Public Health, Welfare and Labor Committee - Senate
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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…”
|
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 |
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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,…”
|
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…”
|
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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Speaker 1
0:00
start back uh let's see we have senator payton
uh you have 287 and 238.
Senator John Payton
Unverified
0:30
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 $5,000 cap on the attorney fees. This is where the attorney is working for the injured employee. And 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 they're up against attorneys. They're getting paid much better on the other side usually. But anyway, it does have a cap of $5,000 and then it raises the caps to $1,525 on the appeals process. There was a pre-existing cap of $500 and $1,000, and those are going to $2,500 and $5,000 on the appeals process.
Any questions? Are there any questions from members of the committee? Seeing no questions from members of the committee, is there anyone here to speak for or against this bill? Yes, Randy Zook. Okay. Mr. Randy Zook, and please come forward. Please state your name for the record. You may proceed.
Speaker 18
2:14
Madam Chairman, members of the committee, thank you for the opportunity to speak to you about This is one of the other package of bills which will severely increase the cost 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 modest increases or adjustments in some of the ways that the benefit formulas are calculated would be appropriate.
it, but we think these bills, including this one, go too far too fast. 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. On behalf of our members, and with a unanimous vote of our executive committee, we urge you to vote down this bill, not to pass it. I'm happy to take any questions. Okay, thank
you. Are there any questions for the witness? Seeing none,
thank you for your testimony. Thank you. Is there anyone else to speak for or
Senator John Payton
Unverified
3:32
against this bill? Seeing none, you're recognized or closed 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 zero. So the only time this pay to the attorney would come into effect is if the carrier, the insurer, the employer side, if they denied medical care that was later determined by the commission or the judge
that should have not been denied. So 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 $5,000. With that, I'm closed, and I move to pass. All right. Is there a second?
Okay. Is there any discussion? No discussion? Okay. All those in
favor say aye. Aye. And opposed?
Speaker 30
4:36
No. Okay, um, roll call. Senator Flippo.
Speaker 34
4:57
Senator Flippo. Senator Hill. No. Senator Hill, no. Yes. Senator Penzo? Yes. Senator Penzo? Yes. Senator Payton? Yes. Senator Payton? Yes. Senator Love? Senator Love? Yes. Senator Love? Yes. Senator
Thank you. Four votes. Bill fails. Thank you. Thank you. Do you want me to run 238? Yep, sure do.
Senator John Payton
Unverified
6:06
Thank you, Madam Chair, committees. You have a handout, I think. Oh, yeah, that's right. Do you want us to put that out? Yeah. Senator John Payton, District 22, Senate Bill 238.
You'll remember from two years ago, we passed legislation on the Senate side to reconfigure, reorganize our waste tire program. And we did consolidate the 11 boards into four. 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, 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 so what this does is it restructures the rim removal fee, the waste tire fees.
And this is just like what was amended out of that bill two 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 tire recycling fees. It will be collected at the point, and could I have one of those handouts? Sure. 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 projected that it'll generate an additional two and a half to three and a half million dollars in dedicated revenue for the tire program, which will make it solvent. Currently, the scale that's being paid by the four tire districts runs in the $2.60 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 dumps, stockpiles, that need to be cleaned up. And I used the figures that were given here by NE on what they're spending per tire on abatement, and it's $9.67 or $0.68 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 point of 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 tire 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 a lot of those tires get reused until they're worn completely out. If we charge 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 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 can 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 back end when the towers are dealt with. And with that, I'll take questions.
Okay, can you, do you mind just going through your handout and kind
Senator John Payton
Unverified
11:09
of explaining it? Sure. So these are sites that are identified
by E&E of ADQ about where tires are currently stockpiled and stored. Most of these sites are several years old. And so if you look in that top box on the right, it says 403,000 tires. And they're looking at $3.899 million to deal with it.
If you run that math out, it's $9.68 a tire. The next column 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 12,400 tons, multiplied it by 2,000 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 gotcha. Okay,
Speaker 56
12:36
thank you. That was helpful. And also in
Senator John Payton
Unverified
12:39
the bill, you might want to notice, but the fee for the regular size tires is $3 a piece.
The boards can set the fee for the large tires up to $5 and the ag tires up to $30. And I would expect they'll probably set that at the maximum. So it will be $5 on the semi-truck type tires and $30 on the ag tires, tractor tires. Okay, any
questions, members of the committee? Senator Hill, you're recognized for a question.
Senator Ricky Hill
Unverified
13:18
Senator Payton, if it's costing you $9.67 of tires, what you were saying,
Senator John Payton
Unverified
13:27
we're only going to collect three for pasture. Where's the math on this? Okay, so what I'm saying is the four tire districts currently have contracts with independent contractors, some private, some 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. Right. When we have to deal with them after they're dumped and stockpiled, then the cost goes way up. I'm with you on that. Okay. Thank you. Thank you. Are there any
other questions from members of the committee? Did you have a question? No? Okay.
All right. Seeing none, thank you so much. We do have somebody, Craig Douglas.
And folks, I know we had a sign in.
I do have a question. Senator Hill, you
Senator Ricky Hill
Unverified
14:27
recognize her question. Okay, while we're looking at this, what's the status of the new
Senator John Payton
Unverified
14:33
poor, them using our used tires? Are you familiar with that? So currently they're buying the crumb rubber from some of our recyclers, and they have expressed that they're going to continue to have a demand for that. Of course, 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 that 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 prohibitive. So hauling full-size whole tires from 150 miles away becomes cost-prohibited.
If you haul them to a processor and they're chopped into some smaller portions, then you can haul more efficiently. So it's very exciting that Nucor 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 first or second stage of chopping, cutting, 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 from northeast
Oklahoma for the product. Thank you. Any other questions? All
Speaker 76
16:24
right. Mr. Craig Douglas, if you'll come forward, please. Thank you, Madam Chairman. I'm Craig Douglas. I'm director of District 2 Waste Tire Program. Just to follow up on the Nucor question, they are currently taking roughly 40, equivalent of 40,000 passenger tires a week.
Now, they do not operate 52 weeks a year. It is spotty at best, but they are taking those tires and could take more in Mississippi County if the other steel recyclers up there would also do what Nucor is doing. So, as the Senator said, it's still very promising, but the infrastructure and the reimbursements to the districts are the problem. As Senator Payton said, roughly the average DEQ-approved reimbursement rate
is averaging about $2.85 a tire. However, the legislative audit, in their analysis, says that the net available revenue from the $3 rim removal fee is only $2.31 a tire, according to the legislative audit. So that's $0.54 a tire that the program is losing. And we will process in Arkansas roughly 3.2 million waste tires this year.
Our district is 27 counties. We'll process about a million and a half tires. In addition to the revenue needs, which would be generated by applying the existing fee without raising the rate to new cars and trailers, we would have the money then to the DEQ, would have the funds to reimburse the districts so that the rural areas of Arkansas could be better served.
This is a cost-distance arithmetic problem. 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 distances from the processor to the location, and you're going to pick up less tires. So we need the money to fund that as well. And I would not, I really don't have anything else to add other than the four districts are
working well, they're improving, those districts were just set up last session, and we are responsible for not only doing the contracts in our district, it is a public-private partnership, but we're also responsible working with DEQ on tire dumps, on the abatement of the dumps. And there's simply not enough money to keep up with picking up tires that are dumped.
