House Public Health Committee Part 2
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Would you like to go ahead and present Senate Bill 66, if
Speaker 2
0:07
you don't mind? Thank you, Mr. Chair. I'll try to make this as non-controversial and as quick and painless as possible. Ladies and gentlemen of the committee, I have Senate Bill 66 here before you, and I could have brought a big, you know, large dog and pony show in here, presented all kind of testimony and things of that sort that at this late hour in the session, I really hope would not
be necessary. We have thoroughly vetted this bill in the Senate. We had a full day of testimony on it there, and we've amended it a couple of times. But basically, let me explain to you what Senate Bill 66 started out to be, and then I'll tell you what it is. It started out to be a mandate on all insurance companies to provide this bariatric surgery services on all their coverages but as it's turned out what I've amended to do and we have gotten everybody on board to agree to it and as far as I know at
this point in time I have no opposition on the bill is to run a four-year pilot program through employee benefits division for the state employees and this and the Arkansas teacher health insurance plans to provide this coverage. It will sunset on December 31, 1917, which is four years from now. That is written in the bill. And what it will do is that employee benefits, the EBD division of DF&A, they will
set up all the rules and regulations and set up the parameters to conduct the study to do a four-year study of seeing if these procedures will provide some long-term cost benefits to the people that are in the program, and I think they will. Let me tell you, what it does, it covers, it's going to cover four different procedures
listed there on lines 24 through 27 on page 2, four different gastric bypass surgeries that are commonly done today, and it's going to set up a study to see if there, as I said, are any long-term cost benefits to the members and to the state. Morbid obesity has a definition, and it basically is being 35 or 40 BMI points, also 100 pounds
are more over your normal weight for your age, sex, body frame style, et cetera, et cetera. When you have morbid obesity, there are a myriad of accompanying factors that usually go with it, such things as high blood pressure, high cholesterol, diabetes, heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and many different forms of cancer. Studies all across the country have shown that folks who have this procedure within
one month no longer have type 2 diabetes after having the surgery done. And in this study as EBD will set it up and create and run, there will be many, many parameters And it will not be a cosmetic thing that anybody can walk in off the street and request to have done. There will be sometimes a year or more of preparation to get ready.
Going through an exercise program, a vitamin regimen, EBD will have all the knowledge and ability to set this up to run according to Medicaid rules. standard practices of the profession, and everything else. I'd like to bring Mr. Jason Lee from EBD up to the table. And EBD has not opposed the program.
They do not endorse the program, but they say that they will run the program. It's something that they have studied in the past. And with that, Mr. Lee, if you'll explain some of the parameters of the way it will be set up if we pass this. If
Speaker 6
4:42
you don't mind just stating your name and who you're with for
Jason Lee
Unverified
4:46
the record. Thank you. Yes, sir, Mr. Chair. My name is Jason Lee. I'm the Executive Director for the Employee Benefits Division. The actuary had looked at this,
Speaker 10
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and they feel that under a structured pilot program
that the estimated cost would be approximately $1.50 per member per month, so it's not a burdensome cost that they expect to have on the plan. Over the next few months, Employee Benefits Division along with our board would structure the program in place for this, but it's thought that we would adopt something similar to the Medicare guidelines. They require that non-surgical weight loss interventions must have been tried prior to
medical procedures like the lap band or those type of procedures. They also do require psychiatric treatment, dietary counseling, all of those things would be envisioned to be part of this program, possibly even along with a participation requirement that the member be on the plan for an entire year before they could have the procedure. So the exact elements of the plan are obviously to be discussed at our benefits committee and to the board. Those are public meetings that we hope to get input from various different people to
help structure the plan. And then, of course, we will have data analysis on the back end to see cost reductions, savings,
Speaker 2
6:16
the impact of the plan. And let me add this, and then we'll just open it up if you have any questions. We had a medical economist visit us in the Senate when we presented it down there. Their studies show, in the studies that they've done and been a part of, that there is a definite cost savings to not only the individual but to the employers, to the state, all the way around.
