Public Health, Welfare and Labor Committee - Senate

DO sure so for the record please Sir. Thank you madam chair committee of Robert Griffin Independence County judge testified on behalf of my constituents and myself personally all right thank you. Senator you're recognized thank you ma'am chair Collins says Senate concurrent resolution eleven deals with the. A spouse the agreements internationally for life saving treatments and drugs this comes to me personally of course and judge Griffen will testify more on to that point but we hear about big pharma all the time I know if you were to mention it to our federal delegation they talk about it a lot to as far as influences and things but here lately we've seen that you know. With COVID pandemic we've seen medications that were fast tracked that were Houston utilized for lifesaving treatments this simply would encourage our congressmen to also look at international reciprocity agreements where drugs have been tested tried and are being used in Europe or other countries with life processes as we have here in the United States to allow those Americans who need those life saving treatments to also access them here in the United States I know most of these resolutions we do may be futile but we have to start somewhere and so to me this was like I said important to a county judge Griffin as well as myself and saw I'll let him say a few words. You're recognized thank Senator thank your. The importance of this to me personally. Is that I have metastasized prostate cancer. And in dealing with it I went to Mayo and was recommended for looked at the one seventy seven which exist all over Europe Argentina and other places but on doing studies here through the FDA so in this December of nineteen my journey needing treatment began. I was in Los Angeles at UCLA Medical clinic for a scan that would indicate whether received appropriate treatment when the world shut down in March of twenty twenty. So we have had no access to go to Europe I'm fortunate I had a business life and capability to afford to go to Europe but a lot of people don't have that so in this we have a right to try in America but we don't have a right to access and right to access is what makes a right to try valuable so I want to use president trump. When there is no issue a for the monoclonal cocktail until president trump got covid they happen to have that available because it have been approved in Europe is being used in Europe with success but it was a month and a half after president trump received that that the U. A. came in if the eight so I reciprocal agreement with modern nations of which we have an agreement of accepting medication from each one and they accepting hours provides a pathway to does not include a multi thousand mile trip every five to six weeks so this is a life saving things it is bipartisan it has nothing to do with any demographic except each person in this state and in this station could benefit I appreciate the opportunity and I appreciate a good vote. A committee do you have questions. All right of seeing no questions but does anyone in the audience want to speak for or against. Seeing none what is the pleasure of the Committee I have a motion to pass I have a second all those in favor say aye all those opposed congratulations you have passed of. Alright ladies and gentlemen let's go on down to the H. B. eleven ninety nine someone someone running this for. A. This representative. All right seeing none no one here for that all right to S. B. nineteen is someone running that for Senator Clark. On down SP three forty seven percent to Clark. Seeing no one I do see Senator Tucker is here do you want to wait to are you you ready okay if you're ready. And this is Senate bill four seventy seven. So you're not running this one all right of. Then we will go to SP five five ten. Is that Senator Senator Leding here. All right. All right the Senate bill five twenty. Senator Hester. Yes. Wait just a minute in ladies and gentleman in the audience today of we have put all the bills that had been sent to the health committee on the agenda before this we S. the senators or representatives to get in touch with us to me is the chair and then Mister Mister price is the committee analyst and would then we would put them on the agenda but now because we're very close to the end of the session of we just put the ones that have already been sent to the public health health committee on the agenda if the senators or house members show up in fund we're going hear them if they don't maybe they'll come tomorrow so that's why we're skipping so many of these bills. HM yes okay so the. All right going on down. We're passing over Senate bill five ninety eight of right and I don't see Senator Leding in the audience. A SP six eleven senator Wallace. Okay this one is deferred. All right Senator Rapert seven Senate bill six one seven. When you're settled in introduce yourself you're recognized thank you madam chair if it pleases your like to have that John Vinson when the pharmacist sociais Asian please yes that would be good I think I need to clamp from a mac down here to. you set my can your right something's wrong. The man down. I could set up a little straighter. You wouldn't to do she says thank you very much Senator Rapert district thirty five Jason Rapert. Thank you madam chair members the committee John Vinson headed for the CEO of the Arkansas pharmacists association thank. You're recognized thank you ma'am ma'am S. B. six seventeen members this is a bill and you know over the last few years we've done things in our state to try our best to make sure that consumers are protected And we've had an issue that we're dealing with and state frankly it's been dealt with around the country if you ever had the experience you know how difficult frustrating it is when you go to the pharmacy and attempt to have a a prescription filled and find out that somehow your company your insurance company or the PBM has put you on a different prescription program and then you're in a situation where you can't get a feel with that I want to tell you some parameters of this bill SB six seventeen is a consumer protection as a consumer protection piece of legislation that promotes enhanced health privacy prevents misuse of medical records or health claims data for soliciting pharmacy services for patients it also ensures disclosure of conflicts of interest and freedom of choice for patients that are seeking pharmacy services due to vertical integration allowed by the Federal Trade Commission in recent years for pharmacy benefit managers retail pharmacies mail order pharmacies health plans healthcare payers medical clinics wholesalers and others and healthcare and the pharmaceutical industry there are health privacy risks conflicts of interest self dealing patient staring in misuse of data and health records risk for consumers by vertically integrated health care entities that's basically they've allowed many of these particular entities I've mentioned basically a form together in many cases they buying some of those practices and then they begin to try to steer patients to those different outlets these conflicts of interest and misuse of patient claims that and health records can result in delayed care interference of patient freedom of choice confusion for people when they're at just as a said trying to get their prescriptions filled. And also violations of patient health privacy what right do they do have to have they to market your personal information especially your prescription out the entities that you are not dealing with personally in fact Arkansas legislative audit recently identified conflicts of interest for pharmacy benefit managers and their ownership and affiliations with large for profit mail order and retail pharmacies that are often not disclosed to health plans for patients if the report is not been released yet but you're soon going to have a report before you this going to outlined several areas that were found in the audit that was completed during last year that is being reviewed now believe by the insurance department S. B. six seventeen regulates licensed pharmacies their employees and the affiliated companies that of ownership of the pharmacy permit that allows them to provide pharmacist services in the state of Arkansas the language defines prohibited practices for seeking new prescriptions refill authorization of existing prescriptions or transfer of existing prescriptions from prescribers or other pharmacies without a proper pharmacist patient relationship disclosure of conflicts of interest is also included and proper patient consent the language also prohibits data mining and misuse of patient medical records clinic notes and health claims data for billing data to solicit pharmacy services for patients who does not request such services madam chair if you please you I'd like for Mr mention to bring some real life examples for the committee's consideration okay let me just intrude for just a minute get to have a an amendment that's true you're exactly right and so less it's a This led to explain the amendment it's very simple and then we'll get back and we'll vote on it they will get back to you as members what you have is a simple minute amendment and I believe that strikes just simple structure hospital out of this bill in that Code section I don't have the amendment front of me but it it's pretty easy to see there were extraction I'll be happy for that a member to be adopted ma'am all right any questions from the committee on the amendment seeing none what do I have a motion or a motion second all those in favor say aye all those opposed amendment has been adopted and you have really explained your bill service of. If you wanted to make some comments and give us some examples would love to hear that thank you senator Bledsoe just a couple of real world examples where patient has an established pharmacy that they utilize and Little Rock or even when in Arkansas and they go to the pharmacy to to refill their medication to find out that their medication refill rejects and the prescription has been filled at a mail order pharmacy it has not maybe not of been shipped yet but they feel that and build it and it it creates a distraction and delays care and the patient has never used that pharmacy before they've never authorize them to fill the prescription and they use some kind of a backdoor loophole and sending a request to their physician often times we think on some of the more expensive medications that require prior authorization we think that they're misusing that prior authorization