House Public Health

January 31, 2023

Rep L Johnson:  Appreciate everybody being here on this cold, wet morning. I will start by saying the meeting this afternoon that had been scheduled for 3:30 is going to be postponed. That was an information only meeting and– exactly. And there’s some folks concerned about the weather and I think that’s a reasonable concern. And so, we’ll send people home this afternoon and we’ll pick up that topic potentially tomorrow. We’re going to go ahead and schedule the room for tomorrow afternoon pending weather again. You know how Arkansas weather is, it may be sunny and 70 tomorrow, who knows? And so, we’ll have the room reserved. I think DHS will be available to come and present. If for reason that doesn’t work out tomorrow we’ll find another time to have that information presented. So, are there any questions on scheduling? Yes, Representative Rose? 


Rep Rose: Do you have time in mind? Same time?


Rep L Johnson:  3:30 is–


Rep Rose: Three-thirty?


Rep L Johnson:  –yeah, same time right now is what we’re going to schedule, is that right? It’ll be the same room, the A meeting room. Is that Big Mac or Little Mac room? 


BLR Staff: Big Mac. 


Rep L Johnson:  Big Mac. All right. Representative Ladyman, are you prepared to present a bill? 


Rep Ladyman:  Yes. 


Rep L Johnson:  Great. You’re recognized to go to the head of the table. Representative Ladyman, you’re recognized to present your bill. 


Rep Ladyman:  Thank you, Mr. Chairman. I have Matt here, do you want him to introduce himself? 


Rep L Johnson:  If you would introduce yourself for the committee. Thanks, Matt. 


Gilmore DOH: Matt Gilmore, Department of Health. 


Rep L Johnson:  Okay. 


Rep Ladyman:  Committee, this bill was brought to  me by the Department of Health. It’s basically a clean-up bill, but I’ll go over a couple of things that are in there. It has to do with the Dietetics Board. And what happened, Act 540 of 2017 reduced the number of members of that board from seven to five, but they did not reduce the number required for a quorum. So, what this bill does is it reduces that number for a quorum to three, which is in line with the new number of members on the board. Most of the other stuff is just clean-up. One other thing in here that I will highlight is, it allows the use of email to send out license renewals, which makes it a lot more efficient for the department, works a lot better for everybody. So, that’s basically it and I’d happy to take any questions. 


Rep L Johnson:  Does anyone have any questions on House Bill 1108? This is Representative Ladyman’s bill, for Mr.– Representative Ladyman or Mr. Gilmore? Anyone here speak for or against the bill? Representative Ladyman, do you have a motion? 


Rep Ladyman:  I’m ready to close and I would make a do pass motion.


Rep L Johnson:  We have a motion do pass. All those in favor say, aye. Any opposed? Congratulations Representative Ladyman, you passed your bill. And if you don’t mind coming up to the chair, I recognize Representative Ladyman with no objections to chair the committee while I present some bills. Thanks. 


Rep Ladyman:  Is that an amendment you’re passing that out now? Okay. Representative Johnson, you’re running bill number 1127, is that correct? 


Rep L Johnson: Yes, sir. 


Rep Ladyman: Members, there’s an amendment coming around to this bill. I’ll give y’all a minute to look over the amendment. Okay, Representative Johnson, you’re recognized to present HB 1127.


Rep L Johnson: Thank you, Mr. Chairman. The amendment you have before you does three things. One, it adds Senator Irvin as a co-sponsor. The second is it reduces the fee required by the Department of Health for this licensure from $1,000 to $500, making it more affordable for our rural hospitals. And then, it adds an emergency clause, which I think is important because this– I think we all know our rural hospitals are struggling. If this bill is enacted, this is going to give them an opportunity to improve some of their funding through how they bill and collect. And so, I think it’s important for us to go ahead and get this bill on the books as quick as we can. And I’ll be happy to take any questions about the amendment. 


