Insurance and Commerce- House and Senate

Still some. Is. There's not. The. If you will take your seats will Still some. Is. There's not. The. If you will take your seats will be a opening the meeting soon I'm a senator RAPERT has been caught in some traffic so we will wait a few minutes. Members I'm going to go ahead and call the meeting to order Uh Senator Rapert it has been caught in traffic. sure he will want to make his chairman's comments so will allow him to do that when he gets here but I know we have a busy agenda. Start with the chairman remarks of maybe by the time I finish she will be here we've got several very critical issues here and that and I have we. Many of you have I'm sure haven't received the same volume of emails and phone calls that I have in my eight years in the legislature I don't know that I've received more emails on issues such as the one that we're dealing with today related to employee benefits and then also the issue of hydroxy Cork when which was a hold over from our last meeting I've I think especially in as it relates to employee benefits the the thing that keeps occurring to me or remembering and taking courses in organizational communication is that the Japanese have a saying that Fix the problem not the blame. And I believe that that's what we're here to do there be plenty of opportunity for us to look it why this emergency occurred why we were given such short notice on it occurring it almost to the point where it is really put a lot of our retirees in a panic and I don't blame them several solutions that I know Senator Rapert I've talked about at one point the chairs of house and Senate insurance and commerce did serve on the life and public health board that happened until nineteen ninety nine that is going to be restored in the next legislative session so that the next piece which is that that board only reports to these committees upon request. Well of we're we're not involved in that process how do we know that we need to request them so that is going to change there will be annual or semi annual reports to the house insurance in the the Senate insurance and commerce committees on employee benefits and the decisions that are made so that we don't have the short it short time to be able to correct the situation in I think it. Adding the chairs of back on of that will be able to give the legislature the kind of oversight that we need so I tried to stretch it out a little bit longer so that to Senator Rapert could make it but we will. You can be rest assured he will he will have something to say if the proper time at this point I would to if you have the minutes before you I would entertain a motion for I see motion and a second for us to adopt the minutes of the August thirty one meeting all those in favor say aye. Any opposed there are nine and so the minister adopted we part in. Yes senator you may and I will. You are on. I just wanna get a clarification on this is here because of the things you said they were going to be done in the upcoming session because I know I'm going to get these questions is that going to be a matter of legislation therefore pending or these things that can just be done which would you just distinguish the differences well what has to happen so people will know right to to to to items that I mentioned which would be restoring in nineteen ninety nine the the membership of that borders reduced from twelve to ten and the two that were removed were the chairs of house and Senate insurance we're going to restore that since it was removed by statute it will have to be restored by statute okay so folks need to know that that's a kind right and then the other issue would be the reporting to the joint committees that will be annual rather than upon request okay and is that also a matter of legislation as well yes okay alright yes so those two things and I'm sure that there will be there will be more sure I which I think would be appropriate of but we we will be receiving report here in the next item that I think everyone will be very appreciative of really fits with the tenor of fixing the problem rather than the blame and I think you'll hear from this report from a dispatcher a solution that being put forth thanks for the clarification messaging right thank you senator. Senator Irvin I believe you have a question as well. Yes thank you represent Lowery just I appreciate the those two items and and I would I agree with them on the annual report back to this committee timing clearly was an issue on how this all transpired so I would just make sure that the timing of that annual reports would be within or you make my a certainly certainly not two months before yes Sir open enrollment yes there so I just wanted to seek clarification on on if there might be a time. Issue with that yes yes that thank you very much for the clarification thank you. And I see seat number eighty who would that be. Senator hammer. You're recognized thank you Mr would you just clarify a little bit the two you mention the to chair members your talk about yourself and Senator Rapert or whoever sitting in those chairs of this committee only yes who whoever that was what the president was previous to nineteen ninety nine was that the chairman of Senate insurance and the chairman of Senate our house insurance did serve on that board and I think just to provide the proper oversight they would need to be restored whoever the chairs are. Okay you're talking about the EBT board that the treated I believe it is a public public health and or or the life insurance and health board that it's a ten member board. Okay. Because we've had a board in the past the back when I think Senator Hendren ran it in I think there's gonna be an idea floated that maybe that needs to be revisited and brought back to life and I just wanna make sure that that does work conflicting ideas as well and we will have plenty of time to to work out of the mechanics of all of that but we're the main thing is to make sure that there is legislative oversight so that since we're receiving the bulk of the emails and the phone calls that we have the ability did not even know as the senator Irvin mentioned well ahead of the time that we receive this time but that we also have the ability to be able to sound the and the and also give feedback two of our committees into our legislative colleagues thank you. Thank you and at this point thank you senator Senator Rapert I'm sure you had to deal with some traffic so we are still. We'll come back come to you for chairman comments. I'll just ask not to apologize I get called in the earliest road work I believe I've ever seen in the world but anyway at least working on the roads and if we had any per and we already had the presentation from as furniture okay well obviously I appreciate everyone for coming chairman Larry knives actually probably had more pre meeting phone calls about this this issue than any other all I will say not to plow same ground that maybe some of you already mentioned this morning is that I harken back to the last time that we vision on this issue which was the public school employees issue that we had special session that we had a governor B. B. was actually still here at that time and we dealt with that and I want to save chairman Lowery I guess most my comments for later since I didn't hear every opening comment that was made but I will say this that I am not comfortable when I shared that with my Senate colleagues about the timing of this in so I'm interested to hear more about what we did know more about this sooner I know that you're going to have some comments later I definitely believe that we need to return to a more regular presentation before our committees for me BT I don't know that that would change the situation but I happen to think may be that with a little bit more over sat potentially maybe we could to hear more about some of these problems but I will say this in and now I will say this will really you puts a point on my stance. All of these retirees that are dependent upon this program. They did have some confidence that these benefits would be there for the. So whether you want to say that it was spelled out in particular one way or another they didn't work thirty thirty five forty years for the state of Arkansas knowing that these were benefits they were provided in one of the reasons they made a choice to work for the state rather than to go to a private private entity or private job where they might have made more money but not of had the same benefits I absolutely believe that there was confidence that this was a part of their benefits and I have a big problem with anybody not fulfilling their obligation in this case the state of Arkansas has an obligation the other thing is is we continue to see pressure between private jobs and working for the public is many of these are obviously all these people have done who are we going to hire. If they can't have confidence that when they work for the state of Arkansas that they're gonna have a benefit there that they always thought would be there for them and so again I want to just close my remarks now and let us get through the presentations here and then we'll see where we stand at the end thank you Mr. Thank you senator and we have already had conversation about possible changes coming up in the next legislative session and there will be that will be a on going compost discussion get this point will move to it engine the item D. and will ask to the table miss Amy furniture this Chris how it Mister Chris Hallett and John bridges with the state employees association. And I will just ask each of you for the record to identify yourself and then you can take whatever order I I assume that you all for the. Touch base with one another about who's going to say what when so I will turn it over to you. Thank you Mr chair thank you committee members for letting us be here today I do want to add my name is Amy fixture on the secretary of the department of transformation and shared services and we also invited Mister Courtney white at the table who is a Representative from elements are actuary group because it it may requested that he give a presentation here as well so I just wanted to give you an update you all now on August fifth our board voted to make several. Different changes in our plan to stabilize our health care plan for state employees and retired public school teachers. Like you all we received a ton of feedback we've gotten mail we've gotten emails we get tax calls we receive the same feedback that all of you have received. Last week we put together a small group of our sixty five plus state retirees to come in and sit down at the table and try to work through their their main issues and try to find a path for that everyone could agree on. Their biggest concerns as we listen to them or as you stated this morning to things the timing and that they felt they did not have an adequate time to choose a Medicare plan that was right for them they did not have the knowledge they needed to do that and then also that there was no discount to their health plan premium one St lost their pharmacy benefits. So today we're here to propose an alternative plan to the board's vote it will take support from you all because there's a funding issue with the proposed plan it'll also take a vote of our board tomorrow we're having a special called meeting at one PM tomorrow to address this. What we are proposing is that we put off the effective date of the loss of coverage for the pharmacy benefits for our sixty five plus retirees for a year so it would not be effective until January first of twenty twenty two. With that and a suggestion that came from our small group last week was that we give the retirees the option if they choose to go on to Medicare this year they can. They will then receive a twenty five dollar discount to their premium to their health care premium if they make that choice but it is their choice this year. How we will propose a five percent increase in their premium if they stay throughout twenty one just like all the active members are getting next year. And then when those are moved to and twenty twenty two we would also give them the discount to their premium at that time. We feel this is a compromise that we can all live with and the the ones that were in our group felt strongly that this was a plan that they could move forward with I wish we could have had a larger group but because of our concerns during the pandemic it was a smaller group by the we brought in the ones that have expressed concerns loudly to all events and try to get their their input. So this the plan you're going to see that Mister white will give you shortly we'll leave that health care plan in a projected deficit of over three million dollars at the end of twenty one and I'll also leave us without a reserve fund. So there is that there is a funding issue and that's something that we will need your commitment and your help to help fix during the legislative session. I will now turn it over to Mister white to go through the actuarial power point presentation and after that we're happy to take any of your questions. Good morning I'm corny white from a principal in consulting actuary with Millman we are the actual road visors to ET de we help them assess trends and and model recommendations from the board and FOR maybe deed to help make decisions about the health plan for both the public school in this state employees. First is going to start off by under that these are actuarial projections so there's a lot of assumptions that go into these numbers were trying to project the future and so there's a lot of moving parts and we set these assumptions based on historical data conversations with the B. D. in their vendors data that we help you have a question Sir numbers okay let me just enter in reference second let you know that you do have a copy of this. When presentation in your handout now my understanding is that there is a correction in this that we were not able to to catch before it was printed to separate no Sir will you have the corrected we do have the power point in front of you and on the screen okay great thank you. Go ahead as I was in these these are projections or trying to projected future and there's a lot of assumptions that are built up to to try to do that so Next year at this time we look at these numbers they're gonna be different in the only way to be the same as if things came out exactly like we projected which which we don't expect so what we try to do is minimize the risk around this projections by sensitivity testing and things like that and then because of that normal very ability it's even been a further exacerbated by the pandemic what we try to do is limit the amount of time between the data we have and what we're trying to project but because of the pandemic the cost that we're seeing in twenty twenty are different and we would have expected because people have deferred care not going to the doctor to to shelter in place and things like that so we there's gonna be a lost a lot more unknowns about twenty twenty one is if when that care is going to come back if it comes back and any additional cost to DO Kobe testing or Kobe treatment that you know it's it's still a lot of unknowns even now so I just keep that in mind as you look at it these are projections and and they are certainly substitute. I saw one thing just wanna point out to about the projections is we're really doing two kinds of projections here a short term projection we're looking at know what's going to happen for the rest of twenty twenty and what's gonna happen for twenty twenty one but we're also looking further down the road past twenty one to make sure that there's funding and money available to help fund the program going forward we don't want to be short sighted and and and not be able to set up reserve so that if something bad happens we we can't react and can't cover those. The also really or five levers that we look at to help manage the plan the first one is state funding. So informasi it's the four hundred and twenty which is now four hundred fifty dollars for budget head count per month the second one is employee and retiree contributions so this year for a Essie the act is in pre sixty fives and as we just mentioned the PO's sixty fives are increasing by five percent. The third one is plan designed to that's increasing deductibles copays coinsurance is out of pocket Max's. So what that does to items right there they actually shift costs from the plan to the employees and the retirees. The third one is the fourth one is cost management techniques so EBT along with their vendors looking for ways to reduce costs through programs or initiatives that can help to save money in the current year and down the road and then the last one is the reserves so we have reserve set up and those can be drawn down to help offset losses and current year now the risk with that is if you do that too many years your over your every year you run out of money so we have to be carefully that so the way I think about this is healthcare trends are going up six seven eight percent a year the combination of those five levers need offset that six seven eight percent per year and it's in and in doing that using those different levels in different years so that we don't run into problems of the putting our reserves or increasing deductibles too much too many years in a row so that's it's on unaffordable for the employees and retirees or increasing contributions to much year over year over year so again it becomes unaffordable for the retirees employees. Okay just just to summarize the board action on August fifth that that was the most recent set of our projection so we increase the employee contributions are the board approved the increasing up employee contributions and the city five sixty five R.. Conditions by five percent at that point there were no change in the post sixty five retirees. The wellness the discount was reduced by twenty five dollars for the active employees. The state funding was increased from four twenty to four fifty for eligible head count and then the pharmacy coverage was reduced and eliminated and expected to be some received through the party market and at that point we didn't make any plan design changes for either the actives or the pre sixty five. Right so the new proposal. Assessor said was to increase the post retiree contributions by five percent that the across the board. And then Medicare pharmacy coverage would now we voluntary so the retiree could choose to get coverage from EVD through the it through the plan have today or they could opt out and go to the Medicare part D. for market I and receive a twenty five dollar stipend to offset the cost of that. So here's how the the funding shows up. So the that the first two numbers that fifteen point three five and the twenty nine point or the in the twenty nine point eight million those those numbers we presented at the September board meeting so does reflect. nope no Medicare part D. coverage and all those in this is I just mentioned as that were approved by the board in August. So the next line down is if we increase the post sixty five retiree contributions by five percent that generates an additional one point six six million in funding for the planned so that that increases the surplus from twenty nine point eight million up to thirty one point four million. That's the big one so if we reinstate the Medicare pharmacy coverage the cost of that is thirty eight point five three million. Sat reduces the. If you give me just a second we're trying to locate do we have a copy of this. It is in the packet. We're trying to get clear if you'll hold this is a bill from. Members are saying that we do not have the summary of the initiatives. Very bottom. Yes. Not. Okay it was separate should be at the very bottom of your stack. If you find it. To yes Sir. Which ones one Paul okay. Grab the room at the bottom that and that's the best instruction I've been given. It's just at the bottom it is a okay. All right I think we have it now we're straight okay Chrissy okay I'll I'll back up on this once and so everybody can I reckon the start the topic in here so this chart shows the funding for twenty twenty one so the the fifteen point three five million is where our projected surplus is based on the August fifth board action. And FOR twenty twenty one there's already fourteen point four six million allocated to help fund the program from prior years that the board approved in prior years so now are are starting numbers twenty nine point eight one million and US in a surplus position. The first changes to increase the imposter sixty five retiree contributions by five percent so that's worth one point six six million. And that increases the surplus from twenty nine point eight one million to thirty one point four seven million. Next item is to reinstate the pharmacy coverage for all retirees Medicare eligible retirees that's where thirty eight point five three million so that takes us from thirty one point four seven surplus to a negative three point or sorry seven point oh six million loss so would be reflect in a in a loss of of substance for seven million dollars and twenty twenty one the last item is it really a new item but it these program initiatives are things that he did in the vendors are doing for twenty twenty one a lot of those are related to the pharmacy program so when the pharmacy programs removed the savings from those initiatives also disappear because they're directly related to the pharmacy spend so by putting the pharmacy program back in we expect to save another three point four one million. do those initiatives that brings our our deficit down to three point six five million I put on another line on there to shows the impact of medical retiree going voluntary. And I do some sense to be attesting around that later my A. opinion is I don't think there's any a lot of people that are going to choose that in your one for for a writer reasons one you've talked about is the timing I think open a Roman starts this week the US for Medicare part B. so there's not a lot of time for people to make those decisions so washer sensitivity around that going for but the way that would work is. Anybody who opts out those those pharmacy spend it is a social with them reduces the surplus I reduces the deficit and makes turn it turns into a surplus so as as people opt out if five percent opt out ten percent opt out. Those costs disappear for the plan. Out of that thirty eight point five million dollars. And also that a little bit more in fee. So what this three point six five nine is that right now is that. We're out spending our our funding for twenty twenty one. And again those those numbers could change you know we we're certainly have another four months or so left in twenty twenty that would help rolling to twenty twenty one so we continue to monitor that and I will look that going for. Now that that was that's not what we just like that was the income statement so that's the that's the look at the funds coming in the funds going out in twenty twenty one so I look at that is almost like your checking account now we're gonna look at is your savings account the savings account are the asset you have available to help fund the program going forward. So. at the end. Sir. At the end of nineteen we had ninety six points not six million dollars in assets. In twenty twenty twenty five point one million of those assets were allocated to help fund the program help offset premium increases. Russia showing about an eight million seven point eight million dollar loss in twenty twenty based on our current projections so that's that's out of a checking account and twenty twenty we're writing checks for seven point eight million dollars more never get in in in revenue. That leaves us with assets at the end of twenty twenty around sixty three point eight million. As a role in the twenty twenty one then we have fourteen and a half million dollars set aside to help offset premiums and help fund the program that were done by previous boards And then we're projecting three point six five million dollar loss in twenty twenty one so that brings our **** down to forty five point seven so you can see that between the end of nineteen and the end of twenty twenty one. We've gone through almost fifty million dollars in assets. And so let me show you what that that what that really turns out Sir. There's. Is a graphical look at the assets from twenty eighteen to a projected twenty twenty one. House point out what some of these items means so the I mean are is in claims that have been incurred but have not been paid yet so there's a lag between when claims happen when you go see your doctor when you go to the hospital and when the vendor actually pays the claim we have to fund for those in the future so that we you know we don't run out of money to help pay claims in the future. the contribution allocations an allocation for twenty twenty to twenty twenty two are those the money to the board has approved to set aside for prior your surpluses help fund the program going forward so these are offsets to premiums offsets to fund help help fund the program and and and to help manage it from year to year so surpluses and deficits don't don't majorly impacted at employees and retirees. Then also there's a catastrophic receipt reserve set up that as the thirty point six million in twenty eighteen. The and twenty nineteen the board may decision to use some of that reserve to offset losses and help fund the programs that numbers down to sixteen point sixteen million right now so and FOR frame of reference for the state employee group. They pay about ballpark a million dollars a day. So sixty million dollars is about two weeks of claims so if you had a really bad two week period. That fund could be depleted and there would be that would be enough money to keep funding the program so that catastrophic reserve is really important it's important to probably get that back up to a level that was before even higher. And the last item is the the allocate assets that's just money that that is unallocated it's my a of where the the gains in any particular year having greater than what we expected and so there's money to hasn't quite been earmarked yeah and so what would happen with that going forward is that money would be pushed forward into the future to help offset funding so half of that would be used for twenty twenty one thirty percent I would go to twenty twenty two twenty percent ago twenty twenty three to get the help fund future further down the road. Know what you can see there is like that last exhibit showed is that from not twenty nineteen to twenty twenty. Our assets of going down by thirty two point eight million. And going from twenty twenty to twenty twenty one projected the gonna go down by another eighteen million. But the real key thing is there that. Aren't on allocate assets are no native so we really don't have enough money in the fund to cover our catastrophic reserve all right in our in our allocations for future years now the board could decide that you know I that sixteen million dollars we're going to cover that three million dollar loss or and that that is probably would have to happen unless there's just additional surpluses that are generated in the rest of twenty twenty second carryover into twenty twenty one. So the funding levels are low and that that's one of the long term views of this to make sure that we're we're getting where we need to be and alas light here just shows the sensitivity so the the bottom bar there that assumes that everybody comes back to the plan all the medical retires come back to the plan for for pharmacy coverage and that's the three point six million dollar loss. If five percent of the costs go to party then it drops down to two point one million dollar loss if ten percent down to point six mind a loss if twenty five percent go it actually flipped over to a about a four million dollar gain so you'll as those people moved in Medicare part B. those costs and are are gone from the program so that it helps to house with the the the short term and long term by by ability the plants. That's all have any questions. Yes it's just going to take a break and I know several members have questions before we move on of Senator Rapert or are you reading. Yes Sir thank you Mister chairman and and I do