Rx from the Hill

Rx from the Hill - 5-8-17

"I have opinions of my own, strong opinions, but I don't always agree with them."
- George H. W. Bush

As advertised, the Arkansas General Assembly came to town May 1 and left by noon on May 3, their business complete.  We knew they meant business when one of their first motions was to suspend all Rules concerning bill filing, in effect allowing a bill to move from committee, to the floor and then to the other body without any time delay. 

First the Honorables had to address the adjournment of the 91stGeneral Assembly which they did in less than an hour.  There was one hold up in the Senate when Senator Flippo, R- Bull Shoals, attempted to over-ride the Governor’s veto of his SB496, To Prohibit the Alcoholic Beverage Authorities from Enforcing Laws Regarding Gaming Devices. It was a valiant but failed exercise. Then it was on to adjournment sine die which they accomplished before 2:00 pm.  Shortly thereafter the Special Session began after opening remarks by Governor Hutchinson. He made it clear, as did Speaker Gilliam and President Pro Tem Dismang, that only three issues would be on the call: Arkansas Works, Shifting $100 million from tobacco settlement funds to a reserve fund and Medical Marijuana.  Directly after opening remarks members adjourned to several different committees to get the required bills into play. 

Surprisingly, the shift of the $100 million to a reserve fund generated the most heat and debate. Recent budget short falls may have triggered the transfer of funds. And putting the funds in a more accessible state reserve account apparently helps the state’s bond rating. Senator Bryan King offered some choice remarks about the transfer.  The move only confirmed his warning about the health of the state’s budget and revenue projections going forward. The Governor’s cuts to the 2017 and 2018 general revenue budgets over the last few weeks only added weight to this narrative. After debate the bill passed easily.

For the first time since it passed under Governor Beebe, the Affordable Care Act/Obama Care/the Private Option/Arkansas Works, there was hardly a dissenting voice on the proposedmeasure which made its’ way to the Governor’s desk by Wednesday of this week. SB3 and HB1003 passed by large margins in both bodies. The new plan cuts roughly 60000 Arkansans from their rolls by moving the threshold for eligibility from 138% to 100% of poverty.  Arkansas Works must still pass federal muster and get its’ waiver approved by the Trump administration. The Arkansas Department of Human Services indicated that they will have their waiver application to CMS by next month. 

The clean-up legislation for the Medical Marijuana Amendment, SB2 and HB1002, passed without a hitch on Tuesday.  The Senate sponsor, Senate Pro Tempore Jonathan Dismang, R-Searcy, said that the legislation simply organized the laws. After bruising battles in the recently adjourned regular session it was a pleasant change to have such easy passage. The Senate voted 33-0 and the House 91-1. No one is toking up yet but they will be soon.

One rumor come to fruition in the Special Session, or directly after adjourning the Special Session, was a vote on House Rules regarding impeachment of judges. For some weeks Senator Trent Garner, R-El Dorado, had urged his House colleagues to bring articles of impeachment against Pulaski County Circuit Judge Wendell Griffin. Griffin it seems had gone beyond the judicial pale by first issuing a restraining order to the state to stop the use of a drug in the execution of 8 death row inmates, effectively stopping the execution for a time. The state Supreme Court removed his stay later in the week. Then Judge Griffen compounded his offense by showing up to protest the executions outside the Governor’s mansion. His ruling and his protest riled a number of House and Senate members who began in earnest to discuss his impeachment.  

It seems that the state’s constitution gives the House the power and duty to bring up articles of impeachment but rules for that process had never been promulgated. So, upon adjournment and over the protests of some members, the House Caucus went into a meeting to pass rules for impeachment should they be needed in the future.  Judging by the debate and comments by members it was clear that the impeachment rules were directed at Judge Griffin. The fact that Judge Griffin’s conduct is being investigated by the state Judicial Discipline and Disability Commission may be the one thing that stopped the House from proceeding. With 4 executions remaining the Judge is not out of the impeachment woods yet. If Judge Griffin remains true to form he will continue to protest the death penalty and face the real possibility of impeachment.

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Rx from the Hill
- 4/5/17

"Unless someone like you cares a whole awful lot, nothing is going to get better. It's not." - Dr. Seuss

In the final days of the session, the Arkansas General Assembly passed legislation to require medical marijuana dispensaries to have a pharmacist involved in the dispensing.  APA believes this is necessary to ensure patient safety.  Our companion bills were HB 2190/Rep. Clint Penzo and SB721 Sen. Jason Rapert.

As promised the Honorables gaveled out on Monday, the 85th day of the 91st General Assembly. They will remain in recess until May 1 at which time they will come back to adjourn sine die.  Then later on that day or the next they will go into a special session for 3 or 4 days to take up the issue of the Affordable Care Act or Arkansas Works.  

By Monday afternoon legislators and the Governor were taking a victory lap touting their accomplishments.  Most put the tax cut at the top of their list of success. Others noted the state sales tax exemption for military retirees, the increase in foster care funding and the reduction of the sales tax on replacement parts for manufacturing as significant legislation.  A key failure was passage of a major highway funding bill. Some members and the governor seemed proud that they avoided a bathroom bill.  Whatever your opinions on the issues, the citizens of the state will now be able to carry a concealed weapon just about anywhere, get your wine at a grocery store and get medical marijuana for certain ailments. 
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Rx From the Hill - 3/17/17

“It doesn’t matter if the glass is half empty or half full. There is clearly room for more wine.” – Anonymous

It seems that the pace has quickened at the Capitol this week with long House and Senate Calenders and members staying late, 4:00 or 5:00. They’ve even taken to calling more committee meetings upon adjournment.  This is a sure sign that leadership is pushing hard to shut this session down by March 31st or shortly there after. And if that’s the case by midweek the Assembly had 13 working days left to pass their legislation. Of course that’s assuming that they work on Fridays. Another sign that the end is near members who have had their bills defeated in committee or on the House or Senate floor are having the votes expunged from the record so they can bring them up for one more vote.  What a system.  That’s why it’s never over until they go home.

APA's focus has turned to medical marijuana.  Medical Marijuana dispensaries will soon pop up across Arkansas.  The Medical Marijuana Commission will award permits to 32 dispensaries.  These Arkansas General Assembly should require these dispensaries to operate in a fashion that keeps them medical, which involves have a pharmacist involved in a dispensary.  This is necessary to ensure patient safety.  Our companion bills HB 2190/Rep. Clint Penzo and SB721 Sen. Jason Rapert are running short on time, so we are focused on trying to get any kinks worked out and get them moving.

Representative Dan Douglas’ highway bills, HB1726 & HB1727, hit a road block this past week. By a vote of 38-35 HB1726, which sets up the bonding mechanism, failed after which Rep Douglas refused to present the funding bill, HB1727. Douglas was clearly frustrated by his recalcitrant colleagues opined, “ We’ll just let the roads fall apart.”  This one is not over yet as Douglas indicated that he’ll work the vote tally and see who he can pick off to reach the 51 votes he needs to pass the bill. To be sure the no votes and the non-voters are about to be lobbied in earnest by the Governor and the highway commissioners from their districts.

And speaking of roads a long overdue bill to curtail the use of texting while driving had a smoother ride to passage in the Senate at the first of the week. SB374, by Senator Will Bond, D-Little Rock, will increase the penalties to $250 for a first offense and $500 for a second offense. Penalties could be doubled if the use results in a traffic accident.  You might recall that the bill was defeated at the first of last week by with only 15 Ayes.  After expungement of that vote the bill rose phoenix-like this week. We are thinking about asking the sponsor to add an amendment to include legislators and lobbyists while walking in the halls at the Capitol.  It gets dangerous out here especially on the stairs.

Guns and wine had a good week at the Capitol. You will recall that Representative Charlie Collins’ gun bill to allow concealed carry on college campuses ran into a little trouble once it got out of the House. On the Senate side, as often happens, the Senate proceeded to add some amendments. Amidst impassioned pleas on both sides, the majority of the Senate saw fit to include language in HB1249 that would essentially allow gun toting in just about everywhere in Arkansas and that includes the Capitol, bars, churches and into most public places. It seems that the most onerous thing about the bill for some Senators was that not only did you have to take the concealed carry training but one also has to have 8 hours of active-shooter training. The House of course concurred in the new language in an apparent agreement between the sponsors, Rep Charlie Collins, Sen Trent Garner, Governor Hutchinson and the NRA. Collins opined that the law would cut down on the “crazy killers” on campus. Seems to us that the law has armed a host of potential killers.  It’s on to the Governor where it will be signed into law.

On a less troubling note the wine bill, SB 284 by Senator Hester, R-Cave Springs, was signed into law on Wednesday. Now grocery stores in wet counties can sell every wine available to them, not just wines from “small-farm wineries.” This was a battle between the big groceries like Wal-Mart and Krogers and the liquor store owners.  And just as the concealed carry law has morphed into what we have today (the first concealed carry was passed in the mid 1990s) we assume that this wine expansion will eventually morph into grocery stores selling all alcoholic beverages.  We believe it’s time that the Honorables take a hard look at fixing the states liquor laws which are a convoluted mess, remnants of prohibition.  

The so-called bathroom bill, SB774 by Senator Collins-Smith, had its first hearing in the Senate Judiciary Committee on Wednesday. After an hour and a half hearing on the bill the sponsor read the tea leaves and did not ask for a vote. This is one that appears to be a fix in search of a problem. Governor Hutchinson has intimated as much saying the bill is not necessary.  With time running out the Senator will have an uphill battle to get it to the House before time expires.

As of Friday the word in the halls among folks who have a vote or veto are saying they will be done by March 31 after taking two days off next week for Spring break.  RSA is rumored to be out next week and the House was in session until early afternoon after starting at 10 on Friday. The Senate went home Thursday after their session.  We are hoping for the 31st but April 2nd sounds more realistic. In any event the end is at hand and it will come none too soon.
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Rx from the Hill - 3/10/17

“Justice will not be served until those who are unaffected are as outraged as those who are.” 

― Benjamin Franklin

Not surprisingly the 91st General Assembly topped their bill total from 2015 by 7 bills. By the evening of March 6, the last day to file, the total had reached 2069 bills. The bill total for 2015 was 2062. It will take another week or so to find out exactly what some of the shell bills will look like once they have language in them.

The long-awaited Provider Health Care bill for was rolled out this week and cleared the House Public Health and Welfare Committee.  The Passe model came in the form HB 1706, Representative Pilkington, R-Clarksville. It will allow groups of providers that cover the BH and DD population under Medicaid to hire a managed care company to assist in cutting costs in the program.  What seemed odd to us is that legislation of this size and complexity was placed into the hands of a freshman legislator.  The announced Senate sponsor was to have been Senator Missy Irvin.  Which begs the question about support for the bill and program.  The bill is on the House calendar for Monday.

The assault on the Freedom of Information Act has begun in earnest at the Capitol and is threatening to reduce the publics’ right to access government documents.  The bills seek to exempt certain documents from the FOI law. For instance SB12 exempts emergency and security records and “other information” for public schools, kindergarten through universities. SB131 would exempt State Capitol Police records and HB1236 which would exempt video or photos showing a police officer’s death. Other exemptions include: agency records their attorney has seen or offered comment; postponing submitting public records from 3 days to almost indefinitely; Arkansas Department of Community Corrections’ emergency preparedness documents; records related to the Governor’s Mansion and grounds held by the state police.  The sponsors and proponents, mostly republicans, argue that the new laws are needed while the opponents insist that combined the bills will effectively gut the State’s Freedom of Information Act. It is worth noting that the FOI Act was passed in 1967 while Republican Winthrop Rockefeller was governor. While a candidate for governor in 2006 Governor Hutchinson expressed his opposition to a reduction of the FOI Act even going so far as to “pledge to veto any bills that would weaken…” the FOI Act.  Now as  governor his opposition is less than fulsome.

