Public Health, Welfare and Labor Committee- House & Senate
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I want to welcome everyone to our meeting today. Thank you all for being here. It's a pretty busy day in the Capitol, so appreciate you all joining in on our committee meeting. We've got quite a few things on the agenda to do here, some rules to review, so we'll go ahead and get started on that pretty quick, but I want to ask my co-chair if you had anything to
Senator Missy Irvin
Unverified
0:21
say. Thank you. I just want to tell everybody thank you for attending the meetings.
If you came last week, I thought they were great meetings, and I just appreciate y'all traveling to my district.
Thank you. Okay, we'll start out with item C there, adoption of the October 7th
and 8th meeting minutes. Do I have a motion? Motion and a second to approve. All in favor signify by saying aye. Aye. All opposed, nay. Motion carries. So we'll move on to item D, ADEQ. if y'all would make it your way to the table down there.
Speaker 9
1:03
This is a third-party rulemaking, which it's really between the company and, you know. So this
is a third-party rulemaking. So if y'all would introduce yourselves. Michael Grappay, Department
Speaker 13
1:23
of Environment and Energy. Alan Gates, a partner with Mitchell Williams,
Speaker 14
1:29
Seeley, Gates, and Woodyard, and I'm here today on behalf of Vulcan Construction Materials.
Okay. All right. Do you all want to go ahead and
Speaker 12
1:42
just present the rule? Yes, the Department of Environmental Quality is here as a third-party rulemaking process, and my colleague here will explain why he's here and what
Speaker 14
1:56
he needs. Thank you, and thank you for the opportunity to speak to you today. Vulcan Construction Materials operates a quarry in Lawrence County.
That quarry's been there for decades and decades. It's near Black Rock. The quarry has rainwater that falls into it and accumulates in the bottom of the quarry, and that rainwater is pumped up out of the quarry to a neighboring farm. There's an agreement with a cattle farmer who has a pond. He has asked that the water be pumped to flow into his cattle pond. It is the source of water for his cattle pond.
That cattle pond has an overflow that flows across his pasture. And the water then enters Brushy Creek, a small creek that flows on to Stenet Creek, another small creek, and Stenet flows into the Spring River. The reason we're here today is that there are no water quality standards for sulfate or for total dissolved solids, for those two minerals. In the unnamed tributary, that ditch that goes across the pasture, or in Brushy Creek, or in Stenet Creek,
as a result of having no site-specific standards, the default ecoregion values apply to those streams. And those default ecoregion values are set on the basis of water quality in the least disturbed streams in the ecoregion. And these streams aren't completely undisturbed. It's no surprise they don't meet those very stringent undisturbed ecoregion values. And we're here today to ask you to set water quality standards, site-specific standards for sulfate and for TDS.
in the unnamed trib, that tributary that flows across the pasture, about a mile of Brushy Creek and a couple of miles of Stinnett Creek, so that the water quality criteria, the site-specific criteria, will match what the water quality has been for decades. The reason Vulcan is making this petition is that about 10 years ago, they were given a water quality permit to discharge the water they pump out. This is the rainwater
they pump out of the quarry floor picks up some sulfate when it contacts a rock. And they cannot treat that sulfate by any cost-effective means. It would require reverse osmosis. Sulfate is a dissolved mineral. It just can't be removed by any standard treatment technology that is affordable. level. So, like most of the quarries in the state, they have sought to have permits that they can meet to discharge this water, the stormwater. And in this instance, we need
site-specific criteria in the streams to match what that water quality is, so the default ecoregion values won't be the standards our permit requires us to meet. The site-specific standards, as I say, won't involve any new discharge or any increase of what's been going on in those streams for decades, but it will involve removing the drinking water designated use. Every stream, ditch, pond, and puddle in Arkansas is defined by default to be a
drinking water source until and unless that designation is removed. In this instance, because the sulfate would be above the taste and odor thresholds for drinking water, the secondary drinking water standards that are for taste and odor. We are asking to remove the designated drinking water use in the ditch that flows across the pasture, the unnamed tributary, and Brushy Creek. There's another quarry nearby that's already removed the drinking water designated use in Stenic Creek.
so that won't be changed. But that's what we're asking you to do, is to approve a rule that would set the site-specific standards basically at the level that the stream's been for decades. The health department, I want you to know, has filed a comment on this, objecting to the removal of the drinking water designation. And in doing so, the health Department, we've consulted with them. They've made it clear that as a matter of policy,
where there's a drinking water source downstream, public drinking water supply, as a matter of policy, they will not agree to the removal of any drinking water designation anywhere upstream. We visited with them. This quarry, the water that comes out of this quarry, is less than a tenth of 1% of the water that reaches the public water supply on the Spring River downstream. It's the Northeast Arkansas Public Water Authority.
And I think the health department agrees with us that there is nothing about the quality of the water coming out of that quarry that has even a measurable impact on the Spring River at that water intake. It's just such a small source. you wouldn't be able to detect the difference if it dramatically improved, dramatically went south, or if you just cut it off. If there was no discharge from the quarry, the impact in the Spring River is just negligible.