appreciate you being here house kind of skewed to the sad little bit so I can see you and how long have you been the actuary for the plan. We start in January of nineteen so you just in January of nineteen. but you do these all over the country correct yes right can you just for for color for the background here little bit so how many state plans of this nature do you support and provide personally I I this is my only state but mass of the firm we support I don't know how many there are but I I could. It's a good number though right we were the number of states yeah you also provide expertise separately and apart from the staff of plans to actual Medicare part D. programs right FOR record okay so that means that you actually Millman as a firm also represents many of these companies that might be recipients of the people moving off of the plan correct correct okay I just wanna lay that out there to make sure we understand that so what you bottom line is is that potentially some of your clients could gain some of these retirees is customers if they left the planet correct correct okay that's issue portent footnote In terms of What you're recommending on this. Number one I think the essence of what actuaries provide to our programs is to basically keep us out of the ditch and give us for warning at what point did you inform anyone at them and T. B. D. that you saw problem. The first time we present it formally was at the March board meeting and it was just twenty twenty twenty eight short of a over a thirty million dollar loss for expected for twenty twenty one K.. And that where what what was the root of those losses in the plan it was not actually prescription coverage was it it actually was other expenses in the plan. Prescription drugs certainly contribute to the losses but I think the main route of it is a struggle funding levels more than the actual cost. I think the rate increases to them active in the retirees have print pretty minimal over time. And then as I mentioned before in the five levers the state funding hasn't changed since two thousand hello eleven or twelve I think the the benefit design hasn't really changed over time so really what's been happened is they've been dipping into the reserves to help fund the program. Well it's interesting because you know we've had these reports given to us. Was every year and then we had the health test task force going this was given to us very frequently and it you know nobody was telling us that we had a problem with the funding throughout that entire period of time. And so really to be honest with you this is being presented as almost a sudden event so if anyone knew that there was not that there was a funding problem. Frankly it's their fault for not saying something to us earlier on so I wanna make sure I'm understanding it re clearly here. So you're telling me that you see what you started in nineteen that there was a funding problem that was occurring from as far back as you said eleven. I said the state funding the four hundred twenty per budget head count hasn't changed I think it went from four ten to four twenty at sometime in the I remember two thousand twelve thirteen time period but the fact remains I I I would ask any of my colleagues here to please inform me if they ever heard at any point previous to the news breaking this year that there was a funding problem in this state employee plan because you know when we looked at the crisis in the teacher appointment at the ex teacher benefits plan you know we went and had a special session of forty million dollars in to keep their premiums from absolutely going through the roof and then we had some other changes that were made to assist that in and say shall streams after that excuse me and so it in all ways there was this there's the parallel given of the public school excuse me the Stacey eight A. Essie plan as opposed to the PSC play. And it we were always advise that it was doing generally pretty good yes I'm just trying to make sure I understand so you're telling me that the first time that you raised a hand on this issue was March of twenty. Correct okay and we didn't hear about that in our committees we frankly heard about it in the news so I I've asked about some about the costs in everyone that I've asked about the cost tell may be that the prescription plan is not the problem that is expenses that were in other areas of planned beat your medical expenses your hospital expenses those cost were probably the reason for these burgeoning claims in the plan and so I'm I'm I'm having trouble. Other than the fact that maybe this is an easy thing to recommend to change. That's what I don't understand is that typically when you have a problem you try to address the root of the problem you don't get rid of parts of the plan they're not really the problem now obviously we all know that if you just ditch the plan is going to save money I mean that's easy but what spot about that issue ditch the part it's easy to fix but you didn't fix the part is really the problem which is going to continue to be a rising cost issue. So have you thought about that it had that discussion. We have looked at that benefit is I'm changes we have talked to the vendors about things that are occurring in the medical plan no one thing I will clarify to is that during those years when the funding wasn't changes to what happened there be cycles of good years and bad years lately there's been bad years after bad years and so you know what and what was the what was the root of that what you see what the two main driver is is what we refer to as high cost claim. So people who have extremely high cost you know it could be a preemie it could be a heart transplant everything those things are high cost low frequency events that are very difficult to predict and you see that from time over time that no one year you might have you know a spike in high cost claims and the overall experience of the plan is that the next year cycles the other way and so those ads in flows of those high cost claims could have a major impact on the overall cost of the plan. In and so. What rationale was it that that was a made a decision and not on talking to you because you're the actuary and and I know they're going to turn to you when you have a problem say actuary what do you think. So who is it that decided that it was a good idea to just slash all of the retiree prescription drugs I was in ET proposal so that didn't come from you yes Sir who did it come from. Mr out okay all right well I'm sure you'll have some comments about this here's we go forward so all I want to say and I'm not trying to be too hard on this. But you're paid to keep EBT out of the ditch your to pay to keep them out of trouble. You been here since nineteen it why did this just get thrown at is like all of a sudden here. We were engaged to start nineteen we don't actually have to take over the fall out for a roll until the fall so the so we started reporting in the fall our first look at twenty twenty one was once we had enough for the nineteen data to back to project the twenty twenty one data. So when we we brought it up at the at the board meetings in March April may. so Mister chairman I'm I want to close off I want to stay on the on the topic at hand though Mr how it you're the one he said that proposed to make this decision so I'm first of all when I ask are you the one that made the proposal to make this decision Mr house. I ask Corning Milliman and his team the and if you would go ahead and I I'm sorry Chris how yeah director of thank you to actually have Milliman model of the request yes Sir okay so when I ask you who decided to make the proposal to get rid of the prescription drug benefit. As far as the the modeling in those pieces that would fall on me. I'm sorry I don't yes Sir quite caught that say that again that would fall on me the modeling of that. Well it so you're saying you did that it was nobody else in the administration advise you that this would be a good approach and wanted you to fulfill that. No Sir not to that degree now. All right that's all for them thank you Mr. Members I just ask that you be patient we do have a long list but I am going to it at this point move to a Representative Wardlaw. You're recognized thank you Mr chair. Committee what kind of go down the real time line here but at the end of August I was made of where this issue and I was told that there was forty eight million dollar deficit and that's why we were cut now. Prescription drug plan I said here this morning I learned that we need three million dollars to fund it because we're going to take twenty six million dollars out of of. How to reserve so that's a twenty nine million dollar problem not a forty eight million dollar problem. I don't like being told numbers that fit whatever plan a department wants to do I want to be told the truth and I think this committee and the people of Arkansas deserve the truth what are the actual numbers when did we actually know of the deficit and when should we have started address in that and Amy you can start because you're the one started giving me these forty eight million dollar numbers in the first place thank you Representative Wardlaw the forty eight million is the amount that the state paid and spent on the cost of the prescription drugs for the sixty five plus retirees so Mister chairman kinda keep going for second issue may sell more so that's that's easy for you to cut out so you're actually going to be making money on this cut compared to the deficit you actually have for next year so after the forty eight million dollar cost we received ten million approximately ten million dollars in rebates and re funds online that that prescription so we get to a thirty eight million dollar loss for the state to cover the prescription plan for this population. In the plan that you are submitted at the end of August at the end of twenty one we would have had a twenty nine point eight one million dollar reserve so the plan you're saying today leave the Senate deficit with no reserve the plan that we presented to your committee at the end of August left us. In the black with a reserve fund to fall back on not knowing that this is a projected. For the end of twenty twenty one and not real numbers. So that that's the difference S. leaving the state. With a surplus reserve fund or S. leaving the state with the deficit and no reserve fund but it goes back to senator RAPERT question earlier the prescription drug problem is not the actual issue calls in this cost rice and you know I've admitted to that but yet you're cutting it because it's easy because teachers got cut in two thousand seven I mean these are stories we keep getting told and it where the forty eight million dollar deficit but we're really wasn't at a forty eight million dollar deficit we were at a twenty six million dollar deficit and you're right you are in the black a year from now because you are making half of that money back to the plan your your your one hundred percent correct but that's not the story you told legislators in August you told us in August that we were forty eight million dollar deficit if we kept that plan and not true I'm not sure where you're getting the twenty six million cop from critics from work today. I got a text from you right here. You said you had a reserve a twenty six million you're going to take three million that you've asked us to help you budget that's twenty nine million dollars that's the actual deficit it's not forty eight million which is what we were told in my text to you during the committee meeting I said I thought it might be twenty six million dollar I look back on and I corrected myself and said twenty nine million to which the so it's twenty nine plus three twenty nine point eight one on the presentation that you were shown then you asked us for an appropriation for three million while ago in your opening remarks no Sir I just said we're going to if if the numbers stay constant we are going to have a deficit with no reserve so the plan falls back on its reserve many times throughout the year so we we will have a projected deficit of three point six five with the no reserve fund to use that way. So I don't I don't know that the ask would be three point six five million I don't know exactly what the ask would be. At this point. Okay Mister chairman I hold. Thank you. I'm just gonna take the order that the these came in Senator hammer. Thank you Mr chair the and these are going to be a Mister white just to nail down the time frame I know which low redundant but when did you get started on this project missed white. We begin our contract on January of nineteen but the prior actually was still in place until September of nineteen so we actually took over at the October nineteen board meeting okay and who is a previous actuary the firm was Chiron K. and when did you make your first proposal to anyone with regards to a potential fix to what you had discovered no let me put words in your mouth but what you had discovered was eight a pending financial loss to the plan represented at the March board million showing over thirty million dollar loss we also presented at the April the made board means at the may board meeting we actually showed. various levers the employee contributions the plan design changes the state funding that could be done to help offset the losses and that was of twenty or nineteen you should I think said may may of twenty of twenty okay. And your force today was solutions that I would have thought would have been in the initial discussion of other than just pushing them off to the Medicare deep plan so in the April may meeting when you presented what you thought would be suggestions to improve the plan. Were there other options on the table other than just putting the population off on the Medicare the plan. That option is not been discussed yet what options were discussed at that meeting increase employee contributions benefit design changes increased in state funding. And the cost the price tag associate with those was one of a very we should a table to show that you know for everyone percent increase an employee contributions that would save ex million dollars same thing for plan design changes okay and were you ever instructed to not share information with any of the legislative branch in your discussions with the border with it ministration that that might have given us early indication of this problem I was not okay and did you look at separating the medical from the pharmacy in order to find the savings that we need to sustain this plan without having to push the retirees off of the pharmaceutical plant. I don't understand the question did you look at the medical spend to the plan and try to come up with a solution as to how to find money to savings so that we would not have to push the retirees all fund to the Medicare D. plan yes Sir we look at different options for increasing the active in pre sixty five deductibles and out of pocket maximums and and what is that represented in a your hand out here today what was your conclusion the changes were relatively small and it's not result never notice no the board did not recommend any plan changes can that file one is in the presentation you're making today first suggestion to resolve this what will the cost be to the high in the users of the drugs because you know we've had discussions at some may actually benefit if they're pushed off to the Medicare D. and some may not that they'll hit the donut hole faster and you know we're getting calls from people that it's gonna be financially devastating to them so how would the proposal that you're making day impact those retirees who use the high and cost drugs. Based on the so called so that it would have the same impact it has on and today they would stay in the plan and get their coverage through BT. Okay alright thank you Mr. Thanks center. Senator Irvin. Thank you Mr chair I have a couple different questions when you refer to preemie or talk about premature babies yes okay and out and do you recall how much those changes and deductible plant and raising deductibles or making changes to the plants how much those would have resulted in. Dollar figure because we don't have those in front of us. Or even a combination of raising premiums plus deductibles how much that would if netted or changes and plant one second I have that presentation here. Mister chairman could I add one thing there there is a spreadsheet in your packet as well I do not know what exhibit is but that was sent over that has all of the suggestions that came and other from legislators or from retirees that that goes through the suggestion members of a again I want to know the dollar amount it's exhibit D. one a Richey that's or suggestions I'm asking a question to Milliman. So at a five percent increase across the board to active early tires impose sixty five was worth about five million dollars. If we increase the deductible why five hundred dollars on so this only applies to the actors in the pre sixty five increased the deductible five five hundred dollars increase the out of pocket Max by two hundred fifty dollars that was worth four point eight million dollars to both of those were would be above the three point six million that's the baseline you have projected correct both of those would be of the five cent is already in there for the pre sixty five and the actives okay but the four point eight million to raise the deductible by five hundred and the out of pocket cost up to two hundred fifty dollars was four point eight million which is more than three point six baseline that you're protecting it or nobody moves off of this prescription drug plan and and to Medicare part D. correct I'm very uncomfortable with the fact that senator RAPERT mentions that Milliman represents people that represent these Medicare part D. plans that makes me very uncomfortable I want to also say that did you ever did any of you all ever contact the chairs of insurance and commerce about this when was the first contact that EVD inmates to the chairs of insurance and commerce. About this age issue Senator Rapert said that he. I found out about it by reading the newspaper as did I and I'm a member of this committee so when did you a BT contact the chairs of this committee did I did not personally contractors you did not personally con the stature did you personally contact the chairs of the committee now I did not okay so we read about it in the newspaper and then we get slammed I'm gonna give you my time line okay this is my time line. We read about this decision in the newspaper. In the middle of a pandemic. Middle the pandemic who are dying of code right now who are the people dying. You know I can ninety five five church members. That have died they're all over the age of sixty five. That's real. In the middle of a pandemic we make a decision. To get rid of a prescription drug plan for retirees. In the state of Arkansas. And no one person. Made the decision to have that model. One person we have a hundred thirty five elected officials sitting in the Arkansas legislature. We have a constitutional officer. Lots of on. We get blown up by emails. This is my time line. I reach out what the world's going on. I have no idea how to answer these emails I text back to some of them. Thankfully some of the state employees that are retired our lawyers. And their CBS and their auditors. So guess what they're skeptical because I've been down this path before we could go down that path again we've had some issues with the B. D. in the past before any of you all got their. So then my time line comes to all the emails I receive so I call and have this on the agenda for public health welfare and labor committee. Correct and then we have this hearing. And then it goes to appear Senator English and I have a long conversation about this. And it's more appropriate that come to this committee because this is insurance and commerce so senator English and I Senator English can consulted and we contacted senator RAPERT and I'm sure other people did as well this is my time line. So I just want to thank you for the latitude Mr chair there's a lot of questions I have I think a lot of them have already been asked that I want to say on behalf of. Brown Burch William rains John Callaway. Why to rights Charles Ellis will miss Stewart's Keith garrison Jim weathered lex and Faye Dobbins Eddie Selvie merry chins fame measure and that's just emails in the past week if I went back to August I'm sure the list would be a mile long. I want to thank them for their emails and I want to thank them for their diligence and being here. And FOR advocating and standing up when they see something wrong that's happened and I am not disputing the fact that we have rising healthcare costs we all know that we're adults here we understand that but we also understand that there are ways and their solutions and if you have just one person making that decision that's not the way this should work. I have a real problem with that because we are thoughtful people we are considerate people and we are elected to represent these people of the state of Arkansas. And we're here to make sure that there is no inconsistencies are improprieties that occur that's our job. And we were denied the ability to do our job. That is my time line and that is why I'm so angry I think that the discussion is appropriate I think this the committee is appropriate I think these chair should have been notified I am disgusted that they weren't because they would have contacted us members because that's the way they are the professional adult people. So that's my time line. And until you can prove me otherwise then you can give me yours but that's what we're here today to do and get to the bottom of this so I understand that this reserve is the problem that we don't have for services that why you were so were were understanding we're not going to go down this other path of changing the design plan. Four of raising the deductible because that's just not going to give us enough free service is that. Is that the crux of the funding issue here. The yes ma'am the increase is what we've been and I'm familiar with many of you having been director during the last years of the task force The reserves actually bridge the gap between your peaks in your valley we've been very fortunate over the last several years to be able to have some success of years of research and we burn to those with increase claims cost the the volatility in the claims. Day over day month over month we spend of roughly ten ten and a half million dollars a week can claim to your you have a forty million dollars swing at any one time so from that standpoint as we burn to those reserves yes we found ourselves eighteen months from now. Eighteen months from now that we're going to potentially have a problem all the utilization for the claims is the sole crest with the whole issue. We're having the benefit. People are utilizing that benefit I have no problem with that that's what it's there for but we're sounding the alarm that the utilization is up or burn to reserved in as this continues on the same path we will find ourselves at point beat down the road the reserve in what's demonstrated here that is kind of the all in peace we we don't have that safety net if you will to ease those peaks and valleys we hope that the claim to come down but in the same sense of that they do not then we then we're going to sound the alarm and we're doing it now correct this is different thank you to follow up questions that are very quick number one there's a difference between sounding the alarm and already making a decision so surrounding alarm would have been Hey we got an issue let's figure this out together and let us help you figure that out that's sending alarm this is past that point in my opinion thank you for the latitude Mr chair I may have further questions later thank you senator and I'm going to call in the vice chair Lundstrum but first let me just say as as I pointed out that at the outset you were we're glad to hear that there is a solution to help all of these people that senator Irvin listed and many of us could list that have contacted this that wanted to speak today retired retirees So we want to fix the problem we we have plenty of time to fix the blame and so members I would I've got a long list here we will we will conduct hearings between now and the start of the next session two actually come up with solutions which might end up pointing the finger of blame that will probably be a time that's more appropriate but I just want to preface that is we try to move through the list of of those who passed to to speak so vice chair Lundstrum thank you one of the things these don't things don't happen in a vacuum it's not an all the sudden thanks growth and cost of insurance happens over time I'm wondering why this we didn't have an increase in the cost or an increase in the copay over from two thousand and ten to two thousand eighteen this thing just didn't of mom didn't just go off you're an insurance actuary. These things don't happen in a vacuum I'm wondering where the board was on this where where where was everybody looks like everybody was asleep at the switch and all the sudden the taxpayer gets handed the bill. I would agree with you Representative Lundstrum and you also have and an exhibit that shows the historical contributions of on the public school employees and state employees going back to two thousand and nine and there are very few increases throughout that time point so I would agree with you and that that would be a question for. For the board back in in those times wine there was a decision made not to make an increase either in the state funding or in the contributions I I have a sneaking suspicion because nobody wanted man up and make the big girl or Big Boy decisions and I figured they just screw the taxpayer when the time came and use emotional blackmail on us. And figured just like they did with the teacher situation that have a midnight session funded with forty million dollars and send the bill to the taxpayer it's getting a little old and is getting a little stale from two thousand and ten to two thousand eighteen they simply could have a small of even appoint a five percent increase our deductible increase our co pay increase and this would have happened if I've got the same phone calls that senator when did and it's pretty shocking to go I have no clue what's going on and and the retirees simply made the comment you know we could have had a small co pay increase in this would have been no big deal but obviously they just want to dump us on Medicaid. They just want us to go away that was the message that was sent and that was a message that was received. So. I'm looking for solutions at at at I thank the chair is correct but the solution isn't dumping people. I'd like to your some solutions from y'all. The current proposals to add their the manager retirees back in its they would still have coverage as I mentioned at the beginning that you the nail on the head it's that's the five levers and using those levers every year to help manage the the increasing cost whether that be small increases and employee contributions every year one two percent or slight changes deductibles or you know also some of the dishes that the median their vendors to that that's the way to you know slower slow and steady over time is better than a a big a big hit at one time do we have a board that's gonna man up to get that done or do we have to step in and do it because obviously it didn't get done for the last ten years. I'll just in my comments with that. Recognize my co chair and then I'll be going to senator Ingram. Thank you. Chairman Lowery up. A couple things again there's a lot of things coming out in the discussion and and I wanna make sure I heard one thing correct before I move on secretary fit your you said you agreed with Representative Lundstrum she said several things in there so what specifically did you agree with that the board was asleep at the wheel is because that's really the part that jumped out at me so I'm just making sure I understood this correct. I wouldn't want to speak for previous board what I was agreeing with is that there should have been a more steady increase smaller increase in both the cost to the member and the cost to the state over the last few years okay and then what you said in the the