House Public Health, Welfare and Labor Committee
Video
Transcript
Bills discussed (15)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
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HB1764
· 5 mentions in chapter, transcript
Matched: “HB1764”
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Pre-2017 bill | ||
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HB1765
· 4 mentions in chapter, transcript
Matched: “HB1765”
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Pre-2017 bill | ||
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HB1598
· 3 mentions in chapter, transcript
Matched: “HB1598”
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Pre-2017 bill | ||
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SB722
· 3 mentions in transcript, chapter
Matched: “…t to be passed out. Mr. Chair, we're actually going to hear Senate Bill 722, and we're amending that. Oh,”
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Pre-2017 bill | ||
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HB1444
· 1 mention in transcript
Matched: “…d potentially run it on Thursday. Representative Wright for House Bill 1444. Don't believe he's here. And Representative Nichols, House…”
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Pre-2017 bill | ||
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HB1445
· 1 mention in transcript
Matched: “…1444. Don't believe he's here. And Representative Nichols, House Bill 1445, are you planning to run that today?”
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Pre-2017 bill | ||
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HB1485
· 1 mention in transcript
Matched: “All right, and Representative McLean, House Bill 1485 and 1486. Mr. Ratliff, I told you we'd get to you pretty so…”
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Pre-2017 bill | ||
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HB1789
· 1 mention in chapter
Matched: “HB1789”
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Pre-2017 bill | ||
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HB1810
· 1 mention in transcript
Matched: “…er of business representative Hutchinson has requested that house bill 1810 be on a special order of business this coming Thursday with…”
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Pre-2017 bill | ||
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HB1852
· 1 mention in chapter
Matched: “HB1852”
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Pre-2017 bill | ||
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HB1887
· 1 mention in transcript
Matched: “…ow that to happen and representative Mayberry has asked for house bill 1887 to be on a special order of business on March the 17th So w…”
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Pre-2017 bill | ||
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HB1905
· 1 mention in chapter
Matched: “HB1905”
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Pre-2017 bill | ||
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SB22
· 1 mention in transcript
Matched: “okay. Is that right? Senate Bill 22? Or 722.”
|
Pre-2017 bill | ||
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SB341
· 1 mention in chapter
Matched: “SB341”
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Pre-2017 bill | ||
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SB401
· 1 mention in transcript
Matched: “Senator Burnett for Senate Bill 401. All right, Representative Wrenn, I think you're up next at…”
|
Pre-2017 bill |
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Good morning. The chair sees a quorum. Let's go ahead and get started. I have a few housekeeping items to take care of, if we will. We're going to have a lot of work to do in this committee. We had 47 bills filed yesterday that's going to come before this committee in the House and 55 bills that were filed yesterday in the Senate. So let's get our roller skates on and we'll get some work done. I will let you know, though, that of the 47 bills that were filed in the House, 17 of those are clearly shell bills, and without objection, we're going to move those to the deferred list, and when you're ready to put some language in those bills, certainly we'll bring them up to the regular agenda.
we have two requests for special order of business representative Hutchinson has requested that house bill 1810 be on a special order of business this coming Thursday without objection we'll allow that to happen and representative Mayberry has asked for house bill 1887 to be on a special order of business on March the 17th So without objection, we'll schedule that as a special order.
Okay. We'll go ahead and move into our regular agenda. First on our agenda is Representative Webb, and I believe she's going to pass over on that bill today and potentially run it on Thursday. Representative Wright for House Bill 1444. Don't believe he's here. And Representative Nichols, House Bill 1445, are you planning to run that today?
All right, and Representative McLean, House Bill 1485 and 1486. Mr. Ratliff, I told you we'd get to you pretty soon, didn't I? House Bill 1598, if you would take your seat at the end of the table and go ahead and present your bill. If you
have some guests with you, have them introduce themselves for the record. I'm Representative Ratliff,
Speaker 6
2:13
and I've got 1598, and I've got a guest here to help me.
Speaker 8
2:19
Good morning. My name is Angie Foster. I'm an attorney for the Arkansas Department of Human Services. This is one of our
Speaker 5
2:27
bills. This bill is an act to clarify the authority of the Department of Human Service to recover cost of medical service from certain third parties and other purposes. Are you
through with the presentation? Yes. All right, members, do we have questions for Representative Ratliff?
I see a little scrambling going on. Of course, Representative Mayberry,
Representative Andy Mayberry
Unverified
2:58
I knew you'd have a question. Yes. I guess my question is,
Speaker 5
3:06
could we have a little more explanation, please? Oh, sure. This bill makes minor amendments to Arkansas law governing Medicaid's right to recoup medical assistance payments that's been paid by a third party. It amends Arkansas Code 20-77-301-302-303-304-305 to constitutionally use the words third party
and is or may be liable and dead. If I
Speaker 16
3:33
may, I'd like to give just a little bit of context
to this. If you would, please make sure your mic's on and get pretty close to the mic.
Speaker 8
3:44
I'm sorry. Is that better? Yes, it is. Thank you. I apologize. I'm sure the committee is aware that Medicaid pays for medical treatment for Medicaid recipients, and if that treatment was caused by harm or if that treatment was necessitated by harm that was caused by someone else.
Say if a Medicaid recipient was in a car accident and it was the other driver's fault and then the Medicaid recipient receives a settlement, Medicaid has the right then to negotiate with the Medicaid recipient to recover for the treatment that we paid for that was caused by the other person's actions, the other driver. And so this bill is just part of that subchapter of laws that allows us to
recoup those payments. Any other questions, committee?
Have you had enough time to digest all
that? Representative Wagner. Thank you, Madam Chair. Could you go through that process one more time of why you
Speaker 8
4:44
received the funds instead of someone else and how that process goes? Certainly. Under federal law and under Arkansas law, Medicaid is authorized to recoup payments that we've made for medical treatment, if the reason for the medical treatment was caused
by someone else, if someone else has harmed a Medicaid recipient, then we get to recover only for the past medical payments that we've made. And as a matter of fact, under federal law,
we're required to pursue these claims.
Speaker 8
5:17
And you recoup from whom? If there's a settlement, we recoup from the settlement. If there's a jury verdict, we would recoup from the medical portion of the jury verdict. Most of the time, it's from the settlement.
Thank you. Appreciate that. Representative Mayberry, you're
Representative Andy Mayberry
Unverified
5:40
recognized. What if an instance occurs where there is no settlement or jury verdict, and would you still be
attempting to recoup? No, there has to be that pool
Speaker 8
5:50
that those funds created first before we can recoup. Okay, so you wouldn't
Representative Andy Mayberry
Unverified
5:54
try to recoup that from someone who was a victim of an accident but had not received some sort of? Correct, not unless they get paid.
We don't get paid unless they get paid.
Okay. Representative Wagner, you're recognized. Motion do pass. We have a motion do pass. Okay. Anyone in the audience who wants to speak against the motion? Anyone in the audience who wants to speak for the motion? Mr. Ratliff, are you closed? Yes, we're closed.
