Public Health, Welfare and Labor Committee - Senate

off. I know you've got a new agenda, and I appreciate that very much, but we're going to go back to scope of practice this builds and kind of move through those. So with that, Senator Hammer, uh, you're gonna be first up, Senate Bill 111. And here's a handout for your bill. So if you'll just sit down and um I remember there's a few Uh, want to, um, wait because you don't have other, um, senators in the committee, we can do that, but if you have a non-controversial bill, then uh we can go ahead and proceed if you're comfortable with that. So, Senator Hammer, if you'll state your name for the record, you may proceed. Thank you, Madam Chair, members of the committee, Kim Hammer, state senator, District 16, present to you today Senate Bill 111, which is to establish a dentist and dental hygienist compact, I'll be glad to inform you that with regards to the Dental Association of Arkansas that they are neutral on this and that this bill is endorsed and supported by the Department of Defense and also by the American Dental Association and basically it frameworks what we've seen in other compacts that have been established does not surrender the state's rights with regards to scope of practice issues or the other things that we hold near and dear and having sat on this committee for several sessions before I can assure you that we are not surrendering anything that we as a state would want to surrender with being able to control either scope of practice issues or accountability of those. This is supported by the dental hygienists Association and Madam Chair, I couldn't really tell you if anybody's here to speak for. against it. I don't believe there is on my end anyway, there's a handout that was given to you that kind of frameworks, the overall of the bill, and Madam Chair, I'll be ready to take any questions that members may have. OK, members, are there any questions from members of the committee on the bill? Right, seeing none. Is there anyone here to speak for or against this bill. There are none, uh, you recognize the clothes for your bill. Thank you, Madam Chair. And again, this is supported by the Department of Defense because they would like the ability for dental hygienists to be able to move freely throughout the states. This is also on consideration for Oklahoma and Missouri, our surrounding states. It's currently in the legislative session or they are currently taking the topic up in the legislative session and so I would appreciate a good. Thank you. What's the pleasure of the committee? And is there a second? Second, all those papers say aye and opposed. I have it congratulations, you've passed your bill. Thank you, ma'am. Thank you for your patience. All right. OK, Senate Bill 99. Senator Penzo. I've got some good news and bad news. OK. This is noncontroversial. But there's 3 of them and are you, if you'll just state your names for the record. Uh, Aaron Lido, and I'm the president of the Arkansas Academy of Physician Assistants. OK, I just want to make sure I've got, I've got you, uh, signed up to speak for the bills, so, perfect. Just marking you off. Please proceed. Thank you, Madam Chair. Good to package of 3 bills here, uh, to support physician assistants. By streamlining, streamlining licensure, clarifying Medicaid recognition and expanding clinical capabilities collectively, these bills will improve healthcare access, reduce wait times, and optimize healthcare resources and promote healthier communities across Arkansas. Um, one of these bills was requested to have amendments made by the Medical Society. We've amended it, um, Senate Bill 99 and 101, uh, didn't have any uh Or didn't have any issues with it, so they're neutral on all three, and I'll go ahead and let you tell a little bit about the bills. Yeah, so thank you for having me. My name is Aaron Woodall, and I'm a PA certified and have practice in family medicine, um, SB 99, uh, this bill allows for PAs to delegate duties to unlicensed medical staff such as medical assistants, emergency techs, and paramedics. Currently, the law states the only physicians have this authority to delegate each 11:31 passed last week through the house, which allows nurse practitioners also to have the same authority. Uh, what this means in practice is that an MA can only dispense medication under the supervision of a physician, uh, PAs are perfectly capable of delegating this task to nurses, and it is well within our scope to supervise over injections. In my experience working in family practice, if I'm in a clinic and the physician isn't physically present that day. I have to rely on the nurse to give all medications or in instances that the nurse is busy or out, I have to give medications. itself. This doesn't change what unlicensed staff are authorized to dispense, and they have the same responsibilities that they currently have under physician supervision and are not authorized to dispense medication that they are not currently authorized to do. Um, you know on the others as well. All right, thank you. Uh, that's, this is Senate Bill 99. Any questions from members of the committee? I see none. Anyone here to speak for or against this bill? See none, you're recognized to clothes for your Senate Bill 99. Is there anything I'd just like to ask for a good vote and I'll make a motion to pass. Motion to pass. Second, all those in favor say aye and opposed as have it. Congratulations, Senate Bill 99 passes. Senate Bill 1, what do you want to do? 100, 100. Uh, so Senate Bill 100 in 2023 Act 303 was signed, and this allowed for PAs to be recognized as rendering and billing providers under all insurers. This has allowed PAs to be recognized for the patients that we're seeing under Medicaid, but this bill SB 100 allows PAs to also serve as primary care providers with Medicaid. There continues to be a strong need for accessible medical care across the state and PAs want to continue to be part of that solution. We continue to work under the supervision. of a position and this bill reaffirms that as Senator Pinzo mentioned, we worked with the Medical Society and amended this bill to be sure that we are again reaffirming that the physician authorizes the the PA to perform these services. Um, all PAs have a supervising position that we are licensed under and the physician agrees to oversee all the care that a PA provides. This means that if a patient has a PA assigned as their PCP, they still have a physician-led care team. However, this allows for the provider that a patient is seeing most often to be recognized as that patient's PCP. This allows transparency and removes delays of service that often arise as patients have to wait on a PA supervising position to sign off on time sensitive orders and referrals that require PCP signature. SB 100 helps provide transparency for patients and expands access to care by allowing more qualified healthcare providers to serve as primary care providers, which is essential in our underserved areas. Thank you. Uh, any questions from members of the committee? You're doing a great job presenting on these bills, by the way. Um, anyone here to speak for or against the bill? All right, see none, you recognize the clothes for Senate Bill 100. I'm closed and asked for a good vote. Motion. Second, all those in favor say aye and opposed I have it. Congratulations, Senate Bill 100 is passed. Next one, Senate bill. Uh, 101. Correct? Yes, Senate Bill 101. This is a PA licensure compact bill. This bill provides for PAs to join the newly formed PA National Licenser Compact. Our goal again is to expand access to care for Arkansans. This allows for easier mobility during public health emergencies, streamlined licensure process for PAs working in border cities like Texarkana and West Memphis and brings patients into Arkansas for specialty care such as medical genetics, where UAMS is the only center that provides this care in a 300 mile radius. It also provides a huge benefit to military spouses who may have to quickly relocate as it makes the transition of licensure a much smoother process. This bill does not change our current state practice laws and NPA's practicing under the compact privilege have to follow all state statutes. It also creates a shared data system among compact states where disciplinary actions can be reported, which improve safety measures for the public. Thank you. Are there any questions from members of the committee? Senator Hill. Certainly depends on this bill is 26 pages long. A lot of under Underlining here What, what, what is not being covered. Which what we just said, what, what in here is not being covered based off the testimony. 