Arkansas Legislative Council (ALC)

Thank you Mr please join me in prayer. What we thank you so much for the state that you've given us we we thank you for the state of Arkansas. In the chance just to come and have a chance to. Work to make it a better place. Father we pray for this meeting today that you would be in our midst. That you would give us wisdom that you would give us guidance and the things that we would do things that we would say would be honoring in your site. Father we pray for those that aren't with us we pray for those that are having issues health wise or otherwise to be with them further just to be with us and guide us now we pray these things in Jesus name amen. Thank you representive. With that do I have a motion for the last months minutes. I have a motion and second by Senator Pitsch all those of favour say aye. All opposed us have it with that we'll go to the revenue report of doctor civil. Yard. If you would of. It's good to have you today and how is the first time up there by yourself I guess so go ahead and not gives revenue port thank you thank you thank you Mr chairman Carl so but legislative economists bureau legislative research right now we don't items the your packet so what we looking is. Is the month of July and August revenue on the on the top there have gross general revenues at one point two billion dollars after that we have to take out claims tax honestly pay on collected checks and so one billion dollars then we have our adjustments. All right off the top that would throw us as though one point zero eighty four that is the increase of fifty million dollars from last year or four point nine percent that's the number in the in in the bottom of page one. As we move forward to page two you're going to see we have up to forty six million dollars above forecast that's not a surplus is just means that we are forty six million dollars before cast from July and August and July and August compared to last year. As we move to page three you're gonna have detail collections a generation you for the toll collections from page three four and and Page five. At the bottom page five you're going to see those thorough generate news is that with the top number talked about their one point two billion dollars and below day going to start looking into the special revenues Page five all the way to the last page Page eight no no major changes out there we do have an increase year over year which tends to be a trend not just in Arkansas but through all the other states near us to have release that revenues of August and with that how I'll take some any further questions thank you. Any questions for members on the revenue report. C. N. nine thank you doctor. Yes so in place of the executive subcommittee I've got a few announcements to make for the committee without objection the man meetings for October will be LC subcommittee meetings for the most part will be counsel for October with the exception of peer review and rules which will be able to meet on October seventeenth or October twentieth in the afternoon only of the reason for that members is because will be three days here for budget hearings and we as the chair's felt like those three subcommittees normally have large amount of business and we want to make sure those get heard correctly before they come to council on that Friday so see no objection must weigh the calendar was set. In October the meetings of subcommittees peer review an administrative rules will meet on Monday October seventeenth and Thursday October twentieth in the afternoon so Monday and Thursday afternoon we we hear from those three subcommittees. All other business date will come before other subcommittees will be heard in full a see on the twenty first. Senator Hammer you have a question. Mr with the include personnel items being heard in full in front of full A. L. C. yes Sir okay thank you. Okay see no objection that's where the calendar will look in October. And now with that representative Hoff do you have a motion. I yes Sir I move that a member elect of the General Assembly may receive mileage and per diem for attending interim committee meetings of the General Assembly or a legislative task force meeting for which members of the General Assembly are entitled to mileage and per diem in the same manner as members of the General Assembly receive these payments a person considered to be a member elect after the general election or special election and which that person successfully ran for office. Thank you thank you representative I have a second. I have a second all members I will explain this motion is a motion we make every two years prior to the November General Election and that motion is made so that those members elect can collect per diem so with that any other discussion. See non all those in favor say aye. All opposed. Hi seven. With that we'll start with the ministry of rules Senator Hammer. Thank you Mister you Mr rules subcommittee met on Thursday September fifteenth the subcommittee filed a report of the review subcommittee concerning its review of a rule concerning procurement the subcommittee received agency updates on outstanding role making percent ACT five ninety five a twenty twenty one subcommittee filed September monthly written updates pursuant to act five ninety five the subcommittee voted to not approve the rules governing mandated man mandatory procurement training program by the Department of transformation search services office of state procurement all the rules were reviewed and approved as noted in the report Mr chairman may for the adoption of the report. That's proper motion that second. I have a second. Any questions. See non all those in favor say aye. All opposed us have it but I will move to higher education center English. Yes thank you of higher education subcommittee met on Monday September the twelfth twenty twenty two subcommittee reviewed reports from institutions of higher education for annual certification of solvency as required the subcommittee heard testimony regarding commitment to workforce and economic development at the university of Arkansas Fort Smith that concludes my report. That's proper motion drive second I have a second any discussion or questions see non all those in favor say aye. All photos guys have it is with that. I will go to representative gray for the of peer report. Thank you Mr chair there are three subcommittee reports on the agenda the first two reports are from September first and September sixth when the subcommittee gave final approval of the third and fourth rounds of A. R. P. as a request by the department of education. The last report is from September thirteenth and includes final approval in the fifth round of A. R. P. S. or appropriation requests on September thirteenth the committee also considered appropriation request fund transfers and received reports several items are held in river in the report there was a various temporary shouldn't appropriate various temporary appropriation request a three that was held in American rescue plan appropriations B. eight B. nine B. ten B. eleven B. twelve B. thirteen B. fourteen B. sixteen and be eighteen that were held and also restricted reserve fund transfers the one that was held. I move adoption of the report and after adoption of the report there are related items for more discussion. That's proper motion I have a second. All right I have a second Senator Davis you have discussion on that motion. Yes thank you Mister chair I was curious how we came to you passing just Black River technical and institutions proposal that we didn't pass out any other proposals that had to do with healthcare we put him on hold and I would just was wondering if anyone on the committee could help me. At one institution but none of the. May I respond thank you I am actually entered is the one who made that motion it was my understanding that it had something to deal with the law enforcement aspect of that particular request. It was best I can tell through discussion and through conversations with general members the other requests were held duties no priority being given to certain requests seem to be on a first come first serve basis and we would have preferred that they've gone through a process to determine what the priority needs of the state actually wire. Thank you follow up please. Yes ma'am and. I'd also be curious to know what the plan is moving forward and we have there were two proposals. And for institutions with nursing programs that have an extremely high success rate in the high nineties at a time when we're facing and healthcare worker shortages across our state and so I would just like to know since their up and ready you know what's our proposal or plan moving forward if US Senator Hickey I'd like to defer that to you. Yes center Davis of course you know what it what it transpired we want we wound up holding a whole bunch of that and what the representative gray told you was correct on the Black River because I think we've had those discussions for some time also included law enforcement it was it was different than the others as far as all the other request what the. What we have had discussions yesterday and with the governor is our intention you know over this next month to try to redesign how these things are coming before peer from the or for so that's going to be an ongoing discussion I can't really give you a full you know commitment of I have a is going to be done so I think you know when of course we have to work we're working with the House also in this it's just we want to with the remaining arc of funds to make sure when we will hear from hospitals today to make sure that the membership fully understands where we're at with all of our hospitals and then tried to designed a way to say that we want so many dollars to go for this silo so much to go for this other silo and things of that nature so that's kind of a very high. Hi point but. I hope that satisfactory for now I do have what an additional follow up if I may Mister chair. Three. Thank you and so I know a lot of the discussion was around and other institutions and and whether or not they knew about the art of funds and how they can apply that and I know that on July twenty third of twenty twenty one there was a press release printed in the Arkansas Democrat Gazette letting people know about the arpa finds the website and then again a follow up story on August second of twenty and twenty one letting people know exactly how to apply so that information is been widely distributed it's been on the website for months and months and my concern is you know I heard multiple times earlier this week that tech had a gold standard of an application and the way that they turned in all their metrics and their proposal that it was very good and I know the same thing within TI and so my concern is that were holding those two institutions back to have well established allied health programs and because they're being punished essentially is what it feels to me because they did their job and we're paying attention as all of this information was running across our state paper in was online and they desperately need the funds to continue the successful programs but the institutions that weren't paying attention didn't know about and and quite honestly they should have been doing their job and paying attention if they truly needed the money so my concern is that we're gonna go through a process creating some kind of a grant application program or whatever it is and we're going to get so many requests we won't have the funds to fill it and then we'll end up pro rating and somehow those two in TI an eighty you will end up with almost no money to complete these and you know projects that they desperately need to complete so if you guys could help me understand I mean if the argument is that the money was not excuse me that the and yeah the funds available the information for the funds available was not widely distributed and we know very clearly that it was both in July and August of last year and so I. I would like help understanding why those schools are being punished because others didn't do their job. Okay I'll attempt to answer that I thought it is is this the way I guess the I am I'm just going to have to say that with such some of what you're saying I understand why you would think that as far as from you know the committee and what we're doing here today I can see where they might think that but I think what what. A road right or wrong during the committee is is that we have I believe it's eight hundred and sixty seven million dollars that's left in those particular Arkansans we also know that we have some infrastructure funds and we've also now learn that there's like a capital account out there that ties with or for. So during those discussions all this stuff with the hospitals came up at that time and we're going to get into these discussions but just just just that maybe now's the time for me to do this. You know in those discussions what what we have learned this week is that a large part of what has transpired that we probably didn't know about is that the feds allowed advance payments I call it loans whenever COVID was going on to the hospital on their meta care payments that's important to note so they allow that on their Medicare payments of course the hospitals took all that money we all understand the code would deal a burn through that plus all the additional funds that we were trying to do to keep them afloat. So now what the feds are doing is my understanding is whenever the hospitals are sent are sending in for their current reimbursements on the Medicare paces patients they're receiving half of that back so in other words if I'm a Medicare patient and this is not this simple but it's close if I'm a Medicare patient and I go to the hospital and there's a thousand dollars that you know of a procedure that I do the hospital bills offense they're now getting back fifty percent thus the reason that they cannot cash flow we also hear the thing about the rule of hospitals weather affected the most and I guess what I you know the thought is on that is you can almost see that because those populations out there probably older in nature so we can see probably why they're struggling a little bit more so I'm not saying I think whatever all that came up that. You know we're looking at the entire state. We decided that we better but really start drilling down into this is because there's only a limited amount of money left and those are both funds which are a little more discretionary than the probably the capital funds or the infrastructure funds. Yes that are I understand what you're saying I mean I think that's what confuses me so much is that and you know we are talking about health care in hospitals and may be going out of business that just desperate need for more healthcare workers but the one thing we passed out of committee was and essentially a dormitories and Barrick's we pass out nothing healthcare related and you know tech I know was already cut the proposal in half and they had already gone through the process and how to cut the proposal in half due to some feedback from the FAA and my concern is that it's going to be continue to be reduced when we're allowing and an additional opportunity for institutions to apply when they've already had almost I mean this is over a year ago that this came out became public sure it may have made just for one thing about the newbie what what I would say that is is you are correct and what what I will say is black rivers thought approved until this vote that we're about to take so if this body does not feel comfortable with that there needs to be a motion I would think to pull that from the report so thank you thank you senator thank. Chairmen Wardlaw. Senator Davis I would to echo some of your comments that if we're going to fix on this hospital problems we got to start at the root and the Medicare advancements are piece of this for sure the biggest piece of this is the cost of of health care workers the cost of nurses the cost of X. ray techs and all the way down through the allied health care workforce. And I to echo your sentiment that we have to start there and educate more those people and do our best to get more more those people into the field so I do feel the same way you do about some of the stuff. Representive great thank you Mr chair eighty eight Senator Davis I did want to respond to one of the other things that we were interested in a committee was what all requests had made it out of the FNA and actually to the steering committee and whether or not someone being held how are they getting out what was their priority list in determining what got out what did And so I we ask that the entire ALC Committee receive the updated spreadsheet from the FNA which we have and I'm looking at it here so I just went through it briefly and just a quick glance it looks like there were eleven requests and so not all of those have made it through the steering committee yet nothing so that was part of our angst in wanting to approve ones is we wanted to ensure that everyone that had applied was treated fairly and equally given the same opportunity to make it through of this are to the steering committee thank you thank you. Representative Jett when Mr McCalla just wanna clarify some stuff on this Black River technical college on the Berrics so we action working on this for about four five years now not something that does come about here recently this is something that so that we don't a long time needs so the backstory this is Black River technical college they fund the law enforcement training center there so in other words all the money comes law enforcement training center comes out of black river's Black River technical college of the budget. So basically the the my understanding the law enforcement center has been. That line funded for several years by knows a cost inflation and how much it costs to operate so the students that come through Black River law enforcement training center they have to stay in hotels around Pocahontas and surrounding areas well the cost of that has risen extraordinarily hi and so. We can actually build a building Cheaper than what you can put students in the hotels and that's what this is all about and also on the backside of the Black River technical college has promised that they will use these barracks in time in the like earthquakes or something like that as well but this is a big need that we've actually worked on about for five years now and I would appreciate a good vote on this thank you all. Sure Davis are you there for rebuttal to. Okay I have a lot of members in the queue someone come to you real quick. Thank you Mr chair and at this time I'd if its appropriate I'd like to make a substitute motion that we amend the peer report and I'm pleased I'm going to hold that and we work through the queue I didn't hear you say that so I'm sorry but we'll we'll come back to you you can go and push a button and I hold in the queue. Senator Elliot you're recognized. Thank you Mr chair I'm if if I think my questions might have to be directed to Senator Hickey I would like to know if we were to delay this today and and whatever else we're thinking about doing sure the folks who have submitted an application already anticipate they'll have to have a redo a resubmission of their applications. Senator Hickey you're recognized I wouldn't think so because we've actually just held the report we've held the reporting peer so you know again those are going to have to be ongoing discussions so that if there you know the money's going to stay the same that I believe that that their application in their process you know it's going to be there the only thing that I would say would be if there was some other detail let's just say there were some there was some talk in the committee about there being a grant program you know as long as there was no additional items I guess that they would have to submit you know to meet what that the. What was included in that grant program if that set up. This if that I'm sorry did you say at the end if a grant program as set up again I want to get that out there because that that was a a large discussion within the committee that you know be it for whatever that if and this was not just for the of the higher ed there was also some of a battered women's shelter that was on the request also had multiple members had questions about that of like will you for doing this for the one here why why are we not doing it for the ones across the state there was some other discussion though that might might lead where they might possibly do imho use with this particular one so I'm not for sure how that one with the. Actually transpiring fall out in the end but. So. I I guess what I'm trying to say is kind of what I said on the on on the front end with the Senator Davis. From the pure Committee there's a lot of new information that come up as far as. true true things that happen with COVID with the hospitals and not say there's not other needs don't does not mean that I don't agree with Senator Davis that you know that the nurses are direct out of that but I believe the thought of the committee was is that we need to make sure that we take care of anything that might be catastrophic in nature if we can right now. Because I just has to be a party it's almost like I would call that crisis management on that but again that's up to the committee that was a that was what the the pure Committee decided in the that's where all this was a passed out or not passed out Health. Thank you and I just amber reminded that time and time again and I'll just have to refer to myself because I can only speak for myself I have said from this Mike many many times when we have this y'all come type of of process however the all happens to be that comes and show us that applications and they're they're supposed to do that's who gets considered I've not liked it it's happened and we have a lot of precedence for not holding up something because somebody else did not get their applications in so I fail to see why it's different on this issue I couldn't wait on this I'm not on peer so that's why I'm waiting and now and I also feel to see as much as I appreciate and understand we need law enforcement I understand representative Jett position totally but I fail to see that weeks of that one group is more crucial than the others we need law enforcement I can't think of anything we need more than we need nurses if we would have that consensus have been it's already happening in front