Senate Public Health

Jan. 19, 2023

Sen Irvin: All right. Good morning, everyone. I wanted to call this meeting to order. Welcome to the Public Health Committee for the Arkansas State Senate. We’re excited to have everybody with us in attendance. And we’ll just quickly, we’re going to do an organizational meeting, but we’re also going to meet a lot of the agencies and personnel that we’re going to be dealing with throughout the session and throughout your tenure here on this committee with a few presentations. So let me first just introduce the people of the Committee. I am Senator Missy Irvin. I represent District 24, which is Stone County, Searcy County, Van Buren County, and portions of Cleburne County, Faulkner County, and Newton County. I’ve been in the Senate since 2010, have served on Public Health and Welfare, this committee, forever and chaired it for two years, and then went over and chaired Education for two years, and now I’m back to Public Health to chair this. So I’m very excited to be back into this world. So just grateful to be the Chair of the Committee, and I want to introduce our Vice Chair, Senator Dan Sullivan. And I will let each of you make your introductions.


Sen Sullivan: Thank you, Madam Chair. Yes. Senator Dan Sullivan. I had three terms in the House. This is my second term in the Senate and my second term on Public Health. Glad to be here and look forward to working with you. Thank you.


Sen Wallace: Hi, folks. Dave Wallace, my third time on Public Health. I have Mississippi County, Poinsett County, Craighead County, or part of it, and I’m glad to be here. Again, thank you.


Sen Penzo: Clint Penzo. I represent Springdale, Johnson, Tontitown, and Elm Springs up in northwest Arkansas. Spent two terms on Public Health in the House, and I’m glad to be on Public Health in the Senate now.


Sen Love: Good morning, Frederick Love. First term in the Senate, and I’ll tell you this, this is a trip, you all. It’s funny because in the House, everybody’s around the table, but now I had to turn and look back. Of course, this is my first term on the Senate, but I’ve been in the Public Health on the House end for several terms. So I’m glad to be back on Public Health. I represent only Pulaski County, but it seems like I get calls from any other counties. So I just represent you all. Thank you.


Sen Boyd: Justin Boyd. I was a state rep for four terms. I was fortunate to be on Public Health all four of those terms. I’m very excited to be able to be on Public Health here in the Senate. My district is Fort Smith, more or less.


Sen King: Bryan King. I represent Senate District 28. I served six years in the House, six years in the Senate. I’ve been out four years. So I’m still confused if I’m a new member or returning member or what. But anyway, I represent all of Carroll County, all of Madison County, the biggest part of Boone, the biggest part of Newton, and the top part of Johnson and Franklin County, and I served on Public Health from 2011-2012.


Sen Irvin: All right. Thank you. And we do have Senator Flippo, who’s not with us, but everybody knows Senator Flippo. But we’ll let him introduce himself when he arrives. I want to introduce our staff with the Bureau of Legislative Research which we are so grateful to have. We have Kate Steele, who is our Committee Analyst. I have Donna Chason, who is our Administrative Assistant, Jessica Beel, is our attorney, as many of you know, and Cassie Howell is also an attorney that we work with. Sometimes we also work with Alex Stevens and others. And we have Miss Jill Thayer as well with us today. She’ll be presenting on a procedure that we have adopted. If you will review the Senate Rules for our Committee, if there are any questions, if you will just review those rules that are in your folder. If you have any questions, we will proceed to review and adopt those. Are there any questions? Senator Boyd?


Sen Boyd: As you know, I’m new to the Senate.


Sen Irvin: Yes.


Sen Boyd: But one of my committees, Transportation, they made a motion to change the rule to where if there were a non-substantive change, there was an extra ‘d’ or something, that that could be made. I don’t know if that’s a good idea for this committee or not, but I just throw that out to see if anybody else thought it was.


Sen Irvin: Are you making a motion to adopt the rules unless there’s–


Sen Boyd: I would make that motion, and then if somebody likes it, then they can second it.


Sen Irvin: Okay. Is there a second?


unknown: I’m sorry, but I couldn’t hear.


Sen Boyd: So on the part that says we can’t have verbal changes to the bills, and Transportation, the way I understood, we modified the rules. So if it were not a substantive change, it were just like a Scribner’s error or just something, it was a clerical error, whatever, we could make those changes verbally.


Sen Irvin: Is there any discussion about? So you’re just making a change to the rules, and with that change if it’s a verbal, we can make a verbal amendment. If it’s not a substantive change, but like a grammatical error or a drafting error, basically. That’s what your motion is. Is there a discussion? There’s a second.


Sen Sullivan: There’s discussion.


Sen Irvin: Yes.


Sen Sullivan: So is that not already accounted for, those kind of changes in a current rule?


Sen Irvin: No. I mean, just verbal amendments are not permitted at all by our rules. So if you want to make that as a verbal amendment change– I mean, if you want to make that a change to these rules, then you would vote for Senator Boyd’s motion. And again, it would only be changes that were drafting errors or grammatical errors or a numbering issue. Well, numbering might could become substantial. But okay, there’s a second. Okay. With that, all those in favor say aye. And opposed. Ayes have it. Okay. Those rules are adopted with that one change. Okay. So just a little bit of housekeeping before we make some introductions and go to our agenda. Just make sure you leave your folders in the room after each meeting. We are meeting here on Wednesdays at 10:00 AM. We will move through our work I would just say as efficiently as possible. The way I will handle legislation, just so that everyone’s clear, is that we will try to work through our agenda with items that are non-controversial. If a piece of legislation is controversial, I will work with that sponsor to order a special order of business. It’s very important to me that we have the ability for the public to weigh in on the legislation, and so we will work as effectively as possible with the sponsors of the legislation. I would ask you as members of this Committee to help me in that process. If there are sponsors of bills that you have questions about or you yourself would ask and request that a bill be held and treated in a different manner such as a special order of business, then just communicate that to me, and I’ll be happy to oblige you.


