Public Health, Welfare and Labor Committee - Senate

Just concurring in the house amendments first memo's won a promise from the floor dealt with public transit and so we amended them out of the out of the bill on the house side and the other one was as some faculty members had of the university had some concerned that maybe their voice may be of opposition to the policy of the university may be silence just simply because of the language of the bill so what this week clarify that what we're talking about is actually physically obstructing rather than obstructed business operation by whatever they're they're published published ideas one anyway I satisfy them the the two amendments and I appreciate a good vote all right ladies and gentleman you've heard an explanation of amendment one an amendment to the to Senate bill three forty one do I have a motion I have a motion and a second to adopt all those in favor say aye all those opposed congratulations you're meant amendments have been adopted Hey you're not renting your bill today correct just the concurrent so that shouldn't mission vision to get it over to the the fourth of March all right I thank you Committee. All right next on our agenda is the. Senator Solomon you are recognized. Thank you madam chair senator Dan Sullivan madam chair would you mind if I had Mr gave mallard join me here to explain the bill thank. If you would introduce yourself for the record please tell who you are and where you're from. Gaver mallard from Little Rock Arkansas I'm an attorney here Miller Gardner PLLC all right. Senator. Thank you madam chair Members over the course of time I've had some constituents come to me about operations of medical clinics will run medical clinics often seem to have a business minded person handling the operation which allows the physicians to focus on providing healthcare this amendment simply brings clarity to the fact that a medical practice may have a nonlicensed individual in leadership so long as the medical care as directed by a licensed physician and Mr Mallon will kind of explain the legal side of this sure all right just just to give you some background madam chair I'm I'm a healthcare attorney mostly for clientele of hospitals and physicians and other healthcare providers when you look at Arkansas code annotated for twenty nine three oh seven to wait strategy it only appears a licensed physician can control all operations of the clinic however that's that's really consistent what's going on the state now I think the eight the Arkansas committed because sociais Asian today benchmark survey night or twenty nineteen excuse me and is it forty seven point nine percent physicians are now employed by health health systems hospitals networks that sort that's that's consistent in Arkansas almost every clinic in Arkansas has the minimum an office manager running the day to day operations of that clinic was far larger operations have a chief executive officer or chief financial officer handling all the business operations when you look at the way it's drafted right now all officers directors and shareholders of of a medical corporation have to be licensed professionals are licensed physician that's not actually what's happening this poem proposed amendment was simply codify the practice within Arkansas a nonlicensed the individual's handling the business side of the medical practice the actual delivery medicine to actual decision making the medicine would remain with physicians as it should so that I think this amendment would allow some clarity in. And leave current clinics less concerned when they have a non physician running the operation of that clinic. All right questions. One of the questions thank you all right any questions for. Anyone here at the end of the table the senator. All right of Mr mailer does that mean that this is allowing non medical people to by a medical clinic. It could but in reality that that's already occurring to some degree if you're to drive through most of Arkansas you're going to see clinics operated by hospitals those hot those hospitals aren't owned by physicians so for hospitals already running medical clinics throughout the state but and this would allow it to stick an independent person who is not. A medical doctor to buy a clean a constituent physicians is that not correct that is correct all right all right we have someone with that would like to speak against the okay you have a question all right. You're recognized thank you measure how would this affect like you M. S. that has the clinics around the state I mean I'm just this is only going to apply in the private setting not I'm just trying to balance what how it would affect like you M. S. or any other hospitals in theory the way that the statutes traffic currently. Any medical practice can only be owned operated by a physician I think just in general that's been ignored until now. Follow up measures yes. May be ignored but what you're saying is in the real world is happening this is just Colonel bring law in alignment with what's actually happening out there yes are they breaking the law currently by doing that if it's not in the law now. That that's that's a good question again it's it's not been enforced and so. I have multiple hospital clients and I think everyone of them say they're not breaking the law because they're providing health care to the community and they're they're meeting a charitable purpose but if you were to look at the most strict interpretation of that potentially yes that's correct and senator I think that's what this bill is trying to do is bring some clarity to that well that's the goal okay thank you Mr all right but again that's a hospital. But we would be opening up not only physician clinics but a podiatrist in and up up a. The mileages but to. A common interest in Dennis would that not be true so that they could vote of just someone could buy a clinic can staff it