Public Health, Welfare and Labor Committee - Senate

we're going to get started right away. Um, just a quick note, uh, scope. Um, Scope Week of the scope bills that have been filed, the deadline, I think was this week. So that will be February 17th through the 21st. So, um, also, uh, I believe Senator Penzo is going to schedule a special order of business for SB 2. Um, so he's not running that bill today. OK, with that, we'll go to SB 58 and Senator Penzo is that you're, you're not running this bill, Senate Bill 2 today. Is that correct? And do you want to schedule a special order of business for that, OK, you just want to let me know the day? Perfect. Yes sir, yes sir. OK, Senator, dismaying, you're recognized to present SB 58. I believe we have an amendment. We'll pass that amendment out. And I am happy to we can either take it line by line by the amendment. I think I've sent this to all the members. There was one minor change. I'll, I'll talk about that. It was technical in nature, does not change. Anything substantive in our conversations or what was previously given, this amendment has been given to all parties that were willing to accept it, to take a look at it, so they've they've had a chance to review um at this point, so I'm assuming they'll have some comments later on, but again, I can talk about it as the bill or the amendment, depending on what order you all want to go in. Motion to adopt the amendment, so move. 2nd, all in favor say aye and opposed, I have it. The amendment is adopted. Present the bill as amended. All right, members, so the the new bill. is the amendment, so I'll go through that with you so you can completely understand the changes as you're aware, I was pretty adamant and still believed that the cleanest thing for us to have done was to strike the prohibition and move forward to allow us to operate as any other states in regards to nonprofit tax exempt or governmently funded hospitals. Uh, in the spirit of compromise, I think I've done everything I can to accept all of the comments that I've heard, even not even given directly to me, that may be with our members that are in the Senate that are associated with the profession or even just news stories that I've listened to about questions and concerns. And so again, I've tried to incorporate everything. I'll preemptively say the one thing that I did not address in this that was questions was steering. My understanding, steering is taken on at a federal level. It's also in our statutes, and it would have created a clouded mess to try to incorporate that into this bill. I think it's covered else otherwise and also is achieved with another provision that I'll mention here in just a second, but we'll go through this amendment, which again is the Bill, the first thing that we're going to do is adopt a definition for a hospital campus. This was a definition that was agreed to in prior session, and so that should not be of any controversy to anyone. We're going to move to section 2, and this is where essentially we say in the retail pharmacy code that nonprofit tax-exempt and governmently funded hospitals can be granted a retail pharmacy permit. And then we're going to move into the stipulations and the parameters of how they can receive that permit and how many they can receive. So the first thing is, again, a nonprofit tax exempt governmently funded hospital can't have a retail permit that is located within 250 yards of its campus, they get one permit for the hospital. Pharmacy permit they have. So all nonprofit hospitals already have a hospital pharmacy permit that would require them to have a physical location in the state of Arkansas, and a standing hospital in the state of Arkansas. In addition to that, they can have one additional retail permit per 100 beds in their senses. There was some discussion of that should be that tied to um The daily census that they have or tied to the employees, those are fluctuating numbers. What we're referring to here is something that is given to the Department of Health. It's a true number and essentially hits some of the same caps that were being presented before, or, or suggested by those that were wanting to make adjustments to the bill. Um, and again, those retail permits still have to be in within 250 yards of the campus. So if they have multiple permits because of their size, they are still within 250 yards of the campus. And that is just purely for the convenience of those that are, you know, trying to utilize the, the, the retail pharmacies there. And it may be for a specialty pharmacy, retail pharmacy. So there's some options that they just have, but again, it's not like they're going to be able to go out and build offsite and, and start just directly competing with pharmacies that are currently in business. Second, a retail pharmacy permit, um, Yeah, one I'm sorry, we move on. And so now we get to section 2 and there's some prohibitions that would or that we would allow some exceptions to the cap, and that would be for fusion centers, for instance, there is no cap on the number of retail pharmacies that can be put in place or in conjunction with a fusion centers. That was something that was widely discussed and accepted by those that were in opposition to the bill as a previously written, and did not see that to be an issue, and so I included that here. And the is, if there is a pharmacy desert, and we define this in law, I think some of you may recall that being discussed. We discussed Rule 128, but if there is an underserved area, and there is not a pharmacy there, a, a nonprofit pharmacy could choose to fill that void. I'm not sure that any will, but they would have the ability to serve an underserved area by the definition. Of underserved or network adequacy. Again, that's not something that I made up. I didn't want it to be controversial. And so I borrowed that straight from legislation that were passed by the pharmacy Association or encouraged by the pharmacy Association. Uh, there were some requests for patient freedom of choice. This mirrors the language that we have for nursing homes and freedom of choice and essentially, you know, on upon exit by a patient, they would have to be made aware that they had opportunity and could ize essentially any pharmacy that they would like to utilize. Again, that mirrors and as the request of what the the burden that's currently placed on our nursing homes for freedom of choice. Uh, hospital