Public Health, Welfare and Labor- House & Senate

All right members if you would you go and take your seats this is the two minute warning. Okay I will call this meeting of public health welfare and labor to order Uh jerseys a quorum. we've got a fairly long agenda and some very important items on the agenda today so uh we will get right into it as quickly as we can and try to move along Before I ask my co chair for comments I'd like to introduce some visitors that we have today we have student doctors a congressional congressional fellows from N. Y. I. T. at a S. you feel would stand up I would like to recognize you. All right of representative I mean Senator Bledsoe did you have comments. All right thank you. Okay we'll move right into the agenda the first item on the agenda. Is the approval of the minutes from July the second I have a motion I have a motion second. I have a second all in favor signify by saying aye. All opposed nay. Motion carries. A down to Adam D. but COVID nineteen update impact of delta variant on children vaccination rates and update on current Arkansas hospital capacities and. Members we've got quite a few people to speak on this item and I'm going to bring them up one group at a time and then we will just keep them there and continue to add so the first group that we want to bring up his doctor Delahaye with the Arkansas department of health. And looks like we have another. Person. So if you all would just please introduce yourself. Hi I am Jennifer Delahaye the chief medical officer at the Arkansas department of health. Donna Adams Arkansas department held deputy director okay welcome to the committee if you would just a go ahead and if you have some comments to make and then we'll ask questions I'm sure sure so you're recognized so we have provided a handout for you today to give a visual illustration of the impact of the delta variant in Arkansas. on this handout you'll see on one side the seven day rolling average of cases per day for children ages from birth to seventeen years of age we began seeing the delta variants increase in may and June and now it is the predominant variant it is eighty six percent of all the sequences that we obtained for variance in the State. On the other side you can see the impact of these hospitalizations and on this a chart of the red represents this year and the blue represents last year so you can have a contrast between the situation at this point in time compared to last year. So I have a few other pieces of information I would like to share with you today we have a total of nineteen thousand seven hundred and thirty nine total active cases in our state. Of those three thousand six hundred and seventy seven R. eighteen point six percent were and the people under eighteen years of age and two thousand one hundred I'm sorry two thousand two hundred eight fourteen or eleven point two percent were for children under the age of twelve. Compared to last year for children overall. And we had one thousand two hundred and fifty six cases at this point last year. And for children under the age of twelve we had six hundred and seventeen so that compares with the two thousand two hundred and fourteen that we have today. The Bill Haley yes that in your hand out those numbers they're not okay. I'm. We can make a hand out from it if you would like me to do that later if that would be helpful I think if you'd seen those numbers to the chair what we compressed so people would have those in their hands be happy to do that thank you. We have at this point in time today one thousand two hundred and twenty people in the hospital that is an increase of eighty one since yesterday. And also we had forty two deaths reported so we are at a total of six thousand one hundred and ninety nine deaths in Arkansas. I'd like to focus a little bit on the A cases in hospitalizations and arched Arkansas and so for children who are. At. Zero through eighteen years of age. We had a a two hundred and sixty seven percent increase between April and July so it went from twenty one to seventy seven children who were hospitalized in each of those months. This is much higher than it was last year for July last year it was fifty seven cases. An of those that were hospitalized who were twelve years of age are under twelve years of age the four July there were forty five that was fifty eight percent of the hospitalizations there are more children under twelve who were hospitalized in July of this year than any month during the pandemic. In terms of I see you admissions for children zero birth through eighteen years of age there was a two hundred and seventy five percent increase. When April and July of this year so in April there were four children who were admitted to the ICU and in July this year they were fifteen. And this is a hundred and fifty percent higher than compared to last year which was six for the month of July so there were more children admitted to the I. C. you in July of this year than any month during the had pandemic. Twelve of them were twelve through eighteen years of age and three of them were under the age of twelve. So I can stop now and see if there's any questions. Yes we have some questions. A representative Bentley you're recognized for a question. Thank you chairman Chuck bill Hey thank you for being here today can you talk to us about what we're doing for early treatment for patients that are diagnosed with code for these children what we give and then what we recommending it for these kids so they're not getting sick and have to be hospitalized. So the FDA has authorized the use of monoclonal antibodies for children who were twelve years of age and older first Pacific treatments for under twelve years of age I would defer to the experts to treat them at children's hospital okay I said my questions for them later chairman thank you. Senator Hammer you're recognized for a question thank you Mr on the handout I think you mentioned is the red line representative of the flu cases in the blue is the COVID or could you distinguish what those laws are so the red or from this year these are COVID cases and the blue or from last year. Okay all right thank you. US senator Beckham you're recognized for a question thank you. The total testing how are your conducting that is a PCR test being used. So the way that is done when we get a positive test someone gets a sample and send for PCR usually then we try to get that sample and we send it to a lab either the CDC or the public health lab in Minnesota to do sequencing so they take the genetic sequences that were in that sample and they run it on a sequencer that tells the genetic sequence. The Bill Haley you don't have any Today the by sectional sections of the state or is it just all state wide data we can pull that date I did not pull them talking about children specific you know yes we can pull it by sections of the state yes I think that's something that might be interesting to members okay but this will be happy to do that thank you. any other questions from committee. Senator Bledsoe thank. Thank you dirty deal Hey since we had you here today I have wanted to ask you this question and probably should have called you at the health department to ask but I'm hearing and I'm assuming that I was thinking maybe you might go into it but I'll just if you are a I'm getting ahead of you but would you please talk to us about the mask and whether a they are effective because we're having such a debate about that I thought maybe you might add to a. It's something that would either convinces everyone we have the other. So we know from studies that look at when you put a mask on how much of the of. The drop let switcher the particles that are large enough to be blocked by a mask. Plus the aerosols which are smaller but can still be blocked by ask that they work very well to do that and then there are studies both on a small scale like businesses or schools or in larger studies looking at hospital systems or cities or counties that show when they are implemented that they decrease the transmission of COVID nineteen. All right so in your professional opinion based on the studies that you've reviewed then they do work they do work okay is there anything else that you would add to your statement about the COVID nineteen as as you know. AS you have mentioned or is are you are you finished I guess well let me add a statement about the Delta variants. The original Wuhan variant that circulated in Arkansas the estimates were that for every person who. wasn't affected. And didn't. Have a vaccine or didn't have Matt didn't use a mask they would on average in fact between two and three people. We know from studies in the United Kingdom. Where it's been of the dominant strain for awhile made a been able to analyze this. That for people who do not have a back who are not vaccinated and who do not wear masks and practice those social distancing they will on average in fact eight people. So it's very likely that this virus which is so transmissible that without vaccines plus masks and other social distancing that we will be able to sufficiently suppressed the spread of this variant to keep from overwhelming our hospital systems. Right and it's speaking about of and I'm sure the hospital association could I add to this but of. So the bed capacity is probably at the at the limit from what I'm hearing. In if you have a case of let's say someone with a heart attack or maybe someone you know with the that need surgery like a gangrenous gall bladder or whatever how did they handle those people if they're no benefits. I would deferred that hospitals to that isn't an issue I would think that is it all rather the pandemic has certainly taken up a lot of hospital beds that sometimes others don't have a chance to to get in and get treatment is that correct which is a very big concern all right is there anything else you would like to add not at this time okay I think we have some others on the keys yeah we have some more questions now of Senator Solomon you're recognized for a question. March no no you're not alone said Mr you you made my my caught not to yes senator Hammer you'll have to wait just a few minutes yeah I will you are returning back in please senator Hammer. Okay thank you Delahaye over here yes thank you could you add to this chart that you've got just the regular flu. I'm sorry that we have regular flu cases I'm guessing also this summer. Yes we do they're quite minimal. Okay can we get that information would be happy to provide great thank you thank you Mr. Representative cloud you're recognized for a question. Thank you Mr chairman your doctor Delahaye in your comments we kind of used the word mask. As all inclusive and of an issue I would ask you to address is the different kinds of master people that wear gaiters people that wear cloth masters people that wear paper mask. we we don't have a discussion hardly ever about N. ninety five mask if we're going to protect people it looks like we ought to go with the very best mask on the market would you mind addressing that please share. So the purpose of the community wearing a mask is. Primarily to prevent spread to block what comes the droplets that come out of people's mouths. And if M. called mask is appropriately made multiple layers of cloth with fine you know densely woven then they can approach the the effectiveness of a medical procedure mass the crime that the surgeon would where for example A there are some mass like in ninety five which is also called the respirator it's but second specifically designed to protect the wearer from inhaling droplets or particles and so it is not it will block what people give off but it also protects people from inhaling particles and so called mass can do the same they don't do it as well they're much better at preventing spread but also some protection for the wearer so if everyone is wearing masks then it actually benefits the individual wearers because they have less exposure to have droplets or aerosols which are the fine droplets that hang in the air for long periods of time they are less likely to be exposed to those that help. I it did you have more questions. Thank you. Senator Hammer you're recognized thank you Mr sawgrass. Where it showed that when we were doing with COVID back in March that wants the vaccines started being given that there was a dramatic drop in the number of cases that got us to the point to where we could get out from underneath the emergency declaration that graph implies to me that the vaccines play as big of a role as anything else would you agree or disagree with that I would agree. So if the significant drop that was represented in the graph was a tribute to the vaccines should we be talking more about that actually means and not putting so much emphasis on the mask. At this point in time because the Delta variant is so infectious and that people who are fully vaccinated can. A get have a breakthrough case in perhaps a ten percent of the fully vaccinated people and they can spread the virus then I think we need to have both. And then there's the debate and we had this the last time around the debate of which study do we believe because the CDC. Almost flip flops and it seems like they're driven more by the political conversation and more by the hot topic conversation and that they produce a different approach to mask which seems to have added to some of the confusion so. I mean which who we believe will you go back to questions. No disrespect to you because I have a lot of respect for you but who do we believe when you have to wait to professional signage to signs to a scientist to scientist doctor doctor hospital hospital who do we believe. Well I think you have to go back to the studies and I do admire the CDC for their ability to be flexible when a study came out recently that showed an outbreak in Massachusetts where there were a number of people who were fully vaccinated M. were infected and and played a part in that outbreak they were able to change their guidance to recommend back mask wearing for people who are fully vaccinated in indoor settings. It was somebody presents. With the covid and we have spent all the money we spent in contact tracing. Are you able to identify that that happened within a family member or public setting or connect the dots between those that present and hospitalized with COVID to identifying the source of where they got it from. In many cases we can but in some cases especially in communities where there's very high rates of spread people are not able to identify where they were infected so the purpose of the case investigation and contact tracing is to make sure that no additional people are infected by making sure that person with the illness isolates and the people who have been X. known to be exposed to that person or can quarantine thank you Mr. Representative Ferguson you're recognized for a question thank you Mr Speaker of one of the things I hear often from people is I don't need to get vaccinated because I tested positive for cocaine already can you sort of address that and why sure recommending vaccines for people who have had COVID or at least right okay well We know that humans are not likely to develop a lasting immunity to corona virus we don't for the other corona viruses that humans get so the question is how long are people immune and one way to measure that is measuring their blood serum for what we call neutralizing antibodies antibodies that can block the spike protein on the virus and keep it from infecting cells. At people develop different levels of neutralizing antibodies depending on the severity of their illness people who are severely ill will develop higher levels and people who have mild illness. And then when you compare this serum even with people who have severe illness you compare it with people who are fully vaccinated people who are fully vaccinated have higher levels of neutralizing antibody so it's more likely that they will be more highly protected from vaccine. The thing that is concerning right now is the Delta variant is someone was infected with one of the other variants in Arkansas and earlier period in time there're neutralizing antibody may not be high enough to protect them from the delta variants so we are recommending people get fully vaccinate because you need you may need that extra cushion of neutralizing antibody to prevent them from either getting infected or if they do get infected having milder illness and staying out of the hospital. Miss following a. The other thing I'm I'm hearing that actually just an antibody test is not diagnostic that there's some T. cell component to the unity that just made a body tests may not be relevant is that well we don't use antibody tests to diagnose people because this comes becomes positive later in the illness you need an actual antigen or PCR tests to diagnose it but we are still learning about COVID nineteen and the illness it causes and it's immunity so at this point in time it's not possible to. Take an antibody test and say okay if you're at this level your immune and if you're below that level you're not that point has not been defined yet and it you are correct it does not say anything about cellular immunity which is another arm of the immune system that's much more difficult to measure and test. In a can