Public Health, Welfare and Labor Committee- House

We ran this bill through committee Thursday, passed out with, I don't believe we had a question on it. Um, but the computer had a mix up when we sent the bills to the floor, and as you remember yesterday we sent a bill back. This bill did not transfer to the floor. So we're going to vote it out real quick to get it in the pipeline where it's supposed to have already been. With that, uh, representative Lindstrom, you recognized to quickly present Senate Bill 132. Senate Bill 134. Thank you. This is the bill that simply changed the commission from meeting 12 times a year at $500 a meeting to 4 times a year at $100 a meeting, and they still included transportation or mileage. Thank you. Can a motion to pass. Any discussion on motion. Anyone speak for or against the bill in the audience. See you 9, all those in favor say aye. all post. I have it. Thank you. For the record, that meets the 2/3 threshold to take it off deferred, so. Just letting everybody know. Thank you, colleagues. Thank you, Chairman Wardlaw. Thank you. Representative Wing, you recognized to run Senate Bill 50. Thank you, Mr. Chair. Thank you committee, Mr. Chair, with your permission, could I have uh Ryan Norris join me at the end of the table. Sure. Colleague Senate Bill 50 addresses an issue that uh kind of took it a particular importance to me and during the interim as we were talking about some of the issues facing Arkansans. When we look at folks who are receiving government assistance, especially kind of mid to long term government assistance. We need to take an approach of what is the goal of, for the folks who are receiving this assistance and what do they want? They want to get off of this assistance. They want to be self-sufficient. They want the things that uh are provided in this uh in this economy. And so what we we're looking at is there are some inadvertent barriers to the growth that some of these people have and such a sense that you might be able to get a 2000 dollar raise at your job, which is a good deal, but then you find that that takes you above a certain income threshold and you lose $4000 worth of benefits, so it's a net loss and so we're actually inhibiting in many cases the the desire for folks to rise and, and grow, get better education, and fulfill the measure of all that they are meant to be. And so what SB 50 does is it sets up a study within our existing legislative framework, no new task forces or anything like that, but through an ALC subcommittee to address this issue comprehensively and to take an approach that's research based so that over the next 2 years as we get ready for the 2027 session, we would have recommendations that would be designed to help us maximize the best use of our funds and most importantly maximize the human potential that is Capable as people are able to rise to what they want to become and uh and so I, I, I feel like what this can do is put the best minds in the state together as this subcommittee meets, make recommendation to the full ALC and reports will be given to the governor, Speaker of the House, the Senate protem, and then we can walk into the next session with some good comprehensive legislation that can help eliminate these fiscal cliffs which are harmful to the overall effect and harmful to the desire of why we have these structures in place. And we can put Arkansas forward, which will have a real economic benefit for the state, but also and very importantly, a benefit to the individuals of the state of Arkansas who are wanting to become better and rise to what they truly can be with their full potential. And uh with that uh Mr. Norris, do you have anything you'd like to add? Yeah Thank you, Mr. Chair. Thank you committee. Um, Ryan Norris with Americans for Prosperity. We believe that prosperity is available and obtainable by everyone, but you have to look at both internal barriers which many of us have probably had to overcome some of those ourselves throughout our lives, and we also have to look at external barriers. And as Americans for Prosperity has become more and more of a grassroots organization that includes voices from all over our socioeconomic spectrum in Arkansas, we're finding individuals that are getting caught up. In the cycles of poverty that they can't seem to get out of because some of the economic trade-offs that Representative Wing has just kind of covered are just not there for them. They're making decisions on the daily about do I have the health insurance? Do I have the food, etc. We believe in the power of free people to do extraordinary things, and you have no freedom when you're hitting up against these criteria or even process. s that keep you from, from receiving the hopefully temporary assistance you need to self-actualize your own life. And this also comes with an impact to our workforce. We have low unemployment in the state of Arkansas, but we have many individuals who are not fully employed. So we would hope that throughout the course of this task force that it would have a, a focus on keeping families together and helping people gain full employment because you can't find anything more purposeful in life than ending up in an industry or a career path, and seeing yourself and being able to improve your economic situation for you and your family. So we don't know at AFP all of those barriers are, but we know that within the expertise of this room, our agencies and those that work with these populations, solutions will be brought to the forefront. With that, I'm open for any questions. A question from Representative Richardson. Thank you, Mr. Chair. Thank you guys, uh. As you guys have, I've I've heard you guys talk about this is uh from your perspective and how you see people who want to get out of this and and do more for themselves, but how often have you guys? Involve those individuals that you speak of, have, have they been involved in this conversation? Did they bring this to you and say, hey, this is what we need help with. I'm just curious. Uh yes, sir. This is come out of conversations among populations that we've worked with in our in the reentry space, those that are trying to break out of cycles of poverty and are frustrated because the trade-off is such that they've gone from a 5-day work week. To a 4-day work week so that they can keep and maintain benefits. We're having conversations with folks that many in this room would probably not say would be an AFP, uh, advocate, but we are broadening this out to where it's about the voices of the people. So there are those in this room who will come up to this microphone and represent the population specifically, but it is my commitment to make sure that if this bill passes when it passes, that we will help to organize as many voices as Possible with lived experience. Thank you. And Representative, let me add as well, I've had personal conversations with constituents of mine that are in my district and also just constituents within the state of Arkansas who have expressed a degree of frustration because they have been that example that I gave of gotten a $2000 raise and lost $4000 in benefits, and they think, well, wait a second, why, why do I have to actually go backward to move forward and so what we've got is a variety of different departments. that are trying to address the same issue and in good faith trying to address the same issue. But what happens is, is that every now and then we have a crossing to where we're actually working against each other and so what this bill is to is trying to do is to put together a committee of of of everyone who's involved with this, whether it's DHS division of Workforce Services, everybody to put them together in the same room so that we don't have those unintended fiscal cliffs which which have very real. consequences for the individuals who are facing this. Representative Ladyman, do you recognize? Thank you, Mr. Chairman. Uh, you may have answered my question already. Uh, I like this bill, and I think you're right. I think it gives people value and when they have a job, and I think that's what most people want. But when I was reading the bill, It, it looks pretty broad, and I, I think that's good, but is there a limitations on what areas of state government, what departments that we're going to look at or is it open? And is it open to um People outside of state government contractors, nonprofits that work in this arena Oops, I think our microphones went out too. Uh, are you, so is your question, will they be part of the solution gathering process or you think, are you thinking in terms of outside consultants. Will you be looking at these areas that this committee, I mean, is it open for them to look at all of these areas, even people that are outside of state government. Yeah, everything is on the table. We want all knowledge to come in. we've got a 2 year process to be able to gather it all. All right, thank you. Representative Ferguson, you recognize. Yeah, thank you, Mr. Chair. Uh, Representative Wayne, one quick question. I think you may have addressed it, uh, with Representative Laman and maybe represented Richardson, but like, are we looking at maybe community action agencies being a part of this working group. Not only just agencies within state government, but community action agencies that deal with a diverse group of population within our state. Yeah, absolutely. In fact, you'll hear from some folks who have come to speak in favor of the bill, just how broad this approach is and how many people want to be a part of finding a solution. Absolutely. Thank you, Mr. Chair. So no further questions, I guess we'll start with the list of people I want to speak for it. A Paul Chapman from Restore Hope. Mm Thank you, Mr. Chair and committee. I'm Paul Chapman. I work for a software and services nonprofit called Restore Hope. And uh we were created and work with 19 different counties in Arkansas right now to be able to organize the different professional services, whether they be governmental or whether they be nonprofit, um, uh, services that already exist in the community to tie them all together and put them using technology on one person's case, who's in crisis, who has a goal of getting through crisis and stability and ultimately on to a career in 2024, there were 1400 users, professional users of the system and probably another 1000 in what we call alliances in these 19 counties that all partnered together to help 3,314 families with 706 of those families achieving the career. goals, so they had full-time employment that would allow them to earn a living wage to pay for them and their families. These families when they come into the 100 families initiative, uh, may have child welfare cases they may be in reentry. They may be suspended driver's license. 50% had no source of income. When we met them, and so these are uh very complex cases. There are many stakeholders, be governmental or not. profit that are trying to assist or manage supervision for these individuals and just through the coordination and being able to put on average 9 different professionals on one person's account. We see things like reunification rates if a child's in foster care, go from 43%, which is standard to in the last 12 months it was 68% for the families that would work in this coordinated way. So I'm here to um to speak. Uh, on behalf positively for this bill, knowing that the coordination of services and community agencies that are already in our communities can result in much better outcomes than the standard kind of non-coordinated way. Seeing no questions? You have a question, Representative Richard. You have a question, Representative Richmond. Mr. Chapman, thank you for being here, and I, I know the work that you guys do, uh, in your organization. My question is, is based on what you're already doing. How do you see this bill helping the work that's already being done because it seems like you're already doing what the bill is trying to do. Right? Yes, sir. Uh, that's a good question. I'd say, you know, in the last 12 months, we helped 3,314 families, but my understanding is that we have persistently seen about 20 to 25% of Arkansas children who have remained below the poverty line for the past 10 years at least, and so we're just scratching the surface. I think what we've done is we've proved that if we can provide the appropriate tools to a community, then they can start to solve their own problems, but we are just scratch. In the surface, and I don't think that we um I don't think that the 100 Families initiative has has worked it all out into totality. And so I think there's more to do. Seeing no other questions. Thank you, uh, Representative Allen. Thank you Mr. Chairman. How will this bill enhance what you're already doing? And I, I think it would be, we, there, there are certain areas, uh, I think that our target clientele, um, like And maybe it's it's Medicaid, which is a huge line item for a state budget. We assist. Our clients and being able to get insured to be able to receive services, and this insurance is things that they already are, are qualified for, but um, but largely the planning for these large areas is not necessarily included in what we're doing. So what, what we do with the support of DHS. Um, is we go into a community and put together an alliance of, of leaders there, um, who want to be able to partner together. That doesn't mean that necessarily we figured out all the different ways that could help put the incentives in the right way, as we heard about benefits cliffs. Uh, we won't, we want ultimately, I think what we want to do is align all the different help. Whether it be governmental or provided by by nonprofits in the community. To um To remove any barrier that exists except for maybe um capacity and willingness of an individual to go as far as they as they can in our communities, but so often what we see is that there are barriers with um large applications that were given with the dollar, maybe from DC using words that no one understands, um. And And the difficulty of understanding how does someone really qualify for a particular benefit? Is it situational? Um, how do we, how do we work that all out with up to 9 different services that someone may need to be able to complete the journey from significant crisis to career. Um So I, I'm giving you kind of a long answer. I would say that um we've proved that coordination. Of the services that that we have in the, in the communities can produce