26 pages. It's got to be something in here. Well, I mean, it's, it's pretty much, I'll, I'll let him so the bill is standard language which is used nationally and so it's the standard language that's that's passed in in every state that's included it so far, um, and so to be a member of the compact, the language has to match in each state and so it really is just kind of fleshing out how the compact is formed, um, and, and what the the states agreed to participate in, but like I said, there's nothing in there that changes scope, it does clearly define in the bill. that, that, um, like I said, any PAs that practice with the privilege have to follow their state's licensure and then that state has the authority to revoke those privileges for any disciplinary actions or any or anything like that. So it does leave um autonomy to the state's medical boards, so it's, how many states are in this pack? I'm sorry, how many states are in the state's 13 currently that have that have passed. So it is It's common language for all the states, but like you said, it's kind of like hammers. They, it doesn't change our ability to limit scope in the state, so OK, thank you. One thing I forgot on Senator Hammer's bill, but I know that in the past on Compact, uh, bills that are compact related. We have language added in there for any rules and regulations to go through ALC for approval. Is that language in here? Um, yeah. I meant to ask Senator Hammer that, but it's kind of standard language that we've been trying to include in all compact legislation I believe so because it's it was headed up the national group is headed up by, by CSG Compact State or State Group, which has also been involved with the the dental hygiene bill, I believe, and other compact bills as well, yeah, well, this is specific to Arkansas Legislative council though, so it, it, it's probably not in the bill, but I would just, um, it's, it's kind of something that we have added for standard procedure, um, And so I would just recommend adding that language, it doesn't change anything. It just makes sure that we have ALC approval of rules and regulations. Remember, OK, um, and I meant to do that with Senator Hammer's bill too, because I don't think that's included in that bill either. It, it, it helps to build I think it is, is it? I'm sorry, 25, uh, the Yeah, rules, palm, yeah. Or the board is out or yeah. OK. Oh, very back. So I'm, that's state medical board 26. last page. Yeah, that's, those are, I mean, I assume that's going to go through ALC. With the legislative says the board shall file the proposed rule with the legislative council, OK. Advance of January 1st. OK, good, good. Thank you. OK, thank you. Just want to make sure because oh, I'm sorry, Senator Payton has a question. In pain and you'll recognize for question. Thank you, Madam Chair. So I'm looking on page 4. And line 4 it says to participate in this compact of participating states shall, and that's followed by some things. Number 6, which is on line 27. Say that, in other words, if we're participating state, we shall comply with the rules of the compact commission. Do we have representation on that commission as a state that's participating, yes, every state in the commission has representation on that. I, I believe so, yes, every state that joins the compact would send a representative to, to the commission the compact requires that we shall comply with the rules of that commission. I definitely want to have representation there. Yes, and like I said, I believe that's written in here, um, I, I, I'd have to find a specific language, but I believe that's it's written in here that all states that participate are are represented on the commission. OK, thank you. Thank you, Madam Chair. I probably, if you can reach out to the folks there and confirm that or how that commission is made up, I think it's probably a good point just because I do have some, I have a representative from the National Compact that I can get in contact with if we need to. That'd be great. That'd be great. But what we can do is like if if there's an issue. You don't have to do it right minute, but Maybe if there's an issue, then we may, you want to address the, the bill, we can always bring it back and amend it if needed. I don't know if it's an issue. Just so we don't lose autonomy. OK. We'll give you time. Is there any other questions while we get Senator Payton any time. questions. I mean, that, that is one of the concerns that he highlighted with compacts because of the commissions, because the commissions, you know, do all these different things as outlined on like page 9, so. Yet Go ahead, Senator Payton recognized so this is page 8, line 25. Each participating state shall have and be limited to one delegate and then later it says that the delegate. is what makes up the commission, so we do have representation. Perfect. OK, good deal. Anything else? Any other questions from members of the committee? See none. Nobody has signed up to speak for or against the bill. You're recognized the clothes for your bill. Go there. I'm closed for a bill, OK, and pleasure of the committee motion to pass. Second. Is there a second? OK, all those in favor say aye and opposed. I have it. Congratulations, Senate Bill 101 is passed. Yes, Senate Bill 119. Are you going to run that one or no? Oh Can I just don't have. Well, we can just wait. It's OK. Um, Representative Clowney. This is HB 1245, state your name for the record and you're recognized. Thank you, Representative Clowney, um, District 21. Uh, thank you committee. Thank you, Madam Chair, um, for your help on this bill and advocacy on this issue in general. Um, senators, this may look familiar to you. This is similar to a bill that I brought last session that made it through committee and off the floor, but just to remind you, um, behavior analysts are a group of providers that work with children with autism. There's currently no Arkansas-based oversight for these providers, and there are parents who would like that. So this bill is an attempt to provide that Arkansas-based oversight without erecting any barriers for people who want to continue to practice behavior analysis, so this bill creates an optional registry. So it is not a mandatory registry, it's optional. People who practice behavior analysis can choose to be on this registry if they do choose to be on their registry, that gives Arkansas's psychology Board oversight over these, uh, providers, and it also gives parents the option to choose their provider knowing whether or not if something goes wrong, they'll be able to go to an Arkansas board for help with any issues they may have going forward. But like I said, this doesn't provide anything mandatory for people who are already practicing. It is a purely optional registration should providers choose to join it. Um, that's kind of an overview of the bill, but I'm happy to answer any questions that y'all may have. Thank you. Are there any questions from members of the committee? All right, seeing none. Anyone here to speak for or against the bill, seeing none, you recognize the clothes for your bill. Thank you. I'm closed. I appreciate a good vote. All right, what's the pleasure motion to pass. Second, all