you sort of address I'm also hearing that there's the south African are motive variant that's probably coming and the with the vaccine may not be effective against that I can use the it would have we seen any of that in the states or. So there is a there have been a few cases of the variant from South Africa that we have identified I think maybe one or two not very many and there is concern about its the vaccine being able to protect against it we know though lacked the Fizer vaccine was tested in South Africa and it looked really good so we have confidence that it can protect that but we would also want to pay attention to the monoclonal antibodies that are used for treatments whether they're effective and they have to be change sometimes. Thank you. Senator Davis you're recognized for a question thank you Mr chair I just wanted to clarify some of the information you gave a minute again make sure I understood correctly said last July and we had a total of fifty seven children under the age of eighteen hospitalized and distilleries seven under the age of eighteen hospitalized I understand that correctly. And let me make sure. Yes under the four one for our birth through eighteen we had seventy seven this past July and last year for hospitalization with fifty seven that is correct thank you. Representative Bentley would you rang it again. Okay you're recognized representative Bentley thank you chairman just a couple quick questions Dr Jill Hey has that covered backs imminent prove by the FDA. Not at this time is under an emergency use authorization okay so my next question follow up with that is you know I'm system studies from Israel that are showing eighty four percent break through our patients that have been vaccinated getting the impregnating getting cold again it seems to me that our best approach to be to treat those people the one percent early that are been infected like there in India with ivermectin with return my soon be dis nine monoclonal antibodies is so much they're doing to treat patients early and I'm having constituents call me and they're being told there is no treatment for COVID for even for adult patients I'm really frustrated that we're not aggressively treating this early in stopping the spread in stopping the spread of the virus like they're doing in other countries and seeing a great response so can you tell me again why it's okay to give the vaccine is not FDA approved but we won't give early treatment that's not been FDA approved at I'm really at a loss because we really need to be looking was going on around the globe and do the best practice here so wire physicians continuing not to treat patients early and then the end up in the hospital very sick and dying and that's that's my real concern so as a nurse you know always street early diagnosed early we treat or we get it done quickly so why do we continue to see the resistance to do those things at some positions are saying a great response and stopping the spread of this virus early anytime in answer to that question. So I would have to defer to the physicians that are actually treating the I do not treat I understand that but there's or so respect you they do this I respect you and I hear you know you have a great you're saying you're greatly respected our department of health is great respect is I think if you could look it was going on around the globe and give good guidance to say even though we know that the vaccination seven FDA approved in this other things may not be approved but there you there being we're seeing great results around the nation let's encourage those things I appreciate that but you are great respect I want you to know that so I think if you would give some encouragement to those positions let's treat this early this let's stop this virus thank you. Senator Chesterville you're recognized for a question thank you so much Mister chair briefly and and welcome it's it's a pleasure seeing you. Can we just. Count on. Every year or during the course of the year that this will change much as the various kinds of flu that infected each year that would have to have a different kind of vaccine as we change vaccines for the flu is that what what is that we're hitting. So we do know that the Sars CoV two virus does mutate and it does form variance. My understanding is that it doesn't do that is frequently as the flu. But you know with the flu at people have seen it before they have partial immunity. It is possible I think that if we do not suppress the spread of COVID nineteen sufficiently we're going to have additional and potentially worse variants evolve and start to circulate so when that happens it's very possible that we will need a change in the vaccines and will need to get people vaccinated with those vaccines that would be more of a fictive against the new variants so far have. I know it's not a wonder percent rate of of protection when you have the the the vaccine what we're about ninety percent effective right. So yes depending on which be on on vaccine eighties yes so in the beginning the effectiveness of the vaccine was much higher probably ninety eight percent and with the a COVID variant we I mean the Delta variant we are seeing and of the drifters slight increase in the proportion of people who are fully vaccinated and do develop break through illness I think at this point it's about ten percent thank you thank you Mr president the opportunity to ask questions. Senator Hammer you're recognized for a question thank you Mr I'd like to take on something representative Bentley said awhile ago the health department does put out guidelines that under the emergency powers we were required to enforced. Does the health department put out guidelines that the medical professionals are expected to follow when it comes to the recommended treatment of COVID and the various forms of it. And we rely on the national institutes of health in the infectious disease society of America and so forth to put out the guidelines for how to treat patients with COVID nineteen we do provide some guidance for example on some of the preventive treatments such as the monoclonal antibodies because it had been the role of the health department to help make those available. So I get reports of people are present to the E. R. they get no treatment at all Senate way two three days later they're presenting back to the hospital they're hospitalized because they didn't get any treatment at all and I'm thinking about the numbers in the hospital and how much of that is being attributed to just by the indifference among the medical field as far as how to treat this or no treatment at all especially if you're putting out guidelines and what if you find out that a physician E. R. provider did not file any of the guidelines you put out at all how are we supposed to address that. So my understanding is that the Arkansas department health cannot A require how. The health professionals treat their patients so we can do education and help people understand the information that's available to them. Are we tracking patients who are presented to the hospital and the history. Of prevention that was giving by the provider that they saw to identify whether or not lack of treatment at all is attributing to the caseloads they're showing up in the hospital does the health department have that capability to do that no Sir okay thank you. A doctor bill Hey to to add to what Senator Hammer was saying there. what guidance with the individual physicians have I mean the they're not just out there by theirselves they they surely get information and shared across the industry so where would they go for this information so the national institutes of health has a group that reviews all of the literature and the studies they look at the studies to see how they grade them you know how strong is this study was it well designed so forth how strong is the evidence that it presents and what were the results and they put together guidelines based on that so that's a huge amount of work and that hardly any single physician can do themselves the infectious disease society of America does something similar and so most people would go to their specially so I'm an infectious disease doctor if I were treating patients I would likely go to the guidelines put out by the infectious disease society of America others may go to the National Institute is the there are body usually or if their body doesn't cover that they'll look for a guidelines from such a group that has done such a review. But so the final decision on the treatment therapy would be that position correct based on the information that they get that is correct thank you. Representative Payton you're recognized for a question. Thank you Mr doctor bill Hey I won't have the proper terminology but I think I'll be able to express what my question you've talked about the monoclonal antibodies but back a year or so ago they were talking about people who had been sick and got better and had the natural antibodies that they would. Use their blood spin it down and have antibodies to give. Two nine two current patients and that would would possibly help where has that gone and why are we not continuing to do that so that was called convalescent plasma that you would take their plasma and get the antibodies from them and of it doesn't work as well as the monoclonal antibodies so they have a discontinued that and focused on the monoclonal antibodies okay thank you thank you Mr. Question that kind of similar to what representative cloud ask about mask he talked about the different types of mask in a Mr Adams you might have input on this I think you've done some work with schools is that correct. so what what I'm wondering is. hello I've had people tell me. That works in schools that the children except especially the small children. The mask may not be as effective because they don't really know how to use them you know they might. I mean I can see for federal securities trading masks and things like that so I mean how effective are the mask in the proper use in schools especially at the lower age levels. Yes the younger the child is of the more difficult they'll have have wearing the mask appropriately and at the correct times but I do think the net effect is very positive in slowing the spread of the disease so I'll defer to doctor del A. for any additional comments on the. So we do have a studies one out of the North Carolina and that looked at school children and they did see a benefit to children wearing masks as imperfect as it may be to prevent additional spread in the classroom setting. Thank you. Senator Solomon you're recognized for a question. Thank you Mister chair I just received a text message that the president Biden's check top COVID man just did an interview and said the cloth masks are not very effective at all that if you wear a respirator is math type mask is representative cloud was describing I think this goes on with representative Ladyman dot com at that now the president's on advisories saying the massive were well It wearing in the schools and most people wear around just or not effective at all. Can you comment on that. Well I would differ in that interpretation of the effectiveness the cloth masks do work very well in preventing spread a respirator works better if you're trying to prevent yourself from being infected okay I guess that kind of disagrees with what the gentleman just testified thank you. The representative Bentley you're recognized. Thank you for your lan chairman this is really important I appreciate let me ask another question doctor delay were looking at school children very much concerned about our kids but I have read. Done my diligence to do as much study as a cans research has been out there and read research that when a child wears a mask that is increasing the carbon dioxide levels six times with they should be for those children are reading so we're talking about little kids that are having headaches and not really getting the auction levels that they should I'm very concerned about that also was a nurse you know I can't help but I worked in you know in the in the hospital you know if you touch a mask if contaminated the mask that we know the kids are there sneezing inside the master touching the massive drop in this been research showing that there's actually stool samples on those masks that kids ring in urine samples on there because I don't wash their hands well it seems to me with a lot more effective for kids to do what I've been trying to push since I got here making these kids healthy I'd really want to response on this to really encourages our kids to eat healthy and exercise and wash their hands properly and to distance and not trying to put a mask on the little child that's depriving them of option they need to grow we're talking to children that are growing not adults that are fully grown so the nursing means very very concerned about us putting masks on children again and and manning it laws listen to parents that are very concerned because we are getting reports on either side of this issue back and forth so do you see a benefit to children to doing the things that we've been talking about for forever healthy eating getting good exercise washing their hands thoroughly in keeping some social distancing D. and in good vitamins do you see a benefit to that to school children as well to combat this. So I think if we relied on mass solely that would not be a good strategy bit masking social distancing good hand hygiene cleaning the environment and so forth is important but as infectious as the Delta varying is I do not see how we can get away from wearing masks I think one of the things that been looking at and looking at the literature that I'm a cloth mask you would have to have a totally enclosed System to increase the a carbon dioxide plus carbon dioxide molecules are so small they can go through a cloth masks so claims that cloth masks would increase carbon dioxide levels in the child or prevent them from getting oxygen just don't make any medical sense to me. Was that last question representative Bentley. The representative Payton you're recognized for a question. Thank you Mr Dr delay. The Delta variant sounds like it's extremely contagious and the mass sound like that may be somewhat effective but not totally should we be considering not having the kids in school at all. I think that it's going to be really important to have kids in school if at all possible and the combination of vaccinating the older kids everyone around the kids who can't be vaccinated and then the measures of mass social distancing good hand John aging cleaning the environment working on the ventilation the school that's going to give us our best shot. If I can have a follow up. Yes you're recognized so they're at school six or seven hours a day for five days of the week but they're going home to family that circulated in the public and may or may not of one I'm mask and things like that I mean it seems to me that the idea of. Of your trying to wear the mask in the school setting is a drop in the bucket towards. Preventing this illness illness. You know. Are we also going to be using quarantine in an attempted taking their temperature and things like that. Are we just going to depend on the mass. Some schools have decided to screen children and staff as they come in that's a local decision at the school level and will be next year as well so we did have some schools attempting to screen take temperatures but that's a local decision as far as whether not they do that this coming year. Okay thank you thank you Mr. Mr Adams if If a school I mean if the school is going to be delayed in starting. The kind of follow up on what representative Payton said there is that a local decision or is that a state decision the land the start of the school. I think we would have to refer to the department of ed as far as what they allow the local schools to do those decisions to make I think last year it was required a consultation with the Department did before they chose to close down I presume that would be going forward but I would prefer that to department of any so would probably would be with the approval of the Department is at least a solid station with I was involved in many of those discussions last year because the health department the department asked the health department to be involved we always came to consensus on what needed to be done with any to stay open and maybe take some additional measures or if it was the best so no schools forced to close down or prohibited from closing down it was always a discussion with the administration department of ed Department of Health and we came to a collective decision. Thank you. Representative Johnson you're recognized for a question thank you Mr chair doctor delay at at think I heard you correctly but I stand the back room kind of talking to somebody else when said something about code CO two mall being so small that a mass doesn't actually stop the transmission of CO two so you're not concerned about low rates of of oxygenation being blocked by mask. What's the size the virus by conspiracy to a CO two molecule. I would have to look up the CO two molecule it's much smaller than the virus and the virus is about point one microns and the the molecule is much much smaller than