House Public Health Committee
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Bills discussed (5)
| Bill | Title | Sponsor | Status |
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HB1315
· 3 mentions in chapter, transcript
Matched: “HB1315”
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Pre-2017 bill | ||
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HR1011
· 1 mention in chapter
Matched: “HR1011”
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Pre-2017 bill | ||
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SB165
· 1 mention in chapter
Matched: “SB165”
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Pre-2017 bill | ||
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SB42
· 1 mention in chapter
Matched: “SB42”
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Pre-2017 bill | ||
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SB43
· 1 mention in chapter
Matched: “SB43”
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Pre-2017 bill |
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all right the chair sees a quorum will call the meeting to order let me give you a couple reminders first if you will members please don't take the bills out of your folder it the staff keeps those from us for us through the whole session so it's important that you leave those bills in your folders so they don't have to track you down. And in your folder today, and thanks to Representative Penartz, we have added a reference to the
Arkansas Code with the list of titles. We are often referring to various titles in this meeting, and I think it's helpful to all of us, not just freshmen, but helpful to all of us to understand what those titles are, and we've expanded the health titles so that you'll see the additional subsections of those titles, and that will be there for your reference. So thank you, Representative Pernartz, for that. We do have a lot of business to take care of today, but our first one we're going to
take care of is a special order of business, Representative Uvalde Lindsey, House Bill 1315, and Representative Lindsey, if you will, go ahead and introduce your guests at the end of the table or have them introduce
themselves and the organizations they represent, and go ahead and present your bill. Yes, ma'am.
Speaker 6
1:28
Thank you, Madam Chair, members of the committee. With me at the table, Diana
Representative Uvalde Lindsey
Unverified
1:34
Verity, who is the mother of Bradley and, quite frankly, the leader of our Arkansas team from the Autism Task Force.
To my right is Lori Umner, who is Senior Legal Counsel for Autism Speaks, Eldon Schultz, who is Senior Chief for Developmental Pediatrics at UAMS, and Dana Miller, who is a mother of Brian and founder of SPARC in Jonesboro. And, of course, we've got our good Dr. Shepard who keeps track of us through all the task force meetings. Thank you, Doc, for being here with us.
Representative Lindsey, I understand you do have an amendment. We do have an amendment we'd like to offer at the proper time. Yes, ma'am. And so you want us to
hold it now? It would be proper to pass out
Representative Uvalde Lindsey
Unverified
2:34
if it's the will of the chair. All right. We'll go ahead and pass out that amendment then. Thank you, Madam Chair. Go ahead and proceed. Members of the committee, it's been, it seemed like forever, but it's almost two years since I started down this journey as co-chairman of the Autism Task Force.
In this very room, during those long afternoons, Friday afternoons in fact, we began at one o'clock and oftentimes didn't quit until five o'clock, and five o'clock on Friday afternoon in the state capitol is a little scary. But during all those meetings, those long Friday afternoons, we talked about why it It was so critical that our kids with autism be diagnosed early. We found that if you reach kids when they're two to six years old and provide appropriate
treatment, we can, as a people and as a state, make great strides in helping the many, many families that deal with autism. And that's where insurance coverage comes in. I believe that if our families had coverage for autism as a medical condition, that there's a greater likelihood that those kids would have regular checkups and the normal things that are there, and that could lead to earlier diagnosis and the beginning of an appropriate
treatment plan. I don't think there's any question in statistics or in the evidence-based background of autism that early intervention leads to great improvement for kids that have autism. Members, as I've talked with most of you over the last few weeks, I've admitted I am not an insurance expert. Representative Mayberry will testify to that.
And I believe and I feel that insurance coverage is a part of the solution. It's not the only solution, but it's a part of the solution for this crisis situation. And you've seen on your desk the flyer, the crisis situation of having one out of 93 boys in Arkansas suffering from autism, one in 345 girls. That's a crisis situation I think, my colleagues, that we need to address.
Members of the committee, I'm humbled, quite frankly, and I'm honored to represent the autism community, and you see many of the members of that community in the room today. And they represent families from all over the state. I'm honored to present to you House Bill 1315, and I'd ask for a favorable review and your consideration. Madam Chair, with your permission, I would like to ask Lori to begin her presentation.
Lori Unum
Unverified
5:35
You're recognized. Go ahead and proceed. Madam Chair, members of the committee, my name is Lori Unum. I'm the parent of a nine-year-old son with autism. I'm also an attorney. I'm formerly a litigator with the United States Department of Justice. I'm also formerly a law professor at the George Washington University Law School, but I gave up my legal career to advocate full-time on behalf of individuals with autism when I saw the inequity in the insurance arena.
So now I am Senior Policy Advisor and Counsel with Autism Speaks on a national level, and I also still teach a law school class called Autism and the Law in Washington, D.C. I do have some slides. going to have to kind of look back and forth between me and the slideshow, I guess, but I wanted to start by reiterating for you that autism is a medical condition. It is brought on through no fault of the family. It is diagnosed by a medical doctor, and treatment is prescribed
by a medical doctor. Now, the chart you have in front of you, I like to spend just a minute on the terminology, because the term autism is a little bit imprecise, used imprecisely even by those of us in the autism community. Some people use the term autism to refer to the entire spectrum, and some people use it to refer to one of the diagnoses. So if you look at the chart, in the manual, the Diagnostic and Statistical Manual, there's an umbrella category called Pervasive Developmental Disorder, into which five distinct diagnoses fall. The
The first two that you see on the left there are extremely rare diagnoses. The three larger ones in purple are your traditional autism spectrum disorders. The first one there called autistic disorder is the most severe one and the one that some people just call autism. And if you look at the bottom, you can see that that one accounts for about one-third of all autism spectrum disorder. Then there's another diagnosis called Asperger's. That's kind of like your rain man, if you will, people who are highly, they have good vocabularies, but they might have more social difficulties.
And then the third category is called pervasive developmental disorder not otherwise specified. That is a milder form where an individual might have some characteristics of autistic disorder or some characteristics of Asperger's, but not enough to qualify for either diagnosis. And the reason I like to point this out is that that last catch-all category of PDD-NOS accounts for half of all children on the spectrum. And that becomes relevant when you're talking about what this coverage will cost,
that only one-third of the children with an autism spectrum
Speaker 17
8:28
disorder have classic autism becomes relevant. Now, although there's no
Lori Unum
Unverified
8:34
known cure for autism, it can be treated so that the symptoms are not disabling. A nonverbal child can gain the ability to communicate. A nonsocial child can gain interaction skills. So while they're not cured, I don't like to use the word cure, they can overcome the disabling aspects of their condition.
The most commonly prescribed treatment protocol is a therapy called Applied Behavior Analysis, or ABA therapy. This is a therapy that has been used for many decades to treat autism, and yet the insurance industry continues to deny coverage for ABA therapy, often on the basis that it is experimental. That conclusion is simply no longer supported by the science. The Surgeon General, the National Research Council, the American Academy of Pediatrics all have endorsed
the use of ABA therapy for individuals with autism. Now, studies show that if ABA therapy is administered intensively and by properly trained therapists, approximately half of the kids will overcome their autistic characteristics to such an extent that they can go into first grade indistinguishable from their peers. Think about that. If we get to these children early, give them this ABA therapy or whatever therapy their doctor recommends intensively for a few years,
they go into first grade like any other first grader, needing no additional supports. About half of the children will have that kind of outcome. And the other half makes significant gains, too, such that they need fewer supports for the rest of their lives. Now, as I mentioned, though, ABA must be administered intensively. Sometimes you hear it being prescribed 40 hours per week, as it was for my own son. This, of course, makes it expensive. My own son's autism is very severe.
He has the classic autistic disorder, and he is on the severe end of that. His therapy that was prescribed by his doctor who diagnosed him cost us over $50,000 per year out of pocket. Out of pocket. We have insurance, but we paid over $50,000 a year to get him the treatment that his doctor recommended. Because of this extraordinary medical expense, we have been audited on our taxes three times just to kind of rub salt into the wound.
You have to pay it, and then you have to go through the audit by the IRS. But we passed, I'm happy to say. Now, most kids don't require that much therapy, but the few truly severe kids do. Fortunately, my husband and I are both blessed with good educations and good jobs. And we were able to make sacrifices to afford the therapy for our son. There were sacrifices. We sold our house and moved to a less expensive house so that we could pocket the difference and pay for his therapy. But how many Arkansas families do you know
that have that kind of money to sacrifice, or even half that much? Most don't, of course, and those children are simply going untreated. I think it's sad that in the United States of America, We know of a treatment that works, and yet we have kids who can't get that treatment because their parents aren't wealthy. And it's not only sad, it's unfair given that these families are paying premiums every month to cover their kids. These are families who are doing the right thing by buying insurance for their families to insure against exactly this sort of unforeseen and unprovoked medical disaster.
This slide just gives an example. I think it's hard for some people to understand how any kind of therapy could rack up $50,000 of bills in a year. But if you look at how ABA therapy is typically administered, there's a top-level consultant, your highly professional person who's board-certified, who might see your child between three and six hours a month. Then you've typically got a mid-level supervisor, a lead therapist, who sees your child more frequently. And then at the bottom level, you've got line therapists, the front line implementers of the therapy who may be in your home 40 hours a week.
So you can see it very easily can rack up quite an expensive bill that's unmanageable for your average family. A 2006 study from Harvard found that if a child with autism is not properly treated, the societal cost for that one child over their lifetime is over $3 million. In addition, I always like to point out a 1998 study from Pennsylvania, which didn't take into account indirect costs such as lost productivity.
It just took into account the cost to the state. It found that treating children with autism will produce an actual cost savings to the state of over a million dollars per person over their lifetime. Now, you can do the math as well as I can. If we've got one in approximately 110 Arkansas children being diagnosed and only the wealthy few are getting treatment, multiply each remaining child by over a million dollars. That's how much Arkansas taxpayers are going to shell out if these kids don't get treatment.
Now, lest you think, well, we'll just handle these people in our state budget the same way we've always handled it, think again. 25 years ago, as you can see from this prevalence chart, 25 years ago, the prevalence rate of autism was about 1 in 2,500 individuals. Today, it's 1 in 110. Scientists don't know or agree upon the reason for the increase, but we all understand the ramifications. There is going to be a huge autism tsunami that is going to hit the state of Arkansas,
and it's going to cost an extraordinary amount of money in special education, adult care, institutionalization, if this current generation of kids does not get the treatment that it needs. And we know without private insurance playing its part, that treatment is simply not going to happen. Now, faced with this reality, Twenty-three other states now require insurers to play their part. If you look at this chart, you can see that it started back in 2001 with Indiana.
