Public Health, Welfare and Labor- House & Senate

The chair sees a quorum of members who would get your seeds we want to get going on this we've got a long agenda today a lot of rules to review. And that's why we move the time up because we thought there might be some discussion because we do have so many rules. So why. Everybody being here today it's been a while we've been around the capital so I appreciate everybody coming in today. like that's my coach here do you have any comments center. Okay all right we'll just get right into it then. Of the first item is items see consideration of approval of the minutes from February seventh that a motion. A second. All in favor signify by saying aye. Is haven't motion carries amendments are approved. moving on to item to the. We have to rules from the department of energy and environment. So if you all would come forward. So if you would please introduce yourself and who you represent. My name is Basil heck's pullout might to you a little bit okay. my name is Basil hex I'm an attorney for the department of energy and environment I'm here for rule to. My name is Alan your come the associate director of office of water quality I'm also here only to. My name is a Michael McAllister I'm managing attorney at any of the I'm here for D. E. Q. on for rule nineteen it's the next. Agenda item and with me is Erica drug of our air staff okay all right thank you. Okay so let's look at item D. which is rule to I'll just let you all explain those changes. Yes this is the rule first the water quality for surface waters in the state of Arkansas this is part of what's called a training or view its it's every three years we review this rule is required under the clean water act to do that we also made some Some housekeeping changes including the statutory changes from rag to rule in this in this In this rule making and we're here for any questions you might have. So these changes to rule to does it expand the authority of BPA or additional areas. No Sir okay. All right any questions from committee. Seeing none. This rule stands review has reviewed with no opposition. All right thank you let's move on to. Item he. Which is rule nineteen so if you would just go ahead and present the changes yes Sir this a rule nineteen is one of the rules dealing with the air program under the federal clean air act this rule changes to adopt some some changes so in the federal rule so it's going compliance with federal law there's some housekeeping issues clean up of references the record a rule change Mr Hicks mentioned is in this one also and we're here for any questions you might have on this. Okay it is there are there any changes in this to the interstate. Pollution across state lines that segment of the rules. No Sir not specifically this does deal with some state implementation plans and you know as opposed to federal implementation plans so the state can address issues as they arise but it does not deal with that that aspect of it thank you. All right committee any questions on the changes to rule nineteen. Seeing none with no objection this rule stands as review thank you Sir. Okay Committee will move on to item else. Of the H. S.. Department of Human Services I think you have to rules I believe. Maybe three. Three rules. So if you would please introduce yourself and who you represent. Thank Mister mark Waterman Department him services. David Jones Arkansas department of Human Services. All right we're gonna look at item if first. And just ask you to go ahead and discuss the changes sure I don't know if this rule that allows DMS or DHS to joy can you point Michael little closer to four sorry I get that court's sometimes rule well I don't know if you're allows the Arkansas department Human Services to join a preferred drug list pool and also join value based purchasing as a way to leverage other states buying power for drugs to realize greater rebates and also to allow some flexibility around certain drugs with regard to well allows the. The V. P. allows us to enter direct contracts with certain drug manufacturers which also affords some additional benefits. So there's a projected savings if we do this yes Sir we project about two million dollars for next state fiscal year how much of that's general fund state or. Just look at the. for next state fiscal approximately five hundred seventy thousand. Okay hi thank you. you didn't have any comments on this. I didn't see any on the list here but. No it's my understanding we did not okay. All right we do have a question. Senator Solomon you're recognized for a question. Thank you Mr so does this increase or restrict the number of drugs we can purchase sometimes we get on these plans and they don't allow the purchase of some drugs are we staying about the same are we increasing decreasing. It's center all is also the subject correction they shouldn't have any restriction or effect on the number on the top sure number drugs we can purchase it doesn't should mean that we will have better rebates on a large number of drugs so get sick gets more funds back but we can still whatever drugs we choose to add to the PTO we can still at ET AL okay so there there is an opportunity of drugs are not covered to add those structures in okay that's fine not a DMO questions thank you thank you Mr. All right Seeing no further questions from committee. Without objection this rule stands as review. Okay we'll move on to item G.. Thank you Mr chairman of this next item and serve you one five one thank this text autumn this is implementing an act from the session this is ACT five sixty nine which provided that APR is backs events practice registered nurses I can function as primary care providers in the Medicaid program as we've gone through made the necessary changes in our manual and our systems are to implement that act in addition we also had announced that we're going to increase the number of PCP visits that are allowed for a Medicaid beneficiary there are limits in place now and how many times during the year someone who's on traditional fee for service Medicaid can go to that PCP and this increases that from twelve visits to sixteen visits per state fiscal year and then that's the substitute ages there Mister I do want to point out one thing I this is brought her attention just about five minutes ago. We a we identified some technical records that may be made in the rule as we made those and put that in the updated copy this before you but in looking at it in section one seventy one point six thirty of the proper manual there is one case where we replace the phrase registered nurse practitioner with a PR