Public Health, Welfare and Labor Committee - Senate and House
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Representative Jack Ladyman
Unverified
7:23
the purpose of this category is to provide temporary coverage for prenatal care to women who attest to being pregnant and
meeting other eligibility requirements while we are determining the full eligibility. So the goal of this is to get health care coverage and access to prenatal care approved faster. The eligibility criteria include declaring to be pregnant. If they already have health care coverage that would cover pregnancy then they wouldn't need this and then we accept self attestation on their income and state residency in order to determine eligibility for this new
category and we and there will be one presumptive eligibility pregnancy period allowed per pregnancy and it is temporary coverage it will be for two months unless we are still processing the full application and as long as we are still processing the full application then the coverage would continue until we complete that full application for the full coverage and the presumptive eligibility category the services include prenatal care
happy to take any questions representative lademan you're recognized because you're talking about they don't really know so how do you communicate it to these folks that may be able to
qualify for this so um we can definitely work with our comms team
to do some social media about the new eligibility category and new services available, but we will be automatically determining presumptive eligibility on any woman that we receive an application from where they have indicated that they're pregnant. So it's not a special thing they have to know to apply for. We're just automatically going to do it when
we get an application. So we'll also work through the county operations, will it? Yes. Yes. All right, thank you.
Senator Fredrick J. Love
Unverified
9:36
Senator Love, you're recognized. Thank you, Mr. Chair. Ms. Pittman, I want to talk about the anticipated federal cuts that we're anticipating for Medicaid. How does that impact this program, if at
Speaker 20
9:57
particular federal cuts around our home and the expansion population would have anything to do with the pregnant women's population. Okay, so you
Speaker 20
10:08
of those are targeted targeting this population
So there's no direct impact to this population. No, sir.
Chair
Unverified
10:14
Okay. All right. Thank you Representative Bentley you recognize. Thank
Representative Mary Bentley
Unverified
10:20
you chairman. Thank you all for being here today I'm excited about what we can do with some improved maternal health with this Just quick
question. So one of these patients go to the physician's office for that first visit Are they able to, is the physician's office able to get information that they can be seen that day? I know sometimes they just show up and are looking for payment. Do we have communications going through with our providers that they can, is there anything they're going to ask?
Could they actually be seen that day and have that, is that we have that communication going with our providers
Speaker 28
10:50
is what I'm asking. So there's a couple of things that we can talk about there. One, I think we can add a communications plan to physician's offices, OBs, PCPs, FQHCs to make sure they understand the presumptive eligibility and encourage their clients who come and see them pregnant to go in ahead and apply for that. There is no retroactive eligibility with presumptive. There is with traditional pregnancy. If the woman is already deemed eligible for any Medicaid eligibility category, there is a portal where the provider can go and check that same day of the service,
and they can always get real time and even if the leader there's retroactive determination that the coverage wasn't available that day if they provide us the information that they did check that coverage and in good faith provided that service we override that and cover that service for them anyway so a quick follow-up chairman so
Representative Mary Bentley
Unverified
11:36
even if they were snap eligible that would um so so personally i'm snap eligible at this point that would allow us to maybe get the presumptive eligibility you think i'm just asking that question
Representative Jack Ladyman
Unverified
11:46
if they when they submit an application Of course, they can apply for all of our programs if they mark snap only
That they only want snap then that's all we would process them for but if they mark that they want healthcare coverage and snap Then yes, we're going to determine them eligible if they're pregnant
We will determine for presumptive eligibility and approve that if for some reason we have to pin the regular full coverage Thank you Representative
Representative Lee Johnson
Unverified
12:17
Johnson you recognize? Thank you. Thank you, Mr. Chairman So when you say, did I hear you say that it won't be retroactive, that the presumptive eligibility won't be retroactive?
Speaker 5
12:25
Presumptive eligibility is not retroactive. However, when someone is approved for the full coverage for pregnancy,
Representative Jack Ladyman
Unverified
12:31
that is retroactive. So if they happen to have medical charges related to the pregnancy before the day that they apply for Medicaid, then it will go back when we do the permanent, the full coverage for pregnancy. Follow-up. Do we have a sense of how many
Representative Lee Johnson
Unverified
12:52
of these women are going to eventually qualify for one of those programs
versus how many are going to be in the presumptive eligibility category and then not be retroactively reimbursed? Is that something we have a
Representative Jack Ladyman
Unverified
13:07
sense of? So it really will depend on how many of them follow through with the application process and meet the full application requirements, because we are going to be approving based on attestation. So, and we only have to verify if when we check our electronic data sources,
there seems to be inconsistencies with what was declared and what we are finding with the electronic sources. So that would be the only reason we would pin a regular application. And I will say this. I didn't think it made it clear. We are doing this in a way that when they apply for presumptive eligibility, they will be applying for the full coverage at the same time. So we won't lose them because they didn't apply for full coverage and they just applied for presumptive. But how many are approved
is ultimately going to depend on how many are eligible.
Representative Lee Johnson
Unverified
14:03
I have a follow-up, and I'm happy to step out of the
queue if you need me to, Mr. Chair, but I have another follow-up. So I thought I heard you say a little bit ago that it would depend
some on the first application and if you needed more information to finish filling out the application. It sounds like that's contradictory to what you're saying now. It sounds like if the
presumptive application is completed, you don't need any more information down the road. Am I misunderstanding what you're saying? So the
Speaker 5
14:33
presumptive application is the same application for full coverage.
Representative Jack Ladyman
Unverified
14:37
So when they complete that application, we're
Speaker 41
14:40
going to determine them for presumptive and for regular health care coverage. So your anticipation
Representative Lee Johnson
Unverified
14:46
is that the application would be
complete? It's dependent on that. If the presumptive application is complete, then there's no more information
Representative Jack Ladyman
Unverified
14:56
you're going to need? No. The application being complete means that we're going to determine eligibility and see if we need more information. Sometimes we have to ask for follow-up income information just in processing and determining eligibility, but we won't do that for presumptive eligibility.
That will be based strictly on attestation, on what they tell us on the application, and compare that to the income limits for full pregnancy coverage. As long as what they have declared is within those limits, we're going to approve them for presumptive eligibility. But at the same time, we're going to ask them for whatever information we might need to finish their full determination. But the application is the application. Does that help? I still don't
Representative Lee Johnson
Unverified
15:41
know that I exactly understand, but I have more questions.
Representative Fred Allen
Unverified
15:44
I'll just get out of the queue and come back in later. Representative Allen. Thank you, Mr. Chairman. Thank you for being here today.
Speaker 5
15:59
Could you go back to your two-month comment? You said something about a two-month period.
Representative Jack Ladyman
Unverified
16:04
Yes, sir. The presumptive eligibility category is temporary, and the purpose of it is to get a woman who is pregnant access to seek prenatal care and receive prenatal care while we're processing a permanent application
so they don't have to wait until we get the full coverage application completed. So it's temporary. It won't last the entire pregnancy. It will last through the month after we approve it, which is two months. But if we still happen to be processing the application for a full determination coverage, then we will leave that presumptive eligibility open and accessible to the client until we make a
Representative Fred Allen
Unverified
16:44
full determination. Follow-up. What's magical about two months?
Speaker 5
16:50
That is part of the CMS rules around presumptive coverage. So we can't approve it long term. It is intended to be short, temporary coverage
Representative Jack Ladyman
Unverified
16:58
while the woman is going through the process to get the full determination. Okay, thank you. You're welcome. Members, I'll say the same thing I said during session
so the Senate can hear it. I don't need to know if
you need a follow-up. just to ask your questions, you guys represent a district that needs to be
represented in this whole heart. So just question the members. If it gets out of control, I'll stop
Representative Aaron Pilkington
Unverified
17:30
it. Um, that is my job. Representative Pilkerton, you're recognized. Interesting. You made that comment
before I started, but you know, no, I appreciate y'all being here. Appreciate this rule. And, uh, mine's just a little, I'm a little more curious on process when, um, if during the application period you are needing more information, is there any way to loop in the community health workers into that i know sometimes getting these women um you know sometimes
they're a little more transient than we would like them to be and so that's obviously part of the community health work i was just wondering if there's a warm handoff process in this with presumptive eligibility to get that additional information could you speak to that i'm fully in support
Speaker 69
18:11
of this rule just kind of more curiosity on this point um yes sir thank you for the question Janet Mann, DHS. The long-term goal will
Speaker 71
18:18
be to involve community health workers. They are not active yet in Medicaid. Y'all did pass that during session. We're working on that certification and that process. So that rule will come before you later, hopefully this summer or early fall.
And then back to previous question, the presumptive eligibility is only good for 60 days per federal regs. So we're just trying to maximize when we have them applying for an application to get all information or as much as possible to not stop the process so no there's no gap
Representative Jack Ladyman
Unverified
18:53
in coverage fantastic thank you representative later thank you mr. chair just well
thanks for bringing this rule I really like it I think you'll help us I like everybody else I'm very tired of
seeing on the front page of every paper that we are number 50 in infant mortality And we're doing a whole lot to try to fix that and I think this is a very good cornerstone for that But I believe because we have such small data small numbers So if we can say one or two babies that it probably moves up to number 40 because we have such a small number That we're looking at small pool of data and a lot of these
problems are in rural areas as we've talked about so to me the thing that we need to make sure of is that this rule as well as all of these other good rules that y'all are going to be bringing to us is communicated across the state but especially especially in the rural areas because that's where the problem seems to be would you agree yes
Speaker 28
19:59
sir definitely wholeheartedly with everything you said there including arkansas needs to not be number 50 out of 51 anymore we are too good of a state to
have those numbers and every woman and child that we that doesn't end up sick or dead because of what we do here is a win in my mind so i wholeheartedly agree with all of the efforts we're doing including with the federal grant that we received in january the transforming maternal health grant we call it tema because we like an acronym um it it includes communication and work with providers in rural areas including doulas chws obstetricians hospitals the perinatal quality collaborative which does the work around infant mortality and maternal mortality so we will be
working with all of those groups to make sure that we're getting access and communicating across the
Representative Jack Ladyman
Unverified
20:47
state so you know i will add to that that this you know we will take this application just like we take all of our other applications they can be done on paper they can be mailed they can be um they can apply online they can apply by phone so all the avenues where we normally take an application is available with this new category and
Speaker 69
21:09
just to you know not be left not saying anything i would also like to add something that you mentioned representative ladyman was on
Speaker 71
21:16
the data piece um this rule today and then the next rule that director pitman will present on the rates is two of our rules to try to begin to address the data to really know what our issues are because we don't have good data on pregnant women going to the doctor and how many different types of clinicians or they're seeing during the pregnancy or where they are delivering. This is
Speaker 74
21:37
our attempt to gather some of that data as one of the largest payers for deliveries in the state.
