Public Health, Welfare and Labor Committee - Senate

Here today we're glad to have you just a couple of notes for the members of the committee and people that are attending this meeting create so much that you're here I'm just four points of clarification as to how I as chair schedule this agenda so that everyone is clear if the bill is a long bill I feel like my members of public health committee need time to look at that bill and read that bill and as we are considering that bill if it's a twenty three twenty four page bill we need to we need to have that time blocked off so that we can be thoughtful and thorough in going through that bill and those bills need a little bit more time that is the only reason that we have played some bills as special orders. and and that is my purview as chair to to try to do that to help my membership of this committee be prepared when we're looking at legislation the way things are written matters the words matter we want to do our work in our due diligence as committee members to make sure that those bills are thoughtfully read understood and we my members have the time to to really because thoughtful and consideration of the language of those bills so unless or another reason why some that might be on special orders because it was requested by a member so just to let folks know. And if if there are any issues or problems or if members have have bills that that they want listed like that they usually come to me and I try to accommodate them representative Pilkington and Senator Flippo are not going to run through a bill today that they want to want to reschedule that which is great with me that's fine and so will move immediately to Senator Rice as senator rice are there any questions from members of the committee. At Senator Rice if you'll just let us know which bill you are we will take it up thank you measures house bill eleven fifteen from representative Maddox. Thank you. You have an amendment know that I would never mind sorry okay go ahead thank you members of the currently at a loss massage therapist can only become a master massage therapist by taking a hundred twenty five hours of continuing ed and this bill allows another path where a licensed massage therapist that can take and pass over three hundred hours as an accredited at an accredited institution to become a master massage therapist the other option is still there this just creates another way at Department of Health bruises Centers no no opposition glad to answer any questions. All right are there any questions yes senator love you're recognized for a question. Okay is there any other questions from members of the committee anyone here with yes senator can you have a question you're recognized. But we just cut down on the amount of hours of continuing education to get. via somebody revenues this was in cooperation with the U. they Ridge mountain in their program and I am a staunch supporter of massage therapy and I believe in the the medical benefits it has so I was glad to do this but I I would measure begins that I do will it does take training the wanted to works only that was going last week because they were here in Little Rock taking training and finding out specialties of people that have special. Problem that they can help within and I I appreciate the extra training three hundred are sound like a long time but again it good massage therapist is highly prized. Our group that is somebody had a hip replacement is that the deal with this so they have to have three hundred hours after they because of Boston's continue education is that right that is that it gives the other opportunity to to have the three hundred our first again they they can take a hundred twenty five hours continuing ed are they can. Passed over three hundred higher from an accredited institution which again Ridge mountain I understand has that. May I speak this is not enough to speak for lowered requirements but that's another issue. All right any other questions for members of the committee. I appreciate your comments about massage therapist I agree with you one hundred percent there there and and they do great work but also somebody has had a back surgery it you do want someone and have training because when it comes to the spinal spinal issues that could occur it's it's important that they have get training of your anatomy and. And and know where to you know proceed and and when not to proceed so appreciate the imprint brought the bill anyone here so as to speak for or against the bill. No one signed up okay all right you're recognized close close Richard good vote Senator live makes a motion to pass is there a second second all those in favor say aye. And opposed ayes have it congratulations your pastor bill. All right. Senator Solomon and if you'll just take the chair I will to the top of the agenda Senate bill one thirty eighths. We have an amendment that I need to concur that we place on the bill and the house. Senator go ahead and introduce yourself and you may present your bill thank you Senate bill one thirty eight members we pass this bill out the only change that the amendment does if we have those amendments just as an emergency clause on the bill and as some sponsorships to the bill that's all the amendment does. Members anyone have any questions on the amendment. Say no questions anyone here to speak for against the bill. Senator would you like to close for your bill yes thank you so much that appreciate or you amendments are yes the representative present the attorney general's office us as well and Sir work on assisting us with the emergency clause so with that I'd make a motion to concur with the house amendment. Members of the we have a motion. Motion the second. House second. All in favor say aye. Anyone opposed. Senator you pressed your bill thank you. Okay house bill one zero zero six. There you are thank you. If. If you're the state institutions offer the record then you may proceed thank you chairwoman thank you committee for having today today president you house bill ten of six with regards to paid maternity leave for certain employers as you recall during the summer with there is the reversal of roe V. Wade with adopt session during that time I saw a lot of companies across the United States put out statements saying that they support women and that they would pay for them to receive abortion services in other states if those states had bands like this like Arkansas if you read the Cavanaugh decision he says that we can't hear fear of interstate commerce and they're kind of exploiting that and so by a circumventing the Arkansas ban and loophole to send these women and other states a lot of women who I knew founded this is extremely hypocritical of this company to say that's the board when they say they support choice yet the only incentivize one choice they only incentivized one option for their female employees and so I thought if they want to do this and they want to take on this extra expense for their benefits why not also offer maternity leave twelve eleven other states already offer it these companies clearly show that their they're willing to do this and so we put this bill together to have twelve weeks of maternity leave offered if they offer abortion related Sir to pay for abortion related services that's essentially the bill we were able to to pass it with widespread support in the house there's no known opposition against that that I'm aware of the twelve weeks was chosen because that's the national average and with that I'd take any questions. All right thank you other questions from members of the committee as senator Sullivan you're recognized for a question. How many states have legislation similar to the what would be the first state with this type of legislation they let other states I mentioned were states that have either a paid family leave or maternity leave for all companies but obviously you know some companies are not offering this abortion related services so they would not be required to offer this twelve weeks and because the a lot of companies they're literally trying to get by day by day they're not trying to play politics they're not trying to be what virtue signallers and and so I didn't think it was right to include them if they were not including the service some paying for those services so there's a lot of states as those are kind of different policies but to offer this it's not like something that's never happened before is water is a fiscal impact on how many small businesses it's going to put a real strain on at this the cars are minimum number of employees you have to have a simple answer of over fifty we we base it off FMLA once again I don't of fiscal impact on the company's it would hit but these are only companies that are offering to use to pay for abortion related services and circumvent Arkansas law by trafficking their employees and other states so it would affect for instance all also give examples if you've you own a small concrete company and then I Jonesborough with a hundred fifty employees if you're not paying to senior employees into illinois' to receive an abortion you're not going to be affected by this law at all but if you decide that you're going to be a woke champion and they want to send all your female employees and say Hey you get pregnant will pay for you to go get in late term abortion in illinois' or Colorado or something like that you you would have to also offer this as well. Freesheet with the bills effort is and I. Empathize with that I just have a hard time when when state government is going to start. targeting businesses because we disagree with how they're going to spend their money. It seems like effectively what we're doing if you do this then we're going to target you make a more difficult for you Is to run your business because you disagree with us and if people find circumvent Arkansas law the time back the lead the state of Arkansas and they come to the state of Arkansas I'm just wondering on the flip side of for incentive if if we incentivize somebody to come here and then we're targeting them on the other side of the market works well if if we're gonna be very selective in who we incentivize and who we attack or target well as an attacking or targeting what I'm doing is making companies that say they want to offer one benefit offer a parity benefit as well we're safe you're going to if you have a employee employee becomes pregnant but you only incentivize one choice which is again abortion but don't incentivize the other choice was to keep the baby that's not real choice for them and so I'm saying if you can offer one you just the offer the other as well so it's not and I would say it's being targeted for. Anything like that I'm just saying if you want to if you say that you care about this is a party we just ask that you also have paid maternity leave as well. because like I said we don't offer it the service you don't offer to pay for abortions in senior boys out of state this doesn't affect you at all thank you thank you manager. Other other questions from members of the committee. All right. I see no other questions is there anyone here to speak for or against this bill. There's nobody so we will recognize you to close for the bill I'm close right bill thank you chairman thank you. Right what is the pleasure of the Committee. Motion to pass second all those in favor say aye. And opposed. try that one more time how all those of favour say aye. And opposed. I'm gonna say the nose haven't we can try to roll call that but but I don't see any hands. The bill fails thank you. All right. let's see H. B. thirteen forty. Good morning madam chair Senator David Wallace District nineteen. Members good bill presented by representative Tosh it's going to have a very small group of disabled veterans. And I'd like to refer you back to the the last page. starting with line one if allowed under federal law if allowed under federal law. The department of human resources of seek a waiver from the United States food and nutrition service to exclude veterans disabled benefits as income. For eligibility for the step program. That's what this is all about and it's for a very small group they have specifically this bill specifically aims at a disabled veteran who was as a result of combat and only combat either wounded or injured. During combat. If you're