Revenue & Taxation- House

Of members that you'll see on the agenda we have to bills were not going to be hearing Senate bill two O. seven we're still working with the stakeholders on that one likely to hear that hopefully maybe Tuesday so currently we're gonna hear house bill fourteen twenty two representative Johnson. You're recognized and we are ready when you are members also keep in mind we're only here in the bill today we're not going to be voting on it quite yet so big in the past all the questions you need to. You're recognized. Don't take to the this isn't intimidating table also for the and it's a little. Little scary I was going to get it pulled up to make sure had in front of me you said this house bill. Fourteen twenty two. The members I'm not sure how familiar of one of the table is with with how we train healthcare providers it as an entity right so healthcare provider with the time that a physician or a nurse or a behavioral specialist at the end of the day like with most professions it ultimately becomes a principal of a top right so as a physician when I went to my training process I certainly had that act that acting classes in medical school I learned gross anatomy and microbiology and biochemistry but at some point you have to start laying hands on patients and to go through that process you need someone to guide you and for many of us in this process that leans on Community physician so depending on where you're training certainly and your M. S. there's a whole lot of employed physicians whose job is to train medical students through a process residents through a process but there's a finite number of those people employed by you a mass there's a finite number of those people employed at the medical school in Fort Smith in Jonesborough and so the way you fill that gap in this is true whether you're talking about a medical student a nurse practitioner or physician assistant a nursing student the way you fill that gap is with community providers so as a community physician working in merger in Fort Smith it's not uncommon and has not been uncommon even throughout my career even before the medical school Fort Smith was built for me to take a student into a month a month long agitation yeah we were taken students back in the early aughts from you and that so we used to take students from some of the DO schools in Tennessee before we had the schools here and and this is a good a good thing right to get that for me to do it's very rewarding but also in a very practical ways a costly thing so for me and for many of us in our profession and again this is physician all the way down. how you get paid a lot of times depend on productivity infirmity take on a student it slows me down it reduce my productivity I have to stop in and visit with them which is important explain what I've done and let them know why I did what I did and if so I will see fewer patients in the course of the day. Many of us are doing this volunteer so you and ask many of the schools in the state don't offer any kind of stopped and for this preceptors ship we call this a preceptors on precept during a student for usually this is a rotation usually this one student for a month that I would preceptors so most of the time in my career one out preceptors students I would get paid nothing there are times where some of the schools will pay you a stop in it is it's a relatively small amounts of maybe five hundred dollars for a month which when you compare that to the loss of productivity that you incur by bringing on a student it's burdensome and so I have colleagues who resisted taking on students because it it is it is a little bit of a financial impact on how they produce and what they do so as we've looked at the bottle necks that we've created from work force when it comes to health health providers one of the bottlenecks is the training and whatever we can do to try to encourage more healthcare providers to take on students in precept them and and and proctor them through an apprenticeship I think it's important that we try to do that this is one strategy that I'm presenting you today that other states of employed with the good effect so this is the at the idea behind this is to give a tax credit to people who are willing to take on students and train them as we've got this bill written right now if you're if you're getting a stipend and you're not volunteering we tap we've maxed the credit six thousand dollars if you're getting if you do this voluntarily when accident ten thousand dollars Right now in the bill is currently read as a written as a refundable tax credit I'm told that's not the best way to do this you know some medical medical expert not a tax expert I do have an amendment compare that plan to run a member's own to make it clear that this is a non refundable tax credit which I think has some significance with regard to how this is. Rolled out and and and also reduces some of the of potential for fraud in this process there is a fiscal impact statement we've asked for from the FNA it's a little hard to predict the fiscal impact because it's hard to know how many people are going to embrace this and take advantage of this but I think when you look at the number of students out there the number training spots I think they did a fair job of trying to analyze this and hopefully have that fiscal impact there to look at and I'd be happy to try to answer any questions on this process the concept or the bill itself if anyone has any questions representative McClendon you're recognized thank you chairman thank you good question for you so just to clarify this is medical students and not residence yes correct I think I said presents to residents have a different training programs to any medical schools and the students in the House as quick follow up and then the person the physician he was doing the preceptory does he have to be at a university at a hospital can be just in private practice does it matter no it does it is it really depends on the guidelines of the school to be clear this is not just medical students so in my career of Procter and presented the nurse practitioners PA's along the process was a physician assistant so all of your it won it in fact it's arguable that the bigger bottom that gives is with the nurse practitioners and the the physician assistants because they have to have physicians take them on it's been time doing rotations their clinical rotations are are I would say more dependent on community providers to take them