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
Speaker 76
19:48
where District 2 is located, Mr. Doug? District 2 is central and north-northeast Arkansas. Okay, thank you so much. We go from Malvern to Pocahontas.
Wow, okay. Senator Love, you're recognized.
Senator Fredrick J. Love
Unverified
20:02
Thank you, Craig. Good seeing you. I just want a couple of things. Number one, I know that Davis tire, or Davis trailers is not in business any longer. So how are we kind of disposing? I know they were taking tires at one time. Yeah, no, Davis
Speaker 76
20:19
is still in business. Yeah, they have the contract for our district. I thought
Speaker 83
20:24
Davis burned. No, they've been in business over 100 years. Yeah.
Speaker 76
20:29
And they are the ones taking the tires to Nucor as well.
Speaker 84
20:34
They have that contract, private business. All right. Thank you. Are
there any other questions from members of the committee?
Okay. Thank you, Mr. Douglas, for being with us today and tonight. Any other questions? All right. seen none. I don't believe there's anybody else here to speak
for against the bill. You're recognized to close for your bill? Thank you,
Senator John Payton
Unverified
21:00
Madam Chair. And just to put it out there,
I have considered a lot of alternatives. I've spent weeks and hours and found hours in meetings and tried to find something that I could believe was a good alternative. I really believe that whoever thought up the idea of collecting this on the front end so that disposal was free, I think it was a great idea. And I think it served the state very well until inflation just outpaced the revenue stream.
I'd appreciate a good vote, and I move
to pass. Okay. Second? All right. Any discussion? All right. Okay. Senator Hill, you're recognized for discussion. Senator Payton, I will say you've worked on
Senator Ricky Hill
Unverified
21:47
this a long time. You're the waist-tired 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.
I've done a lot of hard work on this. All those in favor say aye. Aye. And opposed? I
have it. Congratulations, you've passed your bill. I think I heard it that way, too. Okay,
Senator Hammer. Is Senator Hammer here? All right. Okay, Senator Penzo.
Do you just want to tell us which one you want to run? I think you said earlier you were
Senator Clint Penzo
Unverified
22:53
passing over one of them, and I don't... Yeah, if it's okay, I've got people that have driven to be here, and this is not their first time to be here,
so I've got... But before we set, you said you were passing over 347, that one we're going to do special order, right?
On 4-2, just so if anybody's here for these bills, they can go home.
Senator Clint Penzo
Unverified
23:23
Yeah, I think they arranged that one. Yeah.
4-2 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 or against so they can
Senator Clint Penzo
Unverified
23:39
go home? Well, I mean, yeah, pretty much I want to just do the ones that people are here for. So no SB2, no SB95.
You said SB347. You set up a special order for... April 2nd. SB269. you're gonna pass over that one there's 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 the others as we can okay all right so which one do you
want to start with so so
Senator Clint Penzo
Unverified
24:18
can we start with uh sb 120 there's someone here from springdale and yes okay
SB 120. Sure. And before you say that, we had a sign-in sheet earlier today. We have a new sign-in sheet, but 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 sign this new sheet. All right.
If you will set your name for the record, you may proceed with Senate Bill 120.
Speaker 111
24:58
Clint Penzo, District 31. David Cook, Director of Government
David Cook
Unverified
25:02
Affairs for the Alzheimer's Association. 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 were being promulgated, what we discovered is that here in Arkansas, we only require providers who accept Medicaid as payment to receive a license. So this extends licensure requirements
to the private pay sector. This is, again, a consumer protection bill. 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 is 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 SB120 assumes to close that gap and ensure licensure requirements extend to the 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, standardized training. Right now, only the training requirements we pass in 2023 apply to those Medicaid providers. This would require all those who provide home care to, again, adhere to those training standards. It also requires some fingerprinting,
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 she could just share her story real quickly with you. Okay. Did you sign up to speak for the bill? Okay. I
don't think I got her on the list. Before we go to testimony
for and against, because I think there's people here for and against the bill. Okay. So I just need to follow that process. Yes, ma'am.
Are there any questions for members of the committee? Senator Love? Thank you. And David, I guess
Senator Fredrick J. Love
Unverified
27:17
You're saying that you're trying to extend this to the private side?
Senator Fredrick J. Love
Unverified
27:25
many providers are we talking about? I would have
David Cook
Unverified
27:29
to get the health department to answer that question. But these are providers that just would take private pay. And so if they don't accept Medicaid as payment, 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 and say you can do home care,
Senator Fredrick J. Love
Unverified
27:56
you're in business. Okay. So, as a private provider, do they adhere to any other standards? I mean, I'm trying to understand. There's
David Cook
Unverified
28:05
no regulation currently in statute to regulate that industry if you just take private pay. 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
28:19
Okay, that's new to me. Okay. All
right. Thank you. Okay. I just have a quick question, though. I mean, but personal care are folks that are not nurses and skilled labor folks. So now you're wanting them to become skilled labor? Basically, with 40 hours of training determined and an annual license fee for these agencies, where would that money, where's that money going to go?
David Cook
Unverified
28:56
The Arkansas Department of Health is the regulatory agency, so those $1,000 licensure fees would go to the agency. And that $1,000 fee for licensure already exists for the Medicaid providers. just extending that to those who just take private pay and not Medicaid. And we're not wanting to... I'm
sorry. Go ahead. Okay. Can you... Yeah. Page 4, 35, and 36. Can you Page four, you
David Cook
Unverified
29:42
say page four, line 35 and 36?
Yeah, so this says that subdivisions A1. But that's
David Cook
Unverified
29:51
a carryover CMS requirement for Medicaid providers. We made amendments to the bill to ensure 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. My understanding is you have to do supervisory visits.
We do not want that to carry over to the private pay system. 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 patients that are not Medicaid qualified. Okay. We made several amendments to the bill to make sure it wasn't overburdensome for providers. Okay. All right. Any,
I'm sorry, Senator Love, you're recognized for a question. Well, I guess, Madam
Senator Fredrick J. Love
Unverified
30:44
Chair, I think I want to get
Arkansas Department of Health appeal, because you said that these providers do actually register with the Arkansas Department of Health? If they take Medicaid,
David Cook
Unverified
30:54
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
Senator Fredrick J. Love
Unverified
31:08
in statute in 2023. So who keeps it? So Arkansas Department of Health keeps a record of these providers, but they have no... The Medicaid, those that take Medicaid.
So I guess, is it... I'm confused because if this is a Medicaid issue, it would be DHS, would it
David Cook
Unverified
31:25
not? Medicaid certifies, but ADH holds the licensure for healthcare. Yeah, I would just like to
Senator Fredrick J. Love
Unverified
31:29
talk to ADH when we have the time, Madam 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 state your name for the record and you're recognized.
Matt Gilmore
Unverified
31:51
Matt Gilmore, Department of Health. Can you
Senator Fredrick J. Love
Unverified
31:57
repeat your question? So, well, I was just curious, because I want to know how many
providers would this bill impact? But then also, first of all,
Matt Gilmore
Unverified
32:11
let me just know, how many providers would this? So it's an estimate, but we estimate that we've got about 270 licensed private care folks now or agencies.
So that would, we imagine that doubling the first year. So the first year that this goes into effect, we'd have that many that are now just doing private pay. All
Senator Fredrick J. Love
Unverified
32:35
right, so these private care agencies already register with Arkansas Department of Health, or are they not registered? If they're just doing strictly private and not
Matt Gilmore
Unverified
32:43
taking Medicaid and that sort of thing, then they're not licensed through us. Are they licensed through anybody?
