Insurance & Commerce - Senate

We're going to start out by any bills that we have on the agenda today that have an amendment will present amendments adopted amendments but we're not going to vote on those bills to after session today we're going to come back in here after session that we won't have time to go through the amendments and look at those so we'll go do that they were going to go into We run one bill at the representative Johnson running run a bill real fast and then we're going to go into a single there will be some financial impacts on on everything we're going to get that get those all the way so if you have a bill with an amendment. As comparing let us know real fast so we can. In a get those on the agenda here and I do know we have some amendments that are still in the process of coming to us and once they get those in our hands we will adopt those amendments up or down and then we'll go from go from there. So which bills which which one do we have that all member. That is when we come up here while I run this amendment. What is it. Senate bill three. All right chairman you are recognized to present your amendment to Senate bill three eighty eight. Thank you Mr chair this is just a of several minutes or greed to amendments between Two two different entity we're just trying to it's a peer to peer Amendment we're just trying to get this on the phone here in. When I want to look at I'd appreciate a good vote on this amendment and then we'll come back later this afternoon and now and this I will do this or not. All right with that I'll make a motion to adopt the amendment get a motion to adopt the amendment. I are second all those in favor signify by saying aye hi all those opposed motion carries. Thanks are. See the. Senator Irvin. Right. We. It Irvin. Thank you members of the committee thank you Mister chair and Senator Missy Irvin district twenty four. Representative Lee Johnson District forty seven. So it members at eight this bill and house bill twelve seventy one is the only bill on this issue that we're going to be running and there are others listed on the agenda but this is the one that we've really had all of our and time effort and attention into particularly representative Johnson so I'm just a little bit of a brief history on the prior authorization process this is been an issue that we have started in and worked on I think for many many years and and simply what this bill does is it creates a gold card program so that if the men at and there's a percentage that look a representative Johnson will speak to but it's it is modeled after a Texas law there's also laws in other states that are passing in the same situation basically if ninety percent ninety percent of your claims are already approved and there's not an issue then this would create a cult car status for that healthcare provider so that they would not have to pursue the bureaucratic and issues that that that that they have to deal with with the protestation another words if it's already going to be approved anyway you get gold card status and those get approved automatically and then that it basically just set the process up to create that gold card status with working with the insurance companies I will just say that we appreciate all these people that have worked on this we've worked a lot with all the insurance companies and we've tried to do our due diligence to address every issue that we have. That has been brought to us and streamline certain issues as it relates to pharmacy and pharmacy board so I'll turn over to represent Johnson for more comments thank you senator Ervin committee members will dissect yes the representative of a Johnson which entity will. I want to make our are we on the correct bill with the amendment that we have in front of us we there is no this bill does not have an amendment this is house bill twelve seventy one. Fair enough okay we'll make to your amendment then right after this one that that you have under the bill I'm sorry we asked The Amendment was passed out what you're doing you're running twelve seventy one and and Senator Irvin said twelve seventy one I'm sorry no but we had twelve fifty two in front of okay okay that would accelerate a little together that's seven state thanks go about that serve that members are Suniti yeah I I I would just echo some of the things Senator Irvin said I mean if you can have a collaborative process. I says between parties and ultimately end up disagreeing that's what we had I mean I appreciate all the people in the insurance industry the pharmacist the the passes the different people that have worked hard to get this bill to a place where while I would still say the insurance companies are not supportive of gold carting bills in general I think they're very appreciative of the efforts we've made to create a bill it's workable in their industry and it's fair and so again I want to emphasize authorizations are an important tool for insurance companies to use as guardrails against people that over utilizing abuse the system this bill doesn't disallow that all this bill does is create a pathway for good performers to get exempt from the process for a period of time and would be happy to try to answer any questions on the details of the bill or any other questions any members out. Boyd. Thank you Mr chair representative Johnson senator Evan it's all in preparing for this did you come across any numbers like with the bureaucracy might actually cost the provider like ten dollars we didn't come up with the actual dollars but both on the insurance side and the provider signed it's clear that there's a lot of resources dedicated to working to this power authorization process on both sides you have people working full time we have physicians nurses away from the bedside working full time and hospital systems at clinics just trying to work through the bureaucracy the proprietor session so you know what we don't have an exact dollar figure certainly there's a financial