injured driving a truck state side you don't live. For this. And what it means is that's going to discount the your. They're disability staffer they receive from the federal government for their entries. The average injuries average disability payment for disabled veteran from the federal government is sixteen thousand dollars a year averages out about two thirteen hundred dollars a month. So. If you have a veteran that's been combat mode. If he's making two thousand dollars a month from social security for two thousand dollars a month from a a job he will qualify for this this is truly aimed. At the disabled veteran injured as a result of combat. Who is in desperate need already. That is. With the real source of income making under approximately twelve hundred dollars a month. It's a in my opinion a very good bill and I stand by for your questions. And for clarification the funding for this is one hundred percent federal site correct yes ma'am. And then there's no there's no cap on the income that's in here but just from your testimony. The with the state there is a cap just from the state to qualify for that program as an individual I think it's a roughly twelve hundred dollars a month okay so that would apply here yes of the pictures make it twelve hours a month from any other source of income they will qualify okay. That would just be consistent with the current okay any other questions Senator king you're recognized if you can bring that Mike right to your. So we can hear you on record thank you so I mean I know this has a physical impact it's federal money but still our tax dollars there's no fiscal impact of this. that's good question thirty one here from DHS could answer the fiscal impact of this piece of legislation. and and we can if if we want we can hold us and wait but I don't think there's any state general revenue impact but go ahead and introduce yourself for the record that you're recognized thank you madam chair mark what for him services senator the we have not done a fiscal impact on this in terms of the federal dollars the reason is we do not have a good picture of how many individual might qualify for this we do know that we we have an idea of at least some individuals who are veterans that are on staff but we don't know how many made this specific definition as other star good way for us to make a projection of how many individuals total be eligible and then what that federal fiscal impact would be. There's no way to make projection even though it's for something good in I don't want voting on open ended things I mean we've been down this road with DHS before announcing last meeting last week was about all these projections that came up we're going to save money that didn't save money so I mean I get it but smart and just because it's federal money immunity you look is anybody knows the debt and deficit right now I mean it's. in listen Hey I do this on Education everything else I mean of the second largest contributors to the national debt and deficit sides president converses governors and state legislators. So when we talk but put more dead on her kids and grandkids and everything like that. You know and all this fiscal conservatism the Republicans say well you know I always want to point Democrats and stuff the bus the debt and deficit will they do it too so I mean I just part we need to know how much it's gonna cost center I I do understand your point a course and be clear DHS is neutral on this bill so I certainly do anything I say becomes considered is taken position on it one or the other I will say just on what limited physically have. We we know a handful of individuals who are veterans and on snap and might be eligible but again I just I don't make a projection of that because there may be I can't tell you there is not thousand out there we don't know about. In a listeners on a bill I have that I don't want a projection how much it's gonna cost I mean on. So if I do something I don't get the luxury of going over budget need not get scrutinized Walker what else but I'm just saying you know if we don't know how much it's gonna cost then and Senator Wallace I mean if you look at the debt and deficit every time we're spending federal money we're just put more dead on. Those searches for today yeah and I would I would reply to you senator read a representative Tosh asked that question of the FNA and they would they answered him and I'll be glad to do the fiscal impact that would be less than two hundred I'll give you comparison. Look around the state when you drive. And the last place to see with a Purple Heart. Not many. The ones that have a Purple Heart someone that. Bled shut up get interprets country comment. Hi there is a I'm nothing there's no better talking on auditions it finished I'm speaking I thought you were done senator. Please allow thirty minutes so senator king he's not finished that senator Wallace please finish. That's wrong. But I'll start going. You've got individuals that serve the country. Most of these men and women came back. Get on with their lives. Very very small hand few. Did not and I know these men and women. When I came back in Vietnam fourteen of those came back the ones that were left for those meant committed suicide. There's a real issue for veterans we're not asking to help every veteran with this bill. We're asking to help the most needy veteran that you have that has been injured in combat the service of his country. With that I'll stand by an issue questions I just have a quick question just and then maybe it's a definite question or it could be a DHS questions but I'm just done I'm defining combat and then figuring out how many disabled veterans do you have a combat and injury how would that happen like how would we how would we and. How would we define those people as having a comma in injury would that just be a process of the application or. I'm asking that's why probably it's problematic to make a projection of a fiscal impact because we don't we may know how many veterans there are we may know how many disabled veterans are there are but we may not know how many disabled veterans have combat injuries right that's a good question so so that that just I mean that's why to me there's just no way for you to make a fiscal impact that's I mean other than a gas because we can't tell you I know you're a veteran but I don't know if you're disabled or not or if you're disability came from a combat injury or not or how that's defined or as defined by the federal government as defined by us you know what I'm saying so I don't know how that would work that's just my only question. Right The veteran. Would be able to prove that he was injured or. And there be documentation from the federal government okay okay you you go through a very deep evaluation from a federal VA okay okay thank you senator Boyd you have a question. Okay Senator king at a question. Someone say my dad did not serve my dad my uncle did heads of relatives I mean I have a picture of I mean I understand what you're saying and. Believe me I do Saiva picture down office of two young men that one of them got killed in Iraq one and got killed of it was one of the navy seals that died the grass and grew up with them coaching baseball you know grow up it's families and I spoke about the role since I get that but I'm just saying we have to know how much everything costs be able to do it even if you put a cap in it whatever it is but we have to have something we cannot continue the way we're spending money it doesn't matter if it's me would Senator love or whoever else or what issue it is is noble it is. You know if we don't start watching the money we spent and have accountability we have to have something to be able to we cannot I just don't do it don't matter what the issue is it that matter it's my issue so that's my statement and of I think that you know we need to know at least an estimate on how much it's gonna cost and because of the past history of everything that's been done on here missing cost obviously that's something I don't think so on I think it's for questions and I I will be glad to pull this down and get a fiscal impact from the FNA. Okay. Sounds great. Thank you. Thank you senator Wallace for doing that. H. B.. One one five One one one five. It's representative Maddox here. The. Where is that the sorry HB thirteen thirty four. Good morning colleagues I am state representative terrace Shepherd and I represent District seventy nine house districts seventy nine in two thousand and nineteen my son was diagnosed with Crohn's it has impacted his mental as well as his physical health at that point I decided I would become a champion for our Kansans with chronic illnesses and ways in which I can help them live their day to day lives I wanted it deems I wanted to do was present its appeal which is to allow access to a restroom which someone would Crohn's ulcerative colitis or any other type of IBD issue I have had so many people to come to me after this bill was ray and what was the most humbling and confirm the importance of this bill I had a young lady from BLR to come to me and tell me that her mother passed away with problems I've had individuals in the house to come to me and tell me how important this bill Lee yes right now there are twenty other states with similar legislation I went above and beyond in order to try and get this bill passed in other states they required that there's at least two people within the business in order for someone to use the restroom this particular bill requires that there are three people in a business in order for someone to use the restroom in addition it was concerns about how do you prove it the Arkansas crawls in colitis foundation attended the House Committee meeting with me they are based out of Rogers Arkansas to calls foundation gives individual a I can't wait card to prove that they have and actual of illness in which they cannot control their bodily for. Tions in order to be able to use the restroom there's also an out of I came awake that shows businesses that currently allows open access to a restroom so I'm simply asking for basic human kindness in regards to allowing someone with a chronic illness to be able to use a restroom and there must be at least three people in the business in addition to a person has to be able to show that they have an illness and that's the purpose of the bill and I'll take any questions. The questions from members of the committee Senator Solomon you're recognized questions. I appreciate the intent of what you're trying to do how does one. Validate that the cards are the documentation is valid Committee walk up and and someone makes a copy of someone else's document how do you make sure that is applicables to the person person making the request it's an official card that comes from the Arkansas crossing colitis foundation yes that's the way in which they can have it in addition most of us have some form of ID on us when we're out in public so they could possibly have their I. D. in addition to the card as well as they can have some type of other documentation from the doctor's office in addition to the formal ID. If I'm asking how do you prevent that from being duplicated. Well you would have your ID on you Sir. Are you I understand maybe. So if I have a script. How do I prevent our our our for card I can go to a copy here I make a copy of that document. Falsifies the the name Maddox I appreciate what you're trying to do I'm just concerned and worried about what. How we don't have a prevent fraud and that application and I understand your question and thank you Senator Solomon for the enacting a lot of times we do have to worry about of fraud and things of that nature but it's an official card to come from the cross Foundation and they have their ID with them okay thank you yes thank you senator live you're recognized for questions. Okay are there any other questions from members of the committee. All right Could you just walk me through how that process would work with this is this is a mandate on on a business email private business yes ma'am would they be required to provide and some of those businesses like small businesses don't have a bathroom that's ADA compliance with this then now require those small businesses to have a restaurant that would be ADA compliant. No ma'am so we don't we if you read the