significantly better results, but, but we have not looked at every angle necessarily. I, I think we're depending upon the community to be able to come up with solutions at a local level. I think what this committee or this study might do is look more at a state level at a higher global level to see if there aren't things that we could do to help the communities, um, make it easier for them to align these, their services. shortly. Let me rephrase that shortly. I don't think we've got it all figured out. I think there's more that could be done. Any further questions from the committee? See Annan, thank you for your testimony. We'll move on to Pete Gus. And I hope I pronounced that correctly. Hey, good morning. Pete Gus Economic policy director for Arkansas Advocates for Children and Families. Good morning, Mr. Chair and members of the committee, and thank you for this opportunity to speak in favor of SB 50. As many of you probably know, Arkansas advocates for children and families has been hard at work for children in the state for almost half a century now. Uh, we advocate for evidence-based research-driven solutions to improve the lives of Arkansans. In fact, information and analyses are essential to the work we do. At Arkansas Advocates, we understand that for families to succeed, parents need to have viable economic opportunities. We are paying closer attention like all of you to many of the things that may prevent Arkansas families from succeeding, such as those things related to housing, transportation, health care, child care, education, and workforce development. However, we unfortunately also know that poverty persists around Arkansas and around the country. And some families struggle to meet basic needs, federal and state public assistance programs are important to help remove them from that struggle and to move them from struggle to self-sufficiency to prosperity. We all want children and families to thrive. Let me emphasize one aspect that SB 50 would address an aspect that has been talked about already today. uh, we're very concerned about the negative challenges brought on by benefit cliffs. Of course, all parents make economic decisions in the best interest of their children, um, but sometimes a sudden loss of an important assistance program can make it difficult to accept a promotion or a better paying job opportunity. Uh, some of you may know, the Federal Reserve Bank of Atlanta developed a simulator looking specifically at benefit cliffs. I've been spending some time, um, modeling what's happening to real people in the state of Arkansas, just to give one example, a single parent with 2 children living right here in Pulaski County would face 4 significant benefit cliffs as the mom continues to receive greater salary. These occur when losses come from uh SNAP, um, uh, TANF and chip losses, um, and other kinds of coverage. And some of these, these uh cliffs are quite steep, a loss of $7000 or more. Obviously, a parent is facing really difficult choices when you're facing this kind of uh magnitude of a loss, and we know of lots of stories of individuals saying, no, I can't take that promotion, or yes, I'd like the title, but I won't take the money along with it because I would end up in a negative situation. So there are many proven state-level solutions to challenges created by these benefit cliffs, such as voiding the clustering of multiple thresholds, phasing out benefits to minimize the slope of the cliffs and increasing or limiting threshold limits. Um, the study committee, um, called for by this bill as it works to develop novel approaches to improve workforce and social service programs will minimize the detrimental effects of these cliffs. We believe that the study committee, as it answers its charge, will uncover innovative ways of increasing the efficiency and effectiveness of social services, workforce development, economic opportunities. For this reason, I ask that you support SB 50. If I may respond a little bit to the conversation before, as you may know, Arkansas advocates is not a direct service organization, but we certainly have a lot of partners who are, um, and we hear a lot through our members through the Kids Count Coalition and the Strong Families Coalition, that these are real life cases that parents are facing having to really turn down opportunities because they would end up in a negative financial situation. Thank you. Any questions for committee members? Be a no. Thank you, Mr. Pete, for your testimony. We have Ethan Dunbar signed up from the City of Louisville. Mr. Chair and. If you would hit that, uh, button on your mic. Good morning, committee. My name is Ethan Dunbar. I'm the mayor of Louisville, Arkansas, and I am here to Speak in support of this bill. On the behalf of rural communities and You know For me, and I had some prepared remarks, but I'm just going to speak because this is near and dear to me and I deal with it every day as a mayor in a small community. With a 27% poverty rate, you run into these people every day, everywhere you go. Post office, drugstore, gas station, wherever you go, and they don't hesitate to ask questions, and the main question I get asked is, do you know of any jobs? Can you help me? So as we developed the framework or as you all developed a framework for this bill, I think you need to take into consideration all aspects, and that means getting out into all of the rural communities and speak with these asset limited income constrained employed families. These are families that go to work every day but still find it hard to make ends meet. That has to be considered because as you heard before me, uh, benefits, there's a threshold. Now these benefits aren't designed to be on it for your entire life, but most folks that I know that work, they want to earn more money. But at the cost of losing benefits that will put you in a hole, it's a hard decision. So if there was a tailored approach to or tiered approach that could help me gradually get off of assistance as I make more money, then that's the approach I think that needs to be considered, and I think you need to get into the rural communities to really understand this, you know, to really understand that the the the demographics of Arkansas because in the center of the universe here in Little Rock is a lot different than down where I live in. Louisville, you know, and Most folks I know want a job. We're right now faced with this lithium uh exploration efforts down in our county and I get calls every day about, hey, are they hiring? When are they going to hire? People want to work. Contrary to what some may say that people want to rely on benefits. Well, it may be some, but that's a small percentage. Most folks want to work. And they need a job to be able to earn a living wage, and I think this study will go a long way in helping us or you all as as the legislators understand the true picture of a young family in Arkansas that works every day but struggles to make ends meet and I can't take another job because one, I don't have childcare, but 2, that job is gonna cause me to lose benefits to help me make my ends meet every month. So I think as you develop this framework, please take into consideration the small rural communities. I sit on board. uh that CADC somebody mentioned a community action uh agency. Their whole mission is to alleviate the causes and conditions of poverty, but we have to understand, which means we've got to study what those causes and conditions are before we can address. I think this study will go a long way in doing that, and I am in support of this bill, so thank you. Representative Ladyman, you recognize us. Thank you, Mr. Chairman. Well, Mayor Dunbar, thank you. Thank you for being here. I really appreciate it and uh I was an ex-mayor in a small town, so I understand exactly what you're talking about, and I saw that too, but uh my question is, uh, do you talk to other mayors that you know in other areas, do they, do they support it the same way that you do? Are, are there any mayors that would not support something like this. That you know of? I can't speak for any other mayor, but we all do talk about, I'm I'm a member of a group of mayors and we talk about the issues that we have and how do we address these issues? We can only do so much. We need to help from our our representatives, our senators and the state government. So yes to your question, yes, there are other mayors who feel the same way and they know that we need to take in consideration their populations as we do this study about benefits. Any other questions from committee members? Seeing none, are there anyone else in the audience speak for against thank you for your testimony. Is anyone else in the audience speak for or against this bill? Sinon Representative wing, are you closed for your bill? I have a motion to pass in discussion on the motion. Seeing on all those favor, say ah. I post. I have it. Some members of Representative Kenda Moore, is your bill ready today? OK. Uh, trade representative Stamo. Representative Long. OK. House Bill 1447, correct? Yes, sir. All right, you're to go to the end table and present your bill, yeah. Thank you, Mr. Chairman, and My name's Wayne Long, House District 39. Um, House Bill 1447 is a first for me. Uh, it's uh basically a technical correction and it's noncontroversial. Um, having worked in the on-site wastewater business for over 20 years, uh, and I still maintain a license in that business. Uh recently I was attending one of our continuing education classes, and it come to Come to light that um There's a problem existing that it's existed for quite some time, but has not really been enforced, but now it's going to start being enforced and what the problem is, it's kind of a simple thing, but between your house and your septic tank, there's a pipe. There's always been sort of this controversy about where does the plumber's work start and stop and where does the septic tank installers are work stop and start. Unfortunately, it was sort of. The plumber stops at the stub out and the um the installer stops at the tank and really nobody's actually you know covered under the law for doing the pipe between the two. Um, well, I should say the plumber. could do that, but they don't want to come back just install one pipe. So for years the septic tank installers have been installing this pipe and basically doing it illegally. Which, um, you know, this the health department disorders look the other way, I guess. And now they're wanting people to get a new license, pay $200 a year for this new license that basically enables you to install the pipe from at least about to the tank. And I thought, well, this, this will be an easy fix, so I hope y'all think so too, because that's all it does and I would appreciate it. Uh, any questions? See no questions for committee. Is there anyone in the audience speak for or against the bill? Seeing unrepresented longer your clothes for your bill. Yes, sir. What's a pleasure to the committee. I have a motion to pass Representative Ladyman. Any discussion on the motion? Seeing none, all those in favor, say ah. Ah, I'll post. I have it. Congratulations, your bill is passed. Thank you. Representative Schultz, House Bill 1478. Thank you, Mr. Chairman. Good morning, committee. This is actually a pretty simple bill just for context in the, the early 90s, there was a nationwide push to establish This disease intervention specialist, so In 1993, Arkansas uh created a law. That created the state Board of Disease Intervention Specialist. Well, the national push never came to fruition, so Arkansas basically was just Sitting here with, with this board that that nothing ever happened. Uh, there were no standards ever set. Uh No registry and and there was, there was no fee. So in 2023 Act 365 abolished this inactive board. But did not remove the duties. The duties therefore fell to our Department of Health. And by the way, this bill comes to us from the Department of Health, uh, currently there is no disease intervention specialist as an occupation nationwide. The federal occupational handbook does not identify a disease intervention specialist. 0 states have a registry or a licenger for a disease intervention specialist. There is 0 evidence found of individuals marketing themselves as a consultant for hire, and there's zero evidence of a public or private school that has curriculum for this concept. So what we're doing here is eliminating obsolete legislation, eliminating confusion and clearing the Arkansas cold of code of old and outdated law and with that I would answer any questions. So you know anyone in the audience speak for or against the bill? New clothes for you, Bill. I'm closed and I'll make a motion do pass. That's proper motion. In discussion on emotion. All those in favor, say ah. I'll opposed. I just have it. Congratulations Bill. It's passed. Thank you, Mr. Chairman. Is anyone running Senate Bill 137 for Senator Boyd. Representative Acre, you'll recognize. I Thank you, Mr. Chairman, committee, uh, today, Senate Bill 137 is pretty simple bill, no opposition. Essentially what it does is it allows um healthcare providers to store their records in a digital format as long as it can reproducibly and legibly. Produce all of the same requirements of the physical hard copy and this is preempted any time that there's a I guess a federal preemption on documentation that needs to be stored, such as C2 narcotics documentation, but it's pretty, uh I said simple bill to just modernize the way that we keep medical records, and again there's no requirement that they do so. It's an either or situation. However, in the case of an audit, if a digital format can legibly produce the same information that the hard copy, um. does have on it, then um they will be required to accept that from the insurance company or PBM, whoever's auditing the healthcare provider. Uh, that's essentially it. I'm happy to take any questions. See no questions anyone in the audience speak for or against the bill? Representative, you closed for re bill? I am closed for my bill. What's the pleasure of the committee? I got a motion due pass from Representative Bentley. All those in discussion. All those in favor, say ah. I post. I have it. Congratulations, Bill was passed. Does anyone here to run Senate Bill 180? Representative Ladyman, you are recognized. Thank you, Mr. Chairman. Uh Representative Jack Ladyman District 32, um, the bill that we have before you, uh, I, I have a couple of people that