savings to be had by streamlining some of the prior authorization process and and if I could also respond we do know there have been of folks that have charts that cost and it is a great monetary cost but I will but that that's kind of an internal at themselves tracking that house for themselves I know that certain groups have have done that as well in the past just tracking how much time and effort and energy they're spending on the phones basically trying to get proper sessions pre certifications things like that I can just speak from what I've seen and witnessed first hand as you may have somebody would literally on the phone for eight hours well that's eight hours on the phone where that nurse could be interacting and helping with patient care versus sitting on the phone trying to get a pre certification for that patient to be able to get the scans or lab test or X. ray diagnostics that they need so it it's become an issue and and I think the prior authorization process and like initially it was a great idea to like focus in on real problematic issues you know it is important that you have care plans and that they would have there is a proctor rescission process I think but it sometimes is gone to the extreme where every single thing gets has to require prior authorization when that's really not necessary and I think stream. Mining this will actually let us focus in on problematic areas verses areas that should just be let's try to rely on the training that those healthcare professionals have had and their their expertise. I will say to I was active I can as a follow up to answer it to echo some of those comments is medicines become more complicated that's also created some the issue because we just have more more procedures that when I started my practice didn't even exist before even due to. Do you think may be the key As used to because the price of prescription drugs to go up for instance like maybe there's a cheap oral medication that could treat you know nail fungus but then there's an eight hundred nine hundred dollar you know something that you know in the cheap for medicine maybe have requires a prior authorization and the other one that's more expensive is actually the one that's on formula airy I mean it could that be a part of what's driving that. I mean I perhaps I think it could be I'm at and I think also to there are things that you need to rule out physical examination as for instance I mean physical examination if you do it properly and you know then you know I can allow my physical examination of my training and my treatment training and expert experience versus having to order every single panel every single diagnostic test so we need to get back to you really kind of that all time medals all time way of understanding the patient but but we've seen it go the other way so there has to be give and take what we're trying to focus on though is if you can prove that you have done this and ninety percent of your claims at pre certifications have been approved then you get a gold card status it is reviewable there's a very good process but I do believe that this has driven up costs in some areas yes to your question so would it may be the point of this bill be if if I'm a good prescriber I'm a good clinician and I follow the science and do things the right way and not just well the last representative that was in here to say you know get me to prescribe something and you're you're really practicing good medicine this is here to help you and reduce those bureaucratic costs and it should help both insurance cost and medicine or healthcare costs correct correct. I do not know. Any other questions. Seeing none is anyone here to speak for against the bill. We have one coming up. And. Please enter your name for the record and let us know if you speak for against the bill. Thank you Mr chairman and Jonathan by some pharmaceutical care management association for the national association representing pharmacy benefit managers we are speaking in opposition to the bill today we believe that prior authorization is a partnership and in addition to pointing patients and physicians to lower cost options prior authorization can also be used to point people to higher cost but better effective testing a lot of times there are new indicated tests that doctors may or may not know of and our prior authorization teams try to make sure that patients have access to the highest most recent updated medical information and that's one of the values that prior authorization brings the concerns we have with the gold carting program really relate to the one size fits all night as were all familiar there is no such thing as a free mandate and a one size fits all does not tend to work and when the market is stepping up and creating these programs on a case by case basis we believe allowing the market to work is a better option than a government mandate and for that reason we respectfully oppose the bill. Thanks any questions. Seeing none thank thank you Sir thank you anyone else here to speak for against the bill. This is the one that one more. Please enter several record. Good morning there Committee my name is Derek Smith I'm an attorney with the Mitchell William silicates and what your law firm here in Little Rock Arkansas work practice insurance regulation today I'm representing America's health insurance plans frequently known as they have a hip is the national association whose members provide coverage for healthcare and related services. Before I speak to the merits of the bill I do want to echo the comments both by a representative Johnson and center or they have taught we have had numerous discussions about the bill they have made a number of significant amendments to the bill at our request and we appreciate that we we only speak against the bill because there are some things are still concerning to us and they're not they won't come as a surprise as the previous witness testified we believe that a one size fits all