Transportation, Technology & Legislative Affairs - Senate

Thank you, Mr. Chair. And this is HB 1138. Please present your bill OK. This proposed legislation allows for physical therapists to be added to the list of persons to certify disabilities for parking permits, license plates, and placards. Currently, physicians, APRNs. Physician assistants are on the list. We ran this as an ISP in public health and had no objections. This bill aims to improve accessibility for persons with disabilities by involving additional healthcare professionals in the certification process. And establishes clear certification requirements, reducing the administrative burden for individuals with lifelong conditions by adding additional healthcare providers to perform the certification. This shows our commitment to support individuals with disabilities in Arkansas. You got it. Now repeat after me, motion do pass we heard the bill. Any questions the committee? Center right. Thank you, Mr. Chair. I am. Just trying to catch up, uh. Physical therapist is authorized under 1793104. Unless I got a wrong version, I go from 103 to 201. There is no 104. What was your question in that? We're referencing the section of code that I cannot, I do not see if I go to 17, there's chapter 93, which is physical therapists 101, a short title 102 definitions 103 penalties, and then it switches to subchapter 2, which is 1793 201, 202, 203, then moves into licensing. 301 through 314, so I just don't see. I don't know what we're going with 104. Would be my question. So what you're saying is you're not seeing a definition. Authorized under 1793104, correct? Yeah, I just, I don't see that we're creating a 104. So we're referencing a 104, but there is not a 104. And you're, I'm happy to, Mr. Chair, to bring this to him if he wants to. So top of page 2. Yes, uh, page 3. I'm saying go to the line one. Page 2. OK, so we are creating 104. I apologize, I just didn't see that part of it. Um It does say as authorized under. 1793104. say I'm just I'm just catching up. You just didn't see it in code already and it is created on page 2. So, and just not just kind of blowing out the section of physical therapist, you, you, I believe you are in the field of study of physical therapy. There's, there's all different ranges. There's doctor physical therapy, and there's limited license and there's all the different ratings. which one does this land on all physical therapists, so if I'm just a uh LPA. Well, there's, there's LPTA, there's, and then there's PT. It doesn't matter if it's a bachelor's or a master's or a doctorate. It started out back, it used to be bachelor's and it moved to a master's now they call programs or doctorate, but um it would be specifically to the physical. therapist, not the physical therapist assistant. OK, so if I can prescribe. If I can subscribe, prescribe the motions that a patient needs to do. a physical therapist's assistant would be basically following along with on the prescribed method. It's just the physician of physical therapy. Well, they're not, they're not physicians, physicians, whether they have a doctorate, I mean. doctorate level or not, they're physical therapists. But I mean if you're, if I'm just hired as an assistant, I can't just write a Correct, yeah, I mean, the, the, the PTs uh the only one that can do initial and discharge assessments, so the PTA is following the physical therapists, you know, plan, so whatever plan they set out, so, um, CTA would not be able to do this. OK, I understood. All right, thank you for the clarity. Thank you. Just a little clarity on something, so. The physical therapist has been Given a script from the doctor on what needs to be done. So if the patient has already seen the doctor. Why didn't the doctor do this? Well, they, the doctor doesn't know what level they're going to be discharged from physical therapy yet. So currently if, if a doctor uh Sis sends a patient to a physical therapist, um, and also It could start with a physical therapist. It doesn't have to be a prescription to a physical therapist, but let's say, like you said, the doctor sends the patient to physical therapy, um, if the patient uh needed. A handicap placard, they would have to send them back to the doctor for an appointment to get one currently instead of the physical therapist being able to do it, so it adds an extra step in the process for the patient to get one, and then the doctor's gonna ask the physical therapist, do they need it? It's pretty much how that's going to work, so this just removes the step of, you know, because the doctor's probably going to take the advice of the physical therapist based on the notes provided by the physical therapist on whether or not they would need. Handicap. placard. OK, thank you for that. With so many handicapped placards out there already. This is going to enhance more of them out there. I don't think so. I mean, it just makes it. Uh Removes a step from the patient having to go back to see the doctor to get one. Thank you. Any other questions, Senator Stone? Yeah, I have a question just for clarification on the physical therapist. If you have a doctorate in physical therapy