Indiana passed an autism insurance bill after Congressman Dan Burton's grandchild was diagnosed with autism. It didn't really catch on at that time. Well, Minnesota has an asterisk there. I should explain that. Minnesota actually has not passed a statute, but the Attorney General of Minnesota sued that state's major insurer, Blue Cross Blue Shield of Minnesota, for failure to cover autism. That litigation was settled, and as a result of that settlement, Minnesota Blue Cross Blue Shield has been covering autism since 2001.
Then in 2007, South Carolina and Texas passed the legislation, and five more states in 2008, seven more states in 2009, and eight more states just last year. And there are many, many other states considering similar legislation right now, Michigan, Alaska, Virginia, Oregon, California, West Virginia, North Carolina, Maryland, Rhode Island, Delaware, to name a few. Now, one of the reasons that I'm here today is because I worked on the legislation in South Carolina,
my home state, that sort of started this national movement toward coverage. And I can tell you I have seen it successfully implemented. Children who were never able to receive treatment are now receiving treatment and making remarkable progress. Providers have joined participating provider networks, have negotiated satisfactory reimbursement rates, and insurance premiums have increased a very minimal amount. Let me talk a little bit about what the cost has been.
First of all, if you look up there, you'll see this is just a sampling of some of the states that have passed autism insurance bills. The terms do vary a bit from state to state. Some of them cap the benefit, specifically the ABA benefit, either with a dollar cap or an age cap. Others do not. So there is some variation. But what we see is that the cost impact is minimal across the board. Here, for example, you know, I've heard some of our opponents say,
well, this will cost premiums to go up 2 or 3 or 4 percent. And they come up with these actuarial studies. Well, we've done our own actuarial, or we've contracted with an independent actuarial firm to produce actuarial studies. and every time it comes up less than 1% increase. All of those actuarial studies are available on www.autismvotes.org if you're interested. But in my mind, even better than any kind of actuarial projection, let's look at the claims data.
Let's look at Minnesota, which has been covering this for 10 years, and see what has it actually cost, what has it done to premiums. So, again, in Minnesota, the coverage went into effect 10 years ago. And there's no dollar cap and no age cap on the coverage. Cutting down to the key nugget of information over there on the right column, the premium impact for this benefit on a per-member, per-month basis
has been 83 cents in the commercial market or 79 cents in their state employee public program. And just FYI, the average cost for the behavioral health treatment has been $30,000 a year. So again, like where, as I said, my child needed over $50,000 a year, on average, the cost is about $30,000 a year. We also have kind of hot-off-the-press data from my home state, South Carolina. And again, as a refresher, South Carolina passed this law in 2007.
This data is from our state employee health plan, so I thought you would find that useful so that you understand what the impact will be here in Arkansas on your general fund. So this, the South Carolina statute was applicable to the state employee health plan there January 1st of 2009, and just by comparison purposes, South Carolina has a population of 4.5 million, and our state health plan has over 350,000 members. The South Carolina statute does contain a dollar cap on ABA of $50,000 and an age cap of age 16.
When we were trying to pass this legislation in South Carolina, the budget analysts projected that it would cost the state $18.9 million per year to offer this benefit. We balked a little bit at that suggestion, and ultimately the fiscal analysts revised their projection and said it would cost $9 million per year to cover this in South Carolina's state health plan. The actual cost during the first year, 2009, was $856,000.
So our fiscal analysts were off by a good $8 million. That worked out to be a per-member, per-month increase of $0.20. In 2010, the cost was about $2 million. And I think 2010 is a better reflection of what the cost is likely to be. There's always a ramping up period during the first year of any benefit, so I think the $856,000 is too low. But the $2 million, I'm told by the administrator, is a representative figure.
And that turned out to be a per-member, per-month premium increase of $0.44. Some people also look at it in terms of the per-employee per-month increase, and that was 75 cents. So, and you can see, I can barely read that. Maybe y'all can read it. There are 228,000 employees in the South Carolina State Health Plan. And that translated into, I think one reason that the fiscal analysts always overestimate
how much this is going to cost is because they overestimate how many children with an autism spectrum disorder will be prescribed the very intensive behavior therapy. So if you look, in South Carolina, of 228,000 employees, 79 kids were prescribed and accessed the very intensive ABA therapy. That's why the cost is so much less than people think it will be. Now, I put together a little worksheet just to spend one more moment on the cost.
I understand that in Arkansas, there are approximately 78,000 employees in your state plan, including school teachers. Is that right? Does that ring a bell for you guys? That's what I was told this morning. About 78,000. Okay.
Speaker 28
21:52
All right. Somebody says they think it's larger, but we've got approximately.
Speaker 17
21:59
Okay. Well, let's go with this. And, you know, I'm showing
Lori Unum
Unverified
22:07
you how to make the calculation so that if that turns out to be a little bit off, you can make the adjustment.
So if you take the number of employees in the state health plan, $78,000, and you multiply that times the $0.75 per employee per month increase that we've seen in South Carolina, and there's no reason to expect that it would be different here than in South Carolina, my math says that comes out to $59,000. and then you multiply that times the number of months in the year because that's a per member per month cost, so $59,000 times 12 gives us a total annual cost to the state
of $710,000. Now, I'm not sure in Arkansas if you have your state employees pay part of the premium, so the impact of the general fund would be whatever percentage of that $710,000 you all assume for your state employees. And by the way, if y'all have questions along the way, I should have said that at the beginning, feel free to interrupt me. Now, you know, all this fiscal information,
setting aside the moral value of providing your families with this coverage, we can see that it is fiscally a responsible conservative thing for the state to do. Not only is it a very small cost to provide the treatment, but we see that there are going to be immense savings. Just taking, for example, special education. If you take 47 percent, I said nearly half of the kids will overcome their autistic characteristics.
The seminal study actually showed that 47 percent of the kids who got ABA therapy achieved normal IQ. you, if you take 47% and take them out of special education where they would have otherwise been, that is a significant savings to the state right off the bat. Now, I want to address, I know I'm running short on time, I do want to address that I've heard some opponents say, well, they're trying to seek coverage for education.
This therapy is really nothing more than education. It's educational in nature, and so it shouldn't be covered by health insurance. Well, I want to address that head on. First of all, I would suggest that that is a false dichotomy, a false choice that they're asking you to make. What does it mean for something to be educational in nature? Does that mean that the schools are providing it? Because I think you can survey the parents in this room and learn that the schools in Arkansas do not have the capability to provide one-on-one behavioral intervention to
every child with autism who needs it. That would cost an enormous amount of money, and the schools are trying. I have spoken with your special ed director, and I know that the schools in Arkansas are trying, but it's not realistic to expect them to provide this medical intervention to all the kids with autism. Then I wonder, well, do our opponents mean, well, the schools would provide it if they had adequate resources, and so state, you should just give them more money. I think, though, that there's no obligation under federal or state special education law
for the schools to treat a child's medical condition. The whole point of IDEA, the Individuals with Disabilities Education Act, was to require the schools to accommodate children with disabilities, not to remedy the underlying disabling condition. So if you think about, like, take diabetes, for instance. Schools are
Lori Unum
Unverified
25:59
with diabetes to go in the hallway to get an insulin injection if they need to, to function during the school day.
But that doesn't mean the school has to pay for the insulin. It's the difference between accommodating a child's medical condition and treating it. So while the schools do have a role to play, they should not shoulder the responsibility for treating what is unquestionably a medical condition that's diagnosed by a medical doctor. And then
Speaker 40
26:32
just one more thing on the educational point. I thought, well, maybe the opponents object to paying
Lori Unum
Unverified
26:39
for services provided by school personnel.
What we're asking for in this legislation is for a private provider, a private speech therapist or ABA therapist who is working in the child's home or working in a clinic with the child to be able to bill insurance. So I think this whole, it's educational, it's just a distraction. Clearly autism is diagnosed by a doctor, not by a principal. This argument has been raised in 23 states.
It's been raised in federal court. I've got a sampling there from a federal court decision last year that rejected that argument. And it is not a reason not to provide health insurance coverage for children with autism who need it. Just to sum up, you know, I was a law professor for seven years, as I mentioned, and I spent a lot of that time thinking about this conundrum, autism, because my son was diagnosed during that time. And I thought, you know, really, I know the system was broken because I knew it shouldn't
be the case that only wealthy children could get treatment. I thought, whose responsibility? Is it the schools? Is it Medicaid? Is it insurance? after thinking about that and studying the issue for a long time, I finally came to the realization that it's a shared responsibility, but it's the insurance piece that is not playing a role at all right now. The insurers have not done their part to cover the medical aspects of autism. So I thank you so much for listening. I thank you for taking the first step toward giving Arkansas
children the opportunity to receive treatment that kids in so many other states now have, And I'd be happy to entertain questions now or later if you have questions. Madam Chairman,
Representative Uvalde Lindsey
Unverified
28:36
seeing no questions, can I move to the next presenter? I think we've got about seven or eight minutes. Is that the timekeeper? We have a question from Representative Lindsay.
We do have, looks like, several questions. So if you wouldn't mind, we'll go ahead with that. I
Speaker 54
28:55
would yield. Thank you, Madam. Representative Lee. Thank you, Madam Chair. Representative Lindsay, I'm curious about this because as I've listened to the presentation and you and I have not spoken about this prior to this meeting today, why this is an insurance bill and I'm just really curious as to why you requested it be in public health. I mean actuarial, et cetera, that's an insurance and commerce bill
and I was just curious to know
why it was here. Representative Lee, I think we'll take that question outside of the purview of the meeting. That is a decision that's made by the speaker. So if you'd like, we'll just take that question out of
Speaker 54
29:31
the purview of the meeting. If you have
Speaker 59
29:34
another question, we'll move on. Great. I have another question. Prevalence.
Speaker 28
29:39
Was the prevalence related to diagnosis? There's some indication that the increased prevalence is in part due to expanded diagnostic criteria and in part due... That's what
Speaker 59
29:46
I was thinking. Okay. Okay, and covered under, do you know if it's covered under Medicaid?
