Public Health, Welfare and Labor Committee - Senate

There. Committee meetings but before we do that we have three bills that we're going to have to suspend the rules for to be able to take up today and so I need a motion on page B. ten sixty three. Ten of H. B. fourteen sixty five and H. B. fourteen thirty four I have a motion to have a second all right all those in favor say aye the rules have been suspended for us to be able to hear those today all right going first of we're going to have the representative Lundstrum she has three Bills and. Representative if you'd like to go to the end of the table. Okay all right. Yep that's alright you can go first. You are recognized when you get settled this state your name for the record. Thank you Committee Senator Gary Stubblefield. This is a house bill fourteen await Fortino eight. Some of you may remember fourteen away with a. not fourteen oh eight but I passed a bill back in two thousand fifteen that deal with this and then later the governor keyed in on it he also contribute to it all this bill does basically is when the governor said the policy in two thousand fifteen that Arkansas would no longer reimbursed Planned Parenthood for medical Medicaid expenses this policy was help appealed by the courts in currently stand this bill simply put this policy into law. That's basically all it does. All right questions from the committee. Seeing no questions does anyone in the audience want to speak for the bill against the bill thank you close for your bill senator and chair and all right what is the desired the committee are I have a motion and a second all those in favor say aye all those opposed congratulations you passed your committee thank you all right House Bill Fortino seven. Thank you recognized your name for the record please. Ricky Hill state senator district twenty nine all right. Thank you madam chair. This right here is the bill that placed yes stabilization Tax rate that will freeze the rates for twenty twenty two with the twenty twenty one right. That's pretty much it dear. Anyone want to ask any questions. Questions from the committee. All righty well. Let's take a minute look at that. If you for me talk we have a more say on the record I will say that's no no impact to the state's general revenue and actually the. The the tax increase of ten million over a current balance of trust fund seven or ninety eight me in this is adequate. All right actually lowers it okay. All right seeing no questions does anyone in the audience want to speak for it or against it. Sing NO one of heavy clothes for your bill yes ma'am. All right of what is the will of the committee all right have a motion to pass in the second all those in favor say aye all those opposed congratulations you've passed your bill all right you have the next one yes ma'am and that is HB fourteen oh nine right Fortino nine you're recognized I will stretch this one out a little. The this is a basically a companion bill goes along with that the the pundit unemployment wage base is amount of wages for which an employer pays unemployment taxes the wage basis subject to annual adjustments based on the average unemployment rate for Arkansas in the balance of their employment trust fund for twenty twenty one the wage basis ten thousand dollars per employee per year should the trust fund balance fall below six hundred million for twenty twenty one the current law requires a wage to increase in twenty twenty two to eleven thousand dollars what we're doing is basically putting a freeze on this one as well and and lock it in where it will not increase for the same send a cab to twenty two wage base that same is twenty one twenty one level. Okay anyone of. The question on the committee. All right seeing no questions has anyone in the audience want to speak for or against the bill. Seeing none have because for your bill all right was played to the committee. I have a motion I have a second. Okay. We have a second all those in favor say aye all those opposed congratulations you've passed your bill. All right. I believe that to. Concludes. Welcome all right so let's look and see who else is from the house it's in the committee representative Mickey. fourteen fifty. Thank you madam chair Senators fourteen fifty is a. For those of you that were here last year you know all the fights that we had between two actor provider groups where we stood toe to toe well this one we'll see I know that we're all in agreement. Basically this bill fourteen fifty all it does is is patients that used chronic dry eye drops it's very difficult to squeeze the right amount of drop in that you can imagine you put one drop in one of the last time I tried it out but everyone in this and I'm an ophthalmologist and I tried three times before him out right now and that's what happens with particularly in patients in my age group and an older who began to get tremors and that sort of thing they can't say well and they run out of drops is what they do and and nation nationally there's some studies that typically a bottle of drops as prescribed for a month has enough in the bottle for months a lot of people run at it about seventy percent about twenty one or twenty two days and all this bill does if is the prescribing ophthalmologist or other or optometrist as prescribed the drops if they authorized the patient to have early refills they know what's the patient they know this patient has difficulties that frequently run out of drops. It if they authorize it in the pharmacist can refill the prescription. And it's no charge to the patient in mandates that that there that healthcare plans that have drug plans and all that they pay for pay for the for the extra drops what paper doing. The run it out. They have a week left they have blinding disease if they go without their drops and at the end you know they call the pharmacists Fund what have surveys we can't reveal it until day thirty so so this just authorizes the physician. To to allow farmers to refill it is covered under insurance that's really the essence of the bill any. Do you have questions see you in these questions from the committee. All right the let me ask you one of representative Mickey how many people did you say probably would fall into this category. There's that is really a limited number of patients when I talk to the the prescribers to prescribe a lot of these drops they say maybe it's ten percent of their patients that actually have the difficulty of representive Hillman when I talk to him about the so I can get forty days out of a bottle drops that may be true for him but but but it's not a tremendous number of patients all right into would you say that most the patients are elderly yes okay all right any other questions. Seeing no other questions does someone from the audience want to speak for the bill or against the bill. All right seeing none had to close for your bill close committee and I appreciate your indulgence and appreciate a motion and a good vote all right what is the pleasure of the Committee I have a motion and a second all those in favor say aye on the suppose congratulations you pack your bill Medicare chair of a committee thank you. All right. I'm trying to see if there any other house members here are any other senators that aren't on the committee here to run a bill for someone else okay you have a. well you Senator on the Committee let's let the senator he'll go first okay. And then we'll come back to you. All right Senator Hill. You are recognized to present your bill. And it is what what is your bill number. Senator Ricky Hill district twenty nine the house bill fourteen thirty four okay. You're recognized. Thank you madam chair. This bill basically sets up and establishes nail and Alzheimer's disease and dementia Advisory Council. As we all know that Alzheimer's is growing increasingly in the state of Arkansas and throughout the nation this is a this is what I'm really passionate about my mother passed away from this disease we fought it for ten years so this is something everyone have a calling like you'll go in the Senate or the house what you feel like you should really work on Senator Davis is Arkansas tech nine eleven we Alzheimer's so this is one thing I'm really passionate about because it is close to home hit you in the heart something you can get past about you care about and what I what I'm looking at when I see this bill as us trying to establish this Advisory Council is to be able to get the word out to get a plan to people not. I told my didn't really realize anything like this existed until I came to the Senate we can get help we're to reach to where to go to we've got this professional people on this Advisory Council to get the word out what we need to do to establish this because this is an issue that we're that will continue to increase in the state of Arkansas so we really got to get a hand on this get a good plan in place to go forward and try to be successful with this I'm not with all the details my numbers I'm on that David cook do that here in a second but it's when they want to know here I think this is a very good bill that's what we are we I'm passionate about it so that your role will be faced with one date if you have already been placed with a family member or someone you're close to or someone you know so with that said I'd like to a as David cook to come up and go through some of the statistics on the on all timers with us. All right the. All right. Would anyone like to list let's kind of do it in order I'm sorry all right does anyone want to ask any questions of senator hill. All right seeing no questions we have a. Have of three people I believe to use or for authority to speak for it so let's take the are you Mr cook all right come forward please thank you and and please take your name and who you're with and that kind of thing for the record please. Thank you madam chairman is David cook with the Alzheimer's association. answer to help mention Alzheimer's has a severe impact our status of the public health crisis and growing public health crisis. This legislation does two things and to serve House pointed reestablishes and Alzheimer's Advisory Council Arkansas had a all in all summers about every council that was established during the eighty ninth General Assembly enacted by Act fifteen ten. That original Alzheimer's Advisory Council contain sunset clause and so this legislation sixty reestablished Alzheimer's one of the notable changes is a we've also added dimension because we know that Alzheimer's might be the leading cause of dementia here in state but there's other dimensions at play as well that impact our state yeah today more than sixty R. fifty excuse me where the fifty eight thousand Arkansans over the age of sixty five currently live with Alzheimer's by twenty twenty five in just a short time that number is expected to climb to over sixty seven thousand. Alzheimer's impacts our healthcare system or healthcare professionals the work force members of our law enforcement other first responders from our taxpayers hospitals in multiple state agencies surrounding states are are continually building active in comprehensive strategies towards addressing dementia in recent years Tennessee Kansas and Oklahoma have gathered stakeholders and develop the modern state Alzheimer's plan. Tennessee has similar council actually works with state agencies to develop and implement their state plan. Since two thousand seven forty nine states and territories have published a state Alzheimer's disease plan in addition to establishing Alzheimer's and dementia Advisory Council this legislation also requires the state to regularly update and implement and also our state plan. Again Alzheimer's is a public health crisis it's a central Arkansas the state plan to address Alzheimer's as updated at least every four years without a state