Sen Irvin: And so we have a lot of issues that we deal with in this Public Health Committee that are very serious that touch a lot of people. And there’s a lot of folks that want to weigh in on that. And so my job is just to steer us and navigate us through that so that the public has the ability to be fully engaged on those issues. Just a couple of different things. If you’re presenting and have an amendment, please let the staff know before the meeting. So if you have an amendment that needs to be presented in the Committee, if you’ll just reach out to Miss Steele and Miss Chason, then they will– just let them know before the meeting. A bill or resolution that has been called up for consideration will be moved to the bottom of the agenda if the sponsor is not present and unable to present. If a bill or resolution has been called up for consideration three times, it will automatically be dropped to the deferred list unless that sponsor then notifies the staff or me as the Chair. And then that request to move that bill up to the regular agenda and off the deferred list will come, and we will move that to an active agenda. But it must be made by 2:30 PM two days prior to the scheduled committee meeting. Okay. There are special rules for health legislation, just as a reminder, that any legislation that specifically changes the scope of practice of medical professions and special introduction deadlines require that it must be introduced in the first 15 days of the session, and no action can be taken for 15 days after introduction. So because of our extended recess of Martin Luther King day, I believe that date– no, that doesn’t apply to scope. That does not apply to scope of practice. So it’s 15 days of the session is when it has to be introduced. And then we have to wait.


Sen Irvin: We will hear from Miss Thayer about this portion as well later about bills that would impose a new or increased cost obligation for health benefit plans. And she will talk about that. And then finally, I would just ask that if you’re presenting before this Committee and we, as members of this Committee, it is our obligation to conduct ourselves in a very professional manner. So we will be addressing you using your professional titles and your surnames. And I just think that’s appropriate for our Committee. And I know we intend to treat everyone with that level of professional respect. And with that, I’m going to move to agency introductions. So first, we have the Arkansas Department of Health, and so if you will come to the table. And members you have a handout from the Arkansas Department of Health, and I’ll let them introduce themselves for the record and then give us a little just brief rundown of who they are, what they deal with, and who the people that we will be interacting with are.


Mallory (ADH): Thank you, Madam Chair, members of the Committee. I’m Renee Mallory, Interim Secretary of Health.


Gilmore (ADH): Matt Gilmore, Department of Health.


Mallory (ADH): So thank you. So at the department, we have five major divisions, main divisions that we refer to as centers. So I’m going to go through the centers and just give a little bit about what they do. Of course, there’s a lot more than what we could get through in just a short time. So the first center that I’ll talk about is Health Advancement. They have our chronic disease programs. They have family health, tobacco cessation, nutrition, and oral health. So of course, our WIC program is under that center. In the center for Health Protection, we have some licensing and regulatory roles there. We do health facility licensing. We do radiation control licensing. We also have our Medical Marijuana Program in the center for Health Protection. We also have Injury Prevention which has our suicide call line and our Prescription Drug Monitoring Program. We also have Infectious Disease and Immunizations in that center. The third center would be the Center for Health Practice, and that’s where our registries, most of our registries sit, our trauma registry, our cancer registry, and our hospital discharge registry. That also houses our epidemiology branch and our vital records, which of course, is responsible for issuing birth certificates and death certificates.


Mallory (ADH): The next one is the Public Health Lab. We do a lot of testing in our Public Health Lab. We do newborn screening. We do some prenatal care. We do sexually transmitted infections, TB, immunizations. I’m sorry. That’s not right. Okay. So in our Public Health Lab, we do newborn screening, TB, sexually transmitted infections, rabies, flu, mumps, measles, and food and drinking water. And then our local Public Health Branch, which I was trying to combine the two, is by far our largest branch. We have a local health unit in every county in the state. Some counties, a few counties, we have two, and then in Pulaski County, we have a few more than that. They are responsible for prenatal care. They do sexually transmitted infections, treatment, testing. We do immunizations there, the fluoride varnish, and we also do WIC in that in Local Public Health. We work in partnership with the county. The county, they own the buildings that we house our services in those counties. So they do building upkeep, maintenance, and then we provide the services in those buildings, I mean, the staff.


Mallory (ADH): And then our last one that I’ll talk about is not a center, but during transformation, we got 23 Boards and Commissions, which of course is a big part of the agency now, and that’s what Mr. Gilmore heads up. So with that, that’s a broad overview of what we do at the Department. And I have key staff here, key leadership staff and the staff that you’ll be seeing a lot during the session if you’ll allow me to introduce them. Okay. So first up would be Dr. Jennifer Dillaha. If they’ll stand so you can just see who they are.


Sen Irvin: Thank you. Welcome. Yes, stand up so we can see.


