House Public Health, Welfare and Labor Committee

February 2, 2023

Rep L Johnson: We’ll call this meeting to order. Without objection, we’re going to take things a little out of order on the agenda, we’re going to let Representative Pilkington run House Bill 1009 first. Are you prepared to present that bill?

Rep Pilkington: I am. Thank you, Chairman.

Rep L Johnson: You’re recognized, thank you.

Rep Pilkington: Thank you. House Bill 1009, if y’all recall, I had an amendment in committee changing some of the language, basically creating this working group for ride-sharing programs for nonemergent transportation. This is a pilot program, about 4 years ago we started, it was up and running, got shut down during COVID. We’re just looking to get these programs back up and going, and this is basically creating that working group that DHS has asked for. And so that we’ll get a report by December end of this year of how to move ahead and kind of reform our nonemergent transportation. That’s it, just creating a working group, thank you.

Rep L Johnson: Does anyone have any questions for Representative Pilkington? Representative Ferguson, you’re recognized for a question.

Rep D Ferguson: One of the things I found my federally qualified health center is actually– has vans and transports people at no cost and they don’t get any reimbursement because they’re not a Medicaid transportation service but they– is that something you would consider qualifying them under ride-sharing?

Rep Pilkington: That hadn’t occurred to me. In full disclosure, I work for a FQHC that offers van services, and that never crossed my mind but I’ll be happy to make sure DHS includes them in those discussions so that we’re not duplicating services in areas where it doesn’t need duplicated because I think that the issue is we want to make sure that we’re kind of spreading the wealth to where people who are having issues getting to and from the doctor are being taken care of.

Rep D Ferguson: Yeah, and as you know, I mean, if they use the provided services, I mean sometimes the patient will come sit in our office for 4 hours before they’ll get picked up. So the FQHC provides a very efficient service but for no reimbursement. Okay, thank you.

Rep L Johnson: Any other questions from the Committee? Representative Allen, you’re recognized for a question.

Rep Allen: Thank you, Representative Pilkington. You mentioned that it was a pilot program.

Rep Pilkington: We had created a pilot program back I believe in the 2019 session. And DHS did start a pilot program to use ride-share applications like Lyft, I think was the carrier they used to transfer patients. And unfortunately, due to COVID that kind of got shut down and there were some issues they’re working through. And so now they’re just kind of wanting the authority to go back and start this back up and have a working group to work with kind of the existing nonemergent transportation providers as well as the ride-sharing groups.

Rep Allen: Was your pilot program just in certain parts of the State of Arkansas or was it located throughout the state?

Rep Pilkington: My understanding right now is– or before when it was open it was just in the Little Rock metro area. But I can ask DHS if there’s someone here from there who can give a little more information, but my understanding it was only in the Little Rock area.

Rep Allen: Well, you’ve answered my question, okay.

Rep L Johnson: Representative Pilkington, you ready to close for your bill?

Rep Pilkington: I’m closed for my bill and motion do pass at the proper time.

Rep L Johnson: So is anyone here to speak for or against, thank you? I see none. We have a motion do pass, all those in favor say aye. All those opposed. Congratulations, Representative Pilkington, you’ve passed your bill.

Rep Pilkington: Thank you. Thank you, Chairman, and Committee.

Rep L Johnson: Representative Rose, are you prepared to present Senate Bill 93? All right, you’re welcome to present.

Rep Rose: Thank you, Mr. Chair. Colleagues, I’m presenting SB 93 today. This is an act to amend the Arkansas code regarding a college of dentistry to clarify that the Commission on Dental Accreditation is the accrediting entity for a College of Dentistry. Simply put, this bill updates the law as it relates to a dental school in Arkansas. As is currently law, the statute specifically related to a dental school in Arkansas and the Arkansas Dental Practice Act is outdated and immaterial.

The current statute was written long before the establishment of CODA, the Commission on Dental Accreditation. CODA was established in 1975 and it’s nationally recognized by the United States Department of Education as the sole agency to accredit dental and dental-related education programs conducted at the post-secondary level.