plan we are ill prepared to handle what's coming in just a short period of time and this legislation will ensure that we have an updated and implemented Alzheimer's and dementia state plan. Arkansas is one of the first states I think it's important to share that Arkansas is one of the first states to adopt a state plan in two thousand eleven and I'm sure you start on that original committee. And a committee of the recommendations that original state plan did when it did go on unimplemented but a couple of them that that were implemented is the initiation of the Arkansas also for other programs and of course the creation of a state Alzheimer's task force or dementia visor Council. The state plan again different states focus on different areas but in the interim we worked with several groups to uncover some of the gaps that we see in Arkansas one of the areas we need to address increasing public awareness that encourages early detection diagnosis providing support for care givers and of course the increasing access to care. Estate planning process provides a mechanism to consider all these issues by here from central stakeholders. essentially this bill will help prioritize and coordinate the state's response to Alzheimer's will also prepare the state to submit a competitive application the next round of federal funding ensures the work force the care giving Medicaid and public health issues and opportunities are identified and agencies and partners are working together with advice from internal and external partners. There is no known opposition of this bill to our I'll be happy to take any questions if you aren't living questions of the Mr cook. All right seeing none thank you so much for your testimony and we had to others and they can come up at the same time if they would please we had GT Gabriel in Kerry Jordan and let me just ask ladies if you would be very scenic and quick I think I know have this bill is going and so. The I think I think you will be pleased at the end but if you would just to take just a minute or two all right and you are. D. as a real yes and you from I'm with both hands Arkansas but I've also been a caregiver for ten years all right thank you my mother has engrossed Alzheimer's she was diagnosed at fifty seven and at that time I was twenty eight and had five kids under seven I instantly have committed over I was a patient after work for restaurants and catering and everything else like that but my life completely changed and stopped for me the impact was not only leave losing my professional career but also lost finances retirement benefits all of those other things along with friendships it really does take a mental toll when you're really in the beginning of her career and all the sudden it stops and your friends are going upward in your kind of plateauing and so for me it was mental health wise it was difficult but then just trying to get back into the workforce she Richmond the pandemic hit we decided I decided because I'm delay took place our nursing home she was placed within seven days of the government the governor setting everything down and I haven't seen her since and that was March nineteenth of last year so now we're still you know I'm still a care giver to her but it's a little different and is that a lot much harder sooner or later it's one of those things where I had to figure out what I was going to do next you can't really go into culinary field after ten years it just doesn't exist there's just it's too much to ask for it and so I did little things here and there to figure it out and then all of a sudden I started volunteering with the Alzheimer's association and I was machines here for a few years for some the walks I'm a representative would center cotton so I talked about taking legislature especially regarding under asset because for me it's in my family my grandmother was diagnosed a fifty I have four other and aunts and uncles who have been diagnosed with some sort of dementia I'm another side so in my for me my main concern is myself being it is probably a genetic for me I'm thinking about my seven tomorrow five children and I definitely don't want them to be here ever to tell you guys you know about their mother and her being done under forty so. Thank you all right to host this is the carry Jordan. I am able to professional or would you push a button plea to Mike Senate that was working can you hear me now that I'm a professional caregiver I've been a nurse for over thirty years I'm also a nurse educator I'm just going to jump since we're in a hurry to that my focus as an informal caregiver my father and mother moved into my house three and a half years ago and my eyes have been opened to the burden of both people caring for dementia and their homes and people with dementia themselves so I'll just jump down to the four things that have really I've learned from this. Informal caregiving situation with my parents being in the home of one of the things I've learned is that the burden of care giving this intense you know I was overwhelmed by the impact on my time my finances my social life my physical health emotional health I had no idea how extensive of the impact of care giving for people in the home someone with the mission the home was. I've also encountered limited services in the community we looked for a daycare center for my dad and my community because he was at home board and it was very difficult to find a place and once we did he only lasted two weeks there because he was becoming agitated and the people that were running the care daycare center did not really know how to handle that so they said you to put him on meds or he needs to leave the center so we ended up taking him home that's just one example of the limited services available in the community. the healthcare system is not equipped to deal with people with dementia I got some horror stories which I won't go into but just in one example of this is going to the doctor's office and having to wait with your dad who has dementia for an hour and a half well he becomes increasingly agitated is just one example of how the healthcare system is really not accommodating to people with dementia and finally you know I've been impacted by the fact that society as a whole is not Coming to people with dementia for example when I take off work and I'm fortunate to have a really good bosses understanding but a lot of my peers are not you know you couldn't understand when someone gets off work because I need to pick up their kids it's a little less understandable when you need to go and take care of your parent. So those are just for areas that I I have really grown in terms of my understanding of the needs that are out there in terms of both people with dementia and caregivers and I am. Speaking in support of this bill we really need Advisory Council and we need to implement the state plan thank you very much all right thank you do you have any questions Committee of the prisoners here. Okay I don't see any questions all right senator of with with that being said for the second time I'll close. Is anyone want to speak for or against the bill. Seeing no one the senator is closed what is the will of the committee all right I have a motion to pass in a second all those in favor say aye. Your bill passes committee thank you very much. Thank you all right ladies and gentleman I would need to I need one more bill the the the rules suspended to take up one more bill and it Senate bill eleven forty and the if the I have a motion. All right and a second all right all those in favor say aye all those opposed thank you all right to see the C. there you go Senator while you're at the table would you mind doing the first one the first that wanted to you were going to do would you mind doing H. P. ten sixty three. And and then of. And then we will do this the eleven forty okay. All right if you just the. A. Introduce yourself then you're recognized thank you so Senator bart Hester thank you members so this is the H. B. ten six through telemedicine bill and I want to give you guys a little bit of an update. On it so representative Pilkington and I have been sponsors on this building it's been the lead and kind of had a created some language when it was in House committee a few days ago during testimony the testimony came out from the this is my understanding I have not watched it I was not there for the medical board that says they will during rules not allow audio as a means of establishing relationship and therefore as a means of telemedicine so during the rules they were going to disqualify that option. Because of that we deemed it necessary to add an amendment to this bill to make sure that audio was going to be a qualified a qualifier to be able to use telemedicine. represent Pilkington felt like he had agreed to a particular bill understands what we need to do this so I will in all likelihood be amending him off on through a member's own I want to find a house sponsor so if we we're here today to do this I'm going to do this before running on the floor I'll I'll make sure the House sponsors committed and I'll do a member's own to most likely remove Pilkington well as we know he's a new dad and he's been hard to get a hold of not here to Capitol the last couple days so I do want to run this bill but I want you guys to have a very clear understanding of where that's at that Senate represent Pilkington may not be the sponsor but I will not run it on the floor until we have that until we have that resolved but that's been I and there's there's a couple more amendments more to that amendment then just the audio we we but emergency calls in because the Emergency Clause was necessary because we we don't want to lose ground if the emergency order goes away before before this would become law and we added an amendment for a so insurance companies to make their structure some language that they were that they were they were comfortable with but outside of that I mean the the goal for me in this whole process is to make sure we don't lose ground on telemedicine once the governors emergency order ends and that's what this bill does happy to answer any questions all right any questions from the committee yes Sir go ahead senator so. Thank you so as it stands. If the Pilkington bill stood we would actually be walking backwards from what the governor's emergency order is allowing is that correct that's correct because you know telemedicine providers are are interpreting the governor's io is that that audio works but the understanding after house testimony is that it would no longer work and I was in a meeting with With ms Cholesbury head of DHS few days ago and she was talking about how important telehealth was to our new our home program and how it's really necessary to have that and how much it done and so she was referencing the emergency water because I asked her so I I'm assuming if we walk it back we're going to be making the our home program more difficult that's an assumption but I would I would think so and I would think the what you're trying to do is at least keep us up to what we have so we can do it because it affects so many programs with that be closed accurate that that would be my understanding okay great thank you thank you ma'am I have a question of along those same lines Senator do you not think that if we don't hold up a standard of quality in our telemedicine that it would be detrimental to the people that are using telemedicine I I completely agree and that and I look back on you know basically history I was just business members six years ago we argued about the same thing and six years ago forty nine other states were allowing it here we are still we're fiftieth out of fiftieth in health care and fiftieth out of fifty of on telemedicine and you know we've been into this emergency order for a year we've been