with those people that are in other subs in other specialties is that not correct matter chair that would be correct you you are seeing some other states such as Colorado that are doing those type of things because you're you're trying to provide a wider spectrum of health care to to patients will I mean a. Sometimes it's not a good thing. Hey I don't sit up for fraud for one thing I don't disagree that a chair and I think part of the idea here is to make sure that these clinics continue to be under the purview of the medical board so that the medical board commission or the actual Medicare medical care is being appropriately rendered there as opposed to them just running free at night well this but the thing is the physicians within the clinic that is owned by someone that is not a physician the physicians would be under the medical board. But the owner would not be and how does the owner does the owner not say what we're going to have quotas today. Are we only going to take this. This person or that person I'm asking him please Sir okay would you answer please yes this particular section of the code that would be amended that requires those practices that are formed under this code to be license registered with the medical board so I would argue that those owners would also be under the purview the medical board not necessarily I'd have to disagree but let's it we do have someone that would like to speak against it if you would maybe come and go to the side and and we're going to have Mike Mitchell would you come forward please Sir. You will tell us who you are and madam chair and members of the public health committee my name is Mike met Mike Mitchell I am general counsel the Arkansas medical society composed of approximately four thousand Arkansas licensed physician. I am here to speak an absolute opposition to Senate bill five seventy two. if this were to pass Arkansas would be an out liar is compared to other states it would turn the practice of medicine over to business entrepreneurs and right now the practice of medicine is run by physicians as has the chair's pointed out as other licensed medical practices are the statement was made that well this just brings reality to what's occurring now well sure medical practices can hire office managers and operational people that are licensed certainly but all officers and all directors of a medical practice must be licensed physicians under the auspices of the Arkansas State Medical Board and governed by the medical board. This bill would remove patient care from the hands of positions and place it in the hands of business entrepreneurs there are few states from my research that allow such a deviation it was mentioned about hospitals some states. Recognized hospitals as an exception to this rule in Arkansas our hospitals do hire physicians and that has not been challenged but again a hospital is a medical provider like physicians it's a different very different situation than a business entrepreneur coming here and setting up a business hiring physicians and going into medical practice it would be a similar thing that if a corporation came in and hired up up the attorneys that's not allowed either this this bill is a vast deviation from the practice of medicine in Arkansas for historic purposes as well as throughout this country Arkansas would be an out liar if this were passed up and and I ask you know questions come to mind what is the legitimate purpose behind this bill. What is the positive motivation. For this effort. How would this bill might patient care better. That's the bottom line. I strongly urge you to vote against this very bad idea. K. it would to take questions yes ma'am all right senator Hammer. Thank you madam chair you heard testimony a second ago and asked the question about is this being done now and is the legal is a reason that you and your organization have not pressed against those that are doing it now it is not being done now there are no entrepreneur practices of medicine in this state Sir and that was an incorrect statement now hospitals. DO hire physicians but they're not a business entrepreneurial entity that's the only instance I'm aware of in our state we're physicians are employed there is not one example in our state where an entrepreneur organization is practicing medicine through employed physicians I promise you and if there were we would be fighting that okay follow up measures yes and you you've used the phrase entrepreneur and and you know in the context which used to I'm more of a doctor that is a doctor that has multiple outlying clinics that are run by at least prior to this session run by APR and said he has had them out there seeing the patients but yet he is billing what's the difference between that model and what Senator Solomon is proposing this farce the similarities. Our differences he is a physician. Who is. Obligated to his patients and patient care only not to board of directors and a balance sheet. And I've often said this physician's worship their patients. Not the balance sheet and that's the way it ought to be because that's a fiduciary relationship arrangement physicians have a devout fiduciary relationship with their patients a business person does not. And any other questions. Thank you K. anybody else any other members of the committee. All right thank you so much Sturch thank you thank you. All right to does anyone. Yes. Bencher would you get the previous witness up here because I want to ask him what clinic she knows is doing this now in Arkansas in testimony okay I'd be glad to I may bring Mr Mitchell back up to give us some more testimony if this is not to. That's going to you know if it doesn't compare to what he said go ahead I wanna give you a chance to respond to what was said because of what you said and what he said were were caught the middle here so would you care to respond to what was said absolutely care to identify if your