in and it looks like in Tom context we should not have done that and so that's that's a taken correction will correct that back to the way it was in the original proposal which were verified that but the committees okay we'll make that change before this goes to rules subcommittee okay. All right thank you in this rule would go into effect July one. Yes Sir if it proved yes Sir since the since those PCP visits are measured based on the state fiscal year we thought we less confusing for beneficiaries just start fresh on July one okay. All right we do have a question representative Ferguson you're recognized for a question. I have a question for people who are chronically ill and need more than sixteen visits did I get approved on a one visit by visit of authorization or can they get say six more approved at a time. I believe we have an extension of benefits authorization in place I can I can find out the parameters around that I don't think it's completed visit by visit I believe it's past that way but I will look into that certainly okay thank you. All right saying no more questions without objection this rule stands as review. So going to item H.. I thank Mr chairman of this rule is another rule implementing an act influence ACT eight thirty from the session this is an act that directs Medicaid to cover vagus nerve stimulation therapy and provides for how and what will pay for that treatment we had some pretty in depth conversations back and forth with the manufacturers would ask for this change there's some complexities around hospital reimbursements that is took some time for us to work for we work that for I think the best my knowledge all the manufacturers would ask for this they are all satisfied with with where this is and so I think this is now good to go and so happy to answer questions on it. All right we do have a question Senator Solomon you're recognized for a question thank you Mr chair fussy on exhibit agents as a prior authorization will be requested so you send out a request and they don't do anything and everything goes okay. if you send out a request for it doesn't say if they don't submit a request. Then they won't approve the drug so if it's requested that doesn't. Will be it would if if it says is required that's different than requested. I I see what you're saying yes or the as as I stated the rule will require it will require a prior authorization for this treatment to be provided to new an individual is not what it says. I'm looking first paragraph statement of necessity. Yes Sir I think that's and that's that's in. That is a poorly worded summary player in the rule itself though and let me find it here. Yes some real self on a section to fifty one point two fifty it does say that vagus nerve stimulation therapy device and procedure require prior authorization for medical necessity okay for this is not a official documents and correct correct all right thank you Mr. All right committee any other questions. Seeing none without objection this rule stands as review thank you members thank you Mr chairman thank you. All right the now we have a number of rules from the department of health. So we'll look at I first so if you all would come forward on item I. Please introduce yourself and who you represent. Matt Gilmore from a health. So Ted for director of the board of nursing. David Dawson general counsel for the board of nursing. Okay you're recognized to present the changes under item I. Okay we had multiple changes and multiple chapters through the for the board of nursing someone start with chapter two which is licensure of our ends LPNs and they'll be tienes. The first change was qualifications and it was based on ACT seven forty six. And under section two examinations we just cleaned up some language to clarify what it was saying. In the next change was on chapter two dash eight S. H. and it was a result of ACT seven sixty two. Then on section six temporary permits we removed the about issued a temporary permit to qualified LPNs that was merges the rule that we accidentally got written into rule it was only for an emergency during covid. The next change is section. Seven F. it was ACT nine sixty eight relating to continuing education. Section eight he is that seven sixty two for a waiver for a C. eight dash seventeen dash three dash one of two. We remove section nine duplicate license because we no longer issue different licenses. section new ten is the name and address changes we just updated to current procedure. Section eleven was result of changes due to act one thirty five. Okay. All right we do have a question. You are ready to take questions correct. Senator Solomon you're recognized for a question thank you Mr chair on this that the public comment. it's has lauded the Clerk. And the response to them their comment was taken under under advisement so what is have you. Have you completed that advisement and what's the response to the what and I'm sorry number on which piece of the chapter which Shepherd center of. John exhibit one. And on the back of my second pages of public comment eleven eight twenty one comment section eleven D. two. It says a waiver of continuing education S. S. article read the spouse of a uniform service member can have a C. E. requirement waived without meeting any other criteria what a uniformed service member can only have the CD requirement waived if they are deployed is this correct and the response is comment taken under advisement. We the way we wrote that section is section nine eleven excuse me see we quoted the statute and it allows for uniform service member to have it waived. So what what is it when you say if taken under advisement what is that me. We made the changes that were collected with the statute less. Okay for the for the commenter was correct in there the way they read that. Okay our thank you thank you Mr. All right committee members any other questions. Seeing none without objection this rule stands as review. Earner next chapter that we make changes in this chapter three registered nurse practitioner okay this is Adam J. correct. I think she's doing chapter by chapter was not here I'm sorry I think I can do knowledge when it is your grandson. We have five sectors yep we there's five chapters. Sorry for the confusion of the changes made there we removed again difficult license address changes to reflect current procedure and we added this section for uniformed service members from act one thirty five and just quoted the statute that had not been in that section before. Okay any any questions from committee which which item are you on which exhibit are you on here I'm