Public Health, Welfare and Labor Committee- House

The and the Senate amended this. To delete on page eighteen line twenty eight the words compact or the Arkansas Legislative Council rejects a rule and substitute back to our original morning of just compact but later in the bill on page twenty four. To delete line twenty eight and substitute the following compact commission for those rules to be effective in this state period. A new section D. for the purposes of the member states ability to reject a rule under sections eleven C. at the counseling compact air of Arkansas delegates its authority in this provision to the General Assembly or the Legislative Council and that appears to be the proper place to where we are still given the opportunity to object to a specific rule from the counseling commission. And with that I will take any questions the questions from the committee. Sing then we have a motion. The motion to pass any discussion on the motion to motion to concur in the Senate amendment for house bill eleven a one he discussion on the motion. Seeing none all those in favor say aye. Posed significant graduations you've concurred your amendment thank you very much there's a lady committee prepared to a president house bill. Fifteen twenty. You're recognized. Thank you Mr chairman. members This bill has to do with the petroleum storage tank trust fund act. all it really does is update the Act for cleaning up underground storage tanks in the two thousand and three the upper limit for a clean up was said since that time inflation has increased sixty one point three percent so the amount. The maximum amount for a clean up needs to be increased. for one point five million to two million just due to inflation. So that's basically the bill. Members are there any questions on this bill you're recognized for a question. thank you Mr out so just. Help me understand where does the money for this actually actually come from. I could answer that but let me ask us the fear to come up you would maybe he can give you a better answer than I can. Mr chairman Committee thank you Mr chairman committee my name is the fair and I'm with the Arkansas marketers date your question representative every time you and I as consumers when we buy gasoline or diesel fuel to pay three tenths of a cent a gallon into a trust fund that eighty Q. collects to about six hundred thousand dollars a month right now it's at the thirty two million dollars. You're recognized you follows yeah. So we're not changing the amount that's going into it were just increase the amount that can come out of it that's correct and we don't feel like it's going to follow up we don't feel like that's going to create a shortage or challenge. Historically it has not it could. It could a written Erith medically it could but historically has not we don't think it will be but nobody wants to be the first to be the Guinea pig. President will take you're recognized for a question thank you Mr I just want to be back on representative rich this question and my question was the number of people applying for funds versus the amount of funding well we have people now that are risked not receive funding because of a shortage in dollars by Rick by raising the amount. No okay thank you Mr. The more questions from the committee. Cenote ready close your bill yes this. Mister chairman I'm close I make a motion to pass a motion to pass in sketch on the motion. Seeing none all those in favor say aye. Posed graduations you pastor bear represent Ladyman. Representative Pilkington would you like to present your amendment to house bill ten eighty two. That objection you're recognized to present your amendment thank you Mr chairman This is to At Senator Flippo as a co sponsor and delete some language and replace it with the General Assembly or the Legislative Council your call a few weeks back we had a lively discussion about whether that need to be and are not a Wellesley with the bureau's Health decided on Legislative Council to be in there so that's just fix and clear that up and and Senator Flippo as a co sponsor and with that a motion to adopt the amendment to concurrence an amendment. The motion current Senate amendment in any discussion on the motion. Seeing none all those in favor say aye opposed say no congratulations your minute has concurred. Are you prepared to present that house bill ten oh seven yes I am there's an amendment with that Billy staff start passing an ounce of whether passing out all all kind of explain the bill. Is an act to authorize the dispense of HIV pre exposure and post exposure prophylaxis Senator what is this is medication that we use to treat HIV and HIV exposures and one of the things we saw to help combat the spread of aids and HIV in Arkansas is by allowing pharmacists to to dispense this the language there is a little bit of issue going back and forth about diagnoses so working with the far sociais Asian a medical society this is what that amendment as a compromise to make sure that there's no opposition to this I think it's a good bill and really what is just making sure that when there is an exposure post exposure we people are able to get to that medication as soon as possible because time is of the essence of this medication has been shown in the upper nineties of being able to prevent HIV and and stop the spread so I think it's a good bill and with that I'll take any questions any questions on the amendment. I'm sorry get a minute first motion on the amendment LOL motion to amend the motion to amend any discussion C. nine all those in favor of adopting the amendment say aye aye aye opposed nine you're recognized to present your bill I thank you I think I did president I want to talk about the amendments with that make a motion to pass Senate questions represent public on this bill seeing nine we have a motion to passing discussion on the motion saying none all those in favor say aye. Post. Graduations you've passed your bill representing you prepared to present house bill ten thirty five yes. I got a lot of reports back today. yes