bill we're not asking businesses to make any type of changes to their current structure we're not asking businesses to allow individuals access to restroom in which there will be a safety concern we're not asking businesses to do anything of that nature always simply asking if you have three or more employees in there a person comes in with a chronic illness if they can show you proof the police to allow them to use the restroom in addition to the young lady that approach me from BLR I had a mother that was nine months pregnant that approached me now what was all concerning about her Casey is it wasn't really about the restaurant it was about getting money out of her she was informed that she could use the restroom if she paid when I asked her how will she go about painting the business owner informed of what if you purchase something you can use the restaurant so this how she went about it I had a gentleman that was on a hunting trip with his son and he was allow active but not access to a restroom so quick she had an embarrassing exit me accident on their way back from a hunting trip and ended up having to pull simple overalls out of the truck for the long ride home so this bill is simply asking for basic human kindness and as I mentioned is already in twenty other states and this bill is even more progressive than what the bill is and those other twenty states okay thank you are there any other questions members of the committee senator Sullivan you're recognized for it so I'm looking for what is there a penalty of sorts of a business to says you say here's the card and we want to come in use restroom and then say no we we remove that part out of it it would just be basically up to the individual if they want to see some type of action but let's be honest in their Sullivan how. Many individuals will actually seek out private right to action over being denied access to the restroom. This is not a very harsh Biel she's given the okay to the individual she's to restaurant. Okay and again I'm I apologize for asking so many questions not that's okay on page three. Line for talks but if not willfully or grossly negligent can you help me with that refers to the council but not saying that if they did not allow them to use the restroom Day were being negligent in some form what if I'm not out to criminalize business owners I'm simply asking for basic human kindness and for the business association retail business association now commented on this no I receive no opposition against this bill senator thank you thank you any other questions all right anyone here to speak for against this bill. Okay see nine what is the pleasure of the Committee. Okay. Is there a second. Thank you your diet your your bill dies at because there's a failure of a second to your motion thank you thank you so much. okay let's see senator Patty. Senator Patty here. Senator boy do you want to let Senator dis go ahead first since he's in the room okay let's just do that synergies zero you will take your seat at the end of the table will go straight to yours which is Senate bill two ninety one. members I'm. I try to put my bills at the end just so that we can accommodate people to get back to their committees sent so that's why I'm skipping around on the agenda Senate bill two ninety one. If you will to state your name for the record you're recognized for state thank you madam chair the consumers sanitizer dis Hester thirty five and with permission I I'd like to invite up I Mark golden from UAMS. Piece of. Is not a room that will keep going okay all right all right. Thank you this is Senate bill two ninety one this is a a cleanup bill of sorts this is related to a a committee into legislation act in nineteen eighty nine and it moves the ownership of a registry for a nongovernmental nonprofit organization to for head trauma and bring it back to the department of health and so the benefit of this is that around improving efficiency and data collection and security of of of potential for data risk thank you thank you and and that's what this does so when when there's head traumas across the state currently there's a nonprofit organization that collects the data around that and this bill attempts to bring that in house with you M. S. and our partners there for efficiencies like I mentioned and also for potential risks of data breach and we have Daniel doctor Dr Richard here and I would love for him to be able to recognize himself thank you for being with us appeal to state your name for the record and then you may proceed hi my name is Dr Daniel Bircher part of you medicine is take for digital health did you want me to speak to. What what part would you like me to sure I I think this year it describe a little about this okay absolutely yes have you so please share thank you so the idea that this is a it's the TBI registry and we actually monitor patients that come into the TV I registry there moderate to severe TBI it's and what we do is we try to make sure that they get the resources that they need the actual operations really are not going to change at all we just wanted to make sure that the health department becomes the owner of this bill so that has stability in it has efficiency so that's that's really what it boils down to we we changed very little in the process of the bill itself the only other thing that we added was an opt out is somebody doesn't want to get contacted by us we they tell us one time and we take amount. So that's pretty much the idea the bill the the key is that uh patients get rehabilitation they have an advocate that they can get the rehabilitation they need and we think that's extremely important for their outcomes. Just a quick question do you know if this nonprofit that collects this information of this data on head trauma injuries collect data on any other trauma injuries no okay strictly to a dramatic bring into K. yes all right perfect thank you any questions Senator of love and then Senator Solomon. Thank you Mr. So. Currently. The Arkansas department of health is not collecting this information. They actually are the the independent agency. Did not function anymore and that's yet another reason we wanted to have the Arkansas department of health to actually officially on it but this is all part of the TPI registry this formed in at U. M. S. that we have the database that we put together to make it work. Okay I guess I'm trying to figure out if Department of Health is already collecting this information then why is it that we need this written legislation well because the the entity that is that officially and with the way the legislation is right now the the brain injury alliance of Arkansas really doesn't function that way it's it's you know that's that's kind of how this is it's that lack of official nature that we see that there's the problem. Senator love a I think another point that I that I appreciate about this effort initiative is is when we talk what efficiency you also talk about data security so having multiple data sources out there bringing one in house that we trust with other health care and data it makes sense to have that aligning to one. Can we get somebody from the Arkansas department of health. If you have a question for the department of health okay just one second let me go to Senator Solomon I think he has questions for folks at the end of the table they will get the people from department of health care and then you do as well okay. Sullivan thank you manager you're representing you in mass yes Sir so we're tracking it at you in the we're direct are you familiar with a cat yes so we're tracking you M. S. for tracking it a guy they were tracking the department of health and and one of those is in active are insufficient I don't know what the word you used to us so that sounds to me like we have three different agencies tracking this data. I'm not sure if anybody else tracks are demanding brain injury registry I think it's just as a kind may get the reports that we submit that they don't they're not the ones actively tracking this information where we go to the trauma centers I guess that's my question here we have three different agencies who are tasked with tracking information like this. And we're not getting that done. Is that what we are getting the data now as it is we just want the ownership to be officially through the Arkansas department of health there's no additional change that is going to happen with all this other than the ownership of the TV I registry. The registries just being kind of functioning with the brain injury alliance that really hasn't done anything with it the brain injury alliance I think isn't it okay yeah my point is we have multiple agencies who claim ownership our claim that they are by with you I have the data there for its mind kind of thing and I want to as we have three different agencies making this claim and it seems like the agencies are groups could work together to achieve that is I understand what you're saying I don't know that I I wish folks would work together and get these issues resolved but thank you okay. Yes Senator void. I just wanted to clarify if the state is somehow going to be charged for this what what is it gonna cost I mean is like for having a registry is there some way just we're going to use this law to then yes tell the state you owe us money no. Okay anyone else for these folks okay Senator love you have a question or department of health is there someone here from the department of health. Thank you feel just introduce yourself for the records. Thank you madam chair members of the committee Larson I'm general counsel for the department of health this is just a simple change there will be no cost to the implement implementation cost zero the contract is already in place the brain alliances reforming the organization is not able to work with T. V. I. patients so eighty eight is going to work directly with the contractor UAMS to continue working with the TBI patients across the state to help them and there's no challenges at this time the contractor's been doing the work in this bill just cleans up the language right center left you're recognized for a question okay you so you're saying and. There's not gonna be any cost. No new implementation costs correct. All right and so the. We need in tracking this information keeping this information how does how does that work it is it is it. I guess I'm trying to figure out. And I I guess I had something similar to this I'm trying to figure out this so there's somebody with a traumatic brain injury. Our True Medicaid injury. Any hospitalizations hospital whether it's the M. S. where there is. Some of the hospital anywhere mercy or whatever. Is that is that information already reported. How does that how does that work. Yes it already is being reported it's the ownership that's changing that's what we we want to have happen is that system is. The way it's been operating is under trauma rules and regulations and all the trauma centers are having to report traumatic brain injury patients within five days okay this system so they're already they are ready yes mandated to report yes Is that yeah okay so instead of going to this this other organizations nonprofit now it's switching to right okay and then lock are you sit there is no admission there's no in the. Additional costs contracts or anything it's already in place the contracts already in place yes okay know what is the contract for. The contract is for the operation cost. The doctor may be able to write that's what is in our and you just sit there is no cost in the center contractors there is a cost so which one is it is it is it what decisional cost the contract has been in place for years. There is no additional cost to you. The state okay but there is a contract who's paying the contract the Arkansas department of health has Arkansas Department of Health always pay the contract. Yes through this nonprofit. The non profit. Well as taking in many years ago they were taking these records in by hand caption turning them in and then the at some point before I was here before I understood how that transition occurred we had the trauma system that needed that information. Okay I guess I'm I'm not against what you're doing I'm just you said there's no there's no cost and then use it is a contract with dish cost. Okay I don't know what no additional costs