is someone with a master's or a bachelor's considered an assistant or could someone with a bachelor's degree still prescribe or ask for the uh the handicapped parking. It's, it's the same whether you have a master's, bachelor's, doctorate in physical therapy, you can be a physical therapist. A physical therapist assistant is a two-year associate's degree. Um, so it's a totally different lastener like I said, it started out, you know, was a bachelor's degree, moved to a master's, and now it's a doctorate, but it's the same license. I'm not necessarily against it. I'm just making sure I understand. Right. All right, thank you. Any other questions from the committee? Senator Dima. So I guess I, I guess I confuse myself. I. Is it opening up right now it's just a physician is the only one that's allowed, or that's what I'm trying to know, my understanding is that APRNs and physician's assistants can do it already, already, even though like up here it just says sort of where we're having to change license position to certifying authority. And then the certifying authorities were determining to be these 4 individuals whereas previous to that, it was just licensed physician. What's that? the green sheet. I'm reading the bills, so I can confusion. So because everywhere we've stricken licensed physician, it didn't say certifying authority until now and certifying authority was redone to have all four entities. Not I, I felt like this would have said, Advance, you know, licensed physician, advanced, advanced practice registered nurse is authorized or a physician assistant, but it didn't. It said license. physician So we're actually, it's beyond just the PT folks, right? It looks, it appears to me that way. I mean, I guess My only concern would be is how many of these are going to get issued now that we're opening up to a bigger group of people and then what are the guardrails if someone just starts issuing. Placards for the sake of issuing placards, and then we've defeated the purpose of having handicapped parking because they're so pre, you know, prevalent. That, that would be my only concern because there's, I think one group versus 4 now. Or as it is written, my understanding that was added because of the changing of the definitions. I could be. I could be wrong about that. OK. So, um, would you like to pull this down let's find that information out. You know, the section code where it shows. Mr. Chair, man, but Senator Johnson first. Thank you, Mr. Chairman. Obviously a doctor Uh, the, the APRNs and the Physician assistants work directly under the doctor. Where PT might be. Can I bring to the table? I'm sorry. I, I bring to the table that can answer this once he once he finishes a physical therapist may BA clinical setting outside where the doctor is. It's like a referral. To just like when I had a wreck 34 years ago, my Doctor, my physician, uh, referred me to physical therapy and I chose which PT I went to where the others are under Direct supervision. This just adds the one that the doctor you choose to go get your PT and I'm sure there's some criteria and when he released me and said I was OK. I mean I never of course got a handicapped permit or anything, but, but that, but PTs are often, often, not always in a separate clinical setting. My referral of the physician. The end that I say that well. OK. Yes, Senator Penzo, you may bring up. Thank you, Mr. Chair, members of the committee, Alison Smith with DFA. So technically everyone is right. The code just doesn't match up. Usually that's caught through BLR's process under our law, which is Title 27, right now it only says that a licensed physician can authorize the use of one of these placards, right, a disability, um, parking tag, but under the separate sections, those individuals do have the authority. The APRN and the physician assistant under their law, they have the authority to essentially certify someone for one of these placards. So what, what this bill is going to do, it's just adding the physical therapist as an individual who is allowed to, but it's also cleaning up the code to specifically say in our law, all four of these types of individuals can certify someone. Happy to answer any other questions. Go ahead, Senator Dimay. Thank you. And so my question would be is, when you said in our code is position our license physician only in the other sections there's, do you recognize it from all the others, even though it's OK. Center right. Yeah, I was just gonna follow on Senator Desma's 1780 120, which is what ARPNs and PAs have that actually calls it out certification of disability for patients to receive a disabled parking. Thank you it all lines up. It is just adding physical therapist. Thank you. Senator Johnson I'm sorry. Yeah. Senator Dees, thank you, Mr. Chair. So now that we've, I think that adds some clarity and so just so I'm clear further now the debate is Should, should we allow physical therapists the ability to issue These these placards, right? Like that's, that's really all now we're doing because everything else will be cleaned up in the in the statutes and so the debate is do we want to have one more level of professionals have the