Publich Health, Welfare and Labor Senate and House

If they're members in the back that can come ahead and find your seats if you're in the back there's a few. We're gonna go ahead and get started I'm gonna go ahead and bring to surround a love if you can come on up and we have this Michael fish vice chancellor of UAMS with northwest is here and then I think joining us via the zoom we have now some key cog ed judge. The main St and Susan Barrett's please. So I'm gonna let folks get to their C.. And they will call us of the order great. We now we have a lot of folks watching because they're texting me so that's a good thing to. All right. They should be coming we can get them. We'll get started here in just one second. They're there for you Markham and then. Okay we're gonna go ahead and get started if you'll just state your names for the record will start with miss miss love and miss Michael fish and then those to the same. To run the lab director for the Arkansas minority health commission right. Pearl make health fish I'm the vice chancellor of the university of Arkansas for medical sciences in northwest Arkansas great and then we have Mr pick up. Go ahead okay yet. Yes No peacock on the president DO of the northwest Arkansas council. Thank you. And Mister summing send. Yes I am just sending sent on this the what community clinic the federally qualified community health center and been in Washington County thank you for joining us and miss Barret we have a spirit with us. Yes madam chair this season there at I am the chair of the northwest Arkansas healthcare transformation division alright thank you so much for all of you all joining nice and what out we really wanted to I'll go ahead and start with the presenters we have here if you want to go ahead and just give us the information we'll start with the stock of fish and then we'll go to the folks that have join us via the same. And just pull that Mike right up to you thank you thank you senator thing and and certainly pleased to let me know if if you cannot hear me but I really do appreciate the opportunity to be here today and talk about a really important topic which is the our despair at populations and particularly all focus on those in northwest Arkansas which I am I know the most about but as many of you have heard from doctor Delahaye this morning about twenty five percent of the over all positive cases are in the Hispanic or Latin next community in northwest Arkansas that numbers forty five percent so almost half of the positive cases are in that community and then for the Marshallese community it is eighteen or nineteen right eighteen point five percent of the population that has co that so adding those two together well over half the population in northwest Arkansas who has tested positive our and vulnerable special populations I'm the other part that I'm very concerned about is that about half of the deaths in Vietnam Washington County and northwest Arkansas have been among the Marshallese community I think that's due to several factors we believe that they are getting care much later and so the there it's progressing further before they seek care and they have a lot of underlying co morbidities and so we we are I'm very concerned and need an immediate and coordinated effort in order to address this in the community you'll hear my colleagues for. I'm northwest Arkansas talk more about this but one of the things that I am most proud about is the fact that northwest Arkansas has really risen to the occasion and how the a coordinated effort in our approach much more is needed so we are far from and that from doing everything that's needed but everyone has stepped up and we are doing coordinate testing weve translated about thirty or forty and educational documents into martial lease and Spanish and our continuing video efforts with that community each and every day and so the hospitals community clinic which you'll hear from as as well as others have really focused on a coordinated effort I want to tell a bit of a story which I think is Representative of what is is needed as we address this this issue for both the the Hispanic Latino X. and Marshallese communities that they live I'm in and pretty dense housing so there are multiple families and multiple large families living in one two or three bedroom house and as we tell the family to self quarantine if they do indeed have coded that family has a lot of needs and enhance case management is absolutely going to be needed to support them as they are self quarantine any so what this means practically is that if you have grandma living at home and she has diabetes and doesn't have her met foreman if you the family needs food the babies may need diapers or formula that connecting them with the wraparound service. This is that they need an order to truly self quarantine is going to be a large part of that the second equally important thing that's needed is in language contact tracing in language community navigators to help them find and connect with the resources they need and so there is deep distrust with and both of those communities of that the healthcare system in general and and eight maybe even more than just trust a lack of understanding on how to navigate to testing resources and self quarantine or we sources so the more that we can have in language resources with bilingual and culturally appropriate navigators it will take that along with the enhanced case management for us to begin to slow this surge this gigantic search with and those two communities I will stop there to give time for my colleagues and I'm happy to answer any questions and again commend you on your interest and your priority for this very important topic. When you say half of the death. It is there an age. I'm not so the average age height so I don't know the average age I did see yesterday that the list of of male female and the age and it really did range that there were several people that were in their thirties and and then forty fifties sixties and so they weren't all in that sixty five or older range or the majority with not in that sixty five or older range I can certainly get you the mean age and then the number per each category so I do think co morbidities definitely play into the why there is a higher death rate what we're hearing from the health care providers is that they're also on many in those communities are waiting until things have gotten much worse they're delaying going to the hospital and so Chad will will talk with you a bit more about some of the things that the community clinic has done to help navigate and and how and save some of them from coming into the E. R. but to really help navigate who needs to go to the hospital and who it's appropriate to and self quarantine at home okay let me go to to judge and let me go to him NAAQS then if if that's okay I'm go ahead and because I to follow up on what your comments are I know that they have received I believe he can answer the but I believe they have received direct federal funding to provide testing so and then I also want to know at what I asked you are giving your comments Mister Simmons and how you're coordinating with other community or other clinics in the area whether they're hospital based privates and the health units on testing so I'll go to you next Mr so. Manson. Early in and thank you very much echo my colleague sentiments I appreciate the opportunity to be able to speak this afternoon certainly be as soon always happy to be part of this would be happy to come down and more in person it is a community health center we're you know we're coordinated obviously our our location here and in Washington County and and we serve up after Jordy of the under Sir patients that that alluded to of our patient population. Actually fifty six percent of of our patient population in the year two thousand nineteen identified as Hispanic approximately eight to ten percent identified as Marshall leave so well over half of our population uses the language other than English in their household and so one of the the components this is very dear to us but I'm as we look around the state and coordinate efforts with other community health centers we we in the server a lot of individuals that may be under Sir this is certainly a place where we we want to be in we want to make sure that we are part of that eighteen at a lot of individuals you are very correct suburban that that indeed we have brought we did receive some additional funding as other committee health centers as well increase our testing after the. And approximately six weeks ago the CEO of of our organization I listen and Spencer participated with governor Hutchinson and announced that I community health centers would would would work to increase our testing capability over the last seven days community clinic alone we've done almost three thousand or last thirty days we've done a little over eight thousand and so working with other other entities both throughout the state and your regionally we've worked to increase our testing and access working with the department of health working with our regional coalition our partners such as you and ask the north Arkansas council and other hospital facilities which is mercy wash regional northwest I have been a vital part of this process for us access to long been a big a big key for us so when we talk and and go back in time access to quality health here is is been a big. Big focus for us with really the it regardless of the patient's ability to pay so a good portion of our patients all in that are realign below two hundred percent and in the calendar year two thousand nineteen about thirty eight percent of ours were our patients were an insurer so we want to work to increase that access capability for for patients regardless so we were able to do that in conjunction as I mentioned with with third party entities are we work with a commercial lab west and we work very very diligently with them to increase our testing capabilities you heard earlier this morning a lot was made that in the early response that we lacked a lot of testing complies and we also lack access to a lot of of the EP and that is since been corrected we're seeing an increase in the and five not that they were completely out of the woods but there we certainly have a better access to it as we go for and this is allowed us in in conjunction with other entities to be able to increase our testing significantly you know the other patients that we have tested only community clinic approximately half of those to date have been have identified as Hispanic but fifty eight percent of our positives are Hispanic and yeah I identify as Hispanic and currently within our clinic they are Hispanic populations is about a twenty four percent positivity right of our Marshallese patients they represent about twelve percent of the patients that we've tested but they represent collectively about twenty nine percent of our positive and at about a thirty two percent positivity right. And so is alluded to one of the things that we feel strongly about is we have organized a process for patients to not only get tested if they've had direct contact with a if they've been exposed we want those patients after the but we also have a specific setting where patients do not have symptoms can be evaluated and our goal is that the health center is to try and keep those patients isolated keep them at home as best we can pro certainly alluded to some of the challenges that we see in the household but trying to keep them out of the hospital at the same time having an educational