ALC - PEER

Where we left off was on. The was item fourteen with Arkansas rural health partnership I could have them please come to the table. Hi members the Arkansas rural health partnership starts on page D. seventy ninth on activities Page seventy nine. But. Thank you. Right if you could please state your name for the record. Thank you madam chair mark white farmer Human Services. Miller Broadwell president founder of Arkansas will help partnership. Rex Jones CEO of Arkansas real health partnership. Thank you. Her if you could just tell us real quick what it is what we've got on the table looks like a request for ten million dollars and then you've also got a request for five million. I think that we held to have a discussion for here is we'll start with that ten million. As mentor of mine used very brief explanation of what we brought in why and then turned over to me probably has more details on that so in and to get referred the string Committee there are some Scotians around the struggles that hospitals are having we knew we were hearing that there are a number of hospitals and just really serious trouble because the pandemic and all the effects and in the last two years or snow any business if you're revenue goes down for two years and expenses go up for two years you're going to have issues and hospitals as much as if not more than anyone else have seen that through the pandemic so we know that hospitals are struggling around the state we brought steering committee what we saw as a package of three items help address this issue and we brought the package because not only do we will provide short term relief for hospitals we also wanted to make sure that we're providers things to help ensure that hospitals could take steps to reach long term sustainability so that is not this is not just a one time deal and then we're back in the same spot here a few months but hopefully help get hospitals get back on their feet so they can continue long term so that's where the real health partnership peace came in it was one of those pieces and their talk about insta moment about some the assistance to their proper to provide for rural hospitals the reason that the split between ten million arpa and five million restricted reserve I am talking to our finest administration they concluded that one of the pieces we looked at that we thought was important to helping hospitals again reflect long term sustainability they decided that was not likely eligible for our funding and so that's why that was moved to a restricted reserve request to cover that one piece with the remaining pieces in the ten million dollar our proposal and so that background from male turned over to the partnership to discuss the details. And I would just like to kind of preface this with explain to you who are organization is because this is the first time that we've really been here so the Arkansas will have partnership is a non profit we start in two thousand eight with five rule hospitals our home office is in Lake Village Arkansas I'm with three five hospitals three counties we are now seventeen hospital strong I'm covering most of the south Arkansas area specifically a lot in the delta region along with two FQHC members that recently joined and then the three medical schools and in your packets or and also included are looked bill just to kind of show you some of the initiatives we we have an if there needs to be anymore given out I'll gladly do that one of the things that we we have been doing a lot of work around is you know really working with our rural hospitals to help them with their infrastructure and really looking at ways to help them address the increased you know the work force on which we have a lot of work force initiatives as well as looking at their supply costs as well and how do we collaborate on that so I'm going to kind of go through some of these initiatives as quickly as I can and then if you have any questions please feel free I'm the first proposed service or initiative is the swing bad coordination piece this is a this is a project that we actually have started it's a delta project so we have a few of our critical access hospitals involved in this we've seen drastic changes in their bottom line and revenue this coordination piece is aware of a patient would be would have surgery at a U. M. S. and be able to come home and rehabilitate with physical therapy occupational therapy this is a two full thing we talk about the fact that some of these hospitals can't perform surgeries this allows for those those patients that are ready to kind of down in. To up into a law let I guess a lesser acute care I'm setting into all of them to another hospital on the other side of that these critical access hospitals have really good reimbursement rates so it really allows for them to the very viable so that program that we're we're recommend we're proposing is to do that statewide really help our rural hospitals in that coordination piece by training their staff how to billing code as well as bill the quality of those programs and then work with those larger hospitals one of coordination piece the other section that we have is an on site provider simulation training on this is something that we've done in the past we have hospitals that don't have be departments and so they still deliver babies so we have done that this on a regular basis with a lot of pediatric trauma training we don't have pediatricians and a lot of our rural areas and so you And we hire you and that's to come in we have a actual mobile unit that comes in and does that on site training the great part of that is that they train the train the hospital teams so it's a real team effort and the hospitals learn how to work together it also allows for some of the non emergency personnel to be trained as well and also it it kind of helps the hospitals with setting up their Edie's in case of emergency we have a lot of work our work force that works in different hospitals and so what this does is allow us to set up those ET so that if a nurse from one county comes in works of shift at another hospital they know where things are and it's still and it's and it's very efficient that way the other piece is a rule clinical training piece and actually today we're having a huge task force right now with seventeen chief nursing officers and eight of our college Nursing directors in pine bluff right now talking about how to explain it how to expand the clinical training a lot of your school the schools here have talked about you know the fact that we need to expand nursing and especially we need you know are we are smaller colleges rule colleges to expand those programs for for students that can't leave or can't afford to go away to college but what we don't want is for them to have to go away and go somewhere else like little rock or you M. as to get trained we want to build provide that training in our hospital so that that is coordination piece so really building you know for sceptres engine and and faculty in our hospitals and I can discuss that further we're working on affiliation agreements and they're actually signed an MOU right now and that's a delta project only we would love to see that expand because we do have members that aren't the delta but also I think all hospital should be doing this kind of work and then we have the integration of non behavioral health and we all know that through COVID that's been a big problem we don't have the services in rule are hospitals can really benefit financially from implementing these services in their hospitals but they need help they don't know how to do that we're talking about trying to you know with the work force and not having that we're going to have to work with them one telehealth capabilities and then work with DHS as we try to transition them into our home life three sixty and then the integration of social in terms of health we do we do a lot of enrollment services we have a full one eight hundred number that we currently do in the delta specifically helping folks with mom prescription assistance Medicare enrollment Medicaid enrollment housing assistance we would love to expand this to really include all rule hospitals our initiative here and our proposal here is not something that we are saying we will. Want to expand our membership we just want to be able to offer this to all the rule hospitals in the throughout the state that could use these programs. Rex. Yeah I think one of the one of the things that we saw during the COVID pandemic I'm a hospital exhausted CO one of things we saw during the during the pandemic was a lack of bed space available in the tertiary centers and a lot of the the small rural hospitals that have the capacity with or the the ability to take care some the sicker patients. But we were having a problem finding them in the tertiary facilities that had bed space and part of the reason for that was those bed spaces were taken up by patients that could be handled at a lower level of care and a PPS hospital does not make money on these type of patients where is a critical access hospital actually makes a lot of money on these type of patients and it frees up those bids and allows for an easier transfer of patients especially during a pandemic you know we're all right now the long discussion this morning was about the work force in the workforce problems that are are going on in a lot of our issues during the pandemic was was workforce related where there may have been an empty bed somewhere there wasn't staff to take care of them so seeing these initiatives that we can we started working on this is a partnership of how can we increase the workforce numbers and we have to work with these nursing programs in nursing schools. To increase increase the capacity within their within organizations because we do understand that having clinical rotations is a limitation having hospitals have those clinical rotations through the nursing programs and have the mentors to develop those students when they come through it's been an issue so we were we were beginning to work on this and in the in the area and feel like it could be very successful statewide you know we're looking at taking transaction the successes that we've had