Public Health, Welfare and Labor- House & Senate

members who would go and get your seats we're gonna get started here in just a minute. Okay I want to call this meeting of public health labor and welfare to order. So looking forward to a good interim session look forward to working with Senator Bledsoe on this committee. I think it'll be a real interesting the time we got a lot of good things are going to be working on so I'm looking forward to that Senator did you have comments. Yes thank you so much just wanted to tell the committee that the we've had some questions about two items in the one of the questions is what will happen when the federal public health emergency ends so we're gonna be discussing that Angela and the next one is so the Department of Human Services implementation of Aries which is the Arkansas integrated eligibility system of. And they the questions have come up about that and we'll be discussing that if you have any questions in to laws will so get those questions ready and thank you so much. yes to add to that one other thing that we will be discussing at the next meeting is the ISPs that have been presented we have to do that we're gonna talk about today under other business but next meeting will will have the other ISPs that have been submitted to this committee. So we'll get right into the agenda. items C.. Consideration to adopt the December fourteenth twenty twenty meeting minutes I have a motion. I have a motion second. Thank you I have a second. All in favor signify by saying aye. All opposed nay. Motion carries. Next item on the agenda items the is consideration of a motion to authorize the chairs to approve special expenses incurred by the house and Senate interim committees on public health welfare and labor so this would cover any special expenses that we have during the interim 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. Next item on the agenda is item E. a report on the activities that the Arkansas department of health and Department of Human Services have completed to comply with Act three eleven of twenty twenty one an act to create the no patient left alone act and you have that in your exhibits. So would you all come forward. This thing And now. All right if you would please introduce yourself and who you represent. Thank Mister Clark what was part of Human Services. Assessment department of Human Services. Melody Johns Blackwell Department of Human Services. You're recognized to present a report. Thanks chairman we want come and give you Alston an overview of the act from the DHS perspective and also talk through some of the things we're doing to implement that act. Act through eleven the no patient left alone Act you'll approve this in the legislative session just recently it did have an emergency clause in it so became effective on March tenth it addresses the visitation rights of patients and residents of healthcare facilities a healthcare professional offices hospitals hospice facilities and long term care facilities it is a shared responsibility of enforcement there between department Human Services and Department of health for DHS we are responsible for the portions the act that apply to long term care facilities it was a long term care facilities we're talking about course most commonly nursing homes AS was calling but also assisted living residential care facilities intermediate care facilities for the development of disabled residential care facilities and other facilities that provide a long term medical or personal care. And the reason that those long term care facilities are separated out in the act and treated a little differently from the others is because it is two fold first their already existing federal requirements around visitation in long term care facilities patients in those facilities have rights to visitation under federal law and those are laws that were charged with enforcing on long term care facilities but also in addition to that there been specific federal guidelines and federal requirements that have been in that come into play related to the pandemic that have limited visitation and so we have a responsibility of enforcing those limitations on visitation as well and so that does make us a little unique in comparison to the Department healthful you'll hooker you'll hear from here in just a moment in that we already have those pre existing federal authorities it also gives us more flexibility in terms of enforcing the act and we have stations that we can impose on facilities if we have that that independent federal authority around visitation. So under the act a long term care facilities must allow number one compassionate care visitation as needed by a resident to alleviate either physical or mental distress with protocols that should be in place for personal contact that complies with federal infection prevention guidelines now for long term care facilities that do not have a recent COVID case entering counties that don't have a high positivity level they must also allow access for residents to indoor visitation for other reasons beyond just compassionate care visits. a long term care facility can restrict visitation certain situations of the restricted when it's medically or therapeutically contra indicated we would interfere with the rights or the care of other patients in the facility OR when vistors mis behave or engage in destructive behavior. Now for anyone who is concerned about a particular long term care facility and about they're not complying with the act as I said DHS is responsible for enforcing that run long term care facilities and we do have a process to accept complaints anyone who's aware of a situation can file a complaint with DHS and hi with me of introduce themselves earlier miss melody Johnson Mr Schmidt ms Jett ms Jones is going to talk about the complaint process around nursing homes and how we enforce that and then miss Schmidt is going to address the same thing around other types of facilities like system living in residential care facilities that Mister chairman by mail turned over to ms Jones to discuss that. You're recognized. Thank you. And when complaints come in they can come in from could you pull that Mike a little bit closer. The complaints can come in from various areas you can come in from adult protective services the clients themselves the clients representatives Spelman of police. General public can make complaints and when they come in we do go out and have to investigate. Every complaint that comes into our office as of March the first of twenty twenty one to may the twentieth we've had fourteen total compliance command concerning visitation. Of those fourteen ten were unsubstantiated one was substantiated and we have three that are pending investigation I have not been scheduled to be entered on yet. And then well as I said if it's our Y. mission and dress the other soccer. Yes you're recognized. So on the assisted living side and the residential care side the process is pretty similar we do have a complaint hotline that anyone can call into whether it be a resident or family member of the general public and that complaint is taken in and processed we put it in our tracking system and then ask it'll one of our field surveyors to go out and investigate that to date since March tenth we have not had any received complaints for residential care facilities on visitation we have had one that had several allegations attached to it for an assisted living to a one of those included partial visitation the complaint was that they were only allowing people to come and see the individual on the weekends that was turned into a complaint violating a rule for residents rights it was received on March seventeenth we open the investigation on March twenty second and then closed it out on March twenty fifth is unfounded based on the records that were reviewed and interviews that were conducted. All right thank you for your comments. we do have a question with other questions now US senator Hammer you're recognized for a question the thank you Mr just real quick to complain she will called in where they complaints because the facility was not allowing visitors and to see the patients was that the complaint that was called in. investigated. Are you asking for the nursing homes or the assisted living probably the one okay well for the nursing homes yes it was for nursing homes not allowing of visitors to come in. Okay. Now this is a more than five. Unassisted living side there were a multitude of different allegations one of them included not letting visitors come in during the week only on weekends they did not specify this act. Specifically but we did treated as a visitation violence okay follow up Mr. Follow Mr yes you're recognized thank you. With the emergency having been declared over why are we having to even have this discussion because as I understood the law and maybe I'm wrong on my interpretation of it it would only apply whenever we're under emergency public health situation and even if we're not under one white why are we having to have these guidelines when the emergency has been declared over. But it goes back to what I referenced earlier in that we have not only stop in this act we have in been federal obligations our federal partners that we enforce around but visitation and around the pandemic those are still in force the the state declared a public health emergency doesn't have any impact on the continuation of those federal requirements and so that those are what come and play they're both on the right