Public Health, Welfare and Labor Committee - Senate

committee meeting to get finished, um, and so before we dive into a few things, um, but what I'm gonna do is I'm gonna go ahead and start us and, um, because there are I think a couple of bills that shouldn't be. too difficult to manage. And so I'm just going to go ahead and go down that line, and, uh, start with HB 1310, um, I'm going to go out of order on the agenda. I, I will. I'm just explaining what I'm doing, um, and so thank you. Um, so we're just, for the members of the public, we're just going to go ahead and get started and then, um, wait for the members of, of transportation to get over here as quickly as I can. Right with that. We will call the meeting to order. OK. We're going to go out of order, so Senator Flippo, HB 1310. You'll just state your name for the record and you can, uh. OK, hold on just a second. We've got to have the mics working. Yeah, you. Our technical assistant. Oh, OK, they're coming. One to testing, 12. I'm just checking with Rob to make sure he has his back on live stream. There is. Testing 12. Testing 1212. Thank you so much, Rob. We appreciate y'all. OK, Senator Flipco, you'll state your name for the record and you're recognized to present House Bill 1310. Yeah, thank you, Madam Chair and thank you members. My name is Senator Scott Flippo, District 23, and so this is an. House Bill 1310s and agency clean up bills. So what this does is it's going to abolish the Arkansas Commission for the Newborn umbilical Blood Court Initiative and you know transfer all the authority over to UAMS. This commission has not met in the past 3 years, nor has had any appointments in the same number of years, so the money is already there and in an account with UAMS and so they, along with the Department of Health are in agreement that this is a simplification with the Blood Bank initiative already up and running with UMS. It's just overlap there, so they believe that UMS is best position to serve this need. Andy Davis is here to be happy to take any questions. All right, members, are there any questions? Senator Payton, you're recognized for a question. Thank you, Senator Flippo. So obviously there's no longer going to be a commission, all of the power is going to be vested in the University of Arkansas, which is going to have a director, so it all boils down to one person. Uh, but on page 5 at the top. It says make available to the public the records of all meetings of the commission and all business transacted, that's being scratched, so is it no longer gonna befoable? Anything that's being done. Yeah, we got I'm trying to hear from Department of Health. Oh Good afternoon, Laura Su, general counsel for the Department of Health. All the records are going to be maintained. Everything's just being transferred over to the UAS. but this Paragraph that's being stricken at the top of page 5. As the paragraph says make available to the public the records of all meetings of the commission and all business transaction. Right. That's just in regards to the commission and so the the previous um sections talk about the fact that all of the records will be transferred over and so of course, UAS is, um, beholden to the foyer, so they would, they would have to turn over those records. Thank you. And for the record, how much money is being transferred to UMS. It's already there It's already there. There's an appropriation that's already there, the appropriation is already with UAMS. And so this is the powers of the commission and the authority of the commission, since they're going to disband it, so there's not they haven't met in 3 years there have been no appointments to this commission in the past 3 years, so they're just simply, you know, transferring over to the authority of the commission to UAMS. And I believe and he can, you know, if he needs to speak to this, he can. I believe they already have a blood bank initiative up and running at UMS, which does a lot of this work, so duplicative and so there is the reason for rolling this over right? I just like to know how much it is. It says property and unexpended balances of the appropriations, allocations, other funds. I'm not sure if I can ask any Davis or UMS to join us. Yes, please state your name for the record and then you're recognized. Andy Davis with UAS. Senator Payton, I don't know the exact dollar amount. It's a few $100,000. I want to say the appropriations. Um, it's less than 500,000. I can get the exact number and get it to you. But like Senator Filippo said, the money already flows to UAMS. The issue was sort of the commission was established to Initiate the blood bank, but it's been up and running now for several years without an active commission, there's kind of a, a difficulty with the commission being under the Department of Health and the bank being at UA mass, just administering that so the idea was just to eliminate the commission, solve the administration as UAMS. So when we transfer the statutory powers. I mean, There's a Are there hospitals or, or, or some that have statutory powers. I mean, it seems like we're talking about governmental powers there, but power is a strong word here. It's just OK. There's a medical director that maintains the bank. Well, I'm sorry, I'm not familiar with it. It's just a minor things when you give birth, if you like to store your Cord blood. These are the people that maintain it. Right. OK, thank you. Thank you, Madam Chair. Thank you. Are there any other questions? Yes, Senator Ludding, you're recognized. Just to make sure I'm absolutely clear, nothing about the mission or the work changes. We are just transferring oversight. Yes, OK, thank you. Right. Anybody else? Any other questions? All right, see, is there anyone here to speak for or against this bill? I don't have anybody signed up for it, so you recognize the clothes for the bill a chair. I'm close the bill and I make a motion to pass. Motion to pass. Second, all those in favor say aye and opposed as habit. Congratulations, you've passed the bill. Senator Boyd, let's do Senate Bill 178. Thank you, Madam Chair. Should, are you ready for me to begin? Yes, state your name for the record. Justin Boyd, state senator, Fort Smith. Uh, this bill updates the Health Care Decisions Act from last session to clarifying language, addressing bankers' concerns of running afoul of federal privacy laws. This bill uses agreed to language with the banking association to insert important guardrails into the process which ensure our request is legitimate. OK. Are there any, um, Questions from members of the committee. Any questions? seen none. Is there anyone here to speak for or against this bill? Seeing none, nobody signed up. You recognize the clothes for the bill. I'm closed for the bill and I would appreciate someone give me a due passing second. Motion in a second, I'll have some favor say aye, and opposed, I have it. Congratulations. She passed her bill. Um Let's see. I am going to run Senate Bill 187 really quickly. Um And then we'll come back to Senator Rice. Uh represent Bentley is not going to run her bill today. She, I could run it for her, but Actually, I might as well just go ahead and run it for her. Get it off. OK, I'm gonna do these two and then I'll come back and we'll go to Senator Rice. boy. to do, um 87 The Senator Ervin, you recognized? Thank you, Mr. Chair, members of the committee, Senate Bill 187, uh, very simple bill. It just amends the composition of the Arkansas Medicaid drug utilization Review Board to include physician assistants, and it is uh agency bill with the Department of Health. Happy to answer any questions. Members, are there any questions? Is there anybody here to speak for or against this bill? Say no, Senator. Are you ready to close? I close for the bill. I make a motion to pass. Have a motion, have a second. All in favor say aye. Any opposed? Say none congratulations, your bill's passed. Thank you. And then I can run House Bill 1214. Representative for Representative Bentley. And you are recognized, OK. Representative Bentley, um, amends this definition of primary instructor, um, and that's the bill before you just Adding a clear definition of general nursing experience. Um, this is only as it relates to long-term care settings and long-term care hospitals, home health care, um, and what's this, what it is, uh, seeking to do is just making sure that, um, anybody who is an instructor has a level of knowledge and experience in long-term care because it's a very specialized area, um, and, uh, so the, the meat of the bill is really actually on page 2, and then, uh, adding this eight-hour class that authorized by the department just on best practices and long-term care facilities. Um, it's my understanding that the Department of Health worked with the long-term care, um, industry on this legislation that they felt all felt was needed. Happy to answer any questions. Members, are there any questions? Is there anyone in the audience? that wish to speak for or against. Seeing none. Senator, you're welcome to close. Thank you. I've closed for the bill. Make a motion to pass. I have a motion. Do I have a second? Have a second, all in favor say aye and you polls say nay. Congratulations, 2 for 2. Thank you. Thank you. I got so we'll, we're playing musical chairs today. We play a musical chairs today, um. OK. All right. Well, let's, let's go ahead and, uh, we, we're waiting on some other members to get here, um, so I'm gonna, Senator Boyd, do you want to present your bill? Do you want to wait for other members to to come. Whatever you say. Oh, and center ice, do you want to present your bill now or wait for the members of transportation to come over. OK, Senator Boyd, either one, trying to be respectful of either one. So, Senator Boyd, this is Senate Bill 139. Yes, so we've discussed this bill. There's been a lot of discussion and I've talked to some other members individually, uh, so what this bill does is it exempts Physicians from the current exemption of, you know, the Non-compete clause legislation that we have in place. So in other words, it, it clarifies what case law does, which is that non-competees don't apply to physicians. Right. Yeah, so my understanding is this is already case law, this is a decision that was made by the, I believe the Supreme Court, and it was a pretty landmark case, um, In Fort Smith with Mercy Hospital, um, and basically the, the Supreme Court ruled that, um, by including or allowing non-competees within contracts that would actually harm the citizens of the state of Arkansas and their access to public health care. Is that correct? That is my understanding as well. That's why I'm here because I think that at the end of the day, if you're a citizen of the state, you shouldn't have to on something like this where the case law seems to be so clear, you shouldn't have to go look at statutory law, and then also be able to interpret case law as well. That's why my exemption is very narrow because it's an exemption which seems to reflect case law as it stands today. So you're just trying to, right, you're just adding, you're just codifying the decision. Yes, that is what I'm working to do. OK, perfect. Questions? Senator Payton, you're. Thank you, Madam Chair. So my question is how narrow is it when it says it's a physician, so