Because a person who has this procedure done, as I said, this is a measure of last resort. Most of them are ill many days a month. They miss work quite often. They are expending untold dollars in medical costs, not only for medical costs, but for pharmacy care. Once this procedure is done, those costs are almost rolled back to zero. And the economist testified that he predicts that between the third and the fourth year,
that the insurance carrier will be making money on these patients instead of paying out money on them. And that's what we hope to show through this pilot program so that then the private insurance carriers around the state also might be willing to pick it up and offer it as a part of their service as well. Thank you, Senator Jeffress.
At this time, we're going to go ahead and go to some questions from some of the committee members. Representative Lee, you're recognized for a question.
Speaker 18
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Thank you. How did you come up with, Mr. Lee, how did you come up
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with that cost? The actuary actually provided that cost to us. They were estimating as part of an unrestricted covered service that there would be one person per thousand that would be eligible for it. This was in the first version of the bill. They had estimated $14.5 million in the first three years. As the bill was crafted or recrafted to be part of a pilot program giving the board more
authority to have rules, restrictions, the possibly centers of excellence to get the cost per service down, they estimate that the
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cost would decrease to the $10 million over five years, but it was an
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actuarial provided number. And in page 2, line 21 and 22, well, 22, the coverage offered is going to be without limitation. So that's why I guess I understand actuaries are tough to come up with, but that is a concern to me.
Anyway, that's a concern to me on this. but you're saying the cost will go up $1.50 a month per every health insurance payment that we're making. So that includes, you know, like you and I have spoken about, the unfilled positions as well as the ones that have bodies in them. The $1.50 would be assessed
Speaker 27
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to only the people, obviously, that were enrolled in the plan.
Everyone's premium would go up by the $1.50. Now, one thing that the actuary did provide to us, though, was a statement that the $1.50 cost estimate is only the front-end cost allocation to the plan. It did not take into account any type of premium savings or cost reductions that may be achieved by the plan by reducing pharmacy
Speaker 18
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spend. My experience in the time I've been here is I've never seen DFA or anyone else use a dynamic type of figuring things out.
So I'm kind of surprised here that that's what you're using here, a dynamic scoring on what the
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eventual savings will be. They didn't provide that. The $1.50 is the estimated outlay for the plan
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and is not a net cost to the plan over the five-year
Speaker 31
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pilot. Five-year pilot? I'm sorry. Four-year. Four-year pilot. All right. Thank you. Thank you,
Representative Lee. Representative Lovell, you're recognized for a question.
Representative Buddy Lovell
Unverified
10:51
Well, one of my questions, well, I guess my only question, at that time was answered, the $1.50 per employee, could you tell me how many employees
Jason Lee
Unverified
11:12
there are that would be affected? MR. As of January 1st of
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this year, there were just under 30,000 enrolled employees on the state plan, 27,914, and there are 46,282 on the public school plan.
Representative Buddy Lovell
Unverified
11:32
So you're talking about 75,000 people? 75,000 employees,
yes, sir. So you're actually talking about $75,000 and then $37,500, so you're talking about $112,500 per year to implement this? I don't have the breakdown, but
Speaker 27
11:55
yes, sir. The actuaries estimate approximately $1 million on the public school and the state plan each.
Representative Buddy Lovell
Unverified
12:09
Okay. Just, I guess, a point of clarification. On page 2, lines 19 or 18, 19, 20, it says it would be on the health benefit plans that are issued or renewed after January 1, 2012. and it ceases to be, in fact, December 31, 2017.
Speaker 2
12:47
There's a level. You did some math that nobody else has caught so far. You're absolutely correct. But again, it's to be a four-year program, Mr. Lovell. It ends on December 31, 2017. EBD could still set it up to begin, though, in 2013. That way it would still run four years.
They may need a year to set it up. It doesn't have to run five years just because it says
Representative Buddy Lovell
Unverified
13:27
on plans it starts after this date. Well, once you get them to do that, I think you'd find that January 1, 2012 to December 31, 2017 is, in fact, six years. So, anyway, no more questions. Thank
you, Mr. Chair. Thank you, Representative Lovell. Representative Malone, you recognize.
