Public Health, Welfare and Labor Committee - Senate

L. three forty. And senator when you get settled were ready to hear your bill. Bill has an amendment yes ma'am all right in the amendment actually encompasses most of the bill at that moment actually doesn't change much of what the direction of the bill but it does clarify some things all right ladies and gentleman just look at the amendment and in just a second we will adopt the amendment. It gives you a chance to see a something new. At the the amendment itself is designed to Make it where there's a little more clarification one of the things that makes the reporting not necessarily required to be annual so in the end there's not anything substantive changes to the and even if there's a lot of language. Alright ladies and gentleman we are ready to hear Senate bill sixty five and I just with the. Appreciated the committee I have a motion yeah. Ocean second all those in favor say aye. All those opposed to all right you're recognized okay Senate bill sixty five is actually a very old idea and fact in two thousand and fifteen we brought a bill such I worked on my house and then Senator Eddie Jo Williams carried the and the Senate or what it was designed to do was tried to give some employees to the legislature in the process of developing a state plan and in compliance to the clean power plan so actually in two thousand nineteen I carried a bill that basically did most of that in order to provide some flexibility in working with the trump administration however that was probably a mistake and we're now we're looking at a possibility of getting some new regulations and what this will do just require the of the eighty two public service commission to work with the legislature when they develop a plan to compliance with it to give us a little bit of voice in the process I've worked with all of the stakeholders the different utility providers and eighty Q. and the so everyone is on board with with with this legislation there's no opposition to. All right questions from the committee. Any questions. All right does anyone in the audience want to speak for or against the bill. All right seeing none. I had to close for your bill I'm close I appreciate a good vote all right I need the motion. Motion to pass as amended. And to have a second all those in favor say aye. All those opposed congratulations you passed your bill thank you insurance all right going to Senate bill three forty one. So Senate bill three forty one what it does is that it specifically prohibits the of a collective bargaining with with public secretary public employees it It is designed to fly to to agencies of the state not two minutes bodies and cities and counties you know that I think from a good policy standpoint individuals who work for the taxpayers they have a mechanism to hold the employer of the state accountable outside of a of the union and I think from the policy standpoint it's better to thank you have a union the cabin Association but far as collective bargaining we're we're prohibiting it from a policy standpoint as a state there there was some concerns. Regarding a public transit a I think that the amendment that we did took care of that however I'm working with the university of Arkansas with the razorback transit in order to verify that there's not a concerned with losing any federal funds okay so it's possible that on the house and would be could could do an amendment if if the amendments that we've already incorporated didn't didn't take care of that because that's not really the intent of the legislation to have you know perfect the ability to collect federal funds so there's not any I mean it I think that the the public sector unions that do collective bargaining probably won't necessarily be happy about that but extremely limited in state of Arkansas all right questions from the committee. All right sing no questions I have three people that would like to speak against and no one is speaking for I don't believe if you do want to speak for this this bill would you raise your hand you're not on the list. All right of. If these three people would just come and sit at the very front of the committee table right there and I'm going to ask you this the state your name and and in for your from and that type of thing and I have signed up Wade Marshall Jessica acres and Tracy and Nelson is that correct. Is that correct okay all right. You you can sit at the end right there if you don't mind and then use one of those microphones when it's done in a few would introduce yourself for the record. I'm sorry so it it doesn't matter it. Okay go ahead thank you to the chair thank you members a committee my name's Wade Marshall president Arkansas professional firefighters then why do appreciate Senator Bollinger's Exemption from us from original inclusion in the bill with the amendment I'd. Have to stand in. Ask your oppose this bill for the same principles that I. Was taken aback by myself oh eight skews me for interrupting the other two in ways if you would introduce yourself just for the record. Sure am Jessica acres with the Arkansas AFL-CIO okay. Tracy NO son the Arkansas education association all right and if you would please be syncing with your comments and not repeat what's already been said all right and Sir you're recognized a recognized. Thank you ma'am sorry about that as of right to. As I said of we have been amended out of it but I do ask for the same principles that me as an employee of public employee felt that it was over reach that we couldn't if the location choose a sense right now state law does not compel anybody to negotiate with public secretary. Unions that If they choose to do it this would actually be in her in their rights as well as the employee I believe it does have first amendment rights implications our freedom to speech a simple how we want to an address those grievances through a union and efficient. operations of taxpayers money sometimes so I would appreciate shell to I thought no thank you. Thank you. Right to this mistake because yes all right you're recognized thank you Adam we at the AFL-CIO and have affiliates that are of the public sector and I'm some of them do have collective bargaining rights here in Arkansas and one being the rock region metro drivers and I. Being a representative of them and I would like to just that you guys know their concerns so that legislation would immediately jeopardize rock region metro is eligibility for federal transit funds including COVID nineteen relief funding and twenty twenty rock region metro applied for twenty million eight hundred and forty one thousand four hundred and four and federal transit funding including fourteen million nine hundred seventy nine nine hundred and forty nine dollars and cares Act funding we have quarterly request that transit authorities including rock region metro be exempted from the definition of public employer in this bill under forty nine United States code five three three three B. in order for a public transit agency to receive federal transit funding the US department of labor must certify that arrangements are in place for the continuation of collective bargaining rights for employees affected by the assistance if Arkansas state law stripped transit employees of the bargaining rights the US department of labor would be unable to make such a cert cert jeopardizing Arkansas transit authority's ability to receive federal transit funding further the agency is now receiving federal funding based on rock region metro having lawful authority to comply with all statutory requirements including US four nine. U. S. Code five three three be stripping the employees of their rights to engage in collective bargaining will further subject the authority to litigation over previously certified funding that is our concern you also I just got off the phone with our legal counsel higher ed those colleges state institutions it reaches to those as well and so they to buy indicating any collective bargaining and not having that right would lose federal funding as well so I ask that you oppose this bill I think it needs to be looked at a little bit more so it doesn't reach into some finding issues that we as a state can't afford thank you all right and the. Miss Nell Nelson. Thank you madam chair. the EA as a professional organization working for quality and equitable public education for all students in Arkansas excellent schools and quality working conditions for educators I would like it noted that I made multiple attempts to contact Senator Ballinger and got no response I respect he is a busy person but when you bring forth legislation it is my experience that speak with the author is an important step toward understanding I also note that he has spoken to other organization but seems to not value me as a professional to warrant a response I do not find that to be the spirit of legislative work Arkansas already has limited access to bargaining this bill directly targets our educators who have shown up every single day at schools and in every way possible teaching students transporting them and serving the meals since the beginning of the pandemic knowing they are putting themselves and their families at risk they should be respected not attacked. It members are teaching and supporting students because they care about their students Arkansas's educators have been providing high quality education to students and deserve to be treated as professionals they deserve the same rights as other esteem to public employees and the same opportunity to have their voices heard these are the men and women who know the names and faces of each child that hops on a school bus walks into a school building and signs and online