that's all physicians. It doesn't define the type of non-compete or the situations. So if I'm a physician, I have a family practice in Hebrew Springs, Arkansas, and I want to sell that family practice to another physician coming in, and he's willing to pay me a monetary value for that. Why shouldn't I be able to sell my non-compete to assure him that I'm not going to go down the street in a year or 18 months and open up and take all my patients back. Madam Chair, I think I've got some attorneys in the room who might be willing to come to the table and try to Help me answer that. I think I know the answer, but I'd rather have someone who has a little more experience than Justin Boyd in answering that question. So come on, Mr. Mitchell, if you would come up or Mr. Cummins, either of you, whoever's comfortable, come to help me come to the table and set your names for the record, and we can hear. My name is Bud Cummins, and I'm an attorney and I will weigh on it, weigh in on this to the limited extent. My understanding is that the bill is limited to employment contracts. It wouldn't, it wouldn't apply to a a transactional, you know, buy sell of a business, it's it's limited to employment contracts where a position is the employee. So can you show me what's limiting it to that from what I'm seeing here on the bill. I haven't looked at it. You haven't looked at the, I haven't looked at it since last week and my memory doesn't go that far. I'd have to look at him. Mr. Mitchell may have that answer. I don't have a copy of it in front of me. The issue is, is not the bill, it's elsewhere in the law that that says that that's why you're not seeing the entire law just like every other bill drafter, this is just exempting, they put in the, the pertinent point. And I, and I believe the case that we're talking about was an employment issue and, and so, Basically somebody it was a physician who was an employee and under the employment contract, it said that there was a no compete and the physician wanted to open their own practice and I'm familiar with several employment cases where It had nothing to do with physicians. But I'd like to know. What's restricting this? I mean, we're not just we're not protecting or we're not just protecting, protecting physicians, we're restricting a physician who has Been successful and has a value to their To their business. from obtaining a contract or being able to enter into a contract. That they would be paid for. And, and let's just say that I mean I sold a business one time and went to work for the new owner. So I mean that's an employment contract, but I mean if there's a value to my non-compete or some protection for that employer. Why would we prevent physicians from being able to be paid for that. So Senator Payton, if you go section on line 24 H1. This section does not apply to a covenant not to compete agreement that is ancillary to other contractual relationships. And that's the point is that section again? Yeah, it's on the bill. line 24 H1. I mean, I, I share your concern, and that's not my intent at all as to Delve into other types of Remuneration. This is intended to be an employee physician who goes to work as an employee, not someone who has ownership and another you know. Thank you. That does put some guardrails on it. I appreciate it. I, I wish I had been able to clarify that last week. I wish I'd be able to vote yes on it anyway, but I'm still not going to be able to. Thank you. OK. Are there any other questions from the members of the committee? Right See none. Do you want to pull it down or I, I think I can count, and I think I should pull it down and bring it back when I think I have a 5th vote. OK, all right, thank you. Thank you. wasn't ready to person OK, Senator Rice. But Sorry Yeah All right, if you'll just state your name names for the record, and you may proceed. We are with Senate Bill 168. Thank you, Madam Chair. Senator Terry Rice, District 5. Flushy. Julie Eckert, uh, master of massage therapist. Thank you. Please proceed. Thanks, Madam Chair and committee members, Senate bill. 168 Is something brought to my attention Representative Brown. As someone who has had 3 major spine surgeries from Neck to lower back and a shoulder surgery too. I'm passionate. To support the massage therapy industry. All the industry. I have been disappointed with some of the negative comments that I've heard of. And disgusted and At some other ones regarding this bill. I have received a lot of support from large and small massage businesses. who are having problems getting enough people into the industry. I've spent tens of thousands of dollars of my own money. On massage therapy for myself over the past 30 years. It is less than the need for pain medications. And it's reason that 70 years old I can still work 6 days a week. I want everyone to have Affordable massage therapy. That is currently lacking personnel. I want the state of Arkansas. To retain its sovereignty. On regulations for its citizens. Let me clarify, I am not against national certifications. That can be used reciprocal in other states. That's good and, and fine. There is some reason we're not. Getting enough massage therapist. In the state of Arkansas. So much what we see in legislation. Always comes back to Money. When I was 17 years ago when I was walking down The hall this on on level one, this capital. When I came here after An afternoon session in the house. Somebody stepped out one of those doors and grabbed me and we said, we need you in this side meeting. It was because the massage therapy board had some serious problems. And they were rectified and helped the industry. Because it got out of control. I'm not saying that's what's happening now. I'm saying there are interests on one side. There's interest on another side. There ought to be some resolution in the middle to fix the problem. Julie Eckert here has some other background other than just massage therapy. Let me state this, I am not against a national certification. But let me tell you all their website. That is what is being pushed this session. It is not just to have a national certification, but basically take over. State of Arkansas. They're national exam services brought in 5.6 million. The director made, I believe. Compensation $578,000. Money plays into everything. I'm ordering a Safe qualified Way to get More personnel into the industries. And with that, I'm gonna ask uh Ms. Eckert to She's got some more insight into this. Good afternoon. Thank you for being with us. Thank you for having me, and I appreciate your attention. Um, I'm Julie Eckert. I am now a massage therapists. We have different levels here. I'm a master massage therapist and before that, so massage therapy is my retirement career. I've retired from the North Little Rock Police Department with 25 years in law enforcement while I was on the police department, 20 of those years were spent working sex crimes, domestic violence, crimes against children, and human trafficking. I was also on the FBI's Human trafficking Task Force. in a sense. So let me start off by saying I would never be a proponent of anything that would in any way, uh, promote human trafficking whatsoever. Um, I also work with groups right now trying to legislate and find long term care for these victims of human trafficking. It's very close to my heart. Um, So, uh, while I was detective doing that. I also am an instructor for the Criminal Justice Institute. I graduated from UALR with a degree in criminal justice, part of the training that I provide across the state for recruits, uh, Involve me creating an exam for the recruits, so that's one of the things that I've done. Uh, the prosecutors asked me in court the other day how many officers I had trained. I've trained over 1000 officers in the state of Arkansas on domestic violence and child abuse and sexual assault. So that's a little bit about, about my background, um, but I, uh, I went to an evening classes to become a massage therapist before I retired and I felt that with my background, I found out about the advisory committee, and I thought with my background in human trafficking, I could be a good asset to that. And so I applied to be one of the committee members for that. So, um, always been very active and proactive in trying to do the right thing, someone has been saying that I have an agenda. I, I don't have an agenda. It's, it's me. Uh, I'm a licensed therapist. I did pass the national exam. This does not affect me in one way or the other, it affects the the new graduates that are coming up. These graduates have already spent 700 to $10,000 for their school. And now they have debt. And now they pay to take the exam. And initially when this was brought up, this was brought up in June of 2022 by the attorney at the Department of Health. Who stated it was time for Arkansas to have a discussion about a state exam. This is when the apprenticeship program was starting and there was some question about what kind of exam they were going to have to take. So that's, that's when all of this came about. So an ad hoc committee was created for best practices to see if a state exam would be best practice. We met From June till November on a regular basis and we voted that it was in the best interests of Arkansas to offer a state exam at a lower, lower cost that was straightforward. Some of the issues that had come up and it was on my exam. And I was still in law enforcement at the time. There were questions on the national exam that might be true for other states about the law that are not true for Arkansas. So there's misinformation on the national exam and we're not allowed to repeat the questions because we signed a confidentiality agreement. People have asked me what the questions were. I'm not allowed to say what the questions were, because I signed the form, but they're incorrect. They're incorrect questions. The other thing that's happened, um, when I brought this up to the committee because initially I kind of balked at a state exam as well, and I've probably said some of the things that you may hear today initially. And then when I got home, I, I said I can't believe someone wants a state exam and my husband said, Well, do you remember? How you had to take off work and study before you went to take the national exam and that you had to study like you were taking an exam to become a brain surgeon. And that that's what he had said to me back then, all those years ago when I took the test. I slept on it. I woke up And One of the main issues is that this exam is what they call computer adaptive. Which means if the computer spits out a difficult question and you get it correct. The next question is as hard or more difficult then that question you just answered. And that doesn't seem very fair to me. We're not EMTs. We're not out here saving lives. We're doing massage therapy. I brought that up at a at a meeting and the executive director had zoomed in when I told her how very difficult my exam had been, she told me it was because I had quote over studied. She said that the high the high failure rate for the inblex national exam was because Of the overachievers in the class who study too hard. That doesn't make any sense to me and that doesn't sound like a very fair exam. And these people that have already taken this once and