Public Health, Welfare and Labor Committee - Senate

Right. And the chair sees a quorum. Excuse me. If you wish to speak for or against the bill, if you would please sign in if you have not already. And with that, Senator Love, sir, if you will present Senator Irvin's bill, Senate Bill 134. Mr. Chairman, I have I have a guest that's gonna join me. I don't know if, I don't know if I'm gonna need them, but uh he's here. Go ahead and introduce yourself. And sir, if you introduce yourself and Grant, if you introduce yourself, Grant Wallace, director of the employee benefits division. And Senator Love, sir, you are recognized and welcome start. Thank you, Mr. Chair and committees, I'm here to present uh Senator Ervin's bill, Senate Bill 134, um, and this, this bill does two things. Number 1, it moves the uh quarter it moves the monthly meetings to quarterly to bring them more in line with the board that it needs to work with. And then number 2, the bill. Reduces the stipend uh from $500 to $100 that brings it more in in line also with uh the other boards and commissions that that are related so. With that, I, I don't think there's, it's pretty simple, pretty straightforward and uh appreciate a good vote. Members, do you have any questions? See none. Uh, do you make a motion to Yes, sir. Uh, I close and I make a motion do pass. And do I have a second? I have a second. All in favor say aye. Members that has passed, and thank you, Senator Love. I appreciate the help. Congratulations. And with that, Senator Boyd, So, you recognize and you're up for the next 4. Thank you, Mr. Chair. It's an honor to be Senator Justin Boyd Fort Smith, um, It's an honor to be back in public health. It was a disappointment to me that I could join you on this committee today or for the, for the legislative session. But I'm back here today and I appreciate that. So with your permission, we'll start on Senate Bill 50. Yes, sir. OK. So Senate Bill 50. One second, I got a bunch of paperwork here because I got to be prepared for 4. For, uh, 4 different bills. So colleagues, I appreciate the opportunity to present Senate Bill 50 to you today. Uh, in fiscal year 22, our state agencies received greater than $200 million in state, federal, and other funding for workforce development. This bill seeks to study the successes and potential failures of how these funds are helping Arkansans navigate the government maze of programs and provide a clear hand up rather than just simply being a handout or unaccountable use of government funds. This bill seeks to bring the right people together with the best information to create a gap overlap analysis, highlight the good work in the executive branch and identify opportunities to engage the federal government. This bill sets the structure for a study to be conducted in ALC Hospital and Medicaid. Committee and generate a report to be completed prior to the next General Assembly. And with that, uh, Mr. Norris, with your permission, will introduce himself and have a few comments as well, Mr. Norris. Thank you Thank you, Mr. Chair. Thank you committee. Americans for Prosperity is a grassroots organization that looks for bottom-up solutions and Senate Bill 50 establishes a framework by which we can hear from those that are affected by these programs. Um, Americans for Prosperity believes in that prosperity is possible for everyone, but through our the communities that we are engaged in, we find out that there are barriers that are created in the process. Some of them are administrative, some of them are criteria based and those voices need to be heard so that we can understand why does Arkansas continue To see flat or increasing poverty when we have investments of this amount. Well, some of that is just that people get locked into systems that do not benefit them over time in terms of they want to improve their economics, but the trade-off sometimes between benefits and self-improvement can be vast, and they just don't want to take those. So I don't pretend to speak necessarily for those that are in those systems, but I do recognize that we must Come up to some solutions that will allow people to break these cycles of poverty. We believe again that prosperity is available to everybody. What we really appreciate about Senate Bill 50 is also it's using the legislative council, it is a low cost. We're not spending millions of dollars for consultants to come in and tell us what our people already know. We just need to hear from those groups that are working with this population that do want to improve their life. can. So we strongly support this bill because Arkansas again, is stuck in this cycle of poverty that is nationally understood and known, it's time that we spent some time focusing on what the real root causes of that can be, and some of that root cause is the systems that are designed to help are actually holding people back who want to maximize their their uh contribution to the workforce, to their community, and also just keep their families together. So we'd appreciate a good vote and support of Senate Bill 50. Thank you, Mr. Norris, and I appreciate your testimony. Members. Are there any questions by the members, Central Love. Thank you, Mr. Chair, and Senator Boyd, uh, thank you for, for bringing this Senate bill, but here's Just a few things as I read through the bill, you know, you and Mr. Norris talked about bringing the bringing groups together. However, I don't see any groups specifically named in the bill that we would be bringing together to convene to make sure that we have the fullness and the robust conversation, um, that is necessary if you want to hear from everybody. So I mean, can you address that? I'd say personally I'm open to ideas of groups that you feel like need to be at the table. I mean, that's our goal is to hear from everybody and see how this funding is being used because we're investing a lot of dollars and we want to make sure that we're, again, moving people out of the cycle of of poverty and so if there are groups you have in mind, we're, I'm open to, at the end of the day, the, the co-chairs of the hospital Medicaid subcommittee, and I don't know who those are gonna be. They're gonna be the ultimate, you know, Decision makers in, in that, but I'm confident that I know I would encourage. That you know whatever group to be to be hurt and be a part of the process. And if I may make a comment, Mr. Chair, to that. Yes, sir, Mr. Norris. I think that, again, this is a Americans for Prosperity inspired bill. We're about bringing people together. And I think if you, if we continue to allow those that showed up today to testify for this, you'll see that we've brought together a fairly robust group of individuals who are across the political spectrum even, but who understand that these populations need to have their voices heard, and they will be helping to guide their constituents' voice to this committee. OK. All right, I, I, I guess I'll save my comments for a discussion. Thank you. Members, are there any other questions? Uh, Senator Payton, you'll recognized. Thank you, Senator Boyd and Mr. Norris, I definitely support this effort. We, we definitely need to figure out any disincentives that are in the system to somebody improving their situation and maybe figure out how to incentivize. them