Representative Lee Johnson
Unverified
21:50
Representative Johnson. Thank you, Mr. Chairman. So it seems a lot of this, it seems like a lot of this depends on the application process, right? I mean, it sounds like that in order for a pregnant woman to access the system, whether it's through a traditional Medicaid approach or whether it's through this new presumptive eligibility category, and it seems like a platitude, I know, to say, but you cannot get Medicaid until you apply for Medicaid, correct? Correct. so do we have a sense
of how women are applying for medicaid in arkansas you mentioned a number of ways that women can apply for medicaid what how
are they doing that in arkansas what's the
most common pathway for women to apply for
Representative Jack Ladyman
Unverified
22:27
medicaid i have some data on that but i did not bring it with me but but we get applications through all avenues more uh paper and online than them by phone and
paper and online going from memory but i can get you the the
Representative Lee Johnson
Unverified
22:44
number um it's almost equal so when you say paper and online those feel like two different ways so that sounds like three different ways um half your memory serves half is paper and online half is in so so
when you say paper and online how are they doing that are they sitting at their house and printing off some paperwork are they accessing through a portal at their home from their phone are they doing this from a doctor's office are they doing the paperwork from
the public health county public health unit where are these women filling out these online and paper
Representative Jack Ladyman
Unverified
23:17
applications so it could be all of the above i mean online our portal is mobile friendly so they can do it from a phone from a tablet from a desktop they can do it anywhere they have access to the internet so yes i mean at physician's offices if they have a kiosk
that can be used or someone there that's helping them apply it can be done online we um we all the paper application is available online it can be printed it can be picked up from our county offices we mail paper applications to people if they ask us to it's but we don't have a sense of
Representative Lee Johnson
Unverified
23:50
what percentage of the time they're doing it from what location
or where no no it feels like that would be important information to have i mean if one of the most important parts of this process is application right then finding out where are women most likely to apply in what way works the best
for the women of arkansas and then another question i would have is you know how many pregnant women are not applying and if they're not applying why is it because they don't know how to apply they don't know where to apply um is it because the you know we're not connecting with them in the right way, it feels like the only way this presumptive eligibility helps is if we have more women in Arkansas who are pregnant who are currently not applying for Medicaid applying for this presumptive eligibility. If
we pass this rule and nobody applies for it, it doesn't feel like it moves the needle. And so to your point about data, I think it would be very helpful to have
an understanding of where we are starting out now and then be able to add on to that where are we going, right? Because we only can tell improvement if we know where we begin and where we get, right? And so I would like to
know what the data is currently around total number of women pregnant in Arkansas uninsured. Because everyone in Arkansas, as I understand it, that's pregnant qualifies for Medicaid. Is that in some fashion? As long as they're not incomeed out? Is
that the only reason? As long as they meet the income limits. Yeah. So any woman in
arkansas meets the income limits qualifies for medicaid how many women in arkansas are currently pregnant that meet the income requirements but haven't applied do we have a sense of that is that data is that data we
Speaker 69
25:33
can get we have struggled with how to get that data because if they don't apply and we don't have any
Speaker 71
25:38
visits in our system of claims paid we don't have that data that's part of the reason we're trying so where we're starting at is is what we had used
publicly with self attestation data of when women sought doctor's care in the first trimester second trimester third trimester or delivery and now we are backing that up in trying to gather that data to see when they apply when they go to the doctor how they're going to the doctor yeah because it feels like you could look at that retrospectively because
Representative Lee Johnson
Unverified
26:06
intuitively I would say that every woman that delivers in Arkansas that meets the income requirements for Medicaid is eventually going to land on Medicaid right because they're going to show up in the hospital and deliver with no prenatal care and we're going to discover they're uninsured and so
there's a way to walk back retrospectively and get a good idea of like
how many women aren't applying until their third trimester and is that data we could get?
Speaker 97
26:31
Well that's the self-attestation data that we had that we had over
Speaker 71
26:35
a thousand women that presented for delivery with no prenatal care that's what we're trying to eliminate we're also trying to eliminate I can't remember the statistic but there were there was a large number that did not seek care till their second trimester so we are trying to move that needle and move into prevention and have that's one of the reasons
we presented the presumptive eligibility as an option as soon as you find out you're pregnant have have an application then be able to go and schedule your doctor's appointment to at least get one visit in in that first trimester best practice is 14 visits for an for OB that includes I think one postnatal visit so really trying to adhere to the best practice and open that up as an option I do I want the data just as much as you keep asking me about it I just don't have it
if they only file a claim when the delivery is currently done I don't know if where they went to the doctor when they went to the doctor for prenatal visits or anything which is why the second rule that you're going to hear later this morning is hopefully our
Speaker 69
27:40
attempt to gather some of that data but
Representative Lee Johnson
Unverified
27:42
we have demographic information on these people that delivered right we could survey these people could we
survey them and ask them hey why did you not apply for Medicaid did you not know did you not know how where did you apply for Medicaid why did you not get your
prenatal care was it because you didn't have transportation was because you didn't have a primary care doctor that we
have the ability i would think to survey these people and ask them some of these questions i think
Speaker 71
28:08
i would like to follow up on that conversation offline because to a certain extent medicaid is our responsibility but some of those women may not be medicaid some of those women may be other things i just that's a much broader system question i understand but i think it's important to bring up
Representative Lee Johnson
Unverified
28:20
these questions i mean we're talking about presumptive eligibility which i support i'm in favor of this rule i think it's a good rule i want to support this rule
But I also want to be realistic in what we expect the outcome of this rule to be. If we pass this eligibility category and nobody's applying for it any more often than they're currently applying for Medicaid, then it's not moving the needle. I don't disagree with you. And so I think it's important to ask the questions around the data and then have some follow-up discussions about what those data are. So I would love to see more information about the questions that I was asking, specifically around, you know, the percentage of women that are applying, how are they applying if they're applying online is it in the doctor's office is it an emergency
department you know we have people come in the emergency department all the time and say hey i'm pregnant and i just found out at home and i'm i'm coming in to get checked out right and and so a percentage of those women are going to be low-income women that qualify for medicaid are we connecting them in the hospitals to
this presumptive eligibility now i mean i would think that we would probably just connect them directly to Medicaid most of the time, right?
Speaker 71
29:27
Well, if they've delivered, then we would want to connect them to Medicaid because there's no reason for presumptive eligibility for pregnancy.
Representative Lee Johnson
Unverified
29:33
Well, and that's my point. I mean, I think if
they're showing up at the hospital, we're probably trying to get them enrolled, and we're probably enrolling them right into Medicaid, not
Speaker 104
29:42
presumptive eligibility. Yes, we want to make sure that the mother is covered, but also we want to make sure that
Speaker 71
29:48
the baby is covered. And we have a working relationship between DCO and DMS and the hospitals and other delivery avenues that we're trying to improve upon
Speaker 74
29:54
that between the delivery and getting the baby on Medicaid but also making sure that the mom is still covered and what appropriate category she wants. The attestations you
Representative Lee Johnson
Unverified
30:02
mentioned, I may have just missed that data.
Was that something you shared with us? That was what came through the
Speaker 74
30:07
Strategic Maternal Health Committee. That was publicly available data from the Department of Public Health. Maybe the Department of Health is here.