have been devastated because they thought they were going in and they thought that they had studied enough, but they studied too much and then they didn't pass and then they have to pay again. And that's what, that's what came to my mind was when I was in school, there was a woman in my class and she was the brightest woman in the class. We had exams every week all over the body system. and she always did very well on those exams. She drove from Clinton to Mai 3 nights a week for school. She told us she was excited about the national exam. She signed up and then we didn't hear anything from her. Because she didn't pass. And she is stilling countertops today, and she was a fantastic massage therapist. Because that's how you get your training. You work on each other. So we know that, but she didn't pass and then I thought about the other women as I was sitting in the evening classes would come in and go into the back room and would be sobbing with the instructors. Because they hadn't passed the national exam, and I don't know if those ever people ever tried again, but they don't have an organization. They don't have a Facebook page. They don't have a voice. They don't know to be here today to say, I would have loved to have had a state exam to take that was from the Department of Health was going to be $75 instead of over $200 265 dollars each time. So We just kind of got stuck at the uh at the Department of Health with all of this, and um I was told that if we wanted a state exam that I needed to run a bill and I found Senator Rice and he's here to, to help me do that. I don't have an agenda. My agenda is to get these women, mostly women. Licensed and to work, especially in rural Arkansas, as I sit here last week, I just kept hearing about the cycle of poverty in Arkansas, and we need to get these people out of the cycle of poverty, and this state exam can help. It can help do that. Uh, do you mind answering any questions? I am open for any questions. Thank you, Senator Rice or either one. You had talked about, um, How much is the test to take? The national test, how much? It's, it says 265 and And it's been a while since I took it on the page, it also says that there's a $20 exam fee for the people, I guess, to come in to give the exam. So about 285, if that were the case, OK. And, um, And the, the, the business that you refer to the the total, the 5.6 million that I, I assume that's public information that you were able to achieve and what is the name of the organize the business. It's, it's the FSMBT who administers the Ilex exam, which is the Federation of State Massage therapy boards. OK. That is on their website. Do you, do you know if, or is there anything on their website I haven't looked this up, but how much of that money comes back to the state of Arkansas to support the massage therapists that are licensed. Well, what do you get for your money other than certification. I don't believe we get anything, OK, I mean, does the state of Arkansas get any of this, or is it just strictly the national, this board and That they just retained their money, OK. Questions, Senator Ludding. Thank you, Madam Chair. You referenced on page 2 line 9, the term computer adaptive, which I was going to ask about because I wasn't familiar with that term. I didn't know if that made the exam must be uh Uh, done on paper, but clearly it does sound like it is a computerized exam. Is that common for computerized exams to get harder, the better the person does. Everyone I've talked to has really never heard of that before and I think that's very unfair and it maybe for like the medical field, maybe they have something like that, but I'm not in not in that field since you mentioned EMTs, I didn't know if maybe this was just a common practice, and we were looking to exempt in this case, but OK, thank you. No, I don't think it's it's common practice at all. Thank you. Thank you. Senator Payton. Thank you, Madam Chair. I appreciate you being here today. I love local control. I'd like, like to bring it under local control, but um, It seems like two of your main points are to make the test cheaper and to make it easier and so on the cheaper side, We know what they're charging. But I don't see anything in the bill that that sets the amount that's going to be charged in the state of Arkansas, or we just assuming it's gonna be cheaper or do we have any, anything that's gonna make sure it's cheaper. Thank you for your question. During all of these meetings, these ad hoc meetings, the uh, chair of the Department of Health was working with a third party provider already and they had already figured everything out that um, uh, it was like a one-time fee and then for the person taking the exam, it was going to be, she said, reported $75 and that's just going to be paid by the person and that would go to the state, um, after the ad hoc committee met and decided on an exam, we followed Texas model because Texas also has gone to a state exam as an option, as has Mississippi. They've both gone to to a state exam as an option, um, and I worked with uh with the man in Texas who created. help create their exam to kind of, uh, guide us and show us. The steps that they did, like how did they form their committee? How did they get together? So that's what we did. We formed a committee to come up with the exam questions and over 700 questions in these different categories, already categorized, have already been turned into the Department of Health. So everything's ready to go. There's no cost for anyone sitting around, you know, going through the books and coming up with the questions. That's the other thing about the national exam. So, there were about 3 books that um the committee used to come up with a question for the exam, and for the national exam My understanding is they have a huge library full of books, and I don't know about you, but if I get a test and there's something on there that I haven't seen before. It's so thank you, but, but basically, This puts into Arkansas law that the Arkansas Board of Health shall administer an exam. They're going to make a contract with a third party. And that price is going to be set for a period of time, then it's probably going to go up with inflation. There's nothing in here that guarantees that that price is going to be cheaper than the national. That's a very good point. And to answer the other part of your question was, um, this test is not easy. I don't believe in that. It's not an easier test. It is a straightforward test because it's not computer adaptive. So there's no tricks. It's no tricks and it's laid out what is set forth for Arkansas in the scope of what our education requires. The national test, some places require 1000 hours, but 22 states in the nation require 500 hours. So it's a combation of that I appreciate your effort to make it. Standardized and I took the FAA pilots exam, and they obviously throw some questions in there that they intend to trick you, and so I don't, I do appreciate that aspect. I just don't see in the bill where it actually demands any of that. It does create a test and somebody at the Department of Health is going to create the questions, but I'll, I'll I, I'm planning to vote for it and I appreciate the answers, but I do think that it should contain more. Uh In regards to the price of the test, at least, you know, if our objective here is to make sure that it's affordable and thank you, and I didn't ask for that to be in there, uh, because we do know inflation changes things. I think the state of Arkansas, uh, wanting to add their own test is going to be fair with it. I can't say it won't be $85 next year. I just don't think it's going to spin out of, out of control. But, you know, if you put it in the legislation, you're gonna have to go back and change otherwise they can come to dealing with that on waste tires. They can come to council and rules and, and then, you know, maybe get our approval, and that's kind of my point. It can go up without any restraint. Thank you, Madam Chair. We're on Senate Bill 168, Senator Love, um, so just, uh, to Senator Ledings' question, this is a new term that I also looked in the bill. wanted to understand, and that's correct. Computer-based computer adaptive testing is computer-based tests that adjust to the difficulty of questions to a test taker's ability level. So what's concerning to me about this is that if you're in this for the business, And it's computer adaptive testing, who's to say that it's not an already formulated. For somebody who failed the test just so that they can charge that person to retake the test again and double their money. That's, that's a little I don't, I mean, but that is exactly what it is, computer adaptive testing, and I don't know if this test that you're talking about or if these national certification tests are all done that way. If they are, That that's concerning to me. Because that just, that, I mean, that's why we have a But this is a huge business money making. This seems to be I don't like maintenance of certification. I, I think once you've gone to school, you've, this happens in medical school a lot, and I am not for maintenance of certification. In fact, I think I would, I would support anybody that would run a bill to get rid of maintenance and certification because once you've passed your board exams and you've done this, I don't know why you have to continue to do it over and over and over again. You're just putting money in people's coffers in the state of Arkansas realizes none of the benefit of that. Um, I mean, a little bit separate because I don't think you, you only have to take your test once, but there are other professions once, right? Unless you moved to Louisiana, OK, so they legislated that if it's been 2 years since you've taken their national test. You have to retake it if you move to Louisiana, and the, uh, I went state by state and while the inblex is accepted in a lot of the states, uh, state by state, there's only 7 states that will only accept a national exam. The rest are open to like they hired a really good lobbyist. OK, I think Senator Leding, do you have a question? I guess since you also you brought up the computer adaptive again you mentioned that you, uh, they said you had overprepared, so I guess you were giving really thorough answers and so it was adapting to that level of knowledge and it was making harder questions for you. Yes, it's multiple choice. But under those circumstances, like if somebody knew it was going to be computer adaptive, like intentionally botching the first question too isn't going to like make the test. So there is at least a benchmark of information. that the test is seeking, right? Like nobody could game it to where it's going to be. I don't know that because I'm not that kind of person, but I had I thought of that in advance. My test might not have been as difficult as it was. I didn't mean to imply you were. I'm just I'm trying to learn more because I've never heard of this type of testing before. Thank you, Madam Chair. Thank you. We do have, OK, any other questions from members of the committee? We do have some people here to speak on this bill. Um, so if you could come up to the table when your name is called. Maria Pike. And members, I, I, I mean, I'm sorry, if you can just speak to the bill and