Public Health, Welfare and Labor Committee- House

Its members could work their way to their seats. Give everyone a chance to get seated. Wow I feel like we have a really controversial bill at the table today but I know what we have instead is about to get nurses nursing students here for cabinet nurses that the capital really grateful to have everyone here you know at as a as a physician who spent you know twenty plus years working in hospitals in Arkansas I know that the nurses are not you know just an essential part of the solution for healthcare that the critical part right you are the people that we can't do our jobs without you in forever going to improve healthcare in Arkansas part of that solution is got to be more young people coming into the empty to it coming into the profession so we're glad to see you here we're glad you taking the time to come and spend a little bit of time with this in the capital I hope you get a chance to find your legislator and speak to them that's the best way to affect change you're gonna have a legislator here this capital find them talk to spend a little time with them let him know your concerns is a nursing students and as a nurse in the nursing profession I promise you they'll be eager to listen everyone is anxious to try to help solve the problems that are facing us together and this is a good part of that process is the comments made sometime here the capital so thank you for being here with that said I'm told the rooms a little full hi it's so that we will have to thin out the room a little bit because of the fire code we're we're you know a fifty plus people over the mark so if if we could have some some of you all stores were Sturch then and now in knowledge shall decide how to self regulate that for the moment until somebody else from the security or fire Marshall's team comes up and tells me you got it then out more so about percent everyone being here look forward to visiting with everyone and with that we'll get the meeting started representive Eubanks you prepare to present house bill forty forty five. Thank you Mr chairman with your permission I'd like to have more white Janet man join me at the table. Absolutely for the Senate to show for the committee for the record thank you and jail thank you. You can also add J. health. Thank you Sir Clark why DHS. Janet man Medicaid director DHS. J. hill aging adult services. All right members this bill fourteen forty five establishes cost reports for assisted living facilities in the state of Arkansas if they want to participate in the Arkansas Medicaid program it's seven pages but it basically just provides the definitions and it that framework by which these costs reports will be set up it requires that they follow generally accepted accounting practices it sets up the the timelines required and the penalties that may occur if the the facilities do not follow the instructions in the requirements included in the cost report and. We have the the folks here that can answer any particular questions but I believe it's something that well I know that the governor's office supports in DHS's and support in here to answer those questions. Senate committee any questions represent Eubanks or any other people from DHS here today. No questions there was a hand that we're asked pass out I think you'll have that we do have someone signed up to speak for the bill disability like to push that will your committee recognized speak for the bill. You're recognized this bill this state your name for the committee good morning chairman Johnson the members of the committee my name is Phyllis bell I am the executive director of the Arkansas residential assisted living association also known as a roblox. Thank you for the opportunity to speak to you on house bill fourteen forty five the language of this bill mirrors house bill sixteen eighty eight which was introduced by Richard representative Michelle gray during the two thousand nineteen regular legislative session. Thank you representative for amending the bill and making it better. I'm certain many of you share with me the priority. Of maintaining and improving access to quality of life choices for elderly and disabled our Kansans while ensuring transparency and accountability for hard earned taxpayer dollars. To provide some background on the current processes I have a handout which I believe you all have containing living choices waiver data obtained from DHS and I believe staff as provided that to you the chart shows the number of our Kansans who received waiver services decreased from two thousand eighteen to two thousand twenty one. Over the last several years multiple vendors using different methodologies were paid by DHS to do cost studies with varying recommendations based on data they collected from providers. For example one scenario a vendor using hypothetical fifty bed facility model unfortunately the way of doing things in Arkansas has decreased access to services for elderly. The Medicaid reimbursement rates rates have decreased over several years even in the throes of the public health emergency increase supply chain cost and workforce shortage us. Reliable and accurate cost data is necessary for the accountability and sustainability of the Arkansas Medicaid assisted living program. After several discussions about facility closures due to the declining rate we work with DHS and the temporary reimbursement appendix K. rate was put into place by DHS with CMS's approval in early twenty twenty two. That was until rate review could be completed once again. Inefficiency temporary and uncertain this temporary rate was set to expire on December thirty first again stakeholders in good faith came together weekly working with DHS to provide the necessary cost data to the agency's vendor. Again costly to