a little confused. It's all we're saying that we're still on the nursing board it's still low. Hi two yes so you don't I to that's what yes well we're on item by the nursing board has several chapters are updating so we're on chapter just a chapter three. So you think that's right okay we're doing chapter for next all right so committee were on I to any questions on that. Okay you might see. Still under the same agenda item this chapter for advanced practice registered nurse we had to do several updates in this chapter the first of a section to see on the certified nurse midwife we removed the written agreement as a result of Act six oh seven this midwife. Section three on licensure we added a section about the. X. seven forty six the social security number or this immigration. In that same section. F. on renewals we made those changes based on ACT four twelve and it was just really clarification of one on prescriptive authority as a result of the act a number three and number four. Was just repeating in the act what chapter eleven on independent practice is about because those certification for independent practice has renewed every three years so we put it with the renewals of their license. Then again we remove the section on the applicant license we added this section criminal background checks which was basically quoting ACT six thirty we've never had criminal background checks in the section on advanced practice licensure so we added it will that's practice nurses were originally created they've all had an are in license in Arkansas so you had that statute that related to just when I got there are in there already had their background checks now we have a lot of nurses with compact licenses that don't hold an Arkansas are in license so we wanted to make sure that is reflective we're doing these criminal background checks on those individuals that only however with an advanced practice license in Arkansas so as we added the whole section. Section five of the changes made to it name and address change to reflect current practice. Section six standards of nursing practice D. we added this section on C. R. Nays related to act for forty nine about this administering schedule two drugs and their consultation is at four forty nine that same section number seven. Then section. Eight. Eighty five we just clarifies they're exemption of the collaborative practice agreement based on ACT four twelve an ax six oh seven. Under the same section see we could and clarification on protocols with individuals with a collaborative practice agreement. Section D. we have a three B.. C. D. and E. related to X. six fifty one on opioid prescribing. If we do clarification about pain management. I thank Hey have to do with just clarification of full practice authority. It's kind of confusing when you have some make yards with of practice authority and some that aren't so we're trying to make it very clear if you needed to do what. Continuing that section is H. lapse of certificate of prescriptive authority was added for clarification. And then section nine full practice authority was the section added due to ACT six of seven ACT four twelve we divided it into the certified nurse Midwife is one section in the certified nurse practitioners the other section trying to be more clear clear on what the expectations were based on the Zacks. Then we added in section. fourteen. See three was clarification on basically establishing a patient relationship and telemedicine and we just had by some questions we added that clarification and kind of near the Medical Board's Wording. We then on the telemedicine section we added number twelve which was the result of ACT seven sixty seven. But telemedicine. And we added section. Sixteen based on ACT one thirty five on a uniformed service members. All right we do have a couple questions on hi three a Senator Solomon you're recognized for a question. Thank you Mr we've got some significant changes here that are really good in my opinion so are you having much are you doing actively reaching out to these practitioners to make sure they're aware of the changes and I see a lot of questions here on what it means and how it works so are you actively reaching out giving in service to groups like this yes we're putting in our magazine of with put our articles in that of one of my staff advanced practice the system director talk to the nurses and nurse practitioners association just Friday and discussed it she makes rounds to all the nursing programs and to any of the nurse practitioner groups and find educate them this kind of a subjective question but just based on what questions you're getting do you feel like the practitioners are R. their understanding is is improving and people are getting comfortable with the new rules the changes I'm not sure I'd go forth to say that yet okay we're gonna walk them through it okay hands okay all right thank you thank you Mr. Representative Ferguson you're recognized for a question thank you Mr chair of I have a question about the criminal background checks in the compact if they've already had a criminal background checks in another state as part of the compact we require an additional one for Arkansas is is that my understanding only if we issue a license but not to practice if they're practicing here on the privilege to practice then we don't have any authority to do a criminal background check on I guess my question is is a criminal background check not part of the compact agreement yes every state that's in the compact must a criminal background check okay thank you. Committee any other questions on exhibit I three. Okay seeing none go ahead on I. four. You're still in three oh you still on three other to finish the. They've they broke. Hi it goes to four chapter six isn't for okay I'm sorry my mistake. Okay so we're chapter six standards for nursing education programs. we make quite a few changes in eight the privilege programs. And it was basically ACT seven fifty nine ACT seven fifty seven those acts allowed a nursing LPN programs to be in a consortium of nursing homes and high schools and so we had to make the parent institutions a little bit more clearer to allow for those individuals have LPN programs and we did a little clean up language there to. Okay we do have a question the representative Wardlaw you're recognized for a question thank you Mr chair When I read the public comment here from Wright Lindsey and Jennings your guys responses take under advisement seems to be a common response and yells rules but what what what does that mean and what did John do by taking that under Bosnia because it