Health Services Subcommittee House and Senate

8 Senate my question is like for instance acupuncture you know let's say. A physician or what if it's an oral surgeon I mean I'm not sure. House of any of those things are may not apply to somebody who just got a wisdom tooth pulled does that make sense and so I think you might look at that and then. No if a physician doesn't believe that acupuncture is actually an effective. Medical treatments that could be come problematic. And and then I see. These are just my comments and then on the back page your are you requiring that insurance carriers cover and. 20 visits per offense of. Our practice services chronic pain management occupational therapy osteopathic manipulation and physical therapy. Is that it are you is that that's river a requirement of payment. Is that a requirement. That they pay for those services. It would appear to be. I said this is based off the West Virginia law so when we drafted it pretty much just have them put that in there we can adjust anything in here I said this is a study that yeah is a complete blank plate as far as I'm concerned on how we how we drafted going forward but that's the feedback I need I thank I think Medicare I thank if I'm not mistaken I would just look at this is what my suggestion is look at what Medicare is asking for physicians to do with patients as it refers to these things because I think you have to now offered these things to them under if you if you're under Medicare but I'm not sure but you need to talk to the state medical board out what that is perhaps that's one thing the second thing is you know payments obviously missed that massage therapy is probably not going to be covered by insurance maybe acupuncture may not either so you know that would be an out of pocket probably cost to the patient that's just something and then the third thing is. NO didn't not to 9 prior authorization for coverage of at a minimum 20 that's that's prevent of those different things as that looks to me that your mandating and you may want to do that I'm just making sure that was clear about it. Third those are just things that I see thank you I'm just one other thing to you to your first point if you look at the top of page 2. Under V. in C. and says it does not require physician to refer prescribe all the treatment alternatives list and and then see and does not prohibit a physician from simultaneously prescribing and boyhood for. Any of the recommendations listed so this could be a a. Well that's in is the in the end is. A non exhaustive list so we could add other things to it if there's other suggestions this is just a starting point with. Like I said off of what happened in West Virginia yeah. Well I yes so I guess I'm confused between AMD because they seem to be contradictory. Okay thank you. You're gonna make a note to try to make sure that's cleared up now okay. Representantes and I think you're of Nicks or. Thank you Mr chair of Sir yeah I would occur the idea that you know in a it says section one a it says that you must your cell do these things before you prescribing opioids. Then and see it says you may simultaneously prescribe so I would say simultaneously before contradictory so if you're gonna be able to do it simultaneously that didn't that's not before so I think direct find those things a change maybe from physician healthcare provider because again you're there their number of people decides physician to prescribe narcotics for pain. Assume you nurse practitioners PA's. Dentist oral surgeons. And then I guess. You know it can understand if you if you have see in there your if you say. If you're if you remove the before fit your if you move the last phrase let's say remove the last phrase of a and you take out before the physician prescribing opioids for painting you just say the physician shall refer and then leave it simultaneous at your maybe parsing out the idea of the cute pain versus chronic pain or sub acute pain for instance you know if if if someone comes in members department with the kidney stone I mean they very clearly have a 6 millimeter kidney stone need your order I'm not really gonna say Hey sorry I can't give you these narcotic pain medicines we perhaps I guess massage therapist yes Sir I mean there's gonna be some conditions you know your femurs broke and in in your is this included just an outpatient settings because in a hospital I regularly give one off page shots for something so somebody may come in maybe they have a a kidney stone and I give him a shot of morphine the Dow don't prescribed in any narcotics so you know in this setting. It under this rule before I could give them the shot of morphine I would have to refer them to one of these other things so you kind of maybe looking at taking the emergency setting in separating that out in a clear fashion I think that would be something that would be good. And then that I mean I I'm your the principle of its correct I mean I think the idea of trying to do something to try to you know encourage healthcare providers to look at alternatives to opioid pain medicine for for on going pain conditions is is is valuable I just to be careful in the in the details of it. Thank you Sir. Representing great thank you Mr chair sell one expanded to limit further on what Representative Johnson to the point he just made and it's not only the the I think you need to look at acute versus chronic but also you've got to patients that are in hospice that are at the end of life and terminal illnesses such as cancer that I wouldn't qualifies chronic pain but they do need pain management that can be done usually it's by PCP so I would ask you to look at not just to keep versus chronic but also terminal and end of life. And then I did have