Speaker 41
29:52
It varies. Specifically the ABA part of it? My understanding is that it's not in Arkansas. Okay, thank you. Thank
Representative Andy Mayberry
Unverified
30:06
you, Madam Chair. Representative Mayberry. Yes, ma'am. First of all, I want to thank you very much for being here and for bringing an issue to us that is very concerning, I think, for probably everyone in this room. I'd like to preface just slightly that my background, I sit on the board of directors
for a nonprofit and based out of Conway that provides activities for children with disabilities including an autism resource center. My wife teaches dance classes for children with a wide range of disabilities including autism. This is a big issue to me and I want to do everything I can to
help you. I do have some questions.
You had mentioned about multiple times you said something about how only the wealthy few are getting treatment.
Are you referring specifically to the ABA treatment or just treatment in general, other types of therapies involved? It
Lori Unum
Unverified
31:11
is mostly the ABA that is being prescribed but not accessed because of cost. There is some coverage under some policies for some amount of speech therapy. It's certainly not universal or consistent, but I don't want to stand up here and say that no family has ever been able to access coverage for speech therapy or occupational therapy.
But it's the ABA where there is frequently in an insurance policy a flat-out exclusion. It will name it specifically and say, we will not cover ABA therapy. We
Representative Andy Mayberry
Unverified
31:49
consider it investigational. It's my understanding that in the state of Arkansas that autism meets the functional requirements and is defined among the categorical examples of a developmental disability.
which would allow for a child who has been diagnosed as being autistic to be eligible for services through Medicaid and eligible for up to three hours per day, an hour of speech, an hour of developmental, and an hour of occupation. I'm sorry, I may have my therapies mixed up, but three hours a day of therapies. and that would be for, as I understand, any child in the state of Arkansas who is diagnosed with autism.
It would appear that a lot of the problem is that perhaps some children at that stage, at that early stage that we know is so vital, may not be getting diagnosed. And without that diagnosis, then certainly they're not eligible. I'm not sure exactly how this bill addresses that as the heart of the problem though because as I understand the insurance coverage, private insurance will cover the cost of the diagnosis that I've made calls to some who agree that that is the case.
And, you know, is that more of the problem, is missing out on that early diagnosis?
Lori Unum
Unverified
33:30
I think failure to diagnose children early is part of the problem but not the heart of the problem because what you have is some children who are being diagnosed at two years or three years and their doctor says, great, we caught it early, here's what you need to do. If you go get this very intensive therapy, your child might have a shot of leading a functional life.
And then they can't get it. So what good is an early diagnosis if they can't follow the doctor's treatment
Speaker 28
34:02
protocol once they're diagnosed? But you're absolutely right. There are multiple issues that need to be addressed, and bringing that
Representative Andy Mayberry
Unverified
34:10
HIV diagnosis down is part of it. This is an extremely complex issue. And, again, I very much appreciate everything that you've done here in Ms. Verity and Representative. Are you, and you may not be, but are you aware that in Arkansas there currently is in place
that by the end of the calendar year of 2011, there will be 100 additional Medicaid waivers specifically for children with autism? And I believe that the age range on that is 3 to 11 with, and someone can correct me if wrong here but with emphasis on the younger ages as well the three to six area and if I'm correct and again someone please point out if I'm not but that with that Medicaid waiver that that could be applied toward ABA therapy
Lori Unum
Unverified
35:03
that that may be true I admit I don't know the specific contours of Arkansas waiver but in South Carolina we passed something very similar it's an autism some specific waiver that a Medicaid waiver that covers ABA specifically $50,000 a year and it's through age 11 so it may be that Arkansas was patterned after South Carolina's and that has been critical there are 500 kids in South Carolina who get ABA through that Medicaid waiver and it's great because the kids who have private insurance can get coverage through their insurance leaving
the Medicaid waiver to cover the children who aren't
Speaker 28
35:40
lucky enough to have private insurance it's been a wonderful public-private partnership that provides coverage for many, many kids. Representative Mayberry, do you have another question? Well, I've actually got a big,
Speaker 78
35:57
long list of them, but I will defer at the moment. Okay. Just so that we'll
make sure that we get to the amendment, Representative Lindsay, as we get into the debate, we want to make sure we're debating the bill with
the amendment. I think it's appropriate that we consider the amendment that's on the table. It's been handed out to the members. Committee, what's your pleasure? Representative Penartz. Motion do pass on
do pass on the amendment. Any discussion on the motion? All in favor on the amendment, indicate by saying aye. All opposed, no. Representative Lindsay, the amendment has passed, So we are considering the bill as amended.
Do we have any other questions from the members on the bill? All right, we will be taking – we have a number of people who have signed up to speak for and against the bill. So we'll make sure that we allow room for that for folks to approach the end of the table. The first person signed up to speak against the bill And by the way, there are a couple of people who have signed up as information
And we'll take those in the order of against So unless there's some objections to that, just
wanted you to be aware So Dr. Mike Martin is first up on the list
to speak against the bill thank you madam chairman i hope you'll forgive
Speaker 82
37:39
me for having a cold today madam chairman and members
Senator Percy Malone
Unverified
37:42
of the committee my name is michael r martin and i thank you for the
opportunity to speak against this bill i'm a licensed medical doctor i've been practicing internist in tetra canna for almost 30 years i also want you to know two other things first First, I am the parent of an autistic child, and second, I am an employee of Arkansas Blue Cross Blue Shield as a regional medical director. However, the statements I will make are my own views based on my experience as a practicing physician and, more importantly, as the parent of an autistic child for the past 24 years.
And I want to make the following observations about this legislation. The overall aim of this bill in providing coverage to individuals with autism spectrum disorder is too open ended. Once the diagnosis is made, there are no limits on any therapy, medication, physician, psychologist visits. There are no age limits, no condition specific limits. Any ability to monitor the usefulness of therapy is limited to once yearly. The inability of an insurer to monitor these services and
raise questions about their necessity invites overtreatment and fraudulent billing. Most importantly, there is no scientific evidence that such an approach improves outcomes. Many states, as has been alluded to, have adopted legislation specific to autism. However, in the legislation that I have looked at, almost all of these states have placed age limits, condition limits, or duration limits on treatment. The only state that has passed similar recent legislation is Massachusetts.
Interestingly, Massachusetts exempted their state-run exchange from the provisions of this bill. Arkansas would be joining the state whose increasing health care costs are well documented. ASD is a lifelong condition. There is no evidence that any therapy provides a cure, although there is evidence that some therapy can provide improvement. ASD is a spectrum disorder. Not every individual is equally affected. A few individuals in the high functioning range are those with a diagnosis of Asperger
syndrome, may have normal educational outcomes, hold jobs, and enter into long-term relationships even without specialized therapy. I am not aware of any evidence that any therapy statistically improves these specific outcomes. I am not aware of evidence that people that are severely impaired on the other end of the spectrum. Some of these children are so severely impaired that they have little response to the therapy that's been provided. So there are a significant number of individuals on
either end of the spectrum who either do not need the therapy or cannot benefit from present therapy. This legislation as it's drafted encourages treatment of everyone. With the legislation, parents of autistic individuals may feel they're denying needed therapy to their loved one by ignoring the mandate that this bill provides. Many, if not most, of the therapies mentioned by this bill have been and continue to be covered by insurers. For example, and I checked about this before I came yesterday,
medications, treatment of comorbid conditions, speech therapy, occupational therapy, physical therapy, psychological care, developmental evaluations, and physician visits. The introduction of federal mental health parity legislation has provided equal coverage compared to general medical conditions. In my mind, mental health parity has eliminated the need for separate legislation for autism for those individuals who could not receive needed therapy under their traditional insurance. The exception to this is behavioral intervention.
The most widely known example, as has been alluded to, is ABA. Every state that has adopted autism legislation has specified ABA coverage. ABA is considered by many to be an educational intervention, Most notably, this is referred to in an updated paper in 2007 by the American Academy of Pediatrics as an educational intervention. Health insurers have objected to this requirement since state and federal laws specify such interventions are the rightful responsibilities of public education system.
Expanding health insurance requirements into this arena would invite other equally worthy educational disability groups, such as dyslexia or antigen deficit disorder or others, to lobby for their own coverage for educational therapies. At a time when the emphasis in health care is on cost containment, such an expansion in health care is unaffordable. If we want legislation on a federal level to be financially constrained, how can we expect less on a state level? The legislation does not specify how a diagnosis of autism is to be made or who decides who
is qualified to make the diagnosis. bill states that any licensed psychologist or physician may prescribe these therapies, implying that these providers are equally qualified to establish a diagnosis. However, as also been alluded to, the literature suggests that even now, many clinicians are in adequately prepared to make a diagnosis of ASD. The bill uses a definition of evidence-based which is not standard and does not define, most importantly, who will decide what is evidence-based and how it will be decided.
As the parent of an autistic child, I favor insurance coverage for medical therapy that addresses age, condition, and cost, but most importantly, I support that coverage when there is clear, evidence-based research that establishes effectiveness and defines those circumstances. While I do empathize with the hardships and frustrations the diagnosis of ASD can impose on my family from personal experience, I do not believe the present approach of this legislation provides an effective and equitable solution. Thank you. Dr. Martin, thank you for your testimony.
Will you take questions? Representative Hall, you're recognized. Thank you, Madam Chairman.
Representative Clark Hall
Unverified
43:43
Sir, I don't know if you saw the amendment that has been offered in the past, but
Representative Buddy Lovell
Unverified
43:50
I think it does have a limitation on the annual amount of money to $50,000. Would that change some of your resistance to this bill based on the fact that it does
Senator Percy Malone
Unverified
44:05
have a limitation? I think the evidence base is that there are other limits that are important to consider. But I want to go back to what I primarily said, which is the position of insurers is this is an education, despite what's been alluded to, this is an educational intervention and it's best served under the public education system. That said, if one assumes that insurers should be responsible for this, there are other provisions that should be mentioned. For example, the evidence base says that behavioral intervention is best done early, has been
alluded to, the earlier the better, and the most bang for the buck is obtained in those individuals who receive it early, and in the first two years, we would object to this being open-ended. Almost no literature, particularly randomized controlled literature, suggests that children over the ages of 12 or adults
Representative Clark Hall
Unverified
45:02
benefit from ABA. The most benefit is seen usually in that. You referenced there,
Representative Buddy Lovell
Unverified
45:08
sir, that early diagnosis of this issue should be around two to three years of age.