under their wing then the more structured medical school program so for me this bill is as much about that nurse practitioners and physician assistants as it is the medical students I just that's who I've had the most experience with thank you. In a baby you're recognized. Representative Johnson how many preceptors per student so could one student health. More than one preceptors and in the year yes so one student you know so the way as training set up with the medical school is you can have a Lech division your fourth year of training and you can connect with a different providers based on that elective so you might have an interest in optometry ophthalmology I mean and you might connect with an ophthalmologist in the community that gave you a different feel sometimes having a community rotation as opposed to a rotation academic institution gives you more real sense of what it would be like to practice and then you could go to the next rotation might be something in Rolla G. a community knowledge or rural family practice or and for the nurse practitioners in the PA's well I'm not an expert on their training they have to do clinical rotations in segments that the complete a certain number of hours with the pediatrician certain number of hours without family practitioner depending on what service services wanted to and so does not be months at a time of one single provider but there's no rule that would prevent a student from having multiple preceptors additionally as a preceptor can't have more than one student now practically speaking I don't know of anyone that takes more than one student at a time because it's just you just can't practically teach in that in that process but you could take up to twelve students in the year one a month in this process. And just a quick follow up this bill to qualify as a hundred sixty hours of of time that that preceptors going to dedicate per student correct yes yeah for for forty hours a week for four weeks was the idea from my representative Fortner you're recognized. Thank you Mr chairman the representative I think that this that idea has merit What I see it could be a. This could be the. Much broader program what you are perceiving because I could see anybody that has an apprentice ship program of any type. Would come in and say well how about us would you see that as a possible problem I think any time we start bring forward legislation there's always you know overlapped in what people look out look at do you I think this and it's certainly have worked for shortage across many areas not just healthcare that with with this specific issue the reliance on community providers to fill a gap that we don't have a formalized training makes it I think a little different we have pretty robust technical training schools that are there to help train certain folks in certain professions agreed that apprenticeships are valuable in those professions as well but I don't think there's quite as many as much reliance and in other areas as there is a healthcare that said if it's a workforce shortage in this a productive program can help fill the gap in other areas I would argue that still get expenditure of our state dollars. Okay and I agree with that but I could see that this could expand beyond the scope of what we're considering here and we need to give that some thought because I don't care if it's any of the trades and electricity you don't want someone coming out of trade school where in your house you want them to serve under someone that knows how to do it properly I agree on that's that's that's just my point but thank you it's a good it's a good bill Sir. Thank you representative for a representative may bear you're recognized. Thank you Mr chair thank you for bringing this this idea we know that there's a work force work force shortage my question is do you have the numbers to tell us like what is the backlog how many currently nurses doctors and counselors are waiting maybe to connect with that professional do you do you have a lot of the number I don't have specific numbers I think I can get some of those numbers I didn't come prepared today with the people to come to the table from the schools to give me that idea it's so it's it's hard for me to put spouse it may be hard for them to put specific numbers on it because I'm sure it fluctuates over time part of this too is about encouraging the people that are willing to do this to keep doing it so is it you know certainly hopefully this program to bring new people to the table but at the same time the people that are actively stepping out doing what what I think is an important part of of what we need to do to help realign our new healthcare providers this is certainly would help them along as well so if you could reach out to whoever to to share just just so we can have an idea of what those numbers are I think that would help but I love this idea and so thank you absolutely I'll try to get some numbers at your Mr chairman if I just whatever I got if I could bring it to you would you be able to serve its members absolutely yeah for sure representative what you're recognized. Thank you Mr chairman of representative Johnson I don't Is this line is in the hospital where a nurse takes on someone in a preceptor program was up with is that what you're talking about here certainly would apply to this is well yes something I'm talking specifically have been addressing more of physician proctor ring or preceptory a another medical student or nurse practitioner or physician assistant but the way I intend this bill to be drafted would include nurses taking on other clinical nurses as well as a preceptor role so so in foreign could have a president you know well Sir to your doctor your but I know hospitals do this they have we're students have to serve so does this would be for our ends as well if there preceptors student in a in a program that's not part of the normal curriculum that I would say yes I mean I think that that is the fine line there for with your physician nurse practitioner PA or nursing student there are some times where you have a teacher who is employed in teaching a class and that can occur in a clinical setting versus a single one on one preceptor ship for elected to teach a specific areas so this would apply to the one that's going to preceptor a specific issue but not specifically to someone who is employed to teach classes agreed. So okay I admit that the revision an already in on the floor the floor nurses are in can have a