component in place so that if the patient doesn't the need to go the hospital that we're coordinating that effort in trying to get that patient and in earlier that. And in doing so over the last four to six weeks we worked to provide such needs for the home such as delivery which is normally not in our will house but we started about a month or so ago and has since increased that a partnership with you and ask to increase the the amount of patients that were able households that were able to to help with that the other component we will really working hard with with some of our partners is education we still see a lot of uh of cultural challenges and one of the things we worked very diligently over the last twenty plus years in our existence is building that trust. And that's a big foundation for us so having the the public service announcements going out in a variety of media grants radio television about what does it mean to social distance urging mask where and then we're working as well on our ability to perform mobile. I figured dad doctor Patterson fairly you're not something that you and **** is targeting we to have really been working with that route northwest Arkansas we're able to go to the facilities or go to the places where a patient may not be able to get up but we have seen a tremendous response it is with patients being able to come in and get tested and are taking that to heart so we we appreciate the opportunity to talk more about this and and how we can continue to get access for the the community that you really need it. So just a follow up I want to ask a quick question the No Representative Ladyman house one to the you are see your testing at your facilities but also setting up mobile testing and other areas is that correct. That is correct we have been performing testing we currently have we've had anywhere between forty five testing thanks throughout northwest Arkansas and we move those as we've seen the needs and the needs change I'm currently we have three we see our largest need in our spring della Rogers campus we have a third in our silence brings unity the and we've also done coordinated efforts with the department of health assisting in some of their testing initiatives as well but our we've been working to to mobilize off site at the capabilities to go in further into our community okay thank you Ferguson Ladyman question. Thank you madam chair just a couple quick questions you talk about covering northwest Arkansas so do you just covered the all this cover Washington and men or do you cover some of the rule areas like Madison in some the other rule counties. Is that for us and the community health center our service area is been in Washington County there are other community health centers organizations throughout Arkansas there's a total of twelve community health center the and we work as part of an association with eleven members in a coordinated effort so while my particular service area is in the and in Washington County I work very closely with my colleagues throughout the state for the for the need of a very to other places as well. And Boston mountain health center in particular that have for both Carol and Madison County you I and that's does work very closely with them to make sure that they are having access to the materials and then and we are ex working with them to expand the food delivery services to those real counties and at working with some of the local non profits in those counties. Was that service of up to. The number then that the case is that you found are they mostly concentrated in like Springdale and hi eight population areas or are those cases at in Madison and those counties Carroll County so the numbers we quoted are for Washington and Benton county so that that that is the service area that those cases came from where those two specific counties okay in the high death rate that you mention is that concentrated in older individuals like the rest of the state or or other younger individuals that you have to tell these in so there are certainly more and the older age group but that there were at looking at the list and the ages there were several in their thirties and so yeah that that's quite young if you if you look at thirties forties fifties there it it it does expand that age range and so there may be more for and sixty five then and the thirty age range but it certainly is not exclusively in the older age range and that's that is a really tract number the rest of the state I mean the numbers that we see from coming for statewide so is that because they don't get treatment early enough for what what do you think that's happening to the younger younger people yeah I mean so it so we're investigating that now we don't definitively now but you're asking me what I believe to be true I think it's it's two factors I think they're seeking treatment later and so greater education around the way that cut the Kobe progresses and how quickly it can go from not having very much symptoms to having significant breathing problems I think that's one issue there is also greater home morbidities and. I think this is true whether you're talking about African American communities in the delta is or or the Marshallese Hispanic less so but in in those communities where you're seeing health disparities that we all talk about in higher rates of diabetes and hypertension we're seeing that now playing owl with co that that those co morbidities when something like hope that happens really and go really increase the rate of death and mortality among those communities and so it's an access issue and it's a co morbidity issue. Okay one last question you mention that most a lot of these folks don't speak English as well are they there their main language is another language how detrimental is that to getting data and helping folks I mean is that do you have you have the Spanish and Marshallese speaking folks in your organization but. Is that language very error detrimental to treating people finding the cases. I I think it is detrimental if we try the same approach as we would with the general population and so it but if you do it if you have a bilingual culturally congruent worker then you overcome that barrier and and I would encourage it's language it's also culture and so again if if you look at education and the delta of you may remove the language barrier or education in role general role Arkansas you may remove the education the language barrier but still having that culturally congruent worker and I think we really need to make sure that our contact tracers and to the wraparound services that we may offer with enhanced case management but those workers are from the communities at those that they serve and that we really whether that's role race ethnicity that they really are from those communities speak their language whether that is you know being able to speak to the needs of a a rule community or at a different language other than English and that was so that we really hire the workers to match the need and to match the culture. And is and I'd ask this but the clinics as well but it is that labor force available I mean other adequate number of people that speak the language to do these jobs rather be in the clinics are in U. EMS so there though the adequate work for words is not currently hired I I will definitively at the judge and I would would both status as well as any clinic across Arkansas is that we do not currently have enough bilingual staff today I think we could greatly enhance that as some of the funding is placed in those specific emphasis areas is it going to be a challenge yes but I think that we can meet that challenge and every effort every step we we move towards meeting that challenge will save lives in this is an important effort. Thank you. Technology is also you know can be utilized and so I sent I sent missed us going to contact for you for some technology and that it was in contact with me may be helpful I'm gonna go to Mister peacock and FOR comments and the spirit and then to you miss love. Mr peacock. All okay I I'm sorry I'm having a hard time hearing that they get coming coming to me now but but I'll be really brief I'm Nelson peacock with the northwest Arkansas council just to add so what parole mention what we are doing this year regionally in a really coordinated approach primarily focused on been in Washington County which is the focus of of my organization but we set up a group last year to do some long term planning around graduate medical education other things that I know this committee interested then that we could talk about another time but but the the group of mercy northwest Washington region all Arkansas children's northwest you and that mark west university of Arkansas state bill the better and A. administration the Ozark and a whole hell of health institute and we had a community clinic work coated planning that these entities were meeting on a monthly basis Senate on term planning and one cold with hit we ramp that up from once a month two three times a week getting together to do the search planning and so we feel Pretty good about where we are as far as aberration goes a clearly their challenges to be met but on a lot of that the a lot of the things that we were incredibly worried about back in March you know we've used the couple of months I to be prepared and we are all working collaborating and and community clinic and you M. S. northwest up is our window into the special need population and all the activities that they undertake are reported back to all those other healthcare players in the region and coordinated with the state federal government so we're really trying to do our best to stay coordinated to make sure the messaging that we send out consistent in multiple languages we recently lost a PSA last week I hopefully we can get the word out at in addition on the healthcare side on the public safety side is well so I student Verity starts here and this division and she is a former CEO of mercy northwest I'll ask you really helps those with a lot of the operational in search planning from the hospital and so we continue to work to work hard the coordinating will continue to do so forty thank you for the opportunity that to discuss it thank you and miss parents I'll go ahead and go to you. Okay thank you madam chair I want to just reinforce a couple of things first of all thank you for the opportunity to serve afternoon I was able to listen to several of the earlier reports and so I will repeat anything you've already learned that I wanted to say it's a great. Contribution that you make Justin your awareness of the many facets of what's going on in the state of Arkansas right now as Nelson described this group has been meeting since day one and has worked very diligently to be prepared to be prepared so that we are not overcome with the as a spy or S. surge to use our talents and our resources for the highest and best use to break down the barriers even among us to be able to fully understand so where each party can play the most important role so one of the things that you've witness today is community clinic and you AM as to the northwest Arkansas really have been asked by our regional group to take on the assignment of contact tracing by working with the Arkansas department of health in an urgent way and to try to get a head of what we're seeing in the special political party locations I wanted to also tell you that I'm sure you're aware of this but this is a time that and parallel test for all of this it's really testing how we live our lives it's testing