is if there's a cost there's a confidence not is not is if you're taken on a contract the and the Department offense taken on contract right what is the cost of the contract. My understanding the contract as the original agreement was at five hundred thousand but it's already in place already been approved by the Legislative Council. Okay. All right so there there is costs but the mission is it's already in. Sorvillo what this bill does does not increase any costs in the intent of the legislature intent of this bill today is to take a a duplicated process and bring it in house for security thank you you heard a little bit some of testimony here today about how the the the brain injury alliance has. Has been involved with this process as well as as well as apartment health and we're trying to make sure that it has a one central source that has data security in mind and in none of that has anything to do with an increase the cost because they are already involved in that process we're just now trying to bring it centralized security focus on okay I didn't let my sister know what is unanimous have have to do with what the issue and this have to do with this piece right here. It's with the online TV a registry so that the users in the hospitals if they have a patient that comes into their I see you they will put that data and information into our online system that is already functioning. There is this bill doesn't change any of that in a no I'm out of the address of the site you M. S. owns the online system yes but the registry where you want to have the data is with the Arkansas Department of Health. It still is still going to be under unanimous we we're just gonna be an agent for the department of health that's that's all as as through the contract is. The way it is okay all right I'll stop asking questions. Thank you so I think they're very thoughtful questions the man and think they're very good questions because it is I mean you basically had this nonprofit written into legislation which then required a contract with them and I think we're moving away from that the contract will be with you I am us not following and tracking correctly but that the department of health will be the owner of the information. Arkansas. It's through the Arkansas department executed through the department of health correct. Senator Solomon you're recognized for a question so we paying you The Joe Thompson's group of to also do this aren't they in their. In this also they have a there were reporting these things to them sure we double pay take a cab yeah A. K. so are we if they're recording it and you invested for recording in a lot of UAMS employees work for a guy. So are we doing the same thing And paying two contracts. Senator Solomon and this large to general counsel for the department health I'm not speaking for a high and but the a high System is access through the all payer claims database which is current law. Exactly so we have current law that requires them to practice in our duplicating that I don't like the required to track this but they have access through the A. B. C. D. which is current law yes I agree and we're actually paying them to collect that data. Paying a guy to collect the data they have access to it yes Sir. Okay. This appears word for doubling down with the same people in the same things but I'll look into that further thank you. All right thank you. Are there any other questions from members of the committee. One more question yes. Okay all right no other as there anyone here to speak for against this bill right C. N. nine you're recognized close for your bill thank you members the intent of this again is to is to bring clarity and to take out duplicate processes in this and so thank you for that consideration and I believe this bill will do that so I appreciate a good vote okay thank you your clothes and center live you're recognized. Question do pass second all those in favor say aye. And opposed. Okay sorry the bill fails. Thank you first. Senator Solomon if you will take the chair. I'm gonna run Senate bill six to sixty four members. For. Senator well they're passing out the amendment if you would like to introduce yourself then you can proceed to thank you senator Sullivan and appreciate that Senator Missy Irvin to stir twenty four and the members of the amendments which I would ask for your consideration to adopt M. adds an emergency clause this actually Emergency Clause was also crafted with the assistance of the Attorney General's office. So I make a motion to adopt the amendment. Uber's any discussion centreboard. All the questions on the amendment we have a first and second all in favor say aye I'm sorry anyone here to speak against it R. for. Seeing none all in favor say aye hi. For the are you speaking for the amendment of the bill. All. Okay I apologize I have ever of the amendment okay you're welcome during the table. Glasses were kidnapped to see all the way down there. Madam chair and members of the committee thank you so much for the opportunity to provide testimony on this my name is Laurie d'agostino I'm an attorney with Pacific legal foundation. And in nineteen seventy three PLF is the oldest and most experienced public interest legal foundation of its kind my work is primarily focused on our equality of opportunity project and it's devoted to securing equal freedom for all and working to dismantle unconstitutional barriers to opportunity and particularly legislation that allocates burdens or benefits to some at the expense of others PLF has participated in numerous lawsuits challenging gender and race based classifications and our perspective is that racial classifications and quotas perpetuate stereotypes patronize the qualified and hold back qualified citizens of Arkansas from being able to serve their communities unfortunately there are instances in Arkansas law that mandates racial balancing and some of those include the pharmacy board to matter I'm sorry to interrupt but all we're doing is adopting the amendment right now and you'll get to speak on the bill and just a moment thank you off of the amendment now that I apologize but you're signed up to speak for the for the bill we're just trying to get the amendment through so we'll call you back up in just a second I'm sorry. I thank all right let's try one more time on the amendment all in favor the amendment say aye. Posed. nine Senator you're welcome to introduce your bill sure thank you so much so the amendment just again added represented Womack as a co sponsor in the emergency clause which is important the state of Arkansas I think we've seen this these types of laws being challenged in the court system and what this bill does is to seek to correct that and it strikes the quota that is found online Page one line twenty seven again I think it's just a matter of making sure that we are a constitutional and the legislation that we passed some of the laws that we have on the books with that answer any questions. Members anyone have questions. Saying that the one here to speak for the bill. Now's the time there you go. C.. If you will again introduce yourself and you may begin absolutely members of the committee thank you for your immense patience my name is Laurie d'agostino and again I'm here on behalf of the Pacific legal foundation. Just very briefly I was going over other examples in Arkansas law that include some type of racial quota and that you have the pharmacy board the occupational therapy examining committee the tobacco control board and of course the subject of what we're discussing now the social work licensing board. And we we commend Senator Irvin for proposing legislation that would repeal the unconstitutional quota in asked the Supreme Court has noted at the heart of the constitution's guarantee of equal protection lies the simple command that government must treat citizens as individuals and not simply components of racial religious sexual or national class. We believe that governmental tends to classify people based on their race is not only immoral but it's met with resistance by the courts and this racial quota and while there is a noble goal to maximize citizen participation and attempt to address past injustices we cannot use on constant unconstitutional means to accomplish these objectives and for over forty years the racial quota has required appointing authorities to engage in racial balancing and refrain them from considering qualified applicants for openings and one such individual is our client Mr Hale he is seeking to serve on the social work licensing board but he faces an extreme disadvantage precisely because of his race he is a devoted foster parent along with his wife he has fostered over three hundred children any as direct experience working with social workers and he was also recognized by the Arkansas department of Human Services for being the type of foster parent willing to foster hard to please children. Mr hill wants to serve his community but the existing race quarter precludes him from doing so Senate bill two sixty four would put an end to this race quota and ensure that all qualified people like our client Mr hill have the opportunity to be considered for service I'd be happy to answer any questions and I can be reached by email as well thank you. I think we have a question Senator love question you're reading the question thank you Mr. Now he said that he was precluded from serving on the board because of a racial quota so the way it works or is that the reason for that sets aside a minimum requirement of African American candidates that must be appointed to the board and so in the current lawsuit he would face an extreme disadvantage because the the governor must to determine on how to appoint people based on that balance and so he faces an extreme disadvantage in a high probability that he will not be appointed to the board because of the quota. Are there not seven other positions so each of the other positions also contain specific qualifications like one must be a psychiatrist this specific positions for the representative of the elderly which far client qualifies for he said the representative to the elderly and so the the other seven. Positions don't have that. So the. The race quota does not specify which positions of the board must be met to have the racial balance it's just the current make up the way it is. It would it would fall to fill the quota with one of the positions which would be the representative of the elderly just in terms of the current openings and meeting the ballot so the court itself doesn't say the licensed master social worker seat must be filled it it leaves that discretion to the governor and state Senate but it must be met in however way they decide to do so. Okay but it's the it is decided is a decision made by the Senate and the governor correct so the governor makes the appointment and the state Senate confirms okay all right thank you no problem Sir. From curious I know you work it with many states on these kinds of things insert a trend in that direction we sing more stage move in the direction of removing these kinds of restrictions so I would say it's a mixture of the rates quoted here in Arkansas actually goes back to the eighties so there are some states that have these existing quotas in place that have been there for many years others appear to not directly. Qualifier quota but they will they're collecting demographic information and using vague language to say that the board should be made up in a way that reflects the community so we're we're seeing that there is a trend of state's maybe taking more of an he was formulation of these types of things but we have been involved in challenging quotas in other jurisdictions and even in challenging federal programs that contain discriminatory language so. To answer your question I would say that I we are seeing. Challenges to these types of programs and state legislatures working to revisit revisit this language thank you members anymore questions thank you. The wealth fails to speak for or against. The Bill. Senator welcome to close for your bill thank you members I appreciate the questions for shape the opportunity to present the bill I think it's so important that we have members of that reflects the the society that we live in we just have to make sure we do it constitutionally. Without I'm