Public Health, Welfare and Labor Committee - Senate

Some other senators will be on their way that we're going to go ahead and get started we have Senate bill ninety one. Ahead of us and we've got some folks here to testify on the bill so and there's also a hand outs that's been approved that you'll have at your desk members with that good morning everybody glad to have you here on a Monday Senator Hammer you're recognized president Senate bill ninety one. Thank you ma'am chair Kim Hammer state senator district sixteen a man chair for the second time could I invite the guests have come to testify to come forward and identify yourself for the record please thank you. Committee I'm Dr Madison how I'm an audiologist here in Little Rock and the vice president of the Arkansas speech language hearing association I'd first like to thank senator Hammer for all of his hard work in support of this bill and for wanting to advance care for all our Kansans. Okay. Good morning chair members of the committee thank you for having me my name is not holy cow Office I am general counsel for the speech language pathology and audiology Compaq Commission I'm also legal counsel to counsel state governments and representative occupational therapy and counseling compact which she passed out of this committee last week thank you very much for that I'm happy to answer any questions. Go ahead thank you measure of for the second time in just because these ladies will be more efficient proficient explain content the bill would just say that we've worked hard to work to any traps or any resistance to this bill hopefully we've got it at the point now the committee can feel comfortable supporting it but with your permission manager like to yield to these ways just to briefly give the content of the bill and the value of the bill structure would allow please. Go ahead. Thank you senator Hammer I'd like to share two stories with you today on a personal level first I want to tell you about a patient of mine who's a nine year old she lives in a bordering state and for half a purposes will collar Serra. Stair was diagnosed with hearing loss when she was three years old and her family has very minimal resources and the struggle with follow up care. One of the largest barriers for this family is that they live so far from a clinic in their home state they do have family here in Arkansas and it's a lot easier for them to travel here to get services. Currently without the interstate compact I'm unable to provide follow up care for Serra and because of this her speech her language and academic development has struggled she's now having to receive specialized services and having to repeat the second grade. The burden on this family and on the education system could have been used by being able to provide follow up care across the state border to Serra. And she very much likely to be on track with her peers. Senate bill would not only change Serra's life but several other children just like sterilizing in border towns. Another story I'd like to share today is more of a personal level I am an audiologist here in Arkansas but I'm also a proud military spouse my husband always been supportive of my career and my passion for children with hearing loss is so much that he came here today to support me. But he also supports our country and with that comes sacrifices we often have to sacrifice leaving behind our friends our families our jobs and our comfort zones. The provisions established under Senate bills ninety one would ease some of these burdens for family like ours and it would allow me to continue pursuing my passion and continuing serving the children I love even while we're serving our country. The department of defense recognizes interstate compacts acts such as this one as the gold standard for reciprocity and portability for military families and their spouses. By supporting Senate bill ninety one you are supporting a group of hardworking audiologists and speech pathologist here in Arkansas you're supporting children that need our services that we are able to provide for them and you're supporting our military families and strengthening our troops I thank you all for your consideration of this bill and the impact it will have for all Arkansans. I'd like to hand it over to the Hollinger. Thank you again and thank you senator Hammer and share members of the committee and just wanted to I'll be respectful of your time second answer any questions but I do want to speak quickly to see some of the nuts and bolts of this compact that works the same in form and function as the other three compact's Arkansas's had the prescience to actually an act so it's very similar to the nurse compact to side packed into the PT compact that you're currently member of its mutual recognition model which essentially means that you have your ability to join a contact to your home state license in good standing this compact has it does have a fee provision which I know was was at issue with the last set of hearing such wanted let you know that this commission is likely going to move in the same direction inside Pat did they've not yet voted they they have not yet passed a rule with regard to fees but likely will be a sliding scale much like sign a pact so I packed essentially assesses a state based on how many people utilize the compact in their state that is likely what this group will do we have found through experience with PT nursing a side packed we've we've seen that really these commissions are pretty revenue neutral because they have funding sources this compact has to funders three actually three different funding sources it will be applying for grants as well so we're hoping that that'll keep fees and terms of member state assessments very low the ceiling inside pack to six thousand we don't even think that they'll be selling that high for purposes of this particular contact also the delegates that seeks to get seated from each state just flow as a state actor from their state it'll be one audiologist in one speech language pathologist they need to be current members