using audio and no known outcomes now for our conversation and yet right that they're it back yet is always a it is big on that and so you know that I think history has proven throughout the country that forty nine other states are allowing this we're not seeing negative outcomes Arkansas as a lot of for a year we've not seen negative outcomes well that's all well and good but we don't know exactly what of to what extent they're using the telephone which is audio and so I think we have some people here that are going to speak against the bill they don't speak for the bill and maybe we can get some of our questions answered the Bill let thing for everyone. Is to hold the standard of excellence so that the people that are using it can have confidence in it of in the I don't think anyone wants to go backwards but the you know having had the bill the the lead sponsor in the house on the to the seat was two thousand fifteen and the lead sponsor on the house in two thousand seventeen are here today and I'd like to hear from her as well and so a committee I think that this is the most important bill and I think there's been some mistakes made some asking you to please listen very closely so of all right to Senate to Gilmore you are recognized for a question. Senator Hester of the the physicians utilizing telemedicine are they required to be licensed in the State of Arkansas that they are required to be licensed in Arkansas and overseen by the Arkansas medical board thank you senator any other questions. All right seeing then we will start with those that are with us to foreign against would do against and then we'll do for so anyone let's see I have a list of all right to a representative. For. When the when send. Forty. And he going to die. Stop at this one and sixty. Are you. Yes that's what we representative for the Deborah Ferguson. And if you identify yourself for the record please I'm Deborah Ferguson and state representative from district fifty one. And Well let me start by saying it everything he was saying is absolutely wrong Senator Bledsoe and represented Pilkington and I all had the same telemedicine built back in the fall so we got together and decided since we had the same goal of extending the governor's emergency orders to allow telephone calls in certain situations where you the the doctor had the medical records that we would extend telemedicine to include that of even though you know I've certainly had some concerns about that but I have the bill here there was no testimony from the medical board they weren't gonna check the bill absolutely extends audio in a situation where the doctor has the medical record or access to the medical records to electronic health records but the process with the S. is the bigger issue with may I think we have to have trust between the house and the Senate there's a lot of work that went into this bill there was an agreement between our senator Bledsoe would representative Pilkington and the health insurers and all of those people what this bill would look like and it passed the house with ninety seven votes. And it will be no different eight weeks and then Teladoc decided they wanted changes because they want to call a medical records sent in that the patient feels out themselves and if they had wanted that then they they didn't come to us in the house because they knew it wouldn't pass the house they waited hijacked the bill with amendments in the Senate it would be no different senator Hammer that if you in late Johnson agreed on the APR and deal and then when it came down to the Senate you strip that all the five years of educational of end of practice requirement I mean this is about trust between the house and the Senate representative Pilkington is asked to be removed from the bill because they have hijacked the deal and added hostile amendments to our bill I say our bill because I represent Pilkington and I helped write the bill and we were all in agreement obviously Senator Hester doesn't even understand what the bill does the bombing maybe will talk about the bill later but I would encourage you not to take representative Pilkington off because then he loses control of the bill and I know he's you know he's got a baby's got a lot going on but at when it comes back to the house there will be a lot of people speak to the process and how this is not right if Teladoc wanted to run a bill then they should run their own building had ice paid back in the fall this is just not right and I'm glad to talk about the bill but I mean we're really talking about the amendment now taking representative Pilkington off. Hi thank you The representative so I'm sorry Senator Sullivan. Thank you I appreciate you bringing up the issue of trust are you aware that there is a we have four why did a four year far the president David roton and the president of the medical executive director the medical board and they were colluding to kill that telehealth bill in twenty nineteen of about eighty pages of text messages and emails where there are direct communications between them so when you talk about trust yeah there's a lot of trust there too I am and I met with the medical board. They're not the medical board right and there's a big difference the medical ID what the medical society represents doctors the medical board represents patients I Mark lately different that might or David wrote for the medical society was working with the medical board and asking the medical board to do research on their behalf and I've got all the paperwork they're asking the medical board to do that the medical board also when I met within a month or so ago so they would not take positions but they obviously took a position of a. Mr rove. Skews me about this illegal but it sure to it's not senator bord border let me say that the board appointed a special committee to have hearings on telemedicine that is true. In terms of recommendations they did not do that senator this is what you're saying in public needs to be brought up another time we speak on this bill on the amendment I've just you know unfortunately the amendment he's already engrossed that we don't agree with and that's what Pilkington asked to be removed from the bill I mean this this is just not right the manager of all respect what you're saying what did she did bring up the issue of trust what this is I mean I could get started on trucks to two years and and we we would be here all night but to listen let's keep our remarks on this bill please of all right to yes the Senator Hester. So I'm I'm sure that the verbiage I used is not accurate I know you're a doctor and so you know I'm home she said Dennis Dixon St yeah same thing your doctor the they might disagree with the wealth. The. Is fundamentally we may be talking about the definition of just how the medical or modified a healthcare record but fundamentally their goal will be to not allow audio no that's not true so you will support vessel audio only being used for telemedicine it's in the bill audio only under the same conditions as the emergency order which said you can use audio if you have there and other words if you're there doctor you have their medical records are you can get there hello their medical records sent electronically but the reason for that is you we allowed back when senator Bledsoe and I had the telemedicine bills for two different times we said you can it's about establishing a relationship that it's not really about treating the patient once you've established a relationship you can do it and numerous ways but this this phone call is about establishing a relationship which means you've never seen the patient before. The previous telemedicine it said you can establish a relationship party up with audio visual but not with telephone after emergency orders represented Pilkington and obviously the governor wanted to eight in his emergency orders wanted to extend phone calls in certain situations but not in every situation because when you find out because this bill because the previous bill it also requires payment parity that means they're going to pay for the visit just like it was an in person visit so if you're going to require insurance to pay for this like an in person visit it needs to make the same CPT code there you know the parameters of what defines an in person visit it can't just be your doctor calling you at to check on you that's just a consultation that is not what this audio vis it is what Teladoc is asking you to do is sign a form that the patient feels that themselves it's a medical history and it is not. And I think that clears it up for you right yeah I'm for that so okay thank you for the patience form that they fill out saying that it won't qualifies as a medical history doctors treatment right now yeah but the the point is I have twenty one people they move into my district twenty one every day three to six five days a year times about three and a half years at least they're moving in my district maybe they got kids they're not settled they don't have established relationship with a doctor maybe I got a kid that said I want them to be able to call and get the kid some flu medicine right that's what I want if they're traveling as most people many people corporate white collar mission to travel out I want them to be able to call not have a relationship I want to give a call based on their liberty as if you know that I think this is what I need to much I'll need to get it. Well that and that's and so that's what I was talking about this definition it is on establishing a relationship I think that that phone call should be able status relationship you disagree I'm I'm good with us disagreeing on that I think that clarifies well if you want that then run your own bill don't hijack hours that we had ninety seven people in the House agree to. Bill with ninety seven votes doesn't do anything we all know that. Let me ask a question with just the telephone is there a medical record. If you're using just the two telephone to call in there that knows this bill requires that is other words if you're doing a telephone call it requires a medical record can yes and a real met radical record where you have you know examine the patient and they can be we passed the bill where that that if if certain parameters are met an audio visual I mean how can you do history this call on a patient if you can't see them I mean that's not a history and physical. Right I agree all right a Senator Solomon. Our other states doing what Senator Hester describing. I don't know then I wouldn't I mean I'm sure there are some I know Teladoc say the Texas Medical Society says six million dollars and they're doing it because I got C. but I'm sure there are others are you aware of it or others that are not doing it as well I thank I don't have that information thank you thank you all right Senator Flippo you're recognized for a question you in a question all right anyone else for this witness. All right of may I reserve the right to call you back sure okay we will listen to some more testimony all right of we are going to now against and with. Okay I'm sorry for and we will have Julie I'm sorry can't pronounce your last name. Okay all right John John Burris please come an entity to set for the record. Thank you thank you madam chairman is John Burris on with capital advisors group and represent Teladoc don't know if this is smarter wrong have but given the situation I felt like we on or I'll sit here and and testifying. Tell you my perspective but also lead to questions because I don't mind that at all. I think in the end there is a fundamental policy disagreements here. What I would disagree with is that this is somehow new or surprising or the Senator Hester hijacked a bill that has his name on it. And I would certainly disagree that it's wrong for the Senate committee to have input on