Representative Dan Douglas, R- , spoke with the Chamber Lobby Lunch on Monday and began in earnest to lobby for his highway bills, The Arkansas Highway Maintenance and Construction Bond Act of 2017. Also known as HB 1726 and HB 1727.  Rep Douglas made it clear that this approach to highway funding was not his first choice to generate more revenue for the state’s highways but “the no new taxes” bunch at the Capitol made passing a straight tax increase on motor fuels impossible. HB 1726 gives the authority to the Arkansas Highway Commission to issue bonds for maintaining, repairing, renovating and constructing highways and bridges.  HB 1727 will repay those bonds by levying a 6.5% sales tax on the wholesale price of motor fuels. The tax will not be levied unless and until the citizens of the state vote on it.

Just as the state is getting ready to execute 8 death row inmates the first since 2005, Representative Vivian Flowers, D-Pine Bluff, has filed a bill to end the death penalty in Arkansas.  The bill characterizes the punishment as “unfair and arbitrary” and removes the death by lethal injection language and replaces it with “life imprisonment.” Our guess is that she will have a hard sell to her colleagues.

A second constitutional amendment passed muster.  House Joint Resolution 1016 by Representative Robin Lundstrum, R-Elm Springs, would require voters to show a photo ID at the polls. The measure will be on the next election ballot.  Proponents of the bill argue that the move will cut down on voter fraud and build voter confidence. Opponents insist there is no voter fraud and that the requirement will hurt voter turnout.  It should come as no surprise to anyone that the vote was made largely along party lines.  This HJR1016 along with SJR8, Tort Reform, are the two proposals that will be on the ballot so far. It remains to be seen if the Honorables can agree on a third one.  These proposals do not need the Governor signature.

This week also resurrected the gun-carry-bill-on campus in a new and improved, or not, form, depending on which side you are on. The new version allows concealed carry on college campuses and other public places. It’s out of the Senate and headed to the House. Governor Hutchinson has signaled that he’ll support it. The Freedom of Conscience bill failed in the House Public Health, Welfare and Labor Committee. The bill supposedly protects health care providers who refuse to provide services that would go against their conscience. The bill that makes the Bible the state book is on its’ way. We expect to see the legislative sponsors of these and other questionable bills, to work feverishly to pass their bills over the last few weeks of the session, we hope unsuccessfully.
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Rx from the Hill3/1/2017 

"Diplomacy is the art of saying 'Nice doggie' until you can find a rock." -Will Rogers

Both of APA’s scope of practice bills filed have made it through both chambers. We have been working behind the scenes with the Medical Society and senate Health Chair, Senator Bledsoe for several months to avoid a contentious fight between pharmacists and physicians. SB 162, the Arkansas Pharmacist and Physician Scope of Practice Bill, is the bill that will allow pharmacist to administer all medication, allow pharmacists to dispense naloxone under a statewide protocol, and identifies individual pharmacists as healthcare providers in our practice act. This bill is sponsored by Senator Cecile Bledsoe and Representative Justin Boyd. SB 153, the Arkansas Pharmacist Emergency Refill Bill, expands the supply of a onetime emergency refill dispensed by a pharmacist from 72 hours to the full quantity of a prescription for maintenance medications. This bill is sponsored by Senator Lance Eads and Representative Clint Penzo.

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Rx from the Hill2/10/17

“Federal and state laws (should) be changed to no longer make it a crime to possess marijuana for private use.” 

― Richard M. Nixon

Medical Marijuana legislation made some headway this week. HB 1298 and HB 1371, by Representative House, R-North Little Rock, were stymied on Wednesday in the House Rules Committee. After a day of lobbying and “ ‘splaining” the sponsor prevailed on Thursday. HB 1298 will require a license for a dispensary & a cultivation operation to be held by person. HB 1371 requires that an Arkansan must own 60% of the dispensaries and cultivation operations. On the other pot front, The Arkansas Medical Marijuana Commission, a final draft regulation is nearing completion with a final vote to come at the next meeting February 21.  If passed the rules face a public comment period after which they go to the legislature for a final vote.  It’s anybody’s guess how long that will take but it’s conceivable the rules could be in front of the legislature before the end of March.

Another proposed constitutional amendment was rolled out last week. Senate Joint Resolution 8 by Senator Missy Irvin, R-Mountain View, would place before the voters a tort reform amendment.  Irvin’s news release stated that the voters should be given “the chance to decide whether our state needs stronger tort reform for businesses.” The battle over tort reform is not new in Arkansas. The senator’s side argues that Arkansas has become a venue shopping oasis for lawyers looking for large settlements in tort cases. The opposing side, not surprisingly, is led in large part by the Arkansas Trial Lawyers association. They argue that the bill would reduce the opportunity for citizens to protect their interests “against abusive corporate nursing homes, greedy insurance companies and harmful corporate interests…” Arkansas ranks 41st in the nation for our legal climate for businesses.
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Rx from the Hill - 2/3/17

"I am not afraid of an army of lions led by a sheep; I am afraid of an army of sheep led by a lion." Alexander the Great

The Democrat Gazette reported last week what it costs to run the General Assembly.  In one of their time honored investigations the paper reported that the cost of salaries and expenses for the Honorables had risen from $6.15 million in 2014 to $7.57 million in 2016. The largest part of that increase came as a result of their self-awarded salary increase in 2015.  Legislators’ salaries rose from $2.29 million in 2014 to $5.28 million in 2016.  Those increases were partly offset by a drop in their per diems, mileage and other expenses.  That decline went from $4.02 million in 2014 to $2.29 million in 2016. The cost of good government like everything else in life goes up every year.  If there was just a way to match the performance to the cost.

The biennial attack on Arkansas’ Freedom of Information Act has begun in the last few weeks. SB 12 and SB131, by Senator Gary Stubblefield, R-Branch, focuses on exemptions to the state’s Freedom of Information Act. 

Medical Marijuana made its’ debut in the Rules Committee by mid-week.  Representative Doug House, R-North Little Rock, presented 7 bills.  HB1049, HB1051, HB1057, HB1298, HB1369, HB1370, and HB1371 began to put the meat on the bones of the Arkansas Medical Marijuana Amendment of 2016. The bills added licensure procedures, criminal background checks, taxation and distribution of proceeds, authorized advertising, marketing among other things. The purpose of the bill presentation was to give the members a chance to hear and discuss them.  A vote on the bills will come in a subsequent meeting after some amendments we suspect.  Coincidentally the Arkansas Medical Marijuana Commission met earlier Wednesday and they are still working on precise rules for dispensaries, types of dispensaries and the process for selecting dispensaries.  
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Rx From the Hill - 1/20/17

"Now and then an innocent man is sent to the legislature." - Kin Hubbard

The General Assembly tackled several weighty issues the second week of the 91st General Assembly in spite of an abbreviated week. With the celebration of the Martin Luther King holiday on Monday, the 16th, and the inaugeration of President Trump on Friday, the 20th, the Honorables had 2 ½ days to do their business. Oh, and speaking of the MLK day, Gov Hutchinson is championing an effort to remove General Robert E Lee day from the combined holiday of the two historic figures. We believe that the Governor is on to something because both sides of the issue oppose the move.

Governor Hutchinson’s tax cut proposal to cut $25.25 million in fiscal 2019 and $50.5 million in subsequent years passed Senate Revenue and Taxation Committee muster on Wednesday. SB 115 sponsored by Senator Jim Hendren, R, Sulfur Springs, passed on a voice vote and Senator Hendren expects easy passage of the bill in the full Senate on Monday. An identical bill, HB 1159 by Representative Mat Pitsch, R, Fort Smith, passed the House Revenue and Taxation Committee on Thursday. A competing tax break bill, HB 1161 by Representative Warwick Sabin, D-Little Rock, also passed the House committee. Sabin’s bill allows a earned income tax credit of 5% of the federal earned income tax credit starting in January 1, 2017, and would cost the state approximately $40 million.  Passage of the Sabin bill was likely a result of some bargaining between members of the committee. You may recall the Democrats had packed the Revenue & Taxation committee with 11 members of the 20 member committee, giving them a slight majority to block anything they deemed unreasonable. That majority vanished when past and present Committee Chairman Joe Jett, R-Success, switched parties after he was elected. This dynamic will likely recur as the session progresses. Clearly the state budget cannot afford both proposals and in the final analysis the Governor’s tax cut will prevail. The Hendren bill will also create a tax review task force to recommend any future cuts.

On Thursday the Senate approved HB 1026.  The bill, by Representative House, R- North Little Rock, would extend from 120 days to 180 days the time allowed for implementation of the Medical Marijuana law approved by the voters. Once the Medical Marijuana Board began their work they realized in short order that it would take more than 120 days from the date of passage, November 9, to fully implement the law. That board continues to meet regularly and their meetings draw large audiences. It seems that there a lot of people in the state who are interested in getting into the business in spite of the financial requirements: $1 million in assets and $500000 in cash.

One surprising bill, to allow alcohol sales on Christmas Day, was filed this week. HB 1216 by Representative Brown R-Sherwood would apply to liquor stores and bars. The sponsor noted “that time has passed“ the law.  She also found it odd that alcohol sales were allowed on Easter but not on Christmas.

HB 1001, the $1.975 million bill to fund the House of Representatives, made it to the Governor by weeks’ end. The bill pays the House expenses for the representatives, its employees’ salaries, benefits, maintenance and operation costs for the session. One can only wonder if the Governor is considering withholding his signature until the Honorables release his lottery marketing contract.

We expect to see the pace quicken this next week with 5 full days to meet. Well, at least the House. The Senate you see never works on Fridays usually leaving the Capitol by noon on Thursdays.
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Rx From the Hill - 1/15/17

“Begin, be bold, and venture to be wise.” 

― Horace                                                   

The 91st General Assembly gaveled into session on January 1, 2017, prepared to test drive the newly minted Republican super majority in both the House and Senate.  The first order of business of course was to take a mostly ceremonial vote to affirm Speaker Jeremy Gillam, R-Judsonia, as the 2nd term Speaker. The Senate had already affirmed President Pro Tempore Jonathan Dismang, R-Searcy, in November, also his 2nd term as President. Both men seemed to signal that party politics, Rs and Ds, would not play a  significant role in their deliberations.  Time and issues will tell on that score. Already there has been some push back on the Governor’s $50 million income tax proposal for Arkansans whose taxable incomes are below $21000 a year.   The cut if passed would not go into effect until January 1, 2019.

Governor Hutchinson’s speech before a joint session of the House and Senate came on Tuesday. He mostly outlined his plans for the state. Besides his tax cut he called for a task force to make recommendations for future tax cuts. The Governor has wisely used the task force in the past to navigate contentious issues. Remember Arkansas Works? The tax battle, if it comes, will be fought between those wanting deeper cuts and those who believe now is not the time for a tax cut with state revenues shrinking. If the past is any precedent Governor Hutchinson will have his tax cut bill passed with ease. In this political environment it is doubtful that any legislator, R or D, could vote against a tax cut.

One of the most anticipated events of the first week is the naming of committee chairmen in the House. The Senate had already named their chairmen. Most of the choices seemed predictable but a couple of them were surprises. It had been rumored that Representative Jeff Wardlaw, R-Hermitage, would be named Chairman of Public Health, Welfare and Labor, after he had changed parties.  Representative Wardlaw, elected as a Democrat in November announced his party change shortly thereafter. And as rumored he was named chairman of Public Health on Monday. Two other representatives who switched to the Republican party, after being elected as Democrats in November, fared well in the committee chairman and vice chairman sweepstakes. Representative Joe Jett, R-Success, was named the Chairman of the Revenue and Taxation Committee. You may recall that Representative Jett was named the Chairman of Revenue and Tax in 2015 as a Democrat. Speaker Gillam named Representative David Hillman, R-Almyra, as vice chairman to the Agriculture, Forestry and Economic Development Committee. These three Republican converts also gave the party their super majority.  Regardless of their party affiliation these three men have been good legislators and will be good and conscientious leaders in their respective committees.