Mallory (ADH): We have Don Adams, who’s our Deputy Director of Administration. Casey Cochran, who is our Deputy Director of Programs. Laura Shue, who is our chief counsel, and Chuck Thompson, who is also one of our attorneys, and you will see them a lot over here along with our Chief of Legislative Affairs, Matt, Mr. Gilmore. Yeah. And so that’s my presentation for today.


Sen Irvin: Wonderful. Thank you. I appreciate that very much. Are there any questions from members of the committee? Any comments? Questions? Okay. Thank you so much. We appreciate you all being here. Thank you for the work you’ve done for our State, and we look forward to continue working with you guys.


Gilmore (ADH): Thank you.


Sen Irvin: Thank you. Okay, next up, we have Arkansas Department of Human Services. I’ll let you, Secretary Putnam, introduce yourself for the record and your team.


Putnam (DHS): Good morning, Christy Putnam, Secretary Department of Human Services. And I would like to introduce some members of the team that we have here this morning. We’ve got Mark White as our Chief of Staff. Janet Mann is Deputy for Health and also State Medicaid Director. Our other Deputy Misha Martin is pulling duty over in the Judiciary Committee, so she’s not with us right now. We do have some other members of the team that I’m going to go ahead and Janet Mann introduced. They’re mostly part of and then Mark has a couple of others that we’ll introduce us well.


Mann (DHS): Thank you. Good morning. Elizabeth Pittman is here. She is the Director for Medical Services, and I see Melissa Weatherton who is the DD Director, and I apologize if anyone else is here and I haven’t called her name. But I think that is all for Medicaid today.


White (DHS): And then I’ll add, of course, for most means of this Committee, either I will be in here or Laura McDonald is serving as our Deputy Chief Legislative Affairs, and so two of us will be working to cover this Committee. Also, I know many of you know Jeff Williams, who is with DHS, he’s going to be helping us have a session as well. He is covering Insurance and Commerce for us this morning.


Sen Irvin: Great. Wonderful. Thank you.


Putnam (DHS): And so as you know, DHS is a very large agency, and I appreciate everyone’s patience. The team has been amazing. There’s a lot to learn. We were asked specifically this morning to go over Medicaid and to really give an overview of that as that is primarily what this Committee will focus on, among other things. But there’s a lot of Medicaid work to be done. And so with that, we do have an overview of the Medicaid Program for you this morning.


Sen Irvin: Great.


White (DHS): Well, I think we wanted to start by making clear the differences between Medicare and Medicaid.


Sen Irvin: If you’ll just pull your mics up right to you. Sorry. Our mics do not pick up very well. Thank you.


White (DHS): Apologies, Madam Chair.


Sen Irvin: That’s fine.


White (DHS): We always want to clarify the differences between Medicare and Medicaid because I know when I first got to DHS, it took me a good six months to sort out those differences and to keep that in mind. And so we know, for those who aren’t in this day-to-day, that gets to the point of confusion. Of course, Medicare, of course, is a federal program, is run by the federal government. It’s paid for through, of course, Medicare taxes. There is charge on individuals which they then used to earn coverage through Medicare. Mostly serves individuals who are older or individuals who have disabilities, have been found disabled by the Social Security Administration. Medicaid, on the other hand, covers some of those same individuals, but also covers individuals based on their income as well. In Medicaid, we have a variety of eligibility categories tied to income, some of them tied to the amount of resources that individual may have, and they can seek eligibility for the program through those things.


Mann (DHS): Can I jump in?


White (DHS): Yes.


Mann (DHS): The biggest difference is Medicaid serves approximately half a million children in the State of Arkansas. That’s a large category that Medicare does not cover.


White (DHS): Yes. And so Medicare, of course, is paid entirely about the federal government. Medicaid is a partnership. On average, the feds pay about 76% of our Medicaid Program, and the State pays the remainder of that amount. And there are differences from state to state in Medicare– I’m sorry, Medicaid. See, I just did it. Whereas Medicare is more consistent nationally. And then two overlaps I want to mention for Medicare and Medicaid. One is, as I kind of suggested earlier, we do have beneficiaries who have both Medicare and Medicaid. And so we coordinate with Medicare on what services we pay for, what services Medicare pays for, and certainly, that does create some confusion at times when someone is having an issue getting something paid. We’ve had folks who have called their legislator, they call us, only to find out that’s actually a Medicare issue. The other important overlap is around rates, and that there are limits on what we can pay to providers. And those limits are tied to what Medicare pays for similar services. And so you’ll see that come up in rate discussions, particularly. Now, I’ll pause to see if there are other comments on the Medicare and Medicaid.

Putnam (DHS): Every state has to submit a Medicaid state plan to the Federal Centers for Medicare and Medicaid Services, CMS, that outlines how Medicaid will operate. If state officials do want to make changes, there is some flexibility for the Medicaid program, but you have to submit a state plan amendment or a waiver request. And that was my introduction to Medicaid when I was in Kentucky, is working on the section 1115 waiver for transformation in that state. A couple of differences, a state plan amendment is a formal plan to change how the Medicaid services or operations function in a state, does not have a cost or a budget requirement. It’s typically a 90-day process. So it’s a little quicker than a waiver process, but CMS can suspend that time clock to request more information. The change is permanent to that Medicaid state plan, how the operations are for the Medicaid program in the state.


