Public Health, Welfare and Labor Committee - Senate

He's getting settled I do have an announcmenet of Mundy we are going to list all the bills that are coming to the committee putting them on the agenda and if you would help me when you see the list on Monday and you have colleagues that. They have bills on the agenda I hope you will remind them to come to the committee and run their bills so it's gonna be a little different Monday might be a longer meeting depending on how many show up so with that Whenever Senator Hammer get settled we will. Sturch. And you're recognized. Thank you ma'am sure six twenty five correct. On six twenty five six twenty five in we have an amendment yes ma'am and while we're getting that passed out can I have those are going to testify for the bill or healthy present the bill come to the table that's yes okay thank you. All right with the ladies and gentleman we have an amendment on six twenty five Senator Hammer would you explain your amendment yes ma'am this is actually in cooperation. Per health right. So I'd I believe it's a amendment to help tweak something. In the bill. I. Okay that's it do I have a motion to adopt the amendment like a motion to all right we have a second all those in favor say aye on those opposed all right you're amendment has been adopted and if you would explain the bill as amended thank you Mr handle that would you have them sorry when you have them up what a introduce yourself for the record please tell us who you are and where you're from. Jerry Parker representing the Arkansas permit cosmetics Institute. Mallory Davis with Arkansas permanent cosmetics Institute all right that microphone might not be on are you may have to bring it closer. Thank you Richard would you like to restate for the please okay. Mallory Davis with Arkansas permanent cosmetics Institute all right thank you know you're recognized thank you ma'am chair the goal is to approve the permanent semi permanent cosmetic industry to make it safer for consumers and to accomplish that we're looking for ways to improve the education of the artist will make sure it plays only permanent semi permanent cosmetics not the entire body art industry this bill is as long as it is because this movie all the bar the arts under cosmetology and about half the bill striking language another half the bills move that language under cosmetology we've changed nothing for other body arch other than where they are located in the statute and man chair to take us down in the weeds could we have Jamie or Mallory take us down the we usually do the one thank you you're recognized maybe. Ballot Mallory Sturch just kind of explain what permits any permit cosmetics are and then I can get into more of what the the Bill action all right. So permanent semi permanent cosmetics is where you and it's like a procedure where you can apply pigment to someone for appareils eyeliner and lipstick some paramedical things such is by we are able to give and like three D. Nikulin aerial lift for breast cancer survivors and people who suffered from radiation and for cancer or whatever we are able to give restore the look of having eyebrows or hair such things like that. So primarily over seeking to do here is like Senator Hammer stead relocate permit cosmetics from underneath the Department health to the underneath the cosmetology board and we're adding a seat to the cosmetology board which will allow the permit cosmetics industry to be represented on that board and the really again the goal of the bill is just to have the industry have more direct input in the rules and rags that affect them as well as a direct input and oversight into weeding out some of the bad actors or people that are are doing this and and I think I talked to most of you your free Google permit botched her permit cosmetics and you'll see that these are pretty serious implications if someone is doing this improperly or not properly educating someone and so by moving them to cosmetology and through some of the of the things the spells out for how people are educated educated in this field we're protecting the consumer which is people that are both getting current cosmetics as well as the consumer who are students of some of you know maybe the schools are people that are supposedly supposed to be teaching people how to do this and maybe not our our may not doing so in a way that allows them to be confident or able to deliver a product to the the end consumer that they can be proud of. All right. Any questions. Okay all right of center to give more. How many other states the new license. This. Fielder secretary whatever however your term so Mallory maybe cancer more specifically on how many states this is actually not creating a new license at all this license exists currently is licensed by the Department health specifically there are four and sort of semi related licenses with this what's permit cosmetics tattooing of piercings as well scarf vacation and so those licenses exist we're just moving license from the board felt to cosmetology for not creating new license but now or you can maybe give more insight into what how many other states might license something like this. So most of the states in the U. S. already have a license for permit costs medics there's very few that you do not have to have a license to perform such procedures. All right any other questions. Of. If you have a physician that is a cosmetic surgeon this does not include someone like that correct. No ma'am this is this is dealing with people who are specifically licensed as permanent cosmetics okay workers. Okay any other questions. All right seeing none of. Right there all right we do have to that were signed that we have three total to sign up signed up to speak for the bill but that issue Jamie and and Mallory so we're going to that portion of our meeting so we'll start first with those who want to speak for and Darren Taylor is the third one so if they're in would come up. Is he in the in the committee room all right if you would like to come up and speak up for the bill. I'm sorry. Okay all right thank you Does anyone want to speak against the bill. All right seeing none of have when you want to close for your bill I think explanation stance for the closing manager and I'll make a motion to pass all right we have a motion to pass to have a second okay as amended yes yes as. I have a second all those in favor say aye. All those opposed congratulations you passed your bill thank you ma'am chair members of the committee. We're going Passover of Senate bill five seventy for few minutes up Senator Solomon is in another committee but he'll be back shortly and so we're going on to house bill seventeen twenty three and I believe I see it up represented Johnson. And if you would to. introduce yourself for the record please thank you madam chair representative Lee Johnson District seventy five. You're recognized thank you to House Bill seventy twenty three is designed to mirror process it's been very successful forcing the trauma system so we have within the trauma systems of the call the preventable mortality committee the committee that looks destined trauma and it's been a great opportunity for us I served on that committee was fortunate to do that for several years before I served in the legislature it was a great way for us to look at data and try to provide feedback to providers and how they can pre care and it's been very successful improving care over time so this bill is designed to allow us to similar data collection process for pre hospital medicine looking mainly at time sensitive emergencies so there's certain things like strokes and heart attacks every time sensitive that also allows us to look at other pre hospital care with regard how the procedures is that the design is set up to mirror the process we haven't promise that we can look at that within the health department there's a committee