that you can see a virus and as an electron microscope you can see the CO two molecule. As far as I'm aware of with electron microscope so a mask is blocking the virus more so than. Well oxygen right and so really the virus particles itself or carried in droplets and droplets are much bigger than just the virus particle so the droplets range from up twenty microns or more to sometimes less than ten so you can have a lot of the viral particles in the droplets and that's what the A benefit of the mask is it drops it blocks the droplets that are the vehicles that carry the virus particle so droplets like speed or yeah or the or the moisture so even when you talk you're giving off a very small of not visible of moisture you can see it like on cold days when you watch your brand right you know and so helps block that and prevent the spread so those are the ones that only go like two or three feet away from you before they dissipate they're gone well the larger ones will fall out on the ground if you At don't have a Max you know maybe four to six feet it depends but the smaller ones will actually linger in the air if the ventilation in the room is not good it'll cumulate in the air and when you're outdoors of course the air blows and removes it so it dilutes it so there's a lot of factors that affect how forward be Of the moisture droplets go in it depends on size and ventilation of the drop so would to a mask at I'm just trying to understand the if you're sneezing or coughing or something like that a mask is going to block those larger droplets but the smaller aerosol type droplets that linger in the air mass bill isn't going to know what those are no it does stop those it stops them. Sturch night partly all of them not as good as the larger droplets but it does reduce the. dissemination of the aerosol. Okay thank you. Representative gray you're recognized. If I'm sorry representative Alan you're recognized thank you Mr chairman thank you doctor bill Hey for being here I have a couple questions but I'll try to make it fair for you and your medical opinion. What is the best way to prevent the transmittal of identifiers. Okay so if and I'm not trying to put on the spot right thing right it has to be a combination of things a vaccination so that people are less likely to be infected and transmitted for those people that are infected and transmitted then it would be masking. Practicing social distancing and good hygiene those kinds of things work well there's other things that can be done such as the ventilation in the area but and then people when they're sick they need to stay home and not expose other people. Hello if you don't mind yeah you're recognized we will be one of the greatest country in the world we have stopped fruit flies at the border we have built ins timing bone we have sent men to the moon why can't we come up with a regiment. That we all can agree upon. That would be in the best interest. Of all of us. I don't think I have an answer for that. What is one more than I'm the. Okay you're recognized one more one more recently we were talking about the part in a guidelines to screw what are we a line allowing the Department agent to come up with the guidelines why should the medical facilities like your mask the health department and all those collaborate together to come up with something that we all can agree upon. Yes Sir the guidelines that the department of health it is put out the ready from learning guidelines they worked in close collaboration with the health department numerous experts within the health department colluding Dr del a doctor Tom Wilson and others so that is a joint document that they consulted with this on in creating. In addition it was reviewed by partners at children's and others group others groups so you all agree yes. Is that correct yes. Okay thank you. Senator Elliot you're recognized for a question. Thank you Mr chairman Dr delay I probably like a lot of people have been worried about messaging and what some call mixed messaging confusing. And I I haven't seen it that way. I can understand why that that might be the result for some people this is not intentional I look this is kind of like if we the night before school starts. It's a. Bad weather we get information we're going to go to school tomorrow is not going to be to that. If the next morning things have changed and we got a call saying you're not going to go to school tomorrow because it's too bad we tend to be grateful for getting that information and not send her kids out to school in bad weather. So what I'm wondering guarding a COVID nineteen. Is it not the responsibility of the medical profession. Not to keep information away from from us when things change but to make sure we get that information and that information you're probably only getting because things have changed with the virus. Is that the way a scientist looks at this as opposed to we're putting things out there that just might be confusing and that's okay would you talk about why. We get information that is not the Senate we got yesterday we might get some guidance next week that's different from the guidance we get this week. Would you comment on that please Sir. So we are all learning about COVID nineteen as an illness and our understanding of that is changing over time. We're also learning about the impact of the vaccines and the measures that work other measures that work to prevent it I can say that for myself and my colleagues at the Arkansas department of health we're doing our very best and working really hard to put out clear messages but they change over time and sometimes the changes are faster than we can take away the old messages and put up the new message put out the new messages. But I didn't get it thank you for that and it strikes me and I don't want to assume something that's not the case but it strikes me that if you withheld information from the public I don't know how you would see it medically but that seems like. You know I a a very important Piece of negligence I guess somebody would have performed not to keep us updated on what you're learning about the virus regardless of how we have to keep up with it You do have a responsibility don't you to share it with the public. Yes we want the public to be well informed. So I would just I would just suggest two of those of us who are receiving information It just doesn't seem to be in anybody's interest that anybody would put information out there you know just to confuse us and I would respect that it can be difficult for us to keep up with the information but I think that's something we have to do for the good of everybody because I don't want the medical profession to get cold feet and stop giving us the information we need to have because of politics or are assuming that they can't agree on anything I don't want you to agree with something that you think I want to hear when you know that's not the right thing to do not just want expressed appreciation for that and just ask all of us to just please be a part of that solution respectfully when we get new information let's act on it because that's what we tend to do with everything else if if if the superintendent puts out a message. Don't come to school tomorrow the buses are not running when I told you last night they were going to run you don't get upset about that you say that's responsible might think that's the same thing that you guys are doing. Okay. Thank you Mr. Representative berry you're recognized for a question thank you Mr chairman and doctor Hey thanks for your service over here and thanks for your service as well as the team Department of Health but I guess my question is aside from the physical of physical health of all of our students and we started looking at the mental health side of a you know do we wear a mask not wear a mask we get our temperature checked like to get it checked I get on the bus not get on the bus you know this is creating a lot of anxiety on our on our children had. Says the Department of Health the Department Abed started looking at the mental health aspects of because we end up with a bunch of bipolar kids because they're not gonna be able to figure out exactly what's going on. So one of the reasons we are so intent on allowing children to go to school this year is for their mental health and anything that we can do to support that in person learning is something that we want to do in mental health is a very important part of that so I would agree that mental health should be an important consideration. Senator Solomon you're recognized. Thank you Mr yeah few days ago the governor said he wanted to hear more from schools about their ability and willingness to be the kind of police the mask issue what are your hearing from our schools. You want to take that over we may need to defer that to the department of ed because if you're hearing things I'd like to know what you're hearing. I haven't heard anything directly from the school systems about their stance on masker masking or not masking or policing mass so not meet directly or anyone that I have to relay that information to me. I talked to people at the department of ed but not at the at the local okay so what is your the department of ed. Well I mean we had a variety of discussions you know especially over this guidance that we just produced so there's been lots of meetings and discussions with the department of ed you know I mean there was I don't want I don't want to hear by this time so you have no direct information from schools as to whether they are able capable willing to enforce as were looking forward mask mandate you don't have a direct information on that I do not okay and I'm not saying that other others at the health department don't okay and you don't have any direct information from the department of ed about what they've heard so be indirect I guess on the from the school with the Department of ed has not come to you and said look we're getting calls from schools and they're worried about this you haven't you haven't heard that I've heard indirectly very mixed some schools or in support of having that decision to require a mask and some don't want that authority to make okay Sir and I appreciate it thank you. Representative Larry you're recognized for a question. Thank you Mr chair. I number skews me most conversation has centered around mass because we are talking about children but I'm curious I've had a long conversation with a public relations professional and he was asking to pretty much along the same lines Senator Elliot was talking about will you know there's a justification for mixed messaging but his query to me was that the messaging really seems to be more along the lines of just throwing something up against the wall and hoping that it will stick is there any focus group research being done to find out what what are the core reasons that our Kansans are not getting vaccinated. and. If if that is the case why are we only seeing messaging that seems to deal with a fear motivation or a Be responsible motivation because it just seems to be something beyond those things so I I guess it's too parked or several part question is that research being done and what are we finding out about the lack of receptivity to vaccinations. So we do have some research available to us that was done through the national immunization survey about Arkansas it doesn't tell us what we really need to know at the community level so we are working to A. A support communities that want to do a an assessment of their community so that they can address those barriers we read the publications about communities similar to Arkansas our state similar to Arkansas we try to take all of that information into consideration okay Mr chairman may have a follow up yes you're recognized thank you. And I understand that that's a good starting point to try and find similar demographics and and comparisons but at the point that Arkansas seems to be getting singled out ends and sometimes unfairly as a bad actor in terms of our percentage of those being vaccinated I'd is there a with all of the millions of dollars that I know is being spent being given to ad agencies to craft messages is any of that money being spent to actually have a better understanding of what a targeted message should be on vaccinations as well as mass. So we do have some initiatives going on to work on vaccine hesitancy with our partners that is correct that we're doing that I would have to follow up with you about the specifics because they're still under development. Okay thank you thank you Mr chairman. We've got one more question. Representative solid you're recognized for a question. Thank you Mister chair I just have a question is public school superintendent last year I appreciate the Arkansas department of health working with us through the guidance all were very helpful and I do appreciate the information that was provided by all my my only question is in terms of A guidance. And I and I got asked this by a lot of parents last year I don't have a good answer for it so I would I would I'm very curious to see what your responses to this last year. You know we had a optional mass mandate for K. four students that was left to local decisions whether they wanted to do that in my school district we left it as a optional mask we had less quarantines in that population than we did in the mass population I don't know why but that that seem to happen but the question I got asked the most is what do I have to be mass in our classroom when I can go to athletics and I can sweat and I can read on and I can practice the entire time without a mask. go back into the classroom have to mask up go to athletic competitions when I'm in the game I'm not mask I'm sweating how that was safe and that was okay for our kids however. You know it. We're we're saying that that's okay but we're we're at the same time saying you know why you're in a classroom you have to be maxed so to me I at I guess I don't understand then I think there's a lot of parents who don't understand why that's okay E. but having optional mass mandate in classrooms is not okay so I I'm just curious to see what your response is on that thank you. I think that the delta variant is a game changer and it may be that for all situations outside school especially those children who are not vaccinated the recommendations are for them to wear masks at all times and that may be what would be the best solution to that situation. All right seeing no more questions thank you all for your input I'd like to ask. You also stay at the table and because you might have been put to the next group that's okay and I'd like to call up the representatives from Arkansas children's hospital to the table. If you would please introduce yourself. Good afternoon I'm Marcy voter the president and CEO of Arkansas children's and create the invitation to be here today. Okay you are a recognized the you have if you have some comments you'd like to make and then I'm sure with some questions for you you're recognized absolutely and I am really appreciate after delays comments and I'm all of our presentation today and she has the advantage over me of having a statewide view of what's happening to kids in the state with respect to coca nineteen and I can only report out on exactly what's happening at Arkansas children's today on August second and we have twenty one patients in our to hospice we are to hospital a hospitalized for COVID nineteen so there I'm not just positive for Kobe but they're actually hospitalized to that illness nineteen or in Little Rock into in Northwest Arkansas and eight of those are in the I see you here in Little Rock and five of them are on ventilators that's not been our highest peak in recent days our peak has been I'm AT twenty four total patients in the house because of covid what we're most concerned about our I'm actually several things the increase in the acuity of the kids who are hospitalized because of COVID nineteen so they are sicker than what we saw in previous months and at the beginning of the pandemic and that is now coupled with I'm a very unusual summer season of high respiratory illnesses that are causing children to be hospitalized as well so our hospital hospitals are much fuller these days than we would normally expects in the month of July or August respiratory viruses like R. as being are using something we see in the winter time and and the month of July we will have tested more than five hundred children for R. as fee pot positive for our city that's something like ten times more than we saw last January when children were isolated at home which has its own challenges I think mentioned earlier and when children were masked very readily we didn't see these kinds of respiratory illnesses as the summer season came and people. Got out I'm now we have a hospital full of children that's compromising our ability to staff the number of beds the number of kids who are sick I think you should if you've read the. Do you see it was Arkansas business today I think most hospitals across our state and across our nation actually are are challenged with the not the right number of nursing I'm personnel to staff our hospitals and so again more children hospitalized for COVID more children sicker with COVID when when hospitalized and of the children who