All in favor of House Bill 1598, indicate by saying aye. Aye. All opposed, no. Mr. Ratliff, you have passed your bill. Thank you, Madam Chairman. Thank you,
Speaker 42
7:02
committee. Representative Murdoch. Representative Tommy Thompson.
Representative Lampkin, I think you're going to pass over and Representative Carter.
Senator Burnett for Senate Bill 401. All right, Representative Wrenn, I think you're up next at House Bill 1764. If you'll take your place at the end of the table and go ahead and present your bill. Thank
you, Madam Chair. Colleagues? If you will have your
guest introduce herself again for the record, we'd appreciate it.
My name is Angie Foster. I'm an attorney with the Department of Human Services. Thank
Representative Tommy Wren
Unverified
7:51
you. Representative Brin, you may proceed. Thank you, Madam Chair. Colleagues, this bill adds a definition section to the Arkansas laws governing Medicaid's right to recoup payment for medical assistance payments that should have been paid by another party. The reason for this bill, it's needed because there are no current definitions, current definition section. This bill defines terms already used elsewhere in Arkansas law.
This bill does not cost the state any money. There's no fiscal impact to this bill.
And with that, I'll take any questions the committee may
have. Representative Wagner, you're recognized. Thank you,
Madam Chair. the definitions you have given are the same definitions that are used in code in other
Speaker 8
8:46
sections is that correct the third party
definition of third party is used elsewhere in this same chapter of Arkansas law the term action claim or medical assistance recipient those are new definitions but what I would like to make clear is those terms medical assistance recipient and action or claim are used in this section of Medicaid laws, which is the same section that we were just talking about, but we just didn't have them defined. And who
prepared these definitions? I did. Okay, and could you give your title again? I'm sorry.
Speaker 8
9:21
I'm sorry. I'm an attorney with the Office of Chief Counsel for the Department of Human Services. The Medicaid program is one of
Speaker 30
9:27
my clients. All right. Thank you. Thank you, Madam
Chair. Any other questions? Representative Gary Smith. Thank you, Madam Chair. I have a motion at the proper time. Representative Lovell. We'll get back to
Representative Buddy Lovell
Unverified
9:48
you, Representative Smith. Representative Lovell. Yes. Could you tell me what the main difference in House Bill 1764
and the one we just passed on 1598? Are those almost the same thing?
Speaker 8
10:01
It's in the same section of laws, But the other, the 1598 is what I would call a cleanup bill to make certain terms to be used consistently. And this, that amends existing law, and this would add a new section and defines terms that are used elsewhere in this section of Arkansas law.
Representative Buddy Lovell
Unverified
10:21
Both have to do with the third party that may be liable for.
Speaker 8
10:25
Yes, all three of these bills, 1598, 1764, and 1765, all deal with our right to recover where a Medicaid recipient has been injured by a third party, and that third party should pay. Yeah, this could not have been
Representative Buddy Lovell
Unverified
10:39
done in one bill? I suppose it's
Speaker 8
10:43
possible, but, well, let me rephrase that. A definition section, it's always good to have that separately. Okay. Thank you. Thank you, Madam Chair.
Representative Smith, your motion please Do pass We have a motion do pass for House Bill 1764 Anyone in the audience who wishes to speak against the bill Anyone in the audience who wishes to speak for the bill Representative Wren, are you
closed for your bill I am, Madam Chair, thank you All in favor of House Bill 1764, indicate by saying aye Aye All opposed, no Representative Wren, you have passed your bill
Thank you. Thank you, colleagues. I think
Representative Tommy Wren
Unverified
11:33
you have another one next on the agenda. Are you planning to run it? I am. House Bill 1765? Yes, ma'am. Go ahead and proceed. Colleagues, House Bill 1765 is an act to establish the priority of the Medicaid program to receive reimbursement from third parties for certain Medicaid costs and other purposes. basically what this bill does it makes clear that Medicaid can recover only from the medical portion
of a settlement, judgment, or award this bill makes Arkansas's laws comply with federal law we've heard a lot about that during this session regarding how the money from a settlement, judgment, or award is to be distributed when Medicaid has a monetary claim the U.S. Supreme Court determined that Arkansas law and, in this regard, conflicts with federal law. Without this bill, someone could sue the state of Arkansas because our law is conflict with federal law,
and obviously we want to keep that from happening. This bill clarifies for our judges, our trial attorneys, and Medicaid recipients how the money is to be distributed and when Medicaid has a claim. This bill also correlates with existing state law to recognize Medicaid status as a priority creditor. Finally, this bill makes clear that Medicaid's claim and independent from any other party's claim for medical expenses
and that no other party can do away with Medicaid's claim. claim. DHS, the Department of Human Services, has worked with ALTA to develop this bill because trial attorneys who represent Medicaid recipients need to be
aware of these changes. So with that, I'll take any questions. Representative Woods, you're recognized.
Thank you, Madam Chair. Representative Wren, I have one question for you.
Is the recoupment for Medicaid dollars regarding your bill, is this just for current injury or
Speaker 54
13:37
past payments do man would you get close
Speaker 8
13:40
to the mic please I apologize it's for past medical payments do we don't recover for our future damages it's only for past thank you
representative Wagner you're recognized thank you
madam chair I'm looking at page 1 135 the department's
claim for medical assistance payments under this subject chapter has priority over any claim by a medical care provider is that what has been happening in the past and you're just putting it in writing or has it been the opposite
Speaker 16
14:23
There's already along the books Arkansas Code 2077-101 that says Medicaid is to be
Speaker 8
14:29
the payer of last resort. So the idea is already there. We just haven't had it expressly stated in the law.
What happens most of the time in these cases is that we work with the medical care providers to assure everyone a pro rata recovery so that if we provided 10 percent of the total medical damages, we get 10% of our claim, and it works the same way with their medical care providers, but sometimes we can't work that out. And so the only way that Medicaid can truly be the payer of last resort is if we're paid
Speaker 25
15:03
first after the attorneys. The attorneys get paid first, and then it would be Medicaid.
When you say payer of last resort, that makes it sound like
Speaker 8
15:17
you would be last. That means that we should pay last, that the Medicaid recipient needs to use all of his other sources of income in order to satisfy whatever needs to be satisfied, but if we are to pay last for medical services, then that means we should be reimbursed first if those services were caused by someone else's
action. So let's see. All the others pay first, then you, but then you switch it around and you get paid back
first. I'm sorry. I'm not sure I understood the question. You said you're the payer of last resort. Yes. So they look to all these other sources of funds to pay for it first, then Medicaid pays? Yes, ma'am. All right. But then when you get reimbursed, you're first, even though all the others have paid before you.
Speaker 54
16:17
You said you get paid first, your priority. Actually under the statute, trial attorneys are paid first.