set up already that looks to be a mess things in this allowed them to look at that data provide feedback to the GM S. services in target areas for improvement within the state all the data can be kept confidential it's all there within that currently house within the department of health and I'd be happy to try to answer the questions if anybody has any are members already you for an explanation of the bill or any questions my number's Committee. All right Sam Nunn there's nobody signed up to speak for or against this representative Johnson are you closing your bill I am Mr all right members represent of Johnson's close to a motion. Second by Senator Hester all in favor. Opposed resolutions represent Johnson your bill passed thank you thank you project. All right ladies and gentleman just moving down the agenda. A. We have a house bill ten sixty three we have an amendment and Senator Hester is going to present that bill but first of. The Amendment to I have a motion to adopt the amendment all right a second all those in favor say aye all those opposed to Senator if you could explain your amendment and then your bill as amended. The chairman but so this is a an amendment that you gave to me so you and and understand more than me but on page five line to it the leads telemedicine provider and substitute with commercial telemedicine provider. So that means something to people not me all right the okay and this is so what you plan to do you're not going to go into the bill and all of that since we already passed the bill or yeah I'll get it a little more specific all right members we sent this down to the house and with the encouragement of House members we we have made some other members that were in gross yesterday or the day before that up that has this bill basically mirror the governors emergency order and then clarifies what health care record is and that it will be up held by a medical provider. so I think I think I'm free to say that this is a more agreeable but not to but not agreed on right would probably be the best way of putting this so it's a more agreeable than the bill that we passed out earlier but certainly not you know I don't I don't think we're gonna see Senator Bledsoe speak for this but anyway I'm happy to answer any questions. All right any questions from the committee. All right seeing none is anyone in the audience want to speak for or against the bill. All right would you like to close. I am close make a motion to pass all right we have a motion as amended we have a motion and we have a second all those in favor say aye. All those opposed thank you have passed your bill. All right ladies and gentleman. House bill seventeen thirty five. All right. To the. Introduce yourself please for the record. May I remove I've asked yes please thank you so much good afternoon madam chair as two members of this committee my name is media right I'm the founder and executive director of Arkansas United we're nonprofit that runs immigrant resource centers across the state. All right thank you all right senator service this clearly we've seen bills that come through the past several years that give give people with legal status the ability to teach school people legal status the ability to be a nurse and this just kind of just says Hey rather than doing this piece of the time we're just going to covered if you have if you have legal status to be United States of America then you that's not gonna be a berry or for you to have an occupational or professional license in the state of Arkansas. All right the D. do you have any questions committee. All right seeing none does anyone in the audience want to speak for or against the bill I think we have a few all right let me see we we have a sign up sheet let me see. Thank you madam chair and if if it at the hooves you I I can share a little bit better about the individuals who did register or an offer potential order for the individual speaking today but first and foremost if if I may offer madam madam senator madam chair our deepest gratitude to Senator Hester and his counterpart to a representative Penzo for bringing this bill add to this committee at my organization up was the one that two years ago works out with your colleague representative Dan Douglas again the strong leadership from northwest Arkansas where I'd also from and and bringing the opportunity for us to bring our documented individuals who have work permits at into the nursing force and I want to be able to highlight that as a result of that action that you all took our data nurses were on the front line of the COVID crisis and as you all know so many of our immigrants were directly impacted early on in the crisis and our data nurses were ones that were able to offer them assistance and offer that critical cultural competency and language access add to at that time we came to us that you all without the teachers this session specifically because of the teacher shortage that we have in Arkansas and especially the shortage that we have a of individuals who are Hispanic and knowing that we have those growing numbers I in our school districts and the impact of that individual's again having that cultural competency and background I can have the schools and again that shortage also being expounded by covid and thankfully I you all have not turned that into law and I could not be more excited and we have individuals who will be here at the capitol in the coming days thinking you all of for that effort but Senator Hester and representative Penzo helped us see that we didn't have to do this piecemeal. Well and we're very grateful for the opportunity to now bring this opportunity to look at other professional licensure and who I I want to be able to introduce to you all madam chair is Jake Walker from the university of central Arkansas he's with the Arkansas research center and specifically can speak to the need and the economic impact that are immigrants I'd could potentially have if you will I choose to give us your support for each B. seventeen thirty five we also have hot air balloon now here who has a deck that himself and inspires to be a civil engineer and if you will pass I H. B. seventeen thirty five he will have the opportunity to fulfill that potential and then finally and it's more from the point of questions because we know you all had a very long day but miss Carla problem who is an organizer present Arkansas United actually benefited from that the nurses and eyes as bill is in attendance at the university of Arkansas Fort Smith which has Is several students who have benefited from you all the action can speak to the impact of that bill if that is helpful madam chair all right put that you have the let's start with the Jake Walker and then if he would come up and and he can introduce himself and let's just say two minutes because we do have a long agenda so we would like to hear from him and then the next one would be of this lunar Mr Mr Luna okay and then Of we'll just questions maybe maybe I think that would be good thank you so thank you so much ma'am and not Mister Walker you're recognized thank you madam chair like this is that I'm talking J. Walker from the Arkansas research center project director for current technical education and workforce development. I came to give you some information today concerning the demographics economic impact and work force impact that our immigrant populations served for us in the state currently we have about ten percent of our populations being either immigrants or children of immigrants living with one of that there are eighty percent expanding sixteen percent European and the rest or other various dissents currently in our work force how these immigrants Rep representative we have over a hundred thousand immigrants in our workforce here in Arkansas with them making up one every fourteen workers we have across the state. with approximately seven