to improve their situation. The uh Hospital Medicaid and developmental disabilities subcommittee already exists, and I'm sure they could already be doing this and, and I don't mind giving them an assignment to do this, but And you, you touched on this hiring uh consultants and consulting firms and spending a lot of money. Is there anything in the language of this bill, I don't see it. Um, that sets a guardrail or anything to keep them from From going out and Issuing a contract and get and hiring a consultant. For this work What I would say, and I told Senator King this this morning, there are no plans to hire a consultant. And you, you've got a commitment to me as the vice chair of ALC to figure out how we can do this without bringing in outside resources. I'm a firm believer Jack Welch said we should fire all the consultants and do it ourselves. That's what we were elect in our case, this is what we were elected to do, and we have people in the executive branch who have a lot of knowledge, and I think that the plan is to lean on Medicaid and uh the workforce development, uh, Mike Rogers. and bring in some executive branch experts and help, help them guide the discussion and then bring in groups that have an interest in in this topic and make sure everybody's voice is heard. Thank you. I just wanted to get that on the record and uh Hopefully we can hold you to it. Well, I was going to say it when I closed, but I've already said it now. Thank you. Members, are there any other questions? Saying no other questions, we have 4 people signed up to speak for it as of right now, or 3, as of right now, I don't have anybody signed up to speak against it. So Mr. Paul Chapman. Sir, if you're here, please come up. Mr. Chapman, if you will, please introduce yourself. Hi, I'm Paul Chapman. I'm the director for a nonprofit called Restore Hope. And sir, you, you're recognized. Thank you. Thank you committee. Um. Restore hope helps communities organize um what we call an alliance. It's the professionals that would provide services on the crisis to uh career continuum, which could include your child welfare, your pro-probation, your homeless shelters all the way to colleges, uh, community colleges, private vocational training and um And workforce services. We do this in 19 counties in 2024 these alliances served 3,314 families who started in multiple areas of crisis and 670 of those families completed their journey to care, so they're out of crisis and they have a full-time job that can provide them and their families a living wage. Uh, that's about 1400 professional or Arkansas providers that are using our software system and model and so my testimony today is that um all the different help, whether it be public or private, that exist in our communities is is not connected together. And when we can provide methods like 100 families where a community can actually organize together, then we start to see more efficiencies for the individual agencies, and we see better outcomes for, uh, the, the clients that we're serving. For instance, if we take a child into foster care in Arkansas with the goal of reunification. 43% of the time, do we successfully reunify those children with that parent. But through the collaborative method in the last 12 months, the parents that worked with their local alliance, the greenunification rate was 63%, 90% if you include a place with relatives of the children. And so just by through the coordination of services, you can see more efficiencies for agencies and better outcomes for the target client. Members, do you have any questions? Mr. Chapman, sir, thank you. Thank you testimony. have made to speak against the bill. See none, we're going to move over, move on to Mr. Pete Gus. Uh, good morning, everyone. Pete Gus, Economic policy director for Arkansas Advocates for Children and Families. You're recognized, sir. Thank you, Mr. Chair. Thank you, committee members for this opportunity to speak in half of Senate Bill 50. As many of you may know, Arkansas advocates has been working now for almost a half of a century working to improve the lives of children and families in Arkansas. We certainly advocate for evidence-based research-driven solutions to improve lives for all Arkansans. In fact, information and analyses are essential to the work we do. We also understand that for families to succeed, parents need to have a viable economic opportunities. We have to pay attention to issues that may prevent these opportunities, such as those related to housing, transportation, health care, child care, education, workforce training, all of the things we've been talking about so far today. We also know that unfortunately poverty continues to persist in Arkansas and around the country. Um, uh, some families struggle to meet needs federal and state public assistance programs are essential for them in this struggle to move them from the struggle to self-sufficiency to prosperity, and of course we all want all families and children to thrive. I'd like to discuss one issue that we're especially interested in Arkansas advocates that I think would be addressed by SB 50's study committee. And that is the challenges brought on by the so-called benefits cliffs problem. And it was all parents. It's, it's natural for parents to make decisions that are in the economic best interest of their families. The sudden loss of a public assistance program can make it difficult to accept that promotion or a better paying job opportunity. I recently discovered that the Federal Reserve Bank of Atlanta has a great tool. It's a simulator that's at the county level for looking at the effects of these benefit cliffs. So I've been modeling that for communities across Arkansas, um, just to give you one example, let's say a family of 3, a single parent, and 2 children living right here in Pulaski County would face 4 major benefit cliffs that occur as the mom accepts additionally. Be paying positions. These losses come from the the lack of eligibility for TANF, snap, chip, coverage among some of the others, and some of these are not insignificant at all. They can amount to as much as $7000 in one fell swoop. So a parent is obviously facing a very difficult choice when you're facing this kind of magnitude of a loss. There are many proven state level solutions to minimizing the effects of benefit cliffs, such as avoiding the clustering of multiple cliffs, uh, phasing out benefits to minimize the slope of the cliff and increasing asset limits to to participation. I, I believe the study committee as it works to develop novel approaches to improved workforce and social surface program delivery. We can minimize the effects of these these detrimental effects of these cliffs. Further, as the study committee answers its charge, it will uncover innovative ways of increasing efficiency and effectiveness of of social services, workforce development, economic opportunities. For this reason, Arkansas advocates urges you to support Senate Bill 50. Thank you. Oh, and I just want to say directly to Senator Love's question. We are very happy to participate in the effort going forward. Thanks. Thank you, Mr. Guest. Appreciate your testimony. Once again, does anybody here wish to speak against the bill. Seeing none, we will move on to Mr. Dunbar Ethan. Mr. Ethan, sir, you