process to basically trick a physician or a nurse in the Senate a request or prescription to their mail order pharmacy that the patient never intended to go there so those are just some of the real life examples we I'd never seen this prior to about a year ago and it's really picked up during the pandemic and I just think it's deceptive and it's harmful the state board of pharmacy's received dozens of patient complaints that they don't feel like they have really an authority to do much about it without the statute and with that I'll answer questions I had any questions for either either gentleman at the end of the table. All right seeing no questions from the committee does anyone in the audience want to speak for or against this bill. All right seeing none had to close for your bill I appreciate a good vote all right to a I have a motion from the Committee I have a motion to pass to have a second all right all those in favor say aye all those opposed congratulations you passed your bill thank you committee of all right listen the. It is is anyone here to of. President house bill fourteen sixty five I don't see representative Dotson. All right. Going on down House Bill sixteen twelve. Representative Cozart. All rent house bill sixteen eighty seven Pinza representative Penzo. House bill seventeen sixty senator Johnson. House Bill eighteen ten. All right. House Bill eighteen ten and of Senator Davis when you're settled we would love to hear that bill. All right you're recognized in would you please introduce yourself for the record yes and Breanne Davis state Senate district sixteen. Yes Geoffroy's I work for the manufacture of the medical device in question biggest regeneration all right thank you you're recognized senator thank you and this bill will just establish device reimbursement rates for and Vegas nurse nurse Malaysian therapy devices and equal to under percent of the cost of the device and secretary fees already listed in the Arkansas Medicaid program and all that and explain a little more and take any questions the committee may have. All right. Yes yes I said I represent the medical device the other was amendment that show that that would that would change that from a hundred percent device cost to Medicare reimbursement just wanted to let you know that so it's less than that but basically for eighteen years in this role I've been working with the state trying to get are actually working with the providers first and then also the state to try to see if we can get separate reimbursement for the device itself currently right now there's no separate reimbursement at acute care facilities per se the reimbursement for the devices about three hundred sixty three dollars to every acute facility except for UAMS and children's and it's it causes an access to care issues the patient the patients that are that have this device or for our severe patients there severe seizure patients and they they don't travel well and this device is actually used for the patients that are not cured with medications so they end up in a position where they can't get care and then they can't travel so and that's because pretty much every hospital in the state to shut down including like the last one was to shut down was Baptist and they said they'd never had to shut down a procedure before and they said that they would wait for Medicaid reimbursement to change before they would open back up again no I did you say that that this bill has been amended. Yes it's it is engrossed already all right if you have line thirty three on page one can see. Okay. All righty. Of you have questions Committee. Have any questions. All right seeing none does anyone in the audience want to speak for or against all right of. Mark if you go for please. But if you can introduce yourselves for the record please. Thank you senator Clark one twenty was services at Janet van the director of medical services for DHS you're recognized thank you madam chair I just want to have a bring the committee's attentions more concerns around this bill our concerns is not so much on the direct effects the bill is is is of some of the unintended consequences and couple things one is this does set a precedent for other similar types of devices right now we do not cover these types of plans will devices in the way this bill prescribes and so even though made it for this one device this potentially sets a precedent for other devices well secondly I think more importantly in looking at how to address this. At the elk mismanagement correct me biz I understand I think the only what we found is that it will require us to do a state plan amendment see Mr have to prove in this part of that you would necessarily open up for CMS review our entire system of reimbursement for hospitals including the access tax and the access payments that we make to hospitals and that's a concern for us because that system has been in place for several years and was yes I wanna say it's been at least twenty years COS approved that system in the years since then CMS has taken a much more tougher look at those types of things and we're just concerned that if they start looking through that they may start challenges and things in there not to say we think if there's anything illegal in it is just they are taking a much more strict view of those issues now and so as I said it this morning not so much what the bill is trying to achieve recognized was trying to be done it's just those unintended consequences that are concerned and I'll defer to ms manage his initial comments it's been I don't have any additional comment I can answer questions all right. I have okay Senator Hammer you're recognized for a question. A committee chair and I don't know if this is been said to you in a forgot but Arkansas's lost Mississippi's gain you're going home is that what I understand yes Sir it is next Friday is my last day okay with Arkansas the other person thank you then real credit to the department and we appreciate which sent thank you on a on the question no art whenever they come in to audit you or whenever they do audits do they not do or are they not subject to be able to do what you're concerned about whenever they conduct their annual audits go through their auditing procedures to where they might find some of the things already that you're concerned about. It we do have an annual audit that alate conducts on behalf of CMS and that is on our expenditures and our revenues it's not necessarily with our state plan but they do look for compliance and in our payment then we in addition to that we do send our inpatient or outpatient supplemental payments you PL demonstration is is what it's called to CMS every year for review now certain certain reviews have caused us to have to pay money back because of the weight was calculated D. me would be a great example we came before you all last year with an emergency rule to lower some specific rates because of the U. PL demonstration that we were paying over Medicare are concerned with this particular bill is not necessarily the specifics of the vagus nerve stimulator it is I've just opening that up we don't know what what what could occur that is our concern and so while inpatient reimbursement methodology is set at the per diem an outpatient is set at different levels of surgery. We use the access payments to help the hospitals in the state. To be to get obtain more payment for those services at the end of every year and so while it is true with the gentleman said about the three hundred sixty five dollars per procedure. They do have the opportunity to obtain more reimbursement for that through the supplement payment I don't we have not one of the things we were asked for in a previous committee meeting with to go look for another way to be able to do this we haven't found one yet we've looked if we will open up outpatient and inpatient reimbursement that are concerned that's a long winded answer have a question do you know another stage where they've done this have. Have they gone in and reviewed their amendment and had any negative consequences as a result of what's being proposed here that's been done another state to maybe the sponsor can answer that if you don't know or the gentleman that gave testimony thanks I'm not familiar with another state that has changed the reimbursement methodology for a specific device I have seen other states go into their inpatient and outpatient rehab reimbursement methodology to do a study to look at it I believe two or three years ago Arkansas did one on a P. R. D. R. G.'s for inpatient APCs is a similar term for outpatient I've seen it done for the entire class I've not seen it done for an individual device thank you Mr. All right any other questions all right Senator Sullivan. Yeah I think we just passed a bill yesterday about that allowing LCSW is or one of those acronyms and we for years we heard we don't know what I'll do we don't know what we'll do our default position is not. And here we have testimony where they're saying it will improve and the I'm hearing that testimony from DHS that you're just not sure what it will do is that correct. You have a concern well I think it would be I think clinically it I mean the vagus nerve stimulator has we have pre authorized we authorized twenty five of them last year so we are covering the service so clinically I don't think it's a discussion yes it will help the patients that that need it I think it's the reimbursement methodology that causes the concern but you don't have any evidence that the that is going to happen next I don't but I've never yeah thank you. All right any other questions. All right seeing none thank you very much thank you does anyone in the audience want to speak for or against this bill. All right. Senator are you close for your bill or would you like to close. Yes thank you and I just want to say that because of the low Medicaid reimbursement rates people aren't receiving the care that they need and those who were able to receive this and device and we saw a decrease by ninety nine percent ER visits a decreasing hospitalizations by seventy percent and and a decreased inpatient days in the hospital bias and sixty seven percent so this helps with and quality of care quality of life and reducing significantly medical costs for our state with that I'm close and move do pass all right. Excuse me. Okay we have a motion and a second all those in favor say aye. All those opposed. All right congratulations you have passed your bill. Alright ladies and gentleman I would ask that we suspend the rules for Senator Clarke Tucker he has house bill