and and push them across the state to the other rural hospitals that are not having had the the ability to work with a partnership like us that Senator had grants available to them. Thank you have got seat number thirty six that serve representative Bentley thank you for being patient today thank you chairman thank you all for being here today can you just give us some specifics on what this ten million dollars is gonna do to make all these things happening to share with us those programs. All right so in case of the swat like this swing that coordination one of the things that we've done is we have contracted with element which is out of the Mayo Clinic to really work with our hospital so there's a contractual peace there that we would you if the hospital is interested in in on boarding with this we would provide them with element is systems as well as marketing and communications marketing communications has been a really big piece we do I do community health needs assessments of done twelve this year so for hospitals and the folks in these areas don't even know that they can come back and rehabilitate whether it's after stroke or even an elderly person with a knee replacement so really working with these hospitals or marketing communications and then the coordination platform during the co the pandemic there was a. I have that system where you know of of larger Han of the hospitals to talk to each other and you would know if there was a bed available for co the patient the same sort of platform can be developed and utilized for the swing bed patients to where if a hot if the U. M. S. has a has a patient that they would need to have a bed available for or they want to transfer out they can find a bed as close to that patient's home as possible so that's the funding for that on the simulation training a lot of that would be a contract to the MS centers for stem education they're the only ones that can provide quality and and those C. use needed but also the type of training that we're needing is you know really needing physicians to do that training so that's an expensive training so that basically is a contract with them the nursing and and clinical rotations will be sort of a personnel management we even talked about you know incentivizing nurses to do. To be perceptor and also there's a lot of training involved in that so that money would go towards that as well as potentially we've looked at a mobile training unit where we would put nurses on a mobile unit and that they could actually do their some of their training in in really small areas where there's not even a clinic and then immigration of behavior what health services would be a lot of contractual technical assistance to help these hospitals we don't know everything and I don't think there's anyone really in Arkansas that does but we do work with really well with on the national health resource center and those folks that have experts to help us work with hospitals to see how how many beds do if they want to start behavioral health beds you know how many can they actually would for the hospital and so really working with that as well as you know some grant writing that might be available for them as they transition because when they look at behavioral health they're going to be looking at having to transition their actual physical hospital and that costs money that they don't have and then on the into I think I missed one. That social detect information and social determines health would would be strictly training hospital personnel to support that transition so that they could work with those patients that are in the live three sixty homes that are we hope are gonna be implemented soon I have a follow up chairman real quick yes you're recognized so is this just strictly to the hospital that you're serving now it's not going to be available to buy hospitals in western Arkansas in you know Central Arkansas Specifically okay every role hospital in Arkansas so will be available to everyone hospital okay I think that was some good clarification of those a specific hospitals that you currently working with now so we're not allow ready ourselves so the money will be mainly really for other hospitals outside of our serve as great clarification thank you. The senator Hammer you're recognized thank you measure how much money is actually going to make it down to the hospitals or is this all going to be required for the support services you're talking about that that is going to be provided to the hospitals. We will be facilitating all of this so that the hospitals are not actually going to get the funding everything will be contracted for them to utilize as needed seven okay and do you receive any tobacco settlement funds no okay and then rural hospitals I'm looking at the map this been provided a couple these while I respect the fact they are surrounded by rule areas of I wonder how it is a fit into the category of role can you justify what's role hospital verses and it's not just hospitals the that the council a couple other entities that are not necessarily hospitals is that correct Senator I think the map your first two that's the map of the partnerships membership which includes hospitals but also includes FQHCs as well as so the medical schools so the those in these will not be receiving assistance under this proposal this proposal would be for any of the fifty two hospitals in the state that are classified by CMS of rural hospitals all right shows by CMS classification they've been determined to be real yes Sir okay thank you. Thank you you know what about purchasing guidelines normally like if I'm that mean this is just essentially a purchase service would that be correct I mean this or not do not need to go through an or if Q. type process for something like this. I will give my tentative instrumental differ to some experts terms and the FAA on that. This is a grant I don't believe that's necessary the great can be handed down I know that DFA has their set of requirements they impose on recipients of our funds like this in this case these funds will go through DFA so it'll be DFA's procedures that would cover that okay. When she'll come back to the table. The affidavit come on back. Yes for two years. All right well we'll wait on them to come when to that question. I'm going to answer I'm going to let to committee members go first senator Irvin you're recognized as followup on the question you just asked is that several of the things that were described as far as these initiatives have actually go through different organizations and generally those are contracted through DHS through our of P. through an RFP process and so you know why is this one different and unique. And not go through the RFP process or contract where we actually have deliverables and receivables and we have some accountability. Because I see this ten million dollars I don't have any accountability as to if this nonprofit organization is actually going to do what they say that they're going to do with the money or how we have oversight over these taxpayers dollars to see if it actually achieved something or not we when you have them under contract you have the ability to do that and we have done that in the past with a lot of different things with cares money like contact tracing and all that other stuff so that's my first question. Thank you senator eighty that it would Dismang. With the Arkansans there are certain reporting requirements that we monitor on a quarterly basis to make sure they're meeting their goals in this particular case it'll have to do with the number of individual served I can get you the very specifics of what that reporting will look like that they will have to report to us on a quarterly basis and we will monitor it. That help not really because I have no contractual obligation that they have with the state of Arkansas. We will also as giving This Is committee if they they will also sign a. A an agreement with us and we will only disburse the amount of funds basically on a quarterly basis as they expand that quarter so we control the amount of money they receive on a quarterly basis and we also monitor the reporting to make sure that they're meeting goals and objectives of the grant. Was that part of your discussions established already or is that brand new no no no we've actually had that agreement in place for all Arkansans with the second tranche of money going forward that we will have that in place. Well okay and. I'm uncomfortable with the fact that we have no contract here and you've got a lot of things that you've details you know that are specific to what you're doing in your area of the state of Arkansas that I guess you're want to expand across the state however. You know I know that like a FMC does a lot of these different types of things that you've also outlined here that happens under like a contest contractual or of P. process and so I'm not sure you know again if that's. A good thing or a bad thing I just think it's at something that I would question and then the money just stays with your organization you describe the money for UAMS would then pass through why would we not just goes straight to UAMS or. I mean what does that make sense I mean so that that part and then but none of this ten million we go to the hospitals specifically it would just stay with your nonprofit organization and then how is this different I guess from the five million asking restricted reserve. So okay because what I don't want is a five million dollar admin fee to administer a ten million dollar program because that's a fifty percent. So I I'm confused by that if if I five million on the admin fee and then Mr wood wood for a dress the remaining points the five million that is for a consulting piece that was part as originally proposal in which that may be used to retain consultants to go in the hospital and help them and modify and improving their business practice again to help helping those hospitals restores long term sustainability that's the piece that we're concerned would not be are eligible and that's what split off into a separate case so that would get us out of those consulting services provided the hospital again not paying the partnership council the for