Putnam (DHS): Separate from that, a waiver request is a formal request to waive certain Medicaid requirements in your state. It does require the change to be cost-neutral or budget neutral– cost-effective, sorry, cost-effective or budget neutral. If the request is approved and the state receives that official waiver, it is time limited. The states can request to renew them. Those requests can be approved or denied, but it does offer some flexibility in how the Medicaid program is operated in the state.


White (DHS): One point I’ll mention on that, some of you may remember from past discussions since last year, we’ve talked about the links that CMS will go to in reviewing requests that we send in either state plan amendments or waiver amendments. And I do want to reiterate that in the current administration, we’ve seen significantly longer wait times for approval of state plan amendments and waiver amendments. And so I mention that because I know we have several things that are pending right now that we had thought would be approved sooner and they have continued because CMS raises questions and raises another set of questions. So I started with putting that out there, is that we do our best to predict or at least guess and when we may hear back from CMS on any given item, but we are seeing longer times for that this last couple of years.


Mann (DHS): Lengthy negotiation process. So on the next page, page four, is just a brief summary of the makeup of the Medicaid program. It’s not just one program. There’s over 30 different programs within the Medicaid program. And we are currently serving over 1.1 million Arkansans. And so we’ve separated it to look at that. So you could see the broad breakdown with Arkids A and B, which is all of our children up to 19 and 21. ARHome, which is our expansion category. Parent caretaker, the SSI Medicaid category, which Mark briefly mentioned with Medicare and Medicaid. Newborns, which we like to give them their own category because we hope that they’re all born healthy and if not, that we can be there to help them get through that first year and help the parents. Medicare savings programs is one of those programs we work with the duels as we call them that have Medicare and Medicaid. And then we have several DDS waiver autism and tephra and then the are choices waiver and living choices waiver and then adoption and foster care.


Mann (DHS): And on the next page, we did a summary briefly just so you would know who’s working in Arkansas. We have number of enrolled and active providers, which is over 101,000. And then 49,000 of those providers actively billed us in fiscal year 2022. And we have 85 different types of Medicaid providers. And with those different types of Medicaid providers comes provider enrollment, which is different levels of enrollment in registration. So we can track who is serving and what they’re billing.


Putnam (DHS): So there are general eligibility requirements for Medicaid. There are basic income limits based on a percentage of the federal poverty level or FPL. And number of people in the household, also called household composition. And this ranges from less than 20% of FPL and up to 250% of FPL depending on what category of Medicaid they’re applying for or qualified for. The limits are higher for children, pregnant women and long-term services and support to clients and they’re lower for other adults in Medicaid. DHS does re-determine eligibility each year that has been different under the public health emergency and will go a little bit into that too briefly, but typically clients are required to report changes in their circumstances, which is income, household composition, etc., within 10 days, and that re-determination does happen annually. Clients of LTSS have to meet asset limits in addition to income limits, and they also have to meet an institutional level of care to qualify for LTSS.


White (DHS): And you can see on the next page, we gave you a chart showing some of the current income levels for some of those different FPL levels. But I do want to emphasize that there are many different thresholds depending on the eligibility category that you’re talking about. And that’s because just over the years, Congress will see a situation they see a gap in eligibility or they want to address particular problems, so they’ll pass a law, but that means that we now have this patchwork of a dozen or more different eligibility categories that all have different standards for eligibility. Now, as mentioned earlier, some are tied just to income, some are tied to both income and resources, some that take your medical or functional capacity into account. So we do have some guides that we can certainly provide you all that give some details about each of the specific programs, if you’re interested in that. We always like to come back to, for Medicaid expansion and that’s the most common one right now. It is 138% of the federal poverty level.


Mann (DHS): So I’ll talk a little bit about the public health emergency. So with the omnibus bill that passed in December, they decoupled the end of the public health emergency and the funding that was given to Medicaid with an additional 6.2% FMAP. In addition to that, it set a date of April 1st of 2023 to begin the unwinding. So we have internally already begun in county operations, which Mary Franklin is the division director in working across the whole agency collaboratively to get ready for the unwinding. Everyone will be re-determined in the next six months is the goal. And we are starting to send out those packets. So you may hear from constituents that have questions. And those packets will be beginning to be mailed in early February, the first weekend in February. And we like to give 90-day notices for all eligibility except for long-term supports, we give 120 days. We want to give additional reminders, not just the one reminder. But additional time to be able to work with them to get their paperwork and to get re-qualified. So that’s going to be a lot of work that we’re going to re-determine the entire population in the next six months, starting in February. And you’ll see the first people coming off of the rolls on April 1st of 2023.


White (DHS): And so you will get calls from constituents. I’ll just go ahead and let you know that you’re going to hear from them. It may start earlier than that as they start to get some of the initial notices that we send folks, telling them it’s finally here. We are finally getting ready to remove you. If you don’t show us that you’re eligible. So you may get some calls in about any particularly after those closures go out and people just go to the doctor and find my Medicaid eligibility is no longer active. They will be calling you. And so I just want to encourage you, when you get those, certainly, you can route that through, send to constituent staff. You’re also welcome to write it through our staff. We have, of course, many of you worked with Laura McDonald on constituent services issue. We also have Shelby Welch who is in our office. She is handling the day to to day constituent services work now that Laurie is over here working with us on the session. Let us know, get us that information and we’ll give you the information on that case to help you respond and make sure that that individual’s situation is addressed and that if there is a problem or a mistake that we’ve resolved it.