The other big news for the first week came with the Speaker’s announcement that committee appointments would be made by the Speaker starting in the 2019 regular session.  The speaker moved his rule change out of the Rules Committee on Tuesday and it passed the full House on Wednesday.  Democrats cried foul but that’s about all they could do.  The Senate had already passed a rule which would not allow a minority party to have a majority on any of their committees. Proponents argued that  it would not be fair if the committee makeup did not reflect the party makeup of the Senate.

Of course the Assembly passed their funding bill early in the week so that they could get this 91st Assembly off the ground.  They left town by noon on Thursday and will not return until Tuesday after the Martin Luther King holiday on Monday.  With the Presidential Ceremonies coming on January 20 we expect that they might work 2 full days next week. This pace is about par for the course for most sessions. We fully expect for things to gear up on week three.
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Notes from the Hill - 10/4/2016

"You hit home runs not by chance but by preparation." - Roger Maris

As October begins and APA District Meetings come to an end, I'm pleased to say that Scott and I met with 24 legislators as we traveled Arkansas. Some of these discussions involved the two Pharmacy Practice Act Interim Studies filed by Rep. Justin Boyd. House Rules mandate that any practice act changes must be preceded by an Interim Study of the proposed changes in Public Health Committee. We have been told to expect a physician dispensing ISP in response to these pharmacy practice act changes.  Below are the ISP's:

ISP 2015-180 REQUESTING THE HOUSE COMMITTEE ON PUBLIC HEALTH, WELFARE, AND LABOR STUDY OTHER STATES REGARDING THE USE OF PHARMACISTS TO PROVIDE ACCESS TO CERTAIN MEDICATIONS, TO ADMINISTER MEDICATIONS, AND TO DEFINE PHARMACISTS AS HEALTHCARE PROVIDERS CONSISTENT WITH OTHER AREAS OF ARKANSAS LAW.

http://www.arkleg.state.ar.us/assembly/Interim%20Study%20Proposal%20and%20Resolution/ISP-2015-180.PDF

 

ISP 2015-181 REQUESTING THE HOUSE COMMITTEE ON PUBLIC HEALTH, WELFARE, AND LABOR STUDY STATES THAT HAVE A PRACTICE OF ALLOWING A ONE-TIME EMERGENCY REFILL OF A PRESCRIPTION BY A PHARMACIST.

http://www.arkleg.state.ar.us/assembly/Interim%20Study%20Proposal%20and%20Resolution/ISP-2015-181.PDF

 

The House and Senate will convene the 91st General Assembly on Monday, January 9, 2017. As a head-start on the process of formally adopting the rules that will govern the next General Assembly the House Caucus recently adopted the House Rules draft. The changes include:

  • Deleting the requirement that the Speaker appoint the four Assistant Speakers Pro Tempore by appointing one from each of the four House caucus districts
  • Deleting eight of the twelve official duties that are listed for the House Chief of Staff, mostly removing vague language, i.e., “interact regularly with the Office of the Governor.” Also deletes unnecessary reference to the constitutional provision that requires each house to appoint its own officers.
  • From the new 2015 language that allowed the Speaker to refer shell bills to the Journal Committee until significant amendments are adopted, making a classic "may-shall" swap which means that the Speaker is now required to assign a bill to regular committee if the Journal Committee reports that the bill has been substantively amended.
  • Removing references to the Joint Rules as the origin of certain House Rules

 

The first week of Legislative Budget hearings will begin Oct. 11-13. They will focus on various professional licensing boards and commissions, and small research/promotion boards. Meetings resume Tuesday, Oct. 18, to complete work on those boards and commissions, then to hear budget requests in the afternoon from the Insurance Department, Workers' Compensation Commission, and the Bank Department.

 

IMPORTANT DATES AND DEADLINES FOR FILING AND REPORTING CERTAIN BILLS, etc.

91st General Assembly - 2017 - 2018

 

10/11/16 (Tues.)          Budget Hearings Begin – Meet Tuesday’s through Thursday’s – 11/17/16

 

11/08/16 (Tues.)          General Election

 

11/10/16 (Thurs.)         Executive Balanced Budget:  Prior to November 10, 2016

The Director of DFA is required to present the Official General Revenue Forecast and balanced budget no later than sixty (60) days prior to the beginning of the regular session.

 

11/11/16 (Fri.)             House Caucus

                                     House Rule 2; House Rule 54(a)(1); House Rule 54(b)(2); House Rule 80(a); and 

                                     House Rule 81(a)

 

11/15/16 (Tues.)        Pre-filing of Bills and Resolutions.

                                     House Rule 38; Joint Rule 23(A); (A.C.A. 10-2-112(a))

 

12/04 – 12/9/16         House Orientation (Legislative Institute)

(Sun. – Fri.)

 

12/9/16 (Fri.)              Deadline for the Public Health, Welfare and Labor Committee to launch a

            feasibility study of legislation affecting the licensure of health-care providers not currently licensed or expanding the scope of practice of health-care providers if such legislation is to be considered in the regular session.  (Otherwise, consideration of such legislation requires a 2/3 vote of the membership of the Public Health, Welfare and Labor Committee.)  House Rule 72)  Thirty (30) days prior.  (Whenever the filing deadline for any bill or resolution ends on Saturday or Sunday, the deadline is extended until the close of business the following Monday.)

 

01/9/17 (Mon.)           12:00 Noon – 91st General Assembly convenes.  A.C.A. 10-2-101(a)(1)

                                    Arkansas Constitution Article 5, Section 5

 

01/11/17 (Wed.)         Rules Committee Report—Rule 65(a)(3) (third day after convening)

 

01/16/17 (Mon.)         Celebration of Martin Luther King, Jr.'s and Robert E. Lee's Birthdays - State Holiday (A.C.A. 1-5-101) (must observe)

 

01/23/17 (Mon.) (15th day)         No proposed legislation affecting the licensure of health-care providers not currently licensed or expanding the scope of practice of health-care providers may be filed after the 15th day unless introduction is first approved by a 3/4 vote of the full membership of each house of the General Assembly.  Joint Rule 15

 

01/23/17 (Mon.) (15th day)         No proposed legislation affecting any publicly supported retirement system or pension plan shall be introduced after the 15th day of a regular session unless introduction is first approved by a 3/4ths vote of the full membership of each house of the General Assembly.  House Rule 38(o)(a)(b)(c) and Joint Rule 14(B)(2)(3); (A.C.A. 10-2-115)

 

01/31/17 (Tues.)          Deadline to file STATEMENTS OF FINANCIAL INTEREST.

                        (A.C.A. 21‑8‑306(a) or A.C.A. 21-8-701(c))  (Whenever the filing deadline ends on Saturday or Sunday, the deadline is extended until the close of business the following Monday.)

 

2/7/17 (Tues.)               Commencement of period to consider legislation affecting the licensure of health-care providers not currently licensed or expanding the scope of practice of health-care providers (15 days after the deadline for the filing of such legislation-1/23 deadline) Joint Rule 15(c)

 

02/8/17 (Wed.) (31st day)     No resolution proposing a Constitutional Amendment shall be filed in the House of Representatives or the Senate after the 31st day of each regular session. House Rule 38(n); Joint Rule 19

 

 02/20/17 (Mon.)          President's Day (A.C.A. 1-5-101) (Legislature usually does not observe holidays while in session)

 

02/27/17 (Mon.) (50th day)      No appropriation bill shall be filed and introduced in either the House of Representatives or the Senate later than the 50th day of a regular session except upon consent of 2/3rds of the members elected to each house.  (Deadline fifteen (15) minutes before adjournment on Monday, February 27th.)  House Rule 38(m)(a) and Joint Rule 14(B)(1)

 

03/06/17 (Mon.)          And, no bill shall be filed for introduction in either the House of Representatives

03/04/17 (Sat.) or the Senate later than the 55th day of a regular session except upon consent of 

(55th day)       2/3rds of the members elected to each house and no other bill or resolution except adjournment resolutions and resolutions requesting permission to introduce a bill or resolution except upon 2/3rds of the members elected to each house.  House Rule 38(m)(a), Joint Rule 14(B)(1)  (Whenever the filing deadline for any bill or resolution ends on Saturday or Sunday, the deadline is extended until the close of business the following Monday.)

 

Prior to Adjourning Select non-voting members to Standing Committees.

 

03/06/17 (Mon.)          Notice to reconsider can not be given within three days of the scheduled

(57th day)       adjournment of a regular session.  (after the 57th day)  House Rule 27(a)

 

03/9/17 (Thurs.)           60th day

 

Floating Deadline - No new bill shall be introduced into either house during the last three (3) days of the session.

(Arkansas Constitution, Article 5, Section 34)

 

Notes from the Hill: 2016 Fiscal Session - May 6, 2016

"If you want a happy ending, that depends, of course, on where you stop your story." -Orson Welles

Not without drama and a re-vote in the Senate, both the Arkansas House and Senate approved identical Revenue Stabilization Act (RSA) bills bringing an end to the 2016 Fiscal Session. The $5.3 billion balanced budget includes a 2.75% spending increase from last year. 

Legislators will convene at 10 a.m. on Monday for sine die adjournment. The House will also choose a Speaker for the 91st General Assembly. Current Speaker Jeremy Gillam, R-Judsonia, will likely become the fifth multi-term Speaker in Arkansas history.

Senate President Pro Temp Dismang, R-Searcy, was re-elected as leader of the Senate on Wednesday. Dismang has served in the Arkansas legislature since 2009 and became Senate President in the 2015 session. He’ll begin his second rein in the 2017 beginning in January with the start of the 91st General Assembly.

With the RSA passed and adjournment eminent, Gov. Asa Hutchinson announced a special session focused on highways to begin 10 a.m., May 19. The Governor has a short term fix. However, we don't yet sense a consensus from the legislature on whether they would support a short or long term highway funding mechanism. Hutchinson said he does not anticipate any more special sessions this year (a good politician never says "never"). 



Notes from the Hill: 2016 Fiscal Session - April 29, 2016


"Turn on to politics, or politics will turn on you." -Ralph Nader

What a difference a week makes. As predicted the Arkansas Legislature figured out a way to swing 2 additional votes in the Senate to pass the Arkansas Department of Human Services budget.  The fix to gain those votes was the slight of hand amendment the Budget Committee added to repeal funding for Arkansas Works, with all knowing full well the governor would veto that very amendment. The DHS budget then picked up the two additional votes from Senator Bart Hester and Senator Blake Johnson.  An attempt to override Gov. Asa Hutchinson’s line item veto fizzled out in the Senate.


With the biggest hurdle of the Fiscal Session behind them, lawmakers are passing various departmental budgets and reviewing holds placed on others.  We expect the Revenue Stabilization bill (RSA) to be placed on the desks of legislators next week, signaling the end of the Fiscal Session. By law, legislators must have three days before a vote to review the RSA, which is essentially finalizes what gets funded. 

We expect the Revenue Stabilization bill (RSA) to be placed on the desks of legislators next week, signaling the end of the Fiscal Session. By law, legislators must have three days before a vote to review the RSA, which is essentially finalizes what gets funded. 


April 18, 2016


"I am extraordinarily patient, provided I get my own way in the end." -Margaret Thatcher

The Arkansas Legislature convened for the 2016 Fiscal Session last Wednesday.  Leadership made it clear that the DHS budget, which includes funding for Arkansas Works (recently approved in the Special Session), would be considered at the beginning of the session.  The required super majority vote remained iffy at best.  The House Speaker, Jeremy Gilliam, indicated that he "might' have his 75 votes and President Pro Tem Jonathon Dismang seemed optimistic that the senate was "getting there".