at ten thirty five it's it's an act requires screening for depression of birth mothers one of the things obviously as we look at our brutality rates bill for infants and mothers we found that by increasing depression screenings is one way to health this bill if the main check of you look at line thirty five so the birth all right sorry they do the screening for depression in the first six weeks of birth this is kind of an and a good time in which were able to capture that usually around the times when the birth mother goes in to get checked anyways we got the fiscal impact statement back from Segal group and there is no fiscal impact to any of our plans and then we also got the the fiscal impact from DHS and there's no direct impact as well The pretty straightforward. Members are there any questions on this bill for representative poked in. Resent person you're recognized for a question. Thank you Mr chairman of as someone who had postpartum depression I'm not sure you recognize it at the time of birth only I mean is this cover it looks like it only covers it at the time of birth I mean you can extended to you know a couple months after does it cover it like for the first year or something so if yes there if the plans already covering it they can we just want them to have this screen within the first six weeks after birth that's we're wanting that to go sooner rather than later so we can catch it earlier on the reason the bill was at time of birth which in hindsight made no sense because like you said it's it can happen later on so we wanted to it to be that six weeks is when you're kind of going back and checked in so that it's not to say it's not so burdensome on because that usually around the time when mothers are going back to get their normal check up afterwards with their OBGYN I guess my question is is it limited to the first six weeks were requiring that event is taking place in the presence was because of it so you can't get checked again later on that's like after the first six weeks or no longer able to get that for just one of the providers to check them to do the depression screening within the first six weeks so it's not about limiting the provider after that six weeks we just wanna make sure it happens within that for six weeks yes ma'am am I clear yeah but the bill just covers the six yes ma'am correct yes yes. Members of the any of the questions represent Pilkington. Because your bill right closer bill nation do pass a motion to pass these costs on the motion. Seeing none all those in favor say aye. Opposed senior pastor bill thank you. Yet if you mind will it represent Womack president for Justin Thomas street commissioner I'm sorry your honor roll I know. Of. Thank you Mr chair yeah. Somebody of you're recognized to present this is Senate you're presenting Senate bill two eighty eight is that correct Two sixty four to sixty four. Okay as Senate bill two sixty four this just very simply removes eight words of the language that. I would I would characterize it as a technical clean up bill. The questions represent Womack on this bill. Seeing none are you closing your bill yes I'm close and make a motion to pass a motion to passing discussion on the motion. Seeing none all those in favor say aye. Those guys have that you pass your bill thank you Mr. Local several call. Thank you. Representive Waldridge. license by the board shall. Representative Richardson. Representative Richardson votes yes representative Graham like. Representative Graham like both yes representative road. Representive road. President of more representive more votes yes representative Schultz. Representive Schultz but yes representative Terry. The representative Perry votes now represented Pilkington. Representative Pilkington votes yes representative Alan. Representive Allen. Representative Kenneth Ferguson. Representative Kenneth Ferguson. Representative Gonzalez. Representative Gonzalez yes. Representative Bentley. Representative Bentley. Representative Ladyman. Representive Ladyman votes yes representative Deborah Ferguson. Representative Deborah Ferguson votes No representative Womack. Representative Womack votes yes representive McGee. Representive McGee votes now representive Eubanks. President of Eubanks both yes representative Wardlaw. Representative Wardlaw. Representive Miller. Yes representive Miller votes yes. Graduations you've passed your bill. members would give me a moment here to make sure we're not overlooking anybody I know there's there's two bills that I would like to run. I'm going to. You're the head of the table that's okay we'll review Miller take over. Okay. Represent Johnson you're recognized to run house bill eleven twenty nine thank you Mr chairman so eleven twenty nine is a bill that creates the ability for clinics and hospitals to bill for Matt behavioral screening exams it also allows for hospitals which care currently bill for outpatient behavioral services to bill for those services this is a pretty straightforward bill less discussion before the session with the H. S. and providers about this bill we were waiting on a fiscal impact the fiscal impact from Siegel came back as zero and I'd be happy to try to answer any questions on this bill. Representative's always you're recognized for a question thank Mr I'm just having trouble understand how these fiscal impacts are coming back to the zero one we are requiring these insurance companies to say for this reason you help me understand I can't for for this specific bill asset question Siegel it is it's a this is something that EBT and the state funded plans already cover so this is that's my understanding my understanding is there's no additional impact because those entities are covering the Services DHS was not. So there is fiscal impact other insurance providers potentially yeah and my understanding is that the seagoing consultants are only looking at fiscal impacts for EPD in state funded plans okay this would be your bassist issue system that the college funded plans anybody okay thank you welcome. There are questions from