Public Health, Welfare and Labor Committee- House

Members I see a quorum, so we'll go ahead and get started. We're probably gonna be here a while today. We got a pretty lengthy full agenda. So we would, we'll move on to Chair Jeremy Wooldridge, State Representative District one. Good morning members. House Bill 1255 is a bill that I'm running, um, if you'll remember last session, I'd like to give credit to Representative Pilkington. He ran a bill for CGMs to expand access in Arkansas. He uh created that as a pharmacy benefit, ah it was currently a DME benefit. They're obviously areas in the state where we have pharmacy deserts, there's area areas in the state where we have DME deserts, um, the intention, I believe, was to create and provide access to the majority. of Arkansans, uh, I think, uh, an unintended consequence of that was that the DME section was not utilized because there wasn't a dual pathway created, in essence, this bill requires DHS to create a dual pathway and it's got language in there uh talking about uh making sure that those uh pharmacy benefits, DME benefits are treated the same. With that, I'll take any questions, Mr. Chair. Representative Bentley, you recognize. Thank you, Representative Wooldridge, for bringing this, and I'm not sitting in here and I've asked it, but I just want to make sure, uh, some of the. things that I heard back from my folks that were DMA providers that we had a lengthy prior authorization and it was blocking them for 30 days, so have we taken care of that to make sure they're not having to wait the 30 days for our constituents being delayed for that that time frame. That's correct. The language in here says that it has to be a consistent approval process with paperwork and requirements, so any DME requirement would also be a requirement of pharmacy. Thank you. Thank you, ma'am. Representilin you recognize. Any other questions from the committee? See anyone in the audience speak for or against the bill. So not what's your motion. It's proper motion. Any discussion on the motion? See on all those in favor. Say ah. I'll post. I have it. Congratulations, your bill was passed. Thank you, Mr. Chair. Thank you. Members will go to House Bill 1286, Representative Johnson. Thank you, Mr. Chairman. Representative Lee Johnson, District 47. You reckon. So members, uh, last session, we passed some legislation to create a pathway for reimbursement for ambulance services to treat patients in place and also to take them to an alternative destination. Prior to this legislation, the only pathway for reimbursement for ambulances was if they picked up a patient and took them to the emergency room. There are many opportunities for patients to safely be treated in place. We found this out through a pilot study CMS did and so we created this legislation to try to create a life mechanism through telehealth for these services to interact with the patient in their home in certain situations and try to make an assessment like could they safely stay home, safely go somewhere else. A third pathway we tried to create is there are certain situations where an ambulance will show up and the patient will refuse to go to the hospital, right? And so in those scenarios, we want to engage telehealth, uh, because many times the ambulance services are trying to convince the patient to go to the hospital and if a doctor can be on the phone doing a FaceTime visit. Sometimes they can, you know, encourage them and they can come to the hospital. There were some questions though about based on how the language was written in the last, in the statute last session as to whether or not it was uh. The ambulance services could end the situation where a patient refused transport, then treat the patient. I felt like the statute is pretty clear, but there was some questions on the ambulance service. They asked for some clarifying language around that setting. That's what this language is to just clarify that if a person refuses to go to the hospital. The ambulance service could still provide some treatment for them in that scenario, and that's really all this language is doing. I don't think it has any opposition. I worked on it with the um with the insurance carriers in the state and also with the ambulance services, and I'd be happy to try to answer any questions on that bill. Any questions for committee, Representative Rose. Seeing no que you got a question, Representative Allen? You're recognized. Doctor Johnson, I appreciate what you're doing. My question to you, are they doing this in any other states that you know of? That's a great question. There are definitely states that have created empowering legislation to try to allow ambulances to do these treatment methods. We're one of the few states that require reimbursement pathway, and so we're relatively unique in that situation, um, I think it's important, you know, to pay our ambulance services for the services rendered, but it's also an opportunity for cost savings, you know, and talking to the carriers, if they pay. a service to treat someone in place, that's cost savings because if, if they didn't have that opportunity, they would have to send him to the ER and obviously an ER visit is going to be a lot more expensive than something treated in place. So definitely other states are looking at this, but I feel like we're a leader in this space in the state of Arkansas. Thank you so much. Representative Hey, thank you, Doctor Johnson. The, I know you mentioned cost savings, but have you seen any impact to Medicaid reimbursement through What you've seen with the Ambulance, so, so currently there's a requirement for reimbursement rates through Medicaid as well. What I would say is, since this legislation passed last session, it's been a little bit of a slow rollout, you know, there has to be some infrastructure in place both for um for broadband, you know, some challenges that we have in the state around broadband have made the telehealth requirement a little challenging. Also some infrastructure because of the requirement to have a physician, uh, do, uh, you know, there has to be a network of physicians built. So I would say right now. Um, there's still a lot of opportunity for ambulance services to step into this space, uh, but I'm hopeful that as time goes by, you'll see more and more people taking advantage of this and that hopefully we will see some savings downstream. Seeing no further questions. Uh, Representative Barnes, you're recognized. Um Representative, if you would hit your mic button and get real close to it. OK. When ambulances get there, you said that they can call a doctor. They have the right to call a doctor, so with the patient get A bill from the ambulance and the doctor, how would that work? They could. So there is a model where the physician could build a professional fee the same way you would for an, a telehealth office visit. A lot of uh companies that are trying to work out a relationships with, with ambulance services are doing it as a subscription rate and not necessarily dropping that bill, you know, it's a, it's not a huge amount of revenue that you're going to receive from that and there's certain, you know, certain, um, labor intensive factor for turning in the paperwork and collecting all the information they They could build for that, but I don't know that they're doing it on a regular basis. OK. Thank you. OK, members, any other questions? Seeing none, Representative Rose, you recognize free motion. That's a proper motioning discussion on motion. Representative Bentley, you recognized for discussion. Thank you, Chairman. Just briefly, I want to say my constituents in Prairie County pay part of their sales tax to keep the ambulance service going, so I appreciate this avenue for those to be able to really, I think it's a good opportunity for our rural Kansans to be taken care of if necessary, if they refuse to go. So I just want to thank you for the, uh, for the bill and I would definitely do pass. Thank you. See enough other discussion, all those in favor, say ah. I'll post. I have it. With that members, we're gonna take a bill out of order with no objection. House Bill 1427. Representative Pilkington and Senator Ervin, you recognize. Young, you'll recognize us. Thank you, Chair. Representative Aaron Pilkington, District 45. Good morning, committee. Senator Missy Irvin, District 24. Uh, thanks for allowing me to present, uh, the Healthy moms, Healthy Babies Act, as many of you know, Arkansas is suffering the highest maternal mortality rates in the country. Too many women suffering from preventable complications during and after pregnancy, as legislators, I know we've all worked diligently to try to fix this issue and over the last two years have worked with the governor, part of her task force to kind of to address these issues. Um, this bill is a targeted approach improving maternal health care that focuses on increasing access, strengthening provider support, and investing in solutions that will save lives. Here's essentially what this bill does. We're establishing presumptive eligibility for pregnant women, investing in community health workers and doulas, expanding coverage for remote patient monitoring. This includes remote ultrasounds, blood pressure monitoring, and continuous glucose monitoring as well. Um, We're unbundling Medicaid payments for pregnancy care, which allows us up to 14 prenatal and postnatal visits. This is a huge way to make sure that we're not only utilizing our OBGYN as the best ability, but other providers as well in the, in the health care system. We're increasing provider reimbursement and changing tail coverage reform as well. All this adds up to a $45.3 million investment in maternal health here in Arkansas. Uh, I've said this many times, there's no silver bullet to fixing the maternal health issue that we face here in Arkansas, but this bill is a shotgun blast of silver bullets aimed at directly addressing the issue while at the same time, um, doing it in a reasonable way that understands that a lot of these areas are In rural areas and, and, and, and we need to utilize new technology like telehealth too and different providers to reach those women, um, I'm proud to sponsor legislations alongside Senator Missy Irvin, who I'll let her make any additional comments she wants to on this, and I just appreciate the support of the governor as well and her leadership in trying to address this issue. Thank you, Representative Pilkington. uh, this has really been a two-year process working with so many stakeholders and many of you around this table, uh, have been incredible contributors to this process. Representative Johnson, Representative Bentley for sure, um, we have Representative Ashley Hudson. We have representative Wardlaw. There's so many people I could go down a list of people that just really are, um, have put in a lot of time and effort in studying and understanding this issue, but also talking about it all across the state of Arkansas. I would be remiss to not thank all the people that have really just um focused on the maternal health issues in the state of Arkansas and have come together as a really, really passionate group of stakeholders who are really aimed at trying to fix the, the problem for our state, um, Alice Walton has just an incredible passion for the state of Arkansas and for the people of the state of Arkansas, as does Olivia Walton and so many of those folks, and I really want to thank them because they provided a lot of leadership and just support and data and research to us through this whole process, so this is really a statewide effort and it's a great bill, it's intentional, it's targeted. It really addresses a lot of the issues that we've seen. I want to thank the legislature for um passing the legislation to create the, the reports and the studies on maternal health, I think that's been very, very helpful. This legislature created that that study and those. Um, and so that we could see the data and see what was actually happening with our moms and our babies, and so, you know, this is definitely a direct result of the good work that this legislature has already done in a lot of areas and it's just really helped focus our policy based on the data that we were seeing of why women were, were having complications and why babies were having complications and so it's a very targeted approach. We're excited about this. I would argue the unbundling. Of the payment is incredibly important, uh, in order to stabilize our current healthcare infrastructure that we have in place, we cannot lose any more labor and delivery units in the state of Arkansas and it's incredibly important that we keep OB-GYNs delivering babies, and we have provisions in here to try to help make sure that they can continue delivering those babies longer, um, which is really important for our workforce, um, and, and the kind of the crisis that we're facing and trying to recruit OB n to the state of Arkansas and helping them continue to deliver babies, um, while they're, while they're practicing. So with that, I think we're, we're good and we can answer any questions. Thank you. For the time. Representative Ladyman, you reckon ask for a question. Thank you, Mr. Chairman. Um, I have a question on, uh, Section 4 The last section. And I read the intro there about the 9 year olds and so forth, but, uh, that last statement where it talks about alleged medical injury occurring during childbirth, and it It says shall have until the miner's 5th birthday to commence an action. Why was that in there? Why is that change made? Thank you. In 30 years, we have a dedicated a lot of effort and research, and we've spent, we spent over $250 million annually in Medicaid on early interventions, um, for children who are not meeting those developmentally, uh, delayed milestones, and so, you know, that didn't exist 30 years ago. It does today. And so, uh, we, we just, we We believe that lowering that will help keep our OB-GYNs delivering babies longer, uh, in order to reduce the tail coverage that they may have to carry, uh, beyond delivering a baby. And so, again, this is just only as it relates to the birth itself, and you should know those issues or conditions before the age of 5 and like I said, the state of Arkansas through Medicaid, we spent over $250 million a year, um, on early interventions to correct those developmental delayed milestones. And so that did not exist 30 years ago. It does today, um, we clearly are supportive of early intervention. If you can catch it earlier, then it's so much better for the child. So that's why we've, we put that provision in place. It's, it's really a workforce issue with our OB-GYNs and trying to recruit OB-GYNs and keep them practicing and delivering babies is longer, longer than they are. Well, I understand the goal, and I, I appreciate the goal and I, I, I am glad to see the improvement in that, but When you lower that to 5, you know, a lot of times. Uh, children are, they're only in the family until they're 5 years old. They're not at school. They haven't seen any therapists. There might be issues that you may not, might not know about. Now, I know that's better now than it used to be, but, so if we've done that, then why do we make the change if there's those cases where you don't know until they get out to people who are educated and evaluations at schools and maybe the parents don't want to talk about, uh, a problem. So I, I Why 5 years old? Why before they go to school, before they're exposed to those professionals. I would, I would, I would just argue that they are already exposed to those professionals. I mean, that's based on the spend and the majority of our babies that are, are born are on Medicaid and so we, um, we, we have, we, we have that intense therapy and early intervention to address those issues and those problems, and that's why I believe lowering it to age 5 is appropriate. So you don't believe there'll be cases that will fall through the cracks here when you lower that to 5 and people won't be covered. I do not. I don't. And just to add to the senator's comments as well, I mean, if there is an issue with gross negligence or anything like that, they can still still bring a case against them. It's not just saying there's after 5, nothing can be done. If there was something where there was gross negligence that can and there is a teacher statute of limitation on that as well. So we feel that there is, you know, an adequate amount of time if there is an issue that came with the birth to have those issues addressed by then, but you know, a big issue is when we talk to administrators in rural Arkansas, and that's where all the labor and deliveries are shutting down. This was a big issue for them because they were paid. for coverage for OBGYNs who were no longer delivering babies who were retired. And so they just had to keep paying this because that's the way our current law was set up and so we have money with that essentially was going to to nothing, so. Well, I understand that, but I, I, I'm afraid there might be