of our faces it has rolled out in front of our faces so anybody who thinks that we're not a catastrophic position there is just in my opinion just wrong we have to know better than that it is a catastrophe so I I would certainly be on the side of are moving ahead with. Proving these applications let's just because something that happened the way I thought it should happen that's happened because Ilyin times and this is what happens when we continue with this process of y'all come and it's not kept us from doing business before I don't see why it should today thank you Mr. Senator Chesterfield you're recognized. Thank you Mister chair I share the frustration of Senator Davis with the process having said to appear at these folks coming in at nine o'clock in the morning and not dismiss until four forty five in the afternoon only to say to them I don't care how hard you worked on it I don't care how the rule the price as was based on the current rules now we want to set up something else. I don't think it's in either for I think Black River check should have been funded. But I also think that those other application should have been funded to. All I kept hearing during peer was. It wasn't it was not available to everybody yes it was available to everybody. And the folks who applied for it. Apply for it. And it seems to me if others had wanted to they had ample opportunity to do so. And I let me say this to Senator Davis at least. You're institution was not question as to whether or not they could pass an exam. Only my institutions were which was particularly insulting. During the process. Particularly insulting during the process. We need to do this there is a critical shortage of CNA's there's a critical shortage of LPNs are Ian's. Hospitals are paying humongous amounts of money by travelling nurses. Travelling nurses when we could be growing our own making this process work for this state and moving ahead. I didn't understand it then I don't understand it now it is not an either or is not the the Black River ticket or the others get out of the eight ball and. And I would ask that those entities that have applied done their due diligence. Going over and over and over again and and and refine their request be granted that. Today thank you. Are there any more discussion our questions before I go to Senator Davis for her motion. See non Senator Davis you're recognized for your substitute motion that you brought up thank you Mr chair and I'd like to make a substitute motion that we amend that peer report to include and approval of identity eight the Arkansas tech university proposal and also item D. eleven the northwest technical institute education foundation. And that we approve the report and that way. Can you repeat that one more time please that we amend and I move that we amend the pure report and to include approval of items D. eight and D. eleven. Senator Chesterfield you're recognized for a substitute to the substance yes and Mister chair I move that we are approve the under In the report all of the. Okay okay that would include all of those who made the applications I would move that we approve all of those will meet the applications on time. Okay. I would ask committee to give me two minutes. And I'd like to speak to it by may. I'm all let you speak for second yes Sir and then I'll come back to the committee with what that means. What that means is that everybody who applied to peer. I don't want to get into picking and choosing. Saying that someone more equal than others and that's what this is doing again pitting us against each other every in every entity had gone to a stringent vetting process coming before the opera Committee of the pre committee I think we would call it because you have to go through do you have in a first so they can look at the merits of it we would have almost a half a billion dollars left if we approved all of these and so now we're going to pick and choose only those that are in our district I think that is unfortunate and I think it's wrong I would appreciate a good vote on the substitute the substitute. So. Senator Chesterfield. When you look at F. eight C. in your packet. I think you're referring to all the items in the the section can you can you clarify that for me please. Okay. Let the record reflect. Yes ma'am I'd I just wanna make sure we're good. So. Some members I just wanna explain what this means Because I don't know how many times we've been here we passed things are not on the report it requires fifty one percent of membership to pass her motion to include all the items in item be under else point eight C.. And the adoption of the report so I have members in the queue for discussion on this motion representative Dotson. Thank you Mr chair so speak to this particular motion All items under B. we went through a a very lengthy process on Tuesday listening to every single one of these items and there are some that on an individual basis would not have been approved there's a large discussion on one of the items in particular that was way over funded or the request is over funded and so there's various reasons why some of these were held up and it's not just specifically related to institutions or nursing so. I would have to unfortunately speak against this motion just because as a batch I can't vote for all of them but I do support Senator Davis is Original substitute motion. One of information to the chair yes ma'am would you be specific Senate dots mean representative dots ninety. We. Yeah. He declined to answer. Always declining to answer and yet you throw out the claim that some of these things are not worthy and that someone more worthy than others. You know I've been down here long ten. In a long time. And I want to the chairs one of them tell me I don't have a problem with your particular entity getting this money. and yet they did not appear to be the case when we got to committee used to be you were with your bond down here and now once again we're getting to the guys and they'll use and that's not the way state government is supposed to work. She's not the way it's supposed to work. My institution is Philander Smith College. And one of my colleagues ask in the past the chest. They have a one hundred percent pass rate on practices they have an individual who is noted nationally as one of the best persons in teacher in in teaching the culture of chest. And yet we're saying here that some of these folks that we refused to say who we just can't support but we can support Black River we can support Arkansas check we can't support the others there's something very wrong with that. Something very very wrong with it and if you don't have the guts to say who it is you ought not to make the allegation. Senator Hendren recognized for discussion on the motion. Yeah I guess like probably a lot of members I got some questions because it's particular with regard to representative Dotson statement which clearly none of us want to approve something that is over funded or we feel like it's going to be dollars that are wasteful. That's apparently what I'm hearing is that's not the situation with wide many of these were held there some other reason whether it's process or something we're not saying they're bad with the same not going to hold I don't know that I've seen this many held things from a report. Ever and so I guess what I would ask is I don't care whether it's Richmond Dotson or one of the chairs of the pier Committee is somebody explain to a LC before we put the brakes on all of these are trying to pick and choose without the information can you clarify why so many of these were held outside of the fact that they just aren't worthy because they're over funded or some of the things to represent Dotson said because I again I I don't I don't approve a batch that's got some stuff and it should be approved but I also agree with senator Davis and breast center Chesterfield that there's projects that have gone through the process and played fair and have got of where the report. Particular with regard to nurses which we've been hearing about for years our crisis why would we put the brakes on that so could somebody from the Committee unlike me and maybe some other members. Senator Hickey I'm recognize you to respond to Senator Hendren okay I think Senator Hendren some of it was exactly what I told the Senator Davis you know with the would come out of that you know with where some of the hospitals were with the advance payments with the Medicaid Medicare. As far as what representative Dotson is talking about there may be multiple on there one specific that I remember was with the battered women's shelter who is requesting money what we found out during that meeting was and if I remember correctly it was four million dollars that there was four million dollars worth of an additional grant that they've already received but they had not reduce their request by that much. Well it was it was yes but it was that it was match funds is what it was but because we were giving that money they were automatically going to get that was going we're going to get that match if I understood all that correctly so the in the committee you know all that came out within the discussion where everybody was at the table and that one for a fact I knew everybody was talking about needed to be reduced. In addition to what I'd already stated or it's been stated that you know there we do have multiple members are requesting why was this particular one the only one that was being brought before the steering committee. Senate hearing Hendren sorry no I I appreciate that Senator Hickey and I guess I guess what I think I'm I know that I would like to hear and maybe some other members clearly that if that's the case and there's a four million dollar potential over funding. It needs to be held until that sorted out but what about all the rest of them that were held what's the real rationale on that. Back on. Senator I think the I think the thing was is that we were holding those reports and I believe that kind of goes a long line of a Senator Elliot question and you know at that point it was like well we've we need to look at all this all this is been brought to us and it was the right under half a billion dollars they were coming from mark of funds and it's like we need to look at this from a from a more of a macro level so at that point we can either hold the reports are we can just out right to known and the thing was is some of these comments that Senator Davis and others have have brought forward you know these these individual or these entities did go through those that process and I believe that is why we just held on instead of just out right turn down. There's been some other comments you know about to you know those individuals coming down there and doing the work and then sit there all day well I don't think that anyone can say that that committee did not do is due process because whenever you come in at nine whatever you committed in at nine and probably adjourn around four forty five you take a break but in the back rooms everything was still going I mean there's just been a tone of discussion that is transpired out of out of that meeting and there needs to be a little bit more time to kind of work through this to make sure that the. We're handling of handling the remaining are promoting the way that it needs to be in that the committees will. Senate Chesterfield okay yes I will throw myself into motion and guilt is too representative of great thank you. Representative gray you're recognized thank you I have a motion. I'd like a. I'd like to make a substitute motion to approve all items be except for items B. fourteen and B. twelve. I'll second the motion that's proper motion the second. We. So that is a substitute the substitute motion. And that motion includes adoption of the report correct yeah that would that would be correct and also have discussion on that. Okay. We're not going you're recognized for your Scotians lower here thank you and that's one of the one item that I wanted to touch on was on the B. twelve on the women and children first in discussion on that if your committee was brought to our attention that their overall funding for the project would have been close to eighty million dollars the updated construction cost of the project was going to be eleven point two seven million which would have left them with between six and seven million in additional funds and that according to them would have covered about three years of operating costs and I believe that if they were to return with an amount that would be sufficient to cover the capital that we might look at that again so that is the reason for removing that one. Thank you. Okay Senator Elliot. Last. A past Mr. That will serve Caldwell you have a motion correct. You are a request I will come to you after all this discussion is what you know what I'm under no. Senator Hammer you're recognized thank you Mr chairman Mike I have discussion but I really like to ask a representative Grady a question that may have some bearing on my decision how vote on this while directed to the chair you want I think it's proper if you want to ask representative grace she made a substitute substitute or thank you thank Mister representative great as a set for the majority that meeting the other day myself and what I want to ask was I didn't take away from that meeting that these would not be approved it's just that they would be approved this time around is that a correct interpretation that yes that is correct we held it in the committee and I do realize that I made the motion I don't necessarily think it's a bad idea so made the motion but I don't it's I think it's a bad idea that review process for those those higher it's I fully support the nursing programs and all those things most of these were tied to you nursing or or some code related something all together but no you are correct that it was not our intention to not ever let them through we're not here to begin they were just held. So next month in Pierre would these be considered first above any other requests that would come in between now and then so that they would be given first consideration they yes they would still be on the agenda that is correct or thank you. Senator Ballinger you're recognized. Thank you Mr in this probably would be for represent rates well so I think your explanation may appointed at twelve was it also. I guess what what is fourteen fund and why is that also being pulled out so on number fourteen I think there was just a general consensus is that that that was something that was not currently needed so what that and I'm going to over simplify more than likely but it was ten million dollars for us to. The for the Arkansas rural health partnerships you look at two things one was swing bed utilization is with critical access hospitals just to ensure that critical access hospitals are billing correctly and doing the things correct that they need to do to get paid and the other thing was to provides go lose my word here but to provide training on COVID responsiveness I'm sure there's more to it than what I understand but I can tell you one thing the hospital seven in its region for the last two and a half years kind of slap in the face to think that we need COVID responsiveness training so that one was just I felt what we are not just me of the majority of the committee that got with me are spoke to me about this felt that that was something that was not needed thank you. Senator Johnson you're recognized. Thank you Mr chairman a. I'm so confused I don't know who's on first is on second but to simplify matters I would like to inform the chair that I'm accusing of of president on all matters related to Efate C. B.. Regardless of the ones that are I do not have any kind of potential conflict but just to make sure nothing falls through the cracks I will refuse in this entire items basically the entire year for us thank you Mr staff has noted that you're on. Do you are on voting press. Senator Hickey you're recognized yes I want to make sure that I that I fully understand the motion so does the motion allows the sixty million for the hospitals to go through okay. I guess my comment on that is we're going to have a supplemental agenda and we have two of them that are actually in front of you today. And that's six those two were just sick those to a loner sixteen million dollars. So I guess I will be a little bit confused if if we don't pull out the hospitals and hold that we're going to send that sixteen minutes that sixty million. Are we going to be expecting these two hospitals and I think this is the premise of a lot of our of our discussions that were heading peer there sixty million dollars that for hospitals and we're gonna have to this going to be sixteen sixteen to seventeen million by their self. If you all look at this look at their sustainability plan that we've asked for and approve it so. I thank I think we need to have some discussions on that because if that's the case then there's just sixty million for hospitals and we don't need to do a supplemental. Representative gray are you willing to I am your motion and willing to amend or withdraw to you also remove that. Yes. With that would draw you are willing to put that in a second motion so that we can have that discussion with these two hospitals yes so I'd be willing to say so what then my motion would be to approve all items on B. except for items B. twelve B. fourteen and B. eighteen. Second. Yeah but Mr chairman may have I want to make one hundred percent sure we're going to have a separate vote for a supplemental agenda I don't want to include a subsequently general quote on we don't have a supplemental agenda so I want to be sure we use the words correctly for the record but we will take those two up in a separate motion which means we were here discussion from the two hospitals and DHS separately from okay this discussion. Burn up I thought I understood that we were trying to include not that language within this motion no thank you thank you point out. Representative Dotson you're recognized. That was that was my question. Senator Chesterfield you are the last line no I'm I'm good with this joke I move immediate consideration of I'm not going to take the motion to stop right. You will hear that very. Senator Caldwell you're recognized for your motion thank you Mr I move for a of a roll call vote into split the chambers on which motion in all substitute motions to the motion. That is a proper motion and proper procedure we would do that I will recognize staff miss Marty Garrity to start with the Senate on the roll call. He did it for the substitute. That's right but this is for this motion. Okay. Members for staff to be able to hear the votes correctly this Kaylee conversations all the rooms keep the order Senator Kim Hammer. Senator hammer votes no. Senator Pitsch. Senator Pitsch. Senator Leding. Senator Leding vote yes senator mark Johnson votes president. Senator Ballinger. Hi Senator Ballinger vote yes Senator Hill. Senator Hill votes no Senator Davis. Senator Davis vote yes senator Wallace. Senator Wallace vote yes Senator Blake Johnson. Senator Blake Johnson votes no Senator Flippo. Senator Flippo votes no Senator Hester. Senator Hester votes no Senator Hickey. Senator Hickey votes no Senator Stubblefield. Senator Stubblefield votes no Senator Hendren. Senator Hendren vote yes Senator Ingram. Is not president Senator Clark is not president Senator English sir English votes yes Senator Caldwell. Sir called although it's known Senator sample. Senator sample votes no Senator Dismang. Senator Dismang centers flowers. Senator flowers both yes center Rapert. Senator Rapert center Chesterfield. Sir Chesterfield vote yes Senator Teague. Senator Teague Senator Elliot. Sir it both yes center Bledsoe. Senator wasn't Bledsoe vote yes Senator Irvin. Senator Rice votes no. Motion fails Vocus ten ten just so everyone's clear. So we'll go back to sender Davis's motion. And service for you please clarify your motion. Yes thank you Mister chair and I need to address I said D. eight and eleven and I need and I meant to say be eight eleven so I move that we amend the peer reports include approval of items B. eight and B. eleven. And that's motion includes the adoption of the report yes it does thank you. Senator Colwell. Thank you share in a move that we roll call and split the a division of the House saying. Thank you. Senator Hammer. Senator hammer votes no Senator Pitsch. Senator Pitsch Senator Leding. Senator Leding votes yes senator mark Johnson both president. Senator Ballinger Senator Ballinger votes no Senator Hill. Senator Hill voted no Senator Davis. Senator Davis both yes senator Wallace. Senator Wallace Smith yes Senator Blake Johnson. Senator Blake Johnson votes now Senator Flippo. Senator Flippo votes now Senator Hester. Senator Hester votes no Senator Hickey. Senator Hickey votes no. Once Senator Stubblefield. Senator Stubblefield votes no Senator Hendren. Senator Hendren votes yes center Ingram Senator Ingram Senator Clark. Senator Clark Senator English. Senator English votes now centre Caldwell. Sir Caldwell votes no Senator sample. Senator sample votes no Senator Dismang. Senator Dismang. Senator flowers. Senator flowers. Senator flowers vote yes Senator Rapert. Senator Rapert center Chesterfield. Senator Chesterfield. Senator Teague. Senator Teague Senator Elliot. Senator Elliot votes no senator Bledsoe Senator Bledsoe votes no Senator Irvin. Senator Irvin. Senator Rice. Senator Pitsch. Senator Pitsch votes yes. And I under center Ballinger. Senator Ballinger Baltz yes. Seven to thirteen motion failed so with that we'll go back to representative gray's original motion to adopt the report as it was from choose day. Yes ma'am. Do I see the yes and. Yep. Here we go Senate again. Senator Hammer. We're voting on the motion that representative gray made in the beginning to adopt the report as it was choose day and. With that we will hear discussion from the two hospitals. After this vote represented Davis do you have questions. A discussion on the motion. Thank you Mr chair so just to be clear we are voting on a motion to approve a report that only approved arpa funds for a dormitory for two year institution but did not pass anything out and healthcare related allied health related to institutions that have successful high ninety percent pass rate. Knowing that they've had well over a year to see that this money was available and we've cut the funding projects in half and still chose not to pass out anything health care related with our