fourteen thirty nine do I have a motion all right to have a second all right all those in favor say aye all those opposed. All right we have the first suspended the rules you may proceed introduce yourself please for the record thank you madam chair members Senator Clarke Tucker Senate district thirty two this is a bill is an excellent excellent bill brought by representative Pilkington got caught up in the procedural mechanisms of the legislature little bit was on the floor today Senator Hammer moved to re refer it back to committee we have been working on an amendment for the bill and so we're I just want to add the amendment to the bill and and hopefully pass it back out with your approval should I present the bill or the amend madam chair shall wait for a vote on the motion. Her job vote your vote on the motion already okay okay so the volunteer healthcare act is a is a piece of legislation in the General Assembly passed two years ago excellent piece of legislation that allows medical professionals to to volunteer to help those in need and for every eight hours a volunteer they get one hour of CME credit what this bill does. It just adds a few folks to the list of people who qualify for the volunteer healthcare act It simply adds therapists addiction specialists and counselors and the Amendment as myself as the Senate sponsor and also a dental assistant to the list and then we want to be careful we we learned that so the Department has also authorized some other folks to do this and we want to be careful that by passing this legislation we're not excluding anybody else of the amendment also adds language to say that someone can qualify for the volunteer healthcare act if their healthcare professional is licensed certified or registered under subtitles three of title seventeen of the Arkansas Code so that's that's what the amendment does. We have a motion to adopt all right I have a second all those in favor say aye of those opposed to all right you're most your amendment has been adopted and do you have anything to add to your bill I think that release summed it up but I'm sure so I'll be close for the bills while all right what about have we had questions I was distracted I think we need some questions. Anyone. All right I think you're getting off pretty easy yes ma'am. Okay does anyone in the audience want to speak for or against this bill. All right seeing none. Of what's the pleasure of the Committee do pass as amended all right second all those in favor say aye. All those opposed congratulations you've passed your bill thank you senator thank you members. Okay we're going back to It's house bill sixteen eighty seven senator. Ian Davis is going to run that force and then. We're going to get to Senator hammers Health. You're recognized thank you madam chair and I am writing this bill for a representative Penzo and there are people here to speak to the bill so I'm just gonna let then explain it to save a little bit of time all right. Yes. If you introduce yourself for the record and senator if you would pull that microphone up a little closer. At the microphone up a little closer working that's good thanks good thank you thank you good afternoon centers my name is Casey Castleberry a lawyer from Bates full I'm here on behalf of genesis partners in support of H. B. sixteen eighty seven this bill applies to skilled home health care services and it would allow the license holder of a skilled home healthcare license to provide services anywhere within the state so long as the provider has a physical location within a hundred miles of the location at which they are providing the services this makes the skilled the rules for skilled licensees the same and consistent with the rules for the non skill licensees and we would ask for your support because we believe it's in the best interest of the citizens it increases competition and would provide for greater access to health care and home health care services throughout the state. All right Do you think that this might over extend some of the bed sin that type of thing. Are you getting are you the getting rid of. prior approval and all of that what we are we're not getting rid of prior approval this would only apply to existing license holders and and so it would not to minimize the care anyway we believe what it primarily does it breaks down arbitrary boundaries that sometimes prevent a home healthcare provider from being able to provide services the the way the current rules are structured you can only provide services within a fifty mile radius of your license location and what I can sometimes do is put in a position where someone's just past that fifty mile radius in need of services and they can't find someone to provide those. All right senator Hammer recognized for a question the Committee chair and I'm I'm certainly not opposed to the concept what I'm wondering though is I used to work for hospice and home health and a lot of hospices have home health agencies as well and so natural progression is a move from home health if they need to into hospice and but not including hospice in this you might have a situation where like a. The hospital my on a home health and they get ready to transition to hospice of the ruby limited and have to turn that patient over to another hospice because I think hospice is a fifty mile radius to isn't I do not know the rules with respect to hospice that's not of of a consideration that we have that's been discussed so apologize for not knowing the answer to that question but but respectfully would feel like this bill helps to ameliorate a problem with respect to to home health if in another bill would be necessary to address that same problem as to hospice then that would certainly be something that they could be considered. Okay is it afterwards and thank you thank manager all right any other questions. All right seeing none this anyone in the audience want to speak for or against the bill. All right if you come forward please so you speak for or against. Okay. All right if you would introduce yourself for the record. We're on right. Thank you Mr chairman hi my name's Charlie Martin the executive director of the home care association of Arkansas. And. The. What hasn't been discussed is the permit approval sealing process which does has that structure of the fifty mile radius and the home care association of Arkansas has long been a proponent of the permit approval sale in process we approach it with it's approached with patient care in mind its approach with efficiency in mind it's Prost with the ability to provide enough home care and an area in mind and that's why the rules are structured in such where they are by the healthcare certain permit agency and watch while they're forced by the Arkansas department of health and we feel that this you know while it may not do away with the permit approval C. O. in it certainly has an effect on it and uh we've had there been reviews where that has been determined and I believe that is so and so anyway that's so we uh as a industry The association opposes this bill obviously it was not unanimous within our association we have good put good members who are for this bill and that's just the way it goes sometimes in an association but apart the preponderance of home health agencies that provide skilled home care care in a in and in the state that is the position of the association and has been for after. All right any questions okay Senator Hammer you're recognized the committee chair and I'm asking because I'm just trying get my mind around why the association would be opposed to this unless some of the lower agencies may be afraid they're gonna get gobbled up by the bigger ones because I don't know why there's even a limit if you are a provider that can meet the needs because if I remember right a couple sessions ago Arkansas even got out of the. That may not be the same thing but what why would you be opposed to drop in the barrier to work in the free market to where the quality. Might improve if the competition became greater instead of being limited by fifty miles well senator Hammer some things are not you know free market is not a you know I'm all for free markets as individual but free markets in home healthcare where they're thirty five states that have permit approval rules in place and. In and I have and that protect that and have that structure the some states have dropped on health in the past and cheers later they got they put it back in place because the free market did take over and all the sudden boom there was a ton of age agencies that showed up all over the place cause some problems for the healthcare industry led to some problems I'm not saying that this agency support and this bill would do that they're good agency but it does open up some potential problems for the for the industry down the road. And the ones in your. Association that were for what was their rationale for being for they went through the permit approval process they are Class a home health agencies that do Medicare Medicaid and those are typically the ones that you will see that provides support this bill the ones that were against it was for the reasons you stated well out there again they're good agencies I have you know they're good people pan so um I have no. The other reasons why they want to expand. Thank you thank venture any other questions from the committee. All right. Thank you so much Mister Martin for your testimony thank you does anyone want to speak for this bill. Does anyone want to speak against this bill. All right seeing none of. Senator heavy clothes for your bill. I'm close madam chair mission do pass all right we have a motion to pass him this second all those in favor say aye. All those opposed. Right you have passed your bill. All right ladies and gentleman we're going to suspend the rules for Senator hammer Senate bill six forty so may I have a motion to suspend the rules. I have a motion to have a second all those in favor say aye all those opposed all right of a Senator Hammer. We're ready to hear it of Senate bill six forty is being passed out as a speak. Do you have an amendment yes ma'am I do. Okay. I'll take I'll take a motion to adopt the amendment motion motion do I have a second okay all those in favor say aye all those opposed to all right if you would explain your bill as amended thank you ma'am chair of all the all heard the debate on the floor today there's a little bit of concern about the possibility of this going on into perpetuity and so with the amendment it just brings a little bit more clarity that there is basically a sunset on