reporting, this was a request by Senator Boyd, and this just is, and I, and I agree with it, we probably should have been doing it anyway, but this is just going to require a report to be submitted to ALC so we track the number of openings, closures, requests for permits and all that sort of thing in association of pharmacies that will Let us have a better idea of what's happening and and where the needs are here in the state, so I'm fully supportive of that change. Um And again, so that, that is, that is the bill at the second part where you see the strike through language, that is striking out the prohibition. Again, we're moving that into the retail pharmacy section of the code, and we're going to then put the restrictions in place and that some like to call that guardrails, um, I probably wouldn't term it that way, but there are guardrails in place that that would dictate where and how those could open. With that, I'd be happy to take any questions. Senator Lo recognize for question. Thank you, Madam Chair, and Senator Dismay, thank you for um really this bill, I didn't know that we were going to get started this early, but, uh, the amendments I I I like them, but one question I do have is because she put um back on page 2. In section B you said 11 retail pharmacy per 100 bids. Now how does this impact the the critical hospital, the critical access units that we have, those smaller hospitals because they would get there's, there's a couple of thresholds so they would meet the first threshold, which they would have a hospital pharmacy permits, so that would allow them to have the retail pharmacy. So, and I, I would make it up because I don't know how many beds they have, but if they have 5 beds, 5 or less they would be. ent it led to one retail permit larger institutions which they're going to have generally a much larger campus, that's where you get into the 100 beds and then additional retail permit. OK. And then also does this protect uh I know somebody mentioned uh out of state nonprofit hospitals, um, does this bill, uh, exclude those hospitals? To be able to qualify, you would have to have a physical presence and you would have to have a hospital pharmacy permit, so I mean that we have nonprofit entities that are operating from out of, you know, located generally out of state operating in the state of Arkansas, and I don't think we want to prohibit that. They feel needed voids, you know, but let's take mercy, for instance. I mean they're not no I I don't mean that. I mean just uh out of state hos out of state nonprofit hospitals that may want to come in and set up pharmacists. You're saying that they want won't be able to, they won't be able to have a hospital pharmacy permit to be able to do that, which means they would have to have a physical presence here and providing an actual service beyond just opening up a pharmacy. You cannot just open up a pharmacy for the sake of opening up a pharmacy unless you have, I mean, you just can't. So, and, and one thing I, I, that question was raised to me and so I read it 50 different times last night thinking I'd missed something because it's all about the question that you were asked that was posed to me, if you'll flip to page 3. Uh, that is that section 5, where the entire section is being repealed. It does not mention in any way anything about out of state nonprofit tax-exempt or governmently funded hospitals. I have changed that in no way, and the striking of that doesn't give or take away, um, To that argument. So I still don't really understand. Well, yeah, that was, that was posting me so I just wanted to appreciate the question, but I think we've covered that adequately. All right, thank you. Thank you, Madam Chair. Yes, sir, Senator Payton, you're recognized. Thank you, Madam Chair. Senator Dismay, I appreciate this a lot, uh. I really just have a curiosity question. I don't know that it What, how it affects things and that's why I'm asking is when we define hospital campus, it appears to me That we're throwing every satellite location. Into one singular consideration as the hospital campus instead of saying campuses where where they have other campuses. Is is that intentional or, or it just doesn't seem. It seems weird to me. So no. The, for instance, Baptist Stuttgart is its own hospital with its own hospital pharmacy permit, so it would be its own campus, Spring Hill is its own hospital with its own hospital permit. The main campus is its own hospital with its own hospital permit. And so that's, that's the restrictions. Now I think if the concern is we're counting um, Inpatient center. I'm, I don't know what the word is. I'm not in this field, but a clinic, they did, no, that's not part of the hospital campus. They do not have a um to my knowledge, they do not have a hospital pharmacy permit. So that's not a that's not an issue, and that's where the limitation is created. So they are not strictly contiguous to the main building. We're not talking about satellite campuses. OK, thank you, this is essentially let's just take UAS for example, even with the Big Baptist. I mean that That's a big area taking up lots of land, multiple buildings. What it's saying is whatever building, the outermost building, you can go 250 yards from that. I, I, I will tell you that I don't like it. I, I, I think that it could lend to someone really uh altering the actual real estate value on open par parcels in a densely populated area, uh, if there was going to be an acquisition and construction or whatever of a pharmacy, retail pharmacy by a hospital, but I, I'll walk away from that argument because this is the exact language that has been previously agreed to and I did not want to Meander from that. Thank you. Thank you, Madam Chair. Good point. Senator Pino, you recognize. I want to back up a little bit, uh, section 5 in here, uh, you stripe. for hospital pharmacy permit. I'm sorry about that. You strike the section where it says it's unlawful for a hospital to hold a licensed pharmacy permit, um. And you just said that by striking that, it doesn't affect that. So where else are they prohibited from holding a We're, we're, well, number one, we're, we're removing the prohibition and putting guardrails in place in the retail pharmacy statute. So there's we we are removing the restriction. And to me, when I looked at, and this is me, when I look at the drafting of this bill, we could have referred in this section how we were lifting