offense is that my understanding is that correct. Yes. Thank you Mr chair. I see no other discussion will start to roll call the Senate. Senator Hammer Senator hammer votes no Senator Pitsch. They're Pitsch votes no Senator Leding. Senator Leding votes no Senator Mark Johnson. Senator Mark Johnson was president Senator Ballenger Senator Ballenger votes no Senator Hill. Senator Hill vote yes Senator Davis Sir Davis votes no Senator Wallace. Senator Wallace votes no Senator Blake Johnson. Senator Blake Johnson votes yes Senator Flippo. Senator Flippo vote yes Senator Hester. Senator Hester votes no Senator Hickey. Senator Hickey votes yes Senator Stubblefield. Senator Stubblefield votes no Senator Hendren. Senator Hendren votes no Senator Ingram. Senator Ingram. Senator Clark. Sir Clark. First alternate Senator Garner. Senator English. Sir English votes no Sir Caldwell. Circled over TS Senator sample. Senator sample vote yes Senator Dismang Senator Dismang Senator flowers. Senator flowers what's known Senator Rapert. Senator Rapert. Senator Chesterfield. Centrust provokes NO Senator Teague. Senator Elliot. Senator Elliot road now Senator Bledsoe. Our web service no Senator Irvin. Senator Rice service vote yes. With the vote in the Senate chamber of seven to fourteen vote has failed. Representative gray you're recognized thank you Mr chair Sam emotions I can make today so I have a motion to approve the report as read with the exception of all items under the American rescue plan appropriation all items will be held. Thank. And also the. Proper motion drive second. Actually could I mean that based on. You can do that thank you. I actually need to hold we will may I move adoption of the report as read with the exception of items B. eight through. B. twenty we will hold all those items in committee. Steering committee items. Holding all. That's a a skateboarder around. That's a proper motion do I have a second. I have a second from a representative of. Dotson. Saugor discussion on the motion Senator Hickey your first in the queue yes just clarification was staff. That that motion then we'll exclude us hearing from these two hospitals is that correct Arkansas I'm. If so I'd like to make a substitute motion I'd like to make a substitute motion that what center grade has said will stand. With the exception that we will hear these two reports on these hospitals and vote on those accordingly separately. That's a proper substitute motion and just for clarity your substitute motion is to hear out on the eighteen which is the hospital request correct yes that is that is basically my motion yes Sir I just want to I will stipulate that everything else that representative gray said you know will be hailed yes yeah that is correct. And be referred back to peer correctly yes. All right Processed proper substitute drive second to that I have a second. So the members in the queue understand you're now in discussion on substitute motion to hold all Arkansas's a RP steering committee items except the eighteen which we were here discussion on Senator Elliot you're recognized for discussion of that motion. Mister chair I I need to I get it a clarification I thought we were exempting. B. H. is it still being held. Are not. It's being held for peer committee everything everything under B. is being held no ma'am except that no one at the hospital stuff no ma'am okay B. eight through B. twenty are being held with the exception of the eighteen okay not eight yeah all right thank you yes. Senator Hendren you're recognized yes. So if we pass this motion I guess what I want to know is it sounds like what we're doing here is because we can't agree on which of these are going to find or going to fund none of those are providing and I guess. My question is does that mean everything's delayed for thirty days or is peer going to meet and have another LC meeting. beginning because I kind of think the purpose of these funds is dealing with a crisis and are we just kicking everything down the road thirty days because we can't agree on which of these are going to find. I guess my question is is the plan then that we will come back next month after their regular here meeting to see if we can have an agreement on which of these are going to passers are going to be something expedited on this. I haven't discussed with my co chair but I will in the next few minutes and I will let you know what that looks like. Okey Doke. The. In a Cavenaugh you're recognized yes thank you Mr chair I just want to say from someone who. Has been working on the water projects that we're going to pass over we have communities in the state of Arkansas with brown water. We have citizens drinking brown water. With ball orders. I'm frustrated because we make agreements that we understand that the citizens of Arkansas need clean drinking water. And we go back on that. What ever. Issues we have with the other things in the art of funds. I don't think there's any member here that's gonna say that is okay for us to have brown drinking water in the state of Arkansas. The governor has said on these requests before it was submitted to our before a year. He finally submitted our but it went through the R. P. committee there's five billion dollars worth the needs in the state of Arkansas for clean drinking water and wastewater projects and we as a body. Can not agree to give two hundred and eighty million four a five billion dollar need. I will say. Of my years of sitting here in this chamber. This is the most disappointed I have ever been in us thank you. Senate. Senator Hendren with discussion with staff and co chair and leave or not I had free thought that through before you asked. looking at the calendar the fast as we can have a council meeting to discuss these items would be October to six which is a Thursday we could from the chair. Go ahead and allow the peer chairs to meet between now and October six constabulary during council week without permission from chairs but we can go and give permission and they can meet between now and then I guess two weeks to get some sort of agreement made and brought back to council on October six so. I would say without officially saying that when this motion is done that's that's the plan from the chairs of council. Thank you so with that I will go back to discussion Representatives you're recognized. Thank you Mr these items for example Black River technical college's already been approved by Pierre along with the department of ag and then the do you have an A. items those of already already been approved by Pierre if we don't approve these. This report to those groups have to go back and be re approved with peer. Or they just stay on the report until we meet again they would have to go back to peer with that motion because her motion is to hold those items within peer. Missile in eighteen twenty with the exception of number eighteen with with someone my question is do they have to be re approved or just talk about again or are they after this will they now be not approve they would have to be re approved up here okay thank you they're not not approved they're just held in the peer subcommittee. Representative hopp you're recognized thank you Mr chairman I would like to concur with a representative Cavenaugh on the two hundred eighty million dollars for the department of agriculture for water and wastewater these funds are are desperately needed and have waited there is a time line for these grants to go out they have to be spent by twenty twenty six and they need to get started as quickly as possible and there was no discussion no dissents on at pier on Tuesday about that that money and the need for that money to go out now the communities have been waiting for this information to be able to submit their grant proposals for these needed water and wastewater projects around the state and because there was no dissent or even questions to the department of agriculture on this request I would like to ask for an amendment substitute motion to approve the department of agriculture for water and wastewater of two hundred eighty million dollars. President of hawk I'm not going to take that motion at the moment because I have so many in the queue but we will come back to you are representative Cavenaugh mother is standing she has a motion as well we'll come back to when you guys to take that motion. Senator Hammer you're recognized can I have a opportunist Senator Hickey questions regarding his motion please. Yes all out thank you Senator Hickey is your intent to have the two hospitals come up before us today to present. Their request because they were not heard in peer the other day or what's the motivation be will behind wanting them to come today the the yes that is actually my motion my motion was just to make sure that everybody understood that represented Great made a motion to hold everything however within peer we held the sixty million in hospitals but even during the discussion of that we had said that we understood that we had at least one possibly two or three hospitals that possibly could be built on the very brink of going under and we requested some information and I think they stayed up. twenty four hours a day to make sure they've got got the information that we do so that we can sit here listen to that and make a decision on on those two hospitals so yes Sir that is exactly what what my motion is. The Follow Mr quicken thank you you're recognized thank you. In here the other day what I remember was some of the requests that came through and I think Senator Irvin was one that made the issue of it is some of them just had like one page report other ones were very in detail in depth is that part of the intended why you wanted to single out those two hospitals because to see if they had in depth Renault three if no Sir was not in in relation to any of the hospitals that Senator Irvin was referring to hi thank you. Representative Beatty you're recognized. Just I want to echo the comments of representative Cavenaugh they've been countless hours that those of us in this room and spent dealing with water projects in our districts set through numerous meetings in this room with water projects and the five plus billion is closer to six billion dollars worth of need there. And I understand those grants will be utilized throughout all of our districts I know it's not much money at a big problem but but I think we can all agree that this helps every district in the state I find it hard to believe that this body would pass that off for another month or another thirty or sixty days when we waited this long to deal with this pressing problem we through tons of money to broadband without as much discussion as we've had today so after I respectfully ask that that motion be amended to include the two hundred eighty million and let's put our our little differences over our district what's going to benefit our individual districts aside and do what's best for the state thank you Mr chairman. Is that a do you agree chronic questions. Representive gray you're recognized thank you Mr chair and I think I just want to a slow this down a little bit and I know I've made motion several motions. I just want everyone to understand whether we approve this motion we we we shoot this one down we approve Senator Hickey is motion we shoot that down we approved by motion where we're at with this is if we don't approve a report of some sort today with whatever variation we have the all items that were approved through peer. Correct all of those would all have to start over okay so I just I think I just want to say in this process as we figure out what we can live with together is a body and what we can do that at the end of the day. I think it would be wise that we do finally come to some sort of agreement and approve this report in some fashion and I do also want to say that I do agree with Senator Hickey I should have included that in my motion and I also agree that we need to fund this water project so thank you. Thank you point out I was just this and to do that staff had brought that to my attention for the members to understand that if the report in some sort is not adopted all items have to be requested again through peer and there will be no items in the peer committee Representive off you're recognized thank you Sir that's even our school request right like the school high school the. That that wasn't a separate something all all items. Yes no I'm wrong may represent Vaught I misspoke the ESR funds had final approval by peer from previous council vote so those are not included yes. Senator Blake Johnson. Members this is a I agree we have got to pass something out of this in your in your for. The when a lot of discussion center can I get you to get closer to the Mike revenue hard time hearing you but a lot of discussion about you know nursing programs been prioritized the lease this these birds with Black River have a nursing component in into it I I know we're in a time of discussion I can't get the president to come down here and talk this the this the this is an emergency the preparedness and and in in the in that area for police and nursing that's that's what that does that's what that facility does it has a nursing component and they have went through the peer and they have went through the process for multiple years. And if we're going to include that and and that's the whole region hello our whole region of importance. And I would like to think that will come back and do this again first of October but it has went through the process. And just like these other ones that were held. And I would appreciate that that be included if if we're going to include the department of agriculture and and these water projects because it does have all those parameters in it that have been discussed I have remained silent till now but I would appreciate that for our region of the state and emergency preparedness thank you. Thank you all I'm not. President of flowers you're recognized. Thank you Mr chairman. I would like to piggy back on what Senator Johnson said because just as he is concerned about his. Area and his district and the importance of emergency preparedness in nursing likewise you APP presented a plan for a portion of a larger project that included in that money would specifically focus on nursing my two year college C. R.. Also has a broader plan and augmented that plan and submitted a proposal that would focus on emergency preparedness and Health professions as well. in an area or in a region that is sorely lacking in health services in nursing. And that was very specifically and despair Lee impacted by covid. I would also add I add I was here for the marathon meeting of the other day and approached officials from the FNA and asked specifically. You know if all of the proposals that were funded. were funded or approved out of peer. Would there be dollars less than you've heard today that they will be over almost half a billion dollars left for those areas those projects that didn't get proposals and. And I I also asks is there a timeline is there deadline whereby institutions. Districts with nonprofits of could no longer apply. And they very clearly stated that. Those institutions and organizations can still apply. So you know I think that there are several people who could after me. Press their button and make similar points because finally. Every. Entity that proposed of created submitted a proposal to the FNA and was vetted through that process they met all the criteria that was set by the federal government and by our procurement process. They went through that process they did what they were supposed to do they met the criteria. Then they met the criteria by our steering committee. Then they got in front of us and why in the world we would wait thirty days what's going to change in thirty days except time passing by and are people not being served I don't know. But I just wanted to make the point that approving these projects today. Will not impede any other institution or organization to submit proposals. Thank you. Some members are trying to give everybody a chance for the first time and now everybody's been the queue a lot some school start the top Senator Elliot you're recognized. Yes. Senator Elliot you're recognized. Mister chair I was just a as I would like to ask of you between now and when a tear does meet again what will happen within that amount of time so folks will know what the people need to be doing to be prepared if we when we meet. An order what are we gonna be doing a leadership or whoever. In the mean time to get ready for the next meeting so we don't have this problem. Senator Chesterfield you're recognized yes a measure I had to. There's. What I didn't hear you I'm sorry. One reason yeah. I just use it as our signals but I have a question of between now and whenever peer meets again what is expected to happen within that span of time do the folks who have a proposals need to do something what will we do in the mean time to be prepared or leadership or whoever the we yes that's going to be doing something. What is that. Senator I don't know that. That I'm the right person answer that but I would just say that the same thing you would do for for any other subcommittee vote but if this motion passes those items stay in the subcommittee so that allows you to be able to work the subcommittee to work those items message I'm I'm curious for those of us I mean everybody cares about these issues but if there is some interim discussion going on in those of us who advocates and we should be advocates for everybody district I'm not suggesting not the the we need to know something to hold on the Senate president. Your Hickey will answer that question for you all right I'm attempting to that question the this just let me tell you what is transpired everything that I've said I think you all understand that and everything that you all are saying in here is exactly what happened in Pierre even a little bit deeper we had members calling that one on there they were saying. How about my district on this how about my district because these are as you all know do not are not the actual process of general revenue funds whenever we're in a session and deal with so the thing is is there was even a broader discussion on how things are coming out of the office during to Committee and I hate to say this Speaker Shepherd but. I'm going to because I think we need to yes the morning the Speaker and I got into to Little Rock very early we went had a meeting with the governor of very good discussion you know maybe that should have been done earlier if if I'm at fault on that I'll take that fault it does it doesn't matter to me on that is just where we're at right now but we are going to look at how things are brought out of the steering committee with these remaining funds to make sure that we feel that there is a prioritization within those bring those to the membership so that we understand that at least a majority of you have to agree on those privatizations. And again I've tried this if you like this from the beginning do I think that takes. Good yes I do I'm not saying do I believe that the Black River thing is good yes I do do I believe in battered women's shelters yes I do. As most all of you do however again with all of that we found out with where we were at the hospital and those advanced payments that were taken and now the way that the feds are withholding those Medicare payments. That's why we believe we need to have this broader discussion that has already taken place we have no choice about about doing that as far as the the water goes I understand that. That that's a big thing to all of this the deal is with that too and I understand that the agency department of ag wants to. Know that they have those funds in their account before they start this. But they actually have to put an application process that they could begin that off okay application process I believe contingent upon you know us approving this because actually they would not even need those funds until sometime in December to begin so there's a little more to that story even you know that we could have structure in a different way you know in any one person down here you know if you're a business person you can sit here and try to get that structure that way but whenever it comes to trying to manage exactly what we're doing here today it gets it gets very difficult so I hope that answers your question that that has already began I don't really know how else to say any of this about the way this come out of here I understand that everybody's passionate about their particular thing but that was basically. the reason though that the meeting turned out the way that it did and we just held those items what I am I'm asking on behalf of people who have proposals as well is there something they have to do further I think make it scanned and how will they know that and which is a process for us to tell us who we are so we won't be confused but if if and I'm one member down here and I always want to say that my my answer to that would be as a representative gray is set to slow down and hold up let us get a better grasp of all of this and get it delivered delivered out to everyone through their caucuses are however we have to do that you know we're read we'll proceed from there so that's the only way that I know how to how to answer that at this at this time. I recognize. Yes Sir just for the record. Thank you Mr up. All of this is is about as clear as mud Committee. And what I need to know first of all Mr here is there a motion on the floor. And if so please tell me what they're doing. It It Mr Imus. I just need to know if there is a motion on the floor there is and if it if there is please tell me what that motion and emotional floor Senator Hickey is and I will recognize him. It is a substitute motion representative gray's original motion at this point was what I was I will I will redo that. Representative gray said that we're going to hold all of those items in peer that was her motion and the thing was is that we made the substitute motion says however the two hospitals that are here today which the two reports are on your desk we would hear those it in a moment to make it make a consideration and a vote on whether or not to approve those funds say so number one representative gray's original motion he is that we will hold everything that is in Pierre at this point under item we are all parts that are in the peer to be eight through twenty okay exception of eighteen which is Senator Hickey substitute motion as he substituting that we listen