taxpayers and providers and uncertainty for the residents living and assisted living communities. However the collaboration yielded a recommended Medicaid Rick reimbursement rate for living choices waiver services and effective date no later than January first of this year. The report was approved and reviewed by the previous administration. And the appropriate legislative committees the report was submitted to CMS which came back with technical questions as noted in a letter from then DHS secretary mark white on December sixth to the Arkansas Legislative Council. Communication was provided by secretary white on January six that CMS confirmed the temporary rate will continue through the end of public health emergency. CMS advice DHS. Quote they are expected to approve the waiver amendment imminently. Four days later on January tenth a follow up communication was received from DHS stating we have asked for January first twenty three effective date. And we expect CMS to grant that. Today is February twenty third. There still isn't an updated rate based on twenty twenty one cost even though the legislature review the waiver changes and the providers worked with DHS in good faith again inefficient and uncertain. While this bill includes additional expenses to assisted living providers who are already struggling I am hopeful that if it passes state leaders will insure the house bill fourteen forty five will be used as a tool to ensure access to care and to stabilize their reimbursement rates while saving taxpayer dollars spent on vendors. The intent of house bill fourteen forty five seems to be to. At least in part to assess the reasonableness efficiency and adequacy of Medicaid payments and to identify document verify and analyze reasonable and necessary allowable and non allowable cost and to assist DHS and monitoring the financial stability and solvency of assisted living facilities to which we share a common goal. Arol supports efficiency transparency and accountability in state government programs. Assisted living communities are vital to a stable community continuum of care for your grandma from grandpa for all of our committee elderly and disabled our Kansans. Our role is committed to quality of life choices for Arkansas's most vulnerable adults. In closing and I thank you for your time House Bill fourteen forty five can and should be used as a tool for financial stability and solvency in a more timely less cumbersome and cost efficient way to the state. While reducing unnecessary and expensive institutionalization and a better quality of life for qualifying or Kansans and I appreciate your time and I appreciate a good vote thank you for your testimony zero have any questions from this bill. C. nine represent the banks are you ready to close your bill. Yes Sir I'm close and I make a motion to pass a motion tabled any discussion on the motion. Seeing none all those in favor say aye. Posed graduations are the banks are bills pass president Kevin are you here in prepared to run house bill fourteen. Fifty eight. Thank you Mr chair. And I'm I've brought Christina parks with me and she is the will of the officer Vincent parks that is the evidence of this bill that's why she's here right if you senator self just for the record thank you hi my name is Christina parks thank you for being here we appreciate represent Cavenaugh you're recognized to present your bill thank you very much as many of you know there was a tragic event during some cadet training and twenty twenty two. And in that training unfortunately officer parks lost his life this was a tragedy and there's nothing that we can do to make it easier for Christine and her family and there's nothing that we can do to bring officer parks back but when I heard about the incident I knew in my heart that I could not let officer parks life have been in vain and I know that he would want us to be able to learn from the incident and I'm sure Christine agrees and that's what the evidence of this bill is about. On the day of the training Vincent parks was training in extreme heat and instructors didn't recognize the signs of what was happening to me so this bill is just very simple and what it does is going to require certification of our law enforcement instructors along with firefighters that they will receive receive certain training. On certain health conditions so as people are in physical activity they can see the signs and know what to do and then maybe we can prevent a tragedy similar to what happened to officer parks and that that simply what the bill does. And like I said it's not a bill is not a long bill but it is a bill that does something very important first of all it lets us remember officer parks but what it also does is let us learn from his unfortunate death. And with that I'd be glad to take questions members of the questions represent Cavenaugh. I just I really appreciate you bringing this bill forward I think it's a good opportunity to prevent this moving forward an injury inside thankful for obviously for the service your husband for all we're doing is trying to bring this issue for so thank you for presenting this if there's not any other questions have a motion to pass any discussion. Anyone here speak for against thank you no one C. nine representative Bentley has motion to pass any discussion on the motion. Seeing none all those in favor say aye. Opposed thank you congratulations and thank you members. President officer you here ready to present house bill fourteen sixty. Perfect. You're recognized thank you Mister committee members. I blame for to you today this is a bill that has to do with peer support specialist that so recognized through DHS a peer support specialists Is someone that has been through a certified drug abuse program and what they're asking to be