Public Health, Welfare and Labor- House & Senate

Warren. And I need a motion to adopt the minutes from the last meeting I have a motion to have a second all those in favor say aye all those opposed motion passes want to welcome you today to the Committee and two I wanted to tell you that we do have a date for next committee meeting which will be. The city wanted six. You. October the fifth so mark that down on your calendar. Right to. Chame LA Newman you're recognized for any comments. Thank you madam chair just looking for the good meeting and some good getting some good information thank you. Alright ladies and gentleman of. We had a member of the General Assembly requests the bureau of legislative research the recent research section conducted study of the effectiveness effectiveness of the mass policies in public schools and we're going to let of Julie Holt who is the administrator of the research section discuss the findings and we're going up let her go first and we'll open it up for questions and then we'll continue with the written agenda of identity to let you are recognized. Can you hear me. K. for at. Thank you senator Bledsoe do we hold with the policy analysis and research section here at the bureau and we were asked by a member to do some research looking into the impact of mask policies that school districts on effect of on the number of students and employees with COVID positive for COVID and also on quarantine numbers as you all know all member projects to keep confidential and we don't share with other members we don't share the public unless we've been instructed to do so by member and in this case we were asked to share our results with superintendents we did that last Friday and then this morning we were asked to share the results with this committee so here I am When we get a request our first step in our division or section is to see that they like data is available anywhere else and so we did check with the department of health department of education and with a chi in nobody was collecting all this data in one place and Hey guys you know that has done a good job collecting mask policy information department of health reports on code cases within school districts and up at that number of quarantine was not something that we could find. Because we do the educational adequacy study in our shop it's fairly easy for us to survey the superintendents and that's both regular districts and charter school systems so we let the member know that we could ask the school district's directly for this information and we were asked to proceed with that. we wanted to wait until school and then in session for two weeks to cover that incubation period this was one attempt to try to isolate what we might find to what was going on at the schools we knew that we were going to be able to perfectly narrow that down but we we took that step to do so. We M. so we sent the service out early the morning of Wednesday September first that was last Wednesday and we ask for superintendents to provide as a response that very afternoon. And on this we got a little feedback on that that and this was so we could get an apples to apples comparison as much as possible in a school district's told us even the numbers as they could quarantines and positive cases complex right during the day but it was also not very feasible to ask for a point in time because their data systems didn't really allow them to go back to a certain point time to report information so we and again we're getting this is narrow nearly as we could without and daily burdening the school districts we did get a hundred and eighty responses that was a seventy percent response rate which for a when they survey was pretty good. once we got the data we we ask for the data in raw numbers so we ask how many students are in your district today how many employees are in your district today and then we ask how many or positive the code today how many are quarantine today so we got raw numbers again to try to capture you know that picture for September first. We then calculated the percentages using those numbers and then we divided the school districts and two two groups the first grade was any school district or charter school system that had a full mask policy in place for two full weeks so anyone who said their mask policy had been implemented a August eighteenth or before was in that first grade. Everybody else was in the second grade in these included about sixty three who told us that as of September first they had no full mask policy there were about seventeen that had partial mask policies and anecdotally the seem to range from we will put a mask policy in a school once they reach a certain threshold if positive cases or we require students to wear on the past but not in school and we require our younger kids who haven't been vaccinated so there's a lot of variety in their in and we ended up grouping them with the not having a full mask mandate and then there were if you I don't think it thing is under twenty you had implemented full mask policies that they've not been in place for the full two weeks. So when we have those two greats we had about eighties in our mask policy column in about a hundred and the mask policy less than two weeks column ornaments policy. So you can see the results on I believe there was a handout provided. And we M.. We compared what we did actually calculated and divided the graces we really compare the averages and statistics is called a comparison of the means the imminent committee headed in your packet or your desk will be this. So. Look for that. An. In the grass there on second and third pages. so you can see in what we did was we compared the average percent for those schools that have that full mask policy in place for two weeks against the other schools and what we found in all cases was that the percentage of students or employees with COVID or quarantine was higher and in those schools that have no mess policy versus the school districts with a mask policy and and we checked for a statistical significance an off the record there were three of the instances where the our findings were statistically significant and the only one that wasn't was looking at the number of coded positive students. And with that I'll be glad to answer any questions. All right senator Hammer you're recognized thank you ma'am share the would you talk about the statistically significant at the point zero five level does that mean that if it falls within that range but there's not enough variance for to be considered if we want to draw conclusions what that test really shows you is it's shows you how likely that results would be just a random happening that it would it could happen just as a matter of chance and if it's under that point oh five percent that means that there's fewer than five percent chance that that could be due to just or no random occurrence said that there probably is something and again significant about that finding. In. There isn't anything in this data that shows whether. These cases occurred in the school setting or whether they happened outside the school setting that would have some direct impact on the. On the on the information being turned in by the schools that correct that's correct we did not ask a question getting to that we've had some suggestions from superintendents that that would be interesting to know we've also heard it may be and difficult information for all school districts to supply so M.. We at the member has asked us to. Do the survey again and so we'll be working with the member to see if that's questions should be at I thank you all right the representative Boyd you're recognized for a question. Thank you madam chair of I just want to clarify these numbers were not controlled for the number of people who have received a covered vaccine by any chance now we did not ask anything about code back things but you're right that's and could be a factor in in the what's happening at schools I just want you look across the state you see other certain zip codes that have more you know vaccines and those same zip code seems to be the ones that are adopting the mask mandate you just got I wonder if that control would make sense of our follow up yes Sir so just follow up I don't know the member is but could you ask the member if there's any way to ask for some data that might help control for that and that the next round of questions and see if they're amenable to that that question I'll be glad to do that thank you. All right representative Bentley you're recognized for a question. Thank you chairman and that my questions along with representative board but another manner if we look across the stated amount that we've got today the number of cases per county is there any way to correlate if you ask members I would correlate. The representative where there is force cases in that county. If that makes sense to you because we have some real hot spots and those are not as some that are not as harsh as a way to correct that at all. I'm sure there probably is we if that was not part of our direction that I'll be glad to discuss that with the members of all thank you appreciate it thank you challenger senator Sullivan you're recognized for a question. Thank you madam chair is there anything that indicates our number that indicates whether the student are contracted COVID while they were quarantine in other words we are saying you came in close contact you're going to have to be quarantine I'm wondering how many of those students actually as a result of that assumed close contact at school actually of contracted COVID while quarantine do we know that. We do not know that from the survey we did last week that is that is one of the things that the superintendent that would be great to know I didn't know if all schools to be able to answer that question but again if if the member would likely be glad to have that to our survey if they choose not to ask that I'd like to ask. Follow up manager yes I'm. So when you it seems like if we're going to make data driven decisions and I think a copy and Department of Health of really stress data driven decisions thank you I heard you say that neither of those groups actually collected the information that you're looking for. But not everyone was connect collecting on a daily basis any of the information the I kind of keeping a good list what we were able to do this by doing the survey yourself was find out exactly when that policy was implemented so that gave us a little additional information that we got would get just from the list but the quarantine data was not something that was being collected we we actually talked with the health department because we know they survey schools districts to get the numbers last week if I could put our questions and there are survey and their guidelines but not let them do that so Set to get all of the pieces that we needed and to get a very narrow snapshot in time it it worked I think better for us to do our own sure and so we are making some dramatic decisions on sending children home and going essentially without because many schools have not set up virtual learning as they did last time so we're making some dramatic decisions for kids to leave school we're making having a dramatic impact on parents who may have to take off of their jobs to take home to go home and take care of an a symptomatic child without a doctor's excuse that's really impacting their employment and we're making those decisions by the Department of Health and the Department of Education and they didn't have the data that you're collecting so we don't know what you just they didn't know what they were you just disclosed to us when they made those decisions is that correct. I have to say yes that's proper okay thank you thank you manager all right representative Payton you're recognized for a question. Thank you madam chair so I'm trying to reconcile the two graphs that are. In reference to those students. And one is quarantine and one is positive for covid so you've got one point four percent versus one point two percent mask or no mask on the positive cases. But it's eight point five versus four point six on the Corentin. Now I would assume that quarantine only takes place when you have a positive case so what is the reason that the. The percentage would be so drastically different all quarantine. It seems like the number of cases would would dictate the number quarantines at a two things that I can think of is that not all the exposures necessarily happened within the school building that because some of the quarantines and then the eighty Eads guidance that has gone out says that it is even with an exposure if by the students were wearing masks they do not have to be quarantine and so. So that's what I'm wondering that if I may follow up Madam jerseys so basically the difference in the second graph is policy driven. Because of our quarantine policy. I'm at I really couldn't I don't I haven't studied enough and I don't have expertise to go beyond that to indulge me for one more question so I guess what I want to get at here is it would seem to me that the difference in the two graphs would be because of policy on quarantines the fact that they weren't wearing a mask we quarantine more people in the surrounding area or whatever so can we circle back in a couple three weeks and do a survey of to find out how effective the quarantines are because if if the on mass school districts are quarantine at a significantly higher rate. And they're still not seeing let lower results in the positivity rate then the quarantine would seem to be totally ineffective. So how can we circle back in a couple three weeks and and do a survey that would determine whether or not that excessive quarantine is effective or not. I will be glad to work with you on that I did I would have to think a little bit about how exactly design thank you bye I'd like to work with you on the thanks okay thank you senator Hammer you're recognized for a question thank you measure and may we cover this minute go but listen representative page questions I want to ask it when when we asked the schools about the quarantine. Did the member asked that the quarantines be separated as those that occurred because of school contact versus Cortines that occurred because of outside school contact we did not ask the question that way in this in this verse or by do you know. Is that is that an achievable question based on your conversations with the superintendents that if the members willing it would serve a value to find that out because of the corn injured coming because of policies. Directed well there is no differentiation between policies that the school has to enforce because they come from Department of Health so regards where the quarantine because a contact in school or the a accord team because they had a big family party it doesn't matter the quarantine. But talk to the member and see if we could maybe have that determined if the quarantine occurred outside the school setting or because of inside if you would please. I will thank you thank you all right a chair Ladyman you're recognized for a question. Thank you ma'am chair of my question is kind of similar to what representative Payton was talking about. The first read when you're looking at the student positivity rate. The it says it's point two percent variation in the two different group test groups and it's not significantly not statistically significant so what that says is there's basically. The. None of this affects I mean you could just naturally happen is not significant. But then when we look at the quarantine. It's three point nine percent variance. Which is statistically significant. So we're. It looks to me like we're we have a quarantine policy that is significant based on data that's not significant. Is that what that's telling us. At. One out of this is new data so the policies were in effect before the status so I don't know that it is the policy wasn't based on the study at the end but I'm just I'm a scientifically is yeah right. What what this is This first graph is showing is that at that snapshot in time there was a point two percent difference we can't say that that's going to happen again I mean the results just weren't clear enough that way because of the numbers what have you when the survey's repeated it will be interesting to see once we've progressed a week in school we're going to have more districts who preach that two weeks threshold for having a policy so there may be some differences that occur within a set of data okay thank you. All right representative Boyd you're recognized for a question. Thank you madam chair I'll be very quick this is clarifying thing and so I appreciate the simplicity of these questions and that they just get straight to the heart of what we know but there's a lot of things then raise other questions so clarify for me please quarantine students are only tested for COVID nineteen if the parent or guardian request them to be tested for COVID nineteen is that correct. I in no I do not know that okay I'm not sure with that policies so if that were the case then we wouldn't really know how many positive test there would be because not everyone is so if if if that if the answer to that question is yes then the follow up would be that then we wouldn't really know how many students are positive because we didn't test all of this act would that be correct that would be fair to say thank you. Any other questions committee. Seeing none thank you so very much into a nice job. I thank continuing to Adam D. we're going to hear from Dr Jennifer Delahaye if you would come first Dr Delahaye and president and then we'll have the others to join you at the table. You would recognize yourself for. Good afternoon Dr Jennifer bill Hey with the Arkansas department of health all right. Since their hand. So I have providing you with a handout looks like this. And you will see on one side it has a graph. that is the percent of our Kansans fully immunized by age category. And the ages are listed so at the bottom if you look to the right it's up to September the third so if you look to the right hand side you'll see the key for the age category at zero of course are those children who are less than twelve years of age and then moving up you'll see kind of a brown line which is children twelve through eighteen followed by nineteen through twenty four and then twenty five through thirty four and so forth all the way up to sixty five and older so you can see that the older adults have higher vaccination rates than the younger adults and the children twelve through eighteen have been increasing fairly rapidly. And then on the other side of the page we have seven day case rates of COVID nineteen cases by age group. And they are similar I would point out that at this point in time we have a downturn in terms of the rates for all of the age groups except for children who are less than twelve and also for the twelve through eighteen years of age. Those are increasing in numbers of cases or rates there are rate continues to increase. So I will stop now and see if there's any questions of this anyone on the committee have four questions for doctor bill Hey on this particular. Graham. Thank representative Bentley