of the board said that they are acting as state actors we like that to have some some supervision over the process on each delegate gets a vote with regard to rules are by law amendments and of course Arkansas the sooner you join the sooner you have an opportunity. To really take part in that process we currently have twenty three states in the compact we introduced in fourteen states we're looking at probably passage in at least half of those of the session so we're it's looking good work of course striving for compact nation I think that Madison did very good job talking about why the DOD is so supportive in fact they're so supportive they've had a ten million line item in the National procreation sat to support the development of more contacts Sturch remain available for questions thank you thank you I have some questions and. Number one thank you for the changes made on page twenty three I think that was very important I saw that you amended those in so that it's consistent with the other compact's language in regards to our rule making process and legislative authority so those changes were made on twenty three and twenty four and twenty five I believe yeah so that that's a good thing I'm. Quickly where are these commissions located. thank you chair yes the commission is currently housed where the Secretary dislocated which is in Alabama the Secretary for this particular commission pursuant to but sort of a sole source con contract really is the National Council of state boards of speech language pathology and audiology and there are secretariat service is located in Alabama so it varies all different commissions for instance nursing is housed in Chicago because it's co located with the National Council state boards of nursing site-packages Helston Georgia because there Secretary does their board of board so currently it's in Alabama that may change okay that may change areas I see and then the administration where they located the people that are applying for the grants that you mentioned in the administration where where is that located also in Alabama currently the commission has not yet hired an executive director they have finalized an or if P. for us isn't executive director said that person will be the primary person really leading the charge for grant applications all of course with approval from the executive committee of this commission okay and as far as the grants and what they have a lot of grants have strings attached to them where they'll be are well there where will those grants can you for see any policy changes as a result of any grants that are accepted that that's an excellent question thank you cheering absolutely not I can't let that happen is there council these are very you know these two professors Constitutional creatures and we have to make very sure that we have that fire wall in terms of what these to yeah because I mean that I see in your hand out that it says it's not a waiver of sovereign immunity which I would it that's I think our biggest concern is the state of Arkansas or any other state that would be participate and then my last I think the smallest. Send in your section for compact privileges says this is voluntary is that correct that's correct and then it says if you'll just walk me through this so I can just better understand how this works is says they may only have one home state license at a time so like in your instance if you're a military spouse we just walk me through how that occurs in that transition occurs absolutely I'd be happy to do so interestingly in the case of a military spouse they can retain a home state anywhere that they've been deployed okay that's that is specific to military and that was actually put into this compact first it's now in every compact that follows but this was the first contact to do that and it was at the request of the DOD that we actually put that section and some military member can actually say I choose Virginia because I was stationed there for two years and I'm a keep that is my home state but with regard to everyone else yes and that's just for tracking purposes so we can issue subpoenas and right now where they you know I've tracked it make sure that they're in good standing have the FBI background check what's implement and states have given a lot of time to implement that background check but okay we went we need at home state for that reason okay perfect right get senator Boyd thank you so much thank you. Okay so that I just wanna clarification questions so I live on the border actually mimic a point I've already filled filed a disclosure on this bill just a reminder for everybody my wife Mary licensed audiologist so for a participator so I live on the border in Fort Smith so we got Oklahoma so there might be people who are have Arkansan license so do I understand that I have to then choose I'm going to give up one license or the other to participate in the compact so no you don't you don't have to give up any license this is merely another pathway toward licensure so with so if for instance if if you know of a person that was licensed in both states by reciprocity they went through the full gamut actually have primary source verification of their documents and they have that licensure that's fine this is just another way and it's an easier way because the data system actually enables any other state that's member of the compact to just basically check off and say yes this person has been vetted there in good standing I can look at the data system and get them this privilege to practice just like a driver's license and that the driver's license is a compact so you don't have to stop at the DMV in each state so long term good standing in your home state follow up yes okay so then if if I am and I don't know with Oklahoma participates but let's they did okay so I I'm license in Oklahoma but the patient is in Arkansas. Then the R. or the laws of Arkansas prevailed that's an excellent question thank you yes the laws of the state where the patient is located at the time of treatment that's that's the the component part of