Public Health, Welfare and Labor Committee- House

Entrance to my left and the coffee room is for members and staff only so if you're visiting please come in this door. members we will be having an extra meeting on Thursday morning at nine thirty right here in maxi. That text you got was not an April fools Tax we are actually meeting that day. So we will have to meetings on Thursday one at nine thirty and then again you know me to the after the session and try to get through some of the bills that we have. All right as far as the agenda goes we may move around a little bit I'm going to try to stick with it as much as possible but we're going to try to get to the concur amendments. And then also some of the consent agenda items. Okay since the concur amendments are all members of the committee I'm going to skip that for right now and go to the consent. Agenda and then we'll come back to the amendments. Because we have some folks from outside the committee that are here so we're going to go to the first item on the consent agenda. So that's H. B. sixteen twelve representative Cozart. You're recognized to present your bill. Okay bye. Thank you Mr chair and committee. What you want me to be heard today. Of sixteen twelve is a bill that came out of our occupational licensing review group meetings where we review all of the licensing entities and they come to a certain amount of time for every year and our fees or what we look at a lot of its course where they do things a few of you all in here have been there represent Dotson was an ex officio on there and came to a lot of the meetings they're also this is a bill that is to require evaluation restriction of lasik fees related to the practice of physical therapy we looked over there licensing fees and the way they did things when we came to there and we found out that there recipient Tory license was a hundred and sixty dollars it was very high compared to a lot of other licensing and and just way higher than most of the states the do that so we asked them to why they did that. And they said it's just been like that from the beginning and they were willing to change it because we already put out notes and sent all these out for them to start change thanks coming to this committee tell us what they were doing and they did nothing basically so this is what this bill is for is all brand new language it is to for them to evaluate the restrictions or license fees related to the practice of physical therapy and all of the the things that we're asking for to do and they're not be glad to read the whole thing I'll or I'll just but shall ask questions are going to. All right any questions from committee on this bill. Okay seeing none. do we have anybody in the audience that would like to speak against the bill. For the bill. Seeing none you to close for you bill Mr chair I'm close representative Bentley you're recognized for motion. I have a motion do pass by representative Bentley in discussion on the motion. Seeing no discussion all in favor signify by saying aye. All opposed nay moshing carries congratulations your bill is passed thank you Mr the Committee. Okay I don't see representative Penzo. I don't think he's here yet So we're gonna move down to representative Watson. You're recognized to present H. C. R. ten twelve. Representative Watson you're recognized. The representative Danny Watson district three thank you Mr chairman. H. the R. ten twelve. Getting close to the end of March. this is to recognize and designate the month of March is national athletic training month in the state of Arkansas employee trainers promote healthy lifestyle behaviors through education and communication to enhance wellness and minimize the risk of injury and illness athletic trainers collaborate with physicians and implement systematic evidence based examinations and assessments to make valid clinical decisions as determined patients plan of care athletic trainers as we know integrate best practices in immediate emergency care for optimal patient outcomes the really great help rehabilitate athletic injuries and treat illnesses with the goal of achieving optimal activity level using the applications of therapeutic exercise mobility devices a manual techniques they also integrate best practices in policy construction and implementation documentation best practices to promote optimal patient care will be and athletic training national athletic training month is held every March in order to spread awareness regarding the importance porting work of athletic trainers the twenty twenty one slogan for national athletic training month is athletic trainers are essential to health care the advancement athletic trainers in the State of Arkansas depends on maintaining and expanding its athletic trainer work force and inspiring and motivating the current generation of students to enter the athletic training field this is a basic verbiage doing away with the where as a regular resolution hopefully we'll get to be read in both chambers if there's not any questions I would ask for a make a recommendation to do pass. Any questions from committee. Most of us seeing no questions anyone here to speak against the bill or the resolution. For the resolution. Seeing none representative when you're recognized for motion. I have a motion of do pass any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries graduation your resolutions passed a committee. Is represented Johnson still here. Yeah he's at. Yes. A representative Johnson are you ready to present HB eleven seventy six. I know I surprise you with that but. I'm ready if I get the microphone on all right you're recognized thank you a this is this this egg it's H. B. eleven seventy six of the telehealth bill would pass out of this committee and out of the house a few weeks ago it extends emerge ordered reimburse for behavioral health is eleven seventy six again this skewed but from. President Dotson my presenting the wrong bill. Okay get this is that when I've got a few and I could be off by all the students that I believe all we've done is added to the emergency clause to make sure was to get it be in effect in case emerged order indeed I think that's the only amendment we have so you amended to add an emergency clause and at a gross yes okay. Any questions from committee. Seeing none anyone here in the audience speak against the bill. For the bill. Seeing none the ready close I am close thank you Mr. Representive Eubanks C. has made a motion of do pass a discussion on the motion. Do pass as amended it's engrossing. All right the motion is do pass any discussion seeing none all in favor signify by saying aye. Those opposed nay. Motion carries resolution the bill is passed thank you Mr okay thanks. The. We are you ready to do those others or not how does many things you let me do Mr okay I'll let you do HB sixteen eighty two and seventeen twenty three if you're prepared I will be prepared as soon as I have them in front of me okay committee we're going to do H. B. sixteen eighty two. Having some wifi issues can someone read the title of that bill. This colocation. Okay so as it stands currently there's a rule that prevents co locating and behavioral health clinics at other locations with the Medicaid provider this removes that restriction this is some antiquated policy that's been negotiated between the back house community providers in DHS so it simply removes that restriction and provides now for those co locations to exist so the example of this is you know a lot of these rural areas there's limited commercial real estate limited health care facilities sometimes the only place may be the hospital with their Medicaid provider so that's creating some restrictions toward available services can be located this is just removing that restriction to allow those co locating entities to exist. Representative was there any opposition known opposition known opposition. Any questions from committee. Anyone here in the audience speak against your question. Absent first anywhere any audit speak against the bill for the bill. Seeing none you a close for your bill I am close from a bill. I have a motion of do pass any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay motion carries graduation your bill is passed thank you Mr you're recognized to present HB seventeen twenty three thank you seventeen twenty three said bill those brought here by the department of health this is a provide a mechanism for data collection within our EMS systems to try to do some process improvement through eighty H. this is it provides protect protected data collection it's the same system I like to use for some of the trauma queue I this was something that we've been looking at for some time within the in this section is a way to try to do some quality promote the amass this was negotiate with the email association also been at the hospital association to make sure everyone was comfortable with the language they were using and the process of collecting this data and I'll be happy to try to answer questions. Any questions for representantes you're recognized for a question. Thank you Mr do you have any idea what the cost of this might be so is I would have to defer to my just posted here I think if the president feels would for. I'm sorry I'm saying aye you're supposed to help not DHS a DH spot back. Please introduce yourself and who you represent. Department of Matt Gilmore. So representative also mentioned many costs associated with it is just a group of the members of a of a debt collection group there's meeting and discussing Q. it shouldn't any costs associated with okay thank you. Any other questions. From committee. H. B. seventeen twenty three to twenty third representative Wardlaw you're recognized for a question. Thank you Mr. As a provider over the years we've saw the increase data collection fell over many many areas we've seen face to face requirements we've saw all kinds of stuff come from this and it mostly comes from the time the becomes voluntary to you like this and they're asking for them to do this and and what folks are saying yes hospitals are saying yes the next thing you know is is data starts being used and billing process and what kind of insurance is do we have this data is not going to become part of the building because one of the problems in health care one of the reasons and doc you will know this the health care so expensive is because of all the documentation and in mid school in in nursing school they don't teach you all this documentation insurance companies teaches documentation so what what interest we have this won't be used to drive the cost up as we move down the road. Seven go ahead I was just happy that you certainly the intended this is sincere I've served on the you Miss committee that looks is that civility and since of the intent is to work like the trauma Q. I. system so that we can give you positive feedback negative feedback to our providers when a when their opportunity for improvements and try to look at that as a system is a state so to try to prove the care when there's no intent in what we're trying to do to try to translate this into any sort of insurance billing issue and I I would defer I guess my colleague here as far as the protection of the date I'm not sure that that dated it we've got to set up to be shared and that way we will not be sure to be internal only it will be share with insurance or any other data collection entities. Thank you well not yet. Any other questions. Seeing none anyone here in the audience speak against the bill. For the bill. You may close rebuild. Sturch was will of committee. Senate bill you're recognized. I have a motion of do pass by representative Bentley a discussion. Seeing none all in favor signify by saying aye. All opposed nay. Is haven't resolution the bill is passed. Okay committee we're going to go back up to the concurrent amendments with Senate concurrent amendments. First one is represented Wardlaw. H. B. twelve fifty four represent Wardlaw you're recognized. Thank you Mr I can make this easy and quick and I'm sure there's a few questions but on the house floor I promise to do an amendment to take patient center medical home out and ensure that they came on a run in patients and medical nice exactly what the Senate amendment did. So I make a motion due to concurrent proper time. The questions from committee. A representative first you're recognized. Okay I need some assurance that this is not gonna be able to be changed and rules where they can leave around I PCMH the Amendment language came straight from DHS Serra allowed him I could pronounce her last name she actually wrote the language as you said they could not. Not even in rules and I'm not in statute okay thank. Representative McGee you're recognized okay. Any other questions. Seeing none anyone here any on speak against the amendment for the amendment. Seeing none you may close your bill I'm close make a motion to concur. I have a motion to concur on the amendment any discussion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries your bill is passed The Amendment was passed. Next concurrent Amendment Senate Amendment is representative Bentley. H. B. twelve fifteen. Pilkington zero. Did. Thank you chairman college this is just the amendment that I'm a certified nurse midwife bill that promised you that I would do to make sure we had a referral process for those waivers or outside the hospital the birthing center. For transfer agreements are. That's it all right any questions from committee. Seeing none anywhere speak against the men Amendment. For the amendment saying ninety rate close I'm close to make a motion to pass as amended or concur sorry make a motion concur Senate amendment on H. B. twelve fifteen I have a motion to concur on the Senate amendment in discussion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries graduation your concurrent amendment has passed. Represent Dotson can speak the imminent. Okay committee we're going to pass over HB ten sixty three concur amendment right now. And representative McCollum is running a bill and another committee. Represent Pilkington is not here so representive Lundstrum you're recognized to run H. B. seventeen sixty five. Thank you chairman Ladyman I'm with the permission of the chair mask a guest to come up and join me yes if you would bless yourself and who you represent. Yes Sir my name is Joe Horvath I'm a visiting fellow at the opportunity solutions project may proceed. ladies and gentlemen this is a bill that is a long time in coming this is something I've been pushing for a while so if you'll give me a moment I want to set this up this is the department of workforce services bill that I have been asking for and I think it's very important and I want to brag for just a moment on our department of workforce services as you know they have been pushed to the limit this last year with the pandemic and. Moment of truth and unfortunately we're on video so I'll have to be extremely honest about this this bill this department of workforce services computer is a little bit older than I am. It is a nineteen sixty eight R. I'm older than it is by just a few years we are actually operating on a mainframe. This has some more technology than what we're asking our folks to work with on our unemployment system be quiet Mister Wardlaw I'm. Yes it's old and we're asking these folks to work and make bricks without straw. It's a patchwork we had fraud issues our constituents have been frustrated our employees have been work to the Max our tax payers have been asked to support a system that is old and arcane our businesses are paying for it our governor and director should be able to pick up the phone and in any minute ask for a report. They have done everything we've asked them to do and then some. This system has processed two point six billion dollars in fines we've had eighteen million dollars in fraud. So there's a lot of things that need to be done with the system and should have been done before the pandemic hit but I'm kind of proud that they've been able to do as much