don't they deserve to have the ability to work with their employer I cannot understand why the public educator work force should be singled out and stripped of access to working with their employer to support the needs of students and to advocate for quality school environments Page three line eleven states public schools and public school employees shall be terminated this removes the employer's ability to make decisions about their work force and preempt their knowledge of context to exercise their discretion in employment decisions Arkansas's educators know first hand the struggles that their students are experiencing not only during the pandemic pandemic but at any time this bill would strip their right to advocate for students to help improve student learning conditions and student success. Students and student centered issues are at the heart of our advocacy efforts at the end of the day our calling is to support students and utilize our professional expertise to help them learn and grow as long time professionals devoted to public service why are we singled out. This bill has no redeeming quality and distracts legislators from working towards improving the lives of our Kansans are kind Arkansas's families it is unfortunate Mister Ballinger is focusing his work on silencing and harming our Kansans as opposed to working toward a successful state. Arkansas is public sector workforce has and continues to work in the best interest of our state the the work they have done and the things that they have achieved are the foundations on which you as public sector workers yourselves the benefit from retirement with dignity health insurance provided by the people of Arkansas are just some of those things. Let me close with this the truth is educators have a great responsibility to Arkansas students they are the ones that serve our most vulnerable the children every single day I urge you to stand with Arkansas as educators and protect their rights to have a say in our state's future thank you with two of the three of you be willing to answer questions all right Senator Hammer. Thank you mentored thank you all for being here to the table first of all wait you the fire department exempted other bill correct. I think that's what you said is that right yes Sir okay Senator Ballinger Mendis out okay and then to the question Jessica about the about the funding how many other states do not have the collective bargaining agreement and how may federal dollars had been lost in other states where there is not. Not. I do not have that number on the top of my head and I do have some comparison with Wisconsin hold forward you this letter that came from the I'm not been made a transit unions international president in DC Wisconsin had to carve out something for their transit workers when they made a bill like this in two thousand eleven in order not to lose funding so I will have to get back with you on these exact numbers but I do have some comparison and this letter I'll be happy to share with you. Okay a couple more manager yes thank you. And then. Refresh my memory to the H. drive in little rock during the code and the teachers. They took a job action did not strike what what's the difference between a job action in a strike a strike is not working job action was that they did work they just did it remotely. Okay As a ever introduced legislation without consulting with the legislature other than the primary sponsors of the legislation when you all of introduced legislation. I Senator Hammer and understand the question have we ever introduced legislation without consulting the primary sponsor well you have you have to have primary sponsor in order to use legislation. Have you ever introduced legislation. Other than just the Senate and the house sponsor being on the bill yes. Okay. Because the comment directed toward Senator Ballinger was that he didn't consult with you but yet you all have a history of introducing things without consulting with us and I'm just trying to understand the difference. Well I don't agree with your point of view we do talk with legislators on legislation that we do introduce and I have contacted Mister Ballinger and actually contacted him in the twenty nineteen session on other legislation that he's introduced before so that's kinda surprised that of his lack of engagement okay thank you Mr. Are there any other questions all right senator Sullivan you're recognized. Thank you just kind of follow up on what senator Hammer was talking about when you said that you have a forget what you call the the work remotely with a working remotely anyway. No no they were in classrooms okay and then your statement that you've talked other legislate towards I've never spoken to anybody from the your association by any legislation that's come forward US senators Sullivan we spoke when you were a House member. On Education Committee yeah in the in. In opposition to a I wouldn't say you come to me as you describe about Senator Ballenger you'd describe him is is not contacting you prior. I called him and called him several times and I was surprised that I've never been able to get him. So. What we could go back and forth I don't see a useful purpose in that thank you Ballinger thank you any other questions from the committee. All right sing none thank you so very much thank you madam chair. Senator Ballinger more to come to the end of the table please tell your. All right you ready clothes for your bill. Share and if I do I do apologize the representative with the Arkansas education association to call you back this morning on my way in in order to visit with you and if you check your voice mail I think you'll you'll realize that I did leave a voicemail so I assume it made it through and it obviously. Hey that's actually pretty good if if you are like me you get a whole bunch of calls and sometimes it because voice mail it's it's hard to get back but I do try to do that as much as possible. The the the transit union actual transit union is under the AFL CIO have a great conversation with a guy runs that and their counsel today with the amendment that we did last week that you guys don't see that amended out welcome its policies and and the counties that they feel like that probably satisfies them the one thing that is a potential is what I brought up earlier the situation with with higher at and I had a great conversation with the Mr McMaster deli earlier today he's going to check and verify that if it does then I'll be happy to amend that because no reason to to jeopardize federal funding firefighters are amended out and exempted as the the most of the transit unions the Rockridge rock whatever it is they are amended out I think that the I get people's concern however the question is is it good public policy in order to that that a a public sector so this is government does the employee here that we have actually have the. Agreements with the unions to do all the negotiation or should we do it on an individual basis and what I'd argue is better policy to do it on individual basis so I appreciate a good vote and happy to answer any further questions. All right thank you very much all right Committee we have heard the bill as amended and the we have heard those who are for it in the we've heard those who are against it be taken questions so now what is the will of the committee. The past we have a do pass we have a second all those in favor say aye all those opposed thank you have passed your bill thank you very much committee. Alright ladies and gentleman I see one member here from the house and of representative for a. Mayberry if you would like to go to the end of the table and of. The Senator Davis is going with her and we will hear your bill. All right this is house bill ten sixty one. Thank you madam chair. And we have been working on this bill for and a couple months now and represented Mayberry has and put in hours countless hours and and so I just appreciate the work that she's done and several other groups that are here today to speak and speak for the bill or at least and let you know that they're good with that. And we all know that we've seen everything changed in the past year and and I think one of the harshest parts of what we've witnessed and is what it's like like for people in hospitals and nursing homes and facilities and people of an eight been unable to see their loved ones and people of god alone they've laid in a hospital bed alone and and it's really one of the great tragedies and of Kevin nineteen outside of people contracting covid so for those of us who have had to live through that experience that and we've seen the devastating effects of isolation and we've seen in our education and everywhere and that specific to healthcare and this bill seeks to ensure that no patient is left alone so if we have something like this again in the future a different virus that we don't know anything about today or if we have to go back to some restrictions with COVID nineteen this is to ensure that everyone in a hospital or and some type of nursing home setting will have access to a loved one being with them to ensure that they get the care that they deserve that they should receive and we work with DHS and department of health to ensure that this fits within federal guidelines the last thing that we wanted to do was create false expectations for people to see that we passed a bill that says they can have loved ones in a nursing home with them or in the hospital and only to find out later that due to federal guidelines that wasn't the case so we've worked very diligently I'd say to find that balance and ensure that we're not giving false hope that doing something to ensure that our Kansans could have someone with them