So the question is who does this help? This would help any higher education institution, public or private non-profit that can satisfy the rigorous multi-year accreditation criteria and process through CODA. Separately, this criteria and process goes through the HLC, the Higher Learning Commission, which is our regional institutional education accreditor for Arkansas. Also, this bill does not create nor does it fund a dental school. This only opens the pathway for a dental school to be started in Arkansas as the current law no longer has a pathway for that. I’m open for any questions.

Rep L Johnson: Any questions from Committee members? Seeing no questions, are you ready to close for your bill?

Rep Rose: Yes, sir. Closed for the bill and make a motion do pass.

Rep L Johnson: Is there anyone here to speak, I’m off my game this morning, guys. Anyone here to speak for or against the bill? You’re recognized for motion.

Rep Rose: Make a motion do pass.

Rep L Johnson: Anyone, any discussion on the motion? Seeing none, all those in favor say aye. All those opposed. Congratulations, Representative Rose. Would you like to stay at the head of the table and present Senate Bill 74? 

Rep Rose: Yes, sir. Thank you.

Rep L Johnson: You’re recognized to present Senate Bill 74.

Rep Rose: Yes, sir. Thank you, Mr. Chair. I’ll now be presenting SB 74, and this is known more broadly as the surrogate bill. And to clarify it right out of the gates, first time I talked this over with my wife she asked me, so is this having to do with pregnancy? And I said this is not that type of surrogate, okay. So this is somebody standing in to help somebody who no longer is able to do that.

So let me share a few things with you. In 2017, our legislature passed the Health Care Decisions Act. You’re getting some code passed out to you right now. I want to thank the staff for helping me get that prepared. This act lays out the framework to ensure the most ethical path forward to engage a surrogate in making difficult health care decisions for another person who cannot make his or her own decisions and has no power of attorney. The 2017 legislation clarified who can and cannot be appointed by an attending physician or surgeon.

The issue is that many individuals admitted to hospitals lack capacity to make healthcare decisions on their own, either temporarily or permanently. And most do not have power of attorney or a legal decision-maker. There are examples of patients who’ve been in hospitals 180 days, 200 days, and literally have nobody to act on their behalf. And so that is my primary focus with this.

Today’s legislation makes a small amendment to address a challenge for incapacitated individuals in a healthcare setting, such as a hospital. Here in just a moment, Jenna Goldman, Director of Governmental Relations with Mercy will share some examples of patients who would benefit specifically from this amendment to the 2017 Act, and describe precisely what this change will accomplish.

One thing I want to iterate is that we’re not here to litigate the 2017 Act but address this small change and which will benefit a small number of individuals who desperately need our help. They are truly what I would describe as the least of these and in a most difficult season of life. So at this time, I’d like to ask Jenna Goldman to come forward and share some examples.

Rep L Johnson: Absolutely. If you don’t mind introducing yourself to the Committee and telling who you represent.

Goldman MHS: Good morning, Jenna Goldman with Mercy Health System. And with this bill, it just allows the surrogate to apply for Medicaid, which right now they cannot. As Representative Rose said, we’re not changing any of the statute that’s already laid out on how a surrogate’s identified but this has become a bigger issue as we’ve had adults essentially abandoned in the hospitals. They either don’t have anybody or their family has left them in the hospital and will not come back to help get them appropriate care.

We’ve had some that just need long-term care services. We also have some with traumatic brain injury that are incapacitated and not able to do this themselves. And we can’t transfer those patients until they have coverage, and so that’s what we’re doing here today. And I’d be happy to answer any questions

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

Rep Ladyman: Thank you, Mr. Chairman. Jenna, do you know how many people are in this category? I mean, do you have an idea? And I know you may only have Mercy but can you give us an estimate of how many people are affected?