those in favor say aye and opposed, I have it. Congratulations, you passed HB 1245. Thank you. Alright, HB 1255. If you'll just state your name for the record, you're recognized. Thank you, Madam Chair. Jeremy Wooldridge, State Representative District one. Right. HB 1255 is a relatively simple bill, if you'll remember last session, we created um a pathway, I think the intent of that bill was to create a dual pathway uh to allow more access to CGMs or continuous glucose monitors, uh, that's been a forever durable medical equipment, um, benefit and last session Representative Pilkington and I supported the bill, appreciated what he was trying to do, wanted to make sure that anywhere there were DME or other deserts that there were for Arkansans to get the access to those monitors that they needed. So we created a pharmacy benefit. What we in hindsight did or I think unintentionally did was we took it out of the DME world and just basically put it into the pharmacy world. This just allows and requires DHS to create that dual pathway so this becomes a pharmacy benefit and a DME benefit. So Arkansans have access to this at whatever um availability they see fit. All right, questions and Peyton, you're recognized for question. Thank you, Madam Chair. What's it cost? I'm sorry, what's the cost? I can't find a fiscal impact statement, uh, there's not a physical impact statement on here that I know of. So the cost of the equipment, you mean? Well, I mean, isn't it's gonna make it qualify for Reimbursement It was already qualified for reimbursement. This was the pathway until last year, and then we opened up the pathway for pharmacy. This just requires us to maintain a dual pathway. DHS chose to not continue the pathway for DME, so we're already paying for them then. Yes, sir. OK, thank you. Thank you, Madam Chair. Thank you, sir. Senator Penza, you're recognized for Christian. Thank you, Madam Chair. Um, I'm, I'm a big fan of getting this. In both worlds, but somebody has told me there's probably a 3 to $4 million dollar fiscal impact on this. um, and I know I've talked to the chair about, you know, uh, we discussed all future Medicaid, uh, bills would have uh fiscal impacts on them, so, uh, Uh I, I don't know. Because I'm hearing two stories, um, and I just would like to know if there's a fiscal impact on it, uh, to evaluate. Um, huh? I'm sorry, yeah, OK, so you're um I've got somebody from DHS here or I believe Miss Pitman's here. Senator Love, did you have a question? OK. You'll just state your name and identify yourself for the record. Yes, hello, I'm Elizabeth Pitman. I'm the director for division of Medical Services. Representative Woolridge is correct. We do already cover these, and so the the rate itself is already factored into our budget. Uh, the cost will come from not getting the rebates back on the DME side and potential rate increases, that is about a $6.7 million federal or total computable and about a $2 million cost to the state, uh, for the loss of rebates. Are there any other questions, Senator Payton? OK, I'm sorry, I'm, I'm just. Beginning the light bulbs coming on. Can you restate some of that or be a little more detailed about what you're talking about. Yes sir, absolutely, um, so if you missed our very fun CGM discussion, you probably missed some of this, um, when we do pharmacy, we enter into rebate agreements with the manufacturers to get a portion of the amount we pay back. Are we talking about insulin or on the equipment on the equipment. So this is for the equipment itself. It also on insulin, so a lot of pharmacy manufacturers do this. Uh. So we pay out a rate, uh, that goes to the providers and it's the same um right that we would, you know, that they, they would charge to the providers themselves. So who's going to get the rebate? We do. The state does. So then you're not having a fiscal impact if you're getting the rebate, right, so we're right now we get that rebate on all of the DME that are all of the CGMs that we provide, and because they're all gone through the pharmacy system and we build them that way as the manufacturer requires. If we have to shift some of those back to. EE, we would lose that ability to collect that rebate back from the manufacturer and that be getting the ability to collect in certain instances, not for all manufacturers, but in certain instances, yes, the provider actually gets the discount that we would, we are losing. So the rebate's gonna go to somebody else, to the provider. Thank you. Thank you, Madam Chair. Thank you. I'm sorry, I think there's a dance party outside. It sounds like yes ma'am. OK, any other questions, members of the committee, Senator Flippo. Yeah, and you might have mentioned this and I just missed it, but do you know what the rebate is, how much that is? We are actually not allowed to disclose the rebate, uh, per federal law, those are confidential, so we can tell you total computable on all the products but not individual rebate amounts. OK, thank you. I think the bill, there was a bill that was passed last session that changed it from durable medical equipment, um, to this pharmacy product, and, and I think, There was an unintended consequence when that occurred with DME, um, durable medical equipment providers. And so this is an attempt to try to fix that unintended consequence that I think Representative Wooldridge is bringing forward. Um, there's been a lot of discussion in public health committee meetings about this. That's correct, Madam Chair. Is that correct? Yeah, OK, I'm just trying to catch people up. Senator Payton. I'm sorry. Thank you, Madam Chair. I'm just trying to be clear. I thought you had said that. That there was a $6 million impact, $2 million of which would be the state's part. Yes, sir, from the loss of being able to get that money back from the manly or or total, it's 6 billion and 2 million of that is the state. So somebody else is going to be getting that $6 million. So when Yes, so the the other 4 million will go back to the federal government. So every, you know, we get a match when we get money back, we have to pay the federal government back their portion of that money that we. That they paid. So they'll get the other 4 million back. In this case, they would lose that 4 million. Thank you. Thank you, Madam Chair. Thank you. Any other questions from members of the committee? All right, thank you. Seeing none, uh, there's no one here to speak for or against the bill. Uh, you recognize the clothes for your bill. Thank you, Madam Chair, and thank you committee. I mean, let me just say I'm not a fan of, of sending any money back to the federal government, just like you all are not. I think that, uh, Madam Chairman is exactly right. This bill was passed last session with the greatest of intent. We wanted to create an opportunity for this to be dispersed in every county regardless of DME providers' availability. There was an unintended consequence. We spent a lot of hours in public health discussing this. I think it's um I think that it's a good point that should be made, that the rebate is coming, I believe, at the expense of Arkansans. So that price went up in order for a rebate to be given. Um, so I think that the rebate that's being generated in my opinion, that there's a little bit of false information around the way that rebate functions, the price for the manufacturer got pushed up, that means the price to every Arkansan that uses this through a pharmacy benefit has gone up and then that rebate, we get a portion of that and the federal government gets a portion of that. The rebate that happens with DME providers goes to your DME providers or local businesses in your community. To me, I think that this corrects a wrong. It creates a dual pathway, and I would ask you for a good vote. Thank you. Right, it's the pleasure of the committee. Motion to pass. Second, all those in favor say aye. Uh, discussion, you're recognized in Penzo. Thank