to the sixty thousand sixty million dollars yes ma'am okay so we don't hold everything else except item eighteen that's the way I understand. And then may I ask a in my understanding the rationale. Which did not seem to prevail the other day in Pierre is that we really need the sponsor for these hospitals although last Tuesday we really did need these funds for the hospital so we help it help me understand what happens between Tuesday and Friday. I don't I don't know Senator five Zach Lee concur with exactly what you said about they didn't need it and they do need it what I mean well respectfully ma'am up I do believe that hearing these two hospitals that are before us and what is transpired is actually going to help us give give direction on where this body wants to go because whenever you hear from these two hospitals maybe you decide well they're just on their own and they need to make it on their own I don't know that if you if you decide that on those then I think that's going to give us a clear direction because I think what you're about to see here is something that we're going to see as across all of our districts and. I think everybody needs to know that before we go go forward with the with these other projects I think this will help us to hear these okay thank you ma'am when I was in full support of eighteen and the rest of them as well so I'm not opposed eighteen I just want to know what information we received. Wednesday Thursday. And that would make us come back in support when I was already ready to support on Tuesday. So you had a talk with these people it was that a part of the conversation that the Speaker in the protium had with the governor are you will get back to the chair to Senator Hickey yes ma'am you're talking about the hospital's correct exam number eighteen yes yes ma'am and of course there's multiple conversations with that but what I would have to say is the information where I have brought up the Medicare payments and how those reimbursements are now being hit him being held with the fed. So that is the reason that let me rephrase it that's not the only reason but that's a large reason why these why these hospitals are not going to be able to cash flow and you and we will see a ripple effect across all of Arkansas if if you know if we don't address that and look at this so. That's what I'm saying so if you're asking me what transpired between then and there I believe a lot of that came out of that meeting and then over the next couple days actually delved in and found out what the specifics were and started understanding this advance payment achei a loan from the federal government that was taken out during covid. And now. The hypersphere and they're having to pay it. So that's why it does so there has been an event is taking place that require a bit my opinion requires us to look at all this so the motion is Mister chair and that we hold all items under B. except number eighteen is that correct that is correct and then there was the attempt to make a substitute motion to include number twenty. Was a substitute motion I have not been to they have to do Bennett I have not taken to not recognize that I have not taken any additional motions from doctor he's motion just wanna make sure I'm in the moment I'm not telling you that's not gonna happen right now it has not thank you so much Mister. Senator Mark Johnson you're recognized thank you Mr chairman and this autumn second members let's pay respect to the members that have microphone in the queue at the moment was care conversations out of the room Senator you're recognized thank you Mr chairman and my question may be modified due to your answer to center Chesterfield but we haven't you have not yet taken the substitute by representative Cavenaugh the added the agriculture part to the motion is that pending to you for you to consider that. Senator later depending unless present way I try to offer Kate operate to Q. is not allow everybody to have discussion we had over fifteen members in the queue at that time so I wasn't taking another motion to confuse the discussion we are down down to two members not counting yourself in the queue Revan representative Cavenaugh is in the queue and I will go to her and if she has a motion that time which will probably start more discussion I will take it. At that time I would would ask to be recognized I once we get to that point Mister chairman thank K.. All represent a center Johnson you're recognized. Substitute the substitute substitute right well I'm going to hold you because I've held everyone else and I will go back to center representative Cavenaugh fires and then I will come back to you so I stay in order. Now. I will. Representative Cavenaugh you're recognized thank you Mister chair I do have a substitute motion okay hold on one second. Once she makes the substitute motion center Johnson I won't be allowed to take a substitute to a substitute but she did ask for it first on we'll go to her first fails we will come back to you. Representative Cavenaugh you're recognized for your substitute of substance thank you Mr chair my motion is that we will accept the peer report as read except that we will need to hold items twelve fourteen nineteen and eighteen. So not for clarification staff asked are you want to hear the items separately that are under Adham eighteen. Yes Mister chair so for clarification I want to ask me and actually the report given originally because I don't know what report we're on at this point to be sure that we hold all approve all items except twelve fourteen nineteen leave eighteen out for a separate vote so we can hear the hospitals. Staff has issued they have indicated they have your motion down so we're good we do have discussion and I will go to Senator Dismang to start that discussion. Matt I'm going to have a discussion in general. I mean I know at the you're recognized I don't know that I've ever been so disappointed as I have listening into the conversation that you are having my way in today I'd hoped today to enjoy the inauguration of president Harding university. I didn't get to do that. Fully. Here's what I know do you know we're doing. What we're actually talking about we're not talking about our funds. In all these projects that somehow made it to the front line but no one can really understand how that made it to the front line in which one for prioritizing which ones not some call it timing some call it that whatever I here's what I can tell you no one knows except for those on the steering committee and who ever push those out and since you're in committee how they got to the steering committee. I've lived through GI if I didn't enjoy it we've done everything we can to do away with GIS. We've turned our a into G. I. F. and funny the if funding individual projects that help individual districts what the peer committee tried to do was say whoa. How do we prioritize these items I don't know. If we don't know let's figure it out and make sure that it is fair to all members and in this committee right now. People are heading there might talk about how important it is that is that there is no doubt in my mind that a lot of these items are important your individual district. But it should be a fair process is understood and very transparent and it is not. So yeah we keep talking about we just need to prove it all I've I like all of them the people saying that guess what they've also got through project in the queue. The goal I think should be as we move forward and what everybody needs to understand is there is a limited number of funds left we're about to talk about hospitals closing. If we find a student center and a hospital closes Chaim on us. Now we may be able to do both I don't know because no one can tell me how prioritization works for how we're spending these monies at this point. So I thought we reached a decent balance when we referred report as we did I'm not sure exactly what all of the discussion has been I just know what the latter part of the discussion has been. But we do it you may but I understand we're dealing with GIS and this is what G. I. does it creates dissension. That's why I dislike it so much and did so much to try to get away with it not only is pro ten but later on such a chair. So we're going to get what we want. Individuals will not collectively I can guarantee you we talk about is giving example we talk about wanting to do the women's and children's first project in Little Rock. If you look at the other list the rest listed you know that there are more projects just like that around the state that somehow didn't make it to the list why. They went through the review process they just didn't get called up for a vote on the steering committee does that mean they're lesser. Did you also know that that same project because it wasn't fully vetted received a four million dollar count I matching contribution after they made the request of the RP Committee which means in fact we're going to give them four million more than they actually requested from us for their total project their total spent on top of getting three years to spend how's that fair to anybody else's did their shelter or you know center in the state it's not there is actually on that list a program that funded statewide need but it didn't make to the finalists this one did I don't know why. I'm done I'm frustrated I don't like where we're headed. Now I relinquished my. Representative Hart you're recognized. Thank you Mr chairman I would just like to and I appreciate what Senator Dismang just had to say about the general improvement funds in years past the department of agriculture bons all statewide projects that go to specific communities and so on but. Those funds have to be spent by a certain. By twenty twenty six and those projects are hard to get up and running the costs continue to go up because of inflation and supply chain challenges lack of engineering and all all of those kind of things they're already behind because we've been waiting to give them approval on this and I would just like to say again the importance of being able for the agriculture department to be able to. VOL eight be able to commit the funds to these projects and move forward today on that thank you. Senator Davis you're recognized. Thank you Mr chair Senator Dismang I understand your sentiments and can appreciate that but you know what we are over two billion dollars and at this point we have spent so much money between pairs and are back and now we want to have a plan we want to understand what priorities are why things are or not getting out and I agree not every single thing I have concerns about the things you I sat in here for hours the other day. But. For me I mean might Arkansas tech is on here and that is in my district and of course I'm fighting for tech but not because it's in my district I was also saying the same things about the in TI program and the thing is is that Texas educating ninety three percent of their students our our Kansans and they are meeting a huge work force need across our state and they're graduating people in these programs at a rate of ninety seven and ninety eight percent so this isn't selfish from my end this is about something that's going to greatly impact the entire state of Arkansas because students are being educated in these programs come from all seventy five counties every single one of your districts there are kids at tech taking these classes so for me I feel like the schools that did their homework did their job applied for the money with very very detailed applications are being punished because other institutions didn't do their job apply or maybe DFA didn't let other ones out because maybe DSA or the executive branch whoever did not prioritize how this money should be spent and we haven't held anyone accountable to make them prioritize it either and now institutions like tax and NCI are going to be punished for it and that's my concern I there's a history that I have in the over four years I've been here I've been told be patient it'll work out we'll make sure tech at some point is at least equitably funded or whatever the situation is and I'm kind of on my head and send along my way and that doesn't happen and my fear is that I'm going to sit here in it and watch that happen all over again because of the peer committee deciding they wanted to you know finally prioritise which I'm grateful for I was on track with what you guys were trying to do but I think ultimately tack their program the students there who come from all seventy five counties are going to pay the price. As for that because other people didn't have their affairs in order and I don't think that's right so we need to decide if we're talking about there in this if we're talking about priorities what it is we're talking about in our state that we're trying to fix so I understand you're making a larger point and it felt it felt you know I so I just wanted to say that about tech in my it Fite in this today. Senate is amended you have a yeah I mean items gonna take issue with several things there I mean I I I apologize because it wasn't here for the first we weren't very clear how things report eyes when they were coming out of fear. And then also I think what is happening. And so we have a fine and amount of money left I think if you look back most the monies that have come through our but have been statewide focus whether be broadband or hospital issues I mean brought hospital issues or COVID in general or whatever the amount of the surgeon on we can argue about it those are justified expenditures or not we're now at the point in this is new. We're individual projects are being led out by the steering committee with almost no debate whatsoever without understanding of a bigger picture not some other people may not care how we prioritize things and I guess if you've got a project in the queue and the burning matter cross the line you probably don't care but I did. And no one said anything contrary to that about tech or whatever but of all people I think you understand what it means to be on the outside looking in at least I think that's part of your testimony. I feel like at this point right now it would be good to take a pause to make sure because there is only a limited number of dollars left and understand how we want to prioritize and if that means that we're gonna set aside fifty million dollars that's a made up number for whoever's listening for nursing programs then that's fine but there were other institutions that were told not to apply there other institutions that didn't make it to the front of the queue and no one can tell me why someone could tell me why I would feel differently but no one can they got there for some special reason maybe you need to be on the board maybe you need I don't know what in the member I don't know what the rule is or how it works. But I do want to know and I feel like that's my job is peer chair to make sure we understand what what it is we're doing that yet we could approved everything just move on. But that also isn't contrary to what you said what we've been doing in peer. We're really one of the only places that there's been any vetting whatsoever on our funds. And so again it's not been perfect but we're at a different stage right now in a stage it started really this last committee meeting we're getting funds that are not statewide median within the projects that were let out we felt as though at least the water the water bill for instance that that was a statewide grant program it's hard to argue that's not statewide the training facility like it or not you don't you know whatever it may be. That that there are people statewide are gonna go participate in that because they already do that but again it is committed as I want to do it as a whole then that's fine but that's there was some logic or lease we tried to have some logic on the items that release with your. What and I understand you know the the fairness aspect and that's why I thought it in when you say PAS I'm also fine with that but we didn't because everything we PAS most things but still some things came out and if we are talking about statewide it's the same thing tax educating kids from all seventy five counties meeting a work force the across our entire state so my point is that I'm good with the pas and I understand the work that you guys are trying to do and appreciate it to be quite honest and but it wasn't a full positive still leading a specific project out that I'm for that project I'm not even against it but my but I have to make the point that we did pick and choose their and if we want to pause like let's certainly Popeyes and have prioritize station conversations like let's do that but let's do it a hundred percent. Let's not still let one out or two out and then decide we want to prioritize let's prioritize pause on all of it and then decide how we're gonna move forward I'm great with that and that means my project stays on hold and I'm okay with that but we're gonna talk about fair prioritization then let's have that conversation a hundred percent. Senator Stubblefield you're recognized. Thank you Mr are you know about three weeks ago we had a city county local media on water had a large crowd here and a lot of experts testifying I can't think of any more of a priority that whether to a hospital or nursing school or any other facility then being able to turn on your tap on have clean safe drinking water because without that you don't have any of these other things we have infrastructure in this state it's been here for sixty seventy years we have dark water representative Cavenaugh says we have a neighbor of Mississippi that just dedicated to billion dollars to the water infrastructure in the water needs we have a department of agriculture this identified over five billion dollars worth of projects that need to be done and done quickly and we do like it's been said before we have a certain amount of time it takes a lot of time for studies in engineering to be done this money has been spent by twenty six it's not Spanish could be sent back. Water's water is critical not only for our each individual but is critical for our economic development it's critical for everything we do. And we have an aging infrastructure and two hundred eighty million dollars is a fraction of the five billion this need to fix our water problems in this picture without. What Cavenaugh said and represent fall no dissent because ever this is not from my district this is for all of our districts. I'm not doing this for to help minor and may have some of these projects won't even be in my district. But they'll be here districts. And they will help your people who have priority needs it in regard to water and safe drinking water. Am wastewater project by the way if you drive around ruling even even the urban. Places you'll find out there's a lot of things going on with our water that most of us are not even aware of that are unsafe and of you know we could be like Fort Smith we could be have a federal judge order us to do some of these things and they will be too late. So I would encourage us to go ahead and approve this two hundred eighty million dollars water because it was the with the peer without any dissent with any dissenting votes. I mean it's a no brainer to me because it's not giving anyone of us any. I'm a. I'm not doing it for me I'm sorry for the people of the State of Arkansas thank you Mr. Representative Cavenaugh. I hit the wrong button senator Johnson you're going to get back and representative Cavenaugh you're recognized yes I'd like to withdraw my motion place. that's proper and we will accept that. Senator Blake Johnson. A to make a motion to expunge the vote by other. We're we're by the regional the report was the voted down as proper motion I have a second. Senator Hickey you're recognized. He. Your. You're recognized it give me just a moment I'm trying to think. I'm gonna I'm gonna I'm gonna of me in my motion to say that we go back to the way that the peer report was approved Originally through peer. That that motion has failed so we would have to take Senator Blake Johnson is motion to expunge that vote. And I'm not gonna do that Amendment my amendments this my amendment is is the one that substitute on the table which is. Which is that everything goes back everything goes back to the to appear with the exception. That we're going to hear these to hospital so we're not gonna be pulling having the whole sixty million it'll be just whatever we do here or are whether we not and also include the department of ag water projects for the two hundred and eighty million dollars. Yes. So. We're confirm staff because we can have two motions on the same that one has previously failed so one second staff confers we would take that motion. Senator it is confirmed that motion has not been made nor has it been failed so we can take that motion do I have a second on that motion. I have a second. All the a discussion on the motion I have three members in the queue is that discussion on this motion. The representative Dotson you're recognized for discussion on this motion thank you Mr chair in this is more of a in query of what staff has down that this is included in this motion I'm generally fairly good at following all this stuff but I don't know what we're voting on specifics including B. eighteen and B. twenty. For passage today. Not be eighteen has exceptions that only the two hospitals that are presenting would be funded out of that sixty million dollars so if I understood the the motion correctly everything else would be sent back which would be the rest of the peer report that's right. So nothing else on the peer report would be approval no no no no no he's including the peer report so all the other items on the report would be included other than B. eight through twenty it would only be B. eighteen and B. twenty so. Send everything that road. Released like B. seventeen was part of the report B. two nineteen was part of the report. Those would be sent back as well. Under this motion yes. So we will the only difference is really releasing B. eighteen and then sending those other two I just mentioned back. And that would be part of the original report was not releasing B. eighteen is entirely only be eighteen concerning here is to hospitals. Okay totaling sixteen million and some change I would ask chair if just so everybody's on the same page before we take a vote not right this second but I know there's other discussion that we go back through and identify specifically B. eleven B. eight nine ten all of that