some people that uh fall between the cracks here. Representative Enet, you're recognized for a question. Thank you, Mr. Chair, sorry, um, this is a good bill and I do have a question. Um, we all know that um African American women suffer at higher rates at maternal mortality, um, is there any targeted um Measures that you all are going to do to address this problem. Well, I think I would say I don't think anything in this bill specifically calls out African American women, but I do think in our approach, you know, with the doulas and the community health workers, getting them more inserted into the hospitals and into the health care system to help these women get enrolled. I mean, we see a lot of women who are actually qualify for Medicaid, qualify for expansion, qualify for other plans, they're not getting transferred in that timely manner, and the hope is by having those community healthcare workers in the in in the hospital to go and have a warm handoff. Uh, it is a better way to get them enrolled in the program and get them seen and of course, as you know, a lot, especially a lot of these workers are going to come from their own communities to begin with and so oftentimes I think by having people who are part of your community who are trained in your community, grew up in your community, lived there, are you, there's a trust there as opposed to some top-down method where we're all sending people out through UMS. No offense to UMS, they do a great job. They've been very helpful in this, but I think you could understand having these workers come from these areas is a helpful approach to get them part of the system and get them seen. Um, if I can also add, I think it's a great question, and I really appreciate it, um, because we are seeing those statistics, and I don't think we should ignore that, um, but to, to just to build on what Representative Pilkington said, those in-home services are what the doulas and the community health workers are going to be able to provide, and that's very consistent with the healthcare policy that this legislature supports in long-term care. We know that home health and personal care and home visitation. makes a huge difference in trying to keep people out of the hospital or out of a nursing home situation as long as they can stay at home, but we know that it works, and so to your point, we also know that a lot of those folks are people from the community that have that trust factor just like what Representative Pilkington said, and we, we want them to feel comfortable and being able to have somebody that can support them, who can help watch out for them, advise them, and it's And it's very difficult sometimes to navigate our healthcare world and so we want to make sure that we're very intentional about helping them and meeting them where they need that help. And so I think it's a, it's a great piece of the bill, uh, that really does speak to the point that you just made, represented in it, and we thank you for your question. I have one more question. Can you walk me through, uh, me and Representative of Richardson was wondering um how does a remote ultrasound work. Oh, yeah, fantastic. I love to talk about that. um. So, uh, recently there's been new technology developed in which they can actually, there's like a belt that goes around the woman and, and they uh, they send it home with them. And it's actually it uses a SIM card, much like a cell phone. So even if you don't have access to broadband in your house, if you literally just, it will upload to your phone and then when your phone hits the cell tower, it'll upload the data. So it's a way for them to do this and um basically monitor the baby at home, they're able to basically get the information they need and then of course it'll upload to the doctors and they can review it and then have like a telehealth visit with you as well. There's also remote ultrasounds in which we're using inpatient facilities. They could go to like a primary care clinic and have a a technician do it there. And then of course beam in the doctor as well. So there's, there's a couple of different ways to do, uh, remote ultrasounds, but uh when I uh found out about this belt, uh, I told my wife about it who had to bring two boys to her OB appointments when we had our, our last son, and she said, I don't care how much it costs, buy that belt. I'm tired of bringing them in every week. uh, so, uh, anyways, this is, you know, this would be something we would assume the OB's office would buy and then then lend out to women because obviously if you're, you know, your OB is 2 hours or 1 hour away or a half away, getting to them, especially if you're a single mom who works, that's, that becomes a very arduous ability to go in every week. And so our hope is by doing this we can, we can basically make it easier on them to see the care they need so they don't forego that prenatal care that's so important. That's a great question. Representative Long, you recognize us. Thank you, Mr. Chairman. I was wondering, does this bill, uh change the requirement of um upfront eligibility uh being I guess. proven, you know, Representative Long, can you speak in the microphone? I'm having trouble hearing you. I'm sorry, sir. Yeah, you can pull that thing out. It's got a lot of cord on it. I was wondering, does this change the requirement for upfront eligibility being proven. Yes, presumptive eligibility is in this in this bill. We think that's necessary to make sure that women are going into the hospital to get those prenatal visits, and so, uh, you know, I think this committee hears hears me a lot when I say or heard me say this a lot that I think it's about putting people out of systems. And, and I think the reality is we're putting these women above a system that may be Maybe, maybe slow and we need to get them the care they see as soon as possible. So that's why we've done presumptive eligibility because we think getting them in the doctor and worrying about the paperwork on the back end is more important than worrying about the paperwork first instead of worrying about the woman. It Maybe, maybe slow and we need to get them the care they see as soon as possible. So that's why we've done presumptive eligibility because we think getting them in the doctor and worrying about the paperwork on the back end is more important than worrying about the paperwork first instead of worrying about the woman. It's follow up question. So if later we figure out that they're not eligible will the state be able to get our money back. You won't answer. I I mean, if they're, if they're, if somebody is not eligible, I, I think, you know, clearly they're not going to meet the the eligibility requirements as set by the parameters of the the program as dictated by the state law or the federal law, so they would not be covered, um, and I do believe that there's a, a provision for that. Representative Perry, you'll recognize. Yeah. Thank you, Mr. Chairman. So I'm kind of looking back on what Representative Ladyman was talking about on the going back to 5 years. I understand, I mean, being an insurance guy, the cost of medical malpractice. What are the other states surrounding states around us, have they modified their amount of tail coverage or amount of time. I, I think it probably varies. I think what we try to look at, it was the data that we had um in in our, in our state, we looked at the data that we had, we looked at all of the different spins that we do on early intervention, uh, and we also looked at research and and decided that that was, uh, a, a, a number where we could come in on again, you know, there is a two-year statute of limitations that you can then goes on top of that, so it's not just age 5. So, uh, and, and that's why we've kept that. Language above that in that section, uh, we've kept that language intact as well. So again, it was really just based on the early interventions and the spin that we're doing, and we feel like that was a good, uh, target to come in at. uh, do you have any claim data from insurance companies on any medical malpractice claims from age 5 to 11. I do not, OK. All right, thank you, Mr. Truman. Representative Allen, do you have a question? Thank you, Mr. Chairman. I just want to know where does Arkansas rank when it comes to maternal health care. in the last we last? Yes. Are we dead last? We're dead last. OK. Thank you. Representative Bentley, he recognized. Thank you, Chairman. This is just, would you agree that the targeted approach that we're doing really specifically address the African American women in our state or black women that are really suffering, and one of the highest rate of maternal mortality in our state, what we're doing with the do lose and fighters, midwives and and telehealth and all those things are directly targeted to that population to make sure that we're getting the help they need. Yes, I would agree. And and one other thing too I'd mention is, you know, we talked about the remote patient monitoring on blood pressure and continues glucose monitoring. I mean those are, those are two issues that In fact, the African American population way higher than any other in a group. And so when we talk about That crucisively, they will benefit probably more than any other demographic, um, because those are, those are issues that we see predominantly among, among them, and so that's the hope is those will really help kind of address those issues in the community, but they have, but the reality though is it's in every community, I mean, we're, we, we've got issues across the board regardless, regardless of race, but that's those, those will help that community quite a bit. One quick follow up. Chairman, um, so, and we've seen across the nation that those those targeted approaches have really made a difference, so I think we're, I think, would you agree you guys have really done this with what we've seen across the nation to make things better. Yes, and now we'd go back to the, the maternal, um, health outcomes reports that we're doing and the data that we're collected on maternal outcomes and deaths and infant mortality and maternal mortality those reviews and that data to to exactly his point. I mean, if you're seeing somebody that has Uh, high blood pressure and these complications in the pregnancy that we know are happening, then why wouldn't you utilize technology and, and be very specific and saying this is what we need to pay for in order to dress and to turn that, turn that statistic around. We, we want to make sure women that are pregnant, if they are suffering from diabetes or from high blood pressure and those very important gestational diabetes, those are problems that we know exist, so we've got to apply the policy. in order to address it and fix it, and that's exactly what the bill does. Representative Richardson, you recognize. Thank you. So I, I representative Bentley just made me think about something. She said that. Wouldn't you agree that this is a targeted approach to Specifically, minority people. I heard you agree to that, but the bill does not identify targeted approach. The build is addressing everyone in general, correct? Yes. I, sorry, I, I think when I understood the question was a targeted approach of these are the, these are the big issues in the state that we are trying to do instead of a just broad approach of hey, we're just going to increase, you know, reimbursement by X amount and not try to do anything that's actually going to fix the issues because when you, when you start digging down to the reports that the senator is talking about, I mean, we see that we, because of, of, you know, the issues we're seeing with blood pressure and blood see with gestational diabetes and unhealthy eating habits and all sorts of things that go into having the unhealthy pregnancies that we see that can end up creating complications. Uh, how do we address those instead of just some carte blanche. Um, I think that's the right word. um, approach, and so I heard her comment about targeting I think is the reason why like we have specific policies addressed, uh, you know, the bundling and, and remote patient monitoring and dualism between health workers. That's my understanding. It wasn't just for demographics, but I wanted to address the demographic because I think some of these issues will help probably those communities more than others. Is that making myself clear? Sorry, that was a little bit of a rant, but OK. Committee members, any other questions? If not, we have several people that are signed up to speak for and against the bill. I'm gonna turn it back over to the chairman. Thank you. Thank you. He could have finished that. Jenna Goldman with UAMS speak for the bill. Yeah You would introduce yourself for the record and you're reckon I speak. Good morning, Jenna Goldman with UAMS. Um, on behalf of the providers at UMMS, we are in support of this bill because each of the policy components in this bill demonstrate significant improvement in outcomes for both mothers and children. The innovative approach of this bill will be the implementation of all of these elements at the same time, and this bill has the potential to be transformative in a way that no other state has seen and has the ability to truly move the needle. On maternal morbidity and mortality, as well as reductions in preterm birth and infant mortality. Beyond the critical impact for moms, which is a priority. This bill will have significant economic impact. Uh, we believe strengthening the maternal and infant health leads to more stable rural hospitals which are vital to communities across Arkansas. Additionally, reducing maternal and infant health complications will result in substantial cost savings, both short term and over the lifetime of these patients. We also want to thank the governor and steering committee and legislature for taking steps to improve maternal health in Arkansas. Thank you. Any questions? We have questions, uh, Representative Ennet, you're recognized for a question. Yes, thank you. Um, thank you, Mr. Chair. Um, I do have a question, um, can we request information is it, you know, regarding different demographics. To see how this is rolled out and see if it's. Working the way it's supposed to. Yes, ma'am, I believe you can. Um, it, right now we had Um, the, actually, There have already been reports that I know Akei has put out and the Uh, Arkansas maternal mortality Review Committee, uh, their last report in 2023 does break it down by different demographics, um, and I know that the steering committee took all of that into account while they came up with this plan. I guess my question, oh sorry. Yeah, you're good. My question would be like after this is passed and rolled out, will there be, we can, who can we ask? We can ask those different groups for report to see how it's helping, they have the ability to do that. OK, thank you. Members This committee, we handled way too important issues to worry about follow-up questions. If you guys need a question the witness or question the department, please carry on and let's air out the issues the way they should be aired out. You do not have to ask for my permission for that. So as we move forward, as you're dealing with a witness, feel free to deal with the witness how you see fit and when it's over, I'll move on to the next member. I just want to be clear. I want every issue vetted to the fullest that we can vet it. So you have full freedom to do whatever you need to do. But I do appreciate the respect and I just wanna make that clear. Um Seeing no other questions from Mr. Golden. Thank you for your testimony. Thank you. So we do have uh Paul Bird signed up to speak against the bill. Thank you. If you would introduce yourself a record and you'll recognize. I'm Paul Bird. I'm an attorney here in Little Rock. Uh, I've been doing, um, Personal injury work for Decades you can tell by my gray hair. I've been around a while and to come up here and say I had to write against The bill, Paul Bird is against improving maternal health in Arkansas. That is not why I'm here. Uh, uh, I laud the effort uh of this bill. I'm literally here for one part. And it's the part that Representative Leiderman brought up. The way it reads if an alleged medical injury occurred during childbirth. The minor or his or her representatives. shall have until the shall. That's a big word in the law shall have until the miner's 5th birthday to commence the action. For as a practitioner and practicing in front of every circuit judge I know in Arkansas and probably the Arkansas Court of Appeals and Supreme Court. They're gonna take that shall have until the miner's 5th birthday to be the day I have to file it by when that miner turns 5 years old in a day, I don't have 2 years the way it's read. I would love for it to be amended to say that, to be clarified that the, the part above where there's 2 years of a statute. ations once you reach a certain age, but this says shall. Shall be commenced. On the 5th birthday. Now, there are Uh A neuropsychological exam is very hard to be able to