Senator Fredrick J. Love
Unverified
32:55
I don't think so. That's right. So we just have people just out there. Okay. All
right. I get it now. Thank you. Any other questions? All right, seeing none,
thank you. All right, we will go to, I think, to speak for and against the bills. So you're recognized to come and speak for the bill. If you'll just state your name for the record, you're recognized.
Speaker 157
33:33
Jacqueline Ryan. Thank you, Madam Chair, in the committee. I've been waiting five years, three weeks,
Speaker 158
33:42
and all day for this. 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.
Speaker 159
34:03
What would you do if your loved one fell on broke
Speaker 161
34:07
her 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've got to have somebody for your loved one. How do you best qualify an agency 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 into 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. It'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 in your house, we have to be background checked and fingerprinted. It's just really that simple. We even, as realtors, have a code of
Speaker 158
35:35
ethics that we have to adhere to. There is, as you now understand, Senator
Speaker 161
35:40
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. The estimated revenue was $100 billion in 2020, up 50% from $68 billion in 2013. During my time today, I've learned it's $208 billion of home care services value here in the United States now. And it's going to keep growing because us baby boomers are getting older.
This isn't just about my parents, but other adult children that I've encountered.
Speaker 158
36:23
I even wrote a book about it, not only my story, but other adult children that we've all encountered some kind of ineptness with the caregivers
Speaker 161
36:30
out here. I'll speak a moment about my dad, Jack Perry, who was the co-founder of Cram-A-Lot, named by Mr. Sam. They manufactured the trash compactors
Speaker 158
36:43
and cardboard balers. You can go behind a Walmart store and you'll see those two rams sitting in cardboard.
My father was a co-founder of that company. Walmart was our first account, Springdale, Arkansas. He was president of the
Speaker 161
36:59
Arkansas Cattlemen's Association. So he 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 him for a few days a week.
I didn't call three 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
Speaker 158
37:36
full-time care for the remaining seven years. I'm reading this because I could cut all day, but it's
Speaker 161
37:44
hard to condense seven years into a few minutes. Hiring
Speaker 158
37:48
a 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 stitches when he had
Speaker 161
38:03
a black eye. I called the DHS on that one. They finally showed up. They couldn't do anything because he's not on
Speaker 158
38:19
Medicaid. There was nothing they could do. I have a picture of receipts totaling over $260 in nine days. I text the fraudulent caregiver.
There was many different caregivers. I text the fraudulent caregiver about these receipts. There was no response. We already knew that he'd bought
Speaker 161
38:40
tires for her, her car, paid off her house, and 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
Speaker 158
39:17
have 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, I called the agency and they couldn't speak to me about my dad
because of HIPAA and I no longer had the POA. I told
Speaker 161
40:16
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, 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 not be fired? She was very
Speaker 165
41:02
comfortable. She was a professional con artist. Dad had
Speaker 158
41:07
Alzheimer's, however, he was never diagnosed, even though his mother
Speaker 161
41:10
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 an onion?
Thank you. I just want to make sure that we stick. I appreciate it.
Speaker 158
41:28
My mother was Joanne Perry, 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 of the committee? Any questions? All right. Thank you. Thank you for your testimony.
Speaker 41
41:50
And where did you, what was your name again?
Jacqueline Ryan. Okay. And where are you from again? Springdale. Okay. Thank you. Yes. 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 okay. You just, you can, I think you signed the sheet earlier. If you'll just state your names for the record and then you're recognized to proceed.
Stan Townsend
Unverified
42:29
my name is stan townsend i'm a owner of a personal care agency excuse me a private care agency in mountainview arkansas stone county and i just have a few things to say about this particular bill first of all i would like to say that i agree that we should have these private care agencies all meet the same standards, but reading this particular bill,
it just seems to bounce around. There's some inconsistencies in this bill. I'd like to say that all private care agencies have to meet, that are in Medicaid, have to meet certain standards, And this is a copy of the standards that we have put out by the Arkansas Department of Health and the Arkansas State Board of Health. And these standards are all, they have all private care agencies in Arkansas that accept Medicaid have to abide by these.
So, in my opinion, this bill, what 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, 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 the rules of the State Board of Health as well as the DHS. Now, what I'm talking about is just the way this is written.
This act calls for treatments of people. Private care agencies that do this personal care, we don't treat anybody. Our license does not allow us to do any medical things, nothing. We just provide activities of daily living for these people to keep them in a home and try to either delay or eliminate their need to go to a nursing home. That's what we do. And by going through this and trying to add this and that, almost everything in here is already in here.
All these things that are, they've kind of cherry-picked a few things to try to make this right. But to me, if we just adopted this and made everybody follow the same rules, they would take care of that problem. And also 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, a criminal background check for everybody, including federal, when we already are doing what the state requires, and that is if you've lived in Arkansas the last five years continuously, you don't have to have a federal background check.
You all have to have a state background check. My wife, Meg Ann, 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
Meg Ann
Unverified
45:54
record, you may proceed. Thank you. My name is Meg Ann Townsend, and I am an owner of a private care agency that provides personal care services.
I'm against SB120. 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 five years. Federal backgrounds require fingerprinting. But it's a specialized fingerprinting. We are, our agencies are located in very rural parts of the state.
And so the process to do a fingerprint, a federal fingerprint background check would require over a 40 mile drive each way to get an applicant to come in. And they would have to drive to the next county to be fingerprinted for their federal background check. That's true for us. I know that's true for Stone County as well as our location in West Helena. They have to drive all the way to Wynn.
And so in addition to the additional cost for each and every applicant that came in to fill out an application, that would just be the time, the delay, and the impracticality of that burden to find that, to go to the fingerprint harvester. Additionally, because this is rolling over to our Medicaid care aides,
our Medicaid care aides are already 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 SB120 as it creates unnecessary and redundant burdens to private care agencies. Thank you.
Okay. Any questions from members of the committee? I
have one question is, actually, probably maybe for the Department of Health, but
you are required for state background check.
Is that correct? Yes. I would guess my question actually for the
Department of Health would be, do we require both state and federal for all? And can you describe the difference there for any provider in home health, you know, any home health, any personal care?
Speaker 152
48:51
Could you help me there? Sure. Matt Gilmore, Parton Health. The background check process is set across state government. I mean, it's licensee, you
Matt Gilmore
Unverified
49:01
know, private care or private or personal care with, you know, home health. If you have lived in the state for, you know, five years or more, it's just a state background check. If you've moved in and out, the federal is required as well. Okay.
So it just depends on where you've lived and, you know, your history there. Okay, but this would
create a different standard just for this one particular industry. Am I understanding that correctly? It
Matt Gilmore
Unverified
49:32
would require background checks for which they haven't previously done because it's going to 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 hire them on. So, yeah, it's going to be a new process for them. Okay. But it's similar to what everybody else is required.
Senator Fredrick J. Love
Unverified
49:54
Okay. Senator Lev? Okay. Thank you, Madam Chair. I
guess my question is not necessarily for you all, because you all said that you accept Medicaid. So you're subject to the rules of Arkansas Department
of Health. But, Matt, I guess I'm just wondering why are we not requiring
everybody to register with the Arkansas Department of Health? And
I think that would resolve, that would address the issues that we're having, and then everybody will be at parity.