Rep Ladyman:  Members, any questions about the amendment? We’ll be voting on the amendment first. Seeing no questions, I have a motion to adopt the amendment. All in favor, signify by saying  aye. All opposed, nay. Motion carries. You’re recognized to present your bill as amended. 


Rep L Johnson: Thank you, Mr. Chairman. So, committee members, in 2020, CMS, which is the Center for Medical Services, which runs Medicare federally, they started looking at a new designation status for rural hospitals. So, currently the only designated status available for some of these rural hospitals is Critical Access Hospital. That allows the hospitals who are dedicated critical access to bill at a little bit higher level for Medicaid–Medicare services inpatient services. So, if they’re treating a patient in the hospital for inpatient services, they get a little extra reimbursement if they’re critical access. 


Because of how medicine’s evolved we’ve changed to some degree how we deliver care in rural areas. Medicine has become more specialized. And because of that, more patients are being sent from our rural hospitals to urban centers. And there are fewer and fewer patients who we’re able to keep and take appropriate care of them at some of these rural hospitals, because they just don’t have the specialists there to keep them in house. And so, CMS recognized that and started looking at this new designation that they call a Rural Emergency Hospital Designation. This allows qualifying hospitals to shift their focus from inpatient care to outpatient care. Outpatient care would include observation admission. 


So, if you put somebody in your hospital for a diagnosis like chest pain and you’re planning on only keeping them there 24 hours just to observe them, that still counts as billing for outpatient services. The hospitals that would like to apply for this designation federally need a pathway here in our state to enable that certification. What this bill does is it just creates that pathway so that the hospitals in Arkansas that would like to look at changing from a Critical Access Hospital, to this newer Rural Emergency Hospital Designation, would have the ability to do that in our state. So, it’s really just enabling legislation. And I’d be happy to answer any questions if anyone has any questions about the Rural Emergency Hospital Designation or this bill in particular. 


Rep Ladyman:  Representative Bentley, you’re recognized for a question.


Rep Bentley: Thank you. Representative Johnson, I’m already hearing some good things from the hospitals in my district. Can you give just a real brief summary, since I just walked in the room, of what are some of the benefits you think that will help our hospitals make this designation? 


Rep L Johnson: Yeah, I think the biggest benefit is revenue. So, the way this is proposed is those hospitals that decide to apply for this designation, if they meet the conditions of participation, they’re going to be able to bill at 105% of Medicare for their outpatient services. And again, some of these hospitals. This is not going to make sense for every rural hospital in Arkansas. Some hospitals are going to want to continue to be critical access, because they take care of more patients in the hospital, an receive right now 101% of Medicare for those services. 


Some hospitals have gone to a model of service where they’re transferring most of their patients, and the majority of the care that they deliver is from the Emergency Department already. And, or, as these observation admissions that we anticipate to be less than 48 hour stay. For those hospitals, they’re now, if they apply for this designation going to go from 100% to 105% reimbursement for the Medicare population, which is a pretty significant portion of the population these hospitals have. So, it really is for some of our hospitals going to be a lifeline that allows them get better credit for the kind of service they’re already delivering. 


Rep Ladyman:  Any other questions from committee? Representative Gonzales, you’re recognized. 


Rep Gonzales: Thank you, Mr. Chair. Does this bill prevent any new hospitals from opening up? It appears you have to be licensed already before it–


Rep L Johnson: You have to be licensed to apply for the designation, but you could open a new hospital. And then, the new hospital once licensed, could apply for the designation. So, the process would be if you wanted to open a new hospital, you’d have to get a Certificate of Need, which is the current process to get a new hospital in Arkansas. Once the Department of Health issued that, and you went through the steps for licensure and became a licensed hospital, you could then apply for the designation. And that’s part of the condition of participation to the federal level too is you have to be an established hospital. But it doesn’t prevent any new hospitals from opening, and once they’re open if they qualify, they would be able to apply for this status. 