Senator Percy Malone
Unverified
45:14
Is that correct? If that's what I heard? There's even an attempt to make diagnosis earlier as early as 12 to 18 months of age. So is that
Representative Buddy Lovell
Unverified
45:25
where you need to make that diagnosis? The earlier the better. My understanding then, since we don't start the education process until the four-year-old kindergarten, would that not indicate it is a medical condition and not an educational condition?
Senator Percy Malone
Unverified
45:39
This is a contentious area. There's not going
Speaker 100
45:43
to be a simple solution to it, in my opinion.
Representative Buddy Lovell
Unverified
45:46
I'm sorry, sir. I was sitting down on the far end, and I did not hear your first comments. What is your position? I apologize. I did not hear what your profession. You're a doctor, a medical doctor? In general medicine,
Speaker 95
46:01
parent of an autistic child. I work for Arkansas Blue Cross Blue Shield as a regional medical director. So you're not
Representative Clark Hall
Unverified
46:10
in private practice? Not anymore. So you work for Blue Cross Blue Shield? Thank you, sir. Thank you, Madam Chairman.
Representative Mayberry, you're recognized. Yes, sir.
Representative Andy Mayberry
Unverified
46:26
Do you have any kind of statistics or data that show the difference in a child who receives the ABA therapy versus conventional therapies of some type? in the studies that have been done
Speaker 104
46:42
there have been in the earlier during to interventions
Senator Percy Malone
Unverified
46:46
the better in the studies that have been
done that i'm aware of and i'm certainly not an expert in this regard but as a parent i've read the literature for over the past twenty years approximately fifty percent of kids can be expected to make significant cognitive behavioral adaptive uh... and i keep gains however there is no evidence or not good evidence that they make good emotional or social skill improvement with ABA specific
Representative Andy Mayberry
Unverified
47:16
Is that in comparison with a child who's not receiving any
sort of therapy or is that in comparison
Senator Percy Malone
Unverified
47:23
with conventional therapy? In the early studies that was basically against historical controls that received very little intervention as time has gone on, these are usually compared to other types of therapies such as structured teaching such as the teach program, floor time, and other eclectic mixes of therapy available
Representative Andy Mayberry
Unverified
47:43
in different communities is ABA therapy
one that can there be regression after the ABA therapy is discontinued or do you know in the
Senator Percy Malone
Unverified
47:57
studies that I've seen there has there has been evidence that the gains made are sustained although they may not increase with time but again I'm not an expert, somebody else in this room may be better able to answer that
Representative Andy Mayberry
Unverified
48:14
question. Okay. And just for clarification, would, as you read this bill, as you understand this, would this cover a majority of the children in the state who have autism or? That's a good point.
Speaker 95
48:26
This only covers a small fraction of the state, the children in the state
Senator Percy Malone
Unverified
48:31
with autism. This specifically kind of taxes small employers more than anybody else. As has been alluded to, it doesn't apply to Medicaid. It does not apply to self-insured groups, for that matter. So this is only going
Speaker 100
48:43
to apply to a small fraction of the children in the state with autism. Okay.
Thank you. Representative Wagner, you're recognized. Thank you, Madam
Chair. I think most of my question has been answered, but I was on the Insurance and Commerce Committee in 2009
when we discussed this issue, and at that time there was a lot of discussion about whether this was a mental or educational disorder, and you are indicating, I think, and that's what I'm wanting clarification
on, as a physician, as a father of an autistic child, you lean more toward the educational disorder? I think that this
Senator Percy Malone
Unverified
49:29
particular therapy is an educational intervention. I think it is a medical disorder.
Medical disorder, but the ABA is an educational intervention. As listed under
Speaker 95
49:40
the 2007 Guidelines of Treatment by the American Academy of Pediatrics, they list it as an
Senator Percy Malone
Unverified
49:46
educational intervention. So by it being educational intervention, that would be
one reason why it should not be paid through insurance? Correct. Thank you. Thank
you, Madam Chair. Representative Wilkins, you're recognized.
Representative Butch Wilkins
Unverified
50:09
Doctor, I'm sure you realize I couldn't diagnose autism. Do you agree with that?
I'm sorry, sir? I probably couldn't diagnose autism, could I? The diagnosis can be difficult.
Speaker 100
50:22
Yeah, but it has to be done by a doctor,
Representative Butch Wilkins
Unverified
50:25
don't it? Yes. Thank you. Dr. Martin,
thank you. I think that's all the questions for you. Next on our list, we have Mr. Jason Lee with Employee Benefits. If you will take your place at
the end of the table, introduce yourself with the record, and you may proceed, sir.
Jason Lee
Unverified
50:47
Good morning. My name is Jason Lee. I'm the Executive Director for
Speaker 121
50:52
the State Employee Benefits Division. I'm here this morning simply to provide information about the impact of the bill for our state employees and our public school employees through the health plan.
Mr. Lee, let me interrupt you just a moment. I didn't make it as clear as I should have. Mr. Lee has indicated to us that he is speaking information only, not speaking for or against the bill. and since we do not have a time limit I'm recognizing him
next in the sign up order. You
Speaker 121
51:24
may proceed. Thank you. We provided the information to our plan's actuary this being House Bill 1315 and I believe they have a cost estimate that's included within your packet. The conservative estimate that the actuary provided to us used the enrollment numbers from the last year's rating cycle to look at the number of children that are covered on the plan. The diagnosis rate that was used were six cases
per 1,000 covered children. We used an average or they used an average claims cost of $29,000 per year for the individual seeking treatment and that equates to the public school side of 2.6 million dollars on the state side 2.4 million and I will put those into a little bit of perspective for you the 2.4 million dollars on the state equates to three dollars and thirty cents per member per month or roughly 1.2 percent
cost increase the 2.6 million dollar estimate for the public school equates to a $3.90 per member per month or a 1.1% increase. I do say that this is a from the actuary this was a conservative estimate because the estimate used did not take into account that we may be paying for some of these expenses for the individuals already. We do see a significant number of claims coming with autism as a secondary diagnosis so that passing this bill may not have
impact on those claims since we're already paying for it now we have assumed through this a limited degree of pre-authorization control that we would have in place to determine medical necessity before the services are rendered but obviously with a greater degree of medical necessity control and pre-authorization we would be able to control those costs to some degree more and we have also or they also assumed no age limit on who would seek the services under this autism bill, although, as it's been stated here, predominantly
it's children of a younger age. This assumed the entire 30,000 covered children lives and applied the six per 10,000, or excuse me, then applied the six per 1,000 diagnosis penetration. And with that, I'll be glad to answer questions.
Seeing no questions, Mr. Lee, I'm sorry, Representative Lee, you are recognized. Thank
Speaker 51
54:02
you, Madam Chair. Secondary to what?
When you say it's usually a secondary diagnosis, secondary
Speaker 121
54:08
to what? We see many of the claims come in with the pervasive developmental disability as a diagnosis,
secondary diagnosis being autism. Thank you.
Speaker 133
54:33
Thank you, Madam Chair. Thank you, Mr. Lee. We appreciate your testimony. We
have another information person who has signed up next on the list, Professor Ranko
Oliver, if you will take your seat at the table, please, and introduce yourself for the record and proceed. And as I understand it, you're not speaking
Ronko Shiraki
Unverified
55:07
for or against the bill. It's information only. That's correct, Madam. Good morning, Madam Chair. Good morning, members of the committee. My name is Ronko Shiraki Oliver. I teach at the University of Arkansas at Little Rock William H. Boyne School of Law. I have taught disability law every year since 1992.
I am the proud mother of a 23-year-old woman with autism who, when she was 8 years old, began to receive ABA therapy treatment. As has been stated, I am not here to support or to challenge the bill. I am here because a former student of mine, Ms. Mullenix, Julie Mullenix, asked me a question about disability law
and asked me if I would come and share with the committee my views regarding the source for payment for ABA issues. Parenthetically, I would like to say that as the mother of a young woman with autism, I very much wish that when she was a child, a bill such as the one all of you are debating and considering today had been in place.
As is the case with the first speaker, my husband and I are very blessed that we were able to pay for ABA sessions for my daughter, but those of us who fall in that category are a distinct minority. So one point I would like to make is that these sessions ought to be paid by somebody. As was very eloquently said during the first presentation, ABA is
one of the possible means through which our children have a possibility of becoming productive members of society. The theme of or the thesis of my comments is the following, that ABA therapy sessions can be classified as supportive services or related services under IDEA and under the
Arkansas Children with Disabilities Act. My argument or my position is not through classifying ABA therapy sessions as being educational in nature. My point or my argument is that just as physical therapy, occupational therapy, speech pathology, pragmatic communication,
all of those are therapy sessions that fall within the umbrella of supportive services or related services. They are not educational in nature. None of those, none of those is educational in nature, but all of those, including ABA, permit our children with autism and other disabilities to be able to be educated in a mainstream to the degree that is reasonably
possible to do so, to be educated in a mainstream setting. The argument that the ABA sessions ought to fall within the supportive services under IDEA and the Arkansas Children with Disabilities Act is congruent with the intent of Congress in passing IDEA in 1975, the predecessor of IDEA, Education for All, Handicapped Children's
Act, the enactment of IDEA in 1990, and the most recent reauthorization of IDEA in 2004. That is congruent, placing ABA therapy sessions within those supportive services is congruent with congressional intent, and it is congruent with the intent of the Arkansas legislature.