um I appreciate your testimony, state your name for the record and then you recognize to speak. Uh, my name is Mariah Pike. I'm a master massage therapist and business owner and District 11. Um, thank you for allowing me to be here with you this afternoon. And I come before you today in strong opposition of state-level testing for massage therapists as proposed by SB 168. Um, firstly, I would like to say thank you, Senator Rice, for your interest and your support of massage therapy in the state of Arkansas. We really do appreciate that. I'm here with the greatest respect, only to present some some facts and a little bit of opinion that will show the consequences this well-intentioned bill will have on our profession. And hopefully bring to light some information and issues that may have been overlooked in the creation of SB 168. SB 168 claims that the fee for taking the national licensing exam, the NEx is excessive for many many individuals as a solution, I suggest that possibly school owners and prospective employers can help with some of that cost by considering providing financial assistance assistance program for the MEx fee to the student in need through a loan or more easily through the existing apprenticeship program. Still, massage therapists are either self-employed or operating as independent contractors, financially responsible for their own treatment space, professional and business license continuing education, inspection fees, insurance, equipment, and supplies. Should the cost of taking the molex be enough to stop an individual from becoming a massage therapist, the cost of building a business most certainly will be. Additionally, SB 168 asserts that a shortage of massage therapists in the state constitutes an emergency. A recent Baylor University study states that that 11.1% of people seek care from a massage therapist. Using this average, there is one registered massage therapist for every 165 Arkansans interested in care. This is not an outlandish number of clients for the average full-time therapist offering 80 to 100 hours of massage per month. As not all massage therapists work full time. This does put us, put us in a, in a shortage. We would like to see our our community grow and it would be a great benefit to the public to have more massage therapists available, but Truly, no emergency exists. I'm sorry. Yes, ma'am. So understand all that. I think we're all big fans of massage therapists, me being definitely one of them. But could you just speak very quickly why you're opposed to this bill of a state exam versus a national exam. I, I want just a very Simple answer. Yes, ma'am, um. Truly we had a state exam previously and having spoken with and we've been doing the MEx as our licensing exam since 2007. Um, and having spoken to a massage therapists who were licensed prior to that time, um, there were a lot of issues with the maintenance of that exam. It was very out of date, uh, medical research as, as I'm sure we're all aware, changes very quickly, and the test was not being maintained or up. stated as needed to be to actually be current to be applied. So in addition to that, um, that test just being on paper was available pretty much to anyone, it was always the same. People, people would say, you know, instructors during class would say to them, oh, on the test, this is actually the answer to that question, but that's not right, that doesn't apply in in real, in real life. And so basing off of, off of that, I, I think my biggest concern with the bill and with a state exam is, is the maintenance of the test, um, and how, how many questions are gonna be available. I mean, I think I am in favor of the national exam specifically because of the integration that we're having within the medical community. Um, we work with, we work with doctors, we work with physical therapists, um, and among other, among other professions in the medical community. And having that national exam puts us on a similar, on a similar playing field to them. Um, I, uh, I'm an Air Force veteran and and was a certified EMT during my time in the Air Force and the computer adaptive exam was not new to me. The EMT exam is computer adaptive. Um, and so having that available and bringing that high quality of care and the high quality of knowledge allows us to continue to be the best we can for, uh, for the people of Arkansas, and At minimum, I think more information needs to be available about the state test and we need to have a little bit more, uh, we need to have some more hammered out about that before we go, uh, signing it into law. OK, all right, Senator Love, you're recognized for question. Thank you and I apologize for being like we're calling transportation, so I didn't know that you all had started or I wouldn't have done my grand introduction. Um, so, Um, well, here's a question I would have asked to sponsor this, but I wasn't there, so let's talk about the Ilex, um. I guess let me first begin by asking you, are, are you, are you primarily against this bill because of the of the fact that that it wasn't it wasn't maintenanced this test wasn't maintenance. My, my primary concerns with this with this bill and with the state test are the lowering of a standard. I personally work with a, with a lot of uh kind of complicated medical cases, and, uh, understand the risks of massage therapy, um. The big, that's my biggest concern. Um, with the test itself, yes, maintenance and uh and cost, where is that coming from and who will be responsible for all of that, um, OK, let me take me slower. Alright, so what, what's the cost of the Ilex right now? The cost of the $265 per person with a possible $20 exam fee on top of that. Now you mentioned prior or previously there was a state. on. How much was that study exam? I'm not certain that was long before my time. OK, so, all right, well then I guess you wouldn't have the history on that because I was on a I I had some I had some OK, so 50 and 20065. It's a big difference, but that was that was years ago that was, that was prior to 2007. OK. OK, thank you. Um, all right, any other questions? Right, thank you so much for being here and for your testimony. Uh, Michelle Chris Christian. We'll just state your um, everybody I have is, uh, I believe, I'm not sure if you're for or against. I am against, I am opposing 168. OK, if you'll just state your name for the record and you can make your statement. Um, again, just try not to. Uh, plow the same ground, um, but just speak to the difference of, of why you're posting the bill. Thank you for being here. Thank you for allowing us to be here. Um, my name is Michelle Kristen, um, I am a massage therapist of the caliber of a massage therapy instructor. I own a school that was established in 1991. I also own the state's largest met spa and most honored mid spa. In Arkansas in Conway, Arkansas. I come to you today as an educator to speak in opposition. Of this bill. Lowering the standard. will not help. Our state, it will not help our patrons that see us. For as an example, as a therapist, I am referred personally, my clientele is referred to me from osteopath, chiropractors, um, Also, plastic surgeons and family medical doctors. Those are the types of clients that I personally work with. On the educators side, I can speak a little bit to the computer adaptive. portion that was previously talked about. Computer adaptive tests do not, it does not mean that it goes higher, higher, higher, and you flunk out. The way that the computer adapted testing works is it gives you a little harder, a little harder, you miss one, it calibrates down, so it is not an automatic failure. It is not an automatic ceiling. Um, I come to you as an educator whose school has an 80% pass rate. Of the inblexs. I know there has been discussion maybe not at this table, but there has been discussion also about retakes of the inblex, um, and it being an additional 265. I can tell you that my school outputs 100% passers on retakes. I would also like to share I'm sorry, on retakes so they failed at first failed it the first time. What's your percentage of pass rate for the first time the first time is 80%. I myself took the Ilex. Um, I would also like to speak to the fact that the Board of Health opposed this last year and defeated this as a proposition. This is an unnecessary bill. It is certainly not an emergency. According to the statistics that I received last week from the Department of Health. There are 2150 licensed massage therapists in the state. This is the most that we have had in the 10 years of tenure that since we have been under the Department of Health. Um, the market is plentiful. There are many independent operators and small businesses that are still looking for clientele and seeking clientele. There is no emergency shortage. This emergency shortage. And this bill was constructed from a background of failing schools. One in rural Arkansas, who has a history of multiple failing, and another of a corporate franchise system. I as well as anyone know how hard it is to staff a large facility. My facility, my spa staff, 16 therapists and 3 apprentices. Again, there is no shortage. Truthfully, most therapists do not want to work. For corporate entities. I would also like to address the fact That Schools of massage and the students that we serve. are not always of a caliber of collegiate study. My school helps people enter into this workforce. Through working with Arkansas Department of Rehabilitation, taking on students with learning disabilities and other disabilities. We also work with apprenticeship program. Thank you. I, I'm sorry. I want you to focus your comments to the bill. OK, I appreciate all of that and that's good information. I'm trying to get to everybody, but I haven't, yes, yes, ma'am to the, to the bill. I'm opposed to the bill. I believe it lowers the. standard, um, I also am with my former Uh, massage therapist that spoke, I do not believe that the state has the resources to compile a test that would be of the caliber that we need to take care of our public health. I do not believe they can maintenance that test. I do not believe that the $265 is a barrier. My students graduate debt-free. From their tuition. So on these accounts as an educator, I come to you and ask you to support opposition of this bill. It's only going to add labor to the Department of Labor who is already overstressed and overtaxed, and it's gonna make money flow down and make our dues increase. It's not gonna save money. It's lowering the standard for Arkansas. OK. Senator Payton, did you have a question? OK. Thank you, Madam Chair. So, I guess I'm a little perplexed. You and the sponsor and the proponent for the bill all agree that somehow this state test is going to be easier. And there's nothing in the bill that says make the questions easier. Unless you consider the language in the bill that eliminates the computer adaptive test. Now The proponent for the bill thinks that the computer adaptive test makes the test more difficult. But you're saying that it doesn't. So how are you arriving at the At the determination that somehow this state test is going to be easier. I have looked at the bill and I have looked at the structure I've not seen questions, but I have seen the layout and the structure of the questions and the topics of the bill, I