Public Health, Welfare and Labor Committee - Senate and House
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- October 2, 2026
Representative Jack Ladyman
Unverified
7:28
this category is to provide temporary coverage for prenatal care to women who attest to being pregnant and meeting other eligibility requirements, while, um, we are determining the full eligibility. So the goal of this is to get healthcare coverage. Uh, and access to prenatal care approved faster, um, the eligibility criteria include declaring to be pregnant, um,
If they already have health care coverage that would cover pregnancy, then they wouldn't need this, um, and then we accept self attestation on their income and state residency. In order to determine eligibility for this new category. And, um, we, and there will be one presumptive eligibility pregnancy period allowed per pregnancy, and it is temporary coverage, um, It will be for 2 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 Ladyman, you recognize. Department
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. 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. Thank you. Send her love, you reckon. Thank you, Mr. Chair.
Senator Fredrick J. Love
Unverified
9:44
Um, Ms. Pitman, I, I wanna. Talk about the anticipated federal cuts that we are are federal cuts that we're anticipating for Medicaid. How does that Impact this program if, if it,
Speaker 20
9:59
if at all. Oh, I don't anticipate that those particular federal cuts around our home and uh expansion population would have anything to do with the pregnant women's population. OK, so you don't
Speaker 21
10:11
anticipate any of the none of those are targeted,
Speaker 20
10:13
targeting this population. So there's no direct impact to this population, no, sir. OK. All right. Thank you. Representative Bentley, you
Chair
Unverified
10:19
recognize. Thank you, Chairman. Thank you all for being here today.
Representative Mary Bentley
Unverified
10:25
I'm excited about what we can do with some improved maternal health with this, um,
just quick question. So on this, uh, patients go to the physician's office, uh, for that first visit. Are they able to, is the physician's office able to get information they can be seen that day. I know sometimes they just show up and, uh, looking for payment is just, do we have communications going through with our providers that they can. I think they're gonna ask could they actually be seen that day and, and how that is that we have that communication going with our providers is what I'm asking. So there's a, a couple of things that we
Speaker 28
10:55
can talk about there. One, I think we can add a communications plan to
physicians' offices, OBs, PCPs, um, FQHCs to make sure they understand the presumptive eligibility and encourage their clients to come and see them at pregnant to go ahead and apply for that. Um, 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 later 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 even if they were SNAP eligible,
Representative Mary Bentley
Unverified
11:41
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. If they, when they submit an application, of
Representative Jack Ladyman
Unverified
11:51
course, they can apply for all of our programs and 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 Johnson, you reckon us. Thank you.
Representative Lee Johnson
Unverified
12:22
Thank you, Mr. Chairman. So the, when you say, did, did I hear you say that it won't be retroactive, that the presumptive eligibility won't be retroactively presumptive eligibility is not retroactive.
Speaker 5
12:34
However, it, when someone is approved for the
Representative Jack Ladyman
Unverified
12:36
full coverage for pregnancy, that is retroactive. So if they happen to have medical charges related to the pregnancy before the, the day that they apply for Medicaid, then it will go back when we do the permanent. Um, the full coverage for pregnancy. Do, do we have a sense of how many of these women are
Representative Lee Johnson
Unverified
12:57
gonna eventually qualify for one of those programs versus how many are gonna be in the presumptive
eligibility category and then not be retroactively reimbursed? Is that something we have a sense of? So, um, It
Representative Jack Ladyman
Unverified
13:12
really will depend on, 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, um, 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 at the elec with the electronic sources. So that would be the only reason we would pinned a regular application and I 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
Representative Lee Johnson
Unverified
14:06
how many are eligible. I have a follow up and I'm happy to step out
of the queue if you, if you need me to, Mr. Chair, but I have another follow-up. So if I, I thought I heard you say a, a, a little bit ago that, that it would,
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, if the presumptive application is completed.
You don't need any more information down the road, is that, am I misunderstanding what
Speaker 5
14:36
you're saying? So the presumptive application is the
Representative Jack Ladyman
Unverified
14:40
same application for full coverage. So when they complete that application, we're going
Speaker 41
14:45
to determine them for presumptive and for regular healthcare coverage. If we anticipation is that the application would
Representative Lee Johnson
Unverified
14:51
be complete. It's dependent on that, the,
if the presumptive application is complete, then there's no more information you're going to need that, no, the,
Representative Jack Ladyman
Unverified
15:01
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, 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 compared 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 gonna 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 know that
Representative Lee Johnson
Unverified
15:46
I exactly understand, but I have more questions. I'll just get out of the queue and come back
Representative Fred Allen
Unverified
15:56
in later. Representative Allen. Thank you, Mr. Chairman. Thank you for being here today. We could you go back to your two-month comment. You said something about a two
Speaker 5
16:04
month period. Yes, sir. The presumptive eligibility category is temporary, and the purpose of it
Representative Jack Ladyman
Unverified
16:10
is to, 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 that, it's temporary, it, it won't last the entire pregnancy. It, it, it will last through the month after we approve it, which is 2 months and then, um, 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. full determination. What's
Representative Fred Allen
Unverified
16:49
what's magical about 2 months. The That that is
Speaker 5
16:56
that is. Part of the EMS rules around presumptive coverage. Um So we can't approve it long term. It
Representative Jack Ladyman
Unverified
17:03
is intended to be short temporary coverage while the woman is going through the
process to get the full determination. OK, thank you. You're welcome. Members, I say the same thing
I said during sessions so the Senate can hear it. I, I don't need to know if you need a follow up, just ask your questions. You guys represent a district that
needs to be represented in its whole heart, so just. Question the members if it gets out of control, I'll stop it, um, that is my job. Representative Pilkington, you
Representative Aaron Pilkington
Unverified
17:35
recognize. Interesting you made that comment before I started, but you know, I appreciate y'all being here. I appreciate this rule, and, uh,
mine's just a little um 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, as soon as they're a little more transient, then 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 of this rule, just kind of more curiosity on this point. Um, yes, sir, thank
Speaker 69
18:16
you for the question, Janet Mann, DHS. The the long-term goal will be to involve community health workers, um, they are not active
Speaker 71
18:23
yet in Medicaid. Y'all did pass that during session. We're working on that certification in that process. So that rule will. Come before you later, hopefully this summer or early fall, but, um, and then back to previous question, um, 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 their information or as much as
possible to not stop the process, so no, there's no
Representative Jack Ladyman
Unverified
18:58
gap in coverage. Fantastic. Thank you. Representative Laderman. Thank you, Mr. Chair. Uh, Just, uh,
well, thanks for bringing this rule. I, I really like it and I think it'll help us, uh. I like everybody else, am 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, to try to fix that. And I think
this is a very good cornerstone for that. Um, but I believe, because we have such small Data, small numbers, so if we can say 1 or 2 babies it it probably move us up to number 40 because we have such a small number that we're looking at a small pool of data. And a lot of these uh 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 gonna 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, sir. Definitely, wholeheartedly with everything you said there, including Arkansas
Speaker 28
20:04
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, um, including Doulas, CHW's, 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 state, so.