travel from Jonesboro here to speak on this, to to help me with this bill. So I'd like to ask them to come to the table. And the introduced ourselves. Chad, excuse me, Chad Whitehead, St. Bernard's Healthcare. Yes, and I'm Sheila Williams. I'm actually not from Jonesboro. I'm from Baptist Health. Sorry about that. Uh, well, they drove into to explain this bill to you, and they can do it much better than I can. So I'm gonna just let them start and explain the bill and I'll help them with any questions. Thank you, Mr. Chair and the committee. Uh, so this bill will just to allow the existing and any new pace organizations to function as we are designed and exempt us from having any additional licensure for home health services, uh, the model of Pacecare itself is responsible through the federal regulations for Uh, providing care through all settings, including the home and so we feel our existing licensure allows us to continue doing that and to do that moving forward. Yes, I would just add that we have also spoken to the Department of Health and uh DHS and they are, they have no opposition to this bill either. So I would just add that uh these individual entities provide a great service for our seniors, and it's, it's just a, uh, paperwork issue really that we're trying to correct here in, uh, Department of Health, DHS, they're all good with this, uh, so we'd be happy to take any questions. Representative Rose, you recognize. Thank you, Mr. Chair. Uh, thank you, Representative Ladyman for uh presenting this this morning. I apologize. I haven't had a chance to speak to you about this. I think I wouldn't be doing my due diligence if I didn't at least ask, um, with the exemption from these requirements. What exactly are you being exempted from specifically. I, I, I recognize the value of, of tending to these folks. I just want to make sure that we're not waving something that we're going to look back on and go, well, shoot, why did we, you know, why did we say not to check this or check that. So, um If going into that, um, for Saint Bernard's, we've operated the pace program for over 15 years now. And, uh, for the most part, any of the home care services, home health services, those are contracted, um, and we do that, but we run into some issues and times with those agencies being able to supply the services in the home and therefore we are in a violation of our federal regulations in some of those instances to provide for the provision of services for our participants that are enrolled in the PACE program, um, without having, uh, as we've talked through this. For the last couple of years with DHS and Department of Health, there didn't seem a way for us really to have a licensure for home health because we are licensed as a pace organization, um, but then, uh, there were questions as to whether or not we should be allowed to do that, and we just felt that with the existing licensure that we have that we can provide those services in the home as we are responsible for them 24/7 across all all care settings. Uh, can you think of any reason why? something like this couldn't be done as well for, say, including adult day health also. So the adult day health licensure is a different, uh, uh, you know, providing the services in that setting, and so what we're looking for with this portion of it or this this bill is to exempt us from so we do not have to have an additional license to to provide services within the home. OK. I think, I think you, you've cleared most of that up for me. Did anyone else have any thoughts on that? All right. Thank you, Mr. Chair. See no further questions? Did one of the audience speak for or against the bill? See a non-representative. Are you closed for your bill? Well, I'm just say that the PACE program is in my district and I've visited many times. They do a great job for seniors. It's a place for them to come and to visit and socialize and it's, it's a really good program, um, so I think they need to be able to function as efficiently as they can, uh, so with that, uh, I would make a motion to pass. Promotion. Any discussion on the motion? Seeing none, I was in favor. Say ah. All opposed. I just have it. Congratulations, your bill is passed. Thank you. Members with that will be moving into uh scope bills. Representative Pilkington, House Bill 1132 is first on the list. I And I understand you have an amendment, correct? If you would, well, we'll give staff a few seconds to pass that out and we'll take up the amendment first. OK OK. What All right, I think, I think everyone has a copy right now. I'll explain the amendment. Um This is a simple amendment correcting some language errors and then the big chunk that was of course, on page two, line 22, delete uh Uh Delete and if and then add schedules 2 through 5, and so, and then of course on page 3 delete line 11 and add adopt rules for safe and appropriate prescribing a stimulant medication listed in Schedule 2, so, um. change ups of the bill just makes it better, cleans up some language issues, and with that, I make a motion to adopt the amendment. That's proper motion. Any questions on the amendment before I take the motion? See no questions. All those in favor of adoption of the amendment. Say ah. All opposed. I have it if you would present your bill as amended, please. Thank you, Chairman. Thank you for being here, committee. Uh today I have the privilege of introducing a House Bill 1132, which is to increase access to healthcare services provided by advanced practice registered nurses. The bill proposes allowing APRNs to prescribe medication across all schedules, including Schedule 2 stimulants under specific regulations. This legislation changes, changes seeks to utilize APR's training more effectively, particularly in underserved. areas. Um, oftentimes we find that Patients are going to APRNs in rural areas or even some urban areas that lack MDs providers and are getting Schedule 2's prescribed to them are needing them to be subscribe to them and then being sent to MDs who then have to prescribe the medication, uh, and then they're refilled by the APRM, but then every 6 months they have to go back to that provider to get those prescribed again. To me, this is a burdensome process. I don't think, I think it's a way that we can use APRN to already being trained on these stimulants to better prescribe. medication and in many ways I think we're unburdening some of our MDs who are having to have these appointments and said when they can focus on more higher acuity patient visits presented our sorry, passed out to the committee as well. You can see a map to see how other states in the United States have passed similar legislation and as you can see, we are in the minority and not allowing APRNs to have this sort of ability, um. With that, it's pretty simple, I think we're just letting APRNs basically prescribed to the height of their ability that many other states are already allowing, um, and with that, I'll take any questions. Any questions from the committee? Representative Johnson, you're my, my question is mainly right now on the amendment on it says page 2 delete lines 1 through 15. It's, you know, it's always challenging to read these when they're not engrossed, um. I don't understand what we're doing with that amendment, so you're. That whole line 1 through 15 section. I may be looking at the wrong version. Let me try to pull it up. Yeah. So I just want to make sure I understand what we're doing with these amendments. I know we've already adopted them, but. Page 2 lines 1 through 15. What's the confusion? Sorry. So, so you're deleting, we're deleting what I have on my version of line 1 through 15 is already some deleted language on HT and we're just substituting section one, but that makes the page one end with. collaborative agreement with. Am I reading that right? Maybe I'm reading it wrong. No, I believe that's that that's the right and so we're also eliminating the uh the part about a podiatrist, um. As well OK That's fine. I'll, I'll look at it closer. I've, I know a lot of people are signed up to seek for and against it, so I. We can move on and that the discussion. Representative Ferguson, you're recognized for a question. Thank you, Mr. Chair. Representative Peke, uh, Just for clarification purposes, so right now APRs have the authority to prescribe. Schedule 2 and 2 only? No, that is not correct. There were wanting to allow them to prescribe Schedule 2s. 0, they're not allowed. They're currently not allowed. Yes sir. So this bill gives them permission to expands their prescriptive authority. Schedule 2 through Schedule 5. Yes, sir. Yes. So. So what are they allowed to do now? Uh Do all current schedules except Schedule 2s. 0, except Schedule 2s, 3s, 4, and 5s. Correct, yes, yes, right, right. Thank you. Thank you, Mr. Chair. Any further questions from committee? Representative Richardson, you have one? Yes, uh, so with this representative Pilkington. It's What type of oversight is going to be? Are they just Will they still be Managed by a doctor or is this on their own? They can just write these if we pass this? Uh, it depends. I mean, if they have a collaborative agreement, there's still oversight, but remember we also have our current boards that are in place that already have oversight over our providers, so, um, but if they are independent, my understanding is um they They would um They, they would not need that oversight from an India if they did not have a collaborative agreement anymore, but we already have oversights through our regulatory processes already for providers whether that's RNs, APRNs, MDs, DOs, etc. OK. Any other questions from the committee? See you 9, we'll move on to the list of, uh, For and against We have a Lonnie de Clark, I think I'm saying this correctly. From the Arkansas nurse practitioners Association. OK. OK. Sorry. My name's Leonie De Klerk, and I am the president of the Arkansas Nurse Practitioners Association. I'm, um. Speaking on behalf of AMPA. I'm also a family nurse practitioner, um, for the last 26 years, um. And I am, um, a faculty member at UAMS and I'm not speaking on behalf of UAMS. So APRN to prescribe scheduled medications, also known as controlled substances on their own license and DEA registrations in Arkansas since 1995. Our initial statutory approval was ma'am, can you get closer to Mike? I'm getting members that say they can't hear you. OK. Is this better? OK. I'll start back, um, APRNs have prescribed scheduled medications, also known as controlled substances in their, on their own licenses and DEA registrations in Arkansas since 1995. Initial statutory approval was for schedules 3 through 5. And then in 2014, hydrocodone containing compounds, so Vicodin kind of medicine, was moved up to schedule 2 and in 2015, this body approved as prescribing Vicodin or hydrocodone containing compounds out of Schedule 2 in 2019, um, The APRN's prescriptive authority was increased to include a 5 day supply of Schedule 2 medications for acute pain as well as being able to refill stimulants from Schedule 2, such as Ritalin and Adderall as long as there were no changes in the medication and no changes in the dose. Over the last 14 years, statutory and regulatory changes have increased the safety of opioid prescribings and decrease the number of opioids prescriptions in Arkansas. These included the Arkansas, um, prescription drug monitoring program that was authorized in 2013 and has been um gathering data on prescriptions, sorry, authorized in 2011 and gravethering data on prescriptions since 2013 with a mandate for. all prescribers to check it since 2017. Um, guidance by the CDC on management of chronic non-malignant pain that was first put forth in 2016 and uh revised in 2022. Um, And then the medical access and training, uh, expansion Act, uh, which is a federal act that requires all DEA prescribers to do at least 8 hours of training and substance use disorder. In addition, the Arkansas State Board of, uh, sorry, Arkansas State Medical Board and Arkansas State Board of Nursing collaborated to develop rules for the management of chronic non-malignant pain, use of anorexia drugs for weight loss and use of the PDMP, which are very similar from 2015 to 2023, the number of APRNs with prescriptive authority increased by 2300 from from almost 1700 to over 40. 1000 and the number of active physicians, licenses increased by 1100 from, uh, almost 600, sorry, almost 6000 to almost 7000. The opioid prescribing rate during that time dropped by 39%. from 117.2 prescriptions per 100 Arkansans to 71.5. So there's no evidence that allowing APRNs to prescribe other opioids for chronic pain will increase opioid prescribing. Having APRNs not able to prescribe medications other than hydrocodone containing compounds for severe chronic pain. Um is particularly concerning for patients who can't swallow pills because they're big pills and also for patients that are in hospice or palliative care. Um So as far as stimulant prescribing, we acknowledge that there has been a gradual increase since 2018. This is a national trend that the DEA has noted and has concern about. According to the figure in the 2023 Arkansas PDMP annual report stimulants accounted for about 23% of high risk drug classes prescribed by physicians, 15% by nurse practitioners and 5% by physician assistants. So if we look at the current policy, um, using the Institute for Healthcare Improvement, um, criteria for quality of care that includes patient experience and patient outcomes cost of care, population health, and provider experience. This bill actually improves all of those For patient experience and patient outcomes, initiation of treatment is delayed due to the need for another appointment. parent of a child must take more time off work, and the child has to take more time out of school, um, in two counties and 47 communities where an APRN is the only Medicaid primary care provider, the child and parent may also need to drive 30 or 60 minutes to see the physician. The APRN can then, um, provide regular follow-up visits for the next 5 months, but if the medication's ineffective, has an adverse effects on needs a dose adjustment. The child must be evaluated by the physician again. Once again delaying care, and we know that delayed care of ADHD results in poorer school performance. As far as cost, the, the parent will incur costs related to an additional visit, time off work, and transportation. And um I can work through this calculation of anyone who wants it, but I'm