says here and there comment that you'll fail to modify chapter six to implement acts seventeen fifty nine so did you go back and address either House outing here I spoke with Erica G. who was the attorney representing them I that their client to have the comments and we did make we did tweak some language but when I showed her how it did addressed actions of the client was very comfortable with it okay thank you Mr. Representative Ferguson you're recognized. Okay thank you ma'am chair Mister. Of what programs have new nursing programs have been approved I know washed I was applying Williams Baptist E. just I just didn't know if you know you have many new programs we had approved for nurses since we're so desperate for orient's. I don't want to miss speak I would say in that what time period because I know John brown's been approved within the last few years up in the fight will area we've got several proposals up for review in our next meeting I mean I think in like the last year I'm. Last year probably a couple but I could not answer that for sure remember to to. Wash towing is Williams Baptist been approved to amend his survival asked me laughs I'm not angry with Williams Baptist. Okay thank you. Senator Solomon you're recognized for a question. you Mr chairman question I haven't seen this comment taken under revised used as much in any rules I'm saying now and I'm just thinking if I'm a five question and the submit a question and they I get back taken under advisement I'm really. Confused as the questions are what they did with my question and I see that. Quite a bit do you have any thoughts or comments on that. Our of M. I can offer my off base if you see in there quite a bit also. We have yes that was turning quite a bit of ours and I apologize for that and we'll make sure that we're clear with that. Well my question is related the chair I was just asking Representive Ladyman if if maybe we come up at I hate to see that on a comment on anything that they're just gonna take it under advisement you mean at least I can say we disagree you're wrong you're right we're going to change it will get back to you but taken under advisement really has no meaning to me when I read these questions well senator I I haven't noticed that. comment for that reason sponsor on a lot of rules okay it really could be a little clearer you know if you say. You know implemented or took the response and we we agreed and we made those changes. But for the committee thank you. All right I have another question representative Wardlaw you're recognized comment for the chair I just second of Senator Solomon commented looking through if you started I want to go through of they have listed that as a response I've counted five six seven. Eight. Nine times as a response to these comments and that to me is also unacceptable because it doesn't give the public any kinda instance of what the board is actually doing and the public deserves to know what their board is doing so I just thank you we need to work on that and we need to a tell us exactly what's going on not it is taken under advisement I just think that's crazy Senate. Thank you thank you for the comment representative. Any other questions. All right we're moving on to. Hi five correct. Okay Okay that is chapter eight medication assistance certified. we the changes that we made were in section two is result of ACT seven forty six and some clean up. I will remove the duplicate license certificate trump made the changes to the address and name changes. And we made some changes on section. Thirteen as a result of ACT seven fifty nine. which allows a consortium of five or more skilled nursing facilities have a mac program. And then that same section continuing with macs were originally started in two thousand seven they were in nursing homes only in the statute was passed to allow their in in certain correctional facility so we had to make language that was clear to cover both correctional facilities and nursing homes. And then we. Added section. Sixteen is a result of act one thirty five in the military service members. Okay. one suggestion here that the sections are taller that's not in the summaries that we have. It might be good to refer to the law at least I'm not seeing them there but talk about chapters but I don't see how okay in my clarifies us understanding being on the same page as one time yes okay. All right. Any questions from committee on hi five. And again the comment made earlier there there are some public comments and the same responses in there but we've already talked about that clarify that and we make we make corrections based on those all right thank you comments seeing no further questions without objection this rule stands as review. Thank you. And that's all of. Hi representative Sullivan it sure I'd like to make a motion that they not be able to bring these before A. L. C. next week until they resolved all of these issues that say taken under advisement because there's seventy five or six more of these comments I think it's not advisable to us to be moving forward without knowing exactly what action was taken. Okay. This is so when you say moving forward. What what action. Hold it in this committee of the Senate on to rules with these changes must be made before it gets to rules I'll be fine with that yes okay. All right so I think you're. A representative for long you have a comment. Are you on over there represented. Down front I'll thank you Mr Jana I think I would ask Senator Solomon to amend his motion I I'm fine with them personally moving forward to rules but with explanation explanation on paper to what was done with each comment not just saying advisement I don't want to see these rules held up for months but I would like for the public to understand what that under advisement means and when I look forward throughout five through J. they use that comment. Every single time and we need to know the people deserve to know the nurse's desire to know what was done with those comments and not taken under advisement I think this is a joke to put that on every single one of and that's what's put on every single one of them and I look like I said look forward before walked over and talked to Senator so I think if they can give us an explanation when it comes to rules in the next two weeks I'm fine with the move for personally at center is and but we need to know exactly what was done and how it was handled that's the reason we have a response for the agency not for them to say is taken under process. Thank you Mr. Is that something that can be accomplished if we move this on. Okay. All right yes Sir