As I say, it's less than a tenth of one percent, one one-thousandth. So we have acknowledged the health department's objection in principle, and it's my understanding that as long as that principle is acknowledged, that they're comfortable just letting their statement stand, and I don't believe beyond that there is an objection they have. The Department of Environmental Quality, Division of Environmental Quality now,
staff have reviewed the change that we've proposed, and they've indicated they have no objection to the change and support the idea of getting a permit that the quarry can meet. I'd be happy
to answer any questions. During the public hearing that was held in Walnut
Ridge, was that the only comment you got?
Speaker 14
8:40
Did you get any other comments, public comments? Actually, no one attended the public hearing at all, except my associate, Mr. Wimpy.
I made him drive up to it. But no one appeared. We had an over and under about how long that hearing would last. I picked under for 2.30 and 2 minutes and 30 seconds, and I won the bet. Okay, thank
you. Senator Hammer, are you recognized for a question? Thank you, Mr.
Senator Kim Hammer
Unverified
9:08
Chair. Very good explanation, presentation. In all of that, did you tell me if you test the water quality below where the water is going to be coming out of
Speaker 14
9:19
the mine? Yes, we tested as a part of this.
We tested water both upstream on Brushy Creek and downstream from where the water enters on that unnamed tributary. The water goes from the quarry to the unnamed trib. It was tested in the unnamed trib. It was then tested where it enters Brushy Creek. We had tests upstream to compare to downstream. We also tested downstream in Stenet Creek. And
Senator Kim Hammer
Unverified
9:47
those tests would require the removal of the designation of drinking water status?
Speaker 14
9:54
Is that? That's correct. And the policy of the Division of Environmental Quality is that if the secondary drinking water standards for minerals are exceeded, which are set for taste and odor standpoints or concerns, if those are exceeded, then the designated drinking water use should be removed unless there's existing use. Now, if there's existing use in that water body, it will not be and cannot be removed.
Senator Kim Hammer
Unverified
10:27
And this is all at the request of the property
Speaker 14
10:31
owner, is that correct? Vulcan Construction, yes. But the Division of Environmental Quality staff concur with this request. Okay. Thank
Chair
Unverified
10:38
you, Mr. Chair. Representative Payton, you're recognized for a
Representative John Payton
Unverified
10:46
question. Thank you, Mr. Chair. My question is, would the other landowners in that watershed be affected positively or negatively by setting this standard? No, this
Speaker 14
10:54
won't change anything that's been going on for decades.
The water has always been somewhat mineralized in this area, even independent of the quarries, and the quarries have been there for decades. This won't change or authorize anything new. Okay, thank you. Is Dr. McMullen
with the Health Department here in the room?
Would you come up to the table? Do you have a question for him? Yeah, he's fine. Okay.
Hi. Senator Irvin, you're recognized for
Senator Missy Irvin
Unverified
11:31
a question. So I just wanted to touch base with the Health Department on these issues and those comments that you made. And the testing, so will you still be testing that for, if the designation is removed, would the Department of Health still be testing for water quality or not? Just push your button there.
Yeah, we don't actually test for water quality in that watershed. We test water as it comes into the intake for the drinking water supply. And then when the water is finished,
we sample that in town. Okay. And, I mean, is that pretty much what Mr. Gates said is pretty accurate as far as the Department of Health's opposition?
Just can you? It is. So I had
Speaker 46
12:24
the opportunity to meet with Mr. Gates and Mr. Wimpy following Mr. Stone's letter, and he addressed all of our concerns.
Okay. Thank you. Dr. McMullen, if you would, just introduce yourself and who you represent for the record. Yeah, I'm Dr. Richard McMullen with
Speaker 51
12:57
the Arkansas Department of Health. All right, thank you. Are
there any other questions? If there are no other questions, then this rule stands reviewed. Thank you.
Okay, moving on to item E, ADEQ has
another rule to review, Reg. 14. So if you would, introduce yourself
Speaker 12
13:33
again. Michael Grape, Department of Energy and Environment.
Speaker 56
13:47
Environment. You're recognized to present the rule. Okay. Rule
Speaker 12
13:51
14 was the old tire rule that became, in 2017, we enacted the new the new tire program and we created rule 36 through this body and now we're asking to repeal rule 14 which is the representation of the old rule. Simple as that.
Speaker 58
14:13
Would you repeat that please? I'm sorry. Can
Speaker 12
14:33
you? Yeah, just speak right into the mic. Is that better? All right. Rule 14 is a representation of the old tire rule program. And in 2017, when we passed the new rule, the tire program rule,
we created Reg 36, or Rule 36, to represent the new tire program. Rule 14 is now a defunct rule, and we'd like to repeal it and get it off our books. I'll be glad to take any questions. Are there
any questions? If there's no further questions, this rule stands reviewed. Thank you.
Okay, we'll go to item F. This one is Department of Human Services, Division of Medical Services, to review a rule, which removes the domiciliary care from the Arkansas Medicaid state plan. So if you all would come forward and introduce yourselves. Thank
you, Mr. Chairman. Mark White with DHS. Janet Mann,
Speaker 67
15:42
DMS. Okay, you're recognized to present the rule.
Thank you. So this rule is a repeal. We are removing domiciliary care from the Arkansas State Medicaid plan. The reason is this is a service that it has been in our rules for several years and has not been used in several years. We went back, I believe, at least three years looking for claims. We've not had any claims. We do not have any providers that are certified to provide this service. And so because this is an optional service, we've chosen to go
Speaker 70
16:17
ahead and just remove this rule from our Medicaid state plan.