approach to gold carting of does have the potential to drive increase utilization and and remove some of the benefits of of a prior authorization processes just as there are any procedures and physicians are also different turns companies have different approaches and in our experience of one size fits all approach will increase utilization Dr park cost these are new programs and because of that we believe carriers all have the same flexibility in designing go karting programs is being provided to the past programs of the bill as well as to the Q. H. as well as to the A. R. home programs in our review we were only able to locate one study that really reviews of gold card plan it's out of Vermont it was based on very limited information but that study showed that on average the ordering practices for providers participating in the program was higher that in baseline years and was higher than non participating provider providers resulting in increased premiums we believe those effects could be mitigated by simply offering plans flexibility to to design their old gold card programs and I will point you to an article appearing in today's Wall Street journal Page one where United healthcare and cigna have announced their own gold card in programs that I think would achieve the results presented by this bill what they're doing in their own way. So that's our price that's one of our objections a second objections to provisions in the bill that we believe are patently unfair and all points just one the appeal process so is the bill is set up once a providers been get granted a gold card the carrier can review their their up their practices after the gold card is issued to determine whether they continue to meet the requirements to retain the gold card. The bill requires that process to be based on a random sample of claims. The bill also provides that once the determination is made a provider can appeal that process the bill provides that the provider for the healthcare insurer has to pay for that appeal whether it was justified or not so in every circumstance the insurer has to pay for appeal. A second even though the bill provides for a random sample. That the healthcare insurer has to use for purposes of reviewing standards. The appeal does not have to be based on the same sample so a provider can have their claim reviewed based on a random sample of between five and twenty if the gold card is denied the provider gets to do an appeal but they get to say let's look at a completely different random sample of claims so these are not the same claims that were reviews which we find to be unfair it again if there's going to be an appeal of a decision at all to be based on the same facts of the care use what's more unfair about that it is the fact that even though a second set of claims is reviewed if that second set of claims results in a different result that can be the basis for sanctions against the carrier so again the carrier does not get to review the claims doesn't make any decision based on a review of those claims they can be sanction. Either by fines for the potential to have their license suspended revoked or not renewed so again I do want to say that the sponsor of the bill and the backers of the bill that very good discussions with us and we appreciate that we only have some objections that we think the the bill and some places patently unfair and we would prefer to have the same options for to develop our own plans as provided to other plans under the bill. Thank you thank you Sir any questions. See non creation testimony thank you. Thirty one else here to speak for against the bill. Seeing none representive center. Your free close. Thank you members of. I believe on your desk there should be a letter from the Arkansas medical society that list all of the different organizations that are here are here in the US it here in support of the bill of just for second time they didn't provide testimony in support of the bill but they're listed in that letter and I I appreciate all the comments I think that we worked with due diligence to try to address every single concern we possibly could there are reasons why of course due to fiscal impact that we have put in as a legislature that we decided to allow for Medicaid in the passes to develop their own because of the fiscal impact we're trying to be responsible to those state dollars but we do encourage them to to try to work to your side and so we we did try to to limit and that in that regard but we believe that through the research that we've done with other states and these processes and actually looking at some of the gold card programs that do exist across the states that this is a fair approach and that we worked really really hard to make sure that it was fair and that was a good policy process for us to follow through the insurance department the insurance industry at the end of the day this is really about time for us as healthcare providers to trying to provide the best possible care in a timely fashion for our patients at the end of the day this is become a bureaucratic nightmare for both patient care and for providers and we are trying to find that balance we've amended the bill teen times I think to try to get the right language and be as responsible as we possibly could as we approach this gold card program at the end of the day that's why you have an insurance industry that is regulated because it should be about the consumer's choice and the consumer care and making sure that those policy holders are able to utilize effectively the policies that they have and get the services that they need to be able to take care of them so that they have a healthier healthier outcomes and with that. Alternative reticent represent Johnson I think there's a great comments and I will say to specifically some of the comments that were made we we are not putting this effect for PBMs until January one of twenty five to give them an opportunity to work to some of the nuances