B. B. eight through twenty exactly which ones are being held in which ones are being sent back to committee prior to the vote yes and there is an item under a three that is also held as well as that report so we will we will clarify that motion which is also the one that was held yes so are correct if we can just clarify those before the vote immediately before the vote thank you yes. Senator Mark Johnson. Thank you Mr chairman of. I'm support center Hickey's motion and I'd like to. Clarify something and and maybe even. Ask questions Senator Dismang or or or. Maybe concurrent what he said I think his point was very well taken. but I want to say that we are. We're looking at analogous situation to what we see in Washington with the earmarks. We have big programs that the federal government wants to do in someone's Asa slip their air market and many many and I think all of the way things have been brought forth in items eight through twenty are probably good for our state but this a prioritization let me make clear the difference here with item twenty. And possibly without a mate team which is why I support this we have another layer of approval to make these projects go Secretary ward his staff will be looking at the water and sewer projects to prioritize them based on all the proper criteria that they've used for similar things in the past so they're not your marks their statewide projects they serve the entire state of Arkansas and so Senator Dismang that's how that this difference differs from G. I have some of these other things we the legislative branch Mike this appropriation approval these federal funds to the Department agriculture or other appropriate agencies as in the related to item eighteen. And then they do the job that the executive branch is closed today a lot of our problems are the to much friction and. One branch of government messing with the other one when maybe they shouldn't but but I appreciated Senate is by getting us back on track he was absolutely right but I think the difference in these these cases and and that's what we'll be doing Senator Hickey is motion is putting this in proper order all the state water projects will get to apply and lord knows we have much more needs and are gonna be able to fund but it lets the process go forward and every day we wait on these things the cost of materials inflation cost of the bond just look at interest rates just the bonding part of this that they're having to do for their local share all this goes up while we sit here and and argue over things and really on related so I appreciate the opportunity to ask my colleagues let's pass this and least move those things forward where the people on the part of agriculture and I guess the other would be it to of DHS. Okay can go do their job thank you Mr. Senator are you marked as president are you voting on this. Okay Sir just when you're recognized for his substitute motion Mr. I move that we accept the peer report I move that we accept items H.. Nine ten eleven thirteen fifteen. Sixteen seventeen eighteen nineteen twenty. Of the pure report. I'd like to speak to it. We have had the arpa Fund sent center just okay on one second. I'm trying to get better representative gray's original motion we can't do that and I like that that's what office and the so you would just hold one second while we verify that. We can pour more thank okay and of NC one and two. Which is not the same. This is part of. So we would have to have an expungement so I'm not taking that such to motion at this time Senator Johnson you're recognized. Because it makes those those items were all in two previous of included in two different previous motions therefore I would have to have an expungement of one of those motions to take that motion that is advisement from staff Senator. Hi I'm. Not doing that well I have a motion on the floor Senator Blake Johnson you have something that discussion on the motion share you're recognized the. I would ask that those items that came out of peer. If we're going to be the pier Committee today at least let those items that came out come to the floor and be discussed not just to those items. And and let this committee choose to see if those are viable and in in Senator Hickey is motion. Let all let let all those be heard not just a hospital's let let let those The Addams that came out of the committee be heard. And see see if there this committee sees is that there is a viable as as the pier Committee I would appreciate that. Senator Hickey you're on clarify your motion yes and members whenever you start hearing all this this is this is basically because representative Dotson wanted wanted this clarification so and then so everybody understands so the motion before us is on the table is that is that we're going to adopt the repair report with the exception of this. Items B. eight and out of fairness I'm a go ahead and call now. Arkansas tech university B. nine university of Arkansas at Monticello B. ten University of Arkansas at pine bluff. B. eleven. Best northwest technical. B. twelve. Is wilt women's and children's first be thirteen is Flanders Smith. B. fourteen. Is the role health partnership the fifteens the Black River technical college. B. sixteen. What is Southeast Arkansas college. The seventeen. Is the aging adult and behavioral health. And B. nineteen which is vaccination testing requirements. Now B. eighteen that will be heard separately here in a moment with regards to the two hospitals you see sixty million dollars. But we're going to hear just separately just just the two hospitals are going to come before us if you decide not to approve those than those funds won't be disbursed whenever we hear that so that's part of the motion and B. twenty which is the water projects that you all have been talking part will also be approved because that would be in the original thing that come out appear. One of information you're recognized. The program is saying that we will not fund eight nine and the ones he said today is that what you're saying that's what is it. And so we will yes then we're okay with some folks some items being approved while others are not. That is in essence what this motion is about is that right is motions about hospitals in water good good. And we won't have a chance if we approve this to come back and deal with any of the others that are in this report. You could with an expungement but not at this time. I see. What. You it's really hard to talk against hospitals and water. I mean it really is difficult to do that. I just don't understand why. We have had the sponsor since time immemorial it's things we have we have a process in place all this time now all of a sudden there is a lack of clarity. When these particular issues come before this body. If the interest wise and prioritization should have been done at the beginning of the process. Should been done at the beginning the process not here we are at the eleventh hour when people know that there is a critical shortage of nurses across this state and we're gonna say but we don't really believe that. Because we're not going to deal with them as if it is an emergency so I'm just concerned about the motion a thank you Mr for you to. The motion doesn't kill those items it since those items back to peer to be heard. So. That is a proper motion. As a motion that is non debatable all those in favor meet consideration to Senator Hickey substitute motion say aye. All opposed ayes have it with that we will take a vote on Senator Hickey is motion for autumn eighteen and twenty and eighteen to be heard by the two hospitals all those in favor say aye. All those oppose ayes have it so with that we will move on to hearing from the two hospitals with that I'll bring mark like to the table with DHS. And we will proceed. Mr white if you would in addition seven record you're recognized to start on the two hospital reports thank you Mr chairman mark what department him services Mr I think I'll give just a little backstory just sign others Miller confusion this morning and to make sure that everyone is up to speed with where we are so we had brought to the steering committee a proposal to you sixty million dollars of arpa funds for hospitals that are in immediate jeopardy of closing to be eligible for these funds the hospital would have to demonstrate that number one that they are in immediate jeopardy that have to say that and then provide some financial information and meet certain financial criteria to demonstrate that they are in significant very significant situation we also categorize these to try to address those that are in the greatest need based on their situations and so the first category involves hospitals that are independent hospitals that don't have a system they can rely on or look to for the resources hospitals that are in smaller counties of less than fifty thousand people I and so that gives us a group of hospitals there potentially eligible. Of when we came to peer and discuss this the discussion in peer was that the committee rather than authorizing the full sixty million the Committee would rather take these on a case by case basis and so on Tuesday that was communicated to us we work for the hospital association to notify these hospitals of that opportunity. To have submitted applications in the forty eight hours or so that have passed since then we're seeing those yesterday afternoon we are in the process of reviewing those applications are determined that everything is correct and they provided all the proper documentation but you have their applications before you and so now those are their for your consideration it's my understanding representative of both hospitals are here to discuss those request and answer any questions you may have and with that Mister chairman I'm happy to answer any questions. Represent Dotson you're recognized. Thank you Mr chair And this. I guess this is a. I think this is the six million dollar when I've got a whole pack on here but if I'm reading it correctly. This is three months payroll expenses for June July and August that gets us current. But I guess I guess the question this is one of the things that was part of the overall discussion is sustainability moving forward What. What is the overall plan and this might be in here and it might be something that the the hospital needs answered directly but what is the plan going forward if we're band aiding something just to get your current but it's been poor mismanagement to date. Is there change in management is there changing stuff going forward wow how do we get to where we're at and we just put a band aid on this to where we're going to have to amputate later. Yes Sir I can what will be addressed the the three most personal point because that's I did not match them earlier comments so in order to include a cap in the year we had a ten million per hospital overall cap but we added additional cap the hospital comply to up to three months of their payroll and that was just a tool to give us to make sure that we've got some money would spread around all the hospitals that have a need there also that's where the three month spiral comes in interstate ability what we originally proposed what that the hospital would have to come back to us and bring a plan within ninety days of the sustainability plan however in your committee the committee expressed their intent they would like to hear some information on sustainability on the front end before you as a legislature approve that and so that's that is what should be in front of you as far as the specifics I would defer to those hospitals as far as to what their plan is and where they're at. Okay can we hear from the hospitals. let me get through the members questions and if anyone has a direct question to a certain hospital we will bring those people to table. Send a representative Lowery you're recognized. Thank you Mr chairman. Mark is the oven just generally speaking is the revenue shortfall I mean I know you talked about these expenses but revenue shortfall to cover those expenses that due to unreimbursed care. The thanks we've heard from the hospitals are number one higher expenses across the board particularly in the area staffing which course we seen throughout the economy because the pandemic with especially in healthcare they've also cited these Medicare advantage payments we're at the beginning of the pandemic the federal government advanced them payments on Medicare and now they're reconciling the hospitals have to pay that back my understanding for the hospital told me is that they have their Medicare reimbursements there's a twenty five percent deduction initially in the fifty percent deduction and they're on the verge of having to repay whatever outstanding balance the to Medicare so that also is cutting into their cash flow now okay all right thank you for the clarification. Senator Elliot you're recognized. Thank you Mr chairman I know that all of us surely should know what a hard time it is especially especially in our rural areas and I'm just concerned about the notion that we are in this position because these two hospitals are the victims of poor management if you understand we live in a poor state we live in a poor state therefore you have poor people therefore you're going to have problems I can't imagine we don't understand that so I guess my question to you Mr white or if somebody from hospital I'd like to know before all these hospitals are plastered with the and the victims of poor management in a poor state where we are all struggling unless we are mighty lucky I'd like to know is it a matter of this the mismanagement or is it a matter of this is where we are because of who we are and what we are. I would say that from our perspective DHS we just can't speak to that I mean certainly we are very involved with the hospitals from the Medicaid side but they have course their Medicare operations their private insurance and we just are not involve hospitals on their day to day management of those operations particularly those that rely more on the Medicare and private health insurance and because the timing no we would hope to get a window into that would have that stabilit planned coming within ninety days but at this point I can't say that we as DHS or a position where we can give you any sort of informed opinion to answer that question I guess a hospital administrators can. I would have to defer to this it's it's I'm a as a matter of fact I don't even use a time doing that because I can't imagine any administrator just saying oh I think I'll get up to date and mismanagement hospital so we'll go under that would be sick. Yes I don't need to hear from anybody missed Europe that just ask questions so we can think about. Centerfield you're recognized thank you Mr chairman like my colleague I'd like to hear from hospital association. Just have a question for them okay join in the district admission whatever it yeah. Yeah. Restrict. I am Jody entered on me executive vice president of the Arkansas hospital association. My recognized for a question Mr. Mr it what is the primary source of income for most hospitals is it not surgeries. Sometimes it is it at in patient care is probably the primary source and of course you fully understand patient mix and pay or mix so each hospital is dependent on its payor mix meaning government sources like Medicare or Medicaid commercial insurance and then depending on where you are located in this state also you have uncompensated care completely with people who don't have any sort of coverage in our and what we call self pay and so those individuals even though they have no insurance must be treated by the hospital yes ma'am they must at least be triage through the emergency department during the pandemic a number of surgeries were put off in various hospitals and if if that's incorrect please tell me that is very correct the government had us stop what we call elective procedures but let me explain that elective procedures are not cosmetic surgeries elective procedures can be as serious as a kidney transplants that can be scheduled either on a Tuesday or Wednesday. My husband having just had surgery to repair the torn tendon in his knee and that could be considered elective surgery yes ma'am but it wasn't assess a day for the patient yes ma'am and so if we don't have patients who are able to pay then the hospital suppers yes ma'am our thank you Mr. Senator Hammer you're recognized thank you Mr chairman directives one Jodie and Joanie and you know when the hospital's first became aware of the fact that Medicare was going to do what we've been told they're doing and it came through that cares Act funding apologize for not having the exact date I think that was March the twenty eight of twenty twenty one and I'll have to go back and look to see if my date is correct. How come so long getting to us with the request to the need them because that's over a year and a half ago and did they know that when they took the money and where the fully aware of it so all over simplify Medicare xcelerated payments what happened was when we had to do this things like stopping the scheduled procedures and when we were definitely in a time of crisis where personnel costs were increasing and we were surging in the middle of COVID to where our capacity was and frankly blown out for lack of a better word and Medicare recognize fully that it's reimbursements to us were not adequate for that kind and type of care that hospitals had to provide to patients and so what they did is fully recognizing that they basically advanced three months of what they believe to Medicare would have reimbursed a particular hospital over a period of time to try to make sure we had appropriate cash flow so as a reminder we were searching the east and west coast had already searched and so we were already paying inflated prices or at least excessive prices prices over what we had been used to for personnel and supplies that were in limited supply so when that happened they gave us the dollars to cash flow the ability to staff those beds in the middle of the search time period there was a time period to wear they fully recognize if they took back a hundred percent of those dollars that would put us in what we're now calling immediate jeopardy so for every Medicare patient that came into the hospital after limited amount of time instead of paying the normal reimbursement we would have received from Medicare for those patients they paid a portion of it it started out where we got paid seventy five percent now we're in the time period for most hospitals where they're receiving fifty percent of it Senator Hickey explained that very well it's almost like a garnishment right your you know that you should be. In paid two thousand dollars but you're only being paid one thousand because you had to take these loans out in order to have the beds available for COVID and non COVID patients in the middle of a covert search now we're at the time period to for many hospitals where the demand letters will come from CMS the centers for Medicare and Medicaid Services when those demand letters come due there's an interest charge on top of them a four percent. And we gave money to expand COVID beds do we have an audit as to how all that money was used that we gave the hospitals before they've used at all I'm not sure where you all are in the audit process but I can guarantee you that all of the money that you all gave to hospitals which was very desperately needed and we are so grateful for what you gave us has absolutely been spent on care for patients and it still hasn't covered the increase in supply cost and personnel costs that we're struggling with today and then the last thing is you've heard the conversation but were running out of money on the saying are we just put a bandaid on and should we look for request in the future from hospitals because until this Medicare call back I'll call it finally runs its course or are we just by an what thirty days worth of time sixty days worth time with this or how do we know so that the committee can can maybe hold back some money in case you come at us again. Thank you every hospital is definitely different in that respect you definitely are buying time from the Medicare xcelerated payments it and supply cost increases I will tell you quite fully and quite honestly the way out of this long term is increase reimbursement both from commercial payers who are paying us the same rates or less rates or different rates claiming that they're paying us better rates than they have in a long time and Medicare and Medicaid have stayed the same when you're cost increase and your reimbursement stay the same you can't make that up and that is the predicament that hospitals are in right thank you thank you Mr. Thank you Mr. Senator Teague. This is senator flowers you're recognized thank you mark the other day in Pierre I thought I heard You respond that. You. Estimated are either expected that there are about ten hospitals that needed Yes extra money the sixty million dollars. And if I'm not. Overall I think I just heard you say. That now you it estimate about ten million dollars. would be needed. To help these hospital's office ten hospitals. And sixty million dollars. At ten million dollars each. I don't think that. Sure I'm trying to understand. If if this money is appropriated for these two hospitals. Sixteen million dollars in leased. I mean that's a big dip into this the part that's already not full. Yes ma'am and there are there there ten hospitals in the first bucket of hospitals that are eligible under this proposal none of those ten hospitals we did just we do not have visibility into whether not every single one of those ten hospitals is truly an immediate jeopardy of closure it may be that is two of them it may be ten we just we don't have the information to know that and so in coming to the committee we wanted to have a very targeted proposal recognizing the many demands on these funds and so that's why we we have a sixty million with that was simply our estimate of where we thought would be enough to cover. Those tend to the extent that they needed as well as some critical access hospitals but it just depends on how many those hospitals are truly in immediate jeopardy and where they come back with an all add that it's. For the other hospitals this summer larger summer smaller so what they seek is going to very depending on what their typical payroll amount is in the month. I have a follow up yes my. So. In the last forty eight hours you've gotten is information from these two hospitals. Yes ma'am so do