House Public Health Committee
Video
Transcript
Bills discussed (6)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
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SB77
· 6 mentions in chapter, transcript
Matched: “SB77”
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Pre-2017 bill | ||
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HB1315
· 5 mentions in chapter, transcript
Matched: “HB1315”
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Pre-2017 bill | ||
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HB1431
· 3 mentions in chapter, transcript
Matched: “HB1431”
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Pre-2017 bill | ||
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HB13
· 2 mentions in transcript
Matched: “…s of members of the House to reduce or mitigate the cost of House Bill 13-15 and the insurance premium rates that might result theref…”
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Pre-2017 bill | ||
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HB1324
· 1 mention in transcript
Matched: “…ative Webb. I don't think she's planning to run that today. House Bill 1324, Representative Nichols. 1324 and 1325, I don't think Repre…”
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Pre-2017 bill | ||
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HB1405
· 1 mention in transcript
Matched: “Okay. All right. Next on our agenda is House Bill 1405, Representative Webb. I don't think she's planning to run t…”
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Pre-2017 bill |
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If you will, please take your seat. Welcome this morning on this beautiful, sunshiny day. What a day. It's glorious. We'll go right to our regular agenda. Our first item on the agenda is House Bill 1431. And I don't see Representative Ingram, but he has asked me to run that bill, so I'm going to do that for him. And Representative Vice Chair Woods, would you please preside?
Teresa Marks
Unverified
0:30
Okay, Madam Chair, whenever you're ready to present your bill, and if your guests can state her name for the record, thank
Theresa Marks
Unverified
0:56
you. Thank you. My name is Teresa Marks. I'm the director of the Arkansas Department of Environmental Quality.
Mr. Chair, members, the other day, I don't remember exactly what bill it was, but one of our members said something about it being the shortest number of words in a bill that has been presented. And if this isn't tied with that, it may best it. So this is House Bill 1431 that allows email notification under the Arkansas Water and Air Pollution Control Act. Right now we have legislation that allows it to be mailed,
and all we're doing is getting up with the times and allowing it to be emailed to persons who have requested advance notice of rulemaking proceedings. meetings. So with that, we'll take questions. Thank you, Madam Chair. At
Representative Jon Woods
Unverified
1:52
this time, I'd like to recognize Representative Mayberry with a
Representative Andy Mayberry
Unverified
2:00
question. I saw that it said that it shall be mailed or emailed. Is there some determination?
What determines whether someone receives mail or email? I didn't see anything that said that they specifically request the email in here. And
Theresa Marks
Unverified
2:14
they do. The reason for this bill is that we've had several people request that instead of mailing notices to them, we email them to them, and we don't have the authority to do that now since it limits it to mail. But they do request. We have several people that we still mail things to that don't use email, and we will continue
Representative Andy Mayberry
Unverified
2:32
to do that. So if they want to have an actual physical mailed document, they will still receive that?
Representative Jon Woods
Unverified
2:38
Yes, sir. Absolutely. Thank you. Are there any other questions from the committee at this time? Is there anyone here in the audience to speak for the bill? Is there anyone here to speak against the bill? What is the pleasure of the committee? I recognize Representative Letting. Motion do pass. Okay, we have a motion do pass. All in favor say aye. Aye. Those who oppose. Motion passes.
Speaker 2
3:08
Congratulations, Madam Chair. If they could all
next on our agenda.
Okay. All right. Next on our agenda is House Bill 1405, Representative Webb. I don't think she's planning to run that today. House Bill 1324, Representative Nichols. 1324 and 1325, I don't think Representative Nichols is planning to run that today. And that brings us to Senate Bill 77. Representative Bradford, are you planning to run that for Senator Taylor? If you will take your seat at the end of the table, please. And I believe we have an amendment to that bill, and the staff will
be handing that out while you're taking your seat.