able to do is to be able to be a peer support specialist to help those that are currently in that drug abuse program at but one of the problems and why it's necessary to for me to run this bill today is a few sessions ago there was a piece of legislation that was passed that prohibits someone from serving as a peer support specialist if they've ever been convicted of a crime of violence and we know violence is an extremely broad term so what this bill will do if we've if DHS has got a good applicant someone they feel I would be a great peer support specialists say there employ them or even use them as a volunteer they they will have that opportunity that flexibility to do so so you know who else better to help those that are struggling with an addiction than those that have actually have entered that program made that journey walked at wall came out the other side and now or live in a full and productive lives and the road can be a role model and I understand the struggles that they go through so all we're doing is changing the amending the UL bill just to eliminate the word biology and leave it up to DHS when they do a background check when they receive an application for this position it'll be up to them whether they hire that individual or not and with that I'll take any questions members of any questions representantes. Resembling you have a question you're recognized for a question. Thank you chairman I represent tosses more clarified reading this bill it appears to me that if someone has been sexually assaulted they're not going to be allowed to be a peer support that balances but that way but it looks to me the sexual assault is still left in there I want to make sure that was correct in my assumption that Senator absolutely correct does not mean that you're absolutely correct we do that that still would prohibit them from serving as a peer support specialist just eliminating the word voluntary thank you Sir president bill did you have a question yet do so what are some of the offenses that would have prevented them. Before but now we're going to allow them to potentially work in this role you I know we're limit or devise but you give me some examples of these violent offenses that some of these people might have done and. You know help help help add some clarity for me please well violence like I said in my opening statement that's a broad term that covers misdemeanor offenses were there for some type of violence involved in example you can have a traffic accident or there's personal injuries in that accident that would fall under probably the classification of bollocks so it goes from a very. Could go from a very minute issued to an extreme issue when you talk about balance I mean I guess you could come up with about every conceivable situation that one's imagination could come up with and fall into a category of biology but this leaves it up to DHS to evaluate each applicant and see what that balance was and if there's no other red flags and they feel comfortable with hire employees giving them the flexibility to do so. Okay okay I'll follow up follow you're recognized for follow thank you chairman. So let's say that there's a violent offender who is approved by DHS prove by the employer and then commits a violent act against a patient is there any sort of accountability put in place for DHS for approving someone who. You know in in retrospect should not have been approved the language of this law allows DHS to put those safeguards in place during the process for and hiring an applicant it sure does who follow up can I recognized for the following what you said in place when hiring but what about after the fact and is there any sort of you know they they've they've hired a violent offender they they. Commit a crime against a patient and we can look back and say man DHS approved them to the process there's nothing that holds DHS accountable for approving people who should not have been approved. Well I mean I DHS here but five loaves come the table and address that issue that I think it would be like hired anybody and they would go back and they commit a something against one of the somebody in that abuse program I think the because of that would stay and only child. Mister what Mister you're recognized the. Identifiers of the committee and speak thank you Mr Clark quiet to seventy eight yes. J. with age you know what the agents. Okay Sir I look Lamar trouble there servicing Pilkington. As as we understand the bill the bill would allow us to as to rules that would place criteria limitations on the front end so that we can have we can system criteria to make sure they were only allowing appropriate individuals and to go through this process on the backend I mean I that's I think at the end of the day this. One of the risk in this program I mean when you have someone of that kind of history and you will there are cases where individuals do backtrack and that happens even for those who appears now unfortunately do see occasions where we see peers to thanks they've stayed clean for a long time but then they relate relapse I think the the value judgment passed as been that small risk is worth it to have these individuals have the life experience the council others and work with them through that process and size understand into the reserve talkers bills to open this up somewhat and certainly all the rules we would try and put the proper safeguards in place to make sure that we don't have a bad situation like what you've described gadget I mean I guess my feeling the queasiness I have about this and I like the bill I understand I know about you know recovery coaches peer support I mean those are great programs I just also know that we're going to workforce shortage right now and I guess my fear is that people will Hire applicants