changeover from Chiron to you did you articulate to them that there was something that was not being at accounted for in your previous in the predecessor that was doing the actuary work that suddenly brought you to this. Point is there something there that you might want to pull out force a little bit you know would be helpful to us. I think as the advisors plan we make recommendations about things that can be done to help those aren't always taken so hopefully the final recommendation comes from the body or the board we we can advise them on yeah we when we showed the the scenarios in may it showed the thirty million dollar loss and you know. As I noted AT&T five cent increase barely made a dent in that that loss so they were going there need to be bigger bigger changes or things and we point out things and you know need to be happening over time. As I mentioned the small and steady increases are going to be you know when less less felt by the employees and the retirees out of pocket but also that the shock of trying to plan for those over time is is easier to so we know we certainly pointed out that that you know what we we think that the the keeping pace with the trends year over year over year is is a better approach. So so may be a slight change in and some of the recommendations made a tribute to the maybe that almost a clear from what we had been being reported to now is that what I'm hearing. That the change and yet the change recommendations would be the way that those of the house like we can model week model a wide range of scenarios and and provide feedback on those on on you know the pros and cons of those I think ultimately the you know I don't I don't know what kind of Information EVD or the board gets from other sources to help form recommendations either. Okay thank you Mr chairman. Thank you and before I recognize senator Ingram look let me just also command At this point dispatcher I know reached out to the Speaker and Speaker reached out to me asking that there have been conversations members had possible solutions and could we channel those to use so that the actuaries could model it and be able to come back to us with the solution and that's exactly what's happened that's the way the process should work and hopefully moving forward will be able to participate more in this process the legislative branch will be able to participate so at this point I recognize senator Irvin I'm excuse me senator Ingram. Of thank you up missed co chair of the me first say that I think that there are no retirees that are impacting that pre me catastrophic situation that you're talking about of this speaking of that catastrophic insurance do we have re insurance do we buy reinsurance for catastrophic. We do not we do not okay so we bear all the burden this also featured of missed how like I ask you a couple of weeks ago of what percentage of the made up the plains of hospital docks and pharmaceuticals you were going to get back to me but you still haven't gotten back to me with that yet and what concerns me about you not knowing that off the top of your head is that in private business in any selfinsured fund I can promise you the the the business owner knows to a penny what percentage that their health care eat claims are being paid so let me ask you again what is the breakout percentage wise of your hospitalization your doc's and your pharmacy. I would if if I may um that information we were responsive to that I don't have it I'm sorry I never got up we send it to the To the analyst for the committee and as well as the deputy director for EVD misled it holds and had a conversation with you on the phone and it's amended similar information back to you and to someone in the Senate At one of the Senate constituent services I believe I'm I would be glad to get that information re for those in okay do you know that he was in his break up for last year without risking error I don't I don't have them exactly negotiation is two weeks ago you thank you look it up in a note of any business I have let me let me finish of so without that knowledge of what the break out he is on you don't know you can't do any comparison with other states to know that let's say our pharmacy is twenty percent higher than I appear states in you mean you can't look to that to see if you could make any tweaks or adjustments is to to to why we might be running a higher percentage I think you let it lends itself we have we compared other state yes what to publish according to their state laws and when you look at When you look at what's published and the what we have our mechanics are different from the health plan we operate differently as a self funded plan than other state their funding mechanisms are different their population size and what and what is being covered their coverage policy is difference what you'll never get an app a true apple to apple comparison in that respect so I think there you it lends itself to you can get a general concept and the comparison but you'll never get exact and that's true inside the state lines with any of the private or public sector plans you can't can compare us to a if you were you of a war municipal league for that matter what you can do is look at You can look at the overall cost what we have done with our save on pharmacy with met impact we have five states that are in the south that they have the book of business with summer governmental plans one might fall just right below which one might fall right above this one falls over I believe in Mississippi and we look at those and we are we are the lowest cost of all their five no they have them be identified never got to be careful there not to expose that information of the that's I guess for under NDA for them but when we compare our health plan and I can be I'd be glad to provide you that information we are net cost from a pharmacy perspective overall relative to other health plans of equal size with similar coverage but not the same we actually thrive there Sir. Well it is very base level I mean a self insured plan is strictly of your premiums versus your claims the ad and the over here and I mean that's sort of what it is and do you do you all on an annual basis so me where I think that was a good point that senator RAPERT made and Representative Lundstrum that you know it just appears on the surface that there was just a whole. That you know every year we were running a deficit you could see that we were drawing down in there was just a hole that we weren't gonna have a catastrophic up claim or the planes were going to go down of it would be all are you don't do an annual review I mean all you get most private you know of the self insured funds will look at their their claims experience and then they'll take it and go a hundred and twenty five percent of last year a hundred fifteen percent and fun to the Max the the were you all doing those annual reviews and yet you continue to just sort a hole that we weren't gonna have claims. No Sir we we actually is Mister white here's demonstrated we about ten out of twelve months of the year we provide updated trend analysis minus your IBM or in your which is the concur but not recorded in your run out so you're usually only sixty day pass over in the past as far as actual paid claims it's not in the due to run out so from that standpoint we review claims almost monthly that the difference and I think is the economy of scale We can come in and have a high month. And not we look at the trend over all that you have a high month you you got a forty fifty million dollars wine and so from that standpoint the next month can actually come in a little bit lower but we review those monthly and we have since may twenty third of twenty sixteen today I step foot on the. And your monthly but at the end of the year we review that you review it okay and one last question are we current with are paying our providers at this time I'm. I think we pay our provider very well we we that one because they claim come on my question the people that paid the very well but they might not have been very timely of were extra timely sure the client with the claims are filed that ended last week meaning Friday those will be in a payment run this Thursday. Or S. or thank you Mr thanks center this. Senator Elliott. Thank you Mr chair I I want to get a clarification to one of the questions that Senator Irvin ask I think she was I think she was asking about if we were to I'm concerned I'm talking now about contributions from state as as well as participants. Did you say you had the research to show that we went back to the eleven of thirteen years extrapolated to now you could show what maybe we should have been paying us to keep us out of this this a ditch two way and or did I misunderstand that. I'm talking estimate with him. Yet in say we could go back in and do that mean hindsight is twenty twenty you know certainly can look back and say so you know we miss trend by half percent we miss trend by A percent and so are cost a higher number expected so our funding is going to be short so we can look back and say we could of increased I mean the way I look at is if you know you know trends six percent a year. You've got to cover that through some kind of mechanism so if you and remember that the employee contributions are or maybe a third of the total funding so even if you increase employee contributions by six percent it knowing that's to a two percent increase to the bottom line so you got to figure out how to pick up that other four percent through other means either reducing deductibles are increasing deductible sorry or or or through state funding but well that's that's what I'm trying to get to this I'm trying to get to a balance of What do we do we we've talked a great deal about what the employees could or maybe we could increase that premium. But we up there is another side to that is it's our contributions of the state so out what I'm I have a lot I had questions at least a from before five people since I've been sitting here listening that and they're watching Just going forward as as a our chairs talked about a great deal of what. Would we age should we expect from the employees and the employer out what is that we should expect in most cases because you know that's where the balance comes in do we know about it have we take a look at that do we have any notion about that because I know we're trying to fix a problem now but there are people already concerned about twenty twenty two. Correct so what the private sector would do is say. No we we can we can what we can budget up four percent increase in health care cost and then if costs go up by more than four percent then they make a decision as to how are we going to cover that additional amount so do we increase the employee contributions by more than four percent during reduce their deductible or increase their deductibles or do we have a have a catastrophic fund that can help offset that so you could put some parameters in place to help manage it at a higher level. And up missed how it Has was there ever discussion of. Among the board members about that increase both for the employee and the employer or as when we will lead for both to that you would come and ask our any point both of us to. Participate in solving the problem yes ma'am part of the board responsibility and that is to give me the direction that I would executing that would go to the chief fiscal officer of the state which we did secretary Walter requesting an increase in that contribution amount that to some dialogue in discussions with the office of budget that's where we arrived at the four twenty to four fifty we just statutory capp presently we we Max that out and that generated around twelve point one million dollars but that was board initiate missions okay and of I guess I think this question maybe from section fetter for the for the people who participated kind of been the focus group so to speak I know you said it was difficult to get to get folks involved could just kind of give me an idea of. Who they were like geographically and age wise and. I really don't know all of their ages I know that that several of them are here today as well we had of course heard Scott who is the retiree Representative on the board with their and I took suggestions from him as long as well as others I have a list somewhere well I don't want to give me the list I just wanted to I don't I'm just concerned about how Representative and I recognize that that the you know those short comings here but I'm just wondering about the The Representative of make up of the sample of the folks that I keep hearing from and my because it's it's something that I would like to know. That is we pretty Representative of the people that we're getting all these letters from a phone call right we we had some with that. Disabilities that city diseases that were worse than others we had for males on the board and two females and we had to minorities among those in the in the group if I believe there were six. What aid locally by local folks are all of the different parts of the state I believe most of them are from around central Arkansas. And and then finally for the folks who were rep we were Representative on that board and including the board itself that that that they all come to kind of a belief for understanding that what you're presenting to us today is probably is the best way to go for now. That was my understanding of the take away from the meeting lies if if if if they would have a year to prepare for this they would be agreeable as well as getting a discount in their premium once they go off of that state plan. So if there's a person I just I got another text no person who just sitting here watching today and wants to know about basically said you know I'm not gonna be able to afford the premiums without five percent incentive of whatever the word was. So the five percent increase that's already been announced for all state employees both active and retired starting in January of twenty one. With with this plan we were just saying that. Without them losing the pharmacy benefit they would also get that five percent increase he was address the twenty five dollars a month would be that's what I just looking his text message to make sure I'm getting it right it's consist of concerned about that not be and something that's going to be helpful okay alright thank you thank you Mr chair. Representative love. Thank you Mr chair so I'm I'm trying to a. Get this correct do we. Because if the pharmacy benefit was not the issue. And the catastrophic was the issue do we ever come to a resolution on what we would do to try to. To correct those to correct that issue I guess is that's the driving force behind the that is in the flows in the in the the you know the negative impact of the plan do we ever do anything to address that issue. Because of me intuitively I will say. If we didn't address that issue then is going to continue to be a issue so. Had we just fix the plan had it we just fix the issue there's there's really two ways that that the cash the the the funding can be fixed right there could be an influx of cast they can be set aside in the reserves or changes can be made such that the revenue outpaces the expenses and twenty twenty one to create a surplus. Four or the claims come down lower than we expect okay and you said the claims and the the claims and inflow. Let's let's go back to the ideal of what wrecker US senator Ingram said in regards to to the reinsurance and. So why have we never actually looked at that as a. As in as a I read as a solution to to what were what we're facing we now I've been here long enough to hear this conversation again and again and we still never entertain that or we never. Resolve the issue so so talk to me about that. Generally the reinsurance is used to help Mitigate significant increases for smaller groups so you know group over five thousand employees typically doesn't have reinsurance because they're big enough to absorb the additional claims but we're not we're not absorbent and I guess that's what brings us to this. To this so if you're saying the words over number and we're not anywhere here and talk to me about why it would be an attack. Well that is all from a cost standpoint but the funding levels are not enough to cover those future increases so this kind is leveling out of a funding. I think I'm at a loss because you're saying that were absorbent on however we are here saying Hey wait a minute the plan is in jeopardy so when we go to tech of pharmacy benefit that has nothing to do with actual bringing down the cost. And now I'm getting phone calls and emails just like everybody else but I don't want to beat a dead horse in this you want to wake it up the. At. We're not fixing the issue. But I guess that's my that's my problem listen to all the conversation you were not fixing the issue. So the catastrophic someone was set up to help offset those those ebbs and flows of high cost claims. But decisions to not increase premiums are not increase all right deductibles and coinsurance things required the cash struggling to be brought down and if you do that too many years in a row then you don't have that kind of struck fund there to help with the others and flows and that's why I say why haven't we looked it reinsurance well that base that catastrophic fund is your reinsurance yourself insuring your reinsurance you're holding that money off the side and not using it for anything but if you continually depended that like that numbers down to sixteen million I think it was over thirty that's probably even really not even high enough yet to to cover that so if you're not funding if you're not increasing the premiums. And creating a surplus to replenish that that catastrophic fund in good years. Then the next year when you have a bad you're not gonna have enough money so it's it's that the funds are being replenished. At the at the on a regular basis when there's good years that moneys been said well that's giving the employees know increase let's not change our doctor will the coinsurance so it's it's decisions being made not to refund the cab drivers are. Not that we can't handle it over time okay and let me let me ask you about this five percent increase on the premiums I'll give me a dollar figure on that on just the average don Dahler fifty what would that cost stating retire only as of right now is a hundred and seventy five dollars and some change so I think it's like nine Bucks a month eighty nine dollars a month for retire only. Are you serious so so we're saying that we can't raise not we can't raise. Five percent is it is that. Was the race that five percent. In so it's nine dollars on average. Retiree only so that you know of of retiring in a spouse's is more than that I don't have those numbers in front of me that okay so no wonder people were saying Hey are so we get we could really on me and I'm not saying that I'm advocating for this bill we could really increase because if we're looking at a pharmacy benefit that did you know some people have high cost medication in the we're talking about will. If we get raise the premium even more than five percent then why would we not be looking at that it's unlikely I me nine dollars. Yeah that's that's one point six million dollars so if you raise that ten percent it's three point three million dollars and we looked at with all the scenarios. And tried to tried to the balanced you know what was acceptable and and and. What what would be cost effective well I look forward to working with you because I think this is a better way of us discussing the because I will tell you this and miss Fisher I would mention you just by name because you did call me Paula an hour before the meeting in it was almost like a done deal. In that really I think this that's what kind of upset the legislature little bit because we are going to be getting the calls in so I would just say moving forward out what our preferred eve even get better notice than that so that we can actually work together because the that's what we're we're to do thank you Representative Some of you have been extremely patient but I'm going to start moving in a committee members and then trying to get just just in fairness get back to you of so I'm going to call on sent by sheer pledge of blood so at this point. Thank you Mr chair of Mr hello I just have two questions about the insurance that we are providing at this point. Are the spouses of full time employees who work and have insurance with their own jobs eligible for state insurance because of their. Because of their. Husband or wife being apart of state employees no ma'am that was enacted back in twenty thirteen to remove those if they had call of the spouse of an active employee has qualifying coverage with their employer I was sitting on that committee plan we went to her date teachers insurance and it's hard is that was that was one of the things that we decided not to A layout. All right the other thing is our part time state employees eligible for state insurance it is far as referenced extra help positions I'm sorry well that are you referencing extra help positions would just. Part time employees that would not they would not be unless there is a a different consideration there well it well meaning we would have to have I don't I can't I know we've had the extra help in part time that have been dean to to cover those individuals like the youth home that were in the past fall of sixteen first part of seventeen that the legislative body in the the governor cover those for that contract situation but to my knowledge we don't have any extra help on the planet right now well I just want to be sure because those were two of the things that we decided not to allow when we were facing the teachers insurance all right thank you so much to thank you senator. I'm going to move to AT and members there are some of you that are coming back for a second shot so I hope you you understand that I'm going to go to those who have not ask questions yet and then we'll come to you Representative Ferguson Deborah Ferguson. Thank you Mr chair of I have a question the Milliman report on exhibit D. one D. on page six on the total plan experience. And I guess this sort of goes to senator Ingram is question. I guess I would want you to help me interpret this the do you have that this one right here. The no it's not that summary it's it's exhibit daisy one day page six. Is it this I have no it's not in color for others I don't know it's exhibit day one day I don't have a well I mean I'll just tell you what it says it says twenty nineteen the medical claims was one ninety four fifty six the pharmacy claims for eighty six fifty eight. Which to senator Ingram as question it looks like the pharmacy claims were forty four percent of the. Claims. The air is that sound right the farmer what you paid at a pharmacy claims was forty four percent of the total claims paid out. And then I guess my question any have twenty twenty two thirteen thirty three and ninety six M. pharmacy that would have been forty five percent I guess I'm trying to understand what twenty twenty once projection would be so drastically different it says it's two hundred twenty one and sixty fifty eight in pharmacy that would be twenty seven percent me that's a dramatic change a projection of pharmacy claims. Right that that's from the September board. That reflects that the Medicare pharmacy for Medicare retiree pharmacy is out so there's there's no that's taking it out okay with it I guess I have a another question I refer Mr Hallett of. About the and management of the formulae or a I guess I'm interested to know what kind of things that you're doing in terms of formula the management there a lot of things can be doing to going forward reduce drug ex drug the pharmacy claims I know I've worked with you on a couple of people that I actually needed you to deny the claims on some really expensive biologic so they could get in a trial and it'd be at the pharmacy companies have a imitate out of work site to help people pay for medications I mean we could save a lot of money by having some counseling because I think what two percent of the drugs account for ninety percent a year drug claims these days a lot of that style logics is everything we see advertised on TV you know it's you mera Lipitor everything you say advertisements for so do you have some one managing the formulae or a in looking at patient with had drug claims and helping direct them to trials are to maybe have and pharmaceutical companies help cover the call Sturch helping them find a less expensive pharmacy to purchase the drugs. Yes ma'am and. I'll answer. Broader more broad the evidence based pharmacy program to you a mass is headed by doctor to white Davis and he comes along side of his team he and his team come alongside the health plan and they manage the the are custom formula Terry part of that responsibility is three baiting con of the contract for drugs always staying ahead of the game as we have file similar in a lot of the other pieces They come out we do on average there's probably two to three drugs that maybe up to five that would come out and any given time new to market and we review those drugs before the plan would start paying for those as far as having any part of his team but it's part of would manage any of the one office like some of your situations that we've that we've been proud to assist with it's not a common thing that there's patient assistance to cover just everybody in a broad brush that might not be able to have coverage but certainly manufacturers have a set aside that they actually will facilitate that for any utilize refer their drug one a health plan would not pay for those your situation is a little unique because it was a non cover drug and though the one ounce I think you're referencing and we were glad to help there doctor Davis myself as well of his team what would come along side any member we have hundreds of members we've done that for I'm in my short comedy BT and that's just part of our goals never to not treat someone so from that standpoint what we have whether it be a seven year old with brain cancer on an investigational drugs we take these home to I have a seven year old at home so I see those things so from that perspective we do everything that we can to leverage the opportunities and the value of the health plan to be able to offset that for the member as far as re baiting goes we have a pretty aggressive strategy that gets close around twenty million a year to your point there about under two percent of our drugs in the specialty side account for forty five forty seven percent of our cost. And so we have we've developed a program that I can't go into super details due to non disclosures but we have a situation that we're able to take the specialty drugs and we have special rebate in that comes back and every dollar comes back to the health plan that would that we can maximize their so it's basically a a specially riveting program. Represent Ferguson. Me a line medical in. Jump in here sure okay thank you of members we are going to come back to this issue okay we have other issues that we've brought over from a previous meeting we're going to clear the deck today okay this issue we will come back to because there certainly is plenty for us to digest we've got a lot of attachments year for us to look at so Representative if you have if you can. Records up and then we'll come no that's all I to I just think you know if we're going to continue to pay for this we need to look at ways to mitigate costs going forward it it might be worth hiring a consultant just to look at all these high cost you Sir since they had a. Mitigate some of that cost but thank you thank you I am going to give special bonus points on patients to senator Cheatham. So I'm going to recognize you. Thank you Mr chairman this may be your lucky day. Of like both my question the been answered but Chris did remind me I think you came on board or at the end of that task force meeting where we were working center Hendren we're doing you know would work on the committee that he got called up to active you didn't A well enough setting up the Big this but. Do you think well we were meeting really wrecker. Is that a good idea to it because it did have a sunset clause in it. Do you feel like it would be a good idea to do that again. I came on board may twenty