I would also work for the hospital says the ation the healthcare association and others and and at this time there is no known opposition. All right to a representative may be reading some commented like to make. I just thank you all for the opportunity to bring this bill for you and we ask for a good vote I've loved working with senator Davis on this and so many incredible people who really wanted to make this bill work I mean I can't say enough nice things about the people who came together to find a common ground alright yes the senator. Thank you manager did you all ever substantiate through all the discussions that the federal government actually would prohibit funding coming down to the hospital or the nursing homes. I would prefer that maybe someone from DHS or the health department can answer that question. No and doing nothing but said good question would someone like to come forward from the from DHS to the health department and answer that question. And tell us who you are please for the record. Good afternoon. Martina Smith DHS director for the Division of provider services and quality assurance and that is the division that Office of long term care is the. Yes please first of all of your mask and the message on the magical thank you so does the federal government actually prohibit funding from coming down of I mean that was one of the big arguments are heard through all this and I'm just a little taken aback that the federal government would be that egregious and I'm just. Specifically tell me how they can do that so initially that no not in that sense but initially the concern was that the surveyors that are in the office a long term care when they conduct surveys they must follow federal guidance and CMS guidance and federal law and so additionally the concern was that as the bill was written if there was some provision in there that said we have to follow state law over federal law we could potentially lose our funding if we went with state law is that federal law. So regards whatever state law we would have passed that said. For example we're not going to follow the mass mandate. That would jeopardize the funding and how how realistic is that the federal government would take money away on an illustration like that. President to hypothetical. Very hypothetical for me to determine. how they were taken away or how often they might take it away I'm I'm just not sure that have I heard of that since the Kobe nineteen pandemic no I have not okay all right thank you thanks any other questions. Thank you so much thank you. All right of does anyone else have a question for The representative in the Senate to. All right seeing none we do have some people to speak for the bill but let me just say this. you have for so I would ask that they be very concise because we have put out of the scope of practice. The bill which will take a lot of time and so that they would be very concise I would appreciate it so for those for those had to the time. And I'm gonna call these these names out to Janet Caldwell. Of the buildings. Would you come forward if you would like to speak I'm sorry that not right. Okay we'll let no one to buy those names. Well of. Thank you might go get them and tell all four of them and then of Amy Sorensen and Nicole looks like we've slipped ski. All right. All right if you to if you would come to the table now and then the other two can come in just a minute. In introduce yourself for the record please. Good afternoon it's an honor to be here represent. All of my fellow Arkansas family members who have loved ones in hospitals and nursing homes excuse me if I need to introduce yourself I'm so sorry Janet Caldwell from Cabot Arkansas all right in the lady sitting next to you put it would you like to introduce any Billings from Batesville Arkansas all right and before we get started I didn't realize you weren't in the committee for the if you would be concise because we have a bill coming up at school. Okay all right thank you please go ahead it is. Almost three hundred sixty days. Maybe three hundred fifty eight now March twelfth that I have been able to hug my mother had been able to look her directly in our eyes and tell her how much I love her and how much she means to me. It's been a very rough year we've been advocating for her and her rights to Gideon we were told initially that it would only be a couple weeks and it was to keep them safe when the code outbreak occurred. And that we would bring them in covid. And impact them and it's been over a year now that we have not set foot in our facilities and the they continue to be impacted covid but there's more actually probably more coverage don Code related deaths persons covid isolation is killing our loved ones as we speak. There's patients with dementia and Alzheimer's that are not able to concept why their family members have quit coming. they feel like they've been abandoned they've given up hope they can understand and the Dave basically passed away with broken hearts and not understanding my mother's a portion at one she is not contracted covid she was only there to get respite care about three months prior moved here from another state I had to get everything set up but within three months that she was there she contracted a contagious nursing home communicable disease that prevented her from ever coming home once she has it she will never get rid of it so she was in isolation three months prior to cope it and then called it came the day after Kobe came she fell and crushed her femur she was ambulatory walking with a Walker when she went into this facility and now she's wheelchair bound. last week I was called with great news that the nursing homes was opening up to outside visitors that we could actually come inside I've been visiting my mother the returnees going though. Other outside and update created like a color that paints a duck pond and should they take a route into what we can do is one time a week for thirty minutes to a place the class and she's hard of hearing so it's kind of been difficult however last week I was given the great news from our nursing home that they were Office said just miraculously they were leading us again and that we could visit it wouldn't be in the rooms it would be in a common area social distancing and all and also what was really interesting I could take her out of the facility taker to lunch take her to dinner take home as long as I had it back within twenty four hours so the next day I was all excited to call to make my appointment to see my mother on the inside and for staff members tested positive for covid. So it prevented us from going into the facility however I can still bring my mother out. My mother has been institutionalized now for one year it's so much easier said than done to bring her out she has to be reconditioned she does not know what the outside is that anymore she's upright and up so it's kind of easier said than done so this the limit is model name and I'm not gonna take up very much time but my concern is. That every time there's a test a positive call the case in the facility we go back to school back to ground zero no visitation you know everything he's taken away from us the care giver compassionate caregiver in the H. P. ten sixty one bill speaks about the conditions how we can visit but it get into visit and I believe a very correct saying that it doesn't matter how many. The cases are in that facility that were allowed to come in and burn proper PPE we are the safer than anybody could possibly be with their family members and we're not the we're not the bill it used to be well recognized as being in the paper titled commitments you know parents everyday and we looked at like villains that site we build where carrying something contagious and the communication between my nursing home it's terrible there's no emails there's no nothing and it's systems not functioning properly at the rate that the DSL my concern is these nursing help everybody has to get on the same page with the S. and come up with the solution because it it's it's time it's time thank you very much thank you miss buildings. Going to start with the scripture. Forty. Referring to god. Has not despised. Very short. Where to stand to be afflicted one that has listened to his cry. So we are here today. Hope. You will listen to our price. You start representatives and the closest to us here in our state have started up. Troubled the constitution which protects the rights of all the people. We who have been afflicted by this isolation from our loved ones are here on their behalf. My husband pastor and missionary Kenneth Charles feelings. What picture this was taken like one year before the lockdown you can see he's not a very old man but he is in a nursing home. He was diagnosed with early onset dementia at the age of fifty eight he retired from the ministry and lived with me for the next six years as he gradually declined. At the age of sixty four when I could no longer care for him and keep them safe I had to place him in a nursing home an hour from our house because it had the best accommodation for his needs. This was the saddest day of my life. When I have determined leave with can wondering when what for him. So the next four years I drove several times a week to visit him. We love to sing go on walks interested in holding hands. Because really he doesn't know much more than that. Then the fiber sit. None of us could have imagined that we would be isolated from our loved ones for now an entire year. All for their safety we were informed. Now these months have been like a continual dying for all of us as we have been forced to witness the decline and for some the deaths of their loved ones. Yes some from