you're recognized. Thank you chairman Dr Jill Hey thank you for being here today on the the PCR test that we're doing for the cases four hundred thousand we still doing forty cycles with a PCR test here in the state of Arkansas so it varies with the company and how it's defined so all of the tests are FDA authorized for and they're either positive or negative based on the cycle at threshold and it varies from the manufacturer so as far as I know the cycle at that we use at the health department has not changed but there are other cycles that it depends on the test if they're using a different test than what we use quick follow up that's okay yes engine one percentage of the test that you guys are doing at the health department what is your current rate for cycles at the health department I do not know that off the top of my head will have to get that back to you if you get back the to fill for the whole committee say that be great sure and just one quick follow up chairman on that yes that the the rate going up for school school age students could possibly be that those students are now being tested that they've been exposed as school may that might be some of the recent research an increase on that your thoughts on this children are in school the past two weeks to send it up take is it possible that they've been at school and therefore exposed and therefore being tested were if they were at home that might not have been tested that's possible but they've had an increased sense before school started and then you can see for the big and the middle of August it was a steeper increase so school may be having an effect on that. Thank you jim. All right the senator Hammer you're recognized for a question. When okay. Thank you ma'am chair. A doctor deal Hey what are some of the disk qualifiers I would say that use that term is to win a test would not be counted for example I had somebody I knew personally thought they had covid they when they got a rapid test it shows they were positive they went the next day they got the PCR test showed that they were negative they were told whether true or not they were told that that each one of those counted as a test they work combined together to offset each other is that a is that a accurate description or how how would that play out. Well it depends on the the road. In a situation where you have discrepant results they don't match so you would take into consideration what's happening with the patient so often times a patient may have a false positive antigen test if they don't have symptoms been usually will move to a PC are a if a to verify it if they're negative then we will often trust the PC are over the antigen tests but if they're having symptoms it's very difficult to tell and so we will often have to get more information to determine what the result will be considered positive okay but not I guess my question is which test count in the numbers that are presented to us in graphs such as this do they both count yes yes so if they are considered positive at in the case they would be considered the case and then the cases include both antigen positive up people as well as people have PCR positive. Okay all right thank you. All right who is in a seat seventy four. Okay all right represented flowers you're recognized. Now okay thank you madam chair. as I was listening And then looking at the I'm going back to the sheet the seventy case rate per ten thousand. Obviously in and people of ask questions to this that the only. Are the age to only two age groups that are continuing to search amid downturns on that started in August for every other segment of the population are school age from and young people from twelve to twenty I'm sorry from less than twelve to eighteen. And I'm wondering if you have any statistics or if you know off the top of your head even abroad figure as to what the hospitalization and deaths look like for these age groups. I don't have that with me I do have. The hospitalizations for children of. Zero back from birth to eighteen for covid and we have seen an increase in the numbers from January to August in August we had the highest number of children admitted to the hospital I do not have the death numbers and that would be a hundred and twenty nine compared to seventy six in January when we had our previous pick. And then are we still at two deaths since the beginning of covid last year of pediatric COVID nineteen deaths I believe that is correct. Is it manager would be appropriate task that the. Hospital statistics be provided for on the on the committee so members of the committee and me. Well I have would you mind waiting for that your term as that of the hospitalization is that correct. Is that what you know I'm I'm asking if doctor delay could provide the hospital I'll be happy to all right yes she worried so go ahead all right thank you. All right a senator Hammer you're recognized for a question thank you measure of a couple a couple questions not related to the graft the first one is. On July ninth of twenty twenty one there was an article and it said that the CDC guidelines recommend at least three foot between students classrooms but allow for greater flexibility. In schools were not everyone is vaccinated CDC said distancing should happen to the extent possible but schools should not exclude students from in person learning to keep a minimum distance requirements the current policy the schools operating under our six foot but yet this article stated that on July ninth of twenty twenty one which I think the Delta variants had already come out by that time that that term they should be allowed three foot and above all not to exclude students what is today's position of the department of health with regards to three foot verses six foot because and I'll look at a bag the report we just saw that a member had generated shows that a high number of students are out because of quarantine and quarantine is created by the six foot rule which the nurse the nurses are saying that thank doesn't mean the other day a nurse said if it's five foot eleven they're out so summer very rigid in their interpretation of six foot but against the CDC guidelines it allows for flexibility can you tell me what the department's position is today on the three foot versus six foot please. turn your microphone on please stand thank you. So my understanding is that the six foot is preferred and that the three foot could be taken into consideration and it depends on other factors so and it's up to the At a school to how they want to do the desk and the pods we want there to be at least six feet we know that this not possible in the schools because of this space constraints and so what they're doing is oftentimes grouping them and pods what's less than six feet so that they can optimize the use of the space and creating an differences were how how students are seated so that if a student does become positive there is less transmission in that area. That is. Take into consideration that between three and six foot would be the marginal zone that schools could adopt their policies. At because there's real confusion out there among the schools and I visited with several in my district and there's real confusion among the schools that if we could have clarity that three to six foot is okay we cut down on the large number the quarantines and keep the kids in school which is exactly what the CDC. Statement. Allows for and and and we need to get that communicated to our schools so that they know well let me take that to the. Team that we have a team at the health department that collaborates with the department of education and we take that to them and see what we can do to clarify that that be great and one other thing on the death rates I know that a person is diagnosed you know person is is you know the justifications COVID related and then I know goes through a review process. Can we see the numbers of the cases that have been reviewed to see if there been any changes in the determination as to what's going to be on the permanent death certificate can we get that information. S. so you're asking for help as a result of the review and review that the health department has done how many death certificates have been changed well or I understand that that the finalization of the death certificate is not official until it's reviewed by the health department head MRI wrong in that no that would we don't determine the final on the death certificates we may review them and ask for changes if we see something that's a discrepant okay or that it will have an off line manager if the chair allows someone I have a motion at the end of discussion of the item the if the chair would allow a motion please at the end of the discussion about MD thank you all right Senator Ballinger you're recognized for a question. Thank you for thank you very much manager I'm just following up on Senator hammers question is is it possible that a three foot social distance could actually be superior to putting kids And and pods so there really isn't any social distancing between the two. I'm not sure about that I would have to look at that and think about and talk with the team I'm not I'm not on the education team so I would have to see what considerations they have and what guidance they've been given I I appreciate that that's kind of what I mean my anticipation is that my or my hope would be actually that you would all especially CDC making that recommendation that you would look at that and and sort of my my real question here is you know is it possible that there could be mitigation measures the schools could put in expressly knowing you know the nature of how many students they have size classroom space that that could actually work just as well as the guidance that is coming from the state it and so what what I really hope that you all would consider is whether or not you would provide the same type of flexibility to the schools that we provide to other events it actually all the way through pandemic where if they can present with two U. S. you know a plan to mitigate that maybe they can actually keep the school kids in school so so an example the CDC has a study that they did in Utah of a of a test to to play a test to stay program we're in lieu of quarantine separating keep the kids out of school they set up testing so one of my schools would love to to in lieu of keeping the kids out of school because they have so many kids that are are out of school Senate measures where where they they test kids who otherwise would be quarantine you don't isolate them set him up and whether social distancing maybe require them to wear a mask during that period it you know to put in other measures that frankly probably would be even better than the guidance as far as identifying kids who especially when what they're seeing is the kids instead of staying home and separated they're going to Walmart they're going to visit their friends they're going to the park there hanging out other places because by golly kids are kids it in so if instead directly in the classroom get educated. Or at school getting educated but with with some sort of guidance to keep them into we know whether or not they've actually been been infected they wouldn't have the capability affecting other people it in you know if we can provide provide that type of what's ability to the schools I think that we can have a situation where we're we're not we're we don't have much kids are not getting educated where where you don't have parents were not able to find child care and and still have to get ability to to make sure kids are safe and protect. That makes sense yes well taken yes thank you all right of center to a chest to feel you're recognized for a question. Is there any Is there a consequence to an individual who who knows he or she is tested positive and does not reported to the school system. I don't know the answer to that until a other than the fact that they may have exposed other people there are consequences but do you mean in terms of to that student or that what I'm saying an employee or a student or the student's parent who knows that the chalice this is already tested positive or the individual employee who works for the school system knows that he or she has tested positive is there some consequence for them not informing of their supervisor or whomever the correct person E. is that they're positive. Yes I don't know the answer to that I'm hopeful that the health department will be aware of that case so all right thank you so much. Senator Clark you're recognized for a question thank you manager. Thank you doctor I'm trying to follow the science on this. And you know we have control in the school bus my dad used to drive a bus. And of we run both flowed back and forth and so we got kids three to a seat. Or if they're possible seniors to Tennessee shoulder to shoulder back and forth. Then it. But once when kids are the most active most talking shoulder to shoulder no mass talking spitting. and then probably not I don't know about it the rest of the legislative body but I go to football games as it to football games I've got pictures I posted hundreds of kids hundreds of teenagers milling around hanging all over each other of sans mask which I have no problem with I'm just you know in my business the building materials you we can call around the windows and we can put insulation in the ceiling and we can put insulation in the walls and we can get all our bodies want and then we leave the doors wide open of and it doesn't seem like we've accomplished anything and I'm not encouraged you to of that we have got a lot to see in the mask football games except and that we had a distance everybody up captors but I'm trying to understand how the mask in the classroom when there the quietest or the most distant. This make any difference. When they're in contact everywhere else. Can you explain that size doing. So in every situation where kids who are not vaccinated and cannot social distancing say should wear a mask and in the school setting that's an important setting to minimize the spread so I a I know that the more interchange that kids have after school there. More likely to become infected and bring it to school and that is the issue in our communities. But may I follow up yes but are we not ignoring the real life. The situation that it because it's not just football games but football game certainly. Is one place where we can readily see hundreds of to and I'll show you the pictures but I could be anywhere in the State hundreds of teenagers huddled together milling around of and the way they weren't there they be somewhere else of. How is it that a mask in a classroom when they're together otherwise. Making a difference. There are students in the classroom who may not go to those events they may be immunocompromised or have other health conditions and they deserve to be protected in the classroom. Thank you all right we're going to bring a doctor Joe Thompson bow round in Shopian trip down to the table with you if you come forward please. I do have some other questions but we're gonna let of these people come and give their reports and then we'll go back to the ones that so wanted to ask a few more questions. Right if you would identify yourself for the record please. Thank you. Thank you madam chair Joe Thompson presidency of the Arkansas center for health improvement. rile Arkansas hospital association. Jody internet Arkansas hospitalization Q. thirty times if you want to go first because I to madam chair of ways on thank you for letting us present to you today I'll be very brief you have in front of you a presentation that has a outline the now. We have reinstated our local area support of the health department to provide local information on new known infections and also vaccination rates. You'll see at the top of that graphic this number of new cases and I want to just share with you we're in a different ball game now the delta variant is a different variant then that also therein or the parent COVID nineteen you'll see the slope of the line going up starting in July and August it is much more infectious and is affecting younger and younger people those that are less protected through vaccinations and so that's why we're here and I think your health care community has been advocating for at least near term actions to delay the spread of this delta very this is not sentence going to be here the whole year if you look at other countries they have had a spike in it comes down we're on a spike the more infectious and potentially more deadly virus that's affecting younger and younger kids at the bottom of that graphic you'll see the new known infections by school district for the last two weeks we provided this said last year we stop providing it in marches are testing rates went down we reinstated it in July as they have come back I want to commend the bill our team and and miss hold for their study I think one of the important things the school draws from the community the kids come from the community the teachers come from the community the staff come from the community so it's important to look at what the community level of risk is to determine whether a mask policy or quarantine policy or others are making an impact you'll see on the top of the next page we're trending school districts over time last week a magazine took the. I guess the the top price at two hundred seventeen new infections per ten thousand residents so they don't have ten thousand residents so it's denominated to be able to have apples apples but that means more than two percent of the residents in the mount magazine school district have been newly infected in the past two weeks so it's two percent of the school of everybody in that school district you'll see also working with the health department we are publishing vaccination rates of the residents in school districts it's gets at the the prevention side of COVID nineteen the higher your vaccination rate the lower the risk is going to be in your school district from with students teachers and staff are drawn from. And then finally probably the most sobering statistic is since June the first vaccines have been widely available we know they are highly effective you know they're highly safe one is now fully approved by the FDA we know that ninety percent of the deaths that have occurred in unvaccinated people as so we can look at the total death since June first of over a thousand inch and suggested nine hundred seventy two of those deaths are preventable or were preventable and that number is only going to grow longer we have low vaccination rates and high levels of spread among our community so thank you be glad to take questions right I think what we're going to do is with them that the other his finish and then when I call your name committee member you can tell us who you would like to address your questions to all right. House Bill. Thank you madam chairman depreciate the opportunity to be here today and talk a little bit about how hospital capacity but a few stats just to go through what we're seeing today as of ten thirty this morning one thousand two hundred thirty nine confirmed COVID in patients are high was one thousand four hundred fifty six on August seventeenth. Five