Speaker 83
30:13
maybe you could share that with us as committee members
Representative Lee Johnson
Unverified
30:16
i would like to see that data i will get with the department of health and make sure that you get it
Speaker 83
30:23
and i also just wanted to add one thing i don't know
Speaker 108
30:26
about surveys you know there's there's rules around what you have to require what a woman can be required to answer a person
Speaker 28
30:33
can be required to answer when they apply for
medicaid or receive services so it has to be optional but one thing we are trying to do with the contract that we've put into place around targeting pregnant women and communications to pregnant women is do focus groups with those women around questions like you're talking about and so we can add some of these questions to that focus group about you know how do you get information on applying what prohibits you from going to the doctor
Representative Lee Johnson
Unverified
30:56
those types of things i would love to see that i have
one more question i'll i'll be done thank you mr chair and committee i appreciate the patience of everyone in the room i
think it's an important topic to discuss so we
talked about data once this program has started do we have in place anything to collect
data that you could report back to the committee around how many of the women that apply for presumptive eligibility ultimately end up in categories
of Medicaid. And then additionally, if we're not going to make these payments retroactive to providers, so providers are still expected to see these
patients. If I understand it right, is that what you said around presumptive eligibility? So presumptive eligibility is only good
Speaker 102
31:34
for 60 days. So it's very hard to be retroactive. But if I'm seeing someone for the first time and they don't
Representative Lee Johnson
Unverified
31:41
have medicaid at this point they've not applied to presumptive eligibility and i try to connect them
with dhs and now they've applied for presumptive eligibility but i've gone ahead and saw them that day am i going to get paid for that
Representative Jack Ladyman
Unverified
31:55
visit i think that's what you if if they apply for medicaid that same day and then yes they would get presumptive eligibility that day assuming they attest to income that
Representative Lee Johnson
Unverified
32:04
would that visit if that like in an emergency department setting i'm required to see them before asking information so i'm going to see them in the emergency room i'm going to take care
of them and do everything i'm going to do and then at the end of the visit once i've finished the visit then we're allowed to ask information around insurance is if i get them connected with
presumptive eligibility will that then emergency visit
be paid through presumptive eligibility if they
Representative Jack Ladyman
Unverified
32:26
apply then and they're approved for presumptive it'll it'll be the first of the month during the month they apply so depends on you know it'll depend on the exact date but and then if they approve for the full coverage that coverage will be concurrent with the presumptive eligibility so for example if someone is approved for presumptive eligibility from may 1st and let's say through july 31st and we also determine that they're eligible for full coverage in the full
pregnant women's category and they requested retroactive coverage before may 1st they had they had bills that needed to be covered we can go back as far as 90 days three months from may the 1st in assuming that if they were pregnant and met the requirements and we will basically in our system it will look like they have both presumptive eligibility and pregnant women's eligibility at the
Speaker 5
33:22
same time but it is possible that the full coverage will even
start before the presumptive because full coverage does allow for retroactive coverage right but That's only if
Representative Lee Johnson
Unverified
33:31
they ultimately. Representative Johnson, we're going to have to move on to someone else. I'm happy to move on to someone
else. I'll get back in the queue. Representative Pilkington. Thank you. And
Representative Aaron Pilkington
Unverified
33:43
my comments more directed to Representative Johnson. I think,
I mean, we are getting a little lost in the weeds here, but a lot of this is just making sure that these women who have never seen any sort of prenatal care get in the door as soon as possible. The reality is you've got community partners, you know, hospitals, clinics,
things like that that are going to be advertising this to come in and just be seeing that day if you've got issues, if you've got, you know, I mean, women who wake up at the, you know, and they're, they're bleeding and they're worried, you know, whether or not they're going to lose the baby, you know, but they don't have Medicaid, so they don't know what to do, just get them in the door. So I, I, and I know, you know that, but I just, I know some of the people on the committee are not as in the, in the deep water, like you and me are. And I just want to make sure the committee is going with us down this rabbit hole that we're not losing, you know, losing the forest for the trees. So I just I want I wanted to make that comment. Senator Love, you're
Chair
Unverified
34:35
recognized. Thank you, Mr. Chair. Let me go back
Senator Fredrick J. Love
Unverified
34:40
to almost where Senator Representative Johnson was. But do we have a number? You talked about attestation. Do we have an anticipated number of women that we think are going to qualify for presumptive eligibility i mean because you all talked about at a station so apparently we have those we have those numbers we have that data is that is that i mean just just i just want to
understand i'm trying to frame this up so do we have that number
Speaker 71
35:16
so i will start with what we do have in data she's trying to look something up for you senator love okay so um there are roughly 32 to 35,000 births in the state of Arkansas annually. Medicaid has paid historically 48 to 50 percent for those births. So about 17 to 19,000 depending upon the year is what we currently have covered historically. So with paying for those births we looked at how can we pay for their
prenatal care and then track them. Then I go back to the self-attestation data that we worked with Department of Health on. There was roughly, I think, a thousand women that had self-attested to no care. So somewhere in the middle. I don't know how to give you a number because we don't have the data yet, but that sets the guardrails of why we are trying to do this, trying to get that group of 1,000 women to be able to have access to prenatal care if they qualify and then
the upward band of 17,000 to 19,000 that we currently pay for now that they are having additional access
Senator Fredrick J. Love
Unverified
36:30
to doctor visits and deliveries. Okay, so we can anticipate that roughly about 17,000 to 19,000 women will qualify for this program. Could qualify, yes sir. Okay, number two then, And do we have enough providers, OBGYNs, signed
Speaker 104
36:46
up to accept? Well, we are focused on OBGYNs, but we're also
Speaker 71
36:52
focused on family docs with OB, certified nurse midwives.
We never have enough providers. So I'll take all the clinicians that can deliver children that
Speaker 83
37:01
want to be a Medicaid provider. If they will fill out their provider enrollment,
Senator Fredrick J. Love
Unverified
37:07
we'll take them today. Okay, so, but I guess the women go and they have their own provider, then their provider then have to apply for Medicaid. Yes, so they have the
Speaker 71
37:20
freedom of choice to choose their provider if it is a Medicaid provider. We do not direct them to a specific provider.
Senator Fredrick J. Love
Unverified
37:27
Let me ask you this, then. Do OBGYNs usually accept Medicaid? I mean, just in the general
Speaker 71
37:35
fashion, I mean. They do accept them. We do not have a large number, I believe. I would have to go look at the most recent statistics from the Medical Society and other publications in the state. So that is why, especially in different sections of the state, we want different types of clinicians to be able to open up that access to care.
Senator Fredrick J. Love
Unverified
38:00
Okay. And then, so then I'm going to go to kind of like a, back to where they were talking about how are we getting the word out. Now,
Speaker 133
38:14
have we already launched this program? No, sir. It is scheduled to go live July 1 with approval of these rules and CMS approval. And so there will be communications
Speaker 71
38:25
to beneficiaries and to providers through
Speaker 74
38:28
multiple streams of communication, in addition to social media and different types of communications with providers and associations.
Senator Fredrick J. Love
Unverified
38:35
Okay, scoot up to the mic because you're... I'm sorry. All right, so are we doing
Speaker 71
38:46
a media campaign about this, or are we just doing the traditional... We're doing our traditional communications. Also, these are lessons learned that were successful during the public health emergency. We learned that communicating through providers, sending communications through our billing, communicating with our beneficiaries, digital billboards in our county offices, digital billboards in providers' offices, working with different groups, but really on our social media also.
Speaker 74
39:13
We found that to be effective on communications during the
Senator Fredrick J. Love
Unverified
39:19
public health emergency. Okay, so not necessarily—it's going to be
a campaign, but it's just—it may be a different kind of campaign, not a bunch of
Speaker 71
39:29
TV, but— No, sir. Medicaid really doesn't have the budget or the ability to do a media campaign. That's not really in our scope. I'm trying to get medical services delivered, so we are trying to utilize things that we've used in the past
Senator Fredrick J. Love
Unverified
39:47
and that have been proven to be successful. Okay, and then my last question is, because
I heard you talk a little bit about the Department of Health, and so when we are rolling out this information, this information campaign, let's just call it information campaign, when we're rolling this out, are we talking about not only at the DCO offices but also
at the Department of Health county offices or public health units, I'll say?
Speaker 71
40:16
ADH is a very good partner, and they have been a partner with us from day one with the Maternal Health Strategic Committee and all of our operations.
They actually ran a pilot project in five counties, and that's really all I know. I would have to defer to them to tell you about that. But it's successful, and we continue to work with them on the presumptive eligibility and trying to help with access
Speaker 74
40:39
to care for women to seek clinicians. Well, I think, go ahead. Well, and I was just going
Speaker 29
40:47
to add to what Ms. Director Mann was saying. I've known her a long time. I'm sorry. We also have a great partnership with the Department of Health as far as them being one of our largest maternal health providers for early prenatal care services.
Yes. And we actually have a separate MOU with them around those services where we, you know, pay them directly for those. And we will use that partnership as well to make sure that they're communicating with their beneficiaries who see them for those services to get into a permanent provider for labor and delivery services. Okay. All right. Thank you. Thank you, Mr.
Speaker 149
41:15
Chair Representative Richardson, did you have something? Representative Johnson
Representative Lee Johnson
Unverified
41:35
Thank you, Mr. Chairman in representing picking out had a nice sidebar I just wanted to be clear on on the comments he made so if if a woman
wakes up in the morning she's pregnant, she's bleeding, there's a decent chance she's going to come to the emergency department as opposed to go to a doctor,
especially if she's uninsured and she doesn't have a doctor to see. And the point I was trying to make, which I've made several times here in the committee, is that, you know, EMTALA requires us in hospitals to see patients without asking information about insurance. I cannot ask you, do you have insurance? Do you have Medicaid? I can't ask those questions.
It's illegal. I have to see, and appropriately so. I want to be blinded to that information. I want
to be able to take care of people. This is why I work in emergency rooms. I want to be able to take care of people without knowing whether they have the ability to pay or not. I want to be able to walk into the room and find out, are you having an emergency? How can I help you today? So the process is, you know, for me in an emergency department, for our hospitals, is we have to see these women appropriately, and
then we have to determine if they're having a life-threatening emergency, and a pretty good percentage of them are not, and we can't ask them if they have insurance or don't have insurance until we've already
completed our care cycle, our medical screening exam, until we've already incurred the costs of lab work, ultrasound, urinalysis, physical exam, nursing triage, all of these costs are incurred by the hospital before we
even ask them if they have insurance. And then we ask them, do you have insurance? I don't have insurance. Okay, let us see if we can't get you an application for Medicaid. If I'm understanding this policy right, and I'm trying not to get down
in the weeds, but I'm trying to very specifically ask about presumptive eligibility, which is the rule that we're reviewing today my understanding is that presumptive eligibility will not be retroactive
and so if i have this young lady apply for presumptive eligibility that doesn't help the hospital get paid that day because that unless ultimately they qualify for for a traditional medicaid program which will be retroactive but we're already doing that i know we're already doing that so so again i just want to be clear that when i'm asking these questions about retroactive payments for presumptive eligibility it's not necessarily going to fix the problem that
I'm seeing in the hospitals yeah may
Speaker 71
43:48
I jump in and and Mary Franklin's going to correct me if I get this wrong that our intent is is to pay the provider when they see a pregnant woman a woman and so with doing the presumptive eligibility and the full application at the same time the self attestation does the presumptive eligibility then the work is done on the regular application that does have retroactive that by doing that our intent is to make sure
Speaker 69
44:15
everyone gets paid in every situation and so if we are creating an unknown bottleneck or gap that is not our intent but you
Representative Lee Johnson
Unverified
44:25
understand hospitals are already going through the process yes having patient supply so today today if that same
Speaker 69
44:30
pregnant woman came to your ER and you saw her and you had these questions I'm not sure the process would be very different agree and that's why I'm trying
Representative Lee Johnson
Unverified
44:41
to point out I mean this idea I just want to be clear on what we're getting with
presumptive eligibility and what we're not getting yes leads to my next question which I'd like to see if we've got information on do
we have an idea of what percentage of women who are pregnant are accessing the health care system with Medicaid
or who ultimately end up being on Medicaid, how many of those women are accessing the system for the first time through an emergency department versus through a primary care clinic? I don't believe we have that data. Is that data we could get? We can try.