are recognized. If you would please introduce yourself though. Good morning, Mr. Chair, committee, uh, my name is Ethan Dunbar. I'm the mayor of Louisville, Arkansas, and I'm here to speak in support of Senate Bill 50 from a rural community. perspective And as we consider the framework for this study, I think and and it's been said before, Mr. Norris, he, he hit the nail on the head. We need to have a diverse group, uh, participate in this study to be able to look at because truth be told, um, Upwards of 50% of Arkansas families are Alice families. That means they're working, they just fall short of meeting the monthly or annual requirements, you know, they're working. Some of the benefits that they received just help them get over the mark each month and to lose those benefits is detrimental, especially to a family of 4, you know, my, my community is a 27% poverty rate. I see these guys every day as a mayor, you're at the closest level of government to the people. See him in the post office. I see him in the the grocery store or at the gas station, everywhere you go, so I deal with the problems because they ask the questions when they see you because they think we can help, and I think we can help if we consider all voices. If we take, if we take these families and include them in part of the study and as a mayor, uh, we have a little influence. I have a little influence to bring other groups, community-based groups into the conversation, I think that would help because losing those benefits sometimes is a decision. to take another job. Or a job that pays more but I'm gonna end up losing every month, so I think that needs to be taken into consideration. I also think as we develop the framework or as you all developed the framework, you included disparage report in, in the final report, something that looks at the the outer. Not in the population areas. I mean, not everybody lives in Little Rock, the center of the universe, you know, a lot of us out in those rural communities, we struggle with factories closing with schools barely staying open, all those things that, that affect how we make decisions about our lives, so I think all that needs to be taken into consideration. I support this bill. I think it's a good step toward understanding a true picture of Arkansas demographics. Members, do we have any questions of Mayor Ethan? Send none, Mayor, thank you. You, uh, good testimony. Yes, sir. Senator Boyd, sir, you recognize the close. Thank you, Mr. Chair. Thank you, Senate colleagues. I appreciate the opportunity to present this bill. The goal is again to bring together state resources in the executive branch, help them help us as legislators understand the things that we're doing and things that are working, things that need opportunities, places we can engage the federal government together. And so with that, I would appreciate someone giving me a due pass in a second and good vote. Thanks. OK, and members, I forgot to ask if there was any discussion. See none. I have a, I'm sorry, Senator Love, please go ahead, sir. My apologies. Are we going to take the motion before discussion. I'm, I'll make a motion. Motion pass. All right, so now I, I'll end the discussion, so I am, I'm, I'm very much in support of this bill. The the only thing that I I'm very skeptical about. It's the fact that they're not specific groups that are written into this bill to ensure that we can get the broad um. Input into the bill. Usually I mean I've I've done many, you know, I've done a number of deals like this where it's just pretty much a task force except for the fact that it's going to be happening in the subcommittee, but when you don't name those groups or, you know, or targeted groups that can actually speak to the broader populace then there might be some things that are left out perspectives that are left out and so while I'm in support of this bill and I just, you know, just ask that we really think about. uh, making sure that the groups are are really involved, they're engaged in that that we're seeking that support that those those perspectives, so with that um I close. Thank you, Central Love members, are there any more discussion? Signal Central board, you have closed already. Members, do I have a motion? I have a motion. I have a 2nd. All in favor say aye. Any posed say nay. See none Central board, congratulations, you have passed your bill. Thank you committee. And now we may move on to the next one. Which is Senate bill. 137. So you want me, I, I don't have the agenda in front of me. I've got Senate Bill 136, 1303. OK, so 136, uh, I have Naomi. Lopez, and she'll introduce herself in just a moment to do that. So with your permission, Mr. Chair, I'll I'll quickly begin and then hand it over to Naomi for a brief presentation. Go ahead, sir. OK. Senate Bill 136. This is what I like to refer to as right to try 2.0, uh, since I've been in the legislature, we passed a right to try bill. This bill updates our, our state law to right to try, uh, an individualized investigational Treatment Act means a drug, biological product or device that is unique to and produced exclusively for use for an individual patient. And again, that's why we needed updated based on his or her own genetic profile. This bill places parameters and guardrails around the use of an individualized investigational treatment for a for a patient with a life-threatening or severely debilitating illness in Arkansas. So And with that, ma'am, would you identify yourself? Yes. Chair Urban, Vice Chair Wallace, and members of the Senate Committee on Public Health, Welfare, and Labor. My name is Naomi Lopez, and I'm a senior fellow in healthcare policy at the Goldwater Institute, which is based in Phoenix, Arizona. Thank you for allowing me to offer my public comments regarding SB 136, the right to try individualized Treatment Act. As you consider this important issue to protect the right to try to save one's own life without having to beg the federal government for permission. to do so. Imagine that there's a new treatment for a rare disease. It's custom made for you based on your own genetic profile. It offers you hope, but you can't access it, even though your doctor says it could save your life. The reason Federal regulations are ancient by today's standards, and they're not designed to allow these new genetic treatments. Arkansas has an important opportunity to help lead the nation in solving this problem and save lives by championing the right to try individualized investigational Treatment Act. The federal barriers to life saving treatment are not hypothetical. Arkansas lawmakers have already been a leader in putting patients' rights first and cutting through medical red tape. Under the original right to try Act, which Arkansas passed unanimously and enacted 10 years ago in 2015, patients gained the right to seek medical treatments that are safe enough to be used in clinical trials, but remained under clinical evaluation before final FDA approval. The federal right to Try Act was later signed into law in 2018 and is now the law of the land, and we know that this law is working. The trouble is, is that this law needs to be upgraded and modernized to account for rapid advances in medicine such as gene therapy, which aren't covered under the original law in most cases. That's