to visitation and also the limitations related to the pandemic. Do you know of other state center where the feds are penalizing or even in our situation our state or the feds are penalizing facilities because they're not operating under the guidelines that are being proposed my understanding is the those guidelines or national those those not guidelines there it does not requirements they're loaded Arkansas those upon nationally K. R. thank you Mr. Members now the department of health will present after DHS so you know you can keep your comments to DHS and then we'll have department health up later. representative Mayberry you're recognized for a question. Thank you thank you for presenting the information and I know that we've made huge steps so I'm very grateful for that I think all of us probably sought some point someone posting pictures and finally get to see my love wine or or being created and I know that meant a lot to so many people but I still get phone calls and I still get messages from people saying I'm not allowed in or what have you and some of its hospital related and I'll save that for the other set of and guess that will have coming up but One of the first things I say is well you can file a complaint. And this is something that I really didn't see on the front end but now I very much look back and go will yeah I you know if I'm in their shoes they don't want to file a complaint they're scared to they are petrified that if they file a complaint this is their loved one who is in that residents twenty four hours a day you know could be for a year two three what have you and they'll be seen as the one that's causing a problem so what can we do to ensure that those people who are scared to file a complaint that those long term care facilities are still following along because I know not all of them are. I would suggest a couple things with that and I can understand it no it is difficult you can can be difficult at a level in nursing homes after a good environment you want them to stay there you don't creating issues not certainly understand that about two options also just folks we're number one if they would reach out to use elector presented if you can share that with us without sharing the identity of the person and we'll we'll three thousand flight will follow up on that is appropriate the other option is every and every nursing home they should have information about the long term care ombudsman who represents those who can advocate on behalf of those patients they have requirements confidentiality and they can help take some actions that protect confidentiality the individual but make sure that complaint gets in front of us and so those are the two things I would suggest someone who wants to keep your name out of it. Follow up. Yes you can have a follow up okay can you all may know I've done that quite a few times but there are still situations that have occurred and one specifically finally did filed a complaint and what ended up happening is that what the nursing home said that they were doing versus what this person was being told didn't match up so the nursing home didn't really give accurate information about what they were saying and of this particular friend of mine is still limited and seeing a loved one still only getting fifteen minutes has to schedule an appointment cannot just come in and go out even just day it's it's still limited after filing the complaint so. Help me out here what what else can be done also get that information to us on which which home that is let's go back technicians take a look at. Hold the general anything else but I would say we we we certainly always will take another look at it and see. Of those may I guess how to follow up to make sure that that nursing home is truly telling you what they're what they're telling the families how do you how do you manage that. Would you trying to make on their. No. Has to be raised. So. We got we got it all right anyway M.. Where was I okay so it when we go out we look at what's occurring at that time. Unless there's documentation that we can find that will go back to the time that they're specifying. So. The only way that we can go back out and. Double check on it as the case may be is to have that person again. Lodging another complaint and will go out again we also check on it when we're out there for an annual but that's once a year so the complaints are the ones that we use to go out more frequently. If they. I also use the arms than mine as mark said the arms can get that information also and help and they work with us to ensure the facilities are following the regulations. And and if I may add two things one is yet the ombudsman when they they are out there visiting patients on a regular basis anyway they're trying to stay in touch with families certainly there is an issue that's that's a good person involved because they can they may know this first thing this plan also no officer from this other person in this other person who may not filed a complaint but that they still can help us give some information on that look into a course like anything else it's always good to have something in writing and so if if they're having some difficulties nursing home I'd encourage him to send email and ask for something in writing and that gives you a little more weight to it than just a he said she said. You have one more follow up with other folks and that's okay I'm sorry what my my last my last question so we weren't able to go as far as we wanted to go because of the CMS guidelines do you expect these to be updated soon because I think the last time that the updated guidelines was baby February do you see this. CMS changing guidelines to allow for more visitation because that's what's so much of this had to be based on. Okay the last memo for visitation guidance was updated in. In April the twenty seventh. Got a call okay I. May twenty seventh of twenty twenty one and they have not made any mention of updating this at this time. Senator garner you're recognized for a question. I thank Mr so. Following the law and and for your hand out it seems that there are cases where you can restrict patient access are restricted visitor access one of them is if you disrupt care of the patient as both the law and what you had your hand up can you give specific examples where you think that those out there we know that would be actually qualification it would keep some IBM cedar Love one seems more catch all and I'd like some more clarity on what that definition is so that if people would like to file a complaint and if a hospital or health care administration use that as an excuse to prevent the care are preventive visitation they would have better concrete examples of what that would mean corn DHS and department health. Center I'm. The. What I think intent there was to get if you get someone who truly is disrupting things nope they're causing disturbance no or they come in there and they're impaired by drugs or alcohol something like that think that's was in to my senses that's was intended by the language I'm don't believe the act gives us rulemaking authority so I don't know that we have a good way of clarifying that in a rule for example or narrowing that I think all we had to go on there is the what we understand the intention to be of the act so you're intent will your understanding of that would be it be the visitor's behavior would be what prevented the care not that the hospital could say. This person receiving care right now we will prevent you from getting the visit them and that care being long term of being some kind of thing that that's what concerns me is that your interpretation of it. That is my interpretation it's see here because it I mean there's there's two supervision there's visitors engage in destructive threatening or violent behavior which I think that's pretty self evident and then there is the more broader links the presence of visitors would interfere with the care of or rights of any patient And I are unless ms Jones disagree I think that would tend to be something on the part of that individual visitor rather than like a broad based any business would be harmful that makes sense okay so it would it would be the behavior of the visitor not interpreted by you to be the hospital saying right now we're giving my of the you can't come for next two hours or something like that nature. It's that's they'll be my understanding but again understand that course we only speak the context long term care facilities I don't want to speak for hospital something some because that's not our area Forsman. Okay thank you. The representative Bentley you're recognized for a question. Thank you chairman of direct white thank you so much for being here so quick company almost buttons do we have across the state. We have a state long term care ombudsman and then there's a regional ombudsman in each area agency on aging which with eight or on the State and then we have many other volunteer ombudsman who works through those regional on but I don't know the number off hand but I certainly can get that for use so how's the best way for are constituencies on spending that would without cover their area what's the best way for them to find that there is there should be a poster in every nursing home that has the contact information for the ombudsman but also if there's any question certainly you can reach out to us and we can put you in touch with them or they call their local area agency on aging area agency on aging okay great quick follow up this