Sen Irvin: So I just want to jump in here. That’s really important information for not only us but all of our colleagues as well in the Senate. So if you’ll just get me a little bit of a timeline and a breakdown that I can share with our members of the Senate and then contacts. Because they’re going to get calls and then they’re going to call us because we’re members of Public Health. So that’s how that generally works, but that’s very important information. That was one of the primary things that I wanted us to discuss today, was this public health emergency and how it’s going to be unwinding and what’s in front of this agency in particular in re-determining the entire population within six months. So we have questions. Representative– I mean, I’m sorry– Senator Love. My apologies.


Sen Love: Thank you, madam chair. I think it’s hard for people to give me that promotion. The first thing I want to say is–


Sen Irvin: It’s definitely a promotion.


Sen Love: I usually call Laura McDonald. And so she’s been awesome. So I want to say that. Secondly, is, besides that, I guess, you’re going to be reassessing people. Is that the largest challenge that we’re going to find with kind of the ending of the public health?


Mann (DHS): I think it’s the volume of re-determination. We want to re-determine the entire population, which is 1.1 million and growing. And so to do that is going to be, it’s going to be a challenge, I’ll be honest. And it’s going to be consuming.


Sen Love: I guess the next question I have and this might not be proper. But do you all have the capacity to do that?


Mann (DHS): We are looking at different ways to handle the surge. And I know a few of those, it is day five. If I could ask for a little bit of grace, I would actually like to bring Mary Franklin back who’s been in the weeds, and several of the other team members that have been working on this that can answer all the detailed questions for you. But yes, we’ve been anticipating surge and we are trying to anticipate what to do with additional staffing or different options.


White (DHS): And if I can just add to that, just one detail is, of course, we have our DCO staff, Division of County Operations who handle eligibility, and we’ve been working to get them ready for that. But we also, we already have contracts and vendors in place to provide that additional surge capacity so that as we see that workload increase, we can instantly transfer that over and continue that work and keep up with it.


Putnam (DHS): During the public health emergency– during the public health emergency, operations continued. So there were continual processing going on. So nothing stopped during the PHE. And I think the backlog of applications was down to about a thousand is what we heard yesterday. So the application processing is relatively current right now. And as chief of staff and deputy said, we are looking at other options for additional staffing. It is a concern that we spoke of immediately as soon as we came in.


Sen Love: All right, thank you. Thank you, madam chair.


Sen Irvin: Thank you. Senator Penzo, did you have a question? No. Okay. Senator Sullivan. You had a question. You answered it. Okay. Any other questions from members of the committee? No? Okay. Proceed.


Mann (DHS): So the next page really goes into a little more depth about how we have been operating as normal as possible with the extension of the PHE without eliminating anyone’s services. And so this is just some talking points on what we will be going through and doing.


White (DHS): Well, and I’ll just, of course, we discussed in there about why someone would have been removed up to this point. It is a very limited set of reasons why someone will be left on. So we do have a significant amount of people who are on the rolls now that either we know aren’t eligible or we’ve reached out to them. We’ve asked them to provide us the information to show that they are eligible and they have not given that to us. And so that’s the big mystery at this point is we have no way of knowing of these 398,000 clients. How many of these are truly no longer eligible and how many know they couldn’t be removed and so they just have not responded to this date? And so that’s the challenge and that’s the unknown that we’re just going to have to work through in these coming months.


Sen Irvin: All right. Sounds good.


Putnam (DHS): And I just want to be real and put it out there that there will be people who are determined ineligible who truly are still eligible. So there will be those instances. Our due diligence and our responsibility is to make sure that we go through and that we have re-determined properly, but when someone brings information back in, that’s where things can be reinstated. And we will make sure to get you all a timeline, as well as contact information, who to reach out to, and some talking points around what to expect. So you can have that to share with your constituents.


Sen Irvin: That’d be great. That’s great. Yeah.


White (DHS): And if I can add one additional point, selfishly of course, we want to help you with your constituent issues, but also it helps us because there have certainly been times where a legislator has brought us an issue from one constituent and we dug into it and discovered there was a systemic issue that was affecting a dozen constituents or a hundred constituents. And so that helps us as an early warning. If you can get those to us, we have set up other mechanisms to try and get that early warning as well, but I just want you all to understand that you all are part of that. When you get that to us, that helps us and helps your constituents.


Sen Irvin: Great. Thank you. Thank you so much. Are there any other additional questions from members of the committee? No. Thank you. We’re so excited to have you from Kentucky and from Mississippi and back. Thank you. And we’re glad to have you with us, Secretary Putnam and your whole team. Thank you so much.


Putnam (DHS): Thank you very much.


Sen Irvin: All right. All right. Next agency that we are going to be working with is the Arkansas Department of Energy and Environment. Secretary Corey can introduce himself and his folks.


Corey (Energy): Thank you.


Sen Irvin: Welcome.


Corey (Energy): So my name is Shane Corey. I am the secretary for the Department of Energy and Environment. I happen into live in District 24. Just in case anybody needs to know that. And we’re going to try our best to limit any controversial legislation at least that we’re proposing. I didn’t say others wouldn’t propose. That being said, so the first question I get a lot of times is, how do you do both Energy and Environment? Aren’t those kind of naturally in conflict with each other? And the answer is really no. Because I think in order to have a sound energy policy, we have to take into consideration our environmental impacts. And also, we need a sensible environmental policy to allow us to utilize and maximize our power and energy resources in the state. That being said, we do have– at the Department of Energy and Environment, we kind of have two sections.


