not opposing this one, right? No, sir. I'm not opposing this one. All right. Thank you, Madam Chair. Senator Hickey, I think you have questions. Yes, just on page two, and you, you touched on
this a little bit, ma'am, on the competitive, You said it's competitive bidding process for your procurement method. Is that type of process what is required under the
federal, or is it the stuff where you have to take in their experience, performance, references, and that?
You're required to do this competitive bidding process on that particular thing. If I may,
Speaker 379
2:10:40
Senator. It dictates that we must use a competitive process for broker services. So if we use a non-emergency transportation broker model, it has to be a competitive bid. That could mean an invitation for bid or a request for proposal. It
Speaker 133
2:10:55
could be either one. But they both have
Speaker 379
2:10:58
to consider all of these factors per that regulation.
Which one would you think you all are going to use? I think there's pros and cons to both. and I'm not a contracts attorney, but I've heard that we have had issues with procurements on this service under both models, and the original bill would have dictated the model, but in working with the stakeholders, we've decided this would be the best approach to have sort of equal footing for in-state and out-of-state considerations. We have an experience with the RFP process where sometimes companies are better at writing RFPs
than they are at delivering services, and then we've sort of had the flip
Senator Jimmy Hickey, Jr
Unverified
2:11:44
on the IFB side, so. Okay, and we currently, have we just
Speaker 379
2:11:50
had one company? Is that all we've had? So prior to January 1, we had 12 regions, I believe, served by five brokers. From January 1 to February 1, we had shrunk to seven regions, just bigger regions of the state, served by four brokers and went with the, um, us asking one to leave and other, another one
taking over. We now have three brokers across the seven
Senator Jimmy Hickey, Jr
Unverified
2:12:15
regions. Okay. And that is my next question. Line six, it says to select a broker. So, uh,
Speaker 393
2:12:26
Senator we, I think, uh, that the goal of
Speaker 379
2:12:30
that is just to say any broker that is selected under that model. We just tried to work with the language in the federal regulation to be broad to apply to any of these circumstances.
Speaker 398
2:13:00
I hope we're not limiting ourselves to one,
Senator Jimmy Hickey, Jr
Unverified
2:13:09
because on the front of the page, on line 29, we put the General Assembly of Finance Obligation of the Department of Human Services to ensure that a contractor that is awarded a contract, and then over on the back, we
Speaker 379
2:13:26
have a broker. Senator, I have limited experience working with the Bureau on this, but that's not Representative Gray's intent
as I understand it and that wasn't ours either.
Senator Jimmy Hickey, Jr
Unverified
2:13:35
I understand it's just when we put this stuff in statute and
that's why sometimes we're so we've got to be more detailed with this stuff because it's just somebody could challenge you on it and say that's what it says and I don't read it any other way. If it's not unanimous
then I'll pull the bill down. What do you think? I mean, have you seen that
part? Yes. I mean, I don't, that's not the intention.
The intention, I think, was just to fix the problems that a lot of people experienced from people not getting picked up to go to their dialysis and all of their treatments and all of that. And so we're just trying to put that into place because it was. I remember. Yeah. Yeah. It was a nightmare,
Senator Jimmy Hickey, Jr
Unverified
2:14:19
but I am worried about the way the specific language in this bill is written, just to be honest i understand thank you
Senator David Wallace
Unverified
2:14:29
senator caldwell first then senator hammer if we uh pull
Senator Ronald Caldwell
Unverified
2:14:35
this bill or vote this bill down is there any reason that you can't go do that i'm like senator hickey no that is language i mean we're codifying it it says a and i i we just went through 2 000 pages of uh of agency uh uh reform and we we looked at at everything that that's what the bill says yeah no i don't disagree with you
and i think if they're committed to doing this then i'll just
pull the bill down sure and we're
Senator Kim Hammer
Unverified
2:15:09
all tired so i need some collective wisdom here but on page one line 33 they're going
to have to adopt rules which means you got to come through rules and regs right to get that adopted out, but on the back, they're going to have to follow the procurement process as dictated. If this
got out of here, would those two things together match up with the intent, or is that to... May I talk across the table, Mr. Chair?