Representative Jack Ladyman
Unverified
20:52
And I, 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 just to, you know, not be
Speaker 69
21:14
left not saying anything. I would also like to add something that you mentioned Representative Leman was on the data piece. Um, this rule today
Speaker 71
21:22
and then the next rule that, um, Doctor Pittman will present on the rights 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
21:42
our attempt to gather some of that data as one of the largest payers for deliveries in this.
Representative Lee Johnson
Unverified
21:53
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 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? So do we have a sense of how women are applying for Medicaid
in Arkansas. You, you mentioned a number of ways that women can
apply for Medicaid. What, how, how are they
doing that in Arkans? What, what's the most common pathway for women to apply for Medicaid? I
Representative Jack Ladyman
Unverified
22:32
have some data on that, but I did not bring it with me, but, but we get applications in through all avenues more, uh, paper and online than by phone and paper and online, going from memory, but
I can get you the, the number, um, it's almost equal. So when you say
Representative Lee Johnson
Unverified
22:49
paper and online, those feel like two different ways. So that sounds
like 3 different ways. Um, have your memory serves half its paper and online half its. 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 applications. So it could be all
Representative Jack Ladyman
Unverified
23:22
of the above. I mean, online, our portal is, um,
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 physicians' 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 also 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, it's we don't have a sense of what percentage of the time they're doing it from what location or
Representative Lee Johnson
Unverified
23:57
where? No, it feels like that would be important information to have. I mean. If one of the most important, uh, 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, it's because the, you know, we're not connecting with them in the right way. It feels like the only way this, 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, 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, uh. qualifies for Medicaid, is that in some fashion as long as they have, as long as they're not
incomed out? Is that the only, the only reason? As long as they meet the income limits,
so any any woman in Arkansas who 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, that,
Speaker 69
25:38
is that data we can get? We have struggled with how to get that data because if they don't apply and
Speaker 71
25:43
we don't have any 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 doctors' care in the 1st trimester, 2nd trimester, 3rd 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 because it feels like you could look at that retrospectively
Representative Lee Johnson
Unverified
26:11
because 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 gonna 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 3rd trimester.
Speaker 97
26:33
And is that data we could get that's the self self attestation data that
Speaker 71
26:40
we had that we had over 1000 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 2nd 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 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, um, visit. So really trying to adhere to the best practice and open that up as an option. I, I do, I want the data just as much as you keep asking me about it. I, 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 it's hopefully our attempt to gather some
Speaker 69
27:45
of that data we have demographic information on these
Representative Lee Johnson
Unverified
27:47
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 it? Because you didn't have a primary care doctor, we have the ability, I would think to survey
these people and ask them some of these questions. I, I think I would like
Speaker 71
28:13
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 but I think it's important to bring up these questions. I mean, we're talking about
Representative Lee Johnson
Unverified
28:25
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, 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, I would love to see more information about the questions that I was asking you specifically around, you know, the percentage of women that are applying, how are they applying if they're applying online, is it in a 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, uh, 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? Well, they've delivered, then we would want to
Speaker 71
29:32
connect them to Medicaid because they're, there's no reason for presumptive eligibility for pregnancy, and that's my point.
Representative Lee Johnson
Unverified
29:38
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 presumptive. Yes, we want to make
Speaker 104
29:47
sure that the mother is covered, but also we want to make sure that the baby is covered and we have
Speaker 71
29:53
a working relationship between DCO and DMS and the hospitals and other delivery, um, avenues that we're trying to improve upon that between the delivery and getting
Speaker 74
29:59
the baby on Medicaid, but also making sure that the mom is still covered. And the what appropriate category attestations you mentioned, I may have just missed that data
Representative Lee Johnson
Unverified
30:08
when was that something you shared with us or was that you said that was what came through
Speaker 74
30:12
the strategic maternal health. committee that was, um, publicly available data from the Department of Public Health. Could you or maybe the Department of Health here,
Speaker 83
30:18
maybe you could share that with us as committee members. I
Representative Lee Johnson
Unverified
30:21
would like to see that data. I, I will get with the Department of Health and make sure that you get it. And I also just
Speaker 83
30:28
wanted to add one thing. I don't know about surveys, you know, there's,
Speaker 108
30:31
there's rules around what you have to require, what a woman can be required to answer, a person can be required to answer when they apply for
Speaker 28
30:39
Medicaid or receive services. So it has to be optional. But one thing we are trying to do with a contract that we've put into place around, um, targeting pregnant women in 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 a. applying what prohibits you from going to the doctor, those types of things. I would love to see that. I have one more
Representative Lee Johnson
Unverified
31:01
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. Um,
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 is that, if
I understand it right, did you, is that what you said around presumptive eligibility? So presumptive eligibility is only
Speaker 102
31:41
good for 60 days. So it's, it's very hard. But if I'm seeing someone for the first time and they don't have
Representative Lee Johnson
Unverified
31:46
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 gonna get paid for that visit? If If they apply for
Representative Jack Ladyman
Unverified
32:00
Medicaid that same day and then, yes, they would get presumptive eligibility that day, assuming they attest to income that meets the limit in an emergency department setting, I'm required
Representative Lee Johnson
Unverified
32:11
to see them before asking information. So I'm gonna see them in the emergency room. I'm gonna take care of them. I'm gonna
do everything I'm gonna do, and then at the end of the visit, once I've finished the visit, then we're allowed to ask information on insurance is if I get them connected with presumptive eligibility, will that be an emergency visit be paid through
presumptive eligibility if they apply then and they're approved
Representative Jack Ladyman
Unverified
32:31
or presumptive, it'll, it'll be the first of the month during the month they apply, so it depends on, you know, it depends on the exact date, but, and then if they're approved 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, um, and we also determined 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, 3
months from May the first 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
33:27
same time, but it is possible that the full coverage will even start. For the presumptive because full coverage does allow for retroactive coverage, right, but that's only if they
Representative Lee Johnson
Unverified
33:36
ultimately Representative Johnson, we're going to move on to someone else. I'm, I'm happy to move on
Representative Aaron Pilkington
Unverified
33:45
to someone else. I'll be get back in the queue. Representative Pilkington. Thank
you. And my comments more directed to Representative Johnson. Uh, I, I think, I mean, we're, 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, um, you know, hospitals, clinics, things like that that are going to be advertising this to come in and just be seen that day if you've got issues, if you've got, you know, I mean, uh, 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 gonna
lose the baby, you know, but they don't have Medicaid, so they don't 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. 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
Chair
Unverified
34:40
Love, you recognize us. Thank you, Mr. Chair. Um. Let me go back to.