committee. You may set of revision Eubanks. Thank you Mr chair. Represent Johnson and I had I don't know if I was paying close enough attention about the fiscal impact so does it is it going to affect. Our Medicaid costs so it my understanding from the Medicaid perspectives this was some rules are already changed prior to the sessions just codifying those rules are already changed so I think it's already been accounted for okay thank you. representative Waldridge you're recognized thank you Mr chairman so who who will provide the screen because these clients won't currently or these patients in the hospital currently be enrolled in mental health services correct so who would provide the screen so the screenings as I understand it will come to the clinics and but the outpatient services or for patients that are currently going to be being seen in a hospital so if you're in a merger about now being seen there's no codes at the present time opened up to allow for billing for outpatient services in that hospital setting only for inpatient services follow. You're recognized so who's providing service those my question in the hospital yes Sir it depends on the hospital right and what highway they have that might be able to come down to provide the service I think some hospitals have the capability some don't some people have psychologists counselors on call some down depending on the hospital it would depend on who they had some have nobody this would allow I guess my question then would be external facilities and be able to also or at the external agencies be able to come on bill for this also correct not just the hospital would be approved and approved billing location correct that's correct Sir. Any other questions from committee. Saying that anybody signed up to speak for or against the bill. Nobody is. You're recognized close your bill I'm question bill make a motion to pass we have a motion. Do pass all in favor say aye. All opposed say no. Asset congratulations this bill thank you. Of you're recognized now to present. House Bill. Twelve sixty one I have a I have an amendment on that bill that we need to pass out of camp okay. This is it's not is bigger than in this looks. So it it's always hard to present amendments without actually presenting the bill because you have to understand that the little bit understand the amendment specifically looking at the amendment we're clarifying some language if you compare it to the bill we're clarifying in separating the worst tree I sewed the in the current form it says triage and transport this is this is making it specific that you can triage and transport an alternate destination or treat in place in the current version it is unclear as you read treat triage transport just clarifying that language and we're adding language to to also specified that if it's a medical based complaint that it would be seen and with telemedicine with the physician we were opening the door for behavioral based to complaint to be seen to tell health with a behavioral specialist and those are the two things the amendments changing I'll be happy to explain that more detail as a present the bill. Okay so read the questions on the amendment. Represent Deborah Ferguson. Are you confident that they will be able to differentiate between the high from medical complaint in the field so I I am in the medics are trained to make those kind of this desert discernment in the field with regard to medical versus behavioral and I have the faith that they'll be able to follow through with that and and I think this back up mechanisms in the bill to you with regard to the telehealth component that can help support that and I'll be happy to speak to you as a president okay thank you. Any other questions from committee only amendment. We have a motion to adopt the motion dot in. The motion a discussion on the motion. In all in favor say aye. Opposed say no. The amendment has passed you're recognized to present the bill as amended thank you Mr chairman I have with me Greg Thompson from incidental to allow him to introduce himself I have time to answer any other questions that people might have. I have great Johnson the executive director for men's sandals thank you Sir. So so members current state if if an ambulance services called nine one one call comes in the endless comes to someone's house the only mechanism for reimbursement for that employs providers if they put the patient in the ambulance and taken to the emergency room in there often times were we don't transport is is meant as much just a third of the time in some services nine one one is called the paramedic arrives in for various reasons often times just because the patient's concern was alleviated prior to the endless of rival or in the patient as want to go to the hospital they're not transported the hospital Medicare recognized this back in twenty nineteen is a possible issue and started a pilot program to allow endless services to treat certain patients in place with telehealth through a physician consultation or allow ambulances to transport to a lower level of care not an emergency room but perhaps urgent care clinic or even a mental health facility is long as they were doing that in consultation with the physician to telehealth Net a number of of endless services across the nation this I take it means that pilot and try that there was no one at the time in Arkansas that take advantage of that what we seen across the country in areas where this program is has been enacted we see a marked decrease and transports of of certain types of complaints so when a physician's engaged on the scene three protocol set up by the English service to try to treat someone in place who might have a minor complaint about seventy percent of the time they're able to treat them in place and avoid a trip to the ER that's a pretty significant decrease in transport emerge from the pre cert savings cost to the system by not creating that facility charge so good example of this would be someone you know is doing dishes and they kept their finger and they're