Speaker 8
16:22
And let me put, under the statute as it is, trial attorneys are paid first and then Medicaid and then the Medicaid recipient. So this doesn't change that. What this does is to recognize that Medicaid should be paid before other
medical providers. All right. So the only people who have been out money would be Medicaid and the recipient of the
Speaker 8
16:55
services? The recipient of the services, when you say have been
Speaker 19
17:03
out money, they haven't paid anything for their services at this
point. Medicaid has paid. Medicaid has paid. Yes. The medical providers have provided services. Yes, and have most
Speaker 8
17:17
likely not. I mean, they haven't been paid or else they wouldn't
have a claim. All right. But has it been the practice that Medicaid has been paid first even though it wasn't
Speaker 8
17:32
in writing? Yes. Under the existing law, Medicaid is to be paid, as I said, after the attorneys but
Speaker 26
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before the recipient. that's been the practice yes ma'am thank you thank you
madam chair what's the pleasure of the committee we have a motion do pass on house bill 1765 anyone in the audience who wishes to speak for against the bill anyone in the audience who wishes to speak for the bill representative are you closed for your
bill i am madam chair thank you committee all in favor of house bill 1765 do pass indicate by saying aye all opposed no representative friend you have passed your bill congratulations madam chair thank you colleagues i don't think representative harris is here for 1768 and i'm going to take my seat at the end of the table to present 1789 Thank you.
Thank you, Madam Chair. You may present your bill when
you're ready. I believe an amendment is going around at this time, and we'll allow a moment for
that to be passed out. Mr. Chair, we're actually going to hear Senate Bill 722, and we're amending that. Oh,
okay. Is that right? Senate Bill 22? Or 722.
Mr. Price, correct me if I'm doing this incorrect, please.
All right. This is the plan we agreed upon a while ago, Mr. Price? Okay. Thank you.
Senate Bill 722, and I'll go ahead and have my guests introduce themselves for the record if that's all
Speaker 84
19:58
right, Mr. Chair. Thank you. Thank you, Mr. Chair. I'm Mark Riley with the Arkansas Pharmacists
Speaker 85
20:05
Association. Thank you, Mr. Chair, members of the committee. I'm Ron Fuller with Medco Health, one of the larger
PBMs in the country. And Mr. Hawkins, who represents one of the PBMs, is also here. Committee,
before you, I don't know if you all were like me, but when I came to the House a couple of years ago, one of the things that happened, well, folks pulled me aside and said, boy, one of the things you want to stay away from is a PBM pharmacy bill. And I want to tell you that maybe in the past that would have been correct, but I think
what we've been able to come to today is an agreed upon bill with the pharmacy association and the PBMs. And I, first of all, and I know we'll get into the bill and have an opportunity to talk about it, but I first of all want to say that I appreciate the fact that the representatives who are here from the Pharmacy Association and the PBMs have gotten together and worked so hard and come out, I think, with a very good bill. So with that, I just want to say thank you.
And let me just introduce the bill, and then I'll take any questions that we might have. There are a few changes in the bill. They are in
the process. Madam Chair, at this time I'm going to ask for a motion to amend the legislation.
Do I see a motion? A motion from Representative Lovell. All of those in favor for amendment to Senate Bill 722, please say aye. All those opposed?
Ayes have it. So, Madam Chair, please move forward with the bill as amended. Thank you. Thank you, Mr.
Chair. It's a little different down here, I guess, than it is up there. I say it's kind of like Wheel of Fortune being up there and here. You sit in that living room, you think you can do it just real easily, but you get in the chair and it changes. You've been there, done that.
Me too, many times. The bill predominantly changes the audit procedures with the pharmacists and the PBMs,
and I think I will let Mark describe the bill in detail, and then we'll take any
Speaker 93
22:34
questions. Thank you, Ms. Tyler. What the bill primarily does is what we have considered to be a fairness bill. We work with the PBMs to address some of our specific problems that occur in auditing. The bill has provisions to have somewhat limits on the size of the audits in terms of some
requirements. It has a provision that enforces the State Board of Pharmacy as a regulatory agency for pharmacy. It has provisions about how much recoupment can occur based on what actually happened and an incorrect prescription that's been corrected. And that's pretty much it. It is just kind of polishing off the edges on some things that were a problem for pharmacies that working with the PBMs, they've agreed to some changes that we think will wind up
be valuable to both sides in terms of conflicts. Do you want to
Speaker 85
23:40
add to that, Mr. Fuller? thank you madam chairman uh... for those of you that are in your third term you didn't know how difficult it has been for the form assist in the pbm stick to their goals i think our goals have always been pretty much the same and that's provide safe cost-effective prescriptions pbm's work
to keep cost down for your constituents and for their employers the form assist also have those very same goals somehow in the last few years have disagreed on how to get there but uh... with your chairman's encouragement with the encouragement of uh... speaker more we started working on this actually i believe back in november the bill that we have all accomplished and uh... mister hawkins and mr mullinex representing one of the other companies worked on this as well
what we achieved was what we think is a flexible and bill that will allow us to go ahead and conduct good solid audits that help save money while at the same time allowing the local pharmacists to go ahead and do the business that they need to do. It's a very common sense approach and I hope somebody takes a picture of all of us, me and Mark Riley up here together. I hope this sets a standard for us as those of you that are first-termers as we all move
through that Dr. Riley and the PBMs can work together, and this bill solved certainly not all of their problems, but a lot of them, it gave us the flexibility to keep working. We're very honored to have worked with Dr. Riley, with Ms. Wolf, and with Scott on this, and I think it is a very good bill. Agreed-on bills are very rare in this atmosphere, and I know that from my old days out here as a legislator, and I thank all of the input from everybody that gave us that.
At this time, I'd like to recognize Representative Gaskell with a question, please. Thank you, Mr.
Representative Billy W. Gaskill
Unverified
25:50
Chair. Four years of getting the hell beat out of us, and we're okay now, right? I admire you guys for doing this. At one time, I thought we would never come together, but we have, and I have read this, and you have done some miraculous work, and I just want you to know that I appreciate it, and finally getting a monkey off our back.
Thank you, Mr. Chair. Representative Wagner, you're
recognized with question. Motion. I'll make a note of your motion. Are there any other questions from the committee at this time, committee members? Is there anyone here in the audience that would like to speak for the bill, against the bill? I would like to make one quick comment. Being a third-termer, it is very rare to see everyone sitting at the end of the table.
And Representative Lovell and Doc Gaskell can agree with me and Charlotte. And
I want to say thank you to the PBMs for working as hard as you did in cooperating with the pharmacy and Mark and your hard work. So I appreciate that as well. So thank you. So at this time, I'd like to recognize Representative Wagner with
a motion. Do pass as amended. I have a motion for a do pass as amended. All in favor say aye. Aye. Those who oppose, ayes have it.
Unknown speaker
27:17
Congratulations. Representative Tyler, your bill is passed. Thank you.
All right, we'll go back to our regular agenda now. Representative King, are you ready to run 1800 and 1801 today?
No, I put them on the deferred list. Put them on the deferred list, all right. And I know Representative Hyde is passing over 1808, and we're going to do a special order of 1810. Senate Bill 386 for Senator Johnson. Senate Bill 296 for Senator Teague.
Senate Bill 341. Representative Smith, I understand you're going to be presenting Senate Bill 341 for Senator Laverty. If you would take
your place at the end of the table
Speaker 109
29:04
and we'll proceed. Representative Smith, you're recognized,
and if you will have your guest introduce himself
and who he represents for the record, please.