third of sixteen was the first day presented in June of twenty sixteen to the task force for the first time I welcome any I'm positive approach that we could take that whether it be a subcommittee of a of this committee the insurance and commerce committee or if there wasn't a task force again I think positive steps can be made and to be honest I would say that we could use some legislative allies in that sense on the committee and or borders suggestion I think that would help from a lot of uh angles I know it just kept kept my eyes on the issue it it with with the regular meeting of course you know it it we met pretty frequently yes last language chairman just the Indus my probably we're going to ask but the board. The day ever recommend an increase back in seventeen eighteen I think sending the may have been increased eighteen nineteen was that conversation. Hello little board meetings yes for there was a recommendation for a three percent on state at two percent on public schools FOR plan your twenty seventeen there was a five percent on a is city for twenty twenty and the the board vote through the August fifth meeting was a five percent on them met medic I'm sorry the retiree non Medicare as well as the active population. Let me talk with the salesman but sometimes when the board recommends increases. Does it get into politics work hard thirty five of us pushed back a little bit because we don't want to make our constituents mad. Do you ever see that happening. We're not doing our job but. I'll say that I think sometimes Is is much is individuals want to be consulted when things are being done I think you'd be D. could be consulted for potential impact for different things as well. I think that would be a fair statement thank you Mr chairman. Thank you senator. Memberships and just to give you and I and I do appreciate the sum of you've taken yourself out the cute just to give you insight into what we still have to deal with we have a report from the PSC about utility abatement of being you know during code of being able to help people with their utilities we've got a report from the insurance department on health code is affected insurance payments so what we would get some very critical issues and I do appreciate the job I have been willing to take yourself out of the queue at this point I'm going to call on Representative Fortner. Thank you Mr chairman I'll be very brief secretary Thatcher. This is a personal request and I'm sure we would all benefit from it we represent the I represent approximately thirty thousand people it appears to last week twenty nine thousand of those are retired state employees. And they have all called me and it would be very helpful since I didn't have the answers. If the names of the board members and their phone numbers could be provided to us and may be published in the media because they are the ones that need to answer these questions directly because they should have the answers because I don't would that be possible. We have provided what will first of all of the board members are listed on our website we do not have phone numbers for everyone because some of them are private citizens and not state employees so we are limited on what we can release on them but we we have established a list that we can can I really see you in and we'll be happy to send it to the committee we've we've done that for the other two committees okay I thought I'd like it published towards the and Perhaps it we need to do something if a if a person wants to serve on this board. They should have a phone number that can't be published I assure you hours are all published. And I know we're paid employees up but you know. If you're going to take the job and you're gonna take responsibility you need to accept that I thank and put out a phone number so the people that are concerned can call you. And and get an explanation. That thank you for your time and and your consideration thank you Mr thank you Representative and I think your point is well taken that my understanding is that even though these people or private citizens they were appointed by the governor correct. So the there it does have to be accountability so we I would ask that you. Reconsider that statement of their accessibility to these board members because they need to be getting the same kind of been put from retirees that we're getting on this issue so Senator Irvin Can I ask you fuel. Please be concise ice. Thank you quickly one of the things that Representative Lowery said was there was a legislative process that you called the Speaker of the house and I think you call the Senate president pro tem and then they sent an email out asking us for suggestions and then we send that Ford with all due respect that is not the legislative process that provides no transparency to the public no accountability if the decision to quote fix that behind closed doors. I don't I I I do not believe that that's a correct legislative process I believe that having a task force meeting have an insurance and commerce committee meeting and discussing these things out in the open is the legislative process so I take exception to that because we were asked these decisions I've never seen any of these reports from militant I have no information to be able to offer any type of solution that's unfair and it's not right and I'm tired of us operating that way I'm tired of us doing business that way Mr how it does not need to be the one person put in that position either I will say that so that is my comment and I'm I'm done with that we we are legislators we have a legislative process we have committee meetings we have agendas we are live streaming the public requires that level of transparency when we are discussing the issues at hand and making decisions that's how we do it in the state of Arkansas legislatively so let's stop the backroom doors deals let's stop that. Okay because if you're in the cool kids club you get phone calls if you're not the cool kids club you don't one sorry by Representative rye is equally elected just like I am. So I want to stop that I want these done and transparency and in the public for everybody to watch in witness and so that we can all discuss and have a dialogue about solutions question in this you have plan administration expense for Arkansas state employees it's three eighty five per member per month going up to three ninety six for public school employees it's two dollars and fourteen cents per member per month and remaining steady at two point two dollars and fourteen cents why the large discrepancy in the administration cost of those two plans. First question. eight so we've talked about funding on the employees of the state and Tyrese tech what they can do back pay more in premiums or behind deductibles we talk about state funding administration of the plan where those increased cost here and how is that entertained by the board was that how is that negotiated I want to know the parameters of that contract and Senator I'm sorry I'm going to have to interject at this point these are all very important details for us to get that again this really focuses more on. What's past right. Later so can we just go ahead and get those answers for a later meeting as we look at solutions. I'd like details of the plan administration expense and how those are different and why. Is no one based on I believe the public health you requested that information and we will we were responsive to that and provided the listing for account for playing your twenty nineteen specifically listed all the contract on that ministry of costs to that so if there if you could provide me with what those extra questions or additional question or would be glad to be responsive okay I'm just going off of what this presentation was okay okay. At the end unless any any member of the committee if you want us to final two EBT or to miss venture whoever these questions in anticipation of our next meeting which will delve deeper into moving forward please do that I know at this point I'm going to call on Senator hammer and I know he has a hand down which I believe details a list of possible solutions so letter directed to miss venture but we're gonna make it available to all the members so that you can see the scope of the solutions that that are being proposed. Senator hammer thank you Mr chair and I missed the cut off line to miss Fletcher so that probably would have been included in that handout but those are just some suggestions that I'd like to propose but my question to real short number one. I I get the impression that there's a solution on the table that is going to address this but there's been a lot of conversation today would you just restate what is the solution because we're gonna have retirees calling of saying and what's the solution I wandered communicated accurately that's first question yes Sir Senator hammer we are proposing today that we put off for one year the effective date for the loss of pharmacy benefits for retirees sixty five and over. So that would be effective on January first twenty twenty two this plan year for twenty one they would get a five percent increase in their premiums and we also are proposing to make it optional if they would like to go on Medicare for twenty one and that is their choice then they'll get a twenty five dollar reduction in their premium for twenty one okay could we have that summarized in writing and sent to us so we could just use our social media outlets to push that out there being no miscommunication if the chair would allow that and then the second thing is issued I'm sorry go ahead it does have to be approved by the board and our board meeting will be tomorrow at one PM okay and after that if we could once proof thank you second thing is you currently under contract with the company is supposed to be notifying the retirees of what was the old solution what are you doing with that company and that contract now and how is it going to have any effect house this decision and have the effect on what they are doing so make sure there's no miss communications going on. Right after the board of vote tomorrow then we will work with the call center to revamp the script and to still keep reaching out because as you said there's a lot of confusion so we want to make sure we're getting the good good information to them. Mister chair I I'm not asking me I really thanks lead to but it might be good if that was brought back for this committee to make sure that what they're telling were in harmony with his legislators what that company is contracted a message handle the messaging is and thank you absolutely thank you thank you senator senator Teague. Thank you Mr chairman more observation in a question we've saved all this money would with the transformation process and I wonder fly we can afford to help these poor state pollution and teachers out if if this factor has an answer for that I'd love to hear. Thank you Sir. I've I've been in my position since July one of twenty nineteen so I was not part of setting the rates for the premiums or any of that state contributions prior to that time the last time they were said was in June of twenty nineteen before the one that's before you now so I haven't had enough time to be effective there. Thank you so my question is all this money we've safe walking we spend some of this over there to help state for state employees and teachers I believe it has to do with the way the moneys appropriated and and savings in another department would not be able to be sent over to even ET to use so you can't share services on this. the you all have said very clearly are shared services model. Okay members we are bringing this in for a landing so of Representative Lynch you are recognized. Turn me on our your own all I need is a number have many people are currently paying premiums into this plan between current employees and retired employees. With respect to the question I'll be glad to get you the response to that I'd hate to be on the on the flip seven we have a certain percentage of houses but between spouses and active contracts The active contract to be roughly a hundred thousand give or take probably around ninety eight thousand and that would be the employee side and then the other make up would be of the spouses and dependence covered under the plan give me and then I would say about ninety eight thousand based on the active roster. So we're looking at. Three hundred eighty dollars per. Member on the shortage thirty eight million dollars divide that number. That somebody else do the math real quick well. And how to break a question mark many different ways I'd like to be a consent as far as a specific question than those that are paying into the con to the plant premium dollars. It's going to be depended upon if they're a retiree only if the retiree spouse I just looking at the magnitude of the problem if the problem is three hundred eighty dollars per participant per year. Why can't we just pay that. That that's my question. Unanimous total I thirty and it has to the number okay so we doing the thirty eight and a half million Sir. It would be close to that yes Sir but I'd be glad the I'll be glad to get you that number so if you can solve it by just charging me. Three hundred eighty dollars a year more than what I'm currently paying and the state would pick up part of that doesn't seem like much of a burden to me. And and so that's my contribution to the conversation and thank you thank you Representative. Senator Ingram Ingram. Thank you Mr chair I'd like to make a request of the cochairs that audit look into of the overhead of of of of the the board and how easy the that we're administration against peer groups of the first knee jerk reaction has been to cut benefits but I sort of think the first thing might be to look inward and see besides tweaks in the program of are we operating efficiently as the it is board commission so of we were fortunate that our insurance co chair is also chair of all that so maybe we could provide upon him to look and see if of EBT is operating in the most efficient manner thank you okay thank you senator and this point I'm going to call on Senator Rapert two up kind of bring us some closure. Alright thank you very much I'll address question my colleague senator Ingram I'll be happy for us to to have a discussion with the audit staff about then take a look at just getting an answer for that and and so I ask our staff here to help me remember to make sure we follow up on that please there's so many issues out here. Well as is that your Lowery is stated we're definitely going to be coming back to this issue from the several meetings on this also it some point there may be some legislative ideas that markers mission to me or chamber large mission to me for the future but definitely we're going to have to have a lot more communication I've got a couple questions but I want to. Make a couple points here let me start with members this exhibit D. one B. that you have in your packets did not get a lot of discussion today but I just wanna make a point for the record for us to consider here you go back and look in the in the and you gotta remember when you look at the public school employees at the top you're looking at state contributions and district contributions and the employees contributions and I want you to really take a good hard look at that from two thousand nine to twenty on the employee's rates there and what their contribution is been but for the purposes of discussion going back to sixteen you look at the the state of Arkansas was putting into to. To that formula for their plan and and twenty it sit two seventy one. You look at the sixteen number for the state plan it was four twenty. And it's remain for twenty every single year up to this time so I'm just point that out now we deal there's a different factor when you get the districts involved in that mix but what you see is that you go back to twenty two thousand nine and I know for all those people have been calling us Their employee contribution was thirty seven percent thirty seven and a half to be exact. And it's now up to fifty point four which does come it very close parity with the PSE okay but you you've just got a very ation and we we always talked about parity. In plans and all those things but there's a four hundred fifty dollar captive by statute I believe for the state's portion and we have to make the point very clear that all of this cost burden discussion has been placed on the employee and not any change in the state to hit that for fifty cap is that not correct mismanaged secretary yes Sir we are proposing that the state go up to the maximum amount of four fifty so you are prepared for my yes Sir and in January of twenty one and is that so that that is going to be a proposal from you yes Sir but yes I I I I just talked about the proposals that affected. The Medicare eligible retirees today there there are other things the other things that we've discussed we're still holding in place okay. And go ahead make my point all in with my question then on the re insurance you've not done that have you ever it it anytime. Priced. Eight you know the old saying belt and suspenders approach you've got a catastrophic reserve in that reserve just sitting there. Have you ever thought about buying that extra. Senate suspenders to to help us with the belt yes Sir with a population are size it was it was but it out and sixteen it becomes a fixed cost with the fix premium that you would pay everyone or whatever you call it or not upwards of ten million dollars so Steve was ten million dollars a year for re insurance to cover up at the time the population that we would not. We would be spending more money than what was being re insured against so so that's where in twenty sixteen with the help of the entrance and commerce joint as well as the task force I made the decision to set aside what with being the catastrophic reserves and put those dollars in there to set this as a set aside okay We'll come back and closes off the next thing is in the future and there may be somebody here represent them but just to Representative loves point and maybe some other points have been made that I may have missed but that is that you know we this almost been about getting prescription though it's been identified that there other cost factors that were driving this. So I wonder what if you ask and demanded of health advantage the TP a in trying to address those those particular issues what we have various things on the medical side that we're doing a such as a A claims review to look at that that that does lend itself to reviewing a dollar threshold of claims for proper payment and other things there Sir. The other thing is a. And one more question and I will close my comment and it's going to be a big comment for you but The changing actuaries. So what prompted what was what was the decision point which changed actuaries. I think it lends itself to several questions including some of senator English comments when we came in we were spending a significant amount of money with various entities in a separate nature and we started in twenty seventeen the first part of seventeen through parts of eighteen and we built a combination contracts so we have and Milliman is supporting the actuarial role we have the medical management we have the traditional case management you OR disease management in those those programs rolled in to one that was a competitive bid in it it went out on three five of twenty eighteen it hit the street it was competitive competitively procured and was awarded in that summer and it took affect one one of nineteen in that we were able to leverage a size of the health plan for reduced administrative cost which I think will lend itself to the to the efficiencies of been mentioned I'm in in doing that it. And in my opinion we have different methodologies and different approaches from the actuarial side that will give us more of a true up as far as our health plan. But the this far as what headed down that path they were under Conran was under an active contract but we did a bundled service to try to save dollars. Be a lot to unpack out of all this the future meetings the other thing I want to mention because I do want to inform our members. This is something that I ask you and and so this is a surprise to you and secretary feature on this I I totally unintended opportunity that I got some feedback from someone about the prescription plan I actually was in a out of state different meeting not even on this topic in as I was leaving the meeting I was asked if I knew Chris Hallett with the BT I said sure I actually do act I kind of wondered what apply that came up in an apparent the person had in an attachment or an affiliation I don't even know exactly what it is with a program called sharks essay J. R. X.. In that statement was made by that person we were meeting with the B. D. and nineteen. And so on that we estimated we could save sixty to seventy million dollars on their prescription plan. I said I've never heard of that never never heard this brought up to me. So I ask I called you both. Just a couple days ago maybe not even a week ago last Tuesday and I ask about. Did you have a proposal from this program and they claim they could save that much money. And I know we then went into that I would like this in the future meetings that we address this okay because obviously they make some claims now will tell you that some of the objections that you gave me when I ask why did here about this they say is not exactly accurate there are some differences there and again yeah caught you on the spot when a call Jett so I'm not emphasizing that but here's what I am emphasizing. We're sitting here about to throw thirteen thousand eight hundred I believe is the time for. Retirees off of a promised program whether you say it was in the promise or not they didn't work all these years thinking that they're going to wake up one day and read the paper and realized over. Mary we're getting thrown off the plan. After thirty five forty years and I just want you to know that my expectation this chair of this cut this committee in my expectations long as I happen to be in a position to ask some of these questions is. It's really not your job to withhold from us opportunity that claim that kind of savings. You must inform us and let us have an opportunity to address this because it just so happens that that claim. That they could have that much savings would mean we wouldn't be sitting here today if what they say is true okay now that may not be that they can do it in there's going to be sad issues with what they claim but you know what if our job is to make sure that we're providing coverage for these people and we see that these costs are spiraling out of control as you say all of that. I shouldn't be out of state it a meaty. And get to know by the way. And be caught flat footed not even having heard of an opportunity to address that is all I'm telling you is so I what will want us to address this in our future meetings but I'm telling you what that shocked me in it liens to what senator Irvin and my other colleagues have said look we had a lot of discussion I want to remind you I was one of the primary ones back it's when the public school employee thing went went haywire and they told us the and when I say they the administration said them we don't have any money. And I went out and got all of the money from Arkansas's bank accounts and held at third pointed to about a hundred twenty six million dollars and said well looks like we've got unallocated done appropriated funds that we could help her with this. And we sell set down to begin to talk and we took the session we did what we needed to do but I'm just telling you that I will take another step that we did in this is not to order you and Chris I want to say you're taking a lot of heat today on the situation but you know what you gave us more communication and better health then we had been been getting from the previous person that was in your position we actually went so far in this legislature that we abolish the EBT board. In the legislation and reconstituted unfortunately the previous governor point some of the same people that we did at the time but we went that far. We went that far and so I'm going to expect that what's going to happen here there's going to be more regular communication demands that will and I'm not going to take away from chairman Lowery some of the ideas that he would put out there but look. The idea I'm really frustrated I'm really frustrated that somebody told me on the street yeah we talk to them about an opportunity and I had never even heard the name. That's wrong. In the end that was just literally ninety days before the March twenty at that date that was given earlier and so here is where I'm at. The state of Arkansas requires employees. The performer functions. And I'm sitting here you know getting all these emails and I could name a few of them to but if you're gonna have employees that are going to be public servants. We do have some obligation to make sure that we're doing what we can to provide a basic level of benefits to these people to work for the state of Arkansas. It's so. It is time that we figure out some of the savings from transformation I will end by in on a question on this and and I'm I'm done on this for today we get a lot to do this afternoon and that is it makes me wonder madam secretary. The savings that would let's just say that nobody bucked. On this decision. Thank you quote unquote save money. Since this is now and TSS and transformation shared services with this quote unquote savings have been have gone to your overall department's bottom line and then be reported back to us in any way is savings. No Sir this would have gone into the reserve fund if we had had gone forth with the original plan we have come out with the reserve fund that's good couple members asking the questions of me in a that's the answer I hope that I would get which is the appropriate it answer on that but I I thank you for con thank the members and I thank chairman Lowery in and that he and I both were committed to stand on this issue I think to be honest with you that we're probably need to stay focused as a committee on the issue rather than farm this out any further sure will figure out what we do in the long term but we definitely are going to stay focused on it until we find some real solutions. Thank you thank you senator Ingram will let you thank you have a at the risk of supplanting Senator hammer of wanted to ask the chair if BLR would look into this and we've talked about in the past issues you all know of to try to deter directors from padding of their positions that they Kerry of they are required to provide the benefits even though that those positions are not filled they provide they pay benefits as if it was filled. And we have over the last couple of years cut a tremendous amount of those positions and. Actually what we were doing we were supplementing the health insurance because obviously these are goes positions and there's no claims I would like FOR BLR to look in to have many positions that we have cut and the impact that it's have an own own our our health care fund. Okay. Thank you senator we will add that to our research list thank you to our witnesses for being here and thank you for the the solution that was brought and hopefully that will allow a lot of our retirees to sleep easier tonight in moving forward and we will be taking this issue up again so thank you very much at this point I'm going to call on the insurance department for to the back to back presentations I think we're moving one of the agenda items K. A.. On workers comp you know we're anyway we're going to be taking the commission McLean and Rescue our the believers can be participating as well so as you make your presentation if you would of. Identify yourself for the record. Thank you thank you Mr chair Alan McLean the insurance commissioner and pleasure to be here with you and hope we can sure a few items with you today with me is Centel all Britain our program manager for the Arkansas health pray him and then my general counsel generator so here for any any back up some less Senthil present to you in a minute but first I just want to on health insurance marketplace but first I wanted to give you a few it asked for a few items regarding impact of co they don't and