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Prescribing Authority

White doctor coats, CRNA badges and scrubs overflowed from the House Public Health Committee room Thursday as CRNAs and advanced practitioner registered nurses fought for multiple scope of practice bills.

Three bills failed to pass through the committee prior to recess for the General Assembly: House Bills 1181, 1182 and 1228. The bills focused on APRNs’ ability to write prescriptions and their visibility as primary care physicians to Medicaid.

House Bill 1181 would have “created the transition to Prescriptive Authority Act; and to amend the prescriptive authority of advanced practice registered nurses.” Representative Dan Sullivan, bill sponsor, suggested that 21 other states already have in place legislation granting APRNs the capability to write prescriptions. Ten other states currently are considering the legislation and South Dakota has the bill on their Governor’s desk awaiting a signature.

House Bill 1182 would “remove the collaborative practice agreement as applicable to advanced practice registered nurse to be a primary care provider.”

House Bill 1228 would have “amended the prescriptive authority of an advanced practice nurse.”

Discussion for the bills suggested that citizens struggle to get into a primary care physician because they are full so Medicaid patients seek medical care from APRNs. Some APRNs who are in a collaborative agreement with a physician say that they already write prescriptions for their patients and the bill would lessen some paperwork.

Several doctors and representatives stated the bills “give out more prescription pads” that could contribute to the already opioid epidemic in the state.  Supporters said that since APRNs can only write prescriptions as high up as Hydrocodone, a Type II narcotic, they could not be attributed to the opioid epidemic. Fear was that APRNs could write more Type II prescriptions for narcotics including Xanax, Adderall and Oxycodone.

APRNs argued that through their education and testing they learn how to administer Type II narcotics and in other states, but Arkansas only allows them to prescribe Hydrocodone.

Proponents further stated with HB 1182, APRNs would want more money. Currently, though some patients use an APRN as a PCP, Medicaid does not reimbursement APRNs at the PCP rate in those situations. It was also stated that the collaborative agreement assists in accountability and a clinic “needs a captain on ship.” It was also argued that APRNs would not expand the access to care to rural areas. Approximately 2,200, APRNs are registered with Medicaid.

Though roll call votes showed two bills had more “yes’s,” they did not received the required “yes’s” to pass.


Fine Tuning

From fine tuning hearing aids via mobile units to armored medical marijuana transport units, House Bills 1034 and 1051 were easily pushed through Public Health, Welfare and Labor Committees Tuesday and Wednesday.

House Bill 1034 would “amend the laws concerning hearing instrument dispensers.” Representative Charlene Fite, bill sponsor, brought forth the bill to protect hearing aid consumers as mobile hearing aid units are increasing.  The bill would hold hearing aid dispensers at a higher standard to ensure that all equipment is calibrated to the proper specifications for working on hearing aids.

Operators of mobile units, whether from inside the state or out-of-state, would be required to report to the Arkansas Board of Hearing Instrument Dispensers and list, 30 days in advance, when they will operate in the state, the duration of time and the location.

Fite presented that the bill would not have any fiscal impact on the state and would not require the implementation of new fees. The bill is suggested to help make mobiles that do not have a physical presence in the state like “brick and mortar” dispensers to be visible to the Arkansas Board of Hearing Instrument Dispensers. Also, it would ensure that their calibrations are in-line with “brick and mortar” dispensers’ calibrations.

House Bill 1051 would “amend the Arkansas Medical Marijuana Amendment of 2016; and to add a licensure procedure for transporters, distributers and processers to the Arkansas Medical Marijuana Amendment of 2016.”

Representative Bill House, bill sponsor, proposed that those who intend on transporting medical marijuana would be required to be licensed to transport it and would follow rules and regulations set forth by the Department of Transportation.

Some feared that, without the bill, those transporting medical marijuana would be arrested if a traffic stop is conducted on the transporter while they’re “trying to do their job.” The bill would require armored transporters to have video cameras on the vehicle, keep log books, be licensed to transport and follow DOT rules and regulations.

Senators concerned with the bill inquired if even with transporters upholding to the state’s law could they still be arrested by federal agents. The federal government still recognizes all forms of marijuana illegal.

Senator David Sanders proposed a special order of business to review all bills to amend the Arkansas Medical Marijuana Amendment of 2016 at once, but the motion died without a second in favor.  House did advise that state law enforcement agencies were aware and behind the bill and it was well within the perimeters of DOT.


Still waiting

Several Arkansans who testified during Tuesday’s House Public Health Committee will remain on the disability services waiting list as House Bill 1300 failed to pass through the committee.
House Bill 1300, sponsored by Representative Josh Miller, would have “required the Department of Human Services and Medicaid to prioritize funding for the Developmental Disabilities Waiver Program, and to fully fund home and community-based services for individuals on the waiting list within three years.”
The bill was amended further explaining that funding to support the bill would not affect funding currently being directed to human development centers by DHS.
DHS and Developmental Disabilities Services estimated the bill would require approximately $43 million from the state level to accommodate the mandate it would set.
Arkansans who have a family on the waiting list, themselves are on the waiting list, or are no longer on the waiting list testified saying the services offered through the waiver would assist them in living a normal life. Mothers with disabled children said that they’ve given up job promotions and some even had to quit their jobs to be able to take care of their child full-time. One mother said she has accumulated approximately $50,000 in debt while another said she, a single mother of three, lost their health coverage.
A young girl with muscular dystrophy said that once she graduates from high school she wants to go to college, have a career and live on her own. Currently, she has a nurse that assists her throughout the day, but if she continues to be on the waiting list after graduation, she will not have that resource.
Legislators concerned with the bill raised questions primarily dealing with: where is the funding going to come from? Some feared that the bill would be reprioritizing DHS’s focus from thousands of children in foster care and other programs. Others proposed that with the state government’s proposed underfunding this year as well as the tax-cut legislation that the state could not sustain the $43 million annually for the bill.

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