Matt Gilmore
Unverified
50:34
Yeah, I can't speak to the history of why we've never required licensure for everybody. But with Medicaid and that sort of thing, it is required. So I can't speak to the whole history of why there was licensure for private pay. That's been a long time ago.
Senator Fredrick J. Love
Unverified
50:52
Okay, but is that something that we could do? Instead of, I guess, piecemealing this, if we just required everybody to register with
Matt Gilmore
Unverified
51:01
you? I think he's wanting licensure so they can be held to the same standard with the training requirements in the background check.
Speaker 152
51:08
I mean, a registry is different than a license. Okay, so I
Senator Fredrick J. Love
Unverified
51:10
guess if we required everybody to get some license with you all, then everybody would be held to this standard, correct? I think that's what his bill is trying to do, is
Matt Gilmore
Unverified
51:18
make the same standards of what's required for Medicaid. So, I guess I'm confused. I may not be answering your question. No, I'm
Senator Fredrick J. Love
Unverified
51:30
just saying, why doesn't the Arkansas Department of Health just require everybody to... We can't just... I mean, you have to enable another discussion.
You have to have a law, yeah. This seems like it's a little bit
different than that. The packet that this gentleman just showed me
Matt Gilmore
Unverified
51:51
that... I think it would be the same rules. I mean, they're going to be held to the same standard of
Speaker 206
52:01
what Medicaid is required. Yeah, go ahead. Okay. Senator, my address, Ms. Duncan. Yeah, absolutely. Just use your mic.
You got it on? Okay. The only
Stan Townsend
Unverified
52:13
thing that I can see, I think you're right. In my opinion, anyway, if everybody went by these rules, we're all on the same, as they say, as George Bush would say, everybody's in the level playing field. But this bill goes a little too far. my opinion on these background checks. 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 Arkansans that have lived in these communities all their life, really, we don't require them now to do a federal background check. They all have state criminal background checks, all of them. But this bill 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 five years. And it's going to be very troublesome and expensive for all these people, every single person that works in the door, to get a federal.
That's the problem. The state is
Senator Fredrick J. Love
Unverified
53:15
no problem at all. So is that the biggest difference between what our side of the Department of Health
Stan Townsend
Unverified
53:23
is administering in this bill? I would say that's the thing that causes the most increased expense. on everybody. And how much is a federal background check? It's, what, $13? $13. We already have to do a criminal background check, which is a state.
$22.50. $22.00, yeah. Then a federal will be another $13.00. Then we have to do drug screens. We have to do the state registry, adult registry, and child registry. We'll do all those things. But my point is, every single person that walks, we don't have to do a federal on most of the people who apply for a job, because they've lived here, you know, they live in communities that hadn't been out of the state in the last five years. So we don't have to do it. A lot of them never left the county.
But I mean, so 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 all private care agencies. -
Okay, all right, thank you. - All right, any other questions for these folks? All right, thank you. Thank you for being here and for your testimony. All right, is there anyone else here to speak for
or against this bill? Seeing none, Senator Penzo, you're recognized to close for your bill.
Senator Clint Penzo
Unverified
54:54
Thank you, Madam Chair. Currently, they don't have
to do any kind of background check. Just because somebody's lived in the state for five years doesn't mean they haven't crossed the state line and messed up. Doesn't mean that they haven't lived out of state and have a history. I think it's imperative that we know if somebody has a criminal background, We need to know if they're going to be in, most of the time, an elderly person's home taking care of them one-on-one.
I know somebody close to me that had their Social Security number stolen. 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. I think this is good policy. I mean, we're currently doing this for our Medicaid population. I think we need to be doing it for our private pay population as well. So I'd ask for a good vote on this. Thank you.
Motion do pass. Okay, you've closed. Motion do pass. Is there a second? Second. Second. All those in favor say aye. Aye. And opposed? Ayes have it. There's no opposition.
Senator Clint Penzo
Unverified
56:16
Thank you, committee. So, SB 117, we've already heard it. I think that one could go faster than some of the other ones, so I'd like to touch on
that, and I'd like for Mamie to come up, and we made some amendments. Senator Hill didn't want us to set up a new board. So we merged the acupuncture board,
and that's, if this passes, it will become the natural medicine board. There was also some concerns that Peyton had that I believe were addressed, and I can let her speak to the amendment better because she worked really hard on trying to get all
Speaker 227
57:05
this accomplished. So, okay. We didn't make a lot of changes to the SB 117 itself. We did provide some clarifying language by adding a couple of definitions. For example, on page two, 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 injuries or helping to reduce pain. It helps to stimulate the healing of tissues. So we added a definition for clarification there. We also defined naturopathic physical medicine on page 3, line 18, to clarify that we are not performing chiropractic care or practicing chiropractic science. And it does prohibit grade 5 manipulations from our scope.
So grade five manipulations are like the pop that you get at the chiropractor. So it takes that out of our scope. We felt that was a reasonable concession. Senator Irvin, you had
Speaker 230
58:31
at the last meeting. One second, sorry.
Speaker 227
58:40
I'm having trouble finding it, but there was a point where we were defining some of the routes of administration that we had access to, and the word medications was still within the text, and we removed medications to clarify that we're talking about therapeutic substances, so natural substances and not drugs. that was a question that Senator Urban had at the last hearing so we clarified
that and then in terms of the board structure 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 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 okay 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
59:59
the acupuncture board expanding it to account for regulating naturopathic physicians as well and then renaming it accordingly to the Arkansas State Board
Speaker 230
1:00:06
of Natural Medicine. Do you have, do
you have a, what about the people that
Speaker 1
1:00:15
are acupuncturists? They, are they gonna? I've spoken with, so I am also
Speaker 227
1:00:20
a licensed acupuncturist here, so I did speak with the acupuncture community and they were on board with these changes. So
Senator Clint Penzo
Unverified
1:00:32
we had discussed putting them with the chiropractors, but about half, you know, the chiropractic, there's two associations, and they don't always even get along with each other. So about half the chiropractors I talked to were okay with adding them, and the other half weren't.
I figured that that would just be starting a big fight. The acupuncture board I figured would be, you know, a soft landing for this, and they were okay with
merging the two under one board. Okay. And method of payment for
all these different things that are placed on, I'm just not familiar with hypnosis as a technique in medicine.
What is your source of payment? Are you cash basis only? I mean, at this point
Speaker 227
1:01:44
you have, you have to be cash pay. You know, we can't bill insurance for our services. Yeah. We're
Speaker 230
1:01:53
just consulting, you know, at this point. So yeah,
it's cash pay. Okay. And then I had a question about, you have in here the different level of degrees, I think,
and then you're also requiring that level of degrees on the boards. Is that correct? Yes. Are there
any questions from members of the committee? All right. Any questions? Senator Love, you're right.
Senator Fredrick J. Love
Unverified
1:02:35
Okay, just to make this clear, once you all create this new board, 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 am surprised that they didn't have any pushback on you all. That's just kind of a note, because I remember working with them a session a two ago. But with this creation of this new board, are you all now moving
to Medicaid? You can bill for your services now?
Speaker 230
1:03:24
would be eligible to participate in Medicaid services. But to address
Speaker 228
1:03:28
what you mentioned about the cupping, I think that was more about scope creep because that is very
Speaker 227
1:03:35
much an acupuncture Chinese medicine modality, and I believe this was giving massage therapists the ability to cup, so I think that's more what it was about. Okay. Thank you.