closed. Senator would ask for a few more people step back in the room yes. Just give them a minute take a moment to allow them to come back thank you. Bill yes a motion to pass. The second on that. Second as amended pass the bill as amended amended all in favor say aye hi. All opposed. No discussion on the on the motion. We had a motion do you have a discussion on the motion. We have a motion. May and I'm if you want to discuss the motion we've had discussion on the bill. We have people speak for against this. Okay so we have a motion do pass is debatable so as to have a debate on the motion to pass. We have a motion the second. Give a discussion on the motion. Okay Reporter Mike please. You can ask for discussion but okay the I'm asking for discussion on the motion all right thank you Mr you know. There is a reason why these quotas exist now. Whether or not you know you like the way they're framed. There there is a reason they exist and they existed because there was no representation from the African American community or minority communities on these boards. Whether people wanted to want to challenge him or not this fine but the fact remains that they were set up for any reason. In this I mean I don't I don't think we're moving this is going to steal me the the code for the fact that there was a real issue. Which was there was no representation from minority communities in SO in moving forward I hope that you all keep that in mind that it's always important and secondly I think a. I'd take I take exception to something that I do believe that the the the lady saying when she was making a testimony in the pen and the fact in. Then the members that are local to set aside or whatever are not qualified to serve me they would not they would not I mean just because they're African American or whatever the minority group pass it happens to be doesn't mean they're not qualified and doesn't mean that they cannot serve in a in a potential to actually benefit the board so I will be voting against this and I hope that moving for we will really be more thoughtful in regards to the San. Thank you just repeal and language like this but actually thinking through it in sand are there this is something that we could do to actually improve the situation so with that I'm closed. members anymore discussion on the motion. All in favor of the bill say aye aye All opposed say no. Senator your bill is passed thank you. Senator Patty. Thank you Senator Solomon. Senator had eight Senate bill two seventy four. Thank you madam chair jim petty Senate district twenty nine before I get into the the details of of this bill I want to first emphasize and I truly believe this that although this comes from a an area that is B. and a significant issue within our country dealing with the opioid Pandera epidemic NO one that I've talked to none of the stakeholders on either side I believe that what we're trying to do in in any of this discussion to minimize the seriousness of that and so. My. Bill here is not intended to to minimize the seriousness of that situation we all face with that being said. This I was made aware of this by local constituent that was as a result of the opioid crisis settlement. they were they were the recipient of a a rather abrupt cut off of of their business and so as a result his business was put in jeopardy without any what you would call due diligence died due process and I know that's a legal term and and real no real explanation as to why it was basically you are cut off and as a result his business is at risk from several reputational and financial angles and so just to some some background to that and that's how I got involved some background to that in a federal court in in twenty twenty two issued injunctive relief in a federal lawsuit by the states against the pharmaceutical wholesalers giving them Clause regulatory authority to create mechanisms to the wholesaler to reduce or stop distributing controlled substances to pharmacies with minimal notice without disclosing to the pharmacy the specific rationale behind the termination my bill sent to seventy four seeks to provide the wholesalers in the pharmacies with the statutorily defined process that must be followed prior to the wholesaler terminating the pharmacies ability to purchase controlled substances in my situation he was cut off abruptly. With no response of of any detail as to why and as a result he's got a red flag he can yes go replace that whole server with someone else but he's been cut off for bad axe bad faith whatever the the situation is again not explained so he's flag tee has a hard time replacing that source and then be on that they don't just feel opioids and so if someone comes in fills a prescription of a of of opioids are probably going to feel of cholesterol and blood pressure and so they're not going to partially fill their prescriptions in one pharmacy and then move to another so it's it's more than just the cut off of the opioids it's it's losing by a client's so so having a clearly defined process takes the ambiguity out of it and how the different wholesaler's choose to implement injunctive relief and will provide businesses with some predictability to the community pharmacies and and and the whole sellers and and their business partners it appears based on my conversations with the pharmacy board and and and others that it is small and and and rural pharmacies that are the recipients of of these acts. And specifically this bill will create for mechanisms for the termination of the distribution of controlled substances that will meet the spirit and requirements of what we believe the federal courts injunctive relief was attempting to provide and a specific road map for the pharmacies creating businesses and predictability between wholesalers and pharmacies we do not think that this will not weed out the bad actors will that is not the intent this is to give due process and fairness to those that that do have that. The four mechanisms are are are these requiring the wholesaler to file a complaint against the pharmacy which is what they do currently alleging a violation of the state pharmacy practice and related to their purchase and or dispensing of a controlled substances which are always dispense according to a medically determined and an authorized doctor script such a process would be required to go through the hearing process to determine if a violation had occurred prior to to the terminating of the distribution the wholesaler could terminate without cause with a minimum of a hundred and twenty days written notice the pharmacy are provider could terminate without cause with a minimum of a hundred and twenty days so it works both ways and then the whole seller could flag this certain purchases as suspicious which is what they're supposed to do and not send specific items within a specific order so long as they report to the board of pharmacy the specific reason for flagging the order as suspicious this allows a wholesaler to have a defined process to meet their injunctive relief obligations and to create a transparent process for the local pharmacies and again most of which are smaller rural and the pharmacy board to know why the product is not being distributed to pharmacies and providers in Arkansas and then up to now providing what is basically been laid information little information and as little as five days you're cut off and and so this would provide a more reasonable path forward to determine if the cut off should occur the pharmacy board has has not been involved in it as harmed the back up here the pharmacy board. It has not been involved in it is harmed patient access to medications again in these rural and smaller markets. And this is not pertinent for Arkansas to to keep an eye on the issue at hand which is controlled substances but also allow a more transparent process and provide the pharmacies and and our communities access to back and forth conversation about that termination of their services so with that I will pause and ask that be happy to answer any questions okay I have a quick question and and this could be something that I know State Board pharmacies man but can the currently can the Arkansas state board of pharmacy take disciplinary action against. I distributor like this generally that the so. Is that a yes and so are they do they currently have that ability is not a board of pharmacy or the pharmacy individual pharmacy no the the state board of pharmacy usually they're taking action in with pharmacists that are licensed in the state this would be an outside entity and my question would be do they currently do any type of work and where they would take disciplinary action against you know an entity that. it It such as a wholesale distributor so so I'm I think that question might be answered by Senator void and in full disclosure I think he served on the state board of pharmacy correct or you can speak to that yes so center Petty motor might not know I'm a licensed pharmacist in the state of Arkansas and I have been on the board of pharmacy in the past it is my understanding that wholesale distributors pharmaceutical are licensed by the board of pharmacy okay therefore they would. Have a forty over their lives that was my thank you for answering my questions Senator Boyd you're recognized for questions. Thank you manager I just have a point of point of clarity if you will so nothing in this law if there were a pharmacy who it was clear and obvious with sell on controlled substances out the back door there's nothing that would keep the pharmacy board from having an emergency hearing immediately shut the pharmacy down absolutely that is correct and and that is absolutely not the intent I hear okay thank you other other questions from members of the committee. Yes Sir Senator live here recognized thank you thank you madam chair and I guess this this question how to go back to senator boy but I'm I'm trying to think about is there already a mechanism in place. because senator Boyd all reference that you know the the whole sellers are already licensed by the board the state board of pharmacy so it is there not a mechanism in place already currently in if the if there is then what is that mechanism because sorry notable because of of this being a a federal negotiated injunctive relief the holes there is no Arkansas mechanism in place per se dealing specifically with this issue and as a result and I suspect there may be others that are here to testify today as a result the whole sellers there's about thirty five of them plus or minus then about three of them are the largest in the make up between seventy percent sixty seventy percent of the the whole and in terms of serving and and and supplying and they're all doing it differently it seems that most of these have been through these that I have heard have been through one of the whole social they're doing them all kind of differently this would bring consistency and and and clarity as to how they would do that in Arkansas. Thank you thank you Senator love for the questions any other questions for members of the committee great seeing nine we do have someone here to speak against the bill if you'll come to the end of the table and recognize yourself for the record do you feel be recognized. Thank you madam chair members of the committee my name is William day and I'm with the healthcare distribution alliance representing wholesale distributors. So I'll be very brief and happy to answer any questions okay certainly again William day and on behalf of the healthcare distribution alliance for each TA we are the national trade association representing healthcare wholesale distributors the vital link between the nation's pharmaceutical manufacturers and more than two hundred thousand customers including pharmacies hospitals long term care facilities and other clinics nationwide on behalf of our member companies would like to express our concerns are I would say respectful opposition with Senate bill two nine four as it's currently drafted. Atrix AGA represents three wholesalers under injunctive relief per the settlement agreement reached with states including Arkansas it's important to know we represent thirty two other wholesalers that are not under an injunctive relief for their so four of them are doing business in Arkansas and would be seemingly under the bill as it's currently