this that if the of the bill that is of concern at the national level go through that this would actually have an end date on it so as not to extend it from two to five years permanently and that's pretty much what the amendment does just try to bring a little bit of clarity to it for everyone of the members on the members expressed concern. All right members you earn explanation on the amendment and questions. All right the question is will make sure we are was at the moment this price for the bill. Without the okay we did not imminent yes okay. Members or any questions by members of the committee. All right centers anybody was press one to speak for against this. Okay. All right members of Senator Hammer read as close for your bill I'm close Mr Preciado good vote and I would make a motion do pass as amended all right members are gonna motion do pass as amended gonna second second all in favor. I suppose regular centre Hammer bill passes thank you. All right. Will be an issue. We she wishes. We got somebody to run house bill eighteen twenty eight. Senator Wallace. Sir Davis C. please be quiet and pay attention. Share depreciate that. All right they're also introduce yourself you're recognized to see what the bill. State senator Dave Wallace district twenty two. Members this a House bill is an agency bill gives the HHS ability to update and cleaned up eligibility rules for a long term care nursing facilities without a statutory change the current statues that we have follow rules from two thousand thirteen and those rules Required forms to be facts and they don't allow for email or electronic submission there's no known opposition to this bill. All right members you for an explanation of the bill or any questions by members committee. I see no questions is anyone saw sign to speak for or against. No all right Sir once you're recognized to close your bill I'm closed all right members some walls close for building a motion motion by Senator Gilmore second. Second by Senator Davis all in favor. Opposed resolution senator. All right moving on we got house bill eighteen sixty two. Representative Johnson Dr Johnson. We all know you are doctor but if you go ahead and recognize your soften tells you off for the record thank you Mr chair representative Lee Johnson District seventy five you're recognized perceive your bill so House Bill eighteen sixty two this is this is on this which is eighteen sixty two or seventy six to eighteen sixty two okay I'm sorry at this bill changes the requirement for Medicaid PCP referrals for behavioral health currently there is a current requirements three primary care referrals that's three visits before you you have to have a primary care for all and now we're seeing that from three visits to ten business the main reason for that is you know it takes a little time with these behavioral health services to to to clarify the need for that also renew small schools right now after three visits the federal services have to see these P. PCP referral sometimes they're not timely getting those back and so this just remove some of those barriers to paper all services we worked on this with DHS they're here and happy to visit if we need to this is a good negotiated bill between them in the paper health community and I think it's a good bill that as can improve care in our state. All right members to put an explanation of the building any questions Senator Hammer you're recognized or. Thank you Mr and The representative Johnson thank you issue that we just cleared the bill off the floor to date that actually expanded to include family therapist and license practice counselors so are they gonna be picked up as far as being able to be able to say yes yes absolutely and Medicaid will pay for that four to ten business before required PCP referral correct. And so it without a PCP referral give me an illustration of how you expect this to be used in real life out there is is going to be for some of the urgent care situations or what or or a person even just voluntarily called to seek services you know or they could be referred by an emergency department to seek services anyway they connect with the baby off provider provider be able to see them bill for fee for service Medicaid currently that happens up to three visits and then they have to leave the PCP and this gives them a little more flexibility to see up to ten business that point white white ten how do you grow arrive at ten It negotiation you originally when they talked about looking at this legislation you know a lot when they first put in referrals they they had started at with twelve we then they ended up with three we came back to tennis assistant gestation process and this is what digestive Council within in was a significant expansion of a current state or thank you right. anymore questions for all right scene I don't see anybody speak signed up to speak for against so with that represent Johnson you're recognized close your bill I'll close my bill thank you all right members represent jobs close for the bill motion by Senator Davis. A second. Seven by Senator Hammer all in favor. Opposed commercialise represent Johnsonville passes. And I think next up we've got to Senator Hester can run eighteen seventy five. Thank you senator Flippo members It's bills a branch of the houses just known as the actor to earn while you learn and think that the key to this is. On page two we see here. On page two starting out wine alarm fifteen fifty United States federal government has definitions under apprenticeships and if it if it is defined by the federal government as an apprenticeship program there's a federal government principal Graham basically then the state of Arkansas primary rules where you can work while you earn that license and can be paid so we already have some this week center construction because they already do this so like for instance if I'm working to be a plumber electrician I'm actually I'm I'm a journeyman and I'm working or to punish and apprentice I can get paid to go to school at night one or two nights a week so it's very similar to that but this is basically offering it for anything else that the federal government deems they have they have an apprenticeship program with. So I was a little bit rough but it's pretty simple bill. Happy to answer any questions all right any questions from the committee. Seeing none. Does anyone in the audience want to speak for or against this bill. Yes ma'am come forward into this yourself for the record do you speak for or against. Yes. Use against against I guess all right. All right I apologize up my name is Lee and Warner and I'm a massage therapist and I'm representing massage therapist and my friends you're not able to be here today I am not a politician nor my lawyer and I have not had the opportunity to meet you so nice to meet you and I will begin by saying I am not opposed to this bill in and of itself I was actually not aware of this bill we have been working against another bill H. B. fourteen forty that will be coming that targets massage therapy in general in this was brought to my attention last night in as far as an apprenticeship goes I have a husband that's in the trades I have several clients that work in the trades I understand there is a shortage in many areas that we're needing to get people to work in the apprenticeship offers another way to get people into work into these positions quicker with that being said. I don't see where massage therapy is a viable word apprenticeship is something that should be included in this if you look on the bill page three on line thirty six there is an exemption in this bill issue that says that this does not apply to a license issued by the state board of Barker examiners or the Department of Health regarding cosmetology those two areas were left you know we're amended I'm assuming it to not be included so I went back and watched the testimony given by barbers in cosmetologist recently and many times over and over again they testified. We touch people it's important that we do not have this apprenticeship and we continue with our training because what we do is we're laying hands on people all day long. I'm a massage therapist we touch people we touch people from the ages of birth to the time of passing in hospice our education is a five hundred hour program that when we include clinicals as part of our training where we touch the general public but we must have already have had one hundred hours of technical hands on training before we are ever allowed to touch the general public in a clinical setting when we are in clinical sit there is an instructor that's with us at our side and we also give informed consent to the general public to know that someone is working on them and providing them care that does not have experience there is always somebody that is the first. Amazon's therapy there's always going to be that person that is going to be the first person we lay hands on. That person could be your child you can be yourself it can be your mother it can be a family member in a situation where it's currently set up we are pretty you are protecting your family members are protected because we have an educator there beside us to guide us in apprentice situation it can allow for scenario that someone that has had no experience other than they're beginning their first day of training to walk into a situation and start laying hands on the general public although although already before I came here today I saw for clients this morning two of them were receiving chemotherapy. One is one recovering from an auto accident that was ejected forty feet from the card has a number of medical plans is in their body and the fourth was a fourteen year old who's going through therapy right now to hand handle bullying and stress and anxiety. It takes training you never know what's on your table. We can get all the education that we can we have to take a hundred and seventy five hours of anatomy physiology kinesiology path ology and country indications before we can ever lay hands on someone. And while I agree that apprenticeship can be a viable route I actually think it can be a good thing in companionship with the program that's already in place in the State of Arkansas that standing alone I am not asking that this bill not pass because I think it is a viable option for other professions I am asking that we be given the same consideration as barbers and cosmetologists because we to touch people we touch people ways most most much different from barbers and cosmetology and I think that and I see some smiles down there and so I think we