hundred twenty one confirmed in the icy you are high was five hundred and fifty nine on August sixteenth. Three hundred and twenty two confirmed on ventilators are high was three hundred and ninety two on September first. Current bid situation as a ten thirty AM we have thirty seven adult ICU beds available. I also want to just give you a little information on the funding that you approved through the American rescue act the one hundred and twenty nine million dollars for recruiting and retaining of health care workers we've had fifty nine eligible hospitals so far submitted their cost forms an attestation to the Department of Human Services to draw down those funds based on our own records we know that there are twenty eight more hospitals that are eligible to submit forms and draw down funds. As far as the other moneys that went directly to hospitals the Arkansas department of health through the American rescue act we have created through thirty three adult ICU beds and seventy four med surge beds still working on those but just to give you where those hospital beds have been created Baptist Fort Smith twenty one adult ICU beds Baptist Van Buren seventy four med surge beds St Bernard's ten adult ICU beds Jefferson regional in pine bluff to adult ICU beds we can report those ICU beds are filling up very quickly. Also we're continuing to see the difficulty in obtaining travel nurses from July twentieth to August twentieth regional demand for travel or ends increased by eighty six percent so we're not only competing with the states around us as other states are surging as we know Texas Big competitor now for nurses Florida California so it's big competition out there to try to get travel nurses which is driven the price up quite a bit. With that. The mystery and telling. Thank you for having us today I think Mr price gave you all at a pretty sheet and that actually shows hospitalizations over time so we'll just point that out to you I'm not sure if your copy is color or black and white I can absolutely make sure that you get a color one electronically but it shows that confirm to patients in ICU beds medical surgical beds and and the gray line is suspected cases we're delighted that were starting to take down we hope that's really good news for us one of the big concerns we have is the number of really really really sick patients inside the hospital so while the overall numbers of hospitalizations seems to be leveling off or decreasing which again is super super welcome we're still very high our health care workers are still working today F. working themselves to death I'm trying to make sure that everybody's OK and the sicker the patient the more personnel it takes to keep those folks well so again as my boss said thank you so much for helping us with staffing we're still looking for staff were still attaining them we're trying to retain the staff that we have an incentivized and to continue to work in our hospitals to take care of our Kansans. All right I have a question Judean at one point or. Either one of the up but at one time we had no I see you bids available what what is the status they are at this point. So that's the good news with the finding that you have given us we've been able to increase the number of icy you beds that we have available I will tell you we have surveyed our membership in the final results are not back in and of course we're sympathetic and giving them a little extra time to give us information about how many ICU beds that we've been able to prop up but I believe the last number I saw was it and another increase of about twenty four percent over and above what we had in July so we're doing our very very best to staff our physical spaces that exist now to be able to increase the number of sick patients that we can care for every day all right that is good news thank you all right to Senator Solomon you're recognized for a question and just you might want to tell the person yes thank you Mr minister for doctor Delahaye I'm looking at the memo from secretary key out to schools and it says the department of health has full responsibility to take whatever measures are necessary I'm wondering if you have full responsibility why we were collecting data to drive the policy. So you were talking about that kind of data that was presented today yes so that is a manpower issue there are a lot of data that we do collect and we know that quarantining works and so we have not had used our resources to collect the number of people being quarantine at the school district level. Okay. I didn't I don't know that may mean if for outcome driven and we care in all these numbers are going up or not collecting the data and it's pretty obvious to me I think many others that our policy that that we're doing is not being effective some also wondering if you have all authority and we know is S. the center said kids are you we quarantine them so we send them out of school but we stop following them we have no no. What we are not following to see what behaviors they're going which makes the quarantine almost insignificant so does the department of health are we going to consider having a higher levels of restrictions and following those students and not allowing them to go to football games not allowing them to go to other activities of quarantine works and these numbers are spiking it seems like the next step would be to enforce stricter rags on quarantines. So of course when a person. Is a quarantine they should stay at home they should not go out in public they should not go to football games but we do not have the manpower to enforce that it's going to have to be done at a local level okay and manager had just one more question for the hospital folks all right so we are offering all these incentives and I know. At some point protecting one's private health information is is comes and apply it for incentivizing this person they're going to get a day off or a extra money or maybe a certain healthcare activities are part are provided for one not the other. maybe people have on their badge a you know I've been vaccinated Tax how do we continue and how do we protect people's private health care information while we're offering these incentives that would seem to isolate those I know when we look at data for schools we don't publicize schools I think that have fewer than five cases because we're really concerned about identifying those people so how does the hospital go about protecting HIPAA protected information from other employees. I'll start by saying that hospital policies as well you know are incredibly complex and paramount is privacy not only for patients but also for employees there and many of those opportunities are voluntary by the person by the employee who can or cannot decide to display the batch to do those kinds of things so they would assert that privilege if you will for participating and that kind of activity. For there's no requirement for the for people to wear that in the hospital is not asking them to do that. Not to my knowledge if you have a specific hospital that's requiring that please let me know offline and I and I look into it some hospitals can do things very differently than others and even state laws we have about mandatory vaccine not masks not it cetera treat hospitals differently based upon how they're organized so I'll be happy to get with the same would hold true for offering payment incentives and we're giving private healthcare information to the payroll department. There there in fact know who has and who hasn't gotten that no day is that covered by HIPAA for those people to know that information so patient consent is very important an employee can set is very important and so we have to look at those policies independently and an individually to to see okay so individual and that's the last question madam chair so then. If we're going to offer payroll incentives for vaccinated people we are in fact then turning over private health information to the payroll department true. So again I would need to know which hospitals are incentivizing only vaccinated employees. I don't okay would you stipulate then the made so is it. Regardless of what hospital is that appropriate for them farm to give Hey Roland private health care information to the payroll department if that's happening is that appropriate. It it's voluntary so if there is a huge consent piece to this in order to be eligible for those that can Senate takes precedent over those things thank you manager all right but who did you want to add something to that. All right okay representative Ron when you're recognized. Right representative Brian. Yeah. The. Okay now you're on okay thank you Mr chairman. Dr Jill. You know three four months ago the big thing that we heard was the people that were sixty five and older with the ones that were in the big danger area as far as this now if you look at this chart doctor Joan I think you guys are probably the ones that handed this one out I saw something that was very interesting Joe it looked like between the ages of nineteen years old and sixty four years old are the ones that actually are not taking the shots as well. And then when you turn the back pages tone by seven day case rate and it's got the same thing that sounds like Dr Joe that we've got a problem with that with the shots between nineteen and sixty four years old I just wonder if there's something we can do to let people know that that age group actually needs some work done on. Thank you representative I I think just to be brief. We have been more successful with their older adults and getting them vaccinated with that's in the nursing homes or whether that's the programs or pharmacies in other clinical providers across the state the first round with the parent virus it did not affect younger people very severely in terms of illness this delta variant is a different virus is acting differently it is attacking differently and of course it's our younger folks those less than fifteen of those less than thirty it It hesitated to get the vaccine if you watch the news the stories that are being told our people that didn't believe it is going to affect them in their their loved ones are on a ventilator fighting for their lives and they wish they had gotten the vaccine you're absolutely correct that's the message that we need to get out we need to displace the previous truth that the parent virus did not affect young people as much and replace it with the current truth if the mutated delta variant is both more infections and more harmful to younger people. All right. A senator Hammer you're recognized for a question. Thank you ma'am chair Dr Thompson is just one years Can you tell me a. How many how many deaths are below the age twelve itch not group doubters or something that would. Prohibit you from being able to do that we do not report as the health department does not report deaths with under a friend of its five or ten death so I don't have that number I know that we have had this recently that have driven the pediatric death rate up but I do not have that number for public dissemination and. Are you saying that those deaths were directly linked to the delta very answer COVID or. Is that what you're saying that there they were I don't have specific knowledge to those deaths I do know from the health department to report the ninety nine percent of infections now in the state or delta variant infections not the alpha verify the parent strain community okay and preventable deaths can you define what that means and can you expand on that players no vaccines have been widely available since the middle of March the vehicle Disley available with strong recommendations we trucks arctic counting this from the end of the public health emergency which was on may the thirty first from observations reported by the health department the deaths that we observe ninety percent of those are in unvaccinated individuals so that was ninety percent of deaths had those individuals been vaccinated it's unlikely that they would have died. Then can you tell me a. When it comes to preventable death you are treating it strictly to the fact that they were vaccinated but do you go into a deeper dive to determine if they presented to the physician's office ask for particular type of medical help and were denied or turned away or you take into consideration people at present to the E. R. and are told come back to three days when you're not ready then it will be able to take care of you when you're being very narrowing your definition of president preventable deaths but if you're not incorporating all the things including those two I just mentioned how can you not also or how would you go about also including that in there because preventable death may not just be vaccination it may be doctor's choice of treatment when the patient presents to them and how they respond to the various options of what can be used to treat somebody well we're we are looking at the ultimate outcome which is death there's no. Ariens on death your data your life the issues that you describe or what may be happening in the other ten percent variation in treatment individuals with their immune system may not have taken the vaccine other issues where breakthrough infections do occur and treatments may not be optimal but for those that have died that are unvaccinated or those that have died that are vaccinated we know it's ten percent has been that pretty steady of the last eight weeks and therefore the for those who are vaccinated ninety percent do not die. And so ninety percent of the deaths that have happened or an unvaccinated individuals okay I guess we have offline conversation agreed disagreed that if you're going to have the discussion or label preventable deaths and say it's because you didn't get the vaccine without going back and looking at that individual patients history as to did they present to a physician to the president to an E. R. and had they been able to get treatment and I know there's a difference of opinions as to what goes into treatment for those that have the covert vaccine or the Delta there's disagreement among the medical field but I strongly would encourage you to think that needs to be included in that statement because maybe somebody else could be preventable if the treatment or when the patient presented had been handled differently and be and be glad to engage with you on that I think we do see consistently whether it's hospitalization that's about ninety percent are unvaccinated whether it's ICU admissions in violation about ninety percent of unvaccinated in the ultimate outcome of death about ninety percent are unvaccinated so it may be early on treatments but once you're going down the pathway being sick with COVID it's unvaccinated individuals that are not. Well you made a statement about increase the number of ICU beds have we actually increase the number Vice you better we just shipped to them from one hospital to another I had a conversation with a hospital administrator who made that statement to me that because of them not being able to find help they've actually had closed which created a shift of patients to other facilities have we actually had an increase in the number of ICU beds available or have we just created a greater number at other hospitals and they've moved away from others are you tracking it that way. We got a survey after the membership try to compare back to July and two August twenty seventh to see how many ICU beds were created what we received thus far twenty four percent increase over ICU beds over that time so in our opinion yes we are seeing an increase in ICU beds is that ICU beds dedicated COVID treatment right you bids as a whole I see you business all. What about I see you because we gave money with the intent of standing up I see you bids for COVID patients what about what about that data. Well it's the. Still going to be an increase in the ICU beds themselves so since we're seeing more more COVID patients are going to be in those that so yes ultimately it is an increase for COVID patients in the ICU beds. Okay all right thank you. Representative Boyd you're recognized for a question. Thank you madam chair of the so Dr Thompson this one's for you said recently I came out with some zip code level data and other that was helpful I thank the to see where or how different places are doing I guess the question I have for you though is. What insight the you have on what is driving the zip code level that it is it just we know that people who are sixty five and over are more likely to have been immunized and so those it codes tend to have a little elderly patients who it what what insight can you give us thank you. So we have been working with the health department providing some surge capacity for them to provide local level date at the zip code level the community level the school district level for new infections and now for vaccination rates we've used a green to red color coding to try to let people be able to trend over time we got that from the Minnesota health department and we use the CDC guidance the whole state would be read every week and you couldn't see changes happening anywhere so the reason that we provide the local area data is both for decision makers to decide and understand what the risk is of new infections or vaccination levels are in their local area but also the trending over time is important I think to know if we're making progress we were making progress so that we can try to get at what works and if we're losing ground so that people have a warning system that their community their school district there's if code is becoming a higher risk area for transmission because of the presence of the delta variant. On the zip code and let me to share this some of our larger rural districts cover many zip codes and so many of our superintendents from the rural districts and value the zip code level data so that they can more accurately target some of their prevention efforts for the breath of geographic space that they do cover. He finished. All right. Senator Clark you're recognized for a question. Thank you madam chair I have two of those okay. I will do it go ahead and ask your first one will put you at the end of the queue because we do have several people had a. The. Well as we talked about the danger to young people I've been following this since early to middle July mid July. And your convince me through the media and through talking to the health department. That. Delta was more contagious and more dangerous to young people. But I begin to ask behind the scenes. If it were more dangerous again does the health department in the governor's office. Should we send kids to school in August. And I kept asking that behind the scenes and then again desk publicly lasted in writing. If we think it's this dangerous to kids. Why are we sending to school and I predicted this graph here where we've got the less than twelve and twelve eighteen still going up I said we send kids back to school and then we had Marion we show that mask. Our data shows no statistical difference this exhaustive study that the CDC dental Georgia schools last year shows no statistical difference it's not mask. it's. Kids back togethers reading disease so do we why if we thought it was so