paying outside firms partnerships outside consultants to come into those hospitals know that all the first first remaining part question. I mean okay but that's what it just seems like you just described with for the ten million. Will the ten million is for it is for some more specific purposes the five million is more generally about the hospital business operations and practices. Okay I think I'm probably more confused now. The ten million is to establish incentive programs that like the behavioral health the the workforce training workforce development the five million that's that is part of the restricted funding is to assist with operational assessments and evaluations for hospitals and their operations their markets there designation in their markets and identification of elements within their facilities that they could maybe improve their operations on or maybe make some modifications to what they're doing it is not it's not a part of the ten million from an oversight perspective it's a separate peace okay well it again I guess I would have concern that we're not doing this through an RFP process because you're you know and then I would also want to know I mean this is a five million statewide initiative when we've done statewide initiatives for three million you know that was demanded that every single county have meetings and meetings with elected officials and assessments and data and all this we had like a very clear receivables for statewide initiatives using three million dollars for broadband and we had a very clear objective in a plan this is a five million dollar ask with I can't point to anything that has clarity about where you're actually going to go in the state of Arkansas and who you're going to help are these going to be rule hospitals right that are within health systems are you gonna be then working with your critical access rule hospitals that are within health systems are you gonna be working with critical access hospitals under independence you know where they can be located in the state of Arkansas I mean those are all questions like for me north central Arkansas I don't know if if I with my area would benefit at all from this five million dollars and I don't know but I don't have any. The thing in front of me to show me that. We're looking to do is to try to to provide some support for all the fifty two someone rural hospitals in the state and so anyone that would be designated rule but it would not be a it's not a mandatory program that we're we're talking about we're talking about a a program that's out there and I can I can tell you from. Discussions and from experience that there are a lot of small hospitals they can absolutely and would love to benefit from some type of an assessment and some guidance but they're in a situation where. While they know it would probably be a benefit to them they can't afford to do that so they're in a situation where it's difficult for them to justify that cost but they were able to be provided and they can implement some of those programs that would assist their hospitals and they would there there been a hundred thirty eight hospitals closed since two thousand ten there's a couple of hospitals in the state right now that are in crisis mode right now and this is the type of program that would hopefully go in. And may be identified from a different standpoint. More expertise in that local small hospital that rural hospital has within their within their walls to utilize the experts to help them establish and I think in the in the paperwork that you have here it talks about operational reports that would be provided I think it's maybe the green block but there were in the in the little circle but there be operational reports it could be provided and it wouldn't be the same for every hospital there's gonna be some hospitals that would need very intensive consulting and there are some that like we've got this but we could really use this but it's it's a statewide initiative and they're gonna be some that that they're going to some hospital to take advantage over there to be some don't take advantage of it and it so and so what they're not so what they're potentially not be a five million dollar spent at the end of it if you only have like three hospitals that decided they wanted to take the opportunity to do this. Are we just given you the five million up front and then hoping that you know people participate I mean it's not you know what if only to across the state participate three and so we've spent five million dollars for three hospitals that participated I'm just concerned I hear you I'm concerned that you don't have a contract you know there's lots of probably other entities that probably have the exact same ability to go in from a business perspective and and from a medical perspective and can can advise that you know whether that be the board of the hospital that makes that determination or not or the administration and you know I'm I'm I hear you I'm just I'm concerned with giving a five giving you fifteen million dollars to your nonprofit organization without some clear deliverables and a contract to where specifications where I know where are what I'm person with my money with the taxpayer's money because and that's my job is to make sure that we have some real clear deliverables thank you senator Vice briefly addressed that hello this is just to make clear around five billion dollars using that piece will go through DHS and that will go for us as a grant we will require documentation will ensure that we are only sending out the amounts to reimburse the actual expenses of that program so we we will be monitoring that to ensure that only those dollars that are used to go out well that makes me feel better about the five but not about the ten so thank you. Centered thank you okay I just wanna circle upon the ten I appreciate the clarification five I think that helps. Okay so it's going to go through a R. H. bi which has how many members. Seventeen seventeen hospitals and then the three medical schools and then to ask you agency says okay. But we're going to serve all fifty two House fifty two run hospitals right it might. Why are. So you get a large number of hospitals you're going to look you're looking to serve March more hospitals there even members. I mean I don't know much about health care world so. I mean why are they not members if there rule hospitals of your organization. Well I think we have so we started in she go County so you have to think in terms of the growth and so what we're growing and we have had other hospitals especially like going north central asked to join and we don't recruit members I mean we are strictly there to help so date but there members because they see value in by a member of the organization but you have. In that many more members or people that aren't members because they didn't see the value in joining the organization yeah if you might Senator and I think that's a valid question asked whenever I join the Arkansas real health partnership of the CEO Warren in Bradley County and we were in the delta region and that was a major focus for the A. R. H. P. when I got started with some funding that was specific for the Delta. We were doing some really good things there. And whenever I became the CEO in magnolia I was not a member at the magnolia was not a member and they are outside the delta and so. I was the board chairman at the time whenever moved to magnolia. And. I saw the value that I made a request is a hospital outside the delta area to become a member of the organization. And so that's. But with a lot of the restriction has been because the grants our rural in delta specific but we haven't. We have promoted we're not we are not a rural hospital association but you are are numb yourself rule hardware association but so many that Arkansas ruled Association okay well I mean so then that's mine my question is means you have members right now do we have ten million dollars that it it got understood right earlier you're going to help them develop programs to emphasize particular areas that you want them to emphasize on so maybe it's mental health maybe it's whatever and in so you're simply going to use the ten million dollars to pay them to do whatever it may be I think that's what I called earlier and I tried to read through and I still don't know that I understand because if I read you know just the. Overall deal here it doesn't it talks more about looking at their organization help to make tweaks and adjustments that for the then I heard something in testimony about how we were going to actually pay them to administer different programs that you felt like would bring value to the community. And so. The question would be do you have ten million dollars you're going to go out over hospitals you've got hospitals that pay you some amount of money to be a member and hospitals that don't pay you a certain amount of money or not members. How are you all going to be able to. Not show bias to your member organizations that are more tightly associated already with your board with the organization itself. And then I mean how do we at how big of a disservice is that going to be just a rule hospital in north East Arkansas northwest Arkansas that is in a member doesn't have the association I mean are they even going to be as comfortable working with the organization as your member organizations means this is going to turn into a recruiting tool then you know for your organization hopefully right so I guess how do you see this playing out because I don't see it written clearly enough to understand how you're going to dole out the money. Elessar something then we have some of entities present earlier that we didn't have all the documentation is or anything else that we need to see I think it would help probably if we could come back to you with the budget so we have a lot of federal grants I mean that's what we do we've had okay no. Close to fifty million and and federal grants mainly okay I'm and we don't give money out to our members I mean the way we do it is facilitated so in the case of the swing that program we offer a service to a hospital and we pay for that service to be offered to that hospital and these these