one other question when you're ready. At. Okay on your section 2 you talk about shall not a not prior authorization for coverage at a minimum 20 visits pari Vance and so does that mean 20 visits of all 5 of those are 20 business of each of the 5 of those. So we look at the total or ACT 400 visits okay that's my point is you might want to clarify that. Okay thank you. Anybody else any other questions. Can I just yes ma'am senator Irvin yes I would just echo all these points A and I agree I mean this is a good thing. Look at what Medicare and see a mass and whether they are asking and requiring and the other thing is there is medical continuing medical education that our is geared around that where you can probably find those answers as well but the medical society should be able to help you with Medicare Medicaid Medicare Medicare so that's federal but in a clinical setting that they have they have added that you need to refer or you need to offer these things to your patients so that I think is now of a requirement of Medicare at the federal level at a clinical setting. I would echo all the points that were made but I would look into that but the medical society should be able to help you with that and try to model your language after Medicare is currently asking them to do with those patients and I think you have to offer the patient these things okay thank you Sir thank you. Thanks in Irving okay seeing no other questions on this particular one is great just great discussion we don't need to take any action on this because we're just hearing on this committee than what we just did so with that we will head to item number ET represent Dotson I think that yours also yes Sir thank you yes Sir. This one is a if some of your member a couple years ago ran a bill that allowed for direct access for chiropractors to have up to 12 visits through Medicaid without have to go through PCP in order to get a referral. At that time we had filed the bill originally to match the Arkansas works insurance to be 30 visits. And that was more than than what they were currently allowed under Medicaid this is an interim say proposal to. To basically match the the amount of visits with. Medicaid be authorized 30 the same AS Arkansas works so that's it in a nutshell. Representative gray thank you Mr chair and. So are all of your where but in Medicaid's you only get the Medicaid recipients only get 12 visits per year to any physician currently whether that's a PCP or specialist. I guess so I would. I would ask that you look at it this is something that you're passionate about doing you look at expanding access to physicians as well I know when the physician up also I mean we see patients all the time that are on blood thinners that exhaust their visits within 6 months in the way Medicaid currently works is you have to see the patient and then the rich apply for an extension of benefits with a FMC you either want to apply for that if you're approved you'll get payment if you're denied you eat it you cannot charge the patient so just something I ask you if we're if we think that A chiropractic. Ana position should be allowed up to 30 visits also last that she would look also at other physician types that we expands the access to care for their as well Japan and know how many visits Arkansas works allows for regular physicians it's unlimited unlimited yes okay also Medicaid doesn't allow for like an adult wellness visits were Arkansas works does. Medicaid allows only 3 prescriptions per month with you can do an extension the benefits up to 6 Arkansas works is unlimited so there's a lot of differences not just in the chiropractic area but in the plan overall so thank you. Sender. We have made it that would echo those comments the other thing too is that there is a $500 cap on diagnostics and medicate. And so that is a problem because for people that are on blood thinners or that need their blood work done monthly they use a lot of that up sometimes and that's been a problem with Medicaid with the addition of the chiropractic visits because those diagnostics may all be eaten up in X. rays and then they have no money left in that $500 cap for their blood draws which is again another problem exactly what she's talking about then you have to apply for extension of benefits and you know all that stuff so I mean I don't I would just say you know if we're going to do it for we we need to think of this and a big picture you know for Medicaid recipients and really think about what's good for that Medicaid patient verses what made good be more it may be good for you know this type of provider that for you know what I'm saying so I think I would just. There's a lot of issues are surrounding this but thank you thank you. Representantes. Thank you thank you Mr chair thank my questions just a general one as far as the protocol goes for something like this would would there be a fiscal impact that it if it was is that something we need I mean forgetting increase access to have an idea of what that would be the additional Medicare Medicaid dollars. What the actual fiscal impact is I don't know that there's any way to absolutely no that before before coming I guess my next question on the I cannot I mean again I like the idea of expanding it to but I don't know how much that costs you know as far across the board all providers. I don't know if that's a question is answerable I'm not necessarily asking you I'm just asking it out loud. Thank you. I believe with all those fiscal impact sometimes a more complicated but I believe they do attempt to do it so it would just after questions so you see what roles in so. Anybody else have any questions in regards to this. Seeing none I guess you're finished for today represent doesn't Mr