okay German yes you can follow so I just following up with senator Hammer hammers question do you have any knowledge but any facility in Arkansas being fined or penalized for not following the federal pandemic guidelines. I. We can double check that my memory was I think we do have some citations I don't know that we had a financial penalties but all. So we do have some for infection violations of infection control procedures that is not SO include just pandemic related things but could be other things as well. I think we have to go back and look at this the narrow it down to see if we had a specifically for violations of the code gallons okay just trying in the blast last one chairman so what variations do we have between the federal guidelines currently in our current state and you keep centers differences so can you just briefly go over where the differences on the federal current guidelines for the pandemic and what we have in Arkansas. Can you. Whitaker. For what for. A director you might wonder if you would. Okay all right. For and the regulations of courses for resident rights and where they have the right to receive visitors of his or her choosing but with the pandemic as we all know that. A change things so and CMS did put out a memo That covered all the visitation guidance and And it's in line with the act. At this time until they either do away with they. Of limited visitation that they have or. At the. December I think thirty first is when it. Goes away on its own and did you have a specific so just just to clarify that so make sure you know we're we're all hearing from our constituents okay that want to see their loved ones and so there's we don't wanna be sure I wanna be sure that we're on the same board okay so we don't want our nursing homes to be in violation of federal codes I don't want that to be the excuse but you're saying right now they're pretty much in line with the act that we passed here in Arkansas so it's really it's really not excuse at this point four inches not to see their loved ones and just trying to have their clarification there's if there's an outbreak in a facility a COVID outbreak they're going to limit mmhm okay the visitation they may have to go to just outdoor visitation for a while depending on how widespread that outbreak is. All right but that does not stop the compassionate care if they're visiting related to compassionate care even if they have an out break those. Visitors can continue to go in and they may have to wear more protective equipment or not be able to have hands on. But they'd still be able to go in and visit. Thank you just helps us to clarify things with our constituents call so it hasn't some facts to go on so thank you you're welcome. Mark if you would if you all would review if there have been any fines issued and then send that to Mr price. We will thank you. Senator Hammer you're recognized for a question thank you Mr one of the issues I find is the discrepancy between facilities as far as what everyone is doing and what another one may do they seem to be equal when you look at maybe the number of cases they have or whatever so has the department provided the guidelines to the nursing homes as far as what the consistency of expectation is and then does it become a private interpretation of each individual facility as to how they apply them causing consistency seems to be part of the problem I believe that's published fare statement that we did we did provide notice to them and they they've got to follow that but me as with anything there certainly there can be some room for interpretation and some may interpret differently than others and in and to the extent they do without the without a case by case basis about looking into it and then if necessary bring enforcement action okay thanks. Okay we have a no further questions from the committee thank you all for your report. Thank you the Department health would come forward. Members there's a handout come around from the Department bill for their report. I would please introduce yourself and who you represent. Thank you Mr chair and members of the committee member name Mallory I'm directly to director programs that help part. Matt Gilmore department health you may proceed with your for. Sure will mark did a great job given a overview of the active. How they and interpret it and how they've implemented it we've done some similar things in this Mallory here can address most of the inflation process and in questions that arise but we have drafted guidance as well as which all have their in front of you today that we share that with partners in the facilities as well that we oversee but this marks as a little bit different as far as our process compared to what DHS is required to follow so I'll let miss Mallory take it from here she has anything she wants to say field questions are we going to do this. So I'll speak to the perspective of hospitals to begin with our process a little it's a little different because we don't we don't go into every hospital on the on the federal side on the CMS side there's something called team status so if the hospital is accredited by an accrediting organization we have to go through CMS if we get a complaint on that is determined that it could be possible in what we call immediate jeopardy we have any type of complaint we have to send that to CMS and ask for permission to go in that facility and address that complaint they'll tell let they tell us how to prioritize that that complaint now if the hospital is not accredited then we can make the determination to go into that facility so so you know we have patient rights in the CMS hospital condition with their call conditions of participation which or the rules there are patient rights in there that do address on visitation and and basically it says it's they're not quiet as detailed as long term care but it does say that you know the thing about you know all patients and have the right to have a a visitor in the facility but the hospital has to have policies that say you know if they restrict visitation for anything or visiting hours or that kind of thing that has to be in writing and I have to share that with the patients and the the care givers so it does have the the the things about disruptive behavior and and those kind of things so So if we did if we did the complaint on the federal side than that for an accredited versus a non accredited facility that that's what we would have to do on we would try to stay consistent so if we did get a complaint on an accredited facility about limiting visitation and let's say CMS told us you know from of an immediate jeopardy perspective yes it's immediate jeopardy and you have to go in there within two days then if we got that same topic complaint on an accredited facility we try to do we would for consistency we would try to do the same thing so that so that's the difference between us and long term care right now we have received six complaints regarding visitation in the hospital we've not receive none on hospice and four of those were actually on patients in the in the emergency department so you know we we try to you know because we know that these complaints need to be addressed you know at the time because people want their visit bidders of visitors in there we try to call the hospital called the C. E. O. call the Senate and the director of nursing and say you know you you've got this problem there can we neck you know what's the deal why are you limiting visitation and it could be because you know that's a COVID patient or a a possible code patient in that visitor has been with that patient you know and and probably should be if that's a positive patients should be quarantine so there there's different issues you know or do you know about this law this law says this are you where will not win reasoning that reading it that way well that's the way we read it and that's the way our attorneys read it so you all you'll need to be aware that if if you don't change if you don't go ahead and let these visitors in if if only for these re. As and then we're gonna we're gonna come in on a complaint eventually so. At. Yes so we've received six complaints for those have been investigated into we just received Few days ago and we haven't gotten three of them through the process at. Senator Hammer you're recognized for another question. Thank you Mr. Is there are there any allowances for those individuals that have had their vaccine and have their vaccine card does that does CMS making allowances that those individuals could go in on restricted because they have received the vaccine it would be a case by case basis senator Hammer because you know that I thank you not have policies that say you know they've got certain hours or they've got an you know that I am not I don't even have a good example but we would look at their policies and sat and determine whether we agree that those policies those were limitations that yes should be there or no you can't you don't need to you need to let these visitors planned. And usually when we have a conversation about CMS was the you know DHS the response time is like forever so are you all getting that quick of a turnaround time when U. S. C. M. S. for a ruling on something what your what your turn around time that you get the direction we do we do usually get pretty good turn around time if we haven't received an answer in a couple of days or three days we're on the phone with them saying you know we've really got this complaint in and you know if we really believe