Senate Public Health

February 28, 2023

Sen Irvin: All right, thank you. Calling the Senate Public Health Committee to order. Thank you everybody for being here and braving the weather. We’re going to go ahead and just get started as quickly as possible, but from the outset I’m just going to let everyone know, any bill that has a Medicaid impact we’re going to hold those bills. We’re going to get that fiscal impact of what that might do to our Medicaid system. I think that’s the most prudent way to approach, you know, and big picture so that we can have those conversations in conjunction with everything that we have going on in our state government. 


And I think that just needs to be a conversation we all have as a legislature together. In considering the different reforms that are happening in Corrections or in Tax Policy, or also in Education. So, any bill that has a direct impact to a Medicaid spend we’re going to hold those, and DHS is working on fiscal impact for those bills. All right, Senator Sullivan, SB 42. We’re just going to go down our list and get through these as quickly as we can. If you will just introduce yourselves for the record you may proceed. 


Sen Sullivan: Senator Dan Sullivan. Madam Chair, would you mind if the distinguished Matt Gilmore sat down beside me to help explain this bill? 


Sen Irvin: I don’t mind at all. 


Sen Sullivan: I know you haven’t seen us sitting beside each other in the table much, we’re trying a first. I’m going to let Matt explain the bill. 


Sen Irvin: If you’ll identify yourself for the record, Mr. Gilmore. 


Gilmore (DOH): Matt Gilmore, Department of Health, thank you Senator Sullivan. I’ll go ahead and speak to the bill. This is a bill for the Arkansas Department of Health’s Board of Counseling and the Examiners, and Marriage and Family Therapy. What this bill does is a couple of things. It reduces the amount of supervision where a licensee as they’re seeking supervision can do that part-time instead of full time, makes that easier. 


But then also, it also allows for — Previously, a licensee seeking licensure, if they wanted to change a specialty or add an additional specialty to their license, the board had to review that and approve that. There are numerous specialties out there, and this allows the licensee then to submit that information to the board. The board files it with their intent in their file, and it doesn’t delay the process for those seeking licensure. So, it’s a clean-up bill but also tries to reduce some regulations. 


Sen Sullivan: And I think what I understood is from Matt, now there’s just a checklist. And when you go down that checklist and fill all the obligations, then you submit that to the board, and it’s kind of a done deal. There isn’t much more discussion, there’s no — it’s not arbitrary, it’s just factual what they do. 


Gilmore (DOH): Yeah. And if they decide to add a specialty to their license they would just submit this to the board, and the board would look at it, review it, put it in the file. It wouldn’t require an action by the board to delay that, or bring them into the board and approve all that. 


Sen Sullivan: And with that Madam Chair, I’m closed. 


Sen Irvin: Okay, thank you. Are there any questions from members of the Committee? Anyone wish to speak for or against this bill? Seeing none, you’re recognized to close for your bill. 


Sen Sullivan: I am closed and I would appreciate, make a motion for a do pass.


Sen Irvin: Motion do pass. Second by Senator Wallace. All those in favor say, aye. Any opposed? Ayes have it, bill passes, congratulations. Senator McKee. Thank you. We’re moving to HB 1015.


Sen McKee:  Thank you, Chair Irvin. If it’s okay with you and the Committee I’d like to bring Kelly Hale here who’s the CEO of Hot Springs Village.


Sen Irvin: Yes. If you’ll just identify yourself for the record, thank you.


Hale (HSV): My name is Kelly Hale, I’m the General Manager for Hot Springs Village Arkansas.


Sen Irvin: Thank you, please proceed. 


Sen McKee:  So, in 2019 a, excuse me, a law was passed that required POAs to contribute to a fund for the purpose of cleaning up water and sewer plants that were abandoned by them. This bill simply removes communities or exempts communities over 5,000 inhabitants from paying into that fund. Michael Grappé from ADEQ has done extensive work on this, and basically signed off. He wanted to be here this morning, but the inclement weather has hampered his arrival, and that’s okay. He did a lot of work on this, worked extensively with the Village to make sure they were doing their due diligence, and doing the required maintenance, and making the investments that were necessary. This would just exempt them from making that $5,000, or their deposit into the fund, but it would also exempt them from future state funding in the case that they had any issues. And I’d be happy to take any questions.


Sen Irvin: Okay. Are there any questions? Yes, Senator Love, you’re recognized for a question.


Sen Love: Thank you, Madam Chair. And in looking at this bill, because I guess we also passed a water law in regards to the deferred maintenance and different things like that. So, talk to me in regards to Hot Springs Village deferred maintenance fund, different things like that.