All of you are fully familiar with the activities and the enactment of the Arkansas legislature, but the Arkansas Children with Disabilities Act specifically says that supportive services are there to permit children to have an opportunity to benefit from and participate in an integrated school setting. Now behavior issues, ladies and gentlemen, are very, very serious issues that we as parents
of children with autism in school districts and teachers have to face. Behavior issues are very significant and they are significant enough that in 1997 Congress passed amendments to IDEA specifically addressing behavior issues of children with disabilities. Because we as a society do not want to permit a child with a disability to continue exhibiting
behavior problems even when they are related to their disability so in 1997 congress enacted a number of amendments that put in place disciplinary measures for children with autism and other disabilities and those disciplinary measures range from temporary suspension all the way to expulsion from the school at the same time
and in order to continue its congressional intent and the social goal underlying idea Congress in 1999 through the regulations that accompany the 1997 amendments included in those regulations that school districts are to conduct functional behavioral assessment of our children. Based upon those functional behavioral assessments,
then the child's IEP, which is the cornerstone of IDEA and the cornerstone of the Arkansas Children with Disabilities Act. If the child exhibits behavioral problems through a functional assessment, functional behavioral assessment, it is going to be determined the type of therapy that he will need, the level of therapy that he will need, the frequency with which he
will need those therapy sessions. In 2004, Congress passed additional amendments that once again specifically highlight and emphasize the importance of addressing our children's behavior. In 2005, the Arkansas Legislature, in its amendment of the Children with Disabilities Act, specifically recognizes the functional assessment of our children's progress. I will
not take the time to read to you verbatim from the amendments of 2005, but the 2005 recognize congressional intent to focus on our children's behavior and address that behavior. Now why is behavior so important? It is extremely important because the behavioral issues that our children may sometimes exhibit will inevitably preclude them from participating and attending
school in an integrated setting. Those behaviors affect communication, socialization, ability to understand the rules of the school, and for that reason, not only Congress but the Arkansas legislature, both enabling bodies have placed significant focus on the behavioral issues of our children. The first speaker indicated that ABA therapy sessions are not
educational in nature, and I agree. They are not educational in nature, but neither are speech therapy, pragmatic communication, occupational therapy, physical therapy. Those therapies were brought in the overall structure of both the Federal Act and the Arkansas Act to address the deficits that specific disabilities bring upon our children.
For example, occupational therapy became one of the recognized related services because many of our children exhibit difficulty, deficits with gross motor skills or fine motor skills. So occupational therapy is not educational in nature, nonetheless it is one of those supportive services. The same is the case with physical therapy, speech pathology, and pragmatic communication.
So I, again, I'm not here in support or against the bill. I'm here because Ms. Mullenix asked me to come. I have the utmost respect for her. And she indicated that an explanation of the structure, coverage, and congressional intent underlying IDEA and underlying the Arkansas Children with Disabilities Act would be helpful
to the committee. May I make one last point? If our children do not receive ABA therapy sessions, do not receive other types of behavior management therapy sessions, and school districts do not pay for these sessions. School districts would be thereby violating a very, very important
principle that underlies idea and that is that our children are to be educated in the least restrictive environment. If our children continue to exhibit the behaviors that preclude them from benefiting and participating in an integrated classroom they are not going to be the school districts are not going to be complying with federal law I'm sorry one more point I don't have written notes I'm doing this from my
head excuse me one more point I wanted to to clarify that the first speaker made So the first speaker brought in, I'm sorry that I don't remember your name, ma'am, by the way you gave an eloquent presentation. She brought up the example of insulin shots for a child who has diabetes, and she termed that action by the school as an accommodation.
I'm not talking about providing and paying for ABA therapy sessions as an accommodation. IDEA is not a civil rights statute. IDEA and the Arkansas Children with Disabilities Act statute are enabling statutes. 504 of the Rehabilitation Act of 1973, Title II of the Americans with Disabilities Act.
Both of those are anti-discrimination civil rights statutes under which issues such as getting an insulin shot is termed an accommodation. What I am proposing here, and I am humbly sharing my argument with the committee, is that ABA sessions are part of the supportive services, related services, that are specifically
required under IDEA, which is not an anti-discrimination statute. It is not a civil rights statute. It is an enabling statute through which states enter into a quid pro quo with the federal The federal government provides the funding to educate children with disabilities, and in return, the states open the doors of their public schools to children with disabilities
and provide the supportive services and related services they need in order to be educated in an integrated setting. Thank you very much. you ma'am for
your testimony I appreciate that representative Allen you have thank you I'd like to make
Representative Fred Allen
Unverified
1:09:31
a motion to the limit debate from the public to 15 minutes we have a motion on
the floor to limit debate to the public for 15
minutes on the on the side so that's on the for and the against side that is a
a debatable motion. Any discussion on the motion? If not, all in favor indicate by saying aye. All opposed? All right. We will limit debate to 15 minutes on either side. Ma'am, thank you very much for your testimony. I appreciate you coming to the committee. We will now go to the four, and let me just make sure that everybody understands. We'll have 15 minutes on either side. Mr. Price is going to keep track. Mr. Lindsey, Representative Lindsey, that 15 minutes includes your
opportunity to close. I just wanted you to be aware of that. So we will ask Dana and Brian Miller to please come to the podium, introduce themselves
to the group and whom they represent, and then we'll proceed. Good morning. I'm very honored
Dana Miller
Unverified
1:10:45
to be here to speak among you guys today. My name is Dana Miller. I'm from Jonesboro,
Speaker 141
1:10:50
Arkansas. I am a licensed speech pathologist, a behavior consultant who just took our national board certification to be a BCBA. Most of all, I'm a parent of four children, and I'm going to do this fast. So in my Arkansas language, I can talk fast. I have a 10-year-old son with autism.
So, as growing up, from age two, when we knew something was wrong, he started getting speaks therapy, occupational therapy, physical therapy, and developmental therapy. Received that for almost two years with very little progress made. He had limited progress, but went for his final diagnosis, his first actual diagnosis, and was diagnosed with moderate to severe autism two years after receiving these therapies. I was told that I would need to place him in a group home because he had such aggressive behavior towards his sibling, that he physically hurt him and made him bleed.
He banged his head on the floor until he bled. He wiped feces on the wall. We couldn't go in public because he would throw such loud fits and break anything and everything he could get a hold of. I was lucky to be blessed to meet a very influential family in Jonesboro that was receiving ABA therapy. And they asked me if I would like to meet their doctor and see if that would be right for my family. I met him. I started doing research, which I had done for years. I had my degree in Google University on autism. I met him, and I was amazed by the progress their son had made,
but I knew my family could not pay for it. At the time, I was a factory worker. My husband was a factory worker. We made decent money in Arkansas, but we could not afford it. I had a hard life growing up, and when God gave me my son, I believed that that was the answer to the hard life I had lived and that he was going to be everything in the world. He was going to be the number one quarterback, and he was going to be president. And now I was told to put him in a group home. So I was faced with the fact that I could not afford the therapy that research said could help him.
And we had to find a way. We sold everything we had, which was very little. I went to college so I could take out school loans and become a speech pathologist to give him more therapy. we got an insurance or a tax return in six months after his diagnosis and i was able to pay the doctor that weekend forty two hundred dollars to come in and write a program for my son and that's what it took for the initial weekend we got our friends and our therapist to learn his program to help us run it my husband and i learned to run it my mother my father had died and my mother gave her
our savings gave us her savings to continue his therapy because in seven weeks from a non-verbal child I had a little boy come up to and say mama love you mama ear hurts and he could tell me when something was wrong instead of beating his head on the floor or hurting his brother since I have limited amount of time I want to let you know we continued his program and I continued my education so that I could learn to provide his therapy because I knew I wouldn't be able to pay for only probably about a year so I learned as much as I could and the doctor that I worked with
graciously let me intern with him so that when I couldn't pay any more and I promised him that I would go on to continue my degree to help other kids my son is now 10 years old he goes to Valley View Elementary which is the number one but one of the hardest schools in the state on academics he is in the fifth grade regular education classroom with zero modifications he is in the Duke talent search program for gifted children because of his take state testing is so high. He plays golf. He plays basketball. He shot his first four point this year.
First shot, he nailed it. He got a buck. More than that, he is one of the most compassionate, loving people I have ever met in my life. You have a child that didn't understand and laughed when other people were hurt, who now helps other people and wants every child to get what he has. He is my inspiration, and he keeps me going. But the reason I do what I do and why I'm here is because it's not fair that he got the therapy he needs. It's not fair that he's going to get to be a meteorologist and then governor and then president.
That's his goals. And he told Governor Beebe, look out, he's coming. It's not fair that other kids don't get that. so now very quickly I want to introduce you to the most amazing person I have ever met in my life this is Briar Ray Miller while he's here I want to add when he was first diagnosed he was five points away from mental retardation
he was diagnosed by someone who had never met him recently He has a 119 IQ. He was told that he probably would not qualify for autism anymore, maybe Asperger's. We took him to another doctor last week. They said there's no way in the world they could diagnose this child on the autism spectrum
Speaker 144
1:15:53
anymore. This is Briar Miller. You have to kind of
get close to talk loud if I may love. Mr. Miller, if you will, introduce yourself,
Briar Miller
Unverified
1:16:02
please. We appreciate you being here. Good morning, ladies and gentlemen. My name is Briar Miller, and I have autism. I couldn't talk, understand, or play when I was younger. My family worked hard to get ABA therapy for me, and now I make straight A's, play golf and basketball, and I also go deer hunting.
and I am in the Duke talent search program for gifted students I am where I am I am where I am because of good therapy every kid should have the same chance as I had. Thank you
very much Mr. Mrs. Miller and young man Miller we do
have one question would you mind taking a question sir? Doc Gaskell you
Speaker 142
1:17:00
are recognized. Can I adopt this boy? Not this one but I have an eight and a five-year-old
Representative Billy W. Gaskill
Unverified
1:17:11
me, okay? This is truly magnificent, young man. The rest of my life, of course, we ain't got that much left, but I shall remember you.
You're a fine young American and a great citizen, and I'm extremely proud of you and Mother Bolt. But listen, you give our kid any trouble, I'm taking
him, okay? Okay. Thank you, Madam Chair. Thank you. Ms. Miller, Mr. Miller, thank
you very much for being here. Next to speak against the bill is Marjorie Tullis.
If you will take your place at the end of the table, please introduce yourself to the group and proceed.
Speaker 162
1:18:04
Thank you, Madam Chair and Committee. My name is Margie Tullis, and I've worked alongside since 2000 with children with disabilities. I first worked as a registered medical assistant with some of the best six doctors in a clinic called All 4 Kids. This
Speaker 164
1:18:25
is where I first learned about children with autism. Four years later, I gave birth to a 33-week-old 43-week-old preemie. She was diagnosed at age 2 with PDD-NOS. She was completely nonverbal
until 3 and a half. I also worked at the Allen School where she received intensive therapies. She got the maximum amount and today she speaks not completely in full sentences and she attends East End Elementary School in a regular classroom
Speaker 162
1:19:15
with very limited modifications.