Representative Bradford, if you will go ahead and proceed and have your guests introduce themselves for the record please yes mr. Abbott would you turn your mic on
Speaker 39
5:15
please thank you I'm Bob Abbott from fine bluff I'm a
Speaker 41
5:23
member of the Kidney Commission Jim Moreland Arkansas rehab services and administrator
of the Kidney Disease Commission thank you we're on Senate bill 77 for the members you're You're very
Representative Toni Bradford
Unverified
5:36
welcome. Representative Bradford, you may proceed. Yes. Thank you, Madam Chair. Of course, Senate Bill 77 is sponsored by Senator Jerry Taylor, and it would authorize the State Kidney Disease Commission to recognize persons who have provided living kidney donations
to Arkansans in need of kidney transplantation. And of course, this award is designated as a chain of life award, and its purpose is to honor those donors those living donors who are willing to give that gift of life and of course when we presented it last time there was a little heart burn about part of it and we have amended that section of this bill there is absolutely no cost this will simply be an award to someone who is willing to be a kidney donor we would be glad to answer any questions
Speaker 45
6:28
Representative Penards you're recognized amendment do do pass
Speaker 47
6:31
on the amendment we'll go ahead and deal with the
amendment we have a motion to do pass on the amendment any questions on that motion anyone to speak for against the amendment all in favor of the amendment to Senate bill 77 indicate by saying aye opposed no the amendment has been passed so we'll go ahead and and proceed with the bill.
Have you made your presentation on the bill? Yes. Do we have any questions on the bill? Representative Hall. I have a motion at the proper time. All right. We have a motion at the proper time. Do we have any other questions? Anyone from the audience who wants to speak against the bill? Anyone from the audience who wants to speak for the bill? Representative Hall will recognize you for the motion. Motion do pass as amended. We have a motion do pass as amended for Senate Bill 77. in favor indicate by saying aye. Aye. All opposed no. Congratulations
Representative Bradford and Mr. Abbott, you
Representative Penards
Unverified
7:35
have passed your bill. Thank you
committee. Representative Lindsey, House Bill 1315, if you will take your place at the end of the table. We also have an amendment to that bill. Representative Lindsey, is it appropriate for the staff to hand out that amendment?
Diana Verity
Unverified
8:03
Yes, Madam Chair, with your pleasure. While
the staff is handing that out, if you will go ahead and have your guests
Diana Verity
Unverified
8:13
introduce themselves for the record. I'm
Speaker 60
8:15
Evaldi Lindsey. My name is Diana Verity, and I'm a mother of
Diana Verity
Unverified
8:20
a young young boy who has autism and Diane is sort of our state leader and sort of champion from the autism task force and I'm pleased that she's here to give me support today madam chair the amendment we're passing out today is a real simple amendment it adds sponsors and it adds three or four words what we found on
on proofreading the engrossed bill was that we left out an and and a comma. As you can see on page 2, line 27 in the amendment, we're deleting major medical plans and substituting major medical plans, comma, and plans. Basically, that language cleans up that those plans are not part of the Constitution, and this makes that technical change. So that's all this amendment does. Now on Thursday there was another amendment to the bill that basically did two things
The first thing was Representative Lindsay, let us deal with this amendment right now, why don't we And then we'll talk a little bit about the bill as a whole Representative Penartz Do pass on the amendment So we have a recommendation do pass on the amendment to House Bill 1315 We have a motion to adopt the amendment on House Bill 1315. Any question on that motion?
Anyone to speak against the motion? Anyone to speak for the motion? All in favor of amendment, all in favor of do pass. No. I'll get it right here in a minute. I'm working on it. All in favor of adopting the amendment to House Bill 1315, indicate by saying aye. All opposed, no. Now, Representative Lindsey, if you will, proceed. Thank you, Madam Chair. Members
Representative Uvalde Lindsey
Unverified
10:13
of the Committee, after your favorable action last Tuesday,
Diana Verity
Unverified
10:19
we found some technical errors in the code. The first was to – some of the language was inconsistent with some of the new federal health insurance statutes, rules, and regulations. So we've amended the bill to add those clarifying documents to bring us fully in line with the federal statutes. In addition, and probably most importantly, we have added an age cap to the applied behavioral analysis, the ABA section for treatment, and that age cap is at 18 years.