chair. At some point and. Representative Gonzalez assessment present item I so all we're wages weight jump back in line for that would do that. Okay next up is going to be a. Army of. Representative all. And I apologize we had your name wrong on the agenda your first name. I didn't catch that. Millions the dean. Hi answer pretty much about anything anymore Sir. I thank you for allowing me to be here today I've got before you and I. S. P. E.. Which is an ever growing problem not only in our state but across the United States mental and behavioral health problems we looked at forming a task force to try to go over all of this a bit senator Hickey suggested that we do an I. S. P. and that's how we got to the I. S. P. today the purpose of this I. S. P. is to look at behavioral health and mental health issues in our state state wide not only in our schools but also when the facilities that we have in the bad that we have available we do know that there is a shortage of beds in Arkansas for people with mental health issues I had a young man in my district just last week that we spent 3 days trying to find him a bad a place for him. His mother had killed herself several weeks ago and it put him in a tail spin and then trying to find somebody to take him was. A big fate and it makes it ever so. In your face when you're actually having to deal with somebody who's actually needing help and there's not help available and I think this I is pay will help us be able to look into those situations and how better to help those people. Because in our counties we don't really have enough help in this area and and we hope that this ISP will help with that it'll also help we hope for us to be able to find a better way to deal with as suicide rates in our state. Hi my district is actually and number 4 in the state of Arkansas we have a very high suicide rate in my area and this we hope will help us be able to look at better ways to tackle that situation also I. And I am. Take any questions are. Anybody have any questions. I guess also house bill start off I think whatever this it came through the last session. I think my issues were white with the joint joint performance review committee that we had shall meet yes I just I wasn't for sure about us yes ACT telling a committee that they would do something yes I hold on that particular thing and I think also when we may discuss is. It is this the most appropriate committee to strive to study something like that and you know. With what with mental and behavioral health resources I don't know if there's some some other committee that possibly would be would better serve to do that. So I guess that's my comments on it. And I'll I'll take it wherever you all tell me to take it out on. As well as to look into it and figure out a better system in a better way to help. The people in our state sure. Representative Johnson were you next yes thank you I I just was trying to figure out how to get on that committee because I'm is a great this great opportunity to look in the proving something that we really need here in Arkansas add to your question I don't know enough about the structure the commission of the rider appropriate place I don't know what triggers as to put something for committee versus the task force which sort of I don't know but the intent I mean it's it's well it's much needed so how operate got parsed out I think it's of a real valuable thing to sit down to put some effort into because I do think there's real opportunity there so why would appreciate. Just let me know so I can come in set by some thank you I appreciate any help I can get Senator Irvin. Yeah I would just echo and we're happy to have you in the public health committee meeting okay and we are happy to place this year in my opinion I mean this is something that way you can do an I SP if you'd like but which may help with the budgets that they may as assigned to the public health committee if you have the ISP then that you know that might be something that they need to increase the budget for so that we can get that attendance and schedule those extra meetings but. I think that would be a great place to to put it and I think it's very needed appreciate you bringing that thank you ma'am I'm happy to work with you and hopefully I'll still be the next year but happy to work with you if you want to do that we this will be great Mister chair move it to wherever you suggest forever you tell me and then will we can go from there I'm really that open I just want us to really work on the US I think it's detrimental that we actually look into this and try to figure out some way to to help the people of Arkansas with this sure it's a it's a great I do and I do believe this and Irvin said that is probably going to be better served in public health that's going to be able to sit on that committee not necessarily movie that are you know more knowledgeable and in the same me right so this will be I think that would be a good place to okay to put it represented great get thank you Mr chair and I agree I think public health especially with the expertise that's on their surrounding health care in general would be a good place for it and I also want to say I know I worked with you in represented Gazaway kinda early on and just for the committee what we realized early on is this was so big we couldn't tackle it. There were 20 different angles to tackle it and we were overwhelmed and decided we couldn't do it on our own and I can tell you at the hospital that I work for we've seen a 400 percent increase since the pandemic started an adolescent inpatient psych transfers so there is I mean it's more to the point of this is going to be a merchant specially for our young people during this pandemic so as I appreciate