preceptor and that numbers can give the credit is that what you're saying yes I would say based on the way I understand this bill to be drafted if a nurse took another nurse on as a preceptor in a program to teach that person one on one some skill set it's outside the normal curriculum of the nursing school then yes they would qualify for a request with your yes could we have Mr Gehring come we're gonna grant bring him up here just a few minutes thank you thank you would members any other questions. president Johnson would it be fair to say that we have a nursing shortage right now yes we certainly have a nursing shortage right now okay. That represented brown go ahead. thank you Mr chair Representative Johnson. I think connect all the dots here on the and the difference between the the ten thousand in the six thousand can you explain that it didn't seem like the person that was getting that six six thousand dollar credit was compensated but that didn't total up to anything near ten thousand it is so yeah I think the idea was to give a little more of a tax credit to the people that are volunteering in not being compensated at all and to try to differentiate between those two groups of there are there are preset you should get a small amount of compensation for their time and so we wanted to cap their credit a little lower than the people that are volunteering to do this without any compensation in the making and non refundable yeah the hope would be that that would be you know it would be tied to their total income as well well and when when I first heard these numbers I didn't realize that we were talking about maybe being a preceptor for somebody in through at like ten or twelve consecutive months so it's makes one more sense now thank you. Representative Cavenaugh you're recognized. Thank you Mr chair representative Johnson you know we've had a group that's been working on nurse or the just now for you know some time and if my memory serves me correctly part of that group that was one of the big things is that we didn't have enough of these we didn't have enough people willing to do this so it was creating a backlog with the nurses you know nurse practitioners everybody we were having that issue but it was a huge issue in particular with nurses that we didn't have enough of these spots going around people willing to do it and this is one way we thought of the how to be able to actually incentivize somebody to be willing to do it so we can get more nurses into the work force is that out kind of what we think and when we had this workgroup yes correct in this is something that's been supported by the nursing association and the nurse practitioners well because it's something that they also see as a way to address the workforce shortage and we look at work for Shorty strategies when you if you just Google that this will be one of the ideas that comes up pretty quick is this idea of the state tax credit for people that are willing to step up and preceptor these people because they have to be this is a step they must do to be licensed and we can't skip that step correct thank you. Right representative right recognized. Thank you Mr chairman Mister chairman do we have an impact. Statement on this you should have one on okay green she okay I just where is that Sir can you. Back on. The bill the first pages of toward the bottom says revenue impact got it okay thank you Sir. Representative Michael and then you're recognized thank you did you look at during any type of a corporate incentive instead of a personal rebates has a lot of these people will be working for like a university or practice or like Walmart health for example is changing their their the process of training so they can allow for students and residents to come and to kind of help so to look at that is that I did not I think that would be great not in this silly instead to dition right I think I think looking at something where you are allowing corporations that are willing to take on a train to have some sort of taxes he was well would be a reasonable addition to that bill if I just hadn't thought about that thank you. Members any other questions of representative Johnson. Acting in Paul did during a day of an ace position on this. When you get settled in just introduce yourself and then we'll get started with with your presentation and I think we have some questions for you as well thank you Mr chairman thank you committee Paul gearing with the FAA we did issue a fiscal impact statement for house bill fourteen twenty two the estimated amount of the credits that we would anticipate to be retained was at one million dollars we did take a look at the the Georgia preceptor pro tax incentive program their first year was two thousand nineteen they issued slightly over two million dollars in tax credits for their program of course Georgia does have a a larger population in the state of Arkansas and of course a two thousand nineteen is certainly a repeat of a recent number but it as a result of the pandemic in the nursing source or third there certainly could be some variances and the estimated number of students and and preceptors that might participate in the program would be happy to answer any questions about the fiscal impact statement we did a doesn't have a position on the bill Not representative Wooten you're recognized. Thank you Mr western what do what number of of Students or preceptors. One number students as you use of a low behind the impact statement I understand what you're sharing about Georgia but what number of students. Per person after did you come up with in your how did you have a million dollars. Certainly and. So I'm so we had partially five hundred students who is that for every single class type of student five five hundred students per class type of student that would potentially qualify for the for the training program. Okay we'll we'll okay what how many classes is that five hundred nurses that might take advantage of it five hundred in the October server and the different types of in the different types of training programs five hundred students per per for program per program trains that was available in the programs. Thank you also get our administrator for income tax come the tables well ill she was very helpful and you have preparation. More merry. That's the House. If you just would introduce yourself for the record you can step in and get Paul out of a jam thank you. Your automated bill administrator for income tax. And so yes we have we