perform on a child until they're 5 years old and even you might get one a little before 5, but even if you get 1, then you got to have a couple of years to track and have another one to see the progression. And so, uh, I can tell you having represented families in this situation they are overwhelmed. Um, they are, um, They're kind of hoping in denial that's not gonna be. And they don't really start finding it out completely until they get to school. And so, Um, I think it's a wonderful bill. Uh Some of my favorite people are on this bill, Uh, and I support other bills that they have out here, but uh I I'm only asking for that one provision if just make it say they shall have 2 years after their 5th birthday. I'd rather it not be 5 years old. I'd rather it be 9. Back in 1995, we had a battle out here and and you know if a Walmart truck runs over my child, uh, or my grandchild. They have until they turn 18 and then they have 3 years, uh, that's just the way it works. The law has always protected minors. We considered them in an incapacitated state, uh, and so, uh, for, for the law that's protecting minors, I just. I pray you'd look at this and take a second look at that one provision and then pass the rest of the bill, but if you could just change that one provision to at least give them 2 years from age 5, but this looks like at age 5 it's over. Thank you. Representative Rose, you recognize for a question. Thank you, Mr. Chair. Um, would it be appropriate if I would ask the bill sponsors a question pertaining to this testimony. I will allow that after all testimony has been taken, but if you have questions for the presenter, that's this proper time for that. Thank you. Mr. Bird, Could you speak to your belief for why this language is here. For why it's there, you're specifically speaking against that language. In your view, what is the benefit of that language? The benefit, it's like uh. Senator Irwin said, uh, it, it will let doctors not have to worry about a malpractice case after a child turns 5. Um I yield to Senator Johnson. I've been, I just was gonna question representative, I need to recognize that's fine. Representative Johnson, when you say doctors, I just want to clarify many doctors in the state are employed by hospitals and it's actually the hospitals that are incurring the cost of the malpractice, so a doctor may or may not be saving any money in this process. It's it's whoever's paying the malpractice, correct? Well, yeah, whoever pays the malpractice premium, but the question on to me on the table is. You've got, you've cut off the rights of a 5 year old at their birth. It said it shall have until the 5th birthday to commence an action. So if they come into my office at 5 years and 1 day, I'm gonna say sorry, you should have come the uh a couple of days ago, uh, for me to be able to get this filed so. Will it save Premiums, I don't know. I've, I've never seen a, a tort reform type bill yet that lowers. Insurance premiums, but uh but that's not the issue here. The issue is. Uh, that a family will not know until it's too late. They won't know until it's too late, uh, with, with all the advances in medicine, you still can't get a neuropsy exam. Until that time and, and families, my clients have been bewildered, confused. They don't know the legal system. They don't even know a lawyer, you know, they don't know how to get anywhere, but somewhere along the way, teaching professional will come to him and say, Your child's having some, some issues and, and they may not explore or figure it out until then. I'm just saying. At least give them 2 years, at least give them. 2 years from age 5 just To make it read like the section above shall have until 2 years after the medical injury is known originally could have been discovered. Well, just make it 2 years after they turn 5, and then you've gotten that grace period, but the way this reads right now, it ends on the 5th birthday. Representative Rose, you have follow up. Thank you. I want to jump back in, but I want to get ahead of Representative Johnson here. Uh, so I'm not a, uh, a personal injury, a lawyer or a doctor or an insurer. So I'm reading some of this and I'm just trying to understand the section above that you mentioned that you would like it to read like the section above. Uh, why doesn't section 2 that is directly above that, why doesn't that still apply? It because this third section has its own shell in it. It has its own shell and and the judges and the law take shall extremely serious. Sha means shall, and it says if a medical injury occurs during childbirth, the minor or their parents shall have until the miner's 5th birthday, and here's the language to commence the action. That means it has to be commenced on the 5th birthday, and there's a show that it has to be commenced on the 5th birthday. So my question then pertain to the previous section where it's giving the kind of the The statement of that this could not have reasonably been discovered prior to the 11th birthday, and the minor or his parents or or her, his or her representative shall have until 2 years after the medical injury is known or reasonably could have been discovered. So there's a show there. There's a shell there, and it adds two more years. This shell says shall commence on the 5th by the 5th birthday is the shall in the third section stronger than the shall in the second section, because the shall in the 3rd section is clearly delineating what happens in a childbirth if an injury during childbirth, whereas the section above is not talking about what happens during childbirth and that specifically give somebody 2 more years after the after the 9 year date, but this provision, this. This last provision number 3 stands alone in that it says shall have until the miner's 5th birthday to commence an action. It's almost like it erased away the two-year provision above and it says it shall commence on the 5th birthday. I appreciate your perspective. I would say that it stands alone as Section 3, but it does not eliminate Section 2. If it did, there'd be lines through that, and I'll, I will have a follow up for the sponsors when we get there, but thank you for your testimony. I just I will respectfully. Uh, representative. No trial judge is going to read. That Way that you're thinking that somehow above where it says you have 2 years is going to apply to this section because this section has a shell that says it shall commence on the 5th birthday and uh as a as a judge, I will read that and say. Uh 5 years and 1 day it's over because you didn't commence it on the the day they turn 5. Seeing no other questions. Thank you for your time. Oh, thanks, Representative Ladyman, you do have a question. Sorry. Thank you, Mr. Chairman. Um Mr. Bird, I, um, I'm like you, I, I like this bill. It's a good bill. I can't see the connection of Section 4 with the rest of the bill. I don't really know why that's in there, other than it would reduce the cost at some to somebody, and I agree with Representative Johnson, we're not just talking about doctors here, we're talking about hospitals and I definitely didn't want to get in the middle of the doctors and the lawyers this morning, so. I don't like the position I'm in here, but, but I'm here for the families and the kids. And if there is a child that is 7 to 9 years old. It has this great difficulty. Uh, you know, I don't care if there's just one of them. We, we, we can't let that happen because we talk about the cost, the medical cost of something like this, but the cost of these families and they may not realize until this child is 9 years old or Uh, I don't know what the number is. Maybe you do, but Uh I want us to protect these children and have them the opportunity to say their case. So my question to you is, were you or anybody in your organization that do this kind of work, where y'all involved and were you asked about this bill? Did you have input to this bill at all? No, sir, I didn't, I didn't know anything about this bill, uh, and I, I think there's a companion bill maybe in the Senate that has similar language. I heard about it at the time it was headed to a hearing, uh, but, but no, I. Honestly, I think this is a wonderful overall bill, maternal health in Arkansas, uh, is everything and as a pro-life person I, I hate hearing people say you pro-life people only care about them, uh, when they're in the womb. You don't care about them after they're out of the womb. Well, this bill's taking care of people after that. I'm not against that. I just this one part, one more question. So if the sponsor would be willing to uh pause this bill or, or do something and get input from you and your organization and try to work together to something that we could all support because I can't support it the way it is. We're going to deal with the sponsors after for and against this, but would you be willing to work with people? every time. Thank you. Every time. All right, see you. No further questions. Thank you for your testimony. Thank you, sir. We're moving on to Scott Smith. Speak for the bill. Thank you, Mr. Chairman, members of the committee, I'm Scott Smith with Arkansas Medical Society. We just real quickly wanted to say. We support the bill and appreciate Representative Pilkington, Senator Irvin, and the governor for bringing this bill. It's going to be a big help around the state. That's it. Thank you for your testimony. Sheena Olsen from Arkansas Children's. 4 I have no one else speak against signed up. I will ask for audience at the end. I, Sheena Olson, the Arkansas Children's Hospital, um, I'm not gonna take a lot of time, uh, uh, we echo the sentiments of UAMS, um, Arkansas Children's is deeply committed to changing this generational trend of poor infant and maternal health, and we think the sponsors for bringing this bill, the governor, and we look forward to working with the legislature and the administration and other hospitals and providers to change this direction, and that's all I have. Thank you. Thank you. Seeing no questions. Thank you for your testimony. I have Anna Strong. To speak for the bill. Arkansas chapter of American Academy of Pediatrics. Good morning y'all. Um, I'm Anna Strong. I'm the executive director of the Arkansas chapter of the American Academy of Pediatrics and, uh, my organization rep represents about 500 pediatricians here in Arkansas, and we are speaking in support of the bill, very grateful to the governor and to Senator Irvin and Representative Pilkington for their support and have really appreciated, I will just say being part of the strategic maternal Health Committee's task forces and the work, um, that has been part of this for that focus on both maternal and child health. Um, one of the things we like to convention as part of these conversations is that even though we're number one in maternal health, we're also #3 in infant mortality, uh, uh, sorry, number one in maternal deaths. We are, um, number 3 in infant mortality in this state and there are lots of differences in outcomes in rural communities and other groups of Arkansans that we would love to help make sure are addressed. So in particular, our members want me to mention 3 things as part of our support for this bill, um, number one, they said the the health of the maternal child diet is integral to pediatric. outcomes and the severe illness or death of a parent impacts child wellbeing well into adulthood. Secondly, that pediatricians are increasingly called upon to address maternal health in the pediatric care setting. So for example, maternal depression, um, family needs such as food insecurity and other um other issues, and finally that they support family-centered perinatal care that will reduce infant and maternal morbidity and mortality in the United States, including the role of pediatricians and non and the non-physician perinatal health work force, um, they do support the the pieces of this bill that support. their OB-GYN colleagues as well. And finally, I'll wrap up and just say that in addition, our um our organization has partnered with Excel by 8 to support doulas here in Arkansas as they form an association, the Doula Alliance of Arkansas to help set standards of care for that non-clinical, emotional, and community support for women as they go through childbirth and delivery in that postpartum period. Um, we think the doulas will help reach harder to reach communities and improve. There has been data that they improve infant outcomes, improve breastfeeding rate. s improve, reduce low birth weight and other positive outcomes for kids here in our state. So healthy moms are with good prenatal care, postpartum care, access equals healthy, healthy infants, which all of our pediatricians love and support. Thank y'all. Representative Richardson, you do have a question. Yeah, thank you, Mr. Chait. Do you know how many doulas there are in the state by any chance? Any idea? Alliance of Arkansas, um, they are actually in this room, but they, we think they're around 50 to 70 right now. I know we're still trying to, um, the dual alliance is still working to kind of gather everybody and form their their initial set of members. They have a board of 99 members, including 2 OB-GYNs and um are doing great work to kind of Recruit all the doulas around the state and also train additional workforce in partnership with many in this room. Would you agree that this bill would help increase the amount of doulas across the state as well. Yeah, very excited about that, yeah. Thank you. OK. See, no other questions. Thank you for testimony. Members that all had signed up. Is there any anyone else in the audience that would like to speak for or against this bill? Seeing no before I recognize the sponsors to close because we can't ask questions in closing. I'm going to recognize the sponsors things or further questions from the committee. Representative Rose, I have you first on the list. Representative Ladyman. Second, are there any others that want to be put on the list? roads you recognize. Thank you, Mr. Chair. I just want to give you guys an opportunity to speak to that last section in the bill that we're having some discussion about. I wanted to hear, uh, kind of the rationales that you elaborate on why this is needed, what it does, the benefits, and just kind of go from there. Sure, so, um, you know, as, as the senator said, you know, this is over a 2 year process as we talked about things, um, and I know the question was how do we get to 5 years. One of the things we looked at the surrounding states and so I just have some numbers for you. So Louisiana, it's one year. Tennessee, it's one year. Mississippi, it's 8, and Oklahoma it's 7. And so with the 5 year plus the 2 year after that, you know, we thought that that was a healthy average for what's around the community. Um, but the reality is, is, you know, when we talk about how we improve maternal health. Obviously, if you're going to move the needle, money's involved. OB practices are extremely expensive to run. You can't have a single OB. You have to have two because you have to basically allow the other one to sleep at some point. Um, and so because they're so costly to keep open and keep running, we need to find out ways that would help hospitals be able to run these, and so one of the ways was this reform as part of the package. So, um, well I can understand hesitation from trial lawyers who are concerned about this. The reality is, I assume every hospital minister in the state who runs an OB practice is going to feel relieved and feel the pressure off them. No hospital wants to close their labor and delivery unit. They, I, I can tell you from talking to hospital administrators when they close those delivery units, they feel like they've let their community down and so they will do everything they can to keep those open until they really can. And so that's, that's part of the reason why it's in here. How do we keep these units open. And so, um, you know, we can talk about presumptive eligibility, we can talk about coverage and talk about doulas, but if you can't deliver nearby, um, it makes it really hard. And so, uh, so that's why it's there. That's why the number is what it is. And you can, I would love you to talk to Doctor Manning at UMS and ask him, has she ever seen a resident come out without a lawsuit against them or their residency because they always have one because they get sued at a higher rate than anyone else, and so we're just trying to provide a little bit of relief. And so, um, with that, I give it over to my Senate colleague to see if she has any other comments to make I think very well stated. I want to think about I want, I want you to think about those moms that are in rural Arkansas. And the fact that they have to drive 2 hours sometimes to go see an OB-GYN for the delivery. And the fact is, we are not recruiting doctors out of medical school to go into OB-GYN because of these issues that they're facing. It's just a fact. You can say what you want, but I, we care about all the children, but I definitely care that if you're