Public Health, Welfare and Labor Committee- House & Senate
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Okay, if everyone would take their seat, we're going to start here in just a few minutes. Okay, I want to call the meeting to order.
I want to thank everyone for being here today, supporting the committee activities. Let me just start out with a few announcements. First off, I want to introduce Kate Steele, our new Administrative Assistant, who recently graduated from UCA. Welcome. I wanted to remind everybody of the physical session that is beginning soon.
It'll start at noon on April the 8th, just as a reminder to everyone. Also, our next public health committee meeting will be Monday, April 6th at 1.30, just before the session starts. So that's
all I had. Senator Irvin, did you have something? Yes, members.
If you're a legislator, do you mind coming and sitting at the table so we can free up some seats for others? Do you mind?
Yeah, thanks. Just find an open seat, and if they're not here, then come on in. But that might free up some open seating there for folks. I realize there's a lot of folks here and that it's crowded, but we've tried to schedule that. I also want to say thank you to the members of the legislature that attended the press conference just before this. So we're going to hear from the Arkansas Department of Health. But I think it's really important to note that the Arkansas Senate website will have a link to the Arkansas Department of Health's website for the coronavirus and flu information.
And our communication folks in the Senate will also be asking for that to be put on the Arkansas legislative website. I can't speak for the House. I'll let y'all do that. But from the Senate's perspective, we will provide that link on the Arkansas Senate website, and they will be in contact with the Bureau of the Arkansas Legislative website. And I just look forward to a good meeting and appreciate everybody coming out today. Thanks. I will check on that and see if
we can get it on the House webpage as well.
Okay, well, let's move on to the agenda. We've got quite a few items on there. So we're down to item C, consideration to adopt the February 10th, February 12th, and February 19th meeting minutes. Is there a motion? I have
a motion and a second. All in favor, signify by
saying aye. Aye. All opposed, nay. Motion carries. Down to item D, an update on the coronavirus, the COVID-19. And we have with us today some representatives from the Department of Health, Dr. Nathan
Smith. Would you all come up and introduce
Speaker 16
3:31
yourselves? Thank you, Mr. Chair. Dr. Nate Smith, Secretary of Health, Arkansas Department of Health. And I have with me Dr. Jennifer Dillehay, who is our Medical Director for Outbreak Response and Immunizations.
Yeah, pull the mic a little bit closer if you could, Dr. Smith.
a little closer. There we go. Okay. Well, you know, as everyone knows, this is a really important topic that's getting a lot of attention now. So we appreciate
Speaker 22
4:08
y'all being here so you can proceed. Thank you. The first point I want to make, probably the most important for
Speaker 23
4:13
today, is that as of today, we have no known cases of COVID-19 or the novel coronavirus in Arkansas.
We are aggressively monitoring approximately 100 travelers, and we're responding to calls for people who have symptoms, who may or may not be at risk, and we are testing in our public health lab at this time. We are working very hard to try and keep COVID-19 out of Arkansas, and if it enters our state, to slow the spread as much as possible,
and especially to protect our most vulnerable populations who are those who are older or who HAVE UNDERLYING MEDICAL CONDITIONS. THE
TEST KITS, WHAT'S THE STATUS OF THAT? I MEAN, DO
Speaker 23
5:22
WE ARE DOING PRETTY WELL FOR TEST KITS AT THIS POINT. We have enough supplies currently to test to do anywhere from 1,800 to 2,000 tests. Now, we get multiple specimens on each patient, so it's not 2,000 patients, but we have enough for our immediate needs, and we can request more from the CDC. Also as of this week, some of the commercial labs, particularly LabCorp and Quest, have
started offering the test as well. They don't collect the specimens, but they will run those specimens, and we've requested that they send any positive results to us for confirmation, and that they send any results to us so that we can
have a record of those. All right. Thank you.
Representative Karilyn Brown
Unverified
6:16
Representative Brown, you're recognized for a question. Thank you, Mr. Chair. Dr. Smith, what are we doing
to try to keep it out of Arkansas? The main thing we're
Speaker 23
6:29
doing is any travelers that we identify, we're asking them to home quarantine for 14 days,
which is the outer limits of the incubation period of this virus. And we are monitoring them. We're calling in daily. we actually have software that we have them complete so that we can know if any of them develop any symptoms so that we can test them immediately. Now that's not a perfect system. There are people who are entering the state who aren't coming directly from a country that's high risk or a part of the country of our country that's high risk.
So we're also responding to any reports of symptomatic individuals and making sure they get tested. If we have any positive test results, then we'll, of course, do contact tracing. Follow-up. Yes.
Speaker 36
7:22
Go ahead. Would that be, you're trying to catch people at the airport or at the state line when they
Speaker 23
7:31
drive into the state or? Those coming from particularly high-risk countries, China and Iran, we get reports on.
Unfortunately, there are more and more countries that have transmission, and so it's becoming more difficult. But South Korea and Italy are also high-risk countries at this time where there's ongoing transmission in the community. So many of these individuals have contacted us to say, I just came back from Italy, and so we assist them in that monitoring and checking for symptoms and keeping track of them.
Again, this is not a perfect system. It's quite possible someone could return from Italy to Oklahoma and drive across the border and elect not to inform us, and then we would not know unless they became symptomatic. So this is not a perfect system, but this is what we're able to do at this point to try and monitor the high-risk individuals that we know of. We also have the issue of national conferences.
People go to a national conference. There are people coming from all over the country, and if one of them is carrying COVID-19, then there may be exposure to others who go back to their homes. So for that reason, many of these national conferences are being either canceled or being virtualized to where they're doing what they can by video conference.
Representative Karilyn Brown
Unverified
9:06
So as far as reporting, we don't have any choice but to rely on self-reporting, do we?
Speaker 23
9:18
aware of an individual who is at high risk of exposure and, of course, meets the criteria for self-quarantine and is not complying, then we also have the option of an order of quarantine to compel them to quarantine at home. We have not had to use that very often, but we will whenever we need to.
Senator Kim Hammer
Unverified
9:44
Thank you. Senator Hammer, you're recognized for a question. Thank you, Mr. Chair. Dr. Smith, I think, but I'm not certain it originated from you all. I got a message this morning about a policy regarding people being admitted to nursing homes and about they have to be tested before the nursing homes, long-term care facilities, will allow them to be admitted. Did that come out of you all, or where did that come from,
Speaker 23
10:13
or do you know about it? Yes, that directive came from me, but that was in partnership with Department of Human Services and Industry.
Our Arkansans who are residing in long-term care facilities are probably our highest risk Arkansans. Because of older age or underlying medical conditions, their risk of dying if they were to be infected with COVID-19 is higher than the general population. What we saw in Washington State when the virus that causes COVID-19 entered that nursing home in King County, they've had a number of deaths, and we'd like to avoid that.
We'd like to protect those residing in nursing homes and other long-term care facilities by screening visitors so that we don't have visitors coming who have active infection. infection. I think that will be very important in trying to protect our highest risk populations. But we're talking about
Senator Kim Hammer
Unverified
11:11
a screening, not a test. Those are two different things, right? And I think maybe there might be a little confusion that there's expectation that all patients coming into long-term care facilities need to be tested, but they just need to be screened. Is that correct?
Speaker 23
11:28
This is having to do with visitors to those patients, and it has to do with screening for travel, exposure history, and a symptom check and a fever check. We don't want someone who is actively harboring COVID-19 or influenza or really any other serious respiratory pathogen spreading that around in a nursing home. Can I get one more, Mr. Chair? Short one? Yeah, you can
Senator Kim Hammer
Unverified
11:52
have one more. So in comparison to the amount of deaths of flu, because it seems like
flu has now been pushed to the back burner with this virus coming to the front burner. The number of deaths that are being experienced from flu versus this, can you give us some comparison and speak to that for just a
Speaker 23
12:15
minute? Well, there have obviously been a lot more deaths from influenza. There are every year. What I'm concerned about is the number of potential deaths from COVID-19 because the case fatality rate, the proportion of people who are infected who then become very sick and die, is quite a bit higher for this virus than seasonal influenza.
And that's particularly true among older adults. Thank you, Mr. Chair. Senator
Irvin, you're recognized. So I just want to follow up on Senator Hammer's line of questioning. They did issue a directive this morning that was presented at our press conference. They did work with Rachel Davis with the Arkansas Health Care Association, who also spoke at the press conference. That directive has been sent to all of your emails. Everybody in the General Assembly did receive that directive.
And then also Ms. Davis' comments, I can get those comments for the members of the committee as well if you would like. But she's here today and can speak to you from the industry side of things. They did work with Arkansas Department of Health over the weekend and DHS. I think we were all text messaging together all weekend long. So just so much appreciate what Dr. Dillahay presented today at the press conference, did a phenomenal job just to get that information out to folks in the public.
So that directive can be shared with. And the word was, if you have questions or concerns, contact your representatives and your senators and let us help get them that information that they need, potentially from DHS
or the Department of Health. That's assisted living, residential care facilities, long-term care facilities. I know that DHS is taking steps with human development centers, DYS, all those different residential facilities.
So I just wanted to make that
Representative Deborah Ferguson
Unverified
14:16
comment. Representative Deborah Ferguson, you're recognized. Thank you, Mr. Chair. My health department said there's actually a 24-7 call-in number for the coronavirus and that you have a nurse to review the symptoms with you to see if you need to be tested. And I haven't seen that on y'all's site, but my health department told me about it.
Speaker 23
14:37
a 24-7 emergency call center, and we receive calls 24 hours a day,
365 days a year except for leap year and it's 366 those years. So we have someone answering those phones. We have physicians. We have nurses on call. For this one, we have special, we have staff assigned to take the large volume of calls during normal hours, but then after hours, those are rolled over to the on-call individual. So far, we've received, as of this morning,
Almost 600 calls, and we continue to do that. Now, ones that are not urgent, that can wait until the next day, we'll call them back. But
Speaker 24
15:22
if it's concerning a sick patient, we'll refer that directly
Representative Deborah Ferguson
Unverified
15:28
to the on-call physician. The number they gave me, can I share this and you tell me if it's right? They said to call 501-537-8969 on weekdays and 800-554-5738 on the weekends.
Is that correct? And anyone that had questions could or thought they need to be tested. Also, you know, they do a PCR panel typically when you go in to see if you have other flus. Now that the private labs can do that, is there any chance that the COVID-19 would be added to
Speaker 23
16:02
that panel? I'm not sure they'll add it to that panel, but it can be ordered in addition. What we typically do if someone is referred to us and they seem to be potentially at risk for COVID-19,
we will first screen them for influenza and then a respiratory panel to see if there are other causes. And then if those are negative, then we go ahead and test for COVID-19. And that's a very reasonable approach that private physicians, those in hospitals, or even clinics could use as well. Now that these tests are available through the commercial labs, Quest, LabCorp, and others, then they can use that. They don't necessarily have to go through us.
We have asked that the positive results, though, be confirmed by us so that we can maintain quality control and make sure that a positive test really is positive. And
Representative Deborah Ferguson
Unverified
16:58
wait, you want just the results to go through you or the tests to go through you? I'm confused. If
Speaker 16
17:05
one of the commercial labs has a positive test, and they have not yet so far for
Speaker 23
17:10
Arkansas, but if they do, we want them to send the specimen to us so that we can confirm that positive
result. We want to receive all the results, though, whether positive or negative. Yeah, oh, I understand we're
Representative Deborah Ferguson
Unverified
17:24
saving them, but you actually want to repeat the test. Okay, thank you.
Representative John Payton
Unverified
17:34
Representative Payton, you're recognized. Thank you, Mr. Chair. Dr. Smith, it seems that since our last update, we've become pretty confident in the 14-day incubation period. Is
Speaker 23
17:43
that correct? We've had more experience, and we know that the average incubation period is between three and six days.