She still does receive speech and OT. I do believe in ABA therapy, but as far as the bill goes, it still limits the people that can get it. I am not one of those people that have the ability to get it and did not have the ability to get it. Even with the things that I own and the education that I have, I could sell everything I have and still not be able to afford ABA therapy.
I believe that if it's going to be offered, it should be offered to all children on the spectrum, not just a select few. I know there's more kids out there that are a whole lot more severe than mine. I worked with them one-on-one at the Allen School. I had a little girl in a classroom who weighed twice my weight, who was completely nonverbal, very aggressive. I have my hair pulled.
I have my face clawed. I had to have tetanus shots from being scratched. And believe me, I've seen in her parents' eyes just as well as my own how greatly they wanted her child to be just like the child that was here earlier. And we all wish that for our children. But why just a select few? Why not all? And that's all I really have to say Ms. Tallis,
thank you very much for your testimony
We appreciate you being here today I know
it's a daunting task to sit before this committee So I appreciate you
very much Thank you That's all that we have on our sign-up list Representative Lindsay let me first ask before we move to close what's the pleasure of the committee we have a motion to do pass House Bill 1315 as
amended any discussion on the motion yes sir Representative Wilkins Hey, Ms. Hunter, were you looking
Representative Butch Wilkins
Unverified
1:21:36
for a second on the motion? No, sir. Oh, okay. No, sir,
I was not. We have a motion do pass on the motion as amended, 1315. We don't need a second in committee. All right. Any other discussion on the motion? All in favor indicate by saying aye.
Aye. All opposed? No. Ayes have it. Mr. Lindsey, you have. Yes, sir. We have a – I don't see two hands. We have two hands for roll call. So, Mr. Price, if you will, prepare for the roll
Speaker 174
1:22:20
call. Oh, I should have. Okay. Representative Allen? Yeah. Representative Gaskell? Yeah.
Representative Lovell? Representative Lovell? Representative King? Representative King, Representative Hall, Representative Hyde, Representative Penarance, Representative Wagner, Representative Word, Representative Lee, Representative Smith,
Representative Wilkins, Representative Perry, Representative Malone, Representative Ledding, Representative Wardlaw, Representative Lampkin, Representative Mayberry, Vice Chair Woods chair Tyler
representative Lindsay I owe you an apology first let me say that that I I didn't give you an opportunity to close, and I should have, but that said, your bill has passed at 13 yeses and four
noes. You have passed your bill. Thank you, Madam Chairman. Thank you,
Speaker 181
1:24:10
members of the committee. Ladies and gentlemen, we
are going to go on to a couple of other bills, so if you will
keep your seat at the table. We've got some non-controversial bills. We do. Representative Wagner, you're going to, I believe, present House Resolution 1011 for Speaker Moore. Will you take place at the end of the table and present that bill, please?
Speaker 185
1:25:47
We still have a quorum? Yeah, we still have a quorum.
Representative Wagner, if you'll go ahead and proceed, I think we've got
Speaker 188
1:26:26
just about everybody out of the room that's going
to leave. Thank you, Madam Chairman. It is my pleasure to present House Bill 1011 for Speaker Moore today. This is House Resolution 1011.
This resolution is to support and promote education and research to find better treatments and eventually a cure for Parkinson's disease. And I had a father-in-law and brother-in-law who both had Parkinson's and I helped take care of them and know what the patient goes through and what the family has to deal with. deal with, so I'm very supportive of this, and the resolution also is to commend the dedication of the local and regional organizations and volunteers working to improve the quality
of life for persons living with Parkinson's disease and their families, and to designate April as Parkinson's Disease Awareness Month. I would appreciate a good vote. Representative Smith, you're recognized. Thank you, Madam
Chair. Madam Chair, a motion
Representative Garry L. Smith
Unverified
1:27:42
to do pass. Do we have
any questions from the committee?
If not, I recognize the motion to do pass from Representative Gary Smith on House Resolution 1011.
Any discussion on the motion? All in favor indicate by saying aye. All opposed, no. Representative Wagner, you can go back to the speaker and tell him you did a great job. We have a couple of other, I believe, non-controversial bills, and we're going to go ahead and take those. We're going to ask Representative Gaskell to take the seat in the table and present Senate Bill 165.
Representative Gaskell, you're recognized. If you will have your guest introduce himself, please, for
Representative Billy W. Gaskill
Unverified
1:28:48
the record. Thank you, Madam Chair. I'm Representative Gaskell from Perigou. This is Senate Bill 42. All this thing does is authorize dental hygienists to perform dental hygiene procedures that I allowed them to do 30 years ago. All you're doing is making it legal. The hygienists that worked for me so many years, they trusted her more than did me. You know, there's nothing like doing some surgery on a Friday afternoon and losing half of the pack
and can't get a hold of me because I'm off partying somewhere, but they can get a hold of the hygienist, but they ain't like her. So about all this does is just let them, they can enter into a collaborative agreement, and I'm going to let Senator Johnson explain a collaborative agreement. get in there, boy. Senator Johnson, welcome. Thank you, Madam Chair. We're
Speaker 198
1:29:45
on Senate Bill 42. Is that right? Yeah. Oh, I'm sorry. I
thought we were on Senate Bill 165. No, we're on 42 right
now. All right. Well, we'll take Senate Bill
Representative Tracy Pennartz
Unverified
1:29:57
42 then. All right. Thank you. Thank you, Madam Chair. Thank you, Representative Gaskell. Senate Bill 42 is the product of several months of work between the Dental Association and the Dental Hygienist Association. This issue came up with me because a report, I've got a copy of it right here, called The Cost of Delay. It's a study that came out a year ago from Pew Center on the States. It evaluated state dental policy with respect to children's dental health, and it ranked
all the 50 states on eight benchmarks. Access was a big part of those benchmarks, and Arkansas failed. all but two of those benchmarks fell in the bottom tier. Well, I looked at this report. Most of the time, to get anything significant done, we've got to spend a lot of money to do it. But I looked at this report, and I said, we can spend no money and make some significant gains on children's dental health. And one of the big issues that they pushed in the report was permitting dental hygienists to leave the dentist's office and to go to schools to treat children primarily with strictly preventive care.
And that would be teeth cleaning primarily and applying sealants, which weren't such a big deal when I was a kid, but they've become a big deal in the dental community to try to help prevent cavities. And so that's what this bill does. It permits dental hygienists to leave the dentist's office in an unsupervised setting like schools and do this strictly preventive care for children and do that without supervision and without a prior
Speaker 201
1:31:26
examination by the dentist. Let me continue on that with Senator Johnson.
Representative Billy W. Gaskill
Unverified
1:31:34
These dental hygienists in Arkansas are some of the best well-trained people in the nation. They are very well-trained. And if we have any intelligence at all, when one comes to work for us, we further train them. I'll give you a quick example right quick. Many years ago when I was practicing dentistry, my dental hygienist, who was my left hand being left-handed, a patient brought a lady brought her husband in had a sore denture Carolyn was so well trained that she
looked down in through there and she came to me and she said I don't think that's the denture she said there's something else and I feel a little knot under his jaw this is how well trained she was so I went back and looked at him and it looked like a little volcano a half an inch from the denture I told his wife I thought there was something else there I was pretty sure we referred him to a specialist they did radical neck surgery on him he lived another 10 years and he hated me
Speaker 205
1:32:36
every day because I had found it but these people are just absolutely well trained and if
Representative Tracy Pennartz
Unverified
1:32:44
I may add Madam Chair I think a big credit goes to the dental association on this bill As a lot of you, most of you know, I believe, any time we have a scope of practice bill that comes before the legislature, some of the most controversial things we deal with, and there is always two medical professions that are, it's a turf battle basically. But the Dental Association has been, I think they see the value in this bill
and the value in what we're doing, and I think they approach this in a self-serving manner. The reason we don't have a controversial bill here is because they gave up ground on this issue to allow us as policymakers to approve a measure that's going to help kids out. So a big credit goes to
them. Thank you, Madam Chair. Thank you. Now, we did have Representative Hyde and Representative Hall ask a question, but I think they were asking a question on Senate Bill 165, but I just want to
give them a chance. They still have a question. All right, so Representative Hyde, you're recognized.
Representative Barry Hyde
Unverified
1:33:41
Thank you, Madam Chair, and this bill is appropriate. I just want to kudos to the
new dynamic duo of Gaskell and Johnson, necessarily in that order. And this allows the hygienist to leave the office environment to provide services. And I'm guessing it doesn't affect the old policy that was beneficial in your practice, Dr. Gaskell, that allowed them to get you out of the office so they could actually make money. Yes. Thank you. One of the great things I
Speaker 197
1:34:09
like about this is that all the fees still go to the dentist.
Speaker 211
1:34:17
Representative Hall, you're recognized. Well,
Representative Clark Hall
Unverified
1:34:21
you know, life goes on.
Representative Buddy Lovell
Unverified
1:34:24
Senator Johnson, we actually was going to harass Representative Gaskell because of our long tenure here on this committee. But since you're here, and on a more serious note, could you define the collaborative agreement as your, could you define it in your interpretation
Speaker 198
1:34:50
Or would you? It basically repeats what the bill already provides. Basically,
Representative Tracy Pennartz
Unverified
1:34:56
the dentist and the dental hygienist will be entering into an agreement. The agreement will provide, it defines it right there. Lines 31 on page 1 through 4 on page 2, I think it probably states it the best and lays out the very limited preventive care type things that the dental hygienist can do. So I would just refer you to that definition.
Basically, it lays out the types of things the dental hygienist can do. Thank
Speaker 218
1:35:34
you, Madam Chair. Thank you, Senator. Representative Mayberry, you're recognized.
Representative Andy Mayberry
Unverified
1:35:41
Watch it for us. Just a quick question. I just want to make sure that I'm on the same page here. This doesn't allow them to – this is not expanding any kind of services that they haven't already provided, right? I mean, they're doing things that they typically do each and every day.