are in our hospital today and those who are eligible for vaccination none of them are vaccinated the children who are hospitalized for CO that are on acts need at the time and that sixteen of the twenty one House place kids are eligible for vaccination all stop there and see what kind of questions you might have for me. So the twenty one that you have a hospitalized six hundred twelve. I don't know that exactly M. because not all over twelve are actually eligible for vaccination either I just have the eligible for vaccination or not. M. so you don't know how many you have under twelve. On this exact day no I do not the changes every day. Right. Representative mental you're recognized. Thank you chairman again my my question's going to be the same today for everyone what early treatment with these patients receiving early on when they were first diagnosed. I'm not a I'm not a physician I don't want to speak directly to the clinical pathways that are being followed but we are following and for the age twelve and up we have them on colonel by antibodies available and there's a whole host of drugs being used vertically as the kids are I'm referred house by so when they generally present to us at Arkansas children's hospital in little rock that's when they are most sick right so they come to us at the tertiary center already very ill I can't speak to you and what's happening in a private physician's office or in the clinics around the state representative and we. One quick follow up if that's okay chairman yes you're recognized is it possible these kids have been isolated in quarantine under mask is decrease your immunity and so they're most likely to fight off our SP and I were to children's hospital fourteen years it was very very concerning to me that have such a high speed spike in our services it's possible that would decrease the immunity of our kids by isolating them and putting the mask on these little kids it's a great question I'm I'm not a physician at deferred until he or she wishes to help me with that when I think there is a M. certainly some conversation around that. I appreciate your help I can go ahead. So in the situation of ours fee usually that goes up in the winter time we have more transmission and it's an illness that a. People don't develop lifelong immunity they get re infected re exposed and they boost their immunity over time. The kids that are most likely to have severe disease from RSP or the ones that are under two years to get of agents by Senator one because they haven't had it before this is their first exposure so for those young children who were recent born or very young during that pandemic it's likely that they were more isolated it didn't necessarily. We can their immune system they just didn't have the opportunity to get exposed so that's one reason why we're seeing that served in our is to be at this time of year thank you. Senator Hammer you're recognized for a question thank you Marcy of the of the. COVID patients you have are you separating which co which type they have the original or the new version or they just all blue and together so that the data is there the in the medical record they do you know ones that as Dr go ahead talk about once they are positive in the PCR test echo that than they do and the variance study I personally as the CEO don't get to that level of an of information per patient is trying to keep that on a need to know basis. And then with regards to underlying conditions of the ones that you are having how many of them have underlying conditions like R. as the that complicates it or do you have that depth of information so we are I do know in general we are seeing those kids who have pre existing conditions you are medically complex kids and then some kids who I'm have no underlying health concerns we are seen both kinds of children come down and be hospitalized for covid and do you have the number of are you at bed capacity or staff capacity in his or gap between your staff capacity and your bed capacity that is a great question and something that M. is it is a great use of words we are AT stat we are approaching staff capacity not bed capacity in Little Rock we're license for three and thirty six beds in and Northwest Arkansas we're license for twenty four beds and when we have seen census in the last few months I read few weeks approaching to seventy and north of two seventy that is really stretching out so I'm staffing capacity is the challenge and I think that's probably two of my colleagues across the state in hospitals as opposed to physical bad and are there departments within your hospital that you could temporarily shut down that you're offering services to that are taking up bed space in order to accommodate for the growth of the number of code patients until we can get the vaccinations out to help turn it down so should I am if I can find more and more nurses and other clinical ancillary staff we do have physical space to bring more patience and so I'm not actually too worried about the physical number of beds because we the way we are physically designed in Little Rock we can it shift in turn and close things down or move patient and group patients and in particular spaces I'm to operate at three hundred and thirty six bads. We'll all day every day I need another probably hundred nurses to do that Mr this is maybe not the appropriate time but before she gets out of here the hospital association gets out here I'd like to hear their testimony as far as what they need in order to compete against travelling nurses being pirated out of the state or what they're having to pay travelling nurses coming in and and the people that are here every day you'll be here after this is over if you would I'd like to have somewhere in the conversation date here that testimony whether now or when the board gets clear then I'd like to be put the bottom of the hopper thank you. Thank you. Senator Solomon you're recognized for a question. Thank you I'm going to kind of follow up on Senator Hammer about the co morbid conditions I know older people certainly need to take more risk in the previous pandemic the information is out there that people sixty five and older were highest risk so do you have any recommendations to parents and as we look at going into the school year other students that are more at risk and need to take greater precautions than others and on the other side of that other students that are in our are healthy students at much risk at all. So again I'm not being a medical professional I don't want to overstep my boundaries there I'm Arkansas children's has taken the stance that I'm all people should follow what we call the three W's wear a mask wash your hands what your distance and that that is the best way to protect each other and your families particularly with the delta variant being so easily transmitted and spread recommend for the so I think I mean I would say since we have one position the table perhaps you can help it's not and. I I think we would rely on the American academy of pediatrics to talk through that we there are is information that has been published regarding kids with I am I mean a compromising conditions and other medical complexities that they are at higher risk for really all of these viruses and and should protect themselves at a have occurred with concourse all of us have hundreds of people contacting us every day with everyone seems to think their child is an equal risk because every other child and previously in the pandemic we have the data that said people that have these conditions that are a higher risk so would be helpful if we had the data that said these children are at higher risk to give some of our parents a little little comfort that their child may not be at high risk because others but I'm I like to see that it do we have any data on that. Dr. So that is of in great importance for us and learning more about in terms of the delta variants and we're in discussions now about doing some studies to see if there are differences in children we know that the Delta variant increases the risk for severe disease for children and it M. puts them in the hospital more often we like to understand why and if there are children who are more as we do not know that right now okay so and I know I understand what you're saying and agree with that but it has been the United States is behind several other countries and the trend and so other there are places where that are further ahead of us have seen those that data in their population in England are in the R. wherever I just I don't know the answer to that. Yes the country with the best information it would be probably the United Kingdom and I do not know that information off the top of my head okay that's fine thank you. Representative Dotson you're recognized thank you Mr chair This first question probably for you doctor bill hi your is mentioned the R. S. B. generally is higher in the winter months and it is in the summer months we're seeing a huge spike right now five five hundred percent did I hear you say Does that. Concern you for when we get into the season one percent higher spike or is it just everybody's getting at this time building up that immunity if it if it builds up over time so I think a. Marcy said that you had five hundred positive tests right correct in the month of July which is about ten times our usual suppliers they usually around fifty in July where five hundred yeah that's a thousand socially and and so we did we did observe a in other the southern hemisphere that they had a spike in the summer of our is to be as well and at there's declined a little bit faster than I think what's happening here so we're watching those data but it is concerning in terms of the at what would happen in the fall in the winter and it it's it's an unknown I think we have to think about it and be prepared but the the best defense against that is natural immunities is that is built up over time you said so A we don't have a vaccine for RSV in once you get it there's the treatment is really supportive there are actually monoclonal antibodies to treat. Young children who are at highest risk before they get sick it works for that and so that would be a consideration about we're making that available this summer as if it were winter and will have to think about what is going to be the strategy for the winter time we say. Continue providing those or not and you will have to watch the the trend line of the cases how do you determine which kids are at highest risk so for little children there are certain things and I'm not a pediatrician so I just not sure my answer's going to be complete but some children are born with certain health problems or genetic problems that would make them eligible they may have been born prematurely or have some other health condition that there's certain there's criteria for that and I just don't know them very well off the top of my head okay in this chair I have a another question for one more okay. Of this daughter daughter I guess the question I have is are are you currently mandating vaccinations for your employees like some other health care facilities are we have only mandated vaccines for our leadership team so if you are a leader manager or after the CEO and for new hires starting at the end of August but at current employees we are not mandating were doing at AM what I hope is a fine incentive program to try to get more and more of our staff acts need to but it is not a condition of employment for existing staff will have you considered looking at trying to get some employees increasing your staffing from some of these facilities that are mandating an and the healthcare workers that are not wanting to work for those facilities any longer. It seems like there's maybe some of my colleagues in the ram I refrain from answering. I'll leave that there thank you. The members we've got a lot of questions so I I'm going to start limiting you to one question and then you let the punch back in for a second question Representative Mayberry you're recognized for a question thank you away on the side can you help explain the difference in the children that you have hospitalized this July versus last July I'm under the impression that most of this the the children who are hospitalized last year where children who came in for other reasons before every surgery a child has to have a COVID test and so you were finding out there COVID positive but that's not what put them actually in the hospital can you explain the difference in the numbers of kids that are actually in the hospital with COVID right now. I don't know that I can give you to scientific or empirical data but I am your statement and represent Mayberry is is. Exactly what we're seeing we saw kids hospitalized through the early months of the pandemic or the full year the pandemic that we as. The used ad nomenclature used in the house was there COVID is incidental to their admission they came in for some other illness a secretary a traumatic injury whatever it might be because we test every child tested every child we knew they were positive to Kobe nineteen and could protect them their family and the staff. In the summer months we did have twenty twenty one we are actually seeing children have ill because COVID is making them L. and the numbers off the top of my head or not M. again not precise but where am we in January we still saw us sixty seventy eighty kids positive for covid the kids now at that same number of discrete number of patients the numbers are not that different but the reason for hospitalization is shifting to COVID nineteen versus their original hospitalization was but for some other reason so we're actually trying to get very clear on that data as the I'm hospital billing systems or and. I guess evolving in the light of the pandemic as well we can there is clear building codes so we'll be able to retrospectively go back and really mine that data a little differently now that you can start to pull it pull it out of billing and administrative type coating that wasn't there in the in the early days of the pandemic. Representative Ferguson you're recognized thank you Mr actually of course our doctor tell Hey is there a correlation between obesity and patients who are hospitalized or die from covid. so obesity and does increase risk for severe disease and that's one of the criteria used for someone who would be qualified for early tweet treatment with monoclonal antibodies I have not looked specifically at hospitalizations for that but I would expect that since obesity increases risk that you may find addition a higher proportion of people. Representan Allen you're recognized for a question. Thank you Mr chairman. Thank you mentioned a few minutes ago at children's hospital of your stress which a staffer you run and have a shortage of staff what type of instrument are you provide and to address any. And so we have a revive right if add talent acquisition strategies recruitment strategies there's seven I am a popular one right now is an employee referral bonus where if you are an existing Arkansas children's employee and you referred a new hire to come and you and the new hire get a bonus so it's not just a sign on bonus but it's trying to encourage our existing team members to bring back our bring into the Arkansas children's full their friends and colleagues that they know and then in the healthcare profession for the most positive one. No follow up. I'll give you one follow up on this. All right thank you. By Tucker you're recognized for a question thank you Mr thank you for being here the work that you're doing my question really is just what can we do as a legislature to revive the support that you need to treat your patients at Arkansas children's in the other hospitals who are new here today or to fight the spread of the disease if it's money logistical support communications to our constituents policies laws what can we do to help you do your job better. Support for a vaccine at widespread full vaccination across our state is probably the best thing I think the leaders of the state of Arkansas can help us with right now it I'm. In it you know within the walls of the hospital though it's challenging from a staffing standpoint right now we've been through nursing shortages in this country before and we'll we'll get through this one again we've got some creative ways to try to get and keep staff and bring staff on I'm not challenged with equipment or PP or the ability to create more negative pressure rooms but what I would and most enjoy is support to keep those kids from ever being hospitalized for COPD nineteen and right now and the best advice we have from our experts in public health is to get our children age twelve and that vaccinated and get their families vaccination so the support to really have a at a. Head on push to get Arkansas vaccinated pass the forty one percent where we sit today would be the best thing I can ask of you today. Thank you. Senator Hammer you're you're recognized for a question thank you Mr the of this would be to Marcy of the patients that were admitted how me awhile ago did you state presented with COVID having not gotten the vaccine but were of the age to get the vaccine. Sixteen of R. twenty one hospitalized kids sick with COVID are eligible for vaccine and