And that's all that it does, and with that, we'll be happy to
Speaker 49
16:27
answer any questions. So to your knowledge, it's never been used? Certainly not in the last three years, from what we can see.
Okay. Are there any questions? Senator Hammer, you're recognized. Can you see a need coming in the future in
Senator Kim Hammer
Unverified
16:41
the event one of the programs that we currently have goes away that we might need to have this so we wouldn't have to reinvent the wheel as far as putting it back in the system?
Chair
Unverified
16:57
No, sir, we do not. We've looked at our current state plan and we've talked with the passes, and no. Now, I can't say that it won't come up in the next 12 to 18 months, but we have had that conversation, so we do not believe it will come up.
Okay, thank you. Seeing no further questions, the rule stands reviewed. Okay, the next item is item G.
Speaker 67
17:28
So if you all want to just go ahead and present that rule. Thank you, Mr. Chairman. This next item relates to the Primary Care Case Manager Program, or PCCM. This is the simplest rule change you'll probably see all year. All we were doing is that CMS, they developed a new template. They want this information displayed in, and so we are changing the template. All the information, the details of the program, all of those are remaining exactly the same. It's just that it
Speaker 70
17:55
looks differently on the paper. And because of the requirements of the Administrative Procedures Act, that has to be promulgated,
and so that's why we're bringing that before you. Are there any questions? Representative
Representative Mary Bentley
Unverified
18:12
Bentley, you're recognized. Thank you, Chairman. And Director White, is this going to put any type of changes onto our providers that are out there? Is it going to cause any changes to what they're going to have to do for our primary care folks that
Chair
Unverified
18:25
are involved in this program? Don't believe so. No, ma'am. It is just a format change to comply with CMS.
Representative Mary Bentley
Unverified
18:30
Okay. So make sure not any unnecessary burden on those guys out there.
Thank you. Are there any other questions? Seeing no further questions, this
rule stands reviewed. Okay, we'll move on to item H. Department of Human Services, Division of County Operations, review of the rule, which complies with Act 59 of 2019. So if you would
Speaker 85
18:53
introduce yourself. You just came to the table. I'm Larry Crutchfield with the Division of County Operations, Assistant Director to Mary Franklin. Thank you.
This rule is in response to Act 59 of 2019 regarding the state recovery from ABLE accounts. We have a couple of simple changes that were made in the medical services policy manual. The first one was to remove the statement that those type of accounts are subject to estate recovery. And then the second was the addition of a statement that these types of accounts are not subject to estate recovery. So if you have an ABLE account, it may be transferred upon the death of the holder either
to the estate of the individual or to a designated beneficiary. Are there any questions? Senator Irvin, you're recognized. Just
Senator Missy Irvin
Unverified
19:52
to note, I think this was Representative Julie Mayberry's bill that she passed this past session. Thank you. Seeing
no further questions, this rule stands reviewed. Moving on to item I, Department of
Human Services, Division of Provider Services and Quality Assurance, Office of Long-Term Care.
Speaker 86
20:15
If you would, please introduce yourself. Yes, Gerald Sheram, Director for the Division of Provider Services and Quality Assurance. Thank you. You're recognized to present the rule. Thank you, Mr. Chairman. This rule basically does two things. The first is that it provides that any envelope may be used to submit a national criminal records check. for a long-term care facility employee, and it also removes some language about performing national checks on individuals who have lived in the state for more than five years for clarification purposes. It doesn't change the rules associated with those types of folks.
Chair
Unverified
20:50
Hey, are there any questions? I'm Senator
Senator Missy Irvin
Unverified
21:01
Irvin. You're recognized. Ron I, right? Yes. Yeah, so I just wanted to say I really want to appreciate and thank DHS and all of what y'all are going to be doing on this issue with the criminal background records. Representative Robin Lundstrom and I have met with them back during the session because criminal background checks, as you know, can take a really long time.
And so they're working systematically to try to, and I'm not sure if you want to announce that yet or not, but they are working to try to reduce that time frame down and get it to where it's a lot easier for everybody and to where it's electronic because particularly we know that there's a lot of places out there that really need employees to fill into these different areas and spots, whether it's child care or office of long-term care. And sometimes four to five weeks is a long time to wait. So I just appreciate and I'm looking forward to y'all's work on that whole issue.
And just on behalf of Representative Lundstrom, I
think I wanted to just acknowledge that and thank y'all for working with us
on that. Thank you, Senator. Well, and not only improving the time, but there's some savings involved here by doing this, going electronically, correct? Do you know what the savings would be? I don't know offhand, but
Speaker 67
22:18
I know it should be a good amount because, as you know right now, many of these background checks, they have to be done on paper. We have to print those forms. You've got to mail those in.
You've got the postage plus the waiting time. And
Speaker 70
22:30
so when you add all that up, it is going to be a significant amount. But I do not have an exact figure
Senator Missy Irvin
Unverified
22:38
on that. All right. Thank you. Yeah, and I'm a little ahead of the game here because this is not – this rule is just
getting rid of the mandate for you all to send envelopes. Right. So it's not really changing all that yet.