on insurance and claimed as we've seen it and I want to just highlight that for you real briefly and and then we'll move on to the to the health insurance marketplace update and feel free to stop me along the way if I had if you this up this bike your interest but In. You may or may not be surprised that there haven't hasn't been a great deal of read number of complaints coming to the insurance department that a particular code related there have been a handful of things that you that come up regarding perhaps telemedicine or a few a few other items four one the more contentious things you've heard about is business interruption insurance you may have heard from some of your your constituents or or businesses about business interruption and whether their standard business interruption policies would work during pandemics and the the basic position of the insurance industry is that that that that business interruption is not covered and and under this is your standard me that pandemics aren't optically this covered under the standard business interruption so that's a hot topic that I understand it may be some lawsuits around the the country that that are addressing that so we we what we're watching the industry news as much as anybody else on how that how that transpires had a few concerns about roofs and and adjusters perhaps not to taking enough time on looking getting on Russo looking around as much or looking at the houses because of of code restrictions and we interacted and and got involved in some of those to make sure that that the claims people or are looking at the policy holders appropriately to make sure that that they can know what says the damage and and and and treat everybody fairly so that that's. I would say any that's a pattern but those are some of the more anecdotal some of things this way that's come up over the since code hit as we say. One item of interest might be workers comp is if you if you knew me in my previous life in New else director the state workers comp commission at one point in time so I've follow that just a little bit and that ensure even though we're not the workers comp commission we're not the repository of all the the day today claims and workers comp we we also do manage the public employee claims division which is the state employee workers comp system so look at my notes here for some numbers florea like I said the workers comp commission not the the insurance department tracks the statewide claims but I did get some information from the workers comp commission at the end of August reporting one thousand three hundred twenty one workers comp claims filed. Words of injury filed no not all those were deemed. Accepted by their workers comp carriers the number I have for that is seven hundred twenty one they gives you an idea that for whatever reason people my file a claim for workers comp is investigated and determine whether it is a causal relationship with their with their employment that would cause it to be accepted and deemed compensable as we say so that's that's a statewide basis the subset of that is the insurance department state employee claims numbers which we had three hundred and fifty three state employee workers comp claims filed with three hundred twenty eight of them being accepted as as covered you might not be surprised to know that most of that was most of those claims are within the department of corrections so this is how level on on a on coated clad to dig deeper give more information if you want me to and then a few rejected. And over gentil. Coming from. Yes Mister McLean thank you thank you for coming I think this the first time you've even been able to appear in your new role so we welcome you to your new role look forward to working with you thank you for being here and look forward to working with you I know we actually just had occasion to be with some of your fellow commissioners who came to the in core meeting last week for the in a I see in court by law as we look forward to working with you know venues I did want to mention for you turn it over here that we definitely are going to want your feedback you know in November the Supreme Court is actually going to hear a case only ACA there's a lean toward the fact that it may very well be over rules and thrown out in complete and so that is going to put you in your commission absolutely in the hot seat certainly and your new your new role so we would love to to to make sure that we're talking and having good communication because if that occurs obviously it is going to consume cove it is one thing but throwing out the ACA is and other and if that does happen then Arkansas is going to have a lot of things to deal with and it does give a little shade to the discussion on the market place which we're going to have your so I look forward to hearing the presentation but I just want to say thank you for being here we wish you well in your new role my pleasure I look for to work with everybody on the committee and yes we we've got November on our radar screen in particular whatever the Supreme Court does issue an opinion propping summer or something like that so I do look forward to working with everybody and leading up to this session and during the session and any time in between always feel free to give me a call. And I'll handed over Centel mixtures you refer to go with the health insurance marketplace report. Thank you you're recognized. Thank you I am I want to make sure before we start that you guys have the The exhibits the and please identify yourself for the record I am Chantal print with Arkansas insurance department. And. What do you all have the exhibits for the plan in writing commission the enrollment report and the financial report. Members I would be E. one eight to twenty three. Right I'll start with the plan and rate information we have a new entrant on is the At on a home on the market place and that's health advantage Every one of the companies we have well we have am better back with this call choice and coach was life and health course the new entrant BlueCross BlueShield all the companies are ours covering all counties in the state. I have the plan offerings here for the gold silver bronze and expanded Brian's. That I don't want to for you with just all those numbers. And house I was I just told you about the service areas for all the companies are covering all of Arkansas. Then on the server rate changes in Arkansas this is for actually to get this over a cold and expanded prawns and Brian's. And we have the non tobacco rates for four year old cross print plan years and you can see from two thousand fourteen to two thousand twenty one how those rates of changed for each of the metal levels. Are there any questions on this piece. Other port. Sorry about that that's okay. Are there any questions on this piece there are any questions seconds point. I move on to the enrollment reports. So we have historically with the the market place and enrollment by months and that's for two thousand fifteen to present. I can see where that usually the high as where people first general and then in the effectuate ones that being coming down some because they don't pay their premiums are they drop off for for whatever reason. for the effect of Kevin nineteen on the market place in Romans if you will but. You will see there isn't aero it's a black arrow that shows fifty three thousand eight hundred and five. And then the same time. That's the same time last year as we are right now at fifty eight thousand two hundred and seventy two so that's a an eight point three percent increase so people are wanting to hold on to their their health insurance. Probably out I understand that instead of you know each year we are each time we come we give you like bycounty then roll meant by county. However just to save paper and Space we have a link that's on our website where you can go in and you can choose your you can look on the last it's a sample of how the online visual is visualized station like serving county. And you would just. Click down the drop down and choose your county and then I'll be able to show you your enrollment for your county. Are there any questions about enrollment. Okay we'll move on to the fire on a roll no questions. Well we try to have it all set out in plan for you guys so the financial report is through the fiscal year two thousand nineteen fiscal year so through June thirty. And it shows you the second page of the shows the expenses. And. For operations for January three June and then the total expenses here. And then on the second page it shows you just itemized where those expenses came from. We do have a question I figure is not I said that the last Senator Rapert. Thank you a previously we we had those expenses in years past because that actually was an important issue for this legislature so do you have those with you. From the past yes that's right I'm sorry I did not bring this with well I'd ask for you to to get those submitted over here because that and first of all these expenses look a lot different right lower than what it had been however to keep us on track of of what that cost is and what we did in relation to the some of those changes because in previous reports I mean we it out and I don't even have it because I thought it might be with this but it was several million dollars we already achieving savings up to that point that and we also know that the price of these plans there being held down because of those changes as well yes and so if you would you know commissioner Klein if you would make sure in the future on this that you have a much more robust history there because it helps us remember what we were doing we made those changes and so I thank god for that okay so and I would like to have it you know email to musicians can we can do that so I know we presented in January so you want from January and then back of two thousand nineteen when we know frankly I would love to see you yes that that the definitely from when you took over but actually it Rick it was reporting cost as reported from the exchange on their administration I'm looking it represent first sink is what she and I spent a lot of time on this issue together and it we definitely want to make sure that we don't lose the perspective check on that because that sometimes does get lost and we just wanna make sure and again. All that leave all that is going to become important if there's a decision throwing out the ACA and then what the state is prepared to do as we move forward on how we handle certain things so thank you very much charter and that would historical perspective with especially we had very few controversial issues in the nineteen session but the moving of the market place to the under the insurance department was one of those issues and I think it just helps us it have a historical perspective of the the savings yes the state yes I understand I can also tell you that we're going to it's going to wind up looking very boring which is a good thing because we're too lacking with this five hundred thousand appropriation that we have some. Thank you. On that come on the boring comment again may make sure you understand we'd we want and you may need to go look at some of those reports previous to to being your responsibility so we we definitely have that much history there that was presented in it was in the millions of dollars and fortunately it is getting down to where it does look kind of boring compare the other discussions but the front frankly it was that there was a lot of posturing yes. Nineteen was pretty hairy yeah financially and so you know at this point we know that we made a decision that is saving the state of Arkansas in there by the consumers and their by their premiums because the station was made so that's our point thank you sure thank you. Mr sure that's really all we had to present to Mr Smith's particular questions on the the reports or anything else going off insurance department. We you you covered so much in the short amount time I want to also make sure you reference the workers comp insurance market is that that's the exhibit K. E. of reference is I think we were while you were here we're going to go ahead moved that item up appreciate that no this is a. A separate report this okay we present annually and and I really wasn't it was just presented to you and filed with you and it's a highlight of the workers compensation market in twenty nineteen and not just with state employees but that the entire workers comp market the the high level is that it to work stay the workers comp market in Arkansas continues to be very strong you have the third lowest premiums of anybody in the country behind Indiana and North Dakota I believe so and that's been the case since ACT ninety six of acts seven ninety six of nineteen ninety three that that the soul is start to all trend downward so it's the that the legislature made those changes years ago and you still see and the impact of that that's what's highlighted in this report okay thank you. Present Lundstrum I believe you have a question and comment. Ninety link isn't up in working and maybe I'm just not getting it. Could you restate that. Of I will make sure to speak with R. I. T. to make sure that it is working okay no problem thank you thank you. Members side don't have anyone down it for questions but so I believe that that you've been very. Concise and clear so we appreciate you very much for being here thank you all can you. Be clear five four members of where we are we are going to take a break for lunch at noon and do have some reports on of contact tracing and Hydroxycut for Quinn this is these are the issues that were clearing from the previous meeting At some taking some things out of out of order. I'm going to allow actually we're gonna move item J. chairman Thomas with public service commission we'll go ahead and let you come make your presentation about utilities. disconnection in on the non payment issue and then we'll move to the covered claims issues from a. Mr green wood with that Blue Cross. Thank you Mr chairman Thanks Corinth talk to is when I'm sorry should identify yourself for the record please. You said earlier and I was you remember do that I failed to write at Thomas with the Arkansas public service commission When when the covert thing hit all of our utilities immediately suspended this connection activity A we formalize that in an order afterwards what happens when folks don't pay. And it's what we call under collected that that gets spread to the other customers that's that's how it works that's how it's always worked research also process that the utilities have to go through to the disconnection so where we stand now is it's been suspended since March some date in March two weeks ago we opened the door in an order for utilities to present us plans in terms of resuming disconnection we've asked them specifically to address communication with their customers about what's going on and working in terms of payment plans and stuff like that the utilities have worked to do a lot of these things already A but they will be presenting us plans to resume disconnection and when you start to hear about it we want you to know there were early in the process we haven't made any decision yet our utilities will work with our general staff and members of the public to come up with with the right thing to do and we went to talk to be aware of that that's really my presentation there is a number I don't know there's number utility representatives here on Wall wants to present and who all is just tear and catch on any questions but that's all I have an influx of questions I'd be glad to answer them. We appreciate that presentation I at this point I don't have questions for many members of less. What is your invitation for questions has not listed any so I think I do want to mention the docket number is twenty twelve to dash. Zero one two dash A we have a public comment site on our website so folks want to make comments on this they have the opportunity to do so in our docket so thank you all for your okay thank you very much of what we do have one that has senator Irvin. So some of the carrier's money that came down we did some of that help in payments for people that I have for rent or for utilities I know that some I think some municipalities requested that I'm not sure where it was granted or not otherwise in the federal money that was a lie keep increase I think we've run out of our like the money okay and that is that does occur because that's something or entertaining on the steering task force whether that be the money that sent to the cities of the counties or something additional how would that fit in with what your just report that would get folks paid now that's at the municipal level we don't have jurisdiction over municipal utilities so this wouldn't apply to them anyway they would have to run their own that if it if the money went to but if the money went to the landlord or to to pay for those utilities. How would that affect their paid then there's no there they don't have a disconnect issue or if like the federal program pays for them and they don't have a disconnect issue does not affect what other people are paying you said that spread it spread around okay no okay thank you so in that way those programs work for a benefit for the ones who would otherwise have to pay that. Okay. Okay Senator that take care of your question all right thank you senator. Skis me. By senator RAPERT. I want to ask you quick quickly on the spreading out it did she tapped center retired on that just a little bit I think it are you telling me that that typically unpaid bills from other Can you know customers yes that they just get spread out to the other customers. And that's because it's a regulated utility their costs are recovered from and I know from a private businesses that seems upside down but in the regulated utility world. That's how it works they get return on investment and in the customer's cover all of their costs and there there are times when it seems counterintuitive it mostly because every other transaction do in life is different than that but but overall that's that system works. You know I would like it is dental I would like to discuss this further later so we get through everything but you know I don't have a line item on my bill that tells me that that's why my bill is six. you know we have a line item for kilowatt usage the taxes and everything else but you know it would be interesting for I think for consumers to know what part of that bill getting is actually taking care of you know Johnny down the street to Justin pays bill. Is there a way to get that information yeah it comes to the cost of service it's filed as part of a rate case it's it's small it's sad thank you would be small but that would be interesting you know to I just it just seems like out of transparency maybe we ought to know that now because to be honest with you I don't think the average person paying their rule electric bill or their entry G. bill knows that a little small portion of that not be that you know Johnny just didn't pay is bill now I'm I'll be honest with you I I did not. Actually this is a reminder if I'd ever heard that I did not know that you just automatically think that out well cross response on autumn they have to make a good faith effort to collect it is always an issue and that's why part of why that this policy is important because right now they can't make the good faith efforts of the basically holding. You know accounting for the money separately been no deal with that right recovery later. Thank you. Thanks center thank you thank you Sir times Preciado. Member sign I'm going to have been screen would come for for the next presentation but I want to ask first we have an option we can go ahead and press through on our agenda rather than taking the break I I know Senator Rapert is mentioned to me that this section on contact tracing is very critical for us to hear because it's not working and we need to talk about that so all right I've seen a couple of motions that say let's just keep go one. We are we find okay well that we're going to just keep rolling so screen would if you come forward to the next presentation. Please identify yourself for the record. Morning cemex Greenwood with Arkansas Blue Cross and blue shield Mr chairman I've been asked to call the school had pull the microphone a little bit closer to you thank you sorry is that better okay. I've been asked to come and talk to a little bit about our claims experience during coated first I want to say that we've really not experienced any problems obviously when the pandemic first hit we saw huge decrease and claims providers we're deferring care and our focus was not only on our members but also making sure that we could continue cash flow to providers. I'm going to give you some numbers I've sent you all I've tried to keep you all up to speed on what we've been doing as a company during pandemic I've sent you emails and mail outs but there are things probably that I've forgotten so if there's any questions please feel free to ask for with regard to claims. The first thing we did was we did advanced accelerated payments of about thirty eight million dollars to nineteen for profit hospitals and primary care care clinics across the state to help increase their cash flow. Additionally we have contributed more than or close to four million dollars in grants through our foundation across the state to help frontline workers this included telemedicine equipment for the our rural areas PPP for some of our hospitals infection control systems for hospitals and mobile testing and screening of our Kansans and underserved areas we also contribute contributed over two hundred eighty six thousand dollars to help with the Marshallese and Hispanic populations. We currently for fully insured business are about ten percent below are claims receipts from where we were post pandemic. However we've seen a ten fold surgeon telehealth claims. The total amount from March fifteenth through At let me just say September eighteenth of telehealth claims for fully insured business was twenty million dollars. Of that twenty million dollars slightly more than nine million were for the Arkansas works population. The mental health portion of those numbers for a fully insured business was ten point eight million dollars. And approximately five million of that was for Arkansas works so you're seeing a huge utilization for mental health services as well as telehealth. one of the things we put in place regarding telehealth was we not only expanded our telemedicine services for medical care and behavioral services we also expanded it to select therapeutic services so that more of our network providers could maintain relationships with their patients and also keep a certain level of cash flow. Many of the services that we are providing to our members through telemedicine are at no cost share tore members and reimbursement for providers as you know is the same as it would be for an in person visit. We did have to make many changes to our systems because they weren't program for that but we are still able to pay tae claims clean claims within that ten day time frame. trying to think if there's anything else A with regard to testing just a couple more numbers we've. For a fully insured group over five million dollars have been paid for testing. And one and a half plus million of that has been for the Arkansas works population. Inpatient claims FOR coated five million over four five million dollars for fully insured and nearly two million for the Arkansas works. Most importantly since the pandemic has has been occurring we have not canceled one single individual or fully insured group policy. So we have been absorbing that and using our reserves to help pay those costs claims are still coming in and we're still paying those claims but many people have not been able to pay their premiums whether they're individuals for fully insured groups. And with that I'll be happy to take any questions you have. Thank you have a question that I think Senator hammer also has question the figure that you gave about the for the five million dollars for mental health is that over and above what would normally be spent in claims on mental health so. Chairman Lowery. It's hard it's hard to measure I can tell you that prior to the pandemic the claims for telehealth were pretty nonexistent I mean they're just blueprint for not a lot of providers nor individuals using it. You know it wasn't as if providers could just turn on a switch when we we moved to telehealth well I I'm I'm sorry I was asking about the mental health you said bill there was one category of spending telehealth and then there was another that was mental health right and we have seen and up tick what that percentage is an the utilization I I don't know but I'll see if I can get that okay but there is an up tick which bears bears out what we've been hearing is that though there are costs related to cove ID they're also costs related to suicide prevention mental health you know the bill lot of concern about our kids not being in school all these things that kind of balance out the cost that we have of shutting down our economy and shutting down our schools all these things your figures bear out that there has been that up tick in these other other other areas because of code yes and and we've also seen an up tick and non covered related engagement people are getting services three telehealth we are seeing a pickup of in person services now and we you know we and others were you know we took the lead on trying when court courage people once the hospitals had re opened and providers had read open to go and see their to go ahead and and we see the care that they had been deferring but yes we're we're now seeing in person in person claims increase all still below but getting closer to the level where they were pre pandemic and on top of that we're seeing the surgeon telehealth continue okay thank you. Senator hammer. Thank you Mr chair on the tele health reimbursement for visit the it are the are the reimbursement rates for telehealth visit the same as a face to face visit yes Sir. Okay it do you pay for test for public health surveillance issues for. If they only remembers. or do you only reimburse providers if a patient is symptomatic. We pay we follow the CDC guidelines and pay for all FDA approved testing both the PCR test and the antigen test for medically diagnostic purposes when the order by a provider so even if you are not symptomatic Senator hammer if your provider because you've been exposed for for whatever reason if your provider orders that you have a test we reimburse for that a hundred percent okay and the number of the number of telemedicine visits. Did IT X. do you have data that shows that it exceeded what would have been face to face visits had it just been a normal environment or is there actually any way to to track that. I'm not sure I understand are you are you saying because it's because the options there they're getting services they maybe otherwise would have gotten the one thing I mean that and I'm just thinking has the availability of telemedicine. Shown an up tick that maybe would not have been there if everything would have just been normal so your so if you're paying the same thing are you paying out more now then you would have historically during this time if they'd all been just face to face this is. I don't think we have that information yet you know. As I said our claims volume is still down ten percent from where it was pre pandemic so I don't think we've. I don't think we've exceeded that that baseline number if that's what you're asking okay so I think the answer to your question is now okay and as far as any reimbursement to the insured because of the decrease usage there being no rate increases downward they've just held consistent is that correct. You get paid same on money that you were before the pandemic by for health insurance policies we are for those who are paying their premiums that is correct there are there are As of as of mid August we had more than ten million dollars in delinquencies but we don't we have not you can't change your rates in the middle of a of a plan year one of the things we did do is we I want to say in August we reimbursed to fully insured groups a percentage of their premium a percentage of their