going to go over it quickly. According to an analysis from the Arkansas Center for Health Care Improvement half of children in Urban counties and 65% of children in rural counties were covered by Medicaid and CHIPP in 2022 and 2021. Using the CDC's 2019 estimates of 10.6% of children in Arkansas having ADHD and 62.4% of those receiving medications and 50% on Medicaid, that's approximately 1700 and 17,300 children on Medicaid needing medications for ADHD. We know that 31% of Medicaid primary care providers and nurse practitioners. So if 31% of those children are seeing certified nurse practitioners as their Medicaid PCP. That's 5400 children that will need to be evaluated by a physician every 6 months and assuming half of those, um, Can be moved to the physician's schedule rather than incurring an extra visit for an evaluation and initiation of medications. The current cost to Medicaid is over $300,000 per year because nurse practitioners cannot initiate these medications. As far as population health, the bill would provide rules for APRN's prescribing stimulants and may strengthen Rule 7 of the Medical Practice Act, which essentially says that the prescription, uh, must be for a legitimate indication in the patient should be reassessed before, um, issuing a second prescription. And I acknowledge. What Dr. Johnson has said, sorry, Representative Johnson has said, these are dangerous drugs that have a potential for abuse, diversion, and misuse and we really do need to have some rules in effect that will help to make this a safer prescribing environment. Um As far as the provider experience, this change would allow APRNs to provide the care that they have education and certification to provide and would be consistent with the vast majority of states. It would also allow physicians to spend their time providing the care for complex conditions that they are educated to provide. I'm currently conducting an interview study of nurse practitioners who have obtained a certificate of full independent practice. The psychiatric mental health nurse practitioners and the primary care nurse practitioners who are practicing in rural counties consistently tell me that the inability to initiate stimulants is a barrier to their patients receiving recommended care. Typically there's an additional uh visit needed usually in another town or sometimes in the same clinic when the physician. is available. Nurse practitioners have trouble getting their patients seen when the medication is not effective or has adverse effects and needs a dose change, and some nurse practitioners even have to pay a physician to see their patients who need scheduled medications for these chronic health conditions. Um, And that is all I have. Any questions from the committee? See you, thank you for your testimony. Thank you. We have a Sarah, uh, wait a minute, uh, Mr. David Roden speak against the bill. Yeah Thank you, Mr. Chairman, members of the committee. My name is David Roten. I'm the executive vice president for the Arkansas Medical Society, and it's an honor to be before you all. This is the first time I've had an opportunity to speak to you all here. I was ready last week with Representative Pilkington's delegation bill to speak in favor of it. We like supporting representative Pilkin's bills when we get an opportunity. Unfortunately on this bill we just simply cannot do it. This bill is an opportunity to increase access to drugs. Not providers. The providers are already out there. We have some problems with this. Let me give you a little bit of history and Mr. Clark gave you some, but I want to embellish a little bit of it. And before 2015, APRNs were not allowed to prescribe any Schedule 2s. In 2013, the CDC or whichever federal group it is, reclassified hydrocodone combination drugs. Think of Tylenol with codeine. Uh, reclassified those as Schedule 2s. Well, APRNs had been prescribing Schedule 3s for a long time, so Representative McGee sitting down at the end of that table, he and others sponsored a bill that the medical society drafted. To give the APRNs in the state the ability to write Schedule 2s that had been previously classified as Schedule 3. Then in 2019, Representative Gonzalez and Senator Hammer with the help of Representative Johnson, crafted the bill that this is amending and that bill gave a PRNs limited Schedule 2 prescribing. Um, and with guard rails, those guardrails being that for opioids they're the story at the time was that APRNs needed to be able to write a short period of hydrocodone combination, uh, excuse me, of opioids. In case the physician was not around. If the patient ran out of their opioids on Thursday or Friday and the physician was not going to be available till the next week, then the APRN with the permission of that collaborating physician. would be able to write a 5 day prescription for opioids, and that was the one time thing. Then on stimulants, the, the, what you see in the bill, the current language for stimulants, uh, is that the physician has to diagnose folks, ADHD is not an easy thing to diagnose, and I speak from experience. I, I've got a an adult son who was diagnosed in the 2nd grade with ADHD and with, with all of the good health professionals we have here in Little Rock. Uh, it was a drawn out process getting the right diagnosis and the right medication and it took a while and the medication was trial and error. So that bill was passed in 2019 with guardrails. Now here we are. 5 years later, 6 years later, and we're wanting to expand it again and it's, these are, these are not possibly addictive drugs. These are highly addictive drugs. And that is why they're schedule 2s, and that is why they are guardrails in the current statute. Now, I think it's important to know what these drugs are. Let's start with Adderall, which is the most commonly prescribed ADHD medication. No Adderall, a popular amphetamine, abuse of the drug leads to almost 1500 emergency room visits a year. Serious side effects can include insomnia and stroke, uh, 614,000 teens have admit. using the drug for nonmedical reasons. At some point, Ritalin, another common one, Not, of course, non-medical use of any of these drugs is illegal, but it's also a gateway drug to eventual cheaper, harder drugs like meth. Concerta Dangers of non-medical use of Concerta can include disruptive sleep patterns, vision disturbances, and stroke. Vyvanse, serious side effects include abnormalities in brain chemistry, delirium, and seizures, and then there's. Modaffodil and I may not. I may not pronounce that correctly, but I'm not a physician, so in some cases this drug can abuse can lead to life threatening skin conditions and recurring suicidal thoughts. The way the bill is worded. The nursing board, which is comprised primarily of Aryans and LPNs. We'll adopt rules on the stimulants. But there's nothing in the bill. On regulations for opioids. So we've completely done away with the guardrails on opioids. So for those reasons we have to oppose this bill, and I ask you all to consider that and vote against it as well. Thank you. See no questions. Thank you, uh, Representative Ladyman, you recognize. Thank you for your presentation, uh, but I just got a question about this map that we had. Evidently 46 other states have done this. I think by looking at that map, so why are we so different than those 40 Representative Ladyman without seeing the map, I'm not sure exactly what it depicts, but it's not unusual for Arkansas allows. APRNs to write for stimulants and opioids. So we are not really an outlier. If you really dig into these states, you'll find that different states have different rules. Uh, some, some require supervision of APRNs. Arkansas does not. So without digging down into the what's behind each of these states, I can't tell you what I can tell you is that Arkansas does allow APRNs to write Schedule 2s. All right, thank you. Representative Allen. Thank you, Mr. Chairman. Can you tell me where Arkansas stands when it comes to opioid abuse. Well, I can't tell you about abuse, but I can tell you we've already got more opioid prescriptions than most any other state, and the last thing we need is more. So you're saying that when it comes to opioid prescriptions, Arkansas is number one. The number one or in the top 2 or 3. OK, thank you. Representative Ferguson, you recognize? Thank you, Mr. Chair. Yeah, maybe two quick questions. First question. is in this bill as you see it, uh. APRNs are asking for permission to write schedule to through 5, which is 34, and 5. Am I saying that correctly? currently they are allowed to write schedules 3 through 533 through 5 and limited prescribing for Schedule 2. OK. It, it may be uh uh representative Pilkerton can address this in his closing, I guess I'm confused because I think I heard you say it, but if there's no A collaborative agreement with the physician, there's no oversight by a medical doctor with APRNs and writing these prescriptions. If there's no collaborative practice agreement with physician APRNs are not allowed to write prescriptions at all unless they have obtained the full practice authority. Uh I don't know if it's a certificate or a license, but to get that full practice, and that's a bill that was passed. Was it last session or 21? 21, uh, I know there, there again, Doctor, uh Doctor Representative Johnson and some of you all worked on that bill. And that bill created the situation where an APRN Uh, working under collaborative practice agreement with a physician for a total of 6240 hours, which is basically 3 years of full-time work. Can get out of having to have, they can apply for a full practice authority certificate and with that full practice authority certificate, they can, the, the prescribing doesn't change, but they don't have to have the collaborative practice agreement. Let me ask one final question, Mr. Chair. So all APRNs have a collaborative. Agreement with physicians if they want to prescribe. If they want to persuade if they want to prescribe, so if they wanted to prescribe these schedules, they would have to have a collaborative agreement with the physician. If, if they want to prescribe anything, whether it's a scheduled controlled substances or if it's an antibiotic, if they wanna prescribe, they have to have a collaborative agreement with the physician. Can we come back. Right, thank you. Representative Barnes, do you have a question? Yes, sir. Um I think we're here because of the rural kind of areas. We're having some problems getting doctors. And nurse practitioner nurse practitioners are needing a little bit more leeway. So being that my question is this, are these drugs in the 2, the 2, are they within their scope to write. Uh, right now, within their scope to write are a 5-day supply of opioids and the ADHD medications under the protocol that's in the current statute. OK, and not only are we having trouble getting physicians in rural Arkansas. We're having trouble getting APRNs out there too. And in most cases they're working with physicians in those rural areas. In most cases. So in most cases they're in the same clinic. And we've not heard any, any complaints or any concerns from Medicaid that these kids aren't getting seen. Representative Richardson, you recognize. Thank you, Mr. Chair. So Uh, APRN who has their own practice. Would this allow another APRN who worked for the APRN who had their own practice to write prescriptions. The original, I'm not, I don't think so. I, I'm, I can't answer that. You have to ask representative Pilkington that one. Maybe he can address that in his closing, but thank you. Thank you. See, no further questions. Thank you. We have um Sarah Jones from the Arkansas nurse practitioner. There we go. Is that good? Y'all hear me? OK. Thank you, Mr. Chair. Committee. My name is Sarah Jones. I am a psychiatric mental health nurse practitioner. I have been a nurse for 2 years. Those 1st 8 years in psychiatry, the last 12 years as a prescribing NP, um, I'm also a fellow of the American Academy and Nurse Practitioners and a fellow of the Academy. American Academy of Nurses. In addition, I own a private practice in North Little Rock and Conway and employ 5 other psychiatric nurse practitioners, two of which are dual certified as pediatric nurse practitioners as well. Um, this bill is important to me and I'm here to speak in favor of it, uh, because we see a lot of children and adolescents as well as adults with ADHD, and I want to give you guys some data, some evidence, um, to kind of dispel some of those myths about ADHD in adults as well. But first, I feel like there was a lot of confusion about who nurse practitioners are, what we do, how we do it, um, and so I wanted to clear up a few things. So currently across the United States, 34 other states allow nurse practitioners to uh practice autonomously, uh, whether that is immediately with their license or if that's transition to practice like it's now currently in Arkansas. Which that bill we were very thankful for having that transition meaning doing so many hours, you then can no longer require a collaborative agreement. Uh, important to note, a collaborative agreement is no oversight. We are not supervised. Nobody else has to sign off on our charts when we prescribe medication, those liabilities are solely on us and are not a part of any physician that is our collaborator, um, they may have to look at, we have an agreement they have to check so many charts a year, that might be 10 charts a year. Collaborative agreement just means we have somebody to call if we have a question. I don't know anybody that's worked in health. but particularly nurses, we're good at collaborating. We don't practice in a silo, um, in mental health care, I have LCSWs, LPCs, social workers, counselors that I collaborate with for my patients' care, um, so that's nothing new to us. Currently, once we no longer require that collaborative agreement through transition to practice, we can still prescribe. The collaborative agreement right now is what we need to prescribe once we've applied and we received full practice authority we know. no longer have to have a physician, and we know, uh, with that agreement and we still can prescribe exactly how we've been prescribing before. Um, when it comes to Schedule 2 medications of note and another question was about that map. Pretty much Arkansas is one of 4 states that actually limit nurse practitioners' prescribing Schedule 2s. So that means I'm also licensed in Louisiana. Louisiana actually has