Absolutely. It's after nine. At this point, we could actually talk under the table. Well, that's all that happens. You think there's a resolve there between those two things being written in the bill, throw
in the intent? Because we're going to have to file the procurement. I mean, I think that's a good point. I'm just not for sure.
Kelly, if this didn't get out of here, what's stopping you from doing what needs to be done
that really shouldn't require this law in order to get you all to do what needs
Speaker 221
2:16:29
to be done? What am I missing? There's
Speaker 255
2:16:31
nothing stopping us from doing this. We've had some discussions about what created the failures, and the failures that we had was that we didn't factor in such a long process of protests that we had leading up to this, which gave the eventual winning bidders
a very limited time to get in place. And what we need to do is start the procurement at least a couple months earlier than we did this time in hopes that there's not a long protest period, but just to imagine that there will be, just assume there'll be long protests so that there's at least a couple months of time to make a changeover to a different broker than
Senator Kim Hammer
Unverified
2:17:12
what they had. So why would you not have to follow the normal procurement processes anyway moving forward from this point,
knowing we've had a bad
Speaker 379
2:17:22
experience in the past? Senator, that language was added at the request of the stakeholders that represent some of the Arkansas-based brokers because they wanted it in statute that we would be looking at experience and performance. They felt like our review was insufficient, and we were happy to
Senator Kim Hammer
Unverified
2:17:41
include that as a result. and the new procurement laws that we just passed here recently or we've we've adopted do they not require experience performance references resources qualifications and
costs to be factored into all the other procurements
or not yes if if it's written
Senator Jimmy Hickey, Jr
Unverified
2:18:00
if it's written that way so of course of course it should as long as and if you've already got that from the stakeholders i mean you can do that anyway so i i personally i personally am not comfortable passing the bill because of the that's fine on the just because of the a broker sure
understood i'm going to pull the bill down let's move on last bill of the whole entire session
is going to be senator hammer's bill thank
Senator David Wallace
Unverified
2:18:31
y'all senator hammer you are you are welcome to present your
Speaker 62
2:18:39
bill. Madam Chair, for the sake of time and expediency,
Senator Kim Hammer
Unverified
2:18:45
I think it'd be beneficial if we had DHS come to the table and the parties that are 519. Have we heard this bill already? No,
Well, Madam Chair, there's an amendment to
Senate Bill 519, is that correct? Yes, ma'am. Last bill of the session, I hope.
Okay, is there a motion to adopt the amendment? Motion. And, okay. Sorry.
Unknown speaker
2:19:29
Okay, and the amendment, just tell us what the amendment does.
If you don't mind, or the meat of it. I know you're adding some co-sponsors, but.
Senator Kim Hammer
Unverified
2:20:10
The first part is, I think it's actually just cleaning up to remove the word, well it is, removing the word regulation. the meet is on the back side and it's the
I'll just take it real quick that it enters into a at the division of aging youth of the human service intend to enter into a new professional or consulting service contract with the community mental health center in excess of $25,000 the contract shall be filed for review with us, legislative council before a professional consulting service contract with mental health centers modified it puts in it builds in the criteria of being
the 45 days and i think i'm just going to get to the point because it's late i think that's where dhs is going to end up having the rub and it provides community mental health center opportunity to comment on the proposed contract modification so what it's doing is just building some safeguards to where the provider group can feel like they have a little bit more of an i would say an involvement in the process but also a warning because what this I'm sorry what this builds around is they're afraid they get into these contracts and then funding cuts come down
they're having to make adjustments in some cases as quick as you know two weeks notification and they're wanting to build in some safeguards instead of just having it dropped on them so that's what the amendment does is build in some of that criteria okay thank you
are there any questions? All right. Make a motion to
Senator Kim Hammer
Unverified
2:21:50
pass now, Chair. Senator Hickey has a question.
