Public Health, Welfare and Labor Committee - Senate
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Transcript
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Bills discussed (52)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
|
SB120
· 11 mentions in agenda, transcript, chapter
Matched: “…THE ARKANSAS MEDICAID PROGRAM; AND TO DECLARE AN EMERGENCY. SB120 C. Penzo TO REQUIRE LICENSURE FOR ALL PRIVATE CARE AGENCIES…”
|
TO REQUIRE LICENSURE FOR ALL PRIVATE CARE AGENCIES IN THIS STATE; AND TO ENSURE CONSUMER … | C. Penzo | Died in House Committee at Sine Die adjournment. |
|
SB238
· 4 mentions in transcript, chapter, agenda
Matched: “…h yeah, do you want us to. Senator John Payton District 22, Senate Bill 238. You'll remember from 2 years ago, we passed legislation on…”
|
TO AMEND THE USED TIRE RECYCLING AND ACCOUNTABILITY ACT. | J. Payton | Died in House Committee at Sine Die adjournment. |
|
SB347
Act 1025
· 3 mentions in transcript, agenda
Matched: “You said SB 347, you set up a special order for um April 2nd April 2269 um…”
|
TO REQUIRE THE ARKANSAS MEDICAID PROGRAM TO INCREASE REIMBURSEMENT RATES FOR CERTAIN DENTAL SERVICES AND … | C. Penzo | Notification that SB347 is now Act 1025 |
|
SB117
· 2 mentions in chapter, agenda
Matched: “SB117 C. Penzo TO CREATE THE NATUROPATHIC PHYSICIAN PRACTICE ACT;…”
|
TO CREATE THE NATUROPATHIC PHYSICIAN PRACTICE ACT; TO PROVIDE FOR LICENSURE OF NATUROPATHIC PHYSICIANS IN … | C. Penzo | Died in House Committee at Sine Die adjournment. |
|
SB217
Act 969
· 2 mentions in transcript, agenda
Matched: “…nobody here to speak on that one so we'll pass over that um sb 217 we can pass on that um and then we'll try to do as many of…”
|
TO REQUIRE THE DEPARTMENT OF HUMAN SERVICES TO REQUEST A WAIVER TO EXCLUDE CANDY AND … | C. Penzo | Notification that SB217 is now Act 969 |
|
SB269
· 2 mentions in transcript, agenda
Matched: “…ou said SB347. You set up a special order for... April 2nd. SB269. you're gonna pass over that one there's nobody here to spe…”
|
TO AMEND THE REQUIREMENTS REGARDING LOCATIONS FOR AND GEOGRAPHIC AREAS OF A HOSPICE AGENCY. | C. Penzo | Died in Senate Committee at Sine Die adjournment. |
|
SB287
· 2 mentions in agenda, chapter
Matched: “…THE COMPLIANCE ADVISORY PANEL; AND TO DECLARE AN EMERGENCY. SB287 J. Payton TO MODIFY CERTAIN ATTORNEY FEES FOR CONTROVERTED…”
|
TO MODIFY CERTAIN ATTORNEY FEES FOR CONTROVERTED MEDICAL EXPENSES, APPEALS, AND CHANGES OF PHYSICIANS UNDER … | J. Payton | Sine Die adjournment |
|
SB306
· 2 mentions in agenda, chapter
Matched: “…ERSHIP UPON AN INACTIVE LICENSE OR RETIREMENT. Page 2 of 4 SB306 C. Penzo TO REQUIRE THE DEPARTMENT OF HUMAN SERVICES TO APP…”
|
TO REQUIRE THE DEPARTMENT OF HUMAN SERVICES TO APPLY FOR A HOME- AND COMMUNITY-BASED SERVICES … | C. Penzo | Died in Senate Committee at Sine Die adjournment. |
|
SB348
Act 567
· 2 mentions in agenda, chapter
Matched: “…RTAIN GENETIC SEQUENCERS AND GENETIC ANALYSIS TECHNOLOGIES. SB348 C. Penzo TO AMEND THE ANNUAL CAP FOR DIAGNOSTIC LABORATORY…”
|
TO AMEND THE ANNUAL CAP FOR DIAGNOSTIC LABORATORY SERVICES WITHIN THE ARKANSAS MEDICAID PROGRAM; AND … | C. Penzo | Notification that SB348 is now Act 567 |
|
HB1131
Act 959
· 1 mention in agenda
Matched: “…ERABLE AGING ADULTS. DEFERRED BILLS Number Sponsor Subtitle HB1131 Pilkington TO AUTHORIZE AN ADVANCED PRACTICE REGISTERED NUR…”
|
TO AUTHORIZE AN ADVANCED PRACTICE REGISTERED NURSE TO DELEGATE CERTAIN TASKS TO MEDICAL ASSISTANTS AND … | Pilkington | Notification that HB1131 is now Act 959 |
|
HB1171
Act 625
· 1 mention in agenda
Matched: “…E PERCENT OF PREMIUMS ON HEALTHCARE CLAIMS AND WAGE CLAIMS. HB1171 K. Moore TO MODIFY THE MEDICAID PROVIDER-LED ORGANIZED CARE…”
|
TO MODIFY THE MEDICAID PROVIDER-LED ORGANIZED CARE ACT; AND TO AUTHORIZE AN ABBREVIATED INDEPENDENT ASSESSMENT … | K. Moore | Notification that HB1171 is now Act 625 |
|
HB1185
Act 799
· 1 mention in agenda
Matched: “…NEFICIARIES ENROLLED IN A RISK-BASED PROVIDER ORGANIZATION. HB1185 L. Johnson TO ADOPT THE DIETITIAN LICENSURE COMPACT IN ARKA…”
|
TO ADOPT THE DIETITIAN LICENSURE COMPACT IN ARKANSAS. | L. Johnson | Notification that HB1185 is now Act 799 |
|
HB1186
Act 960
· 1 mention in agenda
Matched: “…hnson TO ADOPT THE DIETITIAN LICENSURE COMPACT IN ARKANSAS. HB1186 Vaught TO CREATE THE PAIN RELIEF PARITY ACT; AND TO REQUIRE…”
|
TO CREATE THE PAIN RELIEF PARITY ACT; AND TO REQUIRE PAIN RELIEF PARITY IN THE … | Vaught | Notification that HB1186 is now Act 960 |
|
HB1218
· 1 mention in agenda
Matched: “…EQUIRE PAIN RELIEF PARITY IN THE ARKANSAS MEDICAID PROGRAM. HB1218 J. Mayberry TO CREATE LICENSURE FOR THERAPEUTIC RECREATION…”
|
TO CREATE LICENSURE FOR THERAPEUTIC RECREATION SPECIALISTS; AND TO CREATE THE THERAPEUTIC RECREATION PRACTICE ACT. | J. Mayberry | Died in Senate Committee at Sine Die adjournment. |
|
HB1252
Act 965
· 1 mention in agenda
Matched: “…HIBIT FLUORIDATION OF THE WATER IN THE PUBLIC WATER SYSTEM. HB1252 L. Johnson TO ESTABLISH THE CERTIFIED COMMUNITY-BASED DOULA…”
|
TO ESTABLISH THE CERTIFIED COMMUNITY-BASED DOULA CERTIFICATION ACT; AND TO CERTIFY BIRTH AND POSTPARTUM DOULAS … | L. Johnson | Notification that HB1252 is now Act 965 |
|
HB1285
Act 856
· 1 mention in agenda
Matched: “…ND TO PROVIDE FOR LICENSURE OF ANESTHESIOLOGIST ASSISTANTS. HB1285 L. Johnson TO ESTABLISH AN EXEMPTION PROGRAM FOR AMBULANCE…”
|
TO ESTABLISH AN EXEMPTION PROGRAM FOR AMBULANCE SERVICE'S OPERATORS FOR CERTAIN HEALTHCARE SERVICES. | L. Johnson | Notification that HB1285 is now Act 856 |
|
HB1382
Act 481
· 1 mention in agenda
Matched: “…8, NO. 4. SPECIAL ORDER OF BUSINESS Number Sponsor Subtitle HB1382 Ladyman TO REQUIRE CERTAIN REPORTING BY THE DESIGNATED PROT…”
|
TO REQUIRE CERTAIN REPORTING BY THE DESIGNATED PROTECTION AND ADVOCACY AGENCY FOR THE STATE AND … | Ladyman | Notification that HB1382 is now Act 481 |
|
HB1403
· 1 mention in agenda
Matched: “…ULANCE SERVICE'S OPERATORS FOR CERTAIN HEALTHCARE SERVICES. HB1403 Pilkington TO AMEND THE ARKANSAS HEALTH AND OPPORTUNITY FOR…”
|
TO AMEND THE ARKANSAS HEALTH AND OPPORTUNITY FOR ME ACT OF 2021 TO ALLOW NONHOSPITAL … | Pilkington | Died in Senate Committee at Sine Die adjournment. |
|
HB1428
Act 855
· 1 mention in agenda
Matched: “…NONHOSPITAL ENTITIES TO BE COMMUNITY BRIDGE ORGANIZATIONS. HB1428 Steimel TO AMEND THE LAW REGARDING PUBLIC LODGING; AND TO P…”
|
TO AMEND THE LAW REGARDING PUBLIC LODGING; AND TO PROVIDE A BED HEIGHT REQUIREMENT FOR … | Steimel | Notification that HB1428 is now Act 855 |
|
HB1429
Act 854
· 1 mention in agenda
Matched: “…GHT REQUIREMENT FOR MOBILITY ACCESSIBLE ROOMS. Page 3 of 4 HB1429 M. Shepherd TO INCREASE ACCESSIBILITY WHILE ENSURING QUALIT…”
|
TO INCREASE ACCESSIBILITY WHILE ENSURING QUALITY FOR CERTAIN FACILITIES PERFORMING MAMMOGRAPHY SERVICES; AND TO AMEND … | M. Shepherd | Notification that HB1429 is now Act 854 |
|
HB1439
Act 853
· 1 mention in agenda
Matched: “…STANDARDS FOR ACCREDITATION OF FACILITIES FOR MAMMOGRAPHY. HB1439 Ladyman TO REMOVE THE CERTIFICATION PROCESS OF THE DEPARTME…”
|
TO REMOVE THE CERTIFICATION PROCESS OF THE DEPARTMENT OF HUMAN SERVICES FROM LICENSURE AS A … | Ladyman | Notification that HB1439 is now Act 853 |
|
HB1440
Act 629
· 1 mention in agenda
Matched: “…OF HUMAN SERVICES FROM LICENSURE AS A PRIVATE CARE AGENCY. HB1440 Bentley TO AMEND THE MASSAGE THERAPY ACT; AND TO ESTABLISH…”
|
TO AMEND THE MASSAGE THERAPY ACT; AND TO ESTABLISH REGISTRATION FOR MASSAGE THERAPY ESTABLISHMENTS. | Bentley | Notification that HB1440 is now Act 629 |
|
HB1442
· 1 mention in agenda
Matched: “…ESTABLISH REGISTRATION FOR MASSAGE THERAPY ESTABLISHMENTS. HB1442 Achor TO SET RESTRICTIONS ON PHARMACY CONTRACTING AND CONFL…”
|
TO SET RESTRICTIONS ON PHARMACY CONTRACTING AND CONFLICTS OF INTEREST; AND TO ESTABLISH PHARMACEUTICAL PATIENT … | Achor | Died in Senate Committee at Sine Die adjournment. |
|
HB1454
Act 674
· 1 mention in agenda
Matched: “…AND TO ESTABLISH PHARMACEUTICAL PATIENT FREEDOM OF CHOICE. HB1454 Bentley TO AMEND THE LAWS CONCERNING CRIMINAL HISTORY RECOR…”
|
TO AMEND THE LAWS CONCERNING CRIMINAL HISTORY RECORDS CHECKS FOR EMPLOYEES OF SERVICE PROVIDERS; TO … | Bentley | Notification that HB1454 is now Act 674 |
|
HB1456
Act 852
· 1 mention in agenda
Matched: “…EQUIRE DIALYSIS CENTERS TO HAVE A BACKUP GENERATOR ON SITE. HB1456 Rose TO AMEND THE STATE KIDNEY DISEASE COMMISSION TO BE AN…”
|
TO AMEND THE STATE KIDNEY DISEASE COMMISSION TO BE AN ADVISORY COUNCIL TO THE DEPARTMENT … | Rose | Notification that HB1456 is now Act 852 |
|
HB1471
Act 966
· 1 mention in agenda
Matched: “…RD IS PROVIDING INFORMATION TO CREDENTIALING ORGANIZATIONS. HB1471 Wooldridge TO AMEND THE EXPIRATION DATE OF ALL LICENSES OF…”
|
TO AMEND THE EXPIRATION DATE OF ALL LICENSES OF THE BOARD OF EXAMINERS IN SPEECH-LANGUAGE … | Wooldridge | Notification that HB1471 is now Act 966 |
|
HB1523
Act 951
· 1 mention in agenda
Matched: “…RD OF EXAMINERS IN SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY. HB1523 Vaught CONCERNING MISSING PERSONS ALERTS; TO CODIFY THE ARK…”
|
CONCERNING MISSING PERSONS ALERTS; TO CODIFY THE ARKANSAS AMBER ALERT SYSTEM; TO CODIFY THE ARKANSAS … | Vaught | Notification that HB1523 is now Act 951 |
|
HB1537
Act 850
· 1 mention in agenda
Matched: “…ERT SYSTEM; AND TO CREATE THE ARKANSAS PURPLE ALERT SYSTEM. HB1537 Ladyman TO REPEAL THE LOCATION ACT FOR COMMUNITY HOMES FOR…”
|
TO REPEAL THE LOCATION ACT FOR COMMUNITY HOMES FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. | Ladyman | Notification that HB1537 is now Act 850 |
|
HB1559
Act 632
· 1 mention in agenda
Matched: “…DIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. HB1559 McGrew TO REQUIRE THE DEPARTMENT OF HUMAN SERVICES TO SEEK…”
|
TO REQUIRE THE DEPARTMENT OF HUMAN SERVICES TO SEEK A WAIVER TO THE ARKANSAS MEDICAID … | McGrew | Notification that HB1559 is now Act 632 |
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HB1576
· 1 mention in agenda
Matched: “…R INPATIENT TREATMENT SERVICES FOR SUBSTANCE USE DISORDERS. HB1576 Lundstrum TO PROHIBIT A SOLID WASTE LANDFILL TO BE PLACED O…”
|
TO PROHIBIT A SOLID WASTE LANDFILL TO BE PLACED OVER A KARST TOPOGRAPHY. | Lundstrum | Died in Senate Committee at Sine Die adjournment. |
|
HB1585
Act 849
· 1 mention in agenda
Matched: “…ULAS IN THIS STATE TO IMPROVE MATERNAL AND INFANT OUTCOMES. HB1585 L. Johnson TO PROVIDE AN EXCEPTION FROM LICENSURE AS A HOME…”
|
TO PROVIDE AN EXCEPTION FROM LICENSURE AS A HOME HEALTHCARE SERVICE TO AN ENTITY THAT … | L. Johnson | Notification that HB1585 is now Act 849 |
|
HB1682
Act 942
· 1 mention in agenda
Matched: “…SOLID WASTE LANDFILL TO BE PLACED OVER A KARST TOPOGRAPHY. HB1682 Puryear TO CREATE THE GOOD NEIGHBOR ACT; AND TO CLARIFY FOO…”
|
TO CREATE THE GOOD NEIGHBOR ACT; AND TO CLARIFY FOOD DONATION LIABILITY AND IMMUNITY. | Puryear | Notification that HB1682 is now Act 942 |
|
HB1712
Act 639
· 1 mention in agenda
Matched: “…HERAPY SERVICES THAT ARE NOT REIMBURSED BY MEDICARE PART A. HB1712 Joey Carr TO ESTABLISH THE SOCIAL WORK LICENSURE COMPACT IN…”