percent of Arkansas social work force with certain industries having large proportions particularly manufacturing serving fourteen percent Administration waste management twelve mining and gas extraction with eleven and construction represent eleven so they're over represented within those fields currently. in twenty eighteen we started looking at the economic impact Arkansas immigrant let family households paid one point one billion dollars in taxes between federal and state income tax with that being three hundred eighty nine million of that coming to the state and local. And of those daca eligible individuals were able to pre pay in almost fourteen million dollars and state and local taxes. Furthermore immigrant businesses represent eight percent of all self reported self employed residents and generated two hundred and eighty two point nine million dollars in business income in the state but the impact is a stop there though immigrants are consent as consumers represent three point one billion dollars in spending power after taxes in our state which is a huge for every sector. Now how to immigrants make such a large impact it starts with education and training. Currently twenty percent of college students are immigrants here in Arkansas with nine percent of those being first generation. Of those first generation most of them are immigrants and tend to go back to their communities your time is it finish your thought there just that they are. First generation college students I'm one myself as a whole we tend to go back to our communities because that's where our families are at and where we've come from and having those commitments by these children of immigrants to their local environments and being able to come back in professions that we need in the license is really going to help the rural economic environment of our state as well as our urban environments thank you so much it's very interesting Mr Lin wood to the like to make some comments and I want to set the time for you for two minutes as well. Thank you can you pull your microphone up little please Sir thank you madam chair I first off I want to start off by saying thank you for the opportunity to be here and gift this important speech that will not only impact me but people in the same situation as me my name is heavier Luna I am currently a senior at Central High School getting prepared to finally take the next step and go to college. I was born in Mexico City but when I was when I turned four years old I move to United States because my mom wanted me to have a better life. Every sense of the whole forty years I've lived here I've always been in Arkansas Arkansas has been the place that opened so many doors for me and I am currently going to the University of Arkansas at little rock to get my degree and civil engineering and construction management. The United States have been the ever even though the after birth certificate says I was born in Mexico my home has always been the United States all the memories I've made all the bonds I've created everything all up everything I've done has been for this country. I want to go to college in thirty seven years so I can give back to the community that's given so much to me I want to help Arkansas grow as a place. A I have to work twice as hard as other students to get to the point I am but I have never been alone I've always had people to get me through the toughest moments whether it was my friends my family my teachers all the people that set up at the recipient and all the legislators that have given us the opportunity to show what we're capable of. Hi I am extremely thankful to be able to do the same thing other people has get a other people have done before me and I hopefully hopefully with your help. Hey you can give us the opportunity to show what we are capable of doing. I hope you can give us the same consideration as the nurse a doctor nurses and doctors teachers to pass the legislation so that we can get our licensure and do we what we have set up to do thank you. Thank you all right of we so appreciate both of you and Mr Lynn of we're expecting great things from the. Thank you all right and do any of the committee members have any questions for yes Sir Senator Hammer thank you are those your parents sitting behind your back there yes Sir once you have them stand up let's give them a hand. Thank you so much for coming both the the and the with no other questions. A yes okay and less a we're going to go back to Leding Senator Hester close for his bill. Our members you virtual great testimony in this we know how important this is to a committee our Kansans and Hey we're we've got a good run going ninety six in the House I hope you keep going down are the Senate I appreciate a good vote and I am make a motion to pass all right have a motion to pass we have for a second all those in favor say aye. All those opposed congratulations you have passed your bill. All right I see that Senator Solomon has returned so let's go back up the agenda and let him take a seat at the end and we'll hear Senate bill five seventy. All right you are recognized thank you madam chair senator Dan Sullivan district twenty one. Over the course of time or boards have become more more powerful controlling licenses of many professionals their income scope and they're by hundreds of thousands of dollars at times these boards have become even more impactful and exercise greater power than legislative bodies there are times when we reset want to reset its appropriate and I believe this is one of those times Arkansas continually ranks at the bottom nationally the boards have some responsibility and accountability in those ranks and rankings as does the legislature and the appointing bodies. This bill is only about reconstitution of the board to allow appointments by the governor and the Senate and the house. Nothing precludes in the re appointments of the current board members so just let me be very clear it the board has to end then there's a reconstitution and nothing in the bill says the same board members cannot be reappointed. So for those that say there has to be some continuity then that's clearly allowed for. There's no intent intent to punish anyone or any by because of any decisions or actions only allow co equal representation and equity within the board. This bill does equalize board representation the board represents eighteen thousand seven hundred professionals medical doctors doctors of osteopathic Pathak meds occupational therapist T. assistance OTC physician assistants respiratory care medical corporations radiologic radiological assistance radiology radiology practitioner assistants genetic counselors and surgical technologist. This bill changes the number of recommendations by one it conforms with senator hammers bill that a PA it is added to the board. And it adds an O. T. to get representation and also to make it equal to get the fifteen so we could divided by five by three people equal and. Currently the medical society which is a private special interest. Organization has around four thousand members of the eighteen thousand professionals governed which is about twenty two percent of the population governed currently the medical society has ten recommendations or sixty percent to percent of the recommendations to the board this moves this bill moves the medical society to three recommendations which is more in line with their representation on the board we also have to recognize the power and the influence American medical society again a private and political act politically active group pass on the board. Medical societies a powerful political lobby they're packed contributes major dollars to campaigns of course legally and ethically in the last three years twenty eighteen nineteen and twenty over a hundred and twenty three thousand dollars according to the Arkansas secretary of state website in full disclosure