House Public Health

Jan. 24, 2023 


Rep L Johnson: Representative Pilkington isn’t here today, so we’ll pass over his two bills. Representative Maddox has informed me he’d like his bill moved to the deferred list. We’re going to pass over my bill on 1126. We’re waiting on some information from DHS. And this is a loose count, Representative Wardlaw. This is a loose count. Representative Cavenaugh may not be here. Yes, she is. Excellent. Perfect. Representative Cavenaugh, if you’re ready to present your bill, we’d be happy to recognize you at the head of the table. Yeah, we’re working it.


Rep Cavenaugh: Thank you, Mr. Chair and committee. I’m going to have Mr. Matt Gilmore sit down here if that’s all right with y’all. This bill is just a clean-up bill from some language we eliminated in 2019 dealing with good moral character. In 2019, we moved that from several different places in the statute. Because one person’s definition of good moral character might be different from another person’s of good moral character. And this was just a cleanup that we noticed that it did not get taken out of this particular board’s language and we’re just asking for it to be removed.


Rep L Johnson: Committee members, are there any questions for Representative Cavenaugh or Mr. Gilmore? Representative Wardlaw?


Rep Wardlaw: So we’ve dealt with this. Thank you, Mr. Chairman. We’ve dealt with this numerous times. Are we sure this time fixes it to where we’re not going to do this again? I mean, it’s the third time I’ve seen good moral character bills. So, Mr. Gilmore, are you responsible for this? Are you making sure it’s right?


Gilmore ADH: Representative Wardlaw. As Representative Cavenaugh said, this is something they’ve worked on, I think, for several years. We were going to run a bill last session and then some other bills were filed so we didn’t do that. I think as far as we know, as far as the Department of Health, I think this is the only last language that hasn’t been removed from all the occupational licensing as far as I know. But I think it does put the board in a bad situation if being subjective as to the definition of what good moral character is. So I think it will clean things up a little bit and make it a little bit easier.


Rep L Johnson: Any other questions, Representative Bentley, did you have a question? Any other questions from committee? Representative Allen? Is there a motion do pass? Is anyone here to speak against the bill? Is anyone here to speak for the bill? Sponsor, do you close for the bill? Thank you so much, Caitlin. You’re helping me out a bunch. Do we have a motion? We have a motion do pass. All those in favor, say aye. All those opposed? Your bill’s passed, Representative Cavenaugh, thank you.


Rep Cavenaugh: Thank you. Thank you, committee.


Rep L Johnson: Representative Evans, are you ready to present your bill? Perfect. Representative Evans, you’re recognized to present your bill.


Rep Evans: Thank you, Mr. Chair. Members, I’m here today to give you and present to you House Bill 1173. As many of you know, and actually some on this committee participated in, in conjunction to legislation that was passed by Representative Vaught back during the 2019 session. There was a working group that was initiated to research, to study, and to seek ways to improve the quality and amount of mental health and behavioral health services in Arkansas. This big working group grew to about a 140 participants, a lot of different stakeholders from around the state, state agency members, state agency practitioners, independent agency providers, and trained mental health experts, community stakeholders, legislators. Most importantly, we had a lot of parents involved. Parents of students, children, some of your neighbors that suffer from mental and behavioral health. From that big group, we were broken out into some subgroups, and I was asked to facilitate the meetings with the participants from across the state on the issue of workforce shortages. 

Time and time again through our meetings, what we continued to hear was the shortage of boots-on-the-ground folks to work one on one with our students, work one on one in our schools and help take care of some of these issues that we find ourselves in a crisis mode. After several months in multiple meetings of collaborative discussion, what we realized was that a lot of the things pertaining to workforce could actually be handled through the manual of practice that is put out by DHS. DHS agreed to change many of the things in that manual to help assist in the workforce problem. One issue that could not be changed just through changes within that manual was the issue of the lack of licensed psychological examiners in our state. 

The reason that they could not change that in rules was because during the 86th General Assembly, back in 2007, House Bill 1230 was passed that placed a sunset on the licensing of those LPEs and stated that no licenses would be granted after December 31, 2013. So what this bill does, it’s very simple. It just repeals that sunset language out of the code, and allows the licensed psychological examiners to reactivate their license, get back out into the workforce. I have been amazed at the number across the state of Arkansas that have reached out to me and said, thank you. This will make a difference in the life of our children and our adolescents that are suffering from mental and behavioral health. Now, let me be clear, this is not a quick fix. This is not a magic bullet. We know from our work group, we’ve studied for some time. That this is just one of the first steps. And I am very committed to continue on to this effort to work with all the additional stakeholders, find additional options that we can help get more people out in the workforce and try to overcome this crisis. And thank you, Mr. Chair. I’ll be happy to answer any questions.


Rep L Johnson: Representative Eubanks, do you have a question?


Rep Eubanks: Thank you, Mr. Chair. Representative Evans, do we have any idea why they did this? What’s their reasoning was?