are the same consideration in protecting for the general public I guess I number asking for an amendment to include us in this exemption. Thank you so much appreciate your testimony. Thank you thank you. I'm glad to answer any questions you might have would you have any questions committee. I really think of that it's up to the The senator or representative they have ownership of the bill and so we will certainly tell us will make sure that they know that you would like an amendment but to. We will hear from a. Senator Hester in just a minute yes Senator Hammer thank you measure did you ask for an amendment on the house side is this your first time to testify this is my first time I apologize and we we were not aware that there is another bill taking place that targets massage therapy specifically and this basically was not on our radar and it was only pointed out to me yesterday so I'm aware we missed it on the house side but it's too important to not address them to come forward and if I'm not following rule of order I I apologize but yes it's too important to let go right we will go ahead after the go ahead I just going to ask the other bills that you posed was for what I know which I just try to get the road you know what the bill the other bill that we have been watching this H. B. fourteen forty of it in what that bill is attempting to create a new path to becoming a licensed massage therapist in the state of Arkansas it is proposing that we eliminate schools altogether in that you can take your academic side which are the science courses how on Law I am outlined on an online course in the end study under a master massage therapist or massage therapy instructor in the clinic or spa setting and we are opposed to that that is well it is another path to try and eliminate schools. Thank you. All right. Thank you very much for your testimony thank you. All right is anyone in the audience want to speak for the bill. All right seeing none senator you closing for your bill I am thank you members I think she just brought up some very good points for a little bit more clarification I should probably giving you whenever I first president of the bill but what this says once this passes whatever board or commission oversees you in this case to be department health they will promulgate rules for the apprenticeship program so day one you're not going to be touching human credit may say that you're gonna spend I don't know whatever whatever the massage therapist come up with with the Department health to be the rules maybe set up machines maybe they learn how to clean clean rooms properly there's maybe they'll learn how to intake patients me there's a lot of things that that that you do in their job before your you know actually touching touching a patient and so um this is a very responsible thing as we hear all the time everyone wants exempted from every billable what we're looking for is not a faster way for somebody to to get a license we're looking for someone that maybe doesn't have the financial means to someone else that they have the ability to work while they learn that's what this is about they're gonna get the same amount of hours just going to work with the department of health OR whatever departments overseeing them to promulgate the rules for an apprenticeship program. And with that I'd appreciate a good vote I make a motion to pass. Committee we have a motion on the floor to have a second. All right second all those in favor say aye. All those posts congratulations you passed your bill. All right to a representative Johnson if you wanted to present your house bill seventeen sixty. Just introduce yourself for the record and you're recognized thank you madam chair and committee I appreciate the opportunity to present this bill this is a a reciprocity bills this is a compact license your bill much like we have for nursing that allows multi state reciprocity for our psychologist is a bill is brought to you by the Arkansas psychology association sort of work on this bill sometime late in the fall I spent time with the bride to different parties trying to make sure base comfortable with that because it is a long bill of the cap because of the nature this compact bills you have to to participate in the compact you have to agree to the compact languages so going to make sure we've added as well as we can the one the the two two questions mainly came up was it does this preempt our telehealth Act to clarify that we added spleen which the and to to put in our telepathic they would you better defined that so that was so that it's clear that if someone's participating in this compact from another state they have to abide by our telehealth Act laws and can't supersede that is same thing with the door to the board so just like with the nursing board of ed nurses participating in nursing care with a license under this compact and they're from Vermont they're still subject to the nursing board toward the the same thing would apply here for psychology board this is a bill that says supported labour's Arkansas psychology association and at this point I don't know of any opposition and we have to try to answer the questions on if I can take questions from the committee. Yes go ahead Senator Solomon you went I know we've had some of the other bills come up in other professions that have been some are posed in some are agreed to most of us due to the ability of our state to regulate. The compact terms of the compact so I think I heard you say that just want to confirm that so Arkansas still retains full disciplinary control and licensing control even though we're a member of the compact is that correct that's my understanding based on what I've been told by the terms the bill or okay our thank you. Any other questions. Seeing none we have one person has signed up to speak for this bill and to. I think that's the doctor what he's here with the Arkansas psychologist's Education thank yous mainly here to answer any questions or a detailed questions okay this show support all right. Any does anyone in the audience want to speak for the bill or against the bill. All right seeing none of heavy clothes for your bill is from bill manager K.. All right you've heard the testimony Committee what is your pleasure motion and then I have a second all those in favor say aye all those suppose congratulations you pass to bill. I going on down the agenda. Senate bill six seventy five. Is anyone here to run that bill. That would be Senator Leding. All right going on just a minute. Contact yeah. With on Passover of Senator Irvin species in the Education Committee she's coming we're texting her right now all right Senate bill six eighty one of Senator Leding. All right Senate bill six fifty Senator Dismang all right. You're recognized senator. Thank you at Madam share this and. Should have an amendment on it we have an amendment. Just a minute. Senator David Davis has it already been engrossed I think so yes all right I was going to be a Committee Amendment so it's already an. Been engrossed and Senator Dismang did exactly what he said he would do and last meeting and capped it and then kept CPI and they're right would you to talk to us about the captain would have the difference and he put it at odds and actually it may have an even come out yet so that thank you. Thanks please introduce yourself for the record. Thank you madam chair members a committee part of the discussion yesterday the Amendment raises the limit to fifty five hundred dollars which I believe by Senator Hester had brought up which which it coincides with the state of Texas and also adds the touches it to and the rate of inflation and I thought and that all the amendment does. All right. So if you say it's already been engrossed. Madam chair I don't know the answer that I apologize right let's look at it just a little while and see if you see that language in the bill and I and I can explain it for you thank. It basically on page two of the original bill it it replaces lines fifteen through eighteen with the new language and and I can read that because it's one sentence the supplemental nutrition assistance program shall double the amount of the asset limit allowable under applicable federal law which is what Arkansas standard is as it existed on January first twenty twenty one. And then the line under that is the adjusted inflation hardcore states the asset limit shall be automatically adjusted for inflation on a biannual basis and if you don't have a number of the committee. I've got a. Well the the the actual limit right now today is twenty two fifty okay for for an individual and that would go up to fifty five hundred okay. Which is consistent you know with one of our sister states Texas and and it just for perspective the state of Louisiana doesn't have a capital. and so that it can states do it differently by this thirty five states that don't have a capital. All right questions Senator Hester when appropriate I'd like to ask DHS a question. so when appropriate I'd like to ask each other questions all right we are getting some copies of the engrossed bill yes ma'am so that will help but senator I think this would be a good time is gonna be a few minutes before we get the engrossed bills so if you don't mind mark if you would come to the table and introduce yourself again for the record of Senator Hester has questions. Thank you senator Clark one twenty Human Services. Okay at thank you Mr Wyatt I've heard a lot of a lot of text and emails and calls on this hearing like we're gonna at thousands and thousands of people snap benefits as many ten thousand like the do you have any thoughts on that. Sure the obvious only changes the asset requires that does not affect the income requirements and I think our experience that's what typically gets most folks is that income limitation so that sent course on a service make it has testified when this is a committee earlier that would be a small number he gave some reasons for that we don't we reason discreet with that we don't have enough data making kind of accurate prediction of what would be but I think on balance we grieve if the if it adds folks have been a small number. All right any other questions ahead Senator Sullivan. And with a small number. I think the number the address that was no more than maybe four percent and something that's in a way I thank you his followers about four percent of the beneficiaries might possibly have some savings that would approach that amount I'm still trying to get to a number. And I and I read for representative for or four percent of fifty thousand or two different