I've not had any donations on the medical side of that I'm aware of. They do have a pack that support package very influential and many members of the medical society also donate privately. Again very perfectly legal ethical and protected by our constitution. This these numbers do not include the salaries of the lobbyist and staff and special lobbyist that they hired during session again this is a powerful political voice in Arkansas they keep a scorecard of victories and losses on their website. They have a bill tracker what well over fifty bills that identifies legislate towards his champions on their web page and they promote can candidates that reflect their views again let me be clear there's nothing illegal or wrong about that those are just the facts however with ten appointments to the board the medical society positions are Jett generally refract reflect of of the medical board positions as demonstrated by their actions or lack there of. The question is should a private group have an overly representative position on the medical board are should appointments be proportional to the membership they represent. The other thing this bill does it gives the house four point R. five appointments it gives the Senate five appointments and it gives the governor five appointments so again it just brings the legislature engaged in this process of composing the board. And we just say in closing that this bill is about coequal branches of government considered an appointments The considers equity in the representation on the board and striving to improve our National Health Care Act rankings. We need to be proactive in bringing Arkansas more in line with national rankings in such things as telehealth scope of practice and business restrictions and I think that a change in how the board members are appointed helps us get there. I can madam chair be glad to answer any questions all right the Senator Gilmore you're recognized for a question. Senator I think you may have already addressed this but I just want to circle back you you mentioned something about continuity well this so the the members are on there now could be reappointed to ensure continuity of operations yes every appointed by by the house or the Senate or the governor and I'm confident that we those making those appointments recognize how important continuity is and would keep those however if the house of the Senate decides differently they're certainly welcome to do that at some point there have to be reset if we're going to change something like this and again the safe thing to do is to allow re appointments which the bill does thank you for the question let me ask a question you're saying that the medical society appoints these people. They make recommendations is what what the testimony was okay and do other states have aboard medical board like the one you're proposing I'm not aware of that and to. Let me see I had and I'm not I wouldn't say agree or disagree I'm just not aware of what their other states to. Well in. I have to people that want to everyone wants to speak on the bill and he has a history of knowing how all this came up so I had I'd like a committee for only be to listen because this is going to be important for the future and the other one would like to speak against the bill up but anyway put other questions do you have before we go to. Those who want to speak for against any other questions. All right seeing none of. I have the first one is this is a Bruce Campbell that would like to speak on the bill and he has a history going back several years institutional memory sometimes is good so we're going to let Bruce and likeness with some good institutional memory so you are please introduce yourself for the record Mr Campbell and then you're recognized burst Campbell I'm currently the senior adviser for gov governor Hutchinson and spent about five years the director of appointments for governor Hutchinson. You're recognized. Well. I spoke to Senator Solomon before this meeting I told that we didn't have any objection beyond. That the fact that the governor currently appoints. The board in toto and and this one sports at five five and five we believe that the governor has exactly the state of Arkansas and we and we addresses back in two thousand fifteen so we you guys the house and governor's office we change the law back then because the law read a lot of these boards and commissions that you would have certain societies that would give would give the list to the governor say of three names to names whatever and the government have to pick from those names. We did not think that was a good way to do things now or going forward so with with y'all's help we change the law now to where we consult with certain associations councils at cetera and the only thing is excluded from that word or the various boll weevil Board the cotton Board AG boards so our only objection to. Two of the senators bill concerns the appointments. So that's basically what I want to say all right do you know of any other medical medical boards that have this kind of model I do not okay all right the. Senator Hester. Mr Campbell just to hear you correctly you're saying if if there was an amendment that it gave the governor those appointments you'd be good with the bill we're good to go thank you. All right it does the governor not have the authority now to do that Mr Campbell to do what I'm sorry to see of board members yes ma'am see yes so you really wouldn't need an amendment to do it because that's what he already does I guess excise in the park concerning the appointment scissors Sullivan has. If he just wants to do other things that I'm not getting into okay then he'd be would be fine with that all right all right thank you so much all right that was to get the one that was speaking for of speaking on the bill all right any did you have a questions Senator all right then is there someone in the audience that would like to speak for the bill. All right seeing none of we have Representative Mickey speaking against the bill. You're recognized. Thank you madam chair thank you Committee. I appreciate the opportunity to be here to speak on on at all and against the Senate bill five seventy I'm here representing myself as a physician and also as a state representative and it's not often the state representative just come down to the Senate and talk against one of the Senate bills we usually have to what talked about on the other hand but but I do appreciate the opportunity to be here at both as a physician in private practice and an elected official I will give you a little brief information about myself so you know where I'm coming from when I speak about this I've been involved in organized medicine for number of years about a physician in Arkansas for forty one years probably for the last thirty years I've been involved with the medical board and also with the medical society I have served in the in the medical society have served in leadership there I now serve in leadership in the American medical association is Arkansas delegate to the AMA. I've also worked in the past extensively with the medical board on the number numbers issues the most recent was a few years ago when when Senator Bledsoe passed the first telemedicine bill there was a committee the the the the medical board commission an ad hoc committee of which I was a member there was one board member who have thank it is miss Simon isn't Dr Sam is now the chair of the medical board she was on the board then she was a member of the committee and then we had Curtis Lowery from UAMS who was really at the forefront of some of the telemedicine stuff early in Arkansas with high high risk obstetrics we had hi Scott pace from the pharmacy association and we had a pediatrician who broke Blake on her name from Arkansas children's hospital but are charging that was to look at the bill that that would that we all passed