So this bill, House Bill 1315, now has two caps on ABA behavioral analysis, a dollar cap of $50,000 per year and an 18-year age cap. That amendment was basically designed to address the concerns of members of the House to reduce or mitigate the cost of House Bill 13-15 and the insurance premium rates that might result therefrom. I'm pleased that the employee benefits section,
And they have now done another analysis of the cost of House Bill 13-15, and it reduces the cost impact from $5 million to $3.4 million, which is a reduction of 32%. Bottom line, the state plan, the state employees, would be $1.6 million or $2.61 per member per month, down from $3.90 in the previous bill without the caps.
On the school plan for teachers, it's $1.8 million in total, $2.16 per month per member. That's a reduction from $3.30. It was in the previous bill. So what the amendment's trying to do is to make a good bill better, and that explains the amendment. Other than that, the bill is, as you discussed, and voted positively on last Tuesday. Thank you,
Representative Lindsey. Representative Hall, you're recognized.
Madam Chairman. Representative Lee, you're recognized for
Speaker 70
12:39
a question. Thank you, Madam Chair. Thank you, Madam Chair. Representative Lindsey, being on personnel together, you know that one of the issues we're discussing is the costs of health insurance for state employees. And currently, we are subsidizing the medical insurance for state employees by $9.4 million a year.
And school employees at $50 million a year, these are statistics I got from Jason Lee, and I appreciate that you brought this here today. Have you heard from the people that will be bearing this cost? I know that the Arkansas Employee Association is pretty vocal. Have they given an opinion on this to you at this point? We
Representative Uvalde Lindsey
Unverified
13:26
have talked with the AEA, and they have endorsed the bill prior to that last amendment.
This actually makes it better for the teachers group represented by AEA. We have talked, of course, to EBD and the methodology of control of the cost And I believe some
Diana Verity
Unverified
13:45
of this will show up in the rights to employees And, Dee, do you have any additional stuff that you can add to that? Okay, I'm trying to representively to get you a more positive, better answer than that But, as you can see, by trying to reduce the cost and contain the cost
We feel the impact to teachers and state employees is more reasonable. What we've looked at in other states, the very highest has been $0.80 per family member, and assuming for that's about $3.20, so we're actually under now what the highest rate we're seeing. The lowest rate we've seen is about $0.44 in South Carolina, and so we're getting in that range. We also, Representative Lee, we did an analysis, the Bureau did an analysis early on, and their estimate was somewhere about $2.8 million.
So we're basically very, very close on three actuarial estimates of the cost, and I think it's coming
Representative Uvalde Lindsey
Unverified
14:50
down to the point where it's a doable process. And I appreciate that, and
Speaker 70
14:55
I appreciate your answers, and of course you know that we don't live in a vacuum when we're making laws, And, you know, you know how I voted on this previously, and one of the struggles I'm having now is understanding state employees, we're hearing from them a lot about wanting to get their – ensure they get their COLA, and we're finding out how much we're subsidizing
their health insurance on top of that, and so I'm looking at the big picture, and so I was curious to know if you had received
feedback. Thank you. Yes, ma'am. Thank you. Representative Mayberry,
Representative Andy Mayberry
Unverified
15:34
you're recognized for a question. Thank you, Madam Chair. I've actually got a couple, if that's okay. First of all, I very much appreciate the amendments that you've made here. I think especially with regards to the cap on age, I think this makes it a better bill. Thank you. We had testimony last week or whenever it was that we were here from a law professor from UALR
talking about the IDEA and the potential for ABA therapy being covered through that. Since then, I've had an opportunity to visit with Dr. Kimbrell from the Department of Education, and I was made aware, or at least the understanding I have, and I guess my question to you is are you aware of this as well, that there are currently school districts in the state of Arkansas that provide ABA therapy to some students under IDEA that it is left to the individual IEP committees at those schools
and that their interpretation can provide that ABA therapy that this bill is trying to address. Representative Mayberry, that
Diana Verity
Unverified
16:43