things that are offered or done want equal base whether you're a member or not so you contract out so that they need to better understand how to utilize the swing bed right and so you're going to find someone that then you're going to pay directly to go to that hospital and show them how to be whatever's yes or to do whatever. And then. You just give them so if you have two million dollars and cost. You've got ten hospitals that want to do it because million dollars a hospital and you just give everybody million dollars each there's no difference there's no admin costs there's no whatever since dollars all in a dollar for dollar out or how does that work we're not necessarily give them to the hospitals we will find a contract are you gonna given to the contract right so if you've got ten million dollars allocated for contractors for swing beds you give out ten million dollars to the contract correct okay not a dime of that stays with the organization right okay. All right and so there is no management oversight fee we are not asking for any indirect calls okay all right thank you. Represented representative Pilkington. Thank you chairman right So I've been a lot of questions one of the things I notice from this was there was no sort of investment to residency programs is that correct for providers I know that's one of the best ways to help. Struggling hospitals recruit physicians and help communities. Why is this not included at all. Well we just don't we did not include that we actually have a grant project right now Hurst rule residency grant program we're starting a residency program in I'm Crossett Arkansas and Ashley County I'm and that's something that we're working on expanding but we received her so funds for that there's a lot of money you know through her Sir for those kinds of initiatives but there's no plan to expand residency programs in any non member counties we would love to assist with that and I'm not part of the proposal not no not this proposed okay you know it's it's interesting to just like you said this to serve the entire state but you know Baptist health is one of your members correct yes so obviously Baptist competes in a lot of markets Faulkner County Pulaski County Sebastian County with a lot of the other health systems and I imagine that's what is health systems aren't part of your network and I would imagine that if you were a ministry at Saint Vincent's and world ten having someone who's affiliated with Baptist come in and consult and tell you all the things you're doing wrong would not be something they would welcome same with light house which I know isn't selain which competes at Baptist and they also on the same merry's and Russellville so I imagine why there's this massive gap in your in your network so can you explain to me why they should not have a reservation because I don't know any hostile initiators gonna welcome and someone who so closely affiliated with the competition. Well in in the case of the it depends what you're somebody like in the case of EMS doing the actual training I mean that's something that most of our hospitals welcome I think Baptist actually does their own training but most of our other system hospitals do participated in the in the simulation training on the other side of this we don't use consultants from any of our systems in our in our in our area I mean I don't feel like right now Arkansas has the capacity to I mean have you know have that role knowledge of knowing what it means to fix a rule hospital I'm we've got new designations out there that we have to consider they're starting to you know really look at different ways for these hospitals to to change and I think that there's a lot of consultants that we could pull in at the national level to help us do that. But I guess my understanding is are my feeling is you would be very hard to trust an organization that literally has your competition as a member of said organization. Injures head. I understand were where that might be a concern of yours but it's really the way we're structured it that's not the way the organization works the organization works as a partnership of the members we lean on members that have strengths that's one of the things that's made us successful and if if the Baptist CEO has a strength that we can use that will take is his information use it if the Jefferson regional has has it if the CEO magnolia has it it's a partnership and it's it's really. There are there are going to be members that are gonna be evaluating information that's. Beneficial to them from a market standpoint. As a matter of fact we just collected a lot of information that we we presented on the difference in the cost of the salaries for our or our member organizations to to try to talk about one the reasons we're trying to get the funding to help the organizations statewide because we could collect our data. We collected from all the organizations. M. A. R. H. B. ID identified it and I sent to the CEOs so even the even that what we gather within our own partnership organization was not shared across the board with all of the all the members in a in a situation where they could use that from a market standpoint so that that's not the intent. The at the intent. In all in in honestly is. We see what's going on in our in our member hospitals in what can we do to assist and help those member hospitals. And we've been successful with some of the programs that we've done and we've had people that are coming and saying Hey you know can we be a part of the membership we don't have the infrastructure right now to take on I mean we're this is this is it one hundred percent to learn to Senator this means concern this is a hundred percent not a membership grab we're we're not interested right now in expanding memberships what our goal our focus is is to help keep hospitals from getting the situation that we have right now with two of our members but I think you can see my concerned where if you're only have seventeen hospitals or whatever and these other hospitals they will want to work with you because we don't feel like there's trust because you have a health system that the member of your organization then you keep the fifteen million dollars within your organization al NO one wanted to be a part of that are applied to it that's what we are able to collect and keep it in our own networking around system that only helps out this one particular part of Arkansas that's my concern. Well I think you heard from the. Mark that the the money will be doled out as it used so if if then the hospitals want to take advantage of of having high powered consultants coming in to do a a thorough review then I mean that's kind of on the what we're what we're trying to do is to provide that service and it it has nothing to do with we have something hospitals two of them are Baptist so I mean that the focus is not to try to get system facilities or to benefit one system over the other it's. What can we do as an organization of hospital CEOs. They can. Help the hospital survive. It even within our the with our partnership. If some of the hospitals failing the partnership it hurts the rest of because we don't have the capacity to take them up we've got hospitals in a partnership now they're having to drop I'll be services because a work force issues because of salary issues because at the end of the day all of this comes down to unless we can correct reimbursement rates for these facilities we can we can help these facilities tweet along a little bit but it comes down to there has got to be a mechanism in place at some point. To help these hospitals from a reimbursement standpoint. But so just so I get that same correctly you're saying if we don't increase reimbursement rates by to spending fifty million dollars these hospitals are going to go under. All right I'd. In the fifty million dollars won't touch what it's going to take to keep hospitals open. But if we can help provide the tools and resources maybe to help some of them look at things differently or to make some changes in their market on how they do their business then perhaps we can save some of those hospitals because I assure you there will be hospitals in this state that close if we don't make some changes that that's I'm not I'm not for a long time hospitals and have been come in same things or bad things or bad and we need money. And I understand that that the money's been given out but I'm just I'm telling the the lead this committee. Things are as bad as they have ever been in my entire career and I've been doing this a long time and so when people are saying now things are bad they are truly we are going to have hospitals closed. It too late for some of so you have to members who are FQHCs another twelve SQ agencies around the state is there any any idea to partner with the other ten FQHCs as you go into different regions because you're too that your are just locator to area so and I know that if you say it sees can be valuable partners to hospitals is there any I don't see anything as proposal about utilizing the other one. I think we do we will start to say FQHCs working more closely with hospitals especially on the primary care level and we start to really see where they're providing some of the O. B. you know support services as well as the primary care and that is a model we really are looking at four hospitals is that they don't necessarily have to own a rule health clinic if they sure hard with the nephew agency which is ideal really because then you have that that funding but it's fifty million are going to your accuracy partners that off I remember hearing occurring right this is just a hospital's career this is a hospital okay thank you. Thank you have a couple questions I've got myself you know we're looking at ten took me awhile to kind of read through this I'm a bulletin kind of point I had to redo this whole narrative to kind of find all this so when I'm looking at no one talking about the ten million that five million separate and I'll get to that but I'm looking at this ten million like on the swing bed coordination you've got at the very last thing on that paragraph one point five million for three years. What exactly are you gonna do with that like