the bill and that because somehow House members a few and other interest groups agreed that you somehow have to accept that agreement I disagree with that premise so what happened here who I worked with representative Pilkington as you all know he's had a child recently and he's away in and. Focused on that understandable in. When he filed his bill we supported it because our goal was all way along with many many stakeholders our goal is always to codify what was in the emergency proclamation he had some things in the bill that we don't necessarily love but as you all know legislation is confusing I voiced a lot of that to him throughout the process talked about adding things wanted to be supportive the situation in the and decided to wait to the House Committee to see you know how how things went the fundamental issue though is two fold with this bill and how it does not codify the governor's emergency proclamation everyone is very simple on its face the governor's emergency proclamation says that a provider can user name means they deem appropriate to treat any technology due to proper you can read the words an emergency proclamation this is not say that it just allows for one audio there's a lot of practical reasons why that matters I won't go until now there's people here on behalf of businesses and companies who can speak to them. The other major wine merchant House committee which is why we're in this situation of trying to address it and Senate Committee representative Ferguson ask a series of questions to the Department of Health around what the definition of health record is. What she said her definition was what the department said that they they agreed to and and none of this was and I. Hostile way it was just conversation in a Committee right but but what representative Arkansas to help definition of health record is is not in law or statute or rule or red or to find anywhere to opinion and I respect that. But it's not but it's not the way that many many companies have interpreted what a health record is. We agree we interpret it to mean and this is really more may have been practically speaking. To be what you do anytime you go to a doctor I am from Harrison Arkansas we went to school at Arkansas tech and Russell I live in Little Rock what is my health record if you if you if is it my physician Harrison as a physician I want to R. but if you walk into the universe clinic down by subway you fill out relevant clinical information the doctor can treat you. And all we want is the same standard applied here because the language in the bill now Senator Hester presents that says that these are our will the rules already Arkansas licensed doctors and they have to meet the same standard of care is an in person as a and I think we can trust doctors if if I call it position on audio only communication provide the right relevant clinical information. To him or her he can decide if you can in American decide if they want to treat me. I think it's about meeting the same standard of care so I did what I want to clarify that the reason we are here was because we don't agree with what was stated in House committee about what a health record is means is not defined and so when people start saying that the concerned becomes what happens after the legislature adjourns. What happens when rules promulgated. how is the health record fine and that's not any malicious intent at all by the department of health of the medical board I just think it's best to settle those issues legislatively and clearly. So but I believe I tried to explain our position and and why we are here. This is the first time I've ever testifying to committee I don't take it lightly no notes and I wasn't prepared to do this but given the situation I think it's important for you all know why there's. ACT a flurry of activity here. That is why in the end we believe the best policy. Teladoc associated telehealth companies cover over half a million lives in Arkansas right now. We believe the governor's emergency proclamations good policy we would like to see that put into law all right. Thank you any questions. All right of center to Sullivan. Do you happen to know how many of the state for doing what we're proposing to do my understanding is the only debate is is it forty eight or forty nine NO a who that allows audio and there's always disagreement about this fact but in the end I think you can trust. Like Teladoc is a publicly traded company that does business in virtually every state so you know I I think they're always different Asterix on things as you all know but in terms of allowing audio. My understanding is forty eight or forty nine so we're not breaking new ground here and doing something about this no serving considered or done thank you Sir we've been doing in Arkansas for a year. All right thank you very much I don't see any other questions. Thank you thank you all right now will go to someone that is against. And that is Scott Smith that you would come forward and. State your name and who you're with for the record please thank you madam chair members of the committee I'm Scott Smith with Arkansas medical society. Appreciate the time here. Just a few. Comments. We were in support of the bill until was amended hi there are parts of the amendment that we're still fine with the basically the emergency order and. Vision on them yes there's a provision for The Blue Cross blue shield ask for we're fine with that but if you would just first second. Take a look at Page two. Lines seventeen through twenty one and I'll read it this is one way that physician patient relationship can be established that was in the bill originally and is still in the bill. Healthcare professional who is licensed in Arkansas and has access to patients personal health record is maintained by a physician other license hawk healthcare professional our local educational agency using real time interactive audio technology including the telephone so what that is that's a little paragraph explaining how you can establish the vision physician patient relationship and that's pretty much taken from the executive order the governor's executive order. Now if you go down one more line. And this is where the amendment really hat has us concerned. Notwithstanding section seventeen eighty dash four oh three C. and I don't want to read all the rest that but the rest of the page is new language but if you will Flippo our our scroll to the top of page three. One one which is Arkansas Code seventeen dash eighty dash four oh three C. so this is the part that. Was just reference not withstanding and notwithstanding as John of means in spite of nevertheless so basically. Below that this is how the professional relationship I would not be allowed to be defined if you follow through on on the first twelve lines here it says that you can't establish a personal relationship through an internet questionnaire an email message a patient general generated medical history a text message a facsimile machine or any combination thereof so basically. By the the language that is on page two. One twenty two not withstanding seventeen eighty four oh three C. which is right here what was. It allows the patient physician relationship to be established now by fax machine text messaging. Patient generated medical history the email message it internet questionnaire. Like I said before we Fine we're supportive of of establishing physician patient relationship with the telephone as long as there is a real medical record like it says with a health it's maintained by physician or other licensed healthcare professional. We're fine with that. What we're really concerned we've got real problems and opposed to the bill as it is amended now and that's all we have decided to take the question CSRS to Senator Solomon I mean I'm sorry senator Hammer did I see you raise your hand okay a Senator Hester. S. mission is but by that testimony is the medical you've selected from closer please with with that testimony do you believe the governors emergency orders been a responsible. Has it been irresponsible no we we support. This language regarding how the foot I've telephone can be used now as long as there's a. medical record it's maintained by a physician or other healthcare provider but that's not that's not how the emergency order is being in practice for the past year that's not correct I respectfully disagree it it has been used in that way. And I think it's been used in that way successfully I've not heard we've not heard any problems or complaints I'm not aware of any well I can tell you that my family has used it without that. Several times during this year without having any relationship with anyone we made phone calls and use and so. Okay maybe I need to so no one held our health care records they made a phone call talk to a doctor yes it was it was that the first time visit first time. I believe the executive order. I would have said then that that I've learned that there would need to be Medical records maintained by a physician. Okay well I think I think we're just circling back to this maybe I misunderstand I'm sorry I think I think you think that's what it says I think most people don't think that's what it says that's not been in practice for the past year. That the executive order does not say that or what. All right I think we have a problem with clarity of. The executive order says that you can use the telephone but it has to be with a medical record. Man man by a physician is that correct that's what the executive order says that's what it says here all right we'll anything else any other questions yes okay the senator you're recognized thank you madam chair. Who can give us and where can I find the legal definition of medical record or we redefining it in this bill is that kept that the health department the medical board whose to keeper of the definition hi in law I do not know the answer to that question and I'm sorry I don't know where they are that's defined or or whether it's in rule rag I'm sorry I don't have an answer follow follow up manager yes. If if you don't know. Then. I'm a just struggling if you don't know. Who does know because if we if somebody can just point to and say this is where it is and this is what it legally says right now I think that would at least give us a point of reference such. In law and if it's not there and that's the purpose of what this laws about then the debate is do we agree with what this bill says or do we not. Can it may be in definition or an rule and I'm not aware of it being specifically I do know that the What's in the red medical record not as physicians but I don't know specifically if I can give you any kind of code or or of a rule site. But I hear what you're saying okay then. They were we're talking about definition it's floating around out there somewhere in the air they were trying to put some substance to it by doing this in the disagreement is. Does one side agree with this is way out of the and the other side agrees this is the way it ought to be and that in my wrong in that interpretation or. I thank I don't know if I can well I think for the other side but at the dentist over in the corner knows how would you like to come forward and explain that and the. A Scott not a medical doctor and the. No but you have to keep medical records at the dentist so maybe you can in life no I mean I can take from my husband's office do you know what to CMS definition yeah absolutely it means you've got a history and physical exam to diagnose it's it's a it's it's defined because when you have to submit medical records for reimbursement or for you know different things to CMS the there's a date I'll have it with me but there's a CMS definition it made you the same in the patient okay manager can ask questions of the. The represented person. Yes please okay so if it's