Representative Garry L. Smith
Unverified
29:33
Thank you, Madam Chair. Thank you, committee members. I'm representing this Senate Bill 341 for Senator Laverty, and I'd like to introduce my guest. Thank you, Representative Smith. My name is Dusty Maxwell.
Speaker 116
29:46
I'm with Pathfinder Incorporated out of Jacksonville, and I represent the Developmental Disabilities Providers Association today. Members, we appreciate the opportunity to bring
Representative Garry L. Smith
Unverified
29:56
this bill to you for the esteemed Senator Laverty. He couldn't be here at this time. He's in another meeting, and I'd be
glad to take any questions that might be from the committee.
explain a little bit of the
Speaker 123
30:23
bill? Mr. Maxwell, if you would, I think that might be helpful. Yes, sir. Senate Bill 341 is an act that would offer a provider fee on waiver revenue for the alternative community service waiver for developmental disability individuals.
Currently, the waiver serves about 4,000 children and adults with developmental disabilities. There is a current waiting list of 1,700-plus individuals on that waiting list. This is an opportunity since the revenues are flat, since DHS has not come forward and asked for more additional funds for this, to do a self-imposed provider fee. Everybody has agreed to it that our providers, the governor's office, has agreed to this.
DHS has agreed to this. It allows us to garner through the laws for CMS, rules of CMS, to put a 5.5 percent fee on our revenue, take that, create it as general revenue, and then match it three to one. This would allow us to pull down some individuals that are waiting for services. This is not a rate increase. this is not a fee that will hit the general public in any shape form or
fashion it will help your constituents who are currently on a waiting list to receive services I'll be
Representative Garry L. Smith
Unverified
32:00
happy to answer any question if I may madam chair this is a
self-imposed fee that the providers have agreed on thank
Representative Clark Hall
Unverified
32:11
you representative Thank you, Madam Chairman. What we're saying here, Representative Smith, is this is a bed tax.
Is this similar to what is called a
Speaker 123
32:26
bed tax? I guess. It is. There's not beds involved. It's on general revenue like what y'all did for the hospitals. Are you all
Representative Clark Hall
Unverified
32:36
about to close? Are you all losing money? Are they
Speaker 123
32:40
going broke? No, there's people waiting on services because of the tight budget system. Individuals cannot get off the waiting list. And if we don't start addressing that over the next two or three years,
we'll have close to 2,000 people on the waiting list not receiving
Representative Garry L. Smith
Unverified
32:59
services. There currently is a waiting list.
Let me read that there. about that could be an estimated time period up to seven years, over seven years for people to wait, and I
Speaker 137
33:12
think that's just doing a disservice to the people. Do you
Representative Clark Hall
Unverified
33:15
not agree? Well, let's go to, this is a one, two, three, four-and-a-half pages of new wording to the existing code.
Is that what we're referring to? Yes, sir. That is a major change in the existing statute. Would you not agree when you
Speaker 123
33:40
have about four-and-a-half pages of new language? Currently, the only state that has a provider fee for waiver services is Kentucky. There's about four or five other states that have applied to CMS for a provider fee on their waiver services. Oklahoma, we know, has currently two provider fees for waivers in their state at CMS waiting approval.
We took the language from the Kentucky Senate bill for this act because it
did pass muster with CMS. Okay. Well, thank you. Explain, if you would, the
Representative Clark Hall
Unverified
34:20
page 3 from starting at, I guess, from 7 all the way down to the bottom of the page on this fines and penalties. Because I haven't, to be truthful, I have not read this bill because of having other things on the agenda.
But could you read that and explain $1,000 fines, $1,500 fines? What does that refer to?
When you start finding people that
Speaker 123
34:53
that is the the same language of the bills that you have passed before for provider fees So that there's not a consideration of fraud Okay, thank you. Thank you, Madam Chairman And if I may
Representative Garry L. Smith
Unverified
35:07
representative that also gives them a reason to file in a timely manner. That's what that piece for
May I ask a couple of questions if sir it's a it's a percentage of the the gross receipts
and I please forgive me I'm just a little bit ignorant on some of these waivers and these fees so educate me a little bit if you will so it's a percentage on the gross receipts the gross receipts come from
Speaker 123
35:42
where the gross receipts come from the revenue generated from the current waiver, individuals on the current waiver, that the
providers receive. And the providers receive that money from
the state of Arkansas? Medicaid, yes, ma'am. From Medicaid. Yes, ma'am. So the provider gets, let's say it's $1,000, and there's a 6% provider fee that they tax on themselves. Yes, ma'am. I can give you a little bit
Speaker 123
36:11
of a breakdown. Now we have a projection on that? Just
kind of walk me through just a transaction, and then let's look at the breakdown, if you will.
Speaker 123
36:20
Okay. Well, it would be the gross receipts that the state has access to of what they paid out to providers in Arkansas. Then a 5.5, which is the current ceiling, would be applied to that. That would generate the provider fee, which would, in this case, be about $8,685,000. Then when it's matched, that would bring in approximately $21 million to the state of Arkansas,
which would go a long ways towards removing people from the waiver list. without causing a tax
Speaker 149
37:01
increase for the citizens of Arkansas on their Medicaid programs?
So I'm going to say back to you what I think I heard you say. The providers provide the service through a waiver process. The state of Arkansas, with federal matching money, pays for those services. The provider then assesses themselves a tax of 5-point-something percent
and pays that tax back to the state of Arkansas, for which we receive a
three-for-one match. So we receive the $8.685 million from the providers, and the state gets $21 million for that. Correct. Now, there are 46 states
Speaker 123
37:51
that use a provider fee in some form on their services.
This has been a way to access a percentage of money using the money. I believe in the current bill, the revenue package for budget, excuse me, for Congress, it would go down, go up to 6% in October of this year until about 2015, I believe. and then it would go back down to 4.5, and then three years later go down to 3.5.
Now, we all know that that budget is in some type of flux. We don't know what they're finally going to decide on that, but it's still there. We're trying to take this opportunity to set the mechanism up in Arkansas that if CMS approves this application for Medicaid, that we are able to do this. Currently, there is no new money in DHS's budget to reduce the number of people on the waiver. So if we don't try to do something, then the numbers are going to grow.
And more people will not be receiving services, which, in our opinion, in the long run, will probably create a more expensive individual
Speaker 116
39:19
for Arkansas if they don't get services soon. Committee, any others, any other questions?
Representative Hall, oh, I'm sorry, I'll get back to you. Representative Hall, I didn't recognize Representative Mayberry, if I may do that.
Representative Andy Mayberry
Unverified
39:40
Representative Mayberry. Thank you, Madam Chair. So just to summarize and make sure that I understand this correctly, Essentially, what we're talking about doing is using existing state funds to be able to utilize those to garner a larger allocation of federal funds that are already existing. With no tax increase, these are existing funds. Arkansas would just simply be getting a greater share of those to be able to take more individuals off of a waiting list for the Medicaid waiver.