scared they're bleeding maybe they're even on a blood thinner and they call nine one one the English shows that by the time the English gets there the bleeding is controlled the medics put a bandaid on the finger and and under the current system there's no reimbursement mechanism for that what we're doing with this bill is is we're creating that reimbursement mechanism for DHS medicated for a private insurance companies as well as EVD a state funded plans in the single concert consultation they did not see this is a fiscal impact because I think long term they see this is a saving so if you're reducing trips to the ER for able to treat people in place to be able to pay people to potentially lower levels of care this is an opportunity for long term savings to the system the other thing we're trying to do is recognize that about a third of non on calls or behavioral health related so we're opening the door in the field have consultation with the behavior health specialist real time with the medics to be able to possibly treat some of these behavioral health issues in place as well or maybe transported into an alternative destination. So what we're trying to do to this bill is is try to make sure paying the EMS services for the work they're doing and then also trying to reduce the burden on the system by reducing unnecessary trips to the emergency room and Mr Thompson's you're with me would be happy to try to answer any questions anyone has about the system or what we're trying to send place. Any questions from committee representative Alan. Thank you Mr chairman for example if I call them lands instead of ambulance taking me to the emergency room and I am up in in urgent care what is the difference in price is going to urgent care. Cheaper than going to the emergency room or less expensive than going to emergency rooms it is certainly the facility fee you know anytime you encounter medical care in that situation you're gonna get a professional P. from the physician and then you're gonna get a facility fee for being in the facility so facility fee for a merger and it can be quite expensive an urgent care clinic visit is markedly less expensive okay. Follow it through when you go to emergency room you might be there might well. Yes sometimes the waves are long answer Mr Thompson can speak to the wall time some of his medics or having the hospitals right now it certainly could be quicker to be in and out of urgent care. Thank you. Of represent Johnson I've got a question. Real quick on our when you talk about the The savings with the and I mean I can say with somebody of the if the Amulets group is able to bill for the tree I'd say at somebody's home at the scene of whatever happened that's that's saving. Some money as far as going to the ER mail so would we expect to see with them now being able to bill for this where they haven't in the past will we expect to see some transport cost and our other associated costs go down now that they can bill for this also. That is the question I think it certainly is possible right I mean I think if they're getting reimbursed now they would be reimbursed at a different rate obviously for treating someone in place at a lower rate than if they transport them to the hospital those rates that's to be negotiated with the plans but certainly if they're now being reimbursed for a percentage of the business whether or not transporting where they weren't getting reimbursed at all that could be the case I don't know how would you have a sense of how many visits how many run shall go on where you're not transporting and and you just leaving there to press right now what we call our no all percentages about thirty percent of our overall rents. Now in fairness to that though these are not some of the that percentage when I capture him separately of that percentage sometimes it's a call for Iraq we get or more waved off so not all of them involve a patient encounter some magic numbers the twenty something percent rate for us. Okay thank you thanks step is represented K. Ferguson. Thank you this chair I think my question is a little bit something to do with your question the representative Miller but well I guess what I'm getting at so a a transportation calls to the emergency room the reason why I'm asking this question I have had a couple of family members in the past couple of months the emergency room transportation is with around fifteen hundred so what we're saying is the transportation to an urgent care facility would be less than fifteen hundred or the same I guess is what I'm asking. You're asking for the able service what their cost of transport costs to transfer with the cost of transport wherever you go maybe less elitist. A less mileage could be could be less mileage yes but the cost to be the same for the for the Amos service yes the transport is the transport yes so to fifteen hundred to the emergency room and if it's if the. Distance is the same so would be the same cost the calls wouldn't change that there is no difference patient correct as far as the transport as a transport is what the transport is I think what we're trying to do is to be able to put the patient in the right place so we talked a wall times like right now the hospitals are full well codes down possible in full because of staffing so sometimes is possible for us to carry patient to the ET and what as much as two hours to take that patient off the cot if we can find another facility that can see that patient faster it will free up that space in the need for more Q. patients. Thank you. All right representative first your question thank you Mr chairman I think I have a similar question and how are these typically being charge I mean the complete charge you're charging the same for the transportation as if you're taking them to the hospital is that what I understand right now there is no I'm in there is no pathway to do this I know but if this passes they'll charge the same for this transportation cost as if they had transported them to the hospital and on a bulletin is speak for Mister Thomas if