our social accountability to each other it has shaken how our families in northwest Arkansas on the rest of the state or create their livelihood it's been a very rigorous test of foundational elements of public health and primary care of those basic things essential healthcare infrastructure that you know we've kind of gotten used to taking for granted. It's a bit of personal test for every position every hurt every therapist our environmental control professionals are ambulance attendants it's been a test for them. That is also testing and I know you heard this earlier today it's also testing the viability of our entire systems and institutions that we spent generations trying to build. your role of being aware of those many facets that your role in asking important questions and stimulating learning at this time is very important to the state and I commend you for that role. There are some underlying issues that. Service in times of test and I want to be it aware of those also there are things that were you four years have placed Arkansas at a disadvantage in being competitive in reimbursement for physicians and reimbursement issues within the healthcare systems having revenue or resources and from the federal government for the enhancement of G. and me all of those things service at the this time the test and we can't lose those as we are also dealing with a scope and. Northwest Arkansas institutions very proud of them they're work relationships and the group has been very good even at high moments of stress they set up screening testing and follow up process is early in the game they participated with Arkansas department of health and special mass testing and there they continue to work out their very peak levels today in our hospitals in northwest Arkansas we have eighty seven patients and it is the highest low that we take in they are sharing and distributing that work load and they do that in a cooperative manner what institution bills that they're getting to a high point testing their their staff resources they help each other and tree either transport for or balance out the staff so great confidence in what they're doing we bring forward related community clinic in UAMS to you today because we are seriously concerned about contact Tracy or special populations and I will end with that madam chair and turn it back to you. Thank you so much miss Barrett all very good points I really do. I agree one hundred percent that the take aways cannot just be left on the table that we need to pick him up we need a March Ford's carrying him with carrying them with us and then be pro active to do something to address them and that is a collaboration at the federal level and the state level and and we've got to really work on those issues And so so thank you for bringing that those those those things in particular one thing I I do want to ask is if if somebody has a vulnerable and you know. It's not just the the community health clinics Sir that treat those folks if there are other and. Folks that are in primary care. Are they able to also tap into that extra level of support for their patients that they don't have that support like the wraparound services that you're talking about and is that being coordinated through the community health center. So we're we're definitely all. Or we're definitely it's open all explain that I would also say it more as needed so with a gas and more is needed so we have a a call line for providers that will provide translation particularly and Marshallese most clinics have a Spanish speaking worker and so that when when we surveyed our providers but we do have a provider specific line if they have a patient and we've we've I know Dr Judd and I have both sent bilingual workers to the hospital to help translate those when it was that cases and then the food delivery it is a really simple form that actually the provider can fill out for their patients who need the food delivery or the patient themselves or family member person that's tested positive can can filled out so yes it's not just you way and that's and community clinic folks it is people who may get tested at the health department mercy or or anywhere else on the the northwest Arkansas community has very much collaborated and torn down those lines between the organizations when it comes to sharing services I am so proud of what we've done that but at the same time I would say there's so much more needed to be able to address the needs and so we're working as hard and as fast as we can and more is needed and I'm judge you may have other at other things as as well to answer that question. Well I would like them to build off of that you mention the question you know the resources with other other private entities and I know many of us especially early goings in the testing we we were very fortunate we we established our testing centers within a week of the first open case in Arkansas and we we certainly work with a number of other groups other of other smaller private clinics that maybe didn't have the same access or didn't have the same volume and so really work from day one to be very collaborative with that contacting and having those discussions with with private entities and other other medical groups as much as we certainly could to to ensure that that at the end of the day the patient with the center of the of the process we have seen more entities develop testing in work was Arkansas and so to allude to to that we try to make sure that the resources that we put together educational materials in multiple languages are part of that piece that is available to other entities as well certainly so from the from that standpoint of resources in collaboration again this is not it is that is you heard us are there is there is no way that one single entity really can carry the load two this process and to this challenge and it thus far from either of of a primary here in in public health standpoint were two hospital standpoint it has taken a lot of work is if you heard. To push that mall for work and so that's a big piece that we want to continue it is we certainly identify those needs the bill also you know what we talked about earlier with the with the health your work force the concept of the community health worker being filed bilingual but also be I tuned to the culture of being able to develop that trap and make sure that that is there I think that the an important part of that and so I know you and that has the opportunities for individuals to be trained as art as a certified interpreter as well as as well in that community health worker so we want to continue to see those resources being undertaken with a with a variety of groups throughout certainly our region but truly throughout the state as well. Thank you and I I can tell you I mean I know that the PP with an issue that it didn't get to clinics in knowing clinics where the front lines that we're dealing with so many of these patients because of this flu like symptoms we your doctor going to go to the hospital for that you're going to go to your clinic right you're going to go to your your local folks so that that was a big issue so I'd appreciate that so much in this comment someone gonna miss love. I'm for her comments and I know you have a presentation due go ahead thank you madam chair and committee members for the opportunity to present to you today you should have a copy of my slides available and ask has been discussed multiple times this afternoon the minority health commission for decades has been working to impact and decrease the health disparities within our state and cobit nineteen is no different that minority population accounts for only twenty eight percent of our population within Arkansas however forty eight percent of our co the cases are from minority populations African Americans are seeing a twenty nine percent of the Kobe cases where we're only fifteen percent and Hispanics are staying in a twenty three percent of Kobe cases while the other populations classified within the twenty ten census ASEAN about an eleven percent and so unfortunately where as in chronic diseases that the minority health commission usually provide screenings for co that is the and an increased rate as well as increase death so some outreach efforts that the Arkansas minority health commission has been utilized in an effort to address these increased emphasis and death include tweet created a cobit nineteen web page on our website that has resources back sheets and national and state links for testing and information that we have been able to share with our more than one hundred and fourteen partner organizations in sixty six out of our seventy five counties we've also been working to provide prison Tatian and billing speaking request as it relates to code bid for community based. Faith based organizations non profits food pantries and schools. We have worked to develop fact sheets that are culturally competent plain language at fifth grade or lower level with fewer words in more pictures and we've also translated them all in English and Spanish. We've also incorporated media campaigns for television we had one instance where I heart media contacted us directly they'd done some fake some focus groups and found that the younger population ages fourteen to thirty four heard the message early on in that seniors were the ones that were disproportionately impacted and therefore had kind of tuned out to the other messages so we have been working with them to develop specific commercials that target that population in an effort to address those Nicks messages that they received early online we also have radio ads on cumulus the Marshallese radio station in northwest Arkansas as Willis delta force and and Helena west Helena in an effort to disobey and met and provide backs for code bit that years daily. We do a daily so cobit update on social media Facebook and Twitter in an effort to you reach all of our population so for the month of may we had fourteen thousand Facebook impressions and almost four thousand Twitter impressions our website saw traffic of just over seven thousand bees and we had over twenty four hundred unique fees for individuals that cold click click links and took them directly to ark code that resources right. as it relates to our state colder and partner participation we have been able to partner with A. M. D. T. AT the Arkansas medical dental pharmaceutical Infosys association to share our resources specifically ACT backseat so that their positions serving minority populations are able to hand those out when they have patients in their office we've also been working with the way MS college of public health and that diversity equity inclusion offices to share resources as well as to develop a repository of resources that can be located in one central place like the Arkansas minority health commission website and people can just go directly and click on those resources. The minority health commission has also have the opportunity to participate and that health equity response team that the collaboration with you A. M. mask and the department of health and it has four subcommittees one that focuses on vulnerable populations the second is state guidelines for health equity the third is data and the fort this community health workers which has been mentioned here today I have been chairing a code sharing that community health workers subcommittee in an effort to look at how we are able to work with individuals and train them in the communities for which they lead up so that they can provide health education as it