that it is immediate jeopardy I mean we're really on the phone with them saying we need to go in there and see what's going on at this hospital or a facility okay thank you thank you Sir. Senator garner you're recognized for a question. Thank Richard did you just say what the determinations were of those investigations. On. I believe senator garner that all for those have said yes one I know one hospital at least you know three of them within the eighty and there you know there could have been some issues that we didn't know whether that patient was positive or not and how long that care giver had been with that patient now one of them one hospital was just not interpreting the on the act the way that we did and once we said you know this is the way we're looking at this is the way our attorneys look at it they said okay we we don't disagree with that. So one misinterpreted law and then they reset factory conclusion yeah three were the emergency room and you think there's a different standard you. I think I think probably guessed until they got the results of the test to now so you know whether they were positive or not they were just trying to limit the visitation at that point yes ma'am similar questions asked DHS and that part of the lower talks about disruptive care of the patient how do you interpret that if CMOS follicle plane do you think that's the behavior of the potential visitor not the hospital be able to say we're giving them care right now you'll disrupt that we can let you see absolutely section one on record thank you ma'am. Representative Mayberry you're recognized for a question. You. Thank you. Make a Gilmore knows that I have had many text conversations and I probably can tell you all six of those complaints have come in and I'm actually surprised that it's that low because I know I've told other people to make more complaints but when not interrupt you but he sits in an office right next time so when you call I'm his next stop okay. Well thank you and and I understand I if we can handle it on a case by case basis and not have to make a formal complaint that's what we want to do I'm not trying to get a hospital in trouble I'm not trying to get a doctor's office in trouble you know it's cetera it let's let's kind of communicated talk and some people don't know so I I I just want to say thank you but just kind of big picture things I know one of the hospitals said that if a person has covid there is absolutely no way that we will ever allow visitation or support person to be there and and I went I don't think that was the intent of the law and and they were interpreting part of it to say I think it's on page six for a is that the person has signs and symptoms of a transmissible infection and that actually refers to the to the visitor not necessarily the patient because I do know that there are hospitals that are allowing if someone has COVID the patient has COVID that they are still trying to work on ways to allow visitation would you at first of all agree with that we'll okay so would you agree you know because there is a difference in the case of but what we would do in that in that situation you know they have they have strict infection control guidelines that they they have to go by in CMS is it you know if we're gonna go in on an immediate jeopardy a lot of them are infection control issues so so we would have to determine what you know are they doing that. You know for everybody or is it are they doing it strictly because of that situation and you know if if if it's a can infection control issue you know we you know our dogs at the health department so we would go to our dogs and say in this situation for this infection control practice or this issue what what would be what you what you would say needs to happen or not happen as the case may be okay but not not a blanketed someone has COVID no if ands or but still never have a visitor is is kind of what we need to paste it on different situations so on the many of the the hospitals are limiting visitation you know what certain hours right now and I understand. That. B. for covid. They didn't have at one o'clock to three o'clock visitation our and I don't I struggle because I try to figure out what what's the difference if someone comes in for fifteen minutes or if they're there twenty four hours they still brought whatever they have with them in and so I have concerns about the hospital still at this point we no longer in the State of Arkansas have a state of emergency anymore why are we still allowing the hospitals or wire the hospital still putting visitation hours a lot of times they need the extra person support bear with them overnight and I don't disagree with that I don't want to sound like a broken record inside and you know different situations call for different things you know on I I you know I understand about the limiting visitation hours I get that you know I'm I'm I nurse by background I I get I get it there's certain things you need to do at certain hours but we also don't want it the limitation of visiting hours to be based on that's just a reason to limit visitation you know something happened everybody limits visitation but I think it also needs to be dependent on the patient you know hospitals are really good even with restricted hours to let people in when a patient actually needs the support of a family member or somebody like that so so we would again. Based on a situation say What was the reason for limiting this visitation on this patient when they're so sick or. There's other needs that could be me at if a family member was there so you know I I don't I don't want to. Answer the question you know just yes they don't need to limit visitation but I do think that we would we would actually talk to hospitals you have a hospital about why you're restricting visitation so much I guess in and I know it sounds like we we talk to our hospitals but we really do we have you know we try to to talk to our hospitals about things in the hospital association about working issues out and not use the regulations until we absolutely have to come down heavy handed it on a hospital you know if we can work it out on the front end and and work it out through the hospital association to work it out for a you know a lot of hospitals at the same time then that's what we wanted to E. I'm sorry follow up when when more and probably went too long again long winded to sorry. I guess I'm stressing there's there's two different ways of looking at it and I think the intense when we passed this was that we would lean towards everybody can have a support person with them at all times. And then in certain circumstances we might need to limit limit the visitation. And I think it's been interpreted kind of way on the other side that it's been interpreted okay we're gonna limit visitation because of covid and in certain circumstances will allow visitors to come in and it's we we need to continue to push the bar and push that way because even when you go to the websites of the hospitals and doctors offices they're still stating the old information that you can't have a visitor there and that's actually part of the law to is that they are supposed to give clear direction on their website and to the patients as to what they're visitation policies are and those have not been updated on many of the the websites well and so we can you know we sent something out to all the hospitals in the association you know when that when the act an. Became effective and so we can actually send something else out again and just say you know please thank about what this act says and with the intent of the act is and where we are with COVID right now thank you thank you. Representative Payton you're recognized for a question. Thank you Mr so the act the bill dealt with the patients rights to have somebody there. And part of what you've been talking about is is how you interpret the language of the bill and in your hand out it's it's exact languages in the bill but it's on page three your hand out for deals with this restrict asset access of visitors and representative Mayberry touched on this. Our the fourth item there says if a person has signs and symptoms of transmissible infection. Can we agree that the language of the bill when it says a person there is talking about the visitor and not the patient. Because. The paragraph that it's under so as a hospital or an office of health care professional may restrict access access of any person to a patient so the fact that uses the term person there instead of patient. Should be obvious is referring to the visitor and not the patient. I would agree with that yes Sir okay so whether a patient has an infectious disease or not the bill's intent is to clarify that they have a right to have a visitor. Representative I would agree with you I think. There is also further on the bill work talks about you know. I think it's Pitsch. Are you Donna page of the bill or page of your handout will page of the bill okay I think it's Page nine. And we and we discuss this about you know is that is that the patient is that the visitor I think we're. We're interpreted that would be you know as you said the the the person the patient thank you know. And we're gonna try to be as you know careful as well is language also the bill what about using telemedicine telemedicine's utility telecommunications so I think we're trying to balance. Keeping with the intent of the law interpreted Mayberry said you know make sure they do have access to administer you know the the