June premium and it deferred between small and large groups and that was based on making sure they obviously were up to date on their payments but we did give groups some relief because administratively it was easier to do that for individuals what we chose to do is continue pulling down from our surplus in order to offset the pandemic initiatives that we had put in place and remember we're paying not just coated but most of our telemedicine services are being paid for it a hundred percent so there is no out of pocket costs to the member which helps the member and also helps the provider because they're not having to worry about trying to collect that copay. And what we did was we wanted to use we we decided to look at twenty twenty one so that's why we requested just a two point nine percent increase for next year for our individual block of business do you anticipate getting that ten million backer you just write it off that you won't see it because they haven't been able to pay it you know we we are working with those people but you know what we're concerned about is making sure people keep their insurance especially during this pandemic and that's what we service or for you know what is it is particularly useful in times like this to have that. You know that money set aside so you can make adjustments were needed especially for those people who and and those groups you know we have plenty of small businesses who are struggling and they want to continue providing insurance to their employees okay last question that is back to what you're saying while ago about the the test and reimbursement to per reimbursement for only reimbursement only happens. If there's a doctor's order for that test so if I just roll up I'm paying that out of my pocket would I be better off just going to my doctor and saying Hey and I need to get a test so that you would then have to reimburse the doctor for it and it and it's totally with the doctor's orders only pathway for they get reimbursed is that right there there may be a way for you to get reimbursed by submitting a claim through our system I'm just not familiar with our with the way our claim system is set up for these but I think you know as far as recommendations you know I would defer to the health department on that I mean we've been we've been following both the state health department and CDC guidelines for testing and I think the the last thing folks want is for. What we want to do is make sure people who need to get tested get tested. And I think that that the backlog that occurred months ago was problematic on many levels so going through your provider probably serves many purposes. Thank you Mr. Thank you senator by senator Irvin. Thank you for such as long as I thank you for all the work that you all did really to you know jump and jump in and and March hard said transition and help people transition through the pandemic and so I do appreciate that personal that work and as you know I I appreciate the fact that you have also discussed the different ways that you were able to utilize the telehealth and Senate to help especially the therapy services the select therapeutic services and I think because we see that in medical care therapeutic services and mental health it's not a one size fits all it's just a cat it's not a one size fits all approach to very it looks very very different in each of those landscapes of what people need so and I I know that you'll have recognize that and appreciate that the is there any way to look at the claims and look at this geographically on the tele health issue and the reason I ask that is because I am so concerned about people that don't have broadband and don't have access to that or you know the technology that they may not have or obviously the fighters did not have but in some remote areas I know and speaking to some physicians and actually participating in some of the webinars that were held about the issue that a F. M. C. that you know that some of those positions are presenting during that weapon are said basically work how we have to counsel our patients to go sit in the parking lot at McDonald's and so. I just I don't know if you're claims data could provide a landscape geographically of the state of Arkansas and where you know there's more higher utilization or if that is a way that we could put those claims data into a geographical picture and overlay it over the state of Arkansas I would really love to know if we could do that because I think then that would indicate to me the disparity that's out there with the lack of broadband. And I don't know if you can do that or not but where I would love to see that I will be happy to pass and see and and the very issues you raised I know we've talked about internally because we've received the very that same feedback from not only our members but also providers you know they had to sort of re teach themselves how to schedule and and you know how to work with this telehealth side the system so I'll be happy to check with our claims department and but yeah and so many people just for not geared up to do that because of the lack of access for the that the patients had so but anyway I just I do appreciate that thank you Mr chair. Thank you senator. Representative Ferguson. Thank you Mr chairman of have it but the two percent decrease have is split cross calculated the medical loss ratio yet. For twenty twenty. Now serves you know I'm as saying it probably will be premiums going back to people some premium reimbursement maybe I'd I don't know that Representative Ferguson I know that for the first half of the year we were within one percent of what we were last year so I think it's premature to eat and start talking about what we're going to say because we don't know what's going to happen and one of the things I think we have to be prepared for is that when people do go and receive the care they deferred they may have other co morbidities that have arisen because they have put off getting care for so long so I think there's just a lot of unknowns right now but no we have not. I did have a question about the the Marshallese of grant was that for in patient care or what that was to the northwest Arkansas council they were putting together a program for the Marshallese and the Hispanic populations and that part of the state I think they were going that the grant was to help them hire bilingual community health navigators so I think it was to help get the word out and help people understand how to get testing and and you know maybe some additional information but it was to the northwest Arkansas council I have made the reason I ask because even though the covetous to spray the people are hospitalized and I don't have insurance they're still responsible for those bills so. Well that are uninsured you know can. It really he amend that involve like cross but the people that are uninsured or getting these big surprise bills to sign for the command com said Kerr had file bankruptcy so thank you. Thank you. What was the amount of that grant to the northwest Arkansas council it was a twenty six thousand dollar grant from our our foundation. How much twenty I'm sorry two hundred and eighty six thousand two hundred eighty six thousand yes okay. Okay yeah and that was and indeed in addition to what the legislature. Okay to the not northwest Arkansas council. That okay this is just from this is our foundation so I don't know what other funding they may or may not have received right. Okay alright thank you of don't see any other questions so thank you very much for the for the presentation. At this point I'm going to go ahead and turn the chair over to Senator Rapert so he can take is to the issues that were carried over from the previous and give you the rate to you as well thank you Mr chairman members at which I intend for us to go rather quickly and G. get to the point on this the under the next one this the contact tracing it and uh would like to go ahead and call up the Arkansas department of health representatives that are here to to give some more and sat on this and we also have following them up is is there actually a presentation dealing with some contact tracing opportunities or some technology to help with that that has been proposed it to help the specially to handle issues related to universities and a large population so Bill Hey I'll let you lead in and. Go ahead if you would both just state your name and who you represent for the record will proceed. I'm doctor Jennifer deal Hey for with the Arkansas department of health. Thank you thank you Mr chair my name is. Don Adams I'm with the Arkansas department of health on the deputy director okay A dot delay I guess in general if you just let you make comments about contact tracing first and then there may be a couple questions sure just give a brief overview of what the process. So when the health department isn't of received notification of a case and usually that's through electronic laboratory or hit or or fax we enter into our case database and it's a sign that unique number in that case each case is assigned a case investigator which is usually a nurse who contacts the case they interview the case and give them instructions about isolation then that case followed up with the contact tracer A who is assigned to them and follows Upton. With the case to get a list of their contacts and the contact tracers and contacts all of the close contacts and advises them about the exposure and gives them instructions about quarantine. So and so right now we have about a hundred and nine case investigators and with support staff about a hundred and forty eight and then we have contracts in place for and. A contact tracing and so we have about a seven hundred and let's see about actually about seven hundred and eighty five contact tracers. Thanks seven hundred eighty five total yes how much of those people being paid. I do not know the amount that they're being paid their with the contract with the General Dynamics information technologies Arkansas foundation for medical care some of them are with the college of public health. Well much access to Arkansas will let's call it what it is patients information to those contact tracers have. They wouldn't have direct access to their medical records or anything of that nature. K. but they are asking pretty specific questions about people's health. And it mostly it's the case investigators to ask questions about the patient's help those at the nurses and they'll ask them about A when their symptoms first began in order to determine the period of infectious nis and they'll ask them about co morbidities and set things similar to that nature. those people of what level of confidence that you have in the seven hundred and is it ninety eight. A yes So what sort of process you know. I actually dealt with the call myself as you know and so I'm getting calls from people around the state with different levels of discomfort in complaints about the process and so some of these calls just seem just way outside the bounds and so what level of confidence you have on who these people are that you are now. Basically they're being hired out but these other companies and they're calling up people about a health issue which seems to me how how are they complying with HIPAA. I guess is a good way to put that. So the they should be hippa compliant when they call they should be following all of the requirements of the contract which is to respect people's privacy so they're not sharing information about those contacts or the case is that they're aware of so the according to the contracts they should be at hearing to those requirements. J.. do you have any doctors because for instance I received a call last week that any church in Fort Smith Arkansas had received a phone call from someone identifying themselves with the department of health and stated that they wanted to talk with them about cases that were showing up from their church would that be a contact tracer. Would there may be a doctor that would be involved with that there's a one of our staff at the Arkansas department of health has been looking at outbreaks that are occurring in churches and reaching out to those churches to make sure they're aware of At. Transmission within the church and of. Helping them understand what the guidelines are encouraging them to here by the guidelines well the nature of this call was that the **** called me after receiving that phone call and I actually got some follow up from information coming to me but the call went generally this way did you know about several these cases that is shown up that had a connection to your church pastor C. yes I've actually called every single one of those people and invested with them to check on them and in it went further a week you know he could tell that she was beginning going to try to lay blame on the church and he said I want you also know that we haven't met for two and a half weeks. and so the call didn't go Mr the way the person want to go and so she asked the pastor DO you saying in church. He said of course we do. And she said have you been properly educated on the dangers of saying. In church. This for Smith Arkansas. It did you know that this is a line of questioning that that you got you are giving to churches. So one of the concerns about the spread of covert nineteen is that its aerosolized when people sing so we're strongly encouraging churches to either not seeing or to wear cloth face covering her body where one when they do sing well so this is breaking news for me today so I didn't know that Arkansas was actually encouraging churches not to sing. When did that start. Well seeing has been an issue ever since it was found that the virus has been errors allies so any organization that would sing we provide guidance service clubs churches schools that have requires Any of those they need to follow guidelines if they're going to sing. Well I would say that riding in and screaming at the top of your lungs not be just as dangerous but I don't see nearly the emphasis trying to stop that a lot of communities but well I just thought it was interesting that that that was the case you know I would ask that you all be maybe a little bit. More sensitive to some folks that you're talking to the the impression of many people are getting it's almost as if they've committed some crime of some sort when that church in particular by the way which you could probably figure out who it was now when you back and look it up they had been practicing the guidelines to such a degree I was advised that even lost some families that were strong members of their church because they had a media at Lee distance done all of the recommendations and so I just find it odd that that the questioning that's going on there and you know. Anyway I hold my comments on that Senator hammer I believe you've got a question Sir thank you Mr chair for lead to have their bean disciplinary actions against any the surveyors FOR them showing any bias or prejudice in the in skiing of the questions of those a call. I'm not aware of any okay and how do you confirm the source of the outbreak because with people that attend church or even you know that attend other activities where is it that you are what is it in the process that you state the outbreak started here. Sometimes it is hard to determine and At usually it has to do with the time line you know where to Kerr's first or situations where you have multiple people at the same spot but not other spots so it's a evaluation of the information that we collect and determine where they've been and what the time line the is. Okay and with regards to the schools and some of the things that are happening with the you know what to quarantine is going on of the US school not in my district but real close and they just had their whole kindergarten section set shut down I think I remember seeing one time that the seas CDC guidelines said that if you're four to six feet that was kind of the latitude that they gave that that's safe social distancing and all of our emphasis has been on the six foot side of things and the criteria is that in the school setting if you're within six feet outside of six feet and you're wearing your mask even if your name was on the contact list that that would disqualify you off the list is that correct that if you're six footer out and that you were in the mask even if your name was listed on the person who tested positive as being on the contactless at your name could be taken off. So me make sure I understand that if the school or the at the school gives a list of contacts and they're investigated and some of them are found not to have been within six feet for fifteen minutes or greater than we would take them off the list and not quarantine them that is correct. Okay. So do you ever seen a document and I was waiting forms Senate through to me because you know people tell you everything so on seat in writing do you member document from CDC that said that if it's within four to six feet that is safe social distancing I don't remember the four to six feet what I've seen is six feet and there's new medical literature coming out that questions whether six feet is sufficient. Okay because in the schools they're having a real hard time trying to condenser students you know what from a practical solution if it is for six feet that would give a lot of latitude to some the schools plus it would keep a lot of kids from being sent home on necessarily if it's documented that they were in a five foot range for example situation happened in a school or several kids got sent home because they were five foot they weren't six foot had a mask on but they weren't six they were at five and it just seems like that's pretty extreme specially CDC has a document out there that says you get the latitude to four to six I would just ask that you you know take a look at that and I know maybe there's some limitations of how much one on one conversation we have because the current environment but I think that would be worth looking at and give the school some relief and last question is this Max from Blue Cross blue shield was in here just a minute ago and if I understood right Mr chair you guys can correct me if I order wrong but when she was questioned about reimbursement for testing that it involved a provider requiring the test she made a comment that she files BlueCross BlueShield guidelines and CDC guidelines does the health department. Have any involvement in the reimbursement practices of Blue Cross blue shield or any other insurance company when it comes to who gets reimbursed for those test or the procedures by which it's determined that some that a a providers reimbursed for those test. I'm not aware that we do. I know that one of when we do tests we may also bill for the Blue Cross blue shield for our state employees. So. We bill but we don't tell them how the bill or what to bill. Do you know if the insurance companies have been reimbursed seen all the tests that you as the state health department have been giving as your reimbursement rate under percent sixty or do you know what the number would be. I don't know the exact figures I can say that we are collecting reimbursement for much of what we're billing for those that have a insurance source. Is that with or without a provider requirement or if they if they just show up to half feel sick and they've got the card and you guys are reimbursing without a provider requiring that just be given our our physicians within the health department or the ordering provider for those claims that we bill. So your reimbursement rates up there pretty good then as far as what you get I think it's the standard rates that that other providers receive yes okay alright thank you thing Mr. You. represent of Sullivan. Thank you Mr chair in our church local church had the same inquisition is yours to I'm over here how many people are we contact tracing today. He'd been help me on this So it would be. I don't know if I can provide you a number to that do you I can give an estimate okay that's fine based on the number of cases we have in a given day there are about two point one. close contacts per case so if you look at any given day how many cases we have with the five hundred to a thousand then that could you could get an estimate of how many. Contacts that we would have. And we get that two point one even though we're spending a whole classroom at a time that's the average of course many do not have the have less than two but two point one is the last figure I heard on the average number of contacts per case did you get that information for me and and along with an explanation of how you determine who's traced or not yes Sir and I guess in your weekly turnover. Would be equal to that your calculate that the same way yes Sir okay Thank you Mr chair thank you we're actually going to have a a presentation just following you and I hope I hope you're able to stay for that quickly which is in technology without any endorsement for me or not obviously it's it's interesting to hear it. I think it's a voluntary thing but do you it is number about to have represented Lundstrum ask a question I want you to speak make sure you speak to any weaknesses that you see in the process because I received another call. From a family who had had covert nineteen positive tests and they were asking you know they were upset. Because they had not had any discussion or contact whatsoever from the Arkansas department of health. And you know they were distancing they were isolating and all of this they had some delay in their test which was one thing but then they pointed out to me that you they hear all of these going remarks about contact tracing but it'd been a week. And she said if this is the standard experience. There's a lot of things that can happen in a lot of people that could be exposed because you actually have failed to to follow up it with them in a timely manner so what's your response that. Well. We are constantly working to improve our processes with the contact tracers that and then the course the contracts are new and so there's a learning curve for some of the employees but we've made good progress in reducing the amount of time that it takes from when a sample is taken it takes three four days to get to the health department and then from the time that were notified until the contact tracing is completed then we've reduced that to two or three days were doing much better than we have in weeks past. Okay Representative Lundstrum you're recognized. The ship but here thank you thank you I'm I had to pull of Senator hammer on you but I have a list of questions Sorry can. First of all I'd on contact tracing what's the average time now from the time the person test positive it's like we've heard in the past have been up I even had a German contact me he was contacted seventeen days after he was tested positive and that was early on so I mean there's all grace and mercy there of so what's the average time frame now. Some of that if you want me to try to address. Go ahead. So in our most recent weeks we have seen that the average time from the time we get notified at the whole department for the the initial case investigation that's where the nurse contacts the case is thirty six hours. From the time we received it to the time that's completed and then that's turned over to the contact tracing group afterwards and we're saying about a average of about. Most recent week it's nineteen hours from the time they receive the case to do contact tracing on they have to contact that case and get the contacts and then contact the contacts. And so that's down to around the day. So that has we're tracking that bye week and that has steadily improved over time both of those to case investigation and the contact tracing time has improved yeah that that's a definite improvement from this that these are averages so you obviously have people that we may not have the right phone number we may have trouble getting hold of folks and those sorts of things but these are average averages I'm giving is there a way to say if you haven't gotten a hold of that person and say the first twenty four to forty eight hours or three to four days that we just say stop because we're spending thirty five million we're spending a lot of money if you haven't gotten hold of men a week it's really not worth the time or effort. The other is a point where we we would not continue to to make any more affluent ma'am what is that point I think for the contact tracers they tried three times minimum is in the contract okay at different times during the day and then in certain situations we we if we have an address we can send staff out to see if they're at the address just not answering the phone so in certain situations we do that as well. we had talked about I believe it was in one of the A. L. C. meetings about having Marshallese and Hispanic translators how many do we have of each of those now. Within the health department we do have several Marshallese and Spanish translators but our contractors also required to have those I don't have those exact numbers but I know both contractors do have. Isn't that big a deal I mean we've got a lot of those folks around that's home folks now but Marshallese that's that's pretty difficult to you do have someone that speaks for both within the department and the contractors to have and we have bilingual translation services where we can call and get a third party on the line for all other languages and so that's also you let's get because in spring of schools right now we have thirty eight different languages being spoken so that's good There's been a big conflict or difference like for example we have a number of different when a restaurant is reported to have had a positive test it just means somebody went to that restaurant it doesn't mean somebody tested positive and they picked it up at that restaurant that's two different things that's a big difference correct how are we separating out that information between somebody just visited the somebody actually tested positive because it's all getting lumped together and that's not really truthful. When we do the investigation we're looking for clusters so if there's several cases that went to one restaurant we might look into that further but if there's just someone who happened to go to that restaurant and there's no cluster we would not think that that person got there got it got transmitted there okay. I'm. All the rest of my questions thank you thank you and I have got Representative cloud and we're going to wrap up with this is that we can get to the next portion this and try to get everyone out of here represent clout. Thank you chairman yes some over here US for of this whole process to start we have to have a positive test so I want to start with my question there. You get results from your own testing from you a images from commercial labs and in my personal situation dealing with the nursing home and you know we're trying to get in the nursing home to see our loved ones and we can't do it and uh it seems like there have been some issues of some false positivity so my question directly is does the health department consider all test equal we understand not all mastery cool all testy cool and and what kind of confidence level do you have in the testing results that you're getting thank you. Okay so there's two main types of tests that we use the PC are and the antigen tests so the PCR is extremely sensitive and that will find someone who it looks for the genetic material in it can multiply the copies of the genetic material till it gets enough that it can actually tested so it's very sensitive and that can help very much would diagnosing someone but it doesn't help with Determining when someone's well because they could have a residual positive that doesn't mean they're infectious so that has been an issue such as in nursing homes if the policy is in place that someone has to test negative so we do not encourage that. The engine test is not as sensitive so it can miss a positive case and so someone test negative but they have symptoms we would want them to get a PCR to confirm it. But with a positive test it can also be a false positive but it's much less likely to be the case so generally if it's positive we accept that is positive so we have confidence when we're using those tests and those that way and but nowadays there's a push to use