The average is five days. By nine days, almost anyone who's going to be sick will have become sick. The 14 days still seems to be very good. Okay, thank you.
Representative John Payton
Unverified
18:02
If I could have a couple follow-ups. Yes, go ahead. Do we have enough data yet to know what percentage
Speaker 16
18:10
of the exposed people are asymptomatic? We don't know that yet.
Speaker 23
18:13
We don't have enough information because there could be people out there who have never been tested. They never had any reason to be tested. At this point, it's thought that 80 to 85 percent of those who become infected will either have, you know, mild or no symptoms, that it's really only about 15 to 20 percent who will have severe illness.
Of course, if you have lots and lots of people infected, that ends up being lots and lots of folks who are very ill, which is why it's important that we not only try and keep it out of Arkansas, but if it comes to Arkansas, that we slow it down as much as possible. We can handle a number of sick people here if it's stretched out over time. If they all come at the same time, then the problem is that our capacity may be exceeded, and then people who need a high level of care, you know, may not have access to it
if everyone becomes sick at the same
Representative John Payton
Unverified
19:08
time. Okay. And do we know the lifespan of the virus
Speaker 23
19:17
it depends on things like temperature and humidity. Under normal circumstances, it's probably hours rather than days, but there's still quite a bit to be known about this virus. If you have exactly the ideal conditions, then it can persist for longer. But probably in most situations, we're talking hours rather than days.
Representative John Payton
Unverified
19:38
And one more question. I think we've heard on the national media that the dry environment, low humidity helps the virus, and higher humidity would be better. Is that
true, or do we have any reason to question that? Are
Speaker 23
19:59
you talking about persistence on surfaces, or are you talking about transmission amongst individuals? Well, what I've heard
Representative John Payton
Unverified
20:07
reported is that as we get into summertime,
somehow they're thinking that the higher humidities is going to help suppress it. And I was just questioning, you know, for inside a house or business, Should we have humidifiers, or
Speaker 23
20:24
would that actually be counterproductive? Yeah, we don't really have evidence that that would be of benefit. With many respiratory viruses, as the temperatures warm up in spring and summer, the transmission tends to drop, and that's true for the human coronaviruses that cause the common cold.
This is a new virus, though, and so we really don't know. Some people are hoping that it will, I think everyone is hoping that transmission will decrease as we get into warmer weather, but we just don't know for sure. Okay, thank you. Thank you, Mr. Chair. Representative Brown, you're recognized.
Representative Karilyn Brown
Unverified
21:07
Thank you, Mr. Chair. I want to ask this really pointedly about reporting.
are we receiving reports of people who return from other countries through the airports whose destination is Little Rock Airport? We are receiving reports from some, but
Speaker 23
21:29
there's ongoing disease transmission. So my question is, is it the federal
Representative Karilyn Brown
Unverified
21:35
government that's reporting or just the travelers? It's both. Okay, thank you. Representative Gray,
Representative Michelle Gray
Unverified
21:48
Thank you, Mr. Chair. I think some of my questions are getting answered as we go through, but I think he's trying to find out, but I was just informed that
a Quest representative just told a hospital that they weren't providing them in Arkansas
Speaker 23
22:09
yet because Arkansas didn't have a contract. Can you talk to that? Those contracts would be with individual hospitals, so it's not as if the whole state
of Arkansas would have a contract with Quest or with LabCorp, but many of the hospitals and clinics have contracts with Quest or LabCorp, in some cases both. Okay, so we'll be up to the individual hospital then to contract for that.
Representative Michelle Gray
Unverified
22:34
I'm just going to keep going. My next question would be, are those tests reimbursable through insurance, or is that a cost that the hospitals or clinics will need to absorb, and what is that cost? Right, those are reimbursable,
Okay. Can I break in here? Joanne Trett, are you here? Do you have an input on that? I have good
answers. Please introduce yourself. Sure. I'm Jody Antred.
Speaker 102
23:08
I'm the Executive Vice President for the Arkansas Hospital Association. Directly to your point, we don't know those costs yet. There, as you might imagine, are a number of hurdles for hospitals to overcome in this kind of pandemic situation. We're being prepared and optimistic that we'll have a lot of things worked out.
We do have many hospitals who have contracts with Quest for certain things and then LabCorp for other things. So I think probably what's happening is we're in the negotiation stage. LabCorp in particular has said that they had tests available for ordering. So once we know kind of what that number is, it can help those individual hospitals
Speaker 104
23:43
negotiate appropriately for what happens. Okay, thank you. And I think more
Representative Michelle Gray
Unverified
23:48
than anything, I just kind of wanted to point out that it's not as simple as just, well, the tests are available. This is a process that the hospitals
and especially clinics, especially those that are individually owned and not owned by systems, are going to have to go through over the next week or two to get prepared for this.
Speaker 102
24:06
Might I add something? One of the things that we do want folks to know, we collect the specimens, but we don't run the lab test ourselves. So we would like for folks to understand that you've got to be a little bit patient. It's a new test, and we do have to have these contracts ready to go. So it's not like it's going to be a quick 24-hour turnaround around to know whether you're positive or negative in these particular situations.
So we do want folks not to be freaked out as a technical term, but do know that we've got three or four days where once the tests are available and we have contracts in place before we can get those data and information back. And we do have a good partnership with the health department to share as much information as we possibly can about those patients who present to us. Thank you. If I might have one
Speaker 104
24:45
more question, or I can come back. Is it for the hospitals or? Not. No. Okay, thank you, Joanne, for your input.
And thank you for attending the news conference this morning. Go ahead, Representative
Representative Michelle Gray
Unverified
25:03
Gray. Thank you. One of the big concerns that I've heard over the last week from hospitals, from physicians' offices, from long-term care facilities, is the lack of availability of masks and protective equipment. Is there anything that
the state that we can do to help be proactive to get these supplies to them? Everything's on back order.
Speaker 23
25:25
Right. I'll be honest with you. That is going to be a challenge moving forward for all the reasons that you're well aware of. Much of our supply chain involves China and production has been shut down there. And there's also a demand throughout the world for these. I think there are some potential solutions that will be helpful to us.
I know the federal government has some through their strategic national stockpile and are acquiring more. I think production is being increased or encouraged here in the United States. And also a large proportion of, for example, the N95 respirators are not used by the health care industry. They are used by other industries like the mining industry. And some of those could potentially be diverted. So some of those are going to depend on our federal partners to help us solve.
We have put in orders at the Arkansas Department of Health, and I know many of our hospitals and other health care providers have. We're waiting for those orders to be filled or for the federal government to release their supplies as needed. Again, because we don't have any known cases here in our state, and there are other states where there's evidence of ongoing transmission in the community, we're likely to be lower priority for now. And I don't mind that for the reason that it is, is because we don't have known cases here.
But we're watching that carefully, and we'll do whatever we can. Senator
Irvin, you're recognized for a question. So, thank you. Could you also talk about two things? One is the funding question. Talk about the federal government, and they just approved a funding bill to address this. Have you been in contact with the Trump administration?
And will we be able to tap into that, or is that going to be as needed across the country? Could you just describe your interaction on the funding portion of
Speaker 23
27:38
states that actually have ongoing transmission have been prioritized, and so they're the first ones to receive funds. But we will receive funds, and once we do, we will have to provide a plan for how we will use those funds, and we've already
done some work on that ahead of time. Okay. I
think that's really important. Do we see that that would probably be sufficient for our needs or I'm assuming and the answer I gave was we would be monitoring that situation and working with you and the governor if there's any need
Speaker 16
28:14
for state general revenue. The federal appropriation and our our planning is
Speaker 23
28:19
is for what I would say immediate needs what we can project over the next couple of months how much the total need will be
really depends on what happens with this epidemic, and I think everyone expects, including our federal partners, that if this, you know, grows large and continues on for some time, there'll be a need for additional appropriations. Okay, thank you. Dr.
Dillahay, during the press conference, I thought your information that you gave to the public was very
good information about if they had a suspected case. It's also information that Ms. Truett gave from the Hospital Association and Ms. Davis gave as well, that if they have a suspected case, what should they do?
I think if you could share that with the members of this committee, but also for the folks that may be tuning in and listening live stream, I think it's very helpful to be able to protect those folks that are out there, our physicians, our nurses that are in clinics, and then also
in hospitals. So if you don't mind just kind of going back through that for the purposes
Speaker 121
29:32
So if a person is concerned that they may have COVID-19, say they've traveled and they've
been on quarantine and now they have symptoms, we would work with them to make sure that they get the right care to get tested. And so when they go to the doctor, we want the doctor or the facility they go to to know in advance because we want them to be wearing a mask when they go inside, because this virus is spread by coughing and sneezing and respiratory droplets, and if you're wearing a mask, it blocks that. Then inside the facility, the clinic, wherever they are,
would be ready to receive them, and they would be escorted to a room where they're by themselves, and they enter that room with the door closed. If it happens to be a facility that has an airborne isolation room, that would be preferred. And then the health care providers who interact with that person would protect themselves. And so for this virus, they would need a gown and they would need gloves, as well as a special mask that health care providers wear, which is the N95
or something equivalent, and then something to protect their eyes from droplets coming in their eyes. And that's how they would interact as they enter the facility. So I just think that's
really important information so that they can take some precautions. They should notify as much as possible their situation before they enter. And I just appreciate, again, your remarks and joining us
in this team effort. Thank you. Dr. Smith, I don't know
What do you know about the cost of these tests and whether insurance covers those? I believe Congress passed a bill, I believe, to pay for the test for people that didn't have insurance or couldn't pay or whatever. Can you give us some insight on that? I do
Speaker 16
31:33
not know what the cost that will be charged from the commercial labs is for this test. I do know
Speaker 23
31:39
that most of the commercial insurance companies have agreed to pay for it, and Medicaid will pay for that as well. All right.
Seeing no further questions. Yeah. Okay. No further questions. Dr. Smith and Dr. Dillahay, thank you very much. Go ahead if you had a comment.
Speaker 23
32:03
Did you also want us to give a brief update on influenza or to save that for another time? No. Go right ahead. Okay. Again, as many of you know, this has also been a fairly severe influenza season. We've actually had two influenza outbreaks. The first was influenza B, and then the second has been influenza A, H1N1. And we have unfortunately, I think we're up to 82 deaths reported in the state, including two children.
So this has been a severe season so far. We are starting to see a decrease in the number of cases, but that's where we are right
now. Thank you. Questions? Representative Boyd. Thank
Representative Justin Boyd
Unverified
32:51
you. Can you address real quickly how effective the flu shot has been this year versus years past and so on and so forth?
Speaker 49
33:01
The effectiveness of the influenza vaccine for this year is similar to what it has been
Speaker 23
33:07
for some other years. Overall, it's been about 45%, 50% effective. In some populations, it's higher. In others, it's lower. In general, in younger individuals and children, the vaccine efficacy tends to be higher, tends to be lower in older individuals. And that's where we are right now. I think the B portion of it has been somewhat more effective than the A portion. Dr. Dillahay, would you like to comment further on that?
Speaker 120
33:40
One thing that we look at for the effectiveness of the vaccine is how well does it match the circulating viruses. And we know that for the A, it matches very well, but it's not as effective for some reason. And then for the B, there's various B viruses around that don't match as well, but it seems to still work pretty well. It's an interesting year. Just a very
Representative Justin Boyd
Unverified
34:07
quick follow-up. You mentioned it seemed to work well in the younger kids, though one of my three kids wound up with flu despite being vaccinated.