who should not of been hired because we just need someone to fill this position because we don't have enough people in the workforce I guess the and that's my concern and Senate you talk these guard rails you any specifics you can kind of share with us may make me feel a little bit better about this. We've we've not built the rules yet and so course away to see what you all decide on this bill portion we are neutral on the bill as will be clear about that but we're going to see what you all decide and then after the fact would work to see what kind of guardrails with the build up okay president will treat you're recognized for a question thank you Mr president Tosh appreciate you bringing this bill I guess my question would be in relation to somewhat of what representative booking with Pilkington will say in so are we talking about substance abuse only here we talking about behavioral health peer support and then how are we going to distinguish between the two because currently qualify behavioral health providers Q. BHP's can provide services but they're held to a standard federally that they cannot had a they cannot have had a felony within a ten year period I believe and I understand that peer support would be a different selection for audience if you will that you're calling from is there any federal regulations that would prohibit what we're doing here look back period. Not to my knowledge I mean you know they now if you're a A peer support specialist the only thing that you're not allowed to do is to be able to counsel with those that are in a substance abuse program I mean people now that are being the use that's had a crime of a balance in the past are still being used at this time in various programs with DHS like the opiate program they also were part of the advanced program the the A. also in the commission of accreditation of a rehabilitation facilities and they also submit ports DHS of concerning the foundation for a medical care they work in our care as a recovery coach my point is they can do all these things and now they're already capable and authorized to do these things now but because the bill that was passed a few sessions ago in the word violence was used. And it was you strictly in relation to being a peer support specialist for a someone in a child I mean a drug abuse program so we want them to not only be able to do all these things that I've just mentioned if DHS is comfortable with them but we also want to be able to help those that are in that program and as I said earlier who better to help them than someone that's actually walk that will. President Ladyman you're recognized for a question. Thank you Mr chairman representative Tosh thanks for bringing this I mean is it something that's really needed and as you say if they walk that wall they know how to relate to folks who are still in it Mr why my question is Related to representative Pilkington some of the questions that he had if we pass this bill would rules be required to be established run through rules and council or could you do these things within the department or would you be required to come back to us to approve some of these rules later on yes our artist of the bill that we would not we would have to develop rules and bring those back through through the normal process and you all will see those legislative review. Are there any other questions from committee. C. nineteen was sent speak for against the bill. The Tashi close for the bill Mister chairman I'm close with the bill or similar you have a motion to pass. motion do pass any discussion on the motion all those in favor say aye all those opposed C. nine U. congratulations pastor Mr thank you committee members. Representative Johnson's gonna run Senate bill one eighty six. Thank you Mr chairman the committee members over the course of time as sometimes happens with legislation we've created a piecemeal approach to criminal background checks on folks they're working with individuals without without E. D. at this legislation is intended to clean up that process make it tighter and make sure we're doing the appropriate criminal background checks in a succinct and and easy to understand way on the people that work with these individuals and have Mister white here we have to try to answer any questions if anyone has any questions. Are there any questions from the committee. Division dissolves. Thank you Mr So this this is the background applies to contractors and subcontractors are we talking about people who are actually come in and would like to be doing construction work and facilities in these places number of what I think I think when they said the term contract within minutes contract labor as opposed to employed labor so if they use contract labor anyone that that qualifies to come in and work with these individuals whether they're contracted employed with would be subject to these background checks. But the fact that that results it is a contractor of the service providers so that service provider that is providing that the in home assistance for that individual is someone that they are contracting with US postal the clients contracting with. Okay all right thank you. Any other questions. and I signed up to speak for or against this bill. C. N. nine what's the bill committee. I make a motion to pass we got a motion is there any discussion. So are all in favor say aye. Congratulations you pass the bill. Thanks for your patience representative Clowney or you prepared to come and present house bill eleven eighty nine. You're recognized can you head of the table in addition yes and she can enter yourself for the committee thank you. Thank you Mr chair morning committee this is doctor Liz Laura she's gonna present with me today if that's okay with you absolutely just state your name for