that are different with pharmaceuticals and regarding the go karting programs at large with insurance companies certainly we wouldn't we would be willing to come back in the next session this year with any bill you pass I think we should over over again you don't always get it exactly right the first time that's what we have the opportunity to come back once the doors that open and improve something I think this is the best that we can make to get a program like this started I think it's showing leadership in the country because we are going to be a state that's now leading this charge forward and there will certainly be looking at this over the next two years as it rolls out and I would be surprised if we can come back with some sort of changes because that's the way these bills happen at some point in the future and would be happy to answer any questions of members happy thank you Sir any other questions or comments from committee. What will the committee. I have a do pass centroid. Thank you senator Johnson. All those in favor say aye. Opposed same sign. I service center your bill is passed thank represent thank you so much committee thank you we're going to take a three minute break and while we're taking a three minute break representative will you get ready. Okay we'll call a meeting back to back to order a real fast Senator Dismang is going to brief us on the the amendments. Yeah I'll I'll do my best member you know we're we're we are in the session there's lots of things are moving pretty quickly also lots of different entities are coming to an agreement on you know various amendments on those types of moments of their shortened everybody can easily understand we plan on pursuing those adopting the committee run to the floor just like we would normally do not worry about getting engrossed and even some of the more substantial amendments of all parties have a chance to look at it may agree that you know there's no more controversy in the bill that everyone's you know it single by in unison I did will adopt that amendment in committee you're the bill committee adopted even if it is extensive so that's that's kind of where we are going to be a kind of case by case basis thank you thank you Senator Dismang. Okay we'll get back to is a deterrent and members at Senate bill one forty three will be moved to deferred and will be withdrawn from the floor today Senate that's my bill Senate bill one forty three will be withdrawn at from consideration. So one forty three will be withdrawn at represented Wardlaw. Thank you Mr Jeff Wardlaw district ninety four and I have with me director grant Wallace I'll let him introduce itself. Great Wallace director employee benefits division. You're free to present your bill Sir thank you Phyllis's house bill eleven sixty two years ago when we finish the BT study the the director made a comment of adding some fees in on the anniversary plans to collect revenue to help B. B. D. will basically what that does is put fees on our members on our employees and that's that's just an increase in premiums so we did draft a bill two years ago it was drafted last minute I would run a bill like that so I told him we would come back this session and fix it when we drafted that bill to begin the session it it wasn't drafted correctly once grant got in place we worked with the department to get it right get the bid process set up in what we actually ended up setting up and I don't have a bill in front of me as a rule making process where the department will set forth the rules for the plans to be bit it and make sure that we get the cheapest available plans for members and those rules will come to council to EBT subcommittee and rules committee to be adopted so we'll still have oversight over those rules as it goes I'll be happy to answer any questions and obviously brought the director with me to answer any as well. Any questions for the committee. Senator anyone here to speak for or against the bill. Mr just if I can take the opportunity I just wanna thank representative Wardlaw in R. C. before working with the V. D. on this bill and getting in a good place where I feel that we are going to be able to get the best service in most competitive rates for our members through the bidding process and making sure that that's done on a regular basis and a lot of work has been done on the financial stability of the plan and I just want to reiterate how by have a vision of being as transparent as possible when it comes to our bids when it comes to our rates when it comes to our plan designs with the legislature so that everybody knows what's going on in that we're doing it with as much transparency as we possibly can and I will add that these plans the last time they were actually bid was in need it was the the two thousand eleven or two thousand thirteen and that's just not right for members to set that long with plans that were not bad and not competitive really sought after so this bill does set that up to be on a regular basis to make sure we're actually out looking for the best rates for members. Thank you Sir any questions. Click here to do it just to and I think we see sufficiently for a LC when when would you expect to have those rules before us just stepped in the door I'm not gonna hold you to it but I want you know remembers are going to be to us hopefully within six months at the longest okay thank you. We're hoping Senator Hickey to have it ready for the next plan year so hopefully by this fall winter that was discussions we've had. Any other questions. Saying that there's no one signed up to speak for against the bill represented or pretty close I just create a good vote Mr thank you thank you what will of committee motion to pass a motion to pass by Senator Irvin secular centre Johnson all those in favor say aye. Opposed same sign resented your bill is passed. Okay we're gonna go to the to the single bills now that have financial impact get over representative maker over here he's going to