not making each state give up their sovereignty because the scope of practice of the state where the patient is located when receiving treatment so that you it could be that you're getting tell of health for instance but what is relevant and what is incumbent upon the professional to know is the scope of practice in the state where the patient is located at the time of treatment one final following okay so then I have an Oklahoma license but not in Arkansas license there's a mishap is it the Arkansas Board which has a hearing how does the hearing works so that we would figure out what might happen to the licensee right so the home state does drive the investigation if that's where the violation occurred and that's just for availability of witnesses and documents just like with your State Board snail you know you want to go to the state where the actual violation occurred yes. Any other questions good information good question any other information okay. Scene no more information is there anyone else in the audience here to speak for or against this bill. C. nine you're recognized to close for your bill thank you measure members of the committee I think ladies have done actual job explaining the bill think from what I hear the tone of the committee they've addressed the concerns I would note there is no opposition because we worked very diligently working through some of the issues as the chair mentioned while ago with the previous amendment and that did not respect for the committee do that members own someone got in here be less confusing so I hope that brings clarity to the bill with that manager I would be close notice for good vote. Motion to pass second all those in favor say aye opposed ayes have it congratulations you've passed your bill thank you so much thank you for. okay we are going to go to I think we're waiting for some additional amendments for the SP seventy nine H. B. eleven twenty eight so we're going to go to represent a brown eyes Senator Hammer do you have another bill right now that you want to. I've got one I can knock out if the okay if you don't mind could you hear and retain a lawyer at the end of the sixteenth let's go ahead. The center would you show it to I'm sorry venture that's okay we'll we'll wait I was in DO three forty four did like it is a let's do it. The non controversial bill. Three forty four yes ma'am okay you're recognized to present Senate bill three forty four thank you and I'm not sure that I even have anybody in the room to testify but again I can go ahead and run this bill for this bill is agreed upon bill working with all the entities that would affect include the hospital association other healthcare providers as we know madam chair there is a rising level of abuse and criminal activity that is being expressed in the arson across the medical of world as far as like nurses being attacked doctors being attacked other healthcare professionals being attacked by patients and members of the committee when they come into the facility for treatment what this bill does is require that there is a notice that is posted to make the public blatantly aware that if they assault a medical provider of of what the charges would be and one of the things that I would want you to notice that this has been it well to two critical things one this has been a a bill it's been worked on by all entities that would be affected by this like I said with regard to the hospital association but the other thing we put in here is there's a real fear that what keeps people from reporting crimes is that they would have to report their they would have to report their home address on the police log and what we worked out is that they can place they could put on the police report the where the where it occurred as the workplace so they don't have to put the home invite they have put a home address on there they get assaulted a House building put the hospital address and that's just issue with protection because one thing we heard is people are free to file reports because it would have the home address on it this I have the work address on it and that gives them that extra layer of protection and measures just a good bill that we can do to help protect our health care providers in the day an agent we live where they're being. Attacked and we just want to put another layer of protection out there be glad to answer any questions and I'm not sure if anybody's here test five four against madam chair in the audience okay. And let's see as Senator Wallace you have questions should Hammer you you mentioned you folks hospitals those include other for places like clinics for health professionals it could it could include them so you know it can be used in nursing homes anywhere that a medical provider is providing care I believe this would be able to be used to to make this posting thank you Sir and and one reason we're doing it through legislation to it bring some consistency as far as what's going to use throughout the various medical providers because we want to all held to the same standard but also we want to public to be very aware and this will give some incentive to health care providers to get these posters up. Okay thank you any other questions anyone here to speak for against this bill. C. nine close for your bill yes ma'am Preciado good vote motion to pass second all those in favor say aye and oppose ayes have it congratulations you've passed your bill thank you measure members of the committee thank you thanks for waiting on your other bills representative brown. Thank you madam chair members committee which are you here for House Bill I'm sorry house bill fourteen twenty fourteen twenty. Okay you're recognized to to present house bill fourteen twenty thank you madam chair members of the committee house bill fourteen twenty as I've been taught to say but my colleagues on their side of the house of the capitol is a little bill don't do much this bill is intended to address some of the abuse that we're saying when it comes to specifically emotional support dogs in particular in housing the Bill has