liberty I thought I I think I can probably speak broadly without define anyone and and the folks in the room may or may not know who were referencing but one there's when we talk about hospitals there's two types of hospitals here they're the nonprofit hospitals they're also for profit hospitals in Arkansas for profit hospitals most definitely are looking at the bottom line secondly you've seen a proliferation of urgent care facilities throughout the state those are typically on bar corporation those are not owned by physicians though they do employee physicians in the southern part of state you have felt or federally health care federal health care qualify community centers those are not by physicians the there are some positions on the board of directors there's also community folks on those border directors those are there for the purpose of providing care to the community and they are doing patient care in providing medical services so it's some of you may have those in your community right now. There are multiple places such as that where people not physicians are making business decisions for those those organizations indeed all the other states are doing this for we the out liar was the term that was used or we the pioneer in this the first one we we are an out liar in that we have the strictest corporate practice of medicine from the standpoint It you can't have directors officers or shareholders and in fact I think the again America American medical association identified Arkansas statute is being this is this end of the spectrum then if you and I can give the committee an article on that what you'll see is like in Texas Texas says that okay a critical access hospital can own a physician clinic or if you're in a rule or you can own a physician clinic and then you go to Colorado and it says that you can be a shareholder if you're not a physician but the majority must still be physician owned and then as you go across you'll see there's a difference and and how that is handled when. Look I always say I I was not here during the advent of Medicare Medicaid insurance but once upon a time you had all the hospitals which were nonprofit and their their goal was to provide care to the community in general you had all the physicians that were independent of the hospitals and they ran their clinics and they work in partnership with the hospitals what during as as you have insurance in Medicare Medicaid make it more cumbersome all physicians to operate their clinics financially I mean right now physician probably spends eight hours of patients in four hours a day on documentation it's easier for them if they can find someone else that will handle that document not the the patient documentation but all the billing pieces and operation of the the the clinic and so what you're seeing is a lot of the physicians particularly in light of the pandemic now running to hospitals and other folks the same can you help me financially you know I I give you a scenario that is just a hypothetical let's say I were a businessman Yellville. Yellville is not a large community but Yellville may need a clinic if I were a businessman to have the money in order to put a clinic in Yellville the way this is trapped right now I couldn't do that I can go ask the doctor to put that that clinic in Yellville but if the doctor didn't come in open a clinic in Yellville there be no clinic in your field what we're proposing is just given opportunity that someone has the financial means to operate the business side and to recruit a physician there an employee the physician why we not allow that to do that that betters the care for all the citizens of Arkansas and so as we look again at the rule areas every ruler in Arkansas the physician's attorneys all of us were fleeing those rural areas for coming to that the metropolitan areas in Northwest Arkansas little rock this is just a matter of means of also assisting there to maybe find a way to get some more providers into role Arkansas that you might not otherwise have. All right Mister Mitchell do you want to come back to the table and. Give us another. The point. Well and you know if a. You mentioned it would be easier for physicians If this were something the positions were in support of they'd be lined up here to support it. I promise you're not gonna hear one single physician today in my opinion support this bill. And while Mr mallard can give you some positive reasons to do this there will be a long list of unintended consequences of for example positions are read a regulated by our medical board hospitals are regulated by the health department business people are not regulated. And they can come in here in our state and practice medicine entrepreneur early up and again they don't worship the patient they worship the bottom line they worship the balance sheet and that is not the way you practice medicine the patient is number one not the balance sheet folks. Okay all right any questions what all right. Flippo thank you madam chair Mr Mitchell if that's the case that how can we have so much problems with positions we did take traditional Medicaid patients because Medicaid doesn't pay the same this same type of reimbursement as what these qualified health plans do so that you know I understand with the Arkansas Works while there's you know the other hospitals and physicians and other providers you know like to take the private insurance because it reimburse them at a higher rate but if the if the if the matter is patient care there should be no regard for that reimbursement rate is that correct no Sir I don't believe it is I I don't know of a physician that turns down a patient because of a pair but I promise you business people will. You're saying that you don't know of any position that's ever decided not or not take it if I'm not original Medicaid no Sir I'm not aware of a physician the patient walking in and what your Medicaid