Rep Evans: I can’t give you an official reason. I think it’s just part of what we find ourselves and a lot of times where when it comes to scope of practice, folks begin to get just a little bit territorial. And they want to protect their entities. I’m not saying that those concerns are not with cause. But I think that was the purpose at this time that the Psychology Board felt like that they needed to draw that back in.


Rep Eubanks: Thank you.


Rep L Johnson: Representative Wooldridge.


Rep Wooldridge: Thank you, Mr. Chair. Representative Evans, so are we talking about expanding the scope of practice for LPEs to do what? Because currently, they can practice. They can do testing. They can do therapy. They can do additional top services. What are we expanding their scope to allow them to do?


Rep Evans: All we’re doing by this is just repealing that sunset so that that license at the master’s level can now be reactivated.


Rep Wooldridge: Okay. So currently, LPEs can’t become licensed to do what? Because they can be licensed currently to do therapy and testing and things like that is my understanding, is that correct?


Rep Evans: So currently, if you look at it kind of from a broad lens. And I made a list just of the things. LPEs interview clients, obtain background information, include family history, education, mental, physical, and emotional health. They can administer, score psychological tests, interpret and evaluate test results and determine the individualized behavior management treatment type programs. So it’s quite limited. They are not, I don’t believe, actually providing mental health therapy. I think this is more of kind of an administrative-type role. But I did find it interesting because I went to the Department of Health website. The Arkansas Department of Health is currently advertising for these positions. And so I think the nature of practice, not necessarily the scope of practice, as we are seeing an uptick in our schools where we’re having a lot more mental health issues with our kids. There is a greater need. But yet, to facilitate that administrative role, we don’t have enough of the LPEs on the ground. And so what this will do is it will let those programs kind of kick back off. Let people get their certifications back to have that and be able to put those folks in the schools.


Rep Wooldridge: Okay. From my understanding and someone from DHS maybe can clarify, but I think that LPEs can currently be licensed to provide therapy and be eligible for Medicaid reimbursement and some private insurances, but I’m not sure.


Rep Evans: Yeah, I’m not sure.


Rep Wooldridge: The scope by which we’re trying to cover. Thank you.


Rep L Johnson: If I can ask you a question, as I understand your bill, Representative Evans, it doesn’t expand the scope of what LPEs can currently do in the state, nor does it create a new licensure in our state. It only lifts the sunset clause to allow people to– to allow us to expand the number of people who can currently obtain the licenses, is that correct?


Rep Evans: That is correct. If you go back and you look at that bill from 2007, line 11 says, after December 31, 2013, no new psychological examiner license shall be issued. That’s all we’re doing is removing that clause so that the licensure can be activated again, but not expanding scope, creating new job titles, or anything like that.


Rep L Johnson: Any other questions, committee? I have one other question. Do you think there are other opportunities outside of this bill to expand opportunities in the future to who might be able to administer these tests in the state to help reduce the bottleneck we have of examining, not just with the licensed examiners as we’re discussing today, but maybe other individuals in the state that might in the future be able to help with this issue?


Rep Evans: I do. I spent quite a bit of time having discussions with specialists in this area, especially speaking with the Dean of Psychology at UCA, who is an extremely valuable resource, Dr. Art Gillespie, and he and I agreed this is not the silver bullet. This is not a quick fix. It’s just one of the tools that can go into the toolbox. There is some really good collaborative ideas that are out there involving technicians and some research that they’ve done to where we could even– I hate to use the word fast track when you’re talking about medicine. But there are some things that we can do quicker to get more people out there, but just do the timeline of filing an ISP and getting that to meet the deadlines. We were not able to do that. And so we’ll be working on that going forward.


Rep L Johnson: Representative Wardlaw, do you have a question?


Rep Wardlaw: Yes, sir. Thank you, Mr. Chair. Do you remember what the act number or the bill number was in 2007?


Rep Evans: That was Act 505, House Bill 1250.


Rep Wardlaw: Thank you, Representative Evans.


Rep L Johnson: Any more questions for Representative Evans? Seeing none. Is there anyone that signed up to speak against the bill? Anyone here speak for the bill? Are you closed for your Bill?


Rep Evans: I am closed for my bill and I would appreciate a good vote.


Rep L Johnson: Motion do pass. All those in favor say, aye.  All those opposed? Congratulations, Representative Evans, your bill has passed.


Rep Evans: Thank you, Mr. Chairman. Thank you, committee for the good vote.


Rep L Johnson: Representative McGrew, my apologies. I missed you in the audience before Representative Evans came to the table. I was in a hurry to try to– he chairs a little committee called Education, and I was trying to get him back over where he belongs. If you have an amendment or you’re recognized to represent your bill. I’m sorry to put you out of order there.


Rep McGrew: Thank you, Mr. Chairman. I’d also like to introduce you to Kelly Hale. He’s the CEO of Hot Springs Village. We also have in the audience Bill Bridges, which is with the Governmental Affairs Committee here. And before you today, with the bill that we brought earlier in the committee that Representative Wardlaw had a concern about. We were able to check on that and what this bill does is take Hot Springs Village completely out of that fund. So there will not be any funds available for them in that fund. It treats them just like a municipality, for instance, the city of Monticello, which is the same size. So that’s what this bill does, and I believe we took care of the concerns.