Speaker 108
45:15
I don't know for sure because of the way we're currently collecting our data
Representative Lee Johnson
Unverified
45:19
if we're going to be able to get that for you. It feels like you could, right? It feels like you could look back retrospectively and be able to say, hey, this person, their first encounter was side of location of charge, was in a hospital. And it feels like that's important information to have. If what we're trying to do is target where women are accessing the system and how we're going to get them applied for Medicaid, if it turns out that 75% of the women in Arkansas are accessing the hospitals for the first time for their visits at an ER, well, then
maybe we need a different strategy. If it turns out that it's 4%, maybe I just need to quit asking questions and go back to the house.
Speaker 28
45:54
So this is getting into the second rule, so I apologize for that. But part of what we're doing with the part of the issue is because we use that global payment that we're unbundling in the second rule, we don't necessarily have data on what the first visit was. All we know is that they saw that woman for the requisite number of visits and delivered the baby, and that's it, and then they get the global. And so we pay that out, and then we don't necessarily have insight into what was done on that front end. So that's where we're having difficulty getting the data on everything that's happened at the front end of that pregnancy.
Representative Lee Johnson
Unverified
46:28
We have an all-payers claim database in Arkansas, correct? Correct. Would that information be available through the all-payer claims database? The global fee goes
Speaker 28
46:35
to the all-payer claims database if that's what we pay. So, I mean, is that information
Speaker 163
46:41
we could request from ACA? I mean, we can find what we have. All I'm saying is our
Representative Lee Johnson
Unverified
46:46
claims data. I understand that as a state, we have more information than maybe what you have. What about SHARE? what can we find out through share we can
Speaker 28
46:55
look through share we actually do have an mou with the health department to hit against share and their vital record system for medicaid births
so we're getting as much information as we possibly can right now that's only on an annual basis we're trying to get that more frequently
Representative Lee Johnson
Unverified
47:07
remind me who runs share is that and santifer no but i mean is that's part of the department of health yes i'm sorry department of health department
of health yes so department of health is in the room do you want to come to the table Let me
Speaker 28
47:23
know if that's information you could get through SHARE. And if I may tell you what problem we were trying to address here, just so, I mean, it wasn't, when we had the stakeholder meetings, the problem that was brought to the table for us was that a lot of OBGYNs in the state were from the stopgap providers, FQHCs and local health units that are seeing women early in the pregnancy that don't have insurance.
We were hearing that they were having a hard time transferring those women to delivering providers if they did not already have Medicaid because providers did not want to risk that that woman would go through the complete application process and get the retroactive coverage. I can't imagine what that feels
Representative Lee Johnson
Unverified
47:52
like working in the emergency department at a hospital. I understand.
Speaker 20
47:55
So I just wanted – that was not one of the problems raised. But this is directly to address that problem so that when they are able to make that transfer, that woman does
Speaker 28
48:02
have that presumptive eligibility and that OBGYN. We would also love that capability within the hospital. Understood. I just understood. And
Representative Lee Johnson
Unverified
48:10
if we knew what percentage of the women were accessing the system
through the hospitals versus the clinics, then maybe that would be helpful. I'll wait for ADH to introduce themselves. Matt, you have more Department of
Speaker 172
48:21
Health. I'd have to check. I don't see
Matt Gilmore
Unverified
48:26
why we couldn't get it more frequent than once a year. When you say more frequent than once
Representative Lee Johnson
Unverified
48:31
a year, what are we getting once a year through Cher? I
Speaker 28
48:36
missed that. Oh, yeah. So we have a memorandum of understanding with the health department already where we actually send them a list of Medicaid clients that are pregnant or delivered and they
send us back the information that share has on them or that the vital records the birth certificate contains because it contains that self-attestation information that Director Mann was talking about right now we do that on an annual basis but we're actually working already to update that more frequently as part of the transforming maternal health grant Mr. Chairman if I may I would love to see at
Representative Lee Johnson
Unverified
49:03
the next agenda of that public health meeting or at a agenda of a public health meeting and maybe you want to refer this to a subcommittee. That would be fine with me
as well. I'd like to dive a little deeper into what we're using SHARE for.
It feels like a very underutilized resource. If you don't know about SHARE, I'd encourage you as legislators to look into it. It has a lot of information that I think we're underutilizing, and I would love to have a meeting where we can discuss how
do we better connect the information we have at the Department of Health through SHARE with the information I'm
Speaker 28
49:32
trying to get through DHS. We agree, and one of the things we're doing with the Transforming Maternal Health Grant is also trying to encourage providers to give more information to share so that we have better information on pregnant women. So we would love to have that
Matt Gilmore
Unverified
49:45
conversation with you, Representative. And if I may, kind of to what she just said, not everyone is connected to share.
And so it depends on the system they've got and how we can connect. I mean, we try to be as flexible and easy as possible, but it does require some basic electronic capabilities. And so I think that's something that we will help any way we can, But it's just not, it's not, I mean, you've got to have the technology side. I mean, it's every provider across the state. So it's, but there's also ways
to do it through the All Pairs Claims Database. We can, I think we can get the data. That's my point. And
Representative Lee Johnson
Unverified
50:18
perhaps maybe ACAD needs to come to the table.
Between the two resources that we have at SHARE and what we
have through the All Pairs Claims Database, it feels like we have a lot of information we're not tapping into that would be very helpful to answer some of these questions that we've had today. Yes, sir. To be clear, yeah, go ahead. If we
can have a conversation offline about that. I would want to have a conversation offline, but I would much rather have a conversation in a committee meeting with other legislators to have a discussion about this in the interim. This feels like what the interim is for is to
have constructive conversations where we come down here as a group of legislators and we spend time talking and discussing and trying to figure out how are we going to solve problems so that when we get to the session, we have meaningful legislation to put forward.
Speaker 28
50:55
Yes, sir. All I meant was that we have contracts with both ACI and SHARE to do maternal health data and analysis. And so if we can make sure we're addressing your questions in those public conversations, that
Representative Lee Johnson
Unverified
51:06
would be very helpful. And to be clear, I support this rule. I think it's a good rule. I just want to be clear on what the limitations of this rule are, and I want to understand better
from my perspective. I think we're really clear on the way it pays hospitals at this
Representative Lee Johnson
Unverified
51:18
point. I'm sorry if I've offended anyone, Mr. Chairman. I'm just here asking questions and trying to learn. I don't mean to credit any patients in the committee.
Representative Jack Ladyman
Unverified
51:25
Representative Leiteman, you're recognized. Thank you, Mr. Chairman. And this may be a long question. I apologize if it is. But I think Representative Johnson asked a very good question, and that is what's the success rate of what we're doing here? And I want to go back in history a little bit to tell you why I'm going to ask this question. So Representative Eubanks, I don't know, John's four or six years ago, something like that, He ran a bill to allow ophthalmologists to do three minor surgeries or optometrists to do three minor surgeries that ophthalmologists were only allowed to do.
I was chairing the committee at that time. And about 24 months after that went into effect, Representative Wayne came to me and he said, Jack, has this been successful? Because that was the very first bill that we ran in this legislative to let lower trained individuals do those surgeries. And so I went to BLR Research, which we have a very good research branch in BLR, and asked them, can you find out this data? How many of these have been done by optometrists, and how many negative outcomes have we had?
And I wanted to communicate that to the committee, as well as the public, because the public needs to know, you know, we're not here, we do things. Is it paying off? Is there money being invested wisely? And so we really need to know the results of that. Well, the numbers I got back, there had been 2,200 of those surgeries done by optometrists with zero negative. When that data was put out, what that did is it stopped a lot of the questions about, well, did this work, did this not work, whatever.
So that history, now I want to ask my question. So I think we don't close the loop on things here. We need to look at, we need to measure the results and do things that have good outcomes. And I know the mountain of data that you all have to worry with, I understand it's very difficult. But if you can code things to where they can be picked out, what's the word? Anyway, where you can look at that column and get a total.
If you can do better coding on those elements like this, I think that would help you all, and it would help us to know what we're doing means something, and you as well. So I don't know if that's a question or not. Yes, sir, it is.
Speaker 97
54:00
It's a very good question about how do we use the data,
Speaker 71
54:04
how do we show results, how do we report it. So I think back to Representative Johnson's question about some of the data on presumptive eligibility and how many pregnant women are going to use it, is it going to be successful.
In addition to tracking how the eligibility category is used, if you approve this rule and we go into effect with this rule, also the second rule that we keep referring to, which is changing how we will pay for office visits and how we will pay for delivery. I think the combination of these two rules will give us some data that we've never had and will give us some data fairly early. We'll be able to look at it monthly and quarterly to see if our doctor visits being billed for OBGYN or certified nurse midwives or for different docs for pregnancy.