two components the first component is a consumer protection opponent component it provides that if a business is in the upper serve businesses in the business of selling dogs or selling accessories for Dog think of the vest that same emotional support and on the side they have to disclose to the consumer that this is not a service dog under the ADA and you're not gonna get the same rights and privileges as a person of a service dog has or the ADA so it's just trying to cut down on folks are buying these vests in thinking that well my dog has is best now I can take it into for example a restaurant or something the second concerning the bills attempting to address some of the abuse that we're saying when it comes to housing and the reason why that problem is is the. The American disabilities act one knows what a service dog is an American disabilities act such as a seeing eye dog or a dog can alert and someone's got to have a seizure or something those are trained animals are protected by federal law this bill does not address that anyway what this bill is trying to address is under the fair housing act we have kind of a loophole where the fair housing act recognizes emotional illness as a protected class and requires landlords to accommodate people who have an emotional illness who did it request an emotional support animal support that illness and under the federal law when we can required documentation but there's no guidelines with that documentation looks like and so as a result an entire industry has developed on the internet where by you can go online to literally motional support animal letters dot com enter your credit card information fill out a quick ten question questionnaire and what you know you know I have a letter from allegedly a therapist saying that you are entitled to emotional support animal I myself try this out myself and because I answered yes to the question have you had a change in your sleeping pattern the past two months with the session million you can imagine that I'm now qualified for emotional support animal if I pay the hundred fifty nine dollars so the second part of this bill is going to address that by simply providing that at least in the State of Arkansas your letter saying that you need emotional support animals to provide your landlord needs to be from an actual license Arkansas physician therapist clinician someone with Arkansas license it also provides that this person needs to have actually seen you and you have to have had a patient client patient provider relationship at least thirty days prior to the day the certification and it provides that they need to annually recertify you're going to need for emotional support animal and the hope on that is that this will folks who generally need these should not be an issue at all but folks are abusing the system by going on the internet printing out a letter in the going to their landlord has no pets policy well golly Gee I need my emotional support pit bull here's my letter from India public cut down on that and with that be glad to answer any questions you might have. The R. K. are there any questions from members of the committee. C. nine anyone here to speak for against this bill. C. nine you're recognized close for your bill thank you I'm sure doesn't thank you madam chair for your co sponsorship but all such thing my co sponsors in the house which is active bipartisan group and I appreciate a good vote thank you all. Motion do pass second all those in favor say aye and oppose ayes have it congratulations you passed your bill thank you senator thank me rates representative Johnson. House bill eleven twenty eight thank you madam chair I do have an amendment I thank you for that bill adding you as a co sponsor appreciate your help with that no problem. Happy to do it. Perfect. I have a motion to adopt the amendment motion to adopt second all as a favor say aye and oppose ayes have it members adopted you may present the bill as amended thank you madam chair so it members of the committee there does exist a certification actually called the emergency medical responder certification it's a very entry level certification requires about forty to sixty hours of of of training there is a test for that it's something that's been given in Arkansas for years we've just never had a process for recognizing that certification with the department of health and therefore there's never been any pathway for reimbursement if someone provided that level of care right now in Arkansas you guard can be a first responder without any training at all or you can be in empty which is about six weeks of training the idea is to open the door for this in between level they could maybe provide some better front line care and then also again provide a pathway to tensely in the future for some reimbursement and I'd be happy to try to answer any questions on that. Right any questions from members of the committee. C. nine is there anyone here to speak for against this bill. C. nine U. close for your bill paying close from the motion to pass second as amended second all those in favor say aye opposed Is haven't congratulations you've passed your bill thank you manager thank you all rights let's see I have two Bills. that I've is there anyone else here before I run these bills. My bill is Senate bill three twenty two Mister Parker I think it's going to come to the table with me Senate. We are the. Senator Teague introduce yourself and your guests for the record to be recognized perceive your bill yes Senator Missy Irvin district twenty four Senate bill three twenty two. Phyllis Jacobson director for the Board of barber examiners. And I'm Dan Parker on the chief legal counsel for the Arkansas department of labor which includes our board a barbecue Sanders welcome what happened here this morning Senator Irvin you're recognized perceive your bill okay I'm gonna let you go ahead and and speak about it at generally this is comes from the department of labor and it is that as a bill to clean up some things and then also there was an amendment that I think was made just