Hale (HSV): All right. So, first-off, this is really in conjunction with we’ve been around for 52 years. We have been given municipality status on all of our water permits. In 2019 they changed over. They’re trying to have unintended consequences here by pulling us in and calling us a POA, HOA. We’re actually like a city, we do everything but provide energies, we’re self-contained. We don’t defer anything, we have funds that are setup. We put the investment in, I have a complete organization that’s on an org chart that has a separate department to take care of our water or waste water treatments like any other city.  So, ADEQ recommended that we work with getting the language changed to recognize us as a true municipality and not a non-municipality, which is what the bill out there now would do. Which as an HOA, POA in many regards of many of which what we live in, would meet that criteria. 


We don’t as a community, we’re actually a municipality, we’d like to keep that status on our water and waste water permits. So, we would be treated like, Monticello was the example that was used. If they had a failure they would be responsible just like we had been in the past. We just got pulled into this new bill on unintended consequences. So, we put money, we have reserve funds that are set up, we have money that we put in that’s budgeted out. We have a seven year O andM that we work off with our board of directors. We have revenue and we show growth within our community to be able to put into this where other communities haven’t, and that was the true intent of the bill when it was brought up before. 


Sen Love: Okay. All right. Thank you. 


Hale (HSV): Thank you.


Sen Irvin: Any other questions from members of the Committee? All right. Seeing one, is there anyone here to speak for or against this bill? Seeing none,  you’re recognized to close for your bill. 


Sen McKee:  We’re closed for the bill, appreciate a good vote. 


Sen Irvin: All right. Motion do pass, Senator Boyd, second, Senator Wallace. All those in favor say, aye. And opposed? Ayes have it, bill passes. Congratulations.


Sen McKee:  Thank you.


Hale (HSV): Thank you, Committee, appreciate you. 


Sen Irvin: All right. Representative Johnson, I’m going to go to you. And then, I will handle HB 1136. Okay, we do have an amendment. Senator Boyd as the cosponsor of the bill. Motion to adopt the amendment? So moved. Second? Second. All those in favor say, aye. And opposed? Ayes have it, amendment is adopted. You may proceed with your bill as amended. 


Rep L Johnson: Thank you, Madam Chair. Members of the Committee, this bill is reducing some hours of training for Community Paramedics. Community Paramedics are a type of paramedic that we recognized in this state back in 2017, 2018, sometime in that range. As of 2019 there were only about 17 states that actually had legislation on the books trying to recognize and move this forward. So, we were ahead of our time when we started this process. We were an early adopter of the concept of Community Paramedic. The Community Paramedic is someone who is an actual paramedic, who then receives additional training to some services that aren’t considered traditional for a frontline paramedic. 


Things like home health, post-discharge consults, where they go into the home, make sure people have medications, make sure they know when their appointments are. Sometimes hospice care, and even more recently some acute mental health responses. So, these are some provider types that have been increasingly utilized in our state and across the country. Part of the problem is there’s not been, until recently there’s not been approved reimbursement pathways through DHS, but they’ve worked out. So, my idea is now to try to help reimburse the services for Community Paramedics, and so, we anticipate more people interested. 


When we set the hours of 300, we didn’t really know where the training would land. It’s kind of all over the place when you look at other states. Like there are some states that don’t really even have any special training or recognition. There are other states that have considerably less training than 300 hours. This is something we worked on with the Ambulance Association, also with the Department of Health. Everyone agreed that backing the hours up would both incentivize more people to go into the field, while at the same time maintaining the standards we need to make sure they’re adequately trained. 


The other change we made,  you can see that we struck Emergency Department Services and replaced that with social determinants of health. That really just lines up the training more with what these community medics are doing. These are not people that are working in the ER, these are people that are going into people’s homes, and have to be trained better to recognize some of the challenges that certain patients have in getting transportation to their appointments, and getting money to pay for their prescriptions. And so, we’re trying to change the emphasis of the training from the emergency department to some of these other social issues that can create challenges that we know are unique to some of the people they see. And I’d be happy to try to answer any questions. 


Sen Irvin: Are there any questions from members of the committee? Seeing none. Anyone wish to speak for or against the bill? Seeing none, you’ve closed for your bill? 


Rep L Johnson: I am. 


Sen Irvin: Motion do pass? Second? All those in favor say, aye. Opposed? Ayes have it. Congratulations, you’ve passed your bill.


Rep L Johnson: Thank you. 


Sen Irvin: Let’s see, Senate Bill 132 is a simple bill. I think it’s a Health Department bill, is that correct Mr. Gilmore? 


Gilmore (DOH):  Yes, ma’am. 