you not need time to verify. What what David written here. What what our intent is is assuming that the committee does prove this we have staff you're working right now to verify the information to get any additional documentation and sars hit is between now and Monday to verify and make sure that this is because the numbers are correct thank you Mr correct information if there is an issue then we will we will not send out payment we will go will will have to comply with the criteria that were set forth in was approved by the steering committee and will may or may not be approved by you is a body. But it doesn't go back to the steering committee. For approval. Correct our understand this point is that if we're going. More or less in line with the terms set forth in what we proposed. We just keep bringing hospitals back to you on a case by case basis up to a total of sixty million and if we get to where we've exhausted that sixty million at that point we would have to go back to the steering committee. I think clarification will come from the peer chairman. Senate dismaying you're recognized. I'm in if we approve these two items in these would simply be the two items are going to be approved one thing I alluded to earlier in it in in in my. Statements maybe a little bit lost because occurred on longer than I should have is that I do not anticipate that this is the end of the road for hospital needed state that try to articulate some of the things going on so the timing issue some of the you know the reality that when these hospitals were taking these advance payments they had no idea that inflation would go the way they did nursing costs would go the way that they have and so there's a there's a lot of medical institutions are in a bind or will be approaching by hopefully must be able to work it out but for those or not we need to make sure we have money set aside as a backstop to ensure that we're able to provide health care in rural areas in the state. But it would if we approve this is only these two items. Thank you senator. Senate budget you have questions a I think I'd like to follow president Hickey Senate president picky because I think he's going to ask questions because mine relates to a discussion and I had so I can wait to see if he covers the. Representantes and you're recognized. Thank you Mr chair Most of the rest of my questions have been answered so I just want to say. I probably misspoke in my haste earlier I didn't want to I want to publicly apologize to anyone that I might have said had poor mismanagement I don't know that specific situations in any of these hospitals so I don't necessarily need to hear specifically from those hospitals after we're done with these Mr but thank you. Senator Pitsch you're recognized I think I got a little clarification. We owe the feds the money whatever's left hospital a of sex dollars left when this money is appropriated back to set hospital is that it their intent or can we force that they go pay what's the load first persons using it for day to day operations or supply chain issues Sir I think that's a key point in clarifying where we're going with this because we're handing money over we tried oversight that money. If it doesn't go to paying a debt back first then that's a different amount of so can you clarify that for us I've talked What we have a great I believe Really don't have any meeting that call back and maybe Jody and I don't know what we can do for hospitals when they're in dire straits and worse and. Pay the equivalent here to your bill when you're you know you're that that's a nice thing to say but that's a really tough thing if they don't do it for us there were in force and I have some concerns with that you want yes Sir I would say that no we two things number one if they do not meet that if you also does a condition and they do not meet that I mean we do have the legal authority to recoup that funding from the I dollars that if if the hospital goes under there's practically there's no way to get that back the other point out throughout there is my understanding from the hospital association the hospitals is they're expecting I think Mr alluded to this earlier they're expecting a demand letters from CMS within the next few weeks which will give with that final balance is so there should be documentation available very soon of what is that balance owed and then if they paid off they would be able to demonstrate that to us. Senator Pitsch a I will follow up with mistreat her and I had a lovely conversation yesterday afternoon can you talk through some of the panel not I don't want to call in penalties but the interest that will be accrued on those loans if they passed on certain dates and if we put some stipulation of sixty days or ninety days Tommy's we would in fact loosen money up from the hospital to be able to not include those type interest payments is that correct yes Sir that's correct an and all publicly apologize to you for the lovely part of our conversation thank you for that at the the truth of the matter is there is a four percent penalty on top of it and if hospitals don't pay it then that can ten used to recruit for the hospitals against once again those Medicare patients that are coming in to visit the hospital so as cost in for personnel supplies and everything else are going up it actually makes the delta between the cost of care for that particular patient and what they're being reimbursed actually widened and it exacerbates their financial problems in their financial distress it is in the hospital's very best interest to pay those loans off before that interest becomes due and hospitals have a plan both of them who are here today can tell you what their plan is to pay off not only that loan at but to actually succeed and move forward to continue to be able to take care of patients in their communities. Thank you Senator Hickey here next in queue thank you Mr chair of just moved from from the chair right here I heard that what DHS said about DF in a and that that they've looked at it I assume that we need to get our consultant to actually look at that I understand the two today are different but I'm I want to go ahead and say that out there that if they're going to get with Arkansas thin and they find out that there can be direct payments on these any of the hospitals are coming in the future. I think that we would swap to that because we would like to do that today but these are critical is what what we're going to say and Mister chair some point whether I'm I know that seems like there's a little bit has entities hesitancy here but I want to hear from each one of these individual hospitals but Mr trip I guess my thing is and you may not know like the balances the current pay off balances or even a rough estimate of these while I'm a problem loans or grants payments but I will I will refer to him as loans because I think Can't stab in the dark is I don't know when the hospitals took the loans because everybody's time clock is the same but their start date wasn't so they have a certain amount of Another amount of time to start their fifty percent clawback if everyone started in April and another one started in June that will leave balances all over the place in different forms okay. When we think we could get that just. We can F. I know that toss where we get ask individual hospitals or and if you all want to make sure any proposal that comes before you from a hospital has that level of detail and we can make sure that they provide that thank you S. on all persons thank you Sir so at this time represent Hickey would you like to pull one administrator up at the time yes I will I believe that that's the appropriate way I mean because if we're going to look at the separately I believe that we need to just have one at a time okay and deals is there transaction which one you want first do you have one on the agenda for Sir I have here since first in my stack then I'd go with that Sir okay see if we would going full administrator from Harrison to the table to answer questions for Senator Hickey. Okay. If you guys would introduce yourself for record and then Senator Hickey is recognized for a question. Good morning thank you for allowing us to come in and share our position with you and thank you for your consideration my name is Sammie Cribbs on the chief executive officer for north Arkansas regional Medical Center. I'm can panel chief financial officer for north Arkansas regional Medical Center. And I'm Josh bright vice president of operations for north Arkansas regional Medical Center. Okay I'm I'm up here to your left by the way thank you thank you for coming today eight and you've been sitting out there and have heard all of this discussion and and kind of understand where we're going so I assume that you made some type of prepared statement it's going to kind of give us an overview of white why you've got were you you're at and I understand sometimes that that may not be comfortable to to say but I would like to know. For for three different things before covid how it how you were operating whether whether or not your cash going at that time and some of your financial information you don't have to get real detail with that but I want to know if you basic consider yourself solvent before then. How the COVID has has affected you. What your balances are on those as I will refer to him on the loans for those advance payments that were calling it and then how are you going to be solvent and I will call it over the long term I like to say over the next decade does this money won't do that for you or or or or if or if we do this if we give you this money. Or are you going to. Only be able to survive a year everything else being the same as far as your reimbursements and and all of that and whatever you do with the engine I mean with insurance companies so if the if you could start no that was a lot but again we're we're looking to give you how much money are you all asking for. Million how much ten million ten million dollars requires a little bit a little bit of detail so if you don't mind starting. Happy to discuss I understand healthcare finances a little bit of a an oddity so we'll start prior to the pandemic in two thousand and nineteen we finished our you're with the one point seven percent margin and so many of us that run businesses would think that that wasn't a very much but in health care were extremely excited when we see that type of margin were able to turn that money back into our community or five oh one C. three not for profit so any of those funds that we that were able to have positive on our balance sheet we turn back into the community we turn back into patient care and so as we look to the same period of time as we've emerge from this pandemic we saying significant increases with labor cost supply cost our cost for per adjusted admission is nine point one percent so that means caring for one patient is nine point one percent higher than it was prior to the pandemic and so we've looked at these numbers and we're now looking at a you'll you'll the contribution margin a negative fourteen percent and so as we have taken great strides we started this In probably February we saw the train coming that there was going to be set be some concerns we understood that we had the Medicare xcelerated payments we knew that was a loan that was due we started setting those funds aside we looked at what we had in reserves we've gone through twelve and a half percent of our reserves and five months and so while we've we have made a payments on those Medicare xcelerated payments the imposition of the S. put is we're taking money out of reserves and obviously if you're not putting anything back in your savings account it's not sustainable so what do you do then and I think that's a lot of of what you are asking is this sustainable so many of you have a document front of you if you if you flip to page two you can see there's extensive information's been provided with expense reduction of looking at our three forty B. program as a drug pricing program there's been a lot of controversy on that utilizing that to the full full extent we can especially the roll market to provide care and to to re use those funds revenue capture net revenue generation Ste and then if if we're not still not able to cash flow that point what happens to we have a catastrophic failure planned we do its readers reducing services reducing access to care that's why we're here that's why we stepped up spoke up and said Hey we want to have a conversation about this before we decrease the access to care across our community because we're all here to serve the people of Arkansas our Medicare xcelerated payments were ten point five million Ishq I could be three your six but I think it's pretty close to ten point five million we have repaid ninety one point two percent of that but as I have explained of that's that's dipped into our reserves are cash flow and we are expecting our demand letter in September we haven't received that yet but as soon as soon as we receive that to Jody ants point we need to make good on that because otherwise we'll increase the interest. Which just further creates difficulty. From a from a payment perspective Sir does that begin to answer your questions it does it I didn't understand what you meant it could be three could be six now you thank your advance payments for ten and a half million switch you to accept that your testimony I'm not not sure the exact amount can right at ten point five million okay Sir so so basically your request all those payments have been made I mean anybody can understand that they've been made but they've been coming out of your reserve your cash for whatever you want to say so basically what you're asking for is really the reimbursement of what your regionally got. You know from those advance payments it appears like to me in an essence the balance comes out to about the same it's not ten million dollars but the the cost of providing care has increased significantly we have seen hi. Seventeen a half percent increase in our average hourly rate throughout the pandemic this is all an effort to retain and recruit staff in order to provide care for our community that is an ongoing challenge in addition to the the increase in our labor costs we have also had to access contract nursing travel nurses through the market and in some cases we were paying as much as a hundred and seventy five dollars an hour those rates have dropped a bit we're now paying on the average about a hundred and forty an hour so the cost of providing care has increased significantly and as Sammy mentioned something like monsters gone up about nine point one percent. reimbursement has not changed About sixty percent of the business that we take care of is Medicare Medicaid patients and we haven't seen an increase in reimbursement for those services many of our managed care are managed care plans have not paid to any a change on reimbursement so we're absorbing the cost of care through the increase our labor rates and the increase in supply cost. But we don't have additional reimbursement to to offset that cost sure and I shortfall I understand you just just I will be just blunt blunt here what what I'm doing here is with these plans from groundwork for committee basically because your number one that will be asking number two because basically although we may not know what the current balances or of all those advance payments on the loans where we want to call them. The manager asking for today is basically is basically what you got on that I understand all this other stuff so with each one of these hospitals. Comes in along the same line then there's going to be a billion dollars of request out there coming in so what that's what the I will ask the same questions of the of the next of the next hospital to so I guess one final trip question for me and I've got a motion up here but I want to don't wanna make into a I hear some stuff personally I wanted to make sure that we went ahead and paid off your whatever your balance was on your direct loans it sounds like to me you said ninety one point two percent to ten million so you're you're only got million dollars left thereabouts made yes Sir we okay Sir we have a nine hundred and thirty thousand dollars right what's left I anticipated demand letter by the end of September and we have funds set aside to pay that okay if this if this body decides to go forward you know with approving this if the motion that I have says that that the funds that we give you that you will use that you will use those funds to pay off the balance of this basically immediately or within the ninety days whatever they've got on there is that going to be an issue for you all. Not at all thank you. Senator Hammer you're recognized thank you Mr can you tell me I'm looking at you she but can you tell me real quick what do you have left in reserves as of today. Which number on the sheet or is it on the sheet the handout. Right now we have thirty four million dollars in reserves we have gone through thirteen percent of our reserves and in the last four months would you mind on the Michael closer if you don't could you pull Michael closely I'm I'm sorry that's right thirty thirty four million thirty four million yes Sir and we have utilized a about thirteen percent of that the last four months okay so with your reserves how far out are you as far as being able to operate in days. I think that depends on on where labor cost if we continue to see inflation we are probably within three to six months of making changes to our service lines decreasing access to care which will further increase the health disparities across the across the area that we serve we serve about ninety five thousand people in our catchment area five counties there's not another facility there and so are concerned there is that we've continue to diminish our reserves we can't we can't run on on zero with reimbursement not changing so we'll look at service line interruption and that'll probably happen within the next three six months and have you received money from I came a few or the hospitals that received money from us before our money or any other money have you made any other request before the legislature for funds in the past. Thank you. We we did receive a are some money yes how much did you get that time the member it was that for the up to expand the COVID beds when we gave up their argument yes yes Sir that is correct and how much we give you member if I recall correctly Sir that was about one point seven million dollars I'm sorry about one point seven million dollars okay all correctly Sir so the way I would summarize it is you're asking for money today that's going to help you deal with the Medicare I'll call call back but that's all I'm going to fix that problem Jody incest one while ago your testimony is if we don't do something in the way To your far right over here so thank you appreciate it I am so just kind of what I would you know through coming through pure Committee and just so you understand I chaired peer committee and one of the things Need currently what's your days cash on hand right now. Our days cash on hand or at a hundred and twenty two hundred twenty two days us on hand okay and I think that kind of brings me to my next point right now So just about the basic math if you've got thirty four million in reserves saying your expenses it looks like your total operating or about thirty two million and that's for it looks like for per month would that be correct. Four shows July twenty two actual so you got thirty two million in total operating expenses that represents four months that represents for months for months ending July that's surfaced our fiscal year operates from April through March okay so essentially you've got enough in reserves to cover for months of expenses without any additional revenue coming in with that be accurate I guess. That is correct correct okay and that did you were you able did you meet the criteria because of your negative of operating margin your net margin. Yes okay M.. In meeting that net operating margin. I guess would it be fair to assume that the the pay backs to Medicare were part of that the because part of that large negative profit margin. Absolutely as dirty and explain that's less revenue coming out is we're paying those loans back okay thank you enough. Mister Mister chair I think I appreciate the latitude here and. The very hard for me to sit here and ask you those questions that I just asked you Europe in my neck of the woods I'm up here all the time I love your hospital a love what you do but as peer chair. It it was not my intent to fund something like this my intent is to find someone who has less than you know fifteen to thirty days cash on hand who I feel like they're they're closing is very imminent I personally unless I hear something a little bit further in testimony I don't feel that the that Closure for you would be imminent so. You're welcome to respond to that. I appreciate that concern and that's why we're here as you can see we we did a very detailed evidence proof that we aggressively went after what opportunities we had to change our to change our business model to try to optimize those levels of care the concern for us is that if we begin to limit care when we talk about immediate closures hospitals don't necessarily just close all at once they start to decrease access and so as you begin to decrease access the first things that go or or EMS services those arguments services cover and Newton County which many of us know is the buffalo national river can you imagine going canoeing or going hiking and had not having an ambulance service available to respond so those are those are things so we're looking at the economics of what what the hospital provides to the community and so we stepped forward for we got to to imminent danger where we had already closed the circuit service lines the service lines or imperative to the care that's provided in those communities and as a business we're not able to continue to provide those without making some adjustments over the next couple of months yeah thank you and that's I know hospitals all across the state or having to redo some service lines in those service lines maybe outlying clinics that effective maybe the only clinic in a county I mean and I do I sympathize and I realize that and I may be in the minority in thinking that my biggest concern I think with the hospitals is to make sure that the for the four walls the main four walls of the hospital stay intact in their A I