What about the high-dose flu
Speaker 135
34:17
vaccine or the adjuvanted flu vaccine in the elderly? Is that seeming
Speaker 120
34:29
to help more? So there are two licensed vaccines available for persons who are 65 and older, the high-dose and the adjuvanted vaccine. And there's no official recommendation in preferring those to the usual quadrivalent because currently those vaccines only cover three different flu viruses,
while most of the others that we have, the health department covers four. However, this next year it looks like the high dose will be four. So we'll see how the comparison studies show to see which are the most effective. But it's hopeful older adults do not respond in general as robustly to the vaccine as younger adults. And so the idea behind these special vaccines is to boost the immune response to the viruses that are covered in the vaccine.
Speaker 22
35:27
And I defer to Dr. Dillahay on that. The Arkansas Department of Health is very
Speaker 23
35:32
blessed to have her. She is trained in both infectious diseases and geriatrics, as well as
Chair
Unverified
35:41
communications. Are there any other questions? Representative
Representative Michelle Gray
Unverified
35:43
Gray, you recognize. Thank you, Mr. Chair. Two questions. One, can you tell us how many cases we have
so far, positive? I know you do a weekly report. Tell us the
Speaker 139
35:56
number of cases. I'll preamble that by saying that influenza is not a reportable disease,
Speaker 23
36:01
so we don't even pretend to report every single case. However, we do keep track of the ones that are PCR positive, and we just got the most recent numbers just hot off the press this morning. So far, we've had 6,145 that have tested positive by PCR. Obviously, there have been many, many more cases that have never been tested by PCR. They've either been tested by rapid antigen or just someone got sick and it's flu season so that we know they have flu.
Representative Michelle Gray
Unverified
36:36
Okay, and that was my second question was how are those reported to the state? So if we have clinics across the state or hospitals that have positive results, and I think you answered that they're
Speaker 16
36:50
not mandated to report that in any way? That's correct, and that makes sense. There are many cases of influenza
Speaker 23
36:56
that are either asymptomatic or mildly symptomatic. so there would, you know, people would never go, you know, seek care, so they couldn't be reported. We do collect data on positive antigen tests, and we require the, we get the reports for the PCRs.
We have other ways that we monitor flu activity, though. We have sentinel providers. We look at diagnoses in outpatient settings in emergency departments, and then we also look at claims data for that. then we also look at school absenteeism because that tends to track very closely with influenza activity during influenza season. And we've even been able to show that those schools that have a higher rate of influenza vaccination in the previous fall have lower rates of absenteeism
during the influenza season in the spring. I know I've
Representative Michelle Gray
Unverified
37:52
had two or five kids get it and they were all vaccinated, so. Fortunately,
Speaker 23
37:57
the ones who are vaccinated will tend to get milder disease than they would have otherwise, but we don't have a perfect vaccine, but it certainly is better than
no protection at all. Thank you. Dr.
Speaker 16
38:14
Smith, what is the acronym PCR? Polymerase chain reaction.
What it does is it actually looks for the genetic
Speaker 23
38:21
material of the virus and amplifies it, And that's the same test that we're, same type of test that we're using for the virus that causes COVID-19, and more and more of our tests for viruses are moving towards those PCR assays, looking for the genetic material itself. Thank you.
to follow up on those cases that you reported, 6,145, specifically who is reporting those cases to you?
Speaker 23
39:00
are reported to us from other labs that do PCR testing. Okay, so it could be
like Quest, LabCorp, do they report to you? Are we getting reports from them? I
Speaker 16
39:23
as many labs as possible. This is not the kind of test that is typically done in an outpatient setting.
Speaker 23
39:30
It may be done at a hospital. So UAMS and Children's Hospital report to us. I'm not sure how often that test is done by other facilities. Yeah, I mean, they do have the ability to test within the clinic. as well.
So, yeah, Representative, well, Representative Gray. Representative Gray, do you have a question? Those aren't reported. Yeah, I have one more question. I think just
Representative Michelle Gray
Unverified
39:55
to Senator Irvin's, kind of to her point, the tests that are available in the clinic are not the PCR type tests. Is that correct?
Speaker 23
40:04
They're typically the rapid antigen tests. Right. Yes, because those are much more useful because you get the result right away. The PCR, you know, you get your result back, you know, 24, 48 hours later or even longer. They're helpful for us because they can tell us exactly what type of influenza it is, whether it's A, B, what type of B, what type of A, et cetera. But they're not as useful for someone who's trying to make a decision on the patient who's in front of them. What you really need for that is a rapid test.
Representative Michelle Gray
Unverified
40:37
I think I was under a misguided. I thought that we, as a state, reported the positive tests in the clinic. So that's something I guess we need to look at moving forward because it's widespread. All of the protocols that we've put in place with the infection control that we're doing for the coronavirus actually are coming in very handy. And I know some facilities have put them in place already due to the high outbreak of influenza right now. We
Speaker 23
41:05
do have reporting of at least some of these rapid antigen tests, and they're part of our
flu report, but the 6,000 that I mentioned were PCR, and the reason why those tests are the most sensitive and most specific, again, they don't come back rapidly, so they're less useful. For a severe hospitalized patient, they may be very useful, but for someone who's just, you know, coming in and sick and you need to know whether to treat them or not, you need a rapid test for that. All right.
Dr. Smith? Seeing none, thank you
all for your input. Thank you very much. Okay. Next, we're down to item E on the agenda, mission of
Speaker 153
41:55
the Arkansas Workers' Compensation Commission. Mr. Greenbaum would you come forward and while
he's getting seated there let me talk a little bit about why he's here before our committee
Representative Kenneth Ferguson and I had some cases and we discussed those and people were confused a little bit about workers commission and procedures so that's why we invited y'all to come and just talk to us a little bit about what you do and how you do that and some of the processes. So please
Speaker 155
42:35
introduce yourself. My name is David Greenbaum. I'm the chief executive officer of the Arkansas Workers' Compensation Commission. This is Mark McGuire, the assistant
CEO. The mission of the Arkansas Workers' Compensation Commission is to administer and enforce the Arkansas workers' compensation laws as authorized by the Arkansas Constitution and enacted by the Arkansas legislature. In summary, our goal is to pay timely benefits to legitimately injured workers in Arkansas.
We have a number of divisions, specifically 10 divisions in the agency. I have some handouts if the committee wishes them that is an overview of the various divisions of the commission, and I'll be glad to answer any questions that you might have. Okay, we'll get those and pass
them out. um representative ferguson did you have any questions you wanted to start with uh just
Representative Kenneth B. Ferguson
Unverified
43:55
you so much for recognizing me
um just a simple question in my other life mr grain bomb when i was in human resources with the city of pine
bluff i handled quite a few workers compensation cases for employees and I had a situation in my district where an individual did not know that he had the right to seek an outside medical opinion. Now, correct me if I'm wrong, it was my understanding that most of this information is on the forms that that employee fills out
when they file for workers' compensation benefits that explains that they have the right to
switch from the employer's physician to their own. The employer
Speaker 155
44:48
is required to give them a form that explains to them their rights with regard to changing physicians. Under the law as it currently exists, the employer or the employer's insurance carrier has the right to provide prompt medical care to that employee,
but the form explains to them that they have an absolute right to change physicians one time only if they're not satisfied with the physician that they've been referred to. Well, I think in this
Representative Kenneth B. Ferguson
Unverified
45:26
case, the employee claim was being handled by an insurance company, and he did not
have that information, I guess, initially. And he didn't find out that he had the right
to change to get another physician until he hired legal counsel.
But that explains it. I thought that was the case because when I ran the Human Resource Department, that's exactly what we did. But that was
the only question I really had. I wanted to get that cleared
up. Mr. Chairman, thank you. Is there any other questions from the committee? Just as a
clarification, people may not know this, but, you know, large companies, some of them might be self-insured, but they typically have a third-party insurance carrier,
and they typically have a clinic or doctors that they use for these kind of cases. and you all just monitor that, is that correct? That's correct. But if in a case like Representative Ferguson is talking about there, if that individual who is injured questions the diagnosis, then they do have the right
to go to get a second opinion of their choice. Is that correct
Speaker 155
46:48
or not? they do have a right to petition one time only to a physician.
That physician is normally agreed to by the parties or selected by the commission's medical cost containment division. And that second
opinion can be outside of the clinic that the entity normally uses? Yes, sir. Okay.
I think that was the clarification. Representative
Representative Kenneth B. Ferguson
Unverified
47:16
Ferguson, you're recognized. So that petition initially goes to the commission or goes to the employer's carrier?
Speaker 155
47:25
The claimant makes that petition to the commission. To the commission. Yes, sir. Okay. Thank you. All right. All
right. Any other questions? Senator Hammer, you
Senator Kim Hammer
Unverified
47:37
recognize. Thank you. In the event the two doctors don't agree, what's the appeal process or where does it go from there? if the two
Speaker 155
47:48
doctors don't agree? Well, of course, if they don't agree, that's when it's normally assigned to the adjudication division
to weigh the competing evidence or the medical opinions. Frequently, the parties will agree to a third medical provider to do the evaluation, but if they can't agree, then the commission could order an independent medical examination in instances where there are compelling circumstances.
Senator Kim Hammer
Unverified
48:28
And the doctors that work for y'all, I'm going to put it in that phrase, that work for y'all, What are their credentials that you approve them to
Speaker 155
48:42
be the ones that the person who's been injured goes to see? Senator Hammer, the commission does not have any physicians that work for us. There is a procedure with regard to the employers and the TPAs.
The physicians have to be on an approved list that's maintained by the Workers' Compensation Commission, but there are numerous physicians in all of the modalities, orthopedic surgeons, neurosurgeons, various specialties that are on that approved list. Okay, thank you. Yes, sir.
Representative Ferguson, you're recognized. One
Representative Kenneth B. Ferguson
Unverified
49:31
final question, Mr. Chairman. What's the wait time that an individual may have before they can get their case before one of the administrative
Speaker 155
49:44
law judges? You're talking about in a contested, controversial claim? Yes. Well, we try to, if you're talking about strictly the change of physicians, that is handled by our medical cost containment division, and we try to expedite those as opposed to going through a formal adjudication,
which takes much longer. And usually within 30 days, the medical cost containment division can set up that examination for a one-time evaluation for the change of physician. In a contested
Representative Kenneth B. Ferguson
Unverified
50:23
adjudicated situation, that takes a little bit longer. Yes, sir. A
Speaker 155
50:30
year or six months? No, we encourage the administrative law judges normally try to get those cases to a hearing within 90 days.
And then the outside time limit on issuing an opinion is 90 days. but currently most of those decisions are rendered within 30 to 45 days. Is the possibility
Representative Kenneth B. Ferguson
Unverified
50:57
that they would actually see an administrative law judge within 90 days or within three months? Yes,
Speaker 155
51:06
sir. Not six? That's correct. It should be, with the caseload being what it is,
they should be able to expedite that and get it to a hearing within 90 days. Okay. Thank
you. Yes, sir. Okay, seeing no more questions. Thank you, Mr.
Greenbaum. Thank you. All right. We're down to item F, which is a rules review by DHS.