Sen Irvin: Okay, if you’ll come to the end of the table. Senator Penzo, you want to run this bill for Senator Flippo if you’re comfortable with it? It’s very simple. I like to get our work done. Senate Bill 132. If you’ll just identify yourself for the record. 


Sen Penzo:  Clint Penzo, Senate Bill 132, for Senator Flippo. I’ll let Mr. Gilmore explain the bill. 


Gilmore (DOH): Thank you, Senator Penzo. Thank you, Senator Irvin. This is a clean-up bill for the Board of Chiropractic Examiners. What this bill does, during COVID we realized that the Chiropractic Board required more time, I think it’s 45 days, before a meeting to receive the information and the licensure for a new applicant, a new licensee. This reduces that down to 30 days. That’s more in line with the states around us. I know it’s 15 days, but it does allow time for the background check-up process, but also allows time for the board to receive that paperwork, get it processed and move it along. So, it does move things forward a little bit quicker and allows more time for the licensee to get those papers submitted to the board and get that moving in the right direction. 


Sen Irvin: All right. Any questions from members of the Committee? Senator Boyd, you’re recognized. 


Sen Boyd:  So, this is a, just a good citizen friendly bill to reduce government bureaucracy? 


Gilmore (DOH): Yes, sir, you’re correct. Thank you. 


Sen Irvin: Any other questions from members of the Committee? Anyone wish to speak for or against the bill? Seeing none, you’ve closed for your bill? 


Sen Penzo:  Closed for my bill. 


Sen Irvin: What’s the will of the Committee? Motion do pass. Second. All those in favor say, aye. And opposed? Ayes have it. Congratulations,  you’ve passed your bill. Mr. Gilmore, if you’ll just stay at the table, we’ve got three more bills with the Department of Health. Senator Wallace, if you will take the chair. 


Sen Wallace: And Senator Irvin, you are recognized. 


Sen Irvin:  Thank you. Senator Irvin, District 24. 


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


Sen Irvin: Members, we’ll do House Bill 1136, which I am a cosponsor of. 


Gilmore (DOH: Thank you, Senator Irvin. This is repealing some language around the terminology good moral character. Several years back the legislature and through red tape reduction and other legislation removed the terminology good moral character from occupational licensing. The reason behind that, it’s subjective. Everyone has their own definition of what good moral character is. It kind of leaves the occupations in a bad situation where they could deny that, and then it’s subjective. This was done like I said, I think 2019. Because of that I think there was some — they overlooked this portion in the social work statute. So, it’s just cleaning it up, making it match the other occupations. So, that’s kind of where we are on it. I’d appreciate y’alls attention to removing that two or three years ago, but I think this will make it more in line with other occupations.


Sen Irvin: And I would just add I chaired the Occupational Licensing Subcommittee through ALC, and this was one of the topics that we tried to go through systematically to clean-up anything that would be subjective. 


Sen Wallace: And is there anybody that would like to speak for or against this bill? Seeing none. Members, do you have any questions? Seeing no questions, Senator Irvin, are  you ready to close? 


Sen Irvin: I’m closed. I’ll make a motion do pass. 


Sen Wallace: Do I have a second? I have a second. Members all in favor say, aye. Any opposed? Congratulations, your bill passes. 


Sen Irvin: Thank you. Members, I’m going to do Senate Bill 138. 


Sen Wallace: Yes, Senator Irvin, go ahead and present your bill. 


Sen Irvin: Okay. So, members, Senate Bill 138 is really a technical clean-up bill and here’s why. We need to revise this because it creates a conflict in state code. The State of Arkansas cannot license an entity that is performing an illegal activity. So, under our current laws as they are, this requires us to strike this language, so that it does not put us in that quandary. I will say all of the licensing requirements remain in the statute, and at any time that we need to license an entity to do this again, then we will act to do that. We all want that to happen, but technically what this has one is create a conflict in the state code, and that’s why we’re bringing this bill. So, it really is a technical clean-up bill. Mr. Gilmore can elaborate. 


Gilmore (DOH): Yeah, I would agree with Senator Irvin. I think this is just making it consistent with the decision that was through the Dobbs decision, and just trying to get that cleaned up, and not allow this to move forward. So, okay. 


Sen Irvin: I will be happy to answer any questions. 


Sen Wallace: Thank you, Senator Irvin. Is there anyone in the audience that would  speak for or against? Seeing none. Do we have any questions? Senator Love. 


Sen Love: Thank you, Madam Chair. I meant, thank you, Mr. Chair. Sen Irvin, so when I, of course, talked with you about this.


Sen Irvin: Yes.