more uh regulations with their collaborative agreement, however, they have been allowed to prescribe Schedule 2s without regulation for years. Somebody asked something about scope of practice. This is absolutely within our scope of practice, we have been trained, we have been educated in these uh prescription, uh, protocols, um, it's just in Arkansas that scope is limited, um, so overall branching, if we look in our scope and standards for our profession, we, it's in our scope. We're just limited here in Arkansas and again as only 1 out of 4 states that is limiting that for us. Um, I do want to, uh, just a few other things to address, and then I want to talk a little bit about some evidence, um, I know that there was mention of how often stimulant medications lead to hospitalizations, um, I wanna let you know it's estimated that alcohol is the highest substance leading to hospitalizations, injuries, deaths, etc. It says 70% of motor vehicle accidents, which are often fatal, are related to alcohol. all use abuse, misuse, and so just because something is not regulated by the DEA and not something that's prescribed. It can be certainly just as dangerous. Um, the other thing is just to mention some of the medications, um, uh, um, and I apologize that he spoke on are not Schedule 2. He spoke on modafinil, which actually is a Schedule 4 medication similar to benzodiazepines, we have no limits of prescribing benzodiazepines. Um, or modafinil, Nuvigil, Provigil, which are other stimulants used for some sleep disorders. Um Saying all that, um, what I do want to come here to say is to emphasize a little bit of history about attention deficit hyperactivity disorder, so ADHD is not a behavioral disorder. In 2013, the American Psychiatric Association. Excuse me, American Psychological Association recognized ADHD as a neurodevelopmental disorder. So now it is in the same category as autism. So when we think about autism, how our brain is not developmentally progressing and is causing symptoms, although can be a beautiful gift as well. Um, ADHD is the same. And it doesn't go away. And so for many individuals, I had a patient once come to me that uh. Her primary care physician told her, oh, honey, girls don't get ADHD. That's a diagnosis for young boys, um, not true. Unfortunately, the research and how we stigmatized ADHD along with many other mental health and mental illnesses. To me, this comes down to some of that stigma. ADHD is a very real diagnosis that affects the brain, that affects how we function in adults, it affects quality of life, relationships, socialization, work. And unfortunately, it happens a lot more than we think it does. Unfortunately, many people were diagnosed as children and adolescents have historically been males, women, girls and women present differently. Um, again, recognizing this is not a behavioral disorder. This is neurodevelopmental. So while we think of ADHD as the little boy jumping around the chairs, yelling hyper impulsive. Girls are more research, present more with the inattentive type. they can't focus, that they are easily distracted, they can't complete tasks. There's lack of motivation to actually start tasks because it feels so stressful to have to focus. And so One of the the myths is ADHD doesn't happen in adults. It most certainly does. It doesn't just stop the day you turn 18, um, and it also doesn't just go away if it's not diagnosed. I agree it is something difficult to diagnose for some. Um, it is a a specialty of mine that I've been doing for years and um I, I do see it often misdiagnosed, undiagnosed, particularly in our adults, um, a lot of research, you know, well, these are being open. overprescribed. It's estimated in the United States across the lifespan that ADHD is in 5 to 10% of individuals if properly diagnosed, and other data shows that stimulant rates of stimulant prescriptions are at 6.6% in adults right now. So 5 to 10% of adults have ADHD, 6.6% of adults being prescribed a stimulant sounds appropriate to me. The other thing that has come up is misuse, abuse and addiction. There is vast amounts of research that actually show properly diagnosing and treating ADHD with medication significantly reduces risk for substance abuse in the future. So when we are properly medicating individuals with ADHD. It's 36% lower rates of substance use. Compared to those that are not treated and diagnosed and treated. And so this also, there are studies that even show this to crime, that those individuals that are medicated properly, um, aren't using as many substances, aren't committing as many crimes, because if you think about it, I mean, I never mind. I personally have lived with ADHD my whole life and managing it can be difficult, um, all I've done, I, I Recognize the difficulties looking back at what that looked like for me, and I'm very happy to be helping, um, my patients and my community with this disorder. Um, and how it stands right now, y'all, is that we have to I assess a patient. I believe they have ADHD. I have to send that patient to a physician. It doesn't have to be my collaborative physician. It can be any EMD that initiates that stimulant, and then if it needs changed or 6 months down the road that patient has to see me and that physician again every 6 months. And if you think of cost of healthcare, I take a lot of private insurance, commercial plans, when they have $5000 deductibles, they have to having to pay out of pocket to see me, a physician, me, a physician during that same time frames. The other part is, um, I actually have primary care providers. I, a few right off the top of my head, physicians that are referring to me to assess them for ADHD, diagnose them with ADHD and then send them back to that physician so he can write the medication, um, so I don't understand why trusting me with assessment and diagnosis is OK, but trusting me not to prescribe appropriate medications. I've coordinated a psychiatric mental health nurse practitioner program for the past 15 years. at our local health science center and now uh at at another and um I can tell you my students are very well trained, educated, and have hands-on learning when it comes to prescribing um stimulant medications. I think that's all I have. Do you guys have any questions? Yeah Representative Bentley, you recognize him? Thank you, Chairman, uh, so much. Thank you so much for being here today and a great testimony to your firsthand. I've looked at some studies that show that actually, um, Nurse practitioners have a better rate overall of getting patients off of opioids and just that one on one care and can you talked down any studies that you might have seen that show that overall because we were very concerned about the high rate of opioid abuse in our in our state. So looking at that really had me intrigued. So do you have any knowledge of that, one thing important to know is in Arkansas, it's estimated that 50% of primary care providers are nurse practitioners, 60% of psychiatric mental health providers or nurse practitioners and the rates of opioid prescription have decreased since the time when not only have our numbers doubled as MPs, but the number of opioids prescribed since the time when we have been permitted to prescribe them has also decreased. Thank you Morocco. Representative Johnson, you're recognized. Thank you, Mr. Chairman and thank you for that testimony. Uh, help me understand a little bit about your training. You mentioned your uh psychiatric nurse practitioner. Tell me some about the training that you went through, uh, you to to to get that status. I mean, I'd help me understand what the process is for a nurse practitioner to be a specifically psychiatric training, yeah, yeah, so, uh, nurse practitioners are a little different than physicians. So obviously we're already RNs initially, whatever specialty or wherever we work, um, that's what we do. Right? Um, when you enter any nurse practitioner program, whether a master's or a doctoral. Um, you pick the specialty from the beginning. So me as a psychiatric mental health nurse practitioner right out the gate. I knew this was my specialty. I didn't do a rotation in primary care or in pediatric prime or older adult um it was all very specific to psychiatric mental health. So all my clinical time was with therapist with prescribers. I say that because therapy is also in our scope of practice as psychiatric MPs, um, with a physician. with other MPs and that was all hands on as far as providing learning direct patient care, um, explaining that How we do that to physicians, I usually say it's somewhat similar to a residency where you're there for a while and then you're getting immersed and then you're having maybe your own patient loads, of course, consulting with whoever your preceptor is. And so it's the same for any specialty as nurse practitioners. Um, so again, all my outside the core of theory, advanced health assessment, advanced path of advanced farm after that, all my um all course work, all clinical work was specifically focused on psychiatric mental health. Follow up. So it looks like this opens up the prescribing to more than just stimulants, but broadly to all Class 2 scheduled drugs which would include opioids. Did you get a lot of training since you were specific to psychiatric in pain management and around opioid prescribing. It's not in my scope. I can't prescribe opiates, but if this bill were to pass, no, it's not in my scope because I was not trained or educated that I as a so maybe that's the other thing to acknowledge. MPs limited to their specialty. So a psych MP cannot treat pain. I don't treat blood pressure. I don't treat pain. I don't prescribe antibiotics, um, just as, let's say you have an acute care. Adult nurse practitioner. The acute care, they aren't working in primary care, they aren't working in psychiatry. They are a limited in their scope to practice in acute care. So, and again, I'm trying to understand, uh, this bill would open up to all nurse practitioners to prescribe stimulants. If it is, if they have had the proper training and education. So again, yeah, primary care, so primary care nurse practitioners do a whole rotation through pediatrics at that time is typically with the pediatrician and um Many pediatricians do treat and prescribe for ADHD, so they would have that hands-on training, yes, and again, is this limited to pediatrics or is this open to all adults that you could prescribe to anyone. I don't see any language in here that would limit that. is specific to our scope. So for example, pediatric nurse practitioner, if you're board certified as a pediatric nurse practitioner, you're not seeing adults. You're not allowed, period. Well, but the primary care nurse practitioner would be able to prescribe any Schedule 2 drug under this change of law So for example, pediatric nurse practitioner, if you're board certified as a pediatric nurse practitioner, you're not seeing adults. You're not allowed, period. Well, but the primary care nurse practitioner would be able to prescribe any Schedule 2 drug under this change of law they have the appropriate training and education, which they do in their schooling and then it depends on the setting they'll be in if they're working in pediatric primary care, they have had that education. They have had that hands-on training in school. If they are working in pain. Management, um. Same pain management, nurse practitioner programs specific for scope of practice for pain management primary care typically includes as well as adult acute care will include some pain management education. OK, so this two last follow-ups. So, so if I understand you correctly, a primary care nurse practitioner would be able to equally prescribe the way you do, even though you have all this extra training. What do you, I'm confused by equally prescribed I think the bill's pretty clear. It just opens it up to Schedule 2s for now it's what's in your scope of practice, however, so we would not be prescribing. I would never, I can't prescribe pain meds, period. That's not in my scope. I would never do it. We're gonna limit this to questions only, not a back and forth conversation. One other question I can get back in the. You, you can ask it now if you want to. This is on a different topic. You said you practiced in Louisiana too. You have a license. I have a license. I don't I have the advantage of sitting here Googling on my phone, but it looks like Louisiana limits Schedule 2 specifically to uh ADHD. Diagnoses Is that your understanding or did they open it up stimulants are indicated for ADHD diagnosis, but you know this map. Makes it look like Schedule 2 substances prescriptive authorities for all of these states, in looking at it like it briefly Googling, uh, it looks like certainly Louisiana and other states have some specific restrictions and that's not open to all Schedule 2. I think prudent practice is prescribing appropriate to the diagnosis, so I don't see why a stimulant would be prescribed to someone without an indication for ADHD or, or other. That's good. Thank you. He and Rose, you recognize. Thank you, Mr. Chair. Um Thank you for your testimony. For those who are concerned about Opioid abuse. How would you quell those concerns that expanding the number of people who can prescribe these. Um Wouldn't increase the abuse, not that there would be intent behind that. But if we already are leading the nation in this area, which is not a good thing for us to lead in. My concern is expanding the ability to prescribe these will only worsen that in some level because we already feel good about who can prescribe, right? We're not wanting to withdraw physicians' ability to prescribe these things. My concern is giving more people that authority or autonomy will only lead to an increase in the problem. Is there anything that you can suggest? About this bill that would would quell my concerns. I think that regulations overall for controlled substances have significantly increased over the past decade, and Nurses will still be prudent to their practice in following those regulations. You also get a few 100 new physicians in the workforce every year. Are we concerned about them prescribing opiates. And so as we open up, it's still remembering we're not there just to Prescribe them because it's fun and we want to, it's still going to be appropriate to the diagnosis and symptoms we're treating. I think it would open up access to those that don't have local uh physicians to provide that medication