don't want clinics to close but I I don't feel that that was the intent of this was to essentially keep you whole necessarily it's to keep you fully open so thank you. Yes ma'am. So in following up with representative grace questions do you guys collect any local sales tax or any local tax money for the hospital and Harrison. We do not okay. With that I'll go to of representatives Bentley. Thank you chairman thank you for being here today just real quickly as we're looking at a rate review for your bed right and I think you said over and over you not get reimbursed from Medicare which you need to cover that what can you give me just a broad ballpark figure what percentage increased you need to see in our daily rate a hospital right from Medicare for you guys to move forward. Well let let me answer that referred by my indicating what's happening with our Medicare reimbursements effective October one there was a impatient market basket adjustment that was just released indicating a national average of I believe four point one percent. For our hospital specifically that impatient rate will be three point one percent for Medicare services With the loss of our low volume adjustment that is set to expire at the at the beginning of October we are going to the net the six nine half percent decrease. From Medicare for the services were providing for Medicare patients in our community so that that overall that's out to about a seven hundred fifty thousand dollar reduction in Medicare reimbursement for that for the next year quick follow up chairman says okay. Okay I'm and I apologize I really need for Medicaid on the state level and I'm sorry I need that as well images save both so on the state level and we're looking at it increase in our daily rate as we do a rate review for Medicaid on the state level so can you give the same kind of ballpark for you what you need our state level I apologize I don't have the Medicare rates available to me but I would be more than happy to pull those up for you and and provide some additional feedback on on what we feel we need for Medicaid in order to to to cover the cost of health care okay I appreciate as we look at as a legislature moving for what are you guys gonna need from the increase in the rate review to make it the report for us that you do my last quick question is as you look at the pandemic and all that we went through did you allow your staff to have a religious exemption continue those employees to work throughout the pandemic we did I we were very fortunate we comply with the CMS regulation of for the vaccine exemption requirements we did not lose any employees we've hired several employees that weren't able to get it other exemptions and other facilities and we've we've been honored to work through that process with them thank you very much thank you chairman yes. Senator sample you're recognized thank you Mr chairman over here. In most of my questions have been answered laws and part of this question has been answered what's your percentage of payor mix meaning you in you said sixty percent with Medicare Medicaid what about what's the percentages on insurance and private by. About ten ten percent of that remaining businesses is Blue Cross and then we have about twenty percent that is commercial. Okay. An interest in it will be that the rest would be rather players Campus other for self pay care center or thank you thank you Mr. Senator Bledsoe you're recognized. Thank you Mr chair I live on the western side of the state and we have a lot of uncompensated care to our hospitals what is the percentage of your uncompensated care. we are tracking about of five percent of the. The five percent as far self paid on our pair Matthew can you get reimbursed by the federal government for your uncompensated care no we did you don't get any reimbursement for. We we we will get a small reimbursement coming through the Medicare report Medicare cost report I do not have those funds available but it is a small reimbursement on uncompensated thank you. Senator Ballinger recognized. Thank you Mr as described you I thank you address this but just having to be your important to make sure we stress that there there's a good chance that no hospitals would shut down at all if all they did was very was limit their their services to services that actually are profitable. The correct. That is correct and I think that's an important thing is we talk about I reference to the four walls that the hot the hospital provides their services in those four walls that are essential I'll share brief example of a patient that comes to mind they were driving through the drive past the hospital the spouse suddenly became concerned he turned around and came back and brought his wife and unborn child indoor facility had or facility not have been there she didn't have thirty minutes to get to another facility and so as we look at that service line and we look at the risk to closing service lines like that that's the concern for the health disparity and the level of care that we're providing across our state especially on a rule area and so that's our reason for stepping up and stepping forward and being concerned about limiting the access to care so yes to your point the four walls may remain in the doors may be opened but the services we provide will not be the same. Thank you very much. Senator Hammer you're recognized. Thank you for sure go back and just give you ask you to clarify something awhile ago how much did you say that you've received so far and funding was at one point six or one point nine. For the I apologize for the A. R. P. A. funding from the state yes yes well or any funny weather was from the health department or whether you know for the code bed expansion or through our funds what's the total amount of any that you've received let's just say such code starting all this money's been coming in since COVID started including in the funding that we have received from HHS funding began in April of twenty twenty and I believe our facility has received it. Just north of twenty nine million dollars in total funding that funding has been utilized to cover the cost of the pandemic from the years twenty twenty and twenty twenty one and those funds were exhausted at the end of twenty one okay and this first any care Sir our money or you including in your number you just gave what you received I got a I got a note of like you've received four point nine six million in cares an arc of funding is that reflected in that number you just mentioned that that is an all inclusive number that includes cares okay loops are profoundly that would include HHS funding we also received a community development block grant at the beginning of the pandemic and and that is also inclusive of that number okay thank you thank you Mr. Senator just food you're recognized thank you Mr chair of questions process if I heard Senator Hickey correctly he was talking about you using this money to reimburse the federal government is everybody's is that did I hear that correctly. That unit Senator Hickey yeah. Just one minute okay Senator Hickey if you just want you to go to southwest. Right repeat that please ma'am yes Sir. Did I hear you correctly in that you are proposing that the money's should they be delivered today be used to repay the federal government. If I make that motion I'm not set on your making that motion on this particular hospital because I thought but yes ma'am that if if we get down and and I'm allowed to make a motion mine will include that the only thing is is that we can't require that the check go directly to them the only thing we can requires at the hospital tell us that they're going through that and if they don't do it and then they go wonder on the although we may have to call back I don't know what we would do at that point so okay we'll my question is did I also hear that we couldn't use federal monies to repay the federal government. And if so would staff speak to that with given a speak to that because that's what I also heard which was confusing to me that we could not use these funds to repay the federal government the funds we already all to the federal government am I right or wrong in that. Your age you said the oven Dave I've got a little information I think that you're possibly correct with that I think that we need to drill down into that with the consultant a little more just to make a hundred percent sure that's why I suggested that however what what this is doing is if you counted ninety days what they're going to be doing is they're going to use this money they're going to use this money to pay those operational expenses and what they normally would have used for their operational expenses they're going used to pay their loan payment or the advance payment okay so this would supplant monies that they would have ordinarily used for payroll and then allow them to be able to use that money to pay the federal government. So that way we would be technically in order yes am I understanding that correctly yes thank you thank you Mr secretary. Representative being there you are recognized thank you Mr chair of the Senate questions for Tammy of the ninety five thousand service area folks that you take care of the there's also probably about two million visitors to that area for the buffalo river and if you do have to because services that's probably going to be ambulance service first so you can have a law a lot of folks there with no service and I and I also appreciate you all put this together in such a short period of time thank you. Thank you. Senator Hickey would you like to hear from the other hospital or would you like to make action on this hospital by itself. Okay. So. With that we would skews you guys and we will bring washed all to the table and we will move on the question. Miss avid if you and your guests would introduce yourselves for the committee and I a short synopsis of your requesting your plan we will proceed with members questioning. Thank you very much I'm Peggy abit on the president and CEO Ouachita County Medical Center in Camden. I'm my own a yes Joe givens on the corporate compliance officer at Washtenaw county Medical Center in Camden thank you. Miss have it if you would give us a short synopsis of your plan and and your request and kind of talk to us about how you got to this point and then we will perceive a member's question. Thank you very much I'm very pleased and appreciative of your time and the opportunity to appear before you today to share our story it's also very difficult to want to become public with our story because as you'll hear many people in the media say it does it could cause alarm in our community but I'd like to open to say and I should I have been part of that organization for thirty five years I've been the CEO this is my tenth year and we have never except for one brief period of time and that that history had more than two million dollars in reserves we are truly as small rule hospital. Before covid we had of course a very narrow margin as I've just shared with you I go back to March the eleventh of twenty twenty that said day of infamy in the health care world as in our society. We certainly have the first diagnosed case of Kobe nineteen in Arkansas we have received a mandate from the governor of the State of Arkansas to immediately cease all elective procedures we basically had to lock our doors to our facility immediately. Of the thought was that everyone coming through the door or die. I want to go back to we have never had more than two million dollars maybe two point four in reserves that I'm aware of and in my time you suddenly are given this mandate I recall that afternoon okay I sat there for about an hour with my key senior management and I said let's get our department managers together and I stated to them we are going to have to immediately look at how we can reduce hours we're going to have to go into an intense shut down we're not going to have any revenue coming in the store other than the coded patient and I'd like to bring to your remembrance that not all throughout the state did we have COVID nineteen patients immediately on March the eleventh that was one hospital we had to cease operating some vital services that cut when I say vital it was vital to the cash flow that came into our organization people were frightened they were staying away from the hospitals mammograms became non existence routine colonoscopy use we weren't doing those people weren't getting those those lives certainly were and in front of me and still that is what has driven us to be here before you today and to humble myself enough to be transparent to say we are bleeding red in Camden Arkansas and I'm proud of that fact I am not do you think that I have not looked at myself and said is there something that I've missed as a manager. I have I have search myself very thoroughly and then because I like to take on the burden then I looked at the climate that we're living in and when you hear the big system hospitals are posting unheard of losses that should ring the alarm in the hearts of everyone in the state of Arkansas we have had a major system to post major losses equate that to the small rule hospital we're license for ninety eight we actually only staff about thirty eight to forty of those bids we offer a substance abuse treatment program in patient one of the few in the State of Arkansas that has literally been one aspect of our care that has helped keep us afloat and we save lives through that problems through that treatment program from the horrible disease of alcoholism and drug abuse we have tried to meet the needs of our community we are fifteen minutes from the major defense industry that is an Arkansas south Arkansas Lockheed Martin Raytheon you can go out General Dynamics you can era jet rocket dyne they depend on as their government contracts depend on us. John Michael and I sit before you today as we've had conversations with our board of directors knowing that we are vital not just to that small community of Camden but to this entire state through the provision of jobs from that defense industry how alarming it would be if we closed but I will I will take it forward to we are in a very poor area of the state there are people who depend on us when their electricity goes off in their oxygen dependent they come to us and I will answer your question of what what do you do about that we have open beds that are being unused for senior citizens to come and hotel in until the ice storm passed we have been there on this hill where we sit right now for seventy years but there's been a hospital in Camden for one hundred we have an independent all but for five years of that we had five years of a of a half cent sales tax that went toward the maintenance and upkeep of the building that we lease from the council that we don't own and that was a wonderful little shot in the arm but that does not keep a hospital of float I work among a team of some of the most dynamic managers you want to ask when did we see this coming March the eleventh of twenty twenty I saw this coming when we have to shut down operations for one month it is painful to an organization our size when you go six weeks eight weeks eight months ten months a year that people are not coming for basic health care services and then you're inundated with the cove in nineteen patients and you're dealing with escalated cost of labor that would be your one well then we inch forward into year two and the early part of this year I wondered how will we keep it going I will tell you what I did first and foremost I stepped forward and made a voluntary salary reduction myself because. Because I love that hospital and I know that we matter intensely to the community to that poor person the non English speaking person who has a sick child where she needs to come in the middle of the night. No transportation how does she get to little rock Arkansas to a tertiary hospital. If she could get here how does she get home. And how do the people who support her even have the money to stay with her when she's here and I'll share a story of things that we do we have allowed a family member to travel to little rock in the ambulance we provide the only ambulance service in Washita county and it trickles out to the fringes of counties been beyond us will allow a family member to come to to Little Rock to get that care and we have collected money among ourselves to be sure that that family member has food to eat because there's more to it than just having that patient in the bed of the hospital. We are vital to jobs throughout Arkansas because that defense industry there are people who commute from Little Rock Arkansas from pine bluff from hot springs from Texarkana when you hear that defense industry in Camden Arkansas R. R. East Camden Arkansas all of those employees do not live in our area but those government contracts would not be issued if there was not a viable hospital nearby let's trickle that out to the entire state but we early this year ending June two to come forward yes you can tell I'm a little passionate about our hospital. In June was a very dark moment. We have our answer before you even have to ask me we have not quite five days cash on hand not quite five days cash on hand. From June our finance guy walked in and said Hey we need to talk money and I said okay I knew what he was going to say spiral week I'm and he said we make pay roll. We don't pay vendors this week. Some is abit I have a lot of sympathy for that but I do want to go into questions because accuse load not so our star Senator Hammer. You may have benches not just overlooked it but the amount that you've given is a very specific amount does that include what would be the demand letter amount that you anticipate getting is that the exact amount or is there anything extra in there. No Sir that is not what we anticipate to be the demand letter from Medicare that is a a formula that we were given as being acceptable formula of calculating approximately three months of salaries contract labor of labor cost that was why we use that number we understood that that is what would be considered to be viable did you know you have what's the anticipated amount than you expect for to be demanded of Medicare. About a month ago you don't get regular updates from Medicare as to what you of it's not like they sent us a statement out each month but no the toss did send a letter approximately four weeks ago and the best that we could calculate on that given day we would still owe one point two million. That money is repaid by revenue from Medicare patients and our Medicare census has been down throughout COVID and even to date so I'm anticipating that October the first or somewhere in that vicinity we will receive a notice that we are now at a one hundred percent take back that's how they'll take it back if you can repay everything that's owed on that particular date with the one hundred percent take back they take a hundred percent and you're good to go if you can't pay it all back they take your one hundred percent Medicare reimbursement and add four point five percent interest on to your remaining balance is a very odd formula but that's what I'm looking at is possibly October the first we can get no Medicare reimbursements and the rate reviews for the hospitals I think you're coming out in October sometime is some of this money then intended just help you hold on until the rate reviews get in and hopefully they'll go up yes Sir okay all right thank you thing Mr. Senator sample you're recognized thank you Mr. And I hate to assist question but one to. What's person and your businesses uncompensated care. Approximately eighteen percent eighteen percent also say that a lot better than I thought thank you thank you Mr. Representative gray you're recognized thank you Mr chairman over to your far right over here thank you and I know to by the five days cash on hand what was your historical if you can remember what was your historical black average I know it varies every month but historical average prior to COVID with at much higher. Well it was higher but to a lot of hospitals it would not have been high it was thirty point five okay in that month that COVID hit okay point five days cash on hand okay you just slowly see that kind of decline ma'am if you were to get this and that you get this what would that bring your cash on hand to. Well if you were to if we were to get this next week it would bring our cash on hand six million one hundred and sixty two I have a hundred and fifty six thousand days cash on hand today. Okay. That's what I was looking here so your June is your total what your total expenses for a month roughly. Our total expenses for a month would in in that first column is about three point six million okay so this would take you possibly to I want to say roughly two months cash on hand just this is a ballpark in it yes the ones that are just one thing yes we're also anticipating the restoration of our full Medicare payment yes yes and I know that would add into that it would that take you down I mean if that if that were to happen and you pay that full back I mean you be back to closer to what you wear yes pre COVID and something that I think is more acceptable and so I I just make my comment now Mister chair based on everything I've heard this is exactly what I was hoping to see as a pure chair was someone that I feel is in immediate distress of an actual hospital closure so I've you know I've had this one I will support and I appreciate you I know it's hard to sit there and say this is where we are and how we got here annual reading through this I think you're doing a lot of the same things that our hospitals are doing you're trying to catch a cause it's hard when the costs are twenty percent higher you can only cut so much just you know keep working hard and thank you for for coming here today. I also echo representative gray's remarks Senator Hickey you're recognized yes I'm up here in triplicate just quick questions were good for me in a few cents on this apologize so your question a little over six million how many dollars in exactly an advance payments did you get. We received four point five. Five million okay and you said if I remember right you think your balances around one point two million yes Sir as of four months ago do you think that's less or close would be slightly less not significantly less maybe would say today three nine hundred thousand. Okay that's just my approximating based upon what we received from Medicare this month to date okay not going don't don't take