Since the biggest hurdle is in the senate, it was agreed the bill would start there. Making quick time, the DHS bill was in the Senate for consideration on Thursday. As predicted, the opposition in the senate, dubbed by the media as the "Tea Party 10," blocked passage of the bill, 25-10. A fix to pass the bill was already in place. The rumored plan after the bill failed in the Senate had Budget Chair Senator Larry Teague transmitting the bill back to his Budget Committee. In committee an amendment would be put into the bill that stripped out funding for Arkansas Works. The bill would be passed with the amendment, transmitted to House and Senate where it would be passed and sent to the Governor for his signature. The Governor would then line item veto the amendment, effectively putting Arkansas Works funding back into the bill, and then sign it.  The plan derailed in Joint Budget Committee when democrats declined to give cover to the Tea Party Ten that stopped the bill in the first place. By a vote of 22-22 Joint Budget Committee failed to reach the 29 votes required for passage. 

After Thursday's failed vote on the senate floor and failed passage of the amendment in committee,  all agreed that a cooling off period was needed and legislators left the Capitol to return on Tuesday.  The Governor made it clear that he hoped to have his votes in hand by Tuesday.  He also publicly stated that he intended to pursue  the line-item veto plan. 

From our perspective, several things appear evident. We expect the Governor and leadership to pass Arkansas Works in the coming week (or two)  It is also clear that the battle over managed will return in the not too distant future, maybe a special session but by the 2017 session at the latest. Finally, it appears that Governor Hutchinson is proving to be an able and deft administrator who is fully engaged.  


December 17, 2015

"Cautious, careful people, always casting about to preserve their reputations... can never effect a reform." -Susan B. Anthony

After nine months of studying Medicaid and the Private Option, the Health Reform Legislative Task Force has delivered their report.  The Task Force was required by law in the 2015 Regular Session to issue their first report by December 31. Their job is far from over, but you can read their preliminary report here. 

On Wednesday, Governor Hutchinson made a presentation and asked the Health Reform Legislative Task Force to approve the concept for Arkansas Works that he will take to U.S. Secretary of Health and Human Services Sylvia Burwell in January. The state must receive a waiver from HHS to implement the reforms. You can read his presentation here.

After the presentation by Governor Hutchinson, a motion by Senator Hendren to support the Gov's efforts to negotiate waivers to come up with $835m in savings passed unanimously.

The motion supported the Gov’s assertion that the state must save $835 million in Medicaid costs over five years. That amount would equal $167 million a year, the state’s share being $50 million-$60 million. The savings would cover the state’s 10% share of Medicaid expansion. He said the state potentially could save $843 million over those five years through a collection of reforms. He said $250 million could be saved with changes to long-term care, $20 million could be saved in the Medicaid dental program, $110 million could be saved in pharmacy benefits, $231 million could be saved in behavioral health, and $232 in developmental disabilities.

A second motion by Sen Chesterfield to task the Stephen Group to come up with $835m in savings without using Managed Care except in dental also passed unanimously.

APA recently negotiated with the Governor to avoid dispensing fee cuts, different fees for pharmacies across the state and using a PBM in traditional Medicaid.  As requested by the Governor's staff, APA will begin to formulate language we would like to see included in a managed care RFP.


April 23, 2015

"Everything has its limit - iron ore cannot be educated into gold." -Mark Twain 

The 90th General Assembly officially adjourned “sine die,” on Wednesday after 81 days of session and three weeks of recess. "Sine die,” is the formal adjournment that prevents the 90th General Assembly from reconvening until the next fiscal session in February 2016 or for a special session called by the governor.  Rumors are rampant of some sort of special session or even multiple sessions later this year to address Medicaid funding, highways and prisons.

The newest member of the legislature was sworn in Wednesday, State Sen. Greg Standridge, a Republican from Russellville, who will represent District 16. He was the victor of a special election in January to fill the seat vacated by former Sen. Michael Lamoureux, R-Russellville. Lamoureux resigned to serve as chief of staff for Gov. Hutchinson.

Also of note this week, Senators passed a rule change that will allow a Senator President Pro Tempore to serve more than one term. This means current Senate President Jonathan Dismang, R-Searcy, could continue in his powerful position for a second two year term. Dismang has said that he has not decided yet if he will seek another term as Senate President. However, House Speaker Jeremy Gillam, R-Judsonia, has declared he will run for the speaker’s post for the 2017 session.

April 7, 2015

"Perseverance is the hard work you do after you get tired of doing the hard work you already did." -Newt Gingrich

The 90th General Assembly kept to their schedule and ended their session on Thursday, April 2 after 81 days. The last week was not particularly pretty as far as these things go, but they got their work done, balanced their budget and left on time - for that we are all grateful.

On Monday and Tuesday of the final week the Revenue Stabilization Act, RSA, passed with ease. It appeared that only a few minor legislative matters remained at that point.  For one, Governor Hutchinson pushed to have 2 constitutional amendments referred to the people.  The first would amend the constitution to allow an Arkansas governor to retain his powers when out of the state, Senate Joint Resolution 3.  The second removed the cap on bonds that the state could issue to bring in new industries, Senate Joint Resolution 16.  The Governor had indicated for some weeks that the two amendments should be presented in the next election while House and Senate leadership had made it clear that no amendments were warranted. A third constitutional amendment, House Joint Resolution 1027, would increase the terms of county officials from two to four years. This was clearly a win for the Governor and another piece of his economic development goals.

Most of the energy and publicity this last week centered on HB 1228, the Religious Freedom Restoration Act sponsored by Rep Ballinger, R-District 97. The bill was viewed by many in the state as a way for businesses to discriminate against the LGBT community. Governor Hutchinson had given early indications that he would sign the bill if it got to his desk.  After some consideration and after hearing from Wal-Mart, Axiom and other corporate entities in the state, the Governor back tracked.  Finding himself in much the same situation as the Indiana governor he made it clear that a new bill, in line with the federal Religious Freedom Restoration Act, must be written.  With only days to spare, a shell bill was used to accommodate the new language (SB975) and a likely veto was averted.  In fact the House went into recess for about 45 minutes, just long enough to accommodate a bill-signing ceremony for SB975. The new bill will give more protection to the rights of all citizens including the LGBT community. 

By late Thursday afternoon the House and Senate had gaveled out of session with plans to return May 8 to adjourn sine die.  As they did so most observers and clearly most members believed they had completed a productive and business-like legislative session, the dust-up over the Religious Freedom bills notwithstanding.

The 90th General Assembly in concert with our new Governor was successful on several fronts. For starters they passed a middle class tax cut of over $100 million.  They extended the Private Option until 2016 with the promise of changing the program.  Those changes will come through the recommendations of a legislative task force that was also set up this session (You might recall that Representative Justin Boyd secured a coveted spot on the task force). Several bills were passed to increase funding for job training and education. Finally, $36 million was set aside for prison and parole reform that is a solid first step in controlling prison overcrowding and recidivism.

As usual, a goodly amount of time was taken up with abortion laws, gun rights and more. One pundit characterized it as the God, guns and gays portion of the session.  The truth is that these issues come up in every session and will in all likelihood never go away.

Pharmacy had a successful session, although nail biting at times. APA passed a strengthened MAC Bill, a Patient’s Bill of Rights, and a bill giving the Arkansas Insurance Department oversight of PBM's doing business in Arkansas. 

Here are a few take-aways from this session.  For one, Governor Asa Hutchinson is an intelligent and resourceful leader that has every intention of leading from the center and occasionally a little right of center. It also appears to us that the Governor plans to build coalitions on his big issues through use of task forces or work groups.  Witness the Medicaid expansion task force and the task force to study Common Core.  Also, we have heard that the Governor plans on selecting a work group to look at highway funding just as soon as they adjourn.  We expect to see this leadership group tackle their big issues early on in the session just as they did with the tax cut and the Private Option. Finally, we expect to see continued close working relationships between the third floor (House and Senate members) and the second floor (Governor’s office). 

March 23, 2015

"It ain't over till the fat lady sings." Unknown

Last week it was evident that the leadership on both ends were sticking to their schedule to adjourn the 90th General Assembly by the first week of April.  The House and Senate worked through long agendas every day. The House even worked into the afternoon on Friday.  That’s rare. The Senate finished Thursday as usual.  

The Speaker and Pro Tem receptions and dinners were held Thursday night of this week.  That is just one more sign that the end is near.  It is usually a pleasant evening probably because most of the spouses attend.  We even ran into former Governor Beebe and first lady Ginger Beebe at the Senate soiree. They looked happy and content and glad to be out of the business of politics after eight years as Governor, eight years as Attorney General and 20 some odd years in the Senate.  It was announced some weeks ago that he was associating with the Mike Roberts Group but he advised that he would mostly be consulting and playing a lot of golf.

From sources in the Governor’s office we hear that the budget team is rapidly finishing up their final items on the budget.  We still anticipate that the RSA will be on members’ desks by the end of next week.  Remember the rules require that RSA must be on members’ desks a full 3 business days before a vote can be taken.

As they near the end of this session a few things have become clear.  First and foremost Governor Hutchinson has a clear grasp of how a session should operate and how he can best mold the Assembly to follow his agenda.  And he seems to know which battles to fight and which are best left alone.

It is also clear that the nexus between Speaker Gilliam, Pro Tem Dismang and Chief of Staff Lamoureaux is a key component of the success of this session.  Their close relationship has practically eliminated any real legislative battles, at least publicly, between houses and members.  For the most part that is a good thing, particularly when your client’s interests have been protected.  When deals get made without consideration of your interests, that is another matter altogether.  It can be very troubling when you know you have your votes to pass your bill but the leadership for whatever reason have decided otherwise.

Another hopeful trend in this session is the number of bills filed.  By the March 9 deadline to file a bill only 2037 bills had been filed.  That is the smallest number of bills filed since 1997 when only 1840 bills were filed. The statistic that interests me regarding bills is how many of those filed are ultimately passed and signed into law.  So far this session the Governor has not vetoed any bill and we don’t expect he will due to the working relationship noted above.

Pro Tem Dismang announced once again that he didn’t believe any of the 41 Constitutional amendments filed, Senate or House Joint Resolutions, should be put on the ballot.  Contrary to what we wrote last week it appears that there may not be a House or Senate Resolution referred to the General Election ballot.  That final discussion will take place this week in committee.

The House and Senate did pave the way to receive their salary increases this week.  Part of the recommendation of the task force to study the state’s salaries required that the roughly $15,000 office expense that all members received tax free would have to be repealed first before the higher salaries could go into effect. Two bills to do just that passed by large margins in the House and Senate last week.

We believe we can hear a rather corpulent young lady warming up her voice in the distance.  

March 16, 2015

"When you reach the end of your rope, tie a knot in it and hang on." -Franklin D. Roosevelt

Monday, March 9, was the last day to file a bill.  It is getting progressively more difficult for a committee chair to get and keep a quorum...due to legislators running bills in other committees.  One committee chair suggested that he wanted to vote on one more bill, Revenue Stabilization, and go home. Some of the legislators who know their bill is going nowhere this session have begun the process to get their issue into an interim study.  Once the final resting place for many an issue the interim study proposal has become the place where issues are raised phoenix like from the legislative grave to eventually pass.   

Another piece of the biennial session puzzle was put into place this past week.  On Friday the House State Agencies Committee voted on 5 proposals to recommend to the joint committee with the Senate. The Senate State Agencies Committee chose not to cull their proposals and will have their list of 16 constitutional amendments to discuss at their March 23rd meeting. Every regular session the members get to pick 3 constitutional amendments to put on the next general election ballot.  This year there have been at least 40 such Joint Resolutions, JR. The proposals include a new voter ID amendment, a response to the Arkansas Supreme Court over turning the voter ID law passed in 2013.  One proposal, HJR1005, by Representative Matthew Shepherd, R-El Dorado, would end the election of judges and in its place implement a “merit-based” system. Another proposed amendment, by Senator Hester, R-Cave Springs, SJR9, caught our attention and may be the first issue we lobby for passage, pro bono.  The amendment would reduce the number of days the legislature would be in session while repealing the fiscal session altogether. It’s got merit but it is doubtful that this body will vote for something that reduces their work load fresh off the extension of their term limits and raises.  The level of frustration and exhaustion was apparent when one member suggested that it would be novel for the legislature not to offer any constitutional amendments for a change.  We cannot remember a session in which the General Assembly did not offer up at least 1 amendment for the ballot.  