as they have been but let me just give you a couple things that I think you need to know about before the pandemic they were seeing twelve hundred to seventeen hundred people of weak and unemployment assistance people coming in the front door now they're seeing at a high fifty one thousand people a week those are our constituents coming in the front door to seek unemployment I'm sure you've all gotten emails in compliance and because they can't get through the system's locked up there's been all kinds of problems what I would like to do is see the system be completely overhauled throughout the system and start all over again and get an updated system that actually works we can detect fraud our businesses can see what's going on our customers can see what's going on and we know what's going on it is going to cost some money about thirty five million I know that that is not enough but if you give them every but everybody the next money that they want it's going to get spent and I'm extremely grumpy and very tight so and we all know that that's not anything new so now we know two things about me we don't need to know about but if we don't give them isn't straw and the mud to make bricks we will continue to have the problems and we will continue to stress out these employees I've gotten emails at four o'clock in the morning from these folks that have worked hard to produce good customer service. With that I would like to open it up. For a few things from this wonderful gentleman that's come so far Mr how with. Thank you representative I'll keep my remarks extremely brief the bill is a good bill and by passing it the this state would join a what is a becoming a parade of states in adopting and codifying good practices lots of states are putting in effort to modify modernize their systems this is a good step in that direction I kind of find good practices like the like the integrity cross checks recommended by the department of labor under both president trump and president Biden and you know facilitating continued cooperation between the legislature and DWS to the annual reporting it's it's good government it's it's simple it's non controversial that don't really have much more to add beyond that. Thank you. Representative Wardlaw you're recognized for a question since I got drug into this I was just wondering I don't think that computers back then just barely it was old mainframe computer technology that we're building a patch work on and I also would like to point out this bill is actually gonna pay for itself with the taxable wages that we've collected that point five percent so we can pay for this and when you consider we've had eighteen million dollars with the fraud it's about thirty five million dollars with the system if we can stop some fraud we can pay for our own system so. I'd like to see these fellows have summer Quitman yes you can follow so this bill has a tax Senate did I hear you said a and we're already collecting the taxes would this would take that tax and use it to upgrade that system are not put in a system. It was the tax going now what what account the unemployment fund managing that fund. Representative Boyd you're recognized for a question. Thank you Mr chair representa LUNDSTRUM this the great bill great idea I appreciate you working investor in our infrastructure did you include anything in there about interconnecting that ministry of offices of the courts and updating the Arkansas department of health well by the. Yes Sir this is just the W. S.. Maybe the others being questions from committee. Seeing none. We have two people signed up to speak against the bill. Randy Zook. But no more no bill. Yeah you're you're good. Okay. Jim Hudson. Thank you chairman part timers for the. Representive you're doing a good job here that. okay seeing no one else signed up to speak for or against the bill is there anyone in the audience who would like to speak against the bill. For the bill. Seeing none are you ready close for your bill yes I'd like to thank the department for for service employees that have responded to all the emails and phone calls to serve our constituents I know they've been stressed to the limit and they have worked incredibly hard to provide customer service and I know it's been very difficult. President Payton the jet motion of. I have a motion do pass any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries congratulations representative your bill has passed thank you colleagues. Okay committee we're going to move back up to the concur Amendment. And we're gonna run H. P. ten sixty three representative Dotson you're recognized. This is. Thank you Mr members the committee this is a concurrence on Senate amendment or on I can HB ten sixty three the telemedicine bill. Concurring on a sentiment this is the bill that we passed out of here. Several weeks ago now and Get over to the Senate ran into a few Questions and. They made some changes to it and send it back to us so I'm gonna go through these briefly for you one that an emergency clause that was part of the Senate Amendment Secondarily on. See page representative Dotson you have to amendments there are two amendments okay we'll have to address those individually so to speak on number ones that would get as I'm I'm on number one okay here it the second one is a is that a co sponsor my son's co sponsored Percy so the main one the me to the bill or the meat of the changes are all within this one. So in addition the merging sea Clause this also add a section H. which is on page two of the bill you can see that there Basically what that did was define the patient medical record more clearly in in the actual statute. And then. Going to. Page for the bill. This section. Section four this also added a some language to I. A. it actually added to be in the C. under eye and more clearly defined the audio on the only communication aspect of this and then and added to a making sure is subject to the same audit review process is required by pairs and governmental agencies. when requesting documentation of other care facility care delivery such as in office or face to face visits. And then on page five it struck language on what is now line five under the The New section four or item for that was as part of a new part of the bill it struck the financial incentive of any kind language I'm sure there may be some questions and I'll be more than happy to try to answer those questions Any questions from committee. Representative McGee recognized. Thanks thank you Mr. So. When this bill first went out of here we had a. There was a. Large part about what comes to the staff is made of a patient physician relationship and. And and and I've got up and spoke for the bill and voted for the bill and voted for on the floor and goes over the sentence been changed such that and I'm all for telemedicine and and and that sort of thing but it's been changed to where they're allowing this patient physician relationship to be established. By any means by facts about the it does they don't have to have a medical record I mean I I think one of the key things in the original bill was was the fact that that that the. Person doing the telemedicine consultation had to have access to the patient's medical record and did you have any comment about that I mean it seems to me that change that now so you don't have to have any record. Well this this defines that someone can call an and just like when you're going into the doctor in the face to face type visit you fill out your information if you've never been to that doctor previously then it's all brand new information that you're giving them this basically defines that you can establish that patient record by telemedicine without having having an in person visit first at the the basic changed the as I understand it in the okay in this more line is what the practices today or for the last year under the emergency order so this is part of the One of the items of the emergency declaration that we extended yesterday this needs to get passed in order for that margin so would declaration to end and without telemedicine coming to a halt in the State. Follows Mr yes yes recognized secretary will still have a problem with there's not really difficulty for patients. I'm a physician you know that and and. Patients that come in the offices. Get latest portals where they have access to all other medical records is a tremendous value for someone if your call me over the phone and I've never seen you if they can fax me or send me a what they're medical record is then the last average relationship with them and and I can treat him and I can understand how that works but by the way this is is there's and there's no access or no requirement to go back and get the patients prior medical records and I us fund that is a problem of. But the second question really is is up there in the original bill there was in it and there was language about not offering incentives. to steer patients toward telemedicine visits that's a that's a patient protection issue I can foresee that there will be. Companies or. Major companies or or or a insurance companies it may steer people with incentives to use telemedicine when it's not in their best interest to you what I don't understand why they remove that. Well to go to the specific language that was was struck and says the financial incentive it of any kind I think that language as I understand it was felt to be a little bit too broad language within the statute It's Basically it's it's government interfering in the terms of private contracts between health plans and and their clients so if this is kind of the practice that insurance companies in various ones use today I'm sure you're familiar with all of us are familiar with the will check up that we do on an annual basis with state health plans in order to get better rate on our policies that those types of incentives would be prohibited under this language at least that's the understanding that I had when it got sent over so I think that's the. My understanding of why that was struck out as as part of this the Senate discussion over there That was all done. Prior to when I. On the bill so. Thank you Mr no particular for a question. The representative Bentley you're recognized for a question. Okay. Representative Wardlaw you're recognized for a question. Thank you Mr when this bill left here weeks ago it was basically a mirror image of the emergency order was not. I'm not entirely sure was a mirror image now. Mr followup yes so today it goes one step further by allowing these visits to be done without any history just like doctor review essay while ago the do you feel safe if you were in a situation where you need a medical care by talking to someone over phone without them knowing anything about your health care. The other no in a certain things could cause your blood pressure to go on through the roof to cause you to have a stroke things that they won't know because they can't see a previous chart and they can they don't have any access to that. I it's been several years probably since I went to a doctor for any sort of thing every time I go And I'm just speaking from personal experience here they have to fill out a new record A lot of times I don't go to the same doctor multiple times In recent years I've had the the the health check ups for the health deal so I guess there is some patient medical record somewhere on me but prior to those annual checkups like I said it's been many years since I've gone and every time I went I had to fill out one of those new forms because as a new walk in clinic or doctor went to I don't see how that's any different today than making a phone call and talking to a licensed Arkansas Dr and that according to the the the statute here. If you look at but it. If you look at section Elliots and section H. This says that they must meet the same standard of care. That are applicables to an in person healthcare setting so if that Arkansas licensed health care professional give me the same standard of care in their their judgment which I have to trust the doctor to make sure that they're the ones actually saying that this is whatever condition it is you're calling me about you can I can treat you for that weather's over the phone or in person or whatever if they can if they need to see me that's when they would schedule an in person visit. Asking a bunch of questions over my my personal health history so. I'd feel comfortable with it okay. Right any other questions. Representative Ferguson you're recognized. Yeah Emmet I have a comment before my question in that representative Pilkington and I essentially had the same be able to work on this I'm. He realized it before the pandemic before everything we had telemedicine in Arkansas we do now the whole thing is when you see a new patient what is the appropriate way to establish a relationship with that patient the emergency order extended being able to see a patient or talk to a patient beyond just audio visual in it it's very difficult to history and physical establish a medical record without seeing the patient the emergency order said a phone call you could use if you had access to their medical record either because you were there Dr or you could get electronically from somewhere else this bill. Takes it way beyond that which quite honestly I was a little uncomfortable extending it to just a phone call. This bill extended way beyond what the governor's emergency orders were which said that you could do a phone call to establish a relationship with a new patient if you had access to their medical records this says you can account as it offices and get paid for it if you don't have their medical record just based on what the patient feels about it that's not a medical record. So why do you think it's appropriate having. Why do you think it's appropriate to take the bill beyond I would never voting for this bill if I had known that it was going to have hostile amendments in the Senate and they would be tried the trust that we have with House that when we send something to the Senate it's not going to be dramatically change state changes so much that they made to the lead sponsor took Pilkington off and and and I think they did it intentionally they knew that if we calendar Dr McGee all of us who voted on it ninety seven to nothing in the house that it would without any opposition then they would change it in the Senate I just I just want to know from you why you think that's fair why wouldn Hester and you just run your own bill instead of hijacking our bill and be trying all the trust of the House we we agree to this bill it's what we pass. So you actually made a couple comments there that need to be set straight for the record one Senator Hester has always been the lead Senate sponsor on this bill so by definition both of these amendments that were talking about concurring in here today are members own amendments they're not hostile amendments the Senate does get a say in anything that we do just like we get a say in anything the Senate does this is no different than the process on any other bill when it goes from one into the other the lead sponsor on either end has full control of that bill and till it comes back to the house if there's a change in it so the characterization that this is this is a a there was a hostile amendment is just false it's not true However there are some changes to it I don't know that that was a predetermined plan however it it Based off of testimony in this committee think that raise some concerns by various folks in the Senate when it got to the Senate senator Hester is the lead sponsor ran amendments made changes I thank you worked with various people hi I wasn't part of those discussions at the time as prior to be being added on to the bill I'm not going to speak for representative it Pilkington on on all of his Discussions in that process But the the bottom line of it is before I agreed to be the sponsor of this Representative bill kind I'd. Visited and discussed and at I think this was a a I did that several members I guess you had in your