Corey (Energy): So I have both Larry Bengal– he is our chief administrator of energy– and Caleb Osborne, recently appointed to the DEQ director position. And he is our chief administrator of the environment. So we do kind of have two different paths to different tracks there. And I’ll let them introduce themselves. And if they want to say anything else. But most of you know, administrator Bengal. He’s been the Oil and Gas Commission director for quite a long time in the state. Caleb’s background recently just coming to us from Parks Heritage and Tourism but had a DEQ background as well as some energy background resources. We have Michael Gripe. Many of you know him. He is kind of our contact here at the capitol, if you all need anything, feel free to reach out to me or him directly. He can coordinate. And the biggest thing that we have in terms of constituent services, which side does it go to, right? Because a lot of people think of energy and environment as just DEQ, and that’s not the case. DEQ is probably 75% of it in terms of number of people, but we also have the Liquefied Petroleum Gas Board, the Oil and Gas Commission, the Arkansas Geological Survey, obviously the Pollution Control and Ecology Commission, they’re all housed under now this Department of Energy and environment.


Corey (Energy): So that being said, I do have a brochure that we’re working on finalizing that will kind of have a breakdown of what all the individual agencies within the department do, who to contact, who contacts for your constituents are, and we should have that to you within the next week or so. We’re just trying to make a lot of changes and update that to reflect all the changes that we need in the near future. So we have a few other people here that I’ll just quickly introduce. We have Andrea Hopkins. She works on the energy side. She is our associate administrator of energy. She works directly with Larry Bengal and then we have Bailey Taylor, many of you might have known her for working with some of the DEQ issues we’ve had in the past few months, but Bailey is the associate administrator for environment and works directly with Caleb. So I guess with that, I’ll ask either Larry or Caleb if y’all have anything you want to add.


Bengal (Energy): No, I just pulled the mic out of the wall here.


Sen Irvin: It’s okay. They’re very wonky. Don’t worry about that. Mine is too if it makes you feel better.


Bengal (Energy): Let’s cause repairs already. One thing you’ll be interested to keep in mind is that the Oil and Gas Commission legislation, if we were to have any, which we do, that goes to the Ag Committee, even though we’re part of E & E, which most of the legislation will come to this committee. And I’m not sure where the energy office legislation would go, but that would probably go to the Ag Committee. No, it would come to this committee because it’s part of DEQ. So this committee would be dealing with several different things in energy only because it’s related to E & E and DEQ. As far as having the two issues dealt with in the same department, we’ve been able to take advantage of DEQs, environmental aspects, as well as the Oil and Gas Commission aspects. For example, where we have joint jurisdiction over environmental issues, the oil spills, and things of that nature, before there was two agencies, each dealt independently with those issues. Sometimes there was some conflict. Now that we’re in the same energy, we are able to bring those together. We have one set of rules for many of those events. There’s no conflict, makes it easier for the regulated community to deal with those not having to deal with different state agencies. Sometimes in conflict with resolutions. So it’s been able to work some of those things out and we continue to work on those.


Osborn (ADEQ): All right. As secretary said, I’m Caleb Osborn on the new chief administrator for the environment. A lot of ya’ll will think about it as the DEQ director. I can answer to that as well. So I wanted to echo or will echo the comments from Director Bengal that I think there is tremendous opportunity for us to work together and having the environmental and energy side in-house. In my past time with the EQ I had worked as with the water quality section and it worked closely with Director Bengal and his team on some issues and as he said, it’s much easier when it is all part of the same organization than two separate agencies. So we look forward to continuing to do that. I will also borrow from what our friends at DHS had mentioned earlier. Many of y’all will probably hear some questions or concerns about various things that come up. My job, we will oversee water quality issues, air quality issues, solid waste, hazardous waste, and a variety of other programs. So please reach out to me, let us know how we can help. We want to help you all have the answers to take back to your constituents and help resolve those challenges. And we look forward to working with you all through this session and beyond. So thank you. And like I said, we will have a brochure that with your indulgence, we’ll get to the next week or so to have that contact information.


Sen Irvin: Thank you. Thank you. I think it’s so important. There’s such an intersection between your agency plus the Department of Ag plus the Department of Health, because of a lot of the water issues that we deal with and licensing issues. And so there’s a lot of cross agency work that happens in a lot of those areas that Mr. Osborne just discussed briefly and so I think it’s just very important for the members of this committee to understand how all of you kind of work in your own offices and agencies, but also how you work across the agency lines in a very important manner to deal with some of these issues, particularly in the solid waste issues, the septic tanks and all of that water quality issues. So just appreciate us understanding that a little bit better. I think is very important. As members of the committee, it helps us kind of help you work along policy lines so that we can just be more efficient as we’re addressing those issues in the state. Any other questions? Do you have any questions members of the committee? No. All right. Thank you so much for being here. Thank you. We look forward to working with you. So we have Arkansas Division of Workforce Services.


Hudson (Commerce): Thank you, madam chair. Good morning senators. Jim Hudson, chief of staff for the Department of Commerce. My boss is Commerce Secretary McDonald. He could not be here today. He is actually traveling out of state on economic development trips, so we’re wishing him good luck on that trip and then Dr. Childers, Sharice Childers, heads the division. She’s traveling to Mountain Home today. So she couldn’t be here. I’ll let Courtney introduce herself.