Is that, then is that pregnancy a full pregnancy or presumptive eligibility? How do they relate? What can we do? There's lots of things that we don't know that we will be able to uncover with this data. Then when we see how the data is, what the data is showing us in the outcomes, one of the goals, I think, of our team and the Maternal Strategic Committee is to see current data on our infant mortality and maternal mortality because a lot of that data that is used by that team
when they produce those reports every year is two or three years old. So we don't have two or three years to try to get better. We have a very short window because if this data doesn't prove that this works, then we've got to come up with something else. One other point, Mr. Chairman, I
Representative Jack Ladyman
Unverified
55:46
want to make was that You know, I think BLR research would have more access, not just to DHS. Matt came up and talked about public health. It may be able to be accessed through the way they keep data,
or there are other organizations out there where BLR might have access where you just have access to your data. So it may be presented another way through another organization.
Speaker 71
56:08
Yes, sir. In addition to all of those examples you gave, I think the APCD will be another example. And then being able to look at the APCD, share, Medicaid, other data, and then obviously eliminate duplication as much as possible. Because I'm sure we will have some duplication in those sources and additional sources that we have not considered so that we can see what is truly happening in the state.
It's a statewide issue. It's not just Medicaid. Medicaid is one of the largest payers, and so we are trying to do our part in addressing the issue. But it is a statewide issue for the health care system to address. And I'm going to harp on
Speaker 160
56:44
the Transforming Maternal Health grant again, and I keep coming back to it. But it is a
Speaker 28
56:49
really good opportunity for Arkansas and all of the partners in Arkansas, not just DHS, to do what you're talking about. And we 100% agree with you. We've got to do a better job of tracking if the things we're doing are working or not, not just in the maternal health space across the board.
But one of the things this grant requires of us is that we do a better job of sharing data across all partners in the state and actually measuring the success of the things that we're doing. Are they doing what we want? Are we seeing changes? CMS, the federal government, will be monitoring that. And it's a 10-year grant, and it's a total of $17 million to the state of Arkansas, and a lot of what we're doing with that is partnering with UAMS, the health department, the hospital association, to give providers incentive payments to do better jobs of data sharing with SHARE and other technology sources.
That's good. Thank you. All right. Seeing no more questions, rule B stands reviewed without objection. If we would, we'll move on to C. And I think we have everyone at the table that's needed, so you
Speaker 28
57:52
guys can carry on. I feel like I've already presented this rule. This is a rule to unbundle the global billing payment for labor and delivery and prenatal care and to increase the rate by 70%. The unbundling allows for separate billing for prenatal services, the visits, the lab x-rays, all of that good stuff.
Those were already billed separately, but now the prenatal visits themselves. and then the labor and delivery will be billed separately. We already had separate rates in our system for those. For instances where the global billing payment did not apply, say a woman showed up at the ER without having received any prenatal care, they were very, very abysmally low. And so after looking at what other payers were paying for labor and delivery, Medicare qualified health payers, we determined we needed a 70% increase, which typically, I will say something like that with CMS, would not go very well.
When I explained what was happening here in Arkansas with the number of labor and delivery units that have closed since 2019, pre-COVID, with the number of providers that we don't have in rural areas, to Representative Leidemann's point, and with our maternal health statistics, they were like, that's all we need, write that down and we're good. So, I mean, that's very unusual for CMS with such a significant rate increase, but just given the state of where we are here, they saw that as necessary. And so that's what this rule does, and we're really hopeful that it will give us better data and insight into what's happening in the prenatal care space.
When women are going, is it the first, second, or third trimester? Who are they seeing? What are their diagnoses at each one of those visits? When are complications arising? Things of that nature, so that we have better information on what is about 60% of births in
Representative Lee Johnson
Unverified
59:34
Arkansas. Happy to take any questions. Representative Johnson. Thank you, Mr. Chairman, and thank you for the rule. Again, I don't intend for my questions to be perceived as an objection to the rule.
I think it's a great rule. Y'all know that. I participated in a lot of the conversations around the maternal health strategy. I'm very supportive of the things you're doing, but I also think it's important when we have these committee meetings to try to ask some questions, try to understand, and get more information. You brought up the number of delivery hospitals that have closed since 2019. And maybe this is a question better for the Department of
Health. Do we know how many delivery hospitals currently we have in Arkansas? It's 33 or 32. We
Speaker 191
1:00:13
think it's 32 now, but the health department could say for sure.
Speaker 202
1:00:19
Sorry, health department. 33? It's 33. Sorry, we're looking in the back. The hospital association also knows. I've got questions I'm sure that he's
Representative Lee Johnson
Unverified
1:00:28
going to want to answer. Come on, Matt. I don't remember ever excusing him from the table. I'm
not sure you recognize me the first time either.
Matt Gilmore
Unverified
1:00:53
Matt Gilmore, Department of Health. 33 is the number that I'm familiar
Representative Lee Johnson
Unverified
1:00:56
with. Okay, and so we have 33 currently. How many do we have in 2019?
Do you know? You know, I will advise the department. So we were talking about maternal health today. The agenda has been posted for multiple weeks. We should have had all the data that could have been asked today in this committee. Here
Speaker 205
1:01:18
for the committee today. You're recognized, Mr. Gilmore. I
Representative Lee Johnson
Unverified
1:01:20
didn't look at 2019. In defense for the department, sometimes my questions come out of the blue.
Speaker 101
1:01:25
We think it's 40, Matt. We would have to confirm.
Representative Lee Johnson
Unverified
1:01:29
Yeah, I was thinking. So we think it was 40 in 2019. Do we have an idea of what it was in 2016? No. I'm just curious about
the decline. I mean, I really do, because,
like, if you look at the population of Arkansas, the population of Arkansas is not decreased, for sure, right? And so the number of deliveries that we have in Arkansas is probably pretty similar in 2025 to what we had in 2015, I'm guessing. Do we have information on that, on how many deliveries?
Speaker 28
1:01:57
I do. Perfect. Good for you, Ms. Pittman. You can thank Ms. Smith, who's actually in Nashville taking care of a loved one,
Speaker 20
1:02:07
who sent me this this morning. She's an excellent deputy director. So I have going back to 2019, and it is roughly the same. It was $36,500 in 2019, and then it was about between $35,000 and
Speaker 28
1:02:23
$36,000 every year thereafter. I have a feeling if you look
Representative Lee Johnson
Unverified
1:02:27
back that that data is going to be pretty similar for the last 25 years.
I think that you're going to find that we're delivering on average around 36,000 deliveries for the last decade and a half, two decades. I think if you look back, and I don't know the numbers specifically, but I have a feeling that if you look back past 2019 when we had 40 delivery hospitals back to, say, 2010, you're going to find that we had more than 40. I think that's pretty intuitive. So what we're doing right now, if I understand correctly, is we're cycling the same number of deliveries through, you know, seven less delivery centers. Of course, do we have information on which delivery centers close?
Because not every delivery center is created the same, right? Some delivery centers deliver 150 deliveries a year. Some
Speaker 213
1:03:14
deliver 1,000. I think we do have some of that information. And as you
Matt Gilmore
Unverified
1:03:18
said, I think they are kind of shifting to other hospitals as some are decreasing the amount of services or shutting down
Speaker 213
1:03:23
their delivery services. So I think you're on
Representative Lee Johnson
Unverified
1:03:26
the right track. Yes, sir. Yeah, they're delivering somewhere, I'm sure. And do we have a sense of from a reimbursement standpoint, you know, there's my understanding from talking to hospital CEOs is that there's a math to this that's fairly straightforward, right?
you have you it's a volume-based reimbursement so you do a certain number of deliveries and then you get an average reimbursement some of that's Medicaid some of its commercial pay and then out of that reimbursement you have to pay your expenses which are providers providers liability facilities do we have a sense of how many deliveries a year it takes based on current reimbursement to be solvent for a hospital?
Matt Gilmore
Unverified
1:04:10
I've heard numbers, I've heard different numbers, and I think it's going to be, I think it's going to be different for, you know, some hospitals based on
the number, the capacity and their expenses, but, you know, you know some of them have closed recently, and I think you could look at those numbers and kind of see what they were delivering on an annual basis and and get a pretty good glimpse of what is where that line is and where it breaks and
they say i'm out and i guess that's why i'm going with this like i'm grateful for the increase and
Representative Lee Johnson
Unverified
1:04:36
i think it's going to make a big difference right but is it going to make enough of a difference is it going
to make enough of a difference for the hospitals delivering 150 deliveries a year 250 deliveries
a year um did we you know it would you know having an anticipation moving forward of how many delivery hospitals do we think are going to close in the next three years and and is what we're doing with this unbundling and this increased payment enough to keep those hospitals that are low volume delivery hospitals viable or should we expect at some point for those hospitals to need some sort
of subsidy even even in you know again even if we increase Medicaid 250 percent I mean is there there you know my point is is there may not be a number to get to for some of these hospitals without doing other interventions, whether it's mandating commercial rate reimbursement changes or whether it's creating some sort of subsidy grant program for these low-volume delivery hospitals, looking at where they are in our state and which ones are too critical to close. Do we have a sense of how many of these hospitals this change is going to now make them viable,
Speaker 71
1:05:49
presuming that number of volume is going to come down? Do we have a sense of that? No, sir. We don't have a sense, hospital by hospital. We were trying to skim our public comments when we put the rule out for public comment. One public comment that we received was asking us to keep a global fee in case that that was what was needed if they presented it in an emergency room to deliver, and we obviously did keep that. We did look at rates in the Our Home expansion category.
We did look at some commercial rates when we were modeling this. So I am not aware, I'm looking at anyone else at the table, that we received any negative comments on the proposed rate increase. No, I'm sure you didn't. I
Representative Lee Johnson
Unverified
1:06:34
mean, I think people are grateful for the increase. I'm just wanting to get a realistic idea of how much is this going to move the needle. Is this a, you know, as much as this is and as good as this is, is this enough to stop the bleeding, or can we anticipate moving forward? And maybe the hospital association, maybe somebody can give us more information.