mind before it was sent over was agreed to but the Senate didn't agree to it the Senate voted seven to one in committee to add these amendments and they passed it out and send it back to the house and that's the process that's the bill we have before us and This is the telemedicine bill that we get to vote on Unfortunately I can't make any changes to it at this point we get this this opportunity to vote on it. Or we don't have a telemedicine bill this session and so that's that's where we're at so well that's not exactly true senator Bledsoe has already filed the same bill that representative Pilkington and she and I agree to in the Senate to come back if we can turn this amendment so I hope we will not concur in the amendment and change the bill the other really bad thing that you changed in the bill or they change in the Senate is eliminating these financial incentives and what that means is these big out of state companies like Teladoc and you can see other doctors are licensed in Arkansas but they're not necessarily in Arkansas. Eight it can allow insurance companies to waive the co pays for them but the same telemedicine visit that you would do with your own doctor which a one of the best things it's come at a cove it is we have really stood up telemedicine in doctors offices I mean day of really against telemedicine is come to the forefront for all doctors in this bill says that you can incentivize. A you can incentivize an insurance company can incentivize you to call the Teladoc company instead of your own doctor doing the same telemedicine visit they make you pay a copay to see your own doctor doing exactly the same visit. Explain to me how that's fair it and it's not better to see your own doctor as a telemedicine visit who has your medical record and is seeing you in the past you're going to incentivize with this bill to call tele docking station. That. Like anything else would be the the choice of the consumer the client on who they are the ones who they want to call and. The main thing is that is it a licensed it is a licensed Arkansas healthcare provider that they would have to call under this bill so we're talking about Arkansas physicians that would be treating patients here in Arkansas and that's kind of the free market people get to actually call whoever they want and get the the care that they need at the time and place of their choosing so I'm I a and they're not necessarily Arkansas positions most of them are not there just licensed in Arkansas and if if I'm a patient if I'm going to pay nothing to call Teladoc but I had to pay a ten or twenty dollar copay to see my own doctor that's not parity and payment which is what the whole telemedicine model that we have had a long question based on yeah that's my question why why is that fair I mean. I think that'll be a decision that everyone on this committee will have to make. Any further questions. Okay we have one person signed up to speak for the bill. Kyle's Embley. Kyle's that Billy Mr while that person's on the way if I may add one other comment discipline at just just to be clear for the committee this is a scope bill so we are far past the deadline for filing scope bills so it doesn't matter if there's a newly filed bill right now we're past the fifteen day window there is no other telemedicine bill coming. Is there anyone in the waiting room do you know if he's. Yes please go the table introduce yourself and who you represent. Thank you so much chairman I'm Kyle's ability I am here representing the American telemedicine association you're recognized thank you so much. Mr chairman and members of the committee as I just said fine because of Lee and I am the director of public policy for the American telemedicine association. I came to the ATA after a decade of experience in the federal government including the three and a half years as a political appointee in the trump administration of the U. S. department of health and Human Services. The eighty eight is the only national organization completely dedicated to advancing telehealth. All right members include companies such as ascension one eight hundred contacts of Vera if you're Ikere Babylon health bright M. D. Doximity hems intermountain life point Phillips Teladoc Health brazen Walmart Ziegler and Psygnosis and these these organizations are providing care for hundreds of thousands of our Kansans. The ATA represents telehealth providers delivery systems and payers as well as partner organizations and alliances working to advance the adoption of telehealth advocate for responsible policy an offer education and other resources to assist in the integration of virtual care into emerging value based delivery models. Many of your constituents work for members of the ATA in support of the delivery of quality healthcare across our our Kansas. Arkansas excuse me eighty eight is pleased to see house bill ten sixty three making its way through the legislative process the amendments made to the bill in the Senate at important clarity and are vital to affected Lee making telehealth more widely available in this state. We hope it will be the committee's pleasure to contort Kerr with the bill as it is now before you. As you know the governor's executive order issued in response to the pandemic improved access to telehealth by removing some of the barriers an existing law and to a large extent this bill would remove those barriers permanently. The governor announced yesterday that he had extended the emergency declaration which will keep the executive order on tele health in effect until the General Assembly can act. But securely the governor noted that his DO was intended to increase access to telehealth that this intent is reflected and H. B. ten sixty three as amended by the Senate. And that he was appreciative of the sponsors of H. P. ten sixty three for acting to replace the io with defective legislation. The governor's comments or of section on how important telehealth has become to ensuring the greatest possible access to quality care across Arkansas. While every state approaches regulation of health care via telehealth technologies differently there's no question that Arkansas is the most restrictive and is the only state to expose explicitly require a prior in person visit and statute. By passing this bill it will no longer be necessary for gubernatorial executive orders to waive restrictions and our Kansans will be able to receive needed healthcare services in a way that is safe effective convenient and patient centered. Arkansas will finally take the important step forward to trust it's a licensed health care professionals to use the appropriate discretion accountable to the standards of care in leveraging technology to evaluate and treat patients remotely. This is not something new or run tried in fact it is best practices nationally. When I testified in the Senate committee a few weeks ago there were discussions around where other states were as compared to Arkansas. We pulled the code language of neighboring states and have provided that to many of you and I have copies as well the short of it is this. They all already have comparable language to H. B. ten sixty three as amended codified. Another question that came up was around establish definitions of a patient personal health record also known as P. H. R.. Simply put there is no universal definition of a patient person up a patient personal health record in fact the closest comparisons or the CMS is electronic health record and the AMA's CPT code which allow a physician to bill for the evaluation and management of a new patient while only requiring a quote medically appropriate history and or examination. Importantly the CPT code was updated in twenty twenty one specifically the per for the purpose of physicians onboarding new patients via telehealth. I wanted to review provide that information to the committee for your information however I believe that with the addition of paragraph H. in the in the bill there is sufficient clarity as to what is required in order to establish a valid patient physician relationship to be clear the Senate amended language in paragraph H. places appropriate requirements. On providers to establish a relationship including one verifying the identity of the patient to disclosing the patient providers name contact information and license information three obtaining informed consent from the patient and most importantly for requiring the provider to meet the standard of care. All or Kansas licensed physicians are required to meet the same standard of care whether that care is delivered is in an in person or virtual setting nothing in this legislation change that obligation nor does it remove the Arkansas State Medical Board's authority to discipline physicians who fail to meet the standard of care. Finally I want to thank the committee for your work on this important legislation. We the ATA are committed to ensuring that patients across the country have access to safe high quality and affordable health care when and where they need it and we believe this legislation will accomplish just that so we very much urge you to concur with the Senate amendments and of course I'm here to answer any questions you might have thank you so much. Okay any questions from committee representative McGee you're recognized. Thank you Mr so you mentioned. Mentions that some other states that that that have several language or not as restrictive language I have the language the Mississippi Missouri. Oklahoma all of those states require more than what this bill requires. In in in Mississippi telemedicine must be real time it does not include the use of audio on the audio only telephone email or facsimile I mean even our surrounding states have more restrictive language and what this is and what what people need understands telemedicine's practice now by physicians in the state is not like of this build and past we're not going to have telemedicine anymore what we're trying to decide is it what's the purpose patient physician relationship and states around us have more restrictive language in the then what this is this this opens the door to a lot of potential can you comment about what the sash around the state saying I actually I have a one pager Sir happy to provide it to you right after this I'm I respectfully disagree I think that if this bill were not to be passed to the Arkansas would remain among the most regressive states in the nation in regards to the ability of practitioners deliver care via telehealth me what Mississippi says use of interactive video or audio video or other electronic media Mississippi code eighty nine dash nine deaths three fifty one another portion of the Mississippi code exam need they need not be in person if the technology is sufficient to provide the same information to the physician as if the exam had been performed face to face Mississippi rules title thirty part twenty six thirty five. No further questions representative Bentley you're recognized. Thank you thank you for coming today I'm vitally concerned with making sure my constituents get some help when needed so do you think this will expand to our constituents bill to give more access to health care yes ma'am easier thank you thank you. Any other questions. Seeing none is there anyone here we don't have any other speakers signed up to speak for against the bill is there anyone in the audience who would like to speak against the amendment. For the amendment. Sing ninety rate close. Thank you Mr chair and if it please the committee I can see where things are at the moment I'd like to pull the bill down. I'm sorry representative I was distracted I said if it please committee I'd like to pull the bill down for the moment I can see where things are at. Well and I wanna make a comment before you do that if you don't mind I was but you're going to make a motion but. And I'm okay with you pulled a bill now but speaking as someone as sees a doctor more often than you do representative Dotson and moving from place to place from state to state which I have done you know when I go to a doctor they don't have any record. I know this face to face with the the access that we have electronically now it would be similar but when you go to a doctor in another state they have no record and they do fill out a form and they see you if if it's an emergency or non emergency then they get that record. They can call where you moved from they can get that record and with electronics nowadays it's easier to get the record the used to have to be mailed or sent by carrier my wife used to work as a Kerry we should go get medical records and taken to another doctor so I don't see where that's an issue now I'm a layman I'm not a doctor and I I respect what our doctors of brought forward here in their you know their concern but I don't see that as an issue I I think you can get a medical record after a meeting with a doctor that's just my comment a couple more comments the Teladoc again I understand the concern and let me just say I have a small business and I like by local and I am part of that but I have to compete with people on the internet. And most businesses do. And I don't want to diminish medical treatment and call it a small business like any other. But that's the world we live in it's it's free market is competition and I know there a lot of concerns I got calls on that but if a person chooses to use Teladoc. That's their choice. So I feel like that's a kind of a free market issue and I'm going to get some folks in my district that called me about that but that's with feel about it one other thing. If this amendment fails. The bill fails. Now I know there's been discussion about another bill but representative Dotson is right this is a scope bill and we cannot get another scope bill because the time has passed that is a true statement. also we had ninety seven members I think represent Ferguson said ninety seven members voted in the house to pass a telemedicine bill. I think we should give those other members other than the twenty members of this committee the opportunity to. Vote on this amendment. Ninety seven of them voted for this. So I think we ought to give them the opportunity to vote on it. that's all of my input so representative you're recognized the which one. I thank like I said at the moment I'll pull it down and try to bring back another day thank you thank you. Okay committee we're gonna move on. Two. Representative McCollum. See out there. He was here a minute ago. He is not there okay. A representative Pilkington are you ready to run H. B. twelve sixty three. All right you're recognized. A Devon you tackle. You're recognized thank you I'd like to have a doctor Grady cross then come up and sit with me please. The running twelve sixty three is that yes twelve sixty three options actually just trying to find the exact bill number yes Today bring to you twelve sixty three an act to establish Arkansas anesthesiologist assistant act provides for licensure of anesthesiologist systems and for other purposes as you know that this session we've spent a lot of time talking about expanding access to care helping our rural hospitals doing well all we can to open up the ability to practice and serve the great state of Arkansas and one of the proposals that came to me was the establishment of the anesthesiologist assistant program here in Arkansas You know what was obvious and other bills we've had as we clearly have a need here in the states we have people who are wanting to come here to practice that currently aren't able to and there are specific cases actually recently of hospitals trying to recruit providers who had spouses or anesthesiologist assistant who were unfortunately unable to make the move to the state because their spouse would no longer be able to practice and so for me I think this is something that's done and other surrounding states and I think it's something that we should open up Arkansas to make sure that we can do more surgeries here in the state that's my quick brief introduction all handed over. The doctor due to educators