the individual is in that are in the emergency room you know I don't know if they also if they went later into a room and then got visitation rights then I think we're trying to be as careful to can also work with a hospital understanding their needs and and their boots on the ground under stand what they're having to go through the time and and the knowledge they have the patient so I think it's we agree with you but I think it's more of a just trying to make sure we give a little flexibility there's well the hospital. Well I think clarification is more important than flexibility at this point a year ago today my mother died without anybody in the room with her while she was conscious. Because the hospital. Was wait until the last minute the letter visitor in. And I remember my dad had a very infectious disease eight or ten years ago we had going to visiting we put on protective gear and things he got well got out the hospital and had several good years after that but I mean there are means of putting protective gear on the visitors and we're far enough into this COVID thing where we have PP available this is not a shortage like it was in the first few months so I think even if the patient has an infectious disease and they're laying their suffering they should have the right and I think the bill tried to clarify that they had a right. To have a visitor and not lay there alone. Of when they're struggling so bad if it means it we used PP to make sure the visitors are safe and that they don't transmitted out that's fine but I think we really need to push these hospitals to recognize that our intent and we can go further if we need to because you have the bill started out a little more clear and it got changed before got passed if we have to go back revisit it is going is gonna be abundantly clear that they have a right to a visitor. At and I would agree with you when I see this will represent a memory before I understand we understand her intent and we have stressed that the hospitals will We have a good relations with most hospitals most of them when they understand we're coming across as with with the intent of the law is what we're trying to impart to them they usually get that pretty quick so I I would agree with you okay thank you thank you Mr. Senator Davis you're recognized for a question. Women. Thank you Mr chair sorry about that and I was curious if you guys just wait until complaints are filed and on the hospital visitation policies or and if possible send them in to you and say you were sure that everyone had apparated there visitation policies as I've gone on to some websites of hospitals here in the state and they have not updated since maybe February or before and so none of their visitation policies are. Legal and so I just wondered like are you just waiting for people to call in the complaint are you is there any accountability there that you check to make sure every hospital have their policies when we go out and actually do those on site inspections Senator Davis we will look at those we've also we're also trying to make it a point if we go out on any other kind of complaint that we are looking at those visitation policies but as far as them send and visitation policies into us you know routinely we we haven't asked for that no. And would that be possible that you know work with maybe the hospital association or something and have every like just they don't even have to update frequently but just since the passage of this bill that they all send in there and policies of that we're sure that it follows that the intent of this bill is that possible I think we could. Again encouraging remind them of what the bill says I mean a lot of that lot of their policies are through their by laws of the hospitals will and so that their medical staff has to approve those so that's part of the process but I think we can definitely remind them worked at hostile so station to encourage them to update those policies most the complaints though relate representative Mayberry said are called in R. Smith online have online portal they can submit complaints through I've gotten some text messages from her and others that you know we just turned down we take phone calls as well staff you know goes into that and started investigation so but as far as the policies yeah I think we can work with hospitals and hospices stations to make sure that they are aware of what the intent of the act is in our interpretation of it and to go out that way. So what you're saying is it's not possible for you to ask the hospitals to send them in to you guys I mean I think we could ask for it I think. That's going to be I'm speaking with is we labor intensive and make sure they all match as far as I don't know that it would be a cookie cutter type policy for each hospital in each you know hospice facility so I think that would be the. The issue there but we can definitely. You know pass on that this needs to be you know injured you know amended to match the act and make sure they're aware of the act yeah I think that would be helpful just for the ones that haven't updated since March that you would know right away they have not updated and so they're not in compliance with the law and or maybe they be delayed in getting them to you realizing that they had not yet updated to be in compliance with the law I think that would and at least be a step in the right direction we can it will work on that with the. Vice chairman so you're recognized for a question. Right thank you so much. how much leeway does a state have when there's a contagious disease in an accredited hospital. Of in CMS is. I would think dictating some of the policies. And we've always been told that to us a federal law supersedes state law so happy you reconcile that and is that part of the problem. Or so federal law would supersede the state law if it's more strict so on but you know we. We've got a lot of leeway Senator Bledsoe in going into into the facilities on you know now if it's a an accredited hospital where more limited there because we do have a state law that also recognizes on Dame status for hospitals in so even for inspections we only go into five percent of accredited hospitals to do a survey you so so we are we are somewhat limited but we can go in on a complaint at at any at any point. So a CMS is not dictating visitation policy when when a patient has a highly contagious disease they are you know what they're pointing us back to is you know they're looking at CDC of course and whatever CDC says but they're also looking at true infection control and do you know that they have been very adamant with us that infection control procedures is what we need to look at not necessarily Strictly what CDC says about visitation if that makes sense yes so so that's why I go back to representative Mayberry and say you know we would consult with our infectious disease physicians and are infectious you know experts infection as experts and ask you know how in this situation what should what should be the answer you know so all right thank you so much. Representative Alan you're recognized for a question. Thank you thank you Mr chairman can we go back to this section part I think representative Payton I ask the question you said that this section Was related to the visitor and not the patient is that correct. So. You CDC does say if if the I think if they have any symptoms if the patient has any symptoms of sars B. two or whatever then they are you should restrict visitation so. You know I think that We still you know representative Payton made a of a good point about you know there is P. P. E. R. senator garner who whoever said you know we have patients with infectious diseases at times that you still you know if your visitor you counting the love and do all that stuff and you can go in and see that patient so I would think that even you know in certain situations and you know representative may very put in her in her bill or her act that you know compassionate care you should still be able to go in and see patients with you know with those symptoms so. I think there are situations where even a patient with. With an infectious disease a visitor could still go in may that in here right thing I think you. Read the Payton said that if it applied to the to the person in that the patient. The disease itself if a person if a individual have an infection not the patient am I correct. At. I don't I think if it. If the person is going in and they're physically sick you know symptomatic. The they're not visible to say in this sick. Chariman section so my I guess my question is what mechanism will we use to determine if the visitor is sick I'm not saying you can't I mean the only thing we could do if a patient is visibility I mean a visitor is visibly sick with and you know is symptomatic then you could talk about limitations but if just you know I walked in and I wanted to visit my person in the hospital your you don't know. Whether I'm COVID positive or not. You've answered my question thank you I'm glad. Senator Hammer you're recognized. Thank you Mr is it not the health department that holds and accredits hospitals no Sir that's an outside accrediting organization the most familiar would be joint commission for accreditation of healthcare organizations Jaco so your whole no authority over the hospitals as far as accreditation correct not accreditation now all right and what is the worst case scenario that could happen. If the hospital does not follow CMS guidelines as has been discussed here today with