as a as a clean up technical amendment that's already been engrossed in the bill eleven hundred over to them so that they can describe the bill to you. Good morning this bill is Like Mike madam chair said it just cleans up the language and it remains some restrictions from some of the licenses. Yeah basically they're bunch a little of tweaks to the legislation that's going to help us run the barber for barber Board better they're designed to address a few things that were will help us run the board better against suspects it's a kind of an administration type bill it's a bunch of little tweaks to like the definition of what a what barbering is what a barber shop is things of that nature one of the provisions will make a. It easier to recruit hire teacher manager instruction instructors that are needed for the barber schools and just a little things like that at all help us run the board better. All right are there any questions from the committee. All right C. nine three by Senator speak for against all see anybody with that Senator Irvin you're recognized for your bill closed appreciate members of the committee appreciate these good folks working hard on getting this language corrected and with that and closed and I'll make a motion to pass got a motion and a second all in favor say aye opposed the resolution center bill passes thank you and what's your next bill is going to run thank you and it's actually Senate bill three forty five I'm going to run for Senator Hill okay Senate bill and three forty five members I am I'm not a co sponsor but I. And happy to be added as a co sponsor sure in fact I could just make that amendment verbally I think we've allowed the rules to allow that so I'll make it meant to have myself as other. Seventy six and second Mister Wallace all in favor say aye opposed right and it has been adopted okay. Members so this out if I thank Mr cook and then the audience here okay may not be he's gonna be surprised anyway you know David cook he's been in front of us have had advocacy days here for dementia and Alzheimer's association and what this bill does is just allows for the Department of Human Services tablets of a dementia services coordinator as a full time position it's my understanding and his discussion with DHS and they can come to the table if they if they're here but that they can the court they can designate somebody that they already have as somebody who can also work as a full time position for coordinator so this wouldn't happen and this is it would not necessary necessitate an additional higher from my understanding. Okay. All right members see for an explanation of the bill or any questions from the committee. All right see no questions there's anybody so to speak for against this bill all right don't have anybody signed up to speak on this bills for that center in you're recognized to close for your bill again I think this is I think this is a really great idea and and I didn't eloquently say that my presentation but as we age and as we are caring for our loved ones who have dementia and Alzheimer's I think it's really going to be good for Department of Human Services to have somebody like this who is the coordinator to really help and assist families when they find themselves dealing with a loved one with dementia so with that I'm close to not make a motion do pass as amended all right this motion the second all in favor say aye. Opposed. Resolution center your bill passes as amended. Okay is there anyone else here to run legislation think and Mr cook we just passed your bill. At anyone else here are you all ready or we're still waiting okay okay so we're gonna go in here Senate bill seventy nine so if representative Johnson wants to just go ahead and come to the end of the table and senator Hammer I'll let them explain the amendments and the legislation together. Senate bill seventy nine with permission the chair I'll go and start explaining the minute if that's okay so as everyone knows last session we worked on a bill to create a pathway for it practice authority for nurse practitioners there were a couple of oversight Senate bill this is an amendment this is an amendment to the amendment but ultimately the goal of this bill or passing out is to clean up some oversights from that the last time so what the amendment does it change it adds the word supervisory so if you look at page two at the top where it says collaborative in some states that use the word supervisory as opposed to collaborative Mississippi and Tennessee are examples of the station is created some confusion so we're just clarifying that it could be collaborative or supervisory it's this same process is just a different word depending on the state and then the other change or tried as hard to explain the minute without explaining the intent of the bill one of the things that we had a overlooked is we created a pathway for autonomy through for a nurse practitioner or to. Two had been in the collaborative practice agreement but we didn't account for a nurse practitioner that might be practicing in another state autonomously without a collaborative agreement so let's say you're practicing in a state like California maybe that doesn't require collaborative practice you could practice twenty years independently and the way we drafted the bill last session the passes an act you would have had to come to Arkansas and find a physician and practice sixty two hundred hours within a collaborative agreement which doesn't make a lot of sense was not our intent certainly pass the bill so the language and Page two the second language is clarifying The intent to allow someone without a collaborative that it's been practicing autonomously to come to our state and practice autonomously here with the with the equivalent granting of the of the boards at permission and also to clarify that their practice in the par state would have been with prescriptive authority. Salata words if I if we can pass the amendment I'll be happy to try to explain a little more in context and certainly Senator hammers can explain it as well okay