explain his bill is not on our agenda he just going to tell briefly about the bill they will have single to go downhill just you're going to go and go down and let everyone know do some sales and they can explain the financial impacted these different bills have as I said you do not have this bill in front of you. It's coming from the house just while they're here we're gonna get them to go ahead and talk about financial impact so that makes it to us they don't have to come back Arkansas. Representative bill please make sure you let us know what bill it is that you're you're discussing yes Sir thank you Mr chairman Committee representative Baker District seventy one and this is bill number House Bill one two five seven. And I appreciate the opportunity for work we'll pass a copy that bill out real fast we'll have in front of you. Sorry about that Sir. Go ahead. Thank you a committee I appreciate single being here to help give some perspective on the bill that I'm passionate about this bill passed the house committee entrance of commerce yesterday it's and will be on the House floor this afternoon. This bill in its simplest form allows city and county law enforcement officers who have met the law the requirements for full retirement to have the option to purchase state employee health insurance until they are Medicare eligible and as you are well aware there's several different requirements for Medicare eligibility the most common one of course is turning sixty four years old there are other ones aside associate with disabilities and other opportunities as well so if a law enforcement officer who does find value and this opportunity does choose to purchase it for his family or her family they will not be eligible to continue it once they themselves become Medicare eligible at the driving force behind this bill was meeting with a lot of law enforcement officers as specially in my hometown and surrounding cities where we have a. Very well seasoned and aged police force and the number one concern they have about retiring even though they've put in nearly or a sometimes over three decades of service and I successfully returned home each night they are choosing to continue that like that line of work simply because they're afraid to pay for insurance in the private market for the three to five year gap they would have before their Medicare eligible I've been excited to work with not just the fiscal impact group but also with the V. D. and yesterday they announced their neutral on the bill and they're also committed to a rule making process to allow this to make it is fiscally sustainable to the state and with that I'll have sequel present their current findings thank you Sir but don't please introduce yourself on the record in Indiana don't go through the sure the financial impact for Matt Kersting Siegel Patrick Klein was single. So I'll I'll cover the fiscal impact on this bill we were provided data by Lotfi the fire department the group to get a sense of who would be eligible for this program as part of the the the population that exists today so we review that data based on eligibility requirements in the program against this the suspected costs of the benefits to to provide to these retirees they were there's separate groups of people that we looked at there's the current active population that would have a presumed impact the and then there's a current group of retired participants that would meet the eligibility requirements based on service that they provided today that still remain under the age of sixty five years old so so based on that data and some of the actuarial assumptions that exist in the current valuation for the state retiree program we came up with with an impact with the suspected cost of around eight thousand dollars after you take into account some of the contributions for participants for each participant that enrolls in this plan and there is a very a good level of participants that would in not be expected to enroll based on based on the different groups so we we've determined in a presumed eligible population in the active group of around three hundred people expecting somewhere in the neighborhood of five to fifteen percent of that population to enroll in the program there's a terminated vested group or are retired population that would potentially be eligible anywhere between five and forty percent were presumed to enroll and then that that retired group anywhere between forty percent and seventy five percent of the population was expected to enroll in a group based on those assumptions in the costs that we determined died from the existing program the existing costs for the retiree population we're expecting anywhere in the neighborhood of two and a half million to around five point two five million dollars in an expected annual cost this has the potential to grow somewhat over the course of time there is some. and points on the costs so there is there an upper limit on expect the cost of the program over time just due to the fact that operatives bins will age into Medicare eligibility and no longer be covered by this program but that based on those assumptions and what we look that that's what we expected to be in addition to that cost there is a liability that would need to be booked for the retirees that would come on this program presumably that would be a state liability but there's potential questions in terms of where that would ultimately the funding would ultimately come from but based on our our expect our understanding of the program who'd be eligible where we're expecting anywhere neighborhood of two and a half to around five million dollars in annual costs. Separately. I want to make sure I fully understand or what your the what you're presenting this courses as a bill as currently written in front of us is that correct let out act that eminent as it's written and based on the data that we were provided right. And supposedly you're going to have an amendment if this comes