Right, but that is coming down the line. All right. Any other questions? Senator Hickey, you're recognized. Yes,
Senator Jimmy Hickey, Jr
Unverified
22:56
sir. Could you just give us a little more information? I see under this description where
it says updated to add a privacy language. What is the privacy language? Who does that affect? Is that the person
Speaker 86
23:10
getting the background check or what? Yes, sir. Thank you for that question. So the privacy language relates to the ability to disclose the background check pieces. In 2018, through a procedure involving the FBI Justice Department, they determined that we weren't meeting certain requirements by not having this privacy statement on these forms. So this just makes it clear about who is authorized to release
criminal background checks when they're done by national database searches, which is through the FBI. And that's on page four of the clean
Senator Jimmy Hickey, Jr
Unverified
23:47
version. And one follow-up. And there's one more about the, there's something about a residency. It says delete a residency question. Is that
Speaker 86
23:57
the same type? So that's more of a clarification. This change relates to folks who aren't demonstrated to have lived in the state for more than
five years. And if you haven't lived in the state for more than five years, you have to get a national background check. So the forms that this changes relates to those folks. So that question really doesn't apply in those circumstances. So for clarification purposes, we wanted to remove it to make sure it's a clear form. Okay. And
Senator Jimmy Hickey, Jr
Unverified
24:22
I'm fine with that one. But as far as the privacy language, you're doing that to meet some type of federal requirement? That's correct. Thank you, sir. Any other questions?
I'm seeing no further questions. This rule stands reviewed.
Thank you, Penny. Okay, we'll move on to item J. Review of rules, complies with recommendations of American Academy of Pediatrics. And if you
would, introduce yourself again, Janet. Yes, sir. Janet Mann, DMS.
Speaker 67
24:59
You're recognized. You want to do the intro? Sure, I'll do. Thank you, Mr. Chairman. This rule is amending our Medicaid state plan regarding the childhood screenings that are performed under Medicaid.
We typically try to provide the recommendations of professional organizations, and the American Academy of Pediatrics has added three additional screenings they recommend for children as part of EPSDT. And so we are amending the state plan
Speaker 70
25:22
to add those screenings as recommended by the pediatricians. And with that, we have to answer any questions. Are there any questions? seeing
no questions this rule stands reviewed thank you mr chairman
Senator Missy Irvin
Unverified
25:43
um would it be okay if they went ahead and gave their rate review update while they're still at the table do you want to bring them back for other touring other
business no that'd be fine do you all want to go ahead and do your rate review updates while you're
Speaker 94
25:59
there yes sir we can we can go ahead and do that. Thank you. I'll just
Speaker 111
26:05
get Ms. Mann back over here and we'll, sorry, rate
Senator Missy Irvin
Unverified
26:07
reviews. Instead of you having to come back during other business, if you could just do the rate review. We had several legislators that were asking us about the rate review and this is something that we're just
trying to get an update on at each public health committee meeting, the timeline, and so I had some questions from legislators about that. So if y'all want to
Katie Sursa
Unverified
26:24
do that at this time. Certainly, I apologize I was trying to answer another question. So we are finishing our second round of
Chair
Unverified
26:32
rate reviews. We have been sending those out Friday and today to stakeholders for getting their comments on the final product so that we can market final. So we have just completed hospice in a nursing home which we is still at a Medicare rate and we are recommending no change to that Medicare rate.
We are looking at several policy issues there that we may bring before you in the future. lab and x-ray we reviewed all of those codes and we are looking at a future oh
Katie Sursa
Unverified
27:04
certainly sorry um we're looking at lab and x-ray so we're going to be
Chair
Unverified
27:10
further studying those codes to do a realignment we um just we have found that we pay the state of arkansas does pay considerably more for certain codes outside of other medicaid programs and medicare so we're
going to do further analysis just to make sure that we have not missed anything and that we are in alignment there. Nurse practitioners, we are finishing. We are not recommending any change there. Any change would come through an increase in the physician fee schedule because they are paid as a percentage of that fee schedule. And the physician codes, specifically the primary care codes, are being evaluated now for increase for budget approval. And then physician assistant is the last rate review that we did this quarter.
We are considering some policy items there, but we're not recommending any changes in the rates at this time. Senator Hammer, you're recognized. Thank you, Mr.
Senator Kim Hammer
Unverified
28:12
Chair. Would you just educate me as to when you sit down with the provider groups and you make the final determination as to whether or not you're going to raise the rate or recommend changes, what goes into that decision-making process once you get all the input?
Chair
Unverified
28:32
Yes, sir. It's a multi-step process. We try to sit down with interested parties, which can be the provider groups or the provider associations or anyone that has voiced some interest. We try to sit down with them at the beginning of the rate review to discuss how we're going to approach this. We try to look at access, quality, utilization, and history, and any other factors with surrounding states and or federal rules. Then we have done cost surveys in certain areas and I sent those out to providers working with the associations
and have gotten that information back. And then the final step is when we have a final draft and we are thinking we will recommend one direction or another or no change, we send it out to those interested parties for a final comment. And so we do not mark it final until after that information is moved into the report. So we ask for that in formal written response so that can be part of the report. Follow-up, Mr. Chair? Yeah, you're recognized.