is correct. We've also had conversation with the Department of Education and Dr. Kimbrell and Marcy Hardy, who runs the special education. Some school districts do provide ABA. The idea of funds that they receive, the Federal Disabilities Act monies that come to the state,
about $100 million a year, a little over, are distributed to those individual districts. what we and this was part of the process we talked about early on about making a mandatory coverage or idea to cover ABA it's everything that we can find from federal statute and from direction from the Department of Education is that this could be an unfunded state mandate that would be passed down
to each one of the 239 individual school districts in this state. That process says that if you're a small rural district and you have one autistic child enrolled, then you would have to provide some sort of ABA program within that district to comply with the process of adequacy and equitably. The Lakeview case drives part of that process. That could lead, I think, to school districts and Department of Education looking to
the General Assembly to find a way to fund general revenue to take care of those districts that couldn't do that process. I'm sorry to
Representative Andy Mayberry
Unverified
18:20
interrupt, but aren't there already federal funds being allocated
Diana Verity
Unverified
18:24
toward? There are federal funds, and Dee can do this because she's got those numbers in her head. May I yield?
Speaker 60
18:32
I was just going to talk a little bit about some of the programs that are
Speaker 80
18:37
being provided through the schools. The programs and the ABA programs that are typically being used in the schools are only being used to support that educational curriculum.
The intensity and the scope of those programs do not meet the level that we need for our children in terms of medical treatment. They're using and they're pulling from a number of different disciplines like speech therapy, occupational therapy, physical therapy, and ABA to support what they're doing in the classroom. They're not providing comprehensive medical treatment. And there is a distinction between the two. And so I don't know if that's helpful or not.
Representative Andy Mayberry
Unverified
19:20
A couple of follow-up questions as well Does this Any of the amendments that you've made Have they been specified toward Who actually can prescribe the ABA therapy I know there have been some concerns that Potentially I
guess I don't want to use the word unqualified But
Diana Verity
Unverified
19:50
folks are not particularly qualified Yes, we have in the amendment last Thursday, we specifically added language that allows insurers to follow their customary utilization review.
That's part of the thing. It's for medical necessity to use their customary utilization review and prior authorization process. See, that's in this bill now. that allows then the insurance companies to ensure that a precision diagnosing and prescribing met certain qualifications of review, utilization, prior authorization process, and determining whether or not the coverage for a specific treatment for an individual
is both evidence-based and medically necessary. That's the two tests that are explicitly built into every piece of this legislation. The point of that, it allows the insurers to insure that you don't have a charlatan, for want of a better word, prescribing or issuing a blank check. This bill does not issue to families or physicians a blank check on which to draw against insurance companies because of the prohibition of review and process that's normal and customary for any insurer to undergo and undertake
as they proceed to define the claims and review the claims and to pay or disapprove
Representative Andy Mayberry
Unverified
21:23
the claims. Okay. Changing gears for just half a moment. With regards to Medicaid, I know that there are this calendar year 100 Medicaid waivers that are being specified strictly for children with autism. How does that or what, if any,
Speaker 78
21:42
effect does that have upon this?
Rep. Mayberry, that's a great question.
Diana Verity
Unverified
21:49
It supplements what's here. If you will look at why this bill was drafted, we believe it's a holistic plan to, one, have insurers participate and to use IDEA, where appropriate, from ages 6 through 18 in the public school systems, second piece. Third piece is Medicaid. The autism waiver will kick in on January 1st. There's about $1.5 million allocated in DDS to do that waiver.
That will address about 100 children within this state. The goal of this plan, and I think everybody sitting at this table, is to ensure that all autistic children in this state, and we'd love to cover all disabilities in this state for our children. have a methodology to access the most applicable source of funding and financing to make the burden of the disease go away.