Any other questions from members of the committee? Senator Hill, you're recognized.
Senator Ricky Hill
Unverified
1:03:52
Okay, I want to go back to this board that we're talking about and creating
and changing the name of it. How can we change the name of the board and we're not even on that board yet? This should be two separate deals. You want to change the makeup of the acupuncture board and list how many acupuncturists, how many natural doctors, how many, et cetera. That'd be broken down into one, two, three, four, however, how many it is. How is that
Senator Clint Penzo
Unverified
1:04:20
going to be determined? Well, I mean, 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
1:04:35
Okay. And so basically we're changing the name of that board as well with this
Senator Clint Penzo
Unverified
1:04:41
right now? Yes. I mean, we're taking the same board, but we're giving it a new name and adding another profession to the existing board.
Speaker 121
1:05:05
Senator Hiller, you still have the floor.
Speaker 251
1:05:09
any other questions members of the committee right
seeing none anyone here to speak for or against this bill come forward and state your name
for the record thank you madam chair members of the
Speaker 253
1:05:31
committee i'll be brief i'm scott smith with arkansas medical society just wanted to tell
tell you we're still opposed to the bill. We have concerns. Page six, potential confusion and title and abbreviations for naturopathic medical doctor, NMD. To me, there's potential for confusion there. Also, you look on page 10, the ability to interpret the results. I think it's line 17, interpret the results of laboratory examinations for diagnostic purposes.
Those are just a couple of highlights, but we're just still concerned about the education. I just wanted to let you
know, and I'm done. Thank you. Question. Can you speak up and into the mic a little bit more, please? All righty. Sorry,
Speaker 253
1:06:22
but page 10, what did you say again? Line 17, and it says interpret the results of laboratory examinations for diagnostic purposes. That's just one of a few others that jump out that concern us.
And then on the top of page six, in the title protection part, it looks like lines four and five, The ability to use NMD tests seems like it can be confusing to the public. Okay. That's it. Senator Hill, you have your mic on. Did you
have a question? Yes, yes, I did. Okay.
Senator Ricky Hill
Unverified
1:07:02
I will say the bill sponsor did try to work with you.
Took it away from the medical side of it and stuff. Separated it totally away from you. You don't have
Speaker 253
1:07:17
anything to do with them now, but you still don't like them. Well, it's a question of whether we feel like patient confusion, as I mentioned, the ability to use the NMD, possible confusion, and just a concern about the efficacy and training. So we still have those concerns.
But yes, we've had good, it's been a healthy discussion all the time. And he's been very good at taking our input, but we just have, I think he knew that we still had problems with it. I understand that, but I think the general public is
Senator Ricky Hill
Unverified
1:07:55
sharp enough and smart enough in the state
of Arkansas to realize the difference between a MD, a DVM, a PhD, and everything else. I think the general public is smart enough to figure that out.
So thank you. All right. Thank you. Any other questions from members
of the committee? All right. Seeing none, thank you so much. All right, Senator, let's see, I don't have anybody else signed up. I'm sorry, yes,
Jahaj Shine
Unverified
1:08:29
go ahead. Come to the table if you'll state your name, please. Sorry. Good evening, my name is Dr. Jahaj Shine. I am a U.S. 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 in 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 as someone who's been on both sides, as a practicing physician in multiple states, to include Ghana, who has pioneered their first functional and integrative
therapeutic center in Accra, Ghana. I've worked with them to really increase 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 shaped my upbringing from my African-American and indigenous grandmother who grew all of our cures in our backyard, 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 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 lakes 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 a 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 my degree is in biological and physical sciences, and I went to Bastyr University where I took four years of my life to learn everything about pharmaceuticals, about physical medicine. teach anatomy and physiology and run the cadaver labs for Grand Canyon University. I teach 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 bioequivalent hormone therapy to people who need it.
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 going to 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 as 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's 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 health care 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 health care, 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 risk that they're undergoing because of poor pain management and so many other things. So with that being said, I really thank you all for your time. I totally am supporting this bill as a doctor and as a patient of what we do. Thank you. I'm open for any questions. Okay. I'm sorry. Are you a DO, an MD? 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 trained program four years of medical school passed the licensing board right and you're from Arizona yeah I moved here from Scottsdale Arizona so okay I gotcha okay thank you I just wanted to make sure I heard it
correctly absolutely any questions from members of the committee all right um senator Hill I'm sorry
Jahaj Shine
Unverified
1:16:09
if I had 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 I can be done. Any
other questions from members of the committee? Seeing none. Is there anyone else here to speak
for or against this bill? Seeing none, you're recognized to close
Senator Clint Penzo
Unverified
1:16:43
for your bill. Thank you, Madam Chair. In MD, 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 that someone has here. So, I just, you know,
we discussed this last time, so I'm going to keep it short, but I I think this is good for Arkansas, and I won't discuss this much more, but let's just, I'd appreciate a good vote. Yeah.
Is there any, I'm sorry, as amended? Oh, yeah, we need to adopt the amendment. It's already been adopted? Okay, sorry. I engrossed it on the floor. I know, but you have an amendment
to add a House sponsor. Oh, okay. Did we already do that? Okay, so we
already did do that the last time. Is that correct? Yes. Okay, sorry. So it needs to be a motion due pass as amended. Motion due pass as amended. Okay, and second? Second. Is there any discussion? Great. All those in favor say aye.
Aye. And opposed? Ayes have it. Congratulations. You've passed your bill.
Senator Clint Penzo
Unverified
1:18:12
Thank you, committee. I've got some more folks here for Senate Bill 348. So
I don't know if they want to come to the table with me now.
Okay, sorry, I've got 311, 306, 262, 255, 122, 121, and 110. Which, I'm sorry, those are the bills that
are on this agenda. I'm sorry, sorry,
348. Sorry, I just didn't have my, I apologize.
It went to the next page, 348.
Senator Clint Penzo
Unverified
1:19:12
Is that correct? That is correct. Okay, sorry, my bad. Okay. So 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.
I can let you go because, I mean, we're trying to
Kristen Neck
Unverified
1:19:42
speed things up this evening. So if you want to go
ahead and start. Madam Chair, members of the committee, my name is Kristen Neck. I'm the Chief Operating Officer for AIT Health and Affiliate of 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 $1,800.
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 is $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 6,500, outpatient 8,600, and medications are 1,500.
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 1,800 would allow for chronic pain patients to be monitored and avoid a substance use disorder that results in them getting ER visits and inpatient admission.
Thank you. Are there any questions from members of the committee? I'd like DHS to come
to the table, please. Good evening, Janet Mann, DHS. Okay,
so clearly this does have a fiscal impact because we are raising this diagnostic
laboratory services, we have $500 or $1,800, so we're 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
Speaker 282
1:22:12
is one. Yes. We have 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. 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. My fear is that it would be more. Okay. And so, so
this is just for chronic pain or pain management. So 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 used by chiropractic services or others, right? And so they weren't able to get their labs done and things like that. So I guess, I mean, why $1,800 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 $1,800 for all diagnostics? How much would that be to the Medicaid program? Because they need their blood drawn. I
Speaker 282
1:23:43
don't have an estimate if we raised it for everything, but 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 limits on children's services. So we could go back and try to get you something very early on raising that, but it still would be a cost to the Medicaid program.