also in her face on a regular with the inblex provider and I know the structure of the content that they test over. I can. that their data bank is much larger. To pull from, then say will be from a Department of Health. So do you know who the third party would be that the Department of Health is going to use to administer the test. I do not know that. So I don't see how we assume that that would cost a lot of money for the Department of Health, would it not? That's been my concern is that it does not put a cap to the fee in the bill. My other concern is that things you're saying that it's going to do are not codified in the bill, but The fact that we would assume That the third party provider is going to do this or that or assume that. I mean, I don't think we're in the business of assuming things. I mean, we need to know what we're doing here and I would I can understand the proponent assuming it's going to be easier because she believes that the, the computer adaptive makes it harder. I don't understand your assumption that it's going to be easier when you testified that the computer adaptive does not make it harder. It raises the standard by increasing. The questions as they go, but if they miss one, it then recalibrates. It is not a test designed for failure. I Personally, do not believe without large committee and oversight that Arkansas will be able to render a test that is. Objective, but on point. And test to the level that we are. OK, just one final question, sir. If this bill passes, does it prohibit somebody from taking the test that you like. No, it does not. OK, thank you. Thank you, Madam Chair. Thank you. I also just, I mean, I've looked at, I'm looking at your the website that you're referring to and all categories are reflected in the bill. So anatomy and physiology is reflected in the bill. Can you see, I'm looking at the exam content based on this national examination, kinesiology is reflected, pathology, the contradiction contraindications, special populations, massage techniques, everything that's listed hydro, now, this actually hydrotherapy, electrotherapy, and heliotherapy is not content that is listed in the national exam. So, uh, and then, hygiene, infection control, um, business management and personal ethics, those are also, uh, reflected in the content of the national exam. So, I just wanted to to state that for the members. So it looks to me that the state exam would Match the content at depending on the questions, but if it's dictated in law, it can't be, it has to be based on what's in the law. It can't, they can't ignore those categories, the state and how often would it be retooled because as was stated previously, we are in an industry that affects health. And its medical and medical research changes constantly. Are there any other questions from members of the committee? Senator Payton. Just real quick, how often is the other test retool? Constantly. They have a data bank of over 10,000 questions that they pull from, and they are constantly pulling from resources. So what limits this Arkansas test from doing the same thing. Um, the ability for a committee to sit down and do it. Who's going to do it? What's it going to cost and what is the pass-through cost going to be to myself and my fellow therapist in terms of our renewals and our licenser. Those are good questions, but they're questions. They're not necessarily established in the bill. No, I think they'll follow. OK, thank you. Thank you, Madam Chair. Any other questions from members of the committee? All right, see you then. Thank you so much for being here today. Thank you. Senator Flippo. How many thank you, uh, how many people do we have set up to speak for this bill or on this bill, 23456 more. OK. All opposed. OK, and if I can't, I'd like to make a motion to, you know, to limit public comment to 3 minutes total total is there a second? No, 3 apiece. I'm sorry, that 3 33 minutes per person, per person. OK. Is there a second? Is there a second to that? I'll suck it. All those in favor say aye and opposed. I have it. OK. So, um, just folks, when you come up to the table to speak, you've got 3 minutes to make your statement each. You should be OK with that, I think. Right, at least will timing. OK, uh, next person, Leeann Warner. You'll just state your name for the record, and we will get you started. Yes, thank you. My name is Leanne Warner, and I am from Conway. I am also a master massage therapist and uh this is a 3rd career for me starting out in the savings and loan industry years ago out of college, and we all know how that ended and from there went into healthcare and managed medical practices and was a certified professional coder and biller and uh worked with physicians. I have been a massage therapist for the last 15 years, and I also teach continuing education to other massage therapists. I am opposed to this bill in its current way that is presented today. The Nlex exam to help you understand is basically considered the gold standard. It is recognized when you say the inblex exam anywhere in the United States, massage therapists know what you're talking about and they know what you had to do to pass that particular exam. It is a difficult exam. It is intended to be a difficult exam because of the way health care is going in the United States right now, um, PT visits often in quickly, um, and massage therapy. has become an allied healthcare specialty. We are not necessarily recognized so in Arkansas and other states, um, hospitals are hiring and having massage therapists on staff, myself personally, I specialize in oncology care. I'm an independent contractor with Cartie, and I'm a lymphatic therapist. I received referrals constantly from other physicians from car ha, from physical therapy to provide a level of care that is a level of education that's needed for that stringent exam to screen. If that you do not pass that test the first time, you can continue taking it as you need to, often not passing that exam the first time. It's not necessarily indicative of the fact that they don't have the knowledge to pass it. Some people have test anxiety. Um, it is the equivalent of nurses take the inclex, massage therapists, take the inblex. The test is administered by a company called Pierce and View, which is actually Here in Little Rock, uh, you go in and you do pay a fee for them and they secure in state that test was administered in such a way that it was not possible for you to cheat. You were given everything you needed to pass that exam, um, and it is the same across the board anywhere that you take that exam, and at this point it does afford us some degree of portability. Um, the way the bill is written now. I might offer us a way forward. If, if he would be willing to withdraw this bill and rewrite it. I think if we presented it in such a way that there were both a state exam and the inblex that were available to members of Arkansas. But this I'm sorry, we we're at our 3 minute willing to lend me their 3 minutes so that I can continue this. Thank you. And OK, thank you. Go ahead. What I was going to state is that um If we had a state exam if we were to pass that, if we can include in that language that by electing to take the state exam, there would be full disclosure that that exam is not going to allow you portability to go from state to state. It would allow you for licensure for practicing in the state of Arkansas, that if you do travel to another state or you should move, you most likely are going to have to take the inblex exam in another. state to be able to practice there and it is proven the distance of time between the time you were in school to when you take the inblex exam, the odds of you passing it at that point, go down vastly. So unless your intent is to always be in the state of Arkansas, you're never going to leave. That can be a pathway, but the way the bill is currently written, it would not allow us to do that, so we are willing to work together to try and find something to help massage therapists in Arkansas, so that we have adequately trained people that are getting the education they need, but also an exam that helps to elevate our profession so that when we do go other places and we say, I took the MEx exam. How many times did I passed it first time. They know then what my knowledge and my skills are based with my experience, right? Thank you. OK, any questions from members of the committee? All right, see you then. Thank you. I appreciate that. OK, uh, Robert Maynard. a proper manner. Hello. Thank you for allowing us in today. My name is Robin Maynard. I am a business owner in Sherwood. I actually am also an educator for massage, and I oppose SB 168. My main concerns about SB 168. I would like for you to think about something that maybe we haven't spoken in these particular terms. If you went to a physician, And that physician had the opportunity To take only a state exam or a nationally recognized exam. Which one would you be more comfortable with. And you can think on that. But mainly when we accept a test that is to be maintained by the state or accepting a level of responsibility that I don't think the Department of Health has reached out and said that they are up for. It is very difficult to put together enough questions in a test bank. To continue ensuring that that information is relevant and that the information as the science proceeds. things that are irrelevant are taken out. Um I've been a therapist for over 12 years and I have seen the industry changed dramatically in that time. I did take and pass the Ilex. We wouldn't want the pass rate to be 100%. If we did, than anybody could take that and pass. Um, Senator Rice, I know that you're a huge proponent of massage and we greatly appreciate that. But what if the therapists that were attending to you had no information or insufficient information on the medical conditions that you present yourself to be treated for. What if they weren't adequately trained for that and yet had passed the exam on a state level. Without that information, what we do know and has been proven is that although massage very often seems very benign. Oh, we're just gonna go in and relax. I accept like Leanne and Michelle. I work with carta and received many oncology patients and were I not properly trained for that. I could potentially create conditions for these people who Could potentially kill them to be perfectly honest. So I would like to oppose that. OK, thank you. You came right in on time, perfect timing. Any questions? All right, thank you, CNN. Appreciate you being here. Ashley Smith. If you'll just state your name for the record, and you may proceed. My name is Ashley Smith. I'm a master massage therapist and business owner out of Little Rock, Arkansas. I am one of the people who did have to take the inblex 3 times because I do have test anxiety and with the state test, it don't matter what test is being given, somebody with test anxiety could possibly fail each time, but I don't feel in my opinion, I don't feel the test is set up for failure for you to uh spend more money. It's set up for comprehension and understanding because we are working with people's bodies and you can harm someone while massaging them. And so that's why I am opposing SB 168. OK, thank you so much. Appreciate your time. Any