the committee you're with thank you good morning my name is Elizabeth Laura. The position and I am the president of the Arkansas association for behavior analysts. Thank you for being here represent Clowney recognized president thank you Mr chair Committee behavior analysis is a quickly growing field in Arkansas it's an evidence based practice that's meant to increase social life and communication skills and decrease challenging behavior among adults and children it's it's been proven to be especially effective in children with autism as well as folks with other intellectual and developmental disabilities I'm currently Arkansas is falling behind here every surrounding state has a licensure has a license for behavior analysts Arkansas currently does not licensure will allow for local oversight folks who practice behavior and analysis right now are all certified through the national board licensure would allow Arkansas to be able to answer after complaints and that sort of thing on the local level before escalating it nationally and the other thing that we just realize after hearing representative Johnson's presentation because there's no license you're currently there's no requirement that behavior analyst receive criminal background checks in order to practice in the state and as I mentioned they often work with children and in our schools so it lots of benefits to licensure and and we're happy to answer questions about what those might be the proposed license would fall under the existing psychology board and I mentioned that this all and kind of the road these behavior analysts presented to our mental behavioral health working group back over the summer and early fall and we've been in conversations with the department of health DHS a lot of stakeholders since that time this is the result of a months of hard work and lots of compromise from lots of people but the compromise the the position that we settled on was that this licensure would not involve the creation of any new board anything like that it's going to fall under the existing psychology board and I think with that that is kind of an over. Review of where things are from where I said I'm gonna turn it over to my expert and then we're happy to answer any questions. Thank you representative Clowney as you've already mentioned I'll just reiterate that the importance of the licensure is that we will provide it will provide consumer protection and localized oversight of our professional practice of the issue of. existing background checks and child in an adult male treatment is huge right now as part of our certifying process we do not complete those creation of a licensure bill would require licensed behavior analysts to have background checks completed. Thank you. Members of any questions for representative Connie here. Experts president dissolves you're recognized for a question Mr so you are working in the state currently so what I don't I don't understand what create the the license if you're. Currently able to work in the state what what else is going to do other than a you. It doesn't make sense to me you just want to do a background check and have that what else are we doing. So currently if there's at the call concern that as ical concern is reported to ours our national board which is located in Denver Colorado and it takes them some time to investigate they often really just kick it back to the state and this is a process that can take months. Localizing that control and allowing our Kansans to evaluate ethical concerns made by our Kansans would expedite that process exponentially and would protect our most vulnerable consumers children with intellectual and developmental disabilities. Any other questions from members. Reckons preserve the road. Sorry this is a little redundant anything you've already discussed that thank you for your testimony on page four on under the list of individuals who are she's me exempted. lines twenty three through twenty six cents number eight says an unlicensed individual pursuing experience in applied behavior analysis consistent with the experience requirements of the certifying entity if experiences supervised in accordance with the requirements of the certifying entity that's a lot for for me to process however I just was curious it sounds like that somebody who you would want. To be able to. To kind of have a pretty good understanding of their background on in in my understand this person would not be required to. Fall in line with everything you're trying to do. So what this is referring to is a student who is accruing supervision hours to become a licensed behavior analyst or board certified behavior analysts and their professional practice is regulated by their supervisor so any infraction that they may commit would be liable to their supervisor who would be a licensed behavior analyst and would fall under all of these regulations. Okay What type of behavior is you know what type of Duties or responsibilities or practices what would a student necessarily be maybe doing an unsupervised way well they would be supervised by their supervisors they wouldn't do anything unsupervised okay our thank you president Womack you're recognized for a question. Thank you Mr of those ethical concerns that you reference just a moment ago in response to president and those questions how many of those do we typically see annually. They get referred to Colorado I'm not aware of that number we would have to contact the behavior analysis certification board in Colorado okay thank you president will bridge you're recognized. Thank you Mr chair I appreciate you bringing this bill and obviously Service it's important to be provided in the state I guess the questions that I would have nothing there fairly simplistic is. Is there an educational program in