Speaker 123
40:15
Is that correct? Correct. This is something that occurred earlier on and has been utilized, like I said, by 46 states. Congress has kept it at a minimal level, but it is definitely currently legal to do this. And we're saying that if they continue to do that, we would like to access that money to draw down on the waiting list. Okay. Madam Chair, I'd like to
Speaker 151
40:36
make a motion at the proper time. Representative Mayberry,
we'll get back to you at that time. Representative Hall, you're recognized. Thank you, ma'am.
Representative Clark Hall
Unverified
40:45
A quick question. Y'all referenced that we have a backlog of citizens who
need the services. How many do we have on the backlog list? Currently 1,700-plus
individuals, and it grows every month. How many,
Representative Clark Hall
Unverified
41:02
if this is approved and we participate, how many of that 1,700 that grows every month are
going to be entered into this program, have this availability of their services?
Out of the $1,700, how many of this, just take the $1,700, how many are we going
Speaker 123
41:28
to be able to take care of? Two? It would be about $10,000 a waiver package if we're able to do this. Again, this is an individualized plan where someone that would be at the top of the list and they're next in line, then they would have a team sit down
and decide what all services they would require. Then that is put into a plan, and then it is billed to DDS. Medicaid pays for it. So, I mean, I can't give you an actual number. We're probably pulling down about $25 a month, $50 a month. Dr. Green is here with DDS, and he knows
more about what statewide numbers this might be. Dr. Green, if you would take your seat at the
end of the table, introduce yourself for the record, and if you could help answer these questions, that would be great.
Speaker 160
42:22
I'm Charlie Green. I'm the DDS commissioner. For every waiver slot costs $10,000 in general revenue. This creates general revenue, in a way, once you pay it in, it turns into general revenue. So for every, and I don't have my glasses and I haven't looked at these figures, so I don't want to say, so for every million dollars we have in that created revenue, a hundred people will get off the waiting list, so.
Representative Clark Hall
Unverified
42:53
Well, how much money are we talking about creating, Dennis? You gave us a figure a while
Speaker 123
43:03
ago, didn't you? How much was it? The total, when matched, Representative Hall, is $21 million. All right. 2,100
Representative Clark Hall
Unverified
43:10
people is what you're saying. So that's going to take care of almost everyone that's right now on the waiting list.
Speaker 123
43:16
Well, if we were able to pull down all of that money, that would be true. But to get this through DHS, we had to share the money with them because, as you know,
they are quickly reaching the point that they can't afford what they have. So we're helping them out. We're
Representative Clark Hall
Unverified
43:33
sharing some of the revenue. How much are you sharing?
Speaker 123
43:40
Fifty percent. Fifty percent? Yes, sir. That's to go to Medicaid for other programs in Medicaid. It could also be used for the waiver, but this was a compromise between us, the providers, and the governor's office and DHS.
Representative Clark Hall
Unverified
44:00
Okay. Thank you, Madam. chairman representative King
you're recognized thank you madam chair dusty you care to look at page four and just explain it to me if you'd be explained it to me I apologize page four line 24 the designated account monies in the trust fund from the provider fee imposed collected from this sub sub chapter shall be exempt from budgetary cuts, reductions, or eliminations caused by a deficiency
of general revenue. Can you explain that? Well, it's self-imposed. We want to make sure that, you
Speaker 123
44:41
know, the department has the ability to move money around in their budget. This locks it in where it is going for what you want it to go for, which is developmentally disabled individuals, to get off the waiver. This is to protect that so we have a stream of funds that will be dedicated to those individuals. So since we're using our own money to do that with, we felt like it should be dedicated
to that purpose. So you're just making it solid in there. What if the economy turns around and we have to
Speaker 165
45:15
make some changes? Are you making it where
Speaker 123
45:17
we can't make changes to our general revenue that would affect this? Is that what you're saying? Well, if the economy changes for the better and revenue picks up, then I'm sure DHS will come over here and try to ask for additional funds for their Medicaid program, we're trying to say that regardless of what happens, if this is successful and CMS approves it, that
our funds that we're putting a fee on will stay for that purpose, that it won't be in a trust fund and will not be
used in the Medicaid division for anything else. Okay. Well, thanks, Dusty, as always, for your answers. Can you explain to me line 30 through 33? Is that basically saying that if the federal government quits this Medicaid or this program that basically this goes away? This
Speaker 123
46:08
goes away. Okay. Thank you, Dustin. And, Mr. King, this is all standard law.
And, again, we took out of what was the law currently that has been passed by this body for nursing homes and intermediate care facilities and hospitals, and this was also what was done in Kentucky.
And we know that CMS approved
their request. Okay. And I'm sorry to back up. If we wanted to, for some budgetary reason, stop this self-imposed fee to get this money from a state perspective, then we would have to pass another law to eliminate or undo basically what we're doing
Speaker 120
46:45
if we wanted to address that, correct? Well, we
Speaker 123
46:50
would either amend the law or the funds would be not collected. So, I mean, it would go away. Now, I would imagine that you will have, if that's true, X number of constituents coming down to ask you to continue their services. Sure. Okay. Thanks, Des. Representative Wagner you're recognized Thank
you Madam Chair Most of my questions have been answered
by Representative King's questions but a couple of items you said
that the fee may just go away would be one way but I thought there were penalties if they did
Speaker 123
47:31
not pay the fee The fee would go away if Congress decides to do away with this program Currently, current law allows it, current law goes up to 6% of the revenue that you can put a fee on.
If Congress continues with their recommended budget from the White House, then over years it would go down to 3.5. Now, that would end up in 2018 or whatever. That's a long time from now, and there's a lot of things that could happen between now and then. But we're trying to say that if we pass this bill and CMS approves this plan, then we want to be able to access this to draw down funds to eliminate the waiting list as much as possible.
Thank you. And the other item that you mentioned was that you wanted to ensure
that those funds would be used for your purpose. Correct. That you stated here, but actually only 50% would be used. Is that correct? Okay. Well, yes. Thank you. Thank you, Madam. But that doesn't
Speaker 123
48:38
stop somebody else from going after DHS's 50 percent. I do
have a follow-up question to that, if I may, and Dr. Green, this might be for you.
The balance of the 50 percent, does that go
into the DHS budget as income and as general revenue? And tell me a little bit about that. Well, and I
Speaker 160
49:02
don't want to give you a legal opinion on that whole special language thing that some of you guys have asked about, but it basically goes to pay for it. It can pay for anything in Medicaid, and it can go in a special trust that would end up being the same as general revenue that you would put in Medicaid's budget.
So if it generates $5 million for them, then that would just be $5 million that the General Assembly would not have to give them in general revenue.
And you're speaking to the 50% that's not going to DHS? That's correct. That's going to DHS.