a CMS definition and it's being done in forty seven forty eight forty nine other states does this definition that we're debating over aligned with what's being done in other states because of it does then problem solved it's just a philosophical or a difference of opinion. But it exist out there. Help me out here well no I think what I mean by maybe you may need to get John burst back up here at my understanding is what Teladoc is saying that they they're not because Act definition says you have to have a medical record they're warning to say it medical record is this patient field form I think when they're doing it in other states the legislation doesn't say a medical record is required to do it they're just saying the patient the what they want to call the patient filled out form that is forwarded to the Teladoc company can be used for the telemedicine visits I don't think they're trying to say that's a medical record. Splendor standing if this all aligns with what CMS says you can bill under then why would we not do this if that's what CMF CMS's definition fits. CMS and I don't say CMS or yes this is a medical definition and I don't I don't have it with me but I mean it does mean you've done a physical exam I'm not sure how Teladoc is rationalizing filing things with just a patient feel that form I mean I may tell you that do we know if there's been any lawsuits filed against them because they're not complying with the definition that there operate and all those other states under add a note to tell adults model is typically you know they contract with big companies and there be no being available for employees to answer the phone into telemedicine over the phone that their model is not to access role healthcare any of that they they they contact people at Walmart and a big companies to do that with patience this not I might mention while we're on it that's the other problem with the amendment that they dated I think it's very important not to incentivize telemedicine overseeing your doctor a person you know we all know it's always better to see your doctor person if you're if you're sick and they tell you I mean telemedicine has its uses but I don't I don't think that's ideal so part of the bill we wrote is that you couldn't incentivize telemedicine overseeing your doctor person in other words does that the telemedicine an in person visit have parity that's important to us part of the amendment that Senator Hester added it would say you could encourage a patient in other words to use telemedicine instead of going to their doctor that that's another problem I have with we're not talking about the amendment because it's engrossed but that's another problem I have with what they added to the bill or thank you thank you all right thank you. All right any other questions all right let's go to the last the person for and that is. No is that it. Chief Justice John O. okay all right I guess there's no other of note I'm sorry you the. You were on the list I believe the Julian you pass to John are you look are you women are you saying you don't want to testify since you're on the list. Exactly okay so you're letting him take your place. He's also on the list of who who was. I believe American element. You're not on the list but I will let you come to the table and speak and then I'm going take liberties by asking you to come up not being on the list and then I may bring somebody else is not on the list of. And if you tell if your of please tell us who you are and questions from Teladoc but please come up I'm actually from the American telemedicine association Teladoc is one of our four hundred members okay thank you so very much for your indulgence chair and and thank you so much of the committee my name is because I believe and I am the director of public policy for the American telemedicine association eighty eight is the only organ national organization completely dedicated to advancing telehealth are over four hundred member organizations includes companies such as one eight hundred contacts ascension of their Ikere battle on right in the Doximity hymns intermountain life point Phillips Teladoc Health as mentioned Verizon Walmart Ziegler that does this and the list goes on the eighty 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 the eighty eight is pleased to see house bill ten sixty three making its way through the legislative process and we believe that the amendments offered by Senator Hester under consideration today are vital to effectively making telehealth more widely available in Arkansas and I'll just say as an aside I think it's pretty unanimous among our four hundred plus members and organizations that Arkansas the most difficult state in which to operate effectively and deliver effectively telehealth to patients. 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 these amendments recognize we should permit or license healthcare preferred providers to use their clinical judgment in training to make decisions best for their patients and the pulled of course the standard of care. By making these important amendments in passing this bill. It will no longer be necessary for gubernatorial executive orders to waive restrictions in Arkansas will fall head to we're forty nine other states are now. Fite finally want to thank the committee for your great work on this important legislation and we of course are committed to ensuring that patients across the country in across the state have access to safe high quality and affordable Care when and where they need it and we we believe this legislation as amended. Particularly with the changes that have been outlined will accomplish just that when of course I'm happy to take questions and again thank you so much for your indulgence any questions from the committee all right to Senator Hammer recommend chair you heard the conversation earlier definition. Of medical records what's what's used. In other states so it varies by states but in terms of requiring this kind of record I don't know I can't think of anything of course a very by each state I can't think of any other state that has such a requirement and I think in Arkansas in terms of that definition and there is uncertainty as to what it actually means and so I think that Senator Hester and supporters of this bill as amended or trying to see clarity in that regard in this bill would do that thank you thank you all right any other questions. All right seen none thank you very much thank you so much chair all right is there anyone else in the committee that would like to speak for or against. Anyone else the. No one else. All right of ladies and gentleman. Of. You have heard the bill I'm sorry go ahead Senator Pitsch no no no you're going back there. They do this formally. This kind of wishing you a little bit here. There you go are you close for your bill or would you like to see some well yeah I would I would just like to to say that like members like I told you a representative Pilkington is one of a hundred thirty five of us that deserves the absolute respect that he will that he will get for me and me Hammer we're close some will be close after this and and meet him will meet and make sure the process for I'm not like I said I'm not gonna run this on the floor until we've we've we've had a talk and we just have literally haven't been able to do that the last couple of days so we were set up to do this and that's what I'm gonna do and I suspect that on a member's own I will remove Pilkington and put a House member on but I'd I'd I do not know that right after I talked Pilkington I will know what that's what I suspect to happen in the coming days floor and I think we saw we see what the what the argument is here and just fold philosophically what we're dealing and that and I would ask for a good vote. All right of you ladies and gentleman you have heard to the bill you have heard the of for and against and you have heard the closing what is the will of the committee. I do pass and a second all those in favor say aye. All those opposed. All right you have passed your bill congratulations right before you leave I'd like to suspend the rules for Senate bill eleven forty please do have a motion all right of a to have the second. Those all those in favor say aye. All those opposed to all right Senator Hester so I told Senator Dismang a few minutes voter on this on his behalf and it just says the funerals General are. Embalmers basically they can do that there I continuing it online as so many people do not does not have online or in person so it's just given that freedom. So we have to answer any further questions any questions from the committee. All right seeing none of these anyone in the audience want to speak for or against. Right seen none of what is the will of the committee he's are you you are the last all rent do pass do pass I have a second all right all those in favor say aye all those opposed you have passed your bill all right we're not proof. All right ladies and gentleman Senator Hammer. The Senate bill three eighty seven. Thank you madam chair manager. Could I ask that members would look at the bill that's in the file folder because I'm not sure it is actually the most current version for yeah sure that we're on the right in the file folder Maybe a description all copy I'm not seven were here only to have mine have at this. Okay you all right. There you go. Madam chair that is not the most current version. there was of members own and it was engrossed. With the. And so the if you're looking at a copy of the bill the stated to twenty four the bottom eight fifty six that is not urgent would you like to pass over it and are you want to. Well it's on the website okay the bill I hate to. Not have the most current bill before the committee that's that's probably not that's probably against the rules okay skews me to yes ma'am. Your hand you have to take us a few minutes to get it okay all right Mr price if we can get it here in a few minutes so if you want to step aside let's go on down the list thank you mentor K.. Okay. All right the looking at the agenda. Senator Flippo. Senate bill two ninety five. Thank you madam chair members on a letter Mr price pass out the Amendment okay we of well he's passing if it out let's go ahead and adopt the amendment to I have a motion motion to adopt a motion to have the second. All those in favor to and in favor of adopting this amendment referred Senate bill two ninety five say aye hi all those opposed to okay the amendments adopted let's get that committee a few seconds to look at The Amendment. All right you are recognized to present your bill as amended thank you madam chair and so a quite a few of us actually we sit down and visit with DHS and mark whiten Made several revisions to you know to I think to make this bill more palatable so they can actually you know enhance their their efforts and making sure that you know people receiving these public welfare benefits are indeed eligible so we changed some of the the time frames in which you know allow them you know we consider that to allow them a longer time to to verify income limits we didn't specifically define a substantial winnings as I had hoped to what we did is we picked that to what it says the federal level and so that's two thousand two fifty dollars free standard household up to three thousand two hundred fifty dollars for a house so that includes a disabled or elderly residents we remove the percentage of eleveld but percent of eligibility for hospitals And I think those are the the the major changes that would be it be made and other than that the bill stands as it was last time I presented it this bill doesn't change any eligibility requirements for beneficiaries all it does is making sure that the state is doing as much as they can to make sure that those receiving these benefits are indeed