Arkansas that currently provides the behavior analysis degree or what you need to become nationally certified yes there are two in this state that have approval it let it over you and everyone at the U. of a and I believe the UCAS in the process of establishing a program follow. At my final question would be are you still going to require national certification and my reasoning for asking that would be are we grow are we going to grow the number of behavior analysis is. Analyst in the state. Not by not by passing the licensure so they will still be required to become a board certified behavior analyst at the national level correct it's just about that localized level of consumer protection thank you welcome. Residuals. You're recognized for a question for him thank you Mr chairman of I want to talk about going to representative roses question on item number eight there what is what is that phrased that way I feel like that's kind of a it should specifically say student if that's the way it's intended to be I just feel like we're. Leave an account open their. So it's it's freeze doesn't unlicensed individual pursuing experience and it's freeze that way likely because not everyone accruing their supervision ours is currently a student they may have formally graduated from their graduate programs that are still in the process of accruing those supervised hours. You're welcome reversion recognized I'm sorry of the labor the point but now he made me think more about my question so is there anybody else other than a student or a graduate. Who would be qualifying as an unlicensed individual. That that could be participating in that training not an unlicensed individual who is pursuing experience in applied behavior analysis consistent with the experience requirements so does your determination that there's nobody else who falls into that category than a student or a graduate yes provided that they are pursuing experience in applied blundered houses under those yeah I think both representive Johnson I just had to the broader concerning you're saying it falls into those two categories and her no body else correct yes. It is all right you're recognized Mr are you currently able to bill Medicaid for your services. Yes. Okay so so we're not just creating another path for. Billing Medicaid now but by creating this license now your bill under now. We bill a variety of providers for services Medicaid is one but also private insurance is another school districts often employee board certified behavior analysts are you have like a provider number that you your bill under for Medicaid or you have to yes okay thank you. There's any other questions. C. nine someone has signed up to speak for the bills miss Maryland the room. You're recognized come to the table speak for the bill. And Senate is set it's a soft for understand that from your comments so we'll we'll listen your testimony eagerly thank you. If you just state your name to in here with the big. Hi I'm add Dr Tiffany murder that I'm at practitioner behavior and nonsense and business owner as well and worked with the archive of Ford for the last six years until sometime last year and spent a lot of time researching and learning about licensure. I'm I think that. Well regarding submitting stated there are several exemptions for students of behavior analysis and other practitioners that are listed in that bill but in regards to the experience all training and falls in line with that supervise experience of other healthcare professionals I residencies internships and stuff for I physicians as well as for psychologists counselors and so I'm so that's just an exemption in there to allow them to still be able to practice under the direct supervision but. Generally speaking I did email this to committee members but just this morning so At the overarching concern and as with regard to the violations are falling under the Arkansas psychology bar to any do understand why that has come about especially in regards to H. B. thirteen fifty nine with the consolidated board and so generally speaking the rules and representations that are being provided permitted for us as behavior analysts to participate in rulemaking as well as discussions about investigations or complaints have made been made are very restrictive given the Arkansas psychology board rules there's only one person in this state at this time that meets requirements to their requirements to be a representative on that board and in order to meet their requirements you would have to be a licensed psychologist for five years prior to being on that board and wild behavior analysis is in itself a derivative of the field of psychology it is a distinctly different practice and when you read through the the rules at a for. The licensing of. Board the Arkansas psychology licensing board there are several points in there that leads to the concerns that have been seen and that many states are still working to address New York in North Carolina pay the biggest examples it's been a decade before they finally got it removed from the psychology board I'm and that just occurred last year and the reasons being are the limitations on the scope of practice and that additional requirements for supervision that align with the current roles in the Arkansas psychology board if we look at Plaisance psychological examiners and narrow state technicians so given all of that One suggestion I had made. At what is. Creating a Committee underneath the psychology board that allows for full representation of behavior and analysts to be able to be the ones responsible for developing the roles and with regards to licensure and be the ones responsible for addressing any any issues regarding licensure or practice concerns and so on and just to protect our practice because it is distinctly