Senator Fredrick J. Love
Unverified
34:46
Almost were uh senate uh Representative Johnson was, but do, do we have a number, you talked about at the station. Do we have uh anticipated number of women. That we think we're going to. Uh, qualify for person of 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 it, is it, I mean, just, just. I just want to understand. I'm
trying to frame this up so do we
Speaker 71
35:21
have that number? I will start with what we do have in data. She's trying to look something up for you, Senator Love. So, um, there are roughly 32 to 35,000 births in the state of Arkansas annually. Medicaid has paid, um, historically 48 to 50% of for those births. 1717 to 1000 depending upon the year is what we currently have. covered historically. So with
paying for those births, we, um, 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, um, worked with, um, Department of Health on, there was roughly, um, I think 11,000, um, women that had self-attested to no care. So somewhere in the middle. I, I don't, 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're trying to. do this, trying to get that, that, that group of 1000 women
to be able to have access to prenatal care if, if they qualify and then, you know, the up, upward band of 1700 to 19,000 that we currently pay for now that they're having additional access to doctor visits and deliveries.
Senator Fredrick J. Love
Unverified
36:35
OK, so we can anticipate that roughly about 17 to 19,000 people, uh, women will qualify for for this program. OK. Number 2 then, do we, do we have enough providers. OBGYN signed up.
Speaker 104
36:50
To accept or we, we are focused on OBGYNs, but we're also focused on family docs
Speaker 71
36:57
with OB certified nurse midwives. We, we never have enough providers. Let me just be, so I, I'll take, I'll, I'll take all the clinicians that can deliver children that want to
Speaker 83
37:06
be a Medicaid provider if they will fill out the provider enrollment, we'll take them today.
Senator Fredrick J. Love
Unverified
37:12
OK, so, but I guess. I guess the women go in and they have their own provider, then they, their providing didn't
have to apply for Medicaid and the
Speaker 71
37:25
freedom to choose their provider if the, if, if it is a Medicaid provider. We do not, we do not direct them to a specific provider, let
Senator Fredrick J. Love
Unverified
37:34
me ask you this then, do, do OBGYNs usually accept Medicaid? I mean, just in, in the general fashion, I mean they,
Speaker 71
37:40
they do accept them. We, we do not have a large number, I believe. Um Um, I would have to go look at the most recent statistics, uh, from the Medical Society and other, um, publications, um, in
the state. So that is why, um, especially in different sections of the state, we, we want different types of clinicians to be able to open up that access to care. OK. And then, so
Senator Fredrick J. Love
Unverified
38:05
then I'm going to go um to kind of like a. Back to where they were talking about how we, how we get the word out now. Have we already launched this program or sir. It is scheduled
Speaker 133
38:19
to go live July 1 with approval of these rules and CMS approval. And so there will be
communications to beneficiaries and to providers through multiple streams of communication
Speaker 74
38:33
different types of communications with providers and associations. OK, scoot up to the mic because you you're, you're. Alright, so, so are we,
Senator Fredrick J. Love
Unverified
38:44
we're doing a media campaign about this or or we just. Well we're just doing the traditional we're doing our
Speaker 71
38:51
traditional, um, communications. Also, these are lessons learned that were successful during the
public health emergency. We learned that, um, communicating through providers, sending communications through our billing, communicating with our beneficiaries, digital billboards in our county offices, digital billboards and providers' offices, working, um, with different, um, uh, groups, but really on our social media also, we found that to be a effective on communications with during
Speaker 74
39:19
the public health emergency. OK, so not necessarily it's
Senator Fredrick J. Love
Unverified
39:24
going to be a a campaign, but
it's just, it may be a different kind of campaign, not, not a bunch of TV, but sir,
Speaker 71
39:34
Medicaid really doesn't have, um, the band, not well, the budget or the ability to do a a 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 and that have been proven to be
Speaker 74
39:50
success. OK, and then my last question is, because I, I heard you
Senator Fredrick J. Love
Unverified
39:54
talk a little bit about Department of
Health and so when we are rolling out this information, this information campaign, that's just called an information campaign. Uh, when we're rolling this out, uh, are we talking about not only at the the DCO offices, but also at the Department of Health, uh. County, uh, you know, county
officers or public health units ADH is a good, is a very good partner and
Speaker 71
40:21
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, um, in 5 counties, and, um, and that's really all I know. I would, I would have to defer to them to, to tell you about that, but it's successful and we continue to work with them on the presumptive eligibility on and trying to help. with access to care for
Speaker 74
40:44
women to seek clinicians. Well, I think, go ahead. I was just gonna add to what Jane was mis Director
Speaker 29
40:52
Mann was saying, um, I've known her a long time. I'm sorry. Uh, 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, and we actually have a separate MOU with them around those services, where we, you know, pay them directly for those, um, and we're 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. OK. All right, thank you. Thank you, Mr. Chair.
Speaker 149
41:20
Representative Richardson, did you have something? Representative Johnson.
Representative Lee Johnson
Unverified
41:39
Thank you, Mr. Chairman. Uh, and Representative Pilkey, I had a nice sidebar. I just wanted to be clear on, on the comments he made. So if 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. Um, and the point I was trying to make, which I've made several times here in the committee is that, you know, Itala requires us in hospitals to see patients without asking information about insurance. I cannot ask you, do you have insurance? Do you have
Medicaid or I can't ask those questions. It's illegal. I have to see and appropriately so. I, 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, 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, you know, pretty good percentage of them are not. 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. So 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 asked them if they
have insurance. And then we asked them, do you have insurance? I don't have insurance. OK, let us see if we can't get you an application for Medicaid. If I'm understanding this policy right and 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. What are you 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 gonna fix the problem that I'm seeing in the hospitals and and Mary Franklin's
Speaker 71
43:53
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 At the same time, the self attestation does the presumptive eligibility, then the work is done on the, um, regular
application that does have retroactive, that by doing that, our intent is to make sure everyone gets paid in every
Speaker 69
44:22
situation. And so if we are creating an unknown bottleneck or gap that is not our intent. But you understand hospitals are
Representative Lee Johnson
Unverified
44:30
already going through the process of patient supply. So today, today. If that same pregnant
Speaker 69
44:35
woman came to your ER and you saw her and you had these questions. I'm not sure the process would be very
Representative Lee Johnson
Unverified
44:45
different. And that's why I'm trying 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, which 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 healthcare
system for, uh, with Medicaid. Or who ultimately ended 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.
Speaker 108
45:16
I don't believe we have that data. Is that data we could get? We can try. I don't know for sure because of the way we're
Representative Lee Johnson
Unverified
45:25
currently collecting our data if we're going to be able to get that for you 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 the hospital and it feels like that's important information to have if, 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'm just need to quit asking questions and go back to the house. So part of this is getting
Speaker 28
45:59
into the second rule, so apologize for that, but part of the what we're doing with the part of the issue is because we use that global payment that we're unbundling in the 2nd rule. We don't, 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. Um, 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. And so we have an all payers claim database in Arkansas, correct?