off the house floor. Yes Sir we're going to work with the DD on an amendment to allow rulemaking authority to allow cities and municipalities counties and counties too often to participate right of so but I do want to make sure here the cost that you're talking about are you are you say the state liability. And I think that's but at least from my standpoint that's what I'm most interested in that's what we're looking for is what what is the state general revenue impact the way that the bills written though the way that we understand the bill as written it would be a cost to the state and that would be a cash cost annual cash cost we're anticipating anywhere between two and a half million and five million dollars okay in in this in this current year that that has the potential to grow over time right to the difference but I guess per person who joins we're assuming eight point one thousand dollars an annual cost so that's the top line claims minus what they would contribute what the member would contribute for for coverage so that's that's the Delta there okay. And your aware of the amendment that he's about to that he's about to do you all it's my it's my understanding this is that the that we were going to come back and we were going to make it so that the the municipalities cities counties whoever it was that they would have to pick up that they would have to pick up those cost is that correct that's what you're moment supposed to do that is the commitment between us and easy to work out what that language looks like but yes that is the intent okay with that and again we understand that we have to make sure that all that was correct before got to this committee with that. How does that change for you all would be I mean at that point if the cities and counties have the option to do it as far as a state G. R. impact. Would there be any at that point. Well. What we're presenting here is is strictly just the cost of the retirees participating in the program if the funding is going to come from a separate source that it's likely of it seems unlikely that the liability would be on the state's books it would be transferred to somebody else that's exactly and that's and that's what I'm trying to get at and this is a little odd understand we're at the end of the session. And from my standpoint if if you bring your moment down here I'm not just I'm not being disrespectful so don't don't take me that way but if your memory is down here and it doesn't have it so that the municipalities counties whoever that they're the one that's going to have to pick up that year. And then it's also going to have to be at their option because there may be some cities or counties that cannot afford it and that has to be their decision that has to be their local decision on that you know if we can get that amendment the way that it's supposed supposedly going to be presented that is my understanding at that point and I know you are looking at system I always say that it's a state that has to put it in so that's why I'm saying state G. R. impact that at that point the state would not have to liability. And then maybe just maybe we could somehow figure out a way to make it work. So but from Siegel standpoint just what I want to hear that if all of that goes if that portion of it goes to the municipalities or whoever it may be. Then we're not good we're not going to have that that impact on us correct. That's right okay. I hope all that makes sense because my understanding that's the amendment that you're going to have to do before will actually have a vote on this bill. Yes Sir that is the intent implant okay. Thank you senator yes Sir patient on that any other questions. Sir John. Thank you Mr chairman of. I'm just you when we talk about. The. The cost of the estimate of a five point two million and then we talk about cost sharing well that could be one dollar on one side and five million two hundred sixty six thousand nine hundred ninety nine other side I'm is there a can you give me a percentage rather than yes they'll be cost sharing and I'm I'm not you know being argumentative I'm just simply saying that's a pretty broad range. I guess I'm dressing is the representative I. Thank you senator so it I believe to answer questions one EBT does have a lot of current autonomy and rule making authority to craft the plan and the benefit to the beneficiary for those cost shares but we do don't want yes okay currently my understanding is you that all right or I'm just trying to get a general idea yes Sir and it's my understanding that Siegel has tried to find the net cost which would be everything that the patient has put in fourth as our current plans so these enrollees were enrolled today and have the expected health care expenses that people in their early sixties have all those assumptions are. Their cost sharing on the current plan today would result in these numbers. I'm not and that would include any retiree contributions that are required under the program so in order to participate there is a there is a contribution of the retiree has to to contribute to participate that's taking into account in the eight thousand dollar number that we're using that as an annual costs for per retiree. Okay and and when I see this five point two million is that an ongoing cost presented no one time costs somewhere in between it would be an annual cost with the potential to grow over time as the the retiree pool increases. Okay where does that fit where is the house the beating on pay for this I'm just you know we're we are at the end of session I mean Senator is my friend talking about you know RSA and then here's five million dollars it's about. I'm not against helping these officers I think it's wonderful thank yes I understand since I've been in that age group doing here in in Medicare but once again you know it's five million dollars just wanna be off and answer yes Sir so I believe one of the limitations and this was the the delay and review an opportunity