Speaker 176
51:45
Would you all introduce yourselves? Thank you, Mr. Chairman. Mark White with DHS. Jay Hill
Representative Fredrick J. Love
Unverified
51:56
and explain the rule. Thank you, Mr. Chairman. This rule is an amendment to one of our Medicaid waivers, Living Choices. As many of you know or remember, this is our Medicaid waiver we use to provide assisted living services to both adults with disabilities and also the frail elderly. Let me state something very clearly on the front end, because I think there may be some confusion
about what this amendment does. This amendment is a rate increase for assisted living facilities. For history, I'm sure many of you remember back in late 2018, we proposed decreasing the rates for assisted living facilities. And we did that for a couple of reasons. One was that our rates appear to be out of line with other states, but also there was not a sound methodology underlying that rate. And CMS was requiring us to do a rate study and develop a sound methodology to base the
rate on. So we went through that process, brought that to you as a committee and to the rules subcommittee at the time, and that was approved in December of 2018 to decrease that rate. However, at the time, we committed to the legislature and to providers that we would do a second rate study, have another cost survey to give providers a second chance to provide that cost data to base that rate on, and that we would reevaluate that. What was before you today is the result of that. There was that second survey, that second rate study, and what the actuaries came
back with was a rate that was somewhat higher than what we had done originally. Originally, what's already in place right now is an ultimate rate of $62.89 per day, and we're in the process of a phase-in down to that. We didn't implement the cut immediately, but we're phasing in over a two-year period. What this amendment before you today does, it increases that final amount to $68.51. And then we also have some other housekeeping changes related to background checks and related to eligibility for past recipients. None of that is substantive. It's
just some cleanup to some of the technical language in the waiver. And with that, we'll be happy to answer
Chair
Unverified
54:11
any questions. Representative Love, you're recognized. Thank you, Mr. Chairman. Okay, so Mark, if I can remember correctly, I thought the rate was $80. Was it not? What
Representative Fredrick J. Love
Unverified
54:23
we did at the time was there were four rate tiers originally. And so as of January 1, 2019, what it did, it combined those four rates into a composite of those four of $80.33.
And then since then, it's been stepping down every six months until it reaches that final rate that was recommended by the actuaries. Which was the $62 rate? Yes, sir. And then
Chair
Unverified
54:44
you said you were going to raise it back up to $68? Yes, sir. And that was due to a study that you,
Speaker 184
54:51
a rate study that you had? Yes, sir. Okay, Mr. Chairman, I think I might get back in the queue after we have some conversation. Thank you. Okay, Senator Hammer, you recognize?
Senator Kim Hammer
Unverified
55:09
Thank you, Mr. Chair. Who's the actuary that did the report for y'all? I was done by Milliman. And
they're contracted with DHS to provide this service. Are they contracted to do other services as well, or was it just one time? They are contracted actuaries, and so they
Speaker 187
55:24
did, of course, they did work on this. They've done work on other rate reviews as well as other actuarial work for the department. And that's all
Senator Kim Hammer
Unverified
55:33
under one contract we have with them. In the other areas where they've done rate reviews for you,
has time been sufficient to prove that their projections have been true to what they said it would come out to be or in the other areas where you've used them? Well, on the rate
Speaker 181
55:51
reviews, they're not so much projections as they are. I mean, they're estimates of where the rate
Representative Fredrick J. Love
Unverified
55:56
should be at, and we've reviewed that. I mean, but so far we've been satisfied with the work that
Senator Kim Hammer
Unverified
56:03
they've done. But have they been accurate? I know you're satisfied, but have they been accurate in what they said it would turn out to be?
I'm not quite sure what you mean by that. Are you mean
Senator Kim Hammer
Unverified
56:20
if they're an actuary doing work for you and you give them a piece of work to
do in this area or other areas, do they have a history of being accurate as far as what they predicted to be or what they've researched to be the true cost and that actually turning out what it turned out to
Representative Fredrick J. Love
Unverified
56:39
be? Well, from what we've seen, yes. But again, understanding that what they do when they do this work on the rates
is it's not a prediction. It's they do an analysis to see what is the cost of providing this particular service. And that's the data that we use to base the rates on. And so, yes, I mean, from what we've seen so far, we believe that it has been accurate and it has been
Senator Kim Hammer
Unverified
57:05
appropriate. One last question, Mr. Chair. Yes, go ahead. Thank you. So as far as what they use to go in their report to you, where do they go to get their information in order to report to you? Do they do national studies, look at other states, or is it just historically relevant to Arkansas?
Where do they get their information from or
Speaker 181
57:23
data from? They look at a variety of sources. And so, for example, for this study, there was the cost survey that was done in which all assisted living facilities had the opportunity to participate. About 29, if my memory is correct, responded to that cost survey. So we had that data from the industry. They also looked at Bureau of Labor Statistics data in terms of wage data. And I know they looked at other data sources and statistics as well. All right. Thank you, Mr. Chair. Okay,
Representative Brown, you're recognized for a question.
Representative Karilyn Brown
Unverified
57:59
Thank you, Mr. Chair. At $68.51, that works out to $2,055.30 for a 30-day month. What does
it generally cost for a person to stay in an assisted living facility for a month? Well, for Medicaid beneficiary,
Speaker 181
58:16
for a month, the assisted living facility, they receive this per-DM rate, which we pay for each day for that individual, and they also
Representative Fredrick J. Love
Unverified
58:25
receive an additional amount from the individual to cover the cost of room and board, and that
amount is tied to the SSI rate, which right now, I believe, is in the neighborhood of
Representative Karilyn Brown
Unverified
58:38
about $700 a month. So that individual then pays the, would be paying at this increased rate, would be paying the nursing home about a little less than $2,800 a
month? For the combined amount, yes. Are there nursing homes in our state that are predominantly populated with Medicaid recipients?
Representative Fredrick J. Love
Unverified
59:10
Yes, ma'am. And just to be clear, this is not for nursing homes. This is for assisted living facilities,
Speaker 181
59:18
which are separate from nursing homes. and for those members who may not be familiar with an
Representative Fredrick J. Love
Unverified
59:23
assisted living facility what that is is that provides a place for that individual to live they typically provide for their room their board and they provide hands-on assistance with some of their activities activities of daily living they do not provide necessarily skilled nursing services to these individuals this is for individuals who may need a little bit of help may need some help with their dressing or their
Speaker 181
59:43
bathing, but they don't necessarily need that 24-7, around-the-clock care you see in a nursing home. Thank you.
Okay. Members, just as a reminder, we've got three people that want to speak on this particular rule, so we'll ask them
to speak after the questions. So, Representative Gray, you're recognized. Thank you, Mr. Chair.
Representative Michelle Gray
Unverified
1:00:08
Can you please just remind me what all is allowed in that survey as far as costs are concerned? Because I know, doesn't CMS have certain things that are allowed
to be included in the cost and certain things
Representative Fredrick J. Love
Unverified
1:00:21
that are not? Yes, we look specifically at their labor cost and any related costs for the hands-on services they provide that individual in the facility. So we cannot look at, for example, the room and board cost. Under federal regulations, that cannot be paid by Medicaid. And that's why that there's that separate payment from the client of that SSI amount to cover those room and board costs. Can't pay those, we cannot pay facility costs either, construction costs, things like that. We can only provide, again, for that
hands-on assistance being provided to that individual. Yes, ma'am. Okay,
seeing no more questions at this point, we'll go ahead and bring up the folks that want to comment. And Mark, if you all just wait around in case there's other questions. Certainly, Mr. Chairman, thank you. Yeah, we do have a handout that's coming around to y'all. While that's being passed out, and I may mess these names up or butcher them,
Ed Holloman, Todd, can't quite read the last name, Todd, sorry, and Scott, Kingsborough, So, okay, if y'all just take a seat there.
Speaker 210
1:01:56
Okay, if y'all would go ahead and introduce yourselves, all three of you, and then one of
you can start first. Todd Hightower with Healthmark
Speaker 212
1:02:10
Scott Kingsborough with the Manor. Okay. Just go ahead and start
Speaker 214
1:02:15
on the left side if you want to start there. Whoever wants to start, go ahead.
Speaker 215
1:02:22
Proceed. Hi there. We're trying not to rehash the old information because we, as the
Speaker 216
1:02:27
group was just told, we've had a couple rate studies. THE REASON WE'RE HERE TODAY OBJECTING TO WHAT'S HAPPENED IS EVER SINCE THE FIRST RATE STUDY AND THE SECOND RATE STUDY, THE ASSOCIATIONS HAVE BEEN ASKING FOR THE UNDERLYING DATA BECAUSE WE WANTED TO SEE THE MATH, HOW IT WAS COME ABOUT. WE DID REQUEST FOR FOI, THOSE FELL ON DEAF EARS, FINALLY WE WERE ABLE TO GET A LEGISLATOR TO GO THROUGH BLR TO GET THE INFORMATION.
When we did get the information, it was still raw data. No way to come up with the conclusion. So it meant just getting the calculator out and crunching the whole thing. The numbers we came up with from the data they provided didn't match what the study showed. They give a median salary number and for nurses' aides in the study at $10, But when you go through all 769 lines of data, you come up with a higher number.
When you add in for the minimum wage hikes, you come up with an even higher number that's not in there. So we have a real problem with the way that was compiled, both for nurses and for nurses' aides. The third page of your handout I've given you today, DHS bears out my case perfectly. They're wanting an 18% hike for their nurses' aides because they can't hire people. We're in the same boat. We don't get enough money to do it.
If DHS wants a raise for nurses and nurses' aides, we're in the same bracket. We haven't had a raise since 2014, and now we're being hit with a decrease of up to 26% from our highest number. 26%. Yes, we do get room and board. It works out to $23 a day. You can't even get a motel room for that, much less a place to live and your meals provided. So this isn't a windfall for us.
Speaker 217
1:04:34
The next part down there, number four, number five, is regarding the overhead. We said the overhead that they
Speaker 216
1:04:43
provided in the study was too low. They said, fine, we'll fix it. Well, all they did was take a number out of the salaries for practitioners and put it down into overhead. So it was a wash. Even worse, more insulting, there was a letter from Milliman on February 14th that said the range for overhead is going to be 103 to 194 percent.
But two weeks later, when overhead came out, it was
Speaker 216
1:05:17
So, I'm just flabbergasted by the whole thing as all the providers. Our request today is real simple. We want this thing reviewed. Our deal back in December of 18 was we would do another study and the John Stephen group would come in to review it. We did the study.
30 of our facilities provided results, but no study was done. And so there was nobody to go after Milliman behind them to say, hey, show us the math. We had to do it ourselves. We came up with numbers totally different from theirs. Yeah,
Speaker 219
1:05:58
I would just like to add, you know, we took the two studies. We took the initial combining of the tiers into one tier and the first two rate cuts. And then in January, we took our, really the second cut after they combined the four tiers.
And at the same time, the minimum wage increase, you know, and that's had a triple-up effect where not only your CNA is going up, but your other staff are going up to meet those minimum wage requirements. We've done the cuts, and it's not working. My fear is to continue the cuts without any adjustment for minimum wage or to really get into the study of what was allowed. It's going to do nothing but hurt quality of care across the state, especially to those residents in the rural communities. and we were just asked to delay it and study it.
Speaker 222
1:06:43
Thank you. I'd just like to point out that I think from your question that, you know, are the reimbursements adequate for us to stay in business? The answer is no. there's a 2.8 percent wage increase that's built into the study and just with what Mr. Hightower
had brought up before in in 2019 there's an 8.8 percent increase 2020 when the wages go up there's 8.1 percent increase so it really doesn't add up and we don't have enough money to employ our caregivers and take care of these folks. We've
Speaker 216
1:07:30
had a total minimum wage hike of 76% since our last rate increase. When was your last rate increase? 2014.
All right. Any questions from the committee? Representative
Representative Michelle Gray
Unverified
1:07:57
Gray, you're recognized. Thank you, Mr. Chair. I'm looking through this, and a lot of what you're citing has to do with direct care workers. And these are assisted living facilities where I would expect that we don't have many direct care workers like we would in a nursing home. Can you tell me, is there a minimum that
you're supposed to staff nurses per residence? Or how many
Speaker 225
1:08:16
do you have in each facility? Well, we do have staffing requirements.