relates to come back to their communities. Challenges there have been Dante the S. everyone else has to mention due to you closings we've had to cancel a lot of our sponsored activities which means that are screenings that we would normally be able to provide throughout the community have had to be halted we also have not had access to you PP or the task and so we're we would normally be able to go out with our mobile health unit to provide access to services that has not been something that we've been able to do lately I did have a conversation with Stephanie Williams at the department of health last week and we may be able to work on that PP issue in an effort to help us to actually get out and serve the people where they are also trained staff the minority health commission usually works with chronic disease not infectious disease and so have been the appropriate staff to be able to provide that need it service as. But when there's challenges there's also opportunities there's been opportunities for us to learn and to move forward and virtual FOR backs and settings supporting presentations not only within our office but with some of our partners as it relates to code it we also had the opportunity to you work directly with the department of health and you AM mass on some of their mobile efforts being able to you take our mobile unit out to a couple of those efforts as well as to recruit from within our partners within the sixty six counties that we work with so that we are able to encourage individuals to go and be tested in addition we've been able to work with some of our National partners with that national minority health office as well as mobile health maps and will health association so that we can find out what others are doing and what we might be able to implement here within our state so that we can provide access as we learn more about code it and of course looking for more opportunities to partner with community health workers throughout the state so that we are able to continue to you reach all corners and provide access to services to decrease health disparities and so those are the initiatives that we have been working on and I'm happy to take any questions thank you so much one of the things that we have a lot of mobile health units right so it is northwest Arkansas since we have clearly if you know arise in cases there is there a efforts maybe through the department of health to identify how many mobile health units that we have and then ship on that way so we have been working there's been an effort with and why IT you mentioned that Time to you work together to you identify we are the mobile units are within our state and how we can better collaborate to make sure that we are providing a more concerted effort however what I have found is that they face the same challenges that we have they either don't have access to the PP or they lack access to the test and therefore even if we were able to get the mobile unit there we wouldn't be able to provide this service this and or protect the staff in an effort to you make sure that we are not driving the code that from site to site right now and I understand that's a huge challenge I just wanna make sure you know. And I know that testing you want to respond but it almost have to have a steady presence right in and have like a military operation so to speak and so I was just but yes the PP is an issue which is why I think a lot of people haven't been tested because lack of areas that could provide the testing and do so in a safe manner to protect their own health care workers so I appreciate that I'm gonna go to questions Representative love. Thank you madam chair there's there's a couple things Then I keep hearing and community health workers is one of but I'm I want to hammer this home and I want to ask the contact tracing for these communities because doctor Mack of fish you gave some alarming statistics and number remember a couple weeks ago receive in. An email from the consul general for the Martian leases says that over over the week that they had four people pass away and I think all my gosh but. You sit there is twenty nine percent of the the testing that was done and came back positive this community so that was jog Mr since since the main sensory who's on and that was specific to the committee clinics test so job would you like to take that question. Certainly to clarify yes for our testing specifically of our of our Haitians identifies Margulies they have they represent about twelve percent of the patients that we have tested thus far they represent twenty nine percent of our positive patient and then currently for us alone that their positivity rate is that thirty two percent so of early significant positivity rate one thing I I should mention we talked before about some of the the cultural challenges and and cultural components of this community and the Marshallese community we did this the have a a very much cohabited in household and and multi generational household in that you may have several families or several generations together living in one household and so if you do have a single positive you can spread throughout that household very quickly and that's one of the the challenges that many are working to overcome how to then isolate that one individual you may have a large number of of Marshallese individuals that become positive but they may represent a very small household so that is certainly a big challenge that we see in that community okay so madam chair have two points to make number one is that. The content tracing is going to be and I'm not mentioned in the last session but I mentioning in a contract take treason contact tracing for these minority communities is going to be vital and the Arkansas department of health is going to have to give an account for how they're going to do this with the contract that they're doing because and you've heard you can't hire somebody from outside the state I don't care of the inside the state and the the the person that they're working with their not in sight the community and help that we're going to get the best results for the contact tracing and the number two is I think this legislature is going to have to draw a line in the sand in regards to ask in the governor to submit A an exception waiver to the Medicaid program to cover the Marshallese population I'm just I mean we've wrestle with that. Time and time again. But if we're talking about people are done at this rate in **** did that did not come in for because they do not have the coverage. There are many either we're going to be about the business of taking care of people. All were not in I think we're going to have to draw a line in the sand in regards to to ask in the governor to submit any way for. To cover the Marshallese population on Medicaid so that person's can start coming for getting testing in the treatment thing they need because this is going to be I said day when we're going to start having five ten people a day or we die in a small the virtually small population and so with that I will howl thank you your address Mr why is here with DHS I know that we have done some things in the past is that the sender eaves ran a bill can you answer that question for Representative love. And the F. the community health centers the FQHCs they do receive federal funding to cover those folks that are self insured add to a degree they have a sliding scale they have an enhanced reimbursement rate as well but you might want to go ahead and address that but manager more quality just enters love I'm sorry can you repeat your question former law or the lawful underdog and I'm talking about in the in the in regards to submitting a waiver to to have to CMS so that the minute though I'll Marshallese population can get covered by Medicaid. In so. That's that's kinda where I am the kiss I believe in I I don't understand I've talked to you I believe that there that the Marshallese population specifically are not coming to get tested for heat treated. Meeks they're not there they are not covered medically sure so I understand that Mister. This is nine. Mr Symington Mr Simmons okay you you may receive reimbursement from the federal government but I'm talking about the population in general so you want to speak to the service of love first of all the lobby change if years ago so that we can cover both children and pregnant women under the chip program rockets first so we do provide that coverage for the for that population in the wind yes but not for the general MAPI Marshallese population not for the non pregnant adult population and. There is also a doubtful that we could get a waiver from CMS to allow for that the issue is that under immigration law it's immigration law as from our lawyers have determined that prohibits Medicaid from covering this population not be the law if there is some ambiguity in the law and there may be a possibility of trying to get something from CMS based on what we've seen what are large and looked at the way Congress at the way the law is structured right now it's simply not possible in this in the Congress will have to address. Are you are you okay so because I'm reason different things and that's why I made the statement on and come here to make a statement just to Senate sure but all right so you're gonna have to bring me what you read federally so that we can look at it because I'm like this and some different stuff so all right doctor medical fishy want to speak to that So at. At so I think part of it. Okay now it's on an so in under welfare reform and nineteen ninety six Micronesian I'm co for migrants were removed from eligibility there have been some states Oregon and Washington who have had very innovative come components where they pay the difference and so that they can be part of the the and that the insurance program or other things and so and my colleagues is accurate in that current federal Medicaid has excluded them and that needs to be fixed at a federal level not just a state level but there have been state to have have come up with some creative things more at it about twenty states is certainly more than just those on the west coast of of Washington and work and and they showed an economic impact that's positive because these people are still going to the hospital so wildly FQHCs may have enhanced reimbursement and do a sliding scale when those patients then go to Washington regional mercy they're having a negative economic impact of millions of dollars a year and some the states have looked at that and said look if we can do put in a little bit to have that gap then we can really downstream not only improve health but also improve the economic viability of our health care system with the savings so I do think that it is not just certainly not just to see and that's waiver but that there are some very important and creative solutions that we can learn from some other state make it specifically appropriate to Arkansas that that you may want to look into. Thank you okay Senator hammer thank you Mr chair could you just give me some basic numbers as far as what is the Hispanic population in men Washington County. So I do not have those numbers before me I believe it is about twenty five percent of the total population and Washington and Benton county and how about the Marshallese population it is about five percent of the total population in Washington County and about two percent of the population across the two counties and so when you look at the positive the rate to percent the total population five and just watched and and then