the antigen test to screen people and more uncomfortable with that because of the. False negatives and false positives it's used for diagnosing someone with symptoms it's much more accurate in much more reliable does that help. That follow pleasure yet so it I understand what the plan rates chain reaction is I understand about all that But if you can if you have a positive PCR test from anywhere yeah I'll take that as gospel but that's my question no actually we don't there are some situations where especially if they've had a positive test before and they're still positive we would not take that is the true positive. If they had a test before in a test down that was positive right to so some some of them. Doctors or clinics or hospitals in the past have used a positive PCR test to after someone's already been diagnosed. Those do serial tests to see when they can get out of isolation and we don't encourage that because the subsequent positive test. A may very well be false positive so we would not accept those okay what what's your opinion then on someone that had a a PCR test yesterday it came back positive they had a PCR test today and it comes back negative. I would have to look into the specific circumstances of that. Thank you. Representative Lundstrum you're recognized for couple follow ups thank you I'll make this brief I'm. I've had a quite a few people that have asked me questions about hospitalizations and covet nineteen they've been hospitalizations due to people that have actually been it's due to cover nineteen and then there are people that check into the hospital for a variety of different reasons but also happened to test positive. Are we separating out those individuals. Because that's not those are two different issues somebody might be going in the hospital for cancer and they happen to test positive but that's not related to Kevin nineteen. my understanding is that when we talk about the number of people who are hospitalized with covert nineteen we do not separate those out and the reason is is because you still have to use that hospital bed and the precautions because they still could be infectious within the hospital under I understand that but when the governor announces we have so many hospitalizations due to cope in nineteen that's not really true for scaring people somebody that has for example I have a constituent that died of stage for lung cancer. Thank god of stage for lung cancer but it was report on their death certificate they died of code nineteen that's not true thank god of stage for lung cancer but they reported it is covered nineteen. We we have the governor standing up giving a press conference listing that is a death due to cope in nineteen and that's not true. I don't I'm concerned about that. All we can look into that to see if there would be a difference. To me there's a big difference someone we need to be talking about co morbidities Harper heart disease yes pressure diabetes those folks have a big market on their back but every day Joe not so much and so when someone checks in the hospital for covered nineteen and dies of actually code nineteen that's a reportable issue but just because somebody checked in the hospital with a broken leg and I by the way they test positive for Kobe nineteen. Okay. The hospital staff needs to know that but I don't know that we need to scare everybody else. That's. There needs to be some factual reporting and and I don't think we're getting all that information. and the death certificate issue is also a that's that's happening quite a bit people aren't need to get the full information and I'd like to see that information. If we could please. Okay so is your question about whether and the covered nineteen was listed as a underlying cause of death or is significant condition contributing to that I'm while I would like to have a broken broken down if that is the cause of death and we need state what it is if it's a contributing factor. Okay fine if it's what push them off the cliff we need to know that but some of this dying in hospice of stage for lung cancer they did not dive code nineteen they datastage for lung cancer or if they died of a heart attack and they tested positive for covered nineteen would be they died of a heart attack that's what they died of it would be separating that out listing the co morbidities that's a co morbidity that's that's part of the problem yes but what they died of this what they died out of but when you lump it all together and just say code nineteen that's giving the public false information we follow the council of state and territorial epidemiologists the way of classifying cobit debts and that is if it's listed as an underlying cause of death or a significant condition contributing to that so either one of those yes I actually sat up and listen to the CDC class and listen to how to fill out a death certificate and all the issues with filling out the death certificate some aware of those issues but percent presumptive. We need still have the facts and we need to make sure and separate that out so the public knows. The full picture not just one section of the picture. Yes ma'am. All right thank you Representative Lundstrum. They're gonna be continual questions and I'm going to follow up with you some on the contract tracer I definitely want to follow up I'm probably going to follow up with you off line I have experience with the contact Rascher we're in this is why I'm aware that this information is A person basically hassling former co would patient and I'm very disturbed about that but I would rather hand let off line with you in so I will follow up maybe with your government affairs folks to do that but I'm concerned about that's why I ask about what level of control for. Concerning be put into who's on the other end of that line call in that people in the state of Arkansas. Because probably it's a part time position. Is there and have they had a background check. I mean are you hiring somebody that has a criminal record it's called up investing with people and now have their cell phone numbers I mean it's really an issue. And and I want to know at what level it because it in this particular case I know this person represent themselves working for the Arkansas department of health when actually work for GDT I believe it is the way you pronounce that so that's a problem and and I'm just gonna concerned with you turning loose somebody with no training no background no prior health association whatsoever they're calling up and asking a bunch questions to somebody on the other end of that line. I don't like it it doesn't feel right it feels very wrong it just so happened some of the stuff this arriving in my own lap and and so I want to follow up thank you on that I wanna move right now and two of the presentation from the other folks on this issue because they do have some information to share with the committee and we apologize for the length of this meeting but there are a lot of issues and to try to let members get their questions ask you just happen offer see that we will be done here definitely by one fifteen and I'm giving probably even more time that we need but if sewer for everybody will hold tight that we're going to get the last few comments on H. and I then we will be out here so thank you for your time here today and so I think it is Mr closers and Mister Sanders I believe for up next and do you have a presentation loaded that you're going to do here. Okay she don't have a presentation recount okay to to first look at so with that if you would go ahead and state both of you state your name and who you represent for the record G. sorry GB cast with Mottola K. Bob centers with information network of Arkansas alright you're recognized. Thank you Sir for your time so I know it's been a long morning so we'll try to jump in and and B. can conscious of ice time so what would like to talk to you today is about an exposure notification mobile apps it complements contact tracing when you heard this morning and some of the discussions that the challenge with all this is about awareness so someone need to be no they've been exposed in a speed which they're made aware so they can take necessary actions to minimize the spread or exposure brothers and so we can do that we believe through a compliment after with technology there's ways that we can people can download an app it's in their pocket if you will with the phone and we can automate some of the process in it that would mean it to be a compliment to the current manual process which we've been here about what contact tracers so it what that would do would be a force multiplier if you will as well as it would meet our Kansans where they are meeting you know I'm forty I never leave home without my phone my kids are worse than me but they you know wherever I am my phone is with me and so through this mobile lab with the technology allows you to do is it's automatically sending and receiving unique keys if you will with all the other phones that around you so everybody who has the phone as the app on their phone would being essentially notifying each other in collecting keys that are unique and they're not identify to a person or to a location is just unique key that's being shared. And so that if we're in a meeting today and I'm walking around and all of us have the out of exchanged key information with you all and let's say three days from now I have symptoms I go get tested I find that I'm positive there's a way through the app that we could communicate with the department of health get confirmation verification code and then I could manually our of hit a button and ex push out a notification to everybody that I've that they've been exposed right there be near smite his been exposed. Now this is done through a API I don't get to technical but through a API with Google and apple that have come out if I see in the news that it's already available on your phone the end the ability to do this is on your phone what it needs is a user interface and a mobile out to overlay an access that capability. it's pretty simple could be deployed very rapidly we believe in and within four weeks would be user testing within eight weeks to be fully deployed across the state I've further you can a few other key elements this is completely voluntary. apple and Google have gone to great lengths to protect privacy and and not share PI is also a voluntary up so you can turn it on and turn it off when you want it's not forced downs there's no Big Brother it's obviously a concern with anytime you have a application like this. So that's mean at a high level that's kind of how the app works again we leverage apple and Google's current A. P. I. it's been deployed to several states already we're seeing more interest in this application and we would also Bob with this because we would work with apartment health and connect into process which we worked with the department health under verify would work using a cell phone number is unique identifier in a verification process that would allow us again to complement their current efforts and expedite the process. Bob you want to add in. just that as GB said the processes Voluntary bill for the folks opting into but also when you publish your notification that you've been infected that's voluntary as well so when they're you get notification by the department health H. your test was positive you can choose whether not to send that notification out and course the people that receive those notifications don't get any information about about the person that they were exposed to. And and the allowed to the technology is you so it's tracking how close and how long your help proximity so as in Sam's this week and sit in lots and in line trying to be social distance would be around a but we were in line for a few minutes and so I don't know those folks if you call me and ask me who we around I may be member a few people but as a large group of people that I may not remember or no so this also fills the gaps of some that we see a population that would be really a great target for this those and high school college younger younger folks we have anecdotal information from college students to read who've been tested positive for code or been exposed and the contact tracing efforts have not met the need they did answer the phone because they recognize the number became later than expected and by that time they were coming out of quarantine already I mean there's the the various things it's all kind of hit on so again we there's no silver bullet but we believe this is a complementary tool that can have multiplier effect especially for those forces the population that are always attached to their phone the last thing I'll leave you is finances the camera view times this morning this is a you know it is an investment and one time investment a relatively small investment a few hundred thousand dollars not millions and millions of dollars and it's a tool that once you have it it's in your tool kit kit for going for god forbid there's another pandemic correct you know or other outbreak of some site you can always position this in a way to use it in the future as well and if god forbid this pandemic continues on through next year you still have a tool that can be used in the next year you're not continue to re up and up you know as I would contact tracing your manual effort so I'll guess I'll leave it to you the committee ask any questions if there's anything I missed. During the Iranian for any particular questions at have you have you may presentation of this the department of health yes Sir we uh we've had a process with the department held the taking the transition committee and and there's several folks along the way department higher read we briefed in this room a couple months ago there seem to be certificate interest from higher ed as well after you can the meeting how they could use it inside their. Institutions. Represent Lundstrum did you have a question on this. Okay if an individual wanted to purchase and not a state descent individual chose to purchase it what would it cost so it's it's it's done by the app on Google only allows one per state an out and it's and it's deployed out overseas no purchased the good thing is there's no cost for someone to download it once is deployed okay thank you Mr was reason given as to why this is not been tried at the university level is for in with all of the emphasis on schools and getting back to the school and the students to come and in the issues there with you know bring them together in that way for for classes is there been any. I've not heard my conversations any issues or sick there's always been interest I think it has to be done about a state level so it's it's it's not I think is higher rate it's the state would have to a doctor before is there any comment from the department of health one way or another on this issue I'm looking for and not yes or no. I don't see anything that I need to know were yes. At what regarding this set I'm just asking is there is there any comment on this technology and that you might have that you want to address the committee with. Okay why don't you just come on up you guys stay right there and if you will at least address it because you know we're starting to see some major holes here with the current process and even for me some concerns with that so what about what about this it's a voluntary application. Not forced on anyone to use it sounds like it it costs significantly less than the thirty five million dollars plus maybe that's being spent so what what of that are you know the health department think they've presented to our technology committee I wasn't involved directly in those meetings so on still learning about this I think the whole department welcomes any tool to supplement what we're doing or to replace some of it so I think we're very open to to the US and I can see the benefit. Based on what I know well sounds like you maybe should set up a meeting to further explore that what if it's a voluntary opportunity in we have people now they're contain the reaching out again I I'm getting a lot of calls direct messages for people us at one stage or another of covert nineteen issue and one of the issues is the concerns and again I think you've got to full from the health department number one I think you need to make sure that you've got. People that are accountable there after making those calls you don't need to just forward out giving money for contracting you don't care I don't want somebody that's on probation or something out here to get a criminal record calling up people in the state of Arkansas and being given their names their addresses and their phone numbers for goodness sake I don't want those kind of people if they're gonna be good actors and so and I know I'm not snot the whole bunch okay but you got some folks out there that I think probably shouldn't be making making calls but this is sounds like a positive step that you could make it which could be complementary and he just identified the situation if it's voluntary and those people that don't even know each other in the line somewhere and it's voluntary they might want to know you know Hey I got two beings offer these people hand and and you're able to at least have some notification that they wouldn't know that wouldn't get otherwise so I appreciate the presentation appreciate you bringing it to bear and with this being is stated this given just one per state and so. It's the state of Arkansas has to make a decision is that one is that the position that we're in. Yes Sir it's I mean if the state of the state will likely for ADHD like before were were ready to roll I mean I said we can be user testing in probably four weeks and we've worked a lot of the issues apple and Google then continue to make advancements in their technologies to make it easier for adoption so it's even less expense no we talked about three months ago because the advancement apple and Google is made on their own on the operating system yeah and again you know I'm all about privacy and if it's something people can turn off on their phone they don't participate what and I I actually have turned it off on mine and when it first came because it in what what all is going to be going on with it so I think if we had our by pulled up you can see it on your phones today and so thank you for your presentations any last word or any last question or comment from anyone I don't see anyone on this particular issue so thank you for being here today on that thank you Mr chairman I will jump right in the last couple points on this H. and I got Mr John Benson is been so patient and I would I'd like to go ahead and ask the folks here we if there is anyone left from Amy Imbrie or Kevin o'dwyer because it's the same topic to come and just sit at the table we're going to have a couple comments on their perspectives on the hydroxy Cork when they stayed the last time and didn't get even to speak and I apologize that your state through this whole thing again today but I'm sure it's been very educational The sale of. And I know we're all hungry too so we're going to we're going to try to hit this pretty pretty quick I do want to it and and I appreciate the department of health FOR staying as well I may have you make a comment a minute if you want to what I just wanna let you know that since our last meetings I have continued to get phone calls and and this would be for the board and for the pharmacy board as well for medical board of pharmacy board I've got in particular one physician and green were Arkansas prescribed out rock sickle work when with the protocol for his patients I went to the Walgreens in Conway Arkansas and were denied to fill a prescription that was legally given by doctor in his practice to is patient on a medication that's been approved since nineteen fifty five has had no major problems with that in treating lupus patients rheumatoid arthritic patients but for whatever reason now you suddenly have a posture you have big box stores sometimes you're the main pharmacy and the community this denying people their prescriptions I have big well not necessarily bad but I have pleaded with the department of health to clarify their guidance on this doctor deal Hey I don't know that you wrote the guys I know you're here so you that you the number one today doctor Merle is not here we identify the last committee meeting Dr Meryl did send an email that was perceived as an absolute direction not to prescribe paradoxical work went to doctor young come we health department she quit and I know she may have had other reasons but that was the straw that broke the camel's back and she quit her position and he stated he had never told anybody not to do that before so there's a little bit of a bit of a problem there with the way that that went down I'm continuing to get the calls doctors telling me that they prescribed it and they're not. Filling the prescription I'm astonished in answer five I know that I've talked with the Mr Bentsen and he is advised me that he is educating pharmacists out there there seems to be a real problem with the big box pharmacies as opposed to the independent pharmacist so if you would now having laid up sort of the issue that that I'm seeing out here I'd like for all of you to please just state your name and who you represent for the record then I will let you get right to the point I start you Mr Spence. My name is John Vincent on the executive director or CEO of the Arkansas pharmacists association. My name is Amy Embry on the executive director of the Arkansas state medical board. Kevin a requirement attorney represent the state medical board thank you Mr Bentsen your first. Thank you Mr chair chair. So with the issue of pharmacists refusing to fill a drug court one I have heard the same stories and some similar reports of coming into me checking with colleagues since I first you know found out that this was happening we have been actively communicating to our membership our pharmacists throughout the last bout month and a half we had the zoom meetings and actually twenty I know you were there senator we had about Six hundred pharmacists on those calls this month it's Thursday our Friday interactions newsletter that goes out that our pharmacists you know have a high readership some Facebook message groups those kind of things you know the exact language we are using just for the record so I know you asked me to to share that is there is no ban and no directive against the use of Hydroxycut work winner Cork one in Arkansas for any reason it should be treated just like any other prescription either for the intended use or for off label use in that decision is course between the prescriber in the patient it's reasonable for pharmacists to counsel to potentially have communication with the local prescribers to understand the rationale but it would be unusual for our pharmacists to refuse to fill it just under corporate policy or Anderson blanket I mean maybe if there was a patient concern over some drug interaction there are some you know like with from this from this severe it's not recommended to use the two together in a patient be entry with covert because hydroxy corking can lower the the drug levels of the drug so anyway that's what we're doing we're communicating I've been in contact with both the independent sector as well as leadership with Walgreens Kroger CVS recently even this latest today Walmart and others and none of them have just blatant do not do it but there are things that you know communication that have come out that might have been misinterpreted you know by individual pharmacists there are also issues with insurance companies and P. B. M.'s that night and paying for the therapy you know for off label use and then the then of course the guidance that if in guidelines that come out from FTA and Arkansas department of health have certainly been interpreted or misinterpreted by some of the pharmacist so that's what I have to report today. When I appreciate you for making it stand by which the state of Arkansas would make is great in attempt to clarify the situation because frankly it is that continuing guidance that they've not taken down clarified that is leading doctors and pharmacists and patients in the confusion will have some questions if you'll hold here I want to go ahead and get comments from the our other presenter should they will just take questions all at once the in the day. We really don't have a lot to say were mainly here to answer any questions you may have but there are no restrictions on physicians to prescribe this okay have you had any again and I realize it is a very interesting dynamic. Because sometimes they don't want to bring something up to you right they don't want to be on the radar right with the problem so have you actually had anyone bring this issue to you from the physician community that answers to your board put it that way we've had. We've received about fifteen phone calls regarding this half of that is probably from physicians but it's more. Questions about it not necessarily can I can I not prescribe this that we receive no complaints. K. anything strode one I was sent out here on a August August thirty first when this issue first came up it out of curiosity I. called some positions friends of mine in Faulkner county and none of them were aware of any restriction whatsoever to prescribe this I don't know if I captured yes that you were speaking I soon not I could tell you top of mind you had information I could have the physician and the chiropractor who is the patient. And bring the pharmacy and I guess in the future but that mean that was Jones were Arkansas. I had a call from Harrison Arkansas. And it was a family who had been told to go home and take Tylenol. And nothing else and they were just begging for an opportunity for something that might be able to help them and they were totally couldn't have that this other some of it comes from Fort Smith and we've definitely had in little rock and Faulkner county is will and I think it's an issue have you communicated is a medical board out to the positions that you know there is an issue that's out there if you tried to to clarify anything with them. We have not taken a position on any medication regarding code nineteen with you could or could not that that really is on most Medications it's up to the individual physician to determine through his own judge of his or her own judgment what the prescribe would you say that it is a typical an unusual that you really have never faced a situation where this type of issue is now come up where the people are questioning the right of the physician to recommend a treatment protocol well I would say up until August thirty first it really hadn't. It would it has it hadn't come up to the medical but we just have not had that that question come up got a list of people questions would jump in on that sent to me Senator hammer's first on the list thank you Mr chair just kind of run down of a quick list questions here the medical association of the medical board. Is not has not does not intend to send out anything that would That would interfere with a physician or PCP in issuing this drug for treatment of cove it if that's what they feel is best practice for their patients I can't speak to the medical association we're not or the medical society but the medical board no. Okay and then secondly you have you or have you not received any directive from the health department that has limited or. Up give you permission to use this drug in the treatment of covert. No. Okay and if the doctor prescribes it treat you know whoever's licensed to issue the prescription of is there any legal ground for a pharmacist to refused to fill it. What that may be. Question for you we don't represent every I don't okay well Johnson there. I will. To your question about whether there's a legal ground or not I would defer that to state board of pharmacy which they're not up here right now but I would say that you know the state board of pharmacy John Curley in particular has been very collaborative on this issue and participated on all those calls that I've mentioned a minute ago and has been speaking and also educating pharmacists on you know their rights in and what they should be doing that kind of thing with their not banned to not do to the point I made earlier but terms of. You know can they not fill a legitimate