Representative Lee Johnson
Unverified
46:34
would that information be available to the Apa claims database? The global fee goes to the all-payer claims database, if that's what we pay. So is
Speaker 28
46:40
that information we could request from ACA? We, I mean we find what we have. All I'm
Speaker 163
46:48
saying is our claims data, but, but as a state, we have
Representative Lee Johnson
Unverified
46:51
more information than maybe what you have. What about Cher? What can we find out through Cher? We can look through. We actually do have an MOU with the health
Speaker 28
47:00
department to hit against Cher 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. Remind me who runs shares that An Santofer. No, but I
Representative Lee Johnson
Unverified
47:12
mean that's part of the department of health. I'm sorry.
Department of Health Department of Health Department of Health in the room, do you want to come to the table and let me
Speaker 28
47:28
know if that's information you could get through Cher. 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 can't imagine. that feels like working
Representative Lee Johnson
Unverified
47:57
in the emergency department at the hospital. I understand. So
Speaker 20
48:00
I just wanted we that was not one of the problems raised, but this is directly to to address that problem, so that when they're able to make that transfer,
Speaker 28
48:07
that woman does have that presumptive eligibility and that OBGYNs, I just understood what percentage of the women were
Representative Lee Johnson
Unverified
48:15
accessing the system through the hospitals versus the clinics, then maybe
that would be helpful, um. I'll wait for an ADH center to do some sales. Matt Gilmore, Department of Health. Uh I'd have to
Speaker 172
48:26
check. I, I don't see why we couldn't get
Matt Gilmore
Unverified
48:31
it more frequent than once a year, um, when you say more frequently than once a year, what are we getting
Representative Lee Johnson
Unverified
48:36
once a year to share? Well, she missed that. Oh yeah, so
Speaker 28
48:41
we, 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 Cher has on them, or that the vital records, the birth certificate contains, because it contains that self attestation information that Director May 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 grants. Mr. Chairman, if I may, uh, I would love love to see it in the
Representative Lee Johnson
Unverified
49:08
next agenda of the public health meeting or at a a agenda of a public health union 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 SAR, 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 SHAR with, uh, the information I'm trying to get through DHS. We agree, and
Speaker 28
49:37
one of the things we're doing with the forming maternal health grant is also trying to encourage providers to give more information to share, so that we have better information on, on pregnant women. So we would love to have that conversation with you, Representative. I may, to what she just said, not everyone
Matt Gilmore
Unverified
49:54
is connected to Cher, and so that and it's, it depends on the system they've got and what we can how we can connect. I mean, we try to be as flexible and easy as possible, but it does require, you know, some basic electronic capabilities and so, you know, I think that's something that, you know, we will, we will We'll help any way we can, but it's just not, it's not, um, I mean you you gotta have the technology side, I mean, it's every provider across the state. So it's, and it's, but there's also ways
to do it through all parish claims database. We can, I think we can get the data point and perhaps maybe the table between the two resources
Representative Lee Johnson
Unverified
50:25
that we have to share and what we have to the all pair
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, uh, to be clear, yeah, if we can have a conversation offline about that.
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 what, you know, how we, how we gonna solve problems so that
when we get to the session, we have meaningful legislation to put forward. I meant was that we
Speaker 28
51:02
have contracts with both Aai and um Cher to do maternal health data and analysis. And so if we can make sure we're addressing your questions in those public conversations that we very helpful. And to be clear,
Representative Lee Johnson
Unverified
51:11
I support this rule. I, I think it's a good rule. I'm not, I just want to be clear on what the limitations of this rule are. And I want to understand better from my perspective on the
way it pays hospitals at this point. I, I'm sorry if I've offended anyone, Mr. Chairman.
Representative Lee Johnson
Unverified
51:23
I'm just here asking questions and trying to learn. I don't mean to create
any impatience in the committee. Representative Ladyman, you
Representative Jack Ladyman
Unverified
51:32
reckon? Thank you, Mr. Chairman. And, uh, this may be a long question. I apologize if it is, but But I think Representative Johnson asked a very good question, and that is Uh, 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 4 or 6 years ago, something like that. He ran
a bill to allow ophthalmologists to do 3 minor surgeries at optometrists to do 3 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 Way came to me and he said, uh, Jack, is this been successful because that was the very first bill that we ran in this legislative to, 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 ask them, can you find out this data? How many of these have been done. Uh, 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, 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, uh, there had been 2200 of those surgeries done by optometrists with 0. 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 wanna 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 we have good
outcomes and I know that the mountain of data that you all have to worry with. I understand it's very difficult. But if, if you can code things to where they can be, um, picked out. Uh, what what's the word? Anyway, uh, where you can look at that column and get a total. If you can, if you can do better coding. On those elements like this. I, I think that would help you all, and it would help us to know what we're doing means something, and, and you as well.
So I don't know that's a question or not, but.
Speaker 97
54:05
Ah yes, sir, it is. It's a it's a very good question about
Speaker 71
54:09
how do we use the data, 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 cat 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, um, 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 did they relate? What can we do? I, I,
there's lots of things we, 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, one of the goals I think of our team and the maternal, um, 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 2 or 3 years old. So we don't
have 2 or 3 years to, 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.
Representative Jack Ladyman
Unverified
55:51
What You know, I think DLR research would have more access, not, 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 that where BLR might
have access where you just have access to your data. So it may be presented another way through another
Speaker 71
56:13
organization. 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 we, I'm, I'm sure we will have some duplication in those sources and additional sources that we've 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 healthcare system to address. And I'm going to harp on the transforming maternal health grain
Speaker 160
56:49
again, and I keep coming back to it, um, but it is a really good opportunity for Arkansas
Speaker 28
56:54
and all of the partners in Arkansas, not just DHS, to do what you're talking about. And we 100% agree with you, you know, we've got to do a better job of tracking of the things we're doing or working or not, not just in the maternal health space across the board. Um, but one of the things this grant
requires is 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? EMS, the federal government will be monitoring that. So, and it's a 10-year grant, um, 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 SAR and other technology sources. That's good. Thank you.