eighteen point five percent the total population that's in fact did you see that it is many times the rate that you would typically see infection in that community and of the Hispanic population do you know how many have died I do not you know this love may I'm sorry. Representative hammer I did not I'm sorry senator hand I'm hammer that bring those those numbers with me but I can definitely send those to you okay and then of the Marshallese population how may have done. It I'm so of course this changes daily I'm and but it has been about fifteen sixteen the last time I got the numbers do you know that fifteen sixteen what percentage that represents of the total Marshall the population. I think I can do the math on that if you give me a second in my head so it is it is a small I mean it's less than one percent of the total population that has died but it is fifty percent of the total gas in Washington in Benton county okay and do you know. Of those deaths if you've been in the room the whole day thank you have having your if you've been in the room the whole day and I have not but I've listened to some of the mornings okay so do you know of those that have died did they die from cope with or did they die with Kobe related symptoms so the there's a there's a degree of that so I'm not I'm health researcher and so we're very careful to not answer questions that that we don't yet know when so there's a degree of we we don't fully know but they died from co but they died from the the the long components that are scope it some of them had co morbidities which I think may be part of your question but I am I did review the age ranges of those that died and there were many in their thirties and forties and so these were not people who work. You know very progressed in their disease soon to die anyway and got cove it and then died these are people who died because of code. And that's the way it's recorded on the death certificate well it's definitely the white recorded on the death certificate I think the complexity of all the other co morbidities is. Is not okay and then when it comes to the contract tracing at what point does the information that's gathered that give somebody the right to track it all way down at what point does that information terminate as far as accessibility of anybody else of that information collected. Under the contract tracing of. Concept I think the health department might be that the best to answer that question okay means at the chair's discretion and one last thing a couple actually miss love do you know where you would go in northwest Arkansas all right or where in northwest Arkansas right now where the Hispanic in the marsh Lee population is that our Desert islands as you would use in the food term world that are are on accessible to the Hispanic in Marshallese population because I think protest in health departments now you a miss has a network out there so what area specifically in the Washington Benton areas do the Hispanics in Marshallese currently not have access to to be able to get tested if they suspect they have code so currently that Arkansas minority health commission is able to access those counties Washington Benton Carol we work and collaborate and all of those counties. Okay. And then early on in the conversation I heard a comment about the reason that the I think it was related to the Marshallese population the reason that there's resistance is because of trust or a lack of trust is I thank the comment I heard early on in the conversation so you know whether we have the financial resources available to address the issue which is one component. Have has the trust level gone up as far as the populations were dealing with because evidently something previously college them to lack trust and I'm just curious is for since these efforts have been made have you seen the needle move on that well I think that the trust issue you can can be seen across all minority populations and what I will say is that it it it just it is cultural and it's sometimes depends on the messages and or messengers and yet we just whether or not the the message will be accepted and so I think you have to look at those populations individually and I would say in the Marshallese population it is a small population that they work with each other and there are some trusted individuals with in that community and you have to be able to work with them and through those leaders in the community to make sure that they are the messengers and so you secured presence with them as far as being the ones that you're utilizing to make the message go out then sure we work it closely with Dr reclining and the Marshallese radio station in northwest Arkansas thank you thank you manager thank you Representative Boyd. Thank you madam chair of miss love I've got some questions here the and that to me and take me just a second to re direct what what I'm thinking here so one of the things I'm concerned about is I mean obviously I'm concerned back over nineteen that's the primary reason we're here today that is the serious situation but on the same token I'm also concerned I keep hearing concerns from physicians not on the radio or the TV but behind the scenes and Hey were with these people who have other diseases they're not coming into the doctor to be treated and so specifically in the minority community I'm concerned about new diagnoses of diabetes are people who already have diabetes or high blood pressure that other things so one I want to see if you perceive that to be a challenge right now the minority community at two if so he are you doing anything specific to let people know Hey you still need to go to the doctor you still need to have other healthcare services to thank you yes for sure said thank you for that question Representative bill Wade so I I completely agree with that assessment what we have heard and seen is that individuals have either not gone into the doctor because they are concerned with either getting co that or and and a culture in population we are going to the doctor sometimes is the thing we do the lease wait until we're deathly sick is what we we heard earlier of course they are not going the and being seen and getting refills on medications or being seen to diagnose new you disease what the minority health commission has specifically done IT is continue to try to work with them partner with our normal organizations that we work with we develop you to you videos that talked about still taking care of your chronic disease being physically active eating healthy. And making sure that you stick with a daily routine taking care of your mental health so that individuals are still aware that they have to continue to care for their chronic conditions in addition to co that and and we're dealing with the pandemic. Thank you one of that's one of my big concerns and I'm not sure if Mr Simmons sent once said to address that as well as you know from a from a patient population they're just not coming in and hello I'm a little worried about that some are not seeking hospital care or medical care because they are very sick and they want to make sure their loved one can come in with them and so we have some end of life issues that people are just too thing to stay home and and not not go to the hospital so that's a little Concerning for me but. You I I know of of a case where somebody didn't have the procedure and ended up passing away this past week so you know it's it's going to be a huge challenge moving forward we're going to see the ramifications of that unfortunately as this all plays out and things were delayed and that's a big fear of mind my last question really for anyone and to it to answer is again like testing are are we are we consistent with accessibility of where those are located what are the hours is there limitations on how long we can operate those isn't it and is that a personnel issue mainly is it personnel RPP. Our or scheduling what what's the I'm sure there's plenty of people that will offer to have that in their parking lot or facility but. So I think at early on it was testing supplies that's gotten better I I think all of us are concerned is there and not steal talking for for healthcare providers certainly community clinic has been the most consistent and every single day of the leap week at all three of their locations consistent hours I do think that there is an opportunity for the health department to partner with us at with others that have not just pop up testing site within the community but some consistent open and I'm testing site so that people can get to those not just every third week on Saturday in one location but consistent with some daytime and night time yet or at least early evening components so I think we're doing good we can definitely we need to do better as a system if we're going to test the masses that need to be tested so that that would be my response and I think that the drive through testing centers work quite well but you would there are major lines and additional additional options were is is not you need it we have not met that the capacity is not met the need right yes we need to test more what we we need to tap needs more we need whether it's a pop up drive through testing centers or mobile health units we definitely need to test more and I am concerned because of people were counting on the mobile health units further treatment of diabetes and that has gone away that is that's you can do all the YouTube and social media that you want that if people are used to something and then it goes away that's probably where they got a big source of their information and you know and people want to say whatever you want about barber shops and hair dry. Seems the lines but I'm telling ya you know my neck of the woods that's where you get all your information. The and that's true in the hardware store but I mean so it's just it's just a different Norman it's sometimes it's hard to get those of word of mouth and and sometimes that's where the most effective message is board of math and we discount that but because of some of our social norms that have completely changed word of mouth has has had a break and and I think that is also affected some of these communities to be honest. I would definitely agree with that sentiment and I will say that the department of health is doing daily testing now at all of the local health units and we have been working three U. department of health and you A. M. S. T. you get back and the habit of contacting our partners to encourage them to go there to be tested and like I said that what top with Stephanie Williams last week about getting PP so that we can begin to get back out there okay Representative Ladyman last question. Thank you Mr chair of northeast Arkansas county unique in the the waiter cases and I'm remembering this correctly you start out with the low number of cases. much lower than the rest the state and then you know all of a sudden you're at the top and with the most cases so I guess I'm I'm wondering why that happened and maybe some of the things you already talked about or or could it be that maybe maybe you thought you know you're not. Gonna have those cases because of your unique mail geographic location or whatever but do you have ideas other than the ones already mentioned the people not coming forward on why that why your curve looks so much different than the rest the state. So I think there are a few factors one testing was very constrained to northwest Arkansas and tell about a month ago very very constrained even more so than other parts of the state so I