dangerous to have kids in school and can you. Compare the danger to say car accidents or the worst flu outbreak we had in the last thirty years. A doctor bill hand doctor comes. So let me start by comparing the current COVID situation that fled. So. The flu season course goes from fall to winter so it the season that we had from two thousand seventeen to two thousand eighteen was probably one of the worst sick leave seasons we've had in many years. And we had a approximately two hundred and twenty seven deaths reported. So to me the deaths from flu compared to the desk from covid is just I'm not even on the same scale. So I find it more helpful to look at it from a point of view of the community and preventing COVID in the community so if we can do whatever we can in schools to suppress the transmission in the school in the community it schools can't do it by themselves the community also has to participate it's got to be done at football games it's got to be done at family gatherings it's got to be done. Within the community and that's why I think it's really important to have this school district and the zip code level so people can understand what's going on in their community and take steps to suppress it. Solid done. Adopted. Senator Clark I think your question several others most all of them today have been you know inquisitive an appropriate I want to go back to COVID pandemic is a new virus that none of our bodies have ever seen before. For our kids their bodies have never seen this first before either most of our kids have seen the flu virus before either because of being infected or being vaccinated and therefore their bodies will react in a more appropriate way when exposed to the flu and that's why we've had fewer flu deaths in adults and children over the course of the last few years. The threat here to all of us is that we have a new virus that we are mounting a response to. Protecting individuals that we can twelve and up to vaccination and safeguarding individuals twelve and under an unvaccinated people through things we know work we know this is a respiratory virus we know distance works we're not exactly sure Senator Solomon if it's three feet or six feet or four and a half feet but it's distance works we know masks work because it's a respiratory virus and we had no flu last year when we were all wearing masks. We know that some of our medications help but we don't have any knockout drugs right now so we're all in this together to safeguard your neighbor from a new threat that their body has never seen before and it has not had years of exposure like the flu I wish I had more specific information on that but it's it's you're not gonna find a specific policy that takes you to zero transmission. You got transmission going on across all of our communities twenty four hours a day seven days a week your corrective action talked with superintendents who have administrative folks at the football game looking for a list of students attending our quarantine to not let them in the football game all of our superintendents are not doing. Back I would hope most would start doing that but we got a few weeks here where the threat is very high because the transmission is so great and we have so many people that are unprotected and we're going to get the herd immunity one way or the other either by protecting the people with vaccinations or by people getting infected themselves and us losing more people that we otherwise could safeguard so I wish I had a more specific answer but I hope that helps Paul what manager all right of because really none of that was responsive to my questions of it was too part of it was if it's the state interest to kids. Why. Did what why do we have them in school. And second again not adults because until lightly we didn't think there were any kids that were under eighteen that died in Arkansas last year and we find out there was one in December of compared to car accidents. for under eighteen car accidents and to our worst flu outbreak in the last thirty years how dangerous is it in a comparison. So with respect to the first party question I apologize the reasons that leadership made decisions to start the school year was because with objective test scores we saw the harm to schools education performance from not having in person learning last year and so there's a balance of risks the actually measure the risk of the infection or continued educational loss N. leadership's decision was to try to manage both with mitigation factors in bringing kids back into school that's where the quarantining comes from that's where the recommendations for masking and distancing two other things I think are incredibly important ventilation you know and contact tracing I mean these are ways we're gonna beat this virus while we get people protected through vaccination. I don't have the answer to your second question we can try to. With that together. If you're going on to another question let me put you at the end of the queue I wasn't I was just I find it but because I have an answer but I I think it's incredulous that we do it when we keep telling people are dangers it is that we don't have a day that we can't tell them compared to car accidents or compared to the worst flu outbreak thank you. All right to her senator Wallace you're recognized for a question. Can you hear me. Okay. You know I want to I think this slide that you've given us so we could this. That's real personal slide. And when I have the medical professionals telling me that. We could have. Nine hundred seventy two people still live in the State of Arkansas that's a powerful statement. I believe the vaccine I think that thank you sister herd immunity fest anybody else I appreciate the message you're trying to give us thank you. All right a representative Bentley you're recognized for a question. Thank you chairman I have several so cut me off when you need to come out okay. but what I'll start with you guys the hospital sociais Asian thank you for what you're doing to get get more beds available I just quick question I am concerned as we get up to some deadlines at some hospitals are instilling mass vaccine mandates that we're gonna lose some staff has remonstrance about that can you tell me are these hospitals giving these the staff religious exemptions like we have another vaccines are they readily able to get a religious exemption for that yes the ones I know of the have a religious exemption yes and they're still able to work with some guidelines. It's exemption okay what is curious about that our hospitals receiving. A bonus from CMS when they reach a certain vaccination rate of their staff. A bonus or and an increase in pay what I've been hearing that just trying to say that no I haven't heard anything about that okay just because you get a check on that for me I just have been hearing that from you know for all of us are. Hearing greatly from our constituents unless these are chance ask those questions under that so appreciate you guys could check on me for that I appreciate that those two questions M. and doctor Thompson the questions I have for be free from here on and doctor delay of this of the seven thousand patients who have died in our state due to code how many have received a multi faceted highly targeted sequential multi drug treatment early in the disease long before they ever get very sick into the R. do we have any idea. We do not have an answer to that question we do not track the treatments that patients receive. You know I'm a set from I'm not trying to be a divisive and the last thing that we need to do is to be decisive I think as Dr Tom so we need to work together as much as we possibly can but that is highly important for us to find out that number if we don't know that we need to know because if. Patients are receiving outpatient treatments working we need to know if they're not receiving any and I hear from multi of my patients who are are livid and angry that their loved ones we're told that they were going to that there was no treatment like any true and then they died so I have very very. I'm angry I'm maybe the people that are in my district have died that I'll never be able to replace and then they were never given the early treatment and ask for Richmond didn't receive is appointed or my heart is at last I want to know we should know if we're getting any treatment that's going to help with this disease because I don't think it's going away anytime soon so Dr Thompson do you have any information that they received any multi faceted drug treatment early I would have said reserve Bentley in a strong message for all of your constituents if you test positive for COVID and if you're getting more ill then the monoclonal antibody that's available in most of our hospitals and many of our infusion centers across the state will have a high I would say a. They are increasing the likelihood that you will not be hospitalized so we have plenty monoclonal antibody it's in the healthcare system that is the treatment of choice for individuals or COVID positive and that are deteriorating their condition prior to needing hospitalization. Can you tell me the cost I cannot tell you the cost can you find out let us know we'll be able to your question over time to the assets to the extent that these were paid to the claims they system your transparency in issue will be able to profile what treatments for use at what locations in port for which patients okay thank you can I have a couple more questions Ritter well and put you at the appointment that's fine and of let the members of the committee if you want to ask a question get on the queue now because we're running out of time for this segment we have quite a few other things to discuss today. All right to we are going to A representative flowers you're recognized for a question. Thank you madam chair I'm. And I guess this could be for doctor Thompson but whoever else might speak to it from your organization or agency as well we've heard a lot about the Delta variant and how much more infectious it is in the differences between that and the original virus and you know over time we've heard I think it through the media about a lot of other variants I think gamma. and most recently the new Virant of variant can you and and the thing I guess that is most disturbing to me about. the new fire variant is that as I've read. it's been detected in forty nine states including Arkansas I think the only state that it wasn't detected and at the time of that article was written was in in a brassica. Can you talk to us about that detection in Arkansas and also what the ramifications are if in fact it doesn't respond to the virus you know what we need to be doing. So so this is part of the uncertainty with this pandemic and with this new virus vaccine advisers are yeah they're they're they're really or for plausible scenarios we were in the first in may and June where we had control of the spread and we were slowly getting of people vaccinated and we were able to relax our defenses the second scenario started to occur with the delta variant we're a more aggressive more infectious and potentially more harmful. Rant over took the previous variant and so we had a forest fire were in a forest fire now of unprotected individual succumbing to that by variant the third and fourth scenarios are ones that you're alluding to one is that we have another variant is either more infectious or more harmful to those that are unprotected or the folk fourth most concerning and and hopefully at least probable is that we have a variant that escapes the control of our vaccine. and therefore we all become at risk again and don't have adequate measures to protect ourselves the you can take the mutations happen at a very small likelihood with every transition so if you're in a very high level of transmission the chance of the mutation is much higher that's why it's so important for us to get the transmission rate down as quickly as we can with the policies and practices that we know work so those are the four scenarios I don't know if doctor deal Hey has specific information about the variance in Arkansas but that's what I would watch for interpret the news that you thank you. My understanding is that we have detected the move new variant in Arkansas the last seduction was about a month ago I suspect that it will not outcompete the delta variant. Thank you. All right have you finished. Representative flowers. I'm all. All right we're going next to Representative bill eleven and then we're going to representative going. Representative bill eleven thank you madam chair question it's actually two part question view Dr Thompson I'm somewhat of a data nerd and so I appreciate the data that a cop puts out and because I like to to follow through on that also follow Hey guys well as you personally on social media so I can keep up with all the information that you put out curious in my district I have multiple nursing homes I have rehabilitation centers I have dialysis centers I have a long term care and senior assisted living so I've got a real broad range of care for the elderly in my district but I noticed a particular quote that you might I believe it was yesterday every nursing home should have a hundred percent vaccinated healthcare staff by now our Kansans deserve total transparency on the safety of their loved ones I'm curious why you would single out private owned businesses being nursing homes but yet not make that statement about dialysis centers or long term care or even hospitals for that matter in the second part of the question is with the. Healthcare facilities that have chosen to go to a mandated vaccine for their staff we've seen long term health care experts. Nurses doctors that have just walked off the job I recently spent a stat and one of our local hospitals received excellent care. But every nurse that worked on me for the days that I was there was from out of state they've been recruited in through the very actions of this body who appropriated federal funds to help with that recruiting strategy. But I'm I'm curious with with this specificity of nursing homes they don't have that funding and if if these nursing homes but that mandated vaccine on their staff now we have CNA's we have LPNs we have kitchen workers that won't walk out. If that's the case then how are we going to provide safety for these level and so I appreciate your explanation that statement. Well specifically in and historically most healthcare facilities have required vaccinations or other protection screenings for tuberculosis other issues that place their patients at risk so that when somebody comes to that facility they know that that is a risk that they don't have to worry about being exposed. most hospitals require influenza vaccine on an annual basis for their employees most nursing homes have similar requirements or expectations were mandates are not in place for going there's an incentive stated she's a high level of compliance with respect to nursing homes the center for Medicaid and Medicare services requires nursing homes to report on a weekly basis the proportion of their patients that got sick and their staff they got sick with COVID nineteen and the proportion of their patients that are vaccinated and the proportion of their staff that are vaccinated in CMS post that publicly although it's not easily navigable site we did put out nursing home specific vaccination rates so that if the look if an individual is looking to put their loved one in a nursing home and there to nursing homes in the same location and the dramatic differences and COVID vaccination rates that that information is transparent and available to the to the individuals I don't know that a hundred percent is ever achievable in fact I can tell you a hundred percent is never achievable but we should strive to have high levels of vaccination rates through all the means necessary in our health care facilities where people are bringing their loved ones to get care. Yes. I'm here. Okay. You somehow you got this thank you okay there you go so thank you for any as I understand it that if these facilities are required but I guess it goes back somewhat to my original question is. I appreciate the fact of a cop putting out data and. The simplification of being able to see that data as you've communicated if there's someone about to have to put someone in a facility and they're looking at comparative data and yes the CMS website is very difficult to navigate through. I'm just curious why it didn't stop there why you as the director made the decision to single out nursing home saying that they should be a hundred percent but yet there's no mention of the other industries that are in my district a long term care the senior centers the dialysis centers rehab facilities because when you make statements like that I get phone calls from a nursing home saying why are we being singled out of being picked on. By Dr Thompson and there's no mention of the urgent care facilities that people are taking their seniors two or three has of the dialysis just just curious what what calls that employs to just single out the nursing home's thank you I I acknowledge that and with. Yes to my colleague to my left I think hospitals should probably have the same amount of information publicly available for their workers. All right represented two point. You will see. Thank you madam chair had the I just a quick question with regards we've we've kind of danced around the issue a little bit we've addressed a little part of the nursing shortage do we know of any nurses in the state of Arkansas who have lost their jobs or been terminated because of their vaccine status. No we do not know of any at this time I think the first deadline coming up is at the end of September or hospital that has mandatory vaccination so what no more than. Thank you all right we're gonna go to Senator Solomon next in because of the lateness of the hour if you're not on the committee I will be calling on you so Senator Solomon thank you madam chair just to write what we heard in our testimony before you all came to the table was that that we didn't track the number of quarantines Department of Health or others didn't track how many quarantines were in school with is that correct or incorrect. That is correct okay I am in order we track the number of students who were. Are are in quarantine and contracted COVID during quarantine is that correct. So I know of a report to that I do not know at this point at how well that we track it but there have been students in quarantine who did turn positive that have been reported to under what I'm asking very specific questions do we are we tracking the number of students who were in quarantine and contracted COVID while in quarantine. I do not know the answer okay thank you thank you madam chair all right senator Hammer you're recognized for a question thank you. Thank you a mentor Bo are we tracking the number of nurses and medical personnel or anybody in the hospital that's not that you're leaving because you said we're not or wait for the first deadline but when the first deadline comes are you gonna be a look back and say we lost twenty we lost thirty are you gonna let the deadline hit and then start the clock. I would say the