saw. Thank you representative Pilkington and thank you representatives for hearing me my name is Grady crosswind I have practice anesthesia for thirty five years I was an associate professor of anesthesiology at UAMS for almost twenty years while at Arkansas children's hospital I taught both anesthesia assistants students and siRNA students on the pediatric anesthesia rotation for several years as I go on to speak I'm going to refer to anesthesia assistance as a a a As are recognized by the centers of Medicare and medical services CMS tricare and all major commercial insurance payers CMS recognizes a As as qualified nonphysician anesthesia providers just like R. C. R. N. A. colleagues a As are as safe and effective as nurses messages their salaries are on a par with C. R. and nays which is appropriate as they provide the same services our neighboring states of Missouri Oklahoma and Texas all recognize a As and allow them to practice thirty percent of the states and the countries have a As practicing in them. Licensure of a As encourages a fair free market at a market that would increase competition which is better for the consumer your constituents and our patients nationally the roughly fifty five thousand C. R. A. days and approximately eight hundred of them practice in Arkansas nationally there only three thousand a a students and if we were to open licensure to them we would hope that at least thirty to forty would come into the state over the next year or two. To qualify for admission to an a a program a student must have completed pre med requisites score well on the M. cat which is the same test that the medical students are required to take and have a grade point of greater than three point of and most of them have a much higher grade point than that the graduate school's master's program itself is typically a twenty eight month endeavor of both didactic and clinical experiences eighty four percent of a a students have worked in healthcare prior to becoming and a and some of those students have held other licenses such as a nursing license respiratory therapist pharmacist at cetera and a majority of them have been working in health care for greater than two years a As are trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques the idea of an anesthesia care team is one of the crucial building blocks to the foundation of the a a profession and a seizure. Anesthesiology assistance worked alongside and under the medical direction of physician anesthesiologists which creates a productive and safe environment for the patient statistics and studies have proven time and time again that patients receive the most comprehensive and highest quality of health care when in anesthesia team cares for the patients. A. A.'s and siRNAs are interchangeable in clinical practice I spoke with a former resident of mine who is on the faculty at Emory in Atlanta a highly regarded Medical Center where. They have a a ratio of C. R. dazed eighty eighths of one to one and this faculty person says they are treated equally they are viewed as equals so there's almost a similarity to physician assistants and advanced nurse practitioners many of the things that they do overlap you take your pick so with this information I provide you I hope that you will strongly consider passage of house bill one two six three and will be available for questions if you have any of the like to offer. You will hear from the testing or take questions. Okay. All right thank you for your comments. did you have anything to add representative Pilkington. All right any questions from committee we got I'm sorry I got some questions here represent about one you're recognized for a question. Thank you Mr chairman my question is on the last page it says the person who has engaged in anesthesiology work for at least one year. Before January first twenty twenty two may receive a license S. the anesthesiology assistance without examination so. This this bill say that people can move to the state of Arkansas. And practice. In practice without examination. These are people who are already recognized doing anesthesiologist assistant work in other states and so we're just recognizing that licensure in other states so they're recognized in those states but they don't have to come to the state of Arkansas. And take an exam is that correct. That's right. I'm not trying to trip you up on the asking for clarification no no you're fine So yes so. Your answers your assistant working in Texas you would be able to come in practice because by the time we get a standards in this goes into effect January first for instance if you're trying to recruit an anesthesiologist assistant and you're practicing anesthesiology already you would be you'd be able to practice I believe that's correct so. Follow up with the chairman of this just yet very quickly so he or she will not have to. they're not subject to being the having this state examination in the State of Arkansas so they don't they don't have to pass a test in the state of Arkansas. Correct as they've already passed the test in another state that's already operating without anesthesiologist assistants these are trained professionals who are eager us. The representative Ferguson you're recognized for a question I haven't maybe I have a question for the gentleman at I think I'm can clear up what he's asking these people very passed a National Board is that right just like every other health care person that is licensed in the state we don't retest them they have a national board exam. Mechanism of national borders of state licensure so National Board that's what I thought so it's typically what we do with every healthcare profession I have a National Board is a dentist and I'm licensed in Arkansas but I've already passed a National Board right. Correct representative Bentley you're recognized for a question. That was my question about the national board on another quick can you come I've heard some. documentation either side to clarify for me an AA must go through the. Do they have to practice their for their undergraduate degree what does that have to be in because I know with nurses they do undergrad in nursing which is medical do they have to have a up graduate with undergraduate medical degree. For for a site you can they graduate with you know English major and then going to be in in making gradually with a graduate with an English major but they have to take the pre medical requisites so they have certain hours of biology certain hours is so ology certain hours of chemistry certain hours of physics just like a pre med student it's a pre med curriculum that's recommended. I'm a physician I was an English major history and philosophy minor I took the science is to get into med school they can do that as well okay and then the hours as an a a system where there was after undergrad. Its agent typically it's a twenty eight month combination of didactic and clinical studies Meghan you have been a number of for hours. Yeah if you want to go to the table to help answer this act to come. This is. Spoiling my surprise witness. Sorry I have Mr chairman and members of committee my name is Megan may okay I'm a first year a student I'll give you my whole spiel right now just in some questions about the don't want me to go ahead and talk. Yes you're recognized. Okay and so my name is Mike Imoke like I said I'm a first year a student with case western reserve university's school of medicine in Houston Texas and I will say I am really nervous today this is my first time being in the capital in doing anything even remotely close to this and finally nervous because it means so much to me so I just hope that you'll appreciate and understand that. And so I graduated from the university of Arkansas in may twenty twenty two may twenty twenty so sorry the ticket. At. With all my but this great state I'm here to testify in favor of house bill twelve sixty three that creates that Arkansas a a act that allows Arkansas Board medicine to license a eight to practice in the state of Arkansas joined seventeen jurisdictions that allow our practice as well as the federal centers for Medicare and Medicaid tricare and Veterans administration first I want to thank you all for allowing me to come speak today I truly feel like I'm home and I'm so excited to be here. Especially get and watch a game here last night even though it's a little bit heartbreaking nothing makes me more proud than to be able to call the hogs especially in this great state. And then the four years has been here many hours are spent shadowing it working with various positions that many hospitals actions able it's not it's laid back here a couple times I got some really good experiences haven't the explosion I got up here was simply very different than what I thought and taxes the. I was became well aware of the role that insurance money in politics play in patient care and things that I think in the way of our patient care every single day. The. It broke my heart to see so many Arkansans struggling witnessing firsthand this desperate need for medical professionals I can't help but want to assist in making this state a better and safer place for all. See may not be aware of all that the a profession expense entails because I didn't even just two years ago so it's a little bit about our education and training. So all a is possessive premedical undergraduate degree complete about twenty eight months of the comprehensive graduate with a doctorate in clinical program the majority of this training is done under and board certified physician is intelligence like doctor costs and who also the same them happy mad wrecked beat but school requisites and that we did therefore we can understand that it's the state pharmacology and all the factors that influence inside X. just as well if they can. The idea the answer care team is a crucial part of our profession As right along side anesthesiologist creating a more productive and safe environment for the patient working with this team needs of the patient always had two sets of hands to sets of eyes into brains and involved in their care but I think anyone can argue is a bad idea. And in my first year training I've done ten months in the costume in eight months in clinical now I've had the honor honor to work with many different anesthesiologist and see our nays and eighties as well and I'm not to different hospitals currently and starting may first I will begin my second year and specific rotations. And at all that's what I got to see in the team's work as a cohesive unit between it's all just an eight a is an intelligence and see our days and I've never seen any amount of animosity between any of them I've seen that this is true you know it's a it's a really good working system the way that we can correspond with each other and just take the best care of the patient and and that's I'm here today because I wanted to be able to work in Arkansas I wanna be able to come home I want to be able to call this place again at home again I want to call the hogs and not have everyone look at me like I'm crazy at. Yes so in summary I believe that your support of house bill one two six three will help to provide the state with the more productive inclusive and safer environment for all our Kansas which they clearly deserve and desperately need. Yeah I think and I can't ask in answer any of those questions now thank you for your comments you need a good job representative Bentley did you still have a question I did arrive she or the physician can answer for me but it from what I understand within a a there the answer is yes has to be in the room at the same time we do certain things can you go over what with things he has to directly be there because anyway with inflation in a supervisory role anesthesiologist is to be present at induction when the patient goes to sleep when the patient wakes up at the end of the case and any critical portions of the case and there should be a discussion with the attending anesthesiologist in the C. or an a or the A. regarding the cared that's expected during the case and at any time the attending anesthesiologist should be in immediate proximity in case there's anything that's emergent or something that needs to be discussed okay so this will not be I'm sorry can I ask another question chair you mistakenly pretty so Most of all the houses in my district or number of Arkansas do not have in this is it was on staff so these As would only be used in urban areas where we have Anastasi's anesthesiologist present is that correct. Well there are rule area voted if anesthesiologist were to be in a rural area then he could supervise one two or three a a switch hopefully the with that in mind then that might help you get physician anesthesiologist in the lesser counties of Arkansas but to answer your question directly yes the a bus always work under the supervision of a physician anesthesiologist okay thank you. Representative Gonzalez you're recognized for a question. Hi Mr my my original question I guess was was for the doctor but since she's at the table I'd like to ask questions to so. Did you know before you enrolled in a school that Arkansas did recognize a ace. And yes Sir I did and that was a really hard choice for me and making a decision but I had a lot of stuff going on in my life and I knew that this is the perfect route for me and it's just that my life I what I wanted and better I mean I knew actually whenever I shot it was late his exact words to me at one point where you're never gonna work in the state of Arkansas if you are in eighty eight and I kind of live fire underneath my seat because I heard a little bit because like I said I love it out here and I wanna be able to return so I knew that and my ambition I would go I would do everything I could to try to come out here and Julie yes so why did you choose a a oversee are in a if the training is equivalent of the time's equipment and all that yes it's a time as a quick but if you start out that way but I started out in the pre med felt inside already completed at whenever I applied for this going on and I already completed my inkind in already completed all my pre medical requisites and so instead of going to med school or instead of going to a school that would just be like to two years I would have had to redo nursing school or not read it but do nursing school and then worked as it I can I see you were something and think I want to do C. on a school so what equivalent to med school out in timely time what is. Representative first you're recognized for a question I want to make sure I understand this so you can trying in Arkansas but you can't get licensed in Arkansas is that what you said you keep in training in Arkansas no ma'am I did my undergraduate here and university of Arkansas yes ma'am it's currently we can't change in the state of Arkansas of your L. U. SEC docslide at your yes I'm sorry I just I don't under him I just said oh you get me to like a rotation or anything of the kind of man thank you. All right any other questions. Representative Gonzalez you're recognized can I ask my question to the physician now. Yes. I will wait on him to appreciate. This is just go for. Question I'm sorry Moses was questions would be recognized I recognize you once. You're recognized again I will continue. Should I'm sorry if I forgot your name but it's a great across the okay So you said that the training is is basically equivalent C. R. A. practices is the same this legislature just removed all the supervision requirements would you support that same thing for the. A ace or or what or is there a difference and I was here speak against that bill okay so so is this so I've seen the same bill filed I've been here for four terms down of scene the C. R. a bill come up and fail every time except for for this session and I've seen this bill be filed and just sat out there and never ran is this a re retaliation bill for the see all right absolutely not absolutely not as I mentioned to you the anesthesia care team model is the most efficient it's the most compassionate it's the