Rep Gonzales: Okay, so tell me if I’m reading this wrong on page three, starting on line 26. “A health care facility shall be eligible to apply for a Rural Emergency Hospital license if the facility on, or before December 27, 2020, was a,” and then it lists everything else. So, you had to be in existence already? Is that not what it’s saying? 


Rep L Johnson: Now when reading that, I have the same questions when I read it. Let me read through it again. That’s a good question, Representative. And I need to look at that closer with some of the folks at the Hospital Association that helped me craft this legislation. My understanding is it would be the way we intended. I don’t think there’s anything that would prevent a new hospital opening up if it met the criteria from applying for Rural Hospital, Emergency Hospital designation. But, that’s a question that typically I would turnaround and ask my Hospital Association fellows to come to the table and address, but I don’t think they were able to be here today because of the weather. 


Rep Gonzales: Okay.


Rep L Johnson: And I’m happy to hold this if you want me to until we get an answer. 


Rep Ladyman:  Can I make a suggestion? Representative Gonzales, would it be all right if he talked to his people? If there’s an amendment needed they can do it on the Senate side and come back to us, or would you prefer he pull it now? 


Rep L Johnson: I would commit to that. If mean, if there– yeah, we drafted this legislation based on federal rules, and so we mirrored what we were doing. If there is some sort of issue with this that I’m misunderstanding, I suspect it’s a federal issue that we can’t change at a state level. If it’s something we’ve done in a quirky way, I would argue that even if for some reason there’s some stipulation that won’t allow any new hospitals to apply for this designation, it’s still critically important for the current hospitals that are seeking this to have that pathway. And I’d hate to see the process slow down for this particular issue that I’m certain I’d be happy to work with and address if it’s able to be addressed on the Senate side.


Rep Gonzales:  Well, I just know that there’s been a lot of rural hospitals closed because of funding issues. And if we’re going to give them an opportunity for increased funding or give the existing ones, then maybe there’s an opportunity for new hospitals to open back up, if they have the same opportunity for the additional funding. 


Rep L Johnson: Yeah, I agree 100% with that statement.


Rep Ladyman:  So, Representative Gonzales, what’s your preference? He’s agreed to do either one, which would you prefer? 


Rep Gonzales: It doesn’t matter to me, you’re the bill sponsor. 


Rep L Johnson: I would rather try to run it through Committee now, because I’ve been getting a lot of calls from some of the rural hospitals eager to try to apply for this designation. And you know I’ll commit to you to, to find out the answer to the question and make sure we’re admitting it on the Senate side, to accommodate that if we can, unless there’s some federal reason why we can’t.


Rep Gonzales: Okay. Appreciate it.


Rep L Johnson: Thank you. 


Rep Ladyman:  Representative Schulz, you’re recognized for a question. 


Rep Schulz: Thank you, Mr. Chair. I was just wondering if you had a feel for, like a ballpark number of how many rural hospitals this– might apply for this or it might impact?


Rep Johnson: That’s a great question. My sense is there are 8 to 10 hospitals that are interested in this presently. I think until we have the statute in place it’s going to be hard to know for sure, because there is some math to this. Some of these hospitals have look at, they’re giving up one enhanced reimbursement for services for a different kind of enhanced reimbursement. But of the hospitals that are out there that have shown interest I think it’s less than 10.


Rep Ladyman:  Representative Rose, you’re recognized for a question. 


Rep Rose: I just missed the section that Gonzales was talking to you about. What section was that? 


Rep L Johnson: Yeah, it’s page three, line 29 I think is where that was. 


Rep Rose: Thank you, that’s all. 


Rep L Johnson: Yeah, 26, line 26 on page three.


Rep Ladyman:  Any other questions from Committee? Seeing none, is there anyone here in the audience who’d like to speak against the bill? For the bill? Seeing none, are you ready to close for your bill, Representative Johnson? 