I'm not taking you are no Sir I. The city for example and you're trying to get a new position and you know all positions or is going to take these new traditional Medicaid patients. Well I can't say all of them but okay but I can tell you that a entrepreneur who is in it for one reason to make money not to take care of people that's going to be their first criteria how much money can I make on this if they can't make any money I promise you will turn them down and hospitals are trying to make money. Well I guess but do you know of a hospital that has tech told the patient to leave because of a pager no. Disagreements with positions that are working for them. Well I I don't know I just I'm not aware of that and then maybe that's happening and I'm just not aware of it but yeah I think it would be a real significant problem if we have hospitals and physicians turning sick people away because of their payer I just don't believe that I just cannot believe a hospital is going to send a patient out the door because of the player in our state and if they do we need to know about it because in a down I think that there's there's there's and I understand that sometimes positions might not you know that the only out of the ability to see so many patients so when it comes down to how many people can you see if that's the going to be a traditional Medicaid patients going to reimburse for the substantially lower rate than a private health insurance plan is who do you think they're going to take. I'm just not aware of that criteria Sir I think the pay out physicians take care of sick people hospitals due to in our state that's my understanding I think it's against federal law to turn the patients down especially in the emergency room and then the other thing is that I think we had DHS present a long list of the panels that to medical they had with Medicaid and the how many patients that each physician had in certain areas and there was a surplus of slots available thousands and so I tend to agree with you of their all right that name you may not get your choice in doctors I might as a Medicaid patient I might call and say I'd like to see doctor Smith or doctor Smith is booked in a fine I want to see anyone else then yes I'll I'll have to do without but if I'm willing to see someone that is open in and does have a slot available then I get to see a doctor according to Medicaid. Excuse me all right senator Davis you're recognized thank you madam chair I think a little bit of the point it sounded like it was not just that and in reference to hospitals and patients are in a way that our hospitals not looking to make money and and the answer to that is yes I mean there are hospitals that have canceled entire departments or programs because they don't make money the impact the impact the bottom line I mean here in Arkansas we seven down syndrome clinic at children's but the populations wasn't great enough so they got rid of the Department so now if you want that specialize you have to go out of state there is one doctor now that will see them and even last session we passed a bill on genetic counselors to and let them be able that that bill directly and and that was for a reason that's because we needed more genetic counselors but the way that our laws were in Arkansas they weren't profitable to hospitals and so we just weren't recruiting them we were hiring them and that's a huge disadvantage to patients that need care and across the state so so it is true that doctors would like to make money of for anyone that is working must make money hospitals need to make money because I need to be able say open and save lives so so the truth is yes they are looking to make money and they're worried about the bottom line I think that was the point. Well I I maybe I misunderstood but I have been doing this for over forty years now and all during my career I have never heard the story of a hospital saying well because of your pay or leave never ever in our state. And I know that if this bill passes Arkansas will be an out liar I did the research today in most states with some exceptions for hospitals and that sort of thing do not allow the entrepreneurial practice of medicine. All right thank you so much. All right any other questions. All right saying no other questions does anyone in the audience other than the ones we've already heard want to speak for the bill or against the bill. All right would be close for your bill. Thank you madam chair and you heard the word entrepreneurial a lot I think it's obviously we have to make profits to do that you also heard that we are an out liar part of our out liars we are forty ninth in the nation and taking some opportunities like this to be innovative and try some different things are good so I would encourage and appreciate a good vote on that and I'll make a motion do pass madam chair and ask for a good vote thank you I have a motion and a second all those in favor say aye. Okay all those opposed. All right You have passed your bill all right going on to the next one. Of. We have representative Perry. Please come to the table with a house bill sixteen fifty nine. Senator Wallace. We'll hear from you first. Share and the members. Senator David Wallace district twenty two and I have with me representative Perry. Representative Perry you are from districts House District forty two forty two it's good to have you today thank you ma'am all right you're recognized senator. Members we've actually passed this bill two years ago. And when we did we we have a problem getting this certificate sent to public health. And. We. Gave some waivers out in those waivers were. that if they if they lack reliable internet connectivity or they had not received requested training. What they did fewer than five per month that they could submit the wait which I believe was paper copies and what's happened is we still have an ongoing problem with Some hospitals