drafted seemingly require obligated to communicate injunctive relief thresholds to the board of pharmacy that just don't exist for those those wholesalers. all sellers are required to follow DA regulations that maintain effective controls against a version including monitoring for suspicious orders and as center but Betty mentioned three distributors have additional more stringent obligations under the terms of the injunctive relief order they are more explicit regarding the termination of the customer if their concerns regarding diversion I think that's where this whole issue has has come about over an agreement there I've had the opportunity to speak directly with with stakeholders on this included putting members of this committee center Petty Mr Benson with the Arkansas pharmacists association I'm confident that we can work together and identify a solution that ensures a collaborative environment for wholesalers and also supports the practice of pharmacy and medicine. Great thank you the questions Senator love you're recognized for a question thank you minister so what what is your biggest objection to to this piece of legislation. Right now as it's drafted there is I can I can go through the provisions but do that's our job here if you are likely to go through the provision so I can better understand that the hundred and twenty day requirement in the legislation to terminate the distribution relationship is a serious concern for those that are under the injunctive relief order so the would be those that's that I signed the multistate litigation agreement settlement agreement rather McKesson AmerisourceBergen and cardinal health As it stands right now if a distributor. It really it really places those three but also all distributors in my opinion in kind of an impossible position where they don't to the extent that that these requirements are cut contrary to any federal law or to the MDL of it injunctive order litigation agreement. There's no clarity on which which would follow. Which budget which law or which regulation the wholesaler should follow so frankly the wholesalers are concerned that about selling concert controlled substances or their ability rather to sell controlled substances in the state. I can tell you on. To another you can get back in thank you I mean we you know we'll come back to you if you'd like Senator line so I just have let's just break this down right okay so this opioid crisis occurs why well because we started to indicate pain as an indicator right that's why you have an increase in opioids just be very clear with the pharmaceutical companies pushing it and that product and now you have an indicator for pain which is why you have to meet the requirements for this indicator of pain in order to justify the claim that you're going to That you're gonna code in order to get payment from the insurance companies that's all that started so we had to justify the the coating and the claims had to be justified because of the intensity of the pain that the person was feeling which led to how do we address the pain and how do we meet the qualifications of this claim in this code in order to get paid for what we're trying to do in the hospital or a doctor so and and so let's just be real clear about that so it does so as I has moved through I think this whole issue you know where you have tons of people now that are addicted to opioids and there's been a lawsuit and there's been as you refer to the injunctive relief in the agreement that's that has been made at that at the federal level. But my issue then becomes are we being fair minded to actually the people that are just trying to do their jobs when a lot of this was happened and created by this huge industry that's a beyond. The individual. That senator Patty is trying to assist and help which is his constituent. So why should we not try to assist senator Patty through legislation for Arkansas citizens. Because of a situation that they didn't create. I can't speak to you regarding the opioid epidemic as a whole we're in I think we're all in agreement there and I've I've absolutely support center at his position that this legislation and No Way is meant to. Change that to an or make it easier to access controlled substances or other service on a concept border in Mexico I mean it's flowing across the border laced with fentanyl. Killing more people and the more we tighten down guess what that what markets just gonna skyrocket even more. I would argue that that that would be a reason not to pass the bill but I made a comment or a not a promise to senator Petty that that we would sit down and work out solutions and language that worked for everyone including wholesalers not just the big three that are under the multi discipline I'm sorry multistate settlement injunctive relief order but also distributors that are not under the I order that still have an obligation to their customers in Arkansas and serve small community pharmacies like Senator produced. Constituents man and I have those as well I'm gonna see I'm going to yield to senator Boyd questions. Thank you madam chair so just you're here giving testimony. Typically historically who sets the standard of care for pharmacy practice and medical practice dental practice is that the federal government through the courts or is that through legislation and the local boards. Be the latter okay so in the injunctive relief your clients your whole sellers has the federal government not created some back door at which they're trying to take medical practice pharmacy practice dental practice podiatric practice nurse practitioner practice all the above and and others. I think frankly I could argue that that that's there is gray area in the injunctive relief with the settlement that the state sign including Arkansas there's also some gray area with the DA regulations when it comes to suspicious order monitoring and stand instead of there being in a specific law regarding controlled substances there's no House that with this there's no quantity amount as you know that that pharmacy can order from the from a wholesaler The manufacturer there's no threshold amount it's it's it goes back to quarters deviating from unusual size frequency four patter so again back to. If I live in a local community with a local physician or local physicians who write prescriptions duly authorized by the state of Arkansas. And then I'm looking at national standards and applying them to the local community is this not a backdoor way to dictate practice in the state of Arkansas by the federal government are you speaking you're speaking that that that I can't. I tend to agree with you regard I I know what what you're trying to plan trying to make and I tend to agree personally I also believe that Both wholesalers and providers have to follow controlled substance regulations as set by the DA even if it if it's if there is ambiguity there and that the the wholesalers that signed on to the injunctive relief order have to have a more stringent Process that they have to follow the issue that comes up is and and I think you can attest to this and and certainly so can you is that the three large wholesalers that signed on settled with states in our under this injunctive relief they're all looking at at suspicious orders by form or if they're looking at their pharmacy customers ordered orders patterns frequency and determining if they're suspicious based on their own. There's no threshold set by the federal government nor by the I. R. that's there's a gray area there there's like I said there's no quantifiable amount there's no you can't order more than two thousand oxy code on pills things of that nature so. You have. Three wholesalers essentially that. We're trying to comply with one the DEA regulations and to the injunctive relief order Absolutely doing their best and concerned that they will not be able to sell controlled substances into Arkansas if this passes as it's currently drafted on top of wholesalers that are not part of the injunctive relief order certainly smaller wholesalers that would be really impacted by the hundred thousand dollar fine if they were the if the under the language currently so so what you're saying is if we pass this legislation you think the federal government will cut Arkansas from controlled substances because they have a they have more of a say in how medical and pharmacy and dental and podiatry practice goes than we do. I think that's a I think that's a totally different bill at a totally different issue and it's not that I don't. I agree with your see your point but when it comes down to it this is the wholesale distributors and how their license both in this state and at the federal level it's the pharmacies it's it's any really it's any provider and how their license with the controlled substance licensure at the federal level and at the state level. But I don't have any I can't I can't do much when it comes to Federal courts or federal agency and there. And I understand we we you know we do have state sovereignty it's in the constitution that's how order here and why we're here and so I think that we do has a as I say it's the state of Arkansas I mean I know I was threatened you know by the. By outside entities that they're not going to come and have their events here because I've passed the fairness women's sports bill I mean okay fine but I mean I don't tend to those are those are hypothetical threats are not sure that are necessary as part of the discussion but that's my opinion any other questions from members of the committee. Hi thank you so much for your testimony M. C. nine is there any other patients persons here to speak for against the bill. Right C. nine center Petty recognized close for your bill thank you madam chair. So I think you guys although I'm new thank you not realize and and and I hope you do it's not tell me I'm a reasonable guy and and and while I am open to have discussions about how we can resolve this up to this point which the started back and an October or November we don't have any progress and and so in the interest of time in the interest of of my constituents I will remain open we've had conversations with with folks from the attorney general's office we had conversations with We'll I'm reasonable but I don't want to wait anymore and so with that I would like to to ask for a good vote thank you thank you motion to pass second all those in favor say aye. And opposed ayes have it congratulations you passed your bill thank you state of Arkansas has spoken today. All rights let's move on. Senator Boyd do you mind running Senate bill two seventy nine you're my co sponsor. Thank you. Senator Justin Boyd here to run Senate bill two seventy nine with your permission madam chair. Thank you so much go ahead and I think if there's anybody that needs to come to the table they can come and join you. I will. Thank you Mr Gilmour so I. Iran legislation I think it's twenty seventeen that enacted this and there was an oversight and I think the department of health is here to kind of help rectified are explained what that might be okay thank you Matt Gilmore department health thank you. Hello David Dawson general counsel for the board of nursing thank you so much for being here. Please please proceed. Yes about. Five or six years ago the legislature created the alternative to discipline act. Which gave the board. The ability to offer an alternative to individuals who had issues with substance abuse and traditionally when these issues would come up either to an complaint procedure or someone self reporting. And then the board would place the individual to make sure they're safe to practice they place them on their license on probation placed them under a drug screening and employment restrictions and reporting requirements and depending on what the evaluator recommended a a a meetings or counseling things like that the alternative well what would happen with those individuals if they completed the probation and and I get action clear letter at the end of it that they would have that on their license as a permanent discipline on their nursing license so the alternative to discipline program offered an Avenue so they can these individuals could go through this program to do the same monitoring the same employment restrictions the same requirements a a meetings all those things that if they