my questions offensive because from now on I will be asking this though okay so what a lot of what we're looking at in here with the members want to see of course is cash on hand have you made any type of transferred to any other entity subsidiary or affiliate of any shape profession so that that cash is not showing up no Sir and have you done anything extraordinary that you normally wouldn't do so to take that that would make that go down if you paid a chunk of it towards the top. Payable or anything like that you normally wouldn't know right one the other members it asked me one thing to ask for them so that at the back of the queue you mentioned something about the county building that that's a county building that you're in is that correct yes Sir. Do do they charge you rent on that a very minuscule amount but then we sustain all of the maintenance and upkeep of the building and grounds okay and all of the renovations through the years we've had to pay for that okay and if if if a motion is made in here in that motion includes that you have to of course pay back the of advanced to advance payments that you received within the the time is that going to affect you in anyway. Well it would give me a big sense of relief I would certainly pay that because our number is lower if we were to get that full amount okay we pay it so if we make that motion in here is basically a requirement so I guess what I'm asking you know obligated as requirement or you or you commit would you commit to that requirement yes Sir I would commit to that because it would allow our Medicare reimbursements to return to the full rate reimbursement and help get out of the land the legs back on to us. Okay thank you ma'am. Been represented Bentley you're recognized thank you chairman right here front and center thank you so much for being here today are you back to pre pandemic as far as your flow through your hospital what you were surgeries in those type of things are you back it to you know prepend emic we are not students like maybe sixty percent discount a rough ballpark where your. admissions year to date. Overall are still down four percent as of June Our surgeries are down thirty four percent year to date which that someone made a comment earlier about income from surgery our secretary has still not rebounded to the pre COVID date The hospital as an inpatient itself in the month of June your today we're five percent under where we would have been pre coded and are the only place we had an uptick is in our substance abuse treatment program are hospice program is down twenty two percent and some of that is this heartbreaking to have to say but some of that is we can only accept the number of patients that we can provide adequate adequate care to so we could see our hospice programs swing back if we could become more competitive with our salaries for hospice nurses our census days there's an odd hospital accounting you look at hospital admissions but then your days are down seven point nine percent year to date our total census days with everything in the hospital is down eight point eight percent And our average daily census is down ten percent R. ER visits have slowly inched back at we've had a growth in the emergency room but pre pandemic our emergency room was averaging eleven thousand of patient visits a year and this year today we're only back to nine point two so there's definitely a huge decline are inpatient surgeries are down thirty four point eight percent are outpatient visits are down thirteen percent so there's just been a steady there's been a slow rebound from covid of of people even seeking some of the care that. Thank you one quick follow up just like a S. of the hospital are you have you guys honored the religious exemptions for some of your staff to retain yes they're so lately right thank you. Senator here are you ready. That's all that's in the queue. You're recognized okay give me just a second track Jimmy I'm trying to work this motion just a tad better. Okay all right members I make a motion I move that Arkansas Legislative Council approves the request of the Department of Human Services for appropriation. An expenditure of funding under the American rescue rescue plan active twenty twenty one in an amount up to six million seventy seven thousand eight hundred and fifty two dollars and sixty five cents. For. Washita county Medical Center. Subject to the hospital subject to this hospital certifying to the department that the receiving that the receiving hospitals. As a condition of receiving Arkansas funds will within sixty days repay the full outstanding balance owed by the receiving hospital to the centers for Medicare and Medicaid services for the COVID nineteen xcelerated an advance payment program. Or. Thank you or they would repay to CMS amount equal to or greater than the amount of Arkansas under C. by the hospital under this court request which is not you'll be were you'll be paying off your balance. Okay. That's by motion sir second. Originated sixty days and I think that we had at fault due to timing of payments and everything and that would that should be ninety days so if I could I'd like to men that say ninety days amended. Second. That's proper motion I have a second from Senator sample if I heard correctly I do have discussion on the motion Senate Chesterfield yes Sir just to be clear we're not we're not actually funding all of eighteen is that right that is correct. So we're only giving these entities six million dollars. Our court is motion he's only funding one entity which is Washita county Medical Center what's happening was the other. Is it going to be a separate motion. I would just not go we just come. I will let you know about and I ask that you do that you're to sanity yes ma'am I'm only making a motion on this particular hospital if there's another member that makes that personally I will not be able to support the other one but on this particular one then I would support it. So my most of my motion is just as it relates to this one I guess. I'm confused about the speaking and shoes and. And we have a hospital in one area of the state this is neat I'm from Southwest Arkansas so certainly I'm a little. You know positive to or the other but the need is so great throughout the state I don't understand why we would not provide funding what I can make a motion myself okay got you that's all I need to do I move that we also include an amendment to the motion Mr I'm not I'm not taking that motion at that moment how you not come take my motion to amend a motion on this chair and I can go out on his own Barker Beck eighty one respond justice center center Chesterfield and others I truthfully I think that if if we get six hospitals down here next month I think that each one of them needs to be the ever motion needs to be done separately you know as it relates to them so we can get the exact balance and everything in there that they're requesting so and but I am going to say this and we go back to this and I shouldn't but that was the whole premise of where we were at in the peer committee these hospitals out here. If we did everyone of on what they're gonna be requesting is going to be approximately it looks like what their original advance payment was which we've already that is already been FO outside and it was over a billion dollars so that's what we were saying we would actually not do the water we would not do anything and we still would not have had enough enough money to probably fund everything that would come through so we've we will because of what all the membership and everything is wanting we are basically forced into a situation like this where we've got to look at each one of them's financial and where they are and to this question and and just and try to work through it so that's my motion on this particular one. Senator Ballinger you're recognized. I have a motion the proper time. Well I want to climb to take that at this point but that come back to you yeah that's mine. Senator Hammer you're recognized for a question thank you Mr Mallya address Senator Hickey on a on a question in under discussion. Senator Hickey the reason for splitting the hospitals does it have anything to do with the percentage of cash on hand. As opposed to the length of days that have been testified that they would be able to operate. Part of the rationale for splitting the two white why this one and not the other one part personally I think. I think that they always need to be split as far as a motion goes but as far as me just doing this one I would say be inclusive of everything you just said okay thank you yes Sir. Okay members. What we're gonna do is take these of wanted time someone take Senator Hickey is motion and if someone has as another motion after that we will take that motion at that time So any other discussion on the motion on Washtenaw county Medical Center C. N. O. for the motion of discussion all those in favor of the motion say aye. All oppose ayes have it. With that I will go in order to Senator Chesterfield have a motion. Yes ma'am I would move that we support the other hospital. In the amount of money that they need to pay back. What the hell. And I'm taking a chance if I can get is I'm taking a chance on them losing out all together I guess I don't understand My heart is going out to people across the state. And the need for hospitals in these areas of the state are so critical and I guess I just don't understand. Well if we have the opportunity today to do something we will allow this to fester. And they would have to cut services in a community that needs it so much. Maybe somebody can help me with that. Actually don't understand it and. You know. Whatever. That's a proper motion to I have a second. I have a second. Of. I come to you we're gonna take discussion are going to Senator Hickey first I do wanna make sure I understand the motion. If I understood correctly and I'm not even sure that they can be done that way but if I remember correctly the move the motion was that the amount to repay so it she says she's not if and please correct me senator from wrong you're not saying that your motion is the ten million dollars your motion is saying whatever they told us. There nine hundred thousand was on their advance payment balance which I think was probably guess. Nine thirty or something to that nature is that correct. That may be detrimental to them can I don't know about the rest of this I'm I'm still confused as to why we didn't just give the sixty million. I don't get all of it all but I don't want this hospital to have to pay interest. All this money because it will certainly put them in a very difficult position so that's what I'm doing right now I would prefer to just a given I'll give the sixty million dollars but I obviously I don't have the votes for that I hope that we would at least do this of that hospital. And may if and I'm all I'm all tenth one more one more time though just just with that rationale. If you if it was up to me I would be the same way I would not be the and the and I'll get my hung out on this I wouldn't be approved in water projects I wouldn't be approving higher ed projects I would do a complete analysis of where our hospitals are I would have our attorneys and CPA's to drill down within those financial statements make sure that nothing has been wrong. And bring that back to us to help them out but from what our discussion is been today and all week. We're saying to we're saying two different things so what I'm saying Senator is we got one in front of us we maybe have fifteen more coming the next one that comes more make something up they may request they may request forty million dollars and their balance is still thirty million so at that point we would be looking at thirty million for that separate hospital what I'm saying we can't do everything that we're going to do here without delving in and trying to to manage his way. Thank you so much so what you're saying is because they have some thirty four million on hand. It sounds like from what I'm hearing within this committee that because because of the cash that they have on hand and is not an immediate crisis where they possibly may be shutting the doors that this committee is is really. Trying to limit it to that and I think that's based on this overall conversation that we've been having about everybody wants to do these other projects I worked on the motion thank you ma'am. So Senator Ballenger do you. Have someone that you it is my understanding that of the motion that represent grades going to make it the one I can support thank as Thank you representative gray you're recognized thank you Mr chair and up I want my I would like to make a motion that the. Request for north Arkansas regional Medical Center the set back to peer. so that we can look at it at a later date if if the need does arise again as a proper motion of second. Second I have discussions Senator Ballenger the it the reason why I think that I'm supportive of this is I don't know that we have the support for the the motion I mean from my standpoint we have a hospital is really working really hard trying to do everything right and and also the concern here is whether or not we're going to have access to services or not I mean we don't want the hospital to shut down at all I don't know because we came to set down but I also don't want the hospital Harrison to make we can't deliver babies you know you got a big dark spot in a huge region where there's no place to deliver babies right or whatever other things that they provide so I I'd prefer to just be able grant on the money but at least today if we can put it off they're not going to go broke over the next thirty days but at least for it often preserve it so that that doesn't die and we don't lose the ability to to Graham those funds later on so I support the motion. Senator Hickey you have discussion on the motion. Rick real simple yes I I support that addition of that emotion and to that motion and agree with the most the comments of Senator Ballenger thank you. Hi is proper motion okay Senator Senator flowers a discussion on the motion. I'm trying to understand of this motion. To send that back to peer. As far as I know. Their application for these are funds has never been before peer. And so. What what what at pier. Is a request for sixty million dollars for. hospitals in emergency situations it seems to me like the process should include. An application by the hospital. To the opera. Committee. Am I wrong. No later than they are you're right and wrong. In choose these peer meeting I was there I was present it was said in the motion to get it the end of the R. a request that the should be brought before the council committee today out of the sixty million dollar request and the pier Committee agreed to hear the hospital request individually and we did it in here today because those requests were not ready for peer Tuesday and they were ready for today so there is nothing wrong with sending us back to peer for further deliberation and let them handle that business and it would come back before council as a report from the pier Committee it just seems to me that there was a stab wish a process for that are the committee to consider and at least have DHS. Involved in the discussion inventing these hospitals applications and request I think that is exactly so the process that's not what I'm hearing it's as though the members only of the pier Committee will get to decide and that the no ma'am okay no maybe anything hospitals anything desired in the peer committee will come before council in a report as not members appear committee here and and final action well it appears to me that it seems like DHS our state agency a would have much more information I'll be AT these requests were brought before AOC today by DHS so that is absolutely the process is being followed the one you're discussing four of four four forty eight our application that was just given to them up it just seems like it if we want to have more accuracy if we want more vetting if we want to make sure that money is not just being thrown out the window. To anybody that comes in and says we are in need seems like the appropriate of. Thing to do would. The to allow. DHS. To get these applications I don't know if you need a deadline for them to do that. But if they suggest that we have at least ten hospitals that might be in dire stress. Seems to me like they'd go. And for the route with hospitals. R&R stress make sure they know that there is money available. And then determine whether or not they meet the needs and I'm not so sure about the the you say it is this what the Camden hospital you're allowing them to pay off the. Loan to the fed's within ninety days. And you're giving them the money that's a planting. The use of the money I. I like the DHS to be able to explain whether that is actually legal. Is that gonna put our state in some kind of jeopardy I'd like to know and I think that needs to be investigated. Thank you senator Senator Teague you're recognized for a question or statement on the motion of sending this to peer. You too good to me Mr chairman thank you I just try to understand this this this this motion include Harrison in the this motion is here's Is a about hers that's good I got a little turn around and all objects that I under I understand that's very easily done today okay members we have a motion on floor and second in all discussions taking place all those in favor say aye. All oppose ayes have it so with that members. We will go to the review subcommittee Senator Flippo you're recognized thank you Mr chairman. During the subcommittee met on Tuesday reviewed methods of finance discretionary grants and services contracts in addition a rule pertaining to state procurement for mandatory training programmes was reviewed no items were held and I'm not holding my breath that that'll be the case but I move adoption of this report. I have a motion and a second and see no discussion all those of favour say aye All opposed I Senate with that we'll move on to senator Wallace for the personnel committee report. keepers there you go Senator Wallace yes Sir Mr chairman now that we've got the easy stuff all the way. The personnel committee meets Wednesday met Wednesday September the fourteenth in room a of the map building the Committee reviewed any questions reports listed as item one through twelve one report items seven was report required by the Arkansas code twenty one dash five dash two two six which provided information related to the process of appropriating and budgeting positions and allowed for recommendations to be made by the committee. There were no recommendations made by the committee to change the current process of appropriating or budgeting positions I would be happy to entertain any questions and I moved to adopt the port at the proper time. As proper motion drive second and second all those in favor say aye All opposed us have it is go to item number fourteen employee benefits division oversight senator Hammer you're recognized to give that report thank you Mr chairman employee benefits division oversight subcommittee met Wednesday September fourteenth twenty twenty two subcommittee heard the following items to propose bariatric surgery policy the R. P. for employee assistance program and receive the formular recommendations report no action is taken on the drug formulary changes that was submitted last month and is still being held and subcommittee motion was chairs that I moved for the approval of the proposed bariatric surgery policy and the R. P. for the employee assistance program and adoption of the report. Proper motion made and seconded all those in favor say aye hi All opposed Is have it so with that members will move on to G. and we have item one a report from the Legislative arts and technology boot camp Senator Elliot you're recognized give that report yes representative Warren I stepped up submit this report the deadline for getting and and was we ended July thirty first and this is the report to you that you have I think most of you have a executive summary the entire report is posted on the website of Legislative Council website and I don't have any need to talk about it any further if you want to read it if you want to ask you some questions further I would appreciate another day do we need to a motion Mister chair not. I do need a motion to adopt okay I move to adopt the report Mister chair that is a proper motion I do have a second CNO discussion all those in favor say aye all those opposed us have it with that we'll move on to the review of communications item to I need a motion to file is reviewed. I have a motion and a second. Second all those in favor say aye. All opposed so that members you're following me over to Adam Katie one. Yeah with K. one I need a motion to approve. And a second all those in favor say aye. Thank you the motion has passed so with that members will go back up to item eight of and that is the Department of Human Services does anyone wish to hear from us secretary Gillespie on the system living. Our waiver. For her yes okay so Secretary of you would. Make your way to the table. I'll do it fast I promise. So I see a five understand Israeli. One second if you guys would introduce yourself for the record and then I'll repeat recognized representative Paul sure Cindy Gillespie secretary department of Human Services smartwatches tacticians. So a quick question is do we we no longer do audits of assisting living we will no longer be looking at any monies that go there is this my understanding that. No there there were some comments related to our requiring audits that's language it's been the waiver for a long time that language has not changed okay thank you. So those audits are still taking place and will be looked at on a annual basis correct thank you Senator Ballinger. Thank you Mr I just cause a secretary Glasby realty again thank you for your service to the state of Arkansas. Thank you sectarian you are absolutely leaving it better than you found thank you. members we do have a supplemental agenda so I will need a motion to suspend the rules to accept it. I have a motion and a second all those in favor say aye. All opposed. So with that there's the interim resolution of presented by representive love some proclamation recognizes September as sickle cell disease awareness month. So I would need a motion to accept that resolution and so moved and second see no discussion all those of favour say aye All opposed Is haven't with that members we have no further business we stand adjourned.