most cost effective model to administer anesthesia and a hospital or even surgery center and so and working with well qualified A. A.'s working with well qualified C. R. Nays I have thoroughly enjoyed practicing in that model and I think it's best for the patients I take care of. This has nothing to do with that. All right any other questions. Seeing no other questions from the committee thank you for your comments. Thank you for your time a representative Pilkington did you have anything to add. No okay all right we do have some folks signed up to speak for against the bill to speak against the bill Michelle Gonzales. Gonzales part of this is going some. The right to shield Gonzalez it was. You will just you. She's not here. Okay. Slayed the bird well. Please introduce yourself and who you represent. Against. Thank you thank you Mr chairman and committee members may mislead Bridwell and I'm a see our name and I'm here today representing the Arkansas Association nursing assistant we stand in opposition of house bill twelve sixty three. Whenever I've had the pleasure speaking to members about these types of bills I've always been asked three questions how's this going to affect access to care how's this going to affect cost and how's it gonna could affect safety. Anesthesiology so in reference access to care anesthesiologist assistants or aides are dependent providers that must practice under the direct supervision of an anesthesiologist As must practice in the most restrictive most expensive and least used CMS billing model called medical direction and this medical model is mostly utilized in our academic training centers. Due to the excessive cost restrictive practices and decrease the frequency of this billing model a a is currently would not be able to practice in our critical access rural hospitals or for that matter most hospitals throughout the state thus creating no increase access to care. In reference to decrease healthcare costs as I said above As much practice in the most expensive and least flexible CMS model billing model Ifill if facilities are not already using this billing model but want to accommodate a As this would certainly increase the cost on to the anesthesia group for the hospital Aizen siRNAs in these practices are paid the same therefore there is no cost benefit to hiring a As. In the CMS medical direction model the study by up steam and published in the American society of and anesthesiology journal concluded that the supervision ratio of one to two thirty five percent of the days there was a lapse and supervision and decrease first case starts. In the supervision ratio of one to three this lapse and supervision increased over sixty percent the authors suggested staggered first case start times to mitigate these lapses however these delays in time we increased cost to the patient and to the hospital as well in addition. This medical model also increases the probability of Medicare fraud due to the increase lapses and supervision. In reference to safety. Currently there are no generalizable peer reviewed studies published in scientific journals that test to the safety of anesthesiology assistance however the obscene article that I just quoted you can attest to the supervision lapse rates in a medical model the As much practice sin. House bill twelve sixty three also allows an aide to perform a pre anesthetic evaluation and present to the supervising anesthesiologist. This is not consistent with CMS medical direction rules for this billing model CMS clearly states that the anesthesiologist must be must personally perform an exam and evaluation prior to the anesthetic period anything less would result in Medicare fraud and lessen the standard of care. And it's already been address bill in the last page of the bill twelve sixty three does not require a is to be certified in either to CMS. According to the bill a person involved in anesthesia work which is not defined for a period of one year can receive licensure as an a a without examination. I thought that was very confusing is confusing some members siRNAs however are one hundred percent certified we take this very seriously and being able to demonstrate our confidence in our contest continued confidence in our institutions specialty. And I'd like to add that yes I did I did mentor Megan a year ago and she spent time with me in the O. R. for a day I don't remember telling her that they would never practice in Arkansas because you never want to say never because that's why we're here I did explain to her the difference and that there is no licensure in Arkansas there's no licensure in Texas either As are not recognized are not given a license in Texas they practice under delegation. Also then the physician anesthesiologists spoke to the A. C. T. model being the most cost effective model not simply not true and there's some there's lots of studies that show that there are more cost effective models like the ones we practice and critical access hospitals in rural hospitals that are more cost beneficial then the anesthesia care team model. Thank you for your time and I'll try to answer any of your questions that you may have. The questions from committee. Representative Ferguson direct. Of well now that we've passed the siRNA bill for essentially independent practice do you think this could actually and increase the number of people in access to care in Arkansas because now you can have the As working in these more acute care hospitals and that would allow the city or nice to go out into the more critical access hospitals so would actually increase the number of people employed in Anastasia and help access is the way I look at it well our critical access hospitals and our rural hospitals operate on very thin margin as we already talked about in the previous bill requiring a medically directed model which is what is required by CMS of a As would require the hiring of more anesthesiologist staff which simply are critical access hospitals in our rural hospitals cannot afford to do. siRNAs provide the most flexible models in our rural access in a rule hospitals are critical access and flexible models in our urban areas that choose to do so which we gave the facilities choice with the passing of eleven ninety eight so I don't think that it's going to increase physician involvement going out to the rural areas in a As cracking it practicing out there because. For instance if you have one anesthesiologist and five siRNAs in the practice. those hearing aids can practice independently in the middle of the night and that is easy I'll just can be at home. Available for consultation or whatever if a As are involved then that anesthesiologist is gonna have to be on call in the House every single night twenty four seven that's not feasible for anybody so they'll have to hire an additional anesthesiologist at the salary that they command and so it just puts an increase demanding cost on to our rural hospitals so I disagree with the with the notion that we could increase access to care by a involved by putting As and practice out there when I think you're missing my point and things are out now that we've given independent practice to see our nineties what you know I mean we've talked about that really thought the compromise bill was to allow siRNAs to work independently and critical access hospitals but then the higher acute level hospitals to have anesthesiologist on staff because they typically do have anesthesiologist in these level one two trauma centers so we can fill that gap with the yeas in these level wanted to hospitals that already have a decision that frees up more C. are a nice to go to rural hospitals in independent practice well that's dependent on the C. R. in a I'm sorry was a question or comment I want to respond it was a comment okay I'm sorry I didn't respond every. All right representive clown you're recognized for a question thank you Mr chair. obviously you've been here we spent hours of discussion concerning scope of practice in this access to care to piggyback off of representative. Can you clarify for me and I think you touched on this how in your opinion this is not really going to increase access of care if we have the A. A.'s in a in a hospital is just say Baptist hospital down the road. Can one anesthesiologist be in charge of fifteen a As and then they would. From the testimony I heard they would have to like stagger start times yes and so I don't know about induction and activation and all that might help with that. Under current CMS rules days have to be supervised are medically directed. In a one to four ratio no more. SiRNAs have the flexibility of not working under that medical direction model and being supervised by you know as you know have they would build themselves under the cues it cues the model so the. Nurse anesthetist would get a hundred percent of that bill. The reason for the delay first K. start times because that anesthesiologist has to be there on induction and if you have force seven thirty starts let's say that one anesthesiologist can't be in four rooms at the same time so you're gonna have to delay or stagger start those rooms which will increase and decrease cases at the hospital and decrease revenue. on the flip side you could have a patient wheeled into the room laying on the table just waiting to go to sleep waiting for an anesthesiologist to come in. If that was to occur anesthesia is build on a base unit plus time unit model so all the time that the patient's laying there waiting for an anesthesiologist to come in they're getting billed for that time. And so it's a very cool ineffective cost model. But the CMS only allows. For about one to four ratio at the maximum. For medical direction billing. Yes you're recognized. So can you can you expand and I'm sorry representative Pilkington gotta get here just a little bit late this may have been covered but. What what are the requirements of an anesthesiologist sure in overseeing and a a is it just the induction of Annecy I'm not know they have to be readily available yes Sir but what else so under the current CMS billing laws there's a tough of there called the tougher seven rules that must be met in order for an anesthesiologist to supervise in a a and receive reimbursement the seven tougher rules that have to be met and documented in real time they can't be that charted or anything like that or perform the preset pre anesthetic examination and evaluation prescribed the and seizure plan personally participate in the most demanding procedures in the anesthesia plan including induction which is going to sleep or emergence which is waking up. Ensuring that a qualified individual provides any procedures in the anesthesia plan and the and is that the anesthesiologist is not personally perform monitor the course of anesthesia administration at frequent intervals remain physically present for all key and critical portions of the procedure and be available for immediate diagnosis and treatment of emergencies and provide posting the seizure care in the post operative care unit those are the seven things that must be documented for each patient so you can imagine if you're trying supervise for patients. You have twenty eight things as an anesthesiologist you have to go around and document or else it could be Medicare fraud been supervising in a. Twenty eight things to a case may only last thirty minutes that puts a high demand on that anesthesiologist that's why in this medical supervision ratio most a lot of practices including our academic training centers are one to two supervision ratios not one to four. but that's also because our academic training centers have to be since we have trainees met CMS requires a one to two ratio they cannot in the academic center supervise more than two trainees. So those are the seven things that must be met. for an anesthesiologist and and the anesthesiologist assistant. Representative Bentley you're recognized for a question. I think it's been answered thank you. Representative Boyd you're recognized. Thank you Mr chair and you had a lot of answers and and I'm still scratching my head okay trying to understand this so maybe you've answered it but please bear with me sir so I've I've got a couple things I think I might have to ask both questions right after another to. Help you try to figure out what I'm trying to get out so. Why are we the state the legislature trying to discern what's best in the lives of our Kansas rather than letting the markets figure this out by offering competition and with that said then also how does this work in other states because I mean you keep throwing all these barriers and all these reasons why won't work but I'm trying to understand why it would be the legislature's role to decide that rather than the market's role thank you. Well first of all another state see others roughly three thousand as the physician anesthesiologists stated three thousand A. as in the country and most of them practice in three states Georgia Ohio and Florida mostly in you know there's some metropolitan areas when there's heavy metropolitan area that's first a As are mostly utilized mostly rural states you don't find them so they're not utilizing those rules states for instance our friends in Oklahoma have less than fifty As practicing in their state So when when you talk about competition I understand that but it's and it's it's not if it's not a fair it's it's not it's a anti competitive type situation if I can hire somebody if I'm an anesthesiologist and I can hire an a a who I board and I train and I control their practice then they're more apt to be hiring in a a rather than hiring a C. RNA so it's there's competition but if you subscribe to that theory I think we have to subscribe to the anti competitive theory as well so I hope that answers a little bit of your question if I got too low. All right any other questions. Thank you for your comments thank you Committee. Okay we have two people to speak for the bill. Deborah the relative. Deborah Perella. Okay. So you do not you're against. Okay Grady Crossman to speak for the bill. He's already spoke okay Deborah you're recognized come the table there does yourself in any represent. Some Dever Ella and the president of the Arkansas association of nurse anesthetists and super happy to have my president elect cover all that I'm just going to touch on a few quick things without dragging you all through everything I thought I would say. Representative Ferguson spoke of you know having a structure in which a Acer Irvin and I can understand how that makes sense and searing Nasr rule first of all we don't have a shortage of anesthesia providers at our state we're very fortunate we've got eight hundred siRNAs I think it's three hundred and it just over three hundred fifty physician anesthesiologist each of which you know. Are able to function in all areas of anesthesia where it's given also we have to really good siRNA programs in our state A. S. U. and you A. M. S. our programs in the past had been master's prepared predominantly and by twenty twenty two they will all be doctoral UAMS is doctoral currently and AS you is coming up quickly and to be ready for the twenty twenty two point being we graduate fifty two siRNAs that will become one hundred percent board certified workforce Texas Wesleyan is one of the very largest anesthesia programs in that country and I think it's about a third of their students Kansans analyze I work with a lot of them anyway and then kind of like within that the van of what you're saying representative Ferguson if we. Set up that sort of a structure in our state has these programs in place in addition to three medical schools that graduate positions to. Many likely will be interested in anesthesia for the searing days what we do is we put them in a place where we graduate our students they train that are large universities that's where they have the clinical rotations that's where also people see who they want to hire but then we say well thank you very much and then they go off into the real area not everybody wants I did it for