for them. Um, but I think it's gonna be like any other practice in healthcare. We have every people that follow rules, regulations, and what what's best for our patients, which includes not leading them towards substance addiction, um. And then there are a few bad eggs everywhere, so. And, and I apologize if this feels unfair with you at the end of the table. But my question was to, could you help alleviate my concerns and Kind of the summary of what you said was, well, there will be some bad eggs. which would suggest my concern is by expanding this we're going to open the door to a potential for bad eggs in your profession who could also increase opioid abuse. Yeah, I totally see that point. I do think DEA with their regulations of that new 8 hours that's required for everybody, which just went into effect yesterday so to hold a DEA you have to have 8 hours of training and substance use, so I think that is one regulation that has, um, advanced our ability. to regulate that. Thank you for answering my questions. Thank you for your testimony. Any further questions from the committee? See you then, thank you for your testimony. We do have a Cawell signed up to speak for the bill. And I'm sorry, I wasn't going to try that first name. I didn't want to butcher. It's OK. I'll help you with that that on the record. I am Kennesha Caldwell. I'm an APRN. I've been in the medical field for 24 years. I am that nurse practitioner who gets the opportunity to go and serve um because my patients in the rural communities, I am the primary care specialist. I specialize in adult geronto gerontology with emphasis in primary care, um, I also do um do some part time in. Pain management. I'm here to speak for House Bill 1132. And the reason I'm speaking on behalf of it and asking you guys to vote in favor of it, it's because I do get an opportunity to see these patients in these rural communities, um. There's a shortage. There's a shortage of medical doctors, there's a shortage of nurse practitioners as well, but one thing that we do know that change is inevitable and it it um causes for us to evolve, never is changed just 100% comfortable and I think I'm, I'm safe in saying that. Um, when I began, when I became a nurse practitioner many years ago, um there was less than 1000 nurse practitioners um in the state of Arkansas since then we've evolved to over 6300 nurse practitioners. And so we are able to go into these smaller communities where the doctors don't want to be and see these patients. I believe that everything deserves a story like I, I tell the story so that you can get the picture, right? So I have a patient that's down in rural Arkansas, Eudora, Arkansas, right down there on the tip of Louisiana and Arkansas, it's right there at the state line. My patient um was diagnosed with cancer, um. I want to say 16 months ago now. My patient comes from a low, from a high poverty area and has socioeconomic challenges that patient has to go from Eudora, Arkansas to Little Rock, Arkansas to see her oncologist. And so not only do we have to deal with if this patient is prescribed X, Y, and Z and it doesn't work, then that patient, I can't make those changes. I can increase, I can't decrease because what I'm, what I can do according to the the rules that are in place right now, it's just renew that prescription for that time being for that for that um specific time frame. So then we have to take into consideration whether or not that patient eats that month or whether or not they make that trip back up here to Little Rock to get to see their um oncologist to have that medication adjusted. Now, I provide care for them for every everything else. Everything else I provide care for. And the, the, the part that overwhelms me most of the time is this, the doctor prescribes it and guess what? We're able to go back behind the doctor and continue to prescribe it. So if he prescribes. Whatever, um, hydro, Vicodin, whatever, we're able to come behind him and prescribe that that same medication for a time for a specific length of time. It's unfair. Because how do you tell a patient that you can't treat them and they have to make this appointment to see their oncologist and then you have to take into consideration that remember I told you there's a shortage. So then you have these oncologists who have a waitlist of 68 weeks because to them they're new patients. So then they're not, they don't get priority of already being established as a patient, so then that patient sits in pain for 6 to 8 weeks while we try to get them in to see someone. It's not fair. It's about putting the people first, giving everyone in Arkansas access to um to health care, to great health care and I, I like to say this and and I'll probably be batted down for this, but in the beginning of your life, we, and I tell everybody this story about nurse practitioners all the time when you are, when the lady goes into to give birth. Um, in the labor and delivery room, who's there? The nurse is there, right? We are there, we Do everything that we need to do and guess what the doctor comes in. The doctor comes in and they catch that baby. We call it catching the baby, right? When you're dying. Most of the time it's the nurse who's taking you out, who's who's ushering you into the afterlife, whatever your afterlife may be. And guess what the doctor does? He comes in and he pronounces, OK? And I, I'm just setting a, a, a, a basis for you and so we decide that we're gonna go a little bit further to further our education and to um be able to provide a little bit more help for them. And you guys have allowed us to do that. So what we're asking you to do is allow us to continue to be to perform at our best and um perform at our best and be able to provide this care for those patients, um, as far as the regulations goes um in regards to. Um, whether or not, um, the opioid would increase or decrease. I do do primary, I do do pain management and so on and so forth and there are guidelines in place. You have the PMP, you have the random drug screenings, you have the pill counts and things like that and so there are ways for us to move forward and get this done, but we need you guys' support and being able to provide the care that these patients need to um provide the, the prescriptions that these patients need. To receive good health care. Open for questions. So I hear you right? you practicing Eudora, Arkansas. I practice all over the state of Arkansas. I primarily practice in Whitehall, Arkansas, Little Rock, Arkansas, um, I'm in Springdale, we do rural clinics in Earl, Arkansas, Eudora, Arkansas, and then um Wilmont, Arkansas. Representative Richardson, you recognize. Thank you, Mr. Chair. I just had a question. You said that. That the doctor prescribes and then you can prescribe after they prescribe. Is it for the same prescription, up or down, or can you adjust it at any bit. We, they are supposed to revisit the doctor if they have to um be adjusted, we just refill the same medication over and over. OK, so you just refill prescription. OK, thank you. Any other questions from the committee? Thank you for your testimony. Representative Pilcoin, you're recognized to seeing no one else signed up to speak for or against the bill or anyone else in the audience. Seeing nonpresentative Pilkington, you're recognized to close for your bill. Thank you. Thank you. I appreciate the conversation. I think it was really Really important for us to kind of go through the implications of what this bill does, um. And I think I want to try to clear up any confusion there might be, but essentially what we're trying to do here is just we're trying to expand access to these medication because the distance from an MD to a rule patient has become cumbersome on them. We've done plenty of things in the past to address the opioid epidemic. Those things You know, those things that we've done in the past are working. I think we'll continue to see improvement in that area, um, but this fear mongering that somehow by allowing APRNs to adjust the script that an MD may be wrote before a year before this bill passed or something like that, it's going to somehow create an avalanche of issues I just truly don't see happening. I think what you can see by that map, while there may be certain nuanced changes in the state. I think the reality is especially in many states as we're trying to expand access to rural and underserved areas, areas where the Pair mixes a high propensity of Medicaid patients and Medicare patients that make it very hard for MDs to practice in those areas. These are ways to get to those patients to eliminate those barriers and improve healthcare all around, so with that I asked for a good vote and as a member of the committee, I make a motion to pass. Any discussion on the motion. Representative Johnson, you recognize. Yeah, members, you know, I, I've worked uh diligently with the nurse practitioners over the last few years. I, I, I have a high amount of respect for what they do for our patients. I have a high amount of respect for the team approach that it takes to care for patients in all situations, whether it's delivering babies or whether it's end of life issues, uh, physicians, nurses. nurse assistants, um, everyone on the team has a place and a role, and I think everyone in my experience, the vast majority handle all of that with a very compassionate approach as a team, and so I'm thankful for the roles and nurse practitioners play in the state. I do have concerns about this bill, you know, we, we do have a problem across the nation with drugs of abuse. This will expand the number of people that can prescribe these. Um, we heard some testimony around scope of practice specific to different types of nurse practitioners, uh. As best I can read this bill, there's no language that would make it specific to different types. I mean, I think the way I read this bill, um, any primary care nurse practitioner could now prescribe without limitation, Schedule 2 drugs, uh, and I have serious concerns about that. Also, the way I read this bill, the rules around stimulants would be written by the nursing board. Um, there are a limited number of people on the nursing board who prescribe stimulants. In fact, the majority of people on the nursing board are RNs and LPNs that have no prescribing experience around stimulants or diagnosing of these conditions. These are very real conditions that need treatment. We heard specifics testimony around children. This bill is not specific to children. The spill is broadly to anyone, adult or children. We heard lots of, you know, testimony around access to care. Access to care is really important. But these are some very specific issues that can be easily opened up to more problematic, um, abuse. The other brief thing I'll mention is the map I think is very a little bit deceptive in how it looks. It didn't take long for me to Google and understand that there definitely are restrictions in place. It's not like that every state but the three mentioned there have wide open free for all prescribe anything, um, so I, I don't know, I, we, we worked hard to get to the place we're at with the current state. We have expanded access to some of these drugs. I feel like the guardrails that we worked hard to put in place are still working and currently satisfactory, and so I'll be opposing this bill and vote now. Representative Bentley, you recognize? Thank you, Chairman. Callers, I appreciate Dr. Johnson has, um, really was stellar and getting things where we are today, but I think we've seen our nurse practitioners move forward. I think we can look and see um if we want to be moving forward in our country we're looking at other states that are already allowing these nurse practitioners to do schedule 2s, and we can see those states are the ones that have lower prescription rates than we do. We have a problem in our state. We are doing some, we have done some great things to move forward to say that this is going to cause more of those issues. I just don't see that we have this not removing the guardrails that we have in. price overall for opioid prescription, so I, um, being a representative of rural Arkansas, I'm just really thinking we need to take better care of our patients, put our patients in the forefront. I think we have people that are well trained and I, I understand that the nurse practitioner, um, licensing is just, it is different because they can only do in their scope and they cannot prescribe things out of their scope and the things that we makes it different, but I'm fully confident Bill, I'm fully confident I'm nurse practitioners, the training they're receiving, and to move forward. So I'll be due pastor. my patients in rural Arkansas. Thank you. Representative Pilkerton, you had some down. Yes, um, you know, I just want to provide some history. I know David wrote the medical side talked about some of the bills we had passed in the past, and I like to talk to some of the bills I passed in the past, you know, we tried to do over the counter uh birth control. There was doom and gloom by allowing pharmacists to do that, that we're going to cause and wreak havoc, but since that's been in place, you know how many complaints and how many issues we've had 0. We heard a lot about telemedicine, how it would be the doom and gloom in the end of healthcare in Arkansas and the end for MDs to be able to practice in Arkan uh, that has not turned out to be true. I think once again as we look to use technology and to use different types of providers to expand our ability to reach these patients. We've seen success time and time again, and I would hate for fear of the unknown to be something that hinders us and once again leads us in the last of the pack, which we currently are in so many things, but I appreciate Doctor Johnson's comments about working as a team. I mean, people who don't understand healthcare is a team. We work within an ecosystem. One thing moves the other, and that's why one of the things I wanted to address in the bill was on the last page it says before approval of Arkansas State Board of Nursing rules, the Arkansas State Medical Board shall review the proposed rules and verify the proposed rules are consistent with Arkansas State Medicalport's rules. I mean, we're already making sure that this, there's part of this collaborative approach together, so I, I think this is a system we've done in the past, and I asked the committee to help me help patients in Arkansas and ask for a good