ability to issue these. Is that clear? Is that how I should understand it? That is correct. OK. Thank you. Senator Scott. Any other questions? Yes, Senator Bryant, I'm going to belabor this for DFA while they're here. It shows how broad this is. So when a physician is given this authority, whether it's as a physician or as a ARPN or a PA. Do we leave it up to their profession to determine that eligibility criteria, or is there something defined in code that talks about immobility or non ambulatory or It is defined in the code, so and since you asked the question, I'll say there's there's actually 3 different levels of individuals with a disability that are eligible for a placard. The first is the temporary, that's just a 3 month and it's the same as what I'm going to call like a mid-range where an individual can get a 4-year, but it talks about the different, essentially it's someone who can't walk more than 100 ft without assistance. There are definitely specifications in the code as to when an individual would, would be eligible for a placard, and then there's a a what I call like a true permanent, and those are also enumerated in the code and individual with spina bifida, an individual with, you know, who's essentially born with an ambulatory disorder. Those individuals get the same 4-year placard and and come to the revenue Office every 4 years, but they don't have to bring a new doctor certification because essentially their disability is permanent. So but those are all outlined in the code and the physical therapist would be subject to the same determination. Senator Love, you got a question. I, I do because now I I'm thinking and me and Senator Deel are here talking. So you just went over the criteria it takes in order for, for, um, for people to assign, right? It it Penzo. Tell me this, when you go into physical therapy, is it usually a permanent disability or is it a disability where it may be temporary, could, could be either, I mean you could, you could come in from a motor vehicle accident and have, you know, Issue that will resolve or you could have been born with, with a disease process that uh You know, required. Some sort of maintenance program or, you know, you have, you know, it, it could be something that's with you for life or it could be an acute issue. Is that, is that what you're asking? Yeah. So I mean, The You know, like, like she mentioned, the, the section where I was talking about ability to walk so many feet without stopping, you know, system of devices, things of that nature. A lot of those are going to be in the notes from the physical therapist that the doctors are going to look at to determine if the person can have. The the placard, so this just eliminates that step from the process. So I mean you were asking if it's could be acute or chronic issue that the patient's dealing with. OK. OK. All right, thank you. So, and I'm not, maybe I don't understand how it works, but I mean it, it, I know on an insurance level. Health insurance level to be able to be eligible to see a PT. And have insurance cover that. I mean, it's because there's been a diagnosis and the insurances, you know, recognize that there's a need. You know, to, to have so many PT visits or whatever it may be. How does it work in this where let's just say that it's. You know, the individual's been released from the physician. But it's still paying out of pocket to go see a PT or whatever. It's no longer are they eligible to be certified by A PT under this situation, do they even have to be a patient of the PT. Well, I mean, if you're seeing a PT, you're a patient of the PT. You don't need a, you don't need a prescription from a doctor and you don't need insurance to pay, you could be paying out of pocket, um, you know, I currently go to a from a motor vehicle accident that I was in, I still go through a maintenance program that I pay out of pocket out of physical therapy clinic, so I mean, you know, when my back gets bugging me, I jump back in their maintenance program, so I mean, I'm a, I'm a patient, so yes, I mean. Insurance or whether a doctor's involved is irrelevant, whether you're a patient of a physical therapist. Does that answer your question? But they don't have a have to be a patient under this. Statue Change to be certified. I don't. If you, if you, yeah, if you're seeing a PT, you're a patient of the PT. I mean, I don't know how you could. I mean, if you go to the doctor. You're a patient and the doctor or you're not seeing the doctor, right? He's saying is this push your button. I, I think just for clarification what he's saying is under under how it's written, you can be a physical therapist and then just write and write it. It doesn't say that you have to be seen. It doesn't, it doesn't say anything. It just says that as a physical therapist, you can write, you can write this. And then they will, they will receive a placard. It doesn't give the qualifying piece of of they have to be a patient. They have to be anything. Is that, is that not what you're saying, Senator Dima. Yeah I don't know what the guardrails are if someone issues one of these to someone that shouldn't have one. I don't, I mean, I'm