Okay, and this would be an annual, this is an annual cap? Yes,
Speaker 282
1:24:13
the benefit cap is $500 currently. It is an annual cap that begins on July 1 of every year. Okay, so we're raising
it from $500 to $1,800 just for the set of providers. That's a
Speaker 280
1:24:28
question for them. That would be the question for them.
Kristen Neck
Unverified
1:24:32
Yes, so originally we did it just for pain management for chronic pain patients.
Kitty Cohn
Unverified
1:24:38
Okay, and could you tell me again what your background is or what your degree is? I have a master's degree
Kristen Neck
Unverified
1:24:44
in health care administration, and my background 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. Okay. Pain Treatment Centers of America. Okay. Are you from Arkansas? No, I'm from California. Okay. I mean, I've lived here for
Kristen Neck
Unverified
1:25:04
four years, but I'm originally from California. Oh, you do live here now.
Yes, now I live here, sorry. I'm sorry, I missed that. Okay, thank you. Are there any other questions from members of the committee? All right. Anyone here to speak
Kitty Cohn
Unverified
1:25:25
for or against this bill? 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, 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.
Okay. Any questions from members of the committee? All right. Seeing none, thank you again for being here and your testimony. All right. I'm sorry. Did
Senator Fredrick J. Love
Unverified
1:26:29
you all have a question? No? Okay. Senator Love, did you have a question? Well, John was just mentioning, did we run a
fiscal impact on this? That's why I had DHS come to the table. I'm sorry.
If you want to come back,
Speaker 293
1:26:59
I'm so sorry. Yes, sir. We ran a fiscal impact. It was anywhere
Speaker 282
1:27:05
on state share from $98,000 to $591,000. So I rounded from $100,000 to $600,000 of state share.
State share? Yes, sir. Because there's a 70-30 match from the federal government. So, if 30% is state share, then the 70% would be the federal part. So, the 30% is state GR, which she is, the fiscal impact that she is referring to of state share is state general revenue for Medicaid.
But the 70%, it would be 70% more than that, that would be the federal share.
Senator Clint Penzo
Unverified
1:27:53
Does that make sense? senator penzo yes thank you madam chair uh just to just to clarify that 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
Any other questions for members of the committee? Seeing none, thank
you for your testimony. Thank
you all for being here. All right. Senator Penzo, you're recognized to close for your bill,
Senator Clint Penzo
Unverified
1:29:01
to stay right here. Like I said, the fiscal impact will be offset by limiting emergency room visits.
I appreciate a good vote on this bill. Okay. Thank you. Any... Okay. And what's the pleasure of the committee?
i assume motion do pass second second all those in favor say aye aye and opposed ayes have it congratulations senate bill 348 passes thank you committee
Senator Clint Penzo
Unverified
1:29:48
Okay, can I do SB 306? Senate Bill 306. In the interest of time, I'd like to have a representative from the home care providers come up and present with me. all right
committee uh senate bill 306 um you have a handout and we're passing that out
All right, well, I can start talking about this being handed out. I just want to kind of explain, you know, I've worked with the home care providers on this, but the genesis of this, my reasoning for it, 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. My goal is to let people age in place, to stay home as long as possible,
and use the facilities when you need the facilities. I don't know how many times we were back and forth between nursing homes and my parents' house, but the quality of life when he was home was obviously better. It was his recliner, you know, his shop. I'd take him down to his shop and we'd hang out and stuff. And he would remember things when he was in a familiar setting. So that's why I am passionate about this bill. For everybody in the room,
I personally think it's going to save the state a tremendous amount of money. And, you I'll let Burris kind of explain the details on that here in a minute, but currently in-home care is capped out at $34,000 a year. Nursing home expenses are usually around $102,000 a year. That gap needs to be narrowed, and if it is, we can leave people at home longer and still save the state money.
And eventually they probably will go into a facility. But that's the person's choice. Not every family has the opportunity to bring somebody home because it still takes a tremendous amount of work from the family to keep somebody home. But with assistance, you know, my parents, my sister's on Medicaid, but my parents had the means to hire personal care themselves. So this wouldn't have affected my family directly.
But I got to see firsthand the differences between my dad's quality of life in a facility. And we were actually able to bring him back home a little bit before we passed in October. But I'll go ahead and let John take over and talk a little bit. Thank you. If you'll state your name for the record.
Speaker 306
1:34:03
Yes, ma'am. John Burris. I'm here on behalf of the Home Care Association. Thank you very much. and out of respect for time, 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 five minutes, so I appreciate all the time. I want to get into the what and the why of this bill, but I want to start with something that I feel like has 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, but some of you I knew before office. He's not here. I got to know Senator Filippo on his path to office, but some of you I served with, and 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. In terms of the what, we kicked around various bills to run as we were debating this legislative session. These only happen every two years, as you know. We thought about getting very granular and getting into details. But when look, 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 as a legislature and
trying to get into really particular details, we started rereading the Medicaid sustainability report that was comprised by Guidehouse, 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 and 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 we 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, the gap is too big. As Senator Penzo said, right now on the home and community-based waiver, you cap out at $34,000, and the average cost of a skilled nursing is $102,000 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 costs when you go to a skilled nursing. So I'll read a couple of points from the Medicaid Services Report, 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. And then 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 on HCBS for 50.2. The national average is home and community-based at 62.5.
So we're about 12% difference in 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 accessing nursing home facilities, which indirectly disincentivizes home care services use and results in a, quote, 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 Godhouse, 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 God House told us. We have a disproportional 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 two, 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 show up in legislative council, you're getting blown up by lobbyists, maybe sometimes me, about a rule or a reg 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 report, set some bump reels to say what the
goal should be. Let DHS and CMS come up with the 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 hearing. 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 to 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 is difficult. But by design, this bill does not get into the details. There's three things that drive the cost of a health plan. It's eligibility, it's benefits, and its rates. 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 save, but it will not cost more because we don't, eligibility is who qualifies, benefits is what they get, and rates 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. 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 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 in mind, 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
thank you for your testimony all right uh seeing the next person that'll speak against the bill Rachel Bunch.
Speaker 136
1:43:19
I'll state your name for the record. Rachel Bunch. I'm the executive director of the Arkansas Health Care Association. And I have two handouts,
if I may. Yes. 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 those in just a bit.
And then these are your handouts. Is that correct? Okay. Go ahead. We'll pass those out quick. Thank you.
Rachel Bunch
Unverified
1:44:37
Okay. Go ahead. Thank you. My name is Rachel Bunch. I'm the Executive Director of the Arkansas Healthcare Association. We are the state's largest provider of post-acute healthcare providers. So I'm here today to speak against Senate Bill 306 and really to provide some facts and more detailed information.
I did bring my comments that we submitted on the Medicaid report. For the sake of time, I'm going to save those. I think the gist of those comments speaks to the fact that no one wants to be in the nursing home. Our members can build nice new buildings. 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, and those are our comments. We'll distribute those again later. Our two fundamental issues with this bill, one is that we believe this bill is a false comparison of programs,
And two, 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 health care policy. One, on the comparison of programs, and I'll add to a lot of the things that Mr. Burris talked about can be done currently. DHS could bring those currently. We could go through these studies. We don't think this legislation is needed. About the comparison of the programs, the bill has a few misleading representations of home and community-based waivers.