Senator Jimmy Hickey, Jr
Unverified
2:22:04
Senator Hammer, we had already looked at this at one point, didn't we? I had this in my, for whatever reason, on page two, line
eight of the bill that's been in my folder, I had, and I vaguely remember this, we had marked or other revenue streams. Do
Senator Kim Hammer
Unverified
2:22:26
you remember why I would have written that? because I
think the I think because the department expressed concern
that that was one of the things is that
they could build in other revenue streams so they'd have some flexibility. I think we were going to
Senator Jimmy Hickey, Jr
Unverified
2:22:51
change that or something but we may have forgot that part. DHS, do
y'all want to talk about this or the amendment?
Speaker 414
2:23:16
Yes, ma'am. Jay Hill, DHS Behavioral Health.
Speaker 415
2:23:20
And Senator Hickey, I believe to your point, when we were having that discussion, we were talking about the removal of funds over this past year, some of the Community Health Center dollars that have been allocated. And the example I had used was one of the programs is now coverable or now covered under Medicaid. And we don't use SGR, State General Revenue dollars, to reimburse for Medicaid. And you had mentioned including other revenue streams, which I took,
Speaker 416
2:23:49
I assumed it may have been incorrect, but I thought you were referring to Medicaid as the other revenue stream.
Senator Kim Hammer
Unverified
2:24:04
And does this amendment, to be honest with you, I vaguely remember it. It's been too far back. Senator Hickey. Sir. I think if Madam Chair would allow
my guests to introduce themselves, I think they can shed some light on that. Okay. Go ahead.
Speaker 419
2:24:19
Madam Chair and members of the committee, I'm Kathy Harris from Southeast Arkansas Behavioral Health Care System. I'm the executive officer there. I'm representing the 12 community mental health centers that have been the state's partner in providing the significant portion of the behavioral health care responsibility that the state has for the mentally ill population. And oftentimes, changes come to us in very short order without any change in performance indicators.
And there is often not the opportunity to have communication with DHS on how these changes can produce the least impact to us and ultimately the least impact on the clients that we're serving. And we've not been successful in engaging those conversations. So a part of this bill is to have the opportunity to discuss how those impacts can be the least impactful to the services that we are providing.
Speaker 411
2:25:28
Senator Hickey, that didn't really address your
Senator Jimmy Hickey, Jr
Unverified
2:25:31
question. No, and it's kind of coming back. I believe this gentleman was right. I think, I think whenever we had looked at
this, however long ago that's been six years ago or whatever, feels like on page two, lines six, seven, and eight, there was, and I believe you're correct, I know you're correct, we had thought that if we didn't put or other revenue streams that we were not going to pick up in this legislation everything that they needed to be funded by.
We were worried about the language of the bill, I believe. But it's not that big of a deal to me, but I just hope that the bill itself is correct
to do what you all are intending, because we're not going to have that or other revenue streams in there. Let Jay speak to it, Madam
Speaker 422
2:26:26
Chair. Yes, go ahead. And with regard to that,
Speaker 415
2:26:28
I don't know that it would be necessary to add other revenue streams in that the community hustlers can bill Medicaid. They have that.
They are all Medicaid providers. I mean, we could put that language in the bill, but whether it's there or not, they have that right and that ability to bill Medicaid for services provided to any individual that qualifies. And that's fine
Senator Jimmy Hickey, Jr
Unverified
2:26:47
with me if you are okay. It's just because I don't think it specifically says that, and I think that was our worry back whenever we had looked at this before. And I think,
Senator Kim Hammer
Unverified
2:26:56
Senator Hickey, it's kind of like an underlying understanding they can do it whether it's in there or not. It would
have just clarified it and cleared it a little bit.