going to prevent a, a bad outcome for a pregnancy, then let's try to recruit some OB-GYNs into the state of Arkansas into areas where they're needed, and this is absolutely a factor as to why doctors and medical students do not go into the practice of OBGYN and why older OB-GYNs are having to retire from delivering babies earlier because of this tail coverage, and we looked at these, these statistics. We looked at the number, we looked at, we weighed all of the information, all the spend that we're doing on early intervention and the surrounding states and where the statute of limitations are. It's not about premiums, it's about actual years of, of coverage that you're reducing is a realized savings. That's a realized savings. That's not hypothetical, that's real. And so that really is targeted to um meet a lot of their problems and the issues that exist in particularly rural Arkansas and these um these hospitals that are having to close their labor and delivery units because they can't find doctors to deliver their babies. And so, it's a huge problem and to ignore it, in my opinion, would really just be reckless. And so I really appreciate the question, Representative Rose. And, and there's a good reason why we did what we did, and I appreciate the question. Representative Ladyman, you recognize. Well, again, I think the bill's good and I understand the reasoning behind what you're trying to do here, but I believe if we work to reduce The medical injuries if we do things, I mean, that's the goal is to reduce the injuries. And I, I know you said this has been vetted for 2 years, but I just saw this this morning. Nobody has, I, I didn't know this was in the bill until this morning. And the lawyer, they have not been involved in the discussion, so I, I mean, I think when questions come up like this, people don't have information. For whatever reason, uh, you need to back up a little bit and try to talk to the folks that are involved here, because I cannot vote for the bill. I mean, I cannot, I will not until somebody talks to me and tells me more detail, more data. We don't know how many cases there are between 5 and 11. That was just asked, you know, we don't know that information. Uh, how do we approach this with uh from another direction to where everybody's in agreement and thinks it's a good idea to go forward. I don't think we're going to be able to find a way to get the trial lawyers to agree to any sort of reform that that restricts their ability to bring these types of lawsuits. It's been 2 years. We've had task force meetings. They've they've never been involved, um, and, and granted, they're, they're not healthcare professionals, but we're just following what we're seeing surrounds doing. Once again, the question was asked, where do we rank? We're dead last, um, these other states that have way more restrictive than we do, are way ahead of us on maternal health. So I, if it was the opposite, that this was going to actually cause harm, you would see the reverse, but you're not. Well, I, I agree, and you may not ever get the trial lawyers to agree. But I think it should be discussion. Which evidently there hasn't been, so thank you. Seeing no further questions or committee. You guys are open to close for your bill. I think we're close. Thank you. I was hoping you said that. So With that, members, uh, what's the pleasure of the committee. I have a motion to pass. Uh, any discussion on the motion? Representative Ladyman, you recognize. Again, members, I, I hate to keep beating this horse to death, but I, I, I just, I'm concerned that there's going to be people. That are going to be hurt by that section 4, it needs to be clarified, um. There, there's a lot of, you know, you got the first section 2 and Section 3 competing against each other. So we, we need to understand, we need to clarify that because as the lawyer said, When you get in court, you don't know how this is going to happen. It needs to be very clear, and it's not. And uh so there's a number of reasons, but I will not be supporting the bill. Any further discussion, uh, Representative Pilkerton, since I'm on the committee, I know I can participate in discussion, um. You know, this language went through the normal process and was vetted by the legal team of the governor's office and DHS, and we, we do not feel that it's confusing and that we feel that it is written in a correct and proper way. So just want to add that context. Remember seeing no further discussion, all those in favor, say ah. All those opposed? I just have a congratulations you have passed your bill. Thank you. Thank you. Thank you so much. Members moving on down through the agenda. We have, uh, next in line be Senate Bill 77. We have, I think Represented Mayberry. Yeah, there she is. If you would, you and your guests introduce yourself for the record and you're recognized to present your bill. State representative District 92. But we and Shaw representing American Physical Therapy Association, Arkansas and rehabilitlitation Network of Arkansas. And how silly I didn't even say my name. I just said state representative district 92. Sorry, Julie Mayberry. What a way to start. Um, members, this, this bill gives us an opportunity to improve access as it stands right now, if someone is on Medicaid, um, the only place where they can get. Physical therapy is to go to the hospital. Now you can imagine how difficult that is, how time consuming that is and how someone is less likely to go get physical therapy if they're less likely to get physical therapy. There's a greater chance they're going to need surgery or they might get addicted to opioids. I sent all of you um information yesterday, um, showing several studies that that demonstrate that, um, and What this bill will allow is for someone on Medicaid to go to someone local to get physical therapy. Um, this has been reviewed by DHS. DHS agrees that it is not going to cost more to offer this, and it has been in discussion for 3 years of which Beau has been a part of that, so I'm going to let him explain what has been taking place the last 3 years to get us to this point. Thank you. Um, so just, just wanna make sure that uh we kind of emphasize this is something we've been working on for, for quite a while and, and making sure that all parties, you know, voiced their opinion on this. There are a lot of studies that have shown uh the total cost of care on a health care system can be affected by certain interventions like physical therapy. So those are the uh studies that she's referencing. One of the biggest things is this bill's gonna do is, is going to make it more time, uh, uh, cost savings, access to care is going to be a huge thing. Um, and then also not only surgeries, but also decreasing imaging has been shown lower use of opioids, uh, lower visits to hospitals, physicians, the, the hospital groups agree with this and uh so it's an access to care issue, really lower um access to care means less care and because the cost it it's gonna uh take to get to different facilities across our state, uh, everything that goes into that, they're not going to receive these services just because they can't afford to get to, uh, you know, hospitals that are a distance away. So this helps that issue, um, surrounding states all have this already, so this would just, uh, add this adult. A Medicaid group, uh, to the existing coverage. With that, we'll take questions. Any questions from the committee? C9 anyone speak for or against the bill? C9, you close for bill? And what's the pleasure of the committee. I have a motion to pass any discussion on the motion? Seeing none all those in favor. Say ah. I opposed. I have congratulations. Members with that, we move on to House Bill 1186. Representative Volt. Someone left their phone. Sorry, is this your phone? Dan bought District 87, and I have a somebody that'll be at the table with me. Just go ahead and introduce ourselves for the record. Stacey James, executive director of Hope Movement Coalition. Thank you for, uh, allowing me to be in a couple of different committees this morning, sir, by passing over me and coming back to me. Uh, House Bill 1186, sorry. Uh, we all know that, um, the impact and devastation of the opioid epidemic has had our state and our country, um, but you may not know that Arkansas has the highest rate of opioid prescriptions in the entire nation. In Arkansas in 2023, uh, which is the most uh recent data available, uh, there was 71.5 opioids prescribed. For every 100 people in our state. Um, that's nearly double the national average, which is 37.5 opioids per 100 persons despite all the awareness of the potential risk associated with opioids, with the potential of addiction, opioid use disorder and so on. We now have the highest rate of opioid pres prescribing in the nation. The reality and the problem that states face is that opioids are cheap. And they're easy to obtain. Additionally, And this is the prop, this is the problem this bill seeks to address, state policies often unintentionally incentivize opioids as a first line treatment. A number of states have Medicaid, a number of states have Medicaid and insurance policies that make it easier to prescribe opioids for pain compared to FDA approved non-opioid alternatives. Those policies Allow doctors to write a prescription for an opioid without needing to get a prior authorization. Or approval from Medicaid or from the insurance plans. If programs or policies subject, uh, non-opioids to more they. We subject non non-opioids to more strengther requirements than opioids themselves. Uh, which leads to, it's easier just to go ahead and prescribe that opioid versus, uh, that non-opioid, um, unless there is a Even playing ground, playing field for the prescribing of opioids and non-opioids. Opioids will continue to be utilized as the front line treatment plan. House Bill 1186, the pain relief parity Act directs DHS to ensure that utilization management requirements such as prior authorization requirements for FDA approved non-opioids are more. Restrictive than the least restrictive requirements set for opioids. Um This bill will ensure that the FDA approved non-opioids also get the same criteria as opioids. Uh, this will level the playing ground. Um, this will also enable Medicaid providers and patients to have the same access to FDA approved non-opioids as as opioids to be clear, this legislation does not tell providers what they have to prescribe. It's simply ensures that non-opioids are every bit as accessible as the opioids themselves. And I have Miss Stacy here with me today and she's wanting to share a story with y'all about how we came to this, uh, legislation before I begin, I just want to say thank you. Um, it's been very interesting to sit in the back and to listen to how you all are taking care of the Stacy's across the state, so it is an honor to be able to bring this matter to your attention, um, I mentioned that I was the executive director of Hope Movement Coalition. Hope Movement is committed. to advocating for families who have lost loved ones to substance use disorder or fentanyl poisoning. Many of those lives were forever changed by a prescription opioid, often following a routine injury or a dental procedure. I personally lost my 22 year old son Hagan in 2019 to fentanyl poisoning, um, it was our loss that led me to start Ho Hope Movement Coalition, but today I'm in front of you as a voice for the, the families of this state. House Bill 1186, the pain relief parity Act, is not just about improving health care policy. It's about preventing unnecessary tragedies. For far too long, opioid painkillers have been the default option for post-surgical and injury-related pain management, but not because they were always the best choice. There has been imbalance which has led to countless avoidable addictions, as many individuals who are prescribed opioids for short term pain relief found themselves caught in a cycle of dependence that ultimately took everything from them, including their lives. The families I represent have experienced the worst possible outcome of this crisis. They are mothers and fathers who had to bury their children. They are spouses who lost their partners, and they are children growing up without parents because of a prescription that was meant to help, but instead led to a lifetime of struggle or worse, a life cut short. Each of them had loved ones who watched in horror as opioids prescribed for legitimate pain tore their families apart and ultimately took their lives. These are not just statistics. These are real people, real families and real tragedies. Each of these individuals was prescribed opioids for legitimate pain. None of them were given an alternative. All of them are now gone. Nicole's sister Kayley, a young mother of two, was involved in a hit and run accident. Bruce's son Cody broke his ankle during a high school football game. Barbara's niece, Danielle suffered a back injury. Claire's husband Aaron met with a spine surgeon on a Monday afternoon to discuss back surgery, that consultation resulted in the surgeon writing him a prescription for 60 Percocet, he filled it and overdosed 6 days later. Debbie's son Michael was involved in a car accident. Tatiana's mother-in-law Jill had been sober for 15 years when a physician prescribed her opioids post-surgery. She returned to use and never recovered. Tammy's son Lane injured his back in college and was given oxycodone for his post-op care. Michelle's son Austin got meningitis in the army and was prescribed opioids. Michelle's son Jeremy was given OxyContin at just 15 years old after oral surgery. Kelly's son Wiley was prescribed opioids at age 13. After breaking his ankle, Cammy's son Christopher was prescribed opioids for gastrointestinal disease. Tanya's son Garrett was prescribed opioids after a high school football injury. Diane's daughter Gillian was given opioids at 14 after a root canal. Susan's daughter Meredith broke her back in a sledding accident. Jenny's son Clay was given opioids for low back pain. Michelle's son Justin was prescribed monthly OxyContin for stomach issues. And my own mother, Sharon was given opioids for migraines. I do want to point out that my mother did not overdose, although had she, I would not be ashamed. Instead, my mother died at 56 from the results of long term opioid use. All of these individuals, these daughters, these sons, these mothers were prescribed opioids during a health crisis, and they are all dead. This is why House Bill 1186 matters. As evident by Arkansas's less than distinctive first place standing nationally for the overprescribing of opioids, too many patients are prescribed an opioid as the only option. Even when safer options exist. This bill ensures that non-opioid pain management options are accessible and that barriers to physicians are removed. By ensuring, by excuse me, by ensuring that non-opioid pain management options are given a level playing field with opioids, hospital 1186 can break this dangerous cycle. It gives patience and providers real choices choices that could mean the difference between life and death. I urge you to support this legislation, not just as policy makers. But as people who have the power to prevent other families from going through what each of the families that I just introduced you to have gone. It is imperative that we get to a point where a 13 year old is not given an opioid where a 14 year old is not given an opioid for a root canal. My own son, my youngest son had his wisdom teeth taken out in November. He's 21 years old. He was handed a prescription for 30 Percocet. For his wisdom teeth to be removed. As his mother, I can tell you the child got none. Not because I wanted to see him in pain, but because I went through the same procedure 35 years ago, and I did it without an opioid. We have to be able to give these families options. I appreciate so much your time. And we can take questions, sir. Representative Woolridge, you're for a question. Thank you, Mr. Chair. Thank you, Representative Vot, uh, for presenting this bill. I know that this is a huge issue and I applaud um anything that we can do to try to move the needle. Um, I do have a few questions I've looked at the bill and I'd underlined those, but also I visited with the chair and, and see that there's an amendment up here to this bill. Is this something that you're looking at putting forward or no, sir, we're not gonna do the amendment at this time. OK, thank you, ma'am. Inval and you reckon. Thank you, Mr. Mr. Chairman. I appreciate what you're trying to do, uh, Representative Vong. Could you give me an example of a non-opioid drug. know I've not been told the name. The FDA approved it last week, and I don't know the name either. No, a nun openly non-opioid drug. I'm asking DHS to come up to clarify what they are. You have Motrin, Advil, yeah, yeah. I think the first one just got approved. It did. It was last Thursday, but it was approved. Good morning, Janet Man, DHS could you ask the question again? I'm sorry, I was multitasking examples