you, Madam Chair. Um, I just, uh, like I said, I'm not, I'm not adamantly opposed to this bill. I just think that we need to, I mean, have you'd like to ask the chair, have you requested a fiscal impact on this? I Myself, I just asked for DHS to come to the table and give a fiscal impact. BLR does not do fiscal impacts on Medicaid bills. That would be done by DHS. They came to the table and they just gave testimony for your request. OK, well, I don't think it was a formal uh uh. Assessment, but what I would like to ask the committee is That all Medicaid bills have a fiscal impact on them. Um, we keep passing stuff that we're not. We don't know how much it's going to cost the state, um. So I just would like us to consider that. Uh, on bills and Anyway, that's, that's my. Request of y'all. I think that I will just say DHS has provided fiscal impact testimony on several bills that may not appear on a piece of paper, but through comments from the governor or through DHS that are public comments, those, uh, on, on fiscal impacts of previous legislation passed in my opinion, answers the call for that. Any other discussion, Senator Hill. I want to go back to what Senator Penzo just said, I feel like if we did require what he was requested for the fiscal impact. We should have done that whenever we did the rules the very first that way the members would know what's going on that they that they're supposed to bring it with them. Thank you. Any other discussion? All right, see none. All those in favor say aye and opposed. Eyesha it. Congratulations, you passed your bill. Thank you, senators. Thank you. Thank you, Senator Wooldridge. I mean, Representative Wooldridge, um, house 1256 while you're here, do you want to go ahead and present that one? Look and see real quick. Oh yes, ma'am, I do. Thank you. Thank you, Madam Chair, and thank you members of the committee, Representative Jeremy Wooldridge, District one, House Bill 1256 is a, um, what I consider to be a common sense piece of legislation. This is aimed at getting providers in the field faster. So what we've done uh over the course of time, I think and and to the credit of the state of Arkansas and all those members, you all and all those that came before me. We've tried to make sure that we get people into the workforce as quickly as possible to combat the need. needs, whether that's nursing, whether that's a behavioral health, any of those other issues that arise. If you look at the behavioral health issues that we have in Arkansas, the shortage of providers, um, it's imperative that we get as many qualified workers into the field as quickly as possible. There are multiple paths to become a licensed therapist. I'm an LCSW. I am a licensed therapist, and the Social Work board creates what's called a provisional license. So in essence, when you graduate from an accredited institution, you submit your documentation to the board, the board issues you a provisional license that allows you to work, uh, start working to meet the need of those individuals that need services while you study for an exam and you are under supervision, this just replicates that and adds it to the counseling world where that provisional license hasn't uh hasn't uh been previously also covers the marriage and family therapist license and to my knowledge, there's no opposition to this bill. OK, thank you. Any questions from members of the committee. All right, see none. Anyone here to speak for or against this bill, seeing none, recognize the clothes for your bill. I'm closed and I'd appreciate a good vote. What's the pleasure motion to pass. Second, all those in favor say aye and opposed as habit. Congratulations, you've passed your bill. Thank you, Madam Chairman. Thank you, committee. OK, let's see, let's go to, um, Senator Davis is not here. Yes, there she is. OK. Senator Davis, Senate bill. 222. Thank you, Madam Chair and committee. Brianne Davis, District 25. Um, so this bill is a fairly simple bill. It just clarifies that it is not a marketing violation to inform an existing or potential Medicaid roll enrollee, um, with a risk-based provider of its status with the past. So, For example, um, I'll use Easter sales and all that, um, him speak to this more in a minute, but if you have a child that goes to Easter seals and um they are working with some passes, but maybe not others. This just says, hey, it's not a violation to inform the parent, um, of what passes you are in network with. Um, parents should be able to know that under current law, they cannot say anything to them, they cannot tell them who they're with or the status of any of their contracts with any of the passes, um, and you need to know if your kids enrolled there, that you need to know if they can get services there or not. So this just simply clarifies and say, hey, and says, hey, it's not a violation. Um, it is not marketing if you simply inform the parents, the current parent or a potential, uh, parent or family enrolling into um this school or this organization, and it also puts protections around it, um, on page 2, It says that the Department of Health, uh, excuse me, Department of Human Services shall not restrict the direct service providers from responding to individuals' questions about open enrollment or network status. Currently, that is not legal. So if a parent, if I have a question about the services my child can be provided at the place I'm sending my child, I cannot ask them to get clarifying information to even know, um, so this will make sure that parents or, you know, that they're able to ask, um, but that they cannot the uh organization cannot attempt to influence the individual's choice of a risk based provider or respond in a in a manner that's inaccurate or misleading. So that's the protection to ensure they can't mark in some way, but they can inform the parents, um, and I'm happy to, um, let you speak if you want to introduce yourself. Hi, thank you for being with us. If you'll identify yourself for the record, you're recognized. Thank you, Senator. My name is Ron Ekstra, and I serve as CEO for Easter Seals, Arkansas. Um, I am here to testify on behalf of the bill we have recently experienced the situation where we are serving families. We've been serving them on Medicaid for a number of years and our preschool, um, in fact, we've encouraged them to apply for waiver services because their child has a lifelong developmental disability and will need services as they age. Um, and, um, recently we also made the decision not to remain in network with all of the passes as we attempted to negotiate waiver rates as a result, if that person, that family signs up and gets assigned to a pass that we are not in network with. And they come to us and even ask, what do I do now? We're not allowed to tell them what passes we are in network with and then what their options are during either open enrollment or the 1st 90 days that they are assigned to a pass, they have the ability to change passes. So we are restricted from sharing that information that families really want to know, and we've got a trusted relationship with them that all of a sudden overnight changes and it risks their ability to continue to get services because if they don't make a We're not in network. They can't get those services from us, they will have to switch to another, another provider, and oftentimes that's not what they want to do. What we'd like to be able to do is to tell them what their options are if you'd like to stay with us. Here's what your options are and if you would like to stay with your past, here's what your options are at the end of the day, it should be the free choice of the members, the families of who they choose to get their services from and who they choose as a pass. Thank you. Any questions from members of the committee? I appreciate your testimony and I appreciate all that you're doing, uh, for those kids. Um, I know there's some challenges, and I think