who are you paying that to you I guess so I would ask another question what do I need you for if you've got the means I can have the same consultants that you can hire me to the State not do the same thing the calendar doing. Yes okay. That that's easy enough answer so let me move to the five million and so on the five million. How are we going to do this I know that you know of a couple hospitals that are in the motion need right now. and I think the obvious answer would be that you would work with them first. Moving forward is there a process in place can we only work with one hospital it's time can we work with up to five at a time can we what's the time line to look at I mean I've hired you know with you with our consultants in the past you know of. Hospital system I work for they might be on site for two years trying to look at all of our processes and try to revamp what we're doing. So give me a little bit more information on that five million. Part of the the five million is A duplication of what some of the grant funding has been able to do we just recently got some grants to do some operational assessments of facilities but from the selection process certainly there are a couple of I've been identified right now that are in absolute immediate jeopardy that that need the assistance in the health And then we would make it available under one of all there are a lot of questions this morning during the process is well they don't make anybody aware that they can access these funds. One of the things that we would absolutely do is to put out to the facilities a. Request for information and interest in would they be interested in providing erred in taking this type of of a consulting and then once we kind of see what that number is then we can make a determination on on how many into there's probably three or four really good firms out there that do this type of thing some I don't think we want but there are some that are out there that do a really good job of it and we can have an idea what those fees would be and we can identify using the metric that we develop and we haven't developed that yet. Of where they are financially on their request the request would would have to include some financial information and it may be that we have to prioritize those within the information that we get because of twenty all the other. Twenty hospitals today call me up Collison said we want. We can't do twenty today so willing five million would only for if you're going to do a true if you're truly going to look at the processes for a hospital. From very thoroughly start to finish five million does one system. Well a system would necessarily qualify K. so does qualify a hospital eight C. just a rural hospital would. The numbers we're getting back are nowhere close to to that. and these are very reputable firms that do operational assessments so there's going to operational assessment they're not they're looking at they're looking at what billing coding they're looking at floor utilization staff fifty utilization what are they looking at they're gonna look at if you take a look at the the sheet in here this got to three blocks on it they're gonna be looking at everything one of the other things are also going to look at is the the the market itself and does your market actually support some of the programs that you offer and this isn't this isn't something that that everyone may be. jumping up in joy in about. Having been told that you know you can support a GI surgeon are you can support three surgeons with your market. But that's the information that we would gather that's that's the depth and and what they're gonna be looking at for these facilities because we're at we're at a point where to crisis point in healthcare we're we're going to have to learn we can only do what we can do. And I had a lot of facilities are already there they're working through all these processes themselves already and maybe not every facility across the state is is essentially self analyzing and looking at every single service line every which way they can cut costs increase revenue we most facilities are already. You know going through these exercises in futility at this point a lot a lot of them are the representative gray. But a lot of them are doing some of the stuff in house with their in house expertise and the. I'm you know a mediocre CEO at best and would do the best job I could at trying to have some operational changes in my facility but they're gonna be things that. The healthcare reimbursement system is the most complex reimbursement. In the mechanism in the entire world it is a nightmare and it doesn't take much if you can get an analysis of a cost report and you can make a couple changes on how you're doing business it could be that you need to actually hire someone here let someone go here in your cost will change in your reimbursement will change it makes no sense to a businessman but that's the kind of depth in the level Chargemaster review you know ensuring that you're doing a Chargemaster reviews so that you can maximize your reimbursement some of facilities get tied up in I'm just trying to survive today and they forget to do those things that's what part of that operational analysis would be. And a number I appreciate all those things and understand all those things in that. If we're just now starting that process with some of these hospitals and the hospitals are about to go under your not going to complete your analysis before they go under I guess that's where I'm at it for thirty days and may I know this ties in with the sixty million requests that we're gonna look at next. Your body by nightfall your round the car will if they're not already doing these things then we're way behind the curve ball. Seven Senator Rapert you're recognized yeah I mean they've been down these for years I mean you know some county Medical Center is you've been there for years and I mean my husband is a family practice physician but you know he works in the hospital he is he worked at Newport hospital as well being for the past twenty five years they've known about swing bed coordination. And how to most effectively use that I mean in the ER doctors know that the physicians that that and I'm I guess my question yeah I'm I'm I have a difficulty with a fifteen million dollars to nonprofit organization without a contract without deliverables without an actual signed agreement that's in black and white writing as far as where the money's going how it's going to be spent eccentrics that are with very strong details and deliverables that we can make sure that we are in good stewards of taxpayer dollars I have a real problem with that I don't know why we wouldn't if we had those identified as why would we do why wouldn't they just give money to directly to the hospital so that they could comes they could hire these consultants themselves. That's and I'm so I'm confused why we would. I'm again not trying to downplay what you do but I don't understand if you're if we give you the money and then you go and hire consultants for the hospital why can't the hospitals just hire the consultants themselves. And if that's and and why can't we give them the hospitals the money to the ability to do that. Through a grant program to specifically for that so it's direct I'm I'm not sure then I'm not sure why we're not doing that and then you know further more. It's always reimbursements we know that. So is this is this really a good spend about a or not we know it's going to be reimbursements and Medicaid insurance reimbursements continuously drop they don't have the negotiation powers for state to be able to contract very well with insurance companies because I mean there's so many complexities to all of the US. And so I you know I'm not sure if this is actually gonna solve any of the problems that you say that we want to solve I'm not sure if this is the route that I don't think it's a route to go because there's so many factors that are never going to be able to be considered and and if you can't raise reimbursements I mean it just comes down to your overhead is going up higher and your reimbursements are still right here and your overheads to hire I'm not sure what the service that you provide can actually change that dynamic. Senate questions for DHS yes Sir I understand your concerns also thing from our standpoint no we recognize there is an issue so that's got to be done to help our hospitals and so we we start looking at this these proposals are out there we thought this makes sense for us to bring these together try to have a comprehensive effort to try to provide at least some relief for hospitals certainly don't want to say that is going to be the end all solution for hospitals it's not because it is it is in the it's a much more massive problem than that but it's also very much a national problem in a course and and Medicare is a big piece of that and we if we don't control Medicare but we thought this is still step in the right direction to help our hospitals and help them reach for that long term sustainability. All right thank yes one more question and then we'll move on you said you know what I brought up the US of the ward system and you gonna smiled at me and said this probably isn't something you'd be doing for system I may have missed it. Are you just going to provide this service although you said it statewide are you just going to provide this service for those that qualify for the sixty million dollar program that's being administered by DHS. No we're and for clarification it's the we've there probably won't be systems that take advantage of this because they've got the the expertise in a system typically to do this type of thing okay but no this is this is a statewide program I think the sixty million is going to be for some of those that are are in that meet the algorithm for immediate jeopardy certainly those are going to be a priority for the request but this is for any other any other it would be for any other facilities and to Senator Irvin absolutely the the state could could do this program in the state could could send out the request and have the the money coming in and but they're happy some oversight from the state and in some