Dave withhold funding with a. Could it can they pull their credit ation if yes not CMS who's doing the accreditation or what would be the results of. You know we kind of forced ourself into it a little bit more okay so let's just say that it was an accredited hospital and they had what a possible and immediate jeopardy complaint and CMS said yes we agree you go into that US the state agency go into that accredited facility in two days and so we go in there we find that that complaint is substantiated so there's there's two remedies if they if they remove you most the time they're gonna remove whatever that immediate jeopardy is before we ever leave the facility again so what happens then is they would be on what's called a ninety day termination I would be out of compliance with certain conditions of participation so they would be put on a ninety day termination possibly within forty five days will they have to send us a plan a correction within ten days we outline with the deficiencies are they'd say how they're going to correct it and we go back again within forty five days forty five be in half and ninety let's just say they haven't corrected it. They then have to submit a nother plan a correction and CMS then has to direct us they have to look at that plan a correction and say you go back in there on the seventy fifth day. If that if we go back in on the seventy fifth day they still have not corrected it at ninety days they will pull their Medicare certify their Medicare providers so they can no longer bill Medicare if they can't bill Medicare Medicaid they also can't bill Medicaid so that basically is how they that's their remedy thank you they pulled their ability to bill Medicare Medicaid. Right now all the hospitals are in compliance with CMS with the policies that are in place so we're not under any current threat of that happening is or when it when they are fit put on forty five day termination date. They consider that very serious they know that they don't want they want to be in compliance on that first follow up visit they don't wanna have to bank on that second one we don't have a hospital's on. I'm. Senator Hester I don't know the answer to that I'd I would I don't know. All right seeing no further questions thank you for your report. Members I had a question about the handout in getting electronically Mr price informed me that any handouts that are handed out during the meeting will be posted on the webpage. So that will be available to you anything that's handed out during the meeting that's not on the web page now. All right so we're gonna move on to item S.. so if the department Human Services would come forward. And this one is the Division of county operations so if you would introduce yourself and. Expert and who you represent. Thank you Mr Clark what organisms Services. Mary Franklin the Department of Human Services division of county operations you're recognized to represent your rule thank you Mr chairman if I may I want to give some level of exploitation background that will apply to the first six items on these rules items F. three K. I saw not repeating myself each time to make clear these are related in which comes plan that for you of last year when the pandemic began DO you just had to make a number of adjustments to operations and to requirements for beneficiaries as a result the pandemic both to accommodate some of the changes that had to be done to help reduce the spread of of of the virus no social distancing things like that would also to reflect temporary changes that the federal government made in its rules and regulations around the programs that we administer and so making these changes in meant that DHS had to spend a number of our promulgated rules under the authority of the governors a merge declaration last year. So earlier this year after some conversations with some several legislators with the governor we started the process to take those rule suspensions and incorporate them into a promulgated rule and we did that so that continuation of those flexibilities I would not be dependent on the continuation of the state public health emergency I'm because does it has things that affects eligibility but also has things that affect providers and we didn't want to be in position where we're having to pull the rug out from under providers on a on a very short notice just because the state public health emergency ended we want to provide some time and with a runway for providers to build adapt and changes they needed to. So we we put all this together into one proposed rule we proposed it as an emergency rule which the exact subcommittee heard back in March and they gave approval to it at that time and as we told the subcommittee that we would bring it back as a permanent rule because there were a number of items that we expected to run through the end of this calendar year and as you know an emergency rule cannot last more than her twenty days so work this is a permanent promulgated rule I understand that for all the provisions in it it has specific dates by which you will in for most of the myth that these are things that will end either at the end of this year or will end when the federal public health emergency ants and that's declarations made by the US department health and Human Services. Now who we brought to the subcommittee one thing they did ask that it was that when we bring this back to you as a permanent rule that rather than have a single manual that we split it up into the individual pieces of one for each division so that's why you have six agenda items there's one for each each division and the one for telemedicine and that just makes a little easier digestion understand as we're going through this. and as I said the pieces that come back to the changes made by the federal government in their requirements most of those things will expire with the end of the federal public health emergency and as senator Bledsoe mentioned the beginning the meeting we're gonna come back to you next month and talk through some of the process for what that will look like when that public health emergency ends. We don't know for certain when the federal government will end the federal public health emergency we know continues at least through July our expectation is they will out go through December that's our our best guess at this point of how long that will go. so with that said starting with autumn if this is the section of the code response manual for a division accounting operations the phone number did loosened some requirements around keeping eligibility for Medicaid for snap which is this possible interest assistance program and also for tea which is transitional employment assistance the largest issue there is that the federal government is giving us an enhanced match rate on Medicaid but the cost of that is that they requiring us to keep Medicaid beneficiaries on the rolls even if those beneficiaries become an eligible the only way we can remove someone at this point for Medicaid is if they die or they move out of state or they ask us to be removed from the program and so that's these changes here those implement those temporary federal requirements and as I said most of those will expire at the end of the federal public health emergency and then there are a few other just related items around the applications process for those programs Medicaid snap and T. R. analisis recognizing thing to add I will be happy to answer questions on the side. Any questions from committee. Seeing none this rule stand review. So we'll move on to items Jean. Thanks chair and Ottoman G. this is the section of the whole response spaniel for our division of provider services and quality assurance this only has to items in it one is a suspension of pre screening requirements for nursing homes it just makes it easier for nursing homes to get residents in the facility and get them started as clients and that is something that we plan to continue until December thirty first of this year the other item relates to a loosening of the time requirements around therapeutic communities this a behavioral health services for individuals who need to be in a or residential setting the law more intensive work and we've reduced the requirements permanently and another rule for a similar type of rider and so for thirty thirty communities we're doing the same thing here as a temporary measure during the pandemic you know that I'll be happy to answer questions. Any questions from committee. Seeing none without objection this rule stand as reviewed. Item H.. Thank you Mr chairman item age this is the section of the code response manual for the Division medical services and this is the the main Medicaid section a separate telemedicine telemedicine is little later and we'll we'll discuss that when we get to it. This has several provisions related to one adopting the pandemic so for example we suspended some of the requirements around submission of fingerprints for providers who are enrolling in the program to give them some time because when the pandemic began there is some difficulty in getting fingerprints taken because a lot of places that we did that were not open to the public at that time we also have suspension of in process months in that we allow in some cases assessments to be to come by telephone instead of in person to accommodate a beneficiary is not being comfortable having outsiders inside their home. There are several changes related to hospitals including allowing the use of swing beds by critical access hospital