of non-opioid drugs. Actually we have a very good example. One was just approved, I believe, in the last two weeks. I think the name is um Vertex. Someone will correct me if I get it wrong. It actually showed up on our drug file yesterday as an option under Medicaid. Thank you. Representative Rose, you recognize? Thank you, Mr. Chair. This is for sponsors, I'm sure you could jump in if you're better suited for the question. I like what you're doing. I think, you know, we've got obviously an epidemic with with addiction to these pain meds across country and I'm sure in our state. Uh, the only question I had, um, having navigated surgery recoveries and those kinds of things, there are times where, you know, a higher tolerance pain med is what's necessary. Is there anything in here that could potentially limit somebody who has some mad that they're accustomed to that they want to receive, whether it's they get 6 to 12 of these, these pills or something, and that's what they know they want with a surgery. With this, uh, limit that or is this just give us an alternative for people who don't want an addictive pain medicine. It's just an alternative to someone that does not want a pain med. Um, and also I will offer up just because I had some of my constituents back home, you know, you have people who's gone through drug recovery, and they can't take an opioid, but they need something for pain whether I don't know what surgery it might be, but, but they need something and they can't take this, it would give them an alternative if they're on Medicaid. And, and I was reading through this and I was pretty sure what you just said was the case because there was this more restrictive and extensive utilization controls and then I kept seeing non-opioid drugs. So I just want to make sure there's no provision in there that would limit what our physicians and pharmacists are able to already prescribe and, and hand out to patients and so that's your understanding as well. No, no limiting of what's currently in place. All right. Thank you. Yes sir. OK Any other questions? See a nun or anyone in the audit speak for or against the bill? Yes ma'am, if you would come to the table and. Introduce yourself for the record. Um, hello, my name is Natalie Nouhini. I wasn't originally planning on speaking on this bill. Because that's why my name wasn't on the list, but, um, just like Representative thought said opioids are what doctors go to first. When I was 18, I broke my collarbone in a snowboarding accident. And I went to the hospital and they tried to shoot this spray up my nose, and I was like, wait, what is that? And they were like, fentanyl. And I was like, fentanyl? ask first, right? At that point, I was 4 years sober from opioid use and the fact that I could have relapsed because a doctor just assumed that it was something I would want. is not great. I think this is a great idea because like the people who sat over here and spoke on it, opioids can ruin lives and non-opioids should be given a shot. I didn't get into opioids by the way of prescription, but I could relapsed. If I would have let her shoot that spray up my nose or if I filled the prescription that I was written, and with that if I'm allowed to ask, I ask for a good vote. Thank you. Anyone else in the audience speak for or against the bill? Miss Janet Mann, DHS. Are you speaking for or against or neutral? Uh, a little of all three. Go for it. Good morning, Jane at me and DHS, um, we are in support of the non-opioid prescription option that is in the spirit of this bill to give an option. It is the structure and some of the limitations in this bill that causes us concerns with our drug utilization review board procedures as I as I stated a few minutes ago, um, we were already covering the bill, I mean, the drug, excuse me. showed up on our drug file yesterday. So I, I would ask for consideration that it does not um immediately upon approval, be treated the same way as an opioid. We have a way that we take new drugs for every single, um, FDA approved drug that comes to us, how we treat that with the DUR board, we automatically will allow it to be prescribed. It may have prior authorization until drug utilization Board hears it, or it may have things in place and we would like to keep that procedure consistent with all of our drug medications. So with that, um, I'll answer any questions. Thank you. Thank you, ma'am, for your testimony and thank you, Mr. Chair. Um, I did have a question. I think the question that I'd raised to the bill sponsor originally was about that approval process, the way I understood the language in there that if it was approved at the federal level, it would then automatically be approved which would bypass the process that you were talking about, correct? No, sir, it's actually 2 steps. Your mic's off. Is it on now? Yes, sir. It's actually two steps. So Medicaid covers, um, medication that is FDA approved and signed up a rebate, and then we will cover it. We use our drug utilization review board to help us with the clinical protocol and approach. So sometimes we will have a prior authorization from the time it gets approved to the time that board meets and then it will set up how it can be prescribed and used in uh um the division of medical services Director Elizabeth Pitman is she could probably answer in greater detail, but with this bill with the automatic um immediate upon approval language that's on page 2 is what causes us some concern, and I also would like to point out on page 2 that Medicaid does not use step therapy, so we would not say you have to be prescribed an opioid before we will prescribe a non-opioid, so we don't use step therapy in that way at all. So, um, thank you. Step two was page 2 was the the question. that I was asking, and I guess the thing, if we don't go before that board for review or approval, would that allow other medications that are approved by the FDA to bypass that process as well. Yes, sir, that's my concern with this language that it will set a precedent for other drugs. That was my concern. Thank you. Representative Gramptledge, you recognize. Thank you very much, Mr. Chair. I guess my question is, um, so this bill would make us immediately start doing it. If we went through your process, how long would it take before people could have easy access to this drug. We're already covering it. It showed up on our drug file last night, which means it's eligible to be prescribed if I'm if if a clinician prescribes it, it's, it's ready to be filled. We may have prior authorization of 7 or 14 days or another type of prior authorization as we work through the process to get to the quarterly DUR board meeting, but we're not stopping it from being filled as of today because it's on our drug file. OK, I guess help me with my ignorance. So you say prior authorization 17 to 14 days. What does that in this context. So I'm going to ask Elizabeth to join us. So on certain types of um prescriptions we will limit the quantity as we, um, are learning about it and waiting for the clinical protocol to be set. You can correct me what I got wrong. Hi, Elizabeth Pittman, and I'm sorry I was talking to the uh somebody back there about this bill. So can I hear the question again? It was in context, I mean, I'm, I'm an education guy. I'm just outside looking in. So when we talked prior authorization, 77 to 14 days on a drug like this just speak in context what that would mean for an individual who needs this drug. So for this specific drug, Expire, which is a Vertex manufactured product that that um, you know, we think a lot of this bill is targeting. It just released yesterday, but I've had my clinicians review it. What we would probably look at for doing for this drug in particular is not putting a prior authorization on it, but looking at quantity limits that are appropriate. I don't know those off the top of my head. I'm happy to get those for you, but we would be looking at something like that for this specific drug, OK, so today if I went and broke my arm and I went to the ER and got it fixed. If an ER doctor knew this drug existed, they could prescribe it to me. Yes, absolutely, and that's FDA approved drug. We, we, that Medicare has entered into an agreement with, we have to cover it by federal law. So. Representative Doctor Johnson, you recognize. Thank you, Mr. Chairman. Thank you, thank you. Uh, I'm trying, so the for an opioid drug that's new to the market. What would be the process for that drug with regard to utilization review prior authorization. What's the current process for an opioid drug. It's the same as what Miss Mann described, our director Mann described earlier, we would get that drug filed, that FDA approval, we would look at it and determine. A lot of times we do a PA automatically. just because it is brand new, we haven't had it reviewed by our board of clinicians, um, that PA would be tied to what the FDA approved. So the indicated uses if I'm reading it right and I, I may not be, but it, I think it's saying that you just can't have a more Uh, extensive prior authorization or step their requirements for a non-opioid, then, uh, for an opioid, and that the immediate language just says it would apply to that portion of the bill. So I mean to me it looks like all they're really asking for is once it's approved, you can still go through the same process as you would go through with an opioid drug, including reviewing all of those things, you just can't make it more restrictive, is that correct? I'm trying to understand that and I'm not, I would defer to. Representative Vaughan and Hen vote on her intent. I think we read it to say that whatever the least restrictive requirements of an opioid drug are, that's what we have to put on non-opioids, all non-opioids, which is a very large group of muscle relaxers, Tylenol, it can be a A uh antidepressant that's used to treat pain. I think that's our concern. OK, OK, I think I understand. I just not, I'm not quite sure I read it quite that same way, and I'm not quite sure that's the intent. I would think the intent. I'd have to ask the bill's sponsor, would be that we just level the playing field between opioid and non-opioid, and if there's a process in place for opioid drugs, we make it the same process for non definitely agree with and would want to do the same thing, I believe, as a Medicaid, I would say that we're doing that today. Yes. OK. I mean, I think if, if I could read it that way, I don't know that. I agree with you. That's the the intent of the bill. Just making sure, sorry, but that is the intent of the bill. Yes, sir. So does, does the sponsor have a request? I mean, I can pull it down and we can put an amendment on it, um. So why don't we do this? We've got a bill that's gonna take a little bit of time. Why don't you go to pull, I'll allow you to pull it down, go work with the department and stakeholders and when we get done with House Bill 1382 we'll revisit it if you're ready. Thank you, sir. Is that, do you still have a question representing Pilkington, or are you OK? Hold on. Um Representative Ladyman, House Bill 1382. Remember this is where you find out what public health is all about. We'll be here until 1:30 if that's what it takes. I didn't start a Representative Allen. lady in you recognize. Thank you, Mr. Chairman. I have an amendment. Yes, sir. Thank you. You take the amendment up first, OK? It's being handed out, uh, and, uh, members, you'll get a copy of this in a minute, but uh, basically what the amendment does, we, we took out some requirements on the reports. And just change some words, like we changed um Being present at each meeting to meetings requested meetings. Um, counsel, when requested. So a few word changes. That's basically what the amendment does. Um Members, do we have a, what's the pleasure of the committee on the amendment. I haven't motion to pass on the amendment. Any discussion on the motion on the amendment, seeing none all those favor, say ah. I post. I have it. Representative Ladyman, you are recognized to present your bill as amended. Thank you, Mr. Chairman. Um, HB 1382. What's this thing? Uh, HB 1382. Um Recently, uh Legislative council passed a rule changing the name of the hospital and Medicare study subcommittee to include developmental disabilities. This was done to allow legislators to understand and be informed of how individuals with disabilities are being served in the state of Arkansas. One, corporation that provides services to individuals with disabilities in Arkansas is disability rights Arkansas. Disability rights Arkansas is a designated protection and advocacy agency for Arkansas. They are an independent nonprofit corporation. Uh, that was appointed by Governor David Pryor in 1980 in compliance with the Olmstead Act that was passed back then. Uh, the, the name of their organization has changed a couple of times, but it's basically the same, uh same group. They are funded by federal funds, private funds, and nonprofit organizations. They received no state funds directly. They have oversight. From their funding organizations. They have no oversight at the state level. They submit reports to a federal organization and other organizations that fund them. Um The reports that are requested in this bill. Uh, they, these reports that they already provide to other people could easily be given to us and meet the requirement of the bill. They have no oversight by the state of Arkansas. While they provide services. To our most vulnerable citizens. They do good work and a lot of areas. But some people who they serve. I think they exhibit government overreach in some of the areas that they work in. So what does this bill do? The bill simply requires them, the RA, to attend our subcommittee meetings when requested and to communicate to the legislature, their successes and their challenges. That's the bill. Any questions on the committee? Representative in it, you recognize for a question. Thank you, Mr. Chair. Um, Representative Laman, um, I too have a child with disabilities, so I do understand some of the things that. Goes along with that. Um, however, I do have a question about this, um. Let me think of how I'm a form it, uh. So this seems to be. With this bill, is this going to open the door for us to ask other non-governmental advocacy groups to be summoned to a committee meeting if they don't receive any state funds. Well, the bill doesn't do that. I mean, that question would have to be addressed by somebody running another bill. Uh But this organization receives government money, um. And, and they, you know, the organization told me that they don't receive any funds from Arkansas, but the federal government doesn't have any money unless we are Kansans pay taxes, so indirectly. They're receiving tax dollars. OK. I have some more questions when I think of them. Thank you. see no further questions or committee. We do have quite a few members signed up to speak. Representative in it because you mentioned you had more questions we'll give Representative Ladymen a chance to answer questions before he closes, because once he closes, we cannot ask questions and sponsor. So I'll reserve that for you. Um. We have Katrina Robertson to speak for the bill. Miss Robertson, if you would introduce yourself for the record and you're recognized speak for the bill. My name's Katrina Robertson, and I'm a mother and guardian to my son Noah, who is 21 years old and is at the cognitive level of about a 4 year old. I speak in favor of House Bill 1382 and if passed, it would provide legislative oversight of the organization Disability rights Arkansas, often called DRA. My position is based on firsthand experience with our family, and it began when we adopted a 9 year old boy with severe intellectual disabilities and he also exhibited complex behaviors, challenging behaviors, mainly due to the abuse and neglect that he had. When he came to us, we entered him in public school and we were able to get waiver services for him. That worked fine for a while, but once he had passed adolescence, our lives became a nightmare. Won't go into all the details of what we endured, but I nearly lost myself trying to make our community work for him. We built Noah's small cottage next to her home. We arranged 24/7. Our caregivers, but his world increasingly became more restricted in his behaviors worsened. We cycled through waiver providers who ultimately would terminate their services with him due to their inability to meet his needs and quote, he was a danger to them and others and a liability and they could not adequately meet his needs. The following stressful years included crisis intervention by police, stays in the hospital, a homeless shelter. And multiple allegations of abuse. Noah was being served by community providers, but we never heard through DRA through any of this, even with the reports of abuse ER visits and police involvement. After another police intervention, NOAA was readmitted to the hospital. This time he spent 45 days heavily sedated on the floor of the hospital ER. After 45 