Rep L Johnson: I’m closed for my bill and I make a motion do pass. 


Rep Ladyman:  Okay, we have a motion of do pass, as amended?


Rep L Johnson: As amended, yes. 


Rep Ladyman:  Any discussion on the motion? I’ll just say, I like this bill and our rural hospitals really need help. And I think this will help them, so I like it. 


Rep L Johnson: Thank you.


Rep Ladyman: So, any other discussion? The motion is to pass the bill as amended all in favor signify by saying aye. All opposed nay.  Motioned carries, congratulations, your bill is passed. 


Rep L Johnson: Thank you, Mr. Chairman. 


Rep L Johnson:  Which bill would you prefer to run next? 


Rep L Johnson: Oh, whichever one’s next would be fine with me. I’m might ask Mr. Gilmore to come to the table in case there are complicated questions that I can’t attend to. 


Rep Ladyman:  HB 1250?


Rep L Johnson: That would be great. Thank you. 


Rep Ladyman:  If y’all would, please introduce yourself and who you represent. 


Gilmore DOH: Matt Gilmore, Department of Health.


Thompson DOH: Charlese Thompson. Department of Health. 


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


Rep L Johnson: Thank you, Mr. Chairman. So, representatives if you don’t know, the Prescription Monitoring Program we put in place some years ago was put in place some years ago was designed to try to curb opioid abuse. And part of the requirement is to have providers who are prescribing opioids, have them to have– to make them take the time when prescribing opioids to consult this database to make sure that the people they’re prescribing these opioids to aren’t already filling lots of prescriptions. And there’s a committee that’s been appointed to oversee the Prescription Monitoring Program. 


This bill does three things. One, is it adds two members to that committee. It adds an obstetrician/gynecologist. We’re seeing more and more infants born having withdrawal symptoms. And so, this has become– the opioid crisis has become more and more of an issue for our doctors and physicians that are delivering babies. And so, adding a obstetrician/gynecologist to this committee makes a lot of sense. Additionally, we’re adding a person from the Partnership for– I have to read exactly the word there. From the Opioid Recovery Partnership, and this is a designee from the Department of Health. So, this is just giving some more experience on the committee to discuss some of the issues that come up from time to time, so we’re adding those two members.


Additionally, we’re giving access to the program to the State Medical Examiner. And this comes up sometimes in criminal cases where there’s questions to the cause of death. And this would allow the medical examiner to get access, and look at prescription records and prescribing patters of the patient who’s passed away, so they can have more information when investigating those cases, which I think is appropriate. And then, additionally, it allows for a mortality review process. So, that if you’re– if we are looking for this– looking into a case, this allows the Health Department to lead that process through a more encompassing group of people that might include providers, pharmacists in gathering that information. And I’d be happy to try to answer any questions on these bills. And I have a couple gentleman here who can answer questions better than me. If there are questions, be happy to field those. 


Rep Ladyman:  Any questions from Committee? Seeing none, is there anyone here who would like to speak against the bill? For the bill? Seeing none, are you ready to close for your bill, Representative? 


Rep L Johnson: Yes, I’m closed for my bill and I’ll make a motion do pass. 


Rep Ladyman:  Committee, the motion is do pass, any discussion on the motion? Seeing none, all in favor signify by saying aye. All opposed nay.  Motion carries, congratulations your bill is passed.


Rep L Johnson: Thank you. 


Rep Ladyman: Are you prepared to run HB 1251?


Rep L Johnson: I am, Mr. Chairman. 


Rep Ladyman: Okay, you’re recognized. 


Rep L Johnson: So, Committee members this bill is a pretty straightforward bill. Currently we’re required to do background checks, criminal background checks on people applying to DMS Services. There’s been some question as to our ability to do those background checks on people coming from out of state, and to access and see whether they’ve had a criminal background in states other than Arkansas. This is just clarifying that statute to make sure that the Department of Health has the ability to do these criminal background checks in states other than Arkansas, which I think’s an important, fair issue. I’d be happy to take any questions. 