Sen Love: This is the one question that I raised in regards to the fact that if we reverse decisions, the Supreme Court reverts the decisions in regards to abortions. And so, right now that means we would have to come back in and put this language back in. 


Sen Irvin: Correct. 


Sen Love: If this language is not put back in, understanding the fact that we do like to license all procedures that happen within the state, but if this language is not put back in then what happens? 


Sen Irvin: I would think that we would act immediately to put the license back in. I will say this on the pro-life side and on the pro-choice side, we all agree that this needs to be licensed. If this is a legal activity it needs to be regulated, it needs to be licensed. There are benefits for having that license in place so that we understand and can ensure that things are done safely, clean. Yeah, all those things are very, very important to the practice of any type of procedures that are done in a health care setting. So we would have to put that right back in place. But right now, as it is now, we would be licensing an entity that is doing something that is actually illegal in the state of Arkansas, that’s what’s creating the conflict. But I assure you, I’ll be the first to run the bill, or to make it through Executive Order, the Governor is absolutely supportive of making sure that we have a license put back in place if the court did overturn anything.


Gilmore (DOH): And if I may, Senator and Senator Love, all the other reporting requirements are still in effect, and then there are rules through the Medical Board as well. And then, I think there’s also criminal code out there as well that would come into pact. So, the license would go away but there are still checks and balances on the things we’re talking about. 


Sen Love: Okay. All right. Thank you.


Sen Irvin: That’s a great question, and thank you for letting me answer that. 


Sen Wallace: Members, are there any other questions? Senator Irvin, are you closed? 


Sen Irvin: I’m closed for my bill, thank you. 


Sen Wallace: Members, I have a do pass. And I have a second. All in favor say, aye. Any opposed? And I rule it passed. 


Sen Irvin: Thank you. And the last bill is Senate Bill 57. 


Sen Wallace: Go ahead. 


Sen Irvin: And so, this bill actually came through this Committee, but I took it to the floor, and I had some questions and concerns by some folks on the Senate, so we amended the bill. And so, basically this is decreasing fees for the State Medical Board. They want to reduce their licensing fees. And so, the amendment, what the amendment does is actually just leaves it in the statute that it cannot exceed what’s already in the statute. The amendment strikes the language that it could be changed through rules, subcommittee, or ALC approval, and the Governor’s approval. That was just a concern that was expressed to us in the Senate. We were happy to oblige that concern. I will say, however, that we need to have consistency across all of our boards and commissions, and we don’t at this point. So, we need to make a decision, it’s going to be one way or the other. But, except that I’m happy to oblige the request that was made. I’ll be happy to answer any questions. 


Sen Wallace: Is there anybody in the audience that is for or opposed to this bill? Seeing none. Members, do you have any questions? Seeing no questions, Senator Irvin, are you ready to close? 


Sen Irvin: I’m closed. Appreciate a good vote. 


Sen Wallace: You are closed. I have a motion, do I have a second? I have a second.


Sen Boyd: Can I get a discussion real quick, did I miss that? 


Sen Wallace: Yes, sir. Go ahead.


Sen Boyd: Senator Irvin, I’d of voted for the bill either way. 


Sen Irvin: Yes, sir. 


Sen Boyd: But I think you did the right thing and I appreciate you doing that.


Sen Irvin: Thank you. Yes, sir. Thank you. 


Sen Boyd: And I’m going to make a motion to do pass if that’s not clear. 


Sen Wallace: So, I have a motion and a second. All in favor say, aye. Any opposed? Seeing none. Congratulations your bill passed. 


Sen Irvin: Thank you. Thank you, Matt. 


Sen Irvin: All right. Is there any other business  to come before the Committee? I don’t see any. Members, we are having a meeting at 3:30 this afternoon in Big MAC A. It is an informational meeting only, we’re meeting jointly with the House members, which should be fun. And we’re getting information from DHS. Do you want to come to the table and just give us a little preview? A tease, if you will. If you’ll identify yourself for the record, and then you can proceed.


White (DHS): Thank you, Madam Chair. Mark White, Department of Human Services. So, yes, what we’ll want to talk about is some funding that’s going to be available for Home and Community Based Services around the state including some opportunities in Behavioral Health,  Crisis Response and some other related things. This is an opportunity that was created in the American Rescue Plan Act that Congress passed a year or so ago. They provided some additional funding connected to our spend on health and — Home and Community Based Services. And so, we’ve developed a plan, we’ve gotten approval from the Feds for that plan. And so, we’re starting to implement that, but we just want to walk y’all through how that money’s being spent and some of the opportunities that we’ll be using that money for. 


Sen Irvin: All right. Thank you. All right, with that we’re adjourned. Everybody be safe going home.