Representative Stephanie Malone
Unverified
13:47
Thank you, Mr. Chairman. I have a question. What's the purpose of the pilot plan? Is it just to see the effects of these procedures? Because we all know the effects of gastric bypass and all
Speaker 2
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of that. We all see what that's done. So what purpose? But ultimately, Representative Malone, this started off as a mandate on all plans. But to show the plan or show the private carriers, to have them to buy into this, we thought, Well, if we ran a pilot program in a set group, that the results would show that there are cost benefits and savings ultimately not only to the individual but, as I said, to the employer, to the state, because those people are going to be working.
Instead of being off work, they'll be paying their taxes. But to the employer, which is the state and the public school systems, these employees will miss less work. So there are more benefits than just dollars and cents that will come from this program. But the ultimate goal is to show to the private carriers that they're...
Representative Stephanie Malone
Unverified
14:56
To have private insurance carriers cover gastric bypass surgery, is that the ultimate goal? Have them to
Speaker 2
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ultimately adopt it on their own rather than amend it.
This is not a mandate at all on them, but we're doing a pilot program to show that there will be cost savings. There are benefits to the plan that if they were to adopt this as part of their plans, that they could also see the
Representative Stephanie Malone
Unverified
15:19
same in their customers. Matt, I have a follow-up, if I may, Mr. Chairman. Thank you. If it is a pilot program, then why do we need to have a law on it? Can they not do this without a law being passed? If it's just voluntary and
it's a pilot program, I don't understand why we need legislation for it.
Speaker 2
15:38
The board has considered doing this. They just never have adopted it. But the law is more or less kind of the kickstart to have them to do it. But it has been
Representative Stephanie Malone
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15:51
something that they have considered doing. What were their reasons for not doing it? If they
Jason Lee
Unverified
15:58
consider it, why did you decline it then? In 2006, this was reviewed. And at the time, the trust funds,
Speaker 13
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the rate increases were going at a level that adopting any new covered service would have been cost prohibitive at that point.
But when the board was presented with this last month, they had no objection to the timing of it. So the reason you turned it down in
Representative Stephanie Malone
Unverified
16:19
the first place was because of the cost of it, but now if the people pay for it, the cost will be made up? Even at that
Speaker 13
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point, the costs were being absorbed by the members to the plan, but the rate increases at that time were, you know, already going to be rather significant, so it was turned down at that time, but we're in a better shape than we were years ago.
Okay. Thank you. Thank you, Representative Malone. Representative Mayberry, you're
Representative Andy Mayberry
Unverified
16:51
recognized for a question. Just kind of to follow up on what Representative Malone was saying a moment ago, if they turned it down before because of the cost, but now that has been alleviated to some degree, they'd had no objections to it if I understand you correctly you could go ahead and implement this without without this legislation is that is that correct
Speaker 27
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or that is the board's option yes but they looked at this legislation as and And we're not opposed to it. But
Representative Andy Mayberry
Unverified
17:27
not necessarily in favor of it.
Speaker 27
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They didn't say yes. They didn't say no. One member actually even said
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that this bill was simply encouraging them to do something that they had been thinking about for years.
So that they were okay with it. So
Representative Buddy Lovell
Unverified
17:49
that's a kind of yes? That was a kind of yes that I got. Okay.
Thanks. Thank you, Representative Mayberry. Representative Perry, you're recognized for a question. Thank you, Mr. Chairman. Senator
Representative Mark Perry
Unverified
18:02
Jeffers, during the pilot program, is there a way that we can track
the data? And, of course, you know, due to privacy laws and all, not actual people, but track the success of the program and find out, or Mr. Lee, you may be able to answer this,
Can we find out, you know, for the number of people that have actually had it done, what type of success rate that we've had? I've got several friends that have had this done, and two of them, it wasn't covered under their plan, and they paid for it personally and had a success for a while. But, of course, as time goes on, they've actually gained their weight back. Yeah, so it's, you know, they spent $25,000 of their own money and did well for about two years,
but after that, it's, you know, they're back to normal. Is there a way that we could track that data to find out over that four-year period, has
Speaker 27
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it been good? The short answer is absolutely yes. We have medical claims, pharmacy claims of the members that would be enrolled in the program. we will be able to in a secure and de-identified way compare pharmacy utilization you know all types of information see the savings to the plan
or net cost to the plan as we proceed through this thank you
representative Perry are there any other questions from the committee at this time represent Malone you
Representative Stephanie Malone
Unverified
19:38
recognize thank you mr. chair just to be clear there this is a dollar dollar fifty increase to state employees insurance yes okay so it is a fee increase and it is a mandated fee increase okay thank you thank
you represent Malone there any other questions from
the committee is there anyone here in the audience I'd like to speak for the bill against the bill
Speaker 2
20:09
Now, Senator Jeffress, would you like to close for your bill? Yes. Again, let me reiterate, this would be a measure that would be used only as a course of last, you know, results. I mean, people are going to have to go through a year-long or a longer period of preparation to qualify for this.