to review of the fiscal impact EQT's have that opportunity they've made their assessment of it and now the amendment that Senator Hickey is referred to is going to be me an EBT working together to address the recommendation to prevent that kind of cost shifting and cost growth is that Amendment again I'll let Senator Hickey explained it necessary but is it too authorized those conversations or is it to codify the result of those conversations. I'll I just need an answer Mr chairman Senator eking after that B. five. And again Mr again I got drug into this this morning so under understand everything we got going on here in the study says thanks a lot of the of the bill I guess at least from my standpoint what I would be saying is that if we don't have the language in the statute that specifically says that is going to be at the option of the city and counties in that they would have to pick it up they need to be a no go in this committee I would hope I would hope that would agree yes Sir so I think the thing is is there in the process of developing that amendment and if they can get it done that I think we deserved to probably look at it but if they don't and is not done correctly right now with our limited time that would just voted down. Okay I hope I'll except putting sentences amendment representative actors okay any other questions it's it's not going to be maybe it's not going to be my amendment hello it's going to be his amendment I'm just trying to help through because of all that the state doesn't own one if maybe they were not voting on this bill today okay not all the let's hold off on that until it is it makes it finds chamber thank thank you repeating thank you Sir appreciate you all very much. Okay we'll move on to another single you want to stay right there Senator Irvin. SB one nineteen. Okay that pulled okay I think that being so if I could just explain her I mean I could just explain to the membership okay on Senate bill I'll go down here. That serve as you got about three or four Bills front row. Okay Senate bill one nineteen and they and they can speak to it but I'm not gonna run this bill and I'm actually probably going to just referred to interim study the reason why is because we are we have struggled and struggled and stroke struggle to get the right and then did language for an amendment and we can't figure it out but the premise behind the bill is what all to speak to which is we want to be able to open up opportunities for outpatient procedures versus just inpatient procedures so historically reimbursements for the exact same procedure was paid higher at an in patient facility purses an outpatient facility which would also include ambulatory surgery centers so many oftentimes if you're gonna get paid to do it paid more to do it here versus there even though you could avoid hospitalization here by doing it outpatient and ambulatory surgery center area then we want to do that and eliminate extra costs associated with inpatient procedurals so that that's the premise behind the bill we've tried to equalize that we've done a lot of work to try to try to and. Try to set up to raise reimbursements for outpatient procedures so that its is so that we can avoid additional costs associated with inpatient procedures. So but we cannot get the right and ended language for the bill and I don't want to run it without that a minute language but we're going to continue to study this but again we want to be able to move patients through outpatient procedures if possible just to avoid inpatient stays and inpatient care and everything that goes on along with that we think actually would be a cost savings in the end but we just don't have the right language in place. Senate so Centerville respectfully. You're going you're you're not going to run this bill you're going to put it in an independence yeah so really from that standpoint for time. We don't we don't need to hear your report because even if it got a minute we have to have you to look at it again from that standpoint right so all right thanks which which one of these bills just for times like to bill if you say office over on house bill twelve fifty two. Okay I have house bill twelve fifty two I would have the amendment that's agreed to house bill twelve seventy four twelve seventy five those are the ones I'd like to run this morning of possible okay you may finally be the same order is there any of these that you're going to run. Now that we need to give a report on that not not that I'm aware of twelve fifty two does not have one. Twelve seventy three or twelve Sunday for that she's going to run in this section that that is correct you know if you because if you're if you're not gonna run in this session if you're going to if you're gonna run one in the session since the eagles here the only other bill then would be that craniofacial bill that I'm not just I mean we've got testimony and you want to try to adjourn at whatever times I'm not sure if we have time are you leaving right now. Are they. Relieving yes this afternoon okay. What what time is your flight out. Three o'clock ma'am may make a suggestion yes Sir. Because of what they're doing could we just here or there discussion if it's okay with you Senator Irvin only on the on the fiscal impact thing so we would know sure and then we could hear the testimony later it shall rest and get senator hammers bill as well while they're here because we will not be back in your life so okay so what we're here we'll go ahead and and do the craniofacial Max that we were prepared. Okay. What what what bill numbers that. It does not have an impact on small children with okay let's go let's just to let them discuss Hammer bill SB one eighty one but then discusses financial and he's on his way selection would start talking about the the. The impact of a okay. Yes. So S. B.. Are you aware of the amendment he has four U. started just informed now. Okay he has an amendment is bringing into this so what we're