days, the hospital gave up, Staff arrested him or and officers took him to the county jail in desperation, I made a Facebook post asking for legislators to be tagged, and that is when DRA finally reached out offering their help. But during the call, it became clear that their primary interest was assessing whether his treatment was grounds for a lawsuit. The DRA attorney applied that choosing residential care for NOA would strip him of dignity, and he, they instead suggested that I allow DRA to help secure better trained caregivers, maybe 2 at all times. I hung up that phone shaking with anger. It was obvious that DRA's agenda was not about what was in the best interests of my son. It was only with what aligned with their agenda. They weren't offering help, at least not the help that my son desperately needed. Noah spent 2 weeks in county jail before we were finally able to secure him a placement at the Boonville Human Development Center. I personally transported him from jail to the center, overwhelmed with a sense of failure that was 3 years ago. Can I give y'all an update on Noah. Noah's hard. He is tough. There's times when staff have to both chemically and mechanically restrain him to ensure his safety and the safety of others. Nobody wants that. But it's necessary at times. But the staff at Boonville are some of the most compassionate, hardworking, dedicated people I've ever met. They worked tirelessly to make sure Noah's safe, happy, and as productive as possible. They include me in every decision they make, and they seek seek my input. Have I had disagreements with them. Yes, I have, but we've always been able to come together and have a conversation until we came up with a solution for him that worked. But you know what, Noah has at Boonville that he would never have at home. Community? He has a job that he loves, and he's even earned promotions. In fact, it's a job through a program called 14C, which is also another program that DRA actively works to eliminate. He has a girlfriend actually I think he's got 3, but they don't know about one another, um, he has peers and friends. He enjoys outings and dances and talent shows and so much more. And when I bring him home in less than 24 hours, he's ready to go back. And when I stepped back and I watch him at Boonville. I see that he does have community. His community and it, I realized how disrespectful and discriminatory. it was for me or for anybody to suggest that a community of his peers was not good enough for him. Disability rights Arkansas, DRA as representative Ladyman already stated is the uh state, the governor appointed protection and advocacy system for our state, and they've been in operation since Prior's administration. So for a long time and that entire time with no oversight, audits or any formal review of their work. In testimony before the Public Health Committee in December of this last year, the executive director openly stated no one oversees us. We are a private nonprofit organization. While they do as he said, submit reports to those who are their funders. One of their largest funders is the administration for Community Living, the ACL. And they are very vocal about their primary agenda being eliminating all congregate care in 14C programs across the entire United States believing that disability rights Arkansas does not follow that same agenda is incorrect. Disability rights groups have already been successful at eliminating state-run facilities for IDD individuals in, I believe, 17 states. Yes, we still have 5 in our state, and they do have building projects going on, but only because the voices of extremely strong parent advocates in our group. Despite that they claim they do not hold a bias against human development centers. Their actions repeatedly contradict this assertion. DRA staff testified that they do not direct individuals towards any specific. Resources because quote they said they are not doctors, yet my own experience proves otherwise. DRA staff discouraged the option of congregate care and only offered to assist if I would agree to community placement, which had already proved to be inadequate and dangerous for Noah. In the past, rather than going in the appropriate route of an advocacy group federally funded by going to policymakers and asking for hearings as we are now. DRA instead used costly federal litigation to achieve their goals to downsize facility-based care. DRA, but at this time they've gone, they've had multiple names, was under the name DRC Disability Rights Center. They brought 3 federal lawsuits against Arkansas, not the HDC specifically, but two of them were class action suits in which they outrageously used HDC residents as plaintiffs in the case without the knowledge or consent of the guardians of those individuals, so essentially we had a federally funded group that sued our state costing it millions in the past, a complaint with the civil rights division of the US Department of Justice DOJ. Uh, they received a complaint regarding the HDCs in our state, uh, they did not consult the families of the HDC residents. I do not know if DRA filed this complaint with DOJ, but I do know that they openly celebrated the costly litigation that followed. They use the trial to use the media to publicly undermine the work being done at these facilities. In 2022, DRA promoted its annual disability rally, Pi Day at the state capitol with the slogan Close the front doors of institutions. I spoke with the DRA attorney about NOAA just before that rally and he outright denied that they had said that. I later forward him the email with their own promotional materials as a reminder. In 2023 Pi Day centered on eliminating 14C programs DRA invited speakers who are not a representative of my son and his peers. One of the featured speakers was a physically disabled individual with no cognitive impairments who emotionally ask the audience, would you work for less than minimum wage? Would you work for less than minimum wage. It was a question framed to evoke outrage despite the fact that this individual held a master's degree and is not a representative of those who rely on the 14C program. Another speaker went so far as to urge legislators to bypass parents and guardians of disabled individuals and instead speak directly to the individuals themselves. Let me be clear, I am the voice of my disabled son. He has been legally deemed unable to make decisions in his best interest, and the idea that they would urge policy makers to consult him directly without my input. It is unrealistic and irresponsible. The DRA exhibits clear bias by exposing imposing stringent recording, reporting requirements on the HDDCs while doing significantly less to gather the much larger population and community and home-based programs. If the community providers were held to the same rigorous standard, there would undoubtedly be substantial cases of error, neglect, abuse, and systemic failure. For instance, just last month in January. 29 year old Katerina Whitten. She was blind and autistic. She was found dead in her home, malnourished and covered in roach bites along with 5 other autistic adults living in the home. Similarly, in 2021, Larry Price, a 51 year old man with intellectual disability, starved to death. Found in his own feces in a cell in the Sebastian County Detention Center. Larry had the exact same IQ as my son Noah, and even had many of the same diagnoseses and took the same medications. It is impossible to claim that care within a facility is worse than care in the community unless both are subject to the same levels of scrutiny. I'm relatively new at this field of advocating for my son in front of a legislative committee, but it was shocked to learn, for me to learn that a federally funded program was allowed. To work against the very program that gave my son life. But even more troubling. Is that a federally funded nonprofit organization would fight this aggressively to simply Report to the people in which they are serving. As guardians of individuals who cannot self-advocate. We respectfully asked your assistance and vote in favor of House Bill 1382. Thank you. Any questions for the witness? Representative Bentley, you recognize. Thank you for being here today and sharing your testimony. Distinctly remember the testimonies that you're talking about during this committee. So can you tell me, do you think this bill will help and how do you think it will help to make uh Dre better. I think it'll make them treat your son better and that are disabled Kansans across the state. I, I hope that it will give an opportunity for the guardians to have a voice and. The reality is, is, is DRA does do a lot of good work, um, they, and they represent a enormous population. The group that we are advocating for is the very much the minority. There's a little over 850 individuals served at our human development centers and then there's also lots of private ICFs. The, the reality is that there is an idealology coming from the federal level, uh, to eliminate congregate care in these programs for the severely intellectually disabled. Like I said, many states have already gotten rid of them with disastrous consequences, but that is not investigated or or researched. So, so ultimately, uh, you know, it's our goal to be able to state the reality of some disabled individuals situation and to be respected. as the Guardians, they very much promote self advocating for disabled people, which absolutely is a very good um priority and goal, but there has to be the awareness that some disabled people simply are not capable of doing that. Thank you, ma'am, you mentioned Larry Price, and I'm familiar with what happened there. Are you saying that what happened with Mr. Price was a result of No, no, what I'm saying and and Larry Price, you know, like I said, um, I felt a lot of guilt and failure when I, I, I came to the place where I had to, um, admit Noah into a facility, but it was just shortly after I did that, that I learned about Larry Price and like I said, he had the exact same IQ as Noah. He had the same diagnosis and I was struggling with him. Am I a failure? Am I advocating the right way for Noah, and I realized were it not for me advocating for Noah. He could have been Larry Price and, and the only reason I, I mention um Larry Price and then the woman who who they found last month is to bring awareness that there are individuals that are Suffer great abuse and neglect in the community as well, but they only want to focus on the institutional care, the facility-based care and you know our HDCs, they're licensed by the Centers for Medicare and Medicaid further there are also accredited by the Office of Long Term Care. They're also accredited by CAF. These facilities do not have any other oversight and they are a very small. percentage of our population of disabled people, there is an enormous population within the community, and it seems like there should be a not such an unbalance as far as where their laser targeting looking for abuse and neglect. Any other questions? Representative Bennett, you're recognized. Thank you, Mr. Sherman. I do have a question. So by requiring DRA to submit reports, what is that going to do I mean by them reporting information, is it going to help solve the problem or how, what's the recourse after they make these monthly reports to the subcommittee, I think that, you know, if they're, if they're advocates and they want to, if they see problems and and issues, they need to report those and give parents and guardians. an opportunity to maybe give insight into those reports and some perspective into the, the, the reports, um, you know, these individuals that are served are highly complex and you really have to understand the whole entire situation to have perspective on certain policies and procedures and uh, you know, this, this isn't just about disability rights Arkansas. Like I said, this is coming from a federal level and, but there are other states. We, we are actually following in the footsteps of a few other states whose parent and guardian groups have also gotten tired of the resources that their loved ones depend on being dismantled and destroyed that have passed similar legislation to just let's bring some accountability that, uh, you know, they, yes, they receive federal funds, but I see them as being employed by the state of Arkansas. The governor appoints them, but since Governor they have not been reviewed or they're the work that they're doing looked at and, and I, I see this also as an opportunity for them to report on all the good things they are doing. They have a huge population. They serve not just the disabled, but also um elderly as well, uh, and it's not only is it huge, but it's growing. See no further questions, thank you for your testimony. We'll move on to Sara Evert to speak against the bill. I, I think I signed up after Tom. I wonder if you could go first and you're on the list, but if you want to reserve your time, that's your request. I would, I would appreciate that. I think he needs to answer your questions before I speak. OK. Mr. Tom. With the disability rights of Arkansas, I'm not even going to try that last name. it Thanks. Us dirt farmers, we're not very good with these long names. That's right. If you and your guests would introduce yourself for the record, you're recognized to speak. Absolutely. So, good morning, um, members of the committee. I am Tom Massa. I'm the executive director of Disability Rights Arkansas, and with me I have Thomas Nichols. He's our director of legal um legal advocacy services at disability rights Arkansas. Um, want to kind of first kind of lay the groundwork of about who we are and what we do. Um, I've seen a lot of misinformation out there and just kind of lay that out for everybody. We're an independent private nonprofit nonpartisan. Um, protection and advocacy organization we're authorized by federal law to protect and advocate for the civil and legal rights of individuals with disabilities here in the state of Arkansas. As has been mentioned, we've been around, we've been incorporated since 1980 as a private nonprofit organization. DRA provides information referral, legal representation, technical assistance, outreach, and short-term assistance to individuals across the state. We provide an extra layer of protection to people with disabilities in Arkansas at no cost to the state. As has been mentioned, we are federally funded. We receive no state funding. Um, we have been authorized through the Developmental disabilities and Bill of Rights Act of 2000 that the protection and advocacy service agencies are to be independent of any agency that provides treatment, services, or habilitation to individuals with developmental developmental disabilities. We are not the state government. We are not the federal government. Our work is is not an extension of any government. Instead, we we are client driven. We cannot make decisions for individuals. That is by design to be independent. Our goals and priorities are set are set annually by our members of our board with input from community surveys which is available for everybody across the state to fill out. Our boys, my board is made up of individuals with disabilities, um, family members, friends of individuals with disabilities across the state. We're a member of the National Disability Rights Network, um, which is a group that provides technical assistance to the designated protection and advocacy services across this country, but they don't dictate the work that we do and just like the National Conference of State Legislators does not dictate how you vote or how you introduce bills. DRA has a budget of 2 million of $2 million.22 dedicated passionate staff who take calls from families across the state trying to access the educational services and supports receive health care and receive healthcare and services through Medicaid Pass, gain and maintain employment opportunities, and we monitor the state institutions. The staff listen to families and investigate complaints just like the cases that we shared with you in our email last night. But those are just a few examples of the work staff have done and yet and yet despite multiple efforts to work with the state to create a safe environment for residents, there is little to no action taken by the division on Developmental Disability Services. The developmental disability Services Board. We get accused by families that the information is overblown or inaccurate. It is demoralizing to see the amount of resources that we put into these reports and provide them. 2, the state developmental disability services, the developmental disability Services Board policymakers, and the administration with little to no action when we do present this information, we are accused of lying, falsifying information, are not being accurate, despite the information obtained from the state records themselves. We provided information on our work to legislators and the work that we're doing with psychiatric residential treatment facilities. Um, we've had meetings with the Department of Human Services over this issue. I believe we met for at least 6 months straight talking about these issues. We've reached out to the legislature. Um, in 2023, we met with the governor of staff talking about these issues, the concerns that we had in the Little to no oversight in these facilities. 