twenty three years in real Arkansas that what we ran the risk of there is fishing siRNAs out of our state. Based on maybe choosing urban lifestyle. I think Slade covered costs and. The. Products you production power with the siRNA model either in anesthesia care team or solo is significantly higher and less expensive in anesthesia care team with a As and M. D. S. given that they make the same as a hearing aid does and the need to in the CCL adjust anyway that's all I really think I heard that maybe could use clarification unless someone's got a question for me. Any questions from committee. Representative Ferguson recognized yeah I mean if if what you're saying is true within a hospital would not choose to use a a sense to say are nice so I don't know what your concern is about licensing them I think it's very disingenuous of you all to come and ask for independent practice and they want to block other competition providers hospitals won't choose this model if it's going to cost them or don't you agree. And. Yes and now I'm like slate spoke to depending on when we're talking of competition and we're talking if you have four people in your practice for instance I work for and have in the past worked for anesthesiology and practices versus hospital ones and you know it's not for me to say what what would be the motive back. if the as supervision as what they would desire then maybe they would do that additionally like I said it's it's not really M. F. straight across comparison or not interchangeable. So. If they're not able to practice without supervision. Any other questions from committee. Seeing none thank you for your comments thank you. Okay is there anyone else here in the audience who want to speak against the bill. For the bill. Seeing none representative ready to close for you bill I am Mister chairman. for like testimony today I'm sorry this is taking so long I know. The Committee can long in the tooth You know I think it's pretty rich like representative Ferguson said for us to pass the C. R. in a legislation which I voted for in this committee on on the floor because I believe in expanding our options and health care you know I'm a healthcare administrator my father was my grandfather was all of the state of Arkansas yeah you know that every. my grandfather him knew each other you know when you're running a hospital your rain a health system it's not like they said it's not always the same thing you have to use different provider mixes to make it work and make you properly whether you're a real community whether in urban communities suburban community. Whichever. You that's why I as a representative of constantly voted to expand the scope of our different providers because I do believe a healthy mix of providers allows us to find the best models to make sure that our healthcare systems work propionate. That's why I voted for the C. R. in a bill and that's why I'm running this bill to and so you know to me I I think seven is pretty rich they say that there's not a short and anesthesiology which is what I heard the opposite of when they're running the other bill. And so you know for the and and to hear this you know it's going to be more expensive than what hospital do it let our hospitals make the decision we are not a hospital board here we are legislative body that makes the laws of the land if it's not profitable for hospital to do it they won't do it so if the if everything so is accurate we're not gonna see a single a a hired in this state. By the way projections only show that only about thirty As would come to the states is not gonna be a monumental change in that all this and every C. R. enable suddenly find themselves unemployed sadly is you have people who are trying to be a little more protectorates which which I understand everyone's got their turf I mean if you work in health care you understand turf wars just kind of go with the flow. But you know I would say this I've always been consistent and in my belief that we should open up our scope to expand access and to help fill in the gaps and to me I think this is an effective way for us to expand scope and to fill in the gaps and I do not find it'll be disruptive and it's not working for healthcare systems then they won't use a As and that's plain as can be and with that I'm I'm closed. As for good vote thank you Committee. And motion do pass goes on the committee. All right a committee the motion on the floor is do pass any discussion on the motion. I do have a discussion I I got a text from representative Miller. Yeah doctor's appointment this afternoon. And He basically says that he is opposed to the bill He feels like it might be revelatory bill so I want to give his comments to the committee any other comments. Yes representative you're recognized Penzo. Thank you Mr chair a unfortunately I missed a lot of the testimony as another committee trying to run a bill the ward I came in for the part about the word disingenuous being thrown around a lot of the the same arguments that were being made against the C. R. days those same people or supporting something with the lower of a standard and I just want to point that out that does I don't to. I don't think it's disingenuous to say that you know the there's concerns about the You know potential fraud if if the if the anesthesiologist isn't there for all the steps anyway I just I don't I don't think that comment was appropriate and against this bill and you know this bill was filed two years ago and and it wasn't ready and because the the siRNA bill didn't pass so here we are the issue this year on a bill passes so the bill's being ran in the word retaliatory I think addresses is adequately but anyway I'll be no one No of thank you. And any other discussion on the motion. I represented first morale was in the same thing but I want to say I have consistently voted for every bill that required supervision by a physician and supervision and interaction with the physician instead of all the scope bills that allow independent practice so don't I don't think you should say that I am having a different position on this because I have always voted for physician's supervision with bills. Any other discussion. All right seeing none motion on the floors do pass all in favor signify by saying aye. All opposed nay. No seven Bills fail. All right committee we're gonna go back up the regular agenda to HB sixteen seventy six representative McCollum. You're recognized to present your bill. Mr. Yes. Thank you Mr we're not recognized a representative Wardlaw Mr we heard most of this bill or day can we can I make a request a chair request we don't have to re hear the stuff we heard the other day. while make that request trying not to be repetitive on things that we've already heard. Thank you. Representing you you're recognized to present your bill thank you Mr chair thank you for committee appointed I want to head on anything that maybe we've already discussed Trying to recount the number of things that I do think it's important to emphasize and that's one that we did make an amendment at the request of the department making not retracting made to go into effect in twenty twenty two thank you. so we met that request and kind of represent Dotson you're looking around we it's to amend we already added last time so just have a sizing that we did do that other than that is any points we feel like we need to add on that we didn't make already if you would introduce yourself again who you represent. Yes Sir absolutely your bathroom a visiting fellow the opportunity solutions project We want tax rates impact on. Really quick enough to be repetitive but it's it's a bill that you know has a track record of success in a number of states three model states in a few more number of states are considering similar legislation right now expect smell slightly different looking versions they're moving their way through Kansas and Arizona it but again not to go over everything that we went over last week so I'll be respectful committees time. The. A representative Gonzales you're recognized for a question. Thank you Mr currently we have sixteen weeks unemployment right can you tell me how many of those weeks are used on on average. Last and I think DWS DWS might have more accurate numbers on this but using the numbers that are published by US deal well quarterly when I last looked it was Q. four twenty twenty was nine point nine weeks on average. The representative Bentley you're recognized for a question. Can you briefly discovery and how this might help our trust fund our employee trust fund please sure absolutely representative So the of the logic of the bill is simple you know when you're full employment five half percent you know you get twelve weeks and that ratchets up for every half point at the end unemployment rate increases up to the maximum of your current level of sixteen and basically it means that you know while I think still a generous amount of time three months to look for work individuals in a scenario in an economy where jobs are plentiful we'll be spending less time on the system less time on the system means fewer claims means more people working which in turn basically reduce costs would Florida saw was the cut claim time in half and that resulted in seventy percent decreases in costs which ultimately allowed for seventy percent decreases in unemployment taxes. Thank you. Any other questions. Seeing none of thank you for your comments. We do have some people signed up to speak. For and against the bill. we have one person signed up to speak for the bill and three to speak against the bill. So first to speak against the bill Randy Zook. Please introduce yourself and who you're representing. Thank you Mr chairman members of the committee Randy Zook with Arkansas state chamber of commerce let me be brief but I do want to be comprehensive in my remarks because this is one of the most important issues that the state chamber and its membership deals with. Just background per call and remember keep in mind that unemployment insurance is paid one hundred percent by the employer there is no contribution or cost to the employee there is no cost to net general revenues. Unemployment insurance is paid into a trust fund operated through the department of labor and in the city basically the W. S. as a contract agent for the department of labor. We have paid close close attention to this issue for years Two years ago four years ago excuse me we with representative Lundstrum to help and Senator Hendren and others at the time we passed a bill that reduce the cost to employers by about sixty million dollars per year that was ACT seven thirty four of twenty seventeen ACT two ninety eight two years later in twenty nineteen the skews me ACT five twelve. A reduced cost to employers by another forty to sixty million per year the trust fund right now has a room near record amount of money in it it's healthy it's being protected it's over funded in any reasonable environment but due to the pandemic and the and the profound impacts on the economy there have been you know it's been sort of a seesaw thing but it's it's way over funded never the less. And reducing these going to this floating basis of of weeks of coverage or payment or benefit whatever you wanna call it. Interview has already been accomplished in the last session when we floated the wage base which determines the cost to the employer an employer pays on average right now about three and a half percent on the first seven No skews me ten thousand dollars worth of wages for each employee so that ranges anywhere from three tenths of a percent to fourteen point two percent of that wage but he's that's a cost per employee depending on the employer's experience of thirty dollars per year per employee up to about fourteen hundred dollars per year per employee it depends on what level of claims you make on the trust fund but again. In summary just headlines because I know time is time is running short and and it's late in the day this system is healthy despite the COVID pandemic your biggest problem in dealing with this over the last year has not been on employment it's been the federal government every time. It gets them there we run close to to some end of benefits of federal government has stepped in and paid to extend benefits and pay that as you know to add to benefits by as much as four hundred but right now three hundred dollars per week the biggest competition for employers right now is the federal government. I have hundreds of experiences where employers say I can't find the people I need right now because everybody's waiting until their benefit runs out right now under the federal rules it's extended through September but despite all of that Arkansas people want to go to work and as you heard the average exhaustion period is less than ten weeks of coverage people want to go back to work if they can go back to work usually but they're also rational and if the federal government is paying more to stay home they're working bodies some of them will choose to stay home no argument about that but bear in mind then be careful here because the economy is exploding this morning there were experts predicting in the jobs report for February that will come out Friday morning will report a million new jobs created in the month of February this economy is on track to take off like a rocket the second half of the year is going to show at least six percent growth in GDP and the least of our worries is going to be adequate funding for unemployment because we're going to have more demand than we can keep up with we already do you many of you have had the experience right everywhere you go people are looking for people to go to work. So there's plenty of jobs available and plenty of people soon with widespread vaccination who will be available to take those jobs so import demand for employees is rising people are going to back to work even though it could be a little faster but you get some perverse incentives in place so my. My message to you is brought on behalf of the people who pay for the system. Please be careful not to disrupt it anymore than it already has been let the system work get the system modernized pay for the system update so the people who run DWS can operate more effectively more efficiently more. within the bounds of the law minimizing fraud so all of that long story short we urge you to be careful voted against this bill. Come back in two years and take another look at whether you want to float the the benefit period based on employment you already have a cost floater around the wage base. I'd be happy to take any questions okay we do have a question representative Bentley you're recognized thank you chairman thank you Mr set for being here today everyone everyone some pain that paycheck out you know as a business owner I don't know the some other states have already passed this North Carolina Florida Alabama and Georgia have all seen improvements to their trust fund it to me well as a business owner I read it seems very pro business pro growth so I'm very much in support of this bill and everything you said to me you in your testimony seems to be actually supporting this bill so let me put your speak for exactly because this is not me as a small business or someone no who you speak for and how this is not programs and pro business when I read it seems very much so well I'm familiar with the Florida and and north Carolina's programs I'm not familiar with the third one that's adopted this but I've spoken with them but we have accomplished essentially the same thing already you have by allowing the wage base to float based on the balance of the trust fund and again this trust fund is very healthy almost seven hundred and fifty million dollars as of the last end of week that I looked that we're over funded under normal circumstances in a normal economy. The key to the trust fund as as in your business is a healthy economy this trust fund was growing by leaps and bounds when you stepped in the legislature two years ago and made some adjustments some further