Senator Kim Hammer
Unverified
29:35
Okay, so help me understand something. You're sitting here saying today that you're not recommending any rate increase, but have you got those finals back yet from those provider groups? No,
Chair
Unverified
29:46
sir. The quarter that we ended right now, that's our initial recommendation, and we are sending it to the stakeholders for their comment and feedback so that we can get some information into the report and make sure that we haven't missed anything. And that could change our recommendation.
Senator Kim Hammer
Unverified
30:05
Mr. Chair, question on the process. I appreciate the
updates we're getting every meeting, but when they get all said and done, they get through all the provider
groups and everything, I mean, we're going to have one big powwow, right, as far as... I think that would be a good idea, yes, sir.
Okay, I just want to make sure that's coming down the line. We
Chair
Unverified
30:29
can do that. Thank you. Thank you. Representative Penzo, you're recognized for a question. My question was specifically for the non-skilled home care providers.
with the increase in minimum wage that's going to change again in January, is there going to be anything done before January to accommodate that? Because if you look at the spread between reimbursements and the wage rates, it keeps going in the wrong direction every year. Two of the big providers in my area have quit taking Medicaid patients, And the other ones are discussing to discontinue taking Medicaid patients,
which forces people out of their homes into assisted living, nursing homes, and which ends up costing more money for the state. I'm just wondering if we're going to do anything before January 1st or if we're going to wait until more people quit serving patients in our communities. I can
Representative Clint Penzo
Unverified
31:28
answer that provider type by provider type. I don't
Chair
Unverified
31:31
know that I can answer it overall for the Medicaid program. The minimum wage and the impact of the minimum wage is part of the factors that we use each time we look at those provider types.
So, yes, for a good example would be the dayhab, which we have finished studying and are in the process of having rebased and anxiously awaiting those preliminary rates to come back. And so we are moving through that process. I can't give you a definitive date, sir. I wish I could. I do know that every time we look at a provider type minimum wage and the impact of the minimum wage is considered. And I might
Speaker 67
32:11
add to that, in terms of scheduling,
of course we have the rate review where we look at
Speaker 70
32:17
it initially, and then for those that we have determined does need to be rebased, we have actuaries reviewing those to come up with a potential rate, and that's where personal care is at the moment is that they're reviewing that rate. But then the next step past that is budget. You know, if there is a rate increase, which certainly seems likely given the minimum wage increase, that rate increase certainly has a budgetary impact. And so we have to look, number one, is that something that can be absorbed within our budget this year? And then if not, we have to look and see how that can be absorbed in terms of our appropriation and budget for the coming year.
And so that's an ongoing conversation, but it's not something that we can finalize until we know where that rate is because that will tell us
Chair
Unverified
33:02
what that fiscal impact is. You had a follow-up? I understand discussion of budgets and things like that, but when the government tells somebody they have to pay somebody more, but then they can't adjust. It's not a free market. They can't adjust their reimbursement rates.
To me, comparing it to what other states are doing, isn't as big of a factor as what we're telling them they have to reimburse their employees. So I would like to see something happen before the end of the year, and I think everybody in this room probably agrees with that. Yes, sir. Thank you. Representative Boyd, you're recognized for a question. Thank you, Mr. Chair.
Representative Justin Boyd
Unverified
33:50
This is a two-part question. I'm going to ask them both together. So, number one, can you confirm for me that you really are reviewing the immunization rates? And two, if you are, give me a quick update on where that is in
Chair
Unverified
34:05
the process. Thank you. Immunizations were under review, and we did do that as part of the physician care and the primary care codes. It is a state plan amendment, and it will be coming forward with those increases. So it has not fallen off.
other questions seeing none this rule stands reviewed oh I'm sorry it's not a rule thank
Speaker 47
34:40
you very much thank you members okay I appreciate
that thank you Mr. Chair moving on to item K 2018-2019 vision screening report from the Department of Education if you all can come forward
and please introduce yourself pull that
Representative Karilyn Brown
Unverified
35:07
mic a little closer if you can that's not on sorry about that good afternoon chair i'm sharia mcdonald and this is the 2018-2019 vision report from the department of education on children pre-k four-year-olds through 12th grade. It's an annual report that is provided every year showing the number
of students that are screened, referred, and then the follow-up exam. And it does show that it continues to be a 35% follow-up exam rate for our kids in schools. So if you have any questions feel free to ask. Senator Hammer you're recognized for a question.
Thank you Mr. Chair. So can you tell me what you've
Senator Kim Hammer
Unverified
35:55
determined as far as the cause for why the
follow-up rate is only 35 percent? So the
Representative Karilyn Brown
Unverified
36:05
process is that the kids are rescreened by the school nurse, and usually the school nurse sends home those reports to be screened, but children to follow up, it's ultimately the parent to take them to the comprehensive eye exam. We have multiple resources in our state that help our children to pay for our glasses, to pay for
services such as Brandon's Burlesworth programs, the VSP, several pro bonos with our eye doctors in the state, but again, it's getting to the comprehensive eye exam that continues to be a problem. All right. Thank you. Representative McGee,
you're recognized for a question. Thank you, Mr.
Representative Richard McGrew
Unverified
36:54
Chair. So has anyone looked at the problems that are detected in these kids?