some positions that are not submitting. This this difference on time or Electronically and so we want to tighten this up. And we have eliminated the unexpectedly we believe that they've they've got that throughout the state now. In public health have been available for two years to help train and they're still available. And what I will allow is they have ten Medical Center this defense per year. Was to allow waiver for that. And would you like to thank. And with that I will stand by for questions all right. Any questions from both of you. All right. The C.. All right said no questions from the committee. All right does anyone in the audience want to speak for or against a limited. Yeah we've got five yeah we we I counted. I was looking in. We we're senator Gardner. Okay thank you to anyway so let's get back to get back to questions anyone have a question. No questions does anyone the audience want to speak for or against this bill. All right seeing none had to close for your bill I'm closed all right of ladies and gentleman he has closed what is the will of the committee and I'm I make a motion to pass all right and then we have a second all those in favor say aye. All the suppose congratulations you have passed your bill. I'm represented Perry now you've had more fun in here then you have them in the house right. Okay thank you hope you come back all right of next bill we're going to see Senator Flippo with Senate bill five. Sixty three at no it's fine it's five sixty eight all right. Yeah. I'm sure if it please the committee the chairman have somebody from department health join me just in case yes but would you introduce although personal and Scott Flippo senator District seventeen. Thank you Martina Smith DHS. Martina Smith DHS welcome did score and the director all right thank you all right you're recognized to present your bill thank you madam chair and so a fairly straightforward bill here and that it limits the annual renewal for long term care facility licenses entry choir notification for the changes of long term care facility management so there's three points to this bill having to read off here expands a review of long term care facility license applications and requests for change of ownership and adds a review for changing magic management companies and other operators of long term care facilities or to it removes the requirement for annual renewals of licenses in favor of requiring long term care facilities to report changes including change the management companies and other operators and the number three current law only provides for nearly written grounds that DHS may you to the nine application renewal request for change of facility ownership and this bill expands those grounds and so to put this on a layman terms this is important because we have seen that out of state actors that operate you know you know nursing homes here in Arkansas as a matter of fact we had won over force you been it was either last year the year before last the state had to takeover of management of this facility the company was out of New Jersey all the came in and the rain these facilities into the ground they do not care about patient care the only care about themselves their own corporate interest in New Jersey where the left and so the purpose of this is to make sure that those those of us that are good actors or wanted to make sure that that and I'm you know having a long term care facility myself it's important to me as a as a long term care facility owner that that we have good actors to play taking care of our state's residents and so with that I'd be happy to turn it over at the anything that you'd like to add or change. Thank you Senator Flippo is correct we just want to make sure that residents and facilities our Kansans are adequately taking care of and so this bill aims to do that by allowing us to look at the management companies as well to make sure that they provide us information financial information information about what the other companies they may own or other facilities that they may own and it also as he said expands those grounds things that we can look at so now we're not only looking at whether or not maybe they have had their license revoked but also we can look at whether or not they're license has been suspended and so I'll take any questions if you have any all right any questions. All right seeing no questions does anyone in the audience want to speak for this bill or against this bill. Seeing none. A few close my bill that right of what's the will of the committee I move do pass do pass and second all those in favor say aye five all those opposed congratulations you passed your bill. I think we've Lissie. I don't see Senator Irvin I'm sure but I got the next two bills on here so I gotta go ahead and then we'll call Senator Irvin okay right and we got somebody here from the AG's. And it's and it's these are House bills sixteen twenty two and the sixteen twenty three all right sixteen twenty two. Here again you're recognized in the yes please Boyd introduced himself and. My name's Lloyd Wofford and the deputy Attorney General in charge the Medicaid fraud unit Attorney General's office all right thank you the manager to please the on let us work for go ahead and explained house bill sixteen twenty two. Madam chair as precipitation Medicaid program the Arkansas is required to have a Medicaid fraud control unit that Medicaid fraud control unit has to meet certain standards in one of those is that are lost must be consistent in certain areas with federal law one of the areas where we are presently inconsistent is in with the the definition of boarding care facilities this bill adopts the federal board and care facilities definition the other thing that we are required to do is we are investigative authority has to coincide with what's required for federal regulations currently it was in if it concurrence but there's been two