|
TO ESTABLISH THE SOCIAL WORK LICENSURE COMPACT IN THIS STATE. | Joey Carr | Notification that HB1712 is now Act 639 |
|
SB111
Act 395
· 1 mention in agenda
Matched: “AGENDA (Revised 3/18/25 @ 5:11PM) Moved SB111 to Concur in House Amendment Senate Committee on Public Hea…”
|
TO ESTABLISH THE DENTIST AND DENTAL HYGIENIST COMPACT. | K. Hammer | Notification that SB111 is now Act 395 |
|
SB121
Act 968
· 1 mention in agenda
Matched: “…SAS MEDICAID PROGRAM TO PERFORM ADDITIONAL CARE AND DUTIES. SB121 C. Penzo TO AMEND THE AUTOMATIC OCCUPATIONAL LICENSURE FOR…”
|
TO AMEND THE AUTOMATIC OCCUPATIONAL LICENSURE FOR OUT-OF-STATE LICENSURE ACT; TO APPLY THE AUTOMATIC OCCUPATIONAL … | C. Penzo | Notification that SB121 is now Act 968 |
|
SB122
· 1 mention in agenda
Matched: “…URE FOR OUT-OF-STATE LICENSURE ACT TO PHYSICIAN ASSISTANTS. SB122 C. Penzo TO AMEND THE AUTOMATIC OCCUPATIONAL LICENSURE FOR…”
|
TO AMEND THE AUTOMATIC OCCUPATIONAL LICENSURE FOR OUT-OF-STATE LICENSURE ACT; TO APPLY THE AUTOMATIC OCCUPATIONAL … | C. Penzo | Died on House Calendar at Sine Die adjournment. |
|
SB2
· 1 mention in agenda
Matched: “…VISE THE ARKANSAS FIRE TRAINING ACADEMY ON CERTAIN MATTERS. SB2 C. Penzo TO REPEAL THE STATEWIDE FLUORIDATION PROGRAM; AND…”
|
TO REPEAL THE STATEWIDE FLUORIDATION PROGRAM; AND TO REMOVE THE MANDATE FOR WATER SYSTEMS TO … | C. Penzo | Died in House Committee at Sine Die adjournment. |
|
SB221
· 1 mention in agenda
Matched: “…AIN TASKS TO MEDICAL ASSISTANTS AND OTHER UNLICENSED STAFF. SB221 B. Davis TO PROHIBIT RISK-BASED PROVIDER ORGANIZATIONS FROM…”
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TO PROHIBIT RISK-BASED PROVIDER ORGANIZATIONS FROM USING CERTAIN TYPES OF CONTRACTING PRACTICES WHEN CONTRACTING WITH … | B. Davis | Died in Senate Committee at Sine Die adjournment. |
|
SB235
· 1 mention in agenda
Matched: “…G FOR SALE A FOOD PRODUCT THAT CONTAINS CERTAIN SUBSTANCES. SB235 J. Boyd TO CREATE THE VOLUNTARY PORTABLE BENEFIT ACCOUNT AC…”
|
TO CREATE THE VOLUNTARY PORTABLE BENEFIT ACCOUNT ACT. | J. Boyd | Sine Die adjournment |
|
SB255
· 1 mention in agenda
Matched: “…FOODS UNDER THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM. SB255 C. Penzo TO AMEND THE DEFINITION OF "DRUG" WITHIN THE FOOD,…”
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TO AMEND THE DEFINITION OF "DRUG" WITHIN THE FOOD, DRUG, AND COSMETIC ACT; AND TO … | C. Penzo | Died in House Committee at Sine Die adjournment. |
|
SB262
· 1 mention in agenda
Matched: “…FOOD, DRUG, AND COSMETIC ACT; AND TO DECLARE AN EMERGENCY. SB262 C. Penzo TO AMEND THE CORPORATE PRACTICE OF MEDICINE DOCTRI…”
|
TO AMEND THE CORPORATE PRACTICE OF MEDICINE DOCTRINE; AND TO AUTHORIZE A LICENSED MEDICAL PROFESSIONAL … | C. Penzo | Died on House Calendar at Sine Die adjournment. |
|
SB273
· 1 mention in agenda
Matched: “…OVIDER-LED ORGANIZED CARE ACT; AND TO DECLARE AN EMERGENCY. SB273 D. Wallace TO REQUIRE DIALYSIS CENTERS TO HAVE A BACKUP GEN…”
|
TO REQUIRE DIALYSIS CENTERS TO HAVE A BACKUP GENERATOR ON SITE. | D. Wallace | Died in Senate Committee at Sine Die adjournment. |
|
SB285
· 1 mention in agenda
Matched: “…T COMPACT. RE-REFERRED TO COMMITTEE Number Sponsor Subtitle SB285 J. Payton TO MODIFY THE COMPENSATION RESTRICTIONS UNDER THE…”
|
TO MODIFY THE COMPENSATION RESTRICTIONS UNDER THE WORKERS' COMPENSATION LAW THAT RESULTED FROM INITIATED ACT … | J. Payton | Sine Die adjournment |
|
SB286
· 1 mention in agenda
Matched: “…OMPENSATION LAW THAT RESULTED FROM INITIATED ACT 4 OF 1948. SB286 J. Payton TO ALLOW ADDITIONAL WAGE LOSS BENEFITS IN ADDITIO…”
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TO ALLOW ADDITIONAL WAGE LOSS BENEFITS IN ADDITION TO SCHEDULED INJURY PAYMENTS UNDER THE WORKERS' … | J. Payton | Sine Die adjournment |
|
SB311
Act 772
· 1 mention in agenda
Matched: “…WAIVER FOR THE AGING AND ELDERLY POPULATION IN THIS STATE. SB311 C. Penzo TO CREATE THE END ORGAN AND GENOMIC HARVESTING ACT…”
|
TO CREATE THE END ORGAN AND GENOMIC HARVESTING ACT; TO PROHIBIT COVERAGE OF CERTAIN HUMAN … | C. Penzo | Notification that SB311 is now Act 772 |
|
SB418
· 1 mention in agenda
Matched: “…SION TO BE AN ADVISORY COUNCIL TO THE DEPARTMENT OF HEALTH. SB418 J. Payton TO AMEND THE WORKERS' COMPENSATION LAW THAT RESUL…”
|
TO AMEND THE WORKERS' COMPENSATION LAW THAT RESULTED FROM INITIATED ACT 4 OF 1948; AND … | J. Payton | Sine Die adjournment |
|
SB440
· 1 mention in agenda
Matched: “…estrictions designating areas as 'Members and Staff Only'. SB440 D. Wallace TO AMEND THE LAW CONCERNING EMBALMERS AND FUNERA…”
|
TO AMEND THE LAW CONCERNING EMBALMERS AND FUNERAL DIRECTORS; TO REGULATE THE USE OF ALKALINE … | D. Wallace | Sine Die adjournment |
|
SB444
Act 970
· 1 mention in agenda
Matched: “…HYDROLYSIS; AND TO REGULATE ALKALINE HYDROLYSIS FACILITIES. SB444 K. Hammer TO AMEND THE MEDICAL ETHICS AND DIVERSITY ACT. SB…”
|
TO AMEND THE MEDICAL ETHICS AND DIVERSITY ACT. | K. Hammer | Notification that SB444 is now Act 970 |
|
SB460
Act 697
· 1 mention in agenda
Matched: “…HE ARKANSAS PRIMARY CARE PAYMENT IMPROVEMENT WORKING GROUP. SB460 Irvin TO MODIFY THE COMPLIANCE ADVISORY PANEL; TO REPEAL TH…”
|
TO MODIFY THE COMPLIANCE ADVISORY PANEL; TO REPEAL THE MARKETING RECYCLABLES PROGRAM OF THE COMPLIANCE … | Irvin | Notification that SB460 is now Act 697 |
|
SB474
· 1 mention in agenda
Matched: “…R ACT; AND TO CLARIFY FOOD DONATION LIABILITY AND IMMUNITY. SB474 C. Penzo TO AMEND THE LAW CONCERNING PUBLIC WATER SYSTEMS;…”
|
TO AMEND THE LAW CONCERNING PUBLIC WATER SYSTEMS; AND TO ALLOW THE BOARD OF A … | C. Penzo | Died in Senate Committee at Sine Die adjournment. |
|
SB9
Act 622
· 1 mention in agenda
Matched: “…OGRAM FOR THE STATE. REGULAR AGENDA Number Sponsor Subtitle SB9 B. Davis TO CREATE THE MAKE ARKANSAS HEALTHY AGAIN ACT; AND…”
|
TO CREATE THE MAKE ARKANSAS HEALTHY AGAIN ACT; AND TO PROHIBIT MANUFACTURING, SELLING, DELIVERING, DISTRIBUTING, … | B. Davis | Notification that SB9 is now Act 622 |
|
SB95
· 1 mention in agenda
Matched: “…E MANDATE FOR WATER SYSTEMS TO MAINTAIN A FLUORIDE CONTENT. SB95 C. Penzo TO AMEND THE ARKANSAS ATHLETIC TRAINERS ACT; AND T…”
|
TO AMEND THE ARKANSAS ATHLETIC TRAINERS ACT; AND TO CLARIFY THE DEFINITION OF "ATHLETE" WITHIN … | C. Penzo | Died in Senate Committee at Sine Die adjournment. |
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Uh, let's see, we have Senator Payton. We are Uh, you have 287 and 238. If he runs 238
Senator John Payton
Unverified
0:42
Thank you, Madam Chair, members, this 287 is the one we were hearing the other day when I realized that we had failed to get the $5000 cap on the attorney fees. This is where the attorney is Working for the injured employee. And um I think you remember the testimony of the young man that was sitting beside me. turned over on a scissor lift and had a broken back and took 18 months to get the surgery approved. These are the
attorneys that would be trying to help him get that approved in less than 18 months. And uh they're up against attorneys, they're getting paid much better on the other side usually. But anyway, it does have a cap of $5000 and then it raises The caps to 1,50025 on the appeals process. There was a pre-existing cap of 500 and 1000 and those are going to 2500 and 5000 on the appeals process.
Any questions? Are there any questions from members of the committee? See no questions from members of the committee. Is there anyone here to speak for or against this bill OK. Uh, Mr. Randy Zook and you please come forward. Please state your name for the record, and you may proceed.
Speaker 18
2:20
Madam Chairman and members of the committee, thank you for the opportunity to speak to you about this is one of the other package of bills, uh. Which will severely increase the costs of workers' comp in Arkansas. The workers' comp system in Arkansas is not broken. It doesn't need to be fixed. We do not argue that that modest increases or adjustments in some of the ways that the formula, the benefit formulas are
calculated would be appropriate, but we think these bills, including this one, go too far, too fast. Um, if you want more litigation if you want more lawsuits filed then pay the lawyers more and that's basically what this bill would do. We, on behalf of our members, And with a unanimous vote of our executive committee. We urge you to vote, vote down this bill, not to pass it. I'm happy to take any questions.
OK, thank you. Are there any questions for the witness? See none. Thank you for
your testimony. Thank you. Any, is there anyone else to speak for or against this bill? See
Senator John Payton
Unverified
3:37
none you're recognized the clothes for your bill. Thank you, Madam Chair, and I just want to remind y'all. This is on a segment where the attorneys currently get paid 0. So the only time this pay to the attorney would come into effect is if the carrier, the insurer,
the employer's side, if they denied medical care that was later determined by the commission or the judge that should have, should have not been denied. So they will if they represent the injured worker and they lose, they get paid nothing. But if they do prove that medical care was denied that should not have been denied they'll get paid 12.5% up to a cap of $5000. With that, I'm closed and I move to pass.
All right, um, Is there a second? OK, is there any discussion? No discussion.
OK, all those in favor say aye
Speaker 34
5:00
Sooner flippo. So a flip out center heel. Senator Hill, no. Sit in or letting Senator letting, yes. Sara Penzo, Senor Penzo, yes. Senator Payton, Senator Payton, yes. Sin of love. Senator Love.
Speaker 37
5:31
Sinner love, yes. Sir No Wallis, Sir No Walliser No Wallace, no. Thank you
4 votes, Bill fails. Thank you. Thank you. Do you want me to run 238. Sure do.
Senator John Payton
Unverified
6:09
Thank you, Madam Chair. You have a handout, I think. Oh yeah, do you want us to. Senator John Payton District 22, Senate Bill 238. You'll remember from 2 years ago, we passed legislation on the Senate side to reconfigure, reorganize our waste tower program. And we did consolidate the 11 boards into 4. It took quite some time for those.
Details to be worked out and for the boards to get organized. They've now been organized and operating for about 15 months, I think if my math is correct and uh but when we passed that legislation, it contained some dedicated revenue, that ended up being amended out on the House side. So even though we reorganized the program and the boards, the program is insolvent without. Revenue being dedicated to it
from somewhere and uh so what this does is it restructures the grim removal fee, the waste tire fees. And uh this is just like what was amended out of that bill 2 years ago, but I'll go through it real quickly. We will be eliminating the fee or the tax on used tires. It was never successful in generating much revenue. We'll be renaming the fee from the rim removal fee to the tower recycling fees. It will be collected at the point.