so we have a motion. Senator Solomon you're recognized yes amend that motion that's what I intend but I don't want to hold my Peter and less but I'd like to see those before goes to a LC with that is. Senator would you restate your motion again please yeah I'd like to where all the taken under advisement are fully explained in writing. So that we can move this through quickly. I don't know what what the date is I don't I don't want to wait a month I guess we would as a L. C. next week two weeks two weeks ever before Our and representative Wardlaw is that what you're suggesting. Hello I think that twenty six the others in writing prior to moving this forward through a LC right and not to go to a L. C. but to go rules rules I'm sorry yes we into X. yeah okay we have a motion and a second. to move this forward with changes before he goes to rules. Any discussion on the motion. Seeing none all in favor signify by saying aye All opposed nay. Motion carries. So though those changes do need to be made before rules. All right thank you. Okay now we're going to move on to item J.. Please introduce yourself and who you represent I'm a member and the director of the state medical board. So you're recognized to present item J.. I'm actually can turn this over to director Ted this is gonna be a joint presentation. I a little bit of history with an act for twelve was passed there was no authority for that committee to promulgate rules so with advice from the attorney general's office and the rules are being promulgated under the board of nursing however the committee that was formed back for twelve did write the rules and basically they were blessed by the board it's been a joint effort between the medical board and the nursing board to work with this committee to get the rules promulgated. Each section in here. Basically talks about what what is the purpose of the committee how the committee functions what it takes for qualifications for full independent practice in the committee spent a lot of time debating with what it what they wanted to see to allow the individual to be independent practitioner so in addition to what was in statute they did add a few additional items that they wanted to see for the and nurse practitioners and And then they also establish fees in this chapter. basically I've noticed probably want to say this because we do get quite a few comments about the term full practice authority an independent practice authority and one ACT used full practice authority and other Act use independent practice authority. So when you're trying to use those terms together it makes it difficult in this chapter we use full independent practice because that's what the statute in this chapter only deals with that statute however when we look at the events practice chapter we did use the term full practice authority more liberally to refer to both groups because that is the more nationwide accepted term for nurse practitioners no matter what type of nurse practitioner they are to practice independently and we got quite a few comments on that and we try to make sure this chapter was totally related to statute in useful independent practice but the other chapter does use of both. Okay are you ready for questions. All right we have a couple a representative Gonzalez you're recognized. Thank you Mr can can you tell me what qualifications the Committee added. And why. they added the publication submission of three letters of recommendation. Believing that they wanted to you can step in and if you would like they needed just to know that these individuals out there were we're practicing within the guidelines of practicing safely and I thought the regulator's recommendations would help that they did not specify who those letters of recommendations came from. so is there anything specific you're looking for in the letters of recommendation. Our I have. I think the idea was that just to make sure that they are practicing that they currently are practice or when they did practice that they were using best practice standards for they need something to verify that yes they have been practicing. So it seems like that would be covered and the number five the image made from a collaborative and that they have practice under collaborating collaborative agreement for the six thousand plus hours yes also under that it does have a section where if they were working under a compact or under state that did not have a collaborative agreements that they have to sign an affidavit for that as well this was just an extra step to say that I have worked with this nurse or I've worked with this licensee all it was a letter of recommendation. The firm may continue yes you're recognized thank you so was was number five under the qualifications added as well the submission of the affidavit from the collaborative. Position. Well the that hours required reading statute but then you get in the issues of what to do if they come from a state that require collaborative practice agreement in their Dorsey and maybe they finish independent practice for twenty years and one of those states and how we can handle those individuals was kinda where five came from and sometimes you have a collaborative practice agreement a position that does not. Is no longer able to be contacted for whatever reason and cannot give the affidavit that they practiced so maybe he is that Incapacitated or whatever. So why would not be good enough for me what why even have that in their period why not just say that it the. APRN has to provide proof of of practice and leave it at that. We're trying to define what proof of practice could me and and I think this is going to be an area that we're going to have to work out as we go through with what proof of practice really what we can get and what it means and I think this may have to be tweaks but this is where the committee thought they would start with. Yeah I agree I think that needs to be tweaked I think that probably needs to be eliminated along with of the. Submission of three letters of recommendation thanks similar excessive may especially for allowing someone from out of state to do something different than what someone in state has done it seems to me like you. You would have have the same. Qualifications there well as the people from out of state will still have to prove that they've practiced those hours right and that's what I'm saying it seems like you would allow someone from in state to do that as well without a specific letter from the from the collaborating physician. Because it says I have to provide that letter or some type of proof that they could not get that to be able to qualify with anything else. That's something we can take back to the Committee. Before this is approved in two weeks a no. What makes it and if I may representative there are a few tweaks and this you know this is this is kind of a new territory for this Committee in the state I think there are a few tweaks Leding made next session to this so maybe some language there that we can work on their going forward yeah I understand that something new but I also know that is something that's been worked on for years and I think the the legislators that in order to pass this work really hard to get what they wanted and it seems like your adding extra steps to it the to qualify for full and open practice. That's my concern can I ask is this time sensitive. Yes and now we're getting a lot of push of why are we doing this yet I'm so the practitioners are pushing and that makes it I guess the let me ask you along the way if we delay this to our next meetings have some discussions here about this it does seem to be a problem if we have in state rules different than out of state rules. if we. Deferred this to our next meeting is that an issue. Which would be next month which will be next month first we can get committee together within a month and come back and they maybe talk with representative Gonzalez about some of his concerns yes the B.. Okay with you representative. So long term reserve officer okay. I would. I would prefer not to see it delayed either look just like the rules going through here but also I just agencies boards adding on more requirements for. Yeah more more so than what the legislature did I think it kind of goes against Legislative intent so. I don't know well I what you're saying but we're breaking new ground here so right there are there do there has to be some things added yeah yeah I I think that's I think this probative one get it in next month and. Okay just give some time to discuss it think about it would that be okay. All right thank you then we'll just we'll we will Senator Solomon you're recognized thank you Mr chair yeah I'm I appreciate you holding this off I've got a real question I don't know if you're looking the same Page I am but in the comments Austin berry made a comment about the composition of the board. determined the composition of the board the statute determines if there's four APR ends and for physicians and the governor pointed them okay and Mister chair again that I don't know if I need to make this motion again or every time we hear this but this is a great comment they have and the responses comment under to taken under advisement so do I need to make a motion on everyone of these are conducted one motion carry for all these issues I think the motion that was made prior to cover all these issues okay thank you thank you. All right any other questions. Seeing none we wanted for this until our next meeting next month. Moving on. Two item K.. So would introduce yourself and who you represent. Thank. Good morning I'm holiday with health facilities services. Charles Thompson twenty Arkansas department health. All right you're recognized to represent Adam K. thank you Mr chair what you have before you I am Kay is the updated rules for perfusion this in Arkansas these are done strictly for the purpose of implementing of implementation of act one thirty five which was all the day update to automatic licensure for military members and ACT seven twenty five which was Center Gilmore's ACT for waiver of initial fees associate with professional occupational licenses for those meeting certain certain financial criteria we had no comments on those I'll be happy to take any questions. Any questions from the committee. Right seeing none. Thank you thank you chair Item. L. is the update for rules regarding or thought of prosthetic and Care the door thick providers and this is the all these are gone pursuant to Arkansas act those include the previous acts I referenced for the per fusionist it also includes ACT seven twenty five ACT eight eleven those are those were acts to regarding licensure of those professions and those were to strictly to implement added to strictly implement those acts and I'm sorry ACT eight eleven as well to learn act which is represent Bryant's Act to allow for like for certain occupations to have a path to licensure through an apprenticeship we had no comments on those I'll be happy to take any questions all right any questions seeing none of. K. exhibit K. and L. without objections these rules stand as received. Thank you madam chair item number M. this is the update for rules for hospitals in Arkansas these are done pursuant to acts to to to twenty six ACT three eleven four forty nine five ninety eight nine forty nine and ten fifty five we only had one comments regarding that and that was the I'm sorry these regarding the when it comes to the certified anesthetist that language was changed pursuant to representative and those act and it went from and we had the old statutory language in there which we have since corrected from under the supervision of a physician to a consultation with a physician and that is also you will note that comment is also we took that and went with freestanding a plea for Samper centers and Article access hospitals added those to make sure that was consistent and and make that correction to comply with the statutory language when it comes to this this particular item I'm pretty happy to other than that other than that comment we had no other comments I'll be happy to take any questions and what I can answer on home is the was Paul be able to help as well. All right we do have a couple questions representative when you're recognized for a question. Thank you Mr this is with regards to section seven. This is the visitation rules for the no patient left alone Act I see where it says in sections two three. And for. it says when when discussing visitors at says may include parent legal guardian or others. but not shall or has a right to and and the statute itself says has a right to. Does may that that just gives me a little bit concerned that that creates an opportunity for those rights to be to not. Thank you for the question represent wing representing this the language was taken verbatim from the statute I believe that may is to and to it is not a exclusive list it is a list of potential persons which may fit that criteria for that visit or we will not that would not be we would not interpret that as a the aye aye as a you can't you you cannot that you can exclude those individuals those individuals are part of a potential less that would be the that status for that position would be that status of that you know the the the parent or the guardian or whoever you know you may have a guardianship court and they don't have a biological parent that's involved so that that's what we would prefer that we don't or that is is limitation okay. does is there any significance to the changing of the word of advice to guidance. I'd be in a section one the one. Hi. Because it wasn't it wasn't pursuant to act three eleven it's because the medical bill the medical exec committees give guidance they don't make rules the hospital makes the roll okay all right the one other thing as I go down there and and I'm also of speak a little bit behalf of representative Mayberry who of course was the sponsor of this bill and she's got some concerns about this she has said that that's actually not verbatim with regards to may include ****. So that was one concern there was another concern about a notification. Let me make sure and state this correctly. And and one other thing just now this is make sure I'm reading this right on section five C.. what we're talking about visitor restriction may include five C. at the request of the patient law enforcement should that be or court order. Yes there should be for okay and I've since made that change okay good deal good deal The the request of the bill sponsor would be for us to get clarification of this. Mister chair. What would be the appropriate action. Well we could. the deferred due next meeting if there needs to be further discussions or we could required answers before rules committee in two weeks. Would that be the probably the most appropriate is similar to what we did with one of the other rules up there will if it's time sensitive which I expect this one most people once it is implemented yes so I I think the better thing would be to get responses to your questions before rules okay and so we would review this and send it on with that requirement okay I would make that motion. Okay then take a motion we can just do that with your suggestion okay. Thank you. Any other questions do you have clarification on what needs to be done before the rules committee. I will be happy to get with represent wing as well as represent Mayberry I will we we have no Mr Gilmore myself I've had conversations with represent Mayberry regarding this issue including cross law those so I'd be happy to refresh and and discuss further if she has any more clarification she needed on this on the on the matter and the statute as it relates to how we took incorporated the rules that would be great just out of respect for representative Mayberry who is unable to be here today. Okay so this rule will stand reviewed with the requirements as mentioned here. we do have another question representative Bentley you're recognized thank you chairman just for clarification I'm continue to have constituents call me that this you know this rules not been implemented and they're not getting their concerns and to not be able to stay with their family members while they're in the hospital so what is the best course of action at this point in this family members call me. Represent Bentley we have we and if we have them enter into the portal on our website their their concerns just like any other investigation we would do that's how they make sure we can track all those that's what we told every constituent that's called up that's what we've been formed other legislators we'd be happy to look at it we just need to get the information we would to start or to start investigation we need to enter that information to our portal and that feeds electronically to our folks so they can start their best so can you give us an idea of how many comments recalls you've gotten about this one state one within the last we've had one enter into the portal in the last. In the last two months we have also I believe sent a couple letters to providers to make sure they're aware of this where this law we we are willing and ready to do whatever we need to to assist as the legislatures asked us to do but we're just not getting the complaints I have currently I have sent out notification to all providers at least three times of the rule. Can I just follow up with one yes yes all of his or phone number or website you can give me to pass out to my constituents because I was there is there going to the hospital and I'm not going to use so that may be going to you because I've gotten at least ten complaints in the past month represent would be happy to send you an email right after meeting with phone numbers as well as the website link that you have to share super thank you yeah I think there's The problem here seems to be that people are coming to their representatives or representatives that were on the bill Rather than go straight to the department of health so if there's anything that can be done to help that situation maybe representatives could refer people to the department of health if you get calls or emails or taxes on that that might help the situation. Thank you. Any other questions. Okay seeing none a repeat of this rule will stand as reviewed with the requirements of discussions before rules committee. Thank you for your presentation. All right we're gonna move on to item and I believe. Thank you Mr chair what you have before you is the update rules regarding freestanding birthing centers these are updated to comply with Act five ninety eight and six oh seven of of twenty twenty one these We had as I said before we have I'm sorry this when we do not have any comments and the public comments on this one we have no freestanding birthing centers in Arkansas as of yet so so we are we're trying to anticipate and implement ensure that we can implement access this body passes when we do have wanna be happy to take any questions. All right committee any questions on item in. Seeing none with the objections this rule stands review. Okay we'll move on to item Thank you Mr chair this is the update the rules for critical access hospitals these of all these are all done pursuant to act most of them actually have already we have already discussed Including I think the update to this one exact two two six Simon's law regarding consent for do not resuscitate for minors our only public comment was again the certified and that's the test under anesthetist comment that we have updated reflect the current law other than that we had no we have no other comments that we have to take any questions. A committee any questions from committee. Seeing none without objection this rule stands as review. Thank you Committee. Thank you. Thank you okay we're moving on to item