or and give a recommendation to the medical board so I'm well aware of how they work with ad hoc committees of the board then took those recommendations and you know is to rules and regulations about how how telemedicine to be practiced in the State of Arkansas they had public hearings at this whole process took took over years I'm intimately involved they have been intimately involved with the board and worked on that and and other issues for the board one of the things as a physician you you will you will want to know its decision is is it not as if it was a physician is deceased now he said he told me one time you said you don't want to ever be at the end of the table to a medical ward unless you're down there presenting something to to them that they've asked for because it's it's that's not a good place to be in and I've witnessed having been at many board meetings I've witnessed what the board has to do displaying fit physicians for various problems of I've even had an issue they investigate every every issue that comes before them that anyone in the state of Arkansas races I had a K.. As one time where a patient wrote the board about what the way that building and I had to present before the board the way I'd build the patient I was found to be everything was correct but but that's how detailed they get and and and what they do and how they regulate physicians in the state of they do a great job and and have have always been there to serve and protect the public but. Anyway. So we kind of move on a little bit. One of the things I'll talk about why I'm opposed to this to this to this legislation and and Hi I understand I think we're gonna we're summer's coming from but but I've also looked at some of the past testimony is being presented to the Senate in various committees and and there been an application that's ever been some inappropriate exchanges of information or are up details of things between the Arkansas medical society which is my professional association in the state medical board of there was mention that there they would that the all of this information was F. O. ad and and but but I will set the record straight on this there's nothing there it's withdrawal or nefarious about the relationship that those two entities had when it when when they were discussing this couple years ago I've read the emails and if you haven't read the mails I would suggest that you read on most of the mails or about telemedicine laws around the state of Arkansas and I as a sitting legislator I'll sit before your table and tell you I requested that the medical board do that. I was a state representative that time I think everyone in this room would agree that that if if any of us request something of a state agency they will do their best to to to get information that we need and what I requested at that time was what were the laws regarding telemedicine from the medical societies per Medical Board's perspective in surrounding states and that's what all those emails about so I requested it I requested that the medical board communicate that information to the medical society and those emails back and forth that's that's all it was about I don't think there's anything nefarious about that I think that that that the board did what any other board in the state will do. They will. Look at a professional association that represents the medical society not only represents members of the medical society they represent all of the physicians in the state. Who is not like the bar you know in the bar you got you got to be a member of our practice law and order several spring court it's our choice to join the medical side or not but they still represent all the physicians so for the board to ask a society for for help in trying to decide how to proceed with something there's there's nothing wrong with that anyway. I just wanted will know that I was one the requested that and and and I don't see that there's anything wrong with that but I think since state boards and commissions do that all the time I think it's appropriate I think it's part of their job and they're doing their due diligence appreciated. Representative or senator now center I'm in the wrong house Senator Solomon concerns and appreciate what he thinks needs to be done with the board of he has investigated this issue and he's drawn his conclusions. And and but I think everyone in this room would agree that that sometimes out here it's capital we draw conclusions and and and raw. And that's why we debate any issue I don't think his conclusions are right and I I think maybe mine are and I'm here to play my part of the case and then we vote and and after the votes now we move on so I just want to give all that to the committee from my perspective and and Just ask a few things I mean. What do you think this might just be a bill that's perceived hi OR and origin reaction to perceived problem that really doesn't exist. What what what are you gonna fix by the bill. you know appointments to state board or political appointments. There there they have to be properly vetted I've been around long enough to know what what the medical board used to do and how the medical society used to make the recommendations before that let's go back a few years before that the the power of the entire medical field was held by one man named Joe overture and I don't see Senators Bledsoe as has been here but he probably knew doctored version if you didn't please doctor first reading practice medicine in the state of Arkansas so so the power of the board has been diluted and I agree with the legislation that we passed a few years ago which took out I was part of meetings where we would when a board position came open the medical society would put that out to all the doctors in the state they would actually interview on and talk to him about it and then they would submit to the governor's office the top three or four five people and the governor still can choose from that list or not but usually they did now it's a position where the governor's office. He seeks the advice and counsel to help him do is help that office do its due diligence in picking someone that quite honestly sometimes might be an embarrassment to the to the to the to the governor's office so I don't think that there's anything wrong with that I think the the power appointing appointments to boards and commissions should remain in the governor's office if why are we singling out the medical board to change it what we just change all the boards on we pass a law and change all the borders that Speaker gets five the house gets five you know protein gets files big is found the governing its five or have the parity is none of the other boards and commissions are appointed in this way I don't think that it's fair to single out one single board based on some of the testimony that I've heard to completely change the way the process is done I'm a proud member of the medical society I'm a proud member of this legislature I respect the medical board I know what they do I know the difficulties of their job you know I don't have concerns about you know if you stop the mon December thirty first report of model January first that's that doesn't bother me what really bothers me is that that that the whole concept of how people are going to be a part of this board is going to change and these people have to have an extreme amount of institutional knowledge to deal with the issues that they deal with the medical board I respect all those people they sometimes it's even hard to get people to volunteer to serve Medical Center shall begin to the bill and specifically that's what that's what I'm I'm speaking to the bill I'm speaking why I'm against the bill thanks giving the institutional knowledge that we don't have and I think that's so important not just for today but for the future. If you would like to well I think that it's it's it's an issue