eligible. Have any questions from the committee. All right seeing none does anyone in the audience want to speak. All right. One four. Thank. Okay all right we have we do have some people that want to speak for and against I will call Dr Thomas Snyder up and I believe you're speaking for the bill is that right doctor. Of fourteen sixty five. Women I'm sorry excuse me excuse me okay I'm sorry of. Senate bill two ninety five sorry of we have a. Townsley. Family anyone here by that name. parmi. Okay all right within let's go to the. John John Tice. And I believe you are against is that correct. Come to the table and introduce yourself for the record. Madam chair members of the committee my name's John Tyson with the Arkansas department of finance administration and while DFA certainly has no opposition to the concept of this bill there are a couple of issues that deal with state taxation that are of concern to listen and I apologize Senator Flippo ordinarily D. if I would have gotten you Senator Flippo on this but several days ago we received an amendment that took care of all DFA's concerns and only after lunch today this afternoon did we see that The Amendment that's actually before you did not take care of those concerns so we kinda surprised Senator Flippo and I apologize to him for that the first issue that we have from a tax perspective is that the bill requires DFA to provide quarterly information to the Department of Human Services about changes in circumstances for us a benefit recipient DFA doesn't have quarterly information all of the information we would have to click from an income tax perspective and withholding tax perspective is received annually and it's received several months after the close of the prior tax year so we we have difficulty we can't comply with that quarterly requirement the second issue that DFA has is that the bill has general language about a as a condition of eligibility the recipient has to allow the release of their income information and employment information that is contrasted against a very strong very specific tax confidentiality provision in the tax procedure act that that impose a civil and criminal penalties if DFA releases tax information and the Bill would benefit from a specific amendment to the tax procedure act that makes it very clear what records DFA could can release to DHS so with that I'd be glad. To answer any questions any questions from the committee. L. okay Senator Solomon. What is it we only get the data once a year. Income tax the main information you're going to have about a taxpayer's change in circumstances is either withholding tax information or income tax information of course the income tax information is filed when the tax return is filed so for twenty twenty taxpayers are required to file that return by the following year withholding tax is we get a monthly return but the multi return is just a single number and the actual W. twos are not filed until January of the following year okay thank you any other questions from the committee. All right seeing none thank you so very much. All right that was against we're going to go to a mark white from DHS. And he is speaking for. And you're recognized tell us your manager mark what apartment services and may miss Franklin join me please please hello there as quick five minute job outside we're speaking on the bill on the bill all right so. It was that we had a good conversation Senator Flippo and we appreciate his working with us we I had a lot of winter loss details I think certainly was before you is a better building stronger bill and so we certainly appreciate is Qualcomm's non on that the one point we're which could come to an agreement on a fully transparent committee about this is again what will make Worcester Tosh just reference was the quarterly check of data from DFA and Arkansas reported one the concern from DFA's perspective are concerned is more of a workload perspective and is that something that's really worth the time expense for the value to generate for the taxpayers and so it must reckon give you some brief explanation of that introduce yourself for the record please good afternoon I'm merry Franklin Director of the Division of County operations for Department of Human Services you're recognized so our market explained it very well my only concern with the quarterly match is that it's the entire case load. in the entire caseload for snap and Medicaid is. Quite a number of people my concern is about. The number of matches we would be working our way through On a quarterly basis for the entire caseload that paying do definitely appreciate you working with us and appreciate the. Changes you did make to the bill very much for night just adds to be working through all that data and as possible and that it may be a year old and we just we don't know that it's going to generate a lot of information that can actually be acted on it a lot of cases all right to questions from the committee a Senator Solomon. I'm sorry Pam list okay no Hammer Senator Hammer. Thank you make sure you know what I guess I need to help get my mind around is you know we we got a you know a our home we are we all these programs and everything and it seems like we can do things pretty real time and that such as you know dropping him off and pick them up why what can we do it in all those other things but we can't do it in this because I mean even tiny and like with unemployment known which of a ghost worker when somebody doesn't and drop them off it's it's not so much the issue of verifying it renders the source so it in our experience the best thing And we get around this topic if information is what's called a nationally our registry and that is is rarely updated gives is timely information when someone gets a new job for that different wages and we also we can work with for work Division workforce services as well so so that we don't don't do these things it's just where is that they're coming from and how how useful is that data. Sullivan chair yes so is that a system flaw software flaw that we don't have integrated systems to be able to cross reference across all the multiple programs that we offer so we could spot check across the the horizon on on individuals we do have those systems for again for for division of workforce services and also provide a state this and also with the national how registry we don't have that in place right now for DFA tax data for the reasons we talked about and that's just I guess just is not so just systems issue as it is it in the past we haven't saying they'll give us enough useful information for just five expense of doing that who wouldn't give you that. Did you say that would give that to you what is that the information that comes from the FAA we don't think would be useful enough in terms of identifying people who are no longer eligible that would be identified somewhere else just give we think it is very small number of people to be identified and whatever savings there is from that would justify that the cost of actually doing the verification the checking would be cost neutral. The favourite is it not cost neutral yes thank you senator Davis you're recognized for a question thank you. And how often you guys now check for fraud. I'll take this one of we have a number of accuracy matches that we do already as mark mentioned we we do match with the national directory of new hires which not only gives us Arkansas new hires but. Other information from other states new hires and for the snap program we also get a quarterly wage match from the national directory of new hires and we check every month we do that monthly for all applicants and re certification. Clients we also as a just routine we check workforce services that application that renewal we have access to check workforce services that our quarterly wage and you live in case changes are reported on the Medicaid side we have a monthly new hire match that we do specifically with workforce services for the Arkansas Works group we do daily incarceration matching we do death matching monthly with department of health and through the CMS territories and. Territory the benefits query we. We are Trying to think my missing anything. Thank you I'm wondering if and and it sounds like maybe alleged to you if they have and you know substantial lottery winnings that you will see that verified somewhere else through other places that you're and catching data is that correct or did I hear that incorrectly. The no earlier that is part of the other other language in the bill it does cover lottery okay okay and can I please and so I've got a question on page three and I just don't know if I'm reading it correctly but I don't think it's and any type as and violation of the program currently to use your and EDT out of state but this says that if there's any changes that may affect eligibility including and changes in residency as identified by out of state and EDT transactions is that are you saying that they have to it now report any time they make a transaction out of state or what does that mean exactly so and that's a match that we also are we already review that data monthly and clients are allowed to use their EBT cards out of state anywhere a vendor accepts that EBT card But we do review it and you know we have a lot of border counties and people may shop on one side or the other for their groceries but we we do review that monthly and follow up on cases that seem to have a sustained pattern about a state or someone who does not this or live on the border but their cost consistently making purchases out of state and we follow up on those to ensure that they remain eligible in another point to mention on out of state transactions when someone does move out of state and report to us I'm no longer in Arkansas are moving to you know another state they are allowed to use the balance of whatever may be left on their card wherever they go so we do see out of state transactions but we do review those okay so that's not anything thank you have spent one clarity on that and you know in the in the first page it talks about you know an adequate eligibility verification policies that fail to maintain program integrity and I'm just kind of wondering maybe what an adequate verification process looks like to you guys in it and last time I asked if we know how much we're currently currently have and and snap fraud and I'm just curious if we have a number on that of what it looks like right now in Arkansas. So I can tell you I have a team in the division of county operations called the special investigations unit and they for they follow up on any complaints reported either from outside the agency from matches and information we may receive in just from polling data out of the system that may look you know households that have no income but they have expenses things like that we we do those kinds of things and and I have a group that investigates those looking for errors and they do around ten thousand of those a year and about ten percent of those result in a referral to our fraud section within DHS who then takes it there and determines if there is enough To substantiate fraud and then follows through with the process from that point okay so we don't know if I'm sick I don't have the specifics okay I just kind of curious what it looks like in Arkansas as far as you know and be on what's referred but what is actually in that being found to be you know that your case of fraud which is information on that thank you. All right any other questions from the committee all right thank you so much thank you we're going to see if miss Townley is in the audience. If she is she wanted to speak against but I don't see right thing would. In the holding room the. She's not here anymore. You want to check for this. She had to leave okay all right. All right the