covid but more from this cruel isolation. I would only say this I'm part of the care giver group all across the nation we have many many members and every day every day I see a new post. My loved one has passed on after months. Ring and some of the ways these people have decline is so heartbreaking I can't even get begin to explain it to you here but we see it day after day. One of the most heartbreaking things that I'm seeing as times goes on now a year is. Someone will say. They're gone and I don't think I am ever going to get office here's what I want you to understand we all have loved ones that passed away we're all gonna die. Wants to all of our lives I've lost both of my parents. But in the way older people die this this is happening to us who has ever been called upon. What your loved ones to tear it before your eyes without being go in touch and touch their G.. It was called upon to do this this is not true it is not normal. And this is. More damage than just the people who have died from covid and I realized that it's happened but this is something that's in human it is not right to protect people to their very deaths. Right thank you any questions all right to Senator Solomon. Thank you. Grieve over what she described. No you mention representative government and this with the same the fifth if you've had an opportunity now to meet with your representatives to consult with them consult with the industry's and come up with a solution of sorts that would help mitigate at least some of the problems that you're going through so you know just in the form of a question did this is not only help relieve and address your issue but help address the bigger the bigger issue of representative government how important it is to have the consent of the governed which issue and participate in a in a way that allows you to have a voice along with the institutions and the state government is that would you say that's correct believe it does correct thank you thank you twice can I add something to your question Sir. We have been in contact constantly with all bondsman we have been rallying and advocating for a loved ones we get no where we contact our nursing homes to to talk about the discussed this matter we present them with all kind of information we're not even allowed to be given the corporate act upon numbers to even talk to corporate. and so therefore if it wasn't for miss Mayberry bringing up this bill we would still just be now where we would be sitting ducks and it's just a blessing in disguise and we support this bill and but if it wasn't for the government get getting the government involved because we keep hearing it's state it's federal it's federal and state and so um. It's a miracle that were here and I'm honored to to Julie Mayberry is done this thank you thank you I can't imagine what you've gone through that I appreciate you coming and telling us about it and uh we can call the other two people love. The Amy Sorensen it she may be in the room okay and then also Nicole ski. And then of. City representative Bentley after this we're going to bring representative Bentley after this you're going to be recognized. If you go to the end of the table please introduce yourselves. Good afternoon thank you for allowing us to come you can see it's a highly emotional. Issue but just to speak a little more clarity on what this call will sell said earlier an example would be my mother is in a rehab facility so when I call them I'm told it's through their corporate it's through state its through federal guidelines they have to find out again you hear federal state corporate you don't ever get a clear answer and they don't allow you any hope for what they might have in place at one point we asked about a partition can we just at least come inside and have a petition there that I could talk to her because my mother is Senate side and introduce myself I'm Amy Sorensen from Little Rock for Bryant and my mother's in a facility here in Little Rock and yes dimensions so when I go and visit with her if I if there was at least a petition then we wouldn't struggle with the phone in her having to manage that and talk to me on the phone through the glass door or window I could at least talk to her or I could play music what we're sitting there something or I could read to her our visiting again Visitation is through phone and through glass door or window Which again state federal corporate we hear this left and right from the nurse from the facility my facility is or her facilities or rehab facility I'm told that the active cover cases are coming from patients they had their required to admit from hospital so it's a because one night asked about the staff being the ones with active code cases that's what I was told so my mother and the all the other residents are kept in a separate hallway but they're subjected to the isolation because it the copay cases that this specifically is required to accept At the C.. She M. again with that the dimension it's very difficult to have any kind of a remote platform such as soon or anything for family and friends to talk to her to see her and her decline in this last year has been very rapid. So we're here in support of this bill. This bill would allow me to be able this one person who is a very willing for participants to do whatever this facility required me to do to come in and care for her basic needs and to have some human interaction you know family member interaction Regard or not regardless but if there is another surge if there's some other reason they've locked down again it would allow me to still come and care for her just basic needs after what I saw this weekend being an Arkansas resident and out in a ballot that restaurants and and stores the masks that were not warned the restaurants full capacity stagnant air. It's hard for me to believe that there's not gonna be another search. Thank you all right to. Miss whiskey it's a wiki my name is wait yes. Madam chair thank you. My husband Douglas wiki is a Vietnam veteran who is at the north little rock the entrance to. Friday March thirteenth twenty twenty. What the day. We were seated new cancer diagnosis what should have been a short term visit after stay there after having major back surgery after beating cancer the first time we were played with this news. The day the state went to lock down. Basically after that with any given twenty four hours with them. I was kicked out of the home. So for over a year. I have been struggling with the threats by the North Little Rock veterans day homes that if. I took come out at all that there would be no chance they come back. But what kills me the most is that as care givers to our loved ones. We're the first ones they're gonna do everything we can to protect their families knowing that we are the first line of care we are going to practice safety first. And throughout this whole. COVID pandemic. I volunteered every week. Just in case openings would come up. To get tested at the Little Rock VA for coke I got squall once a week so yes I contributed to the number here's. But I was given back to reassure the staff at the North Little Rock veterans home that I was doing everything I can to be safe. I have. I haven't been able to see To restore and mentally. That he was going to be okay we are vital for the mental health we are vital for the emotional support especially when you're dealing with cancer especially when you're dealing with someone who fought for their country. Thank you. We're doing everything we can and they give us the good news is that we are going to be able to have visitations but then we get a phone call twenty four hours later say no. A staff member has tested positive. Everything down but it doesn't just hurt me my husband hurts every single that turned in that home. It hurts the other family members there. A lot of them don't understand. When we're doing everything we can. But yes I've personally seen. Workers going against the mandate. Bring it in. M.. Thankfully I haven't tested positive I have it been isolated myself I quarantine myself because of my loved one because of that whole. may twenty twenty was a really bad turning point because he was not getting the support that he needed to deal with the news up cancer occurring again. And that isolation kill me. Luckily in August. I it reach out to governor Aissa Hutchinson. And it turned out he did discover that they were going to extremes on it. So what would work for a good month with at fifteen minute visits through plexiglas change immediately when the Arkansas department of health. the department for Medicare and Medicaid services put out new restrictions. So we were kicked out again basically. I didn't get to see him around Christmas I still have yet to see him. Right. And this will give us the chance to be able to be their voice does not just a nursing home with biggest hospitals to when you have sudden emergencies and. Like a stroke patient. I can't speak for themselves when they're kicking out power of attorney so I've seen that happen. Where do we draw the line he's going to advocate. For you for instance if something were to happen you you'd want someone to advocate for you. That's what they need that's what we all need. All right thank you questions from the committee. All right seeing none thank you so very much we appreciate you coming thank you. All right the. Senator Davis in the. Presented to Mayberry. Members you heard an just four stories today but there are tens of thousands of stories just like this across state and many of us in this room probably have a personal story that we could share if we are going around the room sharing and I know I certainly have one and and I think many other state and outside of