where the right to try individualized investigational Treatment Act comes in. The new law does not change in any way the successful original right to try law. It does however, create a new, safe, and physician directed pathway for those patients with rare and ultra rare diseases who don't have treatment options in clinical trials or who need an individualized treatment approach made specifically for them. This reform is now law in Arizona, Maryland, Louisiana, Mississippi, Nevada, and North Carolina and is now under legislative consideration and a dozen more states across the country today. Individualized treatments are being pioneered all over the world, but too often US patients such as little Kiera Riley in Arizona and her family had to travel overseas in the height of the pandemic to save her life. It doesn't have to be this way. Arkansas can continue to lead on the important goal of getting the right treatment to the right patient at the right time, removing the government red tape that stands in the way of a doctor's treatment options does not require additional taxpayer investment, and it can be achieved in a manner that ensures patient safety and informed consent. Arkansas lawmakers have the authority, as well as the legislative vehicle to unleash the potential of today's medical innovations and to further benefit patients. Thank you for your consideration of this important reform and I'd be happy to take any questions. Cen Boyd, are you ready for questions? Yes, sir. OK, members, are there any questions by the committee, Senator Payton, you'll recognize, sir. Thank you, Mr. Chair. I've been reading through this and most of my questions, you've answered them correctly in the bill, but on page 5 near the bottom line 34, there's a paragraph that starts. This is this subchapter does not require a medical professional who is licensed. So Oh I don't know that I've got a question as to, are we saying that these Decisions and Treatments are going To be suggested, prescribed by people who are unlicensed. Chairman Irvin, go right ahead, ma'am. Oh, sorry. Uh, Vice Chair Wallace, Senator Payton, thank you for your question. So the way that this works is that This law uses the federal-wide assurance, which is part of the Department of Health and Human Services protections for humans being used in clinical research. The the way that um This is, this section that you're referring to is under the immunity section and it is, um, and I'm not an attorney, um. But, but, but, but the um the federal wide assurance that's granted by the Department of Health and Human Services where it has a lot of different requirements on patient consent and also requires a registered institutional review board to a approve the treatment before it moves forward in their facility. For example, a university research organization would be covered by a federal-wide assurance. They have authority over allowing this to move forward or not move forward, as well as monitoring the treatment and they can actually stop the treatment for whatever reason, if necessary, um, yes. Um, so I, I, I don't know, um, I would need to look closer at that particular, um, that particular provision, but I can tell you that um that that that a doctor, even if they hold a Nobel Prize in medicine cannot walk into a a facility with that holds a federal wide assurance and start doing anything there. They have to be approved by the facility and by the institutional review board, those requirements are extremely strict, and they are over, and, and they are in fact um the Federal Assurance is granted by the Department of Health and Human Services, Senator Payton, you said, were you talking about line 34 on page 5, subsection B, so it says this subchapter does not require a medical profession who's licensed under the laws of the state to counsel, advise, prescribe, dispense, administer, or otherwise be involved in the care of an eligible patient. So it's not saying that It's basically saying that if you're the physician, you don't have to be involved, not We don't have to have one. You that because it's the immunity section. It's saying that if, if I, if I'm Dr. Boyd and I choose not to participate, I'm not gonna get sued, right? Like it, it provides immunity, not You, you have to have an Arkansas licensed physician has to be involved in this in order for this to work. If that's your question, that's what it is. It's just this specific section is saying they don't. I can choose not to, if I'm the medical provider, I can choose not to participate, right? Whereas if you're, if there is going to be participation, a physician has to be involved in because I had the same question, uh, when I drafted it, or a very, I, I should say I have a very similar question when I drafted it. Is there anything in the bill that The Uh, sets who is, who can prescribe this or? Or what those Credentials should be. Vice Chair Wallace, Senator Payton. So as I mentioned before, um it does have to be a licensed physician, of course, but, but under the federal-wide assurance, which is the additional requirement and additional layer protection for the provision of these individualized treatments. It has to go, it has to be done in a, in a facility that holds a federal-wide assurance, which is a certification that's granted by the US Department of Health and Human Services and covers the entire entity of that organization and As I mentioned before, a physician, you know, let's say it's, let's, I'm not trying to pick on any medical profession, but let's say that it's a podiatrist. The, the institutional Review Board would have the authority to say no, we are not going to take, uh, we're not going to allow, um, a podiatrist to recommend an immunotherapy treatment for a patient, and so that is under the full um even if it's under the scope of the license. provider, the institutional Review Board of that federal-wide assurance facility still has the authority to say no. You are not uh, you are not uh, for example, um, a provider who has the expertise to be to be recommending this and and and and allowing it to move forward. So, so that is if I could stop you right there. I, I think maybe at the top of page 2 where, where it defines eligible facility. Is that what you're describing, the eligible eligible facilities. So only eligible facilities as defined here. can perform this. Is that correct? Wallace, Senator Payton, that is absolutely correct. This is an additional layer of protection. The, the facilities that hold a federal-wide assurance have to undergo an pretty extensive um Uh, certification process, they have to agree to a very large set of rules and regulations. This has been in place for many decades and in moving forward with creating this bill, we wanted to create something that lawmakers would feel very comfortable knowing that it was a safe approach to providing very serious treatments for patients who are facing very serious medical crises, so we use the federal White assurance as a way to say only these facilities are allowed to operate, um, you know, under this. under this law. Well, thank you. Thank you for your answer. Thank you, Mr. Chair. And the chair recognizes Senator Liddy. Thank you, Mr. Chair. Um, I am on the bottom of page 3 line 35. I'm also generally supportive of the legislation, but