I would love to have more information about, you know, we have 33. Are we, you know, how healthy are the 33? Is this enough? Or can we anticipate four more closures in the next three years? If so, what's our reaction to that? Yes, sir. And I don't know that Medicaid
Speaker 71
1:07:09
can answer those questions. I think that's out of our scope. That's fair. Thank you. Representative Bentley. Thank you, Chairman. Thank
Representative Mary Bentley
Unverified
1:07:22
you all. I think this is extremely important that we move forward with this, but I do have some concerns.
So my first question is, can we get some specifics? What is our current rate for vaginal delivery, and what will the rate be after we do
Speaker 28
1:07:35
this? I do have that information. I unfortunately did not bring it right in front of me, but I can definitely get you the code list of what we pay today and what we will pay. I
Speaker 71
1:07:46
have that already. CMS has asked for it as well. So I'll expand on that. We have about 15 codes that pay for delivery, be it vaginal or C-section. Given certain conditions that are above my pay grade, as I'm not a clinician,
the old rule that we are trying to replace pays the same thing for vaginal versus C-section today. We are changing that. We are paying a higher fee for C-section as C-sections cost more to deliver. We looked at roughly somewhere between $3,200 and above per delivery fee. I'm going off of memory. And that was worked into the model along all those codes.
I'll see if Ms. Pittman can
Representative Mary Bentley
Unverified
1:08:33
get you the specifics. Okay, so that was my question there. So we said we have a 70% increase. Is that a 7% increase for vaginal deliveries, or is that just a 70% increase for a C-section, or is that the highest one? I
Speaker 71
1:08:49
guess that's what I'm trying to get to, give us a little more details on that. So that is the average across all of those fees. And so we estimated spending an additional $25 million on deliveries this year, which is a combination of state and federal funds.
so that average is 70 for all of those fees but um we did increase i forget what the bottom number was for vaginal and then the top number for c-section do you have it if i can find it in my email i
Speaker 185
1:09:18
do have it um if i can't find it during
Speaker 24
1:09:22
this i will show it to you when we leave my concern is and i think it's great because our our reimbursements were
Representative Mary Bentley
Unverified
1:09:28
abysmal i think we all we could all attest that our reimbursement rights were abysmal that's one of the reasons our rural hospitals were closing their maternity wards so we definitely need to do this my concern
is i want to make sure again that as we increase rates for c-sections that we don't see an increase in c-sections because that was one of the reasons that was rule was in place because we have such a high rate across the nation i'm not going to just pick on arkansas positions the united states c-section rate is horrible we should not have one of every three deliveries to be a c-section it's horrible so i want to be sure that we don't see an increase in c-sections because we know hemorrhage is one of the top reasons that women are dying in arkansas i don't want to see more hemorrhage so uh again i want us to track this and i'm going to look at some interim studies to make sure that
we're doing things other states like california are doing to actually change things in the delivery room and change things in our maternity wards that we are decreasing c-sections again i just don't want to see an increase in that because we're increasing the rate which we need to do desperately because our smaller hospitals are are starving and i understand what we're doing but again i'm i'm very concerned if we don't do something as well to decrease c-sections and to change the culture in our maternity wards that we're going to have we're going to have a problem so yes ma'am sharing my concerns yeah yes
Speaker 97
1:10:38
ma'am and we share your concerns and they are valid
concerns and so one of the next
Speaker 71
1:10:44
steps that we are taking is through the team of grant and through the maternal health strategic committee we are working with uams and the perinatal quality co-op I never I get that quality thank you review committee yes and and they are implementing aim bundles across the state with in that different hospitals and those are specific protocols for deliveries one of them is on hemorrhaging with the impact on c-sections and so one of our next
steps will be once those go into place and we have the data do we do a value-based payment do we do a withhold how do we gauge that data to make sure that the care is being delivered and that we are not seeing an increase in c-sections so i agree with you i think there are more steps to take this is our first with the increase in the rates great and i would just say as we as this is a public voice
Representative Mary Bentley
Unverified
1:11:35
as we're here at a public committee i would just like to publicly say at all the hospitals across the nation all across the state as we see this increase and we're doing our part to increase that they'll do their part to try and change things try and change the culture
include more certified nurse midwives on their floors as we start our new school this year that we bring more of those into their practice so we can see a change in the culture as other states have because they've seen a great decrease in c-sections when we bring more doulas and certified nurse midwives to change what's happening with actual delivery of women across our state i think they deserve that so again almost again as we have this platform here to encourage our hospitals to see what we can do to increase breastfeeding what we can do to decrease c-sections because one in three is way too high and we should do everything we can to change that which we haven't seen the
decrease in decades on that yes ma'am and
Speaker 71
1:12:22
may i just quickly follow up that as we monitor our activity in medicaid every week one of the things that we have seen an increase in the last six months and i think it's directly related to the public campaign that adh is doing in the in the work on the maternal strategic committee is we have seen an increase in certified nurse midwives Activity and deliveries in the Medicaid program. I think that's a positive change. I agree with you hundred percent. Thank you
Senator Fredrick J. Love
Unverified
1:12:53
Senator love your recognition Thank you, mr. Chair me and Senator Payton are over here discussing c-sections and I do I want to just echo what representative Bentley is saying because C-section is, as you all know, is a major surgery. My wife went through a C-section, so Sharonda and I, if you're listening to this, please forgive me for just some of the things I'm going to say, but I will say this.
If we give more money for C-sections, that seems like we're incentivizing C-sections, and it may not be the intent. I'm not telling you that that's your intention. However, what I am saying is that I want us to be aware that that is probably what's going to be more convenient. And so I'm going to be like Representative Billy. I really want to monitor this number because this is something that is very important.
I think we really should be encouraging the vaginal birth versus C-section. Yes, sir,
Speaker 138
1:14:05
duly noted. That is not our intent. Our intent with paying additional reimbursement
Speaker 71
1:14:10
for a C-section is for the OR and for the different clinicians that are also involved working with the OBGYN on that delivery. It is a major surgery, and it needs to be used when clinically appropriate. And that's really all I can say about that as I am not a clinician.
Speaker 28
1:14:31
And I'll throw in some TEMA, Transforming Maternal Health Grant stuff again. Part of what that 10-year grant is doing is doing value-based payment arrangements. So we're looking at quality metrics related to maternal health outcomes. So C-section could be a part of that to
Speaker 29
1:14:41
incentivize using vaginal delivery versus C-section. Thank you. All right. Thank you, Mr. Chair. Representative Pilkington. Thank you. And I just want to talk
Representative Aaron Pilkington
Unverified
1:14:54
a little more on the C-sections because I think it's good for the committee to know. You know, a lot of our births, and maybe it's not the most politically correct way to say it, though,
But we have some high-weight individuals who are giving birth that have created more complicated pregnancies. And when they don't show up until it's time to deliver, you sometimes have untreated gestational diabetes, which has a larger baby, which requires a C-section. So some of the things we did in Healthy Moms, Healthy Babies, like Medicaid coverage for strategic glucose monitoring for gestational diabetes, obviously there's presumptive eligibility to get them in sooner. I mean, all those things are kind of going so that we can hopefully reduce that C-section rate. And unfortunately, just because we have a lot of women who are going in who have some of these chronic weight issues because we're just a higher weight state, you're going to see a higher C-section rate.
And so that's just one of the things that I think as we try to focus on making sure people get healthier is that if you want to reduce your chance of having a C-section, getting your weight under control before you get pregnant is an important step. So I just want to make sure that we add that in the conversation because sometimes the reality is because we have such a high obesity rate and those women still get pregnant, you end up having a higher C-section rate as well. And so just wanted to make sure that the committee was aware of those kind of conflating issues. And that's why we've done other things in this bill and other policies to kind of help address that earlier on so that we don't have those issues.
Speaker 20
1:16:17
So thanks. And I know that wasn't a question, Representative, but I will follow up with that with the doula care. I don't know exact numbers, so
Speaker 28
1:16:24
I'm not going to quote them. But I have heard studies show that those who use doulas or CHWs actually do have lower C-section rates. So I do think we'll see some good results from some of the things that we have coming later this year. Representative Pilken, did you have a follow-up? Another
Representative Aaron Pilkington
Unverified
1:16:44
question came to mind, and I just wanted to ask this about it.
Is there any sort of reimbursement, and this purely just came to the top of my head, Is there any reimbursement for providers who offer VBACs? I mean, obviously, a little self-serving here. We had a C-section with our first. We had VBACs with our last two. But I know not every provider does that. But I know a lot of women prefer to do the VBAC. And obviously, I think it's cheaper and it's better. So I didn't know if we'd do anything for those
Speaker 28
1:17:14
who are offering VBACs. We actually have a separate code for vaginal delivery after cesarean.
And then we also have an attempted VBAC. So even if you attempt it and it is not successful and you end up ultimately having to do a subsequent cesarean, we pay you separately for that as well. So we do.
Representative Lee Johnson
Unverified
1:17:32
Representative Johnson. Yeah, I have a couple of questions. So I think we have two committees that we conflate a lot. One is the Arkansas Maternal and Perinatal Outcomes Quality Review Committee, and one is the Arkansas Maternal Mortality Review Committee. Is that correct that we have those two committees? You'll see me glancing down at my
phone because I could never have said those without cheating.
Do we know that – so help me understand the difference. Because we've mentioned – I've heard it mentioned in the testimony in the last rule. I've heard it referenced in testimony on this rule. The data that comes from these committees, and I think even maybe the people at the table are conflating a little bit what those
committees do and what their responsibilities are and what the differences is between those two committees. I don't know, maybe Mr. Gilmore could
Speaker 179
1:18:14
speak to that. Well, before I do, she did mention another committee
Matt Gilmore
Unverified
1:18:17
program that is actually going and implementing some of the things, the unbundling and that sort of thing.