COVID nineteen testing positive for it this is. The cruelest thing that's been happening. And people being alone being isolated. We are human we need each other we need love one fire side when we are alone in a hospital or a nursing home facility and and again I just appreciate everybody working together on this state agencies and representative Mayberry to make this bill possible and it be something that we can probably support thank you right the representative make their. Okay all right the ladies and gentleman you've heard the discussion of the bill to people that have come before us to support the bill of and we're ready for your decision happen okay motion to pass I have a second all those in favor say aye. All those opposed congratulations you have passed your bill and we thank you for bringing. So ladies and gentleman we are now going to representative Bentley's bill house bill twelve fifteen. Thank you chairman and colleague seems okay I like Dr Todd district to come up with me to help present the bill. It's also a couple handles I think that we've got as a male party received from fill on this bill H. B. twelve fifteen. Excuse me let's have your of. It is doctor Todd thank you Todd. Dr Stephen Todd bachelor okay and I practice and Fort Smith and Fayetteville in your specialty is United and all right thank you your. Of. Ready to go. Thank you chairman thank you colleagues so as as many of you know Arkansas unfortunately is a state that has a very high rate of infant mortality impact the third highest in the nation and continue to rise each year as well as that we have the third highest rate of maternal mortality. In the state in the nation here in Arkansas so the last session we passed some great person great legislation establishing the infant mortality Review Committee and the quality review committee to find out what the world was going in Arkansas what can we change to make things better in our state and some of the results that came back. From that review or that we have a very high rate of preterm births low birth low birth weight as well as Severe blood loss in those different things in our state so I looked at what was going on in other states with the states that have the lowest maternal mortality rate was going on those states in the state of Massachusetts has the lowest infant more to mortality rate so we look at the state agency they have exactly the bill that will bring forth you today that allows certified nurse midwives full scope of practice in fact the states with the best rates have certified nurse midwives the full scope of practice this week with which you today to allow certified nurse midwives to practice it in the hospital former center without the restricted. A collaborative agreement or the intrapartum agreement Arkansas actually has the most restrictive of licensing in the state in the nation actually because we live with that we require in order for them to be licensed to have You today from hi March of dimes and explain that as well as what we have going on this state so we in the state we will see a difference we're gonna make a change we can't continue with the status quo expect things to change it's really time to make a difference that will quickly give a personal story then. Tosh share some things but as a as a nursing student here at Harding I want to that I realized going to my state it was time for me to deliver that really want to have a certified nurse midwives by a totally different from medicine allows a woman to deliver in a natural way the the way the guy believe I believe that god designed it so certified nurse midwife delivers totally different than you would from a position so it's a totally different so we have been going to labor and getting your in a your contractual slow down a certified nurse midwife would put you in a different position do things to make your body to make that go faster physicians much more likely to start jumping to ocean and starts on that route then fourthly may lead to a C. section as you can see the states that have a lot of certified nurse midwives to practice the Syrian rates go down and much more permit for women to do a vaginal delivery on their own so this is a whole lot of differences between the two and I think that doing this will allow women in this state to have the option to choose which one they want to do this right now what with the restrictive policies that we have in place to essentially shut the door to certified nurse midwives in Arkansas we have the least amount of certified nurse midwives practicing in the nation in Arkansas so this is a bill to allow for access to care a lot of women the state to have an option I believe as we can look at the statistics in other states definitely increase infant and women health in Arkansas so doctor taught what you share from your perspective on that as well again my name's Todd Baxter again I'm an OBGYN I've got twenty plus years experience I've lived in Northwest Arkansas for four years in the role as a labour rest a site director for the willow creek women's hospital and a medical director of operations for a private corporation I've worked at St Bernard's in Jonesborough. Mercy Fort Smith and willow creek. In my role as a medical director. I oversee OB hospitalist programs from el Paso to Milwaukee and about half of our programs we interact with midwives on a daily basis I also part of implementing many many safety initiatives including hypertension bundles C. section reduction tool kits and many other things. As with most positions I had initial reservations about working with midwives however as a doctor I did examine the data and according to a cog my governing body OBGYN and certified nurse midwives are experts in their respective fields of practice they are educated trained and licensed independently independent clinicians who collaborate depending on the needs of the patients in Europe eighty percent of babies are born by a midwife. With better morbidity and mortality than what the US has Europe has eight to ten times more midwives per ten thousand in the United States with the exact same number of matter of MPs B. U. I. as. A midwife practicing within her scope of care is a safe alternative throughout the world in twenty eight states midwives an OBGYN provide and promote the highest standards for education professionals certification and state licensure ensuring the highest standard of care for all patients. Since I've been in in my in the of all over skews me. I have focused on issues of maternal morbidity patient safety and access the care as everyone knows an African American woman is forty six more likely to die in childbirth than their white counterparts this is corrected for education Social class and. Many many other factors and it just goes down that. The Surgeon General wants the overall number to be cut by four times in this is going to take a systematic approach and some really tumbled government leadership things like maternal level of care such as what they're doing in Texas. I advocate having late obis on the deck of the R. major birthing hospitals and of course increase access to care I look around the state. Magnolia this one OBGYN Monticello's everyone we'd United and I think I learned. In the last meeting at that thirty seven states in Arkansas do not have an OBGYN. And women are traveling a long way to get access to care. So I do support this bill for the end of independent ability of midwives to practice if we open up midwifery as twenty eight of our sister states have Arkansas certified nurse midwives will stay in their states provide access to quality care for more of our population and especially our most at risk folks that's why I supported as a physician. All right of I'd like to start with the question. So many times we. Of. Try to get a nurse practitioners and and now of midwives to go to the rule areas and then like in Kentucky for instance of activity a did away with the a collaborative agreement thinking that that is what would happen it didn't and so what can you give me some confidence in the fact that if we pass this bill that in the certified nurse midwives will go out into the areas that you're talking about that do not have a physician's available to help with this particular problem. Senator Bledsoe like to talk about the in my district is more if we look here on this map yes we'll see that we have so many maternity deserts here one of those is my district a all of the county semi district attorney does is that women have to travel an hour and you get to their visit so I cannot guarantee you that but I can tell you that we as well as that it place called to get to be a new patient to a which is a year wait because they're so backed up so we can allow these certified nurse midwives to deliver babies in to be there will have more openings for women because right now many women have twenty year even to be seen so I guarantee where they're gonna move now but we know that we have increased the numbers that we have here they can be seen or is now they cannot organize options for those women I can't guarantee we will have some will have some sort of a nurse midwives eight that will not testify shortly can ask those questions because right now they're leaving the state to practice so we can keep them here to practice will have more access to care throughout the state which we do not have those maternity districts well you can understand my disappointment when we do things that we think are going to help and it just doesn't materialize and I can think we can look at the numbers and see every state that has done this has much better infant mortality rates much decrease and women that are doing low birth weights preterm and all that every state