were successful at the end of the program they did not have it marked on their license as being displayed on their license the board of nursing in addition to regulating nursing licenses also regulate certifications for medication assisted persons and so on recently the employment areas where medication assisted persons can can be employed was expanded to include local correctional facilities and so certain certain nursing schools have added to some classes for these individuals and so we're getting more applicants now for medication assisted persons and when you get more applicants you years we're getting a few that have issues substance abuse issues and they would qualify for the alternative program except the language of the statute limited it to nurses only so this bill is just changing it to where individuals who are regulated by the nursing board who are who who are either. Licensed or certified. Can be will have the opportunity if they qualify otherwise qualified to be able to take advantage of the alternative program. Okay are there any questions from members of the committee yes Senator Solomon so is there a so you take the class of the required elements to get your life back is there a time period in there that much more must go through with no violations are subject to media. At. Confused about the court so my guess but so is it sounds like you have a violation on your certificate then you can take a course. Of study or whatever it is you have to have the criteria for then after you've completed that your. That is removed from your license is that correct right well. In any alternative program is the only time they would be removing the license if you have normal discipline on the Lysons even if you complete the probation requirement say you're on probation for a year and after you complete all the requirements at the end of the year you get an action clear letter saying you're no longer on probation however it's on the license as a as a history that you've been disciplined in the past and so in the future if in future employer looks set up on there that you you are he went through a probationary period correct okay any alternate program offers if you qualify for it and you go to the program in your release from the program you do not have that on your license so this isn't a question so if I Allen was a probationary that you just mentioned how long would that take. It's it's a fact dependent if if someone is has a severe problem with something very addictive like methamphetamine it could be as long as five years probation other things if it's a someone hand DWI and I go to the one year to use a considerable the individual. Action was yes okay thank you. Thank you any other questions from members of the committee. Right St nine is there anyone here to speak for against the bill. C. ninety close for your bill. Thank you madam chair this the pharmacy board of medical board have similar programs they seem to work well and and provide I have a good balance with protecting public health and allowing individuals the right to work and I would appreciate a good vote and I'm gonna make a motion to pass. Thank you is there a second second all those in favor say aye. And opposed ayes have it congratulations you pass the bill and send a boy to feel to stay at the end of the table you have Senate bill two sixty five. And then we'll go to Senate bill two eighty nine that will come back to Senate bill two eighty eight that will be finished for the day. With thank you madam chair with your permission I'll get started on Senate bill two sixty five yes please do so so right now Arkansas has a provision in state law that keeps hospital permitted pharmacies from our hospice not for profit hospitals from having retail pharmacies there are some exceptions when this a law was passed UAMS children's and. Baptise like there I think it's five that had retail pharmacies at the time they were grandfathered in and so there there have been some concerns about access to pharmacy of late because is like an all health care margins have gone down expectations have gone up the expectations for work are increased it's harder to define people salaries have gone up and so that to a challenging scenario so what you have is a situation in Arkansas where I'm not sure if we have a twenty four hour pharmacy left in the state maybe little rock but I I'm not going to testify that I would know for sure one way or the other but I will testify most of Arkansas does not have a twenty four hour pharmacy and so what happens is say you're in the emergency department at two AM and you really need to get started we'll while technically the hospitals can dispense you know some limited treatments from the emergency department they generally don't because there's not a reimbursement mechanism so with this and then the other issue that's going on is you have expectations for Medicare to not and certain diagnoses codes to not have it readmissions within thirty days and part of the the reason you can have a remission is a someone when I'm on the wrong medications didn't understand the medications didn't get their medications filled for whatever reason or to come a few days to get the medications bill so what this bill does is it allows a hospital permitted pharmacy to ask for an endorsement on its license so it's something they have they do have to request and say we want to do this. And if they have this endorsement it would allow them to dispense medications at retail trade because what happens is hospital pharmacies by at a different class of trade so they by their medications generally less expensive than say a retail pharmacy and so what this would allow is them to have that that class the trade difference and in those situations you know so people discharged from the emergency department or discharge from the general admission be able to supply those medications as a pharmacy so what it does is it seeks to give another Avenue where we could have a patient centric approach and I want to emphasize this is about patient centric approach to to rectify some challenges in the in the pharmacy market okay are there any questions from members yes senator Sullivan you're recognized for a question of this impact the for profit pharmacies that are that they're now going to have I was set on a level playing field with you don't have that or not nonprofit so those pharmacies would have a leg up on others I appreciate your your question so let me clarify if I wasn't clear in the beginning I I'm I'm an hour make a point and then I move clears primer. At full a for profit hospital a hospital that pays taxes paid property taxes pays other taxes it has the ability to open a retail pharmacy full blown right now today it's only the only limitation is for not for profit hospitals now pharmacies I'm not aware of a not for profit pharmacy and so. Allowing this could affect pharmacies the right now and fairness this is about patient centric when I hear the arguments on why we need to change that law this comes back to. I have a patient in this situation and pharmacies just or not if they're not willing or not able to step up in those unique situations like two AM or willing to find staff to go in and and deliver medications to patients in the hospital whatever it is they're barriers that are keeping that seem to be keeping that happen where there is a market solution under the current licensing structure today that that is. Rectifying that and so what this does is it would it would allow them to do that so theoretically a for profit hospital I mean a for profit pharmacy could lose some prescriptions that they're getting from emergency departments they could lose some discharge prescriptions but I feel like as a pharmacist that this is this is patient centric and is the right thing to do it's the right thing to give. The patient the opportunity in those the limited unique city situations access to medications the market will determine whether hospitals want to do this or not this is absolutely not a mandate on anybody it's a it would provide at a choice thank you thank you just clarification of federally qualified health centers are they non profits. As far as I know but but they're not necessarily hospital pharmacies so right they they they do have pharmacies yes for the there are nonprofits in the State of Arkansas that do have an operate retail pharmacies under the fault federally qualified health center yes but the the law in the past with specific not for profit hospitals understand but. Okay but there are nonprofits that operate pharmacist is my point thank you yes okay hi yes when I said that I was not about federally qualified health centers is doing that thank you for the point yes thank you senator Wallace you're recognized. Centreboard the C. pharmacy board have a position on this. I don't think that they have an affiliate they've not reached out to me and said they're for it or against it I would expect if they had a concern that they would. They know the legislation's been filed I'm confident that they would reach out and say Hey I think it's telling that they're not here today to. Yeah express one where the other. I think there are neutral said I'm getting a head check back there for the department of health all right any other questions from members of the committee for eight C. nine is there anyone here to speak for or against this bill. Right C. nine to recognize close members of the committee I appreciate a good vote and I make a motion to pass okay second all those in favor say aye. And opposed. I would say aye ayes have it. This bill passes. Senator Penzo if you will go to the into the table Senate bill two eighty nine. Thank you madam chair Senate bill two eighty nine if for me I'd like a. Mr McClure and missile Mr Castleberry to join me at the table. Yes and and they have I have them signed up to speak for the bill so if you want to bring them up that's fine okay thank you. Yes please thank you so yes please introduce yourself for the record and then you may proceed thank you madam chair centers my name is Casey Castleberry I'm here on behalf of the Arkansas home based services association I'm joined by Matt McClure who is the president of the association of appreciate the opportunity to address you all this morning on this bill what this bill does is simply removes an exemption to the definition of employment under the work services law the exemption as it currently exists provides a blanket exemption for involving home care workers there was a similar bill to the one before you today introduced back in twenty nineteen at the time there were two objections to the bill we believe that the bill before you today addresses both of those objections the first objection was that the bill to remove the exemption from from the act would be retroactive the second concern was that there was some legislative intent language that would dictate the business model to all home care providers. To address the first point the bill before you today provides a sunset of September thirtieth so it makes it clear this bill is not retroactive in in removing the exemption doesn't go into effect until September thirtieth and with respect to the second concern this bill. I'm sorry. Thank you didn't interrupt that would speak the second concern this bill it does not include the objectionable language with respect the legislative intent to dictate a business model to be clear if this bill passes. Any home care provider who wants to treat their their workers their care givers independent contractors can still do so it does not remove that option for home care providers in the state of Arkansas all it does is remove the blanket exempt blanket exemption and the question of whether or not those care givers are independent contractors would be dictated by the the act that this body passed in twenty nineteen the empower independent contractors act this body has expressed its that it favors independent contractors in certain situations and as a result passed an act in twenty nineteen to empower independent contractors that is a test of whether or not the workers an employee or independent contractor we're simply asking that that test should apply in the healthcare field just as it does in any other field at the other day this bill from our perspective just levels the playing field many of the home care