I did have a constituent reach out with a potential concern they're worried that the way the bill is written, a patient could potentially be removed from hospice care without their consent, and I'm not sure that's the way I read it, but I wondered if you could address that. Go right ahead, ma'am. Page 3 line 35. Vice chair Wallace, Senator Leding, thank you for that question. It's a very important one. So if a patient is pursuing a life saving a potentially life saving treatment, then by definition, they may not. qualify for hospice care. And so this is really um a provision that deals with the provision of hospice care under insurance payments. So yeah, I suppose that makes sense if you are pursuing a life saving treatment, you probably don't think you belong in hospice, right? OK, but they would have to have like the patient's consent to, OK, thank you. Thank you, Mr. Chair. Thank you. And Senator Love, you're recognized sir. Thank you Mr. Chair. Um, it, it was raised, well, let me go to my first question, which I mean, I, I think it touched on the cost. Now, In the Senator Bo now how does this impact, how does this impact Medicaid? So if somebody says they want to undergo. Um, this specialized treatment. Does Medicaid actually, I mean, Because I'm reading through this bill quickly. How does this apply to Medicaid? Do we have to, are we going to have to pick up the tab for somebody. I'm just trying to figure this out. Thank you, Senator Love. If you go to the very, very last section of the bill, this subchapter does not require the Department of Human Services or the Arkansas Medicaid program to provide additional coverage for an individualized investigational treatment. So the state would not have to pick up the tab, OK, but I'm looking at the insurance covers part of this bill. I'm not looking at that. I'm looking at it says um an insurance company and and it goes into May, you know, do this piece and but then it goes over to I'm looking at 1 and then 2 it says shall not deny coverage for an item or service that is otherwise covered by an insurance uh contract between the eligible person and the insurance company. I'm just trying to make sure that that if somebody says hey I need this treatment. What you know, so, so the way I read that, Senator Love is. If I'm in the hospital and I'm potentially dying or being severe or I'm severely debilitated and the insurance company has in the contract an agreement to cover something, just the simple fact of using the individualized investigational treatment does not disqualify the patient from services that should otherwise be covered by the, the health insurance. So it's protecting the patient from, you know, a health insurer from coming in and saying, well, you, you did this, so we're not going to cover, you know, this over here, right? It's not saying they have to cover the individualized investigational treatment. It's saying just because you're on it doesn't mean we're gonna quit covering the other things associated with our contract. Got you. Alright, so now, so does, does this individualized plan is, is that additional money? I'm like, I'm just trying to figure the, I'm trying to figure this thing out, so. To better understand. You're recognized, ma'am. Wallace, Senator Love, thank you very much for that question. It's a very important one in the informed consent that is required under this law, the costs associated have to be spelled out and agreed to by the patient before proceeding, and one of the in this law, no one is compelled to participate, an insurer, whether private or public, is not required to cover these treatments, although they may. They're not forbidden from doing that. Um, but, but the, but what this, what this law does is it says that if you use this investigational treatment, a health insurer that's supposed to give you an annual physical, cannot deny you your annual physical because you did this treatment. OK, all right. And so my second thing is because you, you, you bought up IRB, so do all these go through IRB? Vice chair Wallace, Senator Love, all of these go through not just an institutional review board, but they go through one that's already certified by the Department of Health and Human Services because they can only go through facilities that have a federal-wide assurance. So there are a lot of different kinds of IRBs. These are ones that are already approved under the facility that has the federalide Assurance. Give me, so, so the scentative who has federalide insurance here because this, I mean, that's not really into this deal so who has is that is that like you ain't this something like give me. Give me some institutions. I'm, I'm just trying to kind of put this all together. Vice Chair Wallace, Senator Love. So, um, typically, any organization that's taking federal money for clinical research that involves human research subjects is has to be by law covered by a federal wide assurance. Um, and, and so there are probably at least 100s if not 1,000s, within the state, that would be covered by a federal-wide assurance, but really think of all of your medical research institutions and organizations, those all have to have the federal assurance if they're taking money from the US Department. Health and Human Services to conduct research. OK, so then walk me through this. I'm a patient at UMS. Right, there's a treatment, a life saving treatment. How do we, how does the process start? Walk me through that. So Vice Chair Wallace, Senator Love. So if, if you're a patient who's facing a life threatening or severely debilitating disease for which you've considered FDA approved treatments and your physician is recommending that you need an individualized treatment, perhaps a genetic therapy, for example, if the physician attests to your illness to the need for the individualized treatment to having considered other options that are out there, then you can go to a facility that has a federal-wide assurance and ask them, can we do the treatment here and the institutional review board will evaluate the treatment protocol. They'll evaluate um the research that's involved, the individuals that would be involved and decide if that treatment can in fact move forward. They're not required to say yes. They can say no. But if they do decide that it can move forward, then it can move forward and that treatment can be developed for you and you can receive treatment under it. OK. And I think I, I, I think I get it. Alright, thank you. Members, are there any additional questions? Ms. Lopez, thank you for very good testimony today. folks, is there anybody in the audience that wants to speak for or against this bill. So to Payton you recognize for a motion. Thank you, Mr. Chair. I move that do pass. In a second Members, I have a recommission recommendation the 2nd. All in favor, say Aye, in your polls say no. Congratulations, Senator Boyd, you're 2 for 2 so far. Thank you very much somebody else so if you give up your chair just for a while. The chair recognizes Ms. Jill Thayer, Jill, you recognize me? members, we're going to get a short briefing on Um impact. Thank you, Mr. Chair, Jill Thayer, Bureau of Legislative Research. Um, I was asked by Senator Irvin to be here to give just a brief overview to this committee of the fiscal impact process for the bills