Public Health, Welfare and Labor Committee - Senate

That we are awaiting a few things as far as fiscal impacts are concerned with that I will go ahead and we'll start. I will but let's just go through and see what we're running today so members of you'll just look down the agenda are we. Is there anyone here to run a bill right now. Okay Senator Hill. Senate bill one ninety three. It's more appropriate for the practice act of the individual locking patients if they have a currency limit let them apply it there someone may get a a master's degree and it's three or four years in arrears but they can still count that towards a license the what we want to do is allow the practically actual licensing authority to make that determination on the currency of that training and education rather than if it points to fifteen months in all say well you're fifteen months or too late to be able to apply that credential in this just allows the licensing agencies to make that determination. Thank you. I think that was good thank you information to clarify that this little section for for members of the public thank you for that any other questions from members of the committee. Anyone here to speak for or against the bill. Scene nine you're recognized to close yes I'm sorry. Oh oh I see okay. But you can set accepted verbal amendment to add co sponsor feline. I'd be glad to do that. Two. Okay. Thank you very much you wanna make a motion senator. and okay and Boyd and Irvin are added as co sponsors is that this is the amendment okay. We have passed the rule change in this committee to allow for that verbal amendment to occur. All right scene nine there is a motion to pass as amended second all those in favor say aye and oppose ayes have it congratulations you've passed your. Thank you thank you thank you Mr berry thank you senator hill. All right Who else we have let's just go down the list I believe I'm we're waiting on a few bills I'm going to turn this over Senator Solomon he's seven now of an actually I know I am the I'm gonna let me go to. Lee Johnson. Is here representative Johnson is here I believe. I'm gonna run downstairs and I think run a bill and then I'll be right back okay represent Johnson. It's running. Builder run if you'd come to the table and which one are you going to run today. Okay we'll show a twelve fifty one that the first on the list yes Sir okay if you're you're recognized if you'll go ahead introduce yourself when you're recognized to present your bill representative Lee Johnson state representative forty seven members of the committee currently at the public health is empowered to do background criminal background checks on anyone applying to be emergency medical services personnel one of the things that they've encountered having difficulty on is extending that background check beyond the state of Arkansas this legislation is to to clarify their authority to see criminal background checks outside of our state it's just clarifying that issue so we can make sure we're being safe yeah with two pipelines for licensure within this personnel and I'd be happy to try to answer any questions. Members any questions Senator love you're recognized. Thank you Mr deducted out of check to what you're trying to do what was the fiscal impact of it because I know that when you begin to get other background checks outside it's going to cost additional phone so what's the point that this is a question I don't have the answer that question perhaps someone here from the Department felt able to come to the table to give me a better idea of what the fiscal impact would be. thank you members apologize for my lack of support code offering up here in the rain into Aramco without support because there the Senator law there will be no fiscal impact these are still there still run to a C. I. see with the state police so that we know fiscal impact we do background checks now it's still and it runs through state police so that will be that one change the change of his quest practice acts our ability to look at those other. To use those other federal. Those other federal attention federal offenses or other state lines to review for the purpose of prohibiting offenses so we still we already see these we just have to we the key issue is can we apply them to the licensor for somebody coming from out of state so that was not clear in the law it was gray area we wanna make sure I was clear for licensees and for the department okay so it's not actually run in the background checks is upon the the offenses to correct correct thank you for that clarification. Members of the questions. So my experience. Has been that in the healthcare field and we bring in various healthcare professionals that they have to go through a lengthy background check again and so we are. Changing that law across the board are just just help me understand my understanding is right change in the law we're clarifying their forty to utilize the information they find on criminal activities that occurred outside the State of Arkansas to apply to their license application in the State of Arkansas correct represented in this sense and Senator Solomon this is strictly as relates to EMS EMT licensure as paramedics coming from out of state so right now the law as written could be interpreted as. Offenses in other states and and federal offenses would apply but it's great enough that we wanted to tighten it up so that it was explicit that they they still apply not just offenses in the state of Arkansas but offenses that those EMTs paramedics may have committed the federally or another state's. I'm all for the bill our hope we can get I'm just concerned curious as to how we might expand this and if you don't know the answer that's fine but I think many medical professionals coming into this state they have their licensure held up for the some of these reasons just board duplicating what's already been done another state and you're removing that duplication is that close the senator I think when it comes to other medical professionals that falls under title seventeen and the ACT nine ninety of twenty nineteen what Brandon that required the background checks and had the explicit language EMS is an interesting creature statue because it doesn't it's not entitle seventeen it's in title twenty and it has a very similar statutory code as a title seventy but it was just off just a little bit so this actually brings it in line with what we're doing some of the other medical professionals. I don't know if that's necessarily a good thing but I'll take your word for I wish we could streamline it represents senator Boyd you're recognized thank you Mr chair and and I'm asking this just because presumptively our president is on the Senate floor so what this bill does is it clarifies that. Crimes or potential crimes issues that happen other states can be considered by the Arkansas border before licenses grant. Wrecked for each for EMS again this is a separate statute ultimately you if someone is committed a violent felony in Arkansas they're prohibited from receiving a license if it's if it's certain certain violent felonies a state now if that very same action and very same criminal act if they're convicted of federally or in Oklahoma there's a gray area whether we can consider that so that all this does is ensure that it's clear that regardless of where you commit this act or convicted in a court of law that we're gonna have a concern about you have a license. Members other questions. Seven nine Representative of the further comment open up for questions I'm certainly open for questions but I'm close for billing or speaking for against okay. Is there anyone signed up to speak for against this bill. Seeing none representative would you like to close your bill some question about Mister chairman. I have a motion to do pass second I have a second all in favor say aye. Your bill is passed congratulations thank you for coming. Thank you members. Representative Johnson you want to move down to twelve fifty yes I'm a Mister chair and your name again identify yourself and certainly do that again and take off certainly representative Lee Johnson district forty seven so this is also a bill is brought to you by the Department fell as you know we established some time ago the Arkansas prescription monitoring program to help health care providers in a very appropriate way prescribe controlled substances in light of the opioid crisis and trying to make sure we're not over prescribing to people that already have prescriptions so currently providers are required to log into this program before prescribing any opioids or providing new prescriptions for benzodiazepines this is just adding it does three things one is it adds to committee members to the current standing committee that oversees this program one is an OBGYN so one of the issues we've had as a severe crisis is and for all this we had again the increasing number of babies born addictive opioids this is this is a problem that OBGYN have encounter where they're having withdrawal symptoms in these newborns this so adding an OBGYN doctor to this a committee makes a lot of sense the other member we're adding a city are as from the Arkansas opioid recovery partnership is the partnership form between that municipalities and counties to to oversee opioid programs at a municipal level in a county level is so again it makes sense to add them to give them a voice is an entity that is doing a lot of programs are going to be doing a lot of programs as time goes by the state good thing we're doing is we're empowering the medical examiner to come and have access to the program all doing investigations so you know there's certainly a stigma involved with an opioid overdose and sometimes some of the family members are reluctant to accurately report some of the things that the patient might have been doing prior to their Tomasz this is this just allows the medical examiner to have access to that program in. In doing their investigation and then and then adds. The ability to provide for the health part to clearly provide not just a medical examiner but let others doing mortality reviews so if there other if there if there is a formal mortality review they can share some of that information with other providers that might have an interest in how the person passed away and we have to try to answer any questions on that bill manager are there any questions from the members of the committee Senator Solomon you're recognized for a question for those like. Twelve members on and we're gonna make it like fourteen members that's fine standing yes Sir and those members compensated in anyway. I don't have the answer to that question I don't know if they get a per diem or not I have to get out of to turn my comments from the health department to get the answer that question yes you can come up answer questions. With regard to the question for us stipends for travel there are certain boards and commissions that are granted by law to receive stipends and travel and it's it's and but the minimus I'm out I believe this committee is mostly central AR Kansans that that are serving on this committee and so I'm I'm not positive as to the answer to that question as far as someone receiving one at this point but there are committees like this one that are allowed to receive a stipend by law. Can you get that information for me and just last question so can you tell me what actions is committee has taken that have been impactful what are the what are the two that comes down and changes things for the state. They were physically yes Sir Senator Solomon date receive the information from the prescription drug monitoring program and they review at over prescribers they look at certain at data that they receive and the medical board in the nursing board is alerted to prescribers at they also are bad received subpoenas from criminal investigations like the DA and a state criminal investigation how many how many subpoenas that they received and how many actions have the actually taken. We're adding to my point is we're adding to the board right we've got more more people the committees get bigger and bigger I wanna make sure we're doing more and more right we're getting our money's worth with this committee we're getting our money's worth with this program because it's providing information to the medical board and the pharmacy board and at various licensing boards about certain problems if there's red flags the Committee make sure that the the board to receive the information. I'll I'll talk to you off line here I want to know what that is and how much of it they do certainly we can provide as statistics and get that data will meet afterwards thank you. And I is Senator love you're recognized for a question. Thank you ma'am sure so I'm going to page four which is on the backside of ended it scratches up in the language the state medical examiner as authorized by law to investigate cause of death and then it goes down but we at the language a mortality review recognized by the department what what what what was what was a change necessary or what what we what we try to to do with that. Yes center lab we added the state medical examiner information in another section of the law and we removed it on that page four to add to the more mortality review to provide that information to mortality reviews such as the one that was created in twenty nineteen by representative Bentley and that maternal mortality review there's also trauma committees that can review this information to help better inform them okay part thank you. Thank you just that and I may have missed this when you but I think it's worth explaining it and maybe again but specifically why. An obstetrician and gynecologist versus an orthopedist or certainly yeah in our family practice does not make sense have you have to try to answer questions chair and at that one of the things that has occurred as the opioid crisis is expanded as we see more more babies born at birth and so they're going to withdrawals in this is something the obstetricians or having to face and deal with an increasingly the increasing the demand is so there you having them have a voice to explain that particularly unique views across though okay that that's good explanation and then you know I just finally I know with the prescription drug monitoring program and the way that we have in place I know there has been a lot of engagement I think with this great and you might want to speak a little bit to that at the end you may have already but the engagement of this group and how we're looking at that data and how that data is used out in the field you know with people that are prescribing and and I think you know I mean I can speak to it from a personal perspective but but you you might want to just give a little bit of a a review there for seconds. Certainly Senator Irvin at the information is used at the current time by as subcommittee at the medical board at the have a pain subcommittee and they review this information it is provided for hearings when I have a doctor's brought before the medical board and they're using it in other ways to help provide information in general for physicians and prescribers and so it's a useful tool at this point obviously it's still confidential it's not subject to FOIA it's not subject to civil litigation it's only subject to subpoenas in criminal matters at this point but the licensing boards do have access to to further educate their members right so this this committee really does work with the medical board and and and the other part boards as well not just a sport I mean you have the nursing board yet but there I mean you have this is across a wide spectrum so bringing all those components under one roof so that they can have more meaningful engagement as a way I understood it thank you any other questions from members of the committee C. nine anyone wish to speak for or against the bill. Scene nine you're recognized close for your bill close for a bill manager okay. motion do pass is there a second. Second all those in favor say aye. Oppose ayes have it congratulations you've passed your bill all right let's see represent Johnson H. B. at eleven twenty seven thank you madam chair represent Johnson district two forty seven but I should say chair of public health in the House welcome yes thank you glad to have it you know what to say yeah so my concern is that right office so members this is a really good opportunity for Arkansas to embrace a policy that was rolled out by the federal government CMS it was it was started a couple years ago and final rules rolled out this summer this is really enabling legislation so currently is CMS recognizes one separate designation for our rural hospitals which is critical access critical access designation provides for enhanced reimbursement for Medicare patients who were treated in in patient settings on a hospital there are two general ways in which we treat people there's outpatient which would be an emergency room visit or observation visit where your cat for less than forty eight hours in their inpatient stays or people anticipate to be in the hospital for multiple days giving tree of conditions critical access hospitals right now get a small in his reimbursement for these inpatient stays but they get no enhancement for outpatient how we deliver care in the health care system has changed over time as hot as medic As medicine has evolved it's become more specialized means just more complicated how we treat things I'll talk to people about how we treat strokes is a great example you know when I was first starting in my practice in nineteen ninety nine if you came in with the stroke that there is very limited things I could do I could basically just say I'm sorry you're having a stroke or try to get you to re have and maybe we can get some recovery that quickly progressed to the bility to do clot busting medicines that first it was a very narrow time frame we can get these medicines as as we progress to medicine that time frame became broader and we had more opportunity to treat and. Reverse stroke symptoms and not just try to support stroke victims and as time has progressed even further now we're capable of going in to an artery and restore your leg and actually removing the clot from your brain so not just giving clot busting medicines but in a period of time coming in actually removing the clot that's a tremendous amount of medical progress in technology over the last twenty five years unfortunately that kind of progress requires very specialized care in a lot of that care is going to occur in a in a more urban setting because there's just not the specialist our rural hospitals so our rural hospitals have shifted some how they treat people because they're having to transfer more people to an urban setting and so they're treating less and less people inpatient more more people in an outpatient setting to the emergency department or observation missions CMS recognize that and created this new designation to give hospitals the opportunity to get an enhanced reimbursement for emergency room care or observation here this is not mandatory legislation this is a portion of our hospitals to do anything it just provides them that opportunity if it makes sense for them on their business model to convert from critical access to this new role mercy hospital designation and I'd be happy to answer any questions if anybody has any questions on this legislation. Thank you before we get a questions I I want I want to just also speak a little bit about the bill I know I'm in the chair but most of the sponsor of the bill on the Senate side coming from a rule setting in a rule hospital setting it's so critical that these hospitals remained open in rule Arkansas and I cannot stress that. It enough and the reason why is exactly what you talked about being able to arrive at a hospital that can immediately transfer you to where you need to be within an hour will save your life I have a very good friends went to the Salem hospital Salem hospitals a perfect type of hospital that could you benefit from this piece of legislation critical that they stay open that that hospitals now and Senator Flippo as to constrict but it's because the hospital was there that they recognize and were able to quickly gets him to Baxter regional hospital in Mountain Home that saved his life and so you know I I think this is a great thing that CMS is finally recognized we don't want to see these very important healthcare's you know facilities go away because they're also cornerstones of those local economies as well so I think it's a great bill centre Boyd you're recognized for a question thank you madam chair so removing clot from someone's brain is that someone in the our doctor does a disservice to mineralogist or number of service are like best or I like to refer to himself as a pitcher not a catcher so I'm I'm calling the neuro does your vascular interventional list and I'm not telling them informing them this kind of patient and then they're coming to help me out such that's good. But but there are there are situations where your doctors are doing pretty incredible procedures in order to save peace patients lives all around the state and every nook and cranny so. Any other questions for members Senator Solomon you're recognized that on. Page five it talks about a health benefit plan could you help me understand that just a little bit better I'm I'm supportive of what you're doing so that on land I need to get to that place the bill page five is what winery on I'm on the. Line to line ten to adopt rules establishing the system standards and then it on line six it talks about the health benefit plan that is offered so if one is is that that is tell me what that means I was not familiar with the details of that are tell me let me just read to that section briefly if you like completed if hi everyone what it does no I understand I want to read and get in contact before try to answer questions okay. Just how at hope that it plans defined at most places will receive benefit plan with you we mean an insurance company yeah AVOD EBD. There are different different there's certainly definitions and statute where health benefit plan as I could probably pull up one of bills with that would be well defined that doesn't Johnson Ladyman apologetic entry from the Housing Division. Tell me and I think it's just so that they can be paid under the new designation by a health benefit plan I'm Judy entered on the executive vice president of the Arkansas hospital association and you are exactly correct it so an insurance company can continue to reimburse a rural emergency hospital that's a licensed as a real emergency hospital as it would normally pay any other outpatient services in a hospital or the plain terms and conditions that will plan insurance plan not an individual plan and they're get reimbursed at that rate by Medicaid now. No Medicaid will continue to reimburse a real emergency hospital at the critical access hospital rate for outpatient services insurance companies also have different rates for hospitals okay whether they're critical access or judgment or medical surgical or freestanding inpatient psychiatric hospitals so what we were intending to do in the bill is say that however I an insurance company would normally reimburse a critical access hospital it will also reimburse at that same rate for a real emergency hospital licensed or reduce clarifying that Medicare would be the only. Benefit plan health benefit plan that would be providing enhanced reimbursement we don't want to burden other health benefit plans with an enhanced reimbursement mandates this is strictly just applying to CMS Medicare okay thank you okay. Very good question. Any other questions members of the committee of senator Kaine you're recognized. This matter to private hospitals like Eureka Springs with a qualified the yes the answer is yes that would qualify and whether your private not for profit system hospital this is just about where's the house located on the basis that is in a critical access area the the conditions from his patients don't require that you be profit not not for profit in any hospital in the right location qualified and I'm in Mrs but this doesn't affect general revenue or anything we're we're six if these people are paid more money where is that money can for the federal government from the Medicare program. Any other questions. Thanks same nine is there anyone here speak for against this bill. C. nine you're recognized close for the bill close from a bill manager thank you thank you motion do pass second all those in favor say aye. And opposed Is haven't congratulations you faster fill thank you madam chair committee process thank you. The representative Ladyman. Senator hill we've done Hills. Representative Mayberry. Okay. Yes B. twelve sixty seven. David cook sample policy manager for the Alzheimer's association. You're recognized the bill after. To introduce it for Thank you madam chair of this bill it house bill twelve sixty seven attempts to add dimension training standards for home care providers here in Arkansas we have an estimated fifty thousand our Kansans over the sixty five four currently living with Alzheimer's that number is expected to increase by fifteen percent by twenty twenty five to sixty seven thousand the number does not include those living with other forms of dementia home care providers provide critical services for Alzheimer's dementia patients who choose to remain in place and age at home we want to make sure these providers are trained and to address the needs of individuals with Alzheimer's and other forms of dementia such as communication challenges and behaviors what this legislation does home care providers are already required to train and Alzheimer's dementia this doesn't add to the number of hours of training that home care providers have to do it just carbs out of the forty hours already haven't have for our specific to Alzheimer's and dementia we also define the content that we would like them to have as well we've spoken to the department of health and also for Human Services who have no objection to the bill and to providers as well who do not have any objection to the building or no opposition that we've heard of. Are there any thank you very much are there any questions from the members of the committee. I just wanna say thank you for your commitment Mr cook you've been here and involved in this for so long and you've also been a point of contact for a lot of folks that have had to deal with this in a very personal way and you've been a good resource for a lot of those people in a very personal way and with their situations that they're dealing with their elderly loved loved ones so I just want to recognize and appreciate appreciate you for that thank you senator appreciate that and that's what we're here for if there's any way we can provide help to you in your districts please feel free to reach out to me to do that we appreciate that commitment to. All right is there anyone here to speak for or against this bill. C. nine you've close for your bill closed and it's. Pushing to pass a motion to pass a second all those in favor say aye. And oppose ayes have it congratulations you've passed your bill thank you very much senator Wallace house bill eleven OO eight. Senator David Wallace District nineteen. Hello recognized. It members this is a clean that bill ACT five forty of twenty seventeen change the makeup of this board from seven members to five members but we didn't change a quorum what we're doing now is changing the quorum two three so we have three members have a quorum. And with that I stand by for questions all right are there any questions members of the committee. The no questions anyone wish to speak for against the bill C. nine you've close for your bill I'm in do pass and second all those in favor say aye opposed ayes have it congratulations you've passed your bill thank you ma'am thank you members all rights okay I have I have Senate bill one eighty six twenty seven twenty eight one eighty nine and house bill eleven fifty five so. Senator Solomon he'll take the chair. Members we have an amendment were passing out so will take just a moment. Yes so Hi medics plan the bill or explain the amendment also very briefly in the Arkansas code right now there are several different conflicting definitions of intellectual and development disabilities the purpose of the bill is just apply one consistent definition throughout the code so that we know consistently what we mean when we say an individual is IDT in talking providers there were some concerns about the original language and so we work with them and Senator Irvin this amendment just modifies that consistent definition slightly to address their concerns. Senator Chuck to any further explanation of your amendment project because the amendment at close for the amendment motion to adopt the amendment the second. All in favor say aye aye excepting the Amendment says thank you at all opposed. Thank you senator You may go ahead and claim your bill. And so the explanation I think was given an explanation of the amendment and will be happy to answer any questions. Members any questions on the bill. Seeing none is there anyone here to speak for against the bill. Fifty nine Senator you're welcome to close thank our clothes motion do pass as amended and second in all in favor say aye aye opposed same sign. Saying nine thank you senator real fast thank you. And the last bill we have is house bill eleven fifty five witches representative Bentley's House Bill. Where to occur in the State of Arkansas as you know child care is it is difficult to find and when you find it is very very expensive so we want to encourage people to use child care to to be entrepreneurs and open up safe child care facilities what this does is talks about child care family homes and then just makes it it was and she works with the division of child care and early childhood education just to ensure that it's easier for somebody to is opening and a child care family home that they are able to do that without over unnecessary burdens. Members anyone have any questions. Anyone here to speak for against the bill. Seeing none Senator you're welcome to close for your bill but I just want to say that I very much appreciate what representative Bentley is doing and and a lot of a lot of the co sponsors on on this bill child care and early childhood education is really critically important our state so we need more people that are stepping in to fill that that need for our working moms and dads. I think we hear more about that at twelve thirty today I think so thank you so to get that set. If you're making a motion well I'm not sure if anyone's here so here I'm sorry anyone here to speak for against the bill. Saying none Senator you're welcome to close motion to pass second and third Wallace all in favor say aye hi opposition same sign. Saying no thank you senator your bills passed. Great work thank you Committee.