it's important for us to continue to refine and work on this policy because of what y'all experienced, and so, um, You know, I, I appreciate the bill. Any questions? All right, you're recognize the clothes for the bill. Is there anyone here to speak for or against this bill? CNN you recognized the clothes for your bill. Thank you, members. I just asked for a good vote and I'm close for my bill. Thank you. Thank you. Motion to pass. Second, all those in favor say aye, and opposed as habit Senate Bill 222 is past. OK, um, All right. Is there another House member here? 3 Oh, you do? OK. Um, I have one bill. I have a Senate Bill 265, uh, I know we've got folks here for that one. Let me go, if you don't mind, I'll go ahead and do that one real quick. I'll let you take the chair. And please identify yourself with your guest. Thank you. I'm Senator Missy Irvin, District 24, Bailey Taylor, chief administrator of Environment for Energy and Environment. Thank you. First, I need to say they're doing great work, and I really appreciate some of the work that they're doing. We have a gas leak in Mountain View, Arkansas, and they're doing a good job helping with that. Um, so member Senate Bill 265, um, what this does, it expands the eligibility to serve in the environmental officer program to planning and development districts reduces the solid waste licensing Committee from 7 to 5 voting members, reduces the wastewater licensing committee from 8 to 5 voting members makes modification. to the solid waste Licensing Committee to remove outdated references and extends a apprenticeship licenses and solid waste management facilities from 1 year to 2 years consistent with all other solid waste operator licenses, and I'll let Bailey uh speak more to the bill. Yes, uh, thank you guys. Um, so for the wastewater licensing committee and the Waste Licensing Committee. We are just trying to right size those committees for reducing some duplicative representation, uh, 5 voting members is adequate to accomplish the needs of those licensing committees. These are subcommittees of the pollution Control and ecology Commission and uh you may remember we reduced that commission last session and so we're just trying to follow suit with our other subcommittees, um, as far as the environmental officer program, we are expanding that eligibility to planning and development districts, they have reached out um to us with um concerns and being engaged and so we wanted to make their employees eligible to become environmental officers as well. And then on the apprenticeship license, um, a couple of sessions ago we expanded all soloway licensing, um, licenses to be on a two-year renewal cycle. And this is just clean up. It was an oversight that the apprentices were in a different section of the code and so we would just like to put them on the two-year cycle as well. Members, are there any questions? Seeing none. Is there anybody here to speak for or against this bill. Seeing none. Uh Senator Irving, are you ready to close? I am. I and I close for my bill. appreciate to get that any discussion at all. Seeing none, I have. I need a motion. I got emotion. I have a second. All in favor say aye. Any opposed? Congratulations, you have passed your bill. Thank you. Got to find a sponsor for that, OK. All right, Senator Penzo, what you, what you got? Do you have um 1213. Senator Hill. Which bill are you presenting? If you'll identify yourself for a record. Ricky Hill, District 11, and I will present whichever one you want either 1255 or 1257. Well, let's start with 1255. That's Wait, what? I grabbed the wrong one then let's do the other one, OK. Wait, I have, I have you on 1478. Well, that may be it. OK. All right, how about, how about we do the house 1478. Sounds good. Representative Schultz and Senator Hill, there we go. You're recognized, OK, 1478. OK, all this one does is repeals. Uh, The registration of a disease intervention specialist. The repeals that whole section. All the way through. Are there any questions from members of the committee? Say none. Anyone here to speak for or against the bill. See none on a second let him look at it. It's repealing the registration of disease intervention specialists. It's removing code. I believe this is in with work with the health department, correct? That's correct. Yes, Senator Luddy, so just why I'm not opposed. I'm just curious like why they haven't met and have not worked together. OK, all right, thanks. Right. Any other questions from members of the committee? All right, see none. You're closed for your bill. Motion you pass. Second, all those in favor say aye and opposed, I have it, I think. Thank you, Senator Flippo. OK, um, House Bill 1478 is passed. Excellent job, Senator Hill. Thank you. The other bill is under long. It has an amendment in puts me on it. Oh It's a long one. No, we'll, uh, motion to adopt the amendment, just add Senator Hill as sponsor is just adding me to it. And second, all those favor say aye, pose as habit. Amendment is adopted. House Bill 1447. OK, you're recognized to present House Bill 1447 as amended. Thank you, Madam Chair. All this bill does is allow a separate tank installer to connect a piece of pipe. To the actualseptic tanks to have from the stub out of the house to the septic tank. Where the plumber does not have to come back, a lot of times that slows everything down. It's just a simple. Tape, put a piece of flagstick together and, and go on. And no one wants to do that job. The plumber does not want to come back and the said you take his installers are there. I know a lot of them that do. I know a lot of them that do. Yeah. That helps. Wait, uh, Senator Wallace, you're recognized. I have a problem. I have a problem with this bill. It sounds really crappy. And you're right. You're the best. OK. I'll take any other questions. Any other questions? Anyone here to speak for or against this bill? All right, seeing none, you're clothes for your bill. I'm closing. I appreciate a good vote and I make a motion to approve. Motion to pass as amended. Second, all those in favor say aye and oppose Ihabit House Bill 1447 is passed. OK, Senator Penzo, which one are we starting with? You're, you're doing some house bills, right? Yes, Madam Chair, House Bill 1131, 1131. Uh, do we have an amendment? To put you on here. Yes, yes. has the 11:31. I have 2. Right We have one for 12:13. Um 11:31 Right I'll tell you what. I'll tell you what, um. Can we just do a motion to suspend the rules to allow for a verbal amendment to add Senator Penzo as Senate sponsor, so moved. Is there a second, 2nd, all those favor say aye pose I have it rules are suspended, motion to add Senator. Pennzo as Senate sponsor. Is there a motion amendment 2, all those in favor say aye, I. Uh, pose, no, I have it, uh, that verbal amendment is to add Senator Penzo as Senate sponsor, please proceed with House Bill 1131 as amended. Thank you. I had 3 amendments today and I thought that was one of them. So thanks for letting me do that. Um. So, like I said, I worked with the medical society on several bills, um, some were opposed, some were, um, neutral and I think uh this was one that they actually supported, if I'm not mistaken, if Scott was here, I'd confirm it with him, but uh I was going to text him and but I'm pretty confident this was one that they actually supported in the house, um, so House Bill 1131 is to authorize an advanced practiced registered nurse to delegate certain tasks to medical assistance. another unlicensed staff. This bill seeks to allow advance practice registered nurses, APRNs to delegate certain nursing tasks which physicians can currently delegate to medical assistance and unlicensed staff. Physicians are authorized by statute to delegate certain tasks to medical assistance and other unlicensed staff including administration of medications. Nurses, including APRNs may not delegate certain tasks, including administration of any medication, receiving