mental evaluations they have to go through a weight reduction program at the gym there will be many many different things that they will have to do to qualify it no one will walk off the street and walk into a clinic say I want this done and be able to get it done without going through a long time of preparation it's not cosmetic just for anyone that's the point I'm wanting make is for people that have they're at the end of their road and they're next
door to death already and this is the last thing that they've got before dying ultimately and but I think that this will show in the end that there are many benefits to it for those that have it done they become productive workers again they miss less work they're able to go to work pay their taxes be good citizens, be mothers and fathers and grandfathers and grandmothers and whatever to their children and grandchildren, just to be a citizen of the state of Arkansas in good standing.
So also keep in mind that studies have shown that for those people who have all these side related things like blood pressure problems, cholesterol, diabetes, heart disease, for For example, diabetes, within a month, after having it down, most people have normal blood sugar levels and no longer have diabetes. So I think that if we run this four-year program, we will be able to show that there are many
cost advantages to it, that in the long run that it would be a positive net result for the state to adopt this as a study. I don't think that we'll be disappointed when it's over. And I would just appreciate your consideration. Okay. Thank
you, Senator Jeffress. What is the will of the committee? Representative Lampkin, you're recognized. I make a do
Representative Sheilla E. Lampkin
Unverified
22:31
pass recommendation. Okay. We have a
motion for a do pass. All in favor say aye.
Aye. Those opposed? No. It sounds like the ayes have it. Congratulations, Senator
Speaker 2
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Jeffress. Your bill is passed. Thank you, ladies and gentlemen. And I do appreciate your time, and I'm sorry we've taken this long with it, but this is my last session in the legislature. I don't believe I've been to the Public Health Committee ever before. Maybe I have. I don't remember, but I haven't bothered you a whole lot, but I certainly appreciate your consideration today.
Thank you very much. Thank you. Thank you for everything you've done. We're going to go down to Representative Klemmer has been here all morning. So we're going to recognize her next. Representative Klemmer, you have several bills. Which bill would you want to have? I just want to do 20.
Representative Ann V. Clemmer
Unverified
23:27
I mean, I want, let me see. I have two bills. I'd like to begin with House Bill 2127 and see how it goes. Maybe we could just do that.
Is your committee coming back after? What House bill is that again?
2127. It's the second one on the agenda. We have about 10 minutes, so it
probably wouldn't hurt to go ahead and get going. Just this one. Go ahead and dive into it.
Representative Ann V. Clemmer
Unverified
23:52
That's fine. I have a guest with me, and just in the interest of time, I'm presenting this on my own, but I'm going to
ask her to come to the table. House Bill 2127 to the committee members, 2127. And, ma'am, if you can state your name and who you're with for the record, and you may begin.
Speaker 74
24:09
Thank you. Thank you, Mr. Chairman and committee. I am Raeann Fields, and
Representative Ann V. Clemmer
Unverified
24:20
I am Executive Director of the Bryant Area Chamber of Commerce. Ms. Fields is
here because she witnessed some of what I saw in my community as I prepared to bring this bill. This is probably one of the number one concerns of our employers. Let me tell you briefly what this bill does.