deadline had and then we'll we'll depend upon hospitals to let us know if they've lost people due to the to that mandate. I want to ask for that information I'd like to know that and then the second thing is you her doctor Thompson say day we've had it drilled in our head that masterwork you know I got a quote from doctrinaire the says anything other than in ninety five and dark clouds addition to meeting is insufficient and doesn't do the job if mask work as well as we have been told and if a hospital policy requires that a mass B. on an employee at all times then why would a employee have to be let go because they didn't have the vaccine if mass work so well and that's the policy of the hospital and they're wearing at the entire time they're in the hospital. Well I would say the the safety of the patients are paramount in that area and so hospitals have been using mass for many years surgeons have been using mascara and secretary nurses so it's proven to be effective but also There's so many unknowns about the transmission that I think masking is just another another safeguard there to make sure that we're not transmitting the disease thank you. Have you finished senator. All right a representative board you're recognized for a question. Thank you madam chair of I'll be quick I'm still getting information that there that PCR tests are not able to differentiate between the flu and COVID I know that we've discussed this before but could you tell us one more time doctor Tom senator to delay whether that is correct or incorrect and just help us understand thank you so the PCR test for COVID nineteen can only tell you if you have the COVID nineteen virus or not It cannot tell you if you have the flu virus or RSV or any other virus you would have to do a test specifically for the other virus. we are looking forward to this winter when at. It will be helpful to know if someone tests negative for COVID nineteen and they have symptoms if they have the flu. So the tests that we have been doing for COVID nineteen will be combined with a flu test you can do two tests on the same sample you don't have to go back to the patient collect another sample or you don't have to at two two separate tests you can run them at the same time it'll be much more efficient but we we we able to test for flu and covid. On the same sample but the covid at best only test for covid that's all so just to clarify there's not like say a sixty percent false positive rate for the PC are tests for code or some high number of false positive rate the PCR test is very specific and very sensitive for the COVID nineteen virus itself I would like if I can take the moment there's been misrepresentation misinformation presented to this committee and may be the source of questions that you're getting a medical of representatives before this committee because doubt to be placed on the PCR test because you may remember our center for disease control originally in the pandemic trying to develop its own test and that test failed and recently they withdrew the emergency use authorization for that failed test that has cast doubt on every other PCR test that is highly specifically highly sensitive and that is feeding misinformation is rampant in social media. All right of. Representative paid you're recognized for a question. Thank you madam chair so my question I will follow up on representative Bentley's questions about the therapeutics the doctor Thompson Dr bill Hey I was gonna get the vaccine went to the doctor if he tested antibodies and they were through the roof I immediately started trying to find out where I could donate plasma of for the convalescent plasma and I find out that we've turned away from the convalescent plasma any off mention the monoclonal antibodies quite a bit but in the world to therapeutics why have we discarded the convalescent plasma. Candidly some of the studies that were done and well controlled randomized wasted not show that the convalescent plasma was effective against making disease either shorter or less of the year the monoclonal antibodies which are pharmaceutical targeted just for the COVID nineteen of our us do appear shortened both duration of symptoms and decrease the level severity if early enough in treatment that's why I say if you test positive you start deteriorating don't wait until you have to go to the emergency room of the infusion center go early enough so that you can get the infusion give it a day or two so that it can be effective in preventing you from needing to be hospitalized Sir could you for ray via email a study or two about that convalescent plasma thank you thank you madam chair. All right senator Wallace you're recognized for a question. Thank you. I'm of the impression I may be wrong but just before the flu season. I've been led to believe that all of our nurses health professionals and hospitals are required to. Take the flu vaccine center. I do think that's true yes in the point I'm making is we we already doing things. For as a condition to work commission taking of a flu shot and now we're saying we've got a covert vaccine that's been approved by FDA I'm trying to figure out the difference between the two that I and I don't see it. Thank you. All right of. Representative Gonzales you're recognized for a question. Yes. Thank you madam chair I want to follow up on us Senator Solomon questions about the the tracking of those quarantine we we spent millions of dollars on contact tracing two two five I thought to trace that type of information down what what has happened with that. Or are we still doing contact tracing or. Do we just throw that money away. Yes we still do case investigation and contact tracing but we do not contact tracing everyone. the numbers are larger and so we prioritized those situations that A I have to do with a large outbreaks and we also work to A power because those in certain settings certain businesses are large venues we have a good cooperation and collaboration with the schools that can Work with their students and they know who's of. Are in quarantine and they are tracked but not through the health department and we don't gather those numbers. This is so what is the school doing what those numbers are what what's appointed tracking that if that's not reported to the health department. Why why bother what. Why don't we want that information. So the school no locally who's in quarantine and when they're supposed to come back and that handled that way rather than centrally from the health department. Yes I understand I just don't understand why the health department would want that information would want to know how many have been quarantined and how many of those have have actually contracted COVID nineteen virus because maybe maybe we're not doing our quarantine have if. So if there are cases they would be reported to the health department they would become a new case after you know during quarantine but for us it's a matter of of The ability to contact contract trace everyone the we don't have the staff and the contracts that we have with our contractors you know. The number of cases is so great that we are not able to do all of the tracing of all of the contacts and quarantine. So almost contracts was was there a specific number that they were limited to four tracing what with it did we say if you had this number you don't have to contact tracing anymore you this is this all you have to do. Now it's a matter of there being more cases when we have you know a couple of thousand cases today than all of those have contacts and so we simply are not able to do all of the contact tracing that we would like to do we would want to but it's a manpower issue. To. May I have a question for the hospital association. Okay. Go ahead three yet so. As far as the the nurses go you know they worked all through the pandemic. With no back saying before that that was even available as the association do you think it's appropriate the hospitals of fire people term terminate nurses in the short is that we have with. Now just because the there are they don't want to participate in a clinical trial. Well we certainly courage hospitals to have a mandate healthcare worker vaccination but we realize it's an independent decision of hospitals because of losing employees there may be smaller hospitals medium sized hospitals really this time of the pandemic they cannot lose a single person who's working so we recognize that it's an independent decision of these hospitals based on their work for so so you do encourage them to fire nurses of they're not vaccinated we think it's appropriate to have mandatory vaccinations because it protects the patient okay thank you all right the representative Bentley for quick questions please. Thank you chairman of Dr Thompson can you give us the average age of the deaths since June of that thousand sixty eight was average age. Don't have that in front of sorry revision Bentley actually a delay does so thank you doctor okay. So four of. July we have an average age of sixty seven point two years that compares with last November's where was sixty eight point three years. So even with the delta we're the ages sixty seven point two versus sixty eight point two with this. A. Senate again. One so you said that the agent February was sixty eight point two is that what you said to me and in the November November okay so now that we have the seven and eight point three she's in July was sixty seven point two okay okay. I just want to I don't want to get into an argument about vaccines. I think what we do public policy it's important for you all to understand what we're hearing from our constituents and there is a high a high level of distrust for Washington DC and we all know that converses are broken for a while and now most of my constituents feel like we have an incompetent administration of there so there's a very high level of you know a distrust of their thank you need to understand we're hearing from our constituents and I think it's highly important for us to work together to do something that do do prevent disease there are a lot of things that we can do I think we can work together to make some good health policy to we look at so it's going around the world this is not just an American pandemic it's not Arkansas open is a worldwide pandemic work in Israel we see that there is a representative you need to have a political question productive times as well and then got a question this is my life yes to get to the question please. I'll be happy to chairman. Okay so Israel seven huge breakthrough whether vaccines I think it's highly now we're Senate breakthroughs vaccines not answer we're hearing from health officials that vaccines are not going to get us to where we need to be we have to work on some other things as well so things how important is to work together with this hospitals making sure we get early treatment positions making sure we're gonna treatment that we continue to pursue other things so that the question last question have a Dr Thompson was one of the three topical morbidities for the disease as well so we can work on some other things as well because the vaccines are not the total answer we hear that from officials worldwide so what isn't where the top three committed comorbidities we can look at Tucker Jr patients to get healthy as well on that thank you sure when we look at your Transparency Nishant claims data for the last year inclusive of other data from the places individuals with COPD individuals that are obese individual studies those are probably the top three that have adverse outcomes the list goes on cardiovascular disease congestive heart failure dementia cancer therapy people an immuno suppressant drugs this virus parent originally and now the delta variant pushes people over the cliff if they have co morbid conditions that their body cannot you know withstand the onslaught from the virus I would I would caution in your statements vaccines are the way out of this at this point in time. We're at a point in time a year and half your your nine months after the. Presentation for the first time of the code nineteen we will be in a different place a year from now we'll know more but as of right now vaccines are your best way to safeguard you and your loved ones. All right we're going to have the last question representative played. Thank you madam chair as someone just said you know we have I'm up here. You know we've heard people talk about it's not just the US diseases worldwide so and we see things on the internet I I get texts and emails and other people do as well about other countries we don't talk much about that but one of the things saw was in India they had a peak in cases from April to June that would be the delta I believe. and then it was flat after that. And other national banks nation rate is eleven percent. So why do you think that is. So in my scenarios that I shared in this is Joe Thompson with a crystal ball no science behind me and no clinical providers behind me here within the countries where the Delta variant outbreak occurred it was so infectious it moved through the population like wildfire in so it got to herd immunity because it either infected you and you survived or infected you N. you died. We are going to that same situation now we're in a little better place because we have a much higher starting point on our vaccination rate but I think you're going to see because of the infections of the delta area in my third scenario it's going to burn itself out and I hope that by the end of the month two months from now we are seeing that burn out the risk in this is my fourth scenario is that if we continue to have mutations we could have a mutation that gets out from under the protection of the vaccine or the protection the individuals have gotten from being infected correct. Okay one other thing that I saw I'm just this is a Texan they sent me Tokyo's medical association chairman also live news conference and recommended ivermectin one to all doctors for all COVID patients. I mean this is a country that now is recommending that to everybody and it's not highly used here why is that well I think it's not highly used here and I'd be interested in that the broader Tokyo clinical community's perspective because we have clinicians here that recommend off label use of a number of different drugs we've done in this we've done a randomized controlled trial of our where the person giving the placebo or after Mactan in the person receiving the placebo arm Act and are blinded any had no beneficial outcome for COVID nineteen infections. So we've got a randomized controlled trial double blinded gone through the peer review process that shows no benefit we still have lots of people tried it we have some people becoming poisoned by it and so that's why the health department put out there a poison control advisory that if you've got GI symptoms headache. Yes I need to stop right here so you say they're being poisoned by the. Prescribed ivermectin and that is for humans that is used for like river blindness and other things no I'm I'm saying the off label use not only well not for human consumption of for animal consumption but that's that's a different you. You're mixing I mean if you get a prescription for a drug and you take it in the proper way in this okay the someone who goes out and says well that work so I'm gonna go ahead and take the same thing I'm giving my cow. I think you're I think you're mixing things here that we shouldn't be mixing so on the human side only human FDA approved government. You know I've I've prescribed ivermectin for lice in kids that it's it's a parasitic of exfoliant and there are two in the or PO or by mail for consumption for other parasites and other issues would you never taken drugs without there being the potential for an adverse affect or benefit that's why we do the trials the same is the benefit outweigh the risks and right now we're not seeing in randomized controlled trials the benefits outweigh the risks yes you understand when I say when you say people are getting poisoned yes by this drug. Hello people out in the community here that and. That that makes them misunderstand things I mean that's that's a totally different drug that you give animals to what you give the humans it's like one tenth the right strength of that sure do you understand that all it does is make people not trust what's being said. And I I can understand that yes all right thank you ma'am all right thank you so much appreciate your time and the good job you've done up we're going on to the next item. Which is odd to me I'm sorry yes a. Thank you senator Hammer. You had a motion. What's your motion. Thank you Mr in light of some of the testimony today. And also citing CDC comments from July of nineteen I'd like to make a motion. That the public health committee of the House and Senate. Recommend because we're within limited power to the department of health and to the Department they add that if a three to six foot social distancing is achievable that a student does not have to quarantine unless otherwise determined by a local school policy if the three to six foot social distancing is achievable no other quark no other criteria is required to quarantine that student and like to make that for motion for committee Mr Hammer I'm I do not feel comfortable accepting that motion this week this month let's wait till the next of public health committee meeting and give the health department and the education and the education department time to think about that and do some research I feel like this is so not something we ought to do today all rights hearing this thank you measure thank you. Right going on We have the discussion on medical marijuana one a quality control program in Oklahoma clay bill or if you would come forward please. Introduce yourself for the record. Good afternoon clay Bullard. The G. X. medical from Oklahoma all right you are recognized. Can you have an introduction of it please do Mr ball thank you for being here I appreciate it he I ask that you come and talk to us because I was concerned about the quality of medical marijuana in Arkansas and Mr builders worked over in Oklahoma and I became aware of some other issues over there so I want to know more I want to committee to know more about some of the issues in Oklahoma and what we might do to to prevent having the same issues so if you could just give them or direction of kind of who you are what you've done an Oklahoman sure so I have worked with the state legislature the governor's office and the local medical marijuana forty. As a consultant looking at the industry as a whole given the fact that it is under the department of health and it is a medical marijuana program so several things that they looked at Oklahoma's very different in Arkansas in terms of how they have chosen to licensing how they allowed for a much broader acceptance in terms of cards in the number of people that have cards so one of the things I want to look at was how do they ensure quality. Of the product or how they ensure safety on the product as well as how they also make sure that they're protecting those people who are buying licenses and producing product and selling product in the state of Oklahoma so they wanted to add a second letter