Much of the political theater at the Capitol this week centered on Rep Justin Harris and his “re-homing” of his adopted children. The specifics of the case are only now fully coming to light but there appears to be plenty of blame to go around from Representative Harris to the Department of Human Services.  What is clear is that the Democratic Party has used the tragic situation to raise doubts about Harris’ ability to do his job and call for his resignation.  The Governor has already responded to the issue by administratively making new rules in the department concerning adoption.  Not to be outdone by the administrative branch the legislature has filed a number of bills dealing with adoption and the issue of 
“re-homing.” 

Our expectations are to see a host of bills die in committee in the remaining weeks of the session.  Many of them have made it through one side of the Assembly and hopefully will die on the other.  One such bill passed the Senate this week by a vote of 32-1 is SB 803.  The bill would allow a candidate to run for more than one federal office simultaneously.  

You know it’s time to send the legislature home when they start pushing this type of self-serving legislation. 

February 20, 2015

"Even if you're on the right track, you'll get run over if you just sit there." -Will Rogers

The sixth week of the 90th General Assembly was bookended by snow days or threat thereof.  Most legislators had made it back to Little Rock by Sunday night just ahead of the storm.  By Monday morning it was clear that some legislators and most of the staff could not make it to the Capitol due to snow and ice. On Thursday when it appeared that another arctic blast was going to cover the state that night the Speaker cancelled the Friday morning session.  The threat of severe weather did affect the Senate.  They typically go home on Thursday after a short morning session.

As advertised, the final large and significant bit of legislation was put into play this week.  A day after Governor Hutchinson held a press conference to outline his prison and parole reform plan, his nephew, State Senator Jeremy Hutchinson, R-Little Rock, filed SB 472.  The legislation, known as the Criminal Justice Reform Act of 2015, attempts to reform both prisons and parole guidelines.  It is designed to increase available prison beds, take pressure off county jails and fix parole rules as well as the Parole Board. It is believed that the new guidelines will ultimately reduce the number of inmates and recidivism. It also sets up the Legislative Criminal Justice Oversight Task Force, apparently a favorite tool of our new Governor.  The Task Force will meet quarterly to monitor the success or failure of the reforms and make recommendations.  Governor Hutchinson earmarked $32million for the reforms.  This looks to be a slam dunk for the Governor and sponsors. The Governors’ House sponsor is Representative Matthew Shepherd, R-El Dorado.  Both legislators are lawyers, Chairmen of the Judiciary committees in their chamber and well regarded by their peers.  The bill will be heard in the Judiciary committee and nobody votes again their chairman as a rule.

APA expects to introduce legislation next week designed to reduce the power and dominance of PBMs through oversight and MAC pricing requirements. A bill exempting veterinarians from the Prescription Drug Monitoring Program sank in the Senate Agriculture Committee after a short sail through the House. A shell bill intended to increase the pharmacist to tech ratio was withdrawn after the Board of Pharmacy agreed to pursue a one to three increase. Legislation requiring the real time electronic logbook used to track pseudoephedrine sales should be provided free of charge made it out of the House Public Health committee despite an RFP being released the day before the sponsor presented the bill as a special order of business.  We expect a bill to be introduced specifying that a consumer without an existing pharmacy-patient relationship may purchase pseudo ephedrine if they meet the other requirements to purchase.

HB 1158 by Representative Richard Womack continues to attract the interest of many licensed business in the state. The bill would allow certain jobs to be performed by unlicensed people as long as they had the ability to perform the service. The bill sponsor believes that his legislation is a much needed step to get government off the backs of the citizens and a means to put people to work. Needless to say health care professionals, contractors, engineers, lawyers, CPA's, surveyors, speech pathologists, barbers, plumbers, electricians, and just about every other licensed profession in the state sees it differently.  The bill came out of the House Public Health Committee last week with a tie breaking vote made by the Chair, Representative Kelley Linck (R). By the time the bill made it to the full House this week many licensed interests had galvanized their members. The sponsor passed over the bill this week knowing that he did not have the votes for passage. The issue appeared to be dead but by the end of this week it appears the sponsors are working on some amendatory language that would satisfy some of the opposition.

We have heard from a number of incredulous legislators this week over some of the bad legislation that is being passed. Having watched this process up close and personal for years, our level of incredulity is low to non-existent.  We expect it to get worse as they near the end.

February 16, 2015

"Unless someone like you cares a whole awful lot, nothing is going to get better. It's not." - Dr. Seuss 

It's the fifth week of the session and the final pieces of this 90th General Assembly are falling into place.  The final heavy lift will be prison and parole reform.  There will be no easy fix but we are sure that the Governor and Assembly will not allocate $100 million for new prison beds.  New sentencing guidelines and drugs courts will be a part of the plan. The focus will be on non-violent offenders receiving lighter sentences and drug and alcohol rehabilitation where appropriate. Like in the Governor’s other initiatives this session we expect to see a comprehensive plan for prison reform rolled out in the next few weeks. 

Another sign that the legislature is rounding 2nd base on the way to 3rd is their consideration of Constitutional amendments.  So far there have been 40 proposed constitutional amendments filed most of which are in shell bill form with nothing more than a title on it.  The proposals range from how we select our State Supreme court Justices to tort reform to abolishing the office of Lieutenant Governor.  We expect a battle over tort reform proposals. 

The duel personality of the Assembly was also in evidence this week.  Senator Bart Hester’s bill to bar cities and counties from passing anti-discrimination ordinances passed the House and is on the way to the Governor. The bill appears to be in response to a couple of cities in Arkansas, Fayetteville and Eureka Springs, passing the ordinances as a further protection for gay and lesbian rights.  It seems that the Senator believes that the state should make such decisions for the local governments.  We are puzzling over how it can be that local governments get to decide whether they can sell and serve alcohol but not pass other laws that they deem important to them. Go figure.  The Governor has promised to let the bill become law without his signature in effect showing his doubts about the constitutionality of the law but honoring the will of the legislature.  His veto might have sent a better message to people and businesses coming to the state. And his veto would have been the 1st public display of disagreement between the Assembly and Governor Hutchinson.

Another surprising bit of legislation that seems destined for easy passage is SB 7, by Senator Jimmy Hickey, R-Texarkana.  The bill in effect eliminates the Arkansas Lottery Commission and places control and direction of the Scholarship Lottery under the Governor in the Department of Finance and Administration. Oh, and get this, the bill sets up another department in DF&A, the office of Arkansas Lottery. Whatever happened to the legislators who opposed growing government.  Why the legislature and the Administration think they can do a better job than the nine commissioners that they appointed is beyond us. The lottery commission has had its problems but the main one was solved when the first director Ernie Passailaigue left the state.  We are reminded of that old saw, be careful what you wish for because you might get it.  

It seems that we have reached the part of the part of the session where much of the bad legislation is filed. One pundit has called this the part of the session in which guns, gays and abortions are dealt with. The truth is the state can get along just fine without passing many of these laws. The fact is they will be filed and much of it passed. 

February 9, 2015

"Majority rule only works if you're also considering individual rights. Because you can't have five wolves and one sheep voting on what to have for supper." -Larry Flynt

It took only four weeks for the 90th General Assembly to polish off the big ticket items and campaign promises, although it was done with little fanfare.  Governor Hutchinson signed the middle class tax cut bill in a signing ceremony on Friday.  The Private Option funding bill and the bill that sets up the task force to study how best to proceed with the Private Option after 2016 passed easily and are now on their way to the Governor for his signature.  It's expected that there will be far fewer legislators attending the signing ceremony and photo op for the Private Option than attended the tax cut ceremony on Friday. 

During last session the Private Option funding bill passed by the slimmest of margins.  This session with sizable Republican majorities, many of whom ran on their opposition to Obama Care, the bill passed easily:  29 to 2 in the Senate and 82 to 16 in House.  What a difference a new Republican governor makes.  It appears that the Private Option or a reasonable facsimile thereof is here to stay.  

What's impressive about this Assembly is the business-like approach the members are taking to the legislation before them.  Most of the bills and issues appear to be vetted and refined in their caucuses and smaller meetings, resulting in less dissension and prolonged debates.  Sure the Governor and Chief of Staff Lamoureux have had an impact on the process.  But most assuredly this session would not be going so well without the firm and steady hand of Speaker Gillam and Pro Tempore Dismang.  The two leaders are keeping their members on their agendas, avoiding partisanship (as much as is possible in such an environment) and somehow keeping the usual competition between the House and Senate to a minimum.  To be sure that is all subject to change as they near the end of the process and start truing-up the Revenue Stabilization Act. 

With their agendas all but complete, Governor Hutchinson and Leadership could conceivably pass their budget bills over the next several weeks, shut-down this session and rightfully declare it a success.  But that won’t happen until March 13th, the last day to file a bill.  

February 2, 2015

"If you don't like something, change it. If you can't change it, change your attitude." Maya Angelou

In their third week the 90th General Assembly continued to followed the script written by Governor Hutchinson, Pro Tempore Dismang and Speaker Gilliam with barely a miscue.

On Tuesday Governor Hutchinson presented his $5.2 billion balanced budget. It includes increases for public schools, prisons, and the state Medicaid program. Most state agencies will get a 1% cut in their budgets. His budget also includes his $100 million middle class tax cut and a 1% cost-of-living increase for state employees. Overall, Hutchinson’s proposed budget would raise state spending by $149.5 million, or 3 percent. Funding for public schools will increase $50.9 million and for Medicaid by $80 million.  The budget Chairs, Senator Teague and Representative Jean, gave their endorsement.

The funding bill for the Private Option, made it out of the Senate by the end of the week. By a vote of 29-2 it passed with the help of a number of Senators who voted against it in previous sessions. For these recently converted supporters, Senators Hendren, Clark, Bledsoe, Cooper, Hester and Irvin, it seems that Governor Hutchinson’s plan to push the final decision out to Dec.31, 2016, made the difference in their vote. The bill states that after Dec.31, 2016, the Private Option will not continue “without express legislative approval through a proper enactment of law.” Hmmm, sounds kind of like what they are doing already, voting to fund it every year. A Republican Governor who would have been looking at a $200 million hole in his budget may have had some impact on their votes as well.

The companion piece to The Private Option legislation also passed the Senate this week.  The bill, sponsored by Hendren, R-Sulphur Springs, sets up a 16-member task force made up of 8 House members and 8 Senate members to study the Private Option and make recommendations for changing it.  It passed by a vote of 27-7.  Both bills were transmitted to the House and await the House members in their respective committees this week.

With the heavy lifting all but out of the way, some have suggested that this regular session may be over by Spring Break.  There is talk about a Special Session for Highways to follow a few weeks after the end of the regular session.

It appears the Independent Citizens Committee, tasked to make recommendations regarding salaries for all constitutional officers and legislators, will more than double salaries for the House and Senate.  Salaries for all of the other constitutional officers with the exception of the Lieutenant Governor will increase substantially as well. The public will have a 30 day comment period before the Legislature votes on the recommendations. The 30 day comment period may be a time when many voters come to understand what Amendment 3 was really all about: raises and extension of term limits.  

Funny, the more things change, the more they stay the same.

 

Sine Die on May 17, 2013

The 89th General Assembly adjourned on Tuesday, April 23, but the session is not officially over until "sine die" adjournment. Today, the 89th General Assembly returned to the Capitol for Sine Die adjournment. Sine Die is Latin for “without day.” This means they will adjourn for an indefinite period of time or until fiscal session 2014.

During the interim (the period in between sessions), legislators focus mainly on interim studies and agency/board oversight.  Legislative committees conduct public hearings and research issues at a much less hectic pace than is possible during the busy legislative sessions. Currently, there are over 150 interim study proposals (ISP) filed by the 89th General Assembly on a wide array of topics.  APA will be monitoring many of these ISPs on behalf of pharmacists.