capacity within the is the state's organization to to do this and I don't think right now that that's that's available and that's one one the three things to that there's. There seem to be so much value in this potential that even though it didn't meet the RP funding. It was felt to be that there was enough value in this that we should still ask. For this program to be initiated. All right thank you saying no other questions for you guys thank you very much I appreciate your time March I Y. if you will to stay at the table for me. Yes ma'am all right. We're gonna move on to item D. I want to most give seventeen for just a minute let's move on to the eighteen which is the hospitals just to keep in line with that discussion So if you have someone else that needs to join you. Yes Elizabeth felt or joy for this one. All right members it's four o'clock so it's getting late I know we've all had time to look at all these requests are there any questions on this sixty million right now. This or the sixty million were on the eighteen. Page one seventeen Senator Rice. Thank you get this one where mark you will. On the bottom of that application it says this draft is a working document all information contained herein is subject to change and may differ substantially from the final document the information contained in this document should not be considered the abuse or position or views of the agency or the governor. Are we are we will okay and a pig in a poke so you're okay and something that we actually can rely on yes the Bentley was included in there so we have sent to the committee simply because during committed not a descent decision on it just to indicate that this is not our decision we're presenting this the distributor of the steering committee the governor use the legislature and to all of you agree on it it's not so that we can guarantee but now the circuitous prove this this is as we read this binding on us we're so we're have to enforce this as it's written assuming that you all approve it I would like to know Senator Rice that's the online version the printed version. Does not have it on here okay. We make sure that yeah okay the other the other thing in its existence in the discussion we've been having. But if I go back to there are critical things right now own hospitals. But if they have have not. Accepted. Change been assessed to monitor constantly and I know the hospital to do probably even more. But if they not accepted that there. What I'm calling model. It's change. What we what we think we're going to fix if they don't have it. If they not been trying to do it on their own. Because all right to me all you're doing is spending money and they're gonna get the same result. Go ahead. I would say and miss but may want to add to this I would say that the intent here is to have was there were very target Mosel those hospitals there in the most immediate jeopardy of closure but to give them some breathing or they give us some time to continue to work on improving their business practices addressing the issues here as best they can to try and create that path to sustainability so I would say this is this is just like didn't give them some time to work towards that. Good afternoon I'll be brief I'm Elizabeth and I'm the director for Division of Medical Services and I know it's been a long day and I would also just add to it Clark said which is all very true that we are also in the process of working with a hospital association and some hospitals to do a rate study for Medicaid rates I'm the goal is to have that completed by the end of the year so this funding source also allows us some time to look at you know hospital reimbursement in whether or not that's a structure that needs to change to help create sustainability for hospitals and additionally and I am not as well versed in this state it is my understanding that a lot of these hospitals took something called Medicare xcelerated funding which was basically where Medicare said Hey we realize you're in distress we will estimate how much we think we would pay you for claims for the rest of the year and go ahead and pay that out to you now and reconcile that at the end of the year that is now being reconciled in so some hospitals did not bill Medicare what Medicare estimated they would and they're not coming in and taking that money back that is a one time problem that is not something that's going to continue to happen Medicare is not going to continue to accelerate funds so that's also exacerbating that issue at this time and so those are some things I think that that we just need some time to work through. Well I appreciate hearing excel listen to secretary glass beads media interview and and I didn't get any detail in that I understand your problem and course none of us want any hospital to go out that's been set here. Local time today but. I will I need to comfort that they're going to accept the reality what they have to do I mean it is the world changes and and they've got to do that so my concern thank you and just and also a Senate proposal so I want to tell you something you already know but within ninety days of submitting your application we are I'll also asking for them to submit a plan for how they do intend to to create sustainability within their hospital program. And this would be no we're we're asking for that within ninety days and what we're looking at essentially giving them is three months worth of pay roll up to a captain million dollars who's to say that they're still going to be viable in ninety days. I mean I have it that five million dollar contract that we just discussed. Unless you had people on site twenty four seven able to pull this information you're not going to come up with a plan for sustainability in ninety days. I I don't see us because maybe you can in a very small rural hospitals but and I'll say I don't know that are into is the seller to for them to give us a complete comprehensive sustainability plan but we want to say they've identified some steps and they're taking the steps to help address the problem all right representative Cavenaugh you're recognized thank you madam chair my question is just on make sure I understand maybe you can clarify. The hospital getting this five member correctly from the Arkansas meeting they're not critical access hospitals they are not part of a larger system. Correct and they have a formula that we're going to make they have to meet and it's yeah I've got that do we have an approximate number of how many that might actually be at this time right now there are ten hospitals that are in that first category that meet exactly which described and then the next round would be for critical access hospitals and there's at least sixteen hospitals that are in that category okay thank you. Senate is when you want you go question hour in a minute. Okay so much members and I I'm not been in this entirely sought that think some other folks or any kind of speak of about maybe the direction we will go with sixty million here is there some thought there may be a little bit familiar with how we handled the ESR funds which means no regionally we released a big block people call that back essentially then had a release you know each meeting for a lesser amount there's some desire that we do this on a hospital by hospital basis I understand that there is in general allocation of sixty million dollars for hospital so there's some security there but also allow those hospitals make your presentation ensure that they are you know not just utilizing ninety days but have a sustainability plan in place and that we can have a conversation about that is that impacts us as legislators also last thing anyone of us want to see is a real hospital close and so I guess I would just kind of asked in general how you would see that playing out of that something that shall be willing to work with us on that sort of thing gonna get there's other members that have a better understanding of that you can explain it better than me. I will have. Okay certainly we're we will work with the all however you all decide you want to head I think the car the front end I think the only concern that I would express and really be expressed for behalf of this hospital association for what they've totals there are at least one or two hospitals that are in very dire straits and it may be the timing may affect them and in we did I I did understand that I think there's one in particular at least my understanding and so if we could I mean I I'd like to have a conversation the members that were involved I'm just trying to really information now not actually know what I'm talking about so it I'll turn it over someone else and see that you find out how they see that playing out. Senator Hickey yes all right so that that was kind of our discussion that we've been having excuse me is that we would like to see these owners Senator Dismang so that said case by case basis so basically of ABC hospital if you all of that have determined that that they're a critical but there's a problem they're about to go under it you all provide us how much money they're needing a detailed plan of exactly why they're needing that money with no fluff and it but probably most importantly this that there's a there's a business plan that's been developed by that particular hospital they got initiate because they can't cash flow maybe it's because the population declines they're going to have to address that so that they can sustain sustain and be in those communities for the long term I guess the thought process from us out here is that we just don't wanna give this money out here so in six months of their back here warning state general revenue or possibly going under or whatever it may be at that time I think we just like to do it from a comprehensive approach. And as you know we are there possibly is one house bill or so that you know if you're looking to need that money. You know we could probably not talk to the cheers about this if that's something that has to be done you know by this month there could possibly be a supplemental agenda put on for Friday again I've discussed that with the you'll see chairs representing. Wardlaw in the Senator Rice you know for that particular