it's if someone's uninsured I would imagine that the cost would be the cost you know based on this it's if there's if they're insured my sanction is that you would negotiate rates with the insurance company and it's likely insurance company would pay different rates depending on what was what services provided for the maybe a non emergency transport And then I guess in addition to that what other charges of by the telemedicine doctor were charged independently a CPT code is set at different way so sometimes the certainly it can be set up within with the physician is charging for a teller does it courts that would be cheaper and different than in person does it sometimes it's is it set up where the telehealth services contracted with the M. S. service and they're paid off some sort of subscription fee where the EMS service pays the telehealth service and they're not billing for you know a code or doing a chart and that traditional fashion to the model for partnering with the telehealth group can be different what some was some entities do in larger cities is the contract the locally our group he's already in the E. R. in call has a telehealth room dedicated for this kind of thing and and the compensation will be based on the subscription service versus actually billing for the service itself okay thank you. A representative will reach you're recognized for a question thank you Mr I just wanted to follow up on represented most questions so if you and I'm all for you guys getting paid for the service you render if you render are going to this a call but you don't render any service in place the not transported to the hospital you don't render aid on scene are you still able to bill under this bill for that run. So I would say yes I I would argue that if you show up and take vital signs you're providing a service that I don't know that I can think of a situation we would show up and not in some capacity interact with them I guess if we showed up and got waved off we would not charge for that right if we showed up in their stand outside the door the door the house with this offer short for rack and. The some fire like no we don't need job we're not gonna charge for that service okay I'm saying we I don't to be clear I don't have any affiliation with their after the table I'm saying we is the collective group of providers for emergency medicine that clarification thank you. Can asking us to say one thing to that I think there's a nother piece we're not talking about that is in that fits in that is we we arrive at the house right now we have no mechanism to sometimes for somebody if I could just talk to a dock and so we're having to carry them to any D. just to be seen for peace of mind persons being able to go to telemedicine and not transport them to give them at ease the other thing is provides is that patient who just don't want to go and we believe they need to go in being able to turn on telehealth affect I was with you the other day when he took a call just for me to watch that in a page that would have stayed went after he and engaged with him so that's the other benefit to it too it gives us another tool we don't have now see I have the opportunity not in the State of Arkansas to help with some of these programs that are doing this pilot program through Medicare and certainly sometimes you're engaged not to talks to talk someone into doing the hospital so their times with the medics on scene they feel like the patient needs to go to the hospital the patient doesn't want to go to the hospital the families trying to talk the patient in the hospital this allows the medics real time on scene to engage with the physician and sometimes you when the physician says Hey you really need to get that's the difference in the patient agrees to go so yes certainly that's also in the and another opportunity. Representative Gonzales you're recognized for a question. Thermistor now I've got a couple of them one will be what we are we using a different definition of telemedicine or use them we use and other areas of the law. DO answer that for me specifically so this is this is a situation where people calling nine one one and so I think it's important engage with the physician level out of the gate with the service you know everywhere else this is being done to the Medicare polit is done with the physician so specifically physician also flight did the visual component to this for what we're doing on scene is in is really important as well and and those the only two things that I think are different from our current telemedicine definition is requiring the visual component and then for this making it specific to physicians. other question would be wanted none of these ambulance services in Arkansas participate in the pilot program. And and since they did not participate in the pilot program our. We sure that that they're going to use this. When it first came out was called eighty three and it was introduced right at the beginning of COVID in the the amount of work it took to set it up as far as we would have to go out create relationships with the the other facilities to be able transport to the load was so heavy at that time in Arkansas we felt like we had enough on our plate that was not something when you take on this time what we have done though Texas did it and we watch Texas very closely and watch how they work through in and to be fair not a lot of people in Texas got into it but once they did they begin to prove that it works there not just text of the place in the country and in one of the things you're saying I mean this is a Medicare polit where is this is been so successful in other place in the country that it insurance companies and other payor sources have adopted the same system because they see the value of the service in those areas and so while we can't we're too late today to get in it is part of the Medicare politics is our opportunity in the State of Arkansas to take advantage what I think is a really good program and create that reimbursement model for our MS services and also you know reduce