It extends the response time for employers to unemployment insurance claims. Current law gives the employer seven calendar days from the date, not from the date they receive it, from the date the claim is postmarked. So if it takes four days to get to you, as sometimes has been the case in Bryant, you have on your desk three days to respond to a claim that if you do not respond in time,
you are automatically accepting the employee's version, not the employer's version, of what happened to cause their departure from the company. What this bill will do is extend from seven days to ten days, ten calendar days, from seven calendar days, for the employer to respond. I would also like to point out that it does one other thing, and that is that effective January 1, it would allow employers the chance to reply online.
because with more and more post offices doing less and less on Saturday, there's an issue of having two days. You cannot get a postmark, not to mention the possible three-day holiday. Thank you, Representative Klemmer. Are there any
questions from the committee at this time? Representative Penards, you are
Representative Penards
Unverified
26:21
recognized. Representative Klemmer, what type of input on this bill did you have from the Department
of Workforce Services? MS. I had. Since you're changing,
Speaker 79
26:30
essentially, some rules and regulations.
Representative Ann V. Clemmer
Unverified
26:33
MS. Yes. Before I began drafting this bill, I talked with the director
of Workforce Center, and got significant input with him. I talked about trying to get 14 days, and he encouraged me to not do 14 days, but to go with 10 days. Subsequent to that, I talked
with Ron Calkins, head of workforce services, and originally we also talked about the possibility of seven business days, and they encouraged me, if I was going to extend the days, to leave it at calendar days because that fits their computer's program better than to shift to a program that would require business days. In the end, they seem to be very reluctant to accept this. In the end, they actually told me that a bill might not be necessary,
that they could do it by administrative – they could do it by rule. And, of course, my response to that is that employers would have really wanted to have seen that. If that was possible and they were willing, then they would have hoped that
Representative Tracy Pennartz
Unverified
27:49
this would have already happened. Maybe they didn't have the urging of a state representative like yourself. Perhaps. So I guess my question is back to the original question, which is are they in agreement with your bill or do they?
Representative Ann V. Clemmer
Unverified
28:04
I do not believe them to be opposed
Representative Tracy Pennartz
Unverified
28:08
to this bill. So they are neutral
Representative Ann V. Clemmer
Unverified
28:11
on the bill? I would say they are accepting or neutral,
however you want to put it. I don't believe they are here in opposition. They might be or they are
Representative Tracy Pennartz
Unverified
28:28
here to say one way or the other? The second question then, Representative,
is now they've got until January 1st of 2012
They have this website online application where you can do it, right? Let me say, yes, that is January.
Representative Ann V. Clemmer
Unverified
28:43
If I could just elaborate for a moment, claimants have had the ability to respond to their weekly claims online for quite some time. But this privilege was not extended to employers. Well,
Representative Tracy Pennartz
Unverified
28:55
maybe because they just didn't get the software and do it. But I'm a little surprised that employers weren't able to do it if it's done online. it's I know it's some matriculation of the software and that kind of thing but
so when would they have they would have to have by January January 1st 2012 the employer could respond online but not prior to that time that's just their
Representative Ann V. Clemmer
Unverified
29:22
deadline well it's in your
Representative Tracy Pennartz
Unverified
29:24
bill so that's that's what I'm saying it's in your bill that they have
Representative Ann V. Clemmer
Unverified
29:29
to do that by honor before January 12th
Representative Tracy Pennartz
Unverified
29:33
January 1st 2012 MS. Okay. But by that time, definitely, small employers could then, once that's instituted, could
do it online? MS. Yes. MS. But your timeframes would still be the same, even though you're cutting days off by doing it online? MS. I'm going to rephrase that question. I'm sorry. MS. You've increased the days that they can respond, the response days? MS. Yes. MS.
Representative Ann V. Clemmer
Unverified
30:01
additional days? MS. Yes, because everyone wonít be able to respond online. Weíve heard testimony over and over about how many people might not have Internet capability.
So some people will choose to continue to receive their notifications and respond to these notifications by mail. And I would not want to deprive them of that extra time, again, considering postal holidays and post office closures. Well, so no
Representative Tracy Pennartz
Unverified
30:25
one from – to your knowledge, no one is here from DWS today? Not that I've seen in the room, but
Representative Ann V. Clemmer
Unverified
30:33
I could be wrong. Motion at the proper time. Thank
you, Representative Penards. Representative Perry, you're recognized for a question.