Representative Andy Mayberry
Unverified
22:50
How many, and if I understand correctly, ABA therapy is very appropriate for some children, may not be the most appropriate for others. Is that correct? Do you have any way for us to gauge how many
Speaker 60
23:09
kids we're talking about? We don't have really good numbers on how many children. Like, we have prevalence data, one in 93 boys and one
Speaker 80
23:19
in 345 girls. ABA is actually very effective for 90% of the kids who receive it.
Only about 10% of the kids who receive ABA don't seem to benefit from it, and the reason for that is still unknown. There's some speculation that some children may have some underlying seizure disorder or other kind of neurological disorder that's interfering with them and their ability to access that treatment. But in truth, if you look at the studies, 50% of the kids who receive the ABA will benefit so much so that they no longer need any treatment after three years. Another 40% makes such significant gains that they need far less treatment.
So it is actually very effective, and all of the studies prove that. For those children who, for some reason, it's not effective, we don't have the answer to that yet. Let
Representative Andy Mayberry
Unverified
24:13
me ask this. Ken, we had a remarkable young man up here last week, and I saw him. He passed out some wonderful little things a while ago. And I know that he has been an example of the wonderful strides that a child can make utilizing those ABA techniques.
techniques. But if I understand correctly, those weren't provided to him by a licensed ABA provider. Is that correct? That his mother, wonderful lady that
Speaker 60
24:45
she is, is that... Matt, do you mind if
Representative Andy Mayberry
Unverified
24:50
I interject here? I guess what my question is, is it possible to take
the principles and the techniques and apply those ABA principles and techniques at a less expensive cost than $50,000 per child.
Speaker 80
25:06
In the same way that my son's speech therapist now will send us home with things we need to work on to meet his goals in speech therapy, a good BCBA, Board Certified Behavior Analyst, will do the same thing and engage the family in the treatment. And what families are doing typically is they're paying as much as they can out of pocket for that top-tiered BCBA specialist, and then they're pulling in whoever they can to pretty much put in place the program the BCBA has developed.
So it is actually the treatment plan is developed by a professional and probably overseen by a professional, definitely overseen by a professional, but, yeah, mostly family members at this point in time are providing that direct one-to-one. Okay. Representative Mayberry, do you
Speaker 4
25:58
want to speak against the bill when the opportunity comes?
Representative Andy Mayberry
Unverified
26:01
No, ma'am. I am truly just trying to gather some information. Okay.
We'll allow one more question then, please. Okay. Thank you very much. You mentioned that this is a holistic approach, and I understand that there are a number of children, potentially even the majority of children who are diagnosed with autism, who will not benefit from this plan, and children with other developmental disabilities, such as Down syndrome, who could benefit from ABA therapy, who do not benefit from this plan.
Is there a way to address those issues as well? Unfortunately,
Speaker 80
26:49
this bill goes as far as it possibly can in how to legislate. The state only has so much ability to legislate insurance. Self-funded plans are, of course, exempt from the state law. As far as children, other children with other diagnoses who might benefit from ABA,
I think the potential is there, but it just hasn't been studied yet. The problem is that there's no data for any physicians to hang their hat on to say I can definitely prescribe this and I'm reasonably certain it will be helpful for children with other diagnoses. I think over the next decade you'll see more research in that area. Thank you very much. I love
Representative Andy Mayberry
Unverified
27:35
the intention of your bill, and thank you for being here. Thank you, Mr. Baker.
Representative Bryan B. King
Unverified
27:40
Representative King, you're recognized. Thank you, Madam. Thank you, Madam Chairperson. Representative Lindsay, how many, what, and maybe this was in the previous testimony,
I apologize for asking this. What other mandates are in the law right now for conditions like this?
Speaker 62
28:05
I don't know. I don't know, to be honest with you.
Representative Bryan B. King
Unverified
28:11
So you don't know what other mandates are?