recent federal law some then there was a federal law in two thousand twelve that we just sort of ignored we're kind of catching up in trying to to sync up those the investigative authority this bill does not create any new form of maltreatment it does not create a new crimes it does not criminalize any conduct that is not already a crime in our under Arkansas law simply changes who. what circumstances are particular unit can do the investigation. All right any questions from the committee. All right seeing none. I'm close for my bill madam chair and I do pass as well second up. Anyone in the audience want to speak for this bill against this bill all right your clothes for your bill all right puts the will of the committee you've said you've made a motion to pass we have a second all those in favor say aye all those opposed congratulations you passed your bill thank you madam chair of the committee going on to sixteen twenty three house bill sixteen twenty three I'll turn it over to Mr war for. Madam chair the United States Congress has given private citizens the right to bring in federal court false claims under the federal false claims act based upon the Arkansas law in Arkansas Medicaid claims these lawsuits are brought in federal district courts mostly in other states states New York California Massachusetts South Carolina all of the states have keep him statutes that allow these suits to be brought the sought research in the suits the state of Arkansas is not given notice of these lawsuits they're sealed we're not given the opportunity to represent the state of Arkansas Our representation is by the United States attorney in that district in some cases that representation is been very good in other cases we've been concerned about what we've seen coming out of the settlements what this bill does is it gives the Attorney General state of Arkansas the right to be notified or the requirement to be notified of all of these lawsuits it gives us the opportunity when we think it's in the best interest of the state of Arkansas to intervene what this bill does not do it does not create a cause of action or right to file any lawsuit that cannot already be filed under federal law this bill does not create or expand any penalty or civil liability over what can what exists under current president law it's simply a notification statute gives the AG the opportunity to protect the interests of the state of Arkansas. Thank you any questions from the committee. Can you give me an example of how this impeded of the Arkansas. Department of Human Services or. Well it it it doesn't impede the department human service necessarily but I can give you an example eighty relate or what's called a relator is a person who's essentially a whistleblower who works for a drug company in New York City goes to the goes to a private attorney in New York City hires that private attorney that private attorney files a qui tam lawsuit on behalf of of all the different states that are in the Medicaid program for this particular drug is sold. that lawsuit is sealed under federal law and the United States attorney in the department of justice control that lawsuit in all states that have it keep him statute or given notice and the opportunity to respond enjoined states that don't have a key theme statute or not but those claims that are raised under Arkansas law can be heard by that federal judge and decided. Rarely do these cases actually go to trial in most cases there's a settlement and what will happen is is that what I will I will receive a settlement that I have to approve or disapprove and I will share it with the DHS and they have to approve or disapprove and we know absolutely nothing about the relator we've never met and we've never talked to me never had an opportunity to interview them we don't know how good the evidence in the case we know the basic allegation that said we have to basically decided we're gonna take it or leave it Hopefully this law will allow us to make an intelligent informed decision about the interest of Arkansas even in cases where we choose not to intervene no I think this is the bill that is very timely so I appreciate you bringing it to the committee all right to. We've heard the questions does anyone want to speak against the bill for the bill all right of heavy clothes for your bill I'm close my bill and I'm sure I'll make a motion to pass all right motion do pass to have the second all those in favor say aye all those opposed thank you very much. All right to the Senator Hester is not here is anyone running his bill for an. All right of center to Gilmore you're recognized. This is Senate bill five twenty seven. What about germs Committee this bill of I've talked to several of you about this and I will point out that Thank you many of you for supporting this being co sponsors this bill I think this is a very good continuity of care bill this bill does a couple things and the title pretty much describes what that what this bill does but a couple things I want to point out is that I think it's fairly common practice for physicians to have agreements with hospitals to make sure that the there's continuity of care of the patient and this bill just ask that those abortion providers have said agreement with a hospital to accept their patients if needed if the situation arises and those patients The that care so I think it's a very good continuity care bill it also at their some clean up language very minor in this bill that this also addresses and also it requires an abortion facility to have the human trafficking Laura's card on hand to build provided to patients which is fairly common with many other facilities already in our state so with that I'm happy to take any questions all right to explain the card again was not quite as familiar with that yes so Laura's card it's a human trafficking carts what has information about human trafficking hotline that people