motion to adopt the amendment second all those in favor say aye opposed amendment is adopted. So would you I mean continue so if I made the other thing on the bill as we left out clinical nurse specialists which are. A different topic physician extender that that should have been we would have intended to have a pathway to autonomy so you'll see in the bill we're adding the word clinical nurse specialist where it says advanced practice nurse and then in that section if I can see that for a moment this section on page two. The new section on the bill sponsor sixty lines eleven that's attempt to clarify that someone can come from another state and apply for autonomy without having been in the collaborative practice agreement if they're coming from a state that doesn't require that and with this amendment would clarify that they would still have to have practiced with independently with prescriptive authority okay I feel like a model that a lot it's any questions if that doesn't make any sense you're if you're basically just trying to establish what would be an equivalent if the person in a different state did not have that state did not require a collaborative agreements correct one to clarify if there was a case where someone was practicing in the state that didn't require collaborative agreement but did require some sort of collaboration for prescriptive authority the did you still have had to act as independently with both independently and with prescriptive authority right. I'm I'm checking in. All right any other questions Senator boy. So all this really does is takes what we did in twenty twenty one update to clarify the language and the medical societies either okay with that or neutral or something correct okay. Any other questions. Racine nine anyone here to speak for against this bill. Seen at nine you're recognized to close for your bill as amended. Were closed thank you all right. Motion do pass as amended second all those of favour say aye and oppose ayes have it congratulations you passed your bill as amended. Okay is there any other bills to come before this committee today Senator void. I just I had talked to you about the bill I have but it shows it's on the deferred list and okay we can move it or. I mean it I don't know if this is an active that's all okay The fine yeah you can run it okay. Boetticher. Manager yes Sir may make a comment to share to the committee please yes absolutely I have hammers recognized thank you I have some nursing bills on there ahead of budget two army last week with a group of nurses we're gonna meet again Thursday we found some pathways for that when I get back in here with those bills will make some amendments that'll make them non controversial just out of respect for the committee asked that they be leave left on the regular agenda I will a man through member's own so when it comes into the Committee all those things will be there to be nice and clean and I just want to a respect for the Committee let's give you an update on those bills okay so what I'm gonna do is I'm gonna move into this an active bill section it does not require us to suspend rules for you to move on to the regular agenda but I'm just trying to clean up our regular check this so that we know exactly what bills we're going to hear that day so I'm just going to put him on inactive and then when you're ready you let me know and we'll move them back to the regular agenda but that does not require suspension of the rules if they're on deferred to then we would have to suspend the rules to hear that bill but otherwise we'll just put them there and then you just let me know when we want to hear and we'll put it on the regular agenda sure just wanna give the committee report okay awesome thank you okay US senator voids which bill are you on. Thank you madam chair the Senate bill one twelve okay. So with your permission I will begin. There you are okay you're recognized. Okay so Senate bill one twelve is a bill that updates billing regarded regarding physician assistants so what it does is it clarifies that with the physician's permission the. A clinic can bill under the physician assistant's name rather than the overseeing physician and so it's a agreed to I mean it's it's been reviewed medical societies neutral and there's no known opposition. Okay members I apologize the bill's not in here your packet because it's not on the regular agenda but. If you're willing to proceed or look it up we can proceed that way if you are okay with it I just wanted to describe. Senate bill one twelve. Do and give me time for you to look it up on your funds or let me just give them a second if you don't mind Senator Boyd I don't mind at all okay. Okay and I'm asking Andy Davis to go ahead and join me just in case there's questions I just recognize yourself for the record you may speak. Andy Davis you M. S. okay do you want to go ahead of and describe the amendments that was engrossed in the bill forming just. Again. A quick if I remember correctly the amendment basically made it where. The PA would need the positions. Agreement in order to do direct billing. Okay. Optional for the physician right and and that's correct that's so I was I was presenting and that and it's already in there so the physician would have to say it's okay so this is really purely about efficiency for physician assistants less efficiency billing efficiency so that they can get credit for the work that they're doing for the patients there they're saying so some systems have in place the ability to differentiate that other systems down this just makes it where physician assistants as they're seeing patients I can say look out how productive I'm B. okay. Are there any questions from members of the committee. C. nine anyone here to speak for against this bill. Okay C. N. nine what's the pleasure of the Committee. Ask questions do pass second all those in favor say aye opposed ayes have it congratulations you passed your bill thank you Committee all right any other bills to come before this committee. All right seeing none thank you we are adjourned.