that impact the EBD program, the state and public school life and health insurance program and there are a few bills that have been identified for the public health committees that that fall under that. You all just adopted your joint rules, I think last week, and they have provisions in there that require before Bill impacting that program that would impose a new or increased cost to the program, have a fiscal impact statement that's produced by the actuary that the bureau contracts with. So the bureau is under contract with the Segel Group as approved by the Legislative council. They've identified about 28 bills, um, that were filed by the bill filing deadline, which was this past Friday and are beginning to work on producing fiscal impact statements. Under the procedures that the Senate and house insurance and commerce committees have adopted no bill can be taken up by a committee that's been flagged as needing a fiscal impact statement until that statement is produced. Um, I've notified all the sponsors of those bills that have been identified, so they're all aware, as are the committee chairs and Siegel is thinking that they will have those ready within about a 3-week period. Um, if the sponsors would like for the um The actuary to be here to present or answer questions on it, that can be done, but under the procedures, the committees have to establish a special order of business since Siegel is out of state. Um, I'd be happy to answer any questions that y'all may have. And if not, I will Members, do we have any questions and it's there. Senator Love, thank you. So, so it's, it just my assumption, so we just passed out Senator Boysville, so you all looked at that bill and it was, it was. Decided that he did not have any physical impact, so therefore, You let them over here. I mean, that's just one example has been monitoring the bill filing since November when prefiling began and have notified me every day and that was one that I did, um, Notice and asked a question about, but they said it's not mandated coverage, so it's gonna be things that require the program to cover something primarily, I just, I just want to say that that was an assumption. OK, thank you. Members, are there any other questions? See none was there, Jill, thank you. appreciate the good information. Senator Boyd, are you ready for What Senate Bill 137. Yes, sir. Thank you. Senator Justin Boyd here to present Senate Bill 137, um, so this bill makes it clear that in 202025 and beyond that electronic medical records are legally sufficient substitutes for hard copy healthcare records in Arkansas, except where federal law might take precedence. So for instance, in a pharmacy, the, if a physician writes a Schedule 2 drug on a piece of paper, then the pharmacy right now still has to keep that piece of paper because that's what federal law requires. So it would not do away with that, but what if a physician or a nurse practitioner wrote a prescription for amoxicillin, and there's no federal law that says that we have to keep the piece of paper, what it would do is it would allow a clear copy to be stored and you wouldn't have to keep that that piece of paper. Uh, so this bill was based on language and ideas in place from other states. So I asked BLR to help me look at what other states have done in this regard. And so we took what, you know, the, the best from all the states and put it together. Uh, I have sent it to the hospital association to the Healthcare Association, that the pharmacy Association, the medical society, anybody who I thought might have an interest in this to make sure that they did not have a concern. No one has expressed a concern. I've only had uh support. Now you might have a list of 50 people who are coming to speak against this bill. I don't know, but at this moment in time I know of no opposition to this bill. Remember, are there any questions by the committee? Seeing none, is there, is there anybody in the audience who would like to speak for or against this bill. See none. I have a motion. Do I have a second? I have a 2nd. All in favor, say Aye, aye. Congratu anybody opposed say nay. And congratulations, Senator Boyd, you are 3 for 3. And moving on. Central Boyd, are you prepared to brief us on Senate Bill 139. Yes, sir. Mr. Chair, thank you. Committee, uh, so this is what I think is a fairly simple bill, sometimes simple bills become a little more complex, uh, but this is, this is the deal. I've had physicians reach out to me and with concern about non-compete clauses in contracts. And so as I've studied this, I've come across information that shows that I've where I've found there have been 3 cases in the state of Arkansas. There could be more, but I know of 3. And in those cases, the non-compete clauses for physicians were found to be unenforceable for various reasons. So again, can I sit here and imagine possibility and tell you every possibility about how a physician non-compete clause might be enforceable? No, but what I can tell you is when you go to medical school, you shouldn't have to go understand case law to figure out that you're non-compete clause is not enforceable. So rather than having a physician who went to medical school, learned how to treat patients, is busy treating patients and quite frankly is engaged in our community in a way where we need them. I don't know of any community which does not need more physicians then uh what this does is it makes clear for physicians in Arkansas that a non-compete clause is unenforceable. Now, if you're a medical director or you have an ownership, that's a different animal. This is for a physician who shows up to work, goes to work in a clinic every day, and is employed by, you know, uh somebody presumptively a large employer, but it, it could be somebody else. So that said, I'm happy to try to answer any questions. Senator Peyton, sir, you're recognized for a question. Thank you, Mr. Chair. Senator Boyd. What are we talking about here? A covenant not to compete as a contract between the physician and whoever they want to give that. Contract too, it's not involuntarily entered into. And I've been told. For 20 plus years, 30 years, I guess by my attorney that a covenant not to compete is void unless you receive. Compensation for it, it's unenforceable. So we're talking about where a physician would voluntarily accept a payment to not compete in a in a particular county or city or radius, I mean, so Senator Payton, that's a great question, and I, I share your concern, and that's why I went back and I went and tried to understand case law. So you've got Mercy Health System of Northwest Arkansas Inc versus, I don't know how to say this, B I C A K in 2011. Um, and it was the court declined to uphold a non-compete provision lasting 2 years covering an 18 mile radius because the employer could not demonstrate sufficient interest to justify restriction, and the agreement would eliminate competition and interfere with public access to physicians. So that's that's gonna be a case where what the physician received was training. And the employer provided the training. And The agreement between the employee and the employer was that they would not compete if they received this training. So I don't know that training was involved or not, and this, you might know more about the