And could I have one of those handouts? It'll be collected at the point of sale of a new tire. But it will also include new tires that come on new automobiles and new trailers. And so it's predicted that it'll generate an additional 2.5 to $3.5 million in dedicated revenue for the tire program, which will make it solvent, um. Apparently The scale that's being paid by
the 4 tower districts runs in the $22.60 to $2.85 per tire. What you're looking at on your handout or on what I'm handing out to you is what we spend. In abatement. So these are figures that were in an email from E&E to me showing several sites that have tire. Oh, dumps, stockpiles that need to be cleaned up, and I used the number, the figures that were
given here by NE and what they're spending per tire on abatement, and it's $9.67 or 68 cents per tire compared to spending less than $3 a tire when we handle it properly on the front end. My argument is that if we don't collect the waste tire fee, the recycling fee on the front end for a sale. Then we'll have to charge on the end use when that tire needs to be dealt with.
If we're charging at the end, Then there are people who will Rather than properly disposing of the tires, they'll be stockpiled. They'll be dumped. And we'll spend $9.68 a tire on abatement at that point, if not more. It's much less expensive on the taxpayers of Arkansas to collect the tax at the generation point on new tires. And that way there's nothing
discouraging somebody from properly disposing of the tower at the end. But let me give you one more thing to think about. When we Wear out a set of new tires. We usually take them off the vehicle. Most people do with 25, 30% of their life left, and they, a lot of those tires get reused. And until they're war completely out.
If we charge the the recycling fee at the end use. Those users That are having to buy the used tires and the cheapest tires to get by are always paying the recycling fee where People like me who put a new set on and don't wear them completely out and sell them and take them off while they're still remarkable. I would never be paying. The recycling fee. If that makes sense to you. If not, y'all
gonna ask me some questions, and I'll further explain it. But I think it's a great system where we Generate the revenue on the front end. Instead of charging it. On the, on the back end when the towers are dealt with, and
with that, I'll take questions. OK, can you, do you mind just going through your handout and kind
Senator John Payton
Unverified
11:14
of explaining. OK, so these are sites that are identified by E&E.
Of ADQ about where tires are currently stockpiled and stored. They've most of these sites are several years old and uh so if you look in that top box on the right, it says 403,000 tires. And uh they're looking at $3.899 million. To, to deal with it if you run that math out, it's $9.68 a tire. The next column is is identified by tonnage, but if you look back
to the first column, you see that they figure 75 tires per ton. So I took the 12,000,400 tons multiplied by 2000 pounds. That's 24,800,000 pounds divided by 75 pounds per
tire. So it's 330,000 tires. And the 3.199 million divided by the 330,000 tires is $9.67 per tire. It's just an example
of how much more it costs to deal.
With the tires when they're not properly disposed of and recycled in the first place. And I think that if we Continue to collect the fee on the front end to fund the program, we're saving. $6 a tire. Or more I got
Speaker 56
12:41
you. OK, thank you. That was helpful and
Senator John Payton
Unverified
12:44
also in the bill, you might want to notice, but the fee for the regular sized tires is $3 apiece.
The boards can set the fee for the large tires at 5 up to $5 and the ag tires up to $30 and, and I would expect they'll probably set that at the maximum. So we'll be $5 on the. Semi truck type tires and $30 on the ag tires. Tractor tires. OK, any questions?
Members of the committee, Senator Hill, you recognize for a question? General Clayton, if it's cost
Senator Ricky Hill
Unverified
13:26
you $9.67 a tire is what you
Senator John Payton
Unverified
13:32
were saying we're only going to collect 3. For a pastor that where's the math on this? OK, so what I'm saying is The 4 tower districts currently have contracts with the independent contractors, some private, some uh quasi government private. And those contracts are $2.60 to $2.80 per tire. So when we're dealing with them properly from
the tire dealers to the transporters to the recyclers, it's costing less than $3 a tire. Well, we have to deal with them after they're dumped and stockpiled, then the cost goes way up with you on that, OK. Thank you.
Are there any other questions from members of the committee? Did you have a
question? No? OK. All right, see no, thank you so much. We do have somebody, uh, Craig Douglas and folks, I know if we had a sign in
Senator Ricky Hill
Unverified
14:30
Rick, Senator Hill, you recognize her question. OK, while we're looking at this, what's the
Senator John Payton
Unverified
14:38
status of the new cops them using our used tires you familiar with that. So currently they're buying the crumb rubber from Some of our recyclers, and they, they have expressed that they're going to continue to have a demand for that, of course, it's, it's kind of based on The price of other fuels and whether that'll, but it's very
promising. I mean, it looks great. There is, as long as we can Deliver it to them that they can use nearly all that we would produce in the state of Arkansas. Geographically transport is one of the biggest expenses and so if those tires are not processed to some extent, then the transport is, is prohibitive. So hauling full size whole tires from
150 miles away becomes cost prohibited. If, if you haul them to a processor and they're chopped into some smaller portions, then you can haul more efficiently, so, so it's very great, it's very exciting that New Corre can use the end product. And it's beneficial to them. It's beneficial to the state of Arkansas, but we still need an infrastructure geographically around the state to process them into at least the 1st or 2nd stage of
of chopping, cutting, and, and grinding. To some extent before they're transported that far. Thank you, sir. And we have other demands you know from I think from Texas and, and from uh Northeast Oklahoma. For the
product. Thank you. Any other questions? All right, Mr. Craig Douglas, if you'll come
Speaker 76
16:29
forward, please. Thank you, Madam Chairman. I'm Craig Douglas. I'm director of
District 2, waste our program just to follow up on the um On the new Corp question they are currently taking, uh, roughly 40 equivalent of 40,000 passenger tires a week. And now they do not operate 52 weeks a year. It it is spotty at best, but they are taking those tires and could take uh more uh in Mississippi County if uh the
other uh steel recyclers up there would, would also do a new courses to. And so as the senator said, it's, it's still very promising, but the infrastructure and the reimbursements to the districts are the problem, as Senator Payton said, the, excuse me. The roughly the average DEQ approved reimbursement rate is averaging about 285, a tire. Uh, however, legislative audit, uh, in their analysis says that the
net available revenue from the $3 rim removal field uh fee is only $2.31 a tire, according to the legislative audit, so that's 54 cents a tire. that the program is losing and uh we will process in Arkansas roughly 3.2 million waste tires this year. Our district is 27 counties uh we process about 1.5 million tires. Uh, in addition
to the revenue needs uh which would be generated by applying the existing fee without raising the rate to a new cars and trailers. We would have the money then to the DQ would have the funds to reimburse the districts so that the rural areas of Arkansas could be better served. This is a cost distance, um, arithmetic problem, uh, when you have a rural county that needs to be
serviced, you're going to travel longer distances to get them from the process longer, longer distances from the processor to the location, and you're gonna pick up. less tires, so we need the money to fund to fund that. As well, and I, I would not, uh, I really don't have anything else to add other than the four districts are working well. They're improving, uh, those districts were just set up last session,
uh, and we are responsible for not only uh doing the contracts in our district. It is with it is a public-private partnership, uh, but we're not also we're also responsible. Working with DEQ on tire dumps on the abatement of the dumps, and they're simply not enough money to keep up with picking up tires that are dumped. uh, this, this bill will help fund that as well and keep the program solvent so that your tires in
your districts are picked up transported, and
recycled. Thank you. Could you just remind me where District
Speaker 76
19:53
2 is located, Mr. District 2 is central and north northeast Arkansas. OK, thank you, we go, we go from Malvern to Pocahontas. Oh wow, OK, Senator Love,
you're recognized. Thank you, Craig, good seeing
Senator Fredrick J. Love
Unverified
20:08
you. I just want a couple of things number one, I know that
Davis Tyre Davis uh trailers is not in business any longer, so how are we kind of disposing I know they were taking tires
Speaker 76
20:24
at one time. Yeah, no, Davis Davis is still in business, yeah, they have the
Speaker 83
20:29
contract for our district. I thought Davis burn, they've been in business over
Speaker 76
20:34
100 years. Yeah, and they are the ones taking the tires to new
Speaker 84
20:37
course. as well. They have that contract, private business. All right, thank you. Thank you, Senator.
Are there any other questions from members of the
committee? OK. Thank you, Mr. Douglas, for being with us today and tonight. Uh, any other questions? All right, see none. I don't believe there's anybody else here to
speak for against the bill. Um, you're recognized to close for your
Senator John Payton
Unverified
21:05
bill. Thank you, Madam Chair, and And just to put it out there,
I have considered a lot of alternatives. I've spent weeks and and hours and hours and
meetings and tried to find something that I could believe was a good alternative. And I really believe that whoever thought up the idea of collecting this on the front end, so the disposal was free. I think it was a great idea, and, and I think it served the state very well until inflation just outpaced the, the Revenue stream. I'd appreciate
a good vote and I move
to pass, OK. Second, all right, any
discussion? All right, OK, Senator Hill, you're recognized for
Senator Ricky Hill
Unverified
21:52
discussion. Senator Peyton, I will say you've worked on this a long time. You're the was tire king for the state of Arkansas as far as I'm concerned. You put a lot of hours in it, dedication. I know you're passionate about it. And just knowing that you're behind
this, I'm 100% for it. Thank you. I would second those comments, done a lot of hard work on this. All those in favor say aye, and opposed, I have it,
congratulations, you've passed your bill. I think I heard it that way too. OK, Senator Hammer
is Senator Hammer here? All right. OK, uh, Senator Penzo.
Do you, um, do you just want to tell us which one you want to run.
Senator Clint Penzo
Unverified
22:58
I think you said earlier you were passing over one of them, and I don't if it's OK, I've got, I've got. People that have driven to be here and uh and they've, this is not their first time to be
here, so, um, I've got um But before we set you, you said you were passing over. Uh, 347, that one we're going to do special order, right?
Senator Clint Penzo
Unverified
23:26
4 to, just so if anybody's here for these
bills, I can go home. Yeah, I think they arranged that one. Yeah, 42 is going to be a special order, I mean, 347 will be a special order on April 2nd. Any other bills you're passing over in case there's somebody here that's going to testify for
Senator Clint Penzo
Unverified
23:44
or against so they can go home. Well, I mean, yeah, pretty much I would want to just do the ones that people are here for, so, uh, no, no SB2, no SB 95, um, Uh
You said SB 347, you set up a special order for um April 2nd April 2269 um you're going to pass over that one, there's nobody here to speak on that one, so we'll pass over that, um, SSB 217, we can pass on that, um, and then we'll try to do as many of the others as we can. OK, all right.
Which one do you want to start
Senator Clint Penzo
Unverified
24:23
with? So, so can we start with the SB 120. There's someone here
from Springdale and OK. It's be 120. Um, and, and before you say that, um, We had a sign-in sheet earlier today. Um, we have a new sign-in sheet, but uh, if you haven't signed the new sign up sheet, I will
call for anybody that's in the audience that speaks for or against a bill in case you didn't get to uh sign this new sheet.
All right, if you will, uh, set your name
Speaker 111
25:03
for the record, you may proceed with Senate Bill 120. Pennzo
David Cook
Unverified
25:07
District 31. David Cook, Director of Government Affairs for the Alzheimer's Association. Well, SB 120 is a consumer protection bill during the 2023 legislative session, we
passed legislation that would require dementia training for home care providers, as those rules are being promulgated, what we discovered is that um here in Arkansas, we only allow or we only require providers who
accept Medicaid as payment to receive a license. So this extends licensure requirements to the private um pay sector, um, this is again, um, a consumer protection bill. Uh, just if I could have some latitude, my father has a diagnosis called frontal temporal dementia. And because of that damage the nerve damage to his frontal temporal lobe. He has very vulnerable to abuse financial fraud and has, of course, succumbed to that. So when my mother hires a
caregiver, we have to be sure that that individual is trusted and properly vetted. So SB 120 assumes to close that gap and ensure license requirements extended. Private pay side, but it also enhances protections for caregivers by establishing background checks, ensuring that there's registry screenings so that patients are getting quality care, um, standardized training, um, right now, only the training requirements we passed in 2023 apply to those Medicaid providers. This would
require all those who provide home care to again adhere to that those training standards. Um, it also requires um, some fingerprinting, um, but I've also had a caregiver come and just to share her story and how she's been impacted and how her father was impacted by substandard care. So if if she could just share her story real quickly with you. OK, um, did you sign up to speak for the bill? No, OK. Uh, I don't think I got her
on the list. I mean, before we go
to testimony for and against, because I think there's people here for and against the bill, so I just need to follow
that process. Are there any um questions from members of the committee. Senator Love
Senator Fredrick J. Love
Unverified
27:21
Thank you. um. In I guess. You, you're saying that you're trying to extend this to the private side, yes for
Speaker 123
27:27
for private pay providers, how manyrs are we,
Senator Fredrick J. Love
Unverified
27:30
are we talking about? Um, I would have to get the
David Cook
Unverified
27:37
health department to to answer that question, but this, these are providers that just would take private pay, um, and so if, if, if they don't accept Medicaid as payment, they their employees don't have to be properly vetted. They don't have to adhere to the training standards and again you don't have to be licensed. So in essence what we've created in the state is if you put a bumper sticker on your car to and say you can do home care, you're, you're in
Senator Fredrick J. Love
Unverified
28:01
business. OK. Do they do so, so as a As a private. Ford, do they adhere to any
other standards, I mean. I'm trying
David Cook
Unverified
28:10
to regulation currently in statute to regulate that industry if you just take private pay, and we do it on the Medicaid side, but for individuals or providers who just take private pay. There's no regulatory authority.
Senator Fredrick J. Love
Unverified
28:25
OK, this That's new to me, OK, all right,
thank you. OK. I just have a quick question though. I mean, I under but personal care or folks that are not nurses and skilled
labor folks. So, um, so now you're wanting them to become skilled labor, basically with our 40 hours of training that determined by and and an annual license fee for these agencies, where would that money Where is, where's that money
gonna go? the Department of
David Cook
Unverified
29:02
the Arkansas Department of Health is the regulatory agencies, so there's
a $1000 licensure fees would go to the, to the agency, and that $1000 fee for licensure already exists for the Medicaid providers. We're just extending that to those who just take private pay and not Medicaid. And we're not
wanting to, I'm sorry. OK. OK, can you, can you, yeah, page 4, 35 and 36. Can you just
36. Yeah, so this says that subdivisions A1.
David Cook
Unverified
29:56
That's a carryover uh CMS requirement for Medicaid providers. We made amendments to the bill to ensure that um that that CMS requirement. Only applies to the patients that they serve that take
Medicaid because you have to be certified to take Medicaid and there's some additional requirements once you have that certification, um, my understanding is, you know, you have to do supervisory visits. Uh, we do not want that to carry over to the private pay, that's a, that's a CMS requirement, so we made amendments to the bill to ensure that if you're a provider that takes Medicaid but also private pay, you would not have to do those supervisory visits for your Your patients that that are not Medicaid qualify. OK, made several amendments to the bill
to make sure it wasn't overburdensome for providers. OK, all right. Any, I'm sorry, Senator
Senator Fredrick J. Love
Unverified
30:49
La recognize for a question? Well, I guess, Madam Chair, I think I want to get Arkansas Department of Health up here because you said that these that these providers do actually register with the Arkansas Department of Health.