Rep Ladyman: Any questions from Committee? Seeing none, anyone here in the audience who would like to speak against the bill? For the bill? Seeing none, are you ready to close for your bill? 


Rep L Johnson: I am closed for my bill and make a motion do pass.


Rep Ladyman: Committee motion is do pass for the bill. Any discussion on the motion? Seeing none, all in favor signify by saying aye. All opposed nay.  Motion carries. Congratulations Representative, your bill is passed. 


Rep L Johnson:  Members, I think next upon the agenda is Senate Bill 58. Or actually, Representative Bentley, you weren’t here earlier in the room, would you like to present House Bill 1155? That was first on the agenda. You’re recognized to present House Bill 1155. And you have an amendment for that bill? 


Rep Bentley: Yes. 


Rep L Johnson:  Okay. Members, they’ll be passing out an amendment to that bill. 


Rep Bentley: Colleagues, if you remember this was a bill we passed out of Committee to help small rural child cares not to have to comply with commercial upgrades, electrically or on fire hazards. So, this bill we pulled back  because Representative Mayberry, unbeknownst to me as happens sometimes with our colleagues, she was also working on the very same bill. And she had worked on some agreed upon language with the fire marshals across the state. So, I’m bringing this back to add her as a co-sponsor, Senate co-sponsor Senator Breanne Davis, and also to bring that agreed upon language they have with the fire marshals across the state. So, I think it makes the bill even better, it combines with what Representative Mayberry had worked on. So that’s the amendment. So, with that I would make an amendment to pass the amendment to House Bill 1155.


Rep L Johnson:  Members, are there any questions on the amendment? Representative Wardlaw, you’re recognized for a question on the amendment. 


Rep Wardlaw: I don’t understand 2A, “Prohibiting the operation of two or more child care facilities in immediate adjacent residence.” If I have a child care agency and I’ve got five kids, how can I control my neighbor having five kids as well? 


Rep Bentley: That was discussing someone that maybe had a duplex and they were operating more than five children in their child care, so they’re trying to prevent somebody from abusing this. What we’re trying to do is just a residential home.


Rep Wardlaw: I’m not trying to hold your bill up, but this language here is not saying that this is a duplex, it’s saying adjacent. So, in a neighborhood that would prevent me from going into business if my neighbor has one. 


Unknown: It does say case by case basis.


Rep Wardlaw: I mean, it’s not clear. 


Rep Bentley: Again, this was agreed upon language to make sure that one person was not opening up a large child care facility and trying to abuse the residential–


Rep Wardlaw: I don’t think agreed upon here is relative because I’m not agreeing. 


Rep Bentley: –well, Okay, well, I’m just trying to– was trying to make sure that someone would not abuse what we’re passing here to have a large child care facility. 


Rep Wardlaw: And I get that. I just think that’s need to be clear to prevent me and my neighbor from running into an instance where neither one of  us could go into business after the other. I can’t run around my neighborhood and see what they’re doing so I can see what I’m going to do. 


Rep Bentley: Really the bill is focusing on making sure that the fire marshall doesn’t come and add extra restrictions on this. 


Rep Wardlaw: I’m in full agreement with what your bill does. I’m just not full agreement with 2A. 


Rep Bentley: Okay. Well, we’ll —


Rep L Johnson:  We have a motion on the amendment, do you want to take a vote on that amendment, Representative Bentley? 


Rep Bentley: Yeah, I’d like to take a motion on the amendment for sure. 


Rep L Johnson:  Or do you want to–? 


Rep Bentley: And I make a motion of do pass on the amendment. 


Rep L Johnson: We have a motion do pass on the amendment. Are there any other questions? All those in favor say aye. All those opposed say nay. No’s have it.  All right. We’ll give you time to work on the amendment–


Rep Bentley: That’s fine. I think we’ll work on it, make sure it’s clarified. Appreciate it. 