issue. All right. The Senator were certainly what will work towards that I think the challenge is to be honest don't know is how long will take the hospital to put that information together and get that application I believe that there are in the process of gathering information but I just I can't give you a personal guarantees a fast catcher and if I may Mr the only issue that I have with that is that if you have a hospital administration that is it has got in this financial shape they should have already developed a plan on how they should do it and if they had and then I don't really have any confidence that they're going to be able to just get a block of money and then. To them establish a plan so I'd if they haven't done their work on that and they're in this type of situation that I think we got some other issues respectfully I'm not I understand I appreciate what you said thanks to. And. To add to that and from a I would I would say that's also not just a hospital is also you know we were we're working internally and we're meeting with a hospital association right now to come up with what documentation we're expecting them to provide and we want to have very detailed documentation how we're going to measure that the funding is being used the way we do that it be anticipated to be used as well as what we're looking for in those plans and getting that application together so part of that is also a one however how how quickly can we get that together and we have started that we started out last week so I just I don't know how to talk to my staff about exactly where we are in that process sure and we do understand if you have this one this critical that to. you know we we may have to get a little little information after but I think that we can come up with a majority of that I appreciate your comment. Senator Elliot you're recognized. Thank you madam chair I I was curious about these I think the ten most critical ones you're talking about try to find somewhere in all this paper and I didn't of where they're located geographically roughly of a concentrated in some area of a all over. They are not concentrated in give me just a moment I can pull the list out. Okay until at least ones that. It is possible maybe one or two that we missed the notification but just on our review criteria what we thought would meet that okay. So for and this was as it said they're kinda in the mid level where they're not critical access hospitals so they have somewhat less favorable billing options Medicare okay and they're not part of the systems that I have a system they can rely on and that are with hospitals in Danville Monticello magnolia Meena Clark's full Camden Blytheville Paragould Harrison in Mountain Home in a course in three of the A. list hospitals to apply for this everyone happy willing to say in the application and publicly that they fear they are in immediate jeopardy of closure and that is a very big deal for hospital okay thank you thanks manager. All right any other questions regarding this one. Seeing none that was the eighteen percent thank you and did Jessica interstate the table for me and we'll go back to U. D. C.. The seventeen. All right members Hyundai seventeen it's on page one eleven. Are there any questions one of the seventeen. It's five million dollar request. Questions on the seventeen. That we actually don't seem any questions you are good to go thank you thank you all right let's see where we're at. D. nineteen the vaccination testing other any members before I have someone come over there any members with questions on D. nineteen. All right. I got one item said the twenty and twenty one. Of course we're still hearing those I guess I to game and fish to come to the table. They're all right they are pulled. Berlin okay my understanding we're gonna pull those. All right Adam D. twenty two department of agriculture. Hi please state your name for the record. Yes ma'am west toward the center for the Arkansas department of culture. In rhyme benefit deputy director for the natural resources division of the Arkansas department of agriculture there thank you. Hi I know I have would hurt a lot about this adopts a rule people the last couple days this is a large expenditure you want to give us just a quick run down very quick rundown of what we're doing with this. Yes ma'am so so just a quick recap of your last year the government created working groups one of those was water and other infrastructure projects we met with other other departments of state government did a needs survey that needs survey resulted in over fourteen hundred projects and identified over five billion dollars worth of water wastewater needs across the state so we we put together working group put together a proposal last year for over eight hundred million dollars due to cope with another factors we weren't able to move forward with that at this time fast forward to this year we've revised that requested three hundred million total that includes the campus projects server at outside of game fish you will be two hundred eighty million total two hundred seventy four water and wastewater projects and ten million for two separate irrigation projects in the state to address critical groundwater declined so we we do have some of evaluation criteria proposed timeline some different factors there that we put together ideally we would like to open up an application period after of the legislatures given approval on on the process that we would have opened for about fifty days to allow those projects throughout the state to be able to resubmit their projects make sure the most recent up to date information provided then we would have our our staff within the department and working with other departments and state government to evaluate those based on that criteria present there's to a natural resources commission which frequently looks at water wastewater projects and then be able to move forward from there all right thank you on the the criteria how are you prioritizing the applications that come in are you prioritizing them based on or is it first come first serve how are we doing that. So it's a it is not a first come first serve basis we've got the evaluation criteria that we would be more than happy to share with the the entire legislature however however you would see fit but it ranges based off water being one criteria I wastewater and stormwater being the other so it ranges from your other projects in compliance is it your regionalization is a modernization a broad range of criteria that that we've right to come up with a hundred point criteria that we would use to evaluate all the projects that were submitted during an application period to make sure once treated under the same process in a fair manner thank you for that Senator Rice you're recognized. Yes sector warden I wasn't able to hear but the city council meeting that the testimony was do you think you've got the. Right to area. for the application period screwed down on the we're not going to have this back and forth I realize are always may be some but there are some testimony that. if this was over the top do you think we've got to handle my. Yes I think that we do you know and the factors that we looked at were were based off of conversation we had as a working group but you know certainly if there are factors that so that the legislature has a preference on you know if that's under what we've heard concerns about just sustainability projects and not going good money after bad projects that they will have to come back to us in the future so so we we write those that is part of the evaluation criteria where your regionalization they're sort of factors or or included in the in the criteria the evaluation criteria so I I think they were I think were about as good as we can be but we're happy to going back to where we need three more things and then we need to does more things and we need a hundred forty three more than. We think we've we've got a process of. I do yes Sir I think I think the process that we've got right now would it's very similar to what we're using currently for water and wastewater project with the natural resources commissions I think it's it's solid we we don't anticipate San. In two or three weeks into this process And okay wait a second we need to back up and try something different I feel like the process that we've got a stab wishes will be pretty solid and and what would go through the entire thing I appreciate your feedback thank you. Thank you have a question you know we talked about like different charges of money we've got the infrastructure money the capital money the argument any. In. Why could this project not be funded through one of the other sources or could it be funded through one of the other sources that's a that's a great question and it's a complicated question but I think you're you're asking the right questions so there so we do have existing programs that state revolving loan programs that provide fan financing for water wastewater projects throughout the state of the majority of that is is financing so it's low interest loans it's it's very little grant funding or or loan forgiveness for your promissory forgiveness for those projects the RP funding itself would the biggest impact that that makes is it provides more grant dollars as opposed to just financing and access to capital so but you know there's there's existing programs hopefully are profoundly and then the third piece of that is the the by a person of a structure low funding as well so that that one hi just briefly what's been what's been so public is about five hundred twenty eight million for water wastewater projects over the next five years that's a little misleading skews me so that's about about probably half of that's actually going for water projects themselves a lot of that funding is for lead service lines and emerging contaminants and then of that money it's financing it's still it's still that that piece of its not loans or not it's not grant that's actually going on in their pockets they've got to pay it back small portion of it can be for disadvantaged communities there's there's strings attached how that has to be approached but but great question different