burden on the emergency departments and in the costs on the systems all. the general or low register question. It's come a two part question Sturch what are support. Yeah. Thank you Mr I to kind of feel same way to represent Goss's Gonzales feels about the definition of telemedicine the other side that is what what's the impact Medicaid because renews impact statements it only tells the impact to private insurance so how does Medicaid affected and will they pay for the services well so I've worked with DHS in this bill into the amendment language that added was was specifically tied to some request by DHS I think DHS is looking at it is an opportunity on made aware that languages and bills yes language that so the amendment that we added was to add the the component for behavioral health specifically so in a Page line we also Page two line twenty eight to thirty one. Are you on the current bill yep so Sir the amended version would say and aimless Services under B. the name of the services offered in a triage and transport patients alternate destination the state or treat in place of the English services coordinate the care of the patient the telemedicine with the physician for a medical based complaint or behave House specialist for battle based complaint so this is opening the door for us to treat behavioral health crises with someone other than a physician to a psychologist licensed counselor someone that could provide telehealth in those situations where you receive a call the medics assess the situation they feel like this is a by product related complaint that doesn't require emergency care so this is not someone is actively set aside so that suicidal someone this anxious someone who's have and some depression but not society ideation someone's having some mild auditory lease nations not frankly psychotic they could engage let me do what happens when a family's drives often that person shoot yourself right so again the the liability would be with the provider just like would be with the physician self if they call me to interact and I say Hey I think that person safe to stay in the hospital or stay in the house and not go to the hospital I'm making that judgment call in taking on the liability follow the procedure you're recognized we get into that second part thank you so when we're doing this the street. Section here triage and treat are we allowing these paramedics to do what nurses can or can't do today in the hospital or in a doctor's office setting no no they're practicing fully within their scope that is engaging to telehealth provider whose then practicing telehealth to our current loss. Okay. Thank you Mr. represent Kenneth Ferguson you're recognized for a question. Any other questions revenue Gonzales. Thank you Mr now I've got a question on but we just amended in there didn't we just create a license for behavior health specialist and is that who's going to be defined as being able to help these people now or it does does expand beyond that no I think I think behavioral specialists as defined in statute already I think it was a behavioral analyst okay which are different you yeah thanks a. The other questions from committee. Say none it was signed up to speak for against the bill. Jim Johnson you're recognized I am I appreciate to get dialogue in the questions is a good program to get opportunity I think to really deliver health care to our cans is an outside the box way this both safe gonna reduce costs to the system both in the way of resources and financial costs I appreciate a good vote on this bill and close thank you. All right that is closed. We have a motion. President ram. Is made the motion of do pass all favor say aye. He opposed say no the. Is haven't congratulations pastor bill thank you Mr chair. As amended. Yeah. Call. Members we have a more bill I think we're gonna hear represent Pilkington referred to run ten away. A nice thank you keep this quick this is house bill ten oh eight which the next month by coverage for kitties because monitoring if you notice basically were striking the language and then put it back in a different section because what we're going to do is make it a pharmacy benefits an eligible for rebates and pharmacy benefits so but the main thing I want to draw your attention to is we got the fiscal impact back from DHS the annual estimate total impact is a savings of four million three hundred fifty eight thousand two hundred dollars with the state's air STR impact being one million two hundred thirty five thousand three and twenty two so just basically making a from a medical benefits pharmacy benefit and we're going to save the state Senate came out of money and with that I ask for a good vote make a motion do pass. Questions the reason for personal questions at it for this I just I just want to share something with you I have some concerns of a constituent call me because with the employee benefits division insurance he sort of getting the run around because they say it's a pharmacy benefit but then the formula Terry says that click because monitors aren't on the pharmacy benefit they say it's a medical and then the medical side they're not paid for because it's pharmacy benefits so there may be a little thing at the issues of of of making sure that the monitors are actually a part of the formulaire yeah and that's that's that's why we're making sure input in such as part of the pharmacy is make it a pharmacy benefits that we eliminate the Confucian. But making sure that the it's on the formulary yes yes yes yes sorry sorry yes yes yes it's on the form I'm for the bill. The other discussion on the motion. The motion to pass all those in favor say aye. Opposed. Sing ninety passed your bill residuals I would did overlook it looks like there's one Senate bill Senate bill three twenty three. That your name is attached to the mayor may not be prepared to run that bill. Then we will hold that bill anyone else here have anything that they're prepared to run before we adjourn this meeting. Presented by coming back this afternoon good meeting meeting