that has done assessing great increase in their numbers and I think that we have a long way to go only head of Louisiana Mississippi and up again I like to sleep Mississippian was in the distance and do much better in every state that has done this that's a great increase and improvement in their numbers and if we look at other other nations as doctor taught is talked about Dr Stephen in Europe in England where their numbers are much better than ours and have. Eighty five percent deliveries are done by certified nurse midwives over there what one thing I was conceived this is like the the rules grants that the surgeon skit you got the real community you get a certain grant to help you get established and I had thought that might be a good idea to encourage some of these things the nurse practitioners and also these nurse midwives together because it is expensive picking up and leaving so I think we need to look at something like that I would love to work with you on that senator Bledsoe all right to senator Hammer you're recognized by committee chair one issue questions about the bill that I'm carrying on the Senate in the so on page three you've amended bill. About. A delivery outside of an accredited facility certified midwife shall have shall identify license position facility or both what happens if they can't identify a licensed physician or they can't find one who wants to cooperate to provide that relationship how does that affect their ability to do the rest of what's in the bill that only affects if they're gonna deliver at home this has nothing to do with first being done in a hospice only non certified facilities that strictly is what my House members asked me to preserve the delivered home they're going to have something in place to allow them to to visit with a physician so if this if they can't find the ability homers but hopefully that they'll be able to get good relationships with the physician work and in the hospital and be able to work work that out that's what that's about so strictly for that that The Amendment is strictly to cover home versus non accredited facilities okay file a manager yes to the physician like to issues questions or you're practicing physician now that actually delivers yes Sir so in this kind of financially cut into you a little bit by doing this if we set up the practice for the certified midwives to be able to go out and compete on the delivery side of things. Well first of all I don't do I'm not in private practice I I am contracted by a hospital to provide OB emergency department services and handle any emergencies on. In my role what I actively do is I reach out to frankly anybody that's delivering babies and say look if you're in trouble and you need a home. Call me early because I I've I've been on the other side where I didn't get the call and the patient was just left at the doorstep consensually of the hospital so it's very important to me to have that relationship to answer your questions about competition. I mean I I think the short answer to that is yes this is competition. However in very few use areas of Arkansas is that a major issue. Okay how many certified midwives G. anticipate. Taking. Part in this I mean once if this goes through when it goes through how many how many do you anticipate are actually going to apply for this currently we only have ten in the state so hope we have more that have graduated are not working in the field because they couldn't weren't able to get up and it Department remiss I think we'll have thirty right away and even more as as people see this available you'll hear from certified nurse midwives now that are working out of the state because we can't practice here because we're so restrictive and a policy okay I think that and I will I on the competition thing it was like looking. I read a plastics businesses really as it is allowing me so we wanna correlated to a business transaction right would allow me as a plastics manufactures to say that the person down the street in order for you to make this Cup she would have to get your license through me if you guys Sullivan that stored in the certain amount of money so we really have to shut the door because of finances with the restrictions that we have in place and will allow you know and if we look at Arkansas we do we pay for through Medicaid and Medicaid expansion seventy three percent of the person our state. So if we can get a more ugly a certified nurse midwife this last week but say as a state be able to save money as well a lot there's a lot fewer cesarean sections and those things taken place only as a certified nurse midwives so to me I see this one went for state all across the board so right now there's only ten that you know of that would I mean is that what this amazing that no more solicit and speak give some exact numbers but looking at the numbers I have yes okay thank you can you have any other questions. Seeing none. A does anyone we do have someone we think we have for that would like to speak for the bill is anyone in the audience want to speak against the bill all right seeing none. A. Are all the people here in the in the committee room. Okay let's take to miss your nail and to miss Neil. Okay if you would. Introduce yourself for the record where you're from please. My name is Laura o'neill and I am a certified nurse midwife. Thank. Joni arnelle certifying Smith all right Mr now would you like to go first. Any feel would make your. Comments Perry says Singh we still have some people waiting to bring the bill to the Committee all right thank you. Good afternoon and thank you for this opportunity to speak in favor of passing this bill today I am a resident Arkansas since childhood I've been a nurse midwife for over thirty years hi I started practice in nineteen eighty two. I in nineteen eighty two is in a region nurse practitioner and then eighty nine went back to get my training as a nurse midwife approaches into rural hospitals both were out of state one in Tennessee and one in Oklahoma in the one in Oklahoma was in a very remote area of practice with five nurse midwives at three locations in that area. But most of my practice has been in Arkansas. Do you know that Arkansas has the reputation for the fewest number of nurse midwife person the country and if you is number of nurse midwives. The total number of births by nurse midwives in our country and twenty seventeen was over three hundred and fifty thousand ninety four percent of those run hospitals three percent were adverse centers and the ramp remaining amount at home. Twenty nineteen there are over twelve thousand nurse midwives in the same year we had seven practicing in Arkansas that attended purse. Excuse me with the service certified nurse certified nurse midwives I'm sorry if I just mentioned every time. In my experience there primary to primary reasons that we attract few midwives Arkansas. One of those is the lack of physician exposure to nurse midwives. Physicians and hospitals are actually the major employers for nurse midwives in the country and unless they've actually practice with them then it's hard for them to understand what that type of collaborative practice is light and much less harder to understand the benefits of that type of practice. In my experience there are two primary reasons I'm sorry I skipped this section that's your excuse me for that. The other issue is the barriers that exist in Arkansas the intrapartum agreement that you've heard said about. And as representative that we mentioned we are the only state in the country that has that requirement the second is the collaborative practice agreement which you may know is what allows nurse midwives and all a parent's to prescribe in our state. It was mentioned before that there are twenty eight other states that have nurse midwives practicing in full practice full scope practice but there actually there's midwives in all fifty states and we all have to meet the same education training of practice experience and has the same national board exams so just wanted to make sure he understood that distinction. Also we have to demonstrate the same levels of competency which includes prescribing of before we can graduate. There are two remaining things I want to emphasize to before sunrise and one of those is well and both of them are what I refer to as checks and balances these are things that currently are in place with their current nurse practice act but they will remain in place even with the changes that we're talking about today. One of those is The fact that the nurse practice act requires is to practice within our scope of our specialty area. That will remain in place even with the passage of this bill for nurse midwives that specifically includes the standards of practice that are set for us for our specialty nationally as we remain as we maintain our board certification. Pacifico you what's important about this and those guys in those standards is one of them requires is to maintain written practice guidelines these guidelines are significant because they outline with a nurse midwife can perform independently what situations require physician consultation and what situations require a referral to a physician those will not be changed by the passage of this bill the second issue is the rules and regulations are in place for Arkansas hospitals these rules require a process for members of the healthcare team to be credentialed and that process is necessary to know if a candidate for membership has meets the requirements to be able to practice their and support for you know that nurse midwives go through the same process as positions. You will assure and does it sure that the nurse midwives has a physician available in the hospital