a restriction that then we refer to this other section that we're putting the limitations in place and that didn't make a whole lot of sense to me. And so striking this, but then putting in the new language puts in the limitations that we're talking about having, um, yes, by its core, this strikes the complete, you know, banning of nonprofit tax-exempt or governmental hospitals from having one, so that's why you strike the language. I didn't hear completely what you said, so I appreciate you. Thank you. Thank you. Are there any other questions? Yes, Senator Payton. Thank you. I hope this is real simple. Uh, section 2, it says the board shall provide. Is that consistent with the other parts of this code that where they provide permits that it's a shell instead of a me. Yes, because we're going to have to meet the same provisions that anyone else is trying to open up and be underneath the same rules of anyone else that's operating a retail pharmacy. OK, thank you. Are there any other questions from members of the committee? All right, see you then. Uh, I do have two individuals that have signed up to speak, um, against the bill, I believe. Um, and for Mr. Craig Barry, if Mr. Craig Barry is here, we are not going to hear Senate Bill 2 today. It will be listed on our calendar as a special order of business, so you're, you can stick around, but, uh, we won't hear that bill today. Um, so we have, um, I cannot pronounce this last name. So Simon with Highland's oncology group. You're recognized. If you'll just state your name, please, for the record, and who you're with Senator Ervin and members of the committee. My name is Simon De Britsov. I'm with Highlands Oncology Group, um, it's a physician-led oncology um. A group in Northwest Arkansas and I unfortunately did not get a copy of the amendments, but uh so I'm gonna waive my objection right now based on what Senator described, I believe it addresses all of the concerns that we had, but I guess I'll read it later when it's available. Thank you very much. Thank you, sir. Appreciate you being here and for your testimony, Mr. John Vinson. You'll come forward, please. Thank you, Madam Chair. John Vinson, CEO of the Arkansas Pharmacists Association. Uh, I did sign up today to speak against the bill, but I would clarify that did get the amendment last night. I want to thank Senator Dismay for listening to the concerns. I know some of the senators on the committee have met with interested parties and Had interviews on the news that he was speaking to, and we do feel from reading the amendment that he is trying to incorporate the concerns, so we appreciate that. Um, do you want to take it back to my board since I work for a board at the association, have them look at it and get instruction on what to do beyond this committee, but we appreciate Uh, some of the amendments, including the infusion center permit piece that he described, including the serving underserved areas, we don't want citizens of Arkansas to not access care in underserved areas. We appreciate that. And uh the location on the campus, we appreciate that as well. Freedom of choice, appreciate the, the, the language and then we can look at it and monitor it, and I know there's going to be uh presentations to ALC to look at that and see how that's working, so we really appreciate that. And with that, I'll take any questions. Are there any questions for Mr. Vinson? Senator Love. Thank you, ma'am. I'm sure, you know, Mr. Vincent, you know, and we've talked, uh, we talked before, um, and one of my biggest concerns with the bill that was unamended was the fact uh I addressed the proliferation of, of uh clinics with this uh new amendment, do you think that that kind of quells that. That issue right there, I think yes, the only question we would have just on first glance is because it strikes direct and indirect interests that there might be a situation where there might be some company. I don't, I don't think the bill sponsor intended to do this, but If, if there was some um Creative way in a nonprofit with a separate corporation that wasn't a hospital because it doesn't prohibit indirect interest. There could be some loophole. We, we did have our attorney Kevin Crass with Friday Firm look at it. He thinks that the way he's drafted it would prevent that. But if you wanted to make it even stronger, you could address the word indirect interest in the bill with an amendment. But it's just we've just had it just a few hours just like you've just had it for a few minutes. So I'd like to look at that further, but thank you for the question. Are there any other questions from members of the committee? All right, see you then. Thank you so much for being here today. You're recognized the clothes for your bill. As amended. I mean, I think that I started my original presentation of the bills originally filed my main focus is increasing access and bettering outcomes. I think we're still able to achieve that with this version of the bill and with that, I would appreciate a good vote. All right. Do I hear emotion, motion in a second. second, all those in favor say aye and opposed. Uh, do you, would you like to have a discussion? I, I will yield to Senator Payton for discussion. Well, I just wanted to say I, I really appreciate. The working together to get the amendment and getting the language that we can support. I want to support this bill. I'm going to vote yes. I, I just wish that we had some assurance in it. That somebody is actually going to improve access. I understand that we're just lifting the restriction and allowing them an opportunity to, but I would like to have gained some assurance that they actually are going to do that, but I appreciate that and I appreciate a good vote. Any other discussion from members of the committee, OK, although some papers say aye and opposed. I have it. Congratulations, you passed your bill as amended. I think, Madam Chair, committee members, um, just a reminder, we're not going to hear Senate Bill 2 today, uh, Senator Penzo, we will have a special order of business for that because I'm sure there will be people that will have to take off work or reschedule patients or whatever to come on that bill. Um, Scope Week is going to be February 17. through the 21st, and again, reminder, if you're wanting to run your bill, please contact me. We'll get you scheduled. All right, with that, we are done for the day. Thank you so much. We're adjourned.