he. Please introduce yourself and who you represent. Thank you Mr chair large you I'm general counsel for the department of health. Good morning I'm Christy Cressy and this section chief for EMS for the department shall. All right you're recognized to present item P. thank you Mr chair members of the committee we're here to present the rules for emergency medical services we are and implementing several acts from this past session including acts one thirty five seven oh seven seven twenty five seven ninety eight eleven and eight twenty seven of twenty twenty one there were portions of this rule that were implemented an emergency basis during COVID last fall and they have expired we are pursuing that as part of the permanent promulgation process including a tiered response temporary upgrades and downgrades an ambulance staffing we are also implementing the axe dealing with specific health conditions and Garbo's law for canines that are being transported in a vehicle we're also at implementing the act dealing with fee waivers in the military for occupational purposes and several clarification that within the rule itself we did have a public hearing and public comment period we received one letter from the Arkansas aimless Association supporting the proposed rules no negative our concerns from them or other stakeholders and we have no financial impact with this rule for the state and we're happy to take any questions. Committee any questions. Seeing none without objection this rule stands as review thank you. So we'll move on the item Q.. Thank you Mr chair members of the committee this is the rule for the administration of vital records and I have with me a subject matter expert. This I'm Linda lane with the Arkansas department of health you may proceed. Thank you we're here to present the rules for the administration of vital records and this will implement ACT one thirty two of twenty twenty one ACT five sixty of twenty twenty one and ACT seven eighty seven to the extent that forms were required for data collection purposes and also to address the timeline for involving a dead body and these are basically forms to assist our folks with data collection we had a public hearing a public comment period and we receive no public comments we're happy to take any questions. Hi committee any questions on item Q.. Seeing none without objection this rule stands as review. Okay moving on to item are. Thank you Mr chairman members of the committee I have are subject matter experts coming to the table I have Terry Paul the environmental health branch chief and Rick may hand over the plumbing section let me have them introduce ourselves just for the record Terry polymer may help bridge you. Read my and a project preventive health codes thank you you may proceed. Thank you Mr chair we're here to present the rules pertaining to onsite wastewater systems this is to the extent that we address the occupational licensure act that were passed during the past session ACT one thirty five an act seven twenty five dealing with the fee waivers and the military portions we had at public comment period and we receive no public comments on this rule. We're happy to take any questions. All right any questions from committee. Seeing none with no objection this rule stands as review thank you. Thank you all right moving on to item S.. Item S. is dealing with plumbing licenses we have the authority to promulgate the rules under at title seventeen we're also amending the rules to add the qualifications for initial licensure the fee waiver under ACT seven twenty five of twenty twenty one and I believe we made some clarifications and also added the military license or four ACT one thirty five of twenty twenty one we had a public comment period and at receive no public comments. Committee any questions on item S.. Seeing none without objection this rule stands as review. Item T. identity deals with the rules pertaining to restricted plumber gas fitter licenses and the gas utility there were some clarifications I have made to this rule and added some definitions to clarify at the top the terms get the terms corrected also added an outline for the application and renewal methods we had a public comment period and we receive no public comments were happy take any questions. Thank you committee any questions on item T.. Seeing none without objection this rule stands as review. The item you. Items you. Mister chair members of the committee this is the rule dealing with the list of controlled substances. And I have at St David here yes said J. David. This section chief department health pharmacy services all right you may proceed. Thank you Mr chair members of the committee this is the rule dealing with the list of controlled substances by law we have to amend this rule every year Mr David and his team reviews the controlled substances and drugs that are added by the D. EA any items of concern by the crime lab at there's an extensive list of of items of concern that are being added we're also following the axe from twenty twenty twenty twenty twenty one. Including ACT five fourteen by representative way dealing with the scheduling of a schedule six controlled substances and we had a public comment period that expired on March first and we had no public comments were happy to take any questions. A committee any questions. On item you. Seeing none without objection this rule stands as review. Thank you. All right committee the last item on our agenda is item the V.. An I SP by Senator Solomon. I can't see is Senator Solomon over there. A. Do you want to make any comments on Rice B. senator. We are working on. We're on item V. the I. S. P. for dispensing of contact lens. you know we have people who are driving out of state to qualify and this would just kind of change it so some of our businesses could provide those dispensing services in the state this is kind of offense strong around that are a hedge. All right thank you for that In other words some. Some stores big box stores and Arkansas can't dispense. Contact lenses but in other states they can dispense contact lenses so this would make the dispensing of those items more easily and more broad. Okay thank you senator Could you share. Mister chair I guess I'm asking if we can adopt this. All right thank you. yes base your request the Committee will adopt this I. S. P. and we will send this to a one of our subcommittees for further study. we'll have to look at those committees and see the best place to send this but we will adopt the ISP thank you Mr. All right committee that is the full agenda again thank you for being here we are German.