David Cook
Unverified
30:59
If they take Medicaid, but our understanding is if you just take private pay and you don't take Medicaid as payment, you do not have a license, so they do not have to abide by the training requirements that we put in statute in 2023.
Senator Fredrick J. Love
Unverified
31:16
So who keeps it so Arkansas Department of Health keeps a record of these providers, but they have no Medicaid, those that take Medicaid.
So, is it I'm confused because if this is a Medicaid issue, it would be DHS, would it not? Would
David Cook
Unverified
31:30
it be Medicaid certifies, but ADH holds the licensure for health care. Yeah, I would just
Senator Fredrick J. Love
Unverified
31:34
like to talk to ADH when we have the time Adam chair. Is there somebody here from Department
of Health. You might as well come up and let's get that question out of the way.
If you'll just take your name for the
Matt Gilmore
Unverified
31:55
record and if you're recognized. Matt Gilmore, Department of Health. Can
Senator Fredrick J. Love
Unverified
32:02
you repeat your question I was just curious because I, I want to know how many providers with this bill
impact? But then also um. First of all, let me just, how many providers
Matt Gilmore
Unverified
32:16
with this, so it's an estimate, but we, we
would, we have Estimate estimate that we've got about 270 licensed private care. Folks now are agencies, so that would, we imagine that doubling the first year, so we there's. The first year that this goes into effect, that have that many that are now just doing private.
Senator Fredrick J. Love
Unverified
32:40
OK OK that would. Alright, so, so these private care agencies already registered with Arkansas Department of Health, or are they not
Matt Gilmore
Unverified
32:50
registered if they're not, if they're just doing strictly private and not taking Medicaid and that sort of
Senator Fredrick J. Love
Unverified
32:58
thing, then. They're not, they're not licensed through us. Are they licensed to anybody. I don't think so. That's true. So we just have people just out
there. OK, all right. I, I get it now. Thank you. Any other questions? All right, see none.
Thank you. All right, uh, we will go to, I
think, to speak for and against the bills, so, uh, you're recognized to come and speak for the bill. If you'll just state your name for the record,
Speaker 157
33:38
you're recognized. Jacqueline Ryan. Thank you, Madam Chair, in the committee. I've been waiting. 5 years, 3 weeks, and all day for this.
Speaker 158
33:54
First, I'd like to thank David Cook of Arkansas, Alzheimer's Association. I would not be here advocating for our vulnerable loved ones without his diligent work every day that he does for our vulnerable loved ones. I have a few questions for you guys. What
Speaker 159
34:09
would you do if your loved one fell and broke her
Speaker 161
34:12
hip. What would you do if your loved one falls. One fall does it all. You're in a crisis moment. What's the next steps?
After getting home from surgery and the rehab, what do you do? You call a home care agency. You guys are busy working. You could have somebody for your loved one. How do you best qualify an agency or a or a caregiver. How do you do that? You're in a crisis moment. Can you fathom allowing someone to come into your home, that's not background checked or fingerprinted and your vulnerable loved one's home while you're away.
As consumers in a crisis, we assume that the agency would provide the best caregiver for your vulnerable loved one. That's what we do, you know, we all do the best we can at our jobs. We expect the home care agency to provide the best care. By profession, I am a real estate broker in the states of Texas and Arkansas. I have been fingerprinted and background checked in both states. Even if I sell you a piece of dirt and never come into your house.
We have to be background checked and fingerprinted. It's just really that simple. We even as realtors have
Speaker 158
35:40
a code of ethics that we have to adhere to. There is, as you now
Speaker 161
35:45
understand, Senator Love, there is no regulatory oversight on home care agencies in this state. Unbelievable. The home care industry in the United States has grown exponentially estimated revenue.
It was $100 billion in 2020, 50% from 68 billion in 2013. During my time today, I've learned it's $28 billion of home care services value here in the United States now, and it's going to keep growing because as baby boomers are getting older. This isn't just about my parents, but other adult children that I've
Speaker 158
36:28
encountered. I even wrote a book about it, not only my story but other adult children that we've all
Speaker 161
36:36
encountered some kind of ineptness with the caregivers out here. I'll speak a moment about my dad. Jack Perry, he was the co-founder of Cramelot. Named by Mr. Sam. They
Speaker 158
36:48
manufacture the trash compactors and cardboard balers. You can go in a Walmart store and you'll see those two rams sitting in a cardboard. My father was a co-founder of that company. Walmart was their first count. Springdale, Arkansas. He was president of the Arkansas Cattlemen's Association. So he
Speaker 161
37:08
was a very good contributor to our society here. In 2014, In his early 80s. He fell and broke his hip. He returned home. I was referred to a home care agency to assist them for a few days a week. I didn't call 3 agencies. I'm in a crisis moment. We've got to get somebody out there. In a few months he fell and broke his other hip. And then required full-time care
Speaker 158
37:39
for the remaining 7 years. I'm reading this because I caught all day, but it's hard to
Speaker 161
37:49
condense 7 years into a few minutes. Hiring a
Speaker 158
37:53
home care agency. I dealt with no shows, late shows, inept, incapable, immoral. Unethical caregivers. He fell a few times under their care. Once requiring
Speaker 161
38:10
Stitches when he had a black eye. I called the DHS on that one. They finally showed up. They
Speaker 158
38:24
couldn't do anything because He's not on Medicaid. There was nothing they could do. I have a picture of receipts totaling over $260 in 9 days. I text. The fraudulent caregiver, there was two different, there was many different caregivers. I text a fraudulent caregiver about these receipts. There was
Speaker 161
38:42
no response. We already knew that he'd bought tires for her. Her car paid off her house in many, many, many, many other expenses. Gave her some calves. And more. We estimate around $150,000 in financial exploitation over a seven-year period. That is in addition to him paying over 200,000 a year to the private pay home care agency. Yes, my father was wealthy. It's a wonder she didn't break him.
Yes, sir. Over 200,000 a year, 24/7, around $35 an hour for the agency. Had we fired her, he would have
Speaker 158
39:22
bypassed the agency and hired her direct. Because she knew I was on to her. Ultimately, I lost my health POA where I could see my dad's house from where I built my house. I returned to Arkansas from Dallas to be with my family.
My POA was revoked because she convinced my dad I was going to put him in a nursing home and take his money because she knew I was on to her. Besides a fraudulent caregiver there. The one last time my father fell. And broke his elbow. He was about 88 then. I called up the agency. And told them, uh, called the
agency and they couldn't speak to me about my dad because of HIPAA and I
Speaker 161
40:21
no longer had the POA. I told them I'd be damned if the inept inattentive caregiver would ever return. I could tell by their response, they didn't know how many times he had ever fallen. They didn't know. She did not return, but I could not get rid of the fraudulent caregiver because she had my dad wrapped around her finger, totally convinced that only she
could take care of him the best and that I didn't even care about him. A few years earlier, even the fraudulent caregiver had disclosed to me that she had once been in jail. I found her face on mugshot. How comfortable was she in telling me this and knowing that she could not and would
Speaker 165
41:07
not be fired. She was very she was a professional
Speaker 158
41:12
con artist. Dad had Alzheimer's, however, he
Speaker 161
41:16
was never diagnosed, even though his mother and his sister had it. How do caregivers handle someone throwing money at a TV. Looking for Super Bowl tickets in the mail, throwing cash
out. Vacuuming and onion. Thank you. I just want to make sure that we
Speaker 158
41:33
stick. I appreciate it. My mother was Joanne Perry County Washington County treasurer, her narcotics were still in the first week from a different caregiver from a different agency. Who's going to take care of us later?
Thank you for your time and consideration. Thank you. Are there any questions? From members
Speaker 41
41:55
of the committee, any questions? Great. Thank you, thank
you for your testimony, and, and where did you, what was your name again? Just Jaclyn Ryan. OK, and where are you from again? Springdale. OK, thank you. All right, is there anyone here to speak against the
bill? Please come forward. Yes, please come forward.
Just come forward and you can state your names for the record. It's OK. You just, you can. I think you signed the sheet earlier. If you'll just state your names for
Stan Townsend
Unverified
42:36
the record and then you're recognized to proceed. My name is Stan Towns. I'm a owner of a personal care agency, excuse me, a private care agency in Mountain View, Arkansas, Stone County. And uh I just have a few things to say about this particular bill, um,
first of all, I would like to say that um I agree that we should have. These private care agencies uh all meet the same standards. But reading this, this particular bill, uh, it, it just seems to bounce around there's some inconsistencies in this bill. Um, I'd like to say that all private care agencies have to meet that that are in Medicaid have to meet certain standards, and this is a copy of this, of
a, this is a copy of the standards that that we have put out by the Arkansas Department of Health and and and uh the Arkansas State Board of Health. And these standards are all met. They have all private care agencies in Arkansas that accept Medicaid, have to. Abide by these. So in my opinion, instead of this bill, what's it tries to do is say that, but then it goes on to try to cherry pick a few things and
it's just not written but in my opinion, very well. I would say that to enforce what they're trying to do here on that, we should just make everybody abide by these rules. I mean these are These are These are the rules of the of the state Board of Health as well as the DHS. Now, uh, what I'm talking about is just the way this is written, this, this act calls for treatments of people, private care agencies that deal with
this personal care. We don't, we don't treat anybody. Our license does not allow us to do any medical things, nothing. We, we just provide activities of daily living for these, for these people to keep them at home and try to either delay or eliminate their need to go to a nursing home. That's what we do, um, and, and by, by going through this and trying to add this and that almost everything in here is already in here. All these things that they're, they're kind of cherry-picked a
few things to try to make this right, but to me, if they just, we just adopted this and made everybody follow the same rules that would take care of that problem and uh And also by by doing what they've done, they've actually are going to cause the private care agencies to expend quite a bit more money for things like making everybody be federally uh A criminal background check for everybody including federal,
when it, when we already are doing uh what the state requires, and that is if you've lived in Arkansas the last 5 years continuously, you don't have to have a federal background check. You all have to have a state background check. My wife is more Megan is more familiar with these things, and she can give you some more specific information on the cost of that. That's really all I had to say about it and I'd be glad to try to answer any questions you might have. Thank you. If you'll
state your name for record, you may proceed. Thank you.
Meg Ann
Unverified
46:02
My name is Meg Ann Townsend, and I am an owner of a private care agency that provides personal care services. I'm against SB 120, um, the current background process established by the Arkansas Department of Health issues a letter of determination if an applicant is qualified or disqualified. Federal backgrounds are required if this applicant has not lived in Arkansas for the past 5 years, um, federal backgrounds require fingerprinting.
But it's a specialized fingerprinting. We are our agencies are located in very rural parts of the state and, um so the um process to do a finger a federal fingerprint background check would require over a 40 mile drive each way to get an applicant to come in, they would have to drive to the next county to be fingerprinted, um, for their federal background check. That's true.
um, for us, I know that's true for Stone County as well as our location in West Helena. They would, they have to drive all the way to win. Um, and so, In addition to the additional cost for each and every applicant that came in to fill out an um an application that would just be the time, the delay, um, and, um, the practicality of.
That burden, um, to find that, to go to the fingerprint harvester, um, Additionally, um, our, because this is rolling over to our Medicaid care aides, our Medicaid care aides are already subject subjected to a secondary state and federal background check through the provider enrollment, which issues the provider numbers for billing purposes. So therefore, I am against SB 120 as it creates unnecessary and redundant
burdens to private care agencies. Thank you. Um, OK. Any questions from members
of the committee? OK, I have one question, is, uh, actually we probably maybe for the Department of Health. Um,
but you, you are required for state background check. Is that correct? Yes.
Uh, I would guess my question actually for the Department of Health would be, um,
Do we require both state and federal? Uh, for all. And what, and can you describe the difference there? For, for, for any provider in home health. You know, any, any home health, any personal care. Could you
Speaker 152
48:58
help me there? Sure, Matt, partner. The background check process is set across state government. I mean, it's licensee, you know, private.
Matt Gilmore
Unverified
49:10
Private care or private or personal care with, you know, home health. If you have lived in the state, For, you know, 5 years or more, it's just a state background check if it's, if you've moved in and out, it's the federal is required as well. OK, so it's It just depends on, on your, where you've lived and the and the
and the, you know, your history there. OK, but this would create a different standard just for
Matt Gilmore
Unverified
49:37
this one particular industry. Am I understanding that correctly require background checks for
which they haven't previously done because it's gonna license your standards. I mean, it's going to be full on license. It's going to be training as Mr. Cook has alluded to, it's going to be background checks if they don't currently do those now they'd have to do that when they, you know, hire them on. So yeah, it's going to be a new process for them. OK. But it's similar to
Senator Fredrick J. Love
Unverified
50:06
what everybody else is required. OK, Senator Love. OK, thank you, man. I guess
in my question, not necessarily for you all because you all said
that you accept Medicaid, so you're subject to the rules of the Department of
Health, but man, I'm, I guess I'm just wondering why are we not requiring everybody
to register with the Department of Health. And I, I think
that I think that will resolve, that would resolve that would address the issues that were having. And then everybody will be
Matt Gilmore
Unverified
50:39
a parody. Yeah, I can't speak to the history of why we've never required licensure for
everybody, and it's, but with Medicaid and, you know, that sort of thing, it is required, so I can't speak to the whole history of why there whatever was licensure for um private pay.
Senator Fredrick J. Love
Unverified
50:57
That's, that's been a long time ago. OK, but is that something that we could do instead of instead of I guess piecemeal in this if we just required everybody to
Matt Gilmore
Unverified
51:06
register with you all. I think he's wanting licensure so they can be held to the same standard with the training requirements and the background checking, I mean registry is different
Senator Fredrick J. Love
Unverified
51:17
than a license. OK, so I guess, I guess if we were required everybody to get some license with you all, then everybody would be held
Matt Gilmore
Unverified
51:23
to this standard, correct? I think that's what this bill is trying to do. Let's make the same standards of what's required for Medicaid.
Senator Fredrick J. Love
Unverified
51:35
So I guess I'm, I may not be answering your question. No, no, I'm just saying why don't, why doesn't the Arkansas Department of Health just require everybody to we can't just, we have to have enable, yeah, this seems
like it's a, it's a little bit different than Than that The packet
Matt Gilmore
Unverified
51:56
that this gentleman just showed me that that I think it would be the same. rules, I mean, they're going to be held
Speaker 206
52:06
to the same standard of what Medicaid's required. OK. Yeah, go ahead. OK, Senator, may I just Ms. Duncan, OK, um, just
use your mic, use your, you got it on, OK.