Representative Lee Johnson
Unverified
1:18:24
So you want to speak to that and I can kind of. The
Perinatal Quality Collaborative? Yes. Yes. I'm sorry. So let me make sure I understand. So we have three committees. Apparently. Okay. So tell me
that third one I was unaware of. This is good information. I'm glad I'm here learning. Me too. Tell me about the Perinatal Collaborative Committee because it doesn't shock me that we have three different committees doing very similar
Speaker 20
1:18:47
things, but I'd like to understand the nuanced differences. Sure, and I believe it is housed with UAMS, is that correct? So they would know more, and Mr. Gilmore can speak to anything I don't know.
Matt Gilmore
Unverified
1:18:54
I think it's, and I'm not the expert, but I do think it's part of a grant. It scares me if nobody in this room is the expert, but go ahead. Well, I'm a guy up here talking about things that I don't. I appreciate you, Mr. Gilmore, you know. It is part of a grant they have received, is my understanding. And they're working amongst
Speaker 28
1:19:14
lots of different stakeholders, us, DHS, and others. We do have Dr. Golden and then my nurse utilization manager, Kim Wilmont, both serve on the Perinatal Quality Collaborative. They look at data around maternal health, and they are helping to implement the AIM,
Speaker 191
1:19:25
which I never do remember. That's Alliance for Improvement in Maternal Health Care, I believe. Well, that's exactly right. Great. They're helping
Speaker 28
1:19:31
to implement those bundles as well as the Healthy Baby. That begs a question, right, because
Representative Lee Johnson
Unverified
1:19:35
you say they're helping to implement those bundles. How? How are they helping to
Speaker 28
1:19:39
implement those bundles? I believe they're offering, and again, I don't want to speak on behalf of them. Pearl McElfish is much better at this than I am. And I can give you the name of the person who heads the PQC as well. But I believe they're giving hospitals incentive, education and incentive to implement those bundles.
And I believe all but one labor and delivery hospital last time I talked to them had actually
Representative Lee Johnson
Unverified
1:20:00
done so. So those are two different real important things. Education is one thing, incentive is
Speaker 29
1:20:05
another. When you say incentive, what do you
Representative Lee Johnson
Unverified
1:20:08
mean? I'm not sure. Let me get that info for you. I'll connect you with them. You know, quality measures are something we at hospitals do regularly, right, through CMS. I mean, this has been a longstanding effective method, but the only way it works is if there are financial incentives tied to it. I mean, that's what value-based is. Correct. This
is a different reimbursement model where you tie reimbursement to performance. Correct. And so this one thing to implement, in my mind, is we put these in place.
Actually using the bundles is a totally different thing, correct? Yes. And I would venture to say that it would shock me if every hospital that delivers babies in Arkansas doesn't already know what AIM bundles are. And so, you know, I understand education. What I don't understand is the incentive, and I think that's the magic thing, right? If we're going to improve mortality outcomes, which is the Maternal Mortality Review Committee, and if we understand from that committee, and again, correct me if I'm wrong,
but I believe that committee's job is to review data and then just in a very generic, non-specific way say these could or could not have been prevented in deaths. Is that correct, Mr. Gilmore? That's correct, yes, sir. So how are we feeding information back to individual hospitals and providers to provide opportunities for a pre-med around individual mortalities? If they review a case at the Maternal Mortality Review Committee and they say, hey, we missed one here.
This one we could have saved. How are they relaying that information back to the hospital or back to the provider individually? Yeah,
Matt Gilmore
Unverified
1:21:42
I think the scope of the Maternal Mortality Committee and the Perinatal Committee that you're speaking of. those two different committees that seem to
Representative Lee Johnson
Unverified
1:21:49
be doing similar things yes they as
Matt Gilmore
Unverified
1:21:51
you said they are more focused on collecting the data and providing education to the public as to what happened and that sort of thing they're not while they may interact with those hospitals and don't dig into those cases and what happened it's not a whole it's basically just getting the data and
collecting it it's not really a and you know they're they're physicians it's a you know they meet
Representative Lee Johnson
Unverified
1:22:13
four times a year they don't i mean i'm just saying like my understanding from trauma you know we have a trauma preventative mortality committee correct yes sir and that committee differs something like that the name is yeah names i mean there's three different committees three different names i don't know it's the mortality review committee preventable mortality review committee for trauma the subtle difference between that committee that i think is really important in the mortality the maternal mortality committee if i understand it correctly is the
trauma committee because it redacts information because it sends things through a third party which is q source they actually provide real feedback to hospitals so when they identify a case where there was an opportunity for improvement where there could have been a preventable mortality they give the hospitals through our trauma tracks the opportunity to learn from that specific event and do it differently the next time is that correct yes sir
Representative Lee Johnson
Unverified
1:23:12
work yes sir yeah but the maternal mortality review committee doesn't have that that not only does that have that capability they don't can't legally do this i
Matt Gilmore
Unverified
1:23:23
would yes it's it's this is this is this is the committees you're speaking of that we have currently around this are mainly collecting data and it's not so much going back and working with the
Representative Lee Johnson
Unverified
1:23:34
physician and so would you say an important part would you say that an important part of quality improvement is
providing individual providers and hospitals with feedback on when they could have done a better job i mean it feels like
the most important way to move the needle on mortality is not just to say hey these could have been prevented but to be able to provide the feedback directly to hospitals and providers this is how you could have prevented it learn from this opportunity wouldn't you agree that would be a better mechanism of trying to provide feedback to our providers yes sir i
Matt Gilmore
Unverified
1:24:05
think the scope of these two communities we're speaking of we didn't have the data back in 2019 we didn't know how where how bad or how good the situation was with our maternal mortality and that sort of
thing so these communities were formed just to kind of collect that data put these reports out there that we give to y'all once a year and you know they only meet four times a year
Representative Lee Johnson
Unverified
1:24:28
it's you know i understand now we found out the data is really
bad and so yes it's a different scope so how do we how do we then move the needle on providing improvement it sounds like through trauma the way we did this if i recall is we were able to reduce by over 50 percent in a 10-year time frame our preventable mortality and trauma is that correct yes it's been very successful and we did that through a trauma system that was a statewide system of care that allowed for feedback
when we identified opportunities opportunities for improvement back to providers so they could learn and get better at what they do is that correct yes and
Matt Gilmore
Unverified
1:24:57
i think some of the hospitals are actually trying to improve about
we've made lots of progress and they're actually trying to increase their trauma rating to get a higher level because of the successes they've seen. So would you agree that we could, if we wanted
Representative Lee Johnson
Unverified
1:25:07
to as a state, create a system around maternal health that would mirror what we're doing in trauma? That would be a decision for y'all. But it's something that could be done.
Matt Gilmore
Unverified
1:25:18
I see the point you're trying to make. Yes, sir.
Representative Lee Johnson
Unverified
1:25:20
Okay. I would love to have more information about the subtleties between those three different committees. And if there's opportunity, you know, how much are those committees, it seems like they were probably formed at different times in different silos so i would love to have some feedback on how those community how those committees interact and what kind of data they're sharing and is there room or possible room for maybe consolidating some of those committees so that we could have a more efficient way of sharing this data will
do all right seeing no more questions rule c stands reviewed without objection with that we'll move
on to Rule D and we will excuse all of you guys from the table. Matt,
you're welcome to leave at this point. We will invite Kristen Morrison and Bailey Taylor to the table for the Department of Energy Environment Rule.
Speaker 251
1:26:28
Good morning, Bailey Taylor, Chief Administrator of Environment and DEQ Director. Good morning, Keisha Morrison, Chief
Counsel, Energy and Environment. You
Senator Missy Irvin
Unverified
1:26:48
guys are recognized to proceed. Thank you. We're here this morning seeking review and approval of pollution control and ecology commission's rule regarding water quality standards this rule making was necessary to comply with the federal clean
water act and to make necessary updates for the code of arkansas rules the clean water act requires the agency to review its water quality rule every three years to determine if any changes are appropriate and during that triennial review deq determined that some changes were necessary and director taylor will address those changes in a moment in addition to those substantive changes there were some stylistic and formatting changes that were necessary to comply with the code of
arkansas rules this rule has not yet been codified but upon review and approval it will be
Speaker 251
1:27:43
and with that i'll turn it over to director taylor hi good morning so as miss morrison
Speaker 253
1:27:49
mentioned there were were some stylistic changes, some grammatical, and then anything to provide clarification where we could. But for the substantive changes, there were some criteria additions. Those were cadmium 5 toxics, which are hydrocarbon related, benzene, toluene, ethyl benzene, xylene, and phenol. And
then we also added a standard for E. coli. And then there was one criteria revision, which was for ammonia. We extended the primary contact season to include April and October. That mostly plays into the E. coli bacteria aspect of that. We know that in Arkansas, folks are citizens and tourists are still recreating in October, and they can begin as early as April, if not before.
And we also added some site-specific pH and dissolved oxygen criteria. That was through research and studies we were able to determine that these water bodies could meet different criteria other than the statewide requirement. And then we revised the ecoregion boundaries. These are consistent with what other state agencies and federal agencies use. If you see the map in your packet, you can see that the line just kind of follows geologic formations.
it moved slightly so generally the eco-regions are the same but we did update those lines to be consistent with what other agencies use and then we updated the ecologically sensitive water bodies to remove trout waters from bull shells grose ferry and washtaw these were in response to comments from arkansas game and fish and then we removed the exception for no fishable or swimmable or domestic water supply use from coffee creek in cross it i'm happy to take any questions
Representative Jack Ladyman
Unverified
1:29:49
thank you mr chairman i'm here a couple questions um you
had quite a few comments on this rule and i understand it's a big rule so that's that didn't surprise me but there were at least two cities, municipalities, that had more than one comment, and that was Jonesboro and Springdale, and I'm sure there were other cities that had that same maybe concern and didn't comment. But they were talking about the bacteria and the ammonia, the new standards,
and reading through these comments, it seemed to me that their issue was, I'm on page seven here, but their issue was Implementing this not so much the Value, but you know, how do they implement it? Do they have enough time to implement it? Sometimes it You have to buy new equipment. It takes a long time to do that. And then they talked about their NPDES permits You know that this these changes should be implemented at the time of the renewal of the NPDES permit
So there was a number of questions there. Can you all just kind of summarize your responses to that? I mean,
Speaker 255
1:31:02
were those concerns met? Yes, sir. So as far as the E. coli goes, permittees can expect to see the E. coli and fecal limits replaced with the E. coli. The treatment
Speaker 253
1:31:14
is the same. The testing is the same. E. coli is just a better representative test. So that should have no impact. We don't expect that to be any impact to facilities.