All right, see you, no more questions. Rule B stands reviewed without objection. We would, we'll move on to C, and I think we have everyone at the table that's needed, so you guys can carry on. I
Speaker 28
57:57
feel like I've already presented this rule. Um, this is a rule to unbundle at the global billing payment for labor and delivery and prenatal care and to increase the rate by 70%. Um, the unbundling allows for separate billing for prenatal services, the visits, the lab
x-rays, all of that good stuff, um, those were already built separately, but now the prenatal visits themselves, and then the labor. delivery will be billed separately. We already had separate rights 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 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
with CMS would would not go very well. When I explained what was happening here in Arkansas with a number of labor. delivery units that have closed since 2019, pre-COVID, uh, with a number of providers that have, you know, not that we don't have in rural areas to Representative Lederman's Point, um, 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, 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, um, when women are going, is it the 1st, 2nd or 3rd trimester, who are they seeing and what are their diagnoses that each one of those visits when your complications are rising, things of that nature, so that we have better information on what is about 60% of births in Arkansas. Happy to take any questions. Representative Johnson. Thank you, Mr. Chairman, and thank you for the role, uh, you know, again, I don't intend for
Representative Lee Johnson
Unverified
59:45
my questions to be, uh, you know, perceived as an objection to the rule. I, 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, uh, and get more information. Uh, you brought up the number of delivery hospitals that have closed since 2019, uh, and maybe This is a question better for
the Department of Health. Do we know how many deliver our hospitals currently we have in
Speaker 191
1:00:15
Arkansas. We, we think it's 32 now, but the health department could say
Speaker 202
1:00:27
for sure. Sorry, hold the. 33. It's 33. Sorry, we're looking in the back. He is the hospital association also knows I've got I'm
Representative Lee Johnson
Unverified
1:00:33
sure that he's gonna want to answer. I mean, come on, man. Sorry, I don't remember ever
excusing him from the table. I'm not sure you recognized me the
Matt Gilmore
Unverified
1:00:58
first time either, so. Matt Gilmore, Department of Health. 33 is the number that I'm familiar
Representative Lee Johnson
Unverified
1:01:01
with. OK. 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. Magenda's been posted for multiple weeks. We should have had all the data that could have been asked today in this committee. Here for the
committee today. You're recognized Ms. Gil Mr. Gilmore. I didn't look at 2019 for the
Speaker 205
1:01:23
for the department that sometimes my questions come out of
Representative Lee Johnson
Unverified
1:01:25
the blue, so we think it's 40, Matt, we would have to confirm. Yeah, I think he was
Speaker 101
1:01:31
40 and 2019. Do we have an idea of what
Representative Lee Johnson
Unverified
1:01:34
it was in 2016. 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, it's not decreased for sure, right? And,
and, and so the number of deliveries that we have in Arkansas is probably pretty similar in 2025, to what we had in 202015. I'm guessing that we know, do we have information on that, on how many deliveries? Perfect. Good for you, Ms. Pitman. Uh, you can thank Miss
Speaker 28
1:02:06
Smith, who's actually in Nashville taking care of a loved one who sent me this this morning. She's an excellent, uh, deputy director.
Speaker 20
1:02:20
So I have going back to 2019, and it is roughly the same. It's, uh, it was 36,52019, and then it was about between 350 and 36,000 every year
Speaker 28
1:02:28
thereafter if you look back that that data is gonna be pretty
Representative Lee Johnson
Unverified
1:02:32
similar for the last 25 years. I think that you're gonna find that we're 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 gonna find that we had
more than 40. Um, 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 Uh, you know, 7 less delivery centers, of course, do we have information on which delivery centers closed because not every delivery centers created the same, right? Some delivery centers deliver, uh,
150 deliveries a year, some deliver 1000. I think we do have some of that information and as you
Speaker 213
1:03:19
said, I think they are kind of shifting
Matt Gilmore
Unverified
1:03:23
to other hospitals as some are decreasing the amount of services or shutting down their delivery services. So I think
Speaker 213
1:03:28
you're on the right track. Yes, sir.
Representative Lee Johnson
Unverified
1:03:31
Yeah, they're delivering, I'm sure. Uh, 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, you, it's a volume-based, um, reimbursement. So
you do a certain number of deliveries, and then you get an average reimbursement. Some of that's Medicaid, some of it's
commercial pay. And then out of that reimbursement, you have to pay your expenses, with your providers, provider's liability facilities, um, do we have a sense of how many deliveries, uh, a year, it takes based on Current reimbursement to be solvent for a hospital? Uh There, I've I've heard numbers, I've heard different
Matt Gilmore
Unverified
1:04:14
numbers, and I think it's every, it's gonna be, I think it's gonna be different for, you know, some hospitals based on the number,
the capacity and the and their, their expenses, but
You know, I, you know, some of them have closed recently, and you, 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
Representative Lee Johnson
Unverified
1:04:41
with this, like, I'm grateful for the increase, and I think it's gonna 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, 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 3 years. And, and is what we're doing with this unbundling. in 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%. 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, you know, 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, you know, too critical to close. Uh, do we have a sense of How many of these hospitals this change is going to now make, uh, them viable, presuming that number of volume is going to come down. Do we have a sense of that? No, sir, we, we don't have a
Speaker 71
1:06:02
sense hospital by hospital, um, uh, we were trying to skim our public comments when we put the rule out for public comment, and one public comment that we received was asking us to keep a global fee, um, in case that that was what was needed if they presented it as in an emergency room to deliver, and we obviously did keep that. We did look at, um, rates in the our home expansion category. We did look at some commercial rates when we were modeling this. So, um, I am not aware, I'm, I'm
looking at any anyone else at the table that we received any negative comments on the proposed. I mean, I think people are
Representative Lee Johnson
Unverified
1:06:39
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 that, you know, I'm the Boston Association, maybe somebody can give us more information. I would love to have more information about, you know, we, we have 33.
Are we, you know, how healthy are the 33? Is this enough or can we anticipate 4 more closures in the next 3 years? If so, what's our reaction to that? Yes, sir, and I don't know that Medicaid
Speaker 71
1:07:14
can answer those questions. I think that's out of our scope. That's fair. Thank you. Representative Bentley. Thank you, Chairman. Thank you all.
Representative Mary Bentley
Unverified
1:07:27
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 this. I do have
Speaker 28
1:07:40
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 have that already.