Do you have any data on that? I mean, the ones that get the exam, and they go in and they have their exam, are they mostly just have refractive errors, need for glasses, or are they turning up significant other pathology?
Speaker 137
37:16
Do you know, or is there any information about that? So mostly those
Representative Karilyn Brown
Unverified
37:21
are refractive problems, yes. Ultimately, we do have some conditions that are known, but those students are usually followed up by an ophthalmologist of some sort on a continuous basis, those students that have a known disease.
Representative Richard McGrew
Unverified
37:33
Okay. Can I follow up one? Could you get me some information on what, I'm interested, I'm an ophthalmologist, and I'm interested in what these kids, what do they have? I mean, are they a plus one, hyper, that they put plus one glasses on them that Medicaid paid for that they didn't need to begin with? You know, there's a lot of those things that go on that I wonder if they actually need them. So I'd like to see some information on what they're, do you have that, what they had?
Representative Karilyn Brown
Unverified
38:04
So, no, the only information that we have, we have a breakdown of whether they follow up with an optometrist or ophthalmologist
or if they see a regular physician for some other eye condition, maybe that possibly that some kind of conjunctivitis or some sort of, like I said, infectious disease, but not, we don't have a breakdown. That's at the local level. Okay, okay.
Speaker 11
38:23
If you could, what data that you have, do you have
some data you could send out, any data at all on what his question was? Like I said,
Representative Karilyn Brown
Unverified
38:33
the only thing that I could provide would be to show, and I can provide that, would be those that are seeing a regular physician
or seeing the eye physician, an optometrist or an ophthalmologist. Okay, if you would,
send that to Phil, and he'll send it out to the committee. Yes, sir. I can do that.
Chair
Unverified
38:56
Thank you. Representative Brown, you're recognized for a question. Thank you, Mr. Chair. I've just got a real simple question about how to read this chart. We've got a total, let's take it across the first line, total screened. That's pretty self-evident. And you referred 998, which was 11% of the total screened.
Of those 998, 389 received an exam. Is that correct? Is that how I'm supposed to read that? Yes. Okay. Okay, and then out of those 389, confirmed difficulty, what does that mean? So confirmed difficulty would
Representative Karilyn Brown
Unverified
39:31
be the combination of whether they saw an optometrist, ophthalmologist, or whether they saw a regular physician for some other known reason. And that's what I said I would give the breakdown data for.
Chair
Unverified
39:44
Okay, then this other thing, confirmed normal, no treatment, and or lens, Is that 102 of the 389? Yes, ma'am, that is. So
Representative Karilyn Brown
Unverified
39:56
they were identified as having a normal exam. So they didn't need anything? They didn't need anything.
Chair
Unverified
40:04
But then at this, I just don't understand the language confirmed difficulty, that they had a vision difficulty, is that what that means? Yes, a vision difficulty.
Okay, I'm just... No, that's fine. A little slow. So I'd just like to know exactly
what I'm reading here. Thank you.
Representative Lee Johnson
Unverified
40:27
Representative Johnson, you're recognized for a question. Thank you, Mr. Chair. So do we have an idea with other states
who are implementing screening exams? How does this compare? And specifically, it looks like 17% of who actually were referred were screened false positively, if I'm reading that correctly. No, 17% were confirmed. No, 17% said confirmed normal.
Speaker 156
40:48
Is that correct? Am I reading that right? Right. They
Representative Lee Johnson
Unverified
40:56
were normal when they received the exam. But they were screened positive. Yes, sir. They maybe had a difficulty. Do we have an idea of how we're doing with
administering the screening? Does that make sense? Because does that fall pretty much within what we think are expected norms for falsely positively
Speaker 132
41:11
screened patients? So very few, I mean, there are states, other states that
Representative Karilyn Brown
Unverified
41:15
are doing vision, and we are very specific on the type of vision screening that we do that is provided by the I Commission, they are reviewing, looking at updating to see if there's
any needed change in the future. That does take, because it is mandate and it is in law. So it's going to take a little time to look at that, but what other recommendations are out there? And that's a process. But are they needing to update that? But as for the states, I don't have that information from other states. I do work with other consultants across the U.S. and we are very up at least on providing a screening where a lot of states don't have a mandated screening at all. It's going to
Representative Lee Johnson
Unverified
41:54
be expected that you're going to have some right there where you're screening
positively that end up not needing glasses. I was just curious how that stacks up and if year to year are we pretty close to the same? Is this pretty
Speaker 132
42:06
similar to? Very similar to the same but You
Representative Karilyn Brown
Unverified
42:09
know, you also see that the screening process, 83% of those kids that the nurses screen do have a problem. No, I feel like that's probably good.
Representative Lee Johnson
Unverified
42:15
I'm not trying to be critical of it. I was just curious if there were. So
Representative Karilyn Brown
Unverified
42:19
over the last 10 years, it's probably been between 81% and 87% consistently. Thank you. Any other questions?
Seeing none, thank you for that report. Thank you. Okay, we'll move on to item L, Epilepsy Foundation in Arkansas. If you would come forward. And Senator Hammer, thank you for asking this report to be made. If you would, please recognize yourself and
go ahead and do your presentation. I'm
Speaker 163
42:54
Bridget Patterson, the Program Director for the Epilepsy Foundation, Missouri, Kansas. You're recognized. Thank you.