have not been immunized. Do you have. Ma'am Mr. Five are an eligible yes you may. You're recognized for the following thank you. Do you consult with the parents as to why they didn't get the vaccine do you have or do you even have that information to respond to the question here today so we we've taken I would say at a congenial and clinically Gilly approach when we meet with the families when the care team the the clinical team needs of the family to find out what had they had access to vaccine if they didn't what they like to have access to vaccines were also and will vaccinate a child as is appropriate with the parent consents were also vaccinating parents who wish to be vaccinated while they're with their sick child at the hospital so trying to and taken educational support process make sure families I'm can ask all the questions that might be on their mind regarding the vaccine make sure they have access to a trusted healthcare professionals to answer their questions and then to be readily it able to vaccinate them when they say yes thank you. Senator hammer of I have a question we want this hand out that we have here of where is this data come from. You're not alone I'm sorry. Push the button again. Thank you Mr. I solicited this information from the hospital association at my request I asked them to publish information and they did. Okay so hospital association members yes Sir an appropriate time and I know you got a list of questions but appropriate time I'd like to speak to done happy right now can be after bill comes up for down the list but I'd like to speak to it at the appropriate time okay. Thank you. Representative right you're recognized for a question yes Sir thank thank you Mr chairman well what I would like to ask is is one and and you know maybe you guys got the answers and maybe you don't. But we're only of of of taking the shots you know and I'm when we're doing what we think we need to do. But I'm from an area that only twenty or twenty five percent of people actually trust. This shot. Well the federal government has not got behind the shot they sent that down. And I just wonder if that's not got something to do with the situation that worry. So eighteen Arkansas children's we am are following and trusting and and. Retelling the messages that come from the CDC the and I H. from our trusted infectious disease physicians who I am can speak to the science behind the vaccination development process and the vaccine itself and are using those sources as our kind of source of truth to educate ourselves our employees and our patients and their families and I'm fine that way then those conversations they have been best in those small and one to one kind of conversations that trusted healthcare provider with the patient and the family and when those conversations happen we see folks getting vaccinated. Representative Bentley you're recognized thank you chairman March St looking at a report from the CDC about what happened in Massachusetts showing that three force three quarters of the people that were tested positive for covered were vaccinated and so it again I honestly would not be who was better instead of focusing on the ninety nine percent of the people that are not curing the buyers to focus on the one percent or and maybe consider you do doing the monochrome antibodies sooner to our patients at children's a Cummins sicker the site we are with our is to be I just think we're we're really. Really not focusing like we should early treatment of our patients that get it so we can stop this virus of forcing the vaccines already feeling like it is in Massachusetts and in Europe your thoughts on that. So I'm Ark our clinical to clinical officer couldn't be here today but I'm in a text string with merrily are asking exactly the treatment protocols available children's I think those are all there in line but I'm happy to take back to the clinical team the timing of intervention and have I make sure that they feel like they can get to the kids as quickly as possible I think from a state perspective though what we need to remember is for Arkansas children's can only impact the kids that show up in our facility and we're not the only facility taking care of children in particular were not the only facility taking care of children who are sick with COVID nineteen and so figure out a statewide message through the department of health or the medical society that kind of thing I'm around timing the most effective timing for the most effective treatment is price something collectively as a state we can work on. All right seeing no further questions. representative cloud did you have a question. You got to. Can you turn my call Farrer. Now the one next to you I guess. We were. Okay thank you. All right thank you all for your comments of the gin if you can I'd like the of State the table and I'd like to have the hospital association. A representative come forward. In may need to pull up a chair to their. If you want his role on those chairs on the front row be fine. If you want to set done if you will said on the front row that's fine too. Wherever you want to set your. The bill would introduce yourselves. While president CEO of the Arkansas hospital association. In a grade grand president Senator reason for Baptist health. If you have comments to make please go ahead and do that and we'll as I have some questions for you you're recognized. Sure thank you Mr Mister chairman and thank you for the opportunity to be here today I just want to mention a couple statewide numbers here that I think would be of interest and then talk about one of the two main challenges that we're facing as a hospital industry. As we look back at the numbers of whose hospitalized today and and hospitals across Arkansas one thousand two hundred and twenty our high point was one thousand three hundred and thirty nine in January. On ICU beds we have today four hundred and fifty one in ICU beds are high point was four hundred and forty three in January we've exceeded that. We have two hundred fifty confirmed on vents are high point was two fifty two so we should be to passing most of those numbers here by the end of the week also on ICU bed availability we have thirty seven beds available as of noon today that's three percent of the ICU beds available across the state. So the message is clear coming from hospitals also are full they're at capacity other having a hard time serving the patients that they have the main challenge that we see for the last month in going forward is healthcare workers and staffing those badges has been alluded to that has been the main challenge and as senator Hammer brought up what what can we do about that we're in competition with each other we're in competition with hospitals in other states we're in competition with the travel nurse industry so the rate of pay in the viability is low or the right the availability is low but the rate of pay is extremely high it's gone up forty seven percent in the last month we've seen rates for ICU nurses go anywhere from seventy to an hour to a hundred and twelve an hour and I'm sure that's increasing steadily so the way to compete is to increase the rate of pay which is a challenge for hospitals to find the money to be able to compete at that level but when you look at of what's happened surges in other states we're competing with Missouri and have been in Mississippi and Louisiana but now what we're seeing in Texas and Florida since the surge is happening there now we're gonna be competing on that level too so there's a finite number of health care workers and nurses out there which makes the rates go up with that I'd be happy to answer any questions and turn it over to Mister crane here for a Baptist perspective for his system. I just wanna say thank you. Bills you have been so incredibly supportive I just want to tell a quick story my hospitals had more covered patients than any other hospital in the state since is pandemic began. And I say I'm extremely worried the beds are extremely limited I just write down some numbers is thinking about coming here. June sixth of this year total number of patients in the back of a cell systems forty nine. July sixth goal number patients of covid the system was ninety one July thirtieth total number of covered patients two hundred and twelve. Critical care patients so the same dates June sixth there's twenty seven in our system that code in critical care July six there were forty two. They were in critical care that had covered. July thirty there a ninety three. I went back and look at the peak we had in the January February March the peak we had had coding critical care was ninety two. I look back at the number of events. And the peak we had in January February March sixty five I looked on July thirtieth the peak on vents was seventy two body past the peak. Clinical staffing is the issue today I have a hundred sixty two of staff members cross Baptist health that are out on quarantine because of potential exposures those are exposed at work the other exposures outside of work. Seventy percent of our staff vaccinated. What scares me is the difference in ages so quickly I ran through what are the ages of folks are in a critical care unit. This is different than the first wave twenty years old twenty six thirty four thirty seven thirty nine forty two forty seven forty seven forty eight. Forty eight fifteen fifty those are in critical care they have self distilleries. Those that are just covered patients they're not in critical care but in the hospital eighteen years old twenty years old twenty three twenty six twenty seven twenty eight. Monday of this week the ballot so system there fifty four patients The spent the night waiting on a hospital bed. One five approximately one in five patients about. And I'm very concerned I believe you should be very concerned my staff is worried. And staffing issues. Thank you for your comments and we do have a number of questions. Senator Hammer you're recognized thank you Mr two Graham bill I would ask the same question I asked Marcy well go in that is there's a difference between staff capacity and bed capacity what is the difference the message great let me ask in in your network how many beds would you have available if you had the staff to field or do you have that data yeah I don't have the exact number but your your the short answer is we have a lot more happy capacity that we have staff as in other words we have beds we just don't have the clinical staff to appropriately treat folks some that makes sense it is. So. What would what would it take I am here in a bidding war with other states when it comes to the staff. What what are your solutions or what are your suggestions to you and bow to. I to help us get ahead of that a little bit not that we enjoy the idea of taking staff away from other states or the at the same time we're cans and sold I'm asking what your ideas as far as taking care of our Kansans I think that's exactly the case we had traveler nurses in the first half of this that when their contract came back up there were a lot more attractive offers and when they had here so Bo is exactly right the rate in the war for competitive resources is a significant he's got that. Well I would I would just say that the a possible solution we are working on application on American rescue act funds the state's allocation to help hospitals with staffing and I hope to bring that forward and hopefully you'll look favorably upon that when it comes for. I'd like to like to get the data about what the difference of the of the new system is as far as between staff capacity in bed capacity if you're gonna have that in in your proposal Mr ogle barbecue thank you. All right representative berry you're recognized for a question. Thank you madam chairman and I and to follow up with the center hammers question on the the Department of Health or the hospital does have considered you know the National Guard has tens of thousands of doctors and nurses all over this country a lot of the states that may not be so stressed in we saw last year while these doctors and nurses were being used since and states that were staff stressed so have your considered approaching a governor you know you have compact agreements with other states to where you scratch my back I'll scratch yours they send doctors nurses to to the state of Arkansas is labeled able to help out with the problems that you're having the staffing. Thank you for the question yes I think either because other states are surging at the same time it limits what other states consent to help out if you remember back in March and April of last year New York was surging and and other states were not so other nurses and doctors went to New York to help out but since other states are surging almost at same rates we are then they were saying they can't they're not coming to help us as much as we were helping them also in the National Guard is it's my understanding that the some of those will those who who are capable are already working in a hospital or clinic setting so there's not much availability there. Yeah you're recognized. It looks like your ring back in a few with. Cynthia sixty eight. Thank you thank you Mr chairman so your your dresses are states that are searching for a lot of states are not surgeon but my question is have you asked the question has department of health ask the questions of those states that are not reached a surge in their capacity being able to get help we do it we do it all the time I was that the secretary of the military over there we provided assistance other states that needed help so it's when we need help you know there should be people out there is available to help us but I'm just that have you asked the question it was a very good question I'm not directly involved in that I do know we have people at the health department working with the governor's office working with the National Guard and we are working with our federal partners in reaching out to other states asking for federal assistance and there's a series of steps we have to go through and we're going through those steps to make an official request for medical assistance through those channels are we can get you those details I'm not directly involved with that but we are working on that. If you could provide that the staff yes Sir. Yes you would send that the staff will get out the members. Senator Elliot you're recognized. Thank you Mr chair I want to ask his daughter of Mr Crain please We have our staff I know that. And that that's doing everything they can to deliver services and if you just give us a snapshot of what is their morale like at this point That's it just tell us about what's happening with the staff because I often think about. We think we have to go through a lot I just can't imagine what it must be like for them. I am and I think it's probably a little different a children's hospital in the adult world talk up quickly and then allow Greg to answer from the a large adult facility I'm but even in the children's world our teams are tired very tired and I think what makes us different than any other kind of disaster healthcare workers have lived through is and the pandemic is infecting them affecting them not just at work where the work is more intense and more tiring but it follows them home because a pandemic is affecting all of us in our home lives in our work lives and in our social lives and many many workers in I'm healthcare in particular initials hospital and that's majority of my workforce are women and the vast majority of the women are as and young that women with children and so that compounds their and their own mental resiliency challenges because they're worried about their children in school are out of school I'm keeping their child safe and all of those things I would say they're tired and there I am having a hard time rebounding and and during as you might expect usually expect because is it seems to be never ending we are seeing nurses leave the industry at a faster pace than ever before who are truly walking out saying I'm done with being a nurse I'm not coming back and then my thirty years of healthcare leadership this the first time I've really seen it at that level where folks not at the end of their career but mid career as just being done because it's it is such a challenging challenging time to be a healthcare worker right now I thank you. I would only add to her comment that when she says they're tired you think about the staffing shortages we've got a retailer nurses or doctors arrest or therapist they're phenomenal so when they fill in shift after shift after shift because they see a need they're tired and she said to the different disasters we've had most of our very short lived they're not months and months and then the care for COVID patients in the adult world and critical care you have to from the patient and I'm not a physician so but I just see the burden of care with these patients being much more significant and so week after week after week of that our folks of tired the stress because patients pass away that you care for for a while emotional compassion fatigue goes on. And I've never. The way it is of the last eighteen. Thank you. That's it Mr. Representative Alan recognized. Thank you Mr chairman I have of come in. I want to sincerely