prepared this impact student errors statement we anticipated that there would be about five hundred students total in all of the program so that would include that counseling. And the. Nursing and I believe that was like the. P. A.'s and. At counseling so yeah okay the the mean the sure I'm clear are you saying five hundred and holding are you saying five hundred per classification positions the are we notices that. Yes Sir sorry after we said five hundred in total in total thank you all yes Sir. Per year do you know how many students that would include. That might to get that would. The preceptors. If I might that try to help some with the situation to that the process you know is not every medical student graduating would necessarily need a preceptor there's some medical students thinking can fulfill all their desired clock classes course work to the normal a curriculum and structure for nurse practitioners and PA's and they are required there's a smaller number of them the medical students to to go through some sort of preceptors ship but again some of those preceptors ships are already covered through the program summary long community members so the the number of students that actually are leaning on community members to fill this gap to fill this void for preceptors is not as many as the total number of students that are going to training programs because some of the training programs have are able to accommodate the training without leaning on Community members if that helps amendment help would you not agree though that that with this program if you have more preceptors out there that you might have more students take advantage of this it is certainly possible I think it makes hard hard to make a concrete as with any fiscal impact I think it's a little hard to make a concrete prediction but I do think you know considering another state like Georgia and looking at programs like this that are in place in considering worse case scenarios there is certainly cap to how much this could be and from the numbers that they discussed I feel very comfortable at the time that those felt in line with what I would have expected well I think it's a good program would do we have a cat a committee of the the series none most go about the total this took I'm trying to get to the basic foundation of how they have at this. One million dollar number it could be two million it depends will so let's what I'm trying to pursue and the person would there there's not a cap that's provided in the bill so it would be up to the amount of individuals that were that qualified for the credit and redeem the credit So how many students did you say you think would take advantage of five hundred was the estimate of a hundred yes Sir this to one. The total number of students that this could cover do you know that. We don't we don't know that number Sir okay thank you thank you Mr representative Cavenaugh you're recognized. All right representative brown you're recognized. The. Thank you Mr chair and I realize that the F. and I can't do dynamic scoring but wouldn't you agree that if we get more people out into the community earning a good living we are going to We're gonna be able to cover that million dollars pretty easily a well I certainly agree that the the more individual individuals that are working especially in in the the healthcare profession is certainly a good thing in order also to close the gap in the shortage of our healthcare professionals I can certainly agree in terms of the the the pay back for the actual cost of the credits that would be issued under this bill I couldn't say that would have to be a looking backwards to see exactly what what type type of progress was achieved versus the number of tax credits that were actually redeemed for participation in the program thank you thank you Mr Gehring appreciate them members any questions remaining for the FNA. Three nine thank you guys for coming down thank you. There anyone else in the audience wants to speak for against this bill ninety nine clearly we're not yet taking a vote on it but you want to go to give us any of your closing remarks no I just want to say thank you to the committee for giving this some consideration I think all of us are looking for solutions to this work force shortage or seen across all fields and for me this was an opportunity to try to bring forward something that I think it's constructive I think at the end of the day is relatively low cost for our state compared to the pay off that we're going to get from the program it is something that we're not you know what there's been done another state so I don't you know it's not like we're just reinventing this without looking at other states to see what their experience has been so it has been productive in other states and I'd love to see our state adopted and I would be happy to visit with anyone offline again if anyone comes up with any questions I appreciate the time the consideration thank you thank you that members I wanted to add a little personal flair to this you know sometimes the things we do down here. Maybe seem abstract until it happens to you or someone you know or to a constituent and full disclosure I have a daughter and a son in law who are both working toward getting their doctorate of nursing practice and both of them and had an unbelievable challenge in trying to find a precept or they live near mall mail and go to school full time they work more than part time and one of them had to drive from Maumelle area all the way past Russell bill to find a doctor that would be due a do the preceptors for for them that was one that the next one that they're dealing with now is in there it is they can't find anybody to to be preceptor one of them works at Conway I guess it's regional hospital no pre sever they can find has availability so now they're driving from Maumelle to Searcy two or three times a week to get the training that they're required to have so I'll talk to the nursing association about this there they supported we do have a nursing shortage I I support the bill and they get we have to take some steps to try to alleviate this kind of logjam so thank you for the presentation I look forward to hopefully in another week or two will be able to start process on these and take a vote on it but thank you for coming down represented Joseph so much chair thank committee members nothing else on the agenda we will likely meet Tuesday seeing no further business thank you for your participation we are adjourned.