adjustments to keep from keep it from continuing to grow unnecessarily and we we've got a healthy trust fund so. Let them get their job done let him fix their system so they can account for and deal with the processing the claims that they've been overwhelmed with let him get that system in place and then take a look at this I'm not saying it's not a good bill I'm saying it's a bad time to look at this bill for two years ahead of the poor in this bill or be really seriously examine. Thank you. Any other questions representative men's Ollis you're recognized thank you Mr Mister Senator didn't didn't sponsor just say that he was delaying this bill to give them time to implement the new system and amid most what I heard you say and then I think you just repeated it that. Most what you said I believe was in support of this bill it sounded to me like and then you just said that it's not a bad bill just the the bad timing so I'm against the passage of the bill right now that that would be mobile. Okay so. But you're not against the bill itself like you're okay with with index unemployment and stop under twelve weeks and you're saying all that's good for good for the businesses I might argue about the twelve weeks but is not that big a difference because maps again as you heard earlier most claimants are back on a payroll and stop after about ten weeks right now and that's been in in in Amendment COVID pandemic in a healthy normal economy probably gonna be lower than ten weeks because of demand for people. Okay so if you support the bill what why is it not okay to go ahead and pass this legislation with the implementation being delayed. I'd rather see if I'd rather say is hold off before we picked him and and think about this a little bit more make sure it's exactly what we ought to do again because you've already floated the wage base the wage base moves with the balance of the trust fund. Even though. View the legislature this year interrupted that floating to avoid added cost to employers call for the. Right any other questions. Seeing none thank you for your comments thanks very much appreciate. Okay if we have one person signed up to speak for the bill. Joe Hart both. Joe Hart with. For that. President who spoke earlier it is okay. All right to people two more people to speak against the bill jim Hudson. Please introduce yourself and the represent. J. like a motion. Yes the motion to limit debate the five minutes for Speaker. Sabella motion. The. Okay that's about a motion and not debatable. All of the motion is to limit to five minutes per Speaker. All in favor signify by saying aye. All opposed nay. Motion carries so you're limited to five minutes yes Sir Mr office okay we'll bring up Dr Childress as well did it yesterday suspended testimony if represent McCollum McGill S. sure that my okay. Okay if you all are speaking to gather I think this five minutes well I tell you know and think it would be and I'll cover most of it she can handle some of the other administrative stuff very quickly and okay many times is running out here's why we're opposed to to the bill for so we reached out to the sponsor and to to the policy people in favor this several times. The kind of getting at to what represent Gonzales was saying we'd be happy to have conversations about what elements this bill could work in the future to make sure we understand the data that would go into the claims I'm not sure the tears are right in terms of the cut offs between a different levels of unemployment and what the weeks are we need to study that I think a little bit more intentionally also got a little bit of concern of taking a model from Florida which is at twenty six weeks in transporting that two Arkansas we're currently at sixteen weeks now did that that good work four years ago thank you you've done great work in this session for bills you passed out of this committee that passed the legislature helping us to get our unemployment system shored up really helping the employers in Arkansas SO one thank you for that the bill is passed today will represent Lundstrum couple specific problems that we got was take your bill for solar system language issues I have no idea as I look at this bill what unemployment rate we were to look at to determine how much benefit should get paid like for somebody file a claim on April first we won't know the April unemployment rate until the latter part of may we just found out the February work rate last week and the Germans spoke last week said that who we could amend it somehow there's no mechanism to amended in between sessions you know that quite well and we don't need to be riding legislation for you as a regulation so that's one problem the second promise just administration we can't do this. Even with the January first twenty twenty two effective date we would have to take all right T. staff who are currently working to support the pandemic and get them focused on this. We still have the resources to. Couple years now we might be able to do it after we modernize our system you just approved you know a mechanism for us to be able to do that so I commend it would be we would sit down have conversations about what could work the maybe run a bill a couple years we would make that commitment to the now is not the time. Director of the let you add anything else to that a wrecker chills few would introduce yourself. Shuri's Childers director division of workforce services you're recognized the the adult have much to add except that that currently the the reference to a Florida also needs to include the fact that they're one of twenty states that have borrowed money for their trust fund. And just based on the information that I just pulled up because I didn't have the the exact amount of the fund has fallen by roughly four billion dollars since the start of the pandemic so I think it's important they're having to use other sales tax sales tax and other taxes in order to fund their trust fund so our trust fund is currently a balance of seven hundred and seventy four million of roughly every day there are disbursements made from that fund and of course reimbursements made to that fun like was stated earlier the work that you all did in twenty seventeen and then followed up in twenty nineteen took all of these calculations in to a into account and into consideration so it automatically adjust if you'll remember we came to the committee of back and and earlier this year earlier last year I believe it was in September because we were looking at an adjustment that would need to be made on September thirty based on the trust fund balance so we already have all of those mechanisms in place to adjust and that's why Arkansas is one of the states that now this year we and twenty twenty we were not required to to borrow funds from the federal government like twenty other states have in the past during the recession we did have to borrow money. So the work that you all and there's interest on that money of course and then the employers have to pay it back so the work that that this body did in previous legislatures did set us up to be in the place that we are today the last thing that I'll say is that I think it's important to note that reducing the weeks is not is not going to solve a problem of individuals going to work or not going to work as Rick Randy Zook stated we have federal provisions in place that that's why that's where most of these employment benefits are being paid is from the federal government and the federal extensions currently on pandemic an employment assistance an individual can receive benefits right now there September fourth for seventy nine weeks. That started back in in with the pandemic back in twenty twenty for regular United they could start out with their sixteen weeks that we currently have with them with P. U. C. which is pandemic emergency unemployment compensation that's federally funded they get another fifty three weeks and then if that exhaust in their eligible they can apply for pandemic and employment assistance for another sixty three weeks. Just on regular unemployment they can get their weeks of sixteen weeks plus the P. U. C. a fifty three. So. What I'm telling you is that right now reducing the number of weeks from sixteen to twelve is not going to put our state any better position than we are right now it's not going to impact and or help the employer shortage or the the increase or encourage employees error in our Kansans to go back to work as long as we have these federal provisions in place so we would be spending a lot of time and money correcting something that will in hopes of correcting something that isn't going to be corrected just by reducing our weeks so thank you for your time and I will be glad to answer any questions that the committee questions representive Payton you're recognized. Thank you Mr so if the federal government picking up all those extra weeks and we drop ours by four weeks would we save a lot of money. No Sir because the weeks that are that are currently being paid from our regular unemployment benefits are are very minimal compared to the federal benefits that are being paid so and most of these individuals most of our disbursements are happening at the P. U. C. the federal the pandemic emergency unemployment compensation it's federally funded which is after the sixteen weeks and then the P. UA which is the new program that was that was created under up pandemic an employment assistance for those that are self employed or those that were denied regular unemployment benefits so yes to your point you may say four weeks but there's very few people that would be that are receiving regular unemployment. It is a legal matter to represent Payton there's maintenance of effort of our government won't let us shift liability from the state to the federal government during the pandemic if we were to try to do that then we would jeopardize all the benefits receiving federal government so right now at least through the the current state running through September we have to continue things as as is that was a problem previously but the minute that ran the the the the representative ran last time move that an effective date of January first twenty twenty two so it's not an issue anymore okay thank you Mr. Representative Ferguson you're recognized I just want to clarify if if I had an employee that I laid off during the pandemic and then nail businesses back up and I want them to come back if they don't come back they lose unemployment is that right. Representive Ferguson we have communicated with employers that if you have an employee that refuses to come back to work then that's an able and available issue and so their unemployment benefits would would stop and then that issue would go into their claim would go into education. Any other questions from committee. Seeing none thank you for your comments thank you. Okay I have one other person signed up to speak against the bill. Jessica acres. He would come to the table and lose yourself in the represent. You have five minutes yes Sir. Thank you Mr chair thank you Committee I am here I'm not going to touch on everything that everyone else has and and repeat myself but I'm here I'm to not talk about cost of business bite to actually talk about the unemployed worker I've been following unemployment I for the Arkansas AFL-CIO since two thousand ten so I stand in all of our committee meetings and watching watching what we've done in the past eleven years and in two thousand nine you know we had a recession and we got in the hole we had to borrow from the federal government and we took action and we were paid the federal government the the cost to business was we actually went up from ten thousand dollars for your taxable wage rate to twelve thousand as part of that are you know getting back to where we were before the recession of two thousand nine since then as you know that's gone back to ten thousand dollars wage base and you just passed two bills this session that kind of locks it in there right to the point two for your stabilization tax and your ten thousand for your way tree for my our concern is that since two thousand ten we have gone from twenty six weeks to twenty five weeks to twenty weeks now we're down to sixteen weeks I we want to cut it to twelve in the middle of a pandemic. The other concern is you know right now or else January twenty twenty one. What was that Benton county had a rate of three point six. While. Chicot County had an eleven point one. Ashley County nine point two Phillips so still when you are when you look at Arkansas we're so economically different you know if you're in the northwest corridor if you're in central Arkansas there are a lot of jobs but not you know out we've been dealing with a bunch of people down across it when that plant got shut down and the struggles that they have been going through and that wasn't even pandemic related it got shut down and there weren't that many jobs in Crossett waiting for these folks you know we've we've re scheduled we redid the formula so people who might work contract work out a couple years ago we redid the formula where we take all four quarters and we combine them and that's how you get your benefit it really hurt seasonal workers it heard contract workers construction workers nonetheless we did it their benefits went down like I said we've gone from twenty five to twenty six down to sixteen. We just feel that this is unnecessary Amalek we said there is over seven hundred million dollars in our trust fund and you know we have this. Cut unemployment benefits steadily every session since two thousand eleven. it's not necessary for in a pandemic and ask that you not cut them now. I guess that's all I have. Questions from committee. Seeing then thank you for your. All right we have no one else signed up is there anyone else here who would want to speak against the bill. For the bill. Seeing none representive you ready to close. I am made a few notes here that I want to go through and and my closing sorry you're still. One question for you there's an amendment do you want the amendment. We would have to pass the amendment if you want if I do it I thought we we put the amendment into place Los LOS committee but I guess we did not so forget and that our. We have to adopted again we have to adopt we have to adopted again because we didn't take any action on the bill and the amendment is what we discussed and thank you. A motion to approve the amendment. any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay moshing carries present your bill as amended thank you as I close I would like to ask permission chair to have Joe who I had up here earlier come back up said yes is fun in the meantime I'm just. I was trying to decide all the things I heard today I'll just go through it quickly from the testimony I haven't introduced indexing two guys to save a failing trust fund I think that's obvious you heard from the chamber that our trust funds in a good shape coming failing trust funds is why a lot of high on the reason and are looking into this for me this is about jobs competitiveness and then really lowering tax rates Which is very interesting to hear the the chamber speak against that means. I I know it was what we heard from the chamber was they believe it's good policy at this point in time they believe this is not a good time to put it into place what I'll say is that part of the the reason for the thirty five million dollars that we just passed out of this committee to go towards department of workforce services is to address some of those concerns which sounds like most of those concerns are with the implementation of this where they're currently at and how this could be a potentially disruptive with their system I've you know I've talked with some of those that spoke against this and some the main points they told me was you know the systems are sold to be very difficult to code this I think I want to appeal to you guys and just say aye I don't doubt that it will be difficult to to implement I just know what policy makers and we ought to