It's one for 15 as minimum, but you really need
Speaker 216
1:08:22
to staff for what your needs are. in the day and 1 to 25 in the evenings. A lot of other states have been mentioned about having lower rates. Well, Indiana in comparison is one for 50. So we've got some pretty stiff requirements. Just one quick follow-up. Okay, go ahead. Thank you. And so
Representative Michelle Gray
Unverified
1:08:41
an average facility in the state of Arkansas will have, so one of your facilities, how many total residents do you have? Well, kind of
Speaker 217
1:08:48
what we tried to do on this model was to do a 50-bed facility
Speaker 216
1:08:55
to try to model what works and how would people staff it. The original study was done, and they staffed it with 15 CNAs, and we looked at that. Every operator says, no, that doesn't work. You cannot even meet the minimums with 15, so they went to 18. And that's a little more reasonable, but still their salaries were so low that you couldn't do it. With the rate we're going to have at $68, you cannot staff the entire building with minimum wage and still have it cash flow.
That means you're paying your cooks $10 an hour, your nurses' aides $10 an hour, your laundry workers $10 an hour. If you do that with 50 people, the math doesn't work. You're out of business. It's just a matter of how long you want to keep digging into your pocket.
Representative Karilyn Brown
Unverified
1:09:49
Representative Brown, did you have a question? Yes, Mr. Chair.
It's my understanding that in our Medicaid program,
we allow a certain number of people to have assisted living benefits. Is that correct? It's a limited number. Yes, ma'am. That's correct. But these Medicaid patients aren't
sort of evenly distributed throughout the state. They tend to cluster in certain areas? That's correct. There are some counties
Speaker 219
1:10:19
that have no assisted livings. There are some that have assisted livings that do not accept the Medicaid program.
Representative Michelle Gray
Unverified
1:10:25
So they are clustered. Thank you. You're welcome. Representative Gray, you recognize. Thank you, Mr. Chair. I know you're tired of me today already. One more thing. You mentioned the John Stevens group. I don't remember that ever coming into play. Could one of the chairs or someone please talk to me about where the John Stevens group, or if you are aware, where they were supposed to come into play in looking at the Milliman? Okay. I'm not aware. And maybe Mark White, or if you could attest to that, where you came up with that?
Speaker 216
1:10:57
That was our negotiations back in December of 18 to get the new study and to have the Stevens group look at it. Is
Representative Michelle Gray
Unverified
1:11:03
that something that this committee or ALC agreed to on record? I'm not sure. Because I'm not remembering that. Director White's
Senator Kim Hammer
Unverified
1:11:17
telling me no. Okay, thank you. Senator Hammer, you're recognized. Thank you, Mr. Chair. Maybe some others in the room can correct me if I'm wrong, but that was a request that was put Representative Gray before ALC Executive Committee
to see about appropriating the money to have the John Stephen group come back in and review the Millman report for checks and balance, and it was not approved by ALC Executive Committee. And I have questions, Mr. Chairman, at the appropriate time. Go ahead, proceed. Thank you. And this is, I'd like to ask this out of DHS first before I go to the speakers at the end, if I could. Pardon me, would you repeat that, please?
I'd like to ask DHS a question, but
if I could, can one of them sit at the table and
me ask this question? Yes, yes. Come on up.
Senator Kim Hammer
Unverified
1:12:15
When you got the Millman report, Mr. White, were you all privileged to look at the information that they used to produce their results? Yes, sir. We had the data on the cost surveys. Is that information available to the general public and would it be available to the presenters that were at the end of the table a minute ago?
Representative Fredrick J. Love
Unverified
1:12:35
I would have to double check. I know from my memory that at least one or two of the providers, if not more, they included a statement that they did not want it to be released because they said that it was proprietary information and therefore protected from release under FOIA. Now, I don't know what response we may have made on a FOIA request. We may well have denied one on that basis, but I just don't know for a fact. I'd have to check and see. All right, Mr. Chair,
Senator Kim Hammer
Unverified
1:13:04
can we get those providers back to the table, please?
All right, if y'all would come back up. You gentlemen heard what Mr. White just testified to. Did y'all make that request to them that he referred to? A couple of our members did, yes, sir. Is there any reason why that shouldn't, because help me understand, we're sitting here as legislators in a position that the middleman report has come out
based on that information that's in it. And unless we can look at that information that's in that report, I kind of find that we're choosing between you and DHS and help me figure out a pathway forward unless I'm looking at it wrong, and please feel free to give me a different perspective. Well, we had requested the information. It wasn't
Speaker 216
1:14:06
until a legislator went through BLR to get it that we were able to get it, but it took over a year to do that.
Senator Kim Hammer
Unverified
1:14:14
But is that information that you requested, did that include the idea that the content of that report, which would be released, that evidently a couple members of the provider group didn't want released, according to what DHS is saying, because they were afraid it would show some proprietary information? The information was in there. it would
Speaker 216
1:14:38
have been easy enough to block out the names of the providers had they chosen to do it, but it
was all out there, but there's no really proprietary information. We know what everybody's costs are and what it costs to run a
Senator Kim Hammer
Unverified
1:14:54
business. Okay, and have y'all tried to get anybody else on your own as a provider group to well, I guess if you don't have the information, you wouldn't do any good to hire anybody to look at the information because you don't have it
Speaker 216
1:15:09
to give it to them to look at. Is that right? We have it now. And when they say the median or the 50th percentile, that's a real simple way. You go down 96 numbers, find the middle number,
and that's your median number. In this case, I'm sorry, it's 91 numbers. So the 46 number was the median. There's no getting around that. It's not difficult math. So we're able to look at it and and the numbers don't agree to what the study had. Just
Senator Irvin, you're recognized. Thank you. So just a couple of different things. I think that Mr. White said that 29, when
they sent out the surveys for your cost reports
on your labor costs and the hands-on, those are the two areas that they can count
towards their cost reports to determine the, to try to set the rates and compare it to other states. So he reported that 29 sent those surveys in. And how many members do you have total? Are there individuals?
Speaker 216
1:16:17
Medicare or Medicaid provider, waiver providers, but they might have been a 60-bed facility that had
two residents that were on Medicaid. So it wasn't really the bulk of the businesses. So the ones that, I think the ones that were in the survey were
residents. Well, okay. I mean, where am I getting the number 388? I thought there
were 300, are there not, how many facility? Is that the number of
Speaker 225
1:16:49
facilities or? You know, I don't think it's nearly that many. I mean, there's only about 52 or 58
Okay. Mr. White, you want to speak to
Speaker 252
1:17:07
that? Sure. I'll just clarify. 388, that's referring to personal care providers. For assisted living, there are 85 facilities in the state that are eligible to have Medicaid beneficiaries in them. Right now, we have Medicaid beneficiaries placed in about 54 of them. Okay,
but 85 could have responded to the survey, and 29 responded. Is that correct? I don't think that's
Speaker 217
1:17:30
correct, because I don't think those others are signed up in the program, Mark, are they?
Speaker 256
1:17:36
My information is that's not going to be signed up. They don't have to
because they can be signed up. Did you? Okay. I mean, the reason I'm asking is, you know, so about 30%, 34% responded with the information at the onset of the rate review from my math. So I guess what I'm getting at is, you know, I think it's important on these rate reviews to have 100% participation from the onset.
I mean, this has got to be something that we work together. So I question why, you know, I mean, I know it's hard to get 100%, but, I mean, it's something that you're here today about. So I would think that 100% of those facilities would want to participate with our cost reports and share that information so that, you know, we could get a really good, strong look and perspective. Is there any reason why? I mean, it's kind of convenient to come after the fact.
And then present versus on the initial onset to say, here's as much information as we can provide you so we can kind of go through this together and do it at one time instead of back and forth and back and forth like has happened. Senator, first
Speaker 216
1:19:01
of all, we don't do cost reports in assisted living. So these were based off the financials. We were given a very short time span to do this. I can't remember the date. They sent out the letter. I want to say it was late December of 18.
that the letter went out and they wanted responses by January 15th. So it was very quick to get all that together. The survey was very confusing. When we were doing the initial round, we were in there with the accountants from BKD and they had two pages of questions. They couldn't figure out how to do the survey. So this thing was not an absolute science, what they were asking. So I think the degree of difficulty, especially for a smaller facility, maybe that said, what's this? How do I figure this? And it was just the time frame that was
required. So we had to work to get 30 providers in there. And we only had about 52 at that time, I believe, that were in the program. So that was the deal. We had to have a majority of providers to
respond. That was DHS's requirement. Okay. But labor and hands-on cost are the two components primarily that they were looking at? Labor cost and hands-on, any hands-on materials that you're utilizing in order to take care of those residents. Those two components. Those are the two things.
Speaker 216
1:20:28
Actually, it's everything but room and board. The building cost, the interest, the amortization.
But from the testimony that Mr. White said that they are not allowed, that CMS would not allow them to include
the facility cost. So that would be taken out of it.
Speaker 216
1:20:48
That was included in the study. It was not calculated in there. So if there was rent, if there was a mortgage payment, if there was interest, amortization, depreciation, and raw food costs, those were deducted. The
other costs like transportation, a payroll person, an HR person, the laundry workers, the dietary workers, cooks, dishwashers, all that other stuff was calculated
Speaker 264
1:21:10
in there. Okay. And then the second thing I just want to say is minimum
wage. I know we hear that a lot, and I'm just going
to repeat what I've said, is that if that was an initiative that this legislature had put forward and passed, then I would be more sympathetic to that. But the
problem is we did not. And I've asked group after group after group that have come before us,
And I'm not singling y'all out, but, you know, did you campaign and try to beat that at the ballot box? And the answer is no, that we did not. So, you know, I mean, I think these are the consequences that I think a lot of us around in this room knew was going to be the case that when the voters of Arkansas, they pass a minimum wage increase, that there would be those consequences. So, you know, I just think I want to say that one more time, that I was vocal to try to get people not to vote for it.
But I think it would have been nice to have had everybody join in that chorus. Thank you
Speaker 216
1:22:13
so much. And you've made that point clear to me every time I've sat in front of you. But I do with
others, too, because education, Department of Education, we hear it every single
Speaker 216
1:22:22
education. Bottom line is you're subject to the will of the voters. The voters have said we want the minimum wage to go up. And then we're sitting there going, hey, if we've got to do it, somebody's got to pay to play because we're in the same boat. We've had to absorb all these costs without a rate increase.
Senator Hammer, did you have a question? Thank you,
Senator Kim Hammer
Unverified
1:22:47
Mr. Chair. How many providers are positioned for this rate adjustment as far as the assisted living providers being able to survive, and how many are taking Medicaid patients? I think it's still
Speaker 238
1:23:04
around that 58 number from the last thing I got from DHS.
Speaker 216
1:23:10
Now, Mark says there's 82 providers, but I don't believe that many of them have signed up to participate in the waiver. Of everybody that participated
Senator Kim Hammer
Unverified
1:23:17
in the survey that you sent out, they were all providers that are affected by this rate increase. Is that correct? I think he's saying yes on that. It is. DHS sent the survey out. We didn't.
And how much time was allowed for you to respond to that survey? And what have you done since that survey was sent out as far as trying to advocate
Speaker 216
1:23:54
with DHS regarding this rule that's before us today? We had
Speaker 225
1:23:59
roughly two weeks to complete the survey. And DHS doesn't even
Senator Kim Hammer
Unverified
1:24:09
want to tell you how many times I brought it up in meetings. Okay. Okay. Madam Chair, just for perspective, we're talking about assisted living and rate adjustments to assisted living.
And I remember this conversation starting way back when that one of the fears is that if any assisted livings go out, what's going to happen to the residents that are in the assisted living and where are they going to go? And so I'd like to at least, although I know this is a separate issue, I'd like to at least hear DHS as far as when it comes to the nursing home rate, adjustments that have been made to the nursing home rate and what kind of acceptance or pushback has been made by them.