Fair enough. Thank you. Okay. And DHS, do you have any other comments on this? Are y'all, where are y'all
Speaker 424
2:27:12
on this? On the amendment, Madam Chair? Yes. Or on the, no,
Speaker 415
2:27:19
I don't think we have. On the amendment. We're talking about the. On the amendment, there was, we had one concern. In the event that there were to be a reduction that were handed to DHS, whether it was from federal government whether it's from state government that fell inside that 45-day window we would not have the ability to we wouldn't be able to meet that that 45-day threshold that this
amendment requires us to so statutorily we would be out of compliance were we to be given a reduction if you will our request was that should there be an instance where we are are given instructions to reduce funding, where our general revenue is reduced, for instance, or our federal funds, our federal dollars are cut. If that falls inside that 45-day window of when it has to be implemented, we had requested
that we would notify the effective Community Mental Health Center within three business days, and certainly communicate with them and work with them. But we did not want to put ourselves in a position that we would be out of compliance should we not be given that 45 days' notice. Don't foresee that that happens a lot, but it does happen occasionally. And if it
Speaker 425
2:28:33
were to take place, then we would not be able to meet this, meet the bill as it is written.
Okay. All right. Okay. Well, what's the – so we
need to adopt this amendment if you want to adopt the amendment. Do you want to adopt the amendment? I want to adopt the amendment,
Senator Kim Hammer
Unverified
2:28:57
Madam Chair, and then I think we've heard the meat of it, and I can get to it real quick. So I'll make a motion to adopt.
Okay. Is there a second on the motion to adopt the amendment? Second. All those in favor say aye. Aye. And opposed? Ayes have it. Amendment is adopted. So now I think you can go ahead and talk about
Senator Kim Hammer
Unverified
2:29:16
the bill? I can. So what the providers are looking for in this case is they sign, and I'm real to the point, they sign these contracts and then what they're asking for through this is reasonable processes for making sure that they can react appropriately, that they can respond timely because what's happened is if they get that cut, it's direct impact into the community and the way it directly impacts into the community.
These are the people that take care of whenever they get a call from the county jail and they've got to come assess somebody. These are the folks that do it. And so, again, we're dealing with a very sensitive population in our community. Madam Chair, if I may, I'm going to let
them just speak real quick. Well, I mean, I think, I mean, if that's okay, thank you for being here. You can speak. Go ahead. Go ahead. I don't mind. Anything you want? If there's anything else you want to add, what you're trying to do here is a reporting mechanism.
Senator Kim Hammer
Unverified
2:30:20
Is that correct? Well, a reporting mechanism, but also because they provide such a valuable service, it's making a statement that they need to have this coverage that's provided in this bill so that they can provide that essential service because, again, of the population that they're dealing with. and as was testified to the 45 days it doesn't happen very often I'd be curious if the department would say the last time it happened because if it didn't happen that often then 45 days is a good
a good tool to notify the provider so they can make the necessary adjustments once they enter into these contracts because once these contracts are entered into they've got to provide whether the funding level drops because somebody's got to go take care of that need it's like it's like not having a jailer at the jail
if you would okay all right are there
Senator Jimmy Hickey, Jr
Unverified
2:31:14
any other questions okay i'm sorry go ahead madam chair
Speaker 255
2:31:21
if with your permission there is there is a handout i think
that jay would like to address it will that way you just kind of walk through some of the things on it because there is concern over um how the funding how this will change the funding across the state
Speaker 415
2:31:41
and i think this helps you get a visual on it so look reading through the bill uh on the first page it specifies that the allocations that we make will be done per the most current census data and the communal health centers and and and they can speak better than we can to what they do
and they do they provide an invaluable service to the state to primarily our underinsured or those who have no no coverage our contract dollars that's what they pay for us to is for a wide array of services to those populations if we take the most current census data and and what we what you see there is just a very quick estimation of what that looks like today since the last census was in place and and we use things other than just census data to determine how those dollars are allocated poverty level the number of indigents per capita in what we call a catchment
area or a region that we serve but as the bill is written if we take just straight population straight census data the majority of the movement in the state has been to the northwest and our our estimation is seven of the 12 community mental health centers today would take a reduction in funding based on the shift in census, the shift in populations. Some would be very small reductions. Some would be substantial just based on population alone. And so we would prefer and what we want to do is to take into consideration more of those factors
to, as I mentioned earlier, where are our indigent populations? What is the ratio? What is the per capita in the areas where each of the community health centers is located? What are the federal poverty levels look like for those populations to better determine how to disperse those dollars so that we can allow and I say allow enable the community mental health centers to meet the needs of the populations that live in their counties. Our catchment areas are different sizes. The largest is 15 counties. The smallest is a half a county here in the south part of
Pulaski. So the array of people that live there, it looks different for everywhere. But if we just base it straight on population, the vast majority of that dollars will be reallocated to northwest Arkansas. And from the Texas line in Texarkana through the south part of the state all the way up to Missouri in the northeast, that portion of the state, and you see the map is color-colored in blue, it is our great concern that we would be having to take a reduction in funding to
those community mental health centers at the expense, those seven at the expense of the
Speaker 419
2:34:32
five in Northwest. Okay. Opportunity to respond, ma'am. Yes, absolutely. Madam Chairman, most of the time the cuts that we are referring to or the reductions and funding that we are referring to are things that happen on an impromptu basis, not things that happen as a result of the census reallocation.