In the months to come, the legislative battles we've witnessed this session will continue to play out in the courts and in the implementation of policy. Here are five important dates to watch:

May 17: Federal hearing on 12-week abortion ban scheduled. As expected, the passage of Sen. Jason Rapert's ban on most abortions after the first trimester of pregnancy almost immediately attracted a lawsuit against the state of Arkansas.  Should the injunction not be granted, the 12-week ban is scheduled to take effect in August 15.

July 1: Look to Osceola. The legislature authorized the state to issue $125 million in bonds to Big River Steel as an incentive to build a new steel mill in Osceola that will create over 500 full time jobs at an average salary of around $75,000 (language in the legislation mandates this). The Economic Development Commission is saying the deal should be closed in the third quarter. When the groundbreaking occurs, it will be one of the biggest construction projects the state has seen in years.

August 15: Most new laws created this session take effect. A good number of the bills passed each session contain an emergency clause (meaning they take effect immediately) or another specified effective date (most of the tax cuts passed at the end of the session will not go into effect until 2014, for example), but otherwise an act becomes law ninety calendar days after sine die. This year, that day is August 15.

October 1: Enrollment in health care exchanges begins. There are still many unknowns concerning the insurance exchanges mandated by the Affordable Care Act.  It’s unknown how many insurance companies will sign up to sell policies in Arkansas.  It’s unknown how much premium costs may fluctuate, and it’s unknown exactly what the roles of state and federal governments will be.  APA is constantly monitoring, educating and lobbying legislators and administrators on pharmacy’s role.

January 1, 2014: Voter ID law and tax cuts go into effect. Sen. Bryan King's law requiring citizens to present photo ID to vote becomes effective in 2014, although its impact won't be known until primary elections a year from now.  Since voters who live in poverty are less likely to have an ID and since Arkansas has one of the highest poverty rates in the nation, many will be watching Arkansas in the next election.  Several tax cuts passed this session will also go into effect next year.  This will significantly decrease the state's revenue for fiscal 2014. The cuts include an across the board decrease in the state income tax, a cut in the capital gains tax, and exemptions on the sale utilities used by manufacturers and agricultural facilities. As sine die occurs and the interim begins, APA will keep a watchful eye on developments in the changing healthcare environment.

100th Day of the 89th General Assembly

"Leadership is the art of getting someone else to do something you want done because he wants to do it." -Dwight D. Eisenhower 

At exactly 100 days, this was the longest session since the 1920s. The first Republican majority since Reconstruction managed the House and Senate without a lot of party rancor or partisanship. All in all, the 89th Session looked a lot like every other Arkansas Legislative Session.

On April 23, the 100th and last day of the 89th General Assembly, Gov. Mike Beebe signed into law the Private Option Medicaid Expansion legislation.  The Private Option is considered by many to be the biggest accomplishment of the session. This legislation was literally a whole session in the making. It was the primary impetus behind the passage and defeat of other related and non-related legislation during behind the scenes deals to garner enough votes for its passage.  The Private Option will allow Arkansas to use federal Medicaid dollars to purchase private health insurance for thousands of low-income residents.  Research suggests it will save the lives of 2300 Arkansans.  The federal government must still officially approve Arkansas' plan, although federal officials have said the concept is consistent with Medicaid's requirements. 

Tax cuts can also be considered an important accomplishment of this session.  Out of the "trades" for Private Option votes came four tax cut bills and funding for the Big River Steel mill superproject. The four tax cut bills included income tax reform, capital gains taxes, the grocery tax reduction, and a sales tax on utilities for manufacturers. After the passage of the Private Option, tax cut bills were quickly passed and sent to Governor Beebe. 

In total the bills add up to roughly $90 million in cuts in the 2014 and 2015 budgets. Not surprisingly, Speaker Carter got his capital gains tax cut, HB 1966. SB 791 by Senator Bill Sample passed 90-0 in the House. The bill gives relief to manufacturers in the state by reducing the sales tax on energy used for manufacturing. HB1832 by Representative Darrin Williams passed as well. The bill would use tax credits to encourage businesses to invest in poor communities. Governor Beebe’s tax cut on groceries, SB 135 by Senator Jason Rapert, passed 91-0. The bill would eventually lower the 1.5% grocery tax to .125%. HB 1585 by Representative Charlie Collins, passed easily as well. It would cut income tax rates by .1% over several years. The one tax increase bill, SB5, by Senator Sample, amounted to a self-imposed tax by the timber industry. The bill would raise the Fire Protection Tax from 15 cents an acre to 20 cents an acre. All-in-all it is an impressive tax cut package. 

Arkansas lawmakers adjourned April 23 after approving the Revenue Stabilization Act (RSA), which lays out the state’s spending priorities. The $4.9 billion RSA contained $170 million in surplus funds and included increases for public education, Medicaid, and a 2 percent cost-of-living raise for state employees. The House approved the Revenue Stabilization Act on a 77-15 vote. The Senate approved it on a 28-6 vote. 

Legislators will return May 17 to tidy up any unfinished business, correct any errors and officially adjourn the Regular Session of the 89th General Assembly. 

Week 14 of the 89th General Assembly
Legislature approves “private option” Medicaid expansion.  After the House failed to get enough votes to pass the private option funding bill last week, they successfully voted again this week on the Department of Human Services appropriation necessary to fund the “private option” healthcare legislation.  On April 17, the Arkansas Senate approved the “Private Option” Medicaid expansion bill.  The bill will extend medical coverage to over 200,000 Arkansans who have incomes of less than 138% of the federal poverty level.  The expansion opportunity was created under the Affordable Care Act (ACA).  While the ACA envisioned expansion occurring through a direct expansion of the existing Medicaid program, Arkansas legislators opted to expand using a “Private Option” where patients obtain coverage through private insurance coverage instead of the state’s existing Medicaid program.

The access to care for these citizens will be of tremendous benefit to our state.  However, there are still many unanswered questions.  APA’s EVP Mark Riley and Scott Pace created a list of concerns for pharmacy surrounding the private option and presented them directly to the Governor last week.  These concerns include how reimbursement rates, pay cycles, formularies, and other issues will be managed in the private option.  We’ll provide an update when we receive clarification on these issues. Read more.

To say this issue has dominated this legislative session is an understatement.  It has been the underlying cause of the passage or defeat of much legislation as trades for votes were worked out in the back rooms and hallways. Among the "trades" as promised, four tax cut bills and funding for the Big River Steel mill super project cleared the House chamber shortly after the private option passed. The four tax cut bills included income tax reform, capital gains taxes, the grocery tax reduction, and a sales tax on utilities for manufacturers. See how you legislators voted: House and Senate.

We look for the revenue stabilization bill (RSA) to be placed on legislators desks today, April 19. The placing of the RSA on legislators’ desks is essentially the culmination of all the work of the session (they have to fund all of the bills they've passed).  Since law requires that the RSA be distributed three days before a vote, we expect a vote to extend the Session from the April 19 deadline into early next week.  Lobbyists and legislators alike are exhaling a long breath of that pent up "hot air" in anticipation that the end is near.

All of our bills have been signed by the Governor and will take effect in July.   They include:

SB 968 / Act 1169. Sen. Bruce Maloch (D-Magnolia). Authorizes the State Medical Board to continue to regulate physician dispensing of legend drugs. (Effective immediately)

SB 1138 / Act: 1194. Sen. Ronald Caldwell (R-Wynne). Requires Pharmacy Benefits Manager to maintain a Maximum Allowable Cost List and make it accessible to pharmacists.

HB 1185 / Act: 274. Rep. Marshall Wright (D-Forrest City). Authorizes pharmacists to substitute a therapeutically equivalent drug that is at a lower cost to the patient when given authorization in the prescription and after discussion with the patient.

SB 268 / Act: 176. Sens. Jane English (R-North Little Rock) and Mark Perry (D-Jacksonville). Requires active-duty military personnel identification cards to contain an ID photograph and the person's date of birth to be used to purchase pseudoephedine.

Here are some specifics on our Maximum Allowable Cost (MAC) bill.  After much lobbying and a little compromising, with a great deal of help from the bill’s sponsor, Sen. Ron Caldwell (R-Wynne), Senate Bill 1138 (now Act 1194 of the 89th General Assembly) passed.  It addresses issues surrounding MAC payments.  The bill requires:

  1. Access to applicable MAC list(s)
  2. Timely updates – within seven days of any change on which the MAC is based
  3. Prompt notification of MAC updates.
  4. A reasonable process for an administrative appeal procedure to allow pharmacies to challenge MACs:
    1. If the requirements of the section are not met
    2. The cost to the pharmacy is greater than the MAC for the drug in question.
    3. The pharmacy must appeal within three business days of the date of service.
    4. The PBM shall respond within seven business days.

1. If the appeal is upheld: a) make the change in the MAC; b) permit the challenging pharmacy to reverse and rebill; and c) change the MAC on the list effective for other pharmacies.

2. If the appeal is denied:  a) provide the challenging pharmacy with the NDC number used as the basis for determining the MAC is reasonable; and, b) Permit the challenging pharmacy to reverse the claim and submit a new claim. 

Bill enforcement is by the Attorney General under the Deceptive Trade Practices Act. This final bill was agreed to by the PBM industry and will go into effect 90 days after the official end of the legislative session.

Week 12 of the 89th General Assembly
Our MAC and physician dispensing bills are on the Governor’s desk, awaiting his signature. On the House floor April 10, Rep. David Kizzia (D-Malvern) passed SB1138, the Maximum Allowable Cost (MAC) fairness bill. The House also passed SB968 by Senator Bruce Maloch (D-Magnolia), which defines need in physician dispensing of Legend drugs.  Now both bills await Governor Beebe's signature to become law. 

The race to the finish has begun! During the last two weeks, the 89th General Assembly has rounded the final corner and is sprinting to the finish line. In an effort to beat the April 19 deadline and save the taxpayers the cost for yet another extension, they worked into the afternoon last Saturday and there are whispers of a repeat this week. Only rarely has the Legislature chosen to work on Saturday and it is usually the last week of the session. On April 11, the Arkansas House of Representatives passed a bill that lays out the framework for the “private option” health insurance plan for Arkansans who earn up to 138% of the federal poverty level. 

While the voting margins were more than the minimum 51 votes needed, they're still a ways away from the 75 votes required to pass the funding bill needed to implement the "private option.” 

APA legislation awaiting Governor's signature:
SB 968
 Maloch, Bruce (D-Magnolia). Authorizes the State Medical Board to continue to regulate physician dispensing of legend drugs.
SB 1138 Caldwell, Ronald (R-Wynne). Requires Pharmacy Benefits Manager to maintain a Maximum Allowable Cost List and make it accessible to pharmacists.

Now Acts:
HB 1185
 Wright, Marshall (D-Forrest City). Authorizes pharmacists to substitute a therapeutically equivalent drug that is at a lower cost to the patient when given authorization in the prescription and after discussion with the patient.
Bill History: Signed by the Governor. Now Act: 274
SB 268 English, Jane (R-North Little Rock) Perry, Mark (D-Jacksonville). Requires active-duty military personnel identification cards to contain an ID photograph and the person's date of birth to be used to purchase pseudoephedine.
Bill History: Signed by the Governor.  Now Act: 176  

Week 11 of the 89th General Assembly 
Our Maximum Allowable Cost (MAC) bill, SB1138, sponsored by Senator Ron Caldwell (R-Wynne), passed the Senate Public Health Committee March 27. Thanks to all of you who contacted your Senators about SB1138.  It will likely go before the full Senate on Monday before heading to hearings in the House as early as Thursday, April 4. In addition to the MAC Bill, the Physician Dispensing Bill, SB968 by Senator Bruce Maloch (D-Magnolia) has us busy educating Senate Public Health Committee Members on this issue. With the Medical Board and the Medical Society opposed, this will be our toughest issue of the session.