who has been trained in obstetrics it also ensures that nurse midwives are not performing procedures they're not trained to do we've all be credentialed to do C. sections D. and C. successor. Further these these provisions require about normally I would say six months of the temporary privilege agreement so after six months the candidate in this case the nurse midwives is re evaluated before given full of privileges at the hospital. And most hospitals require a new member of the medical staff to be observed as they perform procedures for nurse midwives that usually means we have another member the OB team president for first ten or whatever the hospital's it's deliveries for any procedures that we do none of these things will be changed by passing this bill today. So I would like to summarize with just a few final points one is the reminder that Arkansas is the only state that requires a physician sign an agreement intrapartum agreement so that we can attain a license. Nurse midwives should be granted full practice authority in accordance with the a training education experience and standards of practice that we have in place. This is proven successful and beneficial twenty eight other states were nurse my midwives have full practice authority. It's important understand that patients benefit from it obstetric team that includes physicians and nurse midwives and there's a plethora of research that demonstrates this and finally passage of this bill will not eliminate the requirement for nurse midwives to consult with physicians and other members of the healthcare team. Please understand that's inherent in our training or education in our experience and is necessary for the best outcomes for mothers and babies thank you thank you all right let's hear from of. Miss C.. A missile Neil that's what and then we'll let we'll ask questions yes ma'am thank you madam chair. Good afternoon my name is Paul o'neill and I am a certified nurse midwife first want to say thank you so much for your time and hearing her testimony today. I was born and raised and have my processing job here in Arkansas however the majority of my career has actually been in Alaska I did my midwifery chronicles on the military base and encourage both my job and my clinical site I saw that OBG weigh ins and midwives work together like two ACT house making a whole. To provide the best care they could for their patients the military base had a C. section rate of nine percent and the hires hospital I worked for had a C. section rate of twelve percent this is extremely low when you compare it to the national average of twenty six percent for primary low risk C. sections. Seeing the positive impact the midwifery in Alaska let me talk to Arkansas and hope to bring about positive change in the maternity system within our state I'm going to attempt to try to address many of the concerns about independence go. First I'm going to talk about on the third of scope creep we do not practice medicine physicians do not practice midwifery. A cog a CNN and the American academy of pediatrics jointly developed and endorsed along with other professional organizations a statement on team based care that specifically says that scene and are independent providers who are experts in their care and that team based care is best experienced it meets patients needs past professionals are practicing to the full scope and Sir certification. The Federal Trade Commission also states that rigid collaborative practice agreement requirements may be inconsistent with a truly collaborative and team based approach to healthcare such requirements can impede collaborative care rather than foster it. As a limit what healthcare professionals and providers can do to adapt to varied healthcare demands and constraints provider innovation and team based care. The goal of removing the collaborative agreement is to simply allow us to practice the fullest extent of our training not to expand our scope what is a common thread between all these organizations that team based care and collaborative agreements hindered the ability to truly have a team based approach to medicine. The document also states that law should be congruent like they talked about their twenty seven states and the district of Columbia which currently. Allow independent practice an example of one is Alaska full practice authority for CNN's Alaskans are any different than our Kansans an Alaskan midwives are not practicing educated or certified any differently than that midwives here in Arkansas we practice within a community to refiner council and collaborate collaborate based on the needs of our patients and based on their preferences. Removing the requirement for a collaborative agreement simply removes our barrier to practice which is currently experienced by the scene Ms in Arkansas and used by national organizations including the Federal Trade Commission and the US department of health and Human Services and the restraint of trade. Accent the permission slip to practice from physicians who don't practice midwifery and often the midwives as the competition. Removing the agreement allows us to practice to the full extent of our training and nothing more C. N. N.'s are educated and trained at the master's or doctoral level according to nationally adopted an internationally sanctioned core competencies for basic midwifery practice death sentence must meet these competencies before being able to even obtain a license. I also want you to understand the independent practice from advise does not mean by ourselves those in favor of are not in favor bill would have you believe the ACM position statement on independent midwifery practice states that CNN's use our knowledge skills and judgement to provide care in accordance to our standards and ethics of midwifery without supervision or restriction. A cog in their joint statement on collaboration with CNN's and in their tool kit for team based care which is jointly developed by a scene and the American college of nurse midwives and nineteen other professional organizations of physicians and nurse practitioners states that midwives are independent clinicians and experts in our field we should be licensed to practice to our full scope. The final statement from a cog I believe you as this team based model of care is one that strives to meet patient needs and preferences by actively engaging patients as for participants in their care well encouraging all health care providers to function to the full extent of their education certification and experience State Street rely on clinical guidance set by professional associations when licensing and regulating healthcare providers this will help bring uniformity to licensure rules and practice norms across all state but in a full practice authority framework which would be independent practice healthcare providers still collaborate with members of the healthcare team and seek consultation as determined by the patients need. Twenty seven states the district of Columbia and the United States States military trust and value the benefits that midwifery and advice bring to women children and families it's time for Arkansas to do the same and support autonomous practice for Arkansas midwives thank you so much for your time thank you questions from the committee all right to senator Hammer thank you and cheers I noticed in the bill on page two. At the very top. It makes a statement the certified nurse midwives or advanced practice registered nurses who are nationally certified are the national certification requirements greater than the requirements of the state of Arkansas are they held to the same standards. I would respond that seems not here today to. By saying that They're they're different from the aspects that they take but are the standards from our national organization or above and beyond what the nurse practice act requires they of the nurse practice act requires us to practice within her scope of practice as it is to find their but according to the standards of practice that are set by our national organization so would the nurse. With these nurses that are gonna be practicing give this full authority in Arkansas they're going to be held to the national standards is that correct yes as well as Arkansas law they don't conflict in any way but there we have additional requirements as a nurse midwives because our national organization requires as for example to have written practice guidelines that the state of Arkansas honors practice that does not require a stab in directly but says because you're nationally certified you have to do that as well right but you're gonna be held the higher of the two state. Thank you all right any other questions. All right seeing none thank you so much and we're going good at the next two or three I have a a notice that I had three names here I have error in the. Giltner. And Stephen. These are very small purchases Senate Paschale basket. Okay all right and then the other one is it is the next one come on the. Having trouble with your lessening sense to. Okay if you would be so kind as to introduce yourselves for the. Record please. And if you could be seeing because again it's getting late and we have some more people that need to run their bills yeah. Yes I'm TV sister so and I'm certified nurse midwife. Would you repeat it again please my name is Phoebe system so and I'm a certified nurse midwife in. And I'm airing Giltner I am with the March of dimes good all right you're welcome to be here in which you to start your presentation in sure thank you madam chair. at. So as I said my name is Phoebe assistance from a certified nurse midwife I've been a registered nurse for over twenty years and worked in the area of women's