We absolutely believe that this will have a large fiscal impact. I'll talk about that in a moment. But it's factually incorrect. Home and community-based waivers do not provide services that are comparable to skilled nursing facilities or inpatient hospitals. HCBS services are non-skilled and non-medical. They're limited to ADL help, personal care, transportation, respite, adult daycare, 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. Nursing facilities have to offer 24-7, 365 care. We have to have medical directors, nurse practitioners, pharmacy consultants, RNs, LPNs, CNAs, dietary consultants, a very large variety of professionals that are mandated in our federal regulations. These other programs don't offer the same thing.
They're not bad programs. Our members do therapy for patients across the state every day and discharge them to these programs back home, but they are different. And so to say that they should be paid the same without the same regulation is unfair. Nursing facilities are legally required to provide all of the services for patient well-being. We cannot admit patients to a nursing facility who only need assistance with 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. 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 bill will change the number of people going into nursing homes. We don't think it will change that at all, but we do think it's an unfair comparison of the services.
Speaker 136
1:48:34
Next, to speak just quickly about funding, and these are the two handouts that I gave today. I think it's wrong to just look at the total dollars. I
Rachel Bunch
Unverified
1:48:43
think that's some of our issue with the Guidehouse report, and I think it's a lot of our issue with this bill. I don't have the bill in front of me 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. And this would
provide a range. Mr. Burris mentioned that it would give guardrails. I would argue it doesn't give guardrails. It gives a very wide open range. The first handout that I have here was prepared by our CPAs. And while it is a range, 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. And this handout has a breakdown of how
we arrived at that number, looking at the cost of day, cost per day, sorry, in nursing facility care and then the unduplicated number of participants on the current ARR Choices waiver. The average annual days that they're on that waiver getting services, 295. And that brings you down here to the cost that we think it could be up to this amount. 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 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 four funding sources. They're different. The four funding sources are the federal match, the state match, the provider tax that nursing facility providers pay six percent of gross receipts every facility all year. They've done
this for many, many years and pay into this system to allow for this match rate 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 four 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 sources of the funds, where they come from, but most importantly that we think this is not an apples to apples comparison and that it really, it doesn't change the number of people going to facilities. As he did say, these are really important services and I have members that offer all of them and these are complicated issues
Speaker 136
1:51:58
but I think this 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 their handouts? Yeah, if they would just come to the table and... Sure, Senator Lenny. Let's do that.
And, members, I do apologize. They did prepare a fiscal impact statement on Senate Bill 117. It was
in your folder, so you may—I apologize. But please proceed, Senator Letting. I just kind of wanted to hear their thoughts in
Speaker 317
1:52:52
general on the legislation. I'm sorry, I didn't hear you. I just wanted to give them a chance to weigh in on the legislation.
Okay, appeal, state your name for the record. Janet Mann, DHS.
Speaker 293
1:53:18
We are neutral on the bill. We pay for both of these services, the nursing home and the home and community-based services in the Medicaid program. Okay,
Senator Ludding, you still have the floor? Okay, Senator Payton.
Senator John Payton
Unverified
1:53:36
Thank you, Madam Chair. I'm just trying to figure out if it very specifically says that it can't cost any more than what we're spending. How is
Speaker 282
1:53:51
there a fiscal impact? We didn't issue a fiscal impact. We actually considered several different variations, and due
Speaker 293
1:53:57
to the number of participants and 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.
Speaker 296
1:54:09
And that is why there's been lots of
Senator John Payton
Unverified
1:54:13
numbers discussed. So if I could follow up, it's been stated
that the bill gives DHS broad range in organizing, customizing, creating the program. Does it seem that it would be within your abilities to set the guidelines, to ensure that it would not cost more and that it would not have a fiscal impact? There are budget
Speaker 282
1:54:37
neutrality rules that have to be followed with every waiver, specifically
a 1915C, which I think the bill references, but without
Speaker 293
1:54:44
knowing if this is a new waiver, without knowing if this is going to be a transfer of services, new services, you know, new services, we had no way to do that. And yes, we do
Speaker 282
1:54:56
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 no way. So just to sum it all up, you
Senator John Payton
Unverified
1:55:08
don't know, but if you found out that it was going to cost more, this bill would direct you not to do it.
Speaker 282
1:55:15
Is that correct? I believe as it's written, yes. Okay.
Senator Dave Wallace
Unverified
1:55:27
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 DHS has no idea what this is
Speaker 276
1:55:42
going to cost us. Yes, sir. The way that
Speaker 293
1:55:44
the bill is drafted, we considered various options on trying to do a cost estimate.
We looked at cost savings. We looked at cost growing, and 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 writing a blank check? No, sir.
Okay, I have a question. 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 waiver. We do have this currently in place. And so the numbers that were generated is
Speaker 293
1:56:39
based on current spend, correct? That is correct. We do have this waiver. We actually operate several different waivers. We have two waivers, which I think we provided you a narrative on both waivers. And then we provided you our historical spend on our Choices waiver, Living Choices waiver, our self-direction waiver.
And then we also added our personal care services that the Our Choices waiver
Speaker 282
1:57:06
recipients receive that is under the fee-for-service program to give you all the
total spend for the past several years. Okay. And so I'm just looking like I'm looking at this page under V3, I think. So starting 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 these are the current spend, is that correct? I'm
Speaker 282
1:57:45
sorry, I'm a little confused. If that is version 3, so those are the documents that were released earlier today under FOIA request. Those were the ones that
Speaker 293
1:57:56
we could not come to agreement on. Therefore, we didn't issue them as fiscal impacts. Okay. Okay.
Yes? Can I ask where the committee got it from? I'm
Speaker 282
1:58:19
sorry. I understood this to be fiscal impact information. We had over five versions of fiscal impacts, and we could not agree upon them. We
Speaker 293
1:58:26
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. But what was requested was current spend. Yes, ma'am. And where is
Speaker 296
1:58:48
that? That is on, it's a page that looks like this. I don't know if it's
green. Oh, it's not. Okay. My apologies. This. This is this and this, correct? Correct.
Speaker 282
1:59:01
You had requested, I believe, several days ago, a narrative on the two waivers. I got you. And
Speaker 293
1:59:09
then historical spend, and that's what we sent to them.
Okay, so 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? Correct. Of the different waivers? Yes. Okay.
Speaker 293
1:59:31
And the personal care services column is fee for service, just for clarification. I got
you. Okay. And then the total waiver spend, so these are just for the waivers, not for long-term care.
Nursing home. This is just waiver expenses. I got
Senator Fredrick J. Love
Unverified
2:00:01
you. Okay. Any questions? Yeah. Sure. Turn on my microphone. All right, so I'm looking at this. says on the first page it says current waiver was approved March 1st 2024 8300 people served right and I know that that Miss Bunch said that and it's at
about 57 million and I know Miss Bunch said she didn't like to compare this is not an apples apples comparison but how many people
are served through nursing homes. Do you have that number for a rough estimate? Okay, $11,500. How much do we spend with nursing homes?
Speaker 293
2:01:00
So, in calendar year, excuse me, state fiscal year 2024 for nursing homes, we spent $926 million. Okay. Any other questions?
Senator Penzo, you recognize the question.
Senator Clint Penzo
Unverified
2:01:26
Thank you, Chair. I just want to ask two questions.