vote. Oh, right sorry. Get in the Representative Ladyman, you recognize. Thank you, Mr. Chairman. Well, you know, this is a difficult decision, I believe, and it's a very important decision for our state and, you know, I respect Representative Johnson and and Representative Bentley's opinions on these a lot. Uh, I think what we have here, we have competing things, you know, would it expand opioid addiction, maybe, uh, would it help rule access to medical care. Well, I should say. Probably yes, on both of those. So I see this as a balance, you know, Which would be best for the people in the state of Arkansas. And I believe that we have to try some things to make Arkansas better. Uh, there may be, there will be some negative things associated with this, no matter which way we go, uh, but I think we've got a We, we've got to try changes. And we can go back and adjust this if things go south and go bad. So I, I think what I will support the bill, but it's a very challenging vote. Thank you, Mr. Chairman. Representative Allen, you recognize. Uh, thank you, Mr. Chairman. I concur with everything that's been said, but whenever you have um More opioids out on the street as people prescribing it, you're going to have more abuse. You're going to have that. It's just like if you have uh two drug dealers and you have 4 more to come on the scene, then you're gonna have more drugs on the street. So I think at some point in time. There's gotta be a balance here. But I just can't see. us doing this at the expense of people that are at risk with opioids, so I'll be another. Seeing no further discussion, all those in favor say aye. All those opposed. We'll roll the bill has failed. With that, we'll move on to House Bill 1166. Representative Gramlich. The Representative Granledge, while you're at the end of the table and on the mic. Can we clear up House Bill 1140. Can we move that to deferred? OK. That will be moved by your request. Thank you. So you're recognized to present 1166. Uh, House Bill 11666, um, is a pretty easy bill. Um, so what it does is it clarifies what epinephrine is. Currently, epinephrine is used to treat anaphylactic shock, that what you probably know it is, uh, most commonly is the EpiPen. There's a new drug that's a nasal epinephrine. And so what this does is allow schools to also have that um being used in with a prescription and stuff like that for anaphylactic shock. So that's what it does. Any questions from the committee? See no, anyone in the audience speak for or against. You close for Bill? I'm closed and I have a motion to pass. Promotion, the discussion on the motion. Seeing on all those in favor, say I I post. Is have it. Your bills passed. Congratulations. 1167, Representative Johnson. Thank you, Mr. Chairman. Uh, members 1167. So currently right now, uh, it's pretty clear in statute that nurse practitioners can have signature authority for durable medical equipment. There's been some concern over making sure that nurse practitioners are able to extend that authority, not to, to, uh, orthotic footwear, specifically for diabetics, um, I think most in the medical community would consider that DME, uh, but currently there, this question is being raised, so you're having a situation where A patient may need a diabetic footwear, and they're being required to go to their physician to get that signature, this empowers and clarifies that a nurse practitioner is qualified to make that decision and and sign those forms and so thereby expanding their uh practice to clarify that they're able to do those things, and I'd be happy to take any questions. It's a great deal. It's been aggravating the community for a long time. I'm glad to see it. Um, any questions from committee, seeing no one in the audience speak for or against. Make a motion to pass and I'm closed for the bill. I'm not gonna take that motion because Representative Ladyman beat you to it too quick. Any discussion on the motion, seeing on all those favor, say ah. I'll post. I have it. Congratulations. Are you running 1185 today? Uh, let's see. No, I think the next. No, the next one I'm running is past that, so I'll just wait. I'll get back in OK, Representative Acer, you're recognized for House Bill 1213, and I think you have an amendment, correct? Let's take up the amendment first. We'll give a second for staff to get that passed out. Members, it looks like we're gonna be here through lunch, so just hunker down, we're gonna get through these as, as, as long as we have members ready to run bills, we're going to keep going. No. Yeah. Come on. Come on Members we have amendment in front of you. It's a pleasure to committee on amendment. I got a motion to pass on the amendment. All those in favor say aye. I posed. I have it if you would present your bill as amended. Thank you, Mr. Chairman. committee, the amendment is a just a small clean up on some of the drafting errors that we had in the original bill. Uh, I want to thank Representative Gramlich for helping bring the physical therapist aspect to this bill to align with The athletic trainers helped marry some of the crossover in their capacities to expand their scopes. Uh, so what we have here today, committee, HB 1213 is a bill that modernizes the capacity to serve patients for both the athletic trainers and physical therapists, and it aligns with their current training. Um, so, And start, it does a couple of things. One, it clarifies the definition of healthcare provider as it pertains to student concussion education. This follows an ISP to add to the working list of the current approved AAA providers, and I believe those are listed there in the bill, um, and again this all references back to those who are appropriately trained, so that aspect is that preempts regardless of the list of provider, they do have to be appropriately trained for appropriately trained for concussion. Protocol returned to play, and again this is from the working list that is currently approved from the AAA to add physical therapists to that, um. It also amends the definition of an athlete in the athletic trainer practice, uh, currently to be an athlete, you must be part of an organized sport, i.e. a formal league, school or association. So if, for example, if you had previously played in the legislative basketball game and tore your Achilles and were assessed. Uh, by an athletic trainer in that capacity, technically that person's uh license may have been at risk because I don't really know if I qualify as an athlete, despite my high school record, um, this would update that uh to uh Include athletic injury, so regardless of how the injury occurs, a sprained ankle is a sprained ankle. The new definition covers athletic injuries that occur in the trainings of police, fire, military personnel, and this brings Arkansas more in line with much rest of the country again, they have the training to assess this, and I think the venue in which it happens is a gray area that I think renders athletic trainers. In an odd position to decide whether or not they can or can't treat somebody when they have the scope and capacity and training to do so based on the area or the formal or informal nature in which it occurred. Uh, finally it updates the athletic trainer practices. It updates how an athletic trainer practices in a physician's office. It allows them to work under the direction or consultation of a physician, currently a physician has to be physically on site, um, this bill would bring them more in line with their scope of practice they experience on the field, so their assessment and their capacity to operate in the, uh, I guess football field, basketball, gymnasium, those sorts of scenarios, uh, we found that those are much more acute, much more. Um, I guess emergent areas and so they have greater scope and a much more urgent and emergent scenario or scenery, then they do in a much more controlled um predictable scenario which is in the physician's clinic, and so this bill helps to, I guess, remove some of the gray area and allow um again, the modernization of their capacity to treat Arkansans, to align with their actual training that they have. And so with that I will questions. Did you say you were complaining? A welcome questions. Oh, OK. I mean, we know you well complaints. Oh Representative Gramlich you recognized for a question. Uh, uh, Resident Aker, welcome to the committee. Um, just, just to make clear this is agreed upon language between the ATs and the PTs and everyone is uh totally happy with the bill we're about to. there Yes, that is, that is where I'm sitting. There are people signed up to speak against the bill. Anyone, I'm kidding with you, but there are people signed up to speak against the bill. Are there any, uh, any other questions for a sponsor? Seeing no have a Michael Courtney to speak against the bill. Mr. Courtney is Chris with you or is he you speak individually or speak OK. Michael, you're recognized. My name is Michael Courtney. I'm a chiropractic physician. I have been practicing in Arkansas for 43 years. Um My and I also am the chairman of the Arkansas Chiropractic Society. Our opposition to this bill is that we find it somewhat discriminatory because we're not listed as one of the providers even though we have been. Evaluating and managing concussion for a very, very long time. It is certainly in our scope. It is it's, it's just like it's in the scope of the MD or DO. Uh, we have registered our concerns with the sponsors of the bill. I had personally emailed, I know Representative Gramlich, uh, when he wrote the bill, the first bill, which I think had been pulled, uh, we've registered the concerns and we received no response. So we feel that we should be included in the definition of a health care provider since that is part of our scope of practice anyway, um, in addition, we feel that the bill, if it were if it were to be amended to include us. Uh, what also Uh On the, on the line. 16, we feel that the word physician should not be. scratched out there, uh, that, that needs to be returned. And also on Section 4, Uh, with the last the last page of the bill. Uh, it says in a non-clinical setting an athletic trainer may practice the art and science of athletic training under the direction of a physician and then they've added license by the Arkansas State Medical Board, so we feel that it should just be under the direction of a physician. In addition, uh, We, as a One issue that I find with it is that if this bill passes and becomes an act. It becomes essentially a could be a school board policy we're based on a school board they'll say, well, based on this bill, if it becomes an act, then we would be excluded even though we currently treat patients, uh, and have patients that suffer from concussion, whether it's athletic injuries or whether it's a geriatric patient who has fallen or whether it had or whether uh it's a motor vehicle accident or some kind of trauma like that unrelated to an athletic. injury, concussion occurs in many different scenarios. So our basic concern is that um. We want to be added to the list of healthcare providers. Uh, and we also wish the physician language to be uh taken care of in page 3 as I previously mentioned, if possible, and also be amended. On the last page of. Where I just should say under a direction of a physician. Representative Johnson, you have a question? Yeah, so I'm just trying to understand and uh. Do you currently, the chiropractors currently supervise athletic trainers? We can, uh, I haven't, uh, I have worked with athletic trainers over many years when I was particularly practicing in Pine Bluff. But, uh, they can certainly they can. OK, I was just trying to clarify because there's there in it, the legislative process can be arduous and sometimes there's bureaucratic rules that not everyone in the public is, you know, understands completely. We, we do have rules around scope of practice issues, uh, that require filing deadline of an ISP an interim study proposal before the session, a filing deadline of a bill, and those rules generally are pretty specific. That's why I'm trying to clarify in statute what. You are and are allowed to do. I think in the current athletic trainer Act, it doesn't specifically I may be wrong, is your understanding in the current athletic trainer Act that you're allowed. That's permitted, I believe so, yes. OK. Representative Grahamly recognize. Uh, thank you. First off, if I missed your phone call, I do apologize. I actually was with uh talking with Representative Acer the other day. Some people are using my wrong email. They're putting an h instead of a K and Zach, and so that's possible. I just, I didn't get it. But in either case, um, and I've I've spoken openly about this with members who've talked about it like I'm, because I, I think the scope issue with the ISP is what was messed up and I've I've talked to a couple other individuals in 2 years, if you want to come back. and get in November or probably more like June of 26 or 27, I'd be willing to file an ISP and we could do this work like I'm not at all opposed. It's just I don't think we were able to because of the process, so. Do you agree? That's the question, no or yes, it doesn't matter, but no, I don't agree but I mean, I just to follow our rules, I don't think we were able to to do that for you, you all, but I'm open to helping you in the future. OK, thank you. See no other questions. Thank you for your testimony. Mr. Chris Cathy. You're reckon I to speak against the bill. Thank you, Mr. Chairman. I, I will follow and echo Dr. Courtney's statements. If you don't mind, stay really close to that mic so I hear you. I would like to echo Dr. Courtney's statements and add one more thing to it. The University of Arkansas sports medicine. Mr. Cay, if you would state your name and who you represent for the record, please. Chris Cathy, um, I'm a 30 year practicing chiropractor in the state of Arkansas. I'm the chiropractor practical representative for the Board of Health, but I'm not here in that capacity today. So I would like to echo Doctor Courtney's statements. And point out that the University of Arkansas sports medical staff, which is in charge of our flagship athletic program at the university. Has 3 MDs on staff, 1 PA, 8 orthopedic surgeons, and 6 chiropractors, and the chiropractors do help diagnose. Concussions. So I, I could not think of a more ringing endorsement than that. And that's all I have. Any questions for the witness? See you, thank you for your testimony. Thank you. Representative