case, but what I do know is the court said that non-compete is not enforceable, and, and many times the court will say that if, if the person who entered into the noncompete did not get compensated, but Anyway, I, I just don't think that the state should prevent people from voluntarily entering into a contract. That they've received something in exchange for it and obviously if they didn't receive anything in exchange for it, it's not valid contract, but I don't know if you can address that or not. So what I would say is, while in most scenarios I agree, I think this is a unique situation where what case law is available to me says that non-compees with physicians are unenforceable because they limit competition, they wind up creating a scenario where physicians leave our communities because they feel like, you know, hey, I, I have this and, and so, but when they go hire an attorney or spend money otherwise they find out it's probably not enforceable. And then so we've got somebody who then has to go, well, am I going to leave the community or am I gonna potentially spend thousands of dollars. Defending myself because of this. So what I think is Arkansas law should be clear and a physician should not have to go learn how to be an attorney or hire an attorney on this, and this law makes it clear. That Thank you. I, I don't know what makes physicians so special. Car dealers have to hire attorneys to tell us what the law is, but anyway, appreciate it. Members of the OK, Senator Love, you recognize, sir? Thank you, Mr. Chair. So, Senator Bo, I'm I'm, I guess I'm in line with Senator Payton, but I'm trying to understand, so. Because I, I, I'm pretty sure it's clear that it's probably like um a doctor signing a contract to go work for somebody. They're signing a contract with Mercy and in that contract it says hey, you will not compete with some sort of. I, I guess I'm just, I'm, I'm confused as to if they've knowingly enter a contract or a binding agreement. Why then the state would make it unenforceable by law. Because right now, Senator, my interpretation is case law has already made it enforceable. So if we don't do anything, what we're going to do is we're going to leave in a scenario where there continue to be these non-compete contracts in place and then they're likely going to show up in court and due to limits on competition and interfering with access to public access to physicians, then they're going to continue to be found unenforceable. So The alternative is we make it clear in statutory law that they're not enforceable, and then people don't have to clog up our court systems waiting on that. Just because it's in a statute, so there are different levels of law, right? You got a constitution, then you have statutes, then you have case law, and then you have an agreement between individuals. If anywhere above those agreements between individuals, something says you can't do this, and that overrides the contract. I guess I'm, I'm, I'm, I'm perplexed in the fact that we are now stepping into something that should be between individuals and I guess a company and I mean like you, I understand that you said you had case law, but I'm pretty sure that there are some, there are some cases that the that the agreement was upheld. Well, I mean, you are, but I don't know where they are, right? Like all I know is the research that I did seems to say that when it's a physician, the reason it's limited to physicians is purely because it's only physicians who've reached out to me, and then number 2, the case law I found was around physicians, right? So like I'm not opposed to Having this discussion with any other people, it's just that it's, it's been around that. So what happens is Practically speaking, a physician who went to medical school, went to train, and what they really want to do is, is take care of patients. They sign a contract. They come into a community, they sign a contract, and now what is usually a big company holds that over their head and says, you're either gonna have to leave the community or you're going to have to keep working for us or the alternative is you're just not gonna work, right? And so what this does is it puts into the statute what I believe case law is going to show, which is that a non-compete with a physician is unenforceable. So I mean, I don't, I don't know how else to explain it. I, I think the case I'm trying to make the statutory law reflective of case law. OK. All right, thank you. Senator Penzo, sir, you're recognized. Thank you, Mr. Vice Chair. Um, In these 3 cases you're mentioning mentioning. Did they have any financial consideration? In, in the non-compete. Or do you know that off the top of your head? So my interpretation based on the information I have is That these were employees of You know, so Mercy Health System of North Northwest Arkansas, Cardiology associates of Northeast Arkansas and uh I'm not sure Defner versus Alberti, which had to do with an orthopedic surgeon, uh, in a 30-mile radius. So Well, I think, and that's Peyton brought up something that made me think, you know, if there isn't financial consideration, maybe they aren't forcible, but if there was an exchange of Money for the non-compete. I would hate to go back. Retroactively and somebody got paid and then now we're gonna you don't have to adhere to the so so my question to you is, if I go back and amend the bill and say if you got $30,000 to for signing that, would you agree to the bill? That's the question I want because if so, I'll, I'll go amend it. I mean, that's not a problem. what I was going to say. I, I think what I'd like to see is if you want to sit today's date and move forward. And say they're unenforceable. I just don't know if I'm comfortable going retroactively, uh, because I mean, doctors and if you, if you do medical school, you're intelligent enough to know that a non-compete means you're not going to compete and you agreed to a contract. So if, if we want to make them where they're not enforceable, if we do it from this state forward, then we're looking at the hospitals, no, they're not forceable, they're not going to try to get doctors to enter into them, and then nobody's going into it black, so I mean if we want to el im in ate non-competees for doctors. I think that's the way it should be done. I mean, if, if you don't want to have non-competes, but I don't, I don't, I don't want to go retroactively. Payton, you recognize her? Ah, I mean, I don't know that, so one, I'm happy to amend the bill to to do that. I, what I'm just going to disclose upfront is, again, I'm not an attorney and as far as I know you aren't either. I don't know that that's gonna change case law. But if that's what it takes to make clear going forward, then I'm, you know, I, I'm happy to to make that amendment. I mean, I, I'd still like to have a, you know, an idea of where the rest of the committee is going to be on it before I do that. Well, that's what I was going to say I'd like to know the committee. starts on that as well. may, may someone join me to to give some insight into this who's an actual attorney. Yes, sir, sir, you are recognized. Please state your name. Yes, Mr. Chairman. My name is Mike Mitchell. I have, I have reviewed dozens and dozens and dozens of physician employment agreements over years and