6 and we presented to the US Senate Committee on Finance addressing these issues. 6 years later. We're still trying to get some action and some oversight. And these issues. And yet staff continue to go out and do the good work for the people of the state of Arkansas. What will this, what will this bill change? There's nowhere, there's why, um, what will this bill change? There's no requirement for the committee to do anything with the information presented. Absolutely nothing. We provide the reports already. I have a stack of reports. You say there's no oversight. We report to 9 different federal agencies. We have an audit. We, we've been monitored by the substance Abuse Mental Health Services Administration on site. We have a board. We have a lot of oversight for an agency with $2 million. And there there seems to be some confusion about our work. We don't have the ability to close any human development center or any other institution across the state. That power lies with you, the legislature. I have been the director since 2013, and no human development center has closed. DRA has never filed any legal action against the Human Development centers. If you disagree, I would encourage you to look at court watch, look at the court records to see. Yes, in 2009, the Department of Justice came into the state to file a lawsuit. My agency had no interaction with that. We were silent in that matter. We were not a. We were not a plaintiff. We did not provide information. We don't have enforcement powers. We do not have the ability to force providers to do the work. All we can do is provide the information to policymakers and providers to create change. We are willing to meet with whomever, whenever, to talk about our services that we provide. When asked to present before the committee in November, we happily did so because we thought it was an opportunity to engage the joint uh public health, welfare and Labor Committee to talk about the issues that we see on a daily basis to get some resolution, to get some action taken. However, since that meeting, there's been no communication. At all. We didn't even know in December that the um Arkansas Legislative Committee was going to be proposing an amendment or a rule. We didn't see this bill until it was introduced. So where's the communication if we want, if you want the information, ask me, call me anytime. I'm willing to meet with anybody, right or wrong, to hear your concerns. But this is more than reporting. This is for oversight purposes. Oversight is influence, and we're required to be independent based on our federal statute. Just a couple of things, um, we, we obviously oppose the bill if you haven't figured it out already. Um, the bill is written is is broad and vague. Um, it's an unfunded unfunded mandate. We provide the reports already. They're available. The federal government is a custodial of these of these reports. Reach out. Ask for them. Our audits are public. Um, our board, my board is accessible. Um And then the protection and advocacy systems were established to be independent of state and federal government. While the agency doesn't receive any any state dollars um. We are still a private nonprofit organization and if passed this bill has broad implications for other nonprofits across the state. There and there's no other. Private, nonprofit organization in this state. That has Their organization named specifically and statue to come before a special committee. To present information that's already readily available with no required action from the committee. If you look, Blue Cross Blue Shield, large nonprofit corporation. Are they written if they have to come before a committee? Are there other nonprofits? Were federal, we're a nonprofit with $2 million. What slippery slope are we going to go down if there's a few individuals who are unhappy with the work that we're doing on advocacy. How far are we willing to go down the road to require nonprofits receiving no state money to come before the legislature to provide information which is already readily available and I'm willing to meet with anybody at any time. Nobody has reached out to me since November since that committee hearing. So I'm gonna turn it over to Thomas talk a little bit more. Those of you who have, uh, Access to grant funding, know that you are limited in what you can do with that money. People don't just give you money to do with what you want to do. You, you are limited to the terms and conditions of the grant funding that you receive and the developmental disabilities grant is no different, right? We can't use that grant to help people get into an institution. The very statutory language that uh that grants us, that allocates us that funding as the state's protection and advocacy system, uh. Limits our assistance that we could provide directly to individuals to access services that are integrated that promote self-direction and independence, so we cannot use those to help people get a more restrictive setting. We have to use those to help people find the least restrictive settings in the same way that we cannot use our Social Security grant that we get to help people off of Social Security. We can't turn around and use it to help people get on Social Security, no matter how many people need that assistance. It's simply not the terms of the grant. So to meet, uh, To meet the request that we use funds to help somebody get into an institution that would be misuse of our grant funding and I want to say that uh Ms. Robinson's experience should not be anybody's. Right? We have community services that are supposed to be available to individuals in the community. Uh, we have, uh, Nearly 100 cases right now that are uh just about Medicaid access just about getting people access to those community services that failed her. Many of those individuals, they they are authorized to receive 24/7 care in the community. They're required to have a staff person 24 hours a day, and for whatever reason they're not receiving it. Right? And that leads to the type of situation that Ms. Robinson and her family were in. And I don't think that that should happen to anybody anywhere, but We could not help her get into. The human development center. That's not something that our grants will allow us to do. I would have loved to have had the opportunity to be able to assist her, um, and making sure that those services that could be provided in the community could have been provided in the community. That was not her choice. We did not force that decision on her. We can't assist somebody with something that we cannot assist you with a question for you. Is there a place in this bill where it's instructing you to help someone. Uh, gain access to a facility or to be more restrictive. I'm sorry. You're testifying on something that I can't find anywhere in the language of the bill. And I'm just wondering why. Uh, or, or, or do you owe something we don't know about the language of this bill? Well, outside of the language of the bill, I mean that was That was the testimony of the individual who was here today, uh, of what we could and could not do. Let's just strictly on the language of the bill, please. OK, um, And not having seen the amendment, I'm not sure what is no longer in there, um. Which I would Not knowing what it what what it specifically deletes, I'm I'm not sure, but uh, reporting, uh, Requiring us to recreate and duplicate uh information to the committee. We fear that if the committee is requesting any information that that could impair our ability to provide the protection of attorney-client privilege could put us in the position of possibly violating federal law with the production of Uh, documents that are protected by other federal laws. So this could have a very chilling effect if we're required to uh collect the kind of information and provide whatever the committee wants on our ability to be able to represent individuals. And Mr. Chair, if I can just also address the question regarding in here. There's nothing in this bill that requires Um, yes, we provide the information to the committee. But there's nothing substantial that the committee does anything with the information we provide. Similar to we can we currently do that right now. We provide information and there's no It's to us it's a duplication of what we already produce and provide and also further to mandate a nonprofit specifying disability rights in Arkansas as coming in states in statute to come before a committee when we're happy to come before any committee. We did that in November. We've done that in the past to provide information and talk about the work that we do. I think it's just an overreach to put into law requiring because when we're no longer here, this is still going to exist as a nonprofit to come into and provide information when the committee meets. But again, to what avail? You're not requiring the department to do anything with the information that we provide. There's no requirement for you to pass laws on the information that we provide. We're doing that currently, so I don't, so that's the part that's really frustrating and why we're fighting this is we currently do this already. There is nothing more in this language other than requiring disability rights, Arkansas, a nonprofit organization to come before you, you're legislating it, you're putting it into law. That's it. This this Department of Human Services ignores our stuff that we provide anyways, so what I don't understand. That's, that's. What we're trying to grapple with right now. Representative Pilkington, you recognize. Thank you, chair. I'm, I'm kind of confused by the logic of your testimony here, um, you're saying that you already produced these reports, correct? That is correct. But then you're also saying we're creating a burden on you by having you basically copy these reports, then bring them to a committee and then present them to us. I mean, I guess I'm Rubber meets the road. If you've already created these reports and we're just presenting them and we now have a piece of legislation that requires us to review them. I mean, to me that that's a good thing. What what gets measured gets changed, uh, you know, we just talked about maternal health. I mean, the reports from those committees and have helped us, you know, improve policies. So I'm, I'm kind of confused here. I mean, if you're saying, well, it's already available, it's already out there. Why does it hurt to then take those same reports, put them in front of committee, and then have this legislature shall review So that we can actually, if anything, provide more light to what's going on. I'm just, I'm confused why suddenly this is a burden and it's a problem, but you're already doing it and so that's a very, I feel like. I feel like it's, I'm hearing two sides of a different argument. So my question is, can you provide clarity? That is my question, chair. Can you provide clarity because I don't think it's very clear, is it creating a burden for you, or is it not? And then if you are creating these reports, why is it difficult to then present these not only to the federal government but to the state government as well. Yeah, that's a great question. I think one of the one of the things that um like I said, we have the reports, they're here. Our issue is um putting it into law. I mean, I'm happy to come if you, if you call me up tomorrow and say, can you come before the Joint Committee or the Arkansas Legislative Council to present information. Absolutely, but to legislate it and put it into law. Requiring us to submit these reports, which we have, but then there's also another caveat and it says um respond and report on all information requested by. So that goes above and beyond what, what we have. So I'm just, I'm just Struggling with the fact that as a nonprofit, um who who already has multiple oversights and produces this report. I'm happy to come before you and to provide it, but to legislate and require, put it into law as a nonprofit has to come before. At what point does it stop? because if there's other nonprofits who are unhappy with what we're, what they're doing. Where does that stop? Like I, so do you kind of see where I'm coming with it? It's, I have no problems providing you with the reports. I really don't, but it's the what you're saying is right now. What is you feel is being required. You have no issue complying to that, but you worry about in the future that we will ask for more information and then that will become burdensome to you. Is that what you're saying. I want to be after going through the amendments and seeing them in concert with the bill itself. It changes it from provide all information requested by the hospital, Medicaid and Developmental Disability Studies subcommittee to provide information requested by the, uh, hospital Medicaid and developmental disability studies, uh, so it doesn't change the meaning of it. Instead of it saying provide all information. It says provide information, but it doesn't let us select what. information we provide, it just openly gives the blanket authority. of the legislative subcommittee to request whatever they want. And if this is an Arkansas law, we have to abide by that in the same way that we have to abide by federal law, right? And that steps on things like privilege, uh, potential federal laws that would be implicated by our production of some of this information. We get information that is subject to disclosure laws due to maltreatment. Uh, there's nothing in here that says unless other law prohibits are disclosure of that information, federal or state or Otherwise, and I don't expect that the legislature would be happy if we're making the decision about what we think we ought to give you, uh, versus what you all want to receive. Representative Pilkington, you have further questions? No, no, that was, they answered my question. Thank you. Representative Rose, just getting old is not for the faint, by the way. Representative Rose, you recognize. Thank you, Mr. Chair. It's kind of debating which, which direction, uh, to kind of take the questioning. um. It was brought up And the, the chair kind of took us back to something more germane to the bill itself, but since you did bring it up, I wanted to address, um, you had said something along the lines of that you wish you could have helped. Uh, Miss Robinson with her family's needs and the center that she was trying to get to that you wish you could but that you couldn't. And that your funding wouldn't allow it. I was curious how things stand currently, how do you interact with the facilities, am I interpreting your testimony correctly, but you said you wished you could help, but that you weren't able to, is that right? I said that our federal grants, they don't allow us to work for that purpose. I'm pretty sure that you said that you wished you could. I, I would have loved to have helped her in the area that we can actually work in. Do you guys have any with the facilities and Booneville or Conway or any other similar ones frequently. OK. What are those interactions? Sure, so another one of the uh Another one of the purposes for which we are given this grant is to monitor facilities for things like human rights violations for abuse and neglect facilities and community settings and The idea that we don't go to community settings. Uh, I I don't know where that comes from, but we, we did go to 40 in the past few years, 47, uh, community and employment supports waiver provider settings, 57 individual homes. 