So, I just wanted to provide a quick update for what we've been doing here in the state of Arkansas. This was from last year when I presented, which I believe that information has been attached to your agenda, Sharia that just spoke to you. This was a letter of recommendation for epilepsy education within the state. This is some of the things that we've been doing. So, I was invited to come and speak at the back-to-school nurse workshop. So this was the dates and locations.
So on August 1st, I was in Batesville. There were 39 school nurses educated. On August the 2nd, I was in Jonesboro. The 5th, I was in Plummerville. The 6th, I was in Branch. On the 7th, I was in Farmington. And on August the 8th, I was back up to the OUR co-op in Harrison. In total, there was over 427 school nurses that received specialized seizure education, in addition to some that were in attendance of the community health nursing specialists and also members from the Department of Health.
These were just some fun pics that we took of the event for those 10 days of training. We've also been working to provide some Arkansas Epilepsy Connect programs here. Our first one was on August 5th. Those in attendance were nurses, specialty pharmacists, individuals, and family members impacted by seizures. Again, there's just some fun picks from that evening. From the spinoff of the school nurse workshops, I have then been invited out to other schools to provide seizure education in theirs.
On August 15th, I was at the Sunshine School in Searcy. That school houses individuals impacted by physical and intellectual disabilities, so there's a lot of seizures actually in that school. I educated 26 school staff members there. Went on up to Bentonville to their public school and another 26 school nurses attended that education there. I just wanted to show some industry partners that we have here in the state of Arkansas that I have personally spoken with
and have their support, which is Greenwich Biosciences, UCB, AZI, Sopronis Pharmaceuticals, Equestive, Apresia, Monteros Medical, Walgreens Specialty Pharmacy, SK Life Science, Synovian, LevaNova, which is the VNS device, Neuropace, which is the RNS device, UAMS, Arkansas Children's and Arkansas Epilepsy Program, AEP. We have another connector group, which is actually tomorrow night, and I extend that invitation to all of you here.
It'll be at the Catina Laredo. The science of cannabinoids is our topic, and that's being presented by Robert Welsh, who's the senior medical liaison for Greenwich PharmD, and he will be presenting that education. I wanted to talk just briefly about seizures and vaping. The FDA is investigating 127 seizures reported potentially linked to vaping. The CDC put this document out that, according to them, in just more than one year,
the number of middle school and high school-age students using e-cigarettes jumped from 2.1 million in 2017 to 3.6 million in 2018. That's alarming to me, quite frankly. We have 3.4 million Americans in the U.S. that have an active seizure diagnosis. You add 3.6 million middle school and high school age kiddos potentially causing harm to themselves, and you've got that linked to seizures.
How much more critically important is it that our young people understand seizure education? How they can first aid, how can they maybe save the life of one of their peers? um, that has a seizure while they're, um, with them. Another, um, screen here, the part that I really want you to see here is that that's highlighted in red, and it reads that seizures have been reported as occurring after a few puffs or even up to one day after use. So some of these kids that it's really cool looking to take a hit off of something that looks like a USB drive,
um, and whether something doesn't occur right then as far as seizures are concerned, but maybe even one day after. So again, providing that seizure education to those young people is really, really important. And this is just something that we're exploring right now. VNS is the device, you can see it up there on the screen, it's that device that's implanted in the left-hand side of the chest. It has electrodes that go up and wrap around the vagal nerve in the neck. That vagal nerve serves as a pathway to deliver intermittent electrical stimulation up the vagal nerve into
the brain in hopes to lessen the duration or frequency of that seizure, maybe even warded off altogether. The VNS treats difficult to manage epilepsy patients, which are high utilizers in inpatient hospitals and ER resources. Arkansas DHS reimburses all acute hospitals only $363 per case when that VNS device costs are just north of $40,000. So that's something that hopefully when I come back to the table, I can give another update. Good news on that. But those
are just some things that I wanted to show that we've been doing in the state since receiving education funding from here. So thank you very much for that opportunity, and I'm grateful to serve here. Are there any questions? Seeing none, thank you
for that report. Okay, that's the last item on
the agenda, unless there's other business or other comments.
Senator Missy Irvin
Unverified
49:04
Senator Irvin, you're recognized. So I know that there's also some other questions about the passes, and we'll get an update on the pass, that whole structure, and at a future meeting. So if you have questions, you can contact me personally, but there's a lot of issues swirling out there, and we're going to need to address those, and we will do so in an upcoming meeting. So there's some folks that are going to have to meet together to figure some things out,
but if you have questions, just holler at me about that.