Stan Townsend
Unverified
52:20
The only thing that that I can see, I think you're right, in my opinion anyway, if, if everybody went by these rules. We're all on the same, as they say, as George Bush would say everybody's in a level playing field. But, but this, this bill goes a little too far in my opinion on this, this background checks. We fought these, we follow these rules to the letter, just like you said. But what this is saying is every single person that walks through the door, most of which are uh Arkansans that have lived in these
communities all their life, really. They don't, we don't require them now to do a federal background check. They all have state criminal background checks, all of them, but, but this bill wants wants everybody to have a state and a federal. The only people that get a federal now are people that have been out of the state during the last 5 years, and it's going to be very troublesome and expensive for all these people, every single person that works in the walks in the door to get a federal. That's the problem. The state is no problem at all.
Senator Fredrick J. Love
Unverified
53:22
And and so is that the biggest, is, is that the biggest difference between what
Stan Townsend
Unverified
53:28
Arkansas Department of Health is administering in this bill, I would say that's the thing that causes the most increased expense on, on, on everybody. And how much is the federal background check? It's what it's $13.13 dollars. We had to, we already have to do a criminal background check, which is 2022 in the federal
will be another 13, then we have to do drug screens. We have to do the state registry, adult registry, and, and, and child register, you do all those things, but the, but my point is every single person that walks, we don't, we don't have to do a federal on most of the people who apply for a job. Because they're, they've lived here, you know, they live in communities that hadn't been out of the state in the last 5 years, so we don't have to do it. Or a lot of, a lot of them never left the county, but, but I mean, so that that's what I'm
saying, but this is going to require everybody to do that and it's going to create a lot of additional expense for the for the all
private care agencies. OK. All right. Thank you. All right, any other questions for these folks? Right. Thank you. Thank you for being here and for your testimony. All right. Is there anyone here else here to speak for
or against this bill? See no, Senator Penzo, you're recognized to clothes for your bill.
Senator Clint Penzo
Unverified
54:59
Thank you, Madam Chair. Um. Currently they don't
have to. do any kind of background check, um, just because somebody's lived in the state for 5 years doesn't mean they haven't crossed the state line and messed up, uh, does it mean that they haven't lived out of state and have a history. I think it's imperative that we, we know who, if, if somebody has a criminal background, we need to know if they're going to be in uh most of the time an elderly
person's home, taking care of one on one. I, I, I'd know somebody close to me. that had their Social Security number stolen, um, we assume it had something to do with who was in their house and they tried to file taxes to get their tax return. There's all kinds of things that happen, um, I think this is good policy. I mean, we're we're currently doing this for, for our, our Medicaid uh population. I think we need to be doing it for our private pay population as well. So I'd, I'd ask for a good vote on this.
Thank you. Motion do OK, you've closed motion to pass. Is there a second? Second, all those in favor say aye and opposed. Um, I just
Senator Clint Penzo
Unverified
56:21
have it, there's no opposition. Thank you committee, um, so, SB 117, we've already heard it. I think that one could go faster
than some of the other ones, so, um, I'd like to
touch on that, and I have, um, Like for Mamie to come up and um we, we made some amendments. Uh, Senator Hill didn't want us to set up a new board, um, so we
merged the uh Acupuncture board and that's if this passes, it will become the natural medicine Board. Um, there was also some concerns that Peyton had that I believe
were addressed, um, and I, I can let her speak to the amendment better because she, she worked
Speaker 227
57:16
really hard on Trying to get all this accomplished, so. OK. We didn't make a lot of changes to the. SB 117 itself, um, we did provide some clarifying language by adding a couple of definitions, for example, on page 2, line 26, we added the definition of electromagnetism,
which is essentially the use of the dental electrical currents like a microcurrent or a TENS machine that you'll see physical therapists or chiropractors use when they're helping to rehab, uh, injuries or helping to reduce pain. It helps to stimulate the healing of tissues. So we added a definition for clarification there. Um, we also defined naturopathic physical medicine on page 3, line 18. Um, to clarify that we are not performing a chiropractic care
or practicing chiropractic science, um, and it does, um, Prohibit grade 5 manipulations from our scope, so grade 5 manipulations are like the the pop that you get at the chiropractor. So it takes that out of our scope, um, we felt that was a reasonable concession. Um Senator Irvin, you had pointed out, and
Speaker 227
58:39
One second, sorry. I'm having trouble finding it, but there was a point where we were defining um some of the routes of administration that we had access to and the word medications was still within the text, and we um removed medications to clarify that we're talking about therapeutic substances, so natural
substances and not, not drugs, that was a question that Senator Urban had at the last, um, hearing, so we clarified that. And then in terms of the board structure, um, we, we did, you know, not create a new board. But rather modify the acupuncture board to be combined with them and turns it into the Arkansas State Board of Natural Medicine, um, which would also open up the ability to potentially consolidate other professions within the natural medicine realm at a future time.
happy to answer any questions that you guys have. OK, I'm sorry, on page 13, so, so you're getting rid of the acupuncture board. And related techniques and you're making it natural medicine. We would be modifying
Speaker 227
1:00:04
the acupuncture board, expanding it to account for regulating naturopathic physicians as well, and then renaming it accordingly to the Arkansas State Board of Natural Medicine.
Speaker 1
1:00:20
What about the people that are acupunctures, they, are they gonna, I've spoken with,
Speaker 227
1:00:25
so I am, I am also a licensed acupuncturist here, so I did speak with the acupuncture community, um, and they were, um, On
Senator Clint Penzo
Unverified
1:00:37
board with these changes. We, we had, we had discussed uh putting them with the chiropractors, but about half, you know, the chiropractic, there's 2 associations, and they, they don't always even get along with each other, so about
half the chiropractors I talked to were OK with adding them and the other half weren't, and I figured that that would just be starting a big fight, uh, the acupuncture board, um, I figured would be, you know, a soft landing for uh this and they were OK with.
Merging the two under one board. OK, um, and method of payment for all these different things that
are placed on or. I'm just I'm just not familiar with. Hypnosis as a technique. Um, in medicine. What is the this or
um what is your source of payment? Are you cash basis only? I mean at this point.
Speaker 227
1:01:54
You have to be cash pay. You know, we can't
Speaker 230
1:01:58
bill insurance for our services, yeah. We're just consulting, you know,
At this point, so yeah, it's cash pay. OK. And then I had a question about uh, you have in here the different level of degrees, I think, um, And then
you're also requiring that level of degrees on the boards. Is that correct?
Yes. There any questions from members of the committee? Right. Any questions, Senator Love
Senator Fredrick J. Love
Unverified
1:02:40
you. OK, just, just to make this clear, once you, once you um create this new world, um, I've worked with some acupuncturists and I
remember I was doing a bill on cupping and they were a little
difficult to work with, so I'm, I'm, I am surprised that that they didn't have any push back on you, um. That, that, that's just kind of a note because I remember working with them a session or two ago, but with, with this creation of this new board, are you all now moving to Medicaid,
you can bill for your services now. Is that if we were to be
Speaker 230
1:03:27
licensed, then you would, qualify, yeah, we would be eligible to participate. OK,
Speaker 228
1:03:33
and Medicaid services that's what that's what I need, you know, thank you. But to address what you mentioned about the cupping. I
Speaker 227
1:03:40
think that was more about scope creep because that is very much an acupuncture Chinese medicine modality, and I believe this was giving massage therapists the ability to, so I think that's more what it was about. Thank
you. Any other questions from members of the committee. Senator Hill,
Senator Ricky Hill
Unverified
1:03:57
you're recognized. OK, I want to go back to the, to this board that we're, we're talking
about creating. And change the name of it. How can we change the name of the board and we're not even on that board yet. It should be this should be two separate deals. You're going to have to change the makeup of the acupuncture board. And list how many acupuncturists, how many natural doctors, how many, etc. that'd be broken down into 1234, how many, how many it is. How is that going to be determined?
Senator Clint Penzo
Unverified
1:04:30
Well, I mean, if, if this legislation passes, it's broken down in the legislation how many members of each would be on the board.
Senator Ricky Hill
Unverified
1:04:40
OK. And so, basically we're changing the name of that board as well with this right
Senator Clint Penzo
Unverified
1:04:46
now. Yes. I mean, we're taking the same board, but we're Given it a new name and adding another profession to the existing board, OK.
Speaker 251
1:05:11
Senator Heller. You still have the floor. Any other questions?
Members of the committee, right see none. Anyone here to speak for or against this bill. Come forward
and state your name for the record. Thank you, Madam Chair,
Speaker 253
1:05:36
members of the committee. I'll be brief. I'm Scott Smith with Arkansas Medical Society. Just wanted to
tell you we're still opposed to the bill. We have concerns that Um, page 6 potential confusion and title and abbreviations for naturopathic medical doctor in MD. To me there's potential for confusion there. Also you look on, on page 10, the ability to interpret the results. I think it's line 17. Interpret the results of a laboratory examinations for diagnostic purposes. Those are just a
couple of highlights and what we're just still concerned about. Educational. I just wanted to let
you know and I'm done. Thank you. That question, can you speak up and into the mic a little bit more, please. I'm
Speaker 253
1:06:27
sorry, but page 10, what did you say again? 17. And it says interpret the results of laboratory examinations for diagnostic purposes. That's one of a few others that jump out that concern us.
And then on the top of page 6. On the title protection part, it looks like lines 4 and 5, the ability to use inMD tests seems like it could be confusing to the public. OK. That's it. Senator Hill, you have your mic on. Did you have
a question? Yes, yes, I do. OK, I will
Senator Ricky Hill
Unverified
1:07:07
say the bill sponsor did try to work with you. took it away from
The medical side of it and to separate it totally away from you. You
Speaker 253
1:07:22
don't have any anything to do with them now, but you still don't like them. Well, it's, it's a question of whether we feel like Patient confusion, as I mentioned, the ability to use the NMD or possible confusion and just concerned about the efficacy and training, so we still have those concerns, but
yes, Senator, we've, we've had good, it's been a healthy discussion of all the time and he's been very good at taking our input, but we just I think he He knew that we still had problems with that, but I think
Senator Ricky Hill
Unverified
1:08:00
the general public is sharp enough and smart enough
in the state of Arkansas you realize the difference between a MD, a DVM, a PhD and everything else. I, I think the general public's smart to figure that out. So thank you. All right, thank you.
Any other questions from members of the committee. All right, see none. Thank you so much. All right, Senator, uh, let's see, I don't have anybody else signed up. I'm sorry,
Jahaj Shine
Unverified
1:08:34
yes, go ahead. Come to the table if you'll state your name, please? Sorry. Good evening. My name is Doctor Jaha Shine, um, I am a US Air Force disabled veteran. I'm a practicing naturopathic
doctor from Arizona and California. I've been practicing in those states for many years. I'm here on contract with UALR and building it, building into our program, science and evidence-based medicine to support clinical evaluations and integrative scope of therapies and potential alternatives to other medicines, so I do believe that um as someone who's on both sides as a practicing
physician in multiple states to include Ghana, who has pioneered their first functional and integrative therapeutic center, um, in Accra Ghana. I've worked with them to really uh increased training for medical doctors who want to do integrative medicine. So I've been at this for quite a while. On the flip side, I've been a patient and I can tell you how natural medicine not only. ped my upbringing from my African American and indigenous
grandmother who grew all of our cures in our backyard, um, that had a huge influence on the way that I practice. I've gone from space and missile medicine to air evacuation and rescue, and now I find my home in naturopathic medicine and it's because I can attest to you, people know exactly what they're getting. No disrespect. I do practice in states where we can go by NMD and what I'm hoping to do in this state since it's been known as a desert for what
we do. We have a lot of people who are seeking help with fly out to see me from these states that don't have licensure coming to Arizona and California, just to be treated. So with this being the great natural state and have so many of the herbs that we use and other medicines just growing wild in the woods that I like to hike in and areas and lake. I like to fish in. I've taken full advantage of being in Arkansas and looking at what we have to offer. Our patients are
really getting tired of just medicine, medicine, medicine. We're looking for a way to integrate the care so that there's a great continuity of care and great marriage between medical doctors and naturopathic medical doctors. I do think people are wise enough to know what's going on and everyone has Google and what we saw during the great pandemic is that many people were tired, sick, fatigue, and many other things, and we started to see an uptick in studies on the effectiveness of
things like glutathione and how something as simple as vitamin D in higher doses could influence sleep patterns, mental health, and cardiovascular health. We are very well trained because, you know, my degree is in biological and physical sciences, and I went to Besi University where I took 4 years of my life to learn everything about pharmaceuticals, about physical medicine, I teach anatomy and physiology and run the cadaver labs for Grand Canyon
University. I teach um anatomy and physiology and clinical biology and the science of biology here at UALR, and I can tell you that we are really looking for a change and in a state like the natural state, I would hope that people would be open to natural medicine. And that's a little bit more than taking comfrey and sprinkling it on someone. It's really about physical manipulation, homeopathic therapies, nutraceuticals in the marriage of how we can take
compounding pharmacy to the next level with anti-aging and doing things like introducing um bioequivalent hormone therapy to people who need it. Um, this is why it's important for the protection of not just the Arkansas people, but Those folks who believe that they took a weekend crash course and think they can just say, because I know a few things about herbs and spices. I'm gonna go out there and tell people I can treat and diagnose them. That's not what this is,
so we're very well trained in pharmaceuticals and understand the mechanism of actions and the benefits of having supplementation through nutraceuticals, physical manipulation, intravenous compounding and formulation so that we can take those things and then. make it to where it is accessible. People are educated and the only thing that really separates us from you all is the beautiful thing about being an MD and a DL is that you have on
the job training is what we would call it in the Air Force by having residencies. We can create residency programs, whatever would make you all feel comfortable to let you know that we are educated, we're tasked and we're primed for the care of getting this state to a position where we're looking at improved health outcomes for all of the people of Arkansas, and I do believe that we can do that and there is a great quote done is better than perfect. Once we get this bill passed, we
can always make improvements. We always have time to improve. We always have room to improve, and I think we can foster a healthy relationship between NMDs, DOs, and MDs because at the end of the day we have the same goal to make sure. that patients are healthy to make sure your loved ones have greater access to care, to make sure that we're protecting our scope from people who are just weekend crash courses saying they're naturopaths, that's not the same as someone who is licensed in naturopathic
medicine. So we're here to hopefully change the frontier shift the landscape of where healthcare is going to make sure that our patients have everything that they need and being able to work together we're seeing the home health. initiative in the VA. I am again a disabled veteran, so I go to the VA for my healthcare, and I'm seeing how they've made drastic improvements. I was able to get PRP injections in my knees and once upon a time, just a few short years ago, you could not do that. We could not look
at some of these other scopes and areas like I remember being one of the first people that got auricular acupuncture at the VA. That's not something they were approved before. So they can also approve what we do so we can improve the lives of veterans and hopefully reduce the amount of medication and opioids and suicide risks that they are undergoing because of poor pain management and so many other things, so with that being said, I really thank you all for your time. Um, I totally am
supported this bill as a doctor and as a patient of what we do. Thank you. I'm open for any questions. OK, I'm sorry are you a A DO, an MD. I'm so I have my license as a doctor of naturopathic medicine in the state of Arizona, we can be known as NMDs as long as you've gone through the train program 4 years of medical school, passed the licensing board, right? And you're from Arizona. Yeah, I moved here from Scottsdale,
Arizona, so mhm I got you. OK, thank you. I just wanted to make sure I heard it
Jahaj Shine
Unverified
1:16:14
correctly. Absolutely. Any questions from members of the committee? All right. Senator Hill just a second. I think the board we can work on as well, but I thought what they had was a good idea of working with this board, it looks like we have support to do this, but I see how it
can be done. Any other questions from members of the committee? We're seeing none. Is there anyone else here
to speak for or against the spill. All right, see none.