Speaker 71
1:07:51
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. We, um, 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. Um, we looked at, um, Roughly Somewhere between 3200 and above per delivery fee. Yeah, I'm, I'm going off of memory, um, and that was worked into the model along all those codes. I'll see if Miss Pitman can get you the
Representative Mary Bentley
Unverified
1:08:38
specifics. OK, so, um, that was my question there. So I need to, are we, we said we have a 70% increase, that a 70% increase for vaginal deliveries or is that just 70% increase for a C-section or is that the highest one? I guess that's what I'm trying
Speaker 71
1:08:54
to get to the quote, give us a little more, more details. Average across all of those feet, all of those fees, and so we, um, we estimated spending, um, 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, 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
1:09:23
do have it. I can't find it this, I will show
Speaker 24
1:09:27
it to you when we leave. My concern is, I think it's great because our our our our reimbursements were abysmal, and then we all, we
Representative Mary Bentley
Unverified
1:09:33
can all attest to our reimbursement rates are abysmal, and that's one of the reasons that 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 gonna just pick on Arkansas positions. The United States C-section rate is horrible. We should not have one of every 3 deliveries to be a C-section. It's horrible. So I want to be sure that we're not seeing 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
gonna 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 increase in 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 gonna have, we're gonna have a problem, so yes ma'am, share my concerns. Yes,
Speaker 97
1:10:43
yes, ma'am, and we share your concerns and they are valid concerns and so one
Speaker 71
1:10:49
of the next steps that we are taking is through the TIMA grant and through the maternal health strategic Committee. We are working with UMS and the perinatal. quality cooperative. I never, I get quality review committee, um, and they are implementing AI bundles um across the state with in that different hospitals, and those are specific protocols for, um, 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 with called 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, uh, as we, as this is a public voice, we're here
Representative Mary Bentley
Unverified
1:11:40
at a public community, I would just like to publicly say
all the hospitals across the nation, all across the state, as we see this increase and we're doing our part to increase it. They'll do their part to try and change things, try and change the culture, uh, 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 they bring more doulas and certified nurse midwives to change what's happening, uh, with actually delivery of other women across our state. I think they deserve that. So again, again, as we have this platform here to, to encourage our hospitals to see what we can do
to increase breastfeeding, what we can do to decrease C-sections because 1 in 3 is way too high, and we should do everything we can to change that which we haven't seen the decrease, uh, in decades on that. Yes, ma'am. And, and, and may
Speaker 71
1:12:27
I just quickly follow up that as we um monitor, um, our activity in Medicaid every week. One of the things that we have seen an increase in the last 6 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 as we have seen an
increase in certified nurse midwives activity and deliveries in the Medicaid program. And I think that's a positive change. I agree with you 100%. Thank you, Senator
Senator Fredrick J. Love
Unverified
1:13:01
Love, you recognize. Thank you, Mr. Chair. Um, me and Senator Pay over here discussing C-sections. And uh I, I do, I, I wanna just echo what Representative Bentley is saying because uh C-section is, is,
and, as you all know, is, is a major surgery. Um, my wife went through a C-section, so Sharonda, uh, if you're listening to this, please forgive me for just some of the things I'm gonna say, but But I will say this. If we 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, 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 gonna be like representing 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. So, yes, sir, duly noted, that
Speaker 138
1:14:10
is not our intent. Our intent with paying, um, additional, uh, reimbursement for a C-section is
Speaker 71
1:14:17
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, and that's really all I can say about that as I'm not a clinician. And I'll throw in some Tima transforming maternal health
Speaker 28
1:14:37
grant stuff again. Um, part of what that 10 year grant is doing is doing value-based, uh, payment arrangements. So we're looking at quality metrics related to maternal health outcomes. Um, so C-section could
Speaker 29
1:14:48
be a part of that to incentivize using vaginal delivery versus C-section. Thank you. All right, thank you,
Representative Aaron Pilkington
Unverified
1:14:59
Mr. Chair. Representative Pilkington. Thank you. And I, I just want to talk a little more on the C-sections because I just think it's good for the community 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 covers for glucose monitoring for. Gestational diabetes, um, obviously these pre this 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 um. You know, so I have some of these chronic weight issues because we're just a higher weight state. Uh, you're, you're gonna see a higher C-section rate. And so that's just one of the things that I think is we
try to focus on, you know, making sure people get healthier, is that, you know, if you want to reduce your chance of having a C-section, you know, getting your weight under control before you get pregnant, uh, is, is an important step. So I, I just want to make sure that we add that in the conversation because, um, sometimes the reality is because we have such a high obesity rate and those women still get pregnant. Um, you end up having a higher C-section rate as well. And so just wanted to, 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. So, thanks. I know that wasn't
Speaker 20
1:16:24
a question, representative, but I will follow up with that with the Doula care. I, I don't know exact numbers, so I'm not going to quote them, but I have heard
Speaker 28
1:16:29
studies show that those who use Doulas or CHWs I 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 out later this year. Representative Pilin, did you have a follow up question came to mind and I just wanted to ask this about it. Um,
Representative Aaron Pilkington
Unverified
1:16:52
Is there any sort of uh reimbursement, and this is purely just came to the top of my head. Is there any reimbursements for providers who offer VBACs. I mean, obviously, um, a little self-serving here. We had a C-section with our first. We had feedbacks with our last two, but I know not every provider does that. And but I know a lot of women prefer to do the VBAC and obviously I think it's, it's cheaper and it's better and it's, you know, so I just, I didn't know if we'd do anything for those who are offering feedbacks. We actually have
Speaker 28
1:17:19
a separate code for, um, vaginal delivery after cesarean. So, and then we also have an
attempted feedback. 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 Johnson. Yeah, I have a couple
Representative Lee Johnson
Unverified
1:17:37
of questions. So I, I think we have two committees that we conflate a lot. One is the Arkansas Maternal and Perinatal Outcomes Quality Review Committee. And when is the arcs I maternal mortality Review Committee. Is that correct? We had those two committees. You'll see me glancing down at my phone because I could never have said those without cheating. Um, do
we know that, so help me understand the difference, because we've, 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 speak to that. Well, before I
Speaker 179
1:18:19
do, she did mention another. Committee program that is actually going and
Matt Gilmore
Unverified
1:18:24
implementing some of the things, the unbundling and that sort of thing. So you want to speak to that, then I can kind
Representative Lee Johnson
Unverified
1:18:33
of The perinatal quality collaborative. I'm sorry, so let me make sure I
understand. So we have 3 committees. Apparently, so tell me that 3rd 1 I was unaware of this is good information. I'm
glad I'm here learning. Tell me about the perinatal collaborative committee because it doesn't shock me that we have 3 different committees doing very similar things, but I'd like to understand the nuanced differences. Sure, and um
Speaker 20
1:18:52
I believe it is housed with UAMS. Is that correct? So they would
know more. I mean, Mr. Gilmore can speak to anything I don't
Matt Gilmore
Unverified
1:18:59
know. I think it's, and I'm not the expert, but I do think it's part of a grant that scares me if nobody in this room is the expert. I'm a, I'm a up here talking about things that I don't, you know. It is part of a grant they have received is my understanding, and they're working amongst lots of different stakeholders,
Speaker 28
1:19:19
uh, DHS and others. We, we do have Doctor Golden and then my nurse utilization manager Kim Wilmott, both serve on the perinatal quality collaborative, um, they look at data around maternal
Speaker 191
1:19:27
health, and they are helping to implement the aim, which I never do remember, that's Alliance for Improvement in maternal healthcare, I believe. Great. Um, they're helping to
Speaker 28
1:19:36
implement those bundles as well as the the healthy baby, you say they're helping to implement. those
Representative Lee Johnson
Unverified
1:19:40
bundles. How? How are they I believe they're offering and again, I don't want
Speaker 28
1:19:44
to speak on behalf of them, um, Perlm Ellfish is much better at this than I am. Um, and I can give you the name of the person who heads the PQC as well, um, but I believe they're giving hospitals incentive
and 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 done so. real
Representative Lee Johnson
Unverified
1:20:05
important things. Education is one thing, incentives another. When you say incentive, what do you mean? I'm
Speaker 29
1:20:10
not sure. Let me get that in. for you.