can call and so what we want to make sure is that people coming into this facility you know we're not perhaps in danger of being trafficked or haven't been trafficked and getting a procedure as a result of perhaps being trafficked and so this this card would give them more information and also make sure that their their safety and protection is ensured all right any questions. All right seeing none does anyone in the audience want to speak for this bill. Okay I think we have some. C.. Okay okay are against this bill I do have two people of Karen of music. If you would like to come forward and then next what will take the alley Taylor. All right when you have a chance to get seated would you introduce yourself please miss me seek. My name is Karen music I represent Arkansas abortion support network. I'm sure it's not a surprise I'm here again testifying on another repressive illegal abortion restriction. But each time I have to ask why are you so obsessed with someone else's body. If this legislature wanted to post anti human trafficking posters and cards they could certainly do that. Maybe even health department regulation but this bill takes something that is not controversial. And turns it into an anti abortion bill. They're two different things sex trafficking and abortion. They may overlap but no more than poverty. Or crime or eating breakfast. In this bill is a special one because only Senator Gilmore can bring it he defeated his opponent in twenty twenty by claiming he was the only one hundred percent pro life candidate. Excuse me excuse me miss music we talked to you about this before I believe B. King on the bill that's not the election is not part of the bill. Okay skews me this does address the bill and okay I'm going to have to call you at a voter if you do it again This music. Okay because rape and incest is now because of the unique special consideration that this committee and the legislature passed on this is the reason this bill is being brought forward. It wouldn't have been brought forward with a different representative or a different Senator. The ridiculous language in the bill a written agreement with a hospital. To treat patients with un foreseen complications that's the language do you know anyone that would sign an agreement saying they would cover unforeseen complications related to an abortion. We know all the emergency emergency rooms across the state are capable of treating the rare abortion complications that do arise. Please vote no on SB five twenty seven and realize you are being manipulated by a nonprofit group all right thank you very much up next we have Allie Taylor if you come forward please ma'am. And I would ask that you would to stay on the bill please and I am going to you. this music did a good job of being C. sync and so but just because of a time issues. All right my name is alley Taylor I am a co founder and president of Arkansas abortion support network thank you madam chair committee members. I really have a few brief statements first I want to acknowledge that this bill does contain multiple provisions I do not oppose the entire bill I am only opposing the provisions that would require abortion providers to have transfer agreements and admitting privileges as you already know similar provisions in Texas and Louisiana have already been struck down by the Supreme Court I repeat already struck down therefore I say to the legislators of Arkansas no means no. These provisions do nothing to improve health or safety safety these provisions only serve to make it more difficult if not impossible to provide abortions in the state of Arkansas. As you know abortion is very safe procedure with an extremely low complication rate in the rare event the complications occur patients are cared for exactly as they would be with any other outpatient facility as you know hospitals are unlikely to give admitting privileges to doctors who do not admit patients regularly and you all know that it's incredibly rare that an abortion patient must be admitted to a hospital therefore you know that it will be difficult for abortion providers to get admitting privileges which is obviously the point there for this bill is another obvious attempt to limit access to safe legal abortion please vote now all right thank you so very much a question yes senator. You're recognized for a question thank you ma'am sure only because it was brought up under the previous testimony you've identified yourself being affiliated with the organization are you a nonprofit organization or for profit we're nonprofit okay thank you all right thank you and thank you for your testimony all right ladies and gentleman we have heard to those that are against we didn't have anyone testifying for on that had signed up so you close for your bill would you like to close I would like to close my honor I would just point out this bill does nothing more than insurer better health care and again I will point out it is a continuity of care which is what I think we all want we heard opposition speak to the fact that it's going to be more detrimental I would argue that it's going to improve the health care of of women who have this procedure it's going to make sure that you know their overall health care is is is being accounted for I'd also point out that is very common for providers across the state across this nation to have agreements with hospitals to accept patients I think they use the the term admitting privileges this is not that this is a transfer agreement I think it's is less even less stringent stringent and what we would to no as a admitting privileges standard in the and health care our state I'd also point out that in Kentucky this this very law was challenged and upheld by the US six circuit court so I would like to point that out as well with that I'm I appreciate a good vote I am close I make a motion to pass we have a motion to pass we have the second