sure that's somewhere else in the code and that there's not, you know, talked about here. I know they have to have a qualifying condition, but I don't know what the, you know, what, how punitive it would be if they actually don't have that qualifying condition. I think it's really easy for me to see the need to have a 3 month one from a PT because obviously it's an intimate relationship they're visiting PUT, they know, but I mean if someone is not in maintenance with APT, how does the PT No. Uh, I mean, especially this is a 4 year thing, right? This is, this is giving authorizing a 4 year tag. How would the doctor know? Well technically you go to annual visits for your doctor. I haven't seen PT in my, I mean I'm not trying to be combative and I, and I feel like that maybe that's coming across the way. I'm not, I'm trying to understand. I, I'm assuming somewhere that someone can explain to me there's a guardrail. If you start riding these things up. And issuing to people. If it's not even a patient or it's someone that you've seen once. There is no stipulation that it has to be someone on maintenance. It's not anything there. I think most people in the room have seen their PT or a nurse practitioner more often than they've seen their PT. But OK, so if they They would have to come back in. For an evaluation after it expired, right? 4 years. OK, so if a doctor issues it, For 4 years. They have to go back to the doctor in 4 years, I guess I'm asking what's what's the difference between the physical therapist and the doctor at that point, if it's a 4 year issue. Why, why would it matter which one it came from? Almost all of us have to have a primary care physician. Right through insurance or whatever, that's just part of the stipulations of being a part of the healthcare continuum. OK. I don't think any of us are required to have a PT. Uh, again, I'm not saying it's going to be abused. We've got buddies that are PTs, you're PT. I'm not saying I distrust anyone. It just seems like a We see a lot of these. This is a for a 4 year deal and And I guess if we want to, can we request a list of what general types of people make the request. I mean if it's authorized by PT, if it's authorized by, OK, then I'll, we can just follow up on some other point. Again, I don't have some grave heartburn about what we're doing. I just I think there is a difference between a fission, the physician patient relationship and a PT patient relationship. One is typically more permanent in nature. Then the PT, which you hope is not permanent in nature, that is not going to outlast a four-year time span. If it's a chronic condition, it would outlast more than likely, and I guess I would say it's probably comparable to the APRN and the Um What was the other physician assistant. I mean, those are two. I mean, that's a totally different category than a physician as well, so. OK. Center I Senator Johnson. Thank you, Mr. Chairman, and I want clarify what I think I'm hearing from Senator Dismay, and I agree with him except that your testimony was the permanent Conditions that a patient could have that would qualify. That's where you get the 4 year. And anyone that's in a I'll call it temporary, but, but in the same, say when I had my wreck 4 years ago and I sent to the PT, uh, let's say I had a broken leg too. I didn't, but let's just say I did, then that would make me eligible since I was putting around on crutches for the 90 day or which I guess theoretically could be extended for another 90 days but had to go in and do that where if on the four-year permit. That is considered Absolutely to be uh a uh a permanent condition just that For purposes of what DFNA does, they renew it on a 4-year basis and my understanding those separating those two well enough. Yes, Senator, so the, the physical therapist under this bill would have the ability to certify an individual for either the temporary or the permanent, depending on what their need is the 90 day expires in 9 and it cannot be renewed. They would have to essentially start the process all over but they have to go back and be seen again and and yes, you're still in bad shape and say the pins broke and your knee or whatever, then they'd get authorization for another 9 days. They would have to start over. OK, alright. Thank you. Thank you, Mr. Chair. Senator Brown So does the order right now, if the physician will prescribe typically prescribe a PT visit. Could be. Is that probably more standard than not, so the, the, the prescription or the they asked to have the PT prescribe a treatment. That's all coded through the records of the patient, so it get, does it go back to the physician that looks at the notes of the PT and the like currently. So if I, if a physician says, yes, you, you need some PT on this because you're femur is broke and you got to get some things going in the physician forgets to issue a temporary or even a permit tag based on existing provisions. Does the physical therapist typically provide those notes back like highly recommend, you know, a, a handicap placard. Or is this because again this is this means uh probably unfortunate point. I don't have a relationship with the PT. I