thank Joanne trip with hospitals so session and Mr crane at Baptist hospital three months ago I have a family member that was diagnosed with with COVID and it was to the point where one day made the difference and her live in an apartment and and if she had not made it to Baptist hospital she would be here today. I just want to sincerely thank you all from bottom of my heart for all the hard work that you all do and I want to know that I really appreciate what you did to help me out thank you so much. Thank you thanks for the comment. Senator Tucker. You're recognized. Thank you Mr that's what I ask you general first of all thank you for the work that you in and your hospital in all your hospitals are doing I want to ask the same question that it is Mister order which is what we as a state legislature due to offer you the support that you need to treat your patients and to fight the spread of the disease. Back to that staffing issue to be able to compete to have the staff to have the capacity we need more staff and and to compete we have to have a higher rate of pay and so competing with travel nurse industry competing with hospitals and other states competing with other states are surging at the same time around us that's the challenge to increase that rate a place we can retain the nurses that we have and attract new ones. Thank you. Senator Hammer you're recognized thank you Mr I would like to ask Mister crane this question. You you have a E. R. staff and as you may be heard in the room while ago difference of opinion to treating CoV patients when they present one physician may agree with this treatment another one may agree with this treatment disagrees between the two do you track data in your facilities in your system to determine if a doctor ate treats patients this way has better outcomes than Dr B. that treats patients differently and the outcome is farmers code. I don't know that I have that data. Do you think it be the value because some of the conversations today has been around whether or not they are getting all the treatment options that are out there to keep them from presenting back to the hospital two three days later because they got none at all and how much is that contributing to the covert cases that you're having to manage as of the so as a system I think any data that helps fight diseases better so specifically I think it would be helpful across the healthcare system if you get what you as a system can track that or it's a software I don't know that we've done that I'm sorry I just I don't I don't know the answer to the question or not okay all right thank you thank you Mr. Representative Johnson you're recognized. Thank you Mr chair I'm asking the same question I asked children sure second ago just with regards to your employees I heard you say seventy percent healthcare workers are are vaccinated but I guess are you considering doing any type of employee vaccine mandate. Our strategy has been very collaborative one I would rather have a team that wants to work wants to be and talk about the issues in that area absolutely regarding about it every hospital every business is talking about that issue so have you talked about it sure what are strategists seventy percent now successful is working with folks to talk about why talk about why we should and and down that road so that's been a part of prevailing strategy up to this point and then as a follow up to that have you contemplated let me just. There's a protest over the weekend I'm I'm from northwest Arkansas so mercy health system man and various other facilities of mandated their employees which get a lot of calls from them they don't want to quit working but I have a picture here of a couple nurses that are in scrubs said we worked through the pandemic with no vaccine now they want to fire us last year's heroes this year's unemployed are the signs that they were holding up outside that protesting so I hear you talking about staffing shortages and I understand that is a serious concern we need more capacity but we also have facilities in the state that are getting ready to fire nurses and that that staffing That just blows my mind that they're even considering that and I wanna make sure that maybe you're not considering that or if you're considering that you're thinking through this or or you're going after some of these new to be unemployed folks that are highly skilled before they leave industry altogether and and we lose them or we lose them from Arkansas it's specially so if you have any comments on that but that's why we've taken approach we have is because we rather work with the team that wants to we can make progress together around this issue just like this body does mean don't agree on everything but you try to find common ground to get to the best goal and that's been our strategy so far. Representative Bentley you're recognized. Thank you chairman I like to get this response from Boeing Greg sorry answer this but I have a couple questions chairman staffing this okay well how many hospitals in Arkansas are mandating vaccines for employment. I believe the mercy health system as mentioned Washington regional these are all at a later date or September thirtieth or October first as Morrissey said children's I think Conway regional recently came out with a new policy. I think that's it for right now thank you part of spittle okay last week follow up question on that how many what percentage of your staffing is travelling nurses at this point do you have an idea an average. I do not have that information today we'll we'll try to get the great can you tell us how many at Baptist search percentages travelling nurses. I was trying to do my math my back and I'm sorry I don't wanna this is a pretty large percent you'd say or. I don't want to guess because somebody's record what I'm saying so surely wrong okay one of the following share that's okay one more all right thank you I think it's really important that we get a good protocol for treating patients I think we're failing. As obvious is failing it is showing up in a hospitalizations we're not treating patients aggressively early and I've heard them discuss a regular person constituents of mine that they left Baptist hospital COVID patients with pneumonia with their processes over ninety twos they just were sent home with inhaler they're not sent home antibodies or anything else or apartment and so many things that we're not doing and and and and the coming back very sick England I see you so I can not strongly urge you enough to to stop to encourage physicians to do everything they can to aggressively treat these patients early and let's stop these people get very sick I think it's when what what we're seeing now with the breakouts of vaccines in across the world in the Massachusetts now at three quarters break out with vaccines we have got to start treating the one percent that are sick early aggressively with everything all all all the tools to get an abortion okay so I'm just putting that word out there I think it's it's crucial to keep out the hospitalizations rates that we've got so thank you all so much for being here today I just want everyone to get that plug out there again for schools I'm so. Passionate about getting our state healthy we're forty eighth in the nation we have obese people mess that's the reason we're seeing hospitalizations let's all work together to get our kids and our and our state healthy thank you. A first you're recognized here I am of what but percentage of patients that are ending up in the hospital with COVID or and vaccinated versus unvaccinated. In our system eighty five percent. All right and vaccinated correct yeah seems pretty clear the answers for people to go get vaccinated Amendment thank. Senator Solomon you turn off my car back on. You're recognized thank you Mr chair yeah I'm looking at Senate bill six. six oh three the talk about temporary hospitals and regulating those allow the billing and well that are we getting close to the point that we're going to have to if our of our hospitals are full that we're gonna have to implement something like this temporary law that was passed are we getting there. I don't think it's a number of physical beds I think it's number staffed beds in into my system anyway this the issues thank you try to set up a hospital in a parking lot it's really really hard to do and really hard to sustain over time is easy to do for a short period of time I think the evidence shows is really hard to do over a long period of time. So are we prepared to do that if necessary remaking the steps to prepare for the. Okay. So I'm aware that we had some facilities built and designed in Arkansas for what we call alternate care facility two of them one was located here in Iraq and one in Fort Smith but as and they're still there so there's a discussion planning up in the event that there needed to be able to utilize them but as everyone has said staffing is the issue. Senator Hammer you're recognized just one and that is reports have been that the ambulances have been holding patients in their units until beds open up we don't have the ambulance association here to talk about you know how they have a string because I think maybe even of some of their medics are getting hired to work in the in the hospital facilities you all have any comments and no they're not here which shall have any comments about the turn around time frame religious sitting you know in your parking lots waiting or is that is that a small problem big problem or could you all even comment on it see how they're delivering it to you all deliver the patient's still. I would says an episodic problems like Monday night I would say there's probably a lot of folks holding in the emergency department the ambulances and so I don't have any data for that and I know it causes significant problems for our partners that are trying to provide mercy management or a city okay all right thank you thank you Sir. All right that was last question and if ya as you'll see we're very interested in this and been some very pointed questions but we want the best data possible to serve the citizens but I think I speak for everyone here when I was when I thank you for being here and for your comments in being willing to answer any questions no matter how difficult it is but we do appreciate what you're organizations do and when you know we know it's difficult and we appreciate everything that they do so thank you very much. All right Committee we're gonna move on. Senator. Senator Hammer Gemma comment are you bringing Jody into the table or. Now we're done with that and see thank you. Came I'm sorry Adam in the. Okay moving on to item ET Department of Health. Our Human Services I'm sorry. The H. S. would jump on board. Department Human Services. I would introduce yourself. Good afternoon dawn Staley deputy director of for the Tucker Human Services and Medicaid director. A Dennis Smith senior advisor for Medicaid healthcare reform Department of Human Services members there's a handout on this. You are recognized when president. Yes it's okay we're just gonna make a few remarks and then Walker the slides and any questions of folks have all right wonderful so before you today you have the quarter one and quarter to transformation scorecard reports as you'll see we continue to be on track to achieve the five year savings targets of it heard thirty five million wow actually go through each of the areas and talk a little bit about where we're at we've actually exceeded the goals vertically when you look at development disabilities behavior health long term services and supports pharmacy dental and then pass we also know that wall national healthcare expenditures have slowed for much of twenty twenty the rate of spending is actually returning to pre COVID levels so we'll talk about that a little bit we also are expecting several rate increases in reimbursement changes that will go into effect in this next a fiscal year but that said we do expect to close out the year on target as of state fiscal year twenty twenty one and will be submitting that finals a score card to you in the near future so with that like that we do have a few slides altered over to Dennis Smith walk through that and then happy to take any questions. Thank you yes thank you may proceed go ahead thank you very much Mr chairman of the again this is about half the deck we send over at the so we try to convince condenses a little bit today to get right to the the major points and not going into a all a lot of a lot of the the background of and so again this is to meet the commitment to track eight hundred thirty five million dollars in savings that was arrived at between a governor Hutchinson and the healthcare task force so we've been reporting on this since twenty seventeen and here it is almost the end of the five year period so we are please to tell the committee again that we all have of net the can you just answers or me of we have of the exceeded the eight hundred thirty five with the two quarters yet to go go to slide three of these numbers come straight out of the healthcare task force report so for the twenty seventeen to twenty one again this is a couple cav yachts this is only traditional Medicaid so it does not include Arkansas Works and also this is reduced spending so again we we refer to savings but it's not like we have said deposited savings in a different account we have reduced the amount of spending of which is a typical way that a baseline is is measured off of the healthcare task force had of projected that spending would increase of five percent annually of from the period of time of twenty seventeen to twenty twenty one so we have reduced that rate of growth before the load the five percent income so the next flight is a summary slide. of the eight hundred thirty five of the savings from the the again through twenty twenty would have been six hundred four million dollars. The next. Of what the actual savings and this includes all Medicaid spending of one point four billion below that five percent baseline but we do not count all of the Medicaid transformation savings in those savings the ones that come specifically of from from the transformation is on slide seven so you can see there are to date we have of of reduce spending by one billion one hundred and seventy two million dollars compared to what the bass line had been projected you notice that top grade bar is the eight hundred thirty five million dollars we have added that little gray section of forty million dollars attributed to the pass program so again of we have brought pass up of a year early so we have included so from our perspective it's eight thirty five plus another forty million dollars to accommodate pass so D. D. you can see the blue bars are what we the great bars on the left or what the the healthcare task force savings amount were projected to be and then the blue bars are the actual amounts that we have saved to date so again you DD hundred fifty six million the healthcare task force we've actually accomplished savings up to twenty five behavioral health it is one sixty seven we've achieved to twenty five to twenty four I'm sorry a long term services and support that is a variety of number of different programs so that's personal care but it's also the waiver programs for the elderly and it is also. So private nursing homes placements so the report reforms in each of those areas pharmacy has exceeded its target of two hundred fifty million dollars a cheap savings of two ninety one a dental does achieve savings of thirty two million dollars in the past program to date eighty one million dollars so the these are the next couple of slides and again or are read into quarterly amounts so if I may I'll just skip over each quarter go to slide ten of because what we have also done the healthcare task force already also recognized when we went to dental managed care we went to the past program we would also collect the premium tax. So we are not quite to the premium did the revenue amounts that were projected at that point in time they a healthcare task force projected seventy million dollars between both dental managed care and the past program we're at sixty right now and there's actually a little bit of a lag time to catch up to the the on the revenue side of the the next slide it is the right revenue between pass We've collected fifty five billion of verses the estimate of fifty six a dental has not generated as much of tax revenue as the healthcare task force what it would. A slight twelve is the these this is the spending of Ford these different areas so again these are the error these are the areas that we count the savings from their nose savings attributed to hospitals there's no savings a tribute to physicians those are not included. so again of the it in of the first two quarters of fiscal state fiscal year a twenty one our savings or just under a hundred million dollars. and often times members ask is okay well that's the savings but what how much do we actually spend which is like thirteen. So you see in all of the Medicaid spending is categorized into these amounts institutional medical services those are your hospital's inpatient outpatient a non medical institutional medical services those are doctors different kinds of The physician