or transmitting. Whereverable telephone orders are calling in prescriptions to a pharmacy. Currently, it's unclear whether drawing blood and invasive procedure can be delegated to a medical assistant or unlicensed staff member. This creates delays in care as APRs must step away from patients' visits to perform nursing tasks that are commonly delegated to medical assistance or unlicensed staffed by a physician. Um, House Bill 1131 mirrors uh an act we passed in 2009 that authorizes physicians to delegate these same tasks. Um, there's no other questions then. Appreciate a good vote. Uh, thank you. Any questions from members of the committee, Senator Payton, you're recognized for question. Thank you, Madam Chair. I'm not finding anything in here, but Do they, I mean, like, when they delegate it, they're still their supervising, aren't they? I mean, is there anything that says they can't Delegate it and be at a remote location or somewhere off the premises? No, they'll they'll need to be there and they're responsible for the actions of the person they delegate. To. Is that clear anywhere? It's, I mean, it's not anything I can find in the bill. It does say that they'll remain responsible for it, but doesn't say that they have to be on site. I don't know if that's a problem or not. Thanks. Thank you. I, I believe it is. They have to be there. I don't know if anybody in here can confirm. That might be in the room right now, but Um Like I said, uh Medical Society supported it and This is the same authority we gave them. In 2009, I guess if I could follow up, I'd just say. I, I'd hope if it passed this committee today that you'd find out whether or not we should any issues, I'm happy to bring it back if, if that is not what we want it to be. Thank you, Madam Chair. Yeah, OK. Senator Hill. I'd like to see you pull this down until you get that answer, I can do that. OK. Thank you. So that way we're consistent with what we said earlier today. Understood. Thank you. OK. You want to do, OK, let's go to your next one then. So we'll, we'll wait on that so we'll get an answer and see if the language needs to be in there. OK. Which one now? Um I could do House Bill 1213. OK, and you do have an amendment for that one, correct? That is correct. OK. Um, why don't you go ahead and explain your amendment. Let me get a copy of it. I'll tell you what, Doctor Johnson reached out to me, um, from BLR yesterday and asked for this amendment, um, I've got somebody here that can probably explain the rationale for it. Um, this past Pretty easily in the house, but I think the department, uh, or DHS came up with something they wanted. Address so I can have somebody come up and address that if you, yeah. To come up and state your name for the record. Hello. Thank you, madam Chair, members of the committee, I'm Laura Xu, I'm general counsel with the Department of Health, and we did ask for this amendment on the other side just to make clear that the department would have would just provide the added um information with regard to the updated type of healthcare providers to uh the AAA, uh, just to make it clear that we weren't expected to add an updated list yearly. And so this is just to to communicate with them as to what is available. OK. All right, explanation of the amendment, um, do I have a motion to adopt the amendment, so moved 2nd, all those in favor say aye, and posed as habit amendment is adopted into 1213. Uh, now you may present your bill as amended. OK. House Bill 1213 is a bill that brings together the physical therapists and athletic trainers. These two groups have had sometimes been on different sides of issues, but I'm grateful to say that they have worked jointly on House Bill 1213. Does this bill does a couple of important things. It clarifies the definition of healthcare provider, as it pertains to student concussion education. The term was previously not defined, and it created some confusion as to who is in fact authorized to assist student athletes to return to play after a concussion. The definition in HB 1213 makes it clear that physical therapists should be in that definition of healthcare providers. It also amends the definition definition of athlete in the athletic trainer practice currently to be an athlete, you must be part of an organized sport. An informal league school or an association. When, when the house sponsor rep representative Acor tore his Achilles tendon at the House Senate basketball game two years ago. He wasn't technically an athlete. We all know he wasn't, right? Um, because it was, it was an organized play, even though it was an athletic injury. We're not going to talk about how close he got on the jump ball with me. The updated definition of athlete is related to an athletic injury regardless of the injury occurs in an organized play, so even injuries for the weekend warriors or legislative sports injuries, the new definition also covers athletic injuries that occur in the training of police, fire, and military personnel. This brings Arkansas more into line with much of the rest of the country. Finally, it updates how an athletic trainer practices in a physician's office, allowing them to work under the direction of consultation of a physician. Currently the physician has to be physically on site. This permits the athletic trainer to continue practicing under the direction or consultation if the physician is not physically present, which is how they are allowed to currently practice at their school-based training rooms. It's always nice to see professions coming together in an agreed to bill that helps patients and modernizes healthcare practices in Arkansas. I want to thank the ATCs and physical therapists for working hard on this bill. I'm happy to take any questions. Thank you. Are there any questions from members of the committee? See none. Anyone here to speak for or against this bill? See none the pleasure of the committee. You are you're you're recognized to clothes. I'm closed for this one. Motion to pass as amended. Second, all those in favor say aye and opposed, I have it, HB 1213 passes as amended. We have that amendment for you to sign on 11:31. You can go ahead and sign that and it'll be ready to go when we. Can we do it right now? No, that's the one we pulled down. That's the one we pulled down. Yeah, yeah. OK, do you have another one? Yeah, I've got 2 more 1166. These are quick ones though, especially this 1. 166. Um, House Bill 1166, uh, has to do with epinephrine in schools, epinephrine, uh, or EpiPens is used for anaphylactic reactions, um, all this does is add a nasal um option instead of a a jab, uh, much easier on the kids, much easier for the teachers, so, uh, we'll just ask for a good vote on this one. All right. And then it also allows for certific er certificate from licensed, uh, others, uh, APRN and physician assistant, I'm assuming that they're able to That's within their current scope to be able to provide that certificate. Is that right? I'm, I'm on page 5. When it comes to epinephrine. What, what's your question? I'm sorry. The on page 5 where you included that new language there online 7 and 8. I'm assuming that they, they, that is within their scope to be able to produce that certificate. It's My understanding, yeah, yeah. OK. Any other questions from members of the committee? Seeing none, you're recognized to be anyone here to speak for or against this bill. See none. You recognized the clothes for the bill? I'm closed. OK. Motion to pass. Second, all those in favor say aye and opposed I have House Bill 1166 is passed. All right, if I might have lied to you, can I make a quick statement about uh the ATC 1213, uh, the, the chiropractors had come to me, uh, about some issues, so I'll probably be bringing something later, uh, to address that. Um, so I'm in dialogue with them right now. Shouldn't be scope, but I'll, I'll discuss that with the chair later. I just, if the chiropractors are watching right