think some of it was that what was the the lack of early testing it's also the nature of infectious disease when you don't have any yet don't have any and when it gets started it spreads rapidly within a group of people I do think that. All many of us have gotten on the tee with the with all of the good things that we need to be doing like wearing mask and washing hands and social distance scene and and that the T. K. and can lead to the the types of behaviors that increase that the spread so I think it's it's the nature of infectious disease the lack of sufficient testing early on in northwest Arkansas and then that the the general lack of fifth third of general fatigue in the community to prevent this from happening and judge do you have other things to add of of why you think we despite. Well I would I would definitely agree with that I think in the early going you know we certainly had a narrow scope if if everyone did as far as our testing criteria and so with that has as we've gotten the opportunity to the test more we've you know we've seen more I think also you know we talk about education but up quite a bit earlier in the session I think that the big key because to echo that we talked earlier about trust and and really I commend a lot of our the leadership in our communities the Marshallese leadership has been very pro active of I'd really meeting even before there was a known case within the Marshallese community but yet even despite that there you know we're seeing their numbers certainly be disproportionately affected so be to that degree we still have a lot of work to do to continue that word of mouth so it you know spreading it reading the information for the homes of what it truly takes and how we quarantine and and I go back to the earlier statement some of the challenges when you get one person in a household that there may be you know twelve other people in the household then how do you isolate that one person and so those are some of the challenges that we currently pays today to that degree I still think we've got to continue the of the push forward and and identifying those cases continuing with the education and the very linguistically and and culturally appropriate manner so that certainly are are our communities I gather that understanding but I think that that a big part of also when we see that communal have those you know household was your racial household why we we saw that you know that that number increased dramatically. We visited earlier today with some of the CDC group and we will continue to be in discussions with them so there's a lot of of interest into why that is so that's a great question that you're yeah I think there's a lot of individuals that are really trying to work on that in. So. I guess my concern or my. Curiosity is in the work force you know a lot of these cases were in both the plants or in the work environment. And I guess my concern here is you know working in factories for twenty some odd years I understand that you it's kind of a close community I mean you go to work every day with the same thousand people and that's kind of your community and Based on my experience a lot of times they don't get out it involved with other communities and that we we have a high industrial presence in northeast Arkansas some food processing plants we've had a couple of cases at a couple of factories where we've had positive cases but they haven't spread like they did in in your part of the state but I guess my question you know we is that a factor and. You know why we possibly going to see that in other parts of the state where there might be high industrial presence that just has not been tested because they nobody showed up positive I mean is that a factor in this or not. Well and I think the point that that both you and senator Irvin are bringing up is that testing is key to our economic stability and and being able to have that rapid testing and isolation of those cases is just an absolutely key component to to our factories and our economic viability so will we see that I don't know the importance of catching those cases before they spread your you're absolutely right on target. Thank you. That's great y'all I cannot thank you all enough for coming today and discussing it thank you so much for all the presentations be is seeing thank you so much judge and Nelson and season for all that you all are doing up there you know I wanted to make sure that you all knew yes we we see what's happening we want to make sure we get the information now we want to make sure we can be as helpful as possible and I understand what's needed up there and what we can do so thank you so much for being here in your presentations we really appreciate all of you thank you thank you thank you very much. And and please contact me get get in touch with me text me if there's something that you think I need to come up I will come up there gladly and meets with everybody up in northwest Arkansas or wherever we need to go. Thank you. And met doctor Lowery thank you you are on I wanted to have doctor Lowery on it with talking about telemedicine and broadband to give us an update as to this area and of of what is happening and the treatment of covered nineteen patience in this capacity so thank you for being patient and waiting you're online thank you doctor Lowery for joining us. Thanks On Friday we concluded our um C. tale so this is Senator for telemedicine eHealth wall I'm the board president of this organization and it's an organization that started many years back of to provide meaningful information to the government regarding digital health and telemedicine and we had a meeting with the White House and HHS and and US see a mass of that we did a bit with all of digital video conferencing it was really good beating but at the end there was a discussion of what's happened with the digital health during this crisis this and We went from the sort of people doing telemedicine almost in a novelty fashion to tell a missing being done overnight to almost the all patients in the US and consumers and doctors adapted very rapidly because they had to we had to be able to see patients you didn't want to being patience and to the hospitals or clinics if you didn't have to because you expose them to the virus unnecessarily this particularly important in frail individuals older patients patient with chronic diseases which are more susceptible to the virus and of course pregnant women who are normally healthy and getting prenatal care and so it's better for them not to be exposed to the virus so it's all health you know telemedicine what was a tool that everybody began using in a big way also I'll say that that the federal government in in of what I thought was a very wise thing to do started paying for digital health prior to this it was sketchy as to who would pay for it when they do pay for where they pay for it but overnight they released you know pavement and sort of mandated that all insurance companies and Medicare and Medicaid all paid for digital health and the community and the government responded to that with massive use of the modality and of course the yeah the question now is is what do you do beyond that now are I would like to maybe briefly discuss how the jewel health urge and be used and the one that most people think about is correct. You can see Sumer this is the you know the national companies that are doing really kind of very basic health care to directly to patients and the this is particularly easy to do and urban air areas where there's and with it's more difficult to do and roll areas where there's west you know just a band with capable of doing. there are plenty of purchase from the state of Arkansas that would have to drive to the high points in that where they know where they live so far too old your library or other places where there are hot spot in order to get get care in and this is again. service person holds a center so there's a real problem in the state of Arkansas as bad as many appoint rural areas in the Americas we've got to do a better job of a providing brawl obey and is patients now in Arkansas at UAMS you know I as most people know what that involves for more than twenty years in trying to provide the healthcare started with a high risk OB program and spread into the stroke program Arkansas saves in which the substrate this list or around the state. Can you. Is there a problem understanding the. Yeah it's going in and out a little bit. The signal is. Sorry this I'm surprised there again. What about now is that better yes. What is still a little choppy A. grow gallery that's okay go ahead. Okay well usually with this Mike to work so I can't okay so I basically you know subspace was can also provide a care to roll hospitals and clinics supporting primary care physicians nurses and other kinds of providers around the state we've done that because you know we don't that the broadband networks all the hospitals and many of the clinics around state using three one which is you know high resolution high band with devices providing care to the rule systems maybe I should stop at that point and let people ask questions about what I said to this point Missy. So yes thank you can can you talk a little bit more about the meeting that you had on Friday at the with the White House and it is sad and efforts to continue policies or develop them. Yeah I mean the the policy the been put it effect by the president and legislature are are have been pretty effective in paying for telehealth. but the question is are is going to continue after the code with crisis you know what it would it stop and the the White House and this HHS and CMS all kind of said they thought this been a very successful program and that it needs to continue you know there may be some changes in it but but it need to continue because it does provide resources to roll areas which which often struggle in getting access to sign all the gear that you do in urban areas so they felt like this is going to be something that they didn't stop doing now the question so that's the federal government that's Medicare right of the question was going to happen with local payment you know that's the Blue Cross blue shield and and United and other fighters and of course Medicaid your name up as well which is also a local admin stretcher and you know the idea would be are we going to have to have you know legislation for that is that going to continue for temporarily everybody was and pretty much agreement that it needed to continue if you pull the plug on pavement you'll probably see it a roll back to the old ways which is which is you know largely had to see somebody in your office. You know or in your clinic in order to be able to get paid for. Right yeah I know I think I think that's the the key wave I mean we've we've practices over the telephone really of for forever but never to the ability of being able to be paid for that so I think those are important conversations to have and then to bring up your point I think you know as as this was unfolding and I was instrumental here trying to make sure that this policy got in place as well working with the governor's office and his executive order which I support and appreciate the way he wrote that is the acknowledgment that there are broadband issues that people do not have accessibility to broadband and so at telephone an old fashioned telephone to telephone needed to be included in that coverage so which I appreciate you know I think you have to strike a balance obviously and there has to be a balance as an added guess that's