Aker, you are recognized to close for your bill. Thank you. Um, again, I would reiterate Dr. Johnson and Representative Grahamlich's words that this is not intended to be exclusionary. This is intended to reward those who put in the work to follow the proper procedures and to honor the ISP process and the Joint Public Health Committee that reviewed it. Um, if any other providers who are trained in assessing concussions, want to follow through with that. I echo Representative Gramlich's intent to help them do so as we have here. And with that, I'm closed for the bill. Representative Allen, you have a motion. Does that do pass as amended? Committee, we have a motional flooring discussion on emotion. Seeing on all those favor, say ah. I opposed. I have it. Congratulations, your bill has passed as amended. Uh, Representative Carolyn Brown, House Bill 1244. House Bill 1251, Representative Johnson. I'll spell 1253 Representative Johnson. House Bill 1254. All right I knew we could catch something if we kept fishing. Mr. Chairman, may I have a couple of folks come to the table with me. Thanks. Representative Lee Johnson, District 47. I'll let these two folks introduce themselves. Art Gillespie, I'm a licensed psychologist and former member of the psychology board. I'm also a trainer of psychologists at University of Central Arkansas, but I am not representing Central Arkansas today. At Serena McKnight, I'm a licensed psychological examiner, independent, also the president of the Arkansas Association of Masters in Psychology. Members, as some of you who were here last session will recall, uh, these two were here. We had a bill we worked on pretty diligently to try to remove the moratorium on LPEIs being trained in the state, um, and in part of that discussion, one of the things I agreed to was to come back to this session, work with both of these individuals on a scope of practice bill around LPEIs and how we might define that moving forward as a state. So this bill that you have in front of you is a product of quite a few months of interaction and work and and emails back and. forth and, and these two individuals have been very, very helpful, helping me in a in a field that I'm not an expert in, um, what we have before you is agreed upon language. I don't think there's any opposition that I know of. Essentially what we're doing in this bill is we're the term LPEI, which is licensed psychological examiner independent, um, is a term that doesn't exactly exist currently in statute, so we're creating a new term called lotsense psychological practitioner, which is agreed upon term that will now be the new LPI. These will be practitioners that have a certain amount of training that we've outlined here in this bill, and they will then be replacing that terminology moving forward. We will still have LPEs in the state practicing in their current levels, moving forward, but the new process will be defined as this new LPP, um, and I'd be happy to try to answer any questions. I know these two individuals who have waited patiently to be here today would be happy to answer. any questions that I can't answer if the committee has any questions, we'd be happy to take them. Uh, Representative Woolridges a question. Thank you, Representative Johnson. I just wanted to make sure the current LPEIs, will they be grandfathered in and given this new title, or will they practice under LPEI credentialing, the purpose is hopefully that we'll be grandfathered and that's how the bill reads. Thank you. Representative Johnson, how will this bill impact the availability of mental health services, especially in the rural areas. So I would, I would say right now that that what we're doing between last session and this session is increasing the number of providers available to do the broadest scope of practice that they can within their training, right? And so up until this last session, there were no master's programs and now we have we don't yet. OK, but these are programs that are now open and available for the people that have that training to come to our state. So we're really opening the door for a broader number of practitioners to come and practice in the, in our state and also opening the door for Future programs to be developed now that we've laid the groundwork of what it would look like to have a master's level program in the state. So I, yes, I think this, the short answer to your question is absolutely increase both workforce and access to care. Seeing no further questions, anyone in the audience speak for or against the bill? Seeing no one you closed for your bill? I am closed for the bill and make a motion to pass. It's proper motion. Any discussion on motion? Seeing on all those in favor. Say ah. I opposed. I have it. Congratulations, your bill is passed. Representative Woolridge House Bill 1256. Thank you, Mr. Chair. Jeremy Wooldridge, District one, House Bill 1256 is a piece of legislation that is going to allow an increase in availability for uh licensed counselors and marriage and family therapists, counselors that both go through the counseling board. Currently there's two paths to provide therapy or access for patients in Arkansas and that's the social work route or the counseling route. If you choose the social worker route, you get what's called a provisional license upon graduation, you submit. Uh, your transcript, you issued a provisional license called a PLMSW, which allows you to practice while you are studying for your exam, uh, up to a year that has never been available for the counseling route, all this bill does is makes that readily available for counselors like it is social workers. With that, I'll take any questions. Seeing no questions from the committee, uh, Representative Pilkington, you recognize. Sorry I didn't catch this earlier, but I was looking over it and so just so my understanding is clear, while they have this provisional license, they'll be able to bill Medicaid, and if they for some reason fail to pass the test, there's no recouping of those Medicaid dollars, so they will be able to bill Medicaid with the provisional license and that one year if they're unable to pass their exam, they're provisional is revoked just like through the social work program and to my knowledge, those aren't recoupable services. Got you. That money's just lost. OK. The service was provided. But it wasn't, OK, we could get into the semantic though, but I, I got saying that's it could have been so par service at that point. Could be. Any other questions from the committee? So on anyone in the audience speak for or against the bill. In none of your clothes for your bill. I'm closed and I'm making a motion to pass. That's proper motion, any discussion on motion. Seeing on all in favor, say ah. I opposed. I have it. Congratulations bill passed. Representative Johnson, 1257, and it has an amendment. If you give staff a few seconds to pass out the amendment, and we'll take up the amendment first. Certainly, Mr. Chairman, I have someone here to sit by me again, hold my hand during testimony. Is it OK if they come to the table? Can I have somebody come to the table with me. Thanks. Thank you. For waiting so long. Hello, um, thanks for having me here. My name is Tisha Dean. I am a clinical psychologist and the government relations chair for the Arkansas Psychological Association. I'm also a faculty member at UAMS, but I am not speaking for you AMS today. Uh, members, this amendment does two things. One is it adds some uh Um, ability to do a couple of other things for a so tech. This is a new term we're creating. It would still be under the supervision of a psychologist, so this is the amendment that's being passed out. Additionally, it allows the board to collect a $10 fee. That was something that was, that was requested and I felt like a reasonable fee request to add to the bill for the sock texts to register because we expect there to be quite a few more of these now that we're expanding who can apply, and I'd be happy to answer any questions on the commitment. Any questions on the amendment? It's a pleasure of commit a motion to pass on the amendment. All those in favor say aye. I opposed. You are now recognized to present your bill as amended. Thank you, Mr. Chairman and committee members. So currently in Arkansas we have a a practitioner called a neuropsych tech, correct? And uh that that. me to be a neuropsych technician, they can only practice under a neuropsychologist right now what we're doing is we're loosening those restrictions and broadening it so that it's easier to become what we will now call a psych tech as opposed to a neuropsych tech. This would open it up to any person with a bachelor's degree in psychology, um, and they would be able to work more broadly, not just under neuropsychologists, but under psychologists in general, so this is an effort to expand the workforce and our behavioral health profession. Um, and hopefully, you know, reduce some of the backload and burden that we're seeing in our population and I'll refer for more comments if you have anything you'd like to add. Yes, thank you. Uh, so this bill came out of a couple of issues. So one was our neuropsychologist have been able to use psychology technicians or neuropsych technicians for a long time, but we had Arkansas was the only state that had specific restrictions around classes that they had to take and for a long time that's been a real issue as far as them having to take these very specific classes, um, that in a lot of ways we're not usually offered um UCA did a good job of starting to offer them, but it's still all is. restriction which other states do not allow, and which really isn't required, it isn't something that's necessary. So that's part of this bill and the other part of this bill is that um and part of our uh work with the With the working group for um with the legislators for um for mental health, um, one of the big issues is the access to psychological testing and so one of this, what this does is allows site technicians to work under um the license of the psychologists like me, and to get specific training um from someone like me to do the specific testing and so to like ask the questions, get the answers, scored the test, but then allows me to interpret the test. And so in this way, it allows for extenders. be used to increase access to psychological testing. Any questions from the committee seeing anyone in the audience speak for or against the bill. Sinan, are your clothes rebuild? I'm clothes for my bill. I make a motion to pass. That's motion discussion. Yeah, as amended. All those in favor for the bill as amended. Say ah. Ah all post. I have it. Congratulations, your bill is passed as amended. Representative Johnson, do you want to run 1258. I'd love to run that bill, Mr. Chairman, uh, if it's OK, I'd like to have someone come to the table with me. Sure, yep. So State Representative Lee Johnson, District 47. Good afternoon. I'm Judy Pyle. I'm with the Arkansas Community Health Workers Association. I'm the executive director. So members, this is another product of a lot of collaboration, Ms. Paul and I started working together months ago, uh, a lot of back and forth, you know, trying to come to a process where we can recognize community health workers who have already been working in our state for well over a decade, but up until this point, there hasn't been a process to require reimbursement and or certify them, and so, uh, this bill that you see is the result of deliberation back and forth between the community health workers Association, the Department of health, back to the community health organization, back to the Department of Health, um, and this is all at this point agreed upon language, um, and I don't know of any opposition, but I'd be happy to try to answer any questions on the bill or either one of us would be happy to answer any questions you want to ask. Representative Long, you recognize. Thank you, Mr. Chairman. Representative, um, that certification that you spoke about, is that going to be through like a non-government organization, so there'll be two pathways. So there is a pathway that's independent that mirrors what Archwood does now. So currently you can people in Arkansas can seek a certification through Arwa, which is the governing association in the state, but it doesn't have a government affiliation. The way this is written, ADH will recognize our choice of certification. Process. So if a person wants to get certified through Artua, they can seek certification through the Department of Health. It also creates a separate process that mirrors our choice. So if someone wants to get certified outside of the association directly through the Department of Health, both those pathways are available, so it doesn't require someone necessarily to go through the association or specifically through ADH. It gives both those options. I like that option to be able to do it without the government involvement. Thank you. Yes, sir. Any other questions from the committee? See none or anyone in the audience speak for or against the bill? Represent Johnson, you recognize I'm closed for a bill. Make a motion to pass motion. Any discussion on the motion? See a noun. All those in favor, say ah. I posed. I have it. Members with that, we uh Find herself at the Hold on one sec. OK, see you no other bills for us. We, we stand adjourn. Oh, yeah, hold on. That's right. I knew there was one. OK. So we're up here trying to find it and couldn't find it. What you recognize represent Pilkington and make your motion. 23 Off the first, the healthy. That's a proper motion. All those in favor say aye. All posed, I have it for the record, members, it takes 2/3 to do that. And with unanimous, we met the 2/3 threshold. Representative Pilkington, you're recognized to present Senate Bill 213. Uh, thank you, thank you committee. As you know, this is the sister bill to the Healthy Mom's Healthy baby, which we already discussed and already passed off the house. It's gonna be on the the house versions on the Senate side tomorrow, we're just also trying to get the bills to pass at the same time. So we've already been on this before, so I appreciate a good vote with that, I'm close. Make a motion to pass. Anyone speak for or against. In the audience, seeing no. We have a motion to pass any discussion on the motion. So you know all those in favor, say ah. I post. I have it. Now members, we have no other further business before the committee. We stand adjourn.