Representative Lee Johnson
Unverified
1:20:13
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 long-standing effective method, but the only way it works is if there are financials tied to it. I mean, that's what value based is. This is a different reimbursement model where you tie reimbursement to
performance. Um, and so it's one thing to implement, implement in my mind is we put these in place actually using the bundles is a totally different thing. Correct? Yes, I would, I would venture to say that, 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, um, 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, so like if, how are we feeding information back to individual hospitals and providers. For, you know, 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, I think
Matt Gilmore
Unverified
1:21:47
the scope of the, of the maternal mortality Committee and the perinatal committee that you're speaking of, not that seem to be doing similar
Representative Lee Johnson
Unverified
1:21:54
things. Yes, they, as you said, they're
Matt Gilmore
Unverified
1:21:56
more focused on collecting the data and and providing the to the public as to what
happened and that sort of thing. They're not, while they may interact with those hospitals and 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, and, you know, their, their physicians, it's a, you know, they meet 4 times a year they
Representative Lee Johnson
Unverified
1:22:18
don't I mean I'm just saying like my understanding from trauma, you know, we have a trauma preventative mortality committee, correct? Yes. And that committee differs is names. I mean, there's 3 different committees, 3 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, it sends things through a third party, which is QSource. 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. It's a, it's a larger scope
Speaker 244
1:23:14
of type work. Yes, sir, but the maternal mortality review committee doesn't
Representative Lee Johnson
Unverified
1:23:18
have that, that not only do they not have that capability, they don't, can't legally do this. I, I would, yes, it's, it's, this is, this is, this is. The
Matt Gilmore
Unverified
1:23:28
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 physician and, and an important part, would you say that
Representative Lee Johnson
Unverified
1:23:39
an important part of quality improvement. is providing individual providers in 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 think the scope of these
Matt Gilmore
Unverified
1:24:10
two committees were speaking. of, we didn't have the data back in 2019. We didn't know how, where, how, how bad or how good the situation was with our maternal mortality and that sort of thing. So these committees 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 4 times a year. It's, you know, now we found out the data is really bad so yes, it's a different scope. So how do we,
Representative Lee Johnson
Unverified
1:24:33
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% in a 10 year time frame are preventable mortalities and trauma. Is that correct? Yes, it's been very successful, that a trauma system that was a statewide system of care that allowed for feedback. When we identified our opportunities for improvement,
back to providers so they could learn and get better at what they do. Is that correct? Yes, and I think some of the
Matt Gilmore
Unverified
1:25:02
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 the successes they've seen would you agree that we
Representative Lee Johnson
Unverified
1:25:12
could, if we wanted 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
Matt Gilmore
Unverified
1:25:23
could be done. I see, I see the point you're
Representative Lee Johnson
Unverified
1:25:25
trying to make, yes, sir. OK. Uh, I would love to have more information about the subtleties between those three different committees. And if there's opportunity to, 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 communi, 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 can have a more efficient way of sharing this data. Will do. Right,
seeing no more questions, we'll see 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 um. Chris Morrison and Bailey Taylor to the table for The Department of Energy Environment rule. Good morning, Bailey Taylor, chief administrator of
Speaker 251
1:26:41
Environment and DEQ director. Good morning, Keisha Morrison, Chief counsel, Energy and Environment. You guys
are recognized to proceed. Thank
Senator Missy Irvin
Unverified
1:26:53
you. We're here this morning seeking review and approval of pollution control and environment. Pollution control and ecology commissions rule regarding water quality standards. This rulemaking 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 3 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. Uh, 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. And with that, I'll turn it over
Speaker 251
1:27:46
to Director Taylor. Hi, good morning. So as Miss Morrison mentioned, uh, there were some stylistic changes,
Speaker 253
1:27:54
some grammatical, and then anything to provide clarification where we could. But for the substant substantive changes, there were some criteria additions, those were cadmium, uh, 5 toxics, which are hydrocarbon related, benzene toluen, ethylbenzene, xylene and phenol, and then we also added a standard for E. cola, 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, uh, the E. coli bacteria, um, 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, um, And we also added some site specific pH and dissolved oxygen
criteria that was through, uh, research and studies, we were able to determine that that these water bodies could meet different, uh, 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, um, if you see the map in your packet, you can see that the line just kind of follows geologic formations. It, it moved slightly, so generally the ecoregions 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, um, to remove, uh, trout waters from bull shells, gross Ferry, and Washall. 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 and Cross it. I'm happy to take any questions.
Representative Jack Ladyman
Unverified
1:29:53
Thank you, Mr. Chairman. I'm here. Um, a couple of 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 uh there were At least a 2, cities, municipalities that had more than one comment. And uh that was Jonesboro and uh Springdale, and I'm sure there were other cities that had that same, uh, maybe concerned and didn't comment, but uh they were
talking about the bacteria and the ammonia, the new standards, and reading through these comments, it, it seemed to me that their issue was I'm on page 7 here, but their issue was, um, 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, it, you have to buy new equipment. It takes a long time to do that. And then they talked about their MPDES permits, uh, you know, these
changes should be implemented at the time of the renewal of the NPDES permit. So there was a number of questions there. uh, can y'all just kind of summarize your responses to that. I mean, we were those concerns met?