ladies and gentleman then unless there's anyone else in the audience who that wants to speak for against then we are going to continue on senator do you want to close for your bill. I'm sure. Members good common sense bill appreciated vote number do pass all right all right to have a second all right. So submitted yes we need to pass as amended. Mispriced madam chair I move do pass as amended all right we have the second all those in favor say aye. All those opposed concurrent. We try that. A. All those in favor say aye. All those opposed all right you have passed your bill. All right going on back we're going back to the Senator Hammer is bill and we do have an amendment. Or is this just the most recent bill Mr price this is the most recent bill. So we don't need to have any action. When you're ready senator we are ready to hear it. Thank you madam chair They are ready to copy their. You ready thank you venture. So as we all know we've been actively trying to get a presence for pain and pandas treatment I won't go into a lot of details other than say we that we've been successful as you've heard me testified for getting a center of excellence established over children's hospital conjunction with you M. S. they have two positions on board they were able to get an anonymous donation that allowed them to be able to hire numbers in order to prepare for the patients to be seen by the doctor to make you more efficient process. What this bill does is allow for Medicaid to pay for the off label use of drug treatment for those that have been diagnosed by the center of excellence as needing it for treatment of pain opinions disorder there couple key components in here that I work with Medicaid on and that's why the bill was originally are amended from its original form and that is that in order for it to be done number one they would have to be referred from the center of excellence so that means that all patients would go through the center of excellence in order to be able to receive or be considered to receive the treatment of IV IG antibiotics in order to treat pain appendicitis diagnosis the second one is it would require being pre qualified for it and so there's some good safety checks in there because quite honestly ideology is an expensive drug but it is effective in the treatment of panda pandas and so we've built in some real key safeguards in less they change your mind this is an agreed upon bill with working with Medicaid to get to this point and so I'll be glad to answer any questions questions from the committee. All right seeing none is anyone want to speak for the bill. We don't have anyone signed up for against anyone for against. All right sing NO one in the audience and no one signed up. A you want to close for your bill I just appreciate a good vote because this is one more step in a journey we're trying to get to the end result take care of the kids that have had the unfortunate diagnosis of this disease and so manager with that I'll make a motion to pass all right do pass do have a second. All those in favor say aye all those opposed congratulations you've passed your bill thank you employees and allowing them to file workers comp claims for COVID nineteen exposure on the flip side it also protects the employer as well so with that I'm happy to take any questions. All right of any questions. Right seeing no questions. Is anyone in the audience want to speak for the bill. Against the bill. All right seeing none have to close for your bill close and make a motion to pass all right have a motion to pass up the second all those in favor say aye. All those opposed congratulations you've passed your bill thank you and then fifteen twenty one. Basically the the same thing it's just geared more toward healthcare professionals thank you at the end. Governor's executive order being qualified. Can you explain that a little bit more yeah absolutely so and I also have just now on here as well but again if you're If there it in someway exposed to CO nineteen the course of their duties as a health care professional allows them to you can make a claim with workers comp Commission also again the flip side it allows the employer to be protected as well making the assumption that they're going to be under likely or almost certain exposure to covid and I will ask just now entity some self and collaborative he wishes thank you senator thank you madam chair just miss attorney here in Little Rock the senator I'm afraid got a fifteen twenty one just confuse with fourteen eighty eight so fifteen twenty one is codifying is he said the governor's executive order as it relates to health care liability in the pandemic so this is designed to anticipate and address the situation if someone is exposed to during the course of a healthcare worker providing them services to COVID in they get sick there will be protection against liability as long as the healthcare workers work following the the guidance the directives and is operating in good faith again this is something that most states have adopted in terms of of the pandemic and and another thing I'll note on this bill as with the last one is it is set to expire in two years and the reason is that is that with that and put the onus on the next General Assembly to decide where are we in the pandemic should be extended should we let it expire should we change an extended so that's that's the basics of this bill. And I apologize for the confusion that's all right that's all right yes the question. Senator Hammer the committee chair that's what is hopefully a member of the next general simply we appreciate you taking that down the road like that but. Let me let me ask you though because reports are starting to come out now that long term effects of COVID nineteen you know may actually have some lifetime of consequences to it so. Help me understand at what point does it go from two years to permit what would be the unintended consequences of such action yes the I will make that to your point don't make that decision in two years and and that was the reason the decision was made by the sponsors to put that in there because we don't know what's going to look like in two years and maybe this hopefully will knock on wood won't be needed any longer would be moved from the pandemic but it was done to to make sure that this was given attention it just didn't extend beyond two years because there was no action okay all right thank you thank you Mr any other questions. All right seeing none. I close feet I'm closing make a motion to second forgot something anyone speak want to speak for against this bill for or against seeing none are close for your bill make a motion to pass all right have a motion to pass to have the second all those in favor say aye all those opposed congratulations you pass the bill. All right we are down to H. B. fourteen sixty five I believe that set up representive Johnson. And you when you and then if I yourself for the record. We're ready to hear your bill. Thank you madam Speaker members the committee state representative jim Dotson district ninety three House Bill fourteen sixty five does one simple thing it adds a definition to the term good moral character when it in searches in the code for consideration by licensing entities to consider an individual's good moral character as part of a. On whether or not they get a license or not and so if you recall. Four years ago there's a big licensing occupational licensing overhaul bill part of that bill kind of buried in the sixty pages that didn't really catch told toward the end was a striking of this and the reason I was told as a as a got to Looking into it was that it wasn't clearly defined so over the last couple years working with the AG's office without a definition for good moral character that's already in code that is under set code section twenty three ninety two four oh five and that was the definition we used in this particular piece of legislation to make it as consistent as possible across Code and so that's the term putting that in there and allowing the entities to consider it for licensing. We're happy to try to answer any questions. Bills. Right. Will. Read me through hell this someone applies. For. License and so how do you to determine good moral character except I mean tell me just wanna be through an example of what this will mean so that that will mean probably something a little bit different for each licensing agent entity and how they they make the definition in law or how they make their their policy and rules in line with this definition previously there wasn't a definition it just have the the big term good moral character so this says good moral character means personal history or of honesty trustworthiness fairness a good reputation for fair dealings in respect for the rights of others and for state and federal laws so As you look on page two the licensing entity shall consider good moral character of an individual before issuing a license and they can still make the rules to the place where they can that give exemptions and exceptions and and and and that sort of thing if if someone doesn't fall directly within their their rules but the agency or the licensing entity will be the one promulgate the rules those rules will come back before via the administrative procedures act process over the next couple of years so we'll have another look at it as the Legislative Council before each entity develops their own criteria specifically. Okay. So. Okay let's have a question from Sen senator Wallace. Recognized. The ribs of Dawson to assist me and I could have good moral character. With one agency but not with another. If there's the if the if they all have their own standards well the definition of the law would still be I mean that that's why it's being defined in statute so it's the same across the statute each of the licensing entities would have to comply with the statute in what how they determine their their criteria and then obviously it'll be dependent upon the the license and entity or board. On a case by case basis on whether somebody meets that criteria of when they're considering any individual licensee. Thank you Sir it to the do a background check is that how they get to the knowledge of whether this person has good moral character is that where we're going with this well that that'll be part of what the the the obligation process so that's fairly open as far as how how they promulgate those rules and of course as anyone comes before I mean through the ministration procedures act it'll be several months of Discussion back and forth before they come up. And then eventually comes before the legislature for approval of those rules okay any other questions all right to Senator Solomon. Represent does not really in favor of this one came to the house last year now I have two teachers in my district who are facing the loss of their teacher teacher licensure for attending a rally a political rally and wearing a flag on their motorcycle jacket another thing wearing a gun on a teacher so I'm really concerned about the government making these determinations and I'm also very concerned that we're going to let. The agency make the rules to determine that because that's exactly what the department of education did and they're making up their rules and now these teachers are spending hundreds of dollars for an attorney and there's no one who can there's no process in place to say Hey that's not a good idea let these people go and flopped I'm sorry but I'm I need to see more detail about how the rules will be promulgated before I can fully support it your response to that well. You know as far as how promulgation of rules goes we. I think we all want more input and say in in some of that on the front end and then on the back and were eventually the ones that review and approve those rules so you