Speaker 221
1:35:55
Yeah. Okay. Yeah, they are – they're just well-trained. All right. Was
that an okay question? Yeah. Or maybe. Representative Wagner
you're recognized Thank you Madam Chair I just wanted to ask about since this is going off location and it does add duties
what about the malpractice insurance does that is that still rolling
Speaker 227
1:36:29
on the very last page a collaborative dental hygienist who provides
Representative Clark Hall
Unverified
1:36:36
services permitted under this sub chapter shall be insured under malpractice liability same as the dentist but who pays of course the dentist pays that's why I want
him to get his money back thank you representative Wagner representative Penards you're recognized Thank you, Madam Chair.
Representative Tracy Pennartz
Unverified
1:37:01
Senator Johnson, through the creation of this bill, or if this thing were to pass, you're
actually creating two – right now, we have a dental hygienist, right? Correct. That's the level of person that is basically licensed or certificated. So under this, you're creating now, you're splitting that in two
and now creating two levels of a dental hygienist? We're
not creating two levels. The dental hygienist, which is already addressed in law, will continue to be a dental hygienist. But for purposes of this new subchapter that would be enacted, we had to refer to something besides dental hygienist because once the collaborative dental hygienist, once he or she gets the necessary permits that are permitted by this subchapter
and enters into an agreement, they take on a different status at that point. And so for purposes of applying this, what's permitted by this subchapter, we gave it, we're referring to it by a different name. If we use dental hygienist, it would refer to the same dental hygienist law that's already in place. We want it to be clear in the statute, legislature, and for people who may be applying it down the road, that for purposes of this subchapter, we're changing the name for purposes of this subchapter
to make clear what that authority is. I don't
necessarily have a problem with the extension of this type or expansion of scope of practice. because it may give access in rural areas that's needed. But I'm wondering why it is that you needed to create artificially what is called a collaborative care permit one. If, in fact, the dental hygienist is already licensed by the Arkansas State Board of Dental Examiners,
Why would it be necessary for them to be entering into a collaborative care agreement when the skills that you're asking for aren't necessarily basically different other than in terms of years of practice with a dentist? So I'm a little bit perplexed why you artificially created this or hope to create this collaborative agreement and this permit.
Are you telling me that under current law that a dental hygienist cannot do these same activities in a public setting? They're only allowed, a dentist and a dental hygienist is only allowed to do these activities in a dental office? They can do it in a public setting
Speaker 217
1:40:05
provided they're supervised by a dentist. If the dentist is back at
Representative Tracy Pennartz
Unverified
1:40:11
the office, then the dental hygienist cannot leave the office to go do that.
So can a dentist go out into these public settings now? And take the dental hygienist with him or her. And then they could do it, but they cannot do these activities outside the presence of a dentist at this
Speaker 239
1:40:32
current time. That's the reason for this bill. And that's why
Representative Tracy Pennartz
Unverified
1:40:40
you're creating this structure for that to occur. Right. And are these fees that are to be paid, are they paid by the dental hygienist or by that dentist?
MR. It will be paid. I suppose that is a matter of contract between the dental hygienist and the dentist. The bill does not provide either way and whatever satisfies that relationship is fine, I think, with us policymakers. Madam Chair, if I could, I think Mr. Trice, Bill Trice, who is the attorney for the Board of Dental Examiners, may
Speaker 206
1:41:06
want to add a few comments if he could be recognized. MS. If they are brief
Speaker 243
1:41:11
because I have another question. Sure. MS. Madam Chair,
if you would allow. Trice, I will recognize you.
Chair
Unverified
1:41:18
I'm the lawyer for the State Dental Board. This bill does not change the functions or procedures that a dental hygienist does. But at present, all those procedures that are done by a hygienist are done in the presence or under the direct supervision of a dentist. What the bill allows is that if a dentist knows and has a working relationship with a hygienist he trusts,
he will set out a protocol or a collaborative agreement for those functions that both of them feel comfortable with in her performing away from the clinic. And the board enters into it by keeping that protocol in its office so that the dentist and the hygienist have registered that protocol so that if something goes wrong out there, we know what they have been authorized to do by the dentist and everyone feels comfortable
Representative Tracy Pennartz
Unverified
1:42:25
with. Well, thank you for that clear definition of the activity that may occur. I guess Madam Chair has allowed one last question. I have a concern because you're practicing, because this dental hygienist, by the way, I have a great dental hygienist with Dr. Jeffries in Fort Smith, and I would trust her to do this kind of activity.
But I am concerned that if something were to occur, that some type of requirement be made to establish what would happen in an emergency if an emergency were to occur. And could you assure me that there will be made some provision for
Chair
Unverified
1:43:15
that? MR. First of all, the procedures that they're doing after they're approved by the dentist and are listed in the collaborative agreement, those are not procedures normally where occurrences or, quote, emergencies occur.
Speaker 243
1:43:32
Well, I understand that. But if they
Chair
Unverified
1:43:35
do, they're trained to notify other people and to enter into that. But the board will be, if this is passed, will be in the business of passing some rules and regs to implement it so that that issue alone would be covered. For one person, for sure, they're going to have to be able to contact immediately is their dentist. And then depending on the level or the type of emergency, they might contact EMTs or 911.
But the procedures themselves that the dental hygienist will be performing are not the kind – we're not getting into oral surgery or anesthesia and the like. Thank you, Mr. Trice. I
Representative Tracy Pennartz
Unverified
1:44:19
think that I understand, and I just wanted to make sure, and I think you've indicated in your testimony that there will
be some attention paid to emergency services protocol. Is that correct? Yes. Thank you.
Thank you, Madam Chair. Representative Wagner, you're recognized. Thank you, Madam Chair. Still needing a little clarification. On page 3, line 30, and I realize that may means they don't have to, but it says the Arkansas State Board of Dental Examiners may charge a fee to a registered dental hygienist who applies for a collaborative dental care permit. And since the hygienist will not receive the money, I'm not sure why the hygienist would
even want to pay a fee to do this. So I just need a little clarification on that, please.
Representative Billy W. Gaskill
Unverified
1:45:14
The dentist is going to pay the expenses if he had a collaborative agreement. I mean, if you were working for me, I would be paying
your expenses. Well, it says that
Representative Billy W. Gaskill
Unverified
1:45:25
they may charge a fee to the registered dental hygienist. Yeah, but that could be a private agreement between the dentist and the hygienist. Thank
Chair
Unverified
1:45:36
you. Thank you. There's an additional reason that it's phrased that way.
Within this concept of hygienists going out to serve and do these procedures, the health department in and of itself will have the ability to strengthen and employ hygienists to go out and render services. And again, that might be purchased by the hygienists through the health department. See, this is a dual concept of the hygienist expanding where she would work or he and the dentist who will be the supervising from a central location only if he approves of the collaboration.
That seems to complicate things, but thank you for the explanation. Representative Hall, you're recognized.
Representative Clark Hall
Unverified
1:46:34
Madam Chairman, has anyone signed up to speak against this
bill? No, sir. I'll make a motion do pass. We have a motion do pass
on the floor. It's a debatable motion. Thank you. I tend to forget giving
the representative or the senator an opportunity to close.
I'm closed. Dr. Gaskell is closed. All right. So all in favor of Senate Bill 42, indicate
by saying aye. All opposed, no. Representative Hall. I would like to comment, if I may, Madam Chairman, that
Representative Clark Hall
Unverified
1:47:15
it's nice to see a senator down here with streamlined video. It is. Thank you, Senator. And I'm looking forward to looking at him on the
video. I bet he looks great. Hey, Clark, we're not through with him yet.
All right. We have Senate Bill 43, Senator Johnson. You also indicated that might be a non-controversial bill, so if you'd like to proceed, go right ahead.
Representative Tracy Pennartz
Unverified
1:47:40
All right. Thank you, Madam Chair. This is Senate Bill 43. Similar to 42 in that it's a scope of practice bill, another agreed-to bill between the Dental Association and the Dental Hygienist Association, or excuse me, the physicians and the registered nurses. will permit a very usual treatment in the dentist's office, fluoride varnish, it will
permit physicians and registered nurses under the supervision of a physician to apply fluoride varnish in a physician's office setting. The reason why this is helpful is because children in particular sometimes won't have a dentist's office that they go to on a regular basis until they're older, but children from a very early age are going to a doctor's office, and so to the extent that we can, again, provide
some preventive care to children, this is another way that children can access that kind of care. So that's what this bill does, non-controversial between all parties involved. I think there was a great support among everyone for it, and we'd appreciate a good vote and welcome any questions. Let me add
Representative Billy W. Gaskill
Unverified
1:48:52
to that. A pediatrician that sees a child, a lot of times practicing dentistry, and any practicing dentist can tell you this, we don't see a kid before 10 or 12 years old.
By that time, the six-year molar in there is gone, so let's let them pay a little bit more attention to it. They see them a lot. Then they
Representative Tracy Pennartz
Unverified
1:49:18
can refer them to us. Thank you. Representative Penarts, you're recognized. Just did I hear correctly, Senator Johnson, that who's in
agreement about this bill? The Dental Association, it's their practice into which we're going.
So I think if anybody would be opposed to this scope of practice bill, it would be the dentists. They support it. The physicians support it. The Arkansas Medical Society supports it. I forgot the name of it, but the Academy of Pediatricians. I forgot
the proper name, but they support it. Second question is, Senator, who will do this risk assessment that is indicated in here? The
physician, and it's supervised by a physician, the registered nurse.
So a physician does this risk assessment.
I just want to make sure that. And then the third question is, on line 31 and 32, it says that under the physician supervision, the application may be delegated to a nurse. Is the implication there that nurse means a registered nurse or an LPN? It's a nurse. My recollection was
it was a registered nurse, but it says nurse.
It's going to be an LPN or
Chair
Unverified
1:50:46
a registered nurse. Is that the
Representative Tracy Pennartz
Unverified
1:50:53
far as I know. According to Senator Johnson? That's my definition. What does, Senator Johnson, what does or other licensed healthcare professional mean? And since there's no definition in your bill concerning what a health or other licensed health care professional is, what is that? MR.