factors saw on three different pieces to be able to address water wastewater needs thank you are there any other questions. Senator Dismang. Thank you committee chair members alike to make a motion that we pass over items D. eighteen eight three fourteen sixteen eighteen twenty and twenty one and I move that we approve items fifteen seventeen nineteen and twenty two so again repeat that motion that we pass over items eight through fourteen sixteen eighteen twenty and twenty one and approve items fifteen seventeen nineteen and twenty two. All right that's proper motion if you wish. Senator Hickey you're recognized it was my understanding that twenty twenty one was actually cool down by the the agency so we're not passing over it is that they're not yeah okay just thank you. There Senate it is seconded the motion and discussion on the motion Senator Chesterfield you're recognized. Yes and I need to know why fifteen was acceptable the other. The one that you said was okay fifteen and what else. Fifteen seventeen nineteen and twenty two. Tell me one fifteen which is a college like the rest is more acceptable than the other colleges at which you pass okay fifteen is related to the creation of some living facilities for training program all the others are tied to nursing programs in we felt as though it leases I say we I can only speak for myself Senator Chesterfield felt as though we would like to get a more comprehensive view of what was needed in regards to nursing especially nursing schools here in this state and that was to not stated The all these weren't viable good projects but just to make sure that we're encompassing and something that considers all the needs of different schools in the state or at least those are able to expand realizing that there is a shortage in a need out there well it's just it's not like the others of eggs these just want to say that. Well I. can can't so I understand that my position is not going to prevail but it is very disheartening they're very disheartening that these people have worked all this time. Come down here state all day long. And certainly we just a non responsive to them I think it's a shame I'll be voting no thank you. Any other discussion on the motion. Do I need to repeat the motion against everyone got it. All right. Let me just repeat one more time we're going to pass over items D. eight through fourteen. Passover D. sixteen D. eighteen Adams twenty twenty one recalled and we're going to approve items. Fifteen seventeen nineteen and twenty two. There's number forty six. Representative flowers you're recognized for discussion. You're not you're not actually you're not a member thank you. All right all in favor say aye. Opposed nay nay the ayes have it motion carries. We're not six. Hi I would also like to say and you tell me if I'm wrong Bailey I'm just going to wing it here at this point. earlier in the day I had passed over item B. three are because that tied to you another item that item was passed over just now so we will leave be three as passed over. it's tied to the reserve restricted reserve. Okay we'll get we'll get there. Let's move on to either be rainy day. Applicable we'll get out there I got to get if. Thank you madam chair in section II this is a rainy day fund release request E. one is a letter from the governor this for the department of health this is a three hundred fifty thousand dollar transfer from the rainy day fund it's provide additional training for nurses providing maternal health care in home to new mothers next item is easy to this is a letter from the governor for the Department of specter engine from the for the department inspector general it's one hundred nine thousand or transfer this is provide funding for the fair housing commission as a result of that the increase in federal funding measure those there. All right to have any questions on items ET one or two. All right say no not entertain a motion to approve both items. Got a motion and a second all in favor aye opposed nay moshing carries I don't know if this is what I was discussing earlier. What go ahead. The manager were section of this is to restrict user fund transfer is for the department Human Services it is for the Division of Medical Services it's of five million or transfer from the majority vote various permits and projects set aside is to make a grant to the Arkansas oral health partnership to central hospitals and decrease the risk of closure this is the funding for the appropriation request the song B. three. All right thank you. This one we're going to pass over as well. Let's NO all right we're gonna as B. three were passing over both so we'll move on to items for review with cheap. Thank you ma'am chair inspection Gee this is a catch prohibition quiz first items about letter from the department Education Division of elementary and secondary education it's a two point eight million appropriation it's to spend two different grants of the first of the Walton foundation they granted two point seven million to increase student interest in stem and the next one is national governors association be granted thirty five thousand for a project focused at the program to support the whole child development. Next item G. two is a letter from the Department finance administration racing commission this is a request for four hundred forty five thousand in appropriation is to pay for increased cost due to extension of horse racing season and Are you in. I've been extending okay. Are there any questions on item G. C. nine will mark that is reviewed Adam F. R. I. the age. Thank you ma'am share inspection It's fifteen million appropriation this is to update Part of Education quest for A. R. P. appropriation the for to use S. refunds on today's units departments fifth round request this request for sixty five point six million is to make grants to twenty three school districts the the second hand that you have is a schedule as provided by the department shows a break out of this just responses on whether their use of funds plans follow AOC recommendations to use a R. P. funds for teacher retention strategies of those twenty three schools five school districts had plans that met the LC recommendation seven districts revise their plans to meet the LC recommendation in eleven districts did not revise our plans and it justifications provided the last column. All right thank you have members are there any questions on. Yep Senator Chesterfield so you can make a motion to approve it okay on the agenda. In its entirety all right any other questions okay I've got a motion and a second all in favor say aye. Opposed nay. motion carries Senator Caldwell. Help. Senate foreign yeah just that quickly on the one thing that I think it's important to note when you have the the schools in the reporting at the department of education could give us information about The the the laws around school board members may have people on staff that receive those funds and what type of the disclosures required if they are receiving like increases after. You know like if there's a bonus and and they have a relationship with somebody who is receiving that money are there disclosures that are required to for the school board or for the. Department if it's a bonus yeah that was just something that I thought through when we were looking at this recommendation unless something that act as department of ed and I don't know and I don't think they're here but just so kind they are here they are here. It is if they can look into it that's all they don't need to come up to the table I would just like to know on disclosures like what's required for the bonuses that were recommended if there's a family member that's part of the voting. four yes school board and then what those disclosures look like I think that's probably important for us to know. And all right thank you and we'll move on to reports. Thank you madam chair the first reports the annual port this is the agency carry forward of unexpended balances a special language allows certain agencies to carry for unexpended general revenue fund balances into the next fiscal year the lands requires reporting agency of the amounts to be carried forward from fiscal year twenty two into fiscal year twenty three if the balances carried for the purpose for the funds as provided. All right thank you have any questions on automobile. All right M.. Share in the month reports the first one and one is a surplus income distribution report and shows the sources of the unobligated funds and then the distributions from the rainy day restrict reserve in long term reserve funds as of the end of August three the financials for thirteen point eight million distributions in a balance of two point eight million that e-mail's me to point two nine after today's transfers on the agenda of the research reserve fund shows almost a hundred ninety four million distributions an overall balance of two hundred twenty seven million of the total a catastrophic reserve amounts as one point two billion next report is the budget stabilization trust fund report and it shows the cash flow loans throughout the fiscal year as of the end of August there are twenty point seven million in outstanding loans and cash balance of a hundred and seventy nine million the next reported spackle seven port and this will give us some of the income fund balances investments actual payments to the scene on the second page or all expenses by fiscal year next report is the central services report and this shows the fund balance and disbursements as well as the expenditures of each agency supported by the fund last report is American rescue plan report the first four pages of the report shows requests were approved by the air P. steering committee that the state has discretion awarding on the fifth page begins test with a that's report the RP funds were sent directly to state agencies from various federal entities and the last three pages are attaching to be that's report the RP funds are sent directly to institutions of higher education. All right are there any questions on the monthly report section M.. All right saying none hand there is no other business is that correct. Do I need a motion to adjourn okay and we are adjourned.