since the the. I've seen people on the medical board deal with some of the most sensitive difficult issues that that can occur. I mean you it's it's if you want to go what this all of you look public hearings and and they have knowledge of physicians they want to do everything they can to keep physicians practicing and and they they you don't ever as a position won't be called before the medical board I can ensure you that I worry that by changing this status the way that this is done we'll lose will lose interest and it will have members that will not want to re up and be another member I think we'll lose minutes total knowledge in the institution and I think that's a detriment to not only to physicians but to the patients in the state and I'm open to any questions appreciate the committee's time to senator Hammer. Thank you ma'am chair Dr McGee only because you brought it up to you know how many physicians have been disciplined by the medical board in the last year when complaints were brought against them I have no of information that I could comment on that okay and as I understand bill the pro tem and the Speaker of the house would take recommendations just like the governor would take recommendations do you not believe that the Speaker of the house of the pro timbre Justice competent take those recommendations as the governor in order to make good sound decisions about who would be on the board I believe that if we're going to change this board to where that they split but out of the governor's office that it ought to be the same for all boards. So that there's some consistency and board appointments and and the other thing on this this issue is that. There are only like three positions for which anyone is even allowed to consult with the medical society I think I think that's really cut our nose off medical societies not they don't make recommendations but but they will do some due diligence and work from for whoever that is whether that's the Speaker or the program or the governor so I think cutting them out of the process on fifteen appointments by limit limiting the three selling ourselves short and will end up with some members in the medical board on the medical board that may not be the people that we want their it's extremely important position I have to be vetted appropriately and I think we're tying the hands of the people making those appointments by not letting. That with whoever they want of that about. Okay any other questions for a representative Mickey. All right scene and thank you so very much thank you committee thank you all right can I have we have one of its does anyone want to speak for the bill. All right I have one more that has signed up for against in that smack Gilmore few come forward up missed Gilmore and state your name for the record. Matt Gilmore department health the board. Thank you and I appreciate Senator Solomon visit with us about this The the board's concern our concern is just the all the appointments going to a one time I know they can be reported I appreciate that being brought to the attention but some may not that may cause an issue there's an institutional knowledge if they choose not to be reappointed or if they're not reappointed the board will lose we support is seen issues in the past where we've had repeat applicants applied been denied and you know new board members not familiar with them some of the issues that arise there. also you know there's gonna be some rules coming forward from the session the board will have to implement and it's going to be helpful to have some members understand that process but also get those done and quickly timely manner some so having some continuity there will help as well. as was mentioned there's many complaints come before the board things about former complaints a year the board actually looks at reviews each one of those complaints review by each board member so sinister knowledge there's is helpful but just all the time and effort they put into that I think a board members review applications weekly not just one more member but it's a shared amongst the board so the institutional is what we're concerned about and I appreciate the fact they can be reappointed but different appointing a bodies may have different ideas about that who they want on the board so just want to mention those concerns and residuals time. Any questions. All right scene okay Senator Hammer thank you Mr chairman chair do you know those four hundred complaints how many actually received disciplinary actions. Knocked off my head I know that each board member the board meets every other month for two or three days at a time and two or three two of those days at least a day and a half of those two days are hearings throughout the day so it's outside it's probably. Ten or fifteen hearings per day so I'd say I'm just speculating here senator but it could be twenty five or you know that's like twenty twenty five thirty the hearings every two months something like that. And if the process in the bill was adjusted to where some of the institutional knowledge could be retained. And I I know you've got a answer higher of the mental images but with that relieve the concerns of the health department if some of the institutional knowledge was guaranteed in the reorganization process I think that would help I'm not sure how it will be done and the council the centers trying to do but I think that would be helpful if there's a way to do that but I you know I think it's also helpful as was mentioned you know one this is the this is an executive branch of a board that typically is appointed by the governor square thing And so that's standard practice across the board as well so. All right any other questions all right. Senator Gilmore other any other boards commissions that fall under the health department that have appointments from the legislature so there are several commissions that do but not regulatory agencies that I'm aware of the apartment health thank you thank you all right any other questions thank you so much all right of does anyone want to speak for the bill. All right. A. Sir are you close for or you want to close for your bill yes right of way ahead I'm always amazed folks when they. People testified that the Senate or the house is not capable of making quality decisions and their they tell you that that I was amazes me the second thing out of the one of the witnesses Dr McGee I'm just not sure what he spoke about about the bill But the fact is that we're not trying to change any authority the board retains all the authority they have now and this has nothing to do with their decision making and nothing to do with their authority the power our decisions they may. This does and one the most important parts of the bills get the house in the Senate and the governor equal appointments I think that's critical in moving forward and I would appreciate a good vote and I make a motion to pass. All right ladies and gentleman you've heard of the motion to have a second. All right all those in favor say aye. All those opposed. All right I'm gonna roll call. All right Mister price. All the world. Senator Hester hi. Senator Wallace. Senator Davis. Senator Hammer. No. Hi. Senator Solomon. Senator Gilmore. Vice chair Flippo. No. Hi. Sure Bledsoe no. All right your bill has passed all right going on down the agenda. Yes he. I believe H. B. seventeen seventy six. And I believe that is representative eleven and I think you've been here waiting patiently so. Okay you would you like to sit at the end of the table okay all right. The shares one now just. Okay. All right. In two days Our guest introduce yourself for the record. Good morning madam chair or good afternoon rather state senator Dave Wallace district twenty two. And I'm Rachel bunch of the Director of the Arkansas health care association all right thank you you're recognized this bill. We will help move our