you bringing this Representative Vaught thank you. Senator Irvin also just want to add in White County they have currently 900 cases they're investigating of domestic abuse primarily at those are children. The yes I agree with absent gray Mr chair if it's okay with you I'll get with senator Irvin and we can get it moved to that committee if that's what you prefer I think that I'm good at sure especially especially since the chairs are. Open to that also thank you Mr thank you Representative thank you Mr chair. Okay members arm G. of the members not going to be here today on that one I know. Adam H.. Is anybody here on that one. I don't mind Representative Dotson I think you're going to present that for Representative Justin Gonzales she said. Thank you Mr chair. Is this item is. Again members this is act item I'm wondering if I'm to grab their own. Okay. I read through this. But I'm trying the advanced practice registered nurse as a primary care provider within Arkansas Medicaid program trying to find the title in the. Basically this is to allow to expand the I guess the ability for advanced practice nurses to use Arkansas Medicaid program and. I don't know that I can answer a whole lot of questions for you but I can try. Thank you probably are all lot more knowledgeable but this particular topic than I am. Members of the are you going are you gonna have a lot of questions because if there's going to be questions in regards to this than we probably need Justin get represented Gonzalez to be here so. We have I think it's been debated you know I think it did come up a timer to. I mean I can take a fair shot at it but. I don't know that I can tell you anything new that you don't already know. As there any is there any many members were making suggestions on it or. Once we hear it it's a. That's my cell we're doing I thank you thank you doctor. And the last one is the represented board Adam J.. Whenever you're ready Sir. Thank you Mr chair for the opportunity to present this here today you know just a little background and for those who might not be as familiar with pharmacy technicians as I am it takes a high school diploma or equivalent and the ability to be able to pass a state and well I guess we can't say anymore pass a state and federal background check after the recent court decisions but having have one of those and then be granted a licensed by the state board of pharmacy and like a $75 fee here or something like that so that so that's the background on on what it takes in the state of Arkansas to be the pharmacy technician there's no formal education required though there are national certifications that that can take place but since I've been a not only a legislator but a pharmacist I don't recall ever really looking at the scope of practice of pharmacy technicians and so what this is going to do is just look specifically at the role of pharmacy technicians and are there things that technicians could do that they're not currently allowed by law to do it would not look at things like counseling a patient on medications it would not look at things like making a determination of which patients received an immunization or not it would not look at you know having the technician decide based on a state wide protocol who receive naloxone or or something along those lines that would be more of a a clinical or or clinical decision top making mode so would really get down into you know as a good definition of what is clinical verses what is is non clinical but things such as would it be nonclinical to you know take a call in prescription that might be a good example of of something to consider but anything where you know they were the pharmacist in charge felt like they were trained in and ready to go so that's really the presentation and opened any any question. Senator Irvin. So just quickly when you say to assist with the preparation of intravenous medications so it just be them preparing it's not actually giving. Right of Venus right that would historically be a nurse's role to do that but pharmacy technicians are well integrated in ha and typically a hospital or home of the top facility word they they do a lot of the can records track preparation there I got you know so the pharmacist in charge is responsible for making sure there are appropriately trained in sterile technique and you know grounding loving all the things that have it have to happen to keep a a preparation sterile and that quick questions so like a full bottom asst do you know what the qualifications are for being like somebody who can draw blood in a hospital do you know what degree AS because you mentioned they have high school diploma and have to acquire a background check right Hey if the I don't know what a full bottom miss are I don't. I understand them to be you know significantly higher but but I'm not going to say because anything would be speculation from yes I was just just wondering just to you know what I'm saying. To like create some consistency or something historically a technicians role was to count bills placed in the bottle. At a label on the bottle and then you know pharmacists would be usually inspect the work and make sure it was done now there are some expansion of things were you know the the technician my intercepting send the computer you know and then the pharmacist within verify that so again whatever we were would look at would be under the direct supervision of a pharmacist in appropriately trained in the the pharmacist in charge would have to sign off on on whatever was done. Thank you. Any other members. Okay seeing none thank you thank you Mr chairman committee. Okay members or any other business it but needs to come before this this committee. Seeing none will be adjourned thank you.