Speaker 160
49:43
That's correct. That could go for ongoing hospital medical programs, any programs they have that they pay out that we know they're going to run a deficit here. in the second
Speaker 175
49:53
year of the biennial so okay representative Lee you're
Speaker 176
49:57
recognized thank you madam chair I appreciate what you guys are doing or attempting to do I have a question if if
Speaker 177
50:08
this bill passes do you have the personnel and the facilities to deal with the incoming people in place absolutely okay okay thank you thank you madam chair and thank you for that question I have one other question I'm sorry that I know the chair is not
supposed to ask that many questions but I just do so let's assume we pass this and let's assume we get the additional 2,100 people on waiver and the federal government decides they're not going to do this anymore, what do we do with
all those people that we're serving now that we may not be able to
Speaker 123
50:57
serve in the future? Well, of course, that's not an easy question to answer, but if that goes away, number one, it hasn't stopped the individuals
needing the service now that hopefully that we will plan out better if that's coming down the road. All of you know that have community programs in your towns and in your areas were created to do this for the state of Arkansas. We have always been there for your constituents who are developmentally disabled. We have always worked in concert with the state on providing services
to those individuals. We will continue to do that however, whichever, whatever way we can. And that's the best way I know how to put it. We have always done it, get more out of a penny than most programs in Arkansas, as you all know. And I think we do, all of our providers do an excellent job in your communities and I'm
Speaker 116
52:05
sure most of y'all have already been by your community programs and know that to be true committee I see
no further questions what's the pleasure of the
committee oh I'm sorry representative Mayberry you have a motion we have a motion do pass anyone in the audience who wishes to speak against the bill Anyone in the audience wishes to speak for the bill? All right, then the question is House Bill 1765. Sorry. Thank you, Senate Bill 341. I know it's Wheel of Fortune. Senate Bill 341, indicate by saying aye.
Aye. All opposed, no. Thank you, committee. You're welcome. Representative Smith. Thank you, committee. Thank you very much. Representative McLean, House Bill 1830 and 1831 Representative Nichols, House Bill 1839 Representative Rice, House Bill 1840 Representative Roebuck, I know you're here If you will take your seat at the end of the table for House Bill 1852
Representative Roebuck, welcome to public health Thank you,
Madam Chair. If you will have your guest introduce himself and the organization he represents for the
Robert Breck
Unverified
53:40
record, please. Certainly. Thank you, Madam Chair. My name is Robert Breck, General Deputy Counselor for
Representative Johnnie J. Roebuck
Unverified
53:48
the Arkansas Department of Health. Thank you, Madam Chair, members.
Four years ago, I said at the end of this table, and I brought you a bill that would authorized voluntary reporting of health care associated infections. You were kind to pass that bill out. It went to the floor and on to the Senate where it became Act 845. So you may ask, well, why are you back? Well, I'm back today because we have worked so hard, and when I say we, I include myself in those people because I've followed their work so carefully.
In that act, 845, we actually set up an advisory committee on health care associated infections. And that advisory committee worked for many long hours to put together the rules and everything that went into that data collection and analysis methodology for those health care facilities. And I'm pleased to report today that that's been a very successful venture. So we're back today with the Department of Health and others that are in the audience to support this bill to ask that you now require that health facilities that participate in the Centers for Medicare and Medicaid, the inpatient quality reporting program, and that they make certain data available to the Department of Health.
And with that, Madam Chair, we'll be glad to take questions. We have others in the audience that certainly are here to support this bill and to answer any questions that the committee may have. And I would ask Mr. Breck if he would make also some
Robert Breck
Unverified
55:34
opening comments. I believe Representative Roebuck covered it very nicely, and I'd be happy to answer any questions
that you might have. Committee, do I have any questions? Representative Allen, you're recognized.
Motion at the appropriate time. Motion at the appropriate time. Anyone in the audience want to speak against the bill? Anyone in the audience wants to speak for the bill? We have a motion to do pass House Bill 1852. That is
correct. All in favor indicate by saying aye. Aye. All opposed, no. Representative Roebuck, you've passed your bill.
Speaker 42
56:25
Thank you, Madam Chair. Thank you, Committee.
He's not going to come. Senator Crumbly for Senate Bill 459. Senator Key for Senate Bill 722. We've already done that one. Thank you. Representative Johnston. House Bill 1872. Representative Letting.
Skip. Both of them. All right. Ladies and gentlemen, the agenda online is correct. The agenda in your packets, they have left off a couple of bills. The staff, I think, is going to hand out the agenda, so you have
that. But next up is Representative Woods, and he's going to be presenting House Bill 1905.
Do I? Thank you. I have
it. Representative Woods, if you would proceed. Thank you, Madam Chair.
Thank you, committee members. At this time, there's an amendment being passed out. We discovered in the last 24 hours just a few grammatical errors on page two we're changing he to thee and and then on page three we're changing
made a shout and then we noticed on page seven that we we compromised or we worked together with the Press Association they asked us to take out lines 18 through 21 they just said it wasn't necessary because privacy laws were already covered under HIPAA so we're just kind of redundant beating a dead horse so they actually helped clean the bill so we went ahead and removed that out and I would appreciate a good vote on the amendment ladies and
gentlemen we'll take up the amendment does everyone have the amendment yet not
yet okay we'll give that a moment to get in your hands All right, we're ready to take up Amendment 19, Amendment No. 1 to House Bill 1905. Representative Allen, you're recognized. Thank
Representative Fred Allen
Unverified
59:48
you, Madam Chair. Move adoption of amendment.
We have a motion to adopt Amendment No. 1 on House Bill 1905. I'll indicate by saying
aye. Any opposed? All right, Representative Woods, you may
go ahead and present your bill. Thank you, Madam Chair, and thank you, committee members. Today I have, to my left, Director of Office of Health Information Technology, Ray Scott, and Representative Mark Viviano is here as well, who has a background and is passionate in this area.
So I'd like to thank both of them for coming. And I was in my neck of the woods. Health records are a pretty big deal and pretty important. And in the last year, I've become more and more educated on the importance of electronic health records and the importance that our country and Arkansas move forward in health information technology. And I feel very privileged to be carrying this piece of legislation, which is part of the governor's package.
And it's a small bill, but it does quite a bit. And first, what we're going to be doing is establishing the Office of Health Information Technology, which already exists currently by an executive order, which is part of ASTA. But what this bill will do is break it off from ASTA, and it will be a standalone agency. And then the other couple aspects of this bill is that once that's done, the Office of Health Information Technology will construct a health information exchange,
which is a which is called we'll call it share state health alliance for records exchange an exchange will have a list of duties and responsibilities and oversight to help different a state agency or different private sector groups different hospitals communicate with each other around the state the department of a this new agency health information technology will bridge the gap between the government and different executive branches and aspects of
government so it covers two big areas another area that this bill will do is create a fund and the fund will will allow for future general improvement fund monies or grants that OHIT could apply for and in the future there is another aspect of the bill as well that there will be an oversight committee or Commission within SHARE called the Council, and I believe it's on page 5.
And this is a nonprofit, you know, group, and this council will just consist of leaders and individuals in the health technology field that will help with advice and the dialogue of moving forward in this area. So this is nothing new to the private sector, and Representative Viviano can test And I think I'll hand it over here in just one moment. But in 2007, President Bush created a federal agency to oversee this.