hospitals a swing that is one where the hospital can use that bad as either for acute nursing care or for skilled nursing care. Excuse me. Others provision related to the review and renewal of personal care service plans and this relates back to the fact that we do have to keep beneficiaries on Medicaid if they become that an eligible is that allows us to extend their service plans to maintain their eligibility during this federal public health emergency. There are a number provisions related to treatment and testing specifically related for covid subsample this is where it will allow for payment for use of the monoclonal antibodies which is a when the Midwest effective treatments for COVID as well as exempting COVID testing from our normal limitations on lab cost. And then also allowing for a I code screening and diagnostic testing at mobile clinics so that doctors and providers to get paid for that servicing was outside of their normal clinic operation. And with that be happy to answer questions. Any questions from committee. Seeing none without objection this rule stand as review. The item I. Thank you Mr chairman this is the section of the pro response manual for our division of aging adult and behavioral health services and this has language around the first part is around our Medicaid waiver programs our choices which is our waiver program that serves the elderly and adults with physical disabilities and also living choices which service or provides assisted living services again for the elderly or for adults with physical disabilities and this is I'd mentioned us related region earlier we're so we're spending some of the requirements around assessment and around the annual service plans recognizing that for assessment something folks unless there were people coming in their home right now and also the service plans because we do have to keep some individuals on the program I temporarily until the federal change that we can remove them. In the last section allows for acute crisis units to keep individuals in treatment for longer periods of time this accommodation we made early on recognizing that because the pandemic image it may affect how to process units manage individuals and this includes for example are cross stabilization units run state and so this exempts the limit of ninety six hours on keeping an individual in that queue crosses unit. You know that we have to answer questions. The questions from committee. Seeing none without objection this rule stand has reviewed item J.. Thank you Mr chairman this this section of the cover spots manual for the division of developmental disability services this has we made some provisions related to adult to develop all day treatment and early intervention day treatment facilities these are facilities that they serve the billing disabled but they're clinic based locations where to rituals come to it and and when the pandemic began course it wasn't an option for individuals to come to this Congress settings so we made some allowances for those facilities revised the there for you the other things they do at home to the beneficiaries so they didn't have to come to a Congress setting to receive those services also allowed for some extensions on re evaluations and treatment treatment prescriptions for therapy. and we also allowed for pain DD providers for well checks where they were we're paying them to actually check on folks insurer welfare because they may be at home much more they would have been for the pandemic and so as to make sure that someone is keeping tabs on those clients and making sure they have the things they need to survive. Will that be happy to answer any questions. Any questions from committee. Seeing none without objection this rule stand as reviewed. Item K.. Thank you Mr chairman this is the final section of the code response manual this is the sectional telemedicine when the pandemic again we really opened up the availability of telemedicine for a number of our Medicaid providers and this continues those flexibilities for providers through the end of this year and I'll tell you we saying aye dependent progressed we've really seen the value of telemedicine as have our providers and we recognize that that's an important tool in the toolbox needs to be more widely available so we're working on some other permit promulgation changes that should adopt most if not all of these on a permanent basis this extended through December thirty one as we work through that process but will be clear that we don't expect most of these in December thirty one we expect that we'll have rules in place before the end of the year to make those telemedicine changes permanent. Any questions from committee. Seeing none without objection this rule stand as review. Item L.. Thank you Mr chairman this is unknown code I mean what we'll miss frankness ourselves only her first any questions on this one. You would please introduce yourself and he represents. Mary Franklin Department of Human Services division of county operations may proceed. I thank Mr in this is another one that it started as an emergency rule that was approved by these acts of committee during the session what this rule does is it allows for Medicaid coverage for adult members of the Marshallese population that's the practical result of it what happened is that December in Congress passed a bill president trump signed that allows for Medicaid coverage for citizens of the compacts of free association and this includes citizens from the federated states of Micronesia Republican Marshall Islands and the Republic of Palau members of this discussion from earlier these are areas where back in the fifties and sixties the US conducted extensive nuclear testing cause great damage those areas and as record recommends for that the citizens those nations were granted free access to the United States but some years ago through I think was probably an oversight Congress prohibited Medicaid coverage for these individuals and that creative spirit because other immigrants in some cases can be eligible typically is after after a waiting period for the can be eligible so and what the bill to Congress passed they allowed for Medicaid covers speaks banded to those adult members of the Marshallese population and this just makes that permanent well that would answer questions. Any questions from committee. Seeing none. Without objection this rule will stand as review. Okay moving on item M.. Five all have missed Pittman join me on this one Mr chairman. If you would please introduce yourself and who you represent. Yes good afternoon my name's Elizabeth Pittman and I am the director for the Division of Medical Services at DHS you may proceed. At yesterday were bringing the a rule for medication assisted treatment I'm as you know we brought a rule to you last year in the fall of of twenty nineteen to add medication assisted treatment to the Arkansas state plan that is treatment for individuals with opioid use disorder that allows if physician in consultation with the therapists to provide a comprehensive treatment that includes therapy use of medications to assist not treatment lab work and all of that And CMS came back with some procedural requirements where we had added to certain pages of the state plan we had put it in the wrong place basically so this comes back and fixes that that issue and puts it in the correct location of the state plan does not make any changes to the coverage of medication assisted treatment. Mr financed one procedural note on this one this one is pending for approval by CMS or nearly we we try to get the approval for the rules finalized and we tend to do that here we expect to receive approval probably this week hopefully by next week at the latest but if we don't have service provider time this comes to Legislative Council we will hold off filing this is a final rule into we receive CMS approval. We do have one question Senator Hammer you're recognized. Thank you Mr all four but what I find your part of what I hear is not all the providers. You know subscribe to this approach to treatment are you doing anything to educate the providers that would actually be utilizing this tool in order to help get people off addictions or what are you doing so we have done some education we rode a healthcare journal article that was sent out to all providers regarding what we're doing around medication assisted treatment we of course you are standard notices to providers that the services are now available and we've worked with behavioral health and that and the people that do that drug addiction treatment programs over there to try to make sure that this program is known it will continue those efforts is there any reason to believe that other methods of treatment which may be more costly. Would be used over this one which may be less costly as far as a reason why providers would not subscribe to using this is first option first treatment choice we have not within that specifically our in depth and. To to know whether or not other things are more costly would be used and I know that we are looking at substance abuse treatment across the board as a Medicaid program and working with our division of behavioral health to try to make sure that we're covering it appropriately for our clients and but we have to look specifically at which treatments are utilized in if it's a cost based issue an order okay thank you. Thank you Mr. All right seeing no further questions without objection this would rule will stand as review. Okay moving on to item