Well, I think even though it's not defined, I think any of us would recognize a health care professional who is licensed. If we didn't require that they're licensed, I suppose anybody could claim they're a health care professional. But the fact that it's licensed is going to necessarily… MS. Well, who would that be? restricted to the Board of Dental Examiners, the Medical Society, Mr. Treismanke. Is there any others, Mr. Treismanke, you can
Chair
Unverified
1:51:41
think of? MR. The people that license normal health care professionals are the nursing board,
medical board, and dental board. And those are the only ones that deal in, and then you have others, but they're not related to this sphere, the optometrists, chiropractors, I mean, they're
Representative Tracy Pennartz
Unverified
1:52:05
licensed. So they wouldn't be, they are an other licensed healthcare professional, but you don't
Chair
Unverified
1:52:11
anticipate that those licensed healthcare professionals would be wanting to do this,
Speaker 263
1:52:17
is that correct? We don't anticipate that they're going to be in
Representative Tracy Pennartz
Unverified
1:52:28
a physician's office. It could be a multiple practice.
Well. Thank you, Senator Johnson. Thank you, Madam
Chair. Representative Wagner, you're recognized. Thank you, Madam Chair. I'm just curious who will provide the training and who will
Representative Tracy Pennartz
Unverified
1:52:45
pay for it. Well, the Board of Dental Examiners will set the training,
And Mr. Trice may have some details on it. This
Chair
Unverified
1:52:54
is actually authorizing the physician to do this, and he couldn't delegate it unless he had someone he had trained. And this is the administering of the fluoride. But it's something that's being taken on by the physician. So the physician will train
other people if he or she wants them to do
this who trains him are we assuming he's already
Chair
Unverified
1:53:26
trained he's trained and in fact this the way your statutes are set up between the two professions physician and physicians and dentists this is normally a dental function not a very complicated one but physicians are willing to do this in their clinic and And they're trained, too. They can do other things, too.
They can extract in an emergency and different things like that. But, yes, they're trained to be able to administer this rents. Thank you. Thank you. Representative Smith, you're recognized. Thank you, Madam Chair. And
with all due respect, Senator and Representative, I
Representative Garry L. Smith
Unverified
1:54:08
have a comment from a dentist in my district. May I read that, please? It says, just in case there's an opportunity for you to speak regarding the bill and you'd like to know why I'm so strongly opposed to this bill, here's my argument.
This is from Dr. Tommy Raines. I spent four years learning the skills necessary to diagnose and treat diseases of the mouth, including but not limited to, dental caries. Without the benefit of x-rays and well-developed clinical diagnostic skills, it's impossible to determine whether there is dental caries. Appropriate training, as it's called out in Senate Bill 43, is certainly not the four years of dental school that a licensed dentist has completed, and I fail to see how it can be properly conveyed to a physician or nurse or other auxiliary person in a weekend training seminar.
By allowing these less than adequately trained individuals to perform these two vital services, you open the door for a sense of false security, that there is not a need to see a dental professional for proper and complete diagnosis and treatment. I foresee this bill not as an end-all, cure-all for lack of access, but rather an end to the need for many patients to seek dental care until the undiagnosed decay causes dental pain, at which time it will be much more traumatic and expensive to correct than if it were properly diagnosed in the beginning.
I think this bill is very short-sighted with regards to the potential long-term problems that will likely result from its passage. I felt it necessary to give that testimony since
the dentist, Dr. Rains, could not be here today. Members, may I interrupt just a second, Representative Smith? I'm sorry. We do have House rules that prohibit us to bring testimony for or against a bill via text or email. And I gave you some latitude to do that.
But I wanted the committee to recognize that we don't really have testimony against the bill.
I just wanted to clarify that. I
Representative Garry L. Smith
Unverified
1:56:07
apologize, and I appreciate you allowing me to speak. But I thought it needed to be said. Thank
Representative Tracy Pennartz
Unverified
1:56:12
you. You're very welcome. And if I could respond to the comments that have been
made. Certainly you can respond. And, members, I don't mean to cut off questions. I just wanted to make the members aware that we do have that House rule, and I recognized Representative Smith without knowing that he had that testimony, and I didn't want to
interrupt, so I went ahead and let him read it, but I just wanted to make you aware of that.
Representative Tracy Pennartz
Unverified
1:56:37
Let me say, as far as the background of Senate Bill 43, of all the legislation that this report has caused to come about this session, the Dental Association, they were the quickest to support this bill. In fact, I proposed the bill, and I can say in our very initial conversation that the executive director, he's not here, he's out sick, I believe. But he could almost instantly assure me that the Dental Association thought that would be a good idea. We had a pediatrician speak at the Senate committee, and I think if he were here today, you would find a great deal of confidence in their ability.
The third thing I say is basically what this bill allows us policymakers to do is make a decision between no care and some care. And to me, the best choice is some care. If we don't pass this bill, physicians and nurses aren't going to be doing anything. And this is one step of preventive care when kids are already getting their teeth in at ages 3, 4, 5, and 6, before they're seeing a dentist that will allow them to get some preventive care to help them down the road.
Representative Garry L. Smith
Unverified
1:57:47
This, again, is just one dentist viewpoint, and I apologize for overstepping my bounds, but next time I'll speak against the bill if that will be appropriate, if
that's all right. Thank you. Rep. Smith, please don't misunderstand me. I was not chiding you for that. I just wanted to make the members aware of it. So we do have another
Representative Andy Mayberry
Unverified
1:58:12
question or two. Representative Mayberry. i
apologize i'm i'm my wife normally okay my wife normally takes our kids to the doctor
uh so i don't really know exactly uh but is it common for the
for the doctor at that age to check out their their teeth yes sir
Representative Billy W. Gaskill
Unverified
1:58:28
it yeah you know you get a three-year-old kid they're not going to take them to the dentist. You know, we seem to take all this stuff for granted. An abscessed tooth with a four-year-old child who can get one is dangerous. You can get a generalized septicemia from those things. But they'll see them.
For instance, in rural areas, you'll generally have a physician somewhere. You may not have a dentist where it's Clark Hogan there for 30 miles. So somebody has to see something in there. Yeah, they see them
Chair
Unverified
1:59:11
do. Okay. Representative Penartz, you're recognized. Thank you,
Representative Tracy Pennartz
Unverified
1:59:14
Madam Chair. Senator Johnson, I'm for this bill for one reason, because I believe that it will increase
access to care. And I appreciate the fact, Senator Johnson, I'm over here, that the Dental Association actually is supportive of your bill, and I applaud you in seeking their support before bringing this bill before us. And Dr. Gaskell, I know, is a longtime dentist, and I appreciate all the work he's done and his endorsement of this bill. So that's the reason that I'm going to be voting for it. But I still am concerned about the risk assessment, and I would hope that the Department of Health,
if you could assure me, Senator Johnson, that that risk assessment in my mind is very important, and I hope that you will continue to follow the bill to make sure that risk assessment is
Chair
Unverified
2:00:11
a sufficient instrument. Can you assure me that, Senator Johnson?
Representative Tracy Pennartz
Unverified
2:00:16
Well, I certainly have the same expectations about the risk assessment, Representative And I can assure you that if there is any trouble with that risk assessment, if I hear from Mr. Trice or from the Dental Association, I think I would be the first that they call
over this thing. If there's any concern about how the Department of Health is doing that, I will
be happy to act about that. Okay. Thank
you. Motion at the proper time. Seeing no further questions, Senator Johnson,
Representative Tracy Pennartz
Unverified
2:00:54
do you want to close for your bill? I'll just say that and repeat something I said. I think the committee has a decision between no preventive care and some preventive care. And I think clearly the right step and a step that I think the Pew Center on the States would applaud
is for the committee to take that kind of step. And so I would appreciate a good vote. All
right. We have Representative Penarcher recognized for a motion. Motion do pass.
We have a motion do pass on Senate Bill 43. Any discussion on the motion? All in favor indicate by saying aye. Aye. Any opposed? No. Ayes have it. Senator Johnson, you have passed your bill. Thank you, Madam Chair, members of the committee.
Thank you. And I believe we have one more for Senator Johnson. Now, Senate Bill 165, if you would go ahead and proceed. Madam
Representative Billy W. Gaskill
Unverified
2:01:54
Chair, I'm going to defer to Representative Gaskell. Madam Chair, thank you. Senate Bill 165, this is kind of dear to my heart. Some years ago, I might have been disqualified from this until I found out that going to jail every once in a while was a misdemeanor. I was a little worried
about this thing until I got over to the point about infamous crimes and I found that I had committed no infamous crimes and they didn't keep records of going to jail once in a while so I'm really for
this thing Alright, seeing no questions on Senate Bill 165, Representative Senator Gaskell, are you closed for your bill? Yes, ma'am, I am. What's the pleasure of the committee?
We have a motion due passed. Representative Lampkin? I don't know who.
Representative Wilkins? Somebody, I heard a due pass. I just don't know where it went. All right, we have a due pass. Motion to do pass. All in favor indicate by saying aye. Aye. Any opposed, say no. Senator Johnson, Representative Gaskell, you have passed your bill. Thank you, Madam Chair. Do we have any other business to cover for the committee? If not, we stand adjourned until Thursday.
Agenda
Call to Order
HB1315
HR1011
SB165
SB42
SB43
Documents
No documents posted.
Speakers
Representative Linda S. Tyler Chair
Unverified
Speaker 6
Representative Uvalde Lindsey
Unverified
Lori Unum
Unverified
Speaker 17
Speaker 28
Speaker 40
Speaker 54
Speaker 59
Speaker 41
Representative Andy Mayberry
Unverified
Speaker 78
Speaker 79
Speaker 82
Senator Percy Malone
Unverified
Representative Clark Hall
Unverified
Representative Buddy Lovell
Unverified
Speaker 100
Speaker 95
Speaker 104
Representative Charolette Wagner Chair
Unverified
Representative Butch Wilkins
Unverified
Jason Lee
Unverified
Speaker 121
Speaker 51
Speaker 133
Ronko Shiraki
Unverified
Representative Fred Allen
Unverified
Dana Miller
Unverified
Speaker 141
Speaker 144
Briar Miller
Unverified
Speaker 142
Speaker 153
Representative Billy W. Gaskill
Unverified
Speaker 162
Speaker 164
Speaker 174
Speaker 181
Speaker 185
Speaker 188
Representative Garry L. Smith
Unverified
Speaker 198
Representative Tracy Pennartz
Unverified
Speaker 201
Speaker 205
Representative Barry Hyde
Unverified
Speaker 197
Speaker 211
Speaker 216
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Speaker 221
Speaker 225
Speaker 227
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Speaker 239
Speaker 206
Speaker 243
Chair
Unverified
Speaker 74
Speaker 263
Speaker 261