And this is our effort to be able to address and have collaboration on those reductions that occur on a very short-term notice. Okay. And I'm sorry, state where
Speaker 169
2:35:06
you're from again. I'm the Chief Executive Director at Southeast Arkansas Behavioral Health in Pine Bluff. All right. And
Speaker 166
2:35:17
go ahead. You're here. You've been here all night. Go ahead. Thank you. I'm Diane Skaggs.
Speaker 430
2:35:23
I'm the Executive Director of the Mental Health Council of Arkansas. If I may give an example of the things we're talking about. This past year, we received a call. Each center received a call from a representative at DHS and said, we're cutting your funding from CSP, that's Community Support Program, from 65,000.
Yours was $65,000 or $68,000 effective that day. And the people we serve have nothing so many times, and we can't operate that way. We would like to have a little notice and be able to make comments about, well, where is it going? We don't even know where the money goes. We just don't have any input. it, but yet the performance indicators that we are held to in our contracts, which we
sign and agree to, are we still held to that same standard without the funds to do it. Okay, I
don't, I don't disagree with you. I think you do need notice. I think, I don't disagree with that at all. I'm concerned about the way the bill's written based on what they stated, which could actually hurt y'all, so I'm just, I don't know. So, thank you. I don't want to hurt anybody out there. May I answer? Yes.
Speaker 430
2:37:00
Every 10 years when the census comes out, that's when the population is judged and changes. And it's always the way it's been in the community mental health centers. So we know that that happens. And it does happen. And that happens every 10 years when the census comes out. I see. Okay. But what we're talking about is funding that's just, for instance, at Mid-South Health Systems, they had the youth move, and they just called them and said youth move's no longer funded.
Gotcha. Okay. Understood. Yes, ma'am. Thank you. Senator Hickey, did you have a question?
Senator Jimmy Hickey, Jr
Unverified
2:37:38
No, even though I'm kind of confused now, one of the gentlemen with one of my community health centers in Texarkana had told me he was
Speaker 411
2:37:45
for this bill. but are you telling me that if this bill passes
Senator Jimmy Hickey, Jr
Unverified
2:37:52
that that funding will be cut according to the way it's written is that do i have i understood that if i misunderstood no senator
Speaker 415
2:38:01
i don't think you've misunderstood the if it's just if it's based on population
alone solely on how many people live which is what this bill which is what this which is what the bill but then then we would look at then that would certainly result in a reduction of funding for instance, for Southwest Community Mental Health Center. You're from Texarkana, I gather, in that region of the state. Just to give you a specific example, what we would prefer to do is to take other factors into consideration along with population. The shift in population to Northwest Arkansas versus the population that lives in the Delta,
there will most likely be a difference in the number of those that fall under the indigent category or those who are underinsured. We want to take into consideration when we allocate funding more than just how many people live in your specified number of counties. It is how many people per capita need those services. Of course, we will start with population, but from there, we will have to move into what we traditionally will do is to look at other factors, what I just mentioned. How many people actually need services in those counties and allocate our dollars more appropriately so that we can enable all the centers to meet the needs of those that live in their areas.