probably where the struggle is you don't want it to be a complete replacement that would be problematic particularly and preventive care So I think that's the ballot with the local providers they're gonna use good sense I mean I I've been in Arkansas for many many years as are most local providers and so they're going to do the right thing for the patients I mean these are patients right no national companies maybe not quite so much you know there it's a different models for that so I think as this begins on folder where traditional health care providers like like us begins with that to the model that is the best of both worlds of which were using dental health to provide quality and improving outcomes and it's not just about the money it's about providing a quality product in any broadband for that it and let me just say that Missy is a strong advocate for this I I grew up in rural area and of course miss in many of the other legislatures live in the role areas and you know broadband is just as important to the future world and the world of today as electricity was around the turn of the century without it you just sort of get left behind and so it's not just about health care is also about education which is very important in this time of great crisis and economic development there are many people that can make a living I'm using the I mean if you can write code you can write it you know New York City or you can ride it in and may in Arkansas so there are a lot of good things about this in terms of economic development the on health care if you can have a health care entertainment and work there's no reason to leave the roll area that's I think that's where this is all going now yeah AS you're exactly right is a game changer I believe for economic development for rule Arkansas and and and you're right I mean there is a difference mean you want to do what's right best for the pay. Shin I was on one call and where you know we're getting. Anybody that's been on the same conference I've been on some across the country with other legislators or in CSL and so you get a different perspective when somebody is joining you from their home and and so I had one that said you know I was able to hold My Baby in my lap well it was sleeping in the rocking chair that the baby's used to in the nursery and be able to visit with somebody and I I think that as you know. It was it was a little bit more meaningful they really actually got to talk a little bit more in that setting and there are instances I mean I think it's important it's not a complete replacement and making sure you have that relationship and uses as a tool is so important because there are times where you have to lay hands and eyes on patients to so. Yeah I think it's important and and we want to make sure that we understand that these people are providers that are small business owners and their own capacity whether they're their their business owners within the state of Arkansas brick and mortar folks and and these clinics all across and different capacity so policies have to be at made a you know we have to create policies that taken all those things into consideration I think. So I I appreciate it the our philosophy is they're gonna take patients what I but to support track practitioners in optimizing the best possible care they can for their patients and that's the way this needs to unfold it's it's very important that it's not it was never a land grab at you a mess it was more how can we support the practitioners work where they live where the patients are yeah. Yes and it's been great Senator hammer has question Senator hammer. Thank you ma'am chair and I'm I advocate for one or the other but I'm curious to hear your response to this based on what you just said so you know there's been a high resistance toward della doc tele doc another telemedicine companies company and and now with the cove it it's you know begin to change the mindset that you know we need to open the doors up for telemedicine so if a national company has the statistics to prove that they can deliver just as good a service as an in state network what your argument going to be as far as precluding out of state companies from being able to have a share of the market if an increase if it increases access to care for Kansans. Well that's that's a good question I don't think you can make that argument I mean you can't argue that that's not a true statement in a very basic level of care you know I I think we you know we at the traditional health care systems need to be competitive I mean we can't say well at the well they're just not that good we we have to be able to compete with them like Kate and capitalism just like any other service now I do think that there there are areas of which we're going to see the patient ultimately at UAMS there's a healthcare system in Arkansas it's actually run Russellville hospital and they want us to do the Rolla G. for them you know telemedicine maral G. for there is patients and their there is a solution outside the state were those guys but they said it be better if we did it because if the patients have to be transferred and they're gonna be transferred to you a mess they're not to be transferred to tele doc somewhere else outside the state so they felt like that if we can be competitive with that outside companies that they'd rather work with us and and the other company outside the state so it's going to be that kind of stuff in in capitalism there are winners and there are losers in this model and you can't just say we're better you have to prove it and that's kind of where we're coming from right now is that ensure question that they give me a perspective inside another questions going to be as such as one to hear your answer what we had it page on the line so thank you. Yeah I don't think we should get the contract. Yeah just for the hell of it I think we ought to have to be competitive but I think there's more to it than just who can provide you know the sore throat console and that's the end of it I mean this stuff is much bigger than just doing that I mean we're talking about really fundamentally changing the system of health care in in America ultimately the world with this connectivity that were accomplishing. Thank you ma'am sure. Thank you so I think I think what you're saying is it's a con to continuity of care it's a continuity of care issue thought what yes. Okay I don't have any other questions any other questions all right thank you so much for your presentation doctor Lowery I'm we would I want to have you back on to talk more specifically about broadband and health care at a later meeting and so I appreciate it very very much I think this is the well let me just going conversation a we went we jump we jumped five years into the future into once with the CO this virus and that's what's happened all around the major. You know we everybody jump five years into the future we would still be talking about this with the and now that's the terrible things we had have the you know this endemic to do it but it literally changed everything over not so now I agree to offer have in the I appreciate now and I think policy if you mean it using that as an assessment tool to Ted as in the south as an as it has been really very very important particularly to keep those patience I'm away or or preventing them from having to go into a hospital or to a clinic and there are going to be cases where you're you're going to need to come in but yeah I think that's huge benefits to keeping people safe during this time. Yeah. Thank you so much for joining us thank. Thank thank you happy if anybody wants to call me or talk to be I'd be happy to discuss that with thanks a lot thank you so much I appreciate that. Okay moving down the agenda Melissa stone J. hill mark white and Janet man if you'll all come up we will go to the next thing members I know it's late in the day I'm gonna moved item J. eight to next July meeting those are all the internal studies so we're just going to put it on to J. if that's okay all right so they're just gonna remain on our agenda for the next meeting does that make sense. Okay I'm gonna have you folks gonna come under. And they have a presentation that they're putting their giving out to everybody handing out. Better chair more quiet with DHS and a if you're alright with that we've got list on NJ he'll go through the first couple pages of the presentation regarding the testing at our facilities then after that if we had a questions then an engine and I can discuss the cares ACT preparations after that they'll be fine. The. Good afternoon I'm J. helm director for aging adult behavior health services and I think I'm actually on page two Melissa I'll start you want so we have our division operates to facilities for the state one being the state hospital here in little rock and the other being Arkansas health center down in Benton which is the state's long term care facility and also the largest nursing home in Arkansas so I I wanna I wanna say thank you to to the dock to the department of health doctor Patil was particularly helpful to us it was just a tremendous asset they've been a great partner on June the ninth and tenth following the governor's initiative we began testing went when we begin testing long term care facilities in the state we tested the health center. And what you see here on page two of our of your slide deck in two days we tested two hundred thirty nine patients and five hundred and eight employees for a total of seven hundred forty seven test that was a Tuesday Wednesday I we schedule it this way to catch both ships days and nights and by Saturday we had all of our all of our results back the on on our test we were very blessed we had no positives we were all negative that seven forty seven as used in that seven forty seven represents all but eighteen persons at the facility of those eighteen twelve were employees that were on FMLA five work contract nurses that were not available and one was a was one employee who is out of state on vacation before they return they all too will test before the bill out come back to the and and work at the facility but we're very pleased very proud of the results that we found the facility is has really worked hard to do everything they can to to keep Covin out of the out of the building all of our all employees are tested all new hires must bring a negative test to the facility before we can start a new employee orientation when we send residents out for instance to the hospitals they will test before they returned to the facility new admissions are brought in our or isolated for a short period of time until the negative test results are there and until we can guarantee that they don't have code so I would say in in partnership with the help with department of health we're very glad to know that we don't have code on on the grounds presently and we're working very hard to keep it that way great. Are the questions about the health center Dr I can entertain or the state hospital do you have any questions on the state hospital or the Arkansas health center I just I mean clearly I think it's a this is a great case study. In my opinion of of people that are. You mitigate your circle right and that's what you're that's what your employees have done they have medicated their own personal circles so they have taken all of their and. cautions at David it seems like they have all been very very diligent and taking all of their precautions personally and that's the result that you see right summing to me look at that as a A is a good case