going to hear. He could be null and void am I correct on that. So it. Let's go ahead and present what you what what I got the the the fiscal impact of the essay and we'll we'll see what he can. Server so a Mister chair and just getting back to the amendment process so house bill twelve fifty two does have an agreed to amendments and so I'd love to be able to pass this bill as amended this morning so that on the floor in the Senate I can get engrossed and so we can run the bill on the Senate floor on Monday. So I know you've set a time limit but does that make sense to have the House bills that have amendments in this committee if we run then this morning and pass them as amended then this afternoon on the Senate floor we can suspend the rules and get those amendments engrossed and get those bills out the door I appreciate that very much I try to see what we can do but these guys are on time frame have set them up. Thirty. At one. All right. What is the. This. Okay what was your support is made may I yes here's the thing as we all know or joint rules whenever we passes you know that whenever we worked on all that everything everything that it would affect the B. D. has to have them to discuss it and tell us correct now maybe the. Four five for a lack of a better word is. If they look at a bill the way that is sitting and then somebody wants to come in and put an amendment on that totally changed everything and they're going to have to re look at that in final four so if the bill that we're talking about here was Senator Hammer has an amendment. We're going to have to verify us because like I say I believe we have it in joint rules. The way that it's going to be in final form to figure out the impact you are correct so we're going to have a little bit of an issue right there if there's going to be an amendment on that bill and that's the that has the possibility of totally changing it yes Sir sorry. Yes. A senator Hammer I know it's gonna be hard but we're fixing to take a recess in about three minutes. Per share first of all of all bills at work on this one is one that has been like a tennis ball back and forth trying to get everybody together on it and understand this amendment is put on this it would alter what they would say. What I'd rather do is if I if I could just get with Max is waiting to hear back from somebody about somebody else when you hear back I do not think that what the amendment is going to do is going to alter the numbers. At all but they don't know that okay and I respect we are where we are it is what it is and I'll defer to the committee what I'd rather do is if you're a recess that between baby down noon I can just get with everybody and see but but the content of the amendment is more about who's involved in the diagnosing and other things that I don't think it's going to have a direct impact to the finances but are standing committee can't know that because I haven't signed the amendment in because I'm still trying to see if I get everybody on the same on the same page. Thank you Sir at senator he said while ago we've got to look at in the final four I understand. And and and the thing is that I don't even think it that at that at this particular point that that really is up to the committee because if I remember correctly we have all of this in joint rules with the house and the Senate it is that correct then we have all. The impact. Okay it was approved it was approved and that's that's the way we have everything set up so I don't even that we would need to research and I don't think that we're going to have the authority to do that. And I I couldn't agree with you missed you what do you think. I'm putting you on the spot I know that but that's why we're here mission. We're sorry thank you Sir. I don't think we have the authority at that that's only my my solemn that Mr. To make this easy. I'll present the bill as originally presented let ever to come to the table and speak against it if they've got the fiscal impact I don't think it hits C. B. D. if I remember right I'm not sure let's just put the cards on the table I make my best pitch as it was originally forget the amendment would just go with it the way it is and then we'll see which way it goes Senator fans of. If I might just. Can can we hear the fiscal impact real quick if it changes then they're out of luck but at least let him get the fiscal impact a lot which I that it real fast from them we are fixing that are that way if it if it does in fact it then we could hear this afternoon is that acceptable to everybody yes yes sorry okay thank you should be pretty quick okay it's that straightforward. So. We're assuming the impact would be anywhere from one percent to one and a half percent of medical claims spend. So the bill is adding a mandate for IV IG it's somewhat costly it's it's about fifteen thousand dollars per treatment there can be multiple treatments that we assumed appropriation there'd be three pick three treatments but the utilization is is relatively low so we only expect point one percent of members to to utilize the new benefit. There's been several states that have been passing similar legislation we actually worked on a bill for the state of Kansas two years ago and some of the research that we did that job with the assumptions that we we received from Blue Cross blue shield who administers many of the plans. Thanks any questions the committee Mr chairman ask questions yes Sir. I'm I just wanna make sure we have the the cost EBT is what sets so we had a little confusion on whether it be the covers that are not so we put no impact on our table but we also in the ride up in case they. Don't currently covered we did say that the impact would be five point seven million dollars or one point two percent of their medical spend. Thank you any questions from the committee. Thank you jim for your for your testimony explanation that and we're going to recess until ten minutes after session adjourns thank you Mr chairman.