groups in are included in that habilitated in rehabilitative services those cross over a both behavioral health and physical health in terms of rehabilitation and ability shin long term services and supports pharmacy capitated payments. So passes a capitated payment but the non emergency even transportation is that can at a capitated payment the PCMH of program those are a monthly payments that are paid to physician practices so those are all included as capitated payments then we also have supplemental payments and costs settlements generally these are with hospitals and the nursing homes eight and Nonclaims payments those are ones that are get paid through contracts for example so in a quarter eighty two and again just to because what you're always doing is comparing it over time so the far right hand corner we spent in traditional Medicaid us spent a total of one billion four hundred and fifty nine million dollars in order to. Of the next section is going through again spending comes from three principal areas enrollment so how many people who have enrolled in the in the program. What are the cost of the services and at what rate or services used or utilization so again traditional Medicaid you can see of year over year or quarter to of what we have spent we did on this slide we have included the Arkansas Works spending as well and again these are in millions of dollars so that quarter two of us a twenty twenty one is one billion four hundred and fifty nine million dollars of we're also included involvement of a of course we all know is that of COVID has increased our roles of the and of this was part of the trade off of from the enhanced federal match rate the federal government provided us with a six point two percentage point increase for our regular Medicaid program of but they too in exchange for that we cannot descend role individuals from the program of except under very certain circumstances that they've they have passed away they have moved out of state but we cannot do our regular annual redetermination process so that is why are in rules have have of a bill to up up during this COVID period is that for all groups now not you know just for offering all groups we've seen an increase it's it's all groups that are affected by this okay thanks even though in Arkansas Works the ninety ten match rate we did not get any increase in federal funding of for the the match rate on Arkansas works but we have not been able to do the regular redetermination period on a permanent slides seventeen is a primer per month again a healthcare spending is often catid. Have been a by a PM PM or per member per month and these are across our of Medicaid populations so again this number is in dollar amounts so per member per month in quarter to traditional Medicaid spent six hundred ninety three dollars per member per month compared to sixty six hundred twenty dollars in our Arkansas Works the rest of the slides of our broken down by each of those transformation groups at and again. DD was expected to save a hundred and fifty six million at a saved five twenty a two hundred fifty five today let me also hasten to say in DVD and behavioral health of the. The number of individuals have been moved over to the pass program so these are only fee for service dollars so again as we get a smaller and smaller population in fee for service obviously it is more challenging to find any set it to find additional savings so you see the savings do slow down in both B. H. and B. D.. But those savings are only fee for service not mixed in with the pass a behavioral health again one sixty seven as the five year goal two twenty two hundred twenty four million as the a reduced spending a long term services and supports the original goal was two hundred fifteen million that is three hundred fifty eight million dollars again there were different part components to that of part of it again is as you know the Arkansas will adjourn a a our choices had a new waiver so that the that wait the savings attributed to that waiver already counted in these dollars. Of the pharmacy has was given the largest to share the burden to generate savings two hundred fifty million and in this exceeded that of two two hundred ninety one million. Of the past programs and again this is one we've of because we brought pass it in early compared to the healthcare task force these numbers of. Look a little bit different than what the healthcare task force of we're showing you how Additional savings because we brought the program in sooner and so you notice quarter to of of of twenty was actually we spent more compared to the the baseline in that first quarter again that that was as pass was coming up and really being brought to a completely online but we've generated savings since that time. Page twenty four is breaks down how we arrived at the savings of for the past program and again in capitated propane meant programs a you convert those into per member per month a dollar so this is the projected baseline for twenty twenty one was two thousand four hundred ninety eight dollars per member per month that is a composite because as you know the past program is come it is a combination of different types of individuals the the least expensive our children who who are there for behavioral health needs of the most expensive or those that we call the duels they are the highest cost individuals they have they have an intellectual or to developmental disability and they have behavioral health issues as well so those tend to be the most expensive so the two twenty four ninety eight is a composite across all of the populations in the past program. So the PM PM for the actual for quarter two was two thousand three hundred ninety dollars so in the of that gets calculated by the the number months so the savings of fourteen million four dollars slide twenty five and twenty six are also to give the committee a is a little bit more of the historical spending and you'll see the the changes in this. and what we did in the past program of again these are capitated payments you pay the we have three currently passes we pay them a month in advance they have to maintain a reserves to make certain they can pay all the bills and impasse this is their entire comprehensive medical care this it's not just the B. H. services not just their duties services but it's also the hospital there physician or pharmacy et cetera so this amount is up for all of the service that that are offered both through state plan or the waiver programs have as of the so one of the things that we did. Because this was all new to the state of we built in what we call a risk corridor. So the risk corridor and I know you all are familiar with medical loss ratios that you know when we talk Arkansas Works we talk about the MLR we calculate the MLR on the past site as well of the we set a MLR target that would to achieve a certain level of savings because of the uncertainty we built in the risk corridor of the overtime of the risk corridor. Has we have received money back from the passes because of the we were not meeting our M. L. target as we're going along so we have done a settlement with them we have recovered money back from the passes to hit our MLR a target with them we also have reduced rates so rates are set on a calendar year basis of all we have so we are now in the process of setting the rates for twenty four calendar year twenty two so as we look at that we look at experience now of the actual experience of so what was built in five years ago doesn't really matter at this point it's the actual experience the actual utilization of services to where again we build a rate of an by the adults versus children behavioral health versus the D. dual diagnosis it etcetera so those are the the composite amount so that's why you see from the quarter to of the state fiscal year twenty twenty three hundred fifty one million dollars then that get it a substantial reduction of thirty million dollars and a quarter of that was part of the period of time in which we were of recovering funds of from the passes. and then again these are the enrollment numbers and the enrollment by each of the passes as you can see in power is the largest in terms of the number of enrollees and member months and some active and Arkansas total care are you a generally by the same. Be happy to answering your questions. So it looks like the enrollment overall three passes it is fairly consistent. The correct it is yes Sir it has come up a little bit during covid and But we are we we are around fifty thousand members now. I am we do have a couple questions. Senator Solomon you're recognized thank you Mr back over here. Okay we start we're talking to five percent savings are projected savings and we talked about when all that started that the changes would those savings would occur because we people got better faster. For a more efficient system. And the other way to save money is to cut services can you Do you have the detail not that you present right now what do you have the detail that shows how we came about that savings without that through quality center it is come from a couple of different areas and we we are coming up on our renewal so we have to renew the managed care waiver with the CM mass so that requires an evaluation in excel and that'll be part of them out I'd like to be is less about that because I know that was our projection and then with the I don't know if you can get this number but with the passes yeah we moved away from the fee for service is there a way to compare what we would have paid with a if we had we stayed for fee for service by going to the program we have now is there anyway to make a comparison there US senator the the the passes have continued to base their payments to providers on the Medicaid fee schedule we know that they are talking more and more with their providers about trying to move more to a quality based system of but the the program they are still largely paying on the Medicaid fee schedule okay sure there may be a way down here a little while the look at that yes I'd like to look at that with you but I'm like what I'm saying as far as what we've done a good efforts and good information thank you thank you Sir. He represented Ferguson. Thank you Mr chair of I was really just looking back at your charts seventeen where are we with budget neutrality for Arkansas Works are we meeting that or has the. May has at work yes Arkansas Works budget neutrality is six hundred eighty five dollars per member per month the for this year and we are below that that those payments to the Q. H. P.'s so keeping people on the roles has not really affected that the and the S. correct okay thank you. Senator Hammer you're recognized thank you Mr there's a fourth pass it's going to be in the mix of things by this time next year forgot my memory correct is that is that right there is a fourth CareSource that has been licensed by a ID they will have to go through a reading this review as we have done with the other passes before they would be able to enroll individuals do you have any idea when that's going to be and do you have any opinion you care to state publicly as to how that may affect the the cost of the program or is it just can be competition among the for its competition among the four yes Sir and the review will be done dispassionately you know it it will be an objective review that all of the passes had had to go through previously the what we did was for the program the first time around that I think that we will do again we had the review by internal DHS and then we had an outside expert to come in and also to those who has years and decades of experience in managed care to validate that they the. That the passes would be ready so we see that again we are very That a large part of this effort in why it generally takes a review period takes a period of time is because you're also testing of the IT systems we want to make certain that the the pass can accept we we communicate electronically we do everything electronically with the passes on a monthly basis on their member reports etcetera we will have to make certain that they can accept that on their end of things we have to make certain that they can pay their providers so again reading this review is not just a paper review it is making certain that the that the the member is being protected by the by the past being fully able to carry on their responsibilities and then the I can't hear the call is that the community reinvestment dollars or what yes Sir so can we get a list of where all that went and what programs that went into IT issues in the report or did I it is not in this in this particular of report but we're happy to bring you up to date we have two passes that have been approved to do community investment and we have a proposal from the third one of what they are suggesting to do so again the community investment we allow them to use a percentage of funding that would have regularly being counted on the administrative side so again in a medical loss ratio you're counting pay outs for medical claims and your counting administrative costs these these community investment dollars would typically have been charged against the administrative side but we are allowing them to counted as a benefit site there's an upper limit of five percent so typically we're we're talking a couple of million dollars. but it's advantageous to them we the the projects that are being funded are to expand capacity we think that those are all good and we have to approve those projects as well I'd like to get a list of the projects if you would please the last survey that with you have a sense that the chair here and then we'll get to distribute everybody thank Mr thank you. Representative Perry you're recognized for a question. Thank you Mr chairman only L. Page thirteen. On the. Break out of capitated payments do you have a break out of what each one is far pass and not urgency that right and and a passerby the biggest right part of that so the the the past numbers are of roughly a hundred million a month because the the net in the dental are we're talking. Less than ten million a month so we can break that up okay all right thank you thank you for. All right seeing no more questions thank you for your presentation and give you all of your presenting this every quarter. I believe is that correct we we submit every quarter yes Sir okay all right thank you. All right we're gonna move on to item if Department of Human Services. Mark white. Committee Franklin bill would come board. Please introduce yourself. Thank you Sir Clark one DHS. Very frankly with the Division county operations DHS you're recognized. Thank you Mr chairman of membership for you this is a or a pro state plan for the community services block grant this is not something that ordinarily comes to you but there is a requirement in the federal rule that we bring this plan to you once every three years just so that you're aware of it and can raise any issues as well as for the the public comment there Ford and with that I'll turn Mr Franklin did you ski on overview of the program what this is for and numbers displayed. The service block grant is a federal anti poverty program and its support services designed to help low income individuals and families become self sufficient. And so the proposed a plan that and provides the requirements of the CSPD program in accordance with the CS BG Act and DHS and the community action agencies that implement this program of have to follow the requirements in the state plan. Of the programs administered through fifteen community action agencies throughout Arkansas as required by public law and they they provide statewide coverage in all seventy five counties in each community action agency itself is overseen by a local board of directors which is made up of elected officials community leaders and low income individuals. And the services that are provided through community service block grant a pretty varied there's many different kinds of services that can be offered but they include a services to help low income individuals obtain employment pursue adequate education make better use of the income they do have available to them obtain and maintain adequate housing receive Human Services obtain emergency food assistance become more self sufficient. And in this program. And and the actual property of these services is set by the local board of that community action agency. We do expect to receive Arkansas expects to receive Nine point nine million in community service block grant funds in fiscal years twenty two and twenty three and ninety percent of those funds goes directly to those fifteen community action agencies to provide services in the communities that they serve five percent is used by the ages for administrative expenses and then five percent that's remaining is Issued through grants for different types of programs to eligible entities either to provide technical assistance in training to the community action agencies themselves or for technology upgrades family development projects or any projects to benefit the local communities with that I'll pause and glad to take any questions. Are there any questions from committee. Seeing none thank thank you for the report thank Mister thank you members. Okay