do if it's prescribed by my physician, but once he deems or she deems me. Like I've done all I can. I've got mobility back, then I go back to my physician who maintains that relationship with me via the notes of the PT. I is that an accurate statement? Yeah I, I guess the, the temporary versus permanent, my temporary relationship to get me well, to get me whole ends at some point. If it doesn't end, then I'm not going to see a PT for the next 100 years. I'm going to probably go back to a physician and get surgery or some other activity in any time I've had an injury. Um When I've been discharged from a From the physical therapist. I've never gone back for a follow up with. Now that's just me personally. I've never gone back for a follow-up with my My doctor I mean, I don't, I don't know what the. Typical scenario might look like, but usually after I'm discharged from physical therapy, but I, I, I probably take my own healthcare and, you know, more than most people probably rely more on their doctor's feedback, then I probably would, um. I have more of a holistic approach to it, and I might go see a chiropractor or a physical therapist, and I go to my doctor when I need my doctor. I don't rely on my medical doctor for everything, so, um, but yes, it is in the patient chart. Normally they're going to refer you to a clinic that's affiliated with it, so they, their notes are going to be within the same notes where a lot of times the doctor and the physical therapist can see each other's notes, so this would just, like I said, save, save. an extra step of, I mean, they may recommend depending on the, the injury or the surgery or whatever it might have been if it was a hip replacement, knee replacement, they're always going to be referred back to their doctor for a follow up. Um, if it's a motor vehicle accident, maybe not. I know a lot of the hip surgeries and knee surgeries, they would uh after the surgery they report. You know, a physical therapy clinic. They go through their physical therapy and then their schedule a follow up appointment with her doctor so many weeks to months later, it just depends on the doctor's protocol and what the doctor wants to see, so they may be going back to the doctor, they may not, but normally the notes are going to be relayed to back to the doctor for review. It just depends on if when that patient leaves the physical therapy clinic if they're not to the level they need to be, um, I know when, uh family member had a knee replacement. They were still not getting along real good. Kaine, so they were given a, they had to go back to the doctor to get the the temporary when it could have just been given at the physical therapist, and then they could have went to the follow-up appointment, so that's Did I answer the question? I think so, but this, this allows the PT to give a permanent lifetime pass. Um there are some, I mean, if you had an amputation. I mean, or I'm just throwing out different scenarios that again that would be a physician relationship. Could be in perpetuity, not necessarily a PT relationship unless the physician represcribed a PT. A lot of times with the amputee there's going to be a lot of long term training on prosthetic. Use and things like that, so they're, um, you know, the doctor might write it before you go. It might not be a good analogy, but um this just, like I said, opens up another avenue for was there, do you know if there's any discussion in the House about just limiting a PT to give up to a 4 year. ick instead of a permit because I assume we can't go ask somebody. About their their health status and whether or not they, I guess we, I had this debate two years ago in committee about limiting certain tags to certain peoples that were parking and, and, you know. We're CrossFit members running into the, you know, parking and having a valid handicap pass, but obviously at the chagrin to some of our house members were very upset that they were utilizing a space meant for somebody with real disability and so it was a hard nut to crack because you can't go ask. You can't. Find out what their disabilities are, which I wouldn't. That's kind of a jerk move, but at some point there's probably a limitation of what a PT should do. Did the House have any of those discussions for this. I'm not aware if they did or not. All right, thank you. Senator Johnson. Thank you, Mr. Chairman. Uh, I have a next door neighbor who's a one-legged guy. And he climbed Mount Everest. So can't just say that somebody just because they get around OK, it's not handicapped and not, I mean, he also has a house built on one level with with wheelchair access, so, uh. The law, the way I understand it in 2 or 3 different areas of code. Has the clinicians making this determination and all we're really talking about in this, and it was pretty clear that this is not anything to do with scope of practice. This is just about following the continuum of care. Am I reading that correctly, Senator Penza? Yes, OK, thank you. Thank you, Mr. Chair. Any other questions from committee? Senator Penzel, I personally like the biggest issue that we're facing is giving someone a handicap parking permit for 4 