all those in favor say aye all those opposed congratulations you have passed your bill ladies and gentleman of committee we're going wait a few. Amendments were expecting the Senator Irvin to run her bill you might be looking at it it is Senate bill three ninety five and it she's on her way so we'll just wait a few minutes and you can. tall Kerr just rest within. Fifty. Members of the committee I just want to that say thank you I do have an amendment yes I know you might introduce your guest or have her introduce yes I'm senator Missy Irvin and Janet. I'm Janet Mann the director of medical services for DHS welcome. All right. I think I need to I need to sign those Mr price. We have okay we have an image Amendment yes. She's yes okay you do need to sign the. Thank you. Right. Okay if you want to explain your. Your most of your amendment we already have a met a motion on the floor so if you go ahead and explain that then we will let you then explain your bill as amended. Thank you so the Amendment really add just talks about the fact that if a laboratory or diagnostic procedure is an essential health benefits then it would not count toward the caps that are described in this section and that was a request working with miss man and DHS tomorrow the amendment does all right do I have a motion to adopt had okay second all those in favor say aye all those opposed all right you're amendment has been adopted if you will explain your bill as amended okay thank you members of the committee and what this bill does is and as you know right now there is a five hundred dollar cap per and five hundred dollar cat per person at for the year in Medicaid when it comes to laboratory and diagnostic testing so what this does is separates those two out from one another and creates that five hundred in both of those categories the reason why is many many times radiology and radiological procedures are more expensive than your laboratory and so sometimes and we've opened up primary care visits also to cry proctor and visits which is fine however the the radiology imaging procedures can cost a lot more sometimes and can eat out that five hundred pretty quickly and so then when they go back to their primary care providers for like blood draws and labs and things like that then there they have exceeded that cap already and so what happens then it occurs is you have to do some paperwork in order to I applied for An extension of benefits any of AT and extension of benefits that generally gets approved by Medicaid and so you know we we looked at this for like okay it you know are we have I mean if you're if we're going to get an EEO be extension then is there a possibility that we can just you know separate these two things out so that you have to have a reserve for those laboratory and diagnostic testings so I know you've received an email in support of this bill from quest diagnostics labs which I appreciate however I'm motivated by the patient because the patient really needs the ability to have those particularly if they have diabetes or yet particularly diabetes or different levels cholesterol Tosh and I some I I work so hard to try to lower my cholesterol it's just not working but anyway so I am I am a person that understands the but so that's why this bill is brought forward and I just really appreciate working with this man and DHS on this because I think it's a really good it's a good it's a good piece of legislation to help. Right this may indeed have any comments you'd like to make. No ma'am wait we are in support of the bill and we're also looking at a central health benefits that would be exempted and creating a list for that to be published so that there would be things that would automatically be exempted for the population that we're serving all right thank you any questions we have of senator Hammer thank you measure it I'm just is this a hundred percent reimbursed by feds by doing this service is going to come out of committee current Medicaid budget if we're opening up the capped a higher number. It will not be a hundred percent reimbursable it will have a match rate of approximately thirty percent state dollars it is the med surge rate that is currently enhanced through with the six point two percent on the F. maps that we are anticipating a small impact with if even I brought some numbers even with the but even with the two percent to ten percent increase we are looking at under five million dollars it but we won't know that until it actually get utilized but there are conservative estimates it's something that we think the Medicaid program can handle or and I understand the cost I mean because we outweighed by the good that it does by opening the opposite party rationale yes Sir it is it's also will remove a barrier of additional paperwork in time sensitive tasks that need to be done okay we're trying to accomplish thank you all right any other questions artsy none is anyone in the audience want to speak for this bill. Against this bill. Seeing none Hey would you like to close for your bill I just want to say thank you to DHS and to Janet and mark and everybody there and just I really appreciate their effort and focusing attention on helping patients and this will be a tremendous help to primary care providers and car project providers but particularly for the patients so I don't have to worry about whether or not they're they're you know lab draws blood draws are going to be covered or pay for thank you very much for the cooperation and help all right. Seeing that the we've heard all this testimony and everything and Senators clothes for her bill what is the will of the committee all right we have a motion to pass we have a second all those in favor say aye all those opposed congratulations you have passed your bill thank you thank you members of the committee all right thank you ladies and gentlemen I don't think we have any other business so we or adjourn.