study they're they're avoiding their social distancing they're avoiding places where they may come in contact with this they're practicing good hygiene bubble ball I mean that's that's what happens when you know. Apart H. taken personal responsibility for themselves yes and that's the way I see it you're you're exactly right the staff were very forthcoming with exposures we've had quite a few that have been quarantined for hyper time until they could bring a negative test because they self reported that they had been in contact with somebody that been covered positive we had one one staff member actually contract code is how is entire family had it if the department that he worked in all tested all tested negative he reported that the day he learned of it was it was a it was a spouse that was a symptomatic very you know very unfortunate but he did not come back until he tested tested negative and so we we really have stressed to our staff the importance of doing everything that we can what we know that the meat it can get. If you're going to get it you know and sometimes no matter what you do you may be exposed to that you could contract code but we know that the dangers of bringing code into a nursing home and particularly the health center these are the most vulnerable nursing home patients in the state this is the notice of the facility when you're either to behave early or or to medically acute to live anywhere else the health center operates the only ventilator unit in the state we have an entire wing of vent patients and so we all know the dangers of what this can be to them and everybody is is is committed a very serious about about doing all that we can to to lessen the likelihood that will have an introduction or transmission. Thank you for that thank you for the kind words you're welcome. And the HTC. Hi Melissa stone division director for developmental disability services so the age diseases as Jana we have five centers across state it was a and a fairly large endeavor we did just under three thousand cast and Arkadelphia has M. they have a hundred twenty seven test results back and we're still waiting but this point all or negative which were very happy about and Booneville as you can see we have two hundred forty nine of this test back in their negative as well. Conway is our largest center at that center we have nine hundred and twenty staff and we have four hundred and sixty eight clients at any given time and unfortunately we did have some positives and right now we have sixty three active cases with clients and sixteen staff I was at day this morning that twenty of those cases are about to hit the recovery stage and we check on the clients and throughout the day and they and most of them are and having very very mild symptoms and so they're being treated on site at Conway the majority of them and again like Jay had said department health been very very I'm good to work with about offering assistance and even coming on site to help us and when we had to set up another quarantine area at Conway. James bro we did that that test site first and we tested everyone actions Perot in need of having and three employees that were positive but fortunately they staff were and not around the clients and so and we had we don't have been clients at Jonesborough that have co that'd and then on war and I do have a reason I'm date we have all of the results back and they're all negative at Warren so really we're just focused on Conway at this point on just trying to make sure that we're doing the mass best medical treatment for that and patients who have kind of it it is isolated to just houses because for those of you all have been on that campus you know there and houses across you know a grades and it's really just hit four houses and so staff and clients is just trying to focus on keeping everyone away from those areas and making sure that we give them really good medical care Sam thanks that's really grates I mean and that that's sounds like you're really working around the clock to medicate Medicaid that says they're Murphy his the superintendent there's Jenna fantastic job I what I have to give her credit for that and she's working around the clock got to be very very difficult Representative Ladyman. Yes thank you another chill of completed is that is that all the testing you get all the results back now are you waiting on a few no thank you know when I I did a rip and update I think for you last week and the numbers have risen and the Conway numbers and it's because when we did the baseline testing it first we have the negatives and then we had to go back and retest some clients that started showing symptoms so we're going to have to keep doing that you know we're gonna test people as the symptoms are rice so and we're hoping that we don't rise that con way that that's what that's why you see that number going up even that we received all the initial tests back two weeks ago yeah. Well my question was we talked earlier to the long too long term. Facilities in you know last week you all came and presented and you were talking about if you if you cleared some of the sites you've been work on maybe a protocol or something the allow people to visit like the long term care like they're doing that nursing homes so are you are you are working on that now that you've got all this all these tests back or. Well that are yeah that's a great question so Jerry share who and you guys know who runs and quality assurance and Tammy been brokers in the back who is my assistant director over the HTC's we've been working with department of health on the guidance it looks very similar to the nursing home of course were set at different so where is nursing homes might need to have visitation in patient rooms it's not really gonna work for how we are said there's some nuances like that but we're still on the same timeline of hitting July one team in our actually just talking if if the rest of the centers other than Conway continues to look like this we need to go ahead and start making appointments because parents and guardians and love ones are eager and there are they're calling their warnings that appointments to come out and even with Conway we've talked to doctor Patel about could we do some limited visitation for the houses that are affected because there is such a big area so we're going to keep working with them to see if we can do something like that and safely because we know people are eager see you to visit and we want them to visit. Okay thank you. Thank you I think that's really important and you have large outdoor areas we came that can be utilized as well I think so that would be great thank you. Mister white. Let me just say this is great and we appreciate the US I've I appreciate the something this is information I know there's not a lot of legislators here but this was something that continues to get asked. Certainly thank you madam chair yes we have on on page four of your handout this is a summary of where right now with the different carriers ACT initiatives for healthcare providers and what's been paid out so far your call we started with the first three with the payments for direct care workers in hospitals as well as in direct care workers in the long term care facilities and also the care continuity emerges response for those first two on the director an indirect care workers we now received all of the submissions we believe from the hospitals they'll to us as facilities so we're working through which should be the final round of payments that should run for that that remaining amount available to date we paid out I just over fifty one million for hospital workers just over three million for the and direct care workers in long term care facilities and here in the next few weeks we should have a better picture of how much more that a million will be spent as we work through those remaining request. For the care caught a come back if I made emergency response item for remaining items for we have proposal for nursing homes to assist them optically those that have code clusters in their facilities we have the provisions for hospitals one aspect which is a formula based to go to hospitals based on how many beds they have as well as the cluster payments for those hospitals that have a large number of Kobe patients they are dealing with and then for the we have the proposal for payments for EMS workers paramedics in EMTs her working for anyone services or other EMS services it for those last categories we're gathering information working with the hospital association with the endless sociais shin to get all that dating is with the star processing those payments as soon as possible. And then for the emergency response will turn to page five we have a break down on that one. Initially we've only paid a little over half a million to this point we have had more than that submitted and this is one where we are reimbursing providers for actual expenses they've incurred in so they're sending us some pretty good size policy documentation receipts and other items so we're working through those to make sure we can verify those expenses and then we've got a good audit trail A going forward so as we work through those will continue to release payments and then we looked hope to see a more request from providers coming in because there is still a good amount of money available there for providers you've had those expenses I would that have an entry questions. Yeah I think a lot of folks are working to try to get through you to gather received San. There's also the back order issues. So the on supplies it's very difficult to order them I can just speak to that I think that was part of the testimony to that you have some back order on PP and the supply chains are difficult for a lot of folks so I know that this state finally did get a shipment of in ninety five masks that as far as if you're a local if you're in an entity all by yourself you still can't order those things so if that's an interesting. The one I think is that are there any questions. Ladyman a mark that last line there was as blank not specified can you give an example of what what that might be I mean. Okay categories that might be. Says yes Sir yes Sir Janet man and director division of medical services said the blank category is we have about ten very specific categories they can list their expenses and on the report that is submitted to you and the office of payment integrity an audit and then if it is an expense that doesn't fit those categories we are putting them there and they're getting double checked I don't have a specific one because I'm not a working those claims on purpose because of audit and respond and receipts but they've been very careful about paying those in the blank category I've asked them to be moved around twice. Yes. If I could a sum that with miscellaneous sorry. Great now I think that's great information so everybody knows what efforts are being made out there and I appreciate that very much it's gonna be very needed thank you all for the work they are doing to we know it's a very busy job we just wanted to make sure we got an update from you guys thank you thank you committee. Last thing is Dr Childress. Thank you all for staying holding. Present that. Yes Dr Childress going to join the three of them. see here. Yes house. Okay well it doesn't look like she is here so we'll put her on the agenda for next meeting. We'll just have heard that agenda next meeting if she's not here. Alright members are there anything else if not we are adjourned thank you all for a marathon day.