For the ammonia, we will follow what's allowed in
Speaker 255
1:31:28
the Clean Water Act, and that means that on the renewal, when we're already opening up the permit, and if we see new limits are needed, we will do that, and we can offer optimization, and we can offer a compliance schedule. So that means that facilities on their renewal can expect that if they're not meeting
Speaker 253
1:31:50
certain ammonia limits or requirements, they may have the opportunity to spend the next permit cycle optimizing their plant to see if they can then meet the plant
through process improvements or meet the limit through process improvements. And then they would have a three-year compliance schedule, which gives them three years on their existing limit before the new limit takes place. And this may be a blanket water quality criteria for the state, but it is not a blanket effluent limit. We will review each permit on a case-by-case basis, whether their technology is available to meet this, you know, a new limit, whether they have
the economic ability to meet the new limit. There's
Speaker 257
1:32:33
many tools that we have in order to meet each facility's specific needs. So
Representative Jack Ladyman
Unverified
1:32:38
these two pollutants that we're talking about are those primarily on NPDES permits for municipalities
Speaker 255
1:32:46
or for industry? For E. coli that would be mostly municipality. Industry it would depend on their process but municipality I would say unless there's a
Speaker 260
1:32:54
specific item in the industry process that would result in the ammonia. All right different
Representative Jack Ladyman
Unverified
1:33:01
question you mentioned find it here well you mentioned these solvents that are our health issues you know tylene benzene ethyl benzene xylene and phenol and tylene is a carcinogen benzene is and phenol and xylene affects liver and I mean I understand there's health issues there but these are all solvents and they evaporate and so i mean if you set a drum of xylene outside and
open the bung on it why it's gone in like a week these evaporate they don't typically mix with water now they might but typically they don't so my question is why what's the science behind requiring testing for these things that evaporate when they're exposed to sunlight or heat or whatever why are we doing this this is for if these toxics can be
Speaker 253
1:33:57
found in the waste stream of the wastewater treatment plant and can be expected to be discharged so they are found
yes they yes sir they are found but the facilities that would be required to meet these limits are already meeting the limits through their discharge so we don't expect any
Speaker 255
1:34:17
financial impact to the specific specific facilities that are discharging these pollutants
Representative Jack Ladyman
Unverified
1:34:22
so are these Is NPDES permits primarily for people who manufacture these chemicals? If they use
Speaker 251
1:34:28
it in their process, then we can expect it to be discharged, and
Speaker 253
1:34:33
so that's why we're monitoring for it.
Or if there's a municipality with an industry that pumps to them a pretreatment that they collect and it flags on a priority pollutant scan, then we can expect it to be discharged and they would have to monitor. But everyone in this case is already meeting the limits that we've prescribed
Representative Jack Ladyman
Unverified
1:34:57
here. So is there a good test for checking the quantity of these pollutants? Yes,
Speaker 260
1:35:05
sir. Yes, it's very common. Most labs have that ability.
Representative Jack Ladyman
Unverified
1:35:09
So there's no problem that the entities that have permits in meeting this requirement? No, most
Speaker 255
1:35:15
are already testing for it. They just don't have this specific limit. All right,
Representative Lee Johnson
Unverified
1:35:26
thank you. Representative Johnson. Thank you, Mr. Chairman. So I want to make
sure I understand surface water, surface waters, how do we define surface waters? Is
Speaker 264
1:35:39
that just any? Waters of the state can mean anything.
Representative Lee Johnson
Unverified
1:35:43
Not like a pond? Yes, sir. A pond in my backyard is surface waters? Yes, sir. Okay, so any water flowing standing that's in the state of Arkansas falls under this rule? Yes and no. So, yes, it does. I mean, I'm just trying to learn. I don't have any reason to oppose the rule, but I would like to learn while I'm here
Speaker 251
1:36:05
a little more about it. Yes, so we did not change the definition of waters
Representative Lee Johnson
Unverified
1:36:08
of the state or surface water. Sure, no, I understand that. But to understand the rule, I'd like to understand kind of as a baseline what are we saying surface waters are.
Speaker 253
1:36:15
So we are focusing on dischargers that are permitted dischargers. But as far as the pond in your backyard goes, if someone were to dump a toxic, you know, a pollutant in there, then we would have the authority to claim someone impacted waters of the state. It would be a violation of the Clean Water Act through that. I understand that. And
Representative Lee Johnson
Unverified
1:36:38
when you say dis, you're focusing on dis, you use a term I'm not
Speaker 251
1:36:44
familiar with, discharging. Municipalities, industries that have a pipe where they
Speaker 253
1:36:47
collect wastewater, treat it, and they discharge it from the pipe.
We're concerned with the end of pipe. Yeah,
Representative Lee Johnson
Unverified
1:36:54
and this rule is around what to expect in surface waters at
Speaker 253
1:36:59
the end of that pipe. Yes, and so this is for the ambient kind of water quality criteria. And what our permit engineers do is they take this and they back calculate what those
Representative Lee Johnson
Unverified
1:37:12
effluent limits should be. Okay. So there's a section here that talks about primary contact recreation
season, and it sounds like we're extending that season. Yes, sir. What is the primary contact recreation season?
Speaker 253
1:37:24
That's where we would expect folks to be swimming, recreating in the water, and so there are lower limits for bacteria, especially from dischargers that we expect during the primary contact season. Okay. And
Representative Lee Johnson
Unverified
1:37:37
what was the thought process behind expanding that, and how long has it been
Speaker 251
1:37:43
currently the current season? Um, the, it's mostly been the current season, uh, May through September,
Speaker 255
1:37:48
uh, as long that I recall of this rule being, um, effective, but the thought process is that we're seeing people
recreate in October and April. Um, interesting. So your, your
Representative Lee Johnson
Unverified
1:38:00
perception at your department is that people in Arkansas in the year 2025 are swimming more often in March and October than they were in the year 2020 or the year 1980. Not necessarily that it's
Speaker 251
1:38:14
changed, but that when we open this rule up every three years, how can we
Speaker 253
1:38:19
make this better for Arkansans, the state of Arkansas, and to be compliant with the Clean Water Act?
Speaker 257
1:38:27
And this is a minimal effect on facilities, too, because they already disinfect their wastewater.
Representative Lee Johnson
Unverified
1:38:33
It's interesting to me that after 100 years
plus of the swimming season being march to september was it based on rural comments that we had that we decided to expand
Speaker 271
1:38:43
that to april there were no comments
Representative Lee Johnson
Unverified
1:38:45
regarding the are there other states expanding the recreational contact season i'm not
Speaker 253
1:38:50
sure what other states uh primary contact season i know that it would vary from state to state and we can do that research
Representative Lee Johnson
Unverified
1:38:58
but the perception was more people are swimming
Speaker 255
1:39:00
it's it was necessary to be protective during april and october while folks are recreating but in the
Representative Lee Johnson
Unverified
1:39:07
past we haven't felt like it was necessary in april and october we felt
Speaker 255
1:39:12
like may to september was sufficient um
Representative Lee Johnson
Unverified
1:39:16
i can't speak to the past because it's part of the rule i just wonder why we're deciding now to change the recreational season when it's been in effect
Speaker 255
1:39:30
for long time yeah I don't well just because that of the recreation occurring in April and October we
Representative Lee Johnson
Unverified
1:39:36
wanted to and did you collect data on that recreation was that just sort of a an anecdotal feeling
Speaker 253
1:39:42
about recreation in April and there was no anecdotal stakeholder engagement
Representative Lee Johnson
Unverified
1:39:46
fair enough that's fair enough thank you I
Speaker 192
1:40:00
don't have any other questions any further questions from the committee seeing none the
rule stands reviewed without objection seeing no other business uh we did add uh the request from representative johnson to the july
meeting schedule uh we will be moving our meetings to monday and tuesday until september Am I correct, Ms. Caitlin? So seeing that, we stand adjourned.
Agenda
A. Call to Order
B. Department of Human Services (DHS), Division of County Operations and Division of Medical Services, Review of Rule, Pregnant Presumptive Eligibility [Exhibit B]
1. Elizabeth Pitman, Director, Division of Medical Services, DHS
2. Lori McDonald, Chief of Staff, DHS
C. DHS, Division of Medical Services, Review of Rule, Obstetric Professional Rate Increase and Unbundling [Exhibit C]
1. Elizabeth Pitman, Director, Division of Medical Services, DHS
2. Lori McDonald, Chief of Staff, DHS
D. Department of Energy & Environment (E&E), Division of Environmental Quality, Review of Rule, Rule No. 2, Rule Establishing Water Quality Standards for Surface Waters of the State of Arkansas [Exhibits D1-D2]
1. Kesia Morrison, Chief Counsel, E&E
2. Bailey Taylor, Chief Administrator, Division of Environmental Quality, E&E
E. Other Business
F. Adjournment
Documents
Speakers
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Representative Jack Ladyman
Unverified
Senator Fredrick J. Love
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Chair
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Representative Mary Bentley
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Representative Lee Johnson
Unverified
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Representative Fred Allen
Unverified
Representative Jeff Wardlaw Chair
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Representative Aaron Pilkington
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Matt Gilmore
Unverified
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Senator Missy Irvin
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