And President Obama has also led the charge in creating funds available for Arkansas to get this off the ground. So at this time, I'd like to just hand it over to my colleague here for any comments you
Representative Mark Biviano
Unverified
1:03:24
might have. Let me make a few comments on this, and then hopefully we'll have questions. I've been part of this industry business for the better part of 27, 28 years and had the opportunity to work in almost the infancy of electronic medical records
and see the changes since basically the early 80s. And if we talk about health care reform, this is really the core of health care reform. You can talk about the funding mechanisms and so on and what's happening in the coverage models, but really to cut the cost to provide better clinical outcomes at a lower cost, this is what it's going to require.
You've got to have information available at the time that you need it, the time that decisions are made in the clinical process. Now our world is changing very rapidly. Technology has allowed us to do some things just a few short years ago we could not do. The concept of electronic medical record is not new. That's been around since the 80s and even the late 70s. But the fact the way that it can be accessed and the fact that the way that the technology
can improve its delivery, and the points of delivery is tremendously better now than it ever has been. I mean, imagine sitting in your living room and having a clinical encounter with a doctor or a nurse, checking your blood pressure, checking on your disease and management status. That technology exists today. It's being employed by large companies like Intel, Cisco, Oracle, and Microsoft. We have the opportunity here in Arkansas. We're playing
catch-up. When John asked me and showed me this bill, it reminded me of a time back in the late 80s where I was part of a company that made several presentations to the government in the state of Arkansas to try to sell them on the concept of a statewide healthcare database, much like the health information exchanges that we're seeing evolve today. So while we've made progress, we've made progress with the individual provider organizations
across the state, we've not really made a lot of progress as a statewide initiative. We are behind. Many states, California, New York, Tennessee, have these health exchanges in place. We need to move rapidly. And if we do that and we utilize the technology and experience that I believe is available in the marketplace, especially as defined by the structure of this bill, I think we have an opportunity to serve the citizens much more effectively and get a better clinical
outcome as well as lowering the overall cost here in the state for health care. Without, I'll pass it back. I think at this time, we'll just leave it up
for questions from the committee. Okay. Committee, Representative Letty. Motion at
the proper time. Representative Malone. Thank you, Madam
Representative Stephanie Malone
Unverified
1:06:50
Chair. Okay. I'm sorry. Explain it to me again that you could – the purpose of this is to exchange records of, like,
my medical records with someone else across the state is that
Speaker 201
1:07:07
yes ma'am that's basically correct for the record my name is ray scott i'm the state coordinator for health information technology yes the in simple terms what what we need to do is to move away from the paper record system and make health information used more effectively and more efficiently and actually use it in
a way that it informs better patient care. Basically the way I explain it, the more information your doctor can have in front of him or her about your health condition, the better informed that care is going to be. And if you see multiple providers, right now part of the problem is each health care provider that you have an encounter with basically has their own record system, but that information
collectively doesn't follow you from point of care to point of care. So basically it's right now up to you to make sure that every provider you encounter knows everything there is to know about you. What technology can do is actually make that information more readily available, but only in a way that is private and secure and that you have authorized. Representative Viviano, you
have a comment you want to make?
Representative Mark Biviano
Unverified
1:08:40
Yeah, I want to add to Mr. Scott's comments, and it's not purely clinical data that we're talking about. When you look at some of the biggest problems in our industry right now, or the industry right now is patient identification. Are you treating who is really covered? Are you treating the person who they say they are? And so there's issues with being able to match demographic data from a secure standpoint and ensure that that person is truly who they say they are. Now, why is that important?
Because it plays back into how the insurance processing will take place, the billing, all the administrative aspects, and that drives directly to the overall cost, and if we can identify who we're treating, when we're treating them, making sure they're the right person with the right coverages, you're ultimately going to drive down the cost
Representative Stephanie Malone
Unverified
1:09:32
of health care. May I ask a follow-up, Madam Chair? Certainly. Can you explain to me when it says on page 6, line 116, number 2, about subscribing to
the service? So if the purpose is to share my medical information, if I go to a different doctor, what if I go and they don't subscribe
Speaker 201
1:10:03
to the service? Am I reading it wrong? The intent there is that's really referencing the provider who's actually accessing that
information? Right. You're talking on line 16,
Representative Stephanie Malone
Unverified
1:10:21
page 6. Yes, sir. Number two, a person who participates in or subscribes to the service or information provided. So if I go, does that mean if I go to a different doctor across the state, do they have to subscribe to
Speaker 201
1:10:38
the electronic service or am I reading it wrong? Well, the idea is to make the information universally available through through this health information exchange right it's obviously the way
things are currently operating it's up to the provider whether or not they would take advantage of that information and access it again as a part of your your care process the the issue in this particular paragraph really has to do with the compliance with HIPAA which I'm sure we're all familiar with and It specifically references the fact that there's not going to be any extraordinary liability beyond the reach of HIPAA for accessing and or using information available through this
exchange. So it's an assurance to the provider that the system is going to be in compliance with the federal HIPAA requirements. MS. Okay. Thank you, Madam. Thank you. MR. Thank you,
Madam Chair. log you're recognized thank you
Representative Jeff Wardlaw
Unverified
1:11:43
madam chair I was just wondering on this exchange council there seems to be a representative here from every aspect of the health world except the nursing homes and I was wondering why they're not on there or if we could get them on there at at this particular point quite
Speaker 201
1:12:03
Quite frankly, that is a part of the health care industry that is not a primary point of focus. It's not that we're not going to include them. It's just that we're having to, if you will, kind of crawl before we run. And so the first priority is to try to get the primary care physician where we have the majority of people accessing health care and start with that and then grow this over time over the next three years to
include not only the primary care docs, but specialty providers, long-term care, behavioral health care, and other providers in the process. And we could certainly expand that council at that time when we began to deal with those different points of care. Okay. Thank you. Representative Allen, you have a question.
Representative Fred Allen
Unverified
1:12:59
Thank you, Madam Chair. Last year during the month of December, I spent a lot of time in Silicon Valley, California,
and talking to a lot of technology companies out there. And one of the questions they asked if we had an office of health care, health information technology in the state of Arkansas, and I responded by telling them no. So I guess my question to you, Ray Scott, and Representative Wood, and Representative Viviana. First of all, I want to thank you all for bringing this because this is something that we really need in the state of Arkansas. Do you feel that this will open the door for the technology companies to come into the state of Arkansas
and help improve our health care
Representative Mark Biviano
Unverified
1:13:47
system? Mr. Allen, that's a very good question because I spent about 16 years as an executive one of those companies, Oracle Corporation and SAP, and ran health care for those. And I can tell you without a doubt that those executives, those companies who are investing upwards of a billion or plus dollars in information technology for health care is very interesting in what's going on in the states.