questions? Say none. OK, Christy Strather. She took my OK, well you got. To be fair, you have 1 minute and 30 seconds if you want to be super quick. I, I am, I am a timekeeper up here. You got one minute and 29 seconds I could do it. My name is Christy Strather. I'm a master massage therapist in a business owner in South Arkansas, um, I've been massage therapist licensed for uh 20 years. I took the state exam, um, I actually was one told that I was one of two people that passed it with 100%, but I also have a bachelor's degree in athletic training, and I feel like my education there helped me in a school that was not necessarily, uh, set up to help me pass any exam if I hadn't had the bachelor's degree. My main concern on this bill is I do um I'm very passionate about our industry and that it should go forward as far as getting our massage therapy industry be accepted by the healthcare facilities. I mean, by the healthcare field, um, it's more for the health, wellness of our clients, not, it can be for relaxation, but relaxation is more for our health as well and so this state exam. Can lower our standards as far as us moving forward in our industry. And the other part is that the Uh, health department board and when that stated in earlier, um, that I do not see the capacity, um, or the capability of the health department to be able to do what is needed for this test. OK, perfect. Thank you. Um, you maximize your 1 minute and 30, 29 seconds. OK, Jamie. Um Jamie, is it moody? I'm sorry if I it's correct. It's Moody, OK. State your name for the record, you may proceed. My name is Jamie Moody, and I am here to oppose Senate Bill 168, my, um, background is I'm a speech therapist and I am a massage therapist, and I took the Ilex and passed it the first time, it was a difficult test. It definitely was, but I've taken similar tests that were also computer adaptive tests through. Um For speech therapy and also the GRE has done that way for graduate entrance exams that now have to be taken online. Um, I do not find them to be unfair in any way. So, uh, I would like to speak, uh, uh, Representative Rice spoke about Um, the, what he was talking about was the interstate compact that requires the ILEx. It is not taking over the state. We will still have our own personal Um The state will still stand alone. We will all, we will still have that no matter if the bill he's speaking to passes. That is totally separate from this. We can join that, it's, it's House Bill 1217. We can still join the compact if it passes in Arkansas. But It's, it's separate from this. It doesn't affect Arkansas's ability to have our own massage therapy, licensing board testing choices related to that. So I just wanted to clarify that piece of information. Um, and the inblex is a standardized test. It is. It has been tested for reliability and validity for anyone who does that kind of stuff, um, that have a history of knowing about that. It is very difficult to to create a standardized test. Um, so Arkansas will have to do that if we say that's what we're going to do, right? So the Board of Health has to create this test. They have to make it standardized, reliable, valid, and valid. And if it's not, then we're not meeting the same standards as the rest of the country is with this state. test. If the test were to do that, OK, it is very difficult, expensive, time consuming, and it, who, who pays for that? That's not in the bill, as you were mentioning earlier, and it will fall on us, we don't know how much it's going to cost to do such a thing. Um You're hungry. Any other, any questions for me? Any questions? All right, see you then. Thank you so much for being here in your testimony. Yes, thank you for being here. Last, uh, Bud Cummins. State your name for the record and you may see it. Have you ever talked to me in 3 minutes or less. I. Uh, my name is Bud Cummins. I'm an attorney and a lobbyist, and I represent the Federation of State Massage Therapy Boards, who would have liked to have had a representative here today on short notice that they're based in Kansas City. I didn't have the heart after what happened on TV last night to ask him to get in the car this morning and drive down here, uh. They administer the massage and body work licensure exam referred to as the IMEX, uh, Arkansas is a founding member of the Federation and as a member of the Federation of Arkansas has ownership over the MLEX and members of the MTTAC and or the Department of Health may serve in voluntary leadership positions that govern the development and administration of the Ilux, which is, you know, organic and and constant. Uh The Federation administers the exam at no cost to the state of Arkansas. So presently, uh, the, the states experiencing no cost to have the massage therapist uh examine. As to the computer adaptive aspect. I'm not an expert on computer adapted testing. I did about as much research as maybe the chair. Chairman has done on the computer, but I would point out that what I read said it not only goes up, it can go down. So the point of it is, let's not ask a real hard question and have the person miss it and keep pounding them with hard questions. Let's fish down to where they can't answer questions or work a way back up. It can ask easier questions or it may ask harder questions, but it's a way to, to not waste questions on somebody that that's not going to answer them, to find that vein where they're gonna have some traction. That's my understanding of it. I'm not an expert at it. Uh On the passage rate, I mean, you know, we've, we've heard cost and, and, you know, difficulty of, of, of passing the test, the cost of the test is $265. You can compare that to the national exam for a vet tech veterinary technician $345 funeral service, $285 physical therapy, $485 occupational therapy, $515. The passage rate for Arkansas is 80%. The national passage rate is only 70%, so Arkansas is 10 points above the national passage rate right now on the IBEX. But the, the elephant in the room, uh, Madam Chairman, is uh the Human Trafficking aspect. None of those professions I mentioned have this, this question. Human trafficking is prevalent within the massage profession. Research shows that as many as 6500 illicit massage businesses are active in the US, uh, as many as 9000. Recently, in January, the Attorney General announced arrests in Arkansas where may I finish this thought? Finish that thought where uh illicit businesses were operating in Jonesboro, Russellville, Hot Springs, Rogers, Harrison, and Little Rock. There is danger. This isn't wallpaper hanging. This, there's danger in making it easier or cheaper to get into this profession because of this problem that's national, it's a $5 billion a year problem. Thank you and that's something that this committee this committee should stay focused. I'm sorry, Senator Hill. Mr. Cummings, after hearing all that, were you speaking for or against this bill? I'm sorry. The, the Federation opposes the bill. OK, thank you. I have one question in the bill, it says 7 questions concerning massage therapy, law, business management, and personal ethics wouldn't, wouldn't that fall under personal ethics. I'm sorry, I don't understand the question. Human trafficking, um, you brought up human trafficking, would that not fall under personal ethics. Well, the point is that these this is organized crime, and they move nationwide and they try to get people into into businesses where where the most vulnerability is where they can get somebody to pass some of these people are non-English speaking and they want them to cheat and get a personal ethics though, is, it's wrong to traffic humans. That's a personal ethics question, I think. Um Senator Payton. Thank you, Madam Chair. How do we reach the conclusion or the assumption That the state test would be easier on human traffickers. I mean, Obviously, the risk and the investigations that you just mentioned. Took place and the activity took place under the current law. So how are we, what? What are you hanging your hat on when you reach the conclusion that, that for the state to implement an exam, it would somehow Make that easier. Well, if I were a member of this committee, I would want to hear from the health department because I'd want to hear what resources they have and what capability they have and the cost of administering a test, creating a test, developing it, maintaining it at the level of the inblex before I knew if it was going to be easier or not. The, the, the, the bill is silent to that. OK. Thank you, Madam Chair. Thank you. Any other questions from members of the committee? All right, seeing Nunn, thank you so much for your testimony, Senator Rice, you recognized clothes for your bill. I have nobody else signed up. Madam Chair, I've been in several committees and I know that members can't be here all the time. Ms. Eckert. can testify that some of the Statements were inaccurate. That you just heard and 22 members. Won't have an opportunity to hear that in my closing. Um, I will Go back over this, and one I appreciate as I said in my opening for the two members that were in the other committee. I'm a proponent. Massage therapy. What you heard and what I heard sitting over there, there are some Extra qualified massage therapist. But it doesn't require an EMT, a physician, a medical degree or even a physical therapy degree. To be a massage therapist. These people are doing some, some higher level specialty work kudos to them. And they can put on whatever certification they have. To show that they Above qualified to do that. I'm talking about A basic safe massage therapy law. By the state. That will not affect anybody's national certification that they have, it will not affect them taking the national certification. And again for the members that weren't here. FSMTB, the National Federation brought in $5.6 million testing last year. They had $1.6 million in investments they paid their director. Uh, I believe 568,000 was the figure that I heard. It's, there's a lot of money in this, a lot of money in a lot of things. They couldn't have Mr. Cummins here if they didn't have. Pretty good amount of money. I like Mr. Cummins. But he doesn't work for nothing. This lady setting it on the table, and I'd love if if she had time to testify again. I'd appreciate if you'd go back and watch the video. She's a former LAPD Sca LRPD. Detective She's worked in child trafficking. Let's touch on child trafficking since it was brought up. There's gonna be child trafficking bills come in this session to stop this. These people who were raided And should be. weren't More than likely may only have been 1 or 2 people in in the, the establishment that might have had a license to be open and it's doubtful the rest of them did. I don't know. I, I heard about the race. This is not a legitimate deal. We have people that will, will. be able to take care of that. This is not a dumb down bill. If you look in there, it's got This, the things that the chairwoman mentioned as far as having to be qualified in. If somebody wants reciprocal license, take the national test. I've got people out here in rural areas that don't have anybody that they can get. They have people in Arkansas that want an Arkansas license only for Arkansas, and they want to stay in Arkansas. A bank I guess assistant