years. Instead of the 90 day check of work to be a check and balance with With the PT versus someone with full time. Do you feel like there should be some type of check and balance on this. As far as the time frame goes. I think that I mean, I think there are Checks and balances in place personally because I mean I mean it comes down to the integrity of the physical therapist. I mean, we're trusting doctors to do it, we're trusting APRNs to do it, nurse practitioners, I mean, I mean if, if there are certain requirements that are there to issue one. Are we, are we saying that physical therapists don't meet that threshold, I guess would be my question. I mean, I don't, I don't understand the hesitation with allowing physical therapists to Same abilities as the other three health care practitioners. Thank you, sir. Thank you. You're free to close on your bill. I just did. As for a good vote. What is the will of the committee? But I will, I will. I have a motion to pass by Senator Johnson. Do we have a second? So Taking the central stone. And just any further discussion. All those I would love this. Go right ahead, sir. This is uh house bill. Coming through its last. It's less raw before it goes to the Senate floor, and if there's just flush, flush this out a little bit. Um. If we, if we're given a short term, a short time frame, I'd be all for it. Um, it's, it's writing that ticket for a long term. Long term and Never revisiting it again. Versus a physician relationship that that might. Should revisit it again and I guess I'm just not like my, my mother is disabled. She has You know, has the tag, she's in a walker. And has that, you know, routine care, even if she doesn't go often, she still had that from a physician, not from a physical therapist. If I had a temporary issue. I would want in my physician did not handle that, but my PT decided you'd be, you'd be beneficial to not have to walk too far instead of having to go back to my licensed position having that physical therapist to give that that. Take it for me to have some temporary restriction or temporary paths to do it, but if they sign off on something permanent. I don't know the system well enough to know if it. What, what are the checks and balances of that, and I know we kind of closed for questions, but does anybody else share, share that thought. Senator Dima. Yeah, I mean, my concern is just overutilization. I mean, there's an argument right now with the limited number of people that are that have the ability to issue these that there are more. The needed and we're hampering. The ability for Handicapped people to utilize spaces that have a true need. I guess there's an issue that I don't know about with physicians and nurses not issuing. When there's the request, I mean, typically these are done by request. That that is a concern of mine for the PT is there's a request by a patient to do this, and there's going to be a want to meet that request by the PT. I mean that right or wrong, I think that's the the You know, typical reaction we want to satisfy a request, uh, especially if they're not under maintenance, prescribed maintenance, and we're looking to have them come back. I definitely want to want them to upset, be upset that I didn't, you know, grant them their placard or whatever it may be. I just don't think it's a good situation, maybe even for a PT to be in. I And again, I mean, my biggest concern though is just overutilization. I mean PTs the R in the in the state, but I don't think it's just a handful, and should we allow pharmacists to Have the ability to, you know, write these. I mean they see the medications, they know what's going on. I mean some of them tell me they're the health care professionals in the community. Um, I, I don't know where it stops, but That that is my concern. And since we're just discussing, I guess one of my biggest concerns too is someone we've had elderly parents, 93 years old and seeing him have to walk from the back because all the handicapped parking spots were taken up. By people that you can see coming in and out. They were moving relatively well and him struggling. With a wheelchair To get in And so that to me I have a major issue with that, and he actually had trouble getting a plaque, and he was 93. And so I feel like there is an over overuse of this, the handicap stickers myself. I think our medical medical field should look at how they issue those and be a lot more. Due diligence In how they issue those. Senator Dees Yeah, I, I thank you, Mr. Chair. I think I echo some of the concerns as well, um, I don't think I have an issue with, with physical therapists. I've issued the 4 years, and I know we've we've talked about that. I know there's there's the similar time frame with physicians. Um, it may be an education on my part that I need clarity on that um you know, the most typical case that this would touch. I don't know if it's short term or if it's long term or if it's Uh, but I guess in my mind I imagine this being more short term relationships between physical therapist and patient that have uh needs of A few months and we could be issuing for a few years and so that's where my hesitation is, and