Senator Clint Penzo
Unverified
1:16:48
You're recognized to close for your bill. Thank you, Madam Chair. So NMD, we, we discussed that and we did not want to leave it out of the bill because then somebody might try to use it and this protects it from being used
by somebody that hasn't had the training, uh that uh someone has here, so,
um. I just, you know, we, we, we, we discussed this last time, so I'm gonna keep it short, but I think this is good for Arkansas and I won't, I won't. Discuss this much more, but let's just uh I'd appreciate a good vote.
Yeah. should do Is there any, I'm sorry. As
amended, is that? Oh yeah, we need to adopt the amendment It's already been adopted? OK, sorry engrossed it
on the floor. I know, but you have an amendment to add a house sponsor. Did we
already do that? OK, so we already did do that the last time, is that correct? OK, sorry. So it, it needs to be in motion to pass as amended. Motion to pass as amended. OK. And 2nd, 2nd, is there any discussion? Great. All those in favor say ay. and opposed.
Senator Clint Penzo
Unverified
1:18:09
I have it. Congratulations, you've passed your bill. Thank you. I've got a some more folks here for uh uh.
Senate Bill 348, um. So I don't know if they want to come to the table with me now. just You
Um, OK, sorry, uh. I've got 311, 306 262255. 122, 121, and 110. Which I'm sorry, you, you're on, those are the bills
that are, that are on this agenda. I'm sorry. Sorry, 348.
Sorry, I just didn't have my apologize. It went to the next page. 348. Is that correct? That is
Senator Clint Penzo
Unverified
1:19:18
correct. OK, sorry, my bad. OK, so this, uh, this legislation increases the annual reimbursement cap for diagnostic laboratory services under Medicaid, ensuring that patients receive adequate monitoring and care, particularly patients with chronic pain. The bill addresses patient safety, reduces costs and helps to mitigate the opioid crisis by allowing more comprehensive testing, um. you I, I can let you go because I mean.
Kristen Neck
Unverified
1:19:49
We're trying to speed things up
this evening, so if you want to go ahead and start, um, Madam Chair, members of the committee, my name is Kristen Neck. I'm the chief operating officer for AIT Health and affiliative pain Treatment Centers of America. I'm here to ask for support for SB 348 to increase the annual cap for diagnostic laboratory services to Medicare beneficiaries diagnosed with chronic pain from $500 to $1800. The opioid crisis continues to deepen. Currently, many chronic pain patients and Medicaid beneficiaries do not receive
adequate monitoring, leading to higher emergency room visits and poor treatment outcomes. On average, the cost of an ER visit for substance use disorders, $520 per patient. The average annual medical cost attributed to substance use disorder diagnosis is roughly 15,000 for each infected enrollee. Inpatient care is 6500 outpatient 8600 and medications are 1500, lack of adequate diagnostic testing, which includes urine drug screens, blood tests of opioid
metabolism, electrocardiogram tests contribute to opioid misuse, diversion. Exacerbating the opioid epidemic while increasing the cost to the Medicaid program. Raising the cap to 1800 would allow for chronic pain patients. To be monitored um and avoid substance use disorder, um, that results in them getting ER visits and inpatient admissions. Thank you. Are there any
questions from members of the committee? I'd like DHS to come to the table, please. Good evening, Janet Me and DHS. OK, so clearly this does have a fiscal impact, uh, because we
are raising this diagnostic laboratory services, uh, We have $500 or $1800 so we're more, we're tripling more or tripling the amount if the beneficiary is diagnosed with chronic pain or is being treated for pain management. So do we have a fiscal impact on this because clearly There is
Speaker 282
1:22:17
one. Yes, we have um a conservative estimate of
anywhere from $100,000 to $600,000 in state share. This is an adult-only benefit, which is the reason it has a cap, um, several years ago, lab radiology was split to give each one of them $500 that's only been in effect a couple of years. So, it does have an impact to the Medicaid program, and that's a conservative. estimate. Um, my, my fear is that it would be
more. OK, and so, so this is just for
chronic pain or pain management. So I, I guess we raised that cap to $500 and we split because we ran into an issue with primary care providers hitting the 500 because it was also being, uh, used by chiropractic services, uh, or others, right? And so they weren't able to get their labs done and things like. So I guess I, I, I mean, why,
why $1800 for only those people that are practicing for chronic pain and pain management versus everybody else that needs primary care diagnostics. I mean, why not just raise the cap to $1800 for all diagnostics. How much would that be to the Medicaid program? Because they need their blood drawn. I don't have
Speaker 282
1:23:48
an estimate if we raised it for everything, but it, I mean, we have the limit to help manage the Medicaid program overall for the adults that do
qualify for the program. We don't have um limits on children's, um, services. So I, we could go back and try to get you something very early, um, on raising that, but it still would be a cost to the Medicaid
program. OK, and this, and this would be an annual, this is an annual.
Speaker 282
1:24:18
Yes, this, um, the benefit cap is $500 currently. It is an annual cap that begins on July 1 of every year. OK, so we're
Speaker 280
1:24:30
raising it from 500 to 1800 just for the set of providers. I, I, that's a question for
Kristen Neck
Unverified
1:24:37
them. That would be the question for them. Yes. So originally we did it just for pain management, for chronic pain patients, OK, and,
Kitty Cohn
Unverified
1:24:43
and could you tell me again what your background is or what your degree is. I have a master's degree in healthcare administration and my background
Kristen Neck
Unverified
1:24:49
is in medical billing. And you're associated with who? Pain Treatment Centers of America. I'm sorry, one more time pain
treatment centers of America, OK. Pain treatment Centers of America. OK. Are you from Arkansas? No, I'm from California. OK. I mean, I've lived here for 4
Kristen Neck
Unverified
1:25:09
years, but I'm originally from California. Oh, you do live here now, now I live
here. Sorry, I'm sorry, I missed that. OK. Thank you. Are there any other questions from members of the committee? All right, uh, anyone here to speak for or against this bill.
Kitty Cohn
Unverified
1:25:32
I think you came to the table if you want to state your name, ma'am. Thank you, Madam Chair and members of the committee. My name is Kitty Cohn, and I'm the chief legal officer for Pain Treatment Centers of America. I would just comment that this increasing cap will save the program thousands and thousands of dollars. It is far cheaper to prevent these emergency room costs and inpatient visits due to overdose. Many of the patients that we're dealing with
are high risk, um, and if we do not do this testing, they end up in the ER or they end up with these expensive inpatient stays that run $15,000. So By increasing the cap for this type of testing, we actually save thousands. OK. Any questions for members
of the committee? Right. See then, thank you again for your being here in your testimony. I'm sorry, did you all have a question?
Senator Fredrick J. Love
Unverified
1:26:33
No, Senator Love, did you have a question? Well, John was just mention we did we did we run a fiscal impact on
this is that. We, um, I just, that's why I had DHS come to the
table. It was, uh, I'm sorry. If you want to come back, I'm so sorry.
Speaker 293
1:27:06
Yes, sir. We, uh, ran a fiscal impact. It
Speaker 282
1:27:10
was, um, anywhere on state share from 98,000 to 591,000 so I. Rounded from 100,000 to $600,000 of
state share. State. Yes sir. Because there's a 70/30 match from the federal. Government. So 30%. His state share in the 70% would
be the federal part. So the 30% of state GR, which, which she is the physical impact that she is referring to of state share is state general revenue for Medicaid, but the
70, the 70 70%, it would be 70% more than that for that would be the federal share. Does that make sense? Senator Penzo, yes.
Senator Clint Penzo
Unverified
1:28:11
Thank you, Madam Chair, uh, just to, just to clarify that The number you just gave didn't factor in any uh obviously it wouldn't, but it didn't factor in any emergency room visits that might take place. Um No, sir. Thank you. Any
Speaker 297
1:28:26
other questions from members of the committee?
seen none. Um, thank you for
your testimony. Thank you all for being here. All right, Senator Penzo, you're recognized to close for your bill,
Speaker 298
1:28:57
Senate Bill 348. I'm just going to stay
Senator Clint Penzo
Unverified
1:29:06
right here. Um Like I said, the fiscal impact will be offset by limiting emergency room.
visits appreciate a good vote on this bill. OK, thank you. Any, OK, and what's the pleasure of
the committee? I assume motion to pass. All those in favor say aye and opposed. I just have it. Congratulations, Senate Bill 348 passes. Thank you.
Senator Clint Penzo
Unverified
1:29:59
OK, um, can I do SB 306. Senate Bill 306. And the interest time I'd like to have a representative from the home care providers come up. Present with me.
All right, committee, Senate Bill 306, um a handout and we're passing that out. Alright well I can Start talking about is being handed out. Um I just want to kind of explain, you know, I've worked with the uh Home care providers on this, but
the, the genesis of this, the my, my reasoning for it. Um has to do with my father who had dementia. Um So he was in and out of nursing homes and spent time at home. Um, when he was in the nursing home, a lot of times he would his delirium would compound his dementia. A lot of times he wouldn't know who I was. He would play with things that weren't there. Um,
when like from falls and stuff he'd end up in a nursing home. Then we'd bring him home and his uh delirium would go away and I'd walk in and he'd recognize me. He'd ask me how I'm doing, but when he was in a facility, his condition was worse. Um, my goal is to Let people wage in place to stay home as long as possible, um, and use, use the facilities when you need the facilities. Um, I don't know how many times we were back and forth between uh
nursing homes and my, my parents' house, but, uh, the quality of life when he was home was obviously better. It was his it was his recliner, you know, his shop. I'd take him down to a shop and we'd hang out and stuff. So, um, and he would remember things when he was in a familiar setting. So that's, that's why I um am passionate about this bill. Um, for everybody in the room, uh, I personally think it's going to save the state a tremendous amount of money, um,
and, you know, all, all that, uh, Burris kind of explain the details on, on that here in a minute, but um, Currently, In-home care is capped out at uh 34,000 a year nursing home expenses are usually around $102,000 a year. Um That, that, that gap needs to be narrowed. Um, and if it is, we can leave people at home longer and still save the save money. Um, and eventually they probably will go
into a facility, um. But that's The person's choice. Not every family has the opportunity to bring somebody home, um, because it still takes a tremendous amount of work from, from the family, uh, to keep somebody home but with assistance, you know, my, my parents, um my sister's on Medicaid, but my parents uh had the means to hire personal care themselves so this wouldn't have affected my family directly. But, but I got to see firsthand
the differences between my dad's quality of life in a facility, um, when we were actually able to bring him back home a little bit before he passed in October. But um, I'll, I'll go ahead and let John take over and talk a little bit. OK, thank you.
Speaker 306
1:34:08
If you'll state your name for the record. Yes ma'am. John Burris. I'm here on behalf of a home care association. Uh, thank you very much and uh out of respect for Tom, I want to say I don't believe we have anybody signed up to speak for this, and so we
just thought it would be easiest to do it all at once, and I don't think we have anyone for it. We'll try to make it as efficient as possible. I'm going to try to make my comments less than 5 minutes. So I appreciate all the time. I want to get into the what and the why. This bill, but I want to start with something that, you know, I feel like it's become important to say today, and I want to say it for everyone in the room and everyone watching and that I believe that everyone in this room is going to vote based on what they think is right, and I believe that I really respect this process very much having participated and I served with a
lot of you. I didn't serve with all of you, uh, but some of you I knew before office he's not here. I got to know Senator Fulpo on his path to office, but some of you I served with and I, I, I, I have a Tremendous amount of respect for this process, and so I just want to say very clearly for everyone here that I think all of you are going to vote based on what you think is the right decision, and that's not always clear. These are tough, but I think we all approach it with the right perspective. That said, I have strong opinions that 306 is best
for the state, taxpayers and patients, and so I want to explain why, uh, in terms of the what? We kicked around various bills to run as we were debating this legislative session. These only happen every 2 years, as you know. We thought about getting very granular and getting into details, but when we look at this, this home and community-based waiver is up for renewal. This time next year it will either have been approved by the federal government or at least sitting on their desk to go live July 1 of next year. So this waiver is up for renewal.