now, I want them to know that, um, I will be working with them on that, so, OK, as a result of 1213 as a result of 13, it brought up some concerns I had, so we're going to work through those and I'll, I'll have some dialogue with you about that. I've already spoke to Wardlaw, just we haven't had a chance to catch up on it. It has nothing to do with the bill. Oh, I see. Well, um, if we need to pull it back to the committee and and do any work on it, we can do that won't be amending this. It'd be new change, OK, got you. All right, sounds good. Uh, next bill Senate Bill 1 is to establish the interstate medical licenser Compact, uh, pretty much the same as the, the dental and the uh physician assistant. This is just for, uh, physicians. Um, I did check before I came over here on the last page, um, about having that language about ALC in it. Um, it does not. Impact our ability to control scope of practice, and it's pretty comparable to the, like I said, the dental and the physician assistant when we've already passed. You have an amendment to add Representative Pilkington, I think, as a co-sponsor a house sponsor, go ahead and, all right, let's go ahead and pass that out. Um, motion to adopt the amendment. Second, all those in favor say aye, and opposed I have it and then it is adopted, uh, what the amendment does is just add representative Pilkington as the House sponsor. All right, are there any questions on Senate Bill 119? Members of the committee. It does have that language in here for ALC. Is that what you said? Yeah, on the very last page. Got it. Anybody, OK? Anyone here to speak for or against this bill? Seeing none, you're recognized to clothes for your bill, motion to adopt the amendment. We already did that. I did that already. Oh, I'm sorry, yeah, I'm closed, right? What's the pleasure of the committee? OK, second, all those in favor say aye and oppose I have it. Senate Bill 119 as amended is passed. And just to save steps going down the road to Peyton's question, uh, they would have to be on site or available, uh, by telecommunication per the rules. On the question you had. Oh, that would, that's in reference to House Bill 1131. Yeah, so we're talking about they can delegate to an unlicensed Person And not be on site. They can be over the telephone. Available, yes. Which bill is it again? 1131. Um, I'll tell you what, let, let's, uh, let him process that and go back to I'll I'll get out of here. Yeah, OK. Representative, um, Pilkington. Oh, I'm sorry. the Oh, I see. OK, sorry, uh. OK, just one second. Is there anyone else here? I think these other ones I need to. Senator Clark, Senator Clark here. No, OK, I'm sorry, Representative Pilkington, do you want to try, you want to come back to the table with Senator Pinzo on House Bill 1131. Yes, I just wanted to maybe help answer some clarity. Sorry, I just got out of the house coming over here your name for the record and then we're we're revisiting House Bill 1131. Thank you. Thank you, Chairwoman. Representative Erin Pilkington, District 45. Um, on the question of whether they're on site as Senator Pinzo said it's yes or via telehealth, and so just go I think about that as we have certain telehealth sites. You may have a provider who is who's having a tele visit, but there is maybe the MA within the clinic who's the literal hands in, in the, in the facility. Does that make sense? Well, you said MA this is healthcare worker. The healthcare worker doesn't have to be. Licensed or trained or anything other than just on the job training, but here's why I'm asking line 2829 says a nursing task to be delegated under this section shall include without limitation. When we say shall include without limitation. I mean, that's without limitation. So anything that the that the registered nurse, advanced practice registered nurse. is in their scope they could delegate. Yes, this and this and now you're saying they don't even have to be on site. Well, that they, they have to be through a telehealth appointment. I mean they can't just You know, be at their house by their pool, um, because what we did is we took the language back from the 2009 bill that allowed providers to do this, and so that's what this is modeled off of. So an MD has been doing this since then, and we're just trying to allow APRNs to be able to do this. So when you say who's been doing this, who's been delegating to who? I mean, this is the first one I've recognized or noticed that the delegating to an untrained. Unlicensed person. When I say untrained, I mean not formally trained. Sure, sure, yeah, so think about it right now, you may walk into a clinic and you have a unlicensed medical assistant that a medical doctor is using to help with the appointment and so um that's what we've currently got going on and so we're just allowing APRNs to do the same. Well, maybe so, but When we say they're going to do anything that's within the The scope of the advanced practice registered nurse. And the advanced practice registered nurse may or may not even be on site. I, I don't like that. Sorry, thanks. Well, I think I want to, the thing about on site is they, they are communicating with the staff, with the patient while they're in the office. Like I said, it's not a situation where they may say do these things and I'm not, they're not partic they they're actively participating in the visit via telehealth is what I guess I'm trying to say. It's not the situation where they're in the line at the bank or something like that, and they're dictating to the to the staff to do something. So they're, they're actively participating in the visit. Is that And I think I understand. I hope I'm not making it more confusing, Senator. I no, I'd just like to have them within arm's reach if somebody drops the ball, maybe they can catch it, but thanks. it. And just quick question, I mean, is there, I mean, the way that I read the administrative medications and immunizations that do not require specialized judgment and phlebotomy activities, um, but don't you have to be in order to do phlebotomy, don't you have to be certified? Be a certified phlebotomist, um, yeah, actually, to my knowledge, I believe so. Maybe there's someone who can answer that question better than me. Well, that, that would just be my concern is adding that phlebotomy activities because I, I'm pretty sure you're supposed to be certified to be able to do phlebotomy activities, um, like taking blood and right? Uh, because this would be I mean that that's, and I mean to I guess it, instead of without include without limitation, I think that's where, is that necessary to put without limitation on there, if you've got that next statement, I don't know. I just And honestly, I'm not sure if there's somebody, is there somebody from the health department that could speak to phlebotomy, phlebotomists. I'm not sure. I think that's what you're meaning, right? Oh great. Thank you, Madam Chair, members of the committee. I'm Laura, I'm general counsel, I'm sorry, I don't have that information with me. I'm happy to get back with our experts at the health department and get that for you, but I don't have that with me today. OK, yeah, let's just wait. I'm happy to give you. I appreciate that, no problem. Like I said, we're just modeling this after the 2009 legislation that allowed MDs to do this. So, um, maybe just in pulling that from 2009, maybe a little extra clarity would be great. So I'm, I'm happy to kind of bring that back. The committee's over and feel comfortable. Yeah, I mean, I don't mind about the administration of medications, immunizations is just is giving shots. I don't necessarily have a problem with that, but I know that like, there's some phlebotomists that aren't allowed to give shots, which is strange to me, but it's the way it is. So, we just need to maybe work on a lot of this different types of things, but OK, let's just pull it down and get Madam Chair, um, we've already passed it. So, this