know if there's a license in into your board that is particularly egregious and promulgation of those rules we have the opportunity to stop that Senate back Senate back to the drawing board listen to our our constituencies and make that determination and if there is one that gets out of hand then every couple years we have the opportunity to come in here and pass legislation proactively to to make changes so hopefully there won't be anybody that abuses this Mike the situation you're talking about in Arkansas going forward however over the last couple years since this law into effect and keep in mind the term has been in code undefined for decades maybe over a hundred years or more and so as that standard has been out there throughout the throughout the decades It's been there much longer than the time period it's not been there the agencies have promulgated new rules and and you being the the the former co chair of rules every single month there was another board or commission that came through in and. We reviewed and approved striking of good moral character as a determinant it could thing for consideration for licenses every every month for the last two years kind of. And I went to the well speak against the bill because this and it It greet me every single time that we were lowering the standards that that's something that sends a terrible message to everybody that in Arkansas you don't have to have good moral character to get a license I think it's something we need to make sure we have a high standard of good moral character and then let's address the individual users individually as they come on. And. All right of we're going to go to a thank you the Senator Gilmore and then a senator Hammer I believe had a question and then Senator Davis. Rosa Dotson I appreciate you of bringing this appreciate the intent but I think like Senator Solomon has mentioned I have some concerns about trying to establish what that standard is and determining you know whether the government should be establishing its standard of good moral character because it might differ from say counted or say mine even so I just want to say that I appreciate the intent thank you all right Senator Hammer. Thank venture maybe hit us me to go but it seems like a member last session we get something to try to get rid of the term good moral character I can't remember that apply to those running for office or licensure or whatever but did you hit on that a minute ago or yeah that that's that was the bill I was referring to I think it's called act nine ninety it was a it was a very long lengthy bill that had that these terms stricken in their kind of there's several pieces of the code On down in the bill and so it was at the very end of session and too late to to kind of stop that train and. The AG's office promised to work with me and and try to define it because the the intent as I understood it anyway at the time was They were striking because it was vague okay so we've tried to put a definition and there and that. We'll come at everyone so. If a person passes the requirement to get their licensure and I'm thinking like a like a nurse a doctor. Social workers school teacher. Is that not sufficient that they would by passage of the requirement have met in directly the standards of good. Moral character. At the point that they passed requirements in order to get. The more more than likely yes obviously if there's if there's Something within the. You know they're they're a licensing process that says you have to have XYZ that would be part of this. New rule going forward. Okay all right my only concern is our society is not going in a good moral direction and if we empower. The government to make that definition of moral given the direction that our society is going. That that's a lot of latitude to put in legislation would keep in mind it's it's been there for more than a hundred years without definition this this is just defining the terms so that there's an objective okay thing in statute for everybody to look back to when they're promulgated rules. All right senator Davis you're recognized for a question thank you madam chair I'm just a man concerned about and the bottom of page one where it says that you can and. You consider arrest without a subsequent conviction. I am referring to. And. So. I just you know I think it takes a lot for and prisoners to re enter the workforce and society and we talk a lot about recidivism and second chances and making sure people are employed and I just I mean I have family members who you have not only been arrested but have had multiple convictions and just to be able after they rehabbed and did everything they were supposed to do just to get accepted into the public university to finish their college degree so that they could get a job and that was very cumbersome and they did it eventually you know one of the institutions let him and thankfully and now they're a working member of society and they're clean they work with other prison programs and try to help with other you know for other prisoners other felons and so like my concern there is you know putting something around people who've had convictions and maybe disqualifying them and for you know because they lack good moral character based on that definition and so I don't I just have concerns about that and just making it you know one more thing that's a little bit harder for people to and reenter society and and be contributing members of society so. On that line there. You have to look above in the this is a licensing to each entity shall not. Then drop down consider rest without subsequent conviction right so say you can't consider an arrest without a subsequent conviction like it says don't consider an arrest without the conviction am I reading that correctly like so that's what I'm saying people not just people been arrested but who have been convicted right have served time or whatever so they they have to have before licensing entity can consider that it has to have been committed a conviction in actual convictions rights and so that is what I'm talking about like if you've been convicted in and serve time in prison and then you get out and you're trying to re enter the workforce and society they can take that into consideration against you as good moral character because you have been arrested with the conviction and so that's that's my concern is that we're making it more difficult it's just one more little hurdle for somebody to you know to re enter society because they don't fall under the definition of good moral character than even if they've been clean for one five ten years that still follows them. It is something that they would be allowed to consider yes all right any other questions. All right of we have someone to speak against this and it Sir Thomas Snyder if you come forward economics professor at UCLA if you would introduce yourself for the record please. Yeah Thomas matter UCM I can you can you wait in turn turn on the mind cannot at all speak into the Mike Can. Thomas Snyder associate professor of economics at the UCLA Fay I'm speaking against the bill by the way I think that bill says that licensing entity shall consider the more characters is introducing that as well from the not forces the licensing boards to consider more character and I've done some research in in this area and there's some unintended consequences of so first is the subject of thing more characters if you define it with honesty or dishonesty that still subjective right so the question is what do you do with those people to have a a criminal record right so. You probably want them to be productive you don't want them to be unproductive right so if you gonna block them from coming into the workforce then they're probably going to miss more crime right so the studies to show my that is the probability of committing crime is higher if there is more licensing requirements for these people who had some criminal record in my in my research I which is published in a peer review of the journal says that whenever you have more licensing requirements you see more people out of the work force and once you once you get that you get more crime right so it it sounds like something with good intentions will be would have been more character but you can actually achieve the opposite right we force you would have been more character and actually end up having more people having bad more character because they have no choice and they must to commit crime you get somewhere step two so a couple of years ago Thomas Herald in case the ball there are twenty years old and they they do what a lot of twenty year olds do they got a fake ID and so they could drink a little bit earlier like a few months before age twenty one actually didn't get a chance to drink they got they got busted with a fake ID and okay so carried on this years later they both for getting their CPA but that there initially does that the neither CPA license because they found out that they had a fake ID when they're twenty years old and had to get a lawyer for all that so I think most everyone would agree that that seem to be somewhat but injustice or undesirable outcome right make a small mistake at some point you get something on your record and then your whole career could be ruined right so I do have some other weird stuff to think occupants or acupuncture board had more character mean at sign affidavits from two of your competitors right so people can abuse season they have abused is right so. this bill it does say that ICFI entity shall consider the good more character of individual before issuing a license that I just defines it but says that it shall do that right so there are some negative consequences from that. All right of we. Okay Senator Hammer is recognized for a question just one ma'am would mentor thank you would you clarify for the record are you speaking on behalf of yourself as an individual you speak on behalf of UCLA out of myself on from you yeah okay thank you yeah. All right any other questions. All right seeing none thank you so much I believe you've waited a long time to speak ourselves yes yes I thought ever I saw you come in early so thank you we appreciate you being here we appreciate you speaking I thank you very much thank you all right ladies and. All right ladies and. Okay here we go alright ladies and gentleman has the anybody want to speak for the bill. Before we close at all right seeing none all right what is of the will of the committee. What do you want to close okay. We haven't been. That has been something that people taken an opportunity did today thank you for the opportunity to close for the for good moral character. I understand there's been a lot of questions and people falling very sides of of this particular issue I think this sends a very strong message on where we stand as a state whether good moral character is something that's important to us or it's not important to us and so. I encourage you to vote for going more character in and high standards for all of our folks to be considered it's not necessarily that it will prohibit somebody from actually getting a license but I think it is part of transparency for licensing entities to know ahead of time and to consider someone's good moral character before they issue a license for someone going into people's homes and where they might not be someone that should be going into people's homes and and be a licensed professional of the state so. Cheta a good vote nineteen Q. alright ladies and gentleman put is the will of the committee. Do pass to have a second. All right I'm sorry your bill has failed for lack of a second thank you so much alright ladies and gentlemen before we leave I just want to remind you that Monday is scope of practice day. So. You might. You might not plan on being home too soon so anyway to see no