Rep L Johnson: Thank you. Representative Wooldridge, are you prepared to present Senate Bill 58?


Rep Wooldridge:  Thank you, Mr. Chairman. Colleagues, good morning. Senate Bill 58 is a department bill and it basically does two things. It allows massage therapy programs to do background checks before students or apprentices work with members of the public. It does not raise any fees, and it allows them to work after graduation while they study for a licensure exam for a six month period, which they’re currently not allowed to do. And with that, the Department of Health and I will answer any questions you have. I’ll have the motion at the proper time. 


Rep L Johnson:  Members, is there any questions for Representative Wooldridge? Representative Pilkington, you’re recognized.


Rep Pilkington:  Thank you, Chairman Lee. Representative Wooldridge, can you give me the definition of direct supervision within a massage setting? 


Rep Wooldridge:  I will yield to the department for that. 


Rep L Johnson:  If you’ll state your name for the committee, and then be happy to answer any questions. 


Thompson DOH: Thank you Chair, thank you members. Charles Thompson, attorney, Arkansas Department of Health. Representative, the direct supervision we would state that it would be– in our minds be line of sight. It’s not defined in the code because it’s in multiple places in the code now, and it’s not strictly defined. So, we would define it as at least line of sight or in the immediate vicinity to ensure that someone is not alone with a member of the public in the various states of undress prior to full licensure. 


Rep Pilkington:  Follow-up.


Rep L Johnson:  You’re recognized. 


Rep Pilkington:  So, unpack that a little more for me. So, when you say line of sight or directly there, so are we having a massage apprentice who’s administering a massage, but we’re also having a master massage therapist in the room at the exact same time while they’re giving the massage? Or they’re just allowed to be in the same building? They have to have eyes on them? In most massage settings you have a closed door because it’s a– the patient’s in various stages of undress. And so, my kind of question is, if we’re doing a program because we don’t have enough massage therapists out there, but yet you’re requiring two massage therapists to be in the exact same room at the same time, what we’re doing is limiting our labor force. So, can you explain my concerns on this? 


Thompson DOH: Yes, Representative. Well, what they do in schools an what they do in apprenticeship programs are very different. I would say very different. They are different in the fact that we don’t have jurisdiction over these apprenticeship programs, those are administered by the Department of Labor. So, whatever they’re doing, because you mentioned apprenticeship programs specifically. Whatever the U.S. Department of Labor requires for direct supervision, we would follow their guidelines. Now the schools are a little bit different. The schools are generally –they’re bigger, they’re rooms, they’re generally in larger rooms, so that a teacher, an instructor can see what’s going on– and make sure that everybody’s doing the correct techniques, nobody’s getting hurt. So, for an apprenticeship program, I’d have to punt to the Department of Labor because they actually administer that. Department of Health has no jurisdiction over that under the Earn and Learn Act. 


Rep Pilkington:  Okay. 


Rep L Johnson:  Are there any other questions for Representative Wooldridge? Anyone here to speak against the bill? For the bill? Representative Wooldridge, you are recognized to close for your bill and make a motion if you’d like. 


Rep Wooldridge:  Thank you, Mr. Chair. I’m closed and make a motion of do pass. 


Rep L Johnson:  We have a motion of do pass. All those in favor say aye. All those opposed say no. The ayes have it. Representative Wooldridge, you’ve passed your bill. 


Rep Wooldridge:  Thank you, Mr. Chair. Thank you, committee. 


Rep L Johnson: Members, I think that concludes the business that we have today. I don’t think there’s anyone else here prepared to run any bills. As mentioned, we’ll cancel the meeting this afternoon, and everybody just stay tuned, and we’ll let you know as soon as we can if we’re going to be able to have the  meeting tomorrow afternoon. Thank you. Appreciate it. Meeting adjourned.