providers treat their workers as employees and as a result of a all the requis employee that payroll taxes that are that are required we think that this bill would level the playing field proof required we want to play by the same rules if they truly are treating their workers as independent contractors they can continue to do so if they're not they should play by the by the rules that we played by so with that I appreciate the committee's time and would ask for a vote in favor of the bill. And happy to answer any questions that the the centers I have okay Mr Clark did you want to make any comments before we went to questions. No madam chair I'm just here to answer questions okay all right senator Wallace you're recognized and for questions. Thank you for being here you said play by the rules. Are they playing by the rules as written now and could you all not also do ten ninety nines we could so to answer the first question first they they are playing by the the specific rule which exempts the care givers of from the definition employment it's our position in order to provide good care to the to the patients that we serve we need to monitor those patients monitor the the care givers that we employee make sure they're actually providing the services for which either the resident the patient for the state of Arkansas Medicaid paying for so we think by providing that level of oversight to make sure that the people are getting what they paid for we're treating those those those employees as employees and and should qualify the such but departed Mr Clark who who operates in the business of his anything further to add to that yeah I'd be happy to answer that Senator I would say in the model that we use in my company with the supervision the scheduling of care grammar so like tronic verison visit verifications where we know every fifteen minutes what it is what they're doing with the care tasks and all that I don't believe that we qualify for that I'm not saying that another company would not but what this would do is just remove an exemption that is only in the personal care space and it would just say if you are then you just need to follow the legislation that this body passed in two thousand and nineteen to prove that you are thank you. Do you mind just Mr McClure you have a business demand just let us know what your businesses and just for the purpose of public record yes I own home instead senior care we have locations multiple locations at central Arkansas Conway Fort Smith Mountain Home Rogers and fail okay thank you are there any other questions from members of the committee. All right seeing none. No questions from members okay thank you we do have someone here to speak against the bill from. And he'll come to the end of the table. We stand aside measure shall be fine. That gentleman turning your mind I'm sorry Senator Wallace team on turning your Mike off for me thank you so much. Sure. That's fine. That's fine right there senator level help you. Is there someone else that wants to come to the table. That's fine we'll just bring about that at the same time. If you'll just both introduce yourselves for the records. My name is Justin had a good time with all or senior care. Quincy her stand with superior senior care okay thank you so much you're recognized to speak against the bill. First of all like to thank everyone for taking the time to hear our viewpoint today I represent a group of small businesses private businesses across the state and first off I would like to say we oppose this bill for numerous reasons we feel this bill will be a step in the wrong direction four or independent contractor model. As you can see with the hand that. The independent contractor model service towns all across the state and you can see in on there as well many in low income and rural areas a big portion of our care givers are related or friends of the clients that don't want to be treated as employees they want the freedom to be a ten ninety nine workers. Medicaid rules state that the clients have a choice of who they want providing the care giver this bill being passed to make it even harder for the client to get the care they need. We were given money just last year by the state to recruit caregivers. Back in March of twenty two the if you operated a private care agency thank you followed under the certain rules you were given essentially bonus money to go recruit characters that's how much of a shortage there already is. So if this bill was to pass we feel there would be a mass exodus of care givers with the W. two model that could be potentially put in place the right to choose how to work in our state is a great value to our independent contractors. What is changing or unemployment exemption help there is a shortage of caregivers already across the state. And I wasn't sure who said this point to to monitor our care givers a bill was passed years ago it's called electronic visit verification our care givers are monitored by the electronic visit verification model that shows all the tasks they've done and clocking in and clocking now at the client's house or wherever need be. And my last point is the contractor model has been in place for thirty five years so why change now. And we have out of state national franchise is coming in and trying to change the way we operate in our state and we feel that should be voted down and if I could ask you all to please vote this bill down as well thank you thank you that you're recognized to speak against the bill. Thank you that really don't have much that I think Mr a good covered most everything it just to kind introduce my company and and why this we feel passionate about This exemption superior senior care was started over thirty eight years ago right here in Arkansas said Mr good spoke about that franchises we're in Arkansas company and we have locations all throughout the state twenty six locations. We referred over seventeen hundred care givers to over two thousand clients every single day that we have a great track record we made a huge difference in people's lives caregivers depend on us it sounded like from the other side that that this bill would not have a major effect. I don't know but but we feel like right now is not the time that we can risk anything that could jeopardize home care workers and we feel the exemption gives them the protection that they need that to feel comfortable with their job to have the secure future to keep providing the critical care that they do so we ask you to vote against this bill and I'm happy to answer any questions. Are there any questions from members of the committee. Senator Penzo. so as to ninety nine contractors do you will receive the same reimbursement rate. As the the company's of W. two employees. Yes we do okay does that rate include taxes insurance and other things that the the rate study that was done to establish that rate we were those factors included. I'm not aware of the study okay we'll I am in the rate study does include taxes insurance so you are currently being reimbursed to rate to where you're supposed to be covering taxes and insurance for The your employees they're being referred to as contractors but if they're being kept tabs on every fifteen minutes like you mentioned I kind of feel like those are probably employees so the reimbursement rate does but the employee. Is responsible for their own taxes is that correct. Yes they are well aware they sign a contract at the very beginning that list everything they are responsible for and I would like to say if. What what are average carryover paid me compared to other it's I would definitely say that. And if I can add that part of the reason for that is it and some of those expenses are on the care giver there are some expenses that it that you mention that that we have that maybe the other they maybe don't realize like liability insurance that's a state law that we can that we provide that whether you're an employee or contractor so they do have the insurance protection and that is an expense that we have to pay out of the reimbursement rate. Okay are there any members I have questions any other other questions right thank you so much for coming and and being with us today all right any other anyone else here to speak for against this bill. Right C. nine no other questions Senator Penzo you're recognized close for your bill. I would like to point out that the employees. The the company may have insurance but the employees themselves. More than likely do not have their own coverage and if there I mean it's a thirteen dollar an hour employee or fifteen dollar an employee is not going to be covered. Liability insurance on themselves it thirteen ninety nine contractors I don't feel that You know the the company's not gonna be responsible for because our contractors to classified as contractors that liabilities going to fall upon the the the the customer that's having the services provided to I think I think they're probably needs to be some some clarification on some of those issues I don't think think there's been some information that's been put out that I would like to take time to probably clear with some meal so I'm not going to ask a vote today if I can I just wanted to allow the people that drove down to speak today to do it it's close to luncheon I'd like to take the time to serve clarify some of these things with their everybody so for the public to try to run next week can run for both in thank you so much I appreciate all right thank you yes okay members I know it's lunch time we have one last bill Senate bill two eighty eight and then we've cleared our agenda because we have worked hard and you will be rewarded members of public health committee for staying here and doing your due diligence and your work I am so proud of you. And Senate bill two eighty eight Senator Solomon if you'll take the chair and and just for point of clarification I generally don't ask for if there's discussion on the motion but if a Senator does want to have a discussion on the motion they just need to raise our hand and ask for discussion of the motion once it's that once it is made just for we did a little different down here in the Senate versus the House but I'm just to point that out it's always all the available availability is there you just have to request it I just generally as chair don't ask for it. Just just point of clarification from my perspective okay Senator Solomon you're recognized feel take the chair. The Bill. Okay senate bill introduce yourself and you may begin sorry thank you and now have Secretary Cory here to discuss the bill as well and that. Here and if they will just go ahead. Thank you about take thirty seconds last time I was here I promised he would bring you booklet for the contact information so we do have that for your staff chain Corey and the secretary for the department of energy and environment I have a long with me Bailey Taylor she is the associate administrator for the environment this is a bill relating to the Q. specifically mainly to water quality fees and we're trying to I guess clean up parts of the code to match to make sure that the Director of the queues designate can remain on the board and remove some old antiquated references to revenues from nineteen ninety two to nineteen ninety three there are no fees that would be increased by passage of this bill other than a testing fee that we charge that is reimbursed to a third party any other fee increases would have to go through the rule making process of the legislature would obviously have been the governor's office would both have review and approval of those and I have Bailey Taylor here to answer any specific questions on the proposal. Members anyone have any anything else to say anything that members any questions. Seeing no questions if anyone here to speak for against the bill. Six nine. Senator you're welcome to close your bill just appreciate the great work because these individuals keep in this you know. Out of the ditches and do what we're supposed to do so appreciate their hard work I'm closed the motion sensor yep motion to pass in the second any discussion on the motion. They were for or against the feud everyone for the bill say aye. Proposed saying nine senator your bills passed thank you. Thank you can adjourn us. Go ahead and adjourn us. Senator Solomon DO internus. Thank you.