Senator Jimmy Hickey, Jr
Unverified
2:39:15
Okay, thank you, sir. Not just by population alone. May I ask Senator Hammer? May I ask him a question? Has anything come to light to you
sitting here, Senator? I don't see where that conclusion is found
Senator Kim Hammer
Unverified
2:39:37
in the bill or what in the bill draws to that conclusion because I'm page two.
I'm having a hard time getting around where that conclusion comes from.
Okay, but that's current language. that's that's
the on page one line 31 and 32 the concern that the department is expressing
is current language that i'm not even changing in my bill am i right and and to her point if it if it gets reassessed every 10 years that's going to happen anyway regardless of what this piece of legislation does i don't see where that impacts the bill. But I'd like to give the department a chance to respond. I mean, I want
to be fair in all this.
Speaker 415
2:40:42
That is my understanding. The historical data that has been used to determine the
allocation of funding has also taken into consideration those other factors. Not just how many people live in an area, but how many people live in an area that need the services that would be provided by the state general revenue dollars. Fall under either the under insured or those who have no insurance at all. I just want to make sure that we have the ability to continue to do that and not be forced to simply allocate dollars based on numbers alone and not be able to consider what the actual needs are for a community
Speaker 422
2:41:18
mental health system. And you don't think the bill as written is going to allow you to do that? That was our, when
Speaker 415
2:41:26
it was presented, the immediate concern was when that, this section of the on page one was read is that that would that would
Speaker 425
2:41:32
tie us to being able to to making those allocations based on population mr chair if it's
Senator Jimmy Hickey, Jr
Unverified
2:41:39
all right with you and i know it's late but again it's one of those issues it's really important i want to start going through this whatever line it is and let's just figure it out because i know this is important and so let's uh if you don't
Yes, sir, Mr. Chair, it's, like I say, that's what we're here for. Okay, so where
is your concern on page one that that's going to, that you're going to be limited solely to population? The draft
Speaker 415
2:42:10
I have, Senator's line 31, most recent federal census will be used in determining the per capita of the area on which the
Speaker 422
2:42:17
allocation is made. Okay. And that's old language, though.
That's what's always been in there. I'll trust Senator Hammer that that is old language. Yes,
Speaker 402
2:42:27
sir. It's a new language to be underlined. So old language, anything's not underlined. Yes,
Senator Kim Hammer
Unverified
2:42:34
sir, it's old language. So that's the system that we've been used to operating under previously. And every 10 years, trying to be open, every 10 years, I could see that the adjustment may cause an issue, but I think when you get around to page two,
that's why there are some checks and balances so that this can be monitored in incremental steps and be addressed as they occur. And if I may, what else gives you
Senator Jimmy Hickey, Jr
Unverified
2:43:12
pause? that that that piece was our was a concern as well as what i mentioned earlier is our is
Speaker 415
2:43:23
to work with him sure that was that's our yeah i don't know how to
Senator Jimmy Hickey, Jr
Unverified
2:43:31
to get around that part if i i mean if i understand what you're saying yes i mean it may be better for all for all of them if we had backed up not taking a bill like this not taking a bill like this and put some other factors in to allow you all to weigh that But with this being old language, I don't know what this bill is going to hurt, just to be honest. But I do appreciate your comments and things like that. Thank you. All right. Thank you.