in. You would please introduce yourself and who you represent the church again division of Human Services. You may proceed thank Mister chairman this final rule this is the renewal of the living choices this is assisted living Medicaid waiver admissions earlier this is our waiver that allows us to provide assisted living services to the elderly and also to adults with physical disabilities we made some changes to the waiver from the way it is structured now we modified organizationally how the waivers administered within DHS and so have more involvement for division County operations around eligibility for the waiver we did not adjust the requirements for eligibility is still the same standard for eligibility we just adjusted how we process that internally we also made some modifications to the appeals process. To ensure that when individuals appeal adverse decision under the waiver they can continue to research receive services while that appeal is pending and then also modified language around rates around service plans. Substantively we don't expect beneficiaries to see extensive changes to how to receive service of the waiver we think will be better for beneficiaries will be more simple process I in terms of how they are renewed each year for the waiver and that includes that will not necessarily have to have an assessment every year they will be this bar nurses on a regular basis and of our nurses see a change condition than that would trigger an assessment just to see that individual's needs have increased decreased or what's happened but for most of our clients they tend to remain relatively stable in this or its is gradual decline and so for those individuals we didn't think it was necessary to have them go through an assessment every year and so we're reducing the frequency of those assessments. Any questions from committee. Seeing none without objection this rule will stand as as reviewed thank you members thanks chairman thank you. All right we're gonna move on to item a little department of health if you would come forward. Please introduce yourself and who you represent. Thank you Mr chair members of the committee on large you and general counsel for the department of health. I'm Rick may have been with the department of health. Tree pollen the environment help wrenched you for health or. You're recognized to present your rule thank you Mr chair we're here today to first present exhibit which is the twenty eighteen Arkansas plumbing code we're updating the code from the twenty two thousand and six version and we provided a summary of all of the changes and we had a public hearing on November eighteenth of twenty twenty we receive no public comments there were a few clarification questions from the bureau of legislative research attorneys and we have answered those there is no financial impact to this and we do have a statutory authority to promulgate this rule under title seventeen and I have the subject matter expert here to answer any questions. Are there any questions from committee. See none without objection this rule will stand. As reviewed. Will move on to item P.. So you are recognized to present that rule thank you Mr chair members of the committee again This is the Arkansas fuel gas code and this is been updated to the twenty eighteen version from the two thousand and six version similarly we provided a summary of the changes that were made we had a public hearing on November eighteenth there were no public comments there's no financial impact and we have the statutory authority to promulgate this rule under title seventeen and we're happy to take any questions. Are there any questions from committee. Seeing none without objection this rule will stand as review thank you. Okay committee Under other business we do have two items that we need to address during this meeting. We have to interim study proposals that were bills that were passed during the session and these two proposals have designated timelines that we have to meet one of those is that we need to review these ISPs or discuss some during before June the twenty. So this is the last meeting that we will have before June twentieth. what I want to do is just present these to you and maybe we'll consider sending them to a subcommittee for further discussion want to clarify that we're not approving these is I. S. P.'s we're just discussing them and hopefully you sending them to a group that can discuss them in more detail. Representative Wardlaw did you have a question I have a motion at the proper time all right thank you. Well let me just go over briefly the to bills that are in the ISPs of the first one is an act to create a study on the commercial application of existing technology to reclaim and repurpose spent nuclear fuel rods and for other purposes. and again we have deadlines to meet the first one is that we need to discuss it before the twentieth so. Representative Wardlaw you're recognized. I guess I got a question okay maybe Stafford you Mr chairman do we not just as committee give you and not senator Bledsoe the power to move these to subcommittees that you see fit and so the motion would be to give you the power to move the center proper subcommittee. Yes we can do that and I appreciate that motion. Their second on the motion that I have a second any discussion on the motion. Representative Hammer you're recognized for discussion thank you thank you Mr chairman the only thing I would point out on that is we do have some history in the last year where interim study proposals have not been referred out of this committee which basically terminated them at this point so the only thing I would express as a concern is that not all interstate proposals maybe want to be heard by all members and we do have that right to terminate it in this committee at this level so once we do this we are relinquishing the power to the chairs which by pass the whole committee process should one come before said may we don't want to let go I would just put that out there so I'm not sure I'll be voting for the motion on the basis of that because we do have that experience in the media pastors Mr not dressed up. Representative Wardlaw you're recognized this is only for the power of referring needs to the subcommittee anything is held or any business done by said such subcommittee would have to come back to the Committee is a report so at that point the issue senator Hammer to bring it up could be brought by the whole committee the only thing we're given the chair the power to do is to send it on to the subcommittee for. For hearing. Senator I mean representative Wardlaw with the clarification so it's only for these two ISPs. I would say it's for any for the for the inner for all ISPs early in. Any further discussion. Seeing none all in favor signify by saying aye. All opposed nay. You guys have a motion carried so for these two I. S. P.'s the one that I mentioned let me give you the title of the other one so they're by knows which one we're talking about this is a H. B. sixteen eighty nine an act to create the Arkansas Legislative study on mental and behavioral health and other purposes so. Yes the act number on that bill H. B. sixteen eighty nine ACT number is eight oh two. The other bill the nuclear rods bill H. B. eighteen ninety an act ten ninety two. So what I want to do with H. B. eighteen ninety this is the nuclear rod bill is to send that to the labor and environmental per permanent subcommittee. to review and discuss. the house chair of the committee is represented Penzo the Senate members and chairs have not been name but they will be this week. so we'll send that to that subcommittee and I would ask that subcommittee to review this bill and not set up schedules and have some meetings on that our regular meetings will be at one o'clock the first Monday of every month if you'll recall the last session subcommittees met that morning and that's just a suggestion shares can call those meetings at any time they referred to but that way we could meet and talk about the on subcommittees and then meet in the afternoon with the full committee. So With no objection I would send that to the labor and environmental permanent subcommittee. The other ISP. Of the one concerning the study on mental and behavioral health I would send that to the Health services permanent subcommittee the House chair is represented Pilkington and again the Senate chair will be name this week. So those are the two references on those bills and these particular I. S. P.'s we are required to meet at least every two months to discuss these bills we can meet more often the subcommittee can be more often but we have to meet at least every two months. So any questions on that. Senator Hammer you're recognized thank you Mr chair which the discretion that you as chairs have now to send directly to subcommittees what's the chair's intent of notifying us as the full committee body of when you're going to send them or we just going to have to you know find it on the website or see it appointed to the committee or would you give us report each month of which where you send the inter study proposals to which committees. They will be on the website if the Committee prefers we could send notification other than the website there there will be reports from the chairs of the subcommittees at the regular committee each time they meet. So that would be a follow up on that and the meetings will be posted on the webpage our thank you. Right any other questions. Seeing none we have no further business we are Journ.