prescription I mean there's a I would say there's some gray area of working with prescribers to you know to you know to counsel to you know it's very rare that a patient would actually go into the pharmacy with the legend my prescription and the pharmacist would turn away and less they really believe that they were exposed to fill it under certain some law. Is that okay with that answer your question so what is so there's no directive from the pharmacy board or from you in your capacity telling pharmacist do not fill this medication if it's prescribed for the treatment of code correct nothing coming from us and the board of pharmacy from what I've witnessed is saying just the opposite that there's. To I mean just the opposite of a band but saying that it's fine to do it if it's a legitimate prescription for an off label use okay so if you're going to pharmacy and they will fill it go find your independent pharmacists or go find another one that will and it's just be comes down to custom consumer. Consumer choice at that point welcome to call us or call the state the pharmacy board as well and file a complaint or file a you know concern if that might be a better way to put it that to reporter concern but yes I agree if you're if you're told that is a patient I would say to find the pharmacist you know by name that you ever elation ship with that is willing to work with your prescriber you know to provide the you know patient centered care you to serve okay last saying I had to church members in the last three weeks one of them she's a nurse works on a code unit he's retired fireman has emphysema as a result of his service as a fireman she tested positive for cove it and subsequently he tested positive for covert borderline be put in the hospital local physician prescribe this for both of them and that was on Tuesday by thirsty it was a total complete turn around and they would attribute their life being saved to the fact that they got this drug along with of steroid package most things but that's just a personal testimony maybe that's not scientific double blinded and all that stuff but I'm sure you two people walking around alive today because they got it so thank you. Okay Senator hammer there for in the queue Senator mark Johnson. Thank you Mr chair It is not without first address this to Mr Bentsen John you you heard the testimony on the thirty first. And you heard doctor Yang basically say that the the local family owned the the the local independent pharmacies didn't seem to have any problem filling it and the big box it was Walgreens wal Mart's that the corporate pharmacies which I really think tells a lot. It again I ask you to speak as a expert and and again you can't speak for the regulatory boards but in your experience and knowledge both as a practicing pharmacist and is the CEO of your so C. ation. Have you seen anything that would provide precedent to that type of accusation of me have you ever seen this happen before. US senator my answer to your question on is this unusual and I've I've ever seen this before in my career I've not seen anything quite like we've witnessed over the last six months with all of this but certainly with you know the controversy on hydroxy core going to court one and weather can be used or not some of the action that you know was taken in other states that wasn't taken here that you know we've not had to deal with but certainly there's been a lot of confusion and misinformation on this particular situation. Art and I'm ACT one expand that not just to to Hydroxycut for Quinn cloaking or any of the the quinine drugs or whatever have you ever seen a case where doctor writes prescription. And the pharmacy now I'm not talking about it they have some mitigating record of that person there might be a drug interaction worry or any anything along that line I'm just talking about a policy where that pharmacy said no we won't feel that prescription. The only thing probably close to this might be the opioids which I know there's a lot of controversy with that too so I you know I'm just trying to think through you know as you asked the question in my mind refer back but there has been some controversy about opioids are controlled substances because of the death and the guidelines that have come out in the D. E. A. under federal law has a corresponding responsibility for both the prescriber and the pharmacists you know under federal law and there's some. You know confusion or debate on what exactly that means but that be the only other situation I'm where and in one of the things John it jumps out at me is that we went from from Sudafed and be in a over the counter thing that was no big deal on a bike to get for the Sniffles and course we had a similar situation with that when we found that it was being. Shall I say harvested to create crystal meth and so I'm those types of drug abuse instances of side can you think of any in some other instance where a single medication was singled out at the maybe at the corporate level and set and they said no. Just controlled substances the only right thank you thank you for that and and the last thing that and it again I'm referring back to our minutes Mr chairman when Dr young. During the early and I heard this this is all anecdotal but I heard that in the early days of of of our pandemic back when the doctor felt she was telling her by it mass didn't work in and you don't need to be using them up. There was a House prescribe hydroxy four point. By. My physician. And he was very familiar with tropical diseases and that was why I took it in a prophylactic sense of. The pharmacist did not deny may that but I was told by some other people that because some physicians were now prescribing it that that the supply was somewhat diminished and that their worst fear from people for example I had a friend of a friend that contacted me about a relative that had lupus and was having trouble obtaining that and I believe correct me if I'm wrong Mr chairman but that you AM as had some kind of emergency supply that they could could provided in this person was able to get that but I and I I'm not. Faulting the fact that people that depend on this for their chronic disease did need it but were you aware of any instances similar to that that happened back I mean I know March and April was a different world but I just wondered if you had any information about the. So back in the March April time frame there were definitely major drug shortages of hydroxy core going all over the country you know for five months ago and certainly six months ago UAMS did through a tenant governor Griffin's office obtain that went three U. a mass a hundred thousand doses that were used both in a hospital setting and in the outpatient setting additionally those doses in the outpatient setting or reserve for rheumatoid arthritis patients and patients with other types of auto immune diseases because we had gotten you know to back to the question earlier back then are so she ation did get phone calls about patients with legitimate conditions that they were on maintenance meds for that their local pharmacy had run out like they just didn't have any and so at least early on those doses were reserved for those patients who were you know depending on it to be able to get up and go to work every day or to get up and be able to eat you know they have these debilitating diseases so that that's part of it and then forget was it that ensure question under. You will be the only thing and just he did this was a a supply management issue more than a a band or prohibition of any kind would be safe to say it that way yes that's true okay thank you very much miss Spencer thank you Mr chair we've got three left on the record in and and I will point out and and not in I'm not. Interjecting against anything spent said but I wanna make sure you understand it code nineteen and new Mohnyin diagnoses are legitimate condition okay you didn't mean to do that I know what you're saying is is normal I mean I know you yes that's right that's right want to say that so much and nobody got a hold of you and picked on there and and the other thing you know is it is with that that you know the FDA has not actually. Got there is no approved. Medication for still yet room disappear still experimental hydroxy Cork ones expert you know was out there it's been there but room discovers experimental so it's it's odd how that there is a an option it's coming from certain quarters within that that community to keep people from getting access to something that anecdotal evidence says they're living and so center but so I have you in the know get to more after you. Thanks zero. Thank you Mr chair of just in trying to understand why people are saying that to they can't get this medication would it be possible that as a physician who is employed by the hospital would have to go along with what the hospital wants him to score on a if they don't want this. And if they're not acknowledging that is truly something that helps. Of would that be a would that be one of the reasons why some of these patients aren't getting it it could be it would be and on the relationship the physician has with a hospital there contractual relationship would also you know I would hope that wasn't happening but it certainly could right do you have an opinion on that. A I agree it could I don't know any facts on that so I can't comment on the facts but it could alright thank you so much. Sir Bledsoe I investigated that in my own situation because I was advised that it was not available and that hospital I had been doing that the hospital ended up telling me that they did not make a statement on that but what you have happening is that some of the hospitals contract with a group of physicians and they may just decide to marks to themselves that the you know that this is a standard that that they have decided upon so was very interesting I could never lay my hands on any one that could back up the statement we're no longer doing that you know so it's a very good question represented Murdock and then I have one after you. Thank you chairman so. Listen to this and on August thirty first heard it first it well you know one Senator Rapert talked about in a doctor merit other guys here from AT ace to discuss the influence may be of what he thought or feel like was being put out there but but I went back to seems like now H. it when I first. When I first experienced is is cope with things back in March April whenever it was late March early April and I remember this comment up as my friends so that was the first one out here you that you guys it takes me or email me about different remedy so I heard this I drive to work in. Conversation and I heard both sides of it you know I chose to just not do anything says take Tylenol and and I was fine but in the end was never I would love is nobody spoke at what some people just didn't think it was a debate on the side of them say that but what what what what what is the ball off to now to me and I just watch this and after August thirty first I went in just is research myself with physicians I know farms is I know just to start asking questions about what they were feeling hearing and SO many things happen in our society it become politicized and I promise you all that's what is it is so far out of the barn now in terms of being a true clinical deal is not clinical no more is something else now so you have groups that take sides in fort different reasons and I watched you don't see any and I watched it on fox you get two totally different perspectives on the same thing night and day and is say at the we cannot independent bond now at this level professionals at this point on this date to get a true answer on some of this I I the that's the sad part of it so but the reality is you know I think you need to find someone that you trust of you believe in and you know from a medical standpoint pharmaceutical standpoint in trust and believe in them because now listing to somebody and even after Senator Rapert the mention what he mentioned you know I wanted I wanted not was this bean it what what Dr Meryl rolled how does this affect your actions and so I ask what is some of the most of them I say ninety eight percent of them interpreted as you know he was and they came back and he's not stopping us from the food we want to administer so they did feel compelled not to but I understand some might you know some might and then last add on is is. Sometimes because of people's assumptions a where we are with senator RAPERT may be where I may be political ID out they they would tend to I don't care who it is farms Dr they will tend to present to us a certain way based upon the politics of the day so sometime we have to break that down say hold on I'm not coming at you like that I don't care what politics are just this talk was true so but anyway that's just my commentary on I'll have a question that was my come here with Justin has evolved to and hopefully preferably of people can become can get over it if they choose to use a doctor prescribe it they'll get better and the doc in and if they choose another route that'll work for just press we will we'll have the better but now you guys is so politicized that thank you I agree with that statement present Murdock represent Lundstrum. Representative Murdock is spot on A doctor deal hate talked about come ability factors we had that discussion earlier one of the things that I'm concerned about is I would love to see people that have those quorum court co morbidity factors that have their the target on their back if you will be on hydroxy core clan I think that would be a huge help do you know of any state stir doing blind studies I know people that have had rheumatoid arthritis or lupus haven't had. Covered nineteen but do you know of any studies that are currently going on with the with those comorbidity factors and hydroxy Cork one I do not know of any specific studies right now I you know one thing I've asked several of the physicians on the board because there's a lot of special there twelve positions on the board lot of difference specialties on it and they kind of echo what you've heard I'm sure is that the evidence on how to our school one's kind of all over the map from a from a clinical medical scientific stand standpoint so I don't know of any of them that's particularly had a stance one way or the other on it but I I am unaware of the a specific. A study I'd I'd love to see something like that or in nursing home since that seems to be our most fragile population that would be a no brainer to do something and nursing homes The obvious population that needs serious TLC and we know Arkansans are dying. At a higher rate in that area and we have a premium research facility called you a mass that would be the perfect one to make that research happen. And I'm a big supporter of UAMS I'd love to see them do that knowing that ARE cantons are dying I have a question from another Representative texted me that with so many Arkansans dying why would we not prescribe hydroxy Cork and as a preventative treatment what are your thoughts on that well actually would like to get Dr delay to come as we closer down and maybe sit next to John grab a chair there and you can sure might push it back and forth because really that is a question okay absolutely is there I'd like to have thank you senator who was about to enter into an area don't need yeah I know is I know it is a medical board at you you're you're gonna end up saying we don't have a time run an office there. Yeah he's getting a chair there and I appreciate you being a gentlemen that and I think we're about to close out. Lundstrum appreciate me let me appreciate you let me interject that that's fine. Jennifer delay Arkansas department of health. So as a public health physician at the health department I have Decline from giving recommendations on individuals patient care our for those to you a mess. But I can tell you with regard to preventive treatment and treatment I would encourage my fellow physicians to follow the guidelines from the national institutes of health or the guidelines from the American college of physicians or the guidelines from the infectious disease society of America which all give guidelines for how to treat or prevent cope with nineteen. All three of them have convene panels that review the evidence and all three have recommended against the use of hydroxy Clark one for the prevention or the treatment of coke at nineteen so if a clinician of course they have the right to choose to operate or. M. practice medicine outside the guidelines but there are reasons that these guidelines are in place and. Panel the physicians have carefully reviewed the evidence and that's what all three of these groups have up done is two recommended against the use of it. She's to. I'm familiar with those because I I thought the same thing and and I'm still questioning because they looked at the late research what when it was given to someone later in the state and and higher dosage in that type of thing so I'm wondering if more research should be done at lower dosage and earlier on so I'm I'm questioning that so I'm open I'm open to education. So it would take research that would need to be funded and if an entity wanted to take an opportunity to do that I think I would welcome that thank you. thank you thank you doctor delay in eighty you said the three groups who you say state those groups again the national institutes of health the American college of physicians which is the group of internal medicine doctors of which I'm a member and the infectious disease society of America and so that's the the association or any of those three some of them for instance the one of the journal that recently retracted and apologized for their antagonistic article or negative article about out Roxy Cork one. I don't know which journal that was that was in the lancet not all of the lands as it is the British journal okay but but it also is a journal yeah I think they've been quoted there's more than one there are we would you at least acknowledge that there other groups sufficient physicians across the country that act salute Lee. Are contradicting what you state. contra directing that these groups have recommended again though no no no contradicting the big the guidance that you say not to use at Roxy core well I fences that these are good guidance that people should follow that's not the question but that's not the question but would you acknowledge that there other groups of physicians in this country today that absolutely contradict that guidance that you're talking about all right so is the to clarify that there's groups of physicians that recommend the use. I have heard of individual physicians but I have not heard of any professional societies such as these that have convene panels that recommend for the use of it I have been if that I'm I'm open to be educated if there are such organizations who have convene such panels. Well a yes he just co chair just mention workers from line doctors but of short and I know that they've been attacked on their integrity completely even though they have Melton's of anecdotal evidence they say well it's not a double blind study in all of this thing but the fact remains you do know in our state that that our country has the highest death in in the the world's best the highest recorded deaths and it may be that we're recording it better than some countries I get all of that but we also know that was a college and testified to in the last meeting that the countries in the world with the lowest deaths. Just also happened to be countries were hydroxy Cork when or quirk one is available on a regular basis for anti malarial situations actually that is not correct absent from Miller like you've done some studies that you last came so pleasing educate me. So fell super malaria which is the worst form of malaria around the world began to become resistant to Clark one and about the nineteen fifties so it hasn't been used widely hydroxy Clerk when has you know that not hi this is same mechanism jacks it would be so you're telling me all those reports that have been reported in the news I didn't want to get to this point argue with you but the fact is. We are being told that those countries have a lower death rates and lower deaths than our own country and they use anti malarial medications or regular basis they do use anti malarial medications but hydroxy Clark one in color plan. Have not been used in many of these countries around the world because the malaria is resistant and that has been for decades okay well I will tell you what there are tons of people reporting what I just stated in and doctor delay I won't argue further with the but I will tell you this I will say this is we in because we're not going to get you to concede anything but I want to tell you something. When you have doctors that are prescribing this this been mention Senator hammer I've got people tell me that they were prescribed this in hospitals here you had a doctor said here's a well respected African American doctor in the state of Texas that came and actually testified of what he happen in his nursing home. And they begin to utilize that I find it I find it very very troubling I want to stay away from some other adjectives that I've got this very troubling to think when there is no approved treatment whatsoever from the FDA. For the bi this kinda obstinate we've got people that say they have number one been treated with it and got better number two when physicians are taking it for prophylactic in our state right now. For your apartment. Anybody guiding you within the health arena in our nation. Say that you can't you something that might work in be tried. That that's borderline culpability accountability responsibility if not liability that may end up coming from some people at some point one day. It is very problematic is very offensive to doctors in this state who have seen it turn around in their patients. And you're not the one responsible for some of what you've been quoting. But the option it's in the fact that I have I ask and I have asked our governor multiple times to make you be accountable to clean up the language in that guidance that you've got when you say here and testified doctor Romero testified that he is not preventing anybody from doing this then I would have loved on those daily covert updates for him to have made sure he clarified this over and over again because we're getting people around the state that feel that you are saying not to do it. And to see that you're doubling down on here today it to me it shows obstinate to not willingness to be open just just as represent a Murdock look I really don't care your politics I don't care who you vote for but we have our Kansans that deserve to have access to an opportunity. To turn it around and to send people home we he and doctor hurt she the doctor Murdock represented Murdock in our different into the spectrum cheer he was able to withstand that virus better than I was. We've all heard that laid out here. Only thing I didn't have was get to a ventilator thank god but we had a different experience and I'm just saying it it's it's very bothersome you know my grandfather died from this in a nursing home. I know another member who removed his great they removed his grandmother from that nursing home by the grace of god and said never taking her back yet because multiple deaths in that nursing home and to know that that doctor Armstrong in Texas sat here and told you what happened is nursing home they took it to zero. Zero cases. It's just baffles me it makes me mad too if I wasn't so hungry I might be a little bit more passion. But I'm telling yeah I'm tired of this. It's offensive to me. And so look I just I just think that you ought to go back and clarify your guidance in that. You've got it written such that their people telling patients and arguing with doctors in our communities and our state saying we can't do it. They read it I. Well no you can eat but it reads as if you say you can't do it. Why would you not clarify that last question. On discuss it with doctor Romero thank you very much of Senator hammer you're on the list if you got one thing to add I got a question If a doctor prescribed the drug under question. Is he or she subject to having his or her Lysons withdrawn or not be able to practice medicine as it currently is now if that doctor writes the script fort in the patient can find of pharmacy to fill it. No repercussions against the doctor feed a likely not know me obviously just taken that as I'm writing this because I've got a patient with Covin nineteen and I'm gonna try this now okay used term very likely not which is pride don't know if there other extent but I'm just that as I clarified is eight if I've got a patient with code nineteen no other factors involved I'm just going to try this particular medication now. Would not have the license revoked not discipline not be called before the board. And if the patient says no because we know doctors that have done that. Okay so now okay alright thank you and and we're we're finishing at this point but is question want to make sure it's on the record under the transformation government transformation at just the medical board now answer through to the secretary of health in the state of Arkansas and some way. We still maintain a time to me I mean we still operate as a independent board but we do we are under the department of health it is that not the case also Mr Vinson for the Arkansas pharmacy board. It's very similar to what he described that's right so there is a. Dot dot dot in the you have this accountability and doctor delay you're very pleasant person I don't like to be in opposition to you on an issue and I appreciate all the work that you all are doing so many things but I I for you for doctor Romero respectfully he needs to get his own house in order and so I just feel like there needs to be a clarification on that and so represent Murdock I'd be happy for you to take a comment close yes so I have listened closely to. What you're saying and what the she's saying and. Let me ask you a question senator cause out because I I think I know the clear to you that you warning what exactly do you want to statement from them to be because what let me tell you what I'm hearing what I'm hearing is based upon their research and the guidelines and they've gotten that that's what's come back and they're going battles guidelines what I hear you saying is I know people that have used this drug I know physicians that is and if so your so what do you want them to say exactly what they can keep their integrity and not impugn what they need to it well and and thank you I appreciate your comments that'll be all we're gonna finish this time but what I will tell you is that there are other groups across the country that are utilizing this Representative Murdock you've seen that now they also testified here that there is no ban there is no hindrance but yet they allow language this would be much like you and me being held accountable for statute on the books were people are being prosecuted in a court and we're saying we didn't intend for that to mean that but yet that's happening or maybe we intended somebody to be prosecuted for crime but yet they're not doing it because the language is not clear and you have prosecutors making different decisions and what's happening is you have doctors and pharmacists that are at various levels of different decisions and a doctor that begins to be upset about the fact that he is prescribing at Roxy quirk when to a patient as a protocol in being denied by a in this case it was Walgreens but we also had a CVS so the thing is is that regardless of your opinion at least make your guide it's clear you you think that regularly you would boards are doing that now what what what both of them we're done with this today mean you can talk but but so we cut you mac off because we're done. And today as chairman so the the we what we need to talk about that further because we passed twenty minutes past here's where they're at their guidance is there is not been changed since it was updated months ago. And so the guidance I'm being told by physicians that they're having to Niles of their prescriptions and pharmacies. So you know you got a problem I don't understand why you won't fix it so with that thank you for your time we're Jr.