Budget neutrality in here would keep you from spending more than we're currently spending. And then the next question, Senator Irvin brought up the different versions that were out there. Can you address what the findings were on whether that was going to cost more or if it was going to save the state money? I know that, you know, we can't pin it down, and that's why there were five versions, because they were having a hard time to determine savings or impact on the state.
If you could just address the budget neutrality
Speaker 293
2:02:14
and then the findings from the five versions. On budget neutrality, we do have to show any type of waiver service. For the services outlined in the waiver, we have to show budget neutrality for an alternative source of care. So it is waiver by waiver when we submit it. So depending on how it is designed and
Speaker 282
2:02:35
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 set up by CMS to show that we would spend less on this waiver than we would in another type of
Speaker 293
2:02:57
care. To your second question on the different versions, the different versions showed extreme savings that made us all extremely nervous because we could poke lots of holes in them. So we naturally threw that one out.
Speaker 282
2:03:12
We looked at different versions and even tried to break it down into a per member or per beneficiary annual cost, trying to take into account different factors. That got complicated because of the length of term, average length 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 patients will go 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, we had lots more questions at the end of the analysis than we did when we
started the analysis. Thank you. 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 why couldn't you, so I don't understand 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 not budget neutrality. That's actually stating right there that it would have been made to provide institutional services. And it says that the department shall insure.
So I don't understand how we don't get to a fiscal impact that we take 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 tried to
Speaker 282
2:05:55
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
Speaker 293
2:06:09
actually tried to back into some of the analysis that Mrs. Bunch referred to with the patient liability and the quality assurance fee to actually try
Speaker 282
2:06:21
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 into that,
Speaker 293
2:06:39
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 and hours. Then the struggle was along the lines of beneficiaries and how many beneficiaries and how that would
Speaker 283
2:07:01
grow. That's where we got uncomfortable with putting a number out to show budget neutrality.
Okay. Okay, 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? I mean, is that
not correct? We're paying for very different things here. Yes. Okay, and so it would, in your opinion, in the Medicaid program, is it reasonable to pay for skilled labor 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 they're two different,
completely two different things. But this bill is trying to equate
Speaker 282
2:08:11
difficulty. So home and community-based services have a role. And they have a role. I would agree with that.
Speaker 328
2:08:17
Up until that role can no longer be met, then they
Speaker 293
2:08:22
go into either a skilled nursing facility
or a hospital, or what is the next required level of care? Okay, but
you would agree that they're two different things, and we shouldn't be paying for them at the same way? I agree that they are different things,
Speaker 293
2:08:36
and I think that was why we struggled with trying to come up with... Okay. Senator Payton, you
Senator John Payton
Unverified
2:08:45
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 would DHS interpret that as saying that they should pay equally, or would they take advantage of cost savings if
Speaker 293
2:09:14
available? Without having a design of the waiver, that was our struggle. So not knowing exactly what would
Speaker 282
2:09:22
go into the waiver service-wise of how to look at hours and look at pay rates and look at also the workforce.
Senator John Payton
Unverified
2:09:31
But wouldn't you be in control of what goes in the waiver 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
Speaker 282
2:09:58
we didn't issue a fiscal impact statement, but we are neutral on the bill.
We already pay for these services for Medicaid beneficiaries. So you would know
Senator John Payton
Unverified
2:10:07
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. Okay, thank you.
Speaker 336
2:10:41
my apologies all right are there no other questions from
members of the committee i'm sorry senator thank you madam
Senator Fredrick J. Love
Unverified
2:11:03
chair so i'm i'm kind of thinking through this so And pretty much, you know, with this bill a week, is it asking, because I haven't read it just in depth, is it asking for a redesign of this program?
Is that what we're looking at? Or let me ask you, in your opinion, is a redesign necessary for this program? I
Speaker 282
2:11:30
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 all bodies to be approved as the new waiver. So it's been since 2024.
No, wrong waiver. Sorry. Yeah, 2024. We've got my years mixed up. I apologize. It's late. It has to be renewed next year, so it's approximately five to seven years old. A lot has changed in five to seven years. So does it need
Senator Fredrick J. Love
Unverified
2:12:12
improvements? Yes. What type of improvements would you say it needs? No, don't tell me that, because
Speaker 203
2:12:17
here's the thing. Here's the thing is we're asking DHS, who oversees the program,
what kind of improvements do we need to make to this waiver? You can give me some examples. That's not too hard. Let me have some examples of kind of the redesigns that we would be looking at. Some of the
Speaker 293
2:12:39
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 that we need to consider in a new waiver. And
Senator Fredrick J. Love
Unverified
2:12:53
when you say the number of hours, the number of hours for caregivers to be there?
Yes. Okay. And at the same time, when you start, when you begin to talk about this, that could be skilled labor.
Speaker 293
2:13:11
Is that not correct? Not necessarily. I mean, home and community-based services serve a role, and when you get into skilled labor,
Speaker 282
2:13:20
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 taken into consideration.
Speaker 329
2:13:34
And they already have service packages and service limits in the Medicaid program. Okay, thank
Speaker 346
2:13:51
you. Yeah. Still questions? I'm fine right now. Okay, all right.
Any other questions from members of the committee? All right, seeing
none. Anybody else here to speak for or against this bill?
No? Okay. You're recognized to close for your bill? Are there any other questions for Senator Penzo? No? Okay. You're recognized to
Senator Clint Penzo
Unverified
2:14:11
close. Okay. Thank you. The opposition mentioned they should be paid the same. No
rates are mentioned. DHS will review options and decide what's fair and best for the patient and the taxpayer. This bill does what the Guidehouse report recommends. I just want to point out the budget neutrality in the bill.
Cost neutrality is a requirement under Section 19.5C of the Social Security Act, meaning that the average 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, it saves the state a significant amount of money. One of my goals in a lot of the bills I'm running during this legislative session
is to increase access to care, lower health care costs, and provide options to patients in Arkansas. And my dad, the Maples in Springdale took great care of my father. but but like it was mentioned it is different levels of care it is a different type of care that's why my father went back and forth between home care and 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 to our constituents especially If it saves a state money. And like I said, worst case scenario, it's neutral. Best case, we save a lot of money in this state. I think this is the best thing we can do for our constituents. I know that keeping my family at home as long as possible was very important to me with my dad,
and it's still very important with my sister. And I'm going to try to keep her there as long as I can. 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 where she needs to be. So 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? And second, all those in favor say aye. Aye. And opposed? No. No's have it.
Speaker 34
2:16:47
No call. Broke hole. Center flip on. No. Center flip on, no. Center heel. No. Center heel, no.
Senator Letting. Senator Letting, yes. Senator Penzo. Senator Penzo, yes. Senator Payton, Senator Payton, yes. Senator Love. Senator Love.
Speaker 37
2:17:36
Senator Wallace. Senator Wallace, no.
Yep, three eyes. Three ayes, three no's, two non-voting. Bill fails. Thank you. Senator Penzo, do you have, I know it's almost 10 o'clock. Motion to adjourn. Second. All those in favor say aye. Aye. Opposed, ayes have it. We're 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
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Senator Missy Irvin Chair
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Senator John Payton
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Senator Ricky Hill
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Senator Fredrick J. Love
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Senator Clint Penzo
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David Cook
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Matt Gilmore
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Stan Townsend
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Meg Ann
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Jahaj Shine
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Kristen Neck
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Kitty Cohn
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Rachel Bunch
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Senator Dave Wallace
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