it may just need to be education on my side to feel more comfortable, but I think that's my biggest concern. I also want to echo that I know we're a separate chamber, a separate body, but it did pass with 98 to 2 votes in the House. And so I put those two things into weight for sure on my side, but I know that's where I have uneasiness about about this bill today. Sarah Love Like a share, um, in, in Calis where I do share some of those concerns. I, I kind of go back to there is a criteria that is used to actually set if someone is going to get a placard or not. That criteria doesn't change, so whether it's in the hands of a PT or whether it's in the APRN or adopted that criteria doesn't change, so if that criteria is met, then that placard is going to be issued. And so we're just allowing just another subset of of a health care professionals to actually say, hey, these these criteria are met, um, the second piece in regards to, you know, the the length of time. I mean, we're, I think. We get in our mind that hey, when we go see physical therapy, we're thinking 3 months, 6 months. Hey, that's, that's, that's it, um, but there are other individuals that go see physical therapists and possibly for life. And so if that criterion is met and that physical therapist can see that those individuals are going to be. Going to need a 4 year placard, I think that we That they are qualified enough to see that that individual is going to meet that criteria. If they don't, I don't think that a physical therapist is going to say, hey, Frederick Love, I know he's going to be here for 3 months. He was in a bad car accident, but he's gonna be here for 3 months, but I'm gonna give him a 4 year placard. I just don't. I just don't see that happening. I, I see that that physical therapist is going to say, here's the criterion, that criterion is met. Let's issue a placard, and you know, like I said, as we I saw those concerns, but um I don't, I don't know your name, but um. If there's a criterion that's met, I think that a physical therapist can see that as far as as much as well as the APRN or as well as a doctor, so that criterion is set, so that's not changing, um. And so for that I'll be voting for this bill and I ask you to do the do so the same. Thank you. Thank you. Any more discussion? In bright. Thank you, Senator Love. I was, I was waiting for my, my emotions, my motions here to give me their argument, but I think I don't need to because I think that's a, that is a good argument to have, I guess the question I'll have for a committee and maybe we can open it up for maybe our witness to Just to close it on me is required for a disability that is permanent in nature. I know it's still, it was in code. We just rearranged it a little bit, but permanent in nature is that the definition of the physician. Or is it, does it go beyond that par pardon me if I'm lazy looking for it. Will allow you to answer that question. Thank you. I, whether temporary or permanent, all four of those individuals would be able to certify. So whether it's the 3 month or the 4 year. So there's no definition of permanent nature. It's whatever that certifying official deems as permanent in nature. The code's probably not as pretty as we'd all like it to be in terms of permanent, so you've got 2, you've got the 3 month temporary, right? And then you've got a 4 year permit, what's called a permanent placard, but then there's two types of permanent within that. So the first type is those same requirements, right, about the lung, about walking 100 ft, but that individual gets a 4-year certification, OK, so they get the 4-year hang tag. But they have to come back in every 4 years and bring a new doctor's note that says, yes, I do still qualify for this, right? And then there's what we're going to call like uber permanent. They get the exact same 4-year placard, but there is no changing their medical diagnosis. It's usually from birth and so those individuals do not require a new doctor's certification every 4 years. They're their placard is only eligible for 4 years, but they don't need any doctor's note essentially. OK, thank you, thank you for that. Thank you, Senator Penzo for for taking us through this journey. Arkansas is part of a compact as well, and the the surrounding states, the PTs that are allowed to. To certify these and the surrounding states that were in the compact with were one of the few states that can't. My recommendation, Senator Pennzo is, if this makes it out of this committee that you might want to mention that tomorrow in the chamber. Sounds good. Yes, Senator Johnson. Uh, I note that Representative Torres is here now, and he may or may not want to add anything to this debate, but I would certainly request that he be given that opportunity should he wish to avail himself of it. That'll be up to the one that's presenting the bill, but we're already past that point. We've got, we've got to go. Sorry about that representative, but we're we're past that point. We have a motion. In a second, all those in favor say aye, oppose the same sign. Pennzo, your bill passed. Thank you. We're adjourned. well. All right, can I get your John Hancock.