nursing home. Policy and regulations out of the nineteen fifties to the twenty first century. Nursing homes that particular that participate in Medicare and medi caid programs are already subject to strict staffing standards established by federal and state law. Our problem is that are. State law. Sometime this is redundant or even Overrides are federal law. Now the standards are enforced but teaches surveyors. As they relate to both the state and federal requirements. In CMS service also conduct inspections and facilities all no notice. The current state standards have been in place for over twenty years without modification. Before we really had good internet. This bill update updates these Arkansas standards with an. At which has them agree with our federal standards which will make it easier for any organization. The federal rules require nursing homes to provide each resident with necessary direct your services based on individual assessments in individual personal centered care plans regardless of any requirements on facility staffing levels HB seventeen sixty six six to bring those stay centers into line as I said with the federal rules by removing. Duplicate state laws and that's the key we're just removing duplicate state laws allowing the use of modern staffing practices when when. The rules we have now when the first available. We only had LPNs CNA's and nurses it in nursing homes now we have nurse practitioners and a host of other health professionals but they're not counted. There's nothing about this bill that waters down our staffing requirements. Is relation taking care of her residence. And actually this purpose this bill is to better ensure that our residential care and safety while modernizing regulations it every nursing home we have the state today there's a clipboard hanging. But it eighteenth century technology. It is it what we make our reports to the federal level. We have spreadsheets that we use. So we need to move forward and that's what this bill does. And with that I will stand by for any questions that you have all right are there any questions. All right of seeing none is anyone in the audience want to speak for or against this bill. Seeing none a heavy clothes for your bill. I have closed all right do I have a motion. Motion to pass second all those in favor say aye all those suppose congratulations you passed your bill thank you within this is Michael. I know I struggle with the help. This usually for us is when I'm at the table all right of alright ladies and gentleman we are going to hear Senator Blake Johnson said bill it is house bill seventeen fifty six but we need to suspend the rules for this one. And. So if the bill is on your desk and to. Of. Senator Johnson they may not suspend the rules so don't get too comfortable. No do I have a motion to suspend the rules all right in a second all those in favor say aye all those opposed. Anyway the moves have been suspended and you're recognized to tell us about your bill thank you chairman and and being a contractor I hope Senator Hester don't give a damn fully this this bill is one of his employees but this would make a there's already a master electrician lifetime license in this to do the journeymen elektrische in lifetime license they if they continue to be employed that you still have to the continuing education and that's pretty much what the bill does so appreciate a good vote any questions. Senator hamster Hester sent you know limit this you didn't have a question okay all right members thirty. Anyway all right seeing new questions does anyone in the audience want to speak for or against the bill. Seeing none heavy clothes for your bill yes ma'am thank you all right do have a motion. All right I have a motion do I have a second all those in favor say aye all those opposed congratulations you have put your best your bill. Do I have anyone from the house that is here and wants to run their bill and it. Okay you're running to do all right I was going down to a house bill eleven forty one is that okay Senator Davis is going to present that bill. You might want to introduce your guest. And. At Breanne Davis state Senate district sixteen. My name is Robert acres I am the director of the funeral services division in the prepaid funeral benefits division with the Arkansas insurance department department of commerce. All right thank you thank you I'm M. thank you for reading this bill for representative thought and so I'm an at and let him explain exactly what the bill does And take questions all right. Thank you madam chair and members of committee I will apologize to senator Hammer he's been through part of my spiel already as part of the insurance and commerce department Essentially this only impacts a small percentage of cemeteries in the state of Arkansas in the state of Arkansas we have roughly forty three hundred cemetery statewide but the majority of those are privately on their either family owned church owned usually municipally owned or other they do not fall under our regulations what this pertains to is the one hundred and four perpetually maintained or perpetual care cemeteries in the state of Arkansas typically a cemetery would become license to be a perpetual care cemetery based on size an income. Currently this particular committee among the eight districts that are represented here your districts hold twenty nine of the one hundred and four cemeteries are perpetually maintain Mrs cemeteries and I would say it's nice to see you senator Wallace one of our board members as one of your constituents Mr Billy curl you have the distinct honor of having eleven of the perpetually maintain cemeteries in district twenty two essentially what the deal is is this prior to July first of two thousand and eighteen there were several standalone boards that regulated the funeral services industry in Arkansas under ACT seven eighty eight of two thousand and seventeen the cemetery board the Arkansas embalmers and funeral directors board and the parent association board were essentially close down and their operational assets were transitioned over to the Arkansas insurance department effective July first of two thousand eighteen I took over the directorship of that particular segment and by the time they came over to the ID there was not enough time for us to submit any kind of wish list for repair for regulatory changes in the two thousand nineteen legislative session so this is the earliest session where we can do essentially it a number of the changes for this particular bill H. B. eleven forty one it's clean up there's a lot of language simplification and clean up we have a number of these tales those in need to be replaced with more simple language there are some inconsistencies that we noted when we started looking at the the bill language or the the language within the existing law there are frequent references to the Insurance Commissioner which the insurance commissioners actually de facto a member of the Arkansas state board of embalmers funeral directors cemeteries and burial services and the board has the regulatory oversight over these perpetual care cemetery so there's replacing references to the insurance commissioner to the board we found inconsistencies among for example how are. A committee to twenty seventeen ten thirteen which is permanent maintenance fund generally eighty one B. says that the principle of the permanent maintenance fund shall be preserved but in the very next chapter under ten fourteen B. three B. it says that the commissioner can approve a disbursement of principal funds to a trustee so we're trying to shore up some of the inconsistencies that already exist in in the verbiage of the the law in addition to that we are asking to be able to do background checks on principles associated with cemeteries right now we currently have in the law and in our rules for embalmers and funeral directors we do background