that's never been done in the United States before Oklahoma was the first ever do that and so what I was able to do is use my twenty five years of healthcare experience and consulting to be able to walk them through the process and bill to put some things in that would allow them to be able to accomplish that. Okay so I'm there's some questions that I have I like to ask you about that sure so Oklahoma you know can you compare them Arkansas like the number of licensees they have how many cardholders they have and you know what kind of volume of product how does it compare in Arkansas. So that's the difference in Oklahoma currently they are on the precipice of thirteen thousand licensees of I think you guys in Arkansas are somewhere in the neighborhood of about forty to forty five so little bit of contrast and differences there the number of cardholders cardholders excuse me is roughly four hundred thousand cardholders some people would make the statement that it is basically qualify recreational at this point I think in Arkansas you're in the neighbourhood somewhere around sixty five or seventy thousand cardholders for medical marijuana. what what with that why should we be concerned that Oklahoma has those big numbers and we don't want. Well when you have thirteen thousand licensees as you can imagine there's a whole lot of product that's being produced. That not necessarily do you have enough consumers to be able to have that it's estimated that eighty percent of the product grown in Oklahoma right now. By over eight thousand growers AS being exported out of the state. So for instance just on your western border there the statistic as it is this number is as of two weeks ago so it may have gone up since then but you roughly have twelve hundred and forty licensees operating in a county that but it's up to your western border so when you have eighty percent of the product is estimated to be leaving the state you have to think that would be concerning to me if I were in the neighboring state of Oklahoma with that many licensees one would be how to I am sure that the products not coming across and the people that have. For their money in the licenses and build their businesses here how do I protect the commerce to know that illegal products not coming across secondarily how do I protect the citizens of a neighboring state to know that the product is not being mixed together with product is being grown here that is not tested or doesn't have some type of quality assurance behind it that that would require. Each one to have some credibility in some validation behind what the product is in is if it's safe to be able to be consumed. So what kind of programs as Oklahoma put into place to kind of prevent these these issues so the one thing Oklahoma did I think this is directed to your question is they actually developed the first quality assurance laboratory. In the United States so every state who has. I guess approved marijuana or the voters have asked for marijuana basically put together and said you have to have laboratory testing to put together as you did in the state here some requirements for testing laboratories become license laboratories and the industry just operates to where they do testing for the product. No other state other than Oklahoma currently validates that the testing that is being done is correct so. Contrary to my twenty five years of health care lab experience or any most any other industry in the United States that is a consumer product is not regulated or has any eyes on by the state meaning. Who's testing laboratories to make sure the laboratories are calibrating their machines the right way how do they know that the actual test results are accurate if there's no secondary set of challenge against that meaning challenge meaning a set of standards or guidance by the state. The industry has in my opinion full everybody into thinking that That is it is safe and that the industry operates on an ethical manner and I can tell you the state of Oklahoma that within a matter of weeks of the quality assurance laboratory coming into existence one of the oldest labs have been operating grandfathered into the process in Oklahoma immediately forfeited their license. The reason that's important was because the investigation is going on the there was no lab machines ever turned on he was just producing lab results for his customers so that they could sell their product and have a certificate of analysis and every found out there's gonna be some checks and balances against his work all of sudden he forfeited his license interestingly enough he's not licensed in Arkansas but that's for you to deal with over here so so there was no oversight in the lab what they were doing how they were analyzing what machines are there's no oversight no no oversight whatsoever and to give you a little bit more color to that the standard if you would in the industry is to have a variance of plus or minus forty five percent many of your testing for heavy metals or you're testing for pesticides or other things that may be dangerous to the product think about this we regulate tobacco quite vigorously because consumer product to cause into the lungs. But we're not doing the same thing for another product that were smoking and putting into our lungs are vaping inputting after a lines that may also have heavy metals pesticides or other things in it that aren't necessarily being tested against a standard so we have a standard of a deviant of plus or minus forty five percent that's ninety percent meaning any lab can operate within ninety percent of that on on the fringe of it and still pass the product. But who's even hold the standard to what is that forty five percent plus or minus so like a like water is an example you know you pull water sample Senate to a lab the analyze that they have EPA standards for heavy metals or PH or backed meal D. or whatever but EPA or the state if they have a program. A monitors that land correct because if they're following all the procedures and doing the spikes and all that so you're saying medical marijuana has doesn't have any standard like that no oversight the state of Oklahoma is the first ever to do that it's actually been praised by some of the states but you wouldn't think would pray such a thing Oregon California Colorado have come and said finally somebody setting the standard and that's usually coming from the growers because what what think of the people answer this isn't a a a regulatory issue that should be seen as negative this should be seen positive even by the people that are in the industry I want to know that my product has potency levels at a known standard level or I want to know where the heavy metal standards are so no the Oklahoma is the first one there's still the only one I'm I'm consulting the several states right now that are trying to figure out how to put in the quality assurance laboratory with their department of health. But the biggest thing that I can say is it's even here in Arkansas it's a medical marijuana program and in healthcare where I come from any laboratory is subject to clear Colo or other standards which means the laboratory has to be able to. Twice a year be regulated by a governing body that says that your machines are calibrated the right way that you can produce results against a standard and be able to produce those back in a manner which allow the to to maintain your credit ation I'll stop with other folks questions thank you Sir. Representative cloud you're recognized for a question. Chesterfield sorry I'll take the cloud thank. I know we test for over fifty pesticides is that correct here in the state of Arkansas I believe that's correct yes madam chair us is yes these allegations of Are being made that we're not doing quite right of course our legislation instead of totally differently than that in Oklahoma Mr paschalis here could I ask him to respond to some of this. Of the medical marijuana industry in the state of Arkansas. Concerning the testing. R. Brandon who is one of those persons who does the testing. When one of them up. I think that's brand. Introduce yourself for the record please stating where you work. Brandon for not own operate steep hill Arkansas where a cannabis testing lab the here in Little Rock so you. Do not agree with the what is considered that put Arkansas does versus Oklahoma what the statistics on on Oklahoma versus Arkansas you know we're correct it it's a much bigger program they've got. Twenty five labs there I think maybe more now and you know if the thing the thing to remember about Oklahoma's they had a program for a few years before that any standards at all in Arkansas we we set out originally was pretty strict standards we we all had to be high so accredited before we started operation and hi so credit ation of it actually encompasses a lot of things admissible is talking about like proficiency testing like validation of all of our standards about traceability on calibrations what we're you know we're inspected a couple times a year we actually also employ a third party agency that comes in from Houston and looks at us I did every quarter he denies everything we do are you saying that we we did that as an Arkansas company but we do not do it now we do that right now yes ma'am yes ma'am okay. All right so what what are you saying in terms of what Mr Bullard said you saying that we have adequate things in place already is that what you're saying well yeah I believe we do I think we're to slight difference in Oklahoma and into a state that has so many labs you I think it does make sense to have someone you know checking up on everybody you know we've got we've got four here that that does testing for really everybody and so it's just to a different situation and I believe the Oklahoma up lab mean that I think I read the contract and it was like a ten million dollar contract and I think that the Department health is is accomplishing that pretty well you know overseeing the. The two eight right here. Senator Chesterfield U. S. what has I know one of the things that was of concern to me is the pesticides and all of that and I know we just about how many pesticides each time rent of fifty nine we stayed for fifty nine pesticides so this isn't this is not an industry in the State of Arkansas that does not have any checks and balances I ask for in my view as far as protecting the citizens and the of the quality of the product that is produced we don't have the size of Oklahoma but the legislation that created us. I said we have one forty dispensaries and only six or seven or eight cultivation sites so we were never intended by the legislation to be of the magnitude of an Oklahoma unless that legislation changes that's all for me manager right thank you representative placement. Okay well I. My my concern is that you know if you have oversight it doesn't need to be a company that the person doing the analysis hires. No so some other entity should be doing that and you know I so is great it's great but. That's a little bit different than regulatory compliance like EPA or ADQ so. You don't see any gaps in our quality program do we know that when they say it's five ounces of medical marijuana it's five ounces we check that kind of thing yes Sir all of our weights you know simple way bats weights Arkansas weights is in the ballot track system and it's it's really tightly controlled if if I'm off by a grand on a sample weight that the A. B. C. as is is knocking on my door very shortly after you know so it is far as the with the way to go yet there's lots of checks and balances there and you know I think we're regulated just as tightly it is as any other type of lab you know we it's it's a little bit different because of we are dealing with the product it's federally illegal and so we don't have the same type of federally of federal standards so you know that's why states regulate you know state by state there there isn't a national standards yet and you know and and Arkansas has done a good job the Department health use or again as a as a reference point and we've got some of the strictest testing rules in the country. Well I guess that's what I questions about so you test for pesticides what what's the allowable limit in the pesticide or metal or whatever is there a limit established and is that not just by your lamp or by the department of health and then I'll ask Mister Ballard what Oklahoma has yes so the Department held as an action limit for every pesticide that is on our list and it's in their their regulations and the rules on their website it is different for each analyte it's it's the same listed Oregon uses organs actually change there's a little bit to remove some of the pesticides all those numbers or in parts per million and so you know and and that's the limit there's no there's no variance there's no you know ten percent over a forty five percent over under you know the limits the limit if something is one parts per million above that then and then it's not a pass the variance really comes from potency testing which you know it's it's a when you testing a plant in a plant that grows you know in in it's similar conditions it just has a lot of very ability you know flowers from the top of the plan is gonna have a lot different profile of cannabinoids in the flowers at the bottom of a plant just because a growing conditions it's closer the sign maybe nutrients a little bit different that's why there's a lot of very ability and and potency testing but anything beyond potency testing there's there's no variances it it is what it is. Mr Ballard what what can you give us an idea of the limits that are set in Oklahoma who sets those and. So very similar to hear the limits are set by state law in terms of what passes a lot done and I'll clarify the difference would be. The the reason Oklahoma established a quality assurance laboratory so as he said there's four different laboratories here that matters for others twenty four as it might be in Oklahoma the question is who is regulating each one of those laboratories to make sure that the calibrations and the standards for each laboratory near each other so if I'm a particular grower and I want to send my product anyone of the four laboratories am I going to get a similar result and what I've talked to in some of the growth here is is the results can vary significantly I think you said the benefit of the forty probably test ninety nine point nine percent of all the marijuana grown in in the state so with with all of the going to one maybe this is the standard that everybody that everybody holds two but the difference would be is the state in a quality assurance just like there are with every medical laboratory waters you brought up. You each of those labs at here to the same standard. Or do they all have their own standard their own third party somebody from Houston somebody from Kansas city where it might be and then everybody operates on the island so the that's the biggest difference in terms of calibrations are looking at machines is does the state have a standard that the labs are then required to adhere to that standard regardless of what the limits for each individual pesticide heavy metal or whatever might be. Okay we've got a couple questions. The representative payee representative paid you're recognized for a question. Thank you Mr so Mr Bullard you talked about possibly up to eighty percent of Oklahoma's production is being exported and you mentioned the law that production is along our western border as if maybe it's been imported into Arkansas isn't that already illegal. Totally illegal yes so as far as a legislative body I mean we don't have to do anything to make that illegal it's already illegal it's it's a matter of enforcement at this point. Correct and I apologize if I if if that point was misrepresented the the point of it was that product may be coming into your state and being sold through dispensaries or sold even illegally on the black market that you could not be able to regulate one where the other so it was found where you send that testing to so I share your concern and I'd love to serve those laws enforced but I don't see an action necessary by this body to to make it double illegal thank you Mr. So in Oklahoma what how's the process so does the department of health higher this lamp to enforce these standards this. Standard across the state is that the way it works so they they do so they hired a third party they put it out for an RFP contract through the department of health the reason they did that was so that it would be separated from some of the other things are going on within the health department such as COVID so it doesn't get distracted and has a single focus so it does multiple things that it sets standards and regulations for each of the laboratories that are there they also go out and they collect samples reach the laboratories to collect samples from the dispensaries and from the growers. To make sure that during the process of the product from grow to sell. Is not being of tampered with not being laced with something else on top of it such as Ellis the marijuana being laced with PCP you could have cocaine other things are being put on that product or being adulterated during the process after it's been tested so what the state upon was to make sure that the product is being sold as it was being tested whatever was grown by the grower because once it's been tested from his lab from a grower there's really no other eyes on that from any other point within the industry. So they go out of your randomized testing they bring it back and then they validate that against a certificate of analysis just to make sure their safety other things are going on with the product so they carry multiple they also Oklahoma unfortunately has litigation going on right now with their season so program. And so there's not eyes on that but one of the things that the lab will be required to do is to go into the sea to sell program and look and make sure and see if there's any anomalies within the system that might alert them to a product that was not necessarily as it said it was whatever's representative and the certificate of analysis for testing you. Sure that's only questions I had I want to thank you gentlemen for presenting is good information thank you. Please wait a. All right thank you thank you very much all right we're going on down the the agenda to. A animales. Is the best friend and best Barrington would come forward please. Issue Sir for the record please Sir. Please ma'am. Thank you ran with the Arkansas insurance department. Barrington Arkansas insurance department alright. Do you like to go first Mr green. You're not on Justinian or make a. Three. In all right yes all right thank you very much my name is Bruce read again and I work at the department of insurance one of the jobs that I do as as a managing attorney is of regulate pharmacy benefit managers or PBMs and work with many many members related to the B. M. licensure acting pharmacies and pharmacy association I want to visit with you today because I believe some several pharmacies have contacted the sponsor Senator hammer and some others over concerns about whether the PBMs were violating Nate Act laws me kind of explain the background real