Traylor (Commerce): Good morning. Can you hear me?


Sen Irvin: Yes.


Traylor (Commerce): I’m Courtney Traylor. I’m the deputy director of internal operations at the Division of Workforce Services.


Sen Irvin: Great. Glad to have you.


Hudson (Commerce): Yeah, and just to let you know in terms of Department of Commerce, we’re spread amongst three different committees. So in here, obviously for DWS, we’re an insurance in commerce as well. We’re also in ag and economic development. Dr. Childers will be here most times when something’s before you pertaining to her division. And if she can’t be here, I’ll be here. And then obviously, if there’s a need to have Secretary McDonald here, he will be here as well. And we can get you a contact list for everybody in the division too.


Sen Irvin: Excellent. Great. Well, we’re glad to have you. Thank you so much for being here. And then the other agency that we might have some interaction with is Secretary Bassett and his work. And so anyway, just thank you for the introduction. Any questions from members of the committee? Thank you. Thank you for being here. Thank you. I look forward to working with you. Thank you. And then finally, last but not least, Jill Thayer with our Bureau of Legislative Research. She is going to address our committee about a new process and procedure that we have adopted through legislation.


Thayer (BLR): Thank you, madam chair, Jill Thayer, Bureau of Legislative Research. Senator Irvin asked me to be here just to give you all an overview of some new procedures that have been put in place this session regarding bills that will affect health benefit plans for entities of the state. During your fiscal session last year, Act 112 was passed. And that imposed a 15th day bill filing deadline on these types of bills, and it also requires a fiscal impact statement be produced for any bill that will impact either the EBD program or other health benefit plans for entities of the state. So as we’ve determined now, that’s going to be EBD and some of the institutions of higher ed that have their own self-funded insurance plans. The Legislative Council during this past fall instituted some procedures and adopted them for how the fiscal impact statements will be prepared. They identified primarily the two Public Health committees and the Insurance and Commerce committees as the ones that will most likely receive these types of bills. And so far, that has been the case. They also hired the Segal group to be the actuary that will perform these fiscal impact statements for the General Assembly. Just to go over with you how this process is going to work. Segal began working for us. They have a contract with the Bureau that started last August. They began monitoring the bills with the pre-filing that started on November 15. They are watching for any bills that they feel will have an impact on the cost obligations of these health benefit plans. Segal notifies me, now that session has begun, every day of any that have been filed and referred to one of those four committees that they feel will require a fiscal impact statement. The process then is that I contact the chair of the committee to which the bill has been referred. That chair will reach out to the sponsor of the bill to find out if they plan to proceed with the bill in committee. If the sponsor says that they will, the chair is letting me know and I authorize Segal to proceed with the fiscal impact statement. The process then is that it’s my understanding in this committee Senator Irvin has indicated that she would like to wait until the 15th day filing deadline has passed and then begin having Segal produce those fiscal impact statements. To do these fiscal impact statements, Segal has to have access to the data for those plans. So I’ve been working with Nick Fuller with the Department of Higher Ed. He’s coordinating getting data use agreements with all of the institutions of higher ed and the Bureau is entering those. And then also, we are working to get in an MOU data use agreement in place with EBD. We have not accomplished that yet. With the change of the administration and a new secretary over Transformation and Shared Services, they’re looking at it. And so we’re hoping to have that by the end of this week. Segal will reach out to me and let me know what their data request is and I will communicate that to all these entities. So just so you’re aware, there is a slight time frame issue there, which is why Senator Irvin has said she would like to wait just a little bit to take these up. We’ve been told it could be 5 to 10 business days to receive that data from the institutions, and then Segal will begin their analysis. Under the rules that are going through right now, the joint rules, this information is in there. And then Act 112 requires that the Insurance and Commerce committees adopt these procedures. The Senate Insurance and Commerce Committee did that yesterday. So any bill that requires this type of fiscal impact statement and is identified as such cannot be taken up in a committee until you have that fiscal impact. Once you do, then you can go through your normal process. If there is a bill that a member or a committee feels might require a fiscal impact statement but wasn’t identified by Segal, you can make that request. You can let me know. And then if it is a Senate bill and a Senate committee, the President pro tem of the Senate would just need to authorize Segal to do that work. I’d be happy to answer any questions.


Sen Irvin: Senator Sullivan, you’re recognized. Have a question?


Sen Sullivan: So as you mentioned, there’s a big concern over the data, that data will drive that impact. So, and you mentioned you get the data from higher ed and from EBT, so how does AHEC figure into this? We have a lot of requirements that AHEC collects these database and they hold the databases. Tell me what their engagement is, if any.


Thayer (BLR): At this point, none. We’re going directly to the plans and their providers as they’re the holders of this primary data.


Sen Sullivan: So again, I’m just trying to feel my way through this. AHEC is embedded in the law in several places that we have the different agencies have to report their data to AHEC. They collect all that in their database.


Thayer (BLR): Yes.


Sen Sullivan: Is that database separate from the database that the colleges have, and do they not cross over in what they have?


Thayer (BLR): I’m sure that they do. They do have to report it to there. Our MOUs that we’ve entered with the institutions of higher ed, though, will allow us to pull the data directly from the provider so it’s more up to date. It’s up to the moment that it’s requested.