checks on the premises we do background checks on funeral directors end and bombers but when you get to the cemetery and the things we don't have that same protection and these people are executing contracts with consumers and they're also collecting funds that should be put into bank accounts and instruction we wanna make sure that the people who are the the principles associated with these perpetually main cemeteries will do so. I know all of you have probably read through the bill whether any specific questions associated with some of the proposed changes all right Senator Hammer. Thank you ma'am chair I'm on page three. It talks about a justice center the consist of less than ten acres shall submit a survey and map of the cemetery. For exist or extension of the existing cemetery actually conduct quite a few funerals I did one the other day when they went out there to dig the grave they actually dug up somebody else's grave because it wasn't market wasn't surveyed it wasn't laid out properly does this. Require that if they extend the cemetery that it has to be and I can't hear what the word is where the plots are individually marked. I cannot speak to them not sure on that one I can agree with you there have been some instances in the last few years of some of the actually mean cemeteries not having adequate maps it was a perpetual cemetery that this happened in with having the on highway five I'll talk to private. Okay that's one of the three that are in your district right now I think I'm okay I I wish I could give you better answer on that to my knowledge I'm not entirely certain whether this particular tweet to the the code is going to require markings on those thank you the a lot of them do have markings already on corners and it is unfortunate when we were across the cemetery that doesn't have an adequate mapping system and they cut into the adjacent plot okay and and for the second time I would just it's we're little far down the line to do anything with this one way amendment but for the future I would like to get that in there that if run to anything that it requires that they have it applauded before we do anything in the way of extension because old cemeteries don't have everything adequately plotted so I just put that out. It's wonderful actually in preparation for twenty twenty three we can certainly get together I'm already got a wish list already for things that we could not get at a meeting this session that I'm hoping for in two years so thank you. Any other questions all right seeing none does anyone in the audience want to speak for or against. Seeing none what is the will of the committee. All right have a motion to pass and I have a second all those in favor say aye all those opposed congratulations you passed your bill are moving on down HB fourteen twenty seven. Do you have that one. Senate to fourteen twenty seven okay all right now someone may be coming to join you at the end of the table so if you would do when you get settled if you would introduce yourself. And it. A committee it's fourteen twenty seven what you're recognized good afternoon I'm Sarah Schmidt with DHS the deputy director for the Division of provider services and quality assurance all right senator. Thank you and. This bill and it just requires that in home care givers for Medicaid benefits beneficiaries are paid with Medicaid funds and that they pass registry records checks so this marriage requirements already in place for employees and employers and service providers and and so this will solidified as that requirement and as to what's already taking place in practice and all let her go into more detail and answer questions and I'm just reading this bill for representative Miller all right. You may you continue okay so already existing in our law is the requirement for criminal background checks what this does is adds an additional layer add to that it that includes the abuse maltreatment registries those include the registry such as the adult maltreatment that child maltreatment registries Any care giver who is currently being paid through a service provider or who is employed through a service provider already has to go through those checks so this would just equal that balance and that work within require all employees who are being paid with Medicaid funds to go through both the criminal background check in the registry checks all right any questions from the committee. All right seeing none does anyone in the audience want to speak for or against the bill. Seeing none have you close for your bill yes that motion do pass all right have a motion to pass to have a second. All those in favor say aye all those opposed congratulations you've passed your bill Fite has is anyone here to of a president house bill eleven ninety nine. Eleven ninety nine okay we'll pass over that one all right who you're going to that one. I don't know you can go ahead years is Nicks since there's no one Senate bill six twenty one. Thank you chair but so members I've been asked a lot about this bill recently from people just basically asking why and who's ask you to done and in the end no one has asked me to to do this The reality is this is just a good government bill if you look back through some of these consent decrees. Mr scene nineteen eighty eight. Ninety six eighty five two thousand to two thousand four two thousand five but the world is change we've got different judges we've got different people in policy positions at in Medicaid and DHS we have different lawmakers the just the world is changing it's about time that we just we reviewed some of these consent decrees and see if there's some savings Tennessee did this several years back in and found significant savings in Medicaid budgets reviewing consent decrees that's about as detailed as I can get I think it's proper lets people do that happy to answer any questions any questions from the committee. We'll I have a question eight point read that Senator Hester what came to mind is that usually when you get rid of of the consent decrees you go to managed care. So. Is that the purpose of the bill of did you know that are I've I've I did not know that not I guess it went when she a consent decree something you've agreed to with someone and if you got rid of that I don't know I guess parties would have to come together and agree to something else possibly and we're just asking you know DHS and you Human Services due to reconsider these the Medicaid program. So no it is I can assure you there is no one working with me on this bill I commenced Gonzales to sign up on the House before you read it. And that is it but you can go back and you know just read some articles what Tennessee did on and that's basically how are here after this bill so you're not mandating you're just requesting that they go by back in I don't know we're we're mandate if they go back and review and reconsider get mandating that that change once they've reconsidered and looked at it that's correct okay all right to Senator Flippo you're recognized for a question thank you madam chair Senator Hester how many other house members if you got to co sponsor legislation without having read the bill I wouldn't say I got him to agree to it we didn't volatility it read it. But is it because it would you would you agree that he has not read it as of now. I I know I. I can thank you for the question should not less all right any questions for. Any questions Senator Hester. Senator Hammer you must have a question. All right no questions okay this is anyone want to speak for or against the bill. All right. What's the pleasure of the Committee do pass do pass or a do pass do I have a second second all those in favor say aye. All those opposed congratulations you have passed your bill alright ladies and gentleman do you see anything on the calendar that we have missed on the agenda we've missed if not I feel like we are finished