Representative Mark Perry
Unverified
30:41
Thank you, Mr. Chairman. Representative Clemmer, is it available for workforce services? Is it available to file this
online now? I'm sorry? To file the unemployment online now?
Representative Ann V. Clemmer
Unverified
30:53
Claimants can – I had to help a claimant over the holidays with that. Claimants
can download the form. There is nothing available for employers to do online at all whatsoever.
Representative Mark Perry
Unverified
31:04
So by January 1st, they would be the employer – the
workforce services would have to have the website up and running so employers could do this?
Representative Ann V. Clemmer
Unverified
31:13
Yes, and they would – it also sends notification to them, and it is an option, again, not a requirement, but that they send the notification to them and that it give the response. What kind of cost to
Representative Mark Perry
Unverified
31:24
Workforce Services to implement this software to do that? They did not indicate that it was going to be
Representative Ann V. Clemmer
Unverified
31:30
a significant cost because, again, they are currently doing it for claimants. Okay. Thank you, Mr. Chairman. Thank you,
Representative Perry. Are there any other questions from the committee at this time? Is there anyone here in the audience that would like to speak for the bill, against the bill?
Yes You can come on State your name and who you're with Sylvester Smith, State Director of
Speaker 93
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the National Federation of Independent Business I'll be extremely brief As most of you know, we have roughly 4,000 members in Arkansas And I appreciate the concern about access to technology Because about a third of my members are not computer or internet savvy But this is something that we've heard lots of complaints about And understand, none of us are against people getting unemployment benefits.
I mean, most of them they work hard. They legitimately have earned them. But just imagine a scenario in which someone has stolen from you. They were terminated for that purpose, which would prohibit them from receiving a benefit. And you have a mother-in-law or family member that takes ill. You leave your business for five days to take care of that person. And when you come back, you find this form on your desk, and the deadline has been passed. And your costs are going to go up because that's the way unemployment insurance works, and you never have an opportunity to respond. We feel this is a very legitimate and reasonable request,
just this three-day extension, which would really only allow these small business owners the time that it would take for the notice to get from DWS to their doorstep. So we really appreciate your consideration and support. Thank you. Is
Speaker 74
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there anyone? Mr. Chairman, if I may. I represent a Chamber of Commerce. May I be recognized? Yes, you may. I would like to say that the Bryant Chamber of Commerce is certainly not the biggest chamber of commerce in this state, but we represent a group of very vocal people, and they are frustrated.
The small business owner, and I represent mostly those who are 1 to 10 employee groups, they're very frustrated with the system working as they see against them, and this is a consideration that they have been due for a long time so that they may have the same privilege of going online and doing some business in that manner and also getting a little extra time for those that can't go online. So we do ask your consideration for this bill.
Thank you. Thank you for that. Representative Clemmer, we need to wrap it up. Would you like to close for your bill? Can
Speaker 96
34:01
I just say one thing? Sure. South Carolina allows 12 business days currently, business days not calendar days. Okay.
Is there anyone else in the audience that would like to speak against the bill?
Representative Penarance, you recognize for the motion? Motion do pass. Okay, we have a motion do pass. All in favor say aye. Those who are opposed, ayes have it. Thank you, Representative Klinner. Thank you. And thank you, committee members.
And we've got about ten minutes to head upstairs, and we'll meet again this afternoon upon adjournment. Thank you.
Agenda
Documents
No documents posted.
Speakers
Representative Jon Woods Chair
Unverified
Speaker 2
Speaker 6
Jason Lee
Unverified
Speaker 10
Speaker 18
Speaker 20
Speaker 27
Speaker 30
Speaker 31
Representative Buddy Lovell
Unverified
Speaker 37
Representative Stephanie Malone
Unverified
Speaker 13
Representative Andy Mayberry
Unverified
Representative Mark Perry
Unverified
Representative Sheilla E. Lampkin
Unverified
Representative Ann V. Clemmer
Unverified
Speaker 74
Representative Penards
Unverified
Speaker 79
Representative Tracy Pennartz
Unverified
Speaker 93
Speaker 96