So instead of coming to you uh as a legislature and trying to get into really particular details. We started rereading the Medicaid sustainability report that was comprised by Guide House, I believe was the consultant. I hope that you have in front of you. A couple of pages that we pulled, but this bill is written directly derived from that Medicaid sustainability report. Instead of getting into these
details of saying what had to be set in law, you know, like the rates and the eligibility and the benefits. We thought it was best to ask the legislature to set some bumper rails to say these are the goals and then let DHS and CMS get into the tactics of how we achieve those goals, and we believe the goal should be very clearly stated that as long as it does not cost taxpayers one more dollar, people should be able to age in the place of their choice, be it at home, be it at an assisted living, be it
at a skilled nursing facility, but we're going to leave it up. Our intent is to leave it up to DHS and CMS to decide what those right numbers are, but simply put, we think the caps now are, are the gap is too big, as Senator Penzo said. Right now the home and community-based waiver, you cap out at $34,000 and the average cost of a skilled nursing is 102 in Arkansas. That gap's too big. Skilled nursing facilities are important. I have a lot of respect for the work that they do. They are not bad. They are
not bad people. They do not deserve to be talked about in that way, and that's not our intent either. They serve a role and it's important, but as This population grows, that gap of capping out at 34,000 is too big of a gap between the 102 that it cost when you go to a skilled nursing, so I'll read a couple of points from the Medicaid Services report. I hope or sustainability report. I hope you have it in front of you, but again, this is from the
independent consultant hired by the legislature to review our Medicaid program. It talks about how the demand for these services are going to continue to increase. The cost of a skilled nursing is obviously higher. The cost for home care is obviously lower then I'm, I'm quoting when looking at how our long-term services and support expenditures are distributed between facility and home care and community-based settings across the programs. There is a nearly even split with institutional settings, which is your nursing homes, accounting
for 49.8% of our expenditures in Arkansas and HCBS for 450.2. The national average is home and community base at 62.5. So we're about 12% difference in what, how we utilize home care in Arkansas compared to other states. It goes on and it says accessing home and community-based programs in Arkansas can take several months longer than access accessing nursing home facilities, which indirectly
disincentivizes home care services use and results in a uneven playing field. It says DHS needs to comprehensively review the monetary tiers, service availability, and eligibility requirements to narrow the gap between home care services and skilled nursing facilities. That's from the MSR. report compiled by God House who was hired by the legislature. Our bill really just tries to quote that and say to the degree that it is
possible, people should be able to age in the place of their choice. To the degree that it does not cost taxpayers any more money. DHS is going to have to write the details. They're going to have to come up. These are very complicated, but at the same time other states have done it. We're out of whack. That's what Godhouse told us. We have, we have a disproportionate number of people in institutions compared to other states, and if you can get them at home and keep them at home, they're better served even if they end up in a facility eventually, if they can stay every day they
stay at home, one and most importantly, it's better for them. But 2, it's better for the taxpayer. So I would urge you to consider this bill, and this is very important, not the end of the discussion, but the beginning, as I said, you've all been in these situations where You, you show up and legislative council, you're getting blown up by lobbyists, maybe sometimes me, uh, about a rule or a rag or a waiver or a state plan amendment in front of you and they're trying to tell you, here's what's going on and you feel like you're playing catch
up and our attempt at this bill was to start the discussion now instead of a year from now where you're at the end of the process. We thought it was respectful and appropriate to start this discussion at the beginning of the process. quoting this Medicaid sustainability. For set some bump reels to say what the goal should be. Let DHS and CMS come up with a specifics after stakeholder input, legislative input, governor's office input, agency input, approval at all levels where you're not feeling like a year
from now you're blindsided with something at the end of a process, but you know what's going on at the beginning of the process. That's what we're here. It's the start of the debate, a vote for this bill is the start of the debate, not the end of the debate, and very importantly, the cost has be neutral. I can't say that enough. I think it's very unfair to ask DHS if they come to the table, I think they're going to speak to the numbers on some level, but at the same time I'd say it it is difficult but by design, this bill does not get into the details. There's 3
things that drive the cost of the health plan, its eligibility, its benefits, and its rights. This bill does not mandate anything in any of those categories, so it's hard to score. You can't say for sure what it will save, but we can absolutely tell you without a. shadow of a doubt that it will not cost more money. That's a requirement of the waiver, and it's a requirement in this legislation. It cannot cost more money. We can't quantify what it will say, but it will not cost more because we don't eligibility is who qualifies. Benefits is what they get, and
rights are what we pay for it. We don't mandate any of that. We just say to DHS, we're asking you to say to DHS as a legislature to design a program that lets people age in the place of their choice to the degree that it does not cost taxpayer one more dollar. That's the summary of the bill. It must be budget neutral. Uh again, I would ask you to consider a vote for this bill to be the beginning of the discussion, not the end. We're trying to have a very important public policy debate in a very open and transparent way with input from everyone that can
result in a better outcome in the end, and I'll say it I'll close with this and, and, and happy to answer any questions, but I mean it sincerely. Everyone on this committee and everyone in this room approaches this debate, I think honestly and with the best intention of mine, and I want to make that absolutely clear regardless of your vote, I think open and transparent debate is the best, and that's why we're here sitting at the end of the table to have it. So with that said, thank you for your time and I'm happy to answer any questions. Are there any questions from members of the committee?
No questions. Thank you for your testimony. Right, uh, uh, next person to speak against the bill. Rachel. But You'll state
Speaker 136
1:43:28
your name for the record. Uh, Rachel Bunch, I'm the executive director of the Arkansas Health Care Association. And I have 2 handouts, if I may. Yeah.
Members, the first set of handouts that you received are the handouts from DHS on the fiscal impact analysis numbers that they have, you can look at those and we can have them come up to the table and explain this. Uh, in just a bit, um. And then, uh, these are your handouts, is that correct? OK. Good. will pass us out quick.
Rachel Bunch
Unverified
1:44:51
Go ahead. Thank you. My name's Rachel Bunch. I'm the executive director of the Arkansas Healthcare Association. We are the state's largest provider of post-acute, um, Post acute healthcare providers, um, so I'm here today to speak against Senate Bill 306, um, and really to provide some facts and more detailed information. Um, I did bring uh my comments that we
submitted on the Medicaid report um for the sake of time I'm gonna, I'm gonna save those. I think the gist of those comments speaks to the fact that no one wants to be in the nursing home. Um, our members can build nice new buildings, uh, we can do lots. of things to accommodate people, but no one wants to go to a nursing home unless they have to, and I think that's something that we acknowledge regularly, um, and those are our comments, we'll distribute those again later. Part 22 fundamental issues with
this bill. One is that we believe this bill is a false comparison of programs and 2, there are some distinct funding differences that I think the bill does not acknowledge that are important to consider as we look at Medicaid and healthcare policy. Um, one on the comparison of program, and I'll add to a lot of the things that they, uh, Mr. Burris talked about can be done currently. DHS could bring those currently. We go through these studies, we don't think this legislation is needed.
Um, about the comparison of the programs, um, The bill has a few misleading representations of home and community-based waivers. Um, we absolutely believe that this will have a large fiscal impact. I'll talk about that in a moment, but um it's factually incorrect. Home and community-based waivers do not provide services that are comparable to skilled nursing facilities or inpatient hospitals, um, HCBS services are non-skilled and non-medical. They're limited to ADL help,
personal care, transportation, respite, adult daycare. Um, meal deliveries, skilled nursing facilities have to provide very different services. So to compare the two in the legislation and offer the same amount of money for two drastically different services, we believe is incorrect. Uh, nursing facilities have to offer 24/7, 365 care, we have to have medical directors, nurse practitioners, pharmacy consultants, RNs, LPNs, CNAs, dietary consultants, um, a very
large uh variety of professionals that are mandated in our federal regulations, these other programs don't offer the same thing, they're not bad programs, or members to do therapy for patients across the state every day and discharge them to these programs. Um, back home, um, but they are different and so to say that they should be paid the same without the same regulation is unfair. Um, nursing facilities are legally, legally required to
provide all of the services for patient wellbeing. Uh, they can, we cannot admit patients to a nursing facility who only need assistance with um some things like meals or simply ADL. They have to meet, they have to have medical requirements and meet a certain eligibility criteria to live in a nursing facility. Uh, Senate Bill 306 falsely suggests that HCBS can replace or reduce institutional care, which is a fundamental misrepresentation of Medicaid
policy and the roles of nursing facilities. We don't believe that this, uh, this bill will change the number of people going into nursing homes, but we don't think it will change that at all, but we do think it's an
Speaker 136
1:48:39
unfair comparison of the services. Next to speak just to quickly about funding. And these are the two handouts that I gave today, um, I think it, it's, I think it's wrong to just look
Rachel Bunch
Unverified
1:48:48
at the total dollars. Um, I think that's some of our issue with the guide House report and I think it's a
lot of our issue with this bill, um, I don't have the bill in front of me to to point you to the line, but there is a specific dollar amount that's in the bill, it's total funds there for the facility and nursing facilities are expensive because we're required to provide lots of things. It's very expensive, um, and this would provide a range, uh, Mr. Burris mentioned. that it would give guardrails, I would argue it doesn't give guardrails, it gives a very wide open range. Um, the first handout that I have here was
prepared by our CPAs and while it is arranged, they believe that the cost of this, if they implemented and we took no additional people on the current waiver that we have that has no waiting list, by the way, would cost up to $223 million in general revenue per year, um, and this handout. has a breakdown of how we arrived at that number, looking at the cost of day, cost per day, sorry, um, in nursing facility care and then the unduplicated number of
participants on um the current E Choices waiver. The average annual days uh that they're on that way we're getting services, 295, and that brings you down here to uh to the cost that we think it could be up to this amount. It, it is vague and does have a lot of options in there, but we think that it could cost up to that amount of money. The next thing that I wanted to talk about is um the handout that you have with the pie chart with the colors on it. So the HCBS waivers are only,
they only have two funding sources. They have the state general revenue portion, and they have the federal match. So two funding sources. And so when you talk about the dollars here and then you look at the nursing facility, the nursing facilities have 4 funding sources. They're, they're different. Uh, the four funding sources are the federal match, the state match, the provider tax that nursing facility providers pay 6% of gross receipt gross receipts, every facility all year. They've done this for many, many years
and pay into this. system to allow for this match, right, to have a better deal and offer better quality services for these residents. And then finally, the beneficiary amount, so a patient moves into a nursing facility, their Social Security check that in the community they would keep or their family could use, it would be there. When you're in the nursing facility, that has to go towards your cost of care. So when you have those 4 funding sources on the left side here for the nursing facility, you look to the right on this one, the biggest change, you lose two
of those funding sources. but then that yellow piece of the pie, which is your state general revenue doubles. So you go from 13,000 to 27,000 of general revenue per participant. So I think it's important to look at the, the sources of the funds, where they come from, uh, but most importantly that we think this is not an apples to apples comparison, um, and that it really, it doesn't change the number of people going to facilities, um, as he did say, these are really important services, and I have members
that offer all all of them, um, and, uh, these are complicated issues, but I think this
Speaker 136
1:52:04
bill goes about it in the wrong way. I'm happy to answer questions. Thank you.
Are there questions from members of the committee? Great. Thank
you for your testimony. All right, members, we do have the handouts
from DHS. Does anybody have any questions for DHS on the their handouts. Yeah, if they were just coming to the table and Senator.
And members, I do apologize. They did prepare a fiscal impact statement on Senate Bill
117 and Uh, it was in your folder. So you may, I, I apologize, but please proceed, Senator Lenny. I just kind of wanted to
Speaker 317
1:52:57
hear their thoughts in general on the legislation. I'm sorry, I didn't hear you. We wanted to give them a chance to weigh in on the legislation.
OK, if you'll state your name for the record.
Speaker 293
1:53:23
Uh, Janet Mann, DHS. And we are neutral on the bill. We provide er we pay for both of these services, the nursing home and the home and community based services in the
Medicaid program. And, OK. Senator Lenning, you still have the floor. OK, Senator Pay
Senator John Payton
Unverified
1:53:41
Payton. Thank you Madam. I'm just trying to figure out. If it very specifically says
Speaker 282
1:53:52
That it can't cost any more than what we're spending. How's our fiscal impact? We didn't issue a fiscal impact.
Speaker 293
1:54:02
We actually considered several different variations and due to the number of participants in the services that could or could not be provided because the waiver is not written or designed. We did not issue a fiscal impact statement and that, that
Speaker 296
1:54:15
is why there's been lots of numbers discussed.
Senator John Payton
Unverified
1:54:18
So if I could follow up, it's been
stated that the bill gives DHS broad range in. Organizing, customizing, creating the program. Is it seemed that it would be within your abilities to set the guidelines to to ensure that it would not cost. More and that it would not have a fiscal impact. There are
Speaker 282
1:54:42
budget neutrality rules that have to be followed with every waiver, specifically in 1915C, which I think the bill references, but without knowing
Speaker 293
1:54:53
if this is a new waiver without knowing if this is going to be a transfer of services, new services, uh, you know, new services. We had no
Speaker 282
1:55:01
way to do that, and yes, we do have to renew this waiver in a year and we've got started work groups. We started looking at it, but we don't have it designed so we have. way. So just to sum it
Senator John Payton
Unverified
1:55:13
all up. You don't know, but if you found out that it was going to cost more, this bill would direct you not to do it. Is that correct?
Senator Dave Wallace
Unverified
1:55:24
I believe as it's written, yes, it will. Thank you. Thank you, Madam Chair. Senator Wallace. Thank you, Madam Chair. Well, Senator Payton touched on what my question was, but what I'm hearing you say is that we don't. DHS has no idea
Speaker 276
1:55:47
what this is going to cost us. Yes, sir, the
Speaker 293
1:55:49
way that the bill is drafted, we considered various
Options on trying to do a cost estimate, and we looked at cost savings. We looked at cost cost growing and we, we poked holes in every one of them, so we couldn't issue a fiscal impact. I wasn't comfortable with saying it would save money or that it would cost money, so we were adding a blank check. No, sir. OK, I have a question. I mean,
I mean, yes, and yeah, the check, we don't know what would be on the check, so
it would be blank, basically, but I mean, I think what I had requested for is we do have this, this waiver. We do have this currently in place, and so the numbers that were generated
Speaker 293
1:56:44
is based on current spend, correct? That is correct. We do have this waiver. We actually operate several different waivers. We have 2 waivers, um, which I think we provided you a narrative on both waivers and
then we provided you our historical spend on um our our choices waiver living choices waiver, our self-direction waiver, and then we also um added our personal care services that our choices waiver recipients receive that is
Speaker 282
1:57:11
under the fee for service program to give you all the total spend. for the past
several years. OK, and so I'm just looking like. I'm looking at this page under V3, I think this, um, so starting in year one.
Uh Started in year one, the total AR choices cost went from 900,000 to 1.8 million to 2.7 million to 3.6 million to 4.5 million to 5.4 million. And those are, that, that is, these are the current spins, is that
Speaker 282
1:57:50
correct? I'm sorry, I'm a little confused if that is version 33, so those are the documents that were
Speaker 293
1:58:00
released, um, earlier today under FOIA request. Those were the ones that we could not come to agreement on, therefore, we didn't issue them as fiscal impacts. So. OK.
Yeah. Can I ask where the committee got it from? I'm sorry, I understood
Speaker 282
1:58:24
this to be fiscal impact information. We prepared, we had over 5 versions of Fiscal Impacts, and
Speaker 293
1:58:30
we could not agree upon them. We deemed them not finished. We issued a statement on Senate Bill 306 that due to the number of participants and the number of services we could not issue a fiscal impact as associated with this bill, which is
why we are neutral, right? did you have, but what what was requested was current spend. Yes, ma'am.