different things with with there's got to be a number out there if we know how many people are on it and we know we're expecting a four percent there's got to be a member well it has to be kept costs almost and we're expecting four percent I'm that's that's the number he had thrown out yesterday but as far as a number like that we don't have enough data to give a number so. So it's four percent of how many are on and that I'll do the math. The it may I miss Franklin come up to ensure that. Franklin if you would to introduce yourself for the record. Good afternoon this is merry Franklin on the Director of the Division of County operations for DHS. We have over. Three thousand pulling up my. Chart here. It's taking its time there are over three hundred thousand individuals participating in snap but that equates to over a hundred thousand households so the four percent would be if you were calculating on number of individuals who qualify for snap. it would be on the three hundred thousand number because our number is between three hundred and four hundred thousand right now. I can get you an exact number and my dad is a four percent which they were adding twelve thousand. Okay again that's an individual number that is the number of households is lower so some of those three hundred thousand include children okay yeah our. Thank you madam chair all right any other questions. All right thank you so much appreciate the. The H. is coming to the table in answering some questions. and madam chair have yet I may address that a little a little more and I think what Senator Dismang said on at our last meeting was the national average was four percent and it and that four percent number was at the amount that he was previously requesting service numbers much smaller than that and so I think it's safe to anticipated you know if we just went on national average would be much smaller K. all right does anyone have you finished to questions and everything. No one else has a question. And I think Westerman has one more comment all right thank you madam chair if I may um at little perspective you know my my client and I'm I should introduce myself on and off I did it the hard hot the Terry been with the impact management group and my client of southern Bancorp but but actually I have several clients their support of this bill we see this this issue as a banking issue there are a lot of these families specially single parent families that are that are low to middle low income families that are that are just trying to get ahead and I I want to add a little perspective to it by by telling you that I have first hand experience with this issue my grandparents were on the snap program and when they got too old to take care of themselves I moved on to Bryant from Helena Arkansas and when they have my grandfather had a tool box in the bottom is to a boxy at ten thousand dollars cash and I ask him Is aye so why why are you doing this sign is a is just kind of dangerous and he said because I can't put it in the bank because your grandmother will lose or stat benefits. And it my grandfather's one of the most honest people that you'll ever meet your life I'm As salt of the earth and you know from my grandfather to operate that way or to bank himself that way was quite a statement in and of itself and so when southern Bancorp brought this issue to me and I said is this something that we can work on you know I kind of jumped at the chance to take on the issue I knew is a tough issue I know it's a tough issue because of some of the accountability concerns and look for those that are abusing the system this bill is not gonna solve that problem okay and we're not pretending to solve that problem. And and maybe even from my grandfather it wouldn't solve his problem because he was in his seventies and and he just took a little bit at a time over a decade probably to save that amount of money but for single parent that's trying to get off of the program and wants a chance and wants a chance to be banked you know what my clients other Bancorp. Wants to bank them wants to help them get off of the program and. You know that the the bill is also sponsored by the bankers association obviously but you know state chamber of commerce and retail grocers because we see this as as a way of the corporate community or the business community actively participating as a partner with the state to to try to do what the in true intent of the limit was to begin with and that's that's to. Get people off the rolls and and we see this is a valuable opportunity for us to do that and we think that we can generate the data that we can come back to you and show you that this program worked and all we're asking for is the chance to do that. So thank you madam chair all right any any other comments or questions from the committee. All right seen none does anyone in the audience want to speak for or against this bill. All right if you want to come forward and introduce yourself for the record. Jamie Baker. Barker skis me. Not the first time and chairman the last. Jamie Barker I representing the opportunity solutions project I spoke on this bill I was brought up last time we still have the belief that at the end of the day wall again we believe the intention is good to have a ton of respect presenter Davis just like I have to respect Senator Dismang this is going to expand welfare in Arkansas to start on some the numbers there mentioned went wild I was have the ability to be on my phone and to look at the numbers I most recent I could find it so I looked them up actually on the center on budget and policy priorities which is a left leaning think tank and it's actually extremely liberal they said that Arkansas had three and fifty five thousand participants on the snap program as of roughly one year ago and so even at that four percent number which we feel is conservative that's about fourteen thousand people they'll become newly eligible for the snap program which equates to about fifteen million dollars a year in New taxpayer money going to expand will for Arkansas and so that's important and I know Texas is mentioned as having and are you know semi equitable cap so just going out with other surrounding states do Kansas Missouri Mississippi and Tennessee all have stronger asset tests in Arkansas if this bill were to pass Texas does have one that's roughly fifty five hundred number I'm I'm not sure exactly what that number is and despite having lower rates of poverty in taxes they do have a more a larger per capita population on the food stamp program so there's plenty of evidence in Texas that if you expand the cap you expand the rate of people on food stamps I'm in Arkansas there's another issue with it which is the fact that it continually adjust for inflation which dictates basically and the in interferes with legislatures ability to prevent that without action and so without that it will continue to expand welfare in Arkansas on food stamps in Arkansas every year based on inflation and another point just to make is fifty five hundred is dollars a lot of money so I just I did it forty five dollars that's more than six months of rent for a one bedroom apartment Little Rock that's nearly ten months of child care for one kid that's more than a year's tuition for workforce education Arkansas tech this is a whole lot of money we are allowing people. To accrue in cash assets which again with respect to the banks if I was a bank I would of course love more people bill put more money in my bank would have to spend it when they're putting money under a mattress to avoid cash asset tests that is welfare fraud encouraging people who are committing welfare fraud to come into compliance is an extremely problematic precedent to set especially when it expands that taxpayer resources going towards as people using welfare and so with that I think that pretty much covers most of the things I want to cover but I'll take questions if they are all right Senator Hammer thank you I just try to make sure on that four percent it's a apple apple comparison because you cited three hundred fifty thousand but if I'm not mistaken somebody said something about the number of households in my my confusion on that are we we need to deal with a number households or we need to deal with the number of participants which which one is. Households. The participants of the March children you know so I think it's per household okay so Jamie do you know what the number is of households based on that data you cited logo so again if you reference back taxes they have about a five percent larger population per capita regardless at this act at this cap level despite eight a different demographic any generally lower rate of poverty historically and and currently in Arkansas does so we we actually think the four percent extremely low which is why she's using that number but even even if you use it on at just the household so even at a hundred thousand so let you know that roughly because if I third we still have five million dollars a year in expansion of taxpayer resources going to fund where for welfare programs in Arkansas and I get the state tax dollars federal dollars are we talking federal dollars run state general revenue. They they are primarily federal dollars yes but again those federal tax dollars taxpayers are Kansas just like there they are anywhere else in your program yeah I've just wondered because I wanna make sure as far as our state is concerned in what they've submitted for their budget if this bill was allowed or covered in that in your budget. Okay all right thank you all right any other questions sing none thank you for your testimony thank you. All right senator. Am I want to make one more clarification I think the number is five thousand seventy dollars and not fifty five hundred and and I just want to close by saying you know we debate this at length in committee last time and at that time Senator Dismang and said he would make these amendments if the committee would be good with this bill and and I recall everyone and for the most part it green and that that make them comfortable with this bill and so that's what we're doing bringing back the bill and amended and in the exact way that Senator Dismang said he would do for a committee to pass this out and and with that and I'm close for this bill except I guess I don't know if we it is engrossed so motion do pass all right to vote for the motion I have a second. All those in favor say aye. All those opposed. All right you have passed your bill congratulations all right Senator Irvin. I believe you have to bills on the agenda