Sen Sullivan: So, and if you don’t know the answer to this, you don’t have to respond, but–


Thayer (BLR): I may not.


Sen Sullivan: Why do we need AHEC?


Thayer (BLR): That is a totally separate issue for me. I don’t have that answer.


Sen Sullivan: Okay. Thank you.


Sen Irvin: Are there any other questions? Senator Boyd.


Sen Boyd: Thank you. So I’m just curious. Is this the first time that we’ve ever hired a private company to help with fiscal impacts or is this something we routinely do?


Thayer (BLR): No, sir, we utilize– to give a good example, the Joint Retirement Committee has an actuary that only works for that committee. And we’ve been contracting with that actuary for at least 15 years, possibly longer. So it is something that we have done and I think the retirement committee is a good example of how that process happens.


Sen Irvin: Yeah, I would say it’s modeled after that. When we worked through this through executive subcommittee of ALC, we kind of modeled it after what happens in Retirement. Every Retirement bill has to have a fiscal impact statement. And they’re performed by an outside third party actuarial company. The fiscal impact statements in the Education Committee, I believe, are done– that’s internal.


Thayer (BLR): That’s our legislative economist, Dr. Silva.


Sen Irvin: Right. So that is done internally. Now, from time to time, I do think it’s also appropriate if we have legislation that we have a fiscal impact to Medicaid. And so that also would be something that I would request or any member could request that as well, what’s the fiscal impact of this legislation to the Medicaid program. That is not necessarily in statute, but that is something that we, I as chair, can request as well. And we have requested that in the past. Senator Love, do you have a question?


Sen Love: Well, just a clarification. So we’re no longer requesting impact statements from DFA. We used to get them from DFA. We’re requesting it from the actuary now.


Sen Irvin: Well, just on these.


Sen Love: Just on–


Sen Irvin: Just on this type of legislation.


Sen Love: Got you.


Sen Irvin: It’s just legislation that would impact any health benefit plans through EBD or through our Institutes of higher ed.


Sen Love: Okay. All right. Thank you.


Sen Irvin: The reason why this is is because we did pass a piece of legislation that dealt with insulin, and we did not have an impact statement really at that time, and we had to end up repealing that legislation. I think it was, I think there was good intentions of what was trying to happen. We just didn’t have it fully realized. That’s the way I can– I think that’s what precipitated this change.


Sen Love: Okay. All right. Thank you.


Sen Irvin: Yes, sir. Any other questions? No? All right. Thank you so much, Ms. Thayer. Appreciate that. We will work diligently through that process. Okay, and as we wrap up, we have some familiar faces in the crowd. So I will just start over here, right here. Yes, come on, stand up, and just introduce yourself for the members of the committee.


Anderson: I’m Mike Anderson with Arkansas Blue Cross Blue Shield.


Sen Irvin: We’re glad to have you, Mr. Anderson.


Hill: I’m Martha Hill. I’m a lawyer with Mitchell Williams.


Sen Irvin: Okay. Thank you.


Smith: I’m Scott Smith with Arkansas Medical Society.


Kitchens: Michelle Kitchens with Arkansas Center for Health Improvement.


Sheppard: I’m Courtney Sheppard and my partner and I, Randy Thurman, we have a company called Government Solutions and you’ll probably see us in here mostly for hospital association issues.


Sen Irvin: Okay. Thank you. Others?


Cope: I’m David Cope with the Alzheimer’s Association.


Sen Irvin: Great. Glad to have you. Mr. Cox.


Cox: Hi. Cory Cox with the Care Source PASSE. I think you all know me, so call me if you need me.


Sen Irvin: Thank you.


Williams: Stacey Williams. I represent Arkansas Blue Cross Blue Shield.


Sen Irvin: Thank you, Mr. Williams.


Wills: Hi. Kayla Wills. I’ve been used as a consultant. I have several clients that will be talking to you about.


Sen Irvin: Thank you.


Beaumont: Good morning. Ben Beaumont, University of Arkansas System.


Davis: Andy Davis with UAMS.


Sen Irvin: Thank you.


Lindsay: Olivia Lindsay, Capital Consulting firm, and we’ll have a couple of things [inaudible].


Sen Irvin: Thank you for being here.


Bates: Scott Bates with Impact Management Group. I bring healthcare clients.


Sen Irvin: Thank you.


Bates: Excited to be here.


Sen Irvin: Thank you.


Crasner: I’m Ed Cranser, Arkansas State University System.


Sen Irvin: Thank you.


Sharp: Edward James Sharp, state advocacy for the ALS Association of Arkansas.


Sen Irvin: Thank you.


Johnson: Holly Johnson with the Arkansas Attorney General’s Office.


Sen Irvin: Thank you, Ms. Johnson.


Shaw: Hi. Hannah Shaw and I represent the Arkansas Chapter of the American Academy of Pediatrics.


Sen Irvin: Great. Thank you.


Donahue: David Donahue for Care Source PASSE.


Sen Irvin: Great. Great. Well, we’re glad to have everybody. And I know we’ll have some others that will come in and just appreciate everyone being here. Are there any other questions from the members of the committee? Any other business that needs to come before this committee? All right, we are organized and we are ready to work. We will start hearing legislation next week and look forward to working and serving with all of you. We’re adjourned.