Support
SB 968 Maloch, Bruce ( D-Magnolia), Authorizes the State Medical Board to regulate physician dispensing of legend drugs.
Bill History: Rffered to Public Health, Welfare and Labor

SB 1138 Caldwell, Ronald (R-Wynne). Requires Pharmacy Benefits Manager to maintain a Maximum Allowable Cost List and make it accessible to pharmacists.
Bill History: Senate floor vote on April 1. 

SB 878    Maloch, Bruce (D-Magnolia). Amends provisions of the Orthopedics, Prosthetics and Pedorthics Practice Act.
Bill History: Referred to Senate Public Health, Welfare and Labor 

Opposed
SB 149    Files, Jake (R-Fort Smith). Allows pharmacists to dispense lower cost interchangeable biosimilar drugs in prescriptions for a biological product after first informing the prescription holder; requires notification to the prescribing physician of the substitution.
Bill History: Referred to Senate Public Health, Welfare and Labor 

Passed
HB 1185 Wright, Marshall (D-Forrest City), Dismang, Jonathon (R-Beebe). Authorizes pharmacists to substitute a therapeutically equivalent drug that is at a lower cost to the patient when given authorization in the prescription and after discussion with the patient.
Bill History: Signed by the Governor  now Act: 274

SB 268 English, Jane (R-North Little Rock) Perry, Mark (D-Jacksonville). Requires active-duty military personnel identification cards to contain an ID photograph and the person's date of birth to be used to purchase pseudoephedrine.
Bill History: Signed by the Governor now Act: 176

Week 10 of the 89th General Assembly

"In preparing for battle I have always found that plans are useless, but planning is indispensable." -Dwight D. Eisenhower

Weary legislators have been working on Medicaid and health care expansion behind closed doors for weeks now. We expect the Medicaid shell bill to be populated with language any day now. Then the final vetting process will begin along with the countdown to the close of the 89th General Assembly.Arkansas Medicaid officials said this week that the much-discussed  “private option” can be fully funded with existing resources at the state level and would add less than 15% to federal health-care costs in Arkansas. In some scenarios, there could be no additional federal costs at all.The "private option" would expand insurance coverage with federally subsidized plans in health insurance exchanges. It said, “These estimates find that the private option can be fully funded with existing resources at the state level and would add less than 15% to federal health-care costs in Arkansas. In some realistic scenarios, there could be no additional federal costs at all.” 

We still are working on a MAC bill, a specialty bill, a fix for the physician dispensing issue, and a bill to deal with the sale of diabetic shoes.  All of these may not run for various reasons but we are preparing to work all of them.

Week 9 of the 89th General Assembly

"A vote is like a rifle; it's usefulness depends upon the character of the user." -Theodore Roosevelt

Potential APA legislation includes a Maximum Allowable Cost (MAC) bill, a specialty drug bill, a fix for the physician dispensing issue, and a bill to deal with the sale of diabetic shoes.  A complete list of bills we are tackling appears below. Monday, March 11, was the last day to file bills during the regular session of the 89th General Assembly. It resulted in the busiest filing frenzy of the session and a late night for lobbyists, with 664 bills being filed that day.  Republicans filed 418 bills, while Democrats filed 246 pieces of legislation.  The final bill count for the session comes to 1,300 House bills and 1,192 Senate bills for a grand total of 2,492 bills filed. There were 139 resolutions filed between the House and Senate.

This week the House Rules Committee ruled that a controversial bill requiring a photo ID to vote only needs a simple majority to pass the two chambers of the state legislature, not a super majority. The committee, which has 8 Republicans and 7 Democrats, appeared split along party lines, but the bill passed on a voice vote upon the ruling of the chair, Rep. Stephanie Malone (R-Fort Smith).  Members of this committee are all appointed by the Speaker, Rep. Davy Carter (R-Cabot). The bill passed the House floor on a party line vote.

Support
HB 2228
    Wright, Marshall (D-Forrest City). Gives UAMS-College of Pharmacy the authority to prepare a Specialty Drug List
Bill History: Referred to House Public Health, Welfare and Labor

SB 878  Maloch, Bruce (D-Magnolia). Amends provisions of the Orthotics, Prosthetics and Pedorthics Practice Act.
Bill History: Referred to Senate Public Health, Welfare and Labor 

SB 968 Maloch, Bruce ( D-Magnolia). Authorizes the State Medical Board to regulate physician dispensing of legend drugs.
Bill History: Referred to Public Health, Welfare and Labor 

SB 1138 Caldwell, Ronald (R-Wynne). Requires Pharmacy Benefits Manager to maintain a Maximum Allowable Cost List and make it accessible to pharmacists.
Bill History: Referred to Senate Public Health, Welfare and Labor 

HB 1957  Wardlaw, Jeff (D-Warren). Limits Emergency Department Physicians prescribing authority.
Bill History: Referred to House Public Health, Welfare and Labor 

Opposed
SB 149
    Files, Jake (R-Fort Smith). Allows pharmacists to dispense lower cost interchangeable biosimilar drugs in prescriptions for a biological product after first informing the prescription holder; requires notification to the prescribing physician of the substitution.
Bill History: Referred to Senate Public Health, Welfare and Labor  

Passed
HB 1185
Wright, Marshall (D-Forrest City). Authorizes pharmacists to substitute a therapeutically equivalent drug that is at a lower cost to the patient when given authorization in the prescription and after discussion with the patient.
Bill History: Signed by the Governor. Now Act: 274 

SB 268 English, Jane (R-North Little Rock) Perry, Mark (D-Jacksonville). Requires active-duty military personnel identification cards to contain an ID photograph and the person's date of birth to be used to purchase pseudoephedine.
Bill History: Signed by the Governor.  Now Act: 176

Week 8 of the 89th General Assembly

"Fools rush in where angels fear to tread." -Alexander Pope 

The deadline for filing new legislation is Monday, March 11.  The Session may come to a close April 15, leaving little time and lots of bills.  APA is working to finalize the language on a Maximum Allowable Cost (MAC) pricing bill and Specialty Drug legislation. There could also be potential legislation to address physicians dispensing medications. A number of members have expressed concern about the recent court ruling striking down a portion of Arkansas law that will make it easier for physicians to dispense prescription medications.  We are gathering information and trying to determine the most appropriate way to proceed. The AR HEALTH + AR JOBS Coalition hosted a rally on the Capitol steps March 7. They were there to support expanding access to affordable health care coverage for low-income Arkansans. Speakers included Gov. Mike Beebe and Senator Jonathan Dismang (R-Beebe). Until recently, the two were on opposite sides of the Medicaid expansion debate. Last week’s announcement that the Federal government will allow Arkansas flexibility to spend Medicaid expansion dollars on private insurance plans seems to have brought them closer to agreement.

Week 7 of the 89th General Assembly

"I never learn anything talking.  I only learn things when I ask questions." -Lou Holtz

House Speaker Davy Carter (R-Cabot) made an appearance in House Public Health Committee Feb. 26 telling members that "halftime" is over and that the Session is at the “start of the third quarter.”  He urged House members to take action on issues that would be “in the best interest of the state".  In House Revenue and Tax Committee, Carter told members that he supported a $150 million tax cut package, which included a capital gains tax cut. He noted that it might start at $50 million and add $25 million in cuts per year in future years.

Governor Beebe’s meeting with U.S. Health and Human Services Secretary Kathleen Sebelius gave state lawmakers permission to explore additional options for Medicaid expansion.  The new options would allow the anticipated 250,000 Arkansans that would be covered under Medicaid expansion to shop for subsidized health care plans in an open market system with private insurance carriers beginning in 2014.  It could require subsidizing plans or creating co-pays for certain medical situations. 

Week 6 of the 89th General Assembly (2/22/13)

"I didn't surrender neither, but they took my horse and made him surrender" -Chief to Josey Wales in "Outlaw Josey Wales"

To date, members of the 89th General Assembly have filed 418 House bills and 425 Senate bills. After passing both the Senate and House, Governor Beebe has signed 143 of those 843 bills into law.

Rep. Marshall Wright's (D-Forrest City) HB 1185 passed the full House on Feb. 18 and moved on to Senate Public Health Committee where it was presented by Senator Jonathan Dismang (R-Beebe). Harding University pharmacy students testified before committee in support of the bill. The bill received a "do pass" from committee members and is expected to be presented to the full Senate Monday. The Pharmacy Practice Act change will allow pharmacists to make therapeutic substitutes when indicated on the prescription by the prescriber.  After counseling the patient on their options, the pharmacist can then substitute a product that lowers patient out-of-pocket costs (co-pays) and then notify the physician of any substitutions within 24 hours.  The intent of this bill is to improve efficiency for pharmacists and patients along with maximizing cost savings.

Representative Mark Perry (D-Jacksonville) passed the Military ID bill, SB 268, out of House Public Health Committee Feb. 21.   As you may recall, Senator Jane English (R-North Little Rock) successfully got it through the Senate last week. This bill tweaks the law requiring a valid scan in the LeadsonLab system from an Arkansas Drivers License, an Arkansas State ID or a Military ID to purchase pseudo ephedrine. Due to security reasons, Military IDs were not scannable in the LeadsonLab system. This legislation would make it legal to hand key military ID's.

As the sixth week of the 89th General Assembly draws to a close, APA is on the road to a productive Session.

Week 5 of the 89th General Assembly (2/15/13)

"Love conquers all things except poverty and toothache." -Mae West

Rep. Marshall Wright (D-Fort Smith) passed HB 1185 unanimously in the House Committee on Public Health, Welfare and Labor this week.   The Pharmacy Practice Act Change will allow pharmacists to make therapeutic substitutes when indicated on the prescription by the prescriber.  After counseling the patient on their options, the pharmacist can then substitute a product that lowers patient out-of-pocket costs (co-pays) and then notify the physician of any substitutions within 24 hours.  The intent of this bill is to improve efficiency for pharmacists and patients along with maximizing cost savings. The bill now moves to the full House.

Senator Jane English (R-North Little Rock) successfully passed SB 268 through the Senate and it is expected to be heard in the House Committee on Public Health, Welfare and Labor next week. This bill tweaks requirements in the pseudoephredrine bill passed last session requiring a valid scan in the LeadsonLab system from an Arkansas Driver’s License, an Arkansas State ID or a Military ID to purchase pseudoephedrine. Due to security reasons, Military IDs are not able to be scanned in the LeadsonLab system. This legislation would make it legal to hand key military IDs.

This week, 37 bills were filed to amend the state constitution to meet Wednesday's deadline.  Among them are ethics reform, term limit reform and tort reform. The Legislature can place additional constitutional amendments on the ballot for Arkansans to vote up or down. These proposed amendments will be heard in State Agencies and Governmental Committees.  Sen. Eddie Joe Williams (R-Cabot), the chairman of the Senate State Agencies, said his committee will discuss a schedule to review the proposed ballot measures.   Rep. Andrea Lea (R-Russellville), the chair of the State Agencies on the House side, said she will wait several weeks before debating the amendments to give members time to fill in the details of their proposed amendments.

Week 4 of the 89th General Assembly (2/8/13)

"Those are my principles.  If you don't like them, I have others." -Groucho Marx

Last week, we learned that the state's Medicaid funding shortfall had shrunk from a November estimate of $138 million to just $61 million.  This week, lawmakers and Arkansas Medicaid Director Andy Allison met to discuss the "good news".  Allison had no real explanation for the drop, saying it was a bit mystifying.

The revised projection assumes lawmakers will approve the Governor’s proposal to address up the shortfall with $90 million in general revenue and $70 million in one-time surplus funds in the fiscal year that begins July 1, and with $222 million in general revenue and $70 million in surplus funds the following year.  But the shortfall is still half what was predicted last November.  The remaining $61 million is proposed to come from cuts that in the Governor’s proposed budget include skipping one year’s inflationary increase in Medicaid reimbursements paid to health care institutions and a 3 percent cut to providers. Auditors now say the Division of Legislative Audit report on the state’s Medicaid program may not be released for several weeks. 