If the chair would allow, if DHS wants to come back to the table and
Representative Fredrick J. Love
Unverified
1:25:07
answer that. All right, let's change seats again. Senator, Mark Watt, DHS. Senator, I'll just make sure I understand your question. Are you asking about changes
Senator Kim Hammer
Unverified
1:25:16
to the nursing home rate? Yeah, because the big debate here is we're trying to adjust the rate for the assisted living. And I understand this is not a discussion about nursing home rates,
but I also know there were some adjustments made to the nursing home rate as well. And I'm just trying to get an apple-to-apple comparison as far as what is being done with the assisted living rate. How is that comparable to what's been done with the nursing home rate, if anything at all? My
Representative Fredrick J. Love
Unverified
1:25:43
memory is I don't believe we've made any changes to the methodology for how nursing home rates are calculated. Of course, nursing home rates are calculated very differently from these, in that nursing homes, they file cost reports. They have to report to us pretty much every penny that they spend and how that's spent.
And then that's used to help determine a rate. And there's a formula in place in law that follows, and so that's been in place for some time. There were some changes made around the time of the health care task force that actually took some things out of consideration. So, for example, I think we used to include some element of malpractice insurance in that rate. We no longer do that. We also used to have a temporary rate that was sometimes available to nursing homes that provided them a higher payment when there was an ownership change or a management change.
That was eliminated as well, so there was not that opportunity for that higher rate. But other than that, I'm not aware of any significant changes to the nursing home methodology. Okay. All right. Thank you, Mr. Chair. all
right any other questions from the committee representative gray you're recognized thank
Representative Michelle Gray
Unverified
1:26:55
you and i kind of want to you just to reiterate one time why did we do this rate survey why did we do this survey again to begin with because there's
a difference between why how the rates were set for assisted livings and how they were set for nursing homes i want that and then also you know i had a bill last session not saying it was a perfect bill but I had a bill that would have required cost reports for assisted living facilities and if I remember correctly Senator Hamer you killed that or else we would have
had this information already ready so if you would answer my question but I just had to throw that out there. I would
Representative Fredrick J. Love
Unverified
1:27:28
and we'll give just a little bit of background on that of course we we had the effort in the fall of 2018 to revisit the rate we did that that cost survey at the time we had
to think three facilities respond and there was complaint that was not enough data to use for the rate. And so in the back and forth in November, December 2018, we reached an agreement with the industry and our, at the time, our Chief Legislative Affairs, and I won't name him because he's in the room. I don't want to pull him up here. But he came to a legislative council in December 2018 and actually read the details of that agreement into the record. And the agreement was that we would do another cost survey. And I believe there's actually the dates involved in
that, that we would put that out by, and that we would get a rate review done by March 1, with the thought being that if there were significant concerns about it, there's an opportunity for you as a legislature to address that during the general session in 2019. And so that's what we did. And I also want to mention on the cost survey, we got that cost survey, we distributed a draft of it to the providers at the beginning of January 2019, gave them opportunity to ask questions, provide comment, we made
Speaker 252
1:28:35
some changes based on that and then sent out the final survey and gave them some time to respond.
Representative Michelle Gray
Unverified
1:28:41
Thank you. And I think my point would be that they've had plenty of time and knew that this second rate survey was coming since they
agreed to it last session. Thank you. All right. Any other questions? I see none
on the list here. All right. Thank you, Mark. Mr. Hallman, did you all have any further comments?
Speaker 216
1:29:12
I guess one of the things I'd like to put into perspective here, we talked about the
rate increases for nursing homes. I've also got a nursing home, and in 2015, my rate was 162 a day. Now it's 192. So it's gone up. My cost in the nursing home are identical to the assisted living. My CNAs make the same money, my utilities cost the same, my food costs the same, everything really costs the same. One's gone up because we've got a cost report system and we've got a modifier that CMS provides to use for your inflation.
We get acknowledgment for our labor cost. Our labor cost is much higher than this $10 in this study. My nearest competitor last week is starting new CNAs at $12 an hour straight out of school and they're raiding our place. We can't afford that, but we're going to have to pay it. So these costs have to be acknowledged. The voters have spoken. There's a minimum wage hike. We've got to acknowledge it, and every place is being affected.
You're going to have DHS coming in saying they need this 18% hike for the DDs. That's there today in the paper, so it's included. So we need to have this study reviewed. we need to have an outside group verify the numbers and or correct the numbers it just it's just not right you're we've had four facilities shut down already and we're going to have more on the way all of our facilities have loan covenants require a certain amount of debt coverage and I'm pretty confident that most of them are in technical default right now and this this is not
an acceptable path all right thank you for your comments okay without objection
this yes yes senator go ahead senator hammer
Senator Kim Hammer
Unverified
1:31:13
thank you mr chair i'd like to make a motion regarding this one please okay i'd like to make a motion we pass out all the rules with the exception of the ones that relate to the rate increase and that the Chairs invite Milliman
to be at the next Public Health Committee meeting so we can ask them questions directly regarding their
striking a section of it? I'm looking, if I'm reading it, correctly,
Senator Kim Hammer
Unverified
1:31:51
we've talked all about the rate increase in this
but am I mistaken it also has issues relating to background checks. It's got several things wrapped into this Exhibit F that we've been looking
at but am I I don't know how we can do that unless we can identify a paragraph and a line. I'm
Senator Kim Hammer
Unverified
1:32:17
just we have to identify a section It'd be section 1.2 Section J-1.
Mark, would you come back to the mic down there,
please? Question. So if these two sections are removed, can the other six be implemented? Section 1.2, Section J1. Give me just a moment
Speaker 269
1:32:59
if I can review this and I can confirm one way or the other.
Representative Fredrick J. Love
Unverified
1:33:07
Okay. Yes, Mr. Chairman, that's, I mean, if the changes to Section I and Section J, the waiver, if those changes are pulled out, we could still proceed with the other changes.
Okay, you're sure about that? No, you don't need to talk to anyone else in
Speaker 252
1:33:45
your organization? I mean, I can certainly talk with our leadership in terms of whether we'd
Representative Fredrick J. Love
Unverified
1:33:50
want to advance that, but I'm just saying in terms of a technical matter with CMS approval and things like that, yes, it is possible to do that. Okay. And so with that said, let me just clarify that, of course, I mean, the leadership may decide they want to just pull it down, you know, rather than have only part go through.
That part I can't speak to. So I'll just be clear, I'm only speaking to technically, yes, that could proceed forward. Representative Grave, do you have a
Representative Michelle Gray
Unverified
1:34:38
comment? Thank you. I just wanted to know if a subsequent motion would be in order.
Subsequent motion. Yeah, you can have an alternate motion. I'd like an alternate motion that we go ahead and pass this
out in its entirety. Justice number F, we pass it out in its entirety and we do not break it up.
Okay, yes, we can take that motion. What we would do is vote on
the substitute motion first. If that fails, then we'll vote on the initial motion.
Okay, so we have a substitute motion on the floor.
Is there a second for the substitute motion? Okay, have a second. Okay, any discussion on the substitute motion? Substitute motion is to pass it out as is. Any discussion? Hearing none, all in favor
Speaker 13
1:36:02
signify by saying aye. Aye. All opposed, nay. Nay. Nay. Nay.
I'm going to say the nays haven't. What was that, Senator Hammer? Are you asking for a vote? Do I see two other hands?
All right, so I say the nays have it. I see no other movement out there, so that motion fails. So
we're back to the original motion, which is
to pass this without, it's I-2 and J-1.
Okay, there is an alternate to this. DHS can
Speaker 269
1:37:18
pull this down and amend it and come back. Mr. Chairman, I think
Representative Fredrick J. Love
Unverified
1:37:22
in light of the concern, we're certainly willing to do that, and I would offer that to the committee. We can just pull it down, and we'll discuss the stakeholders and then come back as necessary. Okay. I'm
going to say that that's what we do. Since you requested that, so you withdraw it, and we'll leave it there. All right. All right, thank you. Thank you, Mark.
Yeah, Senator Irvin, you're recognized.
So just to remind, yes, this committee is review only. So we are not the approval. So, I mean, technically we can recommend or we can review these or we can technically not review these.
So what we've just done is technically not review them. It is within DHS's ability, though, if they decide to go forward, they can go forward to the ALC subcommittee of rules and regs and then to ALC, but that's determined by the governor and the agency. So just our role is yes, correct.
We either review or we don't review. So technically we just haven't reviewed these
rules. So this rule stands not reviewed.
Okay, moving on to item G. That's another
Speaker 157
1:38:52
rule. So would you all come up to the table? Please introduce
Speaker 298
1:39:06
yourselves. Chuck Thompson, Arkansas Department of Health. Jeff Stone, Arkansas Department
Speaker 300
1:39:15
all would go ahead and explain the rule.
Thank you, Mr. Chair, committee members. What you
Speaker 298
1:39:22
have before you is a rule related to, there's a little bit of cleanup language based on the way the law reads. We added the connection to public, subsection C, connection to public sewer requirement of the wording ACA 14-235-304. that's verbatim from the statute. Also section eight is updated to the current law regarding penalties when it comes to violation of Arkansas Board of Health, Arkansas Board of Health
violations of their rules. So this is nothing new. This is the way the law reads currently under statute. The substantive portion is Acts 315 and 708. Acts 315 is removing any reference to regulation throughout the rule and the other one is act 708 which is that was act in their regular session of General Assembly 2019 this was not a Department of Health bill we did so we did got the the sponsors and
stakeholders involved had some meetings right after session didn't understand their intent got some agreed-upon language we had one public comment which which we responded to, and they seemed satisfied. That was from Arkansas Central Water. And I'd be happy to take any questions on this. All right, any questions from the committee? Seeing none, without objection,
this rule will stand reviewed. Thank you. Thank you. All right, moving on to H.
Y'all would come forward. This is the Tobacco Settlement Commission. Review. Please introduce yourself. Thank
Matt Gilmore
Unverified
1:41:11
you, Mr. Chair. Matt Gilmore, Department of Health. You may proceed. Thank you. This is a report for the tobacco settlement programs from April through June of 2019. You should have an infographic. It's a colored copy, two or three pages there. Y'all got this room. Yeah, looks like this, but I'll keep this as brief as possible.
I know you've got a long agenda and things to do, but the programs are striving together to improve health, and they do that a lot through education and services and programs they provide. And if you look at the first page there on the top right, you'll see the number of community educations that were provided, community education encounters. The number of youth there, that's a positive increase there from the same time period the previous year. So we're seeing a good improvement working with youth across the state. They do it through a variety of
different ways. That's about a 6,000 number of increase in youth there that they worked with. If you look over to the left, you'll see the number of awards and certificates degrees offered by the College of Public Health at UAMS. Most of Those graduates stay here in Arkansas once they graduate, so it's positive there as well that these folks are trained and educated here in Arkansas on Arkansas issues and then proceed to stay here and practice in their field.
Service is also a way that programs interact and reach out, provide services to the state. That's done through a variety of different ways. Exercise encounters you can see there on the left, health clinic encounters, but also screenings. Screens are very important, and if you look at those numbers there, it's some positive growth there as well. On the right, you'll see the number of individuals that were helped through the Medicaid Expansion Program at DHS with tobacco settlement funds. That's an increase there of about 1,500 individuals helped this quarter versus the last quarter at the same time of the previous year.
And that's across the four populations that they serve as well. So moving on, if you look at the next page, you'll see some research topics that were completed by the Arkansas Bioscience Institute across their five institutions that they worked with across the state. You can see some of the different things working with thyroid cancer, food safety, depressive disorders, things like that. And then on the right, you'll see the College of Public Health and some of their research projects they were focused on.