set policy that we think is best for for Arkansas and then important clarification in this bill was built. In flexibility for DWS to implement specifically regarding the rate in the time in the measure because I heard the note that was said that they didn't have any idea how to implement it with the point the language the way we built it was to give them the flexibility on how to best do that You know I heard a note about Florida having to borrow money for this all note that the US treasury isn't showing that Florida's borrowing anything so I'm I'm really not sure. Where that was coming from six I heard a note about you know federal boost I think those are red herrings this is about getting to work That is it's probably all I have for my notes as I listened to it and then go any longer. A night but I probably wouldn't anything that you didn't it's like I said before at the beginning of that remarks it's a it's a policy with a good track record I think if you ask myself the small business owner or manager some years ago whenever I file my taxes which reports of the state I look at that thirteen thousand dollar line item from employment taxes as a business that had never let anyone off and I would ask you know why I was so high no admittedly with the answer probably should be moved to Arkansas where your taxes are more competitive hi I think that's an opportunity for Arkansas to be among the lowest in the nation just like Florida states like North Carolina Georgia. Are you close. All right what's will the committee Senate bill can make a motion do pass as amended I have a motion of do pass as amended by representative Pilkington and discussion on the motion. Representative Bentley you're recognized. Khalis is a small business owner I just want to make a motion to different passes but we anything we can do to help lower the costs for small business owners for businesses across the state this program with appropriateness and pro Arkansas I think we can I can attest that lower taxes would that would help or cans and I help or small business I think this is a movie a great move and a good move in the right direction really actually good time with the going to redo the system so I would just make a motion for a budget do pass this. Okay any other discussion. Seeing none all in favor signify by saying aye. All opposed nay. No seven. The C.. Okay roll call. Representative Wardlaw. Representive Eubanks. No. Representative McGee the. Representive Dotson. Yes yes. Representative Miller. Representive Miller. Representative Payton. Representative Bentley. Representative great. Representative Gonzalez. Yes. Yes. Representative Boyd. Representive Alan. No. Representive Coleman. No no. Representative Pilkington yes. Representive wing. Representative ****. Representative Penzo. Yes. Representative Perry. Representative Davis. Ms I'm sorry could you repeat yes yes. President of clown yes. Thanks chair Ferguson. Sure Ladyman would be a. Nine four four. Number. Okay your bill has Phil representative. Okay Representative Gonzalez your next but but if you don't mind I would like to have. Representative. Will Smith plays here. Watson on the consent agenda we have a bill for representative once he's been waiting and waiting. So. If you don't mind and if you do mind this representative wants and you're recognized to present is B. two fifty seven off the consent all up there is some of the records in the you're recognized here if you but may allow a. Mark white DHS to also be seated okay. This is S. B. two fifty seven committee. Thank you Mr than committee to amend the law concerning the time for completed investigation of suspected adult male treatment. Or long term care facility resident maltreatment in reference to the APS the adult protective services. Committee this bill provides an additional thirty days for adult protective services to investigate cases of adult adult exploitation primarily financial exploitation it leaves a current deadline of sixty days in place for any other type of adult maltreatment investigation. It allows for additional extension of up to forty five days for any of this to get shin with the approval from the department. Basically that's it they're asking the required for just a little bit more time to do this extensive work hopefully if there's any questions I can answer would not all have somebody to. any questions representative Dotson you're recognized. Thank you Mr representative. That seems kind of like a dramatic increase overall is there going to be an additional cost to the agency or or to the I guess the facilities and how they. They're handling these investigations and I continue to operate while they're going on good question when you to Mister white with a bin or no increase in cost for exploitation cases particularly those ones where we almost always have to go and get financial records from banks and brokerages from others they are notorious for being slow in producing records sometimes it just take it can take weeks to get those records you need in order to make that case are determined if that individual has been exploited so no additional cost is just trying recognized by the realities of those investigations time frame waiting for for records to be returned thank you. Any other questions. Representative Ferguson you're recognized what what is done in the interim to protect the patient that. You know if they have a malpractice claim. Sure if so for those individuals or if they're in a dangerous situation we're going to take them into custody and make sure they can get to save fireman this doesn't have any bearing on that this is only for actually making a final determination of was there a finding of no exploitation or maltreatment in that case so I guess I guess my question was if there wasn't maltreatment then the person's been displaced longer I guess right it's will be ordinarily X. exploitation typically those folks are already in a safe location so for them it's no it's not issue for that individual of the display for the closure that investigation that makes sense. Any other questions. C. not saying none we don't have it did you have a question representative Alan. Okay us or anyone the audience speak against the bill. For the bill. Seeing none red clothes for your bill I am appreciate a good vote committee representative Allen you're recognized for motion. Motion to pass I have a motion do pass by representative Alan a discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay motion carries graduation your bills passing this chair of the committee representative Gonzalez you're recognized to present H. C. R. one thousand three. I thank Mr. Committee this is the same resolution that we heard one time before that calls for an end to this emergency I know a LC had a chance to vote on it this week if we passes out here then the full house will have a chance to vote on it not just the ALC Committee. Is this resolution amended. Yes okay what we adopted the amendment last we have a read option again because I don't act on the mode on the resolution. So you're ready to present your amendment again. A committee to also if if we pass this since the since it has been renewed again it will probably require an additional amendment before it goes all the way through just wanna give the the full House chance to vote on it. So what will amended I saw probably don't even have to adopt that amendment because it'll it'll all change in. It's just changing the dates. okay so you don't want to proposing amendments that yeah let's just vote on it as as is feel we're not going to adopt the amendment so you don't need to pass it out anymore. No so go ahead and present the resolution as unamended okay welcome that is is what it is it will it will call for an end to the state of emergency in. All right any questions from committee. I have a question where is the rest are committee they were all in here and I don't know. Any questions. The no questions anyone here to speak against the resolution. Please introduce yourself and here to represent. Thank you Mr chair members of the committee on large you and I'm general counsel for the department of health. We are speaking against this resolution we respectfully would ask that you would pull your Michael closer so he excuse me. Can you hear me. Thank you as you all know A. L. C. at voted yesterday for the sixty day extension of the public health emergency it's to encourage vaccination for the entire state it was announced today that we've already administered over a million total doses and we are at four hundred and seven thousand for fully vaccinated which is about thirteen percent of the state of Arkansas so we would just ask that we stay the course with the vote from A. L. C. yesterday the public health emergency extension also will help get those executive orders and acted and it will also allow low income residents to qualify for snap benefits so we would just request that we stay the course thank you. Any questions from committee. Representative Bentley you're recognized. Thank you lord for being here these recipients that against that benefits are are will not lose benefits that just might get less amount is that true. Representative Bentley and I believe mark white is here from DHS and he would be best able to answer that question. Yeah mark would come forward. please introduce yourself again. Thank Mister mark white chief staff for him services resent Bentley you're correct the the issue is that since the pandemic began use part of agriculture's allowed states to pay individuals the maximum level of benefits for their family size regardless of their income so as long as our income is low enough to qualify they their benefits aren't reduced based on their income and so that has meant a total of twenty three point six million monthly coming into our retailers and grocers but with that said if the public health emergency ends if this resolution passes or if the governor decides to drop that emergency under the federal Congress we can no longer offer those benefits so individuals to go back to their basic level benefits they were receiving before the pandemic or eligible for before the pandemic thank you. Any other questions. Seeing none. Anyone here to speak for the bill. Seeing none red clothes. For the resolution. The a motion. Okay we have a motion of do pass on a recognized representative Wardlaw for discussion thank you Mr. This is a full body this recognizes the full body of this legislature met yesterday and discussed this at length. That body voted yesterday to continue this emergency there's not even a roll call vote. That vote was made because of the testimony that we heard in testimony from the governor testimony from department of health and testimony from DHS. The mass mandate has been lifted as of today by the governor which is the number one thing the public as concerned about and told us that they wanted taken out of this emergency so with that I feel no need to pass this resolution and till the next time council meets and takes up this procedure. Senate bill you're recognized thank you chairman colleagues I am doubling a vote for this resolution because this mandate is putting untold hardships on child care out there on our schools out there this emergency order has them following through with. Regulations and guidelines that are ridiculous and they're hurting our church our children hurting that their education and I really I know that the management is one thing but there's I have hearing day from folks they're just tired of all the guidelines the regulations from this emergency order so that's why I'm voting for I think the whole House should have a chance to vote for the people of their districts thank you. Representative when you're recognized thank you Mr chair all right now I'm not voted for this the first time and because we didn't have any other procedure in places and since then we've passed representative Gazaway bill that came through which gave us a formal procedure one of the concerns I had was that if we voted for this summer asking you this before that we vote for this come the governor just turn right around the next day and declaring an emergency and rescind what we do and so what we did was we went through a procedure it seems like to be able to give the full legislature through the A. L. C. at an ability to have a say with this so my concern is as well I I supported this the first time and I'm concerned about at this time because I think we've addressed those issues one of the other concerns I had was that we had we had not put together our checklist yet of all the things that we needed to do all those emergency orders that need to take place the legislature has to do before we start rescinding the Emergency we still have a couple things to do one of them was today with our telemedicine so I'm I'm I guess I'm still a little uncomfortable with with going through this since we have put in a nice formal process for us to address these concerns through A. L. C. I'm welcome to anyone else's opinion on this committee as well. Yes you're recognized thank you Mr it just to follow up on that and and what representative Wardlaw said with with the process through a LC I don't disagree with that I voted for that I supported that that you hope will support of of of representative Gazaway the whole time he was crafting that legislation I think that was a very important piece of legislation we needed and a LC does represent this body but they in my opinion they should not represent this body one when we're in session it should we should have a chance for the full legislature to vote on these things and not just just a LC of the few members that are on there I'm I'm not on there I don't have a voice in that yesterday I didn't of and I guess I could have gone down to the table as the public couldn't and spoke on it chose not to do that but but I do think it's support for the full legislature that to have a say in this as far as the. Pieces legislation that haven't been passed yet we you know as far as I know nobody from the governor's office has gotten behind any of those and pushed and we've been a session now for three months we've had plenty of time to get that done we just failed to to advance telemedicine in here earlier as as you said so there's a chance that this may not even get done so at what point are we going to say okay we didn't get all these things done we didn't do our jobs and make policy so let's just continue to let the executive branch make policy for us and stay under this emergency at some point it's gotta end we've got to get back to the legislature legislature making those policy decisions so that's why I want to run it more to give the full legislature a chance to say their navy over let's. We continue to allow the executive branch make policy or or let's do it in here the there are jobs. President Bill Clinton you're recognized. Okay. Any other discussion on the motion. Seeing none motion on the floors do pass for the resolution all in favor signify by saying aye aye All opposed nay. So. Roll call. Senator Wardlaw hello. The representative Eubanks have. Representative McGee of. Representative Johnson yes. Representative Miller. Representative Miller. Representative Payton. Representive Bentley. Representative Greg. I'm sorry no. The representative Gonzalez yes. Representative Boyd. Representative Allen. Representative Coleman no. Representative Pilkington. Representative ****. Representative Penzo. Representative Penzo. Representative Perry. Representative Perry. Representive Davis yes. Representative Davis yes yes yes. Representive clam yes. Vice chair Ferguson. Vice chair Ferguson. Six. Representive you built your resolutions fail. By a committee of. We've got a lot of work done today and procedure work today President Wardlaw Jeff come in. The. I think there's a five o'clock meeting for some. Including me. I. We. We are we are going to have a extra meeting on Thursday at nine thirty. So I think that'll help us get caught up on the bill on the bills and we run quite a few today similar but to go right