Rep L Johnson: So do we have any questions for Representative McGrew? Representative Wardlaw, you’re recognized.


Rep Wardlaw: I’ll make it a question, Mr. Chair.


Rep L Johnson: Yes, sir.


Rep Wardlaw: Representative McGrew, I appreciate you pulling this bill down and looking and researching it. And committee, I will assure you the research I’ve done with him over the last few days, it will not impact trust fund and trust fund will not have to pay for an issue with Hot Springs Village. With that, I wouldn’t belabor the point and Mr. Chairman, I’d have a motion at the proper time.


Rep L Johnson: Is anyone signed up to speak against the bill? Anyone for? Are you closed for your bill, Representative McGrew?


Rep McGrew: Yes, sir.


Rep L Johnson: We have motion to do pass. All those in favor say, aye.  All those opposed? Congratulations, Representative McGrew. You’ve passed your bill.


Rep McGrew: Thank you. Thank you, committee. Thank you.


Rep L Johnson: Can I have my phone? I need my readers too. Never make it down there.


Rep Miller: Representative Johnson, you’re recognized to present your bill.


Rep L Johnson: Thank you, Mr. Chairman. Members, we developed criteria for community paramedics back in 2018 timeframe. This was a project that was worked on by a lot of folks at that time at the Health Department also within the paramedic community. The community paramedic concept is one that’s been around nationwide for quite some time. So we were on the front end of this when we developed these criteria for licensing community paramedics in the state of Arkansas in 2018. We’ve had a lot of experience since then. We were sort of new in that process when it started. And we probably overreached a little bit with some of our criteria. So I’ve worked with the Department of Health with the Ambulance Association to look at reducing the number of training hours necessary to become a community paramedic. So this bill does two things, it reduces the number of hours from 300 to 160. And it also changes one of the criterias of clinical experience. So one of the things that have shifted in the timeframe since this bill was originally passed is we had a lot more medics working through emergency departments at the time we passed this bill. That’s just not something that happens as often now. And there’s been a shift in emphasis to things for these community paramedics to learn about with regard to social determinants of health. And so we’ve changed one of the clinical experiences to kind of reflect better what these community paramedics are doing. What these community paramedics do currently in the state, twofold right now, and there’s other opportunities. One is going into people’s homes, post discharge. So if someone’s discharged from the hospital, one of the things we try to look at is hospital facilities is readmission rates. And so it’s important to us to try to reduce readmission rates. And so the community paramedics have been hired in certain communities to go out to these people’s houses, make sure they understand their discharge instructions, make sure they have their follow-up appointments made, make sure they’re getting their prescriptions filled. The other place we’re starting to see community paramedics use is in acute crisis for mental health. So there are places around the state now that are piloting programs where we’re using community paramedics to respond acutely instead of EMS or police to behavioral health emergencies. So this is a great license for people to have. It’s a great thing for our state to have in the way of a training item. We just want to try to expand the number of people that have access to this. And I’d be happy to answer any questions.


Rep Miller: Representative Bentley, you’re recognized.


Rep Bentley: Thank you, Chairman. So Representative Johnson, these people are paramedics that are getting further training for that. So they already have emergency training so they’re already a paramedic [crosstalk].


Rep L Johnson: Correct, this is additional training on top of their paramedic training, yes.


Rep Bentley: Thank you for the refresher. I appreciate it.


Rep L Johnson: Yeah.


Rep Miller: Any other questions? Anybody signed up to speak for or against the bill? Are you closed?


Rep L Johnson: I am indeed, Mr. Chairman. And I’ll make a motion do pass.


Rep Miller: All in favor say aye. Any opposed? You have passed your bill. Congratulations.


Rep L Johnson: Thank you.


Rep L Johnson: Members, I think we’ve run through the agenda of things that were available to run. Are there any questions for the members on any other issues? I had discussed the possibility of having a meeting this afternoon for informational purposes only just to bring some– we don’t have that set up. So currently don’t plan to meet upon adjournment today. As a procedural issue, as we talked about last meeting, I like the idea of having two types of meetings. The kind of meetings we’re having this morning where we’re running legislation and a kind of meeting where we’re bringing people to the table to bring information forward to us as a committee. I’d like the meetings that are informational to be Tuesday afternoon meetings. And so if you have something that you want as a committee member to hear about specifically, I’ll be happy to try to set that up with Agencies and Associations. Certainly, Agencies and Associations, if you would like to speak to us on a topic, I would rather have those topics be addressed in a stand-alone type meeting where there’s plenty of time for questions and answers from committee members and plenty of times for information present where we’re not feeling pressed by an agenda full of bills. Now, if we keep the agenda clean and we don’t have any bills on a Tuesday morning, I reserve the right to change that idea. But out of the gate, this is sort of my idea for the process. Is there anyone that has any questions or comments on that discussion? Any other questions from members? This meeting is adjourned.