Any other questions? Any other questions? All right. You can close
Senator Kim Hammer
Unverified
2:44:10
for your bill. Thank you, Madam Chair. I think what this
bill is going to do is it's going to build in some safeguards so that in the event there are funding cuts that would impact the community mental health centers, then I think what it's going to do is
build in the safeguard to make sure that they are able to remain functional so as to provide to the need that we have in our community,
understanding the population that they serve and and this bill provides those safeguards and also brings into account that there has to be on page two line 16 through 20 community health center shall report quarterly on the adequacy of funding for fiscal year 20 and fiscal year 21 so we are going to be involved in the process for checks and balances as it goes
along thrust of it and crust of it is this if they get a call like they've got as was testified and they can't provide services we got a problem when it comes to going down to the county jail and evaluating those people that hopefully could get out of jail and get those local services instead remaining in the county jail that's my closing statement ma'am chair and without any questions i'll make a motion at
a proper time okay motion do pat motion do pass is there a
second chair as amended as amended thank you zero second second all those in favor say aye and opposed
eyes have it congratulations you have passed your bill went out on top And with that marathon meeting, we are adjourned for the session. Thank you so much, work of the committee, amazing work, and the staff, absolutely. Thank you, members, for being here so late. Thank you,
Senator Hammer, I've tried my best.
Agenda
Call To Order
HB1691 M. Gray TO REQUIRE THE DIVISION OF DEVELOPMENTAL DISABILITIES SERVICES OF THE DEPARTMENT OF HUMAN SERVICES TO PROMULGATE RULES FOR CLOSURE, SALE, TRANSFER, AND EXPANSION OF CERTAIN FACILITIES AND SERVICES.
SB587 A. Clark TO CREATE THE CHILD MALTREATMENT INVESTIGATION BODY CAMERA PILOT PROGRAM.
HB1542 Burch TO ALLOW THE DEPARTMENT OF HUMAN SERVICES TO OBTAIN CERTAIN RECORDS WITHOUT CHARGE.
HB1543 Burch TO CLARIFY THE LAW ON ELIGIBILITY FOR SERVICES PROVIDED BY THE ADULT PROTECTIVE SERVICES UNIT OF THE DEPARTMENT OF HUMAN SERVICES.
HB1711 Burch TO AMEND THE LAW CONCERNING GUARDIANSHIP SUBSIDIES OFFERED BY THE DEPARTMENT OF HUMAN SERVICES.
HB1664 Crawford TO ESTABLISH THE LIFE CHOICES LIFELINE PROGRAM.
HB1746 Kelly TO PROVIDE CIVIL AND CRIMINAL IMMUNITY FOR INDIVIDUALS WHO MAKE REPORTS TO THE CHILD ABUSE HOTLINE IN GOOD FAITH.
HB1904 Della Rosa TO CREATE A STUDY OF PUBLIC NOTICE AND PARTICIPATION IN THE ENVIRONMENTAL PERMITTING PROCESS.
HB1821 Murdock TO PROVIDE FOR MEDICAID REIMBURSEMENT RATES THAT ADDRESS THE MINIMUM WAGE INCREASES; TO PROVIDE FOR IMMEDIATE AND ONGOING REGULAR REVIEWS OF MEDICAID REIMBURSEMENT RATES AND METHODOLOGIES; AND TO DECLARE AN EMERGENCY.
5 Minute Recess
HB1967 Watson TO CREATE THE ENVIRONMETAL COMPLIANCE RESOURCE ACT.
HB1815 Perry TO AMEND THE DEATH CERTIFICATE REGISTRATION PROCESS FOR THE SIGNATURE OF THE MEDICAL CERTIFICATE OF DEATH.
HB1521 M. Gray TO ESTABLISH RULES TO IMPROVE CONTRACTING AND SERVICE DELIVERY OF MEDICAID NONEMERGENCY TRANSPORTATION AND TO ENSURE COMPLIANCE WITH FEDERAL REGULATIONS.
SB519 K. Hammer TO AMEND THE LAWS CONCERNING FUNDING FOR COMMUNITY MENTAL HEALTH CENTERS.
Adjourned
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — PUBLIC HEALTH WELFARE AND LABOR COMMITTEE - SENATE AND HOUSE, Apr 4, 2019 | Agenda | 3 | Official source ↗ |
Speakers
Senator Missy Irvin Chair
Unverified
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Senator Cecile Bledsoe
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Senator Jimmy Hickey, Jr
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Senator Ronald Caldwell
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Senator Alan Clark
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Senator Kim Hammer
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Gerald Sherham
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Senator Bill Sample
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Representative Danny Watson
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Senator David Wallace
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