different and and it's outlined on and the comments that ace that I sent but I am and further reflection and skipping a lot of my comments I'm. And after talking to representative Connie about other potential boards where the licensure could fall since it is has been stated that we would not be granted an individual licensure board one thought that I had and spent the drive here Northwest Arkansas reading all of the rules and regarding that. That medical board and the occupational therapy committee under seven seventeen eighty eight two oh two I'm SO under it that licensure under the medical board and given that this is a medical practice and it is and the general standards of care and our scope of practice all apply to medical service as the private insurance companies as well as commercial insurance companies have very specific rules to follow with regards to medical necessity but in any case for occupational therapist a separate committee under the medical board was created and they are given under that seventeen eighty eight two oh two code and subsequent areas they are The committee is made up of occupational therapist they have the they're directed to define regular and frequent as they. I have. Sorry I'm reading my or it has a really to supervision of occupational therapy assistants answer rating published a code of ethics for the practice of occupational therapy and rules defining and professional conduct and gross negligence they also are given the power to develop the rules and address concerns within the committees which within that provide that protection for our field as noted And there's more information in there on that but. I think generally and. You know to avoid creating additional and unnecessary barriers to accessing care and our state and to align with I sent a current crisis it's been acknowledged by our legislature regarding mental and behavioral health service as I'm finding an alternative solution for placing this licensure under a committee or a board with a committee that would allow us to ensure that our practices protected unnecessary mental health parity non penetrative in quantitative treatment limitations are addressed appropriately that is one thing someone asked what else licensure would help with and that is definitely one of those things because spending years as a business owner fighting the rules and regulations of insurance regard regarding at. Regarding the roles of mental health parity laws was difficult but once you have licensure and appropriate definitions within our legislation and that's addressed I think I should stop. I'm because I could talk for hours about this I've. We're doing it for six years to get up to take some questions any questions from the committee. A reserve region recognized for a question I thank you Mr so so I I guess I'm trying to follow you and and my concern is that you're requesting that this bill will be at a changed or amended to have a separate licensing process than what's currently within the bill. Slightly the licensing process and following the rules of the National and if a national accrediting board. For certification as with other professions all of those things to stay the same it is just literally in regards to how it's written and falls under that Arkansas psychology board because there is no room for representation of our fair or equitable recreation representation of practitioners on that board and again in regards to the rulemaking procedures and how our current Arkansas Board of rules read in terms of how that would impact our practice. Does that answer that question you have a follow up you're recognized follows so so that that is your recommendation that there would be a change to this bill before it completed this process here yes hi there to add a committee under this psychology board that aligns with that thanks in place for occupational therapists or to move the licensor Committee to that medical part licensure. President will that you're recognized for a question thank you Mr chair thank you for your testimony my question would be are are you concerned that you may hold the national certification with the psychology board would then have the ability not to give you an Arkansas license which would prohibit you from practicing in the state I don't think that there are any ill intentions or anything within the psychology part I just wanna be clear about that but that concerns are with regards to unnecessary restrictions on practice and if you look at the licensure requirements for license and psychological examiners and so on and just the general language of the rules as they exist under psychology and license or. The questions from committee. I could explain that with New York in North Carolina if you it like what happened in the state have you had your question sufficiently answer represent Wilder's. I think that's okay prison county route as everyone else Senate speak for against the bill are you prepared to close your bill yes Mr thank you so much for your testimony and you know this as I said this is been a very long and arduous process getting all the stakeholders on board the the Arkansas association of behavior analysts are happy with this version they're happy being House under psychology psychology is happy to have them this is a version that will get us licensure and I am not sure that there is another alternative it addresses the it addresses the concerns without unnecessarily growing government and I would really appreciate a good vote thanks. I have a motion to passing discussion on the motion. Seeing none all those in favor say aye opposed. Graduation pastor billers inclining thank you Mr thank you Committee. Members I think that concludes our business for today I appreciate everyone's patience and we'll see about next week