Most of those projects, in fact, all those projects are based in Arkansas. 100% of them are. So that's projects that they're looking at here in the state that are looking at issues that we face here and trying to improve those. And then down at the bottom, you'll see the economic impact. This is important as well for the programs. Some operate on, or nearly all of them operate on very limited funds with tobacco settlement funding that's stretched across the program. So they leverage outside funding through grants, through federal dollars, but also through donations and volunteer hours as well that they calculate into that.
So some positive growth there with what they're able to leverage from the outside funding sources. You can see as well the numbers there provided by the Medicaid expansion program through the funding that they get and how they use that across the state and how they leverage that. And then the last page, there's some testimonials there. You'll see those on the infographic there. This just gives a more personal one-on-one account of the programs, how they work with individuals across the state, how they try to improve the work they're involved in,
and especially through health education. So I went through that pretty quickly. If you have any questions, please let me know. I'll be happy
Speaker 285
1:44:56
to answer those, or we can provide more information to you as
well. I have a question, and this may not be possible under the current guidelines. Would it be possible, or have you discussed, any kind of education programs towards vaping? I mean, would that be possible to be covered under this? Has there been any discussion about
Matt Gilmore
Unverified
1:45:16
that? The Department of Health has a, their funding is strictly focused on tobacco, cigarette use, vaping.
They are working with schools. They have a, what's called Project Prevent, working with high school students across the state. They also have a grantee program across the state where they work with individuals on a community basis. They provide educational, informational seminars to students. There's also some media that they also target. So there is a significant portion of the funding that does go towards vaping and ways in trying to reduce that and educate individuals on that.
Thank you. any other questions seeing none thank you for your report thank you
Okay, we'll move on to item I. We have listed there all the interim studies, interim study proposals that were referred to this committee. Sponsors have been asked to present a brief explanation of their ISP and why it should be adopted for study by the committee.
Each ISP will be voted on separately. So, first one there, Senator Cooper, who is not here, I don't think. So what do we do, skip over those? Why don't you skip? Okay. All right, number two there, Senator Clark is not here. We're going to run through these pretty quick if they're not here. Number three is Representative Dotson. Not here. Representative Dobson has number four.
Number five and number six there, those will be going to other committees because they fit better in other committees. So we'll extract those from the list, from our list. Number seven is Representative Miller. He was here earlier, but he left. Number eight, Representative Boyd. You want to go ahead and talk about your ISP? Yes, Mr. Chair.
Representative Justin Boyd
Unverified
1:47:59
I'd like to request adoption of this ISP. I had the opportunity to be an NCSL opioid policy fellow, and I learned a lot during that program. And during that time, you know, I really think we've done a whole lot to stem the supply of opioids, specifically prescription opioids in the state of Arkansas. I don't perceive we've done as much for demand, So I'd like an opportunity to kind of take inventory of all the things we've done to work on the supply side and look for opportunities to what we need to do as a state moving forward on the demand side of the opioid crisis.
So with that said, I would request adoption of my study. All
right, we have a motion and a second to adopt this ISP. All in favor, signify by saying aye. Aye. All opposed, nay. Motion carries. Next one is Senator Hammer.
Speaker 310
1:48:51
Okay, I think Mr. Payton is going to say something to Mr.
Miller. Representative Payton, did you want to talk about Representative Miller's ISPs and what you proceed?
Representative John Payton
Unverified
1:49:06
This is number seven on your list. Shall I do it from here or do you want me to do it? Right there would be fine. Okay, thank you, Mr. Chair. So Representative Miller and McCollum have introduced this bill, an ISP, which would focus on Medicaid expansion efficiency. basically by moving it from private insurance into the, I can't remember the terminology, pay for service. Yeah. I'm sure it warrants an interim study because there's a lot of fiscal impact here,
and I would recommend that we adopt it. Is there a second? Second. Okay, I have a motion and a second to approve
this ISP. All in favor, signify by saying aye. Aye. All opposed, nay. Motion carries. So that one's approved. Okay, we're down
to number nine. Senator Hammer is not here. Now number 10, Senator Irvin.
Not here. Number 11, Representative Boyd. You're recognized. Thank
Representative Justin Boyd
Unverified
1:50:19
you, Mr. Chair. So this really begins back in 2016 in a previous legislature. The Stephen Group, we brought him in at the Health Care Legislative Task Force and looked at a lot of things. And in 2016, his group left us with a recommendation on changing the reimbursement formula for immunizations.
And we're still waiting on Medicaid to follow through on those. When I say reimbursement formula, specifically to Medicaid. So let me clarify that. I'm not talking about private entities and, you know, Blue Cross, Blue Shield. I'm talking about specifically Medicaid or potentially Medicaid-funded plans. And so that hasn't occurred yet. And so I have looked at that. There's new information. There was a study that came out by the Office of Medicaid Inspector General that looked at Medicaid recipients who had received the flu shot versus not
and what we were spending in, quote, Tamiflu, you know, or generic flu medicine. And so I just want the opportunity to study this one more time because if we don't have a change, which there's rumors we're going to have a reimbursement rate change, but I don't know what the details of that are. So I would ask that we adopt
Speaker 311
1:51:34
this and give me the ability to study it. All right. Is there a second?
Second. Okay, I have a motion and a second to approve item number 11.
All in favor, signify by saying aye. Aye. All opposed, nay. Motion carries.
He's already done that. He's already done that. You've got
to number 10, the ISP, number 10 there at the bottom of the page. Okay, so y'all already did
Representative Miller's, correct? Yes, correct. Representative Payton, you did that for him? Okay, sorry, I was supposed to be doing that too.
Item number 10, study the impact of vapor products, alternative nicotine products, and e-liquid products on the citizens of Arkansas. Specifically, wanting to look at open cartridge systems and closed cartridge systems and the policies surrounding those. And that's what the study does. All right, you got a second? So I have a motion and
a second to approve the ISP there listed under number 10. All in favor, signify by saying aye. Aye. All opposed, nay. Motion carries.
we're on number 12. Senator Irvin. So
this is, this ISP basically takes the task force that we
heard a report on last month, last meeting on ambulance services, ambulatory services, and puts that task force into an ISP. Senator Hickey
and Representative Mark Perry presented that and they will continue their work along with those stakeholders so my intention
is to bring that kind of in house as part of the public health committee subcommittee process so that we can continue that really very important work it's a big big hairy problem and we need to continue that work I will also say that this ISP probably will and I'd hope for it to include the stakeholders that are in the industry as part of that meeting.
So they would also probably be around the table when this ISP occurs. So with that, Senator, so it's really on behalf of Senator Hickey and Representative Perry, but also to fulfill the motion that this committee made last meeting. Thank you. All right, I
have a motion. Is there a second? I have a second. All in
favor, signify by saying aye. Aye. All opposed, nay. Motion carries. So number 12 is approved.
So are there any, the ISPs that we skipped over, is there someone here that wants to pick one of those
up from one of the representatives or senators
that's not here? If not, we'll move on. Okay. All right, we're down to item J. Okay,
item J, Department of Energy and Environment.
If you all would come to the table.
Representative John Payton
Unverified
1:55:34
this is a rule review so if y'all would introduce yourselves good afternoon I'm Michael McAllister I am Deputy Chief Counsel for the Department of Energy
and Environment. Here on behalf of DEQ.
Speaker 321
1:55:48
Thank you. My name is Bob Blands. I'm with the Department of Energy and
Environment, the Division of Environmental Quality. All right. You
Representative John Payton
Unverified
1:56:01
all may proceed to describe the rule. This is a proposed change to what What used to be Reg No. 5, Pollution Control and Ecology Commission Reg No. 5, it's now
Rule 5. Rule 5 had a provision that had placed a five-year moratorium on the granting of permits for certain large swine confined animal feeding operations over a certain size within the limited area of the Buffalo River watershed. That five-year moratorium had a provision
that as we approach the end of that, we would need to either act to make it permanent or remove it. And so this proposed rulemaking on Rule 5 is to make that existing moratorium on Rule 5 permits for large swine CAFO operations in the Buffalo River watershed a permanent moratorium.
Okay, are there any questions from the committee? Representative
Representative John Payton
Unverified
1:57:23
Payton, you're recognized. Thank you, Mr. Chair. Is this limited to swine
only? I mean, you said swine a couple of times. It is, and the language of the proposed rule talks about the director shall not issue a permit pursuant to rule number five for a confined animal feeding operation in the Buffalo National River watershed with 750 or more
swine weighing 55 pounds or more, or 3,000 or more swine weighing less than 55 pounds. So yes, sir, it is limited to swine operations. Thank you. Thank you, Mr. Chair.
Representative Bentley, you recognize. Have we done any study or research to show
Representative Mary Bentley
Unverified
1:58:14
that the moratorium that we put in place has caused any effect, positive or negative effect, on the river at this point?
Representative John Payton
Unverified
1:58:23
Since that five-year moratorium was put into place, as you'll recall, there have been a lot of issues involving swine operations in the watershed. There has been a lot of studies done. The university has done a significant study in the watershed. The B-CRET study has been conducted. There's also been ongoing permit appeals and challenges and other contested issues.
So there has been a lot of data that is collected, and it is that data that has informed this rulemaking. I've looked at that
Representative Mary Bentley
Unverified
1:59:09
data as well and I see no reason at all to pursue this so I would differ with that my other question is have we looked at anything else that we might do besides stopping agriculture along the river to improve the quality in there such as sewer that's nubbing in there other things that are happening along the river increase of people that are humans
that are in there defecating whatever along the river have we looked at anything along that lines to increase places for folks to get out of the river to take care of that? Have we looked at anything else at all to improve the river that, in my opinion, would
Speaker 321
1:59:43
do much more than what we're trying to do here? Yes, ma'am. If you'll recall, the governor has created a Buffalo River Conservation Committee, and that committee is actively looking at all of those issues. Representative Gray, you're recognized.
Representative Michelle Gray
Unverified
1:59:59
Thank you, Mr. Chair. I guess I'm just trying to figure out, what's the urgency here? Are we on a time frame? Is there a deadline that we're trying to meet with this? Or is this something that we couldn't take more time and study more data to see what the impacts of actually stopping farming are going to be? And this is the first step. I read the public comments, and a lot of the public comments were, we don't go far enough with this, and they want to stop cattle, poultry, and that's my biggest concern. So I
Speaker 42
2:00:31
guess my question is, what's our timeline here? The urgency, if there is any,
Speaker 321
2:00:35
has to do with the current Rook rule, which expired five years after the old rule was passed.
And that was passed on 15 September 2015. So it would expire this September if we don't extend it. Yeah,
just let me add, there is another committee working on the other issues other than the swine. And we actually had a couple of meetings in the Buffalo River Basin.
And those committees, I think, are starting to work. Senator Irvin, you want to add something to that? Yeah, thank
you, Representative Leigh Newman. I do want to make some comments here because I think it's really, really critical that agencies,
when it comes to rules and regulations, that they meet and that we work together in a partnership with the legislative branch of government. This is incredibly important because we want to make sure and ensure that the language and the way that these rules and regulations are written, that it does not affect current people that have permits within the Buffalo River watershed for the different farming operations that they currently have. And so I think being able to work collectively and jointly is really just very important.
And so I think that those types of information just helps us do our job and get clarity. The Buffalo River Conservation Committee, we had meetings, public health. We met in Marshall and in Jasper. Many of you attended those meetings. And I really want to appreciate you attending those meetings because I think that you understand the sentiment that exists there amongst the people that live there. And so we've got to make sure that there is a balance here,
and we need to listen to those people and listen to those constituents which is to your question and to your point I questioned why is there an urgency right now why is this necessary to review this right now I'm not sure if I understand that urgency because to my knowledge there are no current applications at this time there are no current applications at this time and so that work is occurring through folks that we have brought to the table that were necessary
that represent the farming industry and interests. And all those things are being discussed because there has been no proactive plan to deal with increased tourism. There has not been. There has not been any proactive plan to deal with the waste that is occurring because of the increase in tourism in this area. There has been no plan to address a sewer system that is overloaded because of the increased tourism to this area.