Thank you. Thank you. There's no further questions, no further business. We are adjourned. You
Agenda
Call to Order
Comments by the Chairs
Consideration to Adopt the October 7 and 8, 2019 Meeting Minutes (EXHIBIT C)
Arkansas Department of Environmental Quality, Office of Water, Review of 3rd Party Rulemaking Regarding PC&E Commission Regulation 2 Establishing Water Quality Standards for Surface Waters of Arkansas. Establishing Water Quality Criteria for a) a segment of the Unnamed Tributary (UT) from Vulcan Outfall 001 to the confluence with Brushy Creek, for a segment of Brushy Creek from its confluence with the UT to its confluence with Stennitt Creek from its confluence with Brushy Creek to its confluence with the Spring River and also b) remove the designated, but not existing, domestic water supply use for the UT and Brushy Creek.(EXHIBIT D)
Discussion by the Committees
Arkansas Department of Environmental Quality, Office of Land Resources, Review of Rule which repeals a regulation that is obsolete. Regulation 14 Waste Tire Program has been replaced by Regulation 36 called the Tire Accountability Program which was created by Act 317 of 2017 called the Used Tire Recycling and Accountability Act. (EXHIBIT E)
Department of Human Services, Division of Medical Services, Review of Rule which removes Domiciliary Care from the Arkansas Medicaid State Plan and all corresponding rules. This is an optional program that is not routinely used through Medicaid and there are no active providers enrolled to provide this service.(EXHIBIT F)
Discussion by the Committees
Department of Human Services, Division of Medical Services, Review of Rule regarding State Medicaid Plan Amendment (SPA #18-0013). There are no changes to the Primary Care Case Manager (PCCM) program. The formatting of the PCCM Medicaid State Plan changed, but the information and program remains the same. The PCCM portion was submitted to CMS on January 7, 2019, and was approved along with the Patient-Centered Medical Home (PCMH) on February 28, 2019. Although there are no programmatic changes to the PCCM program, the formatting has changed and is being promulgated. (EXHIBIT G)
Discussion by the Committees
Department of Human Services, Division of County Operations, Review of Rule which complies with Act 59 of 2019 which prohibits an agency from recovering Achieving a Better Life Experience (ABLE) account proceeds upon the death of a designated beneficiary. The statement in the Medical Services Policy Manual, Section E-600 ABLE Program, which requires the estate recovery to reimburse the Medicaid benefits has been removed. (EXHIBIT H)
Mark White, Chief of Office of Legislative and Intergovernmental Affairs, Department of Human Services, Chief of Staff
Mary Franklin, Director, Division of County Operations, Department of Human Services
Discussion by the Committees
Department of Human Services, Division of Provider Services and Quality Assurance, Office of Long-Term Care, Review of rule which requires national criminal background checks for employees of long-term care facilities and applicants for employment. (EXHIBIT I)
Discussion by the Committees
Department of Human Services, Division of Medical Services, Review of rule to comply with recommendations of the American Academy of Pediatrics by adding three childhood screenings for Medicaid and ARKids B beneficiaries. (EXHIBIT J)
Mark White, Chief of Office of Legislative and Intergovernmental Affairs, Department of Human Services, Chief of Staff
Janet Mann, Director, Division of Medical Services, Department of Human Services.
Discussion by the Committees
2018-2019 Vision Screening Report from the Department of Education (A.C.A. 6-18-1803) (EXHIBIT K)
Discussion by the Committees
Epilepsy Foundation in Arkansas
Other Business
Adjournment
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — PUBLIC HEALTH WELFARE AND LABOR COMMITTEE - SENATE AND HOUSE, Nov 4, 2019 | Agenda | 3 | Official source ↗ |
| EXHIBIT C - DRAFT MINUTES 10-7-2019 and 10-8-2019 | Exhibit | 6 needs OCR | Official source ↗ |
| EXHIBIT D Proposed Rule ADEQ | Exhibit | 18 needs OCR | Official source ↗ |
| EXHIBIT E Proposed Rule ADEQ | Exhibit | 7 needs OCR | Official source ↗ |
| EXHIBIT F Proposed Rule DHS Div of Medical Services | Exhibit | 9 needs OCR | Official source ↗ |
| EXHIBIT G Proposed Rule DHS Div of Medical Services | Exhibit | 8 needs OCR | Official source ↗ |
| EXHIBIT H Proposed Rule DHS Div of County Operations | Exhibit | 9 needs OCR | Official source ↗ |
| EXHIBIT I DHS Div of Provider Services and Quality Assurance | Exhibit | 11 needs OCR | Official source ↗ |
| EXHIBIT J Proposed Rule DHS Div of Medical Services | Exhibit | 10 needs OCR | Official source ↗ |
| EXHIBIT K School Vision Screening Report | Exhibit | 5 needs OCR | Official source ↗ |
| PowerpointArkansas Budget Finance Presentation Update | Exhibit | 16 | Official source ↗ |
Speakers
Representative Jack Ladyman Chair
Unverified
Senator Missy Irvin
Unverified
Speaker 9
Speaker 13
Speaker 14
Speaker 12
Senator Kim Hammer
Unverified
Chair
Unverified
Representative John Payton
Unverified
Speaker 46
Speaker 51
Speaker 54
Speaker 56
Speaker 58
Speaker 67
Speaker 70
Speaker 49
Representative Mary Bentley
Unverified
Speaker 85
Speaker 86
Senator Jimmy Hickey, Jr
Unverified
Speaker 94
Speaker 111
Katie Sursa
Unverified
Representative Clint Penzo
Unverified
Representative Justin Boyd
Unverified
Speaker 50
Speaker 47
Representative Karilyn Brown
Unverified
Representative Richard McGrew
Unverified
Speaker 137
Speaker 11
Representative Lee Johnson
Unverified
Speaker 156
Speaker 132
Speaker 163