The Arkansas 89th General Assembly met in a “committee of the whole” for nearly three hours to discuss the $1.1 billion Big River Steel Mill, to be located near Osceola and provide 525 jobs.  Securing the project will require legislators to approve a $125 million bond program to help with start-up costs. This is the first test of the state’s Amendment 82, passed by voters in 2004, which allows for state-supported bonds to help with economic development.  In anticipation of the super project, 30 state Senators and House members have formed the Steel Caucus.  Senator David Burnett (D-Osceola) and Rep. Monte Hodges (D-Blytheville) will co-chair the group.  

Rep. Ann Clemmer (R-Benton) joined Senator Jason Rapert (R-Conway) to push forward a bill that would outlaw doctors performing abortions after the twelfth week of pregnancy.  Rep. Rapert toned down his original bill that would not allow abortions after a hearbeat is detected using a vaginal probe at about six weeks.  Although, the Governor believes the twelve week version may be unconstitutional, it is expected to pass the House and await his signature next week. 

To date, the House has filed 280 bills and the Senate has filed 262 bills. None of our bills have been run yet but the action should pick up soon.  These are our three major issues: 

1.  HB 1185 – Practice Act Change to allow limited therapeutic substitution:  Our primary opposition will be PhRMA.  The bill is designed to allow pharmacists to therapeutically substitute for a formulary drug when the physician indicates on the prescription that we can do so.  After consulting with the patient about their options, the pharmacist can then substitute a product that lowers patient out of pocket costs (co-pays) and then electronically submit the choice to the physician.  The intent of this bill is to shorten a process that now can take from hours to days to about 10 minutes.  We are currently deciding on who the best lead sponsors are in the House and Senate and which day is best to run it. 

2.  HB 1184 – A bill that defines specialty drugs and requires the State Board of Pharmacy to adopt a list of drugs that fit the definition criteria.  This list would govern what a PBM could classify as specialty drugs. 

3.  A bill concerning Maximum Allowable Cost (MAC) issues – Not yet filed.  Just beginning to meet with the PBM folks to try to work out as much as we can before the fight ensues.  We will be sending out more about this as we know more. 

Bills APA is tracking in 89th General Assembly:  Below is a list of bills APA is currently following during the 89th General Assembly. Click on the bill number to read the entire bill. 

Support
HB 1185                Wright, Marshall    Authorizes pharmacists to substitute a therapeutically equivalent drug that is at a lower cost to the patient, when given authorization in the prescription.
Last Action:  Referred to Public Health, Welfare and Labor

HB 1184               Wright, Marshall      Requires the State Board of Pharmacy to prepare a list of specialty prescription drugs that require special handling, administration, inventory management, or patient support; provides regulations for pharmacy compliance.
Last Action: Currently on deferred list-Public Health, Welfare and Labor 

Oppose
HB 1186     Malone, Stephanie   Removes the dispensing restrictions for pseudoephedrine that prohibited the sale of more than three packages, changes identification requirements for purchasers, and specifies that verification system must share data.
Last Action: Placed on House calendar- Public Health, Welfare and Labor 

SB 149    Files, Jake     Allows pharmacists to dispense lower cost interchangeable biosimilar drugs in prescriptions for a biological product after first informing the prescription holder; requires notification to the prescribing physician of the substitution.
Last Action:  Placed on the Senate calendar

Monitor
HB 1011    Altes, Denny  Creates a professional licensure procedure for naturopathic practitioners under the Department of Health; creates the Naturopathic Practitioners Advisory Committee to advise the State Board of Health on adoption of rules for licensure.
Last Action: Placed on deferred list-Public Health, Welfare and Labor. 

HB 1066    Joint Budget  Appropriates funds to the Pharmacy Board for fiscal 2013-14 operations. 
Last Action: Notification that HB1066 is now Act 48

HB 1140    Burris, John   To amend laws related to Medicaid. (Incomplete bill) 
Last Action: 1-28-13 H Introduced and referred to H-Public Health, Welfare and Labor 

HB 1141    Burris, John   To amend laws related to public assistance benefits. (Incomplete bill)
Last Action: 1-28-13 H Introduced and referred to H-Public Health, Welfare and Labor 

HB 1142    Burris, John   To amend laws related to health provider organizations. (Incomplete bill)
Last Action: 1-28-13 H Introduced and referred to H-Public Health, Welfare and Labor               

HB 1143    Burris, John To amend laws related to Arkansans' health. (Incomplete bill)
Last Action: 1-28-13 H Introduced and referred to H-Public Health, Welfare and Labor 

HB 1144    Burris, John   To amend laws governing licensed health care professionals. (Incomplete bill)
Last Action: 1-28-13 H Introduced and referred to H-Public Health, Welfare and Labor 

HB 1219    Joint Budget  Appropriates funds to the Human Services Department - Division of Medical Services for fiscal 2013-14 operations.
Last Action: Referred to Joint Budget 

HB 1220    Joint Budget  Appropriates funds to the Human Services Department - County Operations Division - Medicaid Expansion Program for fiscal 2013-14 operations.
Last Action: 1-31-13 H Introduced and referred to Joint Budget 

SB 189    Johnson, David , Williams, Darrin Makes technical corrections to various provisions related to public health.
Last Action: Referred to S-State Agencies 

SB 218    Irvin, Missy      Requires the Insurance Commissioner to develop a uniform prior authorization form and requires health care insurers to use the form to request prior authorization for coverage of a prescription drug benefit.
Last Action:  Referred toPublic Health, Welfare and Labor

 

Week 3 of the 89th General Assembly (2/4/13)

"We in America do not have government by the majority. We have government by the majority who participate.” -Thomas Jefferson 

 

Week three of the Session was filled with news of Medicaid, economic development and abortion bills. January 28 was the last day for filing scope of practice bills and February 1 was the last day to file retirement related bills. To date, the House has filed 244 bills and the Senate has filed 232 bills. APA is currently tracking 15 bills. 

 

New budget numbers say the Medicaid shortfall has been reduced to a managable $61 million.  Medicaid Director Andy Allison attributed the reduction to the new episodic care delivery model instituted last October. Legislators on both sides of the aisle were skeptical of the reduction and the reason given for the reduction. 

 

On February 1, the release of a special audit of the state Medicaid program was postponed. At the committee meeting, Joint Audit Co-Chairmen Sen. Bryan King( R-Green Forest), and Rep. Kim Hammer (R-Benton), announced that the Division of Legislative Audit was still reviewing its draft report with the Department of Human Services and the report presentation would be delayed. The report was originally scheduled to be presented in March; legislators had requested an earlier date. The audit comes during a session in which legislators are considering whether to expand the state Medicaid program under the federal Patient Protection and Affordable Care Act. Beebe favors expansion which would make Medicaid available to an additional 250,000 Arkansans, most of whom work but can’t afford coverage. Republicans in the Legislature have generally opposed the expansion.  

 

The first of two economic development announcements began with the Governor’s announcement of the Big River Steel plant coming to Osceola.  The construction phase of the plant will utilize up to 2000 workers and upon completion Big River Steel will employ 525 permanent workers with average salaries of $70,000.  In a second announcement,  Inuovo, Inc., an Internet marketing company is moving to Conway. The company will employ 30-50 people initially. The Governor’s Quick Action Closing Fund helped to secure both endeavors for Arkansas. 

 

Three abortion-related bills made it out of committees. Senator Jason Rapert’s bill, SB 134, would prohibit an abortion where the heart beat of the fetus has been detected, usually at about six weeks using a vaginal probe. The bill made it out of the Senate and is now in the House Public Health Committee. HB 1037 by Representative Andy Mayberry made it out of the House Public Health Committee and will be up for a House floor vote. The bill prohibits the abortion of an unborn child that is 20 weeks or older. HB 1100 by Butch Wilkins would prohibit Health Insurance Exchanges policies from covering abortions except through a rider. All three bills packed the committee rooms with supporters and opponents. They will continue their trek to the Governor's desk in the week to come. 

 

As the fourth week begins, the 89th General Assembly, with its 44 freshman members feeling at little more at home in the state Capitol, it's full steam ahead.


2011 Notes From the Hill Retrospective

By Debra Wolfe, APA Director of Governmental Affairs

Some people think that lobbying is a four-letter word.  However, lobbyists perform a critical role in shaping policies and laws that get enacted by the state.  As one of the lobbyists for the Arkansas Pharmacists Association, I spend my days building relationships with the great men and women who serve the citizens of Arkansas in the Arkansas General Assembly.

I am happy to report that the relationships that the pharmacists of the state have with their legislators and the relationships that the APA has built and maintained with Arkansas legislators have made pharmacy a strong political force at the Arkansas State Capitol.  This legislative session, pharmacy scored a number of key political victories in Little Rock.  Here is a summary of our legislative successes and how they will impact the practice of pharmacy:

The Pharmacy Audit Bill of Rights – Senator Johnny Key (R - Mountain Home) and Representative Linda Tyler (D - Conway) co-sponsored a bill that protects community pharmacies from the unfair and predatory auditing practices of the Pharmacy Benefit Managers (PBMs).  The new law includes provisions that require a PBM to allow a pharmacist to correct a claim before any money is recouped and any recoupment can only be for the amount in excess of the corrected claim.  This provision will prevent PBMs from finding an insignificant error in a prescription and recouping the entire prescription amount from the pharmacy.  In addition, random audits will be limited to two per year, and each random audit may only include 25 prescriptions.  These provisions will limit the number of times each year that a PBM may conduct a random desk audit, and it places an important limit on the number of claims that they may audit.  Many provisions of the bill become effective on July 1, 2011, with the full implementation occurring on January 1, 2012.  Click here to read the PBM Audit Bill.

Senator Key also ran a separate bill for pharmacy that protects the pharmacist-patient relationship and prevents a PBM from interfering with this relationship.

Expansion of Pharmacists Ability to Immunize – Senator Percy Malone (D - Arkadelphia) authored a bill that permits Arkansas pharmacists to administer medications down to age seven.  The previous age limit for pharmacists was 18.  In addition, pharmacists may provide flu shots down to age seven under a general protocol.  All other immunizations and medications will require a patient-specific prescription for ages seven to 17.  This expansion of pharmacy practice opens up a new opportunity for pharmacists to provide immunizations to many children who currently go unvaccinated.

Pharmacist-Only Third Class of Drugs – Senator Malone and Representative Mark Perry (D – Jacksonville) co-sponsored a bill that creates the framework for a pharmacist-only third class of drugs.  The new law maintains patients’ ability to access pseudoephedrine products from a pharmacist without a prescription, and it requires a pharmacist-patient relationship and the determination of a medical need by the pharmacist before a sale can be made. 

In short, it prevents non-pharmacist store managers from forcing a professional pharmacist to sell these products and it allows the State Board of Pharmacy to discipline the pharmacy permit holder if someone attempts to force a pharmacist to make a sale.  More importantly, the new law permits the State Board of Pharmacy to add new over-the-counter (OTC) products in the future that should require the specialized knowledge of the pharmacist before a patient may purchase them.

This bill drew many opponents, including the OTC manufacturers, the National Association of Chain Drug Stores, Walgreens, and Wal-Mart.  However, pharmacists from all practice settings overcame this opposition by rallying at the State Capitol on March 15 to help ensure the bill’s passage. 

Prescription Drug Monitoring Bill – Senator Malone also led the effort to create a statewide prescription drug tracking system.  This electronic database will capture all Schedule II, III, IV, and V prescriptions that are filled in the state of Arkansas.  The data will be housed at the Arkansas Department of Health and will be available as a tool for healthcare providers to use when making determinations about patient treatment.  Pharmacists will have access to the system and the legislature hopes that the system will help reduce doctor and pharmacy shopping for controlled substances.

State Board of Pharmacy Appointