Public Health, Welfare and Labor Committee- House

Senate bill we're gonna get some of this today and forty is more quiet in the room. He's not in the room then what we'll do is going to the. Hearing bills that's okay with me will circle back. Let's see. I don't see anyone in the room is ready gives represent Scott in the room. All right represent degree were you here. We'll hear your bill if you come to the table. Which that may that may be a discussion before all said that let's not embrace the paper yeah what to talk about that in the. Representing either you're recognized thank you very much. Committee members again house bill ten fifteen today what this bill does is A few years ago the change that. Change to. The. The communities and how they were accepted what this does is add to the the list. Exempt them such as the federal families universities and colleges and entities for any community this five thousand or more and specifically I represent Hot Springs Village. Hot Springs Village is a community of over seventeen thousand in my district if it was a city I thank their five hundred two cities in Arkansas it would be rated number twenty six their facilities are are manned and maintained and have met all requirements in the past so this would put them at the same place that to me test you missed missed a penalty was on those requirements and that's what this bill does not be. Available for any questions. Any questions from the committee president Ladyman you're recognized. The representative group. Thank you Mr chairman It looks like what your bill does it exempts those cities exceeding five thousand population from in P. D. E. S. permits they don't have to get those permits because the only discharged domestic waste is that based which build us that's my understanding but let me ask if I can get Mr pay up here he can assist me with any questions. my understanding of the. We started identifying marks my name is Alan York on the associate director also water quality at Arkansas the the. my understanding of the bill is the weights drafted is to exempt Home owners of property owners associations that are greater than five thousand members from the nonmunicipal domestic wastewater trust fund contribution each year right now Hot Springs which operates to permitted in PDS facilities and in PDF stands for the national pollution discharge elimination system. they're still required to be permitted it wouldn't change any of the requirements under federal rules what do is is basically exempt them from contributing to the trust fund each year for those two facilities they contribute five thousand dollars per year for facility towards that trust fund. So we would make them more like municipalities for their operations the correct as far as the trust funds concerned it would exempt them from that contribution thank you. They represent Gonzales you represent recognized thing Mr what what is this Trust Fund for the trust fund is to step in when there is a failure of a nonmunicipal domestic wastewater system in Arkansas we have we have numerous systems hot springs village is the only one of this kind of size or scope that have their own discharge permits to operate wastewater systems for small communities neighborhoods except for this would exempt them from that trust fund that trust fund basically steps in if you have failure or form goes bankrupt or things like that. So we're gonna exempt them from the trust fund but then they're still going to benefit from the trust fund because or they still qualify as one of those facilities it's entirely possible but not likely we had we had some discussions with hot springs village regarding the reserves that they keep on hand and I'll certainly be happy to ask them to to speak to that but they assured us that they had adequate reserves to cover both their wastewater and they're turning to water systems if any issues or should have. Okay thank you. The representative would like to have a question yes Sir correct represent Gonzales touched on where I was going but there's no requirement in this bill and I scanned through it really quick there's no requirement is bill for that for that reserve fund to be at a certain level and if we're going to take them out of contributing to the trust fund we probably should or should have some kind of reserve mark that would ensure that the states not paying for that for somebody is not contributing to that to that trust fund. representative group do you how do you plan on addressing this when the day comes to me we've seen some of this happened with landfills we've seen it happen when our tire districts Where is the assurance that we're not out paying for all these people. Ten fifteen years from now or twenty years from now and they haven't paid into this trust fund over those years when everybody else has I understand that let me point out that hot springs village is fifty years old hi Spring Valley is the biggest gated community in the United States they contribute their financial impact on a recent study showed that they contribute three hundred ninety seven million dollars annually to Arkansas and because they are gated community they get nothing from the state nothing to support the infrastructure the roads are placed on the fire department or anything so to me there contribution way out of that and also the fact that they have preserved to do that that they're huge committee there's a twenty six largest in the state and we're just asking that they be treated like the others so I understand the concerns there but I think the contributions that they make the promises they may outweigh that. Okay we keep referring back to these reserves and I'm not worried about to police and fire does not we're talking about here we talk about the sewer. There's no requirement in this bill on what that reserve needs to be I mean we're talking bout they have these use reserves and I'm fine with that I think that's great but why not require that you to reserve be reserved for a disaster if one was to take place so that the trust funds not liable for that if they're not going to contribute. So I guess I could I could to. Full back to bills and and talk with them amended to make sure to put in there that they have a certain reserve to what you're asking for yes Sir. I think I think that would make everybody feel more comfortable that they're not going to get the trust fund once they pull out of the trust fund. Okay I would be willing to pull this back and add an amendment thank you for any other questions from the committee. All right thank you representative really look for dissing that amendment when we come back thank you thank you. Represent Pilkington the ready present sure bill do you have an amendment use would you want to present your amendment first is that easier what's easier for you. This is yeah this is to House bill one zero zero nine. Okay. So let's list if it's okay with committee again there's several bills we're gonna try to hear the members repression gonna maybe taken some of these out of the agenda with that out of the order of the agenda without objection trying to just organize the bills in the way of how much time I think they're going to take it to spend about talking to members it is okay represent Pilkington after you present your member of the before you present your next bill eleven a representative Scott coming present a bill sure okay that's an issue at all so the end of the members should be passing out to this amendment to house bill one zero zero nine and representative you're recognized to present your member thank you I'll just wait until I get the actual language of the amendment but real quick I can tell you all kind of the background on this as you know two sessions ago I ran a bill to create a pilot program for ride sharing for non emergent transportation using Medicaid funds there's another pilot programs like this. Another state's district of Columbia as well so one of the things That happened was basically time went by covid came in lands and then are faded and there is still no pilot program and so I filed this bill to say well if you wanted to the pilot program we're just going to go into the program fully come to find out we did do the pilot program it got shut down due to some issues in some incidences that need to be resolved DHS is working through that and so in one meeting last week with them they had asked me that I made some changes so that we could strike the language from the original bill add this new bill to create a expansion study work group and so that the non emergent transportation groups can work together with DHS to get this program back up and running so that essential this bill as I'm not running today I'm just amending it I'll give you a plenty of time to review it but it's a really simple non controversial bill and I appreciate DHS help working with me on it so that we can you know find innovative solutions to an area that but does for a long time. Thank you represent Pilkington yet anyone have any questions about his amendment. Get a motion approved amendment second yep lows in favor. Your members adopted thank you represent okay review starting here. Are you prepared to prevent present your bill comes to. You're recognized thank you Mr chairman. Colleagues today I bring house bill eleven forty five which would designate April twenty third as lupus stay in Arkansas if you don't know lupus is an autoimmune disease which attacks the healthy issues of. Healthy tissues of your body what may seem as a harmless fresh one day can lead to a more serious health conditions such as heart attacks strokes seizures an organ failure lupus disapprove lupus affects women and there's currently over ninety ninety percent of the patients are women and typically typically tend to be of child bearing age impact eighty percent of the people that are diagnosed with lupus are women while the symptoms when the symptoms become serious to dis can't the disease contracted a affect the livelihood of those if basis currently there's no cure for lupus but with early diagnosis many of the severe effects of the disease can be migrated it is my hope that this bill will raise awareness in this state this bill was brought to me by a group of women who are advocating for loop is in our in my district I have a friend whose who's no longer with us and she bought lupus from much of our adult adult life she left behind two kids and I have a family member that's fighting with this right now lupus impacts all communities and ice is just my hope that this bill would just kind of bring more awareness to this issue in this state I'm also working with DHS to kind of see what we can do with some better data collection in regards to lupus and That's all I have. Zero any questions representative Scott. The motion to pass second all those in favor say aye. Congratulations Bills thank you so much of a welcome. Reserve represent pill container you prepare now to present your bill of house bill ten eighty two. You're recognized representative thank you chairman Johnson I would like to ask Mr Sims from the council of state governments to come up here with me as well as certain of my bill instantly if you can just introduce yourself to the committee. Hey Carl sensitivity program director with the council of state governments thank you. Six one all over the place They're passing out one sheeter real quick to kind of this is a little longer bell but just to know what's going on so as you know and we've seen this there a lot of these committees we've got compact that the compact this is another one for occupational therapy twenty two states have already enacted it was six more states on the way you know as you know we've we try as much as we can here in Arkansas to make it easier for people to come to the state to work especially at a licensure and so that's basically this is we have no no no opposition no one signed up here to speak against it only to speak for it I think this is a good step in the right direction to once again make it easier for people to come to Arkansas who have these kind expertise to get to work I mean I hear this over and over again and every health committee and subcommittee workforce workforce workforce and so I think anything we can do to make it easier for an occupational therapists to come and work in Arkansas we should see we can do to make it work so with that ask for a good vote this is the thing that you like to add. Yeah I just want to underline a few points of regarding B. contact one that it does preserve state sovereignty fight not altering the scope of practice for occupational therapists occupational therapy assistants it in preserve the process for initial licensure it also enhances public protection by requiring an FBI background check for those wishing to seek a compact privilege that's authorization practice in other member states it also allows contact member states to have access to a data system allows me sir information if there's adverse action that occurs between contact member any contact member state so they're aware of those different actions to able to take appropriate action based on their state laws on anyone who's practicing any contact member state has to abide by the laws or regulations of that state thank you. You have any questions. I make a motion to pass image the pass is second all those in favor say aye graduations your bills passed. Let's see representative Bentley do you have a bill that you're prepared to. Excellent. With this sorry again apologies I'm trying to see using the remitted Rev run bills this is house bill eleven fifty five. This is one representative pressure about today she says she's prepared read the bill and we're prepared to hear. Reserved bill you're recognized to run your bill thank you chairman thank you colleagues I for the past four years we have been looking at ways of how we can increase childcare accessibility across the state with the biggest need that we have is for infants to three years old so it's a really big need I see represented Graham of. Secretary of this saying yes we do is a huge need for us so that's a really big air we need to get some more child care across the states we've looked at how can we encourage entrepreneurs to start a business for those moms at home to start a business to have their own child care at home and we looked and looked what we do in the state to make a difference or the only thing we came across and at risk the business listening to represent a person who had an instant his own committee where this is happening so we have a individual has a child care home they have four five kids that they're staying with sometimes unfortunately folks will come and try to treat them as a commercial business and try to change their home into a commercial business so I with the fire regulations and they have to have a door that goes outside from every room where they have to change the vent hood in their in their home excessive things that they're really not making a whole lot of money having four five children their home they're trying to turn them into a commercial business and actually shutting them down and making those women and those of our cans is unable to open up their business and their home and have accessible child care so as a person bill to say that we're going to treat a residential a home like a residence that it is or not gonna cry require them to have a commercial Stover I can require them to fill a far regulations for commercial business because as a residence is a home as a they were fully follow the I know you guys have a copy the bill in front of you they're gonna follow all the regulations that currently have the child care of folks make sure they follow every other regulation which is and they're not a commercial business they're not a commercial they should have to follow commercial regulations for fire in those things and we don't need to show these people that I'm trying to open up the necessary childcare for cans and some of that I will take some questions to give you guys a chance to pull it up if you'd like. It yes represent letting your inner policies to the committee at work we try to print bills bills that I dissipated as running but you know it's of such polluted situation and we're gonna be efficient in this committee and everybody hopefully have some kind of electronic device that can pull this up on resented Ladyman your recognized ask questions thank you Mr chairman of representative Bentley is there any limit in this bill on the size of these operations I mean you can't have a large. You know multi level building whether keeping Q. is there any limit if there's is is if you look this huge amount of of regulations through our child care system I could have had Tonya Williams here to answer those questions BSS five representatives as a home is a residence would not have some is going to have a you know a duplex with huge day care that this is going to cover this is a residence in this very much restricted if you look on page two just they're gonna comply with all apple zoning and land use regulations and all things that the shall care folks Tanya Williams knows what's already have all those regulations in place so it's a limit of five children yes okay thank you. There any other questions from the committee. Reserve grand like you're recognized. Thank you Mr chairman are they going to still have that like business licenses and stuff to operate this yes and I'm I'm sorry going together have the the bill in front of you BSM page to that have to have all those false if you look in there. Zoning fire safety all those things building codes they're gonna fully follow I could just read it to you guys of the bottom of page one actually the division of child care early childhood education shall require every child care facility seeking licensure under this subchapter to comply with applicable zoning and land use development regulations of the intimate Mr Pelley in county with a child facilities located second to follow all the regulations currently we just saying you can't treat them like a commercial business was a home that the child care facilities and okay thank you. Any other questions representative Bentley. The motion and such motion bill I make a motion to pass thank you thank second all those in favor say aye. Graduations your bills passed thank you committee I appreciate. We have representation DHS to now. Excellent sorry at the we we may have moved the meeting time on the island expectedly that says for not giving you a little better notice we've. Shuffling around you chair will be better in the future at accommodating those things. President shall be in here today to give some information to committee committee I'd like to say before you started you know I know all of us have a lot of questions I'm sure for DHS that run the spectrum of things you could ask right is a large entity that covers a lot of different areas and I wanna make sure the that everyone understands the intent of this meetings introductory to get to know how to navigate to DHS I'd like to try to hold questions from the end of the presentation and if you have questions I'd like to try to ask that you limit those to specifics about how to logistically contact people we're gonna have opportunities to dive into specific issues I'm sure it many many times during this committee so again that that would try to limit the questions that specifically just to get ideas and not I've been a specific policy issues if that's okay and with that I I you're recognized introduce yourself and present to the committee. Good morning Kristi Putnam secretary department of Human Services and with me today I have. Good morning Janet Mann deputy of health Medicaid director. Mark white chief of staff. And we also have Laurie macdonald. Who is constituents services historically but she has stepped into the legislative affairs coordinator role so we're very grateful to her for taking on additional. Duties. Hey and there's additionally staff Elizabeth Pittman he's the director of medical services and also polished and he was interim children stricter for B. H.. Did I miss. So we wanted to do today we do have a very DHS is very large agency Esther Johnson mentioned we know you have lots of questions of us we are comprised of just very high level per for youth and families and the department health those are and then we also have shared services within our agency a separate shared services group we will go into more of those areas but today we want to focus primarily on giving you an overview of Medicaid and so with that I'd like to mark what to keep us off. Thank you certified in so it's and talking through Medicaid firstly we would put out there is something that always confuses folks if you don't work on this today today I know it took me several months to to get that distinction straight in my mind when I started it just that is that stinks when Medicare and Medicaid or Medicare is federal program it is primarily for our citizens who are sixty five years of age or older as well as those who have been declared disabled by some security ministration funded by Medicare taxes charged on our payrolls and it is operated in most entirely by the federal government we as a state do not have a role in administering the Medicare program Medicaid on the other hand is for course individuals lower incomes but also individuals with disabilities and children and other populations that have been particular needs Medicaid as contrast of Medicare is administered by the state in cooperation with federal government we operate under a set of federal rules but we also have some discretion and how we've missed program under those federal rules and for front of financial is partnership on average the federal government pays about seventy six percent of the cost of what we pay our Medicaid with the state picking up the remainder of that cost provides benefits NO through healthcare providers around the state an one to a couple things I mentioned there is some overlap between Medicaid and Medicare one is that you we do have beneficiaries who are on both programs and so we coordinate with Medicare on what is paid for by Medicare what's paid for by Medicaid but secondly in this one this particular important at that would want to keep in mind around provider payment rates we do have limits on how much we can pay medical providers under Medicaid and those limits are tied to what Medicare pays for similar services and so that does give us some restrictions on our discretion in terms of when we set payment rates for providers. Each state has to submit a Medicaid state plan indicating how the state plans to run the program we submit to the federal centers for Medicare Medicaid services or CMS and we outline details and how we're going to operate if we want to make changes there is some flexibility allowed to states we have to submit a state plan amendment to CMS or a waiver request and those are two very different process sees the state plan amendment is a formal plan to change how Medicaid services are operated in the state does not have a cost or budget requirement is typically a ninety day process just submit a state plan amendment and work through that process with CMS although they can suspend the clock of that process requesting additional information and that change is a permanent change to Medicaid operations. In contrast a waiver request is a formal request to waive certain requirements of the Medicaid program itself the federal Medicare program it does require that request to be cost effective or budget budget neutral so there's no increase or it's more cost effective to do to waive the certain requirement and if the request is approved and state does receive that official waiver it's a time limited waiver the state can request renewal but it does have you the state does have to go back and seek approval each time it comes up for renewal. At one point I want to put out there is as part of Mr the program we do have extensive administrative rules and those rules set out how providers bill us what will pay for what rates we pay and other details are on the program so you as a committee we have to bring any change those rules or any new rule has to be reviewed by a public health and so that's in that you'll be seen for us over the next two years as we will be regularly bringing to you changes in those rules as we make changes through the state plan amendments for for those waiver amendments. Thank you. On the next page we M. have an outline of just how many and our tendons we are serving in the state to primarily and with our kids a and B. it's up approximately three hundred eighty seven thousand in our home three hundred forty eight thousand all the way down the page to adoption and foster care which is approximately sixteen thousand in the state. We have copies with us to hand out we apologize since. Yeah I. Well my apologies Committee we'll we'll work this paper situation is going to be the case from the paper day before sauce and that I just just passing down around and we'll get that's passed out thank you. Hi that anyway save. Currently there proximately one point one million our cans and on the Medicaid program and when you receive page four you will see. Right now all of the of the beneficiaries I'll wait for her to finish handing that out. Fifty. And. So it looks as indicated earlier on page four is our beneficiaries and then on page five gives a brief summary of our providers in the state said in F. FY twenty two we had approximately a hundred and one thousand almost a hundred two thousand active providers enrolled in the Medicaid program and then forty nine thousand of those actually build us in that same year and that is made up of eighty five different provider types throughout the state. The general eligibility for Medicaid clients must meet certain income limits based on a percentage of the federal poverty level the FPL and the number of people in their household it's a combination of factors the FPL ranges from less than twenty percent and up to two hundred fifty percent of the FPL depending on what category of Medicaid the individual or family is applying for limits are higher for children pregnant women and long term services and supports clients and they are lower for other adults DHS return to client eligibility every year that's been a little different during the public health emergency and we'll cover that in more detail later clients are required to report changes in their circumstances within ten days that could be changed income or household composition and then clients of long term services and supports our LTSS have to be asset limits in addition to the income limits and they also have to meet institutional level of care to qualify for that Medicaid. And we go on the next page we given you a chart just give me some idea of what those and feel percentages mean in terms of dollars these dollar amounts are updated annually by the federal government and so those do change from time to time and it it does I will say does create some confusion because there are so many different income thresholds and eligibility thresholds and Medicaid and that's just a legacy of over the last fifty years Congress will see some situation they'll see a gap we'll pass the bill to fix that gap but as a result Medicaid eligibility is just this patchwork of more than a dozen different categories all of which have different inconsistent requirements and so that does create some confusion but we work through that and that's why we've got eligibility staff we train on this one ninety system that helps us with that processing so that one folks Committee playa we we can look or situation find which categories they're eligible for and then placement the correct category but as I said you can see on their of that chart that'll show you based on how many individuals are in the household of what income would make them eligible for any particular category. And I would just add that this chart is updated annually around April one it comes from the feds updated and then we put it into our system effective April first. And it's an integrated eligibility system it's it's areas that Arkansas integrated eligibility system that that has all these categories and in addition to our other public benefits programs. First public health emergency. All right so the public health emergency which we mentioned this earlier in twenty twenty when the co nineteen pandemic began the federal government declared a public health emergency for code and that public health emergency is still going on that is extended about every three months by the US department of health and Human Services one consequence of that is Congress early on the pandemic they issued a directive the said that state Medicaid programs would receive enhanced funding during the pandemic seneschal six point two percent that we receive on certain categories but the the consequence of that was we could not remove individuals from the Medicaid rolls they're only very limited situations in which we can remove folks from eligibility and so that has meant that are eligible are eligible numbers have climbed throughout the pandemic and are now the highest they've been because we cannot remove those folks from the roles that is about to change congresses now that's good put a schedule in place so as of April one we can start removing those in as an eligible beneficiaries from the roles and that is going to be a massively complex effort because we will be re determine eligibility for more than four hundred thousand Arkansans as we go to the pandemic this one thing we've done other that not all states have done we continue to process eligibility we continue to reach out to clients and say sinister opted updated information and we can find a militia we do so that's put us ahead of a number of other states but we still have these four hundred thousand Arkansans who have either we have information so they're not eligible or they have not responded to us to give us the information we need to show that their eligible as a as a result their status is in is in question and so we started that process here very soon working for me now on April one to this in the initial notices and then as a vapor one folks will start coming off the roll. This is that means that members you will be getting calls I will just tell you when people go to the doctor and find their Medicaid eligibility is closed out they're going to call you and so when that happens we're certainly can reject the House constituents that but you're also welcome to reach out directly to us and which missed McDonald overseas constituents services for us we also shall we will to in our office who is the day to day contact for constituents or Mrs they will work with you that will help track down situation see what's going on and and do whatever we can to assist that constituent and I'll also tell you selfishly that's also good for us as an early warning system because there are times when we get a referral from a legislator about a problem and we find after digging into it we've got twenty other people have the same problem and so we encourage you if you get calls from constituents about this please send that to us let us work with them and see we can do to resolve the situation. And we are going to provide this committee and the Senate public health committee with a timeline a list of contacts and in a brief bulleted list of talking points just for your awareness so that you know what's happening when it's happening and who to call. And and just to and wrap up on the public health emergency all one point one million our Kansans will be REDETERMINED and in the six months so we've already started that paperwork in the first mailings will go out in February four on the redetermination decisions for April first and will continue on until we have REDETERMINED everyone. Yes the extra staffing to we and we're anticipating a surge in redetermination processes and appeals and hearings and we're looking at our options between staffing and contractors on how to handle that to remain timely Senate. Thank you thank you are you are finished with prestige referred questions represent Eubanks and you have a question. Thank you Mr chair with regard to returning their eligibility are are these folks going to have a another dance notice and a you know a transition time in order to deal with that yes Sir what we try to do on the metapopulation is we try to send notices beginning at ninety days prior to a decision being made and we send to up to two reminders and all multiple points of contact so we do try to work with ninety days in addition to that a long term care we start the process a hundred and twenty days out before their redetermination date so we do try to build in plenty of time for that that's also why we're anticipating a surge in activity and trying to look at staffing and to the point so that one is that for individuals who are in looking nursing homes or her receiving in home care through the ARChoices waiver we do provided some additional time once we've issue those closure they have some additional time before services stop so they've got time to to get notice get it addressed and get that taken care of and if they do appeal any Medicaid beneficiary can receive services while their appeal is pending and so if it's a problem if they get a closure notice they dispute that they need to send an appeal in a particular for for again for those long term care categories on those we automatically continue those benefits if we get up you'll notice from that beneficiary thank you. Resembling Minya question. Thank you Mr chairman I know. We anticipated that we would not have to do this for the public health emergency until July one and I know that you all had a plan to do that and when they pass the consolidated procreation is active twenty twenty three and they D. couple that brought that up to April first so my question is you know do we have adequate I know you mentioned staff but I mean can you adjust that program to be able to do what was planned for July and April. Yes that's exactly what we're trying to just right now in working with Mary Franklin with county operations and our contractors to move everything up we are ready to send those notices in February for the first round and we've divided the population into categories to try to address that and more than happy and we mention to chairman Johnson that we would bring Mary with us and we would do further details and the outlining the timeline and contact information at the pleasure of the Committee. Of another question on if there's a step down what we pay. Or or what the federal government will pay they currently pay six point two and then they step that down quarterly the five percent second quarter two and a half percent third quarter one half fourth quarter so we we knew that this would cost us a lot of extra money but is this change going to affect budgeting I mean do we have adequate money in the reserve to to take care of this with this different timeline it it it has changed and so by decoupling it it has allowed us to do a little extra planning and to be able to look at the budgeting because now they're graduating the money down each quarter as opposed to just cutting it off at the end of the quarter for a specific answer to the budget questions we're still looking at it I'm I'm trying to get to some of those very answers that you questions and answers that you are asking but it appears this could be beneficial instead of an egg. It but I think it'll be a combination because the money will graduate down that we will be able to claim. But it also allows us that the six months to do the pre determinations without completely cutting off the additional funding I just don't have the delta on what that number is yet thank you yes Sir. Represent rest you have a question. yes thank you Mr yes to be do you have an estimate on how long the appeal process would take. Any kind of ballpark. I do not at this time and we expect to serve I will say is if my memory is correct there is a there is a limit on how long we can take for an appeal I believe it's ninety days is the time within which we have to process that appeal and I'll double check that and correct if that's not right that's my memory of the following you senator kind of in it long a different vein. Have you considered any type of a like a PSA campaign. Letting people know because I mean I know how postal service communication can be with folks but I mean television radio social media any of those means what what are what are ways we're going to let people know the benefits they're heavily relying on or about to maybe to you know leave yes Sir we do have a communications plan that and several individuals in the agency have been working on for several months if not a year it does involve interaction with our community action agencies in Arkansas county offices and other stakeholders but in addition to public service announcmenet TV social media mail and other off and we're looking at all other options we can get you a detailed list and copy of the communications plan if you would like if I switch to quick things one we did a a communications plan and a PSA effort back in the fall to encourage beneficiaries to reach out to us and update their contact information because that's what the big worries is we will send a closure notice and as to an old address and that was very successful with more than a hundred thousand or Kansas reach out to us update their information so we're very pleased by that will be repeating many of those efforts in the coming months no no our director any told me earlier we just saw the initial thirty five thousand dollar budget for one piece of this. I would like to receive that plan okay and you know when you're planning to start that. Thank you to think it's February one that. We'll welcome back thank you. Are there any other questions from committee members yes repair thank you Mr chairman I don't know where to start so. We we're actively involved are insurance agents agencies actively involved in helping people solve this in me Laurie's been a rockstar I mean we we reach out to her quite often and she helps explain and but looking at the eligibility limits. If you has the federal level been raised for twenty twenty three because I know you know with the cost of living increase everybody's excited about but sometimes that will knock that person on Medicare so security out of the program for five by. You know a five dollar increase cost of a hundred and something dollars on a month on the backing yes Sir we anticipate the federal poverty guidelines being updated approximately March first then we put that into our system to be effective April first okay so we've not receive them to my knowledge yet at this data you know I'm. We talked to so many clients when we're enrolling in the M. and A. R. home and you know we ask them who their primary care physician as they said I don't have one I always go to the ER. And you know you A. M. S. back before the private option I was here when we implemented that you a M. S. had close to a hundred million dollars and uncompensated care I think what will happen for the short term is when these people get kicked out the quick going to their primary care doctor. Going back to the ours which are already backlog so I'm I'm hoping that doesn't occur and hope we we can figure out how to implement the contact procedure to to get these people taking care of. And I will say one thing we will do is that we work with folks know if they're not eligible if there in many cases they may be able to from the marketplace so they get subsidized coverage through the marketplace which may have little or no premiums and so we certainly will point them to that so we can help help you get in that continuation of coverage thank you. President Ladyman you're recognized for a question. Thank you Mr chairman of secretary had a question for you. Skews me with the governor's freeze on hiring I've got lots of calls I'm sure of the members of this committee has gotten calls about the human development centers the turn over there is a hundred percent sometimes in a year and I talked to one of the directors this morning and I ask her if she was doing okay with hiring because they're constantly hiring and they said that they were doing okay but the all right as they were having trouble because they constantly lose those people the hospital or whatever and this could become a critical very critical situation we've got a hundred people in these facilities five level around the state and they need our Carol the time so do you know if the governor or have you all had that discussion about releasing that hiring freeze for the human development centers and I mean that he's been on right away. We we have had that conversation with the governor's office and PM we are in the process of identifying for them not just the HTC's but other categories of essential workers that we really need to pay attention to it DHS frontline social workers being among those are our child care or family care services workers so there are several categories that were in active discussions with both governor's office in OPM to problem solve and be able to move forward with those. Well I would ask that you reach out to some of us that are very close to these facilities if you have questions about their needs because they're great yes they are. Thank you there is a question for the committee. Senate thank you so much for taking the time to come present appreciate you thank you representative Cavenaugh are you here and ready to present your bill. Thank you. Leave it. Representative Cavenaugh you're recognized present your bill thank you Mr chair polygons for running late had another bill running you dove tailed riding on time is perfect thank you members Fran Cavenaugh representative district thirty this bill is a simple one page bill it actually adds two words into this statute which basically says that cities now will have the ability to do vegetation disposal currently cities do not have the authority to do a burning of their vegetation this will allow them to do so. And that's it. Yes question represent Ladyman you're recognized for a question representative Cavenaugh we had a discussion and I ask you to talk with AD EQ about this if they had concerns about this and the reason I ask you a question. We've had to cities in the past that we're not attainment cities which means that particular matter was over the EPA limit in those cities are Little Rock West Memphis and west Memphis is always on the border because of the city of Memphis across the river so burning adds a lot to the particulate matter in the air. And you know I I think we need to talk to eighty two about this and see if they can study the impact or no because we we do not need to have nonclaims cities in Arkansas is a lot of cost to the cities and I know you you're talking about saving the cities and I'm all for that saving them money and reducing what goes into landfills but some of these cities like West Memphis little rock could incur a lot of extra cost if they go over this attainment level one particular matter so have you had this discussion with AD EQ ADQ mentioned that they may have an issue with that but here's my take on that representive Ladyman just because you're giving the city the ability to do it doesn't mean a city has to do it. And if you got cities that now there in that particular area of the leadership should be able to make that decision. Finally if they call AT T. to you and ask for a permit to burn they're able to burn so all this does is allow not to have to call a DQ and be able to burn. But I think many cities are not aware of these are federal EPA standards we're talking about not state and a lot of time cities are not aware of that that's what we have eighty Q. to to to to do that I think they need to be at the table and I'd like to hear their opinion on this bill. Some of made each year that would like to speak. You get introduced after the committee stage nine thank you I am is David with the roll I'm with the Division environment quality on the office of air associate director. And Caleb Osborne the chief minister for the environment or the D. Q. director. A nice wondered if you could talk about this and talk about you know or other potential problems or is it okay a you know what might be the issues with this. to your concern about particular matter in fact the EPA is proposing to re visit that particular matter standard and with the way the EPA's B. and we are pretty sure they're gonna drop the standard possibly snip significantly and two there is a concern that we're watching very closely or Crittenden County in Pulaski County that could potentially go into non attainment if they drop it too far of course is your where open burning tends to add heavily to the particular matter in whatever area. What about the student does some issue with. Is that something that might be affected by this and I I would be down the road but we just spent millions of dollars up Bellavista that trying to put out a stop fire under the ground and again what causes that is if they don't win feeling properly and then years later you have spontaneous combustion and you can have buyers can't put out and I mean is that a concern with cities doing this or or not is that is that not a concern potentially Sir the depending on the way you interpret vegetative debris stops Chipped wood could potentially be interpreted as vegetative debris so this would inhibit the department in the states ability to deal with those problems because it. Would end up being a. something we would regulated all so if we could define that better that would levy eight that potential problem maybe potentially. Okay thank you. President will urge you're recognized thank you Mr president of Cavenaugh is just a point of clarification are these things that the individuals could burn had the city not pick them up and just burning them in mass. Yes currently citizens can burn the so rather than each state doesn't have a burning this would allow the city to do that so it's not anything that is currently not being burned so I guess for clarification from eighty Q. what would the difference be if they're burnt individually versus by the city at one time. I think the concern with the city burning is you end up with a large amount of this potentially a stockpile which would potentially end up with the. Rather large source the. We can't predict how that's going to how that's going to affect air quality standards so large fire impacts it differently than the same amount of small fires digital yes Sir how's that well When you. Create a gathering place I think we believe that a. This combined Potentially. All potentially all the time the way we do it right now with storm debris is the department has the ability to kind of know when these things are happening and going on but without that ability we wouldn't be able to have any curtailment or any kind of knowledge of the on going this. So then the issue becomes an ongoing burn site not the air pollution of the ongoing brand size would impact the on. Because the small fires would not be on going. No Sir I don't believe so well in one of the I can add to this is that some of this material would also there's a solid waste issue which I think is what one of read Kavanagh's concerns has to do with is the cost of the pick up and collection but there other pieces of our regulatory program this would impact that's where the reserve Ladyman mission stops in lands that is typically collected in and for placement a landfill there are other pieces the program that this would impact into his question he asked earlier about further definition would be beneficial because there's just some of this material that creates additional environmental impacts for burning it is day is David mention. Under the scope and scale of how large the stockpiles are the the the fire bill this is the representative Ladyman mentioned that was an illegal dumpsite but what happened is a large amount of debris accumulated over a longer time mutually knighted which there's some some issues with that as well but it was a and permitted disposal site and so some of the definitional things we we would like an opportunity to work through or would like to get some more clarity because it it just touches a lot of other aspects of our programs. The other questions. There's a Miller you have a question eight yes thank you Mr I represent Cavenaugh. This may seem a simple but are you a. Is trying to. Bring about a simple fix for the towns in your district that you work for. Yes this was a bill this and you're not trying to represent mark for the EPA now I'm trying to represent my constituents that elected me thank you any other questions from the committee. Seeing as it was signed up to speak against the bill. See Mr Richman you hear you Senate speak for the bill if you could press the table immunity suffer the committee. Dispatcher nine here with please thank you. Yes my name's Lannie Richmond I'm with the Arkansas Municipal League. You're recognized so it won't be a whole lot of new ground I do think it's a fairly simple bill but this came to us to help draft out of some of the cities in northeast Arkansas as you can imagine with representative Cavenaugh here in their main concern was just. Picking up all the debris that they have to pick up paying to get it to the landfill and then paying those fees I think they run the landfills up there someone can correct me on that. Currently residences can burn their limbs burning the debris the farmers up there I believe can burn their fields if I need to and by and large the city just want to be on the same playing field without passing those additional costs on to the citizens of the city I better take any questions. The questions from the committee for Mister Richmond. The server represent road of. Do you have any thoughts on what the potential drawbacks would be what comes to mind. For citizens or municipalities. For the municipalities you know they may be getting some more calls from the citizens to engage in this behavior I think the citizens would probably appreciate quicker debris pick up from the yards for the citizens I could see someone complaining that there's more you know smoking for doing this in an area that's residential but I don't believe any city would be in gauging that type of behavior record certainly see that possibly coming up. There any other questions from the committee yes represent waters thank you Mr chair how our cities currently disposing of these items what what's the sociais cost with that verses this currently I'm smart my understanding and I don't do it I haven't seen the numbers but it's the cost to literally hall this degree which I believe is fairly sizeable because it's not easily compacted anyway to the landfill wherever that is and then you have to I believe the landfill pays for some amount of space and pods so the landfills paying fourteen that's run by the cities of northeast Arkansas is my understanding then it's the cost of transportation the cost the workers to pick it up and get it out there that's my understanding I want going to be an expert on on the costs associated there Sir. the lady when you're recognized. Thank you Mr chairman I just try to clarify some members are saying that you know burning this in one big pile is the same as an individual files but wouldn't the volume go up because isn't some of this going to landfill now not being burned out I would suspect sensor yeah so I mean I know it's individual cities ability to do it but the volume. Could I would say probably would increase the volume of material that was being burned would probably increase would you agree that I would agree Sir thank you. The the questions from the committee. Two men have a motion. I move motion to pass second all those of favour discussion relating you're recognized for discussion of representative Cavenaugh I like the idea I love say money for cities but I believe I mean I have many concerns about this I believe the term needs to be as defined and I believe that you need to sit down with the ADQ and and make this bill a better bill I think it's a good bill a good idea but but I really have concerns I I can't go for it because I have concerns right now about a lot of things when it talked about pollution. Three of the discussion from the members. President Womack you're recognized thank you Mr of my. Immediate concern when I read this bill today was was four grand cities municipalities or route that your average everyday citizens have because I was pretty sure that most of the cities have you know. Ordinances against burning this environment so I instantly got on the phone with some. A code enforcement people on fire stations is not anyway truth is I think it's exactly is representative Cavenaugh has presented it it's not allowing the cities to do anything extra all these materials that can be burned under these definitions can currently be burned by. By individuals so if. To me it just made sense to allow. What's going to be burned anyway to be burned more efficiently you know if the city city needs a little help honestly what hurts because no expense to the taxpayer would not grant any special permission at least the cities that I talked to in my district. Any other discussion. Emotional pain table do pass all those of favour say aye up. Almost Gates. All those in favor say aye. All those against. Is have it. Thank you this represents Cavenaugh your bill is passed committee members if you'll allow me a few minutes for some housekeeping just briefly first of all we have a lot of bills on the agenda the time to a common theme of maternal fetal medicine issues a lot of these anticipate we'll have some of the same people coming to testify there's at least four five maybe six on the agenda now that we're gonna try to potentially have those on special order just because there's gonna be a lot of the same people coming in to testify right now we're looking at the first of the thirty first of January as the day to do that that's assuming we get the fiscal impact on the ones that are setting the fiscal impact statement if you have people were no member's that have bills that fall into a category that similar to this theme it be a great to go ahead and follow all those that we committee here those at the same time because then similar nation that the myth similar people here they're gonna be here to testify the paper. It may be one and done guys I will do the best I can at it you know once it when I when I said yes to that I had no real thought to how many committees might want that same privilege offered it looking back retrospectively in my tenure here since twenty nineteen we haven't had paper bills provided there's been a tablet twenty nineteen last session we are working on for phones from personal devices my understanding is members have been provided access to their laptop or tablet one this is still a work in progress I can't commit to having paper bills every time we're here but I did commit to this so want to try to hold that commitment represent what you have a comment. Yes Sir I think I would amend my request to the agenda only. Okay so we'll try to do that that the challenge that for me is that I you know again this is what I'm trying to courage members we're gonna try to run a clean agenda will try to look at right you know trying to be clear on what we're thank you to be able to get to but everything's gonna fall of the agenda so there's a potential there first have multiple bills that are sitting on the agenda multiple days the running copies for that we're not going to hear and we're just gonna keep running these copies on bills we don't hear so I hear you're a minute you recommendation I can't commit to that right now but we'll keep working on this process and how we can with process everybody can can live with that be happy with the only other comment on may I like there's gonna be topics come up that we're all gonna have interest in we're we're gonna want to call an agency or association somebody the table to give us information on the topic and I'm open for discussion on this issue but I like the idea if if we're gonna have a topical informational type meeting if a member wants to cause me to have like that DHS to come discuss a specific topic or Department of coming to workforce development who whoever come and bring that to me I will try to set that as a special meeting perhaps at a different time than our normal meeting so that everyone can know and be aware this is a meeting we're gonna come in here information not here bills that way we don't have a situation we're trying to hear information everybody has a lot of questions I wanted to get their questions answered the roll also said with an agenda with your ten fifteen bills on there trying to get to so without objection from the Committee my approach I think will be that if we're gonna have an informational meeting I'll try to set that a separate time will send that information your body will announce the meeting so everybody committee and and I would encourage if you want this kind of means to be you have come come responses will set that up.