years and years. Never once was there a a specific payment for a non-compete. The way it works is the physician is presented a contract. There is a non-compete in there if you go to work for us and never once was there special payment for a non-compete. Uh, and the, the, the point here is you put physicians in a situation of having to go to court and spend a ton of money to contest and noncompete if if they leave that employment. And so, uh, while there may be a case out there where somebody pays specifically for non-compete. I have never seen it in my practice. Senator Pino, sir, you recognized? So I'm saying if there's a physician on clinic. And they sell it With the agreement they're not going to compete. That would be a financial consideration. I'm not saying just as flat out payment. Are you saying that you've never seen that happen either? I've, I'm not. I, again, the contracts are presented, uh, some hospitals, by the way, do not Washington Regional. I, I, I reviewed a contract for a physician for Washington Regional. There was no non-compete and I called the general counsel and said, what is this? Because generally, they're always included. And he said, you know, we find out if we treat physicians uh fairly, they don't want to go compete because they don't want to do administration. I talked to a pharmacist a couple of days ago that had to sell his pharmacy, um, and he signed a non-compete for a certain term. So I mean, I think it happens every day that people sell businesses with the agreement they're not going to compete. Oh that's a different situation. That's a totally different situation than a simple employment. Yeah, Section H1 of this this section does not apply to a covenant not to compete agreement that is ancillary to other contractual relationships, including any type of agreement for the sale and purchase of business, franchise agreement, any other agreement, not ancillary to an employment relationship or employment contract. And so I was very specific, like I was not going to let somebody out of one if so like, as you know, I own a pharmacy or co-own a pharmacy in Alma. I think it's absolutely wrong if I like sell my interest and then go, so no, this, this does not get into this. This is really truly an employee a lot of times though that doctor will go to work for the bigger corporation that bought their business. And so they, they are an employee of that business. So in that scenario, if they sold their business, I'm just, but it's, it would be another in Again, this section does not apply to a covenant not to compete in agreement that is ancillary to other contractual relationships. And so that's covered up here in H1. This doesn't apply. This is just some I wrote this as narrowly as I could figure out how to write it, where it's, I'm a physician. Who went to work for a specific company right out of school or even 30 years, but if there are other contractual relationships, this isn't going to apply. I mean, that's what H1 clarifies Senator Pennzo, and that is a typical provision in a sale, uh, that is enforceable. And, and obviously, you don't want to sell your business and then go into competition with the with the buyer, no, that's a different situation. Senator Payton, sir, you recognize? Thank you, Mr. Chair, and I'm not a doctor and I'm not a lawyer, but I am somebody who once sold my non-compete got paid for it and agreed not to compete because I was selling my business. I've also seen a lot of businesses and I've, I've hired people where we pay to sign-on bonus. And I think hospitals do that with some bringing in physicians and paying them a big upfront sign on bonus. I always thought doctors were Considered very intelligent people and capable of navigating life as much as any of the rest of us are, and I don't think it's I don't think it's unreasonable to expect doctors to be able to read the contract before they sign it and know what's in it. And I don't intend to give them relief through through this legislation from, from the same responsibility that all other citizens are held to. If, if we should If we should do this for doctors, why shouldn't we be doing it for everybody because case law is different for everybody else. You show me the case law of another entity. What happens is, say Fort Smith, but it could happen in your community as well as I have a physician who basically has said you sign this and so you're either gonna continue to work for us. You're going to pack up and leave the community or you're not gonna work. I, I really appreciate you saying that about the case law, because this is not the Judiciary Committee, and maybe this bill should have went. For the judiciary Committee, the fact that it Has physicians, I guess is the only reason it came before the health committee. But uh I, I, I'm not comfortable with. Pulling out such a small subset of the of the society physicians, I mean, we're not including nurses, we're not including anesthesiologists, all the other things that are in the medical field, and I'm sure those hospitals are signing contracts with all those people too. So I don't know how you can remedy that with an amendment. You might be better served to put it in the judiciary Committee where you can argue case law. OK, so what I'm hearing from you is that you would support me in getting this re-referred to judiciary. No, I'm not on the judiciary, but you would support me in getting it re-referred to the judiciary. Yeah, I would. I think that's where it should be considered. They would, they would have a better understanding. Yeah. Well, I, I, I'll just ask and Phil Philip had a Mr. Treat how to, how to do that and we'll go to argue it in judiciary's handle this with a with a motion. OK. Thank you, Senator Penzo. Do I have a second? Do I have a second? I have a 2. All in. But Yeah, that Yeah, that's, that's what I would prefer to do is just let me pull it down and go ask Philip the rules and if I need to bring it back here, then I'll just, I know what questions I need to try to answer before I come back. You know, yeah, that's, are there any other questions? And Senator Boyd, I understand you would like to pull down your, your bill. Yes, but first I'd like an opportunity to say thank you for passing the other 3. Well, 3 out of 4 and this senator Lidding. Thank you, Mr. Vice Chair. I just have one comment. I would just ask the Senator Boyd consider running fewer bills because you're making some of your family look bad. I'll give it serious consideration. Thank you, Senator Boyd. Members, uh, The next bill would be OK. House Bill 1214 and represent a Bentley is not here. Is anybody here to carry it for her? Yeah, and then, Members, I'm going to recess this for 5 minutes and allow Senator Rice to have time to come up here. Yeah, so we'll, we'll resist for 5 minutes and then we'll Come back in With that we are in recess. Senator Rice I guess. I, I wasn't sure if we could that's a good point. You look good in the chair, Dave. Good. the judiciary I'll shoot you a text I'll let you know if it's going or not OK. Hey John. You know, I'm calling us back into committee. And we're not going to be able to hear any more testimony today based on folks being in other committees, so with that, unless there's any objections, I am going to adjourn. Seeing none, we are adjourned.