hold on just a second we have a question. Senator Johnson you're recognized thank you Mr chairman of what you probably knew was going to ask you about this Has anything been resolved on ACT five seventy nine of twenty nineteen regarding how an OP Tom trees can bill for the. changes in the scope of practice. Yes Sir it is we've with files are financial projections the fiscal impact of that finalized the legal determination we can move forward with it so the system changes are ongoing it is going to happen and those system changes I don't believe they should take too long I need to get a final due date for the system changes everything's on track to get that implementing that taken care of and I thought and I we've I notice I saw updated going out to you you mental senior email but certainly I'm less convinced I must admit I'm a bit behind on some of my okay but I appreciate that and again as I remind you this was acting twenty nineteen not twenty twenty one yes Sir thank you for following up on that thank you Mr chair for allowing me this. All right we do have another question. Senator Davis you're recognized thank you Mr chair and I don't want to get off topic or in the weeds but I just wanted to catch you while you're here and have there's several members that care about the issue that we're dealing with with that role nursing homes I just wanted to check in and see if were and making any progress on that based on our last conversation I certainly and I thought I could just sit today's updates little earlier today it was Garrity on a shoestring that to to many of you we are making some good progress in the last week complete a whole lot one is that for Mister and miss recognition or is this more detail the we got we just three ninety six apple cases they were brought to us by nursing homes look at initially initially have issues there's a hundred of those we have finalized that issued either approval or not I'll there's another hundred one where there wasn't a for for information we sent that to the applicant as well as with a copy of the facilities there where there sixty that had some other issues we're still working on our end to get those process and that left about a hundred and thirty still need to be reviewed and assess what the next step so next steps are that was as of midday Friday sophomore of gone through the cycle and so so that eligibility piece or moving for and making good progress on getting those those cases taken care of for the for the homes on the cost port policy side we. I've lost count of how many calls we've had with the association last week which is good good communication there and we appreciate their cooperation we're working through all those issues and making really good progress on getting some changes ready to come forward for you all thank you very much service. All right see no more questions thank you for your report thank you okay we'll move on item G. Department of Health. So would come board. Please introduce yourself for the record. Thank you Mr chairman members of the committee Larus you and I'm general counsel for the department of health right before you today to rules this is just our normal promulgation process under the administrative procedure act the first as the proposed amendment to the Department health rules pertaining to lead based paint changes to the clearance levels for lead in dust this is to meet industry standards we do have a pending public health hearing on August sixth and as of this date we have not received any public comments there's no financial impact to the state and this is to meet EPA requirements that require the states to update the rules to reflect this change by January first of twenty twenty two I'm happy to take any questions. Seeing no are there any questions from committee. Seeing none without objection this rule stands review. You may proceed thank you Mr chair the next rule I have is the summary of excuse me or changes to the rules pertaining to the Arkansas cancer registry this was an eighty H. initiative in the twenty twenty one legislative session and you all passed ACT three forty five of twenty twenty one and this remove the port requirements of the board of health approval to release the statistical information from the cancer registry and also added the definition of a qualified researcher the axe of correlates with the rules and we do have a pending public hearing on August eleventh and as of this date we have received no comments there's no financial impact to the state and I'm happy to take any questions if there are any. Seeing no questions without objection this rule stands review thank you very much. Okay we'll move on item online review of the Arkansas tobacco settlement commission annual value what evaluation report. Please introduce yourself for the record. Mr chairman at Gilmore department health. You may proceed thank you members you should have a copy of the tobacco settlement commissions twenty twenty report. There in front of you this is the a report we provide we provide quarterly reports as well as you saying but this is similar to what you've seen before it's broken down by sections for each program. there's also a graphic in the front around wage for five. That kind of gives some of the overall numbers and talk about some of the different activities programs are involved in. I'll go over that quickly and we've had a long afternoon I'll keep this brief as possible couple things I'll point out and you can see the numbers there for yourself but with COVID there's been an impact so the educational opportunities provide these are good numbers of some of them are down just due to the way the program directly community and educational portions of the services provided by the programs are not all the numbers down to some of them are so just I think that will change over time but it is just due to the nature of COVID and trying to reassess and find different ways to serve the populations they serve some of the numbers are up if you look at the service portion there on page we was paid for towards the bottom you'll see the Medicaid expansion program that the this this covered through DHS with tobacco settlement dollars they served more individuals during this year also the college public health was able to serve more individuals and then also the a number of students engaged in research across the program through A. B. in those programs increased. moving on there's also increases with research projects number of patents awarded so not all the numbers are down but I think that some of the programs are tried as best they can to pivot and to continue to do what they do but just in a different way. In the back of the book you'll see conclusion I think it's around Pitsch. one forty one one forty two and so forth. Talk about some of the part of the just overall kind of a summary of the challenges and different things the programs are engaged in I think with that's because we know COVID has had a huge impact on the state in their health care industry they've had to re prioritize staffing due to some of the different engages they're involved with the testing or code screenings health education things like that if the report reprioritize staff there's also been some of staff turnover retention I think they've seen some issues there so that's important to notice as well. And I think there's some good things to come out of the changes that you'll see in this report I think the programs have engage more using to technology to serve their populations across the state whether that's through webinars and zoom meetings things like that but finding ways to reach more individuals in different populations at risk before but through different avenues of doing that so I think overall the programs done well again the numbers are not what we're used to seeing as far as individuals like impact and and different groups they reach out to but a lot of that's been shifted a lot of it also has been affected by COVID but with that I don't think anywhere time I have happy to take any questions you might have or address any issues you you know. A man just one question on if these are down these things that you're tracking yes Sir how does that affect the finances I mean does that mean there's more money that we use later on or how does that work so it's it's all a lot of the programs when they all get tobacco settlement funding as part of their budget they also have other sources of income as well but there's also money that they use from tobacco settlement funds to to use a seed money further grants but as far as the funds they receive that will be carried forward to future years I don't lose that and this is tied to a grant which is outside of the tobacco settlement gives them okay thank you I got a question here. Thank you senator Hammer you're recognized thank you afternoon may discern question is we just hired a consultant that's looking at a B. D. and looking at the other school insurance and question I asked was because it came up in the conversation about back of settlement money and the effectiveness how is being used the my question is do we have any metrics or what we do as far as a measurement tool to determine that the dollars that were put into all programs to the tobacco settlement money are actually producing return on investment in moving us as a state from number forty eight or forty nine whatever we are down toward the number one position. Sure so the report you have there there's in the in the tobacco settlement act of two thousand there were specific Requirements or I should say directives in the act that said you know focus on this focus on this and it's it's each spoke each program has various populations there to serve as far as the matrix I mean we do track that the report shows that with each indicator and it shows I think in this reporting by email it shows the previous year and if it's going down or up and then there's also a summer in the back of the report that shows the different We're H. program stands as far as the indicators on the progress they're making I think a lot of the one of the things with tobacco settlement funding is I mean it's it's about a twenty seven programs so each program of course Medicaid expansion is the largest chunk of the money and it's highly dependent on but it's the other programs don't get a whole lot I should say and then what they get is used to leverage other funding to support the other services they do I think they're making progress I mean there's always room for improvement they strive to try to manage the funds is is it's firmly as they can but The matrix artists are Gates from year to year they'll go back and tweak some of the indicators as well to see if there's another way to do it or to track it differently and see if they're missing something open answer your question since it was. Since inception of it denoble program one that got on it that's ever been terminated because it wasn't producing. So the same programs are on there I think there was a program with Medicaid expansion that went away and had redirect that money but as far as the programs that were initially they're they're still receiving funding but it's a large portion of their budget okay but as far as the program being removed from it there been changes and reorganisations but I think Medicaid was one of the programs that did that but that was a changed our thank you thank Mr. I see no more questions without objection this report stands review thank you thank you Sir. All right members we're gonna move on to. item J. report of the status of availability of A. E. D.'s on each public school campus. No come board. Please introduce yourself for the record. Thank you chair I'm sure remain Donald and from the department of education the state school nurse consultant I'll make this brief this is the annual a ET report and all campuses in the state of Arkansas are consistent with having an ADD about thirteen thousand plus staff are trained in CPR and first aid probably a little low from this last year but those numbers tend to be a little higher and the schools that reported no trained staff for nineteen of those five or Burchill virtual and the other fourteen. Comprised of seven school districts and since this report is due July first I have had the opportunity to contact each one of these districts and they all have trained staff so that's an update to the report. You may not have this but just I'm curious of what about the usage I mean you get any kind of information are these benefiting schools you have any idea about that. Every year we collect the school health survey of some sort and we did have three sudden cardiac arrest and state in the state so every life saved yes Is benefit to this great. We have a question. Senator Beckham you're recognized over this way. Is there a program or a policy of how often the batteries are checked in the eighties there is a person that is assigned to that task and that is provided and they do have to do a monthly check on that the key to the city to school that school each school is an assigned has an assigned person that does the department have a central database to keep track of that because the battery is only good for like two to seven years we do collect to this person is we do not monitor to see if there maintaining that we. I hope that that's what they're to in I'm sure they are because. I have that responsibility to maintain that. I don't know what kind of a ways you have a some of them have programs from the manufacturer that can keep track of that they do and most people that are again responsible for that are checking and again I have a check they do have a checklist system that they have to go through with that to verify. Okay. One more question here. Mister the the the reason the reason for the question is there is a fairly large company that recently had a finality and when the supervisors responded to that they pulled ways out in multiple ways at that batteries this is not a company that takes safety lightly it's a very large company in the state of Arkansas and also in the region and that's just want to verify that we do have these being checked because I would be at. Heartbreak to anyone involved if we do have a child that does because we're not able to get that AD in place in on them and working because of a dead battery this someone spent their career pencil whipping the reports on you know what we know what reporting does. We go into other departments and bridges and things like that so just want to make sure that that is something that we're taking a serious look at and I just hope that they do it. Well and I think it's or something they are like I said they have a risk I mean they do provide the person is responsible and they do have a checklist system that they're required to maintain S. for checking that that can be done when there is standards and accreditation there to make sure they're maintaining a health and safety standards for that school district. All right seeing no more questions thank you for this report. Thank you. All right committee we're down to item Katie. Which is the I. S. P.'s. And we have twenty two of those. So hopefully you've looked at those so what I'm gonna do is just bats these and if there's some if there's one that you want to discuss before it moved to a subcommittee then push your button there and will will recognize you and you can bring that number we'll get the sponsor the to talk about that the give me some time to look over this what you're doing that I. S. P. twenty twenty one that's fifty eight. representative Christiansen you make a comment on that push the button on the. Mr chairman I'd be glad to I think this is a good solid thing but it needs a little tooling a lawyer re working to bring it forward and have a good consensus on it so we're going to pull it back. And we'll redo that presented another time. All right that's a valid request thank you that was item number eleven on the sheet. Any others that had any comments. If there are no comments. We need to vote on this. State okay if there's no comments or no Without no objections then we will adopt these for study. And I have the list of subcommittees I'm going to go over this real quick your where we've got three subcommittees. So hold on because I'm gonna go through these numbers real quick we have the health services we have labor and environmental and we have Human Services so here are the ones that are going to be sent to health services. So this is twenty twenty one dash zero thirteen zero twenty three zero thirty seven zero thirty eight zero fifty one zero sixty three zero sixty seven zero fifteen one hundred one oh three and one oh four. And you know we'll we'll have information later on to make sure you know which ones are in that subcommittee going to the labor and environmental subcommittee twenty twenty one dash zero seventy six dash zero seventy seven dash zero seventy eight and that zero eighty nine. Human Services subcommittee twenty twenty one dash zero seven dash zero ten dash zero sixteen that zero fifty seven that zero fifty eight that zero seventy three that zero eighty six. In as we get other ISPs we will assign those to subcommittees when they come in. There's no more questions on those seeing no more business we are adjourned. One. The manager what do you say.