vice president was my massage therapist for many years. till she had to retire for health reasons. Had one now that is a, was working for the school as in the, in the office had a good job and quit because she's doing well at massage therapy full time. There is another category of people not to have a dumbed down test to have a safe and qualified tests. That will get more people in this. I'm a little disappointed today because I've got emails I'm gonna show you name places that I've used. And single massage operators that are in support of this bill. In some of these places need more personnel, as I said before, qualified personnel, they don't need the specialty maybe to work in oncology. If somebody's not, doesn't feel their skill is for that, they don't need to be doing that type of work. Lastly, test taking. And I appreciate Senator Peyton mentioned in Pilot. I passed my pilot exam too. I'm not a good test taker, but you showed me how to do something and I can pretty much excel at it. I had a pretty good pilot Payton. Not everybody, and we've heard about test anxiety. Not everybody's as good as that, but you show, you can tell in 500 hours of training, you can tell if they're going to be a good massage therapist. So One last thing. Talking about cost on this. It's not in the bill because I really didn't want to tie it down to that. I would be open to if it passes in committee today to any passes in the Senate, on the House end, or maybe some other amendment need to be done to put in a cap. $100 or whatever affordable needs to be, I would be open to that. Um, I think this, the, the need for this is here. The emergency calls was my Call It wasn't that far. You know how long it takes before a bill goes into effect, then you know how long if you own council, how long it takes them to get the rules together and all. There is an emergency that we need more qualified personnel in Arkansas. Nothing again against these people who have these national certifications. With that, uh, I would appreciate a good vote. motion to pass. Is there a 2nd, 2nd, all those in favor say aye. I'm sorry, discussion. You'd like discussion? Senator Penzo, you're recognized for discussion. Thank you, Madam Chair. Um, I, uh, and unfortunately, we're wearing another committee when this all started, but, um, I Like, like a lot of things I've got a background in this too. I taught anatomy and physiology to massage school for 3 years. Um, so I know a lot of massage therapists out there. Every, every massage therapist that I've talked to. Has been in opposition and I've gotten a few messages from, uh, some massage schools that said they wanted to see this passed. Um, I, I don't. One of the ladies that presented One of the ladies that presentedment um, you know, because back in the day it used to be a uh a state test, then they moved to the nationwide test, um, which allows for portability. Um, somebody mentioned amending it to where you could have both. Why would we preclude somebody from taking the national exam. Why, why do they have to take both exams? They've got to take one to pass the state and then another to work in another uh state that's, that's something I have reservation with, um, it's, you know, because you said that they can take, take another test. So, um, I don't think somebody should have to take 2 tests in order. the Working in another state. I'm sorry we're in discussion only. We've already closed for the bill. Um, so this is just discussion only. Senator Penzo. Well, that's, that's my discussion. I'm, I'm, I'm a no vote at this point. Thank you. Any other discussion? On the bill. Anybody, Senator? Nobody else? OK, there's a motion on the floor. Do you pass, 2nd, all those in favor say aye and opposed? I have it. Congratulations you've passed your bill. Thank you, Madam Chair and committee. All right, members, we have one last bill. Um If Senator Wallace will take the chair. You Thank you. I Oh. OK. Senator, you are recognized, ma'am. Thank you so much, Mr. Chair, members of the committee, happy to have Representative Erin Pilkington with me as well, Senator Missy Irvin, District 24. Um, members, it's really exciting to be able to be here today to present this bill, um, before you, this, this bill is a result of a lot of work, uh, over the past year and a half, I would say working with all levels of stakeholders across the state of Arkansas, the Department of Human Services, the Department of Health, the Governor's office, uh, this is the, the bill that the governor, Governor Sanders, uh, spoke about last week in a press conference, the healthy moms, healthy babies Act, um, and again, just a lot of hard work went into this legislation, and I would just appreciate the bipartisan support that we've had, uh, reflected in the sponsors on the bill, um, that representative Pilkington worked really closely with Representative Hudson, Ashley Hudson, who's also on the bill, um, as well as I, I would just say key, key members of both the Senate and the House that worked on this issue for about a year and a half, um, just I'm going to go quickly through the the bill and what it does, um, it really is just talking about um making sure that, uh, we continue to do the depression screening for pregnant women, and we're just moving that into a different code section, uh, well, really, really important that we're unbundling the payments for prenatal care, delivery, and postpartum care, um, right now it's a bundled payment, uh, that's very difficult to make sure that um it it it causes a lot Problems and I would just say has led to the significant crisis in maternal health at the Arkansas is facing in um so many of our labor and delivery units and hospitals closing. So not only does this bill unbundle those payments to make sure that we're paying separately for prenatal care, delivery, and postpartum care. Um, it also will increase the payments for labor and delivery, I believe, by 70% is what the governor is proposing, um, in this, uh, presumptive eligibility for pregnant women, making sure that we can just get them onto the Medicaid rolls as quickly as possible and into the right, uh, Medicaid program that will, um, that will cover their pregnancy and the cost for that. Blood pressure monitoring and continuous glucose monitoring upon medically necessary if that's determined that we would be able to provide that coverage for them and remote using telemedicine, remote monitoring for those services. think it's really going to be key to helping those moms that may have a difficult pregnancy or facing complications, we can then utilize that technology and pay for those services to monitor those very important um health conditions to hopefully prevent a premature, uh, premature labor and birth, um, and then also just making sure that they're getting uh the bed rest that they need and kind of continuous monitoring and uh we think that those measures will specifically speak To, uh, the maternal mortality or infant mortality areas that our state has unfortunately faced, um, and so those, those are reflected in the bill and then reimbursement for a remote ultrasound procedures again, uh, monitoring a baby, especially if it's a high, uh high complication, um, pregnancy, um, and unfortunately many of the babies that are delivered on the Medicaid program are sometimes very, very complicated cases that require um, another level of um, Of, of, of just, I would say care and um intentional, um, monitoring. Um, then we also have uh coverage will be provided through the Medicaid for uh program for doulas and community health workers, and this is for home visitation for those moms as they are expecting their babies, and then after they deliver their babies. Um, so that's really, really important for these women. Just to make sure that they've they've got somebody who's checking in on them and helping them. We know that home visitation works in a lot of our long-term care populations, home health care, personal care aid. It's really kind of using that same idea here, um, as well. And then the final section is really just trying to keep more OB-GYNs delivering babies longer and limiting their, uh, tail coverage, uh, that they have to provide after they finish delivering babies. So with that, we would be happy to answer any questions. Thank you, ma'am. Members, I see a question Senator Payton. Thank Mr. Chair. Sounds great. What's it going to cost? So the governor has put in um her budget $13 million but, um, for it to pay for this, um, understand that that then is um matched, well, not matched equally, but matched with federal dollars to the tune of about 45 million. So 13 million from the state level and the additional amount comes from the federal funding 45 million total with state and I'm not finding the fiscal impact statement. I mean, where did we come up with? That figure I don't, I think the figure was, um, provided by DHS. In in writing or anywhere where I can see it or it was stated from press conference that the governor, it was at the press conference, the governor Senator Mitchin last Thursday and then of course when the governor presented her budget earlier in the year that $13 million that she mentioned in her speech is is reflective in here in the state's share of what that 45 million would be. So as we know, the RSA is referred to as a budget. And it's the funding and funding is everything, so we're capping it at 13. That's all we're gonna have for funding or Or I mean, when we calculated what the state share would be to increase those reimbursements to this level, that's what it came out to be 13 million, so that's what we expect it to be. OK, well, thank you. Normally, I would think we'd have a fiscal impact statement, but thank you. Thank you. Central living. Thank you, Mr. Mr. Vice Chair. Just two quick questions. Senator Hill and I were going back and forth a little bit, just curious since we don't know, doulas aren't the same as midwives or are those terms interchangeable? They're different, OK, yeah, so you, you have like a certified nurse midwife, which a good way to think about it and you can correct me if I'm wrong, Senator, but I think that kind of is like a um oh, like a like an APRN might be to to an MD. Is that, is that fair? And then, but Adoula's less qualified than that, if that makes sense. And so, um, they, they are different than each other. I would, I, I, I equate it to like a personal home care. So in personal home care, you have folks that are helping, um, in those settings, um, and we, we allow that for, for Medicaid, but they're not RNs, they're not at that level of certification, but they do have, you know, Safety standards, um, and levels of training and then just one more question I would say, I'm sorry, we, we will see the specifics of that in representative Lee Johnson's bills that are coming. Thank you. Um, and the only other question, and I asked you about this earlier, uh, I just wanted to follow up on it one more time. I can't imagine not voting for this, so I'm supportive, but I have had people reach out about the very last section where we are and I suppose it's specifically those last three lines, page 4 beginning at line 26. where we're talking about alleged medical injury occurring during childbirth. I guess we're taking currently the age is 11, but we're rolling back that