Senate bill six sixty three and then. Of. Senate bill six seventy seven which one would you like to run for seventy six sixty three first however Okay so Senate bill six AC three is we actually I'm gonna work with the department of health we've got to make this more inclusive and so there was some confusion about the amendments that we were going to put this on to the US to get it to where it's more inclusive And I did not get any of that information so you had I'm I'm not of the Department health that others I don't have the amendment or the language yet so. I'm not sure if I want to go ahead and get it in the process and then concur because I'm not sure what our time frame is going to be. That's. At. Let me let me pass over it and let me get Jordan and them to let me let me go to six sixty seven first or six seventy seven first. And in the meantime we'll get a plan together on making sure that our language gets here for six sixty three all right the Committee instance Senate bill six seventy seven. Okay. Recognized yes so we worked with the Department of Human Services on this legislation and what this does is helps we have we have churches that are operating in some of the space and so we're just changing that one line right there on page one line twenty seven page one provide services to clients for periods of four hours or less per day no more than two days per week because we do have some facilities or at church in this manner it's a church that is actually operating two days a week instead of one day a week and so they wanted to do that without having to go through the licensure process DHS works with us on that bill on this. All answer any questions any questions from the committee all right senator Hammer thank you after just. We're helping the church were not hurt the church or yes for help in the church. One of thank you yeah help in the search right any other questions as. All right seeing none is anyone in the audience want to speak for against the bill. I don't see any so had to close for your bill yes I appreciate a good vote all right ladies and gentleman I have a motion from the Committee. Motion I have a second. Second all those in favor say aye all those opposed congratulations you passed your bill thank you and members of the committee I'm going to go ahead and ask and just present six six three and just tell you a little bit about this so and then what I'm gonna do is I am actually going to amend it and if you pass the bill out of this committee will amended over in the house and and then just try to bring it back over here for concurrence because I I think that's probably the fastest thing today so what this bill does I want to. Go back to the pandemic can go back to win everything was heading and what was happening and things are rapidly changing at the federal level as well as the state level department of health is doing I think the best they could to keep up with everything that was happening and so um this program became available at the federal level three CMS with a hospital without walls program which creates the opportunity for temporary hospital facilities but it also gave some lead way and that's what the amendment is also going to address it's going to give some lead way to some of the hospitals and outpatient services and different types of things like that and to allow them to continue to do what they're doing with the flexibility and the relaxation of some of those hospital rules and regulations that are part of the licensure at the department of health so and what this does is allows the department of health and this program to track at the federal level just to avoid confusion on that licensing issue that you get into when you've got it approved at the federal level but it also needs to kind of have the stamp of approval does at the state level so you know we there is just and I think sometimes you know we time is of the essence it was back then when we needed to increase our capacity for hospital beds and utilization for patient care and so that's what this bill does and at and I'm gonna work with the department of health to actually make this more inclusive for everybody that's covers because we did or issue some executive orders from the governor on the sayings and so if that's okay with the department of health we'll go down that path and that the governor's office and get that language that he had in those governors and executive orders and have them reflected in this legislation and I think that will just cause a little bit of the That the delays or confusion that that may occur we're just trying to simplify that so people participate in this all right any questions from the committee Senator Sullivan so you're asking if the path this passive yes and then you'll come back yet the amendment the Department of Health or were giving. This bill is giving the department of health more authority. To make changes no are you ready to make changes no no I mean what this is doing is with the these under the federal a declaration president trump declared that there are certain facilities basically trying to get all hands on deck to meet the needs of the pandemic and to increase bed capacity and increase at care for patients and so when president trump did that he allowed for he directed CMS at the federal level to relax some of the rules and regulations under the hospital licensure in order to create the opportunity for people to participate in the hospital without walls program and which allow them to become temporary hospital facilities so in order to get a hospital license for instance you would have to have an emergency room well some of these folks don't have an emergency room or you would have to have twenty four hour nursing all the time twenty four seven in order to be a hospital well that was relaxed so that you don't have to have that requirement unless you have a patient that staying twenty four seven correct and and then also for some facilities they actually cannot keep a patient for longer than twenty three hours so there had to be some flexibility at the federal level and what we're trying to do is just match the state with the federal when those things get declared so that they're it avoids confusion yeah I guess I'm just I'm I've got problems with what the federal government's doing now. And without and I'm very hesitant to pass anything to vote for anything. Like this without saying the changes that are made. Yes four AM no I understand I mean we can have somebody from the department health talk about their authority but and I'm fine with you asking that question and I'm just hesitant to allow them to have any authority without me voting on it so that's just where I am thank you well I mean I I would also just say you know that these folks are trying to participate in the program that was designated this at the federal level and there there was some. There are some problems actually at the state level Department of Health letting them do that as quickly as they could you know as quickly as we could and so when you're trying to line these things up just to avoid that from happening. All right thank you senator Hammer recommend chair of a couple things first of all procedurally. With the Saudi here you make those members on the house and it's going to have to come back by us to concur ration will get another look at it we will be back through okay and then the second thing is. If we do what you're asking us to do. Would it not actually. Potentially keep the federal government out of our business because we were already set this up so that it this should never happen again we will have to be depend on the federal government tell us what to do or not do because we've got this in place yes yes I mean that that's that's why the people that are supporting this you know they just they want one set of of guidance and so that we can kind of go down this path and and they then they can step up as quickly as they can to answer the call if needed okay and if because I was reading this as far as like the Ambulatory surgical centers that's part of what this is intended to do is open it up that's why they may not be licensed correct function as a hospital in times of Medicaid and is this going to be depend upon the governor issuing a statewide disaster declaration or the public health department issuing health directives or what's going to trigger this will just be standing protocol once we vote on the CMS so this is sick when CMS designated this then they were allowed to do this at that when CMS that you can you can we need you to apply our this is now open to you it's it's up to CMS non Department of Health can come and talk about it is not a sufficient present that but the yeah I can't see that you can come up. but when this is really a designated program by CMS and so what we're just saying aye. You know instead of. Figure out what to do here and to do here can we just Mursi's thing together so we know exactly what we're trying to do here so we can encourage these people to step up and fill the need and I think. You can talk about. What we're trying to do to make it more inclusive because there's hospitals that are participating in this program in a different way then the ambulatory surgery centers are and that's what the amendment would do would be to help them keep doing what they're doing okay. All right did you have something you'd like to add yes I think once Matt Gilmore partner helping with Senator Irvin is trying to do is allow for the facilities at a function as a hospital during the pandemic when CMS issues a their word to allow entities to do that it would just automatically it would give us a lot more flexibility automatically happen and state level the fall the CMS guidance or guidelines. All right any questions for Mr Matthew Gilmour. All right seeing none all right. Any other questions all right thing And does anyone in the audience going to speak for or against this bill. Seeing none what's the pleasure thank you any clothes for your bill. Yes I just also want to say that one of the individuals that stepped up to do this his his brother spent six months and I see you with COVID one day he was running the marathon and the neck and that night he came down with it and he's been and as since November he's been in ICU and I happened to yeah back in the fall for six months he's been on a ventilator and then also at meadow has been transferred to Texas and then back to Arkansas so and I know that there's a great deal of passion behind what drove this individual of what that has one of the A. C. A. S. sees that participated in doing that