is the one we pulled down. We pulled down, yeah, OK, I'm sorry you're running too many bills today. I'm confused time to quit. Senator but my question is this, is because you, you said that it would it would it was copied from the language that we pass for MDs and so do we allow MDs to actually delegate to Unlicensed persons. So they can, they can delegate their authorities to unlicensed persons. Is that, is that what you're, is that? Am I hearing you correctly because here it says the question we have um we have Scott Smith here with the Medical Society. You might be able to answer that question for us. So Scott, did you hear my question because they, they said that this language is, is, is strictly taking this modeled after what we did for MDs. My question is because My question is, do we allow MDs to delegate? There scope to unlicensed persons. Scott Smith with the Arkansas Medical Society. And the answer is yes. There are A number of duties that can be done that can, that can be done with the appropriate training. When a person medical assistant because you don't have very many nurses, and so there are medical assistants that are trained in the office. There's actually a medical assistant program at Arkansas Tech as well, maybe other places, but what happens is that the physician maintains the liability. So typically it's a, it's a very small and defined group of tasks that can be done. Uh, and I just, when you are talking about this and I don't know. If you want me talking on this or not because every time I've been here today, it's not turned out well for for. But, uh, but what I, I think I was able to pull it up pretty quickly and that as it pertains to um Whether the supervision requirement, if there's administration of drugs that has to be done within the physician's office, but the physician may or may not have to be there specifically, but if there are drugs involved, that there's been a delegation that the medical assistant can do from what I was able to pull up pretty quickly, you know, just walking in late here, that can be done. So I, I hope that's helpful. OK, so, so. Trained healthcare worker then would assume that if they were doing phlebotomy, they would be certified to be able to do that. Is that what we're, is that what trained healthcare worker means defined as, does that make sense I think that because even when I first got the bill when you have the part that is like unlicensed, is there a word that's very confusing, but you have like some MAs that are trained, but maybe they're not a licensed MA, but they are an MA within your healthcare. Do they, do they get a certification? or anything like that? Do we have, is there any, is there any verification of the training. Does that make sense there is at least one program, as I mentioned at Arkansas Tech that has a medical assistant certification program. There may be others. I'm not aware of any others in the state, but I do know that our Insite Tech has a, a certification for medical assistance, but in large part, most of the medical assistants are just trained in the office very, you know, simple, simple tasks that would be what would refer to unlicensed as that group of MAs. And even those, those medical assistants from Arkansas Tech are not licensed. They're just, that's correct. They're certified, not licensed. That's correct, yeah. But if there's, OK. OK. Sorry, yes, I'm sorry, let me go to Senator Payton and then Senator. Thank you, Madam Chair. Don't leave, Mr. Smith. So, so, so you, what you seem to be communicating there is that we did this for physicians, for doctors, MDs, and there is a defined list. of tasks. I no, there's not a defined list in statute. There's basically in each physician's office, he or she, the physician, can come up with those tests that that physician feels comfortable enough with because at the end of the day, if anything goes wrong, that physician is still liable for whatever action is taken, I'm and they're generally very simple that but the question that I have about this particular book. is on line 29 when it says without limitation. we are absolutely not creating a list and when When Madam Chair talks about the phlegma phlebotomy, it's part of this list, but I just want to remind members that that list is without limitation. So in other words, those things are included plus anything else. That that the advanced practice registered nurses wants to delegate and, and I guess if you're saying that maybe we did that for the MDs. Well, I hope there's some limitation on it because there is, as it pertains to anesthesia, and that, that's, I was just looking at a summary of the bill from 2009, but yeah, there're some prohibitions there aren't necessarily that I recall, so what, 16 years ago, um, That delineated what was allowed, but there were some prohibitions as it pertains to um anesthesia. And that's administration of anesthesia, um. Can't do anything that's beyond the physician's training expertise through normal course of practice, and then the physicians delegate medical practice if the practice is beyond the person's competence, so some general Prohibitions from that bill 16 years ago. OK. Thank you. Thank you, madam. Thank you, Senator Pino, you recognized question. Mr. Smith pretty much. Adressed what I was, the point I was going to make, um, that it's the doctor's license that's at stake right now if, if they have the person do something that they don't feel comfortable, that they've trained them to do, and I just wanted to, and we're supportive of this bill, by the way, I'd like to like to say that. When it's my bill, that's a big deal. OK, I have a quick question and on page 2, line 19 and 20. Does that, is that supposed to say it, say that that way. Uh, 1920, an individual to whom a nursing task is not authorized to delegate to delegate the performance of the nursing task to another individual. Is that what you're referring to, to delegated to delegate. And it We see I see what you're saying. An individual to whom the nursing task is not authorized to delegate to delegate the performance of the nursing task to another individual. I think that's a typo 6 of the previous page. Yeah, but it's, it's is not authorized to delegated to delegate, you see what I'm saying? A No, I understand that. It's just, I understand that, but I don't think that's written correctly. I think it, I think there's one too many delegates in there. I don't know. If I may read it. Out loud So starting on line 35 of page 1 says if an advanced practice registered nurse delegates a nursing task under this section. Where's that other line? Oh man, I I lost it. Where's the part you were talking about? Uh, line 19, page 2. OK. To an individual. To whom a nursing task is not authorized to delegate it. To delegate Oh, it's hard to jump back and forth and read them together, but yeah. I thought, I think that's a typo. Anyway, I mean, it doesn't affect the bill. I'm supportive and fond of the bill, but do you want to fix that? We need to fix that. I think we need to fix that, right? I don't understand. I do wonder if that was supposed to be a comma between the two delegate delegates. That's what they were. Or to be delegated I think. Well, let's just not my nursing task is not authorized to be delegated to delegate. I think you're missing a beat maybe. I don't know. OK, I'll I'll get him in and fix that typo, and you know, I think people chew on it a little bit unless Madam, my question is this bill has been pulled down. We've been discussing it for about 20 minutes, I'm sorry, what's our objective here? We plan on owning the bill again or what are we planning on doing? No, I tell you what, let's just pull it down. We'll fix it. We'll come it back. Thank you. Thank you. Thank you. Alright, any other bills to come before this committee. All right, good. Thank you, members, seeing none were adjourned. We will meet Monday afternoon upon adjournment of transportation. Thank you.