health for about ten years the last two years I've been a certified nurse midwife. But in two thousand nineteen I graduated from frontier nursing university with my master's degree in nursing with frantic my national exam but I was unable to find a job practicing full school nurse midwifery that's delivering babies not just providing prenatal and postpartum and women's health care I'm here in Arkansas. so currently I hold ASEAN and licensing both Arkansas and Oklahoma and but due to the practice restrictions here in Arkansas I can only practice in Oklahoma so every week I drive to Tulsa and stay for a few days that the person term where I have worked for about a year and a half providing prenatal postpartum and one woman and newborn Kerr. First of all I also get to provide safe holistic and evidence based intrapartum care to women and their families I actually frequently get calls from women in Arkansas who are seeking nurse midwifery care and cannot obtain it here that includes a lot of the members of our military there used to nurse midwifery care and they cannot get it here. In just the past six months are smaller center in Oklahoma has delivered babies for three women from Arkansas. So even though the nurse midwives other person or do not have a collaborative practice agreement to per to provide intrapartum care because that's the rules in Oklahoma. We are actually well integrated into the surrounding medical community we regularly refer patients to higher levels of care and consult with maternal fetal medicine obstetricians pediatricians and other specialties as needed we have a transfer agreement with the physician group in a hospital across the street from member center I just transferred someone there yesterday. We have a good working relationships with the hospital and together we have come up with transfer protocols and procedures we work together to provide evidence based care for all the families in our community. from my experiences working in the person or is a nurse midwife I do think that a certified nurse midwives can be the answer to a lot of these maternal health problems that Arkansas faces today for example and sometimes maternal and infant morbidity and mortality isn't just at the moment of birth it can it often is a post partum issue. and I think that nurse midwives can be part of that solution at the person or where I work the nurse midwives do a home visit which with each mother and beating together at twenty four to forty eight hours post partum then visit that the person at one week two weeks four weeks and six weeks as a direct result of this close follow up we have excellent breast feeding success rates and low post partum depression rates we are able to quickly identify issues in the newborn like jaundice and poor feeding and problems in the mother like any other pre preeclampsia hypertension and diabetes we are then able to treat a referred to others in the larger medical community is needed this kind of nurse midwifery care could greatly improve these maternal and newborn health care here in Arkansas. I was going to talk some about the military but I think you guys have heard about that already I'm actually military spouse myself so I understand those issues while. So you guys are all well acquainted with the discouraging statistics and systemic problems in the turtle infant health care here in Arkansas and I really do think we can do better we can do better for our families we can do better for our wives and daughters and sisters and babies so please advocate for nurse midwifery care here in Arkansas right thank you. Okay you're next all right again my name is Erin Giltner I'm with the March of dimes and I'm here to testify in support of this bill on the behalf of March of dimes in it which leads the fight for the health of all moms and babies in the nation access to high quality maternal care is an extremely important component of maternal health and positive birth outcomes unfortunately millions of women in the US and over one hundred thousand women of childbearing age in Arkansas have little to no access to maternity care almost half of Arkansas counties thirty seven of seventy five counties do not have access to it delivering hospital or a maternity care provider. In their county. Arkansas has persistently high and that maternal death rates overall and rates for women of color compared to their white counterparts are even greater these disparities that prompted interest in models of care to improve outcomes including midwifery and specific evidence based supportive and preventive care programs developed and led by midwives the Arkansas is not in a place to implement such models due to the low number of C. N. N.'s practicing in the state this shortage cannot be addressed because Arkansas's requirements for signed collaborative practice agreements and and are part of agreements that restrict CNN's from exercising their full scope of practice or from receiving hospital credentials clinic privileges or third party reimbursement for such services that fall within their scope of training and licensure. So March of dimes supports twelve fifteen because it would allow certified nurse midwives to practice to their full extent of education and training it would allow for low and moderate risk women to access midwifery care as part of an integrated system of care that further integrates midwives in their model of care and to maternity care studies have revealed the importance of integrated care in collaboration just as many of the speakers have already talked about and suggest when professionals collaborate on decision making and when coordination of care is seamless if you were enter part of. And fin and maternal deaths occurred during obstetric emergencies so we further endorsed this bill as we believe the bill can improve access to maternity care providers and under resource areas reduced interventions that contribute to maternal mortality and morbidity and and national and subsequent pregnancies lower cost and potentially improve the health of mothers and babies in the state so we thank you for the state's contribute continued efforts to improve the health of all moms and babies in Arkansas all right thank you any questions from the committee. All right seeing none thank you so very much. The representative Bentley be closed for your bill. I appreciate your time colleagues I know like you I'm really tired of our state being fourteenth in the nation it's time for us to make changes we can't continue to do the same thing I think we're going to get a different result we're gonna get better I'm so excited about the aspect of Arkansas improving our maternal infant mortality rates in our state and better for our moms I can take this will be a bill that you can probably go back home is that we made a difference here and we've improved maternal health in Arkansas if it helps so with that colleagues I would appreciate a good vote all right thank you of. We have a motion thank you in a second all those in favor say aye. All those opposed congratulations you have passed your bill thank you senator Wallace appreciate art going on to some of the House bills. The Senate today this believe you are running house bill eleven thirty seven. When you're settled we will. Be glad to hear the bill. Thank you madam chair. And so this bill. It really just says that and health care professional cannot performance health like exam on a patient and that is and conscience unconscious unless they have written consent there's a court order for DNA and or some type of evidence and the Public exam as part of the procedure or there's an emergency situation and then the same thing as outlined for students or and trainees in a clinical setting so and this has been happening in Arkansas and where somebody is undergoing some type that and surgery or treatment or something where they're put to sleep and and a pelvic exam is done on them unbeknownst to them and then they wake up and listen if discomfort and and didn't know what was done or why it was being done but it's typically I think for training purposes and and like a student at that school setting and twenty five other states that have passed similar legislation to keep this from happening and there is no opposition to this bill okay any questions from the committee. Seeing none this anyone want to speak for the bill against the bill. All right heavy clothes for your bill yes all right of what is the will of the committee are to have a motion and a second all those in favor say aye on the suppose congratulations you have passed the bill so let's see now the. H. B. eleven seventy six yes all right you are recognized thank you madam chair and this just allows for I am certain behavioral and mental health services that have been allowed via telemedicine through that public health emergency and to continue while ensuring that Medicaid continues to reimburse for those services so and this was negotiated with DHS's my understanding and there's no known opposition all right any questions from the committee right seeing none of these any one want to speak for the bill or against the bill. All right seeing no one come forward because for your bill yes all right do I have a motion all right have a motion. I have a second all those in favor say aye all those opposed congratulations to pass the bill thank you committees is there anyone in the committee room that is here for you representative Meeks is bill house bill eleven eighty eight. You want to do that. okay all right the will but it's the last one so. I think the. Do you know how long that's going to be. Okay all right all right we are going to just leave that on the calendar and we will let him run it another day and I do not see