There's many, many public-private type of partnerships, pilot projects going on across the country, both at the state level as well as the federal level and, of course, across international boundaries. So there's a high degree of interest, and Arkansas needs to be a little more proactive. And if we do that, we'll get the attention, we'll get the opportunity to work with some of those companies that perhaps would not be as aggressive here in the state of Arkansas
saw without this type of partnership set up and type of office
Representative Fred Allen
Unverified
1:14:52
set up. Okay. Madam Chair, if we don't have anyone, make a motion
motion at the appropriate time. Representative Allen, we don't, and
Speaker 215
1:15:03
we'll recognize you in just a moment. Representative Perry. Thank you, Madam Chair. A couple
Representative Mark Perry
Unverified
1:15:08
of questions. On this, it looks like as far as technology, what kind
of cost is involved in establishing this? Right now, well, there's $7.9 million of stimulus funds that have been set aside for a while that OHIT had already applied for
and has been running off those dollar amounts or those monies already, so that is already available to help right now. There will be a time where those funds will go down, and we'll have to figure out if this is something the state government needs a hand in or if we're going to turn it over to a nonprofit status. And so that is actually in the bill where there will be a point in time where we'll have to make a decision to keep it funding, keep it going with state money,
or turn it into a public-private partnership. That
Representative Mark Perry
Unverified
1:16:03
leads me to another question. And if we turn it over to state government, do you feel there should be a fiscal impact study done to
determine the cost and expense on this? I think not currently yet. I think
right now it's already under executive order, so it is already up and going. We're just breaking off, creating a new agency. So I think – I'm not sure what your budget is, but there's – we're not sure the direction of where the government's role will be in in five years or ten years, so it's kind of still a mystery.
But we do have funds available that are out there right now that are helping
sustain it. Representative Wood, if I might just add, we have a – and Representative
Perry, we have a companion bill that's an appropriation bill that's going before joint budget. budget, so this is the enabling bill to do that, but we also have an appropriation bill that's going before joint budget. Great. Thank you. I
Representative Mark Perry
Unverified
1:17:10
know, being in the insurance business, I know technology and dealing with health insurance,
it's such a vital point to have accurate records and the ease of obtaining those records. I know the delay in obtaining those. Viviano, I understand you've been in the business. Do you ever see the day where we'll be implanted with that chip where we walk into the doctor's office and they scan you and it tells you everything? I know we have these dogs that we do that. You know, the veterinarian says, hey, put this chip in them. If you get lost, you can be found, and sometimes we're lost. Last time I was
Representative Mark Biviano
Unverified
1:17:43
at Intel, they went ahead and put one in me.
Speaker 224
1:17:49
Now that explains it. Representative Penards,
you're recognized. I wondered
Representative Penards
Unverified
1:17:58
why you beeped. Let me follow up
Representative Tracy Pennartz
Unverified
1:18:02
on something on page six. I was interested. I thought I knew the answer to the question, but when you said that it might be turned over to a private nonprofit corporation, it interested me on how that corporation may
itself sustain itself through its subscription. So what that meant to me was, and please help me clarify this, is that when you have subscriptions to that service, there's a cost involved, And so you charge them for a
Speaker 201
1:18:42
subscription, is that correct? Over time, what the exchange actually is going to have to do is to find a way to sustain itself. And at this time, there are a variety of different models and strategies that are under review
and analysis, but we don't have a final direction, if you will, on that. But there's a variety of ways of user fees, subscription fees, transaction fees, a universal charge. All right. So I guess the point there,
Representative Tracy Pennartz
Unverified
1:19:17
Mr. Scott, is that at some point in your planning, you're talking about the sustainability. And I know you've probably talked about that issue already because I've had a discussion
or two about sustainability over the interim and so to me this really this legislation allows this entity to look at those methods of shall we say sales or income that they can use through subscriptions or other methods that you indicated and especially when you We talk about a person who participates in on line 16 or subscribes to the services.
That's what that implies to me down the road because if you're going to sustain this organization, it needs some sources of sales or money coming in other than just from general revenue if that is something you all have been talking about. But to me, certainly, that is – would you agree that that is a possibility? Yes, ma'am, that is a possibility. Okay, well, that clarifies that for me.
Okay, thank you. Thank you, Madam Chair. Representative Letting, did you ask first for a motion? You did. Representative Allen, I'm going to – since I erred on that, I'm going to let Representative Letting, if he's
ready and the committee's ready to make a motion. Would you have a question,
Speaker 176
1:21:02
Representative Lee? All right. Thank you, Madam Chair. I notice as I'm going down the list of
Speaker 177
1:21:07
people that are going to be on the Share Council that you have listed a representative of the Arkansas Minority Health Commission.
I was wondering if the intent, and I'm going to assume it was, that there would be at least one woman, if not more, on
Speaker 223
1:21:36
affirmative. Thank you very much. Representative Woods. Since, never mind. I was going to
say, I agree with Representative, with recognized Representative Allen since Greg Letting is a freshman.
Speaker 121
1:21:48
But that's fine, though. We can. Shall we flip a coin? Well, I had made myself a note, but I had overlooked
it, so that's all right. Representative Allen is quite gracious. I'm thinking about do
not pass at the moment, but I don't want any more of those. Thank you. All
right. Seeing no further questions, Representative Leading, you're recognized for a motion. A reluctant do pass.
We have a motion do pass as amended. Anyone in the audience who wishes to speak against the bill? Anyone in the audience who wishes to speak for the bill? Okay. Then the question before us then is do pass as amended. All in favor indicate by saying aye. Aye. All opposed, no. Representative Woods,
Representative Greg Leding
Unverified
1:22:39
you have passed your bill. Congratulations. Thank you, Madam Chair. Thank you, committee members.
Speaker 234
1:22:49
Let's see. Do we have anything else? the new agenda. Is that it?
No, we're not. Ladies and gentlemen, I don't think we have any other business before the committee, so we stand adjourned. Thank you very much for a good meeting.
Agenda
Call to Order
HB1598
HB1764
HB1765
HB1789
SB722
SB341
HB1852
HB1905
Adjournment
Documents
No documents posted.
Speakers
Representative Linda S. Tyler Chair
Unverified
Speaker 6
Speaker 8
Speaker 5
Representative Andy Mayberry
Unverified
Speaker 16
Representative Charolette Wagner Chair
Unverified
Speaker 42
Representative Tommy Wren
Unverified
Speaker 30
Representative Buddy Lovell
Unverified
Representative Jon Woods Chair
Unverified
Speaker 54
Speaker 25
Speaker 19
Speaker 26
Speaker 84
Speaker 85
Speaker 93
Representative Billy W. Gaskill
Unverified
Speaker 109
Representative Garry L. Smith
Unverified
Speaker 116
Speaker 121
Representative Bryan B. King Chair
Unverified
Speaker 123
Representative Clark Hall
Unverified
Speaker 137
Speaker 149
Speaker 151
Speaker 160
Speaker 165
Speaker 120
Speaker 175
Speaker 176
Speaker 177
Robert Breck
Unverified
Representative Johnnie J. Roebuck
Unverified
Representative Fred Allen
Unverified
Representative Mark Biviano
Unverified
Representative Stephanie Malone
Unverified
Speaker 201
Representative Jeff Wardlaw
Unverified
Speaker 215
Representative Mark Perry
Unverified
Speaker 224
Representative Penards
Unverified
Representative Tracy Pennartz
Unverified
Speaker 223
Representative Greg Leding
Unverified
Speaker 234