to the age of 5 and not being an attorney, I don't quite understand what we're doing there. Sure, so sorry, you want to answer, you're fine. So you have tail coverage with an OBGYN and so a lot of these rural hospitals are end up paying for this coverage years and years after that NDS retired and as you know with the cost of running labor and delivery is pretty high. And so we're just trying to Find ways to it. The reason why the age 5 was used because most of the time 99% of the time you're going to see the issues that resulted from, um, From a birth within that time frame. So we're just trying to do that just to give the hospitals and give the providers a little more um Um, what's the word I'm looking for? Just a little more help because it's, yeah, it's relief because it is just so expensive and so, you know, we, when we put this out there, I, I didn't get any sort of negative feedback because everyone thought that was a pretty reasonable age number and so we're just trying to shore it up because I think obviously when I first went in there, I think we thought That need to be further, but as time goes on, I think age 5 is inappropriate and you still have a 2-year statute of limitations beyond that 5 years. So, uh, that's maintained in the bill or in the law, I should say. Thank you, Mr. Chair. Members, are there any other questions? Seeing none. We have one person signed up to speak against this bill, Mr. George Wise. Where I've got a heavy lift here, I think. To speak against it because I think this is a great bill, uh, This is something that we've needed for a long time to improve maternal health. I'm George Wise. I'm a trial lawyer. I'm at the Brad Hendricks law firm and we probably represent more brain damaged babies, more babies who have a brachial plexus injury that gives them a useless arm. Withered arm for the rest of their life. I'm here to speak for those babies. I'm not speaking for any group. I'm speaking for The babies I've represented in the past, the babies I represent right now in the babies I hope to represent in the future. I'd like to give you a little bit of history. I've been a lawyer since 19708. And I've done malpractice cases, uh, as the main part of my practice since 1988, so I've seen The different iterations of this statute of limitations for minors. In 1970, it really wasn't clear whether a minor, uh, had a statute of limitations, and there was a case that was decided in 1970. That said that the general saving statute for minors and people with disabilities applied in a malpractice case, so that gave uh a minor at that time until age 24 to file a lawsuit that was probably uh too long. I would even concede that the Arkansas Medical malpractice Act was passed in 1979. 2nd year of practice and it created a lot of special legislation to deal with malpractice lawsuits, uh. The only part I want to talk about today. Is the statute of limitations, uh, in the original medical malpractice Act of 1979, a miner had until age 19 to file a lawsuit. And the reasoning for that is that sometimes and we still see that in the cases we get uh before us. Today that we get calls on, uh, I get calls occasionally from A minor or um An 18 year old, 19 year old who had a brachial plexus injury and for whatever reason, his parents didn't follow that lawsuit for him. And the thought was when the 1979 Malproducts Act was filed. Let's give About 18 year old a year to file his lawsuit on his own because right now my babies, they can't file their suit by themselves. They depend on them, a mother, father. To file that lawsuit for them. That statute, uh, stayed there and some people thought it was too long and so in 1991, uh, it was amended to age 9. And I was out here. I've been around long enough uh to have listened to the debate and the rationale for making it age 9, and it was in part because uh people thought there you got to be a time by which The parents know. Uh, that they have a case. And so from 1991 until 1995, the statute of limitations was age 9. In 1995, the law was amended to what we have today, age 11. I was out here for that debate. And the reason, uh, They bumped it back up to age 1 was that a lot of times. The parents don't know. That Their child has a problem that's related to birth until they reach certain milestones and it was thought that OK, 11's right before puberty, let's put it right before puberty. And uh so for the last 30 years, that's been the statute of limitations, uh. Not that things don't need to change, but what, what I'd like to point out to you is that we, we get cases, we have cases where By age 67, and 8. We don't always know whether that child is gonna reach the normal milestones or the parents aren't going to know whether that child has reached the normal milestones from that birth injury. I'm working on a case right now. This is not anecdotal real case where The bartenders read this child suffered. She's completely deaf. That's Uh, that's the injury. She had a ischemic encephalopathy. She had brain damage during the delivery process, and her injury is deafness. We're not going to know. Whether that child is going to be able to compete, reach all the milestones with her peers until she's in elementary school. We also get uh We do I mentioned we do more uh birth injuries than any other law firm in the state, Brad Hendricks, uh, did, that's all he did in the early part of his career, Lamar Porter, uh, one of my colleagues, that's all he did in the early part of his career and so we have that reputation for doing birth injuries, but There aren't a lot of birth injury cases in my Inventory, I guess one would call it in cases right now we have 6. So, this is not a common problem, but it's going to be a big problem. For those parents. who call me When their child is 6 or 7 or 8 or 9 or 10. And I have to tell them, the law was changed. We can't help you. You may have a case, but we can't help you. Um, another thing I'd like to point out, there was some discussion in presenting this bill about Medicaid. We recover a lot of money from Medicaid. Most of I'm trying to think of the cases that we're working on right now. Most of those, those, those babies are. Have Medicaid. They injuries are covered by Medicaid and so Medicaid, DHS doesn't file a lawsuit on their own. They don't have the skill. They don't have the resources to file a birth injury case. We do that. And we recover a lot of money for Medicaid And if this is reduced from 11. To far to the 5th birthday. That's gonna limit the cases that we can take and recoup money for the DHS. Uh, I, I'm not sure. With all respect, Senator Irwin, how reducing the statute relates to the other parts of this. Bill. I know that it's, it's Not gonna reduce uh the amount of money that a doctor or a hospital has to pay for a malpractice insurance tell. I can guarantee you that. It's not going to do that. They'll cut off maybe a few years that they have to pay for that tail, but it's not gonna, not gonna reduce that premium. I think that if you're your beef is with. Uh, the amount of money that somebody has to pay, whether it's a doctor or a hospital for their malpractice insurance. Tell your beef ought to be with the insurance company because I can show you studies that show that they're making billions and they're overcharging for malpractice insurance in this state, and that's where the problem should be and with uh that because I know it's getting late. I'll be happy to answer any questions. Members, do I have any questions of the witness? See none. Thank you, sir, for your testimony. Senator Irving. Thank you. I really, I, I appreciate the testimony. I would, um, Mr. Chair, members of the committee, I would just state, uh, we have advanced early intervention now for children that don't meet those developmental milestones that those are um social safety nets that did not exist previously and all of that shows up before the age of 5, or by the age of 5 and then the 2 years beyond 5 still is in existence. So, um, just wanted to mention that. Um, because we do have those developmental milestones in place, um, also to answer Senator Peyton's question, the $13 million is that the state pays for 17,000 to 19,000 Medicaid bursts a year, and the 13 million will mostly cover the increases in costs for the 19,000 bursts, and that was according to Janet Mann, who's our deputy director of DHS and Medicaid Director. Yes, sir. The other cost would be the associated with the Um, additional monitoring glucose, uh, continuous glucose monitoring, blood pressure monitoring, or telemedicine ultrasound monitoring and the services for the doulas and the community mental health or community health workers, that would be the other, um, part of the cost, but that generally in speaking, the majority of that cost is going to be based on the deliveries and the numbers that they've they've calculated. Um, members, I just, uh, again, I really appreciate the questions, appreciate the testimony. Um, and it's really been, as you know, Arkansas is facing a mental health, a maternal health crisis, mental health too, but maternal health crisis in the state, and we've got to retain and recruit doctors, there's no doubt. We have to increase these payments for our hospitals for labor and delivery, and we have to do a better job of really just supporting our moms and our babies so that they have the best chance of success for themselves as a expecting mom and for that baby when that baby is born, this bill is intentional, targeted, really smart policy and just appreciate all the stakeholders, um, that have worked with us on this bill. And with that, we're close, we'd ask for a good vote. Is that a motion for a good vote? Yes, I'll make a motion to pass. OK, I have a second. Members all in favor say aye. Any opposed? One opposed. I should have said that last part. I was looking for discussion. Well, OK, we'll back up, uh. Uh Discuss. OK, thank you. And, and this is a clarification that I want to make because I am definitely in support of of everything that we're doing in this bill, but when it did get to uh page 4. That's when I, I, I had paused. The reason being is that I have a daughter. Who is actually went under surgery like this, and she's 5 years old and we're still seeing possible failures to thrive, and we don't know if she's going to she we don't know if she's going to thrive and so when when when somebody tells me that that 5 year, that 5 year old piece, the 5 year old 5 year old threshold is the determining piece. I'm like, wait a minute, hold on, I'm having a daughter go through this period right now and we don't know if she's. not going to if if she's not going to have any after effects, so with that piece I'm like that causes me pause because I'm going through it personally, so. Uh, with that I will be a no vote. I support everything else in the bill, but that, that's the piece that caused me to. To say I have to pause, so with that, Mr. Chair, that's Thank you, Central Love. Members, I'm going to back up a little bit. And, and do a do over. You have a motion. And I have a 2nd, all in favor say aye, aye in the poll, say nay. Congratulations, you're 3 for 3. Thank you, members of the committee, and you can gavel us out if you'd like. You can gavel us out if you'd like. I'm not sure who did. I'm not sure I did that right towards the end.