15 residential care facilities, 36 skilled nursing facilities and 29 uh community support service, uh service providers. So I over oversight capacity, is that what I'm hearing? We don't we, we're not the federal government, right? We're not the state government. We don't promulgate rules. We don't, we're not law enforcement, OK? We're a private organization that's been granted authority to be able to go in and monitor uh uh facilities and anywhere that an individual with a disability uh lives or receives services. OK, oversight may have been. Slightly the incorrect word, monitoring and looking for violations. Yes, and we can also investigate abuse or neglect or exploitation. Do those places send you any kind of reporting? They do. Um, is it, is any of it mandated or do you have to request it? Some of it's mandated. We we do request additional things, but yes, so you're monitoring those facilities for Bad behavior. I'm just trying to, that's, that's something that would be a violation, essentially, yes. Um. Now, your organization is a PNA, is that, is that correct? And that's, that's federally mandated. That's correct. OK. Um, So I, I heard and Representative Pilkington kind of went down the same path that I was trying to go down. Um, I heard that You guys would be opposed to having something that's more stringent and in requiring you to provide reports. Is that correct? Can you this bill you, you, you're opposed because of the requirement. Of, of you being a nonprofit requiring these reports to come in. Yeah, we're, we're opposed because you're putting into law requiring a nonprofit to come before. We already provide the reports. All you need to do is just ask and request. There shouldn't have to be written anything written into law to do that. We can make them readily available at I just don't understand the need for to write into law that we as a nonprofit must come before. The only nonprofit to come before a committee to provide these reports. Can we, for a second, set aside. Not understanding the why. Just, just for a second, I'm not saying that that doesn't matter. Is there some reason beyond not understanding the why that you'd be opposed to the reporting requirement. Um, no, I mean my question would come back to you is, so, The reports we have supplied multiple reports to the department and to various members of the legislature on various issues. No action, little to no action has been taken thus far. So I guess my question is the purpose of providing these reports is to what? Is it to look at the what we're doing and to review and ensure that we're providing all that, or is it to look at, OK, yes, there was an individual who was malnourished at a human development center. The state took 5 months to investigate it and nothing was done with it. What does, what, what does that mean to this committee that would be What would they do with that information? because we've been doing that since I have been here to little to no action on some of these reports that we provide. So the suggested ALC subcommittee in this bill, so it's hypothetical in nature at the moment because it doesn't exist, so I can't, can't speak to what would exactly happen, um, but my guess would be This is going to have to do with more transparency. And I would also suggest that it would be able to analyze whether one particular group. Um, of family members who may require lifelong care and guardianship or a different type of care. Are they being responded to or treated differently and or are we seeing a a a reduction in parental involvement in maybe that particular subset of of of patience, and those are obviously some concerns that have been voiced. So if the transparency would show that. And open up pathways to providing care for those families. Wouldn't that be a good thing? It In reality, yes, but based on my experience, it has not occurred. So based on the experiences that you've had without having these reporting requirements. Again, we provide the reports already and they're available and little to no action is taken on them. We we don't distinguish between whether or not a family member is actively involved in in their in their lives and we're out, when we're monitoring when we're doing the work. We are client directed, so if we see somebody with a broken with a black eye or not receiving services are not going to education when they're supposed to be, we, we address those issues, so we don't, we Single out, oh, this is a vocal family. We don't do that. We look at all individuals in these facilities, um, and there's a lot and there's a lot of individuals that have no voice in these in these facilities who go and abused or neglected and receiving no services that don't have the family support that you just heard from. So we're looking at all individuals whether they're in the community or not, to ensure that they're receiving services. I appreciate the latitude, Mr. Chair. This is I'm wrapping up here. So for the families who feel like maybe they have slipped through the cracks or that their family members slipping through the crack. You're saying our grants prohibit us from helping these people. Is there an option for you guys to be able to help them to access uh facility as opposed to community services. Our developmental disability grants are pretty clear that we have to use them with the principle to access integrated services. So are there other grants that you could apply for or receive that would open up those pathways. It wants to establish a protection and advocacy system to access facilities. You all have that authority. OK, so when you agree if, if a decision like that were to take place. Maybe be reviewing some reports in a subcommittee and having those things would lend some assistance in that. I'm, I'm not sure how the legislature comes to their decisions about that, but I understand and I appreciate that. I would, I would suggest that I think some of these things are trying to take place with this bill, and, and providing some oversight that would help those families who are really in a hole. in coverage, so to speak here. So thanks for answering my questions. Representative Bentley, he recognized for a question. Thank you, Chairman. I'll try not to be redundant on this, but I'm really, I'm really troubled by the lack of concern you have for the last testimony of the parent that was here and her concerns, and I find it, can you tell me that you cannot, you're prohibited from telling individuals in the community that had been failed by community services because she had community services, and they failed her family and you're telling me that you can't even let these individuals know that these are residential. facilities exist in Arkansas. We can't even let the parents know that they exist. Is that what you're telling us? No. No. OK, that's what I seem to hear from you is that you couldn't even let them know that they exist. No, no. If, if that was your impression of what I said, I'm, I apologize. OK. And I also want to say that I, um, do you not agree that here today we're hearing some things that we haven't learned about and being in, I would suggest that non-government agencies would just thrive to have the opportunity to become it before a body and hear these concerns and make different policies situations, and fix the things that you're concerned about with the Department of Health and those in The DHS. This is what this committee is for. We fund those and um Do you not agree that every tax dollar that you receive whether this federally comes from taxpayers across the nation, including taxpayers here in Arkansas. I, I, I would agree with that, but then I would also agree that the other nonprofits that receive federal funding also should be subject to the same scrutiny that you're holding us to. I would, I would, uh, disagree with that because it's not scrutiny. We're trying to get to, we're trying to make things better for our disabling. Would you not think that that's really a subset of our community that we really should get higher attention from us that disability disabled our Kansas. get higher scrutiny from us and that we should be able to advocate for them better. I think that they deserve, I think they deserve that. Do you not think they deserve that? Absolutely I do, and we've been, we've been, we've been doing that since I've been here in 2013, providing that information to the state and else into this body as well as the agree that information needs to be available and provided to you. My issue is just legislating and putting into law that a nonprofit organization come before a committee to provide information for what purpose because there's no direct piece of what are you going to do with the information we have this information we provided it. And nothing is being done with it. We've given it to the state and so that's, that's where I'm, I completely agree with you. I think there needs to be um looking into what services are available across the state, both in the community as well as in the residential and I think you as a legislative body needs to be looking into that, and we can provide those reports but requiring a nonprofit legislating into statute that we come before you. I think it's a, it's a a little bit of an overset because it's a slippery slope for other nonprofits to look at, and that's just We provided the reports and there's been little to no action taken so far, OK. Thank you, and we've heard that 50 times, so it might be good to be a little shorter with your answers would help things move along here so we can get to some more answers, but, um, I would say I've been a member of this committee for 10 years. I've been happy to be a part of this, and I have not heard any of these reports or seen any of these reports, and so to me it's a way for us to be targeted just like we did with the maternal health. This will give us an opportunity to be targeted to make effective policy decisions for us to get together and hear what's going on, to see the report, to discuss and bring different policymakers into the room, I would say that you should be delighted with this bill. I think this will be help our disabled Arkansans greatly, and I'm just concerned that you're not delighted with this bill with an opportunity to see policymakers because you're frustrated You're not seeing changes, but this bill will allow you to see some changes. This bill will have you in front of lawmakers that can make the changes that you're wanting to see, and so I, I'm just very disappointed that you're not delighted with this bill for us to see the reports, for us to come together and subcommittee and make some substantial changes from our Kansas because I'm very distraught, very distraught about the emails I have received from parents across the state of what you have been doing and how you have failed patients across the state, so I would say this is a great opportunity for you to make some good policy changes and uh with that chairman, I'll close. Representative Johnson, you recognized. Thank you, Mr. Chairman. Do you know, are there other nonprofits in the state that are federally mandated to take on the roles that you take. Are there other like entities in the state. I mean, it seems like you're pretty unique nonprofit. Would you agree? Absolutely. Yeah, and so when I hear you say that we don't require reporting of other nonprofits. I, I don't know that there's a A similar nonprofit in the state, so it feels like a very unique situation, and I do think, and maybe you could help me because you are a nonprofit that all nonprofits are required to do reporting and accountability and fundraising, all those are reporting to the Secretary of State. I mean we do as a body require nonprofits to provide reporting across the board, so it's not unprecedented to think that we might require some reporting, and it does feel like to me that you're at a very unique nonprofit, um. would also, and this is, I don't know, it's hard to frame this as a question, but it seems that one of your biggest concerns is the lack of action that's been taken by DHS and others when you've drawn attention to some of your reports. Is that true? That that's um a portion of it. I mean, that's not the the big piece of it, but yes, and so again this bill, if I read it correctly, it says that the subcommittee shall Review the report, so you're now forcing legislators to listen to the issues. I, I, I guess I would agree with Representative Bentley, do you agree that it's a good thing to have your voice heard. And be mandated that your voice be heard in a committee. I I agree that our voice should be heard. I disagree with the with the intent of mandating it. And going beyond. that's not our only issue with, with the bill. I mean, the, the, the fact that it requires us to provide information requested by the committee regardless of what that is, and we provide Legal representation to people. Yeah, I don't think that was my question, but sure, I heard that. Representative Long. Thank you Mr. Chairman. Um earlier, y'all had mentioned that I guess your organization was started under Governor Pryor. I was wondering if you could tell me, was that done through the legislature that they created your organization or was it like an executive action by the governor. So, um, so we're part of um just I'll try to make this really quick, um, back in the late 79 in the late 70s, Geraldo Rivera did an expose on Willow Brook. It's an institution. He went in and crawled under the fences and this did this big expose of individuals who were not receiving services, who were abused, who were being neglected. He came and presented that to to Congress and then Congress created the protection created the protection advocacy systems, and from that it required at that time, every state to designate a nonprofit organization to implement the federally protection and advocacy services. So that's how it all started back and then. It was, it was congressionally mandated, and President Kenny did that. OK, so the governor did it through executive action, not wasn't done through the legislature. Is that what you're saying? I believe so, but I can go back and double check to make sure. The reason I was asking is I was wondering, you know, if the prior governor did that, could the current governor basically abolish Y'all's organization and start a new one. So yeah, that's a good question. One of the things that um that we've also often get questions about is um redesignation, um, and so the only um it requires the administration of community living and redesignation is only happens if we're mismanaging our our funds. That's why we do all of the the audits and everything that we provide to the to our funders, um, and whether or not we are abiding by the rules and regulations set forth in the Xs which govern us. Well, kind of building on what Representative Johnson said earlier, it does appear that y'all are very unique type of nonprofit organization and because of that, I think that's why you're getting maybe a little more scrutiny than uh you know, other nonprofits because of, you know, not only just the tax uh taxes that are being paid by the, you know, federal. Federal taxpayers, but also because of this unique way y'all were created, so I don't think she feel picked on, you know, it's sort of a just a result of having you all come into being. Thank you, sir. See no further questions. Thank you for your testimony. We do have a Julia Frost signed up to speak for the bill. I've got a motion. OK, uh, hear your motion before I recognize her to speak. Uh, motion for a consideration. I cannot take that motion because there's not a motion on the floor to immediate consider, but I could take a motion of call of the question. Motion call the question. That's a proper motion. All non-debatable. All those in favor say aye. All opposed. I have it. Can you state your question, Representative Billerton. I guess my or your motion motion is pass. That's proper motion as amended, as amended. Is there any discussion on that motion? Representative Rosa Recognize you first. How many others, uh, fors and against do we have signed up to speak today. I can't answer that this time we've passed that. OK. It's OK Uh, I guess my discussion is I'd like to let the the speaker at the table and give their testimony we're like I said, we're past that with the passage of the call the question. Representative in it, do you have a discussion on the motion? Yes, I'll be able to say something on the motion before we we're voting right now. You're in discussion. You can speak um, many moons ago I used to work with parents who have students or have children with disabilities as an advocate. I too have a somewhat disabilities, multiple disabilities and DRA does great work throughout the state of Arkansas. I partner with them. several events I've used them. I refer parents to this organization. I feel like this is a one-sided. Argument Mandating A nonprofit to make reports when they have repeatedly said that the reports are made available. I feel like it's government overreach and um I will be voting now. Thank you. Any other discussion on motion? Seeing all those in favor, say ah. I post. I have it. Congratulations, Representative Ladyman, your bill is passed. Two of the members, we will go back to Representative Vault. And I believe we have the amendment. Yes sir, there's an amendment. I'm I Time to go. Yeah Yeah We'll give staff a second to pass the amendment out. The moment that's being passed out, um, both parties have come together. This is a good amendment to clean up, I think Representative Wooldridge's questions and representative Johnson's questions, um, and I want to thank DHS and the, uh, people that I was working with solution and still do something great favor, say ah. I post, I have it. Without going over any old information. Yes, sir. So, um, as DHS was talking in the hall with the partners, they felt like the last paragraph was redundant and not needed, um, and the other uh part was there was just one word that uh Representative Johnson thought needed to be changed and it was just an A online, uh, page one on line 28. We're still doing it's still the spirit of the bill to, to, uh, do non-opioids and give a level playing ground for them and the opioids, and I, and I'm closer.