Speaker 255
1:31:07
Yes, sir. So as far as the E. coli goes, Permes can expect to see the E. coli and fecal limits just or the fecal limits replaced with the E. coli. The treatment is the same, the testing
Speaker 253
1:31:19
is the same, E. coli is just a better representative test. So that should have no impact. We don't
expect that to be, um, impact to facilities for the ammonia, we will follow what's allowed in the Clean Water Act,
Speaker 255
1:31:33
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, um, optimization, and we can offer a compliance schedule. So that means that, uh, facilities on their renewal can expect that if they're not meeting, um, certain ammonia limits or requirements, they may have the
Speaker 253
1:31:58
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 3 year compliance schedule, which gives them 3 years on their existing limit before the new limit takes place. And, 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 they're
technology is available to meet this, um, you know, a new limit, uh, whether they have the economic ability to meet the new limit. Uh, there's many tools
Speaker 257
1:32:38
that we have in order to meet each facility's specific needs. So these two pollutants
Representative Jack Ladyman
Unverified
1:32:43
that we're talking about are those primarily on NPDES permits. For a municipalities or for industry? Uh,
Speaker 255
1:32:51
for E. cola, that would be mostly municipality, um, industry, it would depend on their process, but municipality, I would say, um, unless there's
Speaker 260
1:33:00
a specific item in the industry process that would result in
Representative Jack Ladyman
Unverified
1:33:05
the ammonia. All right, uh, different question, uh, you mentioned I find it here. Well, you mentioned these uh solvents that are, are health issues, you know, Tyle, benzene, ethylbenzene, xylene, and phenol. And tyline is a carcinogen benzene is and phenol and xylene affects liver and. I, 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 opened the bung on it, 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 the sunlight or heat or whatever. Why, why are we doing this? This is for if these toxics can be found in
Speaker 253
1:34:02
the waste stream of the wastewater treatment plant and can be expected to be discharged. So they are found? Yes, they, yes, so they are found, but the facilities that would be be required to meet these limits are already meeting the limits through their discharge, so we don't expect any financial
Speaker 255
1:34:22
impact to the specific specific facilities that are discharging these pollutants. So are these
Representative Jack Ladyman
Unverified
1:34:27
NPDES permits primarily for people who manufacture these chemicals or
Speaker 251
1:34:34
if they use it in their process, then, um, then we can expect it to
Speaker 253
1:34:38
be dished. charged and so that's why we're monitoring for it. Or if there's a municipality with the industry that, um, pumps to them, a pre-treatment, um, that they collect and they 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, um, is already meeting the limits that we've prescribed here, so is there a good uh test for
Representative Jack Ladyman
Unverified
1:35:05
checking, uh, the quantity of these pollutants. Yes, it's very common.
Speaker 260
1:35:10
Um, most labs have, have that ability. So there's no problem that the
Representative Jack Ladyman
Unverified
1:35:15
entities that have permits in meeting this requirement. No, most are already testing for it. They just
Speaker 255
1:35:20
don't have, uh, this specific limit. All right, thank you. Representative Johnson. Thank you, Mr.
Representative Lee Johnson
Unverified
1:35:31
Chairman. Um, so I wanna make sure I understand surface water.
Surface waters, how do we define surface waters. Is that just any Waters of the state can
Speaker 264
1:35:44
mean anything, um, a pond. Yes pond in my backyard is surface waters. Yes sir. OK, so any,
Representative Lee Johnson
Unverified
1:35:51
any water flowing, standing, that's in the state of Arkansas falls under this rule. Yes and no. So yes, it does. 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 a little more
Speaker 251
1:36:08
about it. Yes, so, so we did not change the definition
Representative Lee Johnson
Unverified
1:36:13
of waters of the state or surface water and, and to understand the role I'd like to understand kind of as a baseline, what are
Speaker 253
1:36:21
we saying surface waters are. So, um, we are focusing on dischargers that that are permitted dischargers, um, 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
Representative Lee Johnson
Unverified
1:36:43
that understand that and when you say dis you're focusing on dis you use the term I'm not
Speaker 251
1:36:49
familiar with dischargingunicipalities, industries that have a pipe where they treat waste collect wastewater,
Speaker 253
1:36:52
treat it, and they discharge it from the pipe. We're concerned, uh, with the end of pipe. Yeah, and this rules around what to
Representative Lee Johnson
Unverified
1:36:59
expect in surface waters at the end of that pot. Yes, and so, so we
Speaker 253
1:37:04
would, this is for the ambient kind of water quality criteria and what our
per permit engineers do is they take this and they back calculate what those effluent limits should be.
Representative Lee Johnson
Unverified
1:37:17
OK. So there's a, there's a section here that talks about primary contact recreation season, and
it sounds like we're extending that season. What, what is the primary contact recreation season. That's where we would expect
Speaker 253
1:37:29
folks to be swimming, recreating in the water, and so there are. are different, there are lower limits for bacteria, especially from dischargers that we expect during the primary contact season.
Representative Lee Johnson
Unverified
1:37:41
OK. And what was the thought process behind expanding that and how long has
Speaker 251
1:37:48
it been currently the current season. Um, the, it, it's mostly been the current season, uh, May
Speaker 255
1:37:53
through September, uh, as long that I recall this role being, um, effective, but the thought process is that we're seeing people recreate in October and April, um, interesting, so you, your perception
Representative Lee Johnson
Unverified
1:38:05
at, 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
Speaker 251
1:38:19
it's changed, but that when we open this roll up every 3 years, how can we make
Speaker 253
1:38:24
this better for Arkansans, the state of Arkansas, and to be compliant with the Clean Water Act, and this is a minimal effect on, on facilities too,
Speaker 257
1:38:33
because they already disinfect their it's interesting to me that after 100 years plus
Representative Lee Johnson
Unverified
1:38:38
of the swimming season being March to September.
Was it based on real comments that we had that we decided to expand that to
Speaker 271
1:38:48
April. There were no comments regarding the
Representative Lee Johnson
Unverified
1:38:50
are there other states expanding the recreational contact season? I'm not sure what
Speaker 253
1:38:55
other states, uh, primary contact season, I know that it would vary from state to state, and we can do that research. the perception was
Representative Lee Johnson
Unverified
1:39:03
more people are swimming. It's, it was necessary to be
Speaker 255
1:39:06
protective during April and October while folks are recreating the past we haven't felt like it was necessary in
Representative Lee Johnson
Unverified
1:39:13
April and October. We felt like May to September was sufficient. Um I
Speaker 255
1:39:17
can't speak to the curious because it's part
Representative Lee Johnson
Unverified
1:39:21
of, 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 for a long time. Yeah. I, I, I don't, well, just
Speaker 255
1:39:35
because of the recreation occurring in April and October. We wanted to collect data on that recreation or was that just sort of a, an
Representative Lee Johnson
Unverified
1:39:44
anecdotal feeling about recreation in April. There was, uh, no,
Speaker 253
1:39:47
anecdotal stakeholder engagement. That's fair enough. Thank you. I don't have
Representative Lee Johnson
Unverified
1:39:51
any other questions. Any further questions from
Speaker 192
1:40:05
the committee? See 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? Yes. So, um,
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
Speaker 3
Representative Jack Ladyman
Unverified
Senator Fredrick J. Love
Unverified
Speaker 20
Speaker 21
Chair
Unverified
Representative Mary Bentley
Unverified
Speaker 28
Representative Lee Johnson
Unverified
Speaker 5
Speaker 41
Representative Fred Allen
Unverified
Representative Jeff Wardlaw Chair
Unverified
Representative Aaron Pilkington
Unverified
Speaker 69
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Speaker 29
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Matt Gilmore
Unverified
Speaker 160
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Speaker 24
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Speaker 251
Senator Missy Irvin
Unverified
Speaker 253
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Speaker 271
Speaker 192