Speaker 80
28:14
You mean in other states or in Arkansas? In Arkansas. In Arkansas, I have no idea. I know I can tell you about bills that have passed in other states around autism legislation, but I don't know about similar bills in Arkansas for other conditions. Representative Lindsey, could you
Representative Bryan B. King
Unverified
28:31
get us that question? I mean, I'm not going to hold the bill up today for that question, but I'm just curious. I'm curious, can you get us that information or get me that
Diana Verity
Unverified
28:42
information? We will ask the insurance department for that information.
I am sure those policies are filed, and we will ask Jay Bradford's shop to try to provide us that information if
Representative Uvalde Lindsey
Unverified
28:51
it's available. Of Representative McCain, of course, we'd like to provide the committee with any
Representative Bryan B. King
Unverified
28:57
and answer to any and all questions. Well, when Commissioner Bradford was in here testifying, and I'm trying to
remember correctly, He said that basically with the new federal health care law that was passed that if the federal government had mandates in what they thought should be applied and the states didn't have those mandates, that we would have to comply with the federal mandates.
So this is not addressed as a federal mandate? Not
Diana Verity
Unverified
29:23
at this time. Essential benefits comes out of ACA, but it won't be applicable until 2014?
Representative Bryan B. King
Unverified
29:32
Correct. So if we do this, how do we answer the question to other people that have conditions that they don't have a mandate?
Diana Verity
Unverified
29:42
It exempts policies in the state of Arkansas that issued under the insurance exchange under ACA.
It specifically exempts policies issued under the exchange. So what we're trying to do is to deal with the potential. Nobody knows exactly what's going to happen with the Affordable Care Act. But the process is to try to address to the best knowledge we have today how you would ensure that this meshes with and provides a continuum of service between today and 2014 or later years as the Affordable Care Act moves forward or whatever happens with the ACA.
Representative Bryan B. King
Unverified
30:20
Okay, that's a good answer. How do we answer the question of this mandate to other conditions out there that have Why do we need to pass this one compared to other conditions that might be serious issues Such as cerebral palsy or
Speaker 80
30:42
my usual pat answer to that? Yes The honest answer is that this is good cost prevention.
In the same way that good prenatal benefits benefit the state and society in the long term because we don't have as many children born preterm and costing a lot of money to care for, this offsets it. It's a cost aversion strategy in many, many ways. It's good quality medical treatment. It's proven through 30 years of research. And to provide these benefits, this coverage,
means that we'll save society somewhere to the tune of $1.5 to $2 million over each child's lifetime. I appreciate your
Representative Bryan B. King
Unverified
31:33
testimony today. Thank you. Thank you. There
being no further questions before the committee, Do we have anyone who wishes to speak against the bill? Anyone who wishes to speak for the bill? What is the pleasure of the committee?
Speaker 52
31:54
Representative Hall. Madam Chairman, a motion to do pass as amended. We
have a motion to do pass as amended for House Bill 1315. Any discussion on the motion? All in favor indicate by saying aye. Aye. Opposed, no. The ayes have it. Representative Lindsay, you have passed your bill. Thank you, Madam Chair. Thank you, members of the committee. Representative Wright's not going to.
That Representative Wright has indicated he's not going to run House Bill 1444.
Representative Nichols, I don't believe, is here for House Bill 1445. Representative Allen plans to run House Bill 1453 on Thursday. So I believe that brings us to the end of our agenda. Unless anybody has any further business, we stand adjourned.
Agenda
Call to Order
HB1431
SB77
HB1315
Adjournment
Documents
No documents posted.
Speakers
Representative Linda S. Tyler Chair
Unverified
Teresa Marks
Unverified
Theresa Marks
Unverified
Representative Jon Woods
Unverified
Representative Andy Mayberry
Unverified
Speaker 2
Speaker 28
Speaker 39
Speaker 41
Representative Toni Bradford
Unverified
Speaker 45
Speaker 47
Representative Penards
Unverified
Diana Verity
Unverified
Speaker 60
Representative Uvalde Lindsey
Unverified
Speaker 52
Speaker 70
Speaker 80
Speaker 78
Speaker 4
Representative Bryan B. King
Unverified
Speaker 62
Speaker 95