quickly because I know this is a late afternoon but pharmacies in Arkansas are guaranteed a safety net in their reimbursement by PBMs one of the safety nets as they can't be reimbursed below national average drug costs you need to act you'll be hearing me say Nate Act what that stands for national average drug cost it operates as a safety net for PBM reimbursement that's that's one safety net the other the other legal safety net that this legislature has required for PBM reimbursement as it can't be any lower than the pharmacies invoice cost or what we call maximum allowable cost rimac so you hear me say Nate Act imac they that the massacre abbreviations for the safety nets this body imposed by the people in licensure act on PBMs and the insurance department started regulating of Nate Act reimbursement violations and mac violations since twenty eighteen since the legislature gave jurisdiction to regulate PBMs the insurance department we have a PBM division this was the best pairing ten is our PBM Director of we don't have a large staff it's usually me and Beth and precip to Beth Margie former handle complaints we get about. twelve to fifteen McElroy pills or complaints to the PVM department each week from PBS from pharmacies over the last month and a half we've received approximately a hundred and fifty complaints and appeals so that's kinda giving a roof of a server of steel for the rhythm of complaints that we get response things that we have to do with pharmacy spa complaints there almost all from pharmacies complaining about reimbursement and some of the concerns raised by pharmacies recently have been they are seeing violations of Nate Act they want to know what the department is doing about it there are a lot of frustration pharmacies over reimbursement violations I want this body to know that we are pursuing them actively and aggressively one of the things in your handout is a bulletin I believe it's the second hand out the address is made Act violations the insurance department has jurisdiction to impose fines and penalties of up to fifty thousand dollars read six month period for violations of Nate Act that's to also true with Maximo our costs while she's so I know that the tile this meeting shows says ACT nine ninety four of twenty nineteen that is a reference to the Nate Act requirement the PBMs the PBMs reimburse at least eight ACT levels so I want this fight understand we're going to be very aggressive we have issue bulletins the the I believe the other hand out is the numbers of adjustments that we have made B. M.'s make over the last year in response to mac and they'd Act complaints but I want to spider standing we are no longer going just make adjustments will be finding these entities going forward now that's one step that were undertaken we've also reached out to the PBMs to see if they can improve their reimbursement systems we had four meetings with the PBM since the summer they are trying to improve their. Max systems and data access someone's to make it where less complaints are being filed an appeals the insurance department so it is a process that we're working with the PBMs so I'll be glad to answer any questions. All right of. A best did you identify yourself for the record. I did but I will be introducing myself no that's. US senator Chesterfield you're recognized for a question. Thank you madam chair and thank you both for being here and I know the evening as long but the pharmacist in my area concerned about the fact that they are not getting a response a quick enough response the ones that I had there were twenty three violations since July and not an email in response to the the the complaint why is the turnaround so slow why is it taking so well we had our PBM Director retire in in July first and so one of the problems we had was it was only me handling the the backlog and so we hired Mr intended so she had to be trying we had to find or and we had a higher so long as you got an answer. You're not we we are we are I believe we're caught up as and I think that's a great thing. When you when you are you know how it is when you have a business and you have a concern. Our people have a right to have a quick response at your mitigating circumstances and you have demonstrated to me what that mitigating circumstance was if nobody's there they can't answer right and we're going to do better going forward is that right yes and ing out to the pharmacist I know that we've worked with some different places and putting out in the news bulletin that I'm now here because there was a lag between Margie and myself so I I do know that there was a little down time but I've not been with the department not quite a month yet and I've forged nonstop to where I'm finally at asake caught up every day I come in there something new but I'm that I'm the cost of this call will ever get all right well thank you madam chair thank you so much as I'm not a member of the committee for allowing me to ask questions all right and when you speak up please speak into the microphone. next we have a question from representative Boyd. Thank you madam chair and just I want to disclose I am a licensed pharmacist before I ask a question so you use the term safety net a lot and I just kind of wonders stand what is happening in the market or from your perspective so like how many licensed PBMs we now have operating in the state of Arkansas in. Of those is there one that clearly has the lion's share of the market. We have nineteen that are licensed and I would say CVS probably has a license here actually CVS Optum and yes are the largest I would say CVS's largest PPL I that we've got because the they do the GPS there the IBM for approximately shall. All right so just follow up yes so so then there are very many people Ms if you will but there are a lot of the pharmacies which might change the market power yes there's there's big ones but there's not very many of thank you. All right the next is represented flowers. Thank you madam chair just very quickly you mentioned the fifty thousand dollar fine that you all will be implementing and I'm wondering what will that would that apply per complaint or per violation as there are pharmacist who are submitting complaints for several violates thank you question the fines based upon a pattern number of violations multiple violations not a single violation and I believe Senator Hammer and is working with the insurance department to try to get new legislation I believe you and I visited about this since last week to make it a per violation fifty thousand dollar requirement and not a per pattern or practice population patterns so we are working on legislation to help make that much more severe than what it is and so right now it's very specifically defined in the law as a per pattern per complaint will okay and then follow up managing yes. And then is there anything in the loss to allow the insurance to Hartman to apply fines to those PBMs that. Where there may have been a decision made to Remunerate for past claims or payments that have not been paid. But in light of the twenty eighteen in the recent Rutledge Supreme Court decision now. That would be applicables they would want to pay so what are that would will you all be able to apply fines to say Hey you guys need to pay this we see we can find suspend the license or revoke a license we we really don't get involved in civil retroactive damages that is the attorney general's office on. Okay. and then finally if you are have there been any changes to this process in terms of the Nate ACT and math claims. Since the Supreme Court decision yes okay good question Nate ACT and mac Womack is the maximum allowable cost law was the law that went up on on to the Supreme Court in the Rutledge case okay so Mackle plows to the self funded employer plan market because of Rockledge Nate ACT now do preselected station I believe it's ACT six sixty five of the the last session requires Nate Act to be paid by self funded employer plants so both of those representive flowers I have been changed to apply the self funded research market effective since July twenty eighth of this year. Thank you very much thank you madam chair. Thank you all right to senator Hammer. Thank you have chair I'm I'm looking at the bad actors is all calm on the list Caremark's seems to be at the top are you finding that that's is that correct I think they're there because just your volume I mean that that they do most of the at the TPS reports we have works of their therefore they're going to be subject to more the complaints simply because their market share okay and then I noticed also that it seems like the majority of the pharmacies are independent pharmacies I don't see change stores on here might correct in that is correct so so why where they're ninety chain store pharmacies on here file I think I think the the primary the primary frustrated are impactful reimbursement situations on the independent pharmacy and not on the injured feel it's. And when you expect to up with and welcome on board by the way of when do you expect to start the litigation against him or start the process of working toward finding well you know we try to work with him so we want to work with them before we we get to the situation before we have to do dramatic enforcement of our last meeting with the PM's to improve the system senator Hammer was last week we had is a phone call the insurance commissioner was there PCMA was their their lobbying organization all the PBMs read on the call it was our third call we certainly express the frustrations the insurance department is having in having to process these complaints it's just as frustrating performances having to spend three or four hours each night to send them to us and we are invited him to the legislatures probably is frustrated with them as we were in that they need to improve things they were going to be such a dramatic fonts and I think the insurance question is we're looking at within the next month of looking at dramatic enforcement actions unless the PBMs change or systems more effectively okay and a final comment word would be that I don't recall a time that a PBM ever contacted you or us and said Hey we need to fix something that's going to make things right it's always that we've had to be the aggressor in the case unless or have you had PBMs reach out to you and say Hey we would like to I just received a letter yesterday from PCMA indicating their commitment to help improve their mac and they'd Act of reimbursement systems I just received that yesterday so I didn't have time to the record but but by and large I mean we we really don't have any written consent legal documents with them and so the only alternative I've got is to do administrative force but they come back to this body and try to improve these funds to make sure these. Farms are higher than what they're supposed to be so we were just going to have to do aggressive enforcement well I would just encourage it to up we've talked with them long enough go ahead and do what you got to limits to will kick it up a notch next time thanks okay. All right the last questions Senator I mean I'm sorry representative flowers. Thank you madam chair I'm I was wondering madam chair if someone from the AG's office is here in the building. And we might be able to get from them what is happening on their end with regard to the retroactive claims I don't see anyone but we can put that on the agenda for the next time that the awesome thank you so much thank you. Thank you so much thank you know other questions we appreciate you being here. All right we are going to the update of on unemployment insurance the unemployment insurance program if you come for. All right the introduce yourself for the record the Committee jim Hudson department commerce. Sri Sturch orders director of division of workforce services all right we're ready to hear what you want to tell us good afternoon. So we were asked to provide an update on unemployment insurance and so I'll go over the current unemployment insurance information and then also talk about education and appeals the Arkansas unemployment rate for July twenty twenty one is four point three percent the rate for August will be available on September seventeenth the US unemployment rate for July twenty twenty one was five point four percent and is five point two percent for August that percentage is already been released Arkansas's jobless rate is down from seven point one percent in July of twenty twenty there are forty seven thousand four hundred seventy five more employed our Kansans compared to this time last year so this reflects that our economy is growing the challenge with that we have now is getting people back into the labor force and so we're doing everything that we can in order to encourage individuals to go back into the labor force and of doing so by encouraging job postings and job fairs I'm currently our job site AJ L. system that we use has fifty two thousand two hundred eighty five jobs posted are there are multiple sources used to estimate the number of jobs in Arkansas not every employer of post all of their jobs as you all know so according to various job sites the number of job postings in Arkansas ranges from around thirty thousand to seventy nine thousand full time and part time positions. Recently I reported on a form in a report that we were using for employers to report individuals not reporting to work and so I'm just on our last a report that we received with fifty five employers reporting with two hundred fifty eight reporting refusal to work and hundred and twenty for failure to appear for the interview so that is that's something that we are appreciative of it helps us look at those individuals that they are reporting and then get with those individuals to let them know that that we have received this report and it's important for them to to make sure that they are able and available and that they accept work when offered to them. I'm on are you are initial claims those are people applying for unemployment weakening September fourth one thousand two hundred and sixty eight that was compared to five thousand six hundred and twenty four last year same week so that is a really that that's good progress also individuals receiving payments of last week it was four thousand five hundred eighty eight individuals receiving an input regular unemployment payments compared to forty one thousand one hundred and forty three last year same league. So we've made tremendous progress in and getting our numbers down for those applying for unemployment obviously we have those that still need employment and we're working to help those individuals by doing numerous job fairs and events throughout the state all over the state and we're encouraging any employer or any entity that has that can combine several employers so that we can do job fairs and assist them to get employers into our centers and then also there are Mobile units with several Mobile units that are that are on the ground and all are at locations around the state on a weekly basis also in education we've made tremendous progress on the backlog and I know that something that is always something you're interested in We we had a high of twenty five thousand four hundred ninety two claims and adjudication in October of twenty twenty two to twenty twenty total claims weakening nine four is down to fifteen thousand one hundred and sixty four this is a forty percent reduction are claims backlog since the first of the year so we're making progress we're seeing improvement in the way that we're processing claims and and looking at at other options and and. And use of our staff in order to get the information that we need from the employer and from the employee before that claim is looked at by an adjudicator so that will speed up the process. then any appeals we are also making progress and appeals with a high of three thousand five hundred sixty one in regular United or in United at three thousand two hundred eighteen in P. U. I. N. October twenty twenty we're down to not two thousand nine hundred and thirty in United and one thousand seven hundred and ninety three and P. U. at. Glad to take any questions all right I do have a question and when what was the number of those refusing to work what was it is one of the better begin is also worked two hundred and fifty eight and then the ones that did not show up for work one hundred and twenty four and that was in for the month of August okay what what I'm sure that if they refused to work that's the end of any kind of help that they've been getting right there is a process that we're required to take in order to notify them that we've been notified and then work with them on getting back on track in the center and for those that do not show up for work if you remember I think had towed to a some constituents that were complaining about that very thing so I assume you have a process to. Find out why they didn't show up and then go from there is that correct yes ma'am all right well thank you very much for that appreciate and not you had some really good numbers here so I appreciate that is encouraging it is encouraging of representative lame. Thank you ma'am chair of this I think I know the answer has been one make sure the extra payment the three hundred dollars whether the extra payments that were being sent out of that estante in Arkansas is that correct the last payment federal of payments that went out including the three hundred dollars was on July that we can in July twenty sixth of June twenty June twenty six okay thank you one follows so you still have the two systems you have the P. U. I. you still haven't operate two different systems is that right yes Sir because we still have claims that are in appeals are adjudication and appeals and so as those claims are coming out of the judicata and and or appeals then we process those claims based on the previous dates prior to the end of the program okay thank you all right of senator Hammer you're recognized for a question. Thank you ma'am chair to the point about those the two fifty eight and one twenty four when you say you're working with them are you finding that any of them have legitimate reasons and if they don't have legitimate reasons do you terminate their benefits retroactive back to the date that they were supposed to show up to work or did. Senator hammer there I asked about that earlier and there is a process that we must go to it through according to unemployment insurance law and so I think if I remember correctly we must notify them and then give them an opportunity to correct and to continue to apply for unemployment but I make sure I send that to the to the Committee if that's acceptable or they are they continue to draw unemployment while that process is taking place. I'm not sure Senator Hammer I don't know if it's because if they're put on if they're put on hold of what would happen is their weekly claim is where they would answer they would also have to answer that question on their weekly Klein whether or not they were able and available and so if then if they if they answer that and it was. Not in and it was in conflict with what we found then I assume that that weakly claim would be would be held for further review and would be that