None of that has occurred yet. We are at just very initial discussions about what we can do and how we can do it and where we want to put those resources to address all this. But I think it's just so important that our government works so much better when we can discuss these things with legislators that sit on this committee and represent, you know, that area. So I just appreciate responding to these people on this committee and the work that y'all do as members of this committee,
and I think we need to recognize your questions and your concerns, and I really appreciate y'all tuning in on that. Representative Wardlaw,
Representative Jeff Wardlaw
Unverified
2:04:03
you're recognized. Thank you, Mr. Chair. If I remember correctly, and you guys could nod because this is going to take me a second to go all the way through, the hog farm got there on a Reg 6, right? not a Reg 5? That's correct. Okay. So why, and we put a moratorium on a Reg 6 because it did not require public comment. It did not require scrutiny from the department. Is that correct?
Representative Jeff Wardlaw
Unverified
2:04:29
Well, that was the reason. These guys reapplied in the Reg 5. They were not awarded a permit because the systems worked. They worked in a place that they determined that the soil was too coarse, the soil didn't work, and then the state came in and gave them millions of dollars to shut down the hog farm. So my point is, why do we need this moratorium on a Reg 5 when it seemed to have worked just fine in stopping that farm from being in the Buffalo
Speaker 321
2:04:56
watershed? I can only answer this question this way. The Secretary, Secretary Keogh, is honoring THE REQUEST OF THE GOVERNOR TO MAKE THIS MORATORIUM PERMANENT? THAT'S NOT
Representative Jeff Wardlaw
Unverified
2:05:13
AN ANSWER TO MY QUESTION, BUT MR. CHAIR, I'D MAKE A MOTION AT
THE PROPER TIME. ALL RIGHT. OTHER COMMENTS? OTHER QUESTIONS?
SEEING NONE, REPRESENTATIVE WARLAW, YOU'RE RECOGNIZED FOR YOUR MOTION. My motion is
Representative Jeff Wardlaw
Unverified
2:05:33
that we hold this in public health to next meeting till we have more people in the committee, senators and representatives, to make a wholesome decision on whether we want to review or not review this item in public health.
All right. Okay, I have a motion and a second. Discussion, I mean, Senator Irvin, you're
recognized. I would also ask that ADQ send the language of the proposed rule to every member of the House Public Health
and Senate Public Health Committee. We can do that. Okay, we have people who are here that want to comment on this. We have an open motion on the floor. So unless there's another motion or withdrawal, we have to vote on the motion and then we can
let the other people. Representative Ward-Long, what did you have?
Representative Jeff Wardlaw
Unverified
2:06:35
I don't want to withdraw the motion. Okay. But Mr. Gruppe has
a comment, I think. Okay. Please introduce yourself, and
Speaker 344
2:06:45
then you'll be recognized for your comment. Michael Gruppe, Department of Energy and Environment. We have provided the committee, both Senate and House, with a copy of the markups for Rule 5 and 6, what we were going to change, as well as the draft as it would look with the approval of those changes.
In addition, we have also provided the committee with write-ups on the summaries of what we were changing. So we've provided the information already. All right, thank
you. Okay. Okay, any other discussion on the motion that's on the
floor? Seeing none. So the motion is to hold this until the next meeting and then review it or not review it.
Yes, just this rule. Just on this rule.
Seeing no discussion. All in favor of the motion, signify by saying
aye. Aye. All opposed, nay. Motion carries. So we will hold it until the next meeting. So it is neither reviewed or not reviewed. It is
held. Thank you. Now, we have three people here who want to make comments about this rule. So I would ask.
have three signed up. So anybody in those three groups that want to come to the end of the table, please go ahead and get you a seat and make your comments. So is everybody out or does anybody of those three want to make comments? I don't see any movement out there. No, no?
Okay, all right. I see nobody moving to
the end of the table. So, this will be on next meeting's agenda. So, let's move on. So, we have another rule from the Department of Energy and Environment. This is a review of
Rule 6. So, please introduce yourself again and present this rule.
Representative John Payton
Unverified
2:09:15
Thank you, Chair. Again, I'm Michael McAllister. Deputy Chief Counsel, Department of Energy and Environment here on behalf of DEQ. This is Rule 6, which governs the state delegation and administration of the federal non-pollution discharge elimination system permit program, the NPDES Rule 6 permits. This rulemaking had been proposed and was in progress to make a number of technical changes to Rule 6.
And so there are those changes in here, but it was recast at the time we did the previous Rule 5 to include the same provisions on the moratorium on swine CAFOs and the Buffalo River watershed. So that is also part of this rulemaking. So are you
saying these two need to be approved or misproved together?
Representative John Payton
Unverified
2:10:26
They are two different rules. They involve two different permitting programs. The Rule 5 we discussed previously, the only substantive change in that rule has to do with making that moratorium on medium and large swine CAFO operations in the Buffalo River watershed permanent. A similar change is included in this Rule 6, but this rule also has other technical changes and revisions to address other issues in that permitting program.
So is it urgent that we pass
Representative John Payton
Unverified
2:11:10
this rule? The moratorium language in Rule 6, similar to that that was in Rule 5, says that five-year temporary moratorium upon its expiration date that the director shall initiate a rulemaking to either, you know, delete the expiration or delete the whole thing.
and that is what prompted that part of this rulemaking. But the other parts of Rule 6 we also need to move forward with as just part of the program and revisions needed to that permitting program. So if we were
to hold this and review both of them together, would that jeopardize the state's ability to execute the NPDES program? am? Not. No, sir, it would not.
Okay. All right. Senator Caldwell, you're recognized.
Senator Ronald Caldwell
Unverified
2:12:20
Thank you, Mr. Chair. I will make a motion that we delay this rule until next month's meeting, put it on the agenda, give everyone time to gather information on this, just like did on the previous. Is there
a second? I've got a second. So let me ask you again, if we delay this rule to the next meeting, which is next month, does
that jeopardize anything that you all are doing as an
Speaker 337
2:12:45
agency? No, sir. Okay. I would like to add one thing, if I may, representing. And
Speaker 321
2:12:51
that is Rule 6 deals with the point source discharges under the
Federal Clean Water Act. So that would mean that if they came forward to locate in the Buffalo River. In order to be covered by Rule 6, it would have to have a direct discharge. Rule 5 does not have such a limitation. Okay. Representative Gray, you recognize? Thank you, Mr. Chair. Just one
Representative Michelle Gray
Unverified
2:13:12
quick question. I know we're getting ready to hold this, but do we have any rule?
Do we have any permit 6 in the state of Arkansas? Because it's my understanding that this was going away a federal reg. This is a federal reg. It was going away. We would no longer be doing it.
Speaker 321
2:13:27
We do not, to my knowledge, we don't have any Rule 6 K-fold discharge permits in the state.
Thank you. All right, so we have a motion to hold this until the next meeting as well, being not reviewed or reviewed, and I have a second on that. Any further discussion? Seeing none, all in
favor signify by saying aye. Aye. All opposed, nay. carries. So, gentlemen, we'll hold
both of these until the next monthly meeting. Thank you, Mr. Chair. Yeah, Senator Urban, you're recognized. So, Mr. Grappé
did say that those were emailed on February the 13th, but I will request if Mr. Price can you resend the rule and regulation, all the complete rule and regulation language back out to the members. So, I just want to correct. Thank you, Mr. Grappé. All right, anything further?
Agenda
A. Call to Order
B. Comments by the Chairs
C. Consideration to Adopt February 10, February 12 and February 19, 2020 Meeting Minutes (Exhibit C-1) (Exhibit C-2) (Exhibit C-3)
D. Update on the Coronavirus (COVID-19)
E. Mission of the Arkansas Workers’ Compensation Commission
F. Arkansas Department of Human Services, Division of Medical Services, Review of Rule Which Revises the Payment Rate for Living Choices Assisted Living Home and Community Based Services Medicaid Waiver and Living Choices Assisted Living Medicaid Provider Manual based on a cost study and actuarial analysis conducted for the operating agency, and to implement a revised phase-in of the new final rate. This rule also updates language regarding criminal history background checks and central registry checks and clarifies language regarding eligibility dates for PASSE beneficiaries. (Exhibit F)
G. Arkansas Department of Health (ADH), Center for Local Public Health, Review of Rule Pertaining to General Sanitation (Exhibit G)
H. Review of the Arkansas Tobacco Settlement Commission (ATSC) Quarterly Report for April 2019-June 2019 (Exhibit H)
I. Below are listed the Interim Study Proposals (ISPs) referred to the House and Senate Public Health, Welfare and Labor Committees to date. The sponsors have been asked to present a brief explanation of their ISP and why it should be adopted for study by the committees. Each ISP will be voted on separately.
1. ISP2019-081- “To Combine the Cosmetology Technical Advisory Committee and the State Board of Barber Examiners” (Exhibit I-1)
2. ISP2019-093- “To Create the Child Maltreatment Investigation Body Camera Pilot Program” (Exhibit I-2)
3. ISP2019-001- “To Require a Physician to Utilize Treatment Alternatives before Prescribing an Opioid” (Exhibit I-3)
4. ISP2019-006- “To Limit Access to a Chiropractic Physician by a Medicaid Recipient” (Exhibit I-4)
5. ISP2019-032- “To Require Video Cameras in Certain Classrooms upon Request” (Exhibit I-5)
6. ISP2019-033- “Concerning the Offense of Cruelty to Animals” (Exhibit I-6)
7. ISP2019-083- “To Create the Medical Expansion Efficiency Act of 2019; and to Declare an Emergency” (Exhibit I-7)
8. ISP2019-135- “Study Strategies to Address the Opioid Crises in Arkansas” (Exhibit I-8)
9. ISP2019-136- “To Promote the Collection of Labor Market Data; and to Require Employers to Participate in Surveys Conducted by the Bureau of Labor Statistics of the US Department of Labor” (Exhibit I-9)
10. ISP2019-138- “Study the Impact of Vapor Products, Alternative Nicotine Products and E-Liquid Products on the Citizens of Arkansas” (Exhibit I-10)
11. ISP2019- 146- “Study Increasing Access to the Influenza Vaccine in Arkansas by Modernizing the Influenza Vaccine Reimbursement Methodology” (Exhibit I-11)
J. Arkansas Department of Energy and Environment, Division of Environmental Quality, Review of Rule which makes permanent the Prohibition of Issuance of new permits pursuant to Rule 5 for the operation of certain, defined size of Confined Animal Operation in the Buffalo National River Watershed. (Exhibit J)
K. Arkansas Department of Energy and Environment, Division of Environment Quality, Review of Rule 6 for state operation of the National Pollutant Discharge Elimination Systems (NPDES). The purpose of this rule is for the State to adopt rules necessary to qualify the State of Arkansas to receive authorization to implement the state water pollution control permitting program, in lieu of the federal NPDES program, pursuant to the federal Clean Water Act, 33 U.S.C. 1251 et seq. To receive the authorization, it is necessary for the Division of Environmental Quality to have rules as stringent as the federal program administered by the US Environmental Protection Agency. (Exhibit K)
L. Other Business
M. Adjournment
Documents
Speakers
Representative Jack Ladyman Chair
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Senator Missy Irvin Chair
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Speaker 13
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Representative Karilyn Brown
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Senator Kim Hammer
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Representative Deborah Ferguson
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Representative John Payton
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Chair
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Representative Michelle Gray
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Representative Justin Boyd
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Representative Kenneth B. Ferguson
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Representative Fredrick J. Love
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Matt Gilmore
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Representative Mary Bentley
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Representative Jeff Wardlaw
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Senator Ronald Caldwell
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