and so that he wanted to step up and do whatever he could to help patients because of what he personally experience with his brother and continues to struggle at Saint Vincent's to try to survive this so I would just appreciate a good vote to encourage these people to step up and participate in these programs all right. A committee what's your pleasure. I have a motion second all those in favor say aye all those opposed congratulations you pass to bill thank you madam chair members of the committee all right ladies and gentleman is there any other business C. O. okay Senate senator Gardner. What you which of. Which bill are you presenting today's B. six one five six fifteen I believe you have an amendment to run okay got it Amendment okay. No six fifteen. All right senator do you wanna explain your I'm amendment while we're passing them out yes ma'am I think it's it's it's fairly substantial so we cut out two of the requirements of what actually affects the impact port would be if we take out the test negative for corona nineteen or two thousand nineteen or recover from the crown two thousand nineteen buyers we thought is you know if you go to school and you have a positive test that they might require you to show that your negative fourteen come back and there are some concerns from the chamber some other folks that it would go that I don't think that's what I passed me by a faxing passports intent was Singapore is on the last line we cut out employment I before the head of in nearby no the chamber had some heartburn about that I think this gets some to more of a neutral position for this bill and I think the subset of all what this bill would do is this report and we can still get through so that's basically what the amendment does all right to have a motion to adopt the amendment. I have a motion and second all those in favor say aye all those opposed all right you have adopted the amendment and if you would present your bill as amended please thank you madam chairwoman members committee I think one of the most dangerous things that could come out of the COVID nineteen pandemic is the idea that the government can force you to show papers nor do basic services that you're supposed to do every single day the idea of a vaccine passport is catching traction. Gasoline at it by the by administration and some of their positions they've taken the last few weeks what is compelling private business so when they come for the federal government when it comes from the state of Arkansas the idea for you to live your day to day life to show a piece of paper to show that you've been vaccinated is frankly unamerican. It's goes against what we've done in our history for the last two hundred years and it's something that we can't let a backpack a pandemic change the way we live our way of life in French on basic bill of rights protections like the right to privacy that is I have to do what you're going to get a vaccine go to school because of well established vaccination process is happening for a long time this is a new novel pandemic a new novel vaccine while I am not anti Baxter by any means I think there are people out there who have real concerns we've seen that with the recent polls of a certain vaccine because of a very rare kind of blood clotting it happened not a widespread issue by any means but still something that could affect or Kansas okay this is a choice between a person out there so what I want to say I'll publicly is I think everybody should get vaccinated and I'll be doing that the government tells you have to I think that's a consistent position and if this is gonna be mandated from the state from private businesses or anybody else we need to put a stop to it before it gets a foothold because let me tell you if it does it's just going to grow and become worse and worse and worse and I'll be your vaccine passport today it'll be some kind of unification tomorrow it'll be something else next week and at the end of the day it'll be so much information you have to show the existence exciting that it will fundamentally change how we interact and deal with a new way of life madam chairwoman with that we'll take any questions any questions all right sent to him. Do you know the states around in Arkansas that are requiring this no Sir this is such a new kind of concept that I haven't seen legislation I know there's been some movement at the federal government and I have not seen this become more of an issue as far as bills get passed but I can anticipate this becoming more more issue as we move forward and I'm not opposed the idea I'm just thinking what if one of our neighboring stage required to say taxes and some eleven text can work in taxes and Texas says you can't come in unless you've got a card what kind of position is that going to put that person in. Well that person are you talking about working in Texas yeah the resident of Arkansas Texarkana Arkansas but they want to go they work in Texarkana Texas and Texas passes a law that says you have to have it and then we don't have it what is that due to that person I think it does nothing to on because the employment will be in Texas if they have a tap vaccine passport in Texas that person be required to show under Texas law says that's where the employment yes we have nothing to do with Arkansas either for Senator or otherwise that be specifically to Texas law and you know if they have to travel across the across the border down there to do that the employment would be tied to Texas law not Arkansas law in that capacity thank you all right any other questions from the committee Senator Flippo. Thank you madam chair is Senator Garner is the health department support of this bill well I know they had some disagreements with it I think an amendment made them more favorable but I do not know their position I'm sure they'll explain manager if it's okay I'd like to get Matt Gilmore appear well to what let me just called question sure they want to commit all right any other questions all right seeing none does anyone want to speak against the bill and I believe Michu from the health department has signed up to speak against are you are you coming is what gets all right. The it go so introduce yourselves please for the for the record thank you madam chair members of the committee I'm Larson I'm general counsel for the department of health. Matt Gilmore department of health. Thank you the senator we're not supportive of vaccine passports Senator garner share the member with us a little while ago appreciate doing that I think it's it's better I think it services are not fun. And what that would envision with businesses and that is the is are. Question a little bit of concern there you know I think the governor I don't want to put words in my mouth but I think he is made some comments in the past about letting businesses have the freedom to make those decisions for what they require in their business so that's kinda I think are are pointless you might have some more comments you'd like to make an issue. Thank you madam chair and we are just concerned about the fact that there's a lack of definitions in this bill and for any purpose is not defined in section B. it says that the state is prohibited for any purpose that such as that made it also prohibits incentives or rewards of the state obviously is not required this but it does take away local control cities and counties will also be affected as it includes local officials while it took out the word employment it still leaves an education does that include private educators still leaves in the words services that is not defined we don't know what services mean are those public and private services that may affect health sciences schools higher ed the governor's been consistent and what's private businesses to be able to have the the decision and and get the latitude to the private sector many employers do require proof of at at any station especially the healthcare industry and and personnel that are exposed to vulnerable immunocompromised and the elderly and this doesn't allow the employers in those areas to make decisions for those businesses there maybe services that a business may not be able to provide or it may be that a business or health provider needs to know if someone has had the vaccine before treatment can be given so that's another important consideration their standing use that would require this and and and the bottom line is that this sends the wrong message we're trying to encourage accepted the vaccines and lessen the hesitancy at this point for sixty five and up for it sixty sixteen point eight percent partially vaccinated but we are at fifty percent fully vaccinated for sixty five and up at this point as of today for sixteen and older where partially vaccinate about fourteen point eight nine percent but only fully vaccinated twenty four percent of the of the state with regard to the blood clots in the J. and J. obviously that was only six out of six point eight five million doses for the Johnson Johnson vaccine that has been put on pause but that will. I would likely be addressed at a at a future date we just think that this bill sends the wrong message and that businesses should be able to have the decision thank you all right any questions. All right seeing none thank you so much for your testimony. All right we have heard from those who are against is anyone want to speak for. Seeing none are you close for your bill very briefly so I got a text from somebody in my district shall remain anonymous who happens to work under the department of commerce and they said that Secretary Preston is pushing them all make sure they get vaccinated in order to keep employment. Now that's on verify claim from somebody in text message that I trust. But when you say this doesn't happen that's a real example right there something happening per your requirement so something we need to think about expressly want some of the city's start figuring out they can start mandating these kind of things trust governor Hutchinson will not do it but I think once cities pick us some they smell this special we're after session you're going to see some very interesting mandates come down to do that is something we need to address as a legislator that I'm close manager all right you've heard the discussion. those that were against it what is the will of the committee. Do pass a second all those in favor say aye. On this post congratulations you pass to bill. As amended you're right all right ladies and gentleman and less there is someone else in the committee room that wants to run a bill out we are adjourned.