Goldman MHS: I do not. I only have Mercy but we have multiple come in a week. It’s very expensive for hospitals. But more importantly, we can’t– hospitals don’t provide the care these people need. And so our end goal is to get them appropriate care, which has become very challenging.

Rep L Johnson: Are there other questions from the Committee? Seeing none, is there anyone else here to speak against or for the bill? Representative Rose, are you closed for your bill?

Rep Rose: Closed for my bill.

Rep L Johnson: What’s the will of the Committee? A motion do pass, any discussion on the motion? All those in favor say aye. All those opposed? Congratulations, Representative Rose, you’ve passed your bill.

Committee members, I think there’s–is Representative Bentley here? I think she is not here yet. She had discussed maybe presenting her bill. Oh, that’s a good idea, there she is, we don’t even have to take a short recess. You’re right on cue, Representative Bentley. Are you prepared to present your bill? Okay, this is House Bill 1155. This is one that we rereferred to Committee, and ready whenever you are to present the bill again.

Rep Bentley: Thank you, Chairman, colleagues, we presented this Bill 1155 is a very simple bill to allow those–

Rep L Johnson: I’m sorry, the amendment you had, has that been engrossed now?

Rep Bentley: It’s been engrossed, yeah. The amendment–  

Rep L Johnson: Was that changed at all from the last time?

Rep Bentley: Yeah, it was changed. Remember, Representative Wardlaw had a question on that. He thought we were decreasing competition by the one statement that was in there in the bill, I’ll pull it out and read it.

Rep L Johnson: Okay, so the amendment that was presented before has been re-amended, has been engrossed on members own, and now currently the bill that you can see on Ark Leg 1155–

Rep Bentley: Is the bill.

Rep L Johnson: –is currently the bill. Okay, members, I’ll give y’all a chance to pull that up on whatever device you have. That’s my fault as well.

Rep Bentley: I’m sorry. It’ll give me a chance to pull it out of my folder.

Rep L Johnson: Yeah, we’re throwing you at the end of the table right through the door. We’’ give you get plenty of leeway to get ready.

Rep Bentley: Yeah. Thank you, Chairman. Has everybody got it pulled up, are we good?

Rep L Johnson: I think so.

Rep Bentley: So, I remind colleagues the one thing that was a concern to Representative Wardlaw was prohibiting the operation of two or more childcare family homes and immediately adjacent residences. So we’ve just stricken that part out of the bill, so it’s no longer in there. So we’re again a very simple bill allowing those people to have a residential daycare, an area that we desperately need folks to help moms out with infant to 3-year-olds in a residential daycare, they will not be forced to do things that a commercial business would have to do as far as increasing sprinklers and all those things. So fire marshals have come in and added unnecessary regulations to these folks, making it impossible for them to operate. So we’re just saying a residential home is a residential home, and you can’t add extra regulations to them to operate as a child daycare.

Rep L Johnson: Are there any questions from Committee members? Seeing no questions, is there anyone here speak against or for the bill? Representative Bentley, are closed for the bill?

Rep Bentley: Thank you, Chairman. Just really quickly want to say this is agreed on language with the fire marshals and that Representative Julie Mayberry has worked well on this bill, and I’ve added the things that she’d asked me to add and added the Senate sponsor. So thank you all very much for your time. With that, I’d make a motion do pass on 1155.

Rep L Johnson: Is there any discussion on the motion? Seeing none, what’s the will of the Committee, all those in favor say aye. Opposed? Congratulations, Representative Bentley, you passed your bill.

Rep Bentley: Thank you, Chairman. Thank you, colleagues. I appreciate it.

Rep L Johnson: Members, I don’t think we have any more business for the Committee unless there’s someone that has any comments or discussion before we adjourn. We’ll plan to meet again Tuesday morning at 10 o’clock I think is the next meeting. And our photo’s going to be that morning what time? Okay, 9:30 in the morning, is everybody okay with 9:30 in the morning photo on the steps out here? House steps, okay. Any other questions? On Tuesday, yeah, Tuesday, 9:30. All right, meeting adjourned.