Speaker 296
1:58:53
And, and where is that? That is on, um, it's a page that looks like this. I don't know if it's
green. Oh, it's not. OK, my apologies, but. This, this is, this is this
Speaker 282
1:59:06
and this, correct? You, you had requested, um, I believe. Several days ago, a narrative on the two waivers um
Speaker 293
1:59:14
and then historical spend and that's what we back to this.
This is where I'm looking at.
So these are the different from starting in fiscal year 2011 down to 2025, correct?
Speaker 293
1:59:31
Of the different waivers. Yes OK. And the personal care services, um, column is fee for service just for
clarification. I got you. OK. And then the total Total waiver spend. So these are just for the waivers, not for long-term care. nursing home. This is just this
is just waiver expenses. I got you, OK. Any questions? Yeah,
Senator Fredrick J. Love
Unverified
2:00:01
sure. I turned on my microphone. All right, so I'm looking at this, it says on the first page it says um current waiver was approved March 1st, 2024, 8300 people served, right? And I know that that Miss Buch said that and it said about 57 million. And I know Ms. Bunch says she didn't like to compare and this
is not an apples to apples comparison, but how many people are served through nursing homes. Do you have that number or a rough estimate. 11, OK, 11,500. How much do we spend? With nursing homes. 12.
Speaker 293
2:01:10
In calendar year, excuse me, state fiscal year 2024 for um nursing homes. We, um, Spent $926 million. OK. Any other
questions? Senator Pen so you recognize the question.
Senator Clint Penzo
Unverified
2:01:31
Thank you, Chair, um, I just, uh, want to ask two questions, uh.
Budget neutrality in here would keep you from spending more than we're currently spending. And then the next question, uh, Senator Irvin brought up the the the different versions that were out there. Can you address, uh, what the What the findings were on whether that was going to cost more or if it was gonna. Uh, save the state money. I know that, you know, we can't. pin it down and that's why there were 5 versions because they were having a hard time determine savings.
Or impact on on the state um if you
Speaker 293
2:02:19
could just address the budget neutrality and then the findings from the 5 versions. Uh, on budget neutrality, we do have to show any type of waiver service for the services outlined in the waiver, have to show, we have to show budget neutrality for an alternative source of, of care. So it is waiver by waiver when we submit it. So depending
Speaker 282
2:02:40
on how it is designed and number of
participants, we do have to apply for a cap or X number of slots in a waiver and that has to be shown. To follow the budget neutrality rules as um set up by CMS to show that we would spend less on this waiver than we would
Speaker 293
2:03:02
in another type of care. Um, to your second question on the different versions. The different versions showed, um, extreme savings, um, that
made us all extremely nervous because we could poke lots of holes in them, so we naturally threw that
Speaker 282
2:03:20
one out. We looked at different versions and even tried to break it down into a per um member or per beneficiary annual cost, trying to take into account different factors that got complicated because of the length of term, average. of term on the waiver and the average length of stay in the nursing home. So it was not an apple to apple comparison of
going from the waiver to the nursing home. There's also when um patients will go to the, to rehab in a nursing home and how to account for that because they can bounce back and forth. So each time we looked at something that either had a savings or a cost, it, we had lots more questions at the end of the analysis, then we, then. did when we started the analysis. Thank you. I, I have a quick
question on page 2 of the bill lines 33, 34, 35, and 36. It says the department shall ensure that the average per capita expenditures estimated in a fiscal year for home and community-based services waiver recipients does not exceed the average per capita expenditure
that would have been made to provide institutional services. So to me that does create the comparison of anybody that's on a waiver now. That's part of home and community-based services, they
would be paid at the same rate
as if they were in an institutional service. That's how that's written. So, so why couldn't you, so I don't understand. How, how that's
not. Basically saying, That Now home and community-based services recipient beneficiary. That they are being reimbursed
at the same level as nursing home institution, if you're institutionalized in a nursing home. Because that's, that's not budget neutrality, that's actually stating right there that it would have been made to provide institutional services in and it says that the department shall
insure so that, so I don't understand how we don't get to a fiscal impact that, that we take the beneficiary, the number of
beneficiaries that are currently inside the waiver and apply to them what we're currently spending per beneficiary per year. at institutionalized care. We
Speaker 282
2:06:00
tried to look at the average per capita, I think in the bill, it's $102,000 and odd dollars. It's not an even number. We took that into account on one of our versions and actually tried
Speaker 293
2:06:14
to back into some of the analysis that um
Mrs. Bunch referred to with the patient liability
Speaker 282
2:06:26
and the quality assurance fee to actually Try to see if there was a new cap to a waiver potential to be spent annually if we wanted to try to look at the average spend there versus what would be the average spend minus some of the additional funding that goes
Speaker 293
2:06:44
into that, that could set a new cap with that, then we tried to look at services that would be
provided in that cap. We couldn't define all of the services to be able to apply rates in our then, then the struggle was along the lines of beneficiaries and how many beneficiaries and how
Speaker 283
2:07:06
that would grow. That's where we got uncomfortable with putting a number. Out to show budget neutrality, OK,
OK, well, I understand that. I guess what I'm trying to understand
though is that Would you not agree that
The level of care in the waiver is very different than institutionalized care. Would you, I mean, is that not
correct? We're paying for very different things here. Yes. OK, and so it's, it would, in your opinion in the Medicaid program. Is it reasonable to pay? For skilled Uh, skilled labor for with for unskilled. Positions.
In other words, it doesn't make sense to me that we would pay the same amount for institutional care as we would home-based care, because there are two
different, completely two different things. But this bill is trying to equate
Speaker 282
2:08:16
our difficulty. Hammon community-based services have a role and they have a role and I would agree with that up
Speaker 328
2:08:22
until that role can no longer be met,
Speaker 293
2:08:28
then they go into either a skilled nursing facility or a hospital or what is the next required level
of care, OK, but you would agree that that there are two different things and we shouldn't be paying for them at the same way. I agree that they are
Speaker 293
2:08:41
different things, and I think that was why we struggled with trying to come up with. Senator Payton, you
Senator John Payton
Unverified
2:08:50
recognize. Thank you, Madam Chair. I would agree they're not the same, and I would agree that it shouldn't cost the same, but I disagree that the bill says that you'll pay the same because
The bill on line 35 says does
not exceed. So with DHS interpret that as saying that they should pay equally, or would they take advantage of cost savings if
Speaker 293
2:09:19
available. OK. Without having a design of the waiver, that was the that was our struggle. So not knowing exactly
Speaker 282
2:09:27
what would go into the waiver service-wise, of how to
look at ours and look at pay rates and
Senator John Payton
Unverified
2:09:37
look at also the workforce, but wouldn't you be in control of what goes in the way for up to the point that I mean, this doesn't tell you to spend the same. This is not to exceed it.
So I would think that you would have total freedom on what goes into the waiver and how much you're going to pay for those services and surely you would justify that by what you pay for those services in other programs that you manage. So that's why we didn't issue a
Speaker 282
2:10:05
a physical impact statement, but we are neutral on the bill. We already pay for these services for Medicaid beneficiaries. So
Senator John Payton
Unverified
2:10:12
you would know what a reasonable pay grade is, there'd be no reason, you wouldn't feel compelled by this bill to exceed that, would you? No. OK, thank you.
in that. No. My apologies. Alright. Are there no other questions from
Senator Fredrick J. Love
Unverified
2:11:08
members of the committee? I'm sorry, Senator. Thank you, Madam Chair. So, um, I'm kind of thinking through this, so pretty much, you know, with this bill are we. Is it, is it asking because I haven't read it just in depth.
Is it asking for a redesign of this program. Is that, is that what we're looking at? Is it or, or let me ask in your opinion, is a redesign.
Speaker 282
2:11:35
Necessary for this this program. I think the waiver is due for renewal next year. I think work groups have started and I think that will be determined by those work groups of something that will come before it all bodies to be approved as the new waiver. So it's been since 2024.
No, wrong waiver, sorry. Yeah, 2024. We've I've got my ears mixed up. I apologize, it's late. It, it has to be renewed next year, so it's it's approximately 5 to 7 years old. A lot has changed in 5 to 7 years. So does it need improvement? Yes.
Senator Fredrick J. Love
Unverified
2:12:17
What type of improvements would you say? No, don't tell me that because here's the thing, here's the
Speaker 203
2:12:26
thing is we're asking DHS who oversees the program? What kind of, what kind of improvements are or do we need to make this waiver. You can give me some examples. That's not, that's not too hard. Let me have some examples of kind of the redesigns that we would be
Speaker 293
2:12:44
looking at. Some of the things that I think the agency hears about are going to be home delivered meals. They are going to be personal care. They're going to be the number of hours, those are all things
Senator Fredrick J. Love
Unverified
2:12:57
that we need to consider in a new waiver. And when you say the number of hours, the number of hours for caregivers to be there. Yes. OK. And at, at the same time when you start when you begin to talk about this.
Speaker 293
2:13:16
That could be skilled labor. Is that not correct? Not necessarily. I mean the the home and community-based services serve a role. And when you get into skilled
Speaker 282
2:13:28
labor, then I get into other provider types that I have to look at. I have home health, I have private duty nursing, I have skilled nursing. I mean, those are all things that have to be
Speaker 329
2:13:39
taken into consideration. And they already have service packages in service limits in the Medicaid program. OK.
Speaker 346
2:13:56
Thank you. Yeah. I So questions? I'm I'm fine right
now. OK. All right. Any other questions from
members of the committee? Great, seeing none. Anybody else here to speak for or against this bill? No? OK, you recognize the clothes for your bill. Are there any other questions for Senator Pinzo? No? OK. You recognize
Senator Clint Penzo
Unverified
2:14:16
to close. OK, thank you. Uh, the opposition mentioned they should be paid the same. No
rates are mentioned. DHS will review options. Decide what's fair and best for the patient and the taxpayer.
This bill does with the guide House report recommends, um, I just want to point out the budget neutrality in the bill, um. Cost neutrality is a requirement under Section 195C of the Social Security Act. Meaning that the average per participant cost per participant cost for home and community based services must be no more costly than the average per person cost at a skilled nursing facility. It's not going to cost more. Worst case scenario, it's
neutral. Best case scenario saves the state a significant amount of money. One of my goals in a lot of the, the bills I'm running. During this legislative session, uh, is to increase access to care, lower health care costs, and provide options to patients in Arkansas. And you know, my, my dad, you know, the maples in Springdale took great care of my, my father. But, but like it was mentioned, it is different. Levels of care. It is a
different type of. That's why my father went back and forth between home care. In a facility because there were times when we needed to care at a facility. There were times where he was. Able to come home and be with us, and we need both forms of care, and it's, we need to give the option. our constituents, especially. If it saves the state money. And like I said, worst case scenario, it's neutral, best
case we save a lot of money in this state. Um I think, I think this is. The best thing we can do for our constituents. I know, um, I know that. Keeping, keeping my family at home as long as possible, uh, it was very important to me with my dad, and it's still very important with my sister and I'm gonna try to keep her there as long as I can, um, and I think because that's what's right for my family. And if it doesn't cost the state
any more money, that's, that's where she needs to be, so, um, I just would like to ask everybody for a
good vote on this. All right. Thank you for
what's the will of the committee? that And second, all those in favor say aye and opposed. Nose habit. Broco.
Speaker 34
2:17:13
Center flippo. Send her flip oh no. Center Hill. Senator Hill, no. So letting letting, yes. Center Penzo Senator Penzo, yes. Senator Payton, Senator Payton, yes. Say a love. So a love
Wallace San no Wallace, no. Yeah, 33 eyes. 3 eyes, 3 no's, 22 non-voting bill fails. Thank you. Um, Senator Penza, do you have, I know it's almost 10 o'clock. Motion to adjourn. Second, all those in favor say aye. And opposed I have it. were adjourned.
Agenda
CALL TO ORDER
SB287 J. Payton TO MODIFY CERTAIN ATTORNEY FEES FOR CONTROVERTED MEDICAL EXPENSES, APPEALS, AND CHANGES OF PHYSICIANS UNDER THE WORKERS' COMPENSATION LAW THAT RESULTED FROM INITIATED MEASURE 1948, NO. 4.
SB238 J. Payton TO AMEND THE USED TIRE RECYCLING AND ACCOUNTABILITY ACT.
SB117 C. Penzo TO CREATE THE NATUROPATHIC PHYSICIAN PRACTICE ACT; TO PROVIDE FOR LICENSURE OF NATUROPATHIC PHYSICIANS IN ARKANSAS; AND TO CREATE THE ARKANSAS STATE BOARD OF NATURAL MEDICINE.
SB306 C. Penzo TO REQUIRE THE DEPARTMENT OF HUMAN SERVICES TO APPLY FOR A HOME- AND COMMUNITY-BASED SERVICES WAIVER FOR THE AGING AND ELDERLY POPULATION IN THIS STATE.
SB348 C. Penzo TO AMEND THE ANNUAL CAP FOR DIAGNOSTIC LABORATORY SERVICES WITHIN THE ARKANSAS MEDICAID PROGRAM; AND TO DECLARE AN EMERGENCY.
SB120 C. Penzo TO REQUIRE LICENSURE FOR ALL PRIVATE CARE AGENCIES IN THIS STATE; AND TO ENSURE CONSUMER PROTECTION FOR VULNERABLE AGING ADULTS.
ADJOURNED
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — PUBLIC HEALTH WELFARE AND LABOR COMMITTEE - SENATE AND HOUSE, Mar 19, 2025 | Agenda | 4 | Official source ↗ |
Speakers
Senator Missy Irvin Chair
Unverified
Senator John Payton
Unverified
Speaker 18
Speaker 30
Speaker 34
Speaker 37
Speaker 56
Senator Ricky Hill
Unverified
Speaker 76
Senator Fredrick J. Love
Unverified
Speaker 83
Speaker 84
Senator Clint Penzo
Unverified
Speaker 111
David Cook
Unverified
Speaker 123
Matt Gilmore
Unverified
Speaker 157
Speaker 158
Speaker 159
Speaker 161
Speaker 165
Speaker 41
Stan Townsend
Unverified
Meg Ann
Unverified
Speaker 152
Speaker 206
Speaker 227
Speaker 229
Speaker 230
Speaker 1
Speaker 228
Speaker 251
Speaker 253
Jahaj Shine
Unverified
Kristen Neck
Unverified
Speaker 282
Speaker 280
Kitty Cohn
Unverified
Speaker 293
Speaker 297
Speaker 298
Speaker 306
Speaker 136
Rachel Bunch
Unverified
Speaker 317
Speaker 296
Senator Dave Wallace
Unverified
Speaker 276
Speaker 283
Speaker 328
Speaker 203
Speaker 329
Speaker 346