then the claimant would go into the G. the claim would go into education. Okay we'll we'll visit because I've got a problem if there continue to receive the benefits they did show up and and that of how many dollars are affiliated with the cases that are and Still waiting to be heard the twenty nine hundred that you mentioned while ago. I don't have a dollar amount for each of those because like I said before each of those has a and most claims have multiple issues And so with each of these in appeals it could be that you know one of the reasons that they're an appeal it there they had to they're in appeal the appeal process is for Timeliness one maybe for you know I'm I'm not gonna go to the list of issues but there may be several issues for why they're in appeals in the appeal process and then they would have to go for hearing for each of those so there's not a total dollar amount it would be some of them are in a peel for just a certain period of time for a couple of weeks and some and they maybe an appeal because they were to not at the very beginning and I did receive any funds yeah I'm getting some calls from constituents still that they're in the appeals at the current rate of which were chipping away what's your projection as far as the backlog being caught up or does that twenty nine hundred represent people that are still COVID related or is that adding to the new ones that are coming in. Try again idea one we're going to see the end of this. Yes Sir I did I did not check on the timeline for the appeal process that I can do that for adjudication were looked on we're looking at based on the current rate of processing summer of twenty twenty two so I'll be glad to get the the right of the expected date to get back to normal processing time for appeals and I can submit that with the information about the denial or anything we can do to get extra help if we have to go ask for some of the you know the money coming down to because I mean some of these people maybe they don't have legitimate claims I don't know but you know if you're talking twenty twenty two and they've been waiting I gosh that's that's a long time is there anything we can do to call up anybody and I know it takes time to train people but anything when due to. Work on that if if I could Senator Hammer I think you part of the issue is for some education questions it requires a level of expertise and understanding and system to actually be able to resolve the issue so it can take months before you can take somebody's new heart and put them in that context just a little bit of slicing on that date it's fifteen thousand currently education but at fifteen thousand about nine thousand of those have been Judy cation for less than ninety days now if you're one of those folks nine days doesn't feel good doesn't sound good but it the the pots not all the same you know group of people it's about six thousand visuals who've been education for for more than ninety days again waiting is not a good thing but it does take some time to work through this and the pace it's been pretty pretty impressive so far this year thank you working and. Okay thank you. All right to a representative Payton you're recognized for a question. Thank you madam chair of this maybe one of those questions where you have to forward us an answer later but if employee voluntarily leaves work they quit their not fired they're not eligible for benefits is that right. Represent Payton is a general rule if someone resigns voluntarily they're disqualified from receiving unemployment benefits and that means I've actually got to go to work for at least thirty days before they become eligible again so it's a purity disqualification so that leads into the second half of my question if the if they quit a job voluntarily to go to work for a another job in and it and it doesn't pan out a week or ten days down the road there out of that job and they file for unemployment claims or maybe they're even released or fired from that job. Which employers suffers the charge for any claims that are paid. I hate to answer your questions of like this because we answer your questions like this often but it depends so if like Mr Henson said if they are worn we're not employed by that employer for thirty days then they haven't have they don't have enough wages in order to file unemployment on that. Current employer or the second employer that they that they had during that period of time so then it would go back on the previous employer but then that depends on what the circumstances were when that individual left that employer and on the circumstances of why they left the first employer not know we're there claim may be justified on the second employer but they didn't have thirty days. But those. Situation those things that are applicable to the section employer don't count as to whether or not they're eligible to be charged back to the first employer. I'm I didn't follow your question I'm so the only thing that determines whether or not the the benefits paid will be charged to the first employer are the conditions that they left the first employer has nothing to the second floor. And if they if they've been employed with the second employer less than thirty days. And if they wait for a second employer more than thirty days it would never get charged back to the first one was it. Yeah I think of the circumstances they would have enough wages with the first employer for that first employer to have a charge rather not speculating or how that works is that it is a technical accounting for which employer gets charged lot how about we give you a specific and accurate answer to your question I would appreciate that thank you. On charges. All right there are no other questions we so appreciate you being here and. I like that good needs thank you all right we are going on with their agenda and I believe that we are now ready for DHS. So Marquand eight and let's see of Mary Franklin and anyone you would like to bring with you would be great thank you so much for. The. Being here when we finally got to you. So long morning long afternoon. And you're recognized if you would just the state your name and. Where you're from we'll get on with your part. Thank you madam chair more quite or use services. Good afternoon merry Franklin department of Human Services division of county operations all right you're recognized. We are bringing before you today an update to the new board policy of the Medicaid eligibility manual could you pull your my phone a little bit closer thank you for that better this better. We're bringing before you an update to our medical eligibility policy for a newborn categories in that update is to make it clear in the policy that newborns born to mothers who are in the unborn category for pregnancy coverage are eligible for the special newborn category which which provides for continuous coverage for the first twelve months so that income changes of the House will do not affect the newborns eligibility. All right I think we have a question for that the representative Payton. Thank you madam chair this just curiosity here should be a simple answer but under the financial impact what does it have an impact this year and then not going forward. The financial impact for this year is for the system change we need to make to make sure those new words go to the right category so they're protected for the twelve months so it's an internal cost yes thank you thank you madam chair all right I see no other questions without objection this rule stances Review right next. All right this this next rule is also for our medical services policy and it is related to the sponsor deeming requirements sponsor deeming is a process that we use to determine eligibility for lawful aliens who are admitted for lawful lawfully admitted for permanent residence when they have a sponsor and when they do have a sponsor that sponsors income and resources can factor into whether or not that alien is eligible for Medicaid coverage in the change that we need to implement allows for Deductions we would allow from that sponsor that sponsor spouse's income and resources if that sponsor themselves we're applying for coverage and also allows and makes it clear that we are to use the household size according to whether this is going to be a magic category or SSI category when we're determining eligibility for that lawfully admitted alien who has the sponsor. All right the Senator Hammer you're recognized for a question. I thank you measure the Tell me again who this applies to your what population the supplies to. So this this this applies to their non citizens there so they're considered aliens and lawfully admitted for permanent residence aliens who are required to have a sponsor to come into the country that sponsors income and resources factor into whether or not that alien is eligible for Medicaid and it is updating the policy related to how we count that sponsors income and resources and count the household size for that alien. Would that be a discourage meant to somebody considered to be a sponsor if say for example they're above the poverty level or I'm trying to figure out why we is this all federally mandated we're just yet often the rule to that take what we've been handed by the federal government that is correct but I I don't see it as a I don't think it would discourage people from being sponsors because again this doesn't affect the sponsors eligibility it's House sponsors income and resources what affected that that incoming aliens eligibility for the program. But if somebody's an alien who would come into. The sponsorship of somebody who is independently wealthy let's just say. Would that prohibit that alien from being able to receive services because of the financial condition of the person who sponsoring them. What it It could depending on that a court again depending on household size the income and resources and whatever allowed deductions we can take from that sponsors income in center out at if it and miss Franklin correct me if I'm wrong as I understand this only in those cases which under that federal immigration law that individual is required to have a sponsor correct which that may not actually true for other immigration categories but there are some more before federal law does require that sponsor to be responsible person okay is this going to have anything to do with those that are resettling here from Afghanistan are they going to be considered in this population or exist the key phrase that you're used I guess who defines that they're lawfully here would be the defining criteria what it. It's that that is the criteria but that that phrase is a unique it's a term of art in immigration law and so there other people who they're within the bounds of the law to be present but they don't fall in that category and is from what we understand the individuals who are coming from Afghanistan are under some different categories and I think the US for homeland security still working through that but at this point I don't think we've got any indication they would fall into this category that's affected by this rule our thank you thank you all right seeing no other questions without objection this rule stances would be next. Manager will have a David Jones from a division medical services join me for the next two. Since the Adam J.. You would recognize yourself for the record please. David Jones Arkansas department of Human Services division of medical services okay you're recognized the manager this is a clean up change to the provider manual manual for physicians we discovered I say wait this providers brought her attention there was a socially an error in the provider manual related to how positions bill for anesthesia services and so this is just correcting that error is so I think a one line change that's all to does and we proceed no comments there were no opposition all right to a representative Eubanks recognized for a question. Thank you madam chair mark this question I ask you a few minutes ago the physician rate studies have all of them being completed they are in process so we last year I believe we completed the rate study for fan offer primary care physicians and we implemented the those changes and so those races of are you going through right now we're on the last round of the provider types they're being reviewed presented the governor's executive order if you are member he directed us to review all provider tops Medicaid for their rates and so now this the last group are working through we're collecting data working to issue reports to make recommendations about what we'll do with those rates so all that say there are some specially positions that are still in the these last categories of working through those exposed expect those to come out shortly. Could you define shortly I my understanding is within the next few weeks but I and I will clarify that the staff who are over that are out this week but once they get back in I'm going to double check with them and make sure and I can get you back to a more definite answer on that all right thank you very much thank you right of seeing no other questions without objection this rule stands as we be. The next one and manager on item K. I apologize as we're reviewing the materials just for the meeting we noticed there's some paper incorrect paperwork that was given to what was in the those include what the committee saw not quite sure where that happened the process but this is not a time sensitive rule so with your indulgence would like just push this next month so we can make sure you'll have the right paperwork all right I do have one question it won't interfere with that mark can that so when I read this so. The hospital acute crisis unit that has nothing to do with the crisis stabilization units does it you're correct that is those who are not going there similar types and bill in similar ways but the language that we're proposing would have no effect all right all right thank you will hold that over for next month. All right going on to a bill. We have. And then Mr J. hill from our division of Asian opium Health Services will join me for autumn Health. J. here with the H. S. aging into. I think you're recognized thank you madam chair as many of you know we have the our choices Medicaid waiver program this is a program where we provide home can be based services for the frail elderly and also for adults with physical disabilities I because the Medicaid waiver waivers have to be renewed at least every five years so this is the new renewal of that program we're not posing for many significant changes to we did a lot of clean up work on the waiver itself so there is lot to strike through of what we cleaned up language made it more accurate because these away regulations they're very lengthy ask for a lot of detail a lot of information the key changes US one point out to you are number one we're clarifying and and modifying the roles of the divisions within DHS in the process for determine eligibility and for managing this waiver we are also making some changes you may recall that last year we brothers and changes for our choices that simplifies the application process for eligibility for some individuals when they're once they're found eligible if they are if they're condition remains constant based on a review of our nurses they will not be required to go through another into the system for the renewal is estrangement change we made last year but we're continuing that into the waiver on a permanent basis we're also updating is language around heels and we do have a rate increase as well this is for attendant care services these are this is in home hands on assistance with activities of daily living things like bathing eating toileting and we're a clot were increasing the rate for ten care so they will be equal to the rate for personal care services which are provided outside the waiver because they're essentially the same service they're they're they're funded differently and bill differently but the actual work is essentially the same there is a. Fiscal impact from that rate increase bill included that there and with that be happy to answer any questions all right Senator Hammer you're recognized for a question. Committee chair tell me tell me about your justification process for increasing the rate. Sure we and we've gone through the review process for personal care services in twenty nineteen I believe in the twenty twenty and so that actually is made after that as well the personal care rate we looked at the cost of providing that service we looked at was including the impact of the minimum wage increase because these are typically going to be minimum wage or slightly over minimum wage workers in providing the services and unlike some services the bulk of the cost here is paying for that in home worker and so it's very dependent on the minimum wage so we review that and we come up with a rate we thought was sufficient for the cost of providing the service in the personal care side and we implemented that change we put that into effect last year we could not carried over to this rate because this rate was part of the way for conserve the waiver self had to be amended to increase the rate and so that's what we're just following a loss that will be equalized and follow along with that personal care rate what's the daily rate than. It is it is an hourly rate Say I'm sorry it's a five dollars twelve cents for every fifteen minutes. What's the total to two a day rate increase. Our. It. We're supposed. It's a so on an hourly basis isn't to offer five cent increase not quite sure what you mean by day rate because this service is only as provided on on a raid fifteen minutes fifty minute units this is not some of this done day except in residential care facilities and those there's a formalist used converted depending on the acuity of the patient did Millman do your actuary study or who did they actually study to and I'm against these people got raises for everybody in the audience I'm fine with it but I. Who who is actually that used to come up with this Millman to the work. At I just. Struggle that will give everybody rate increased. Over treatment system living is why we are. at a just struggle with that I just want to know no I understand center but I mean the keep in mind no of course the issue assisted living was where the rate was and it still was at a rate that just could not be justified no the method methodology for determining what's appropriate rate very similar for deterring this rate as what was done on this is to look inside looking similar factors look at the cost of labor I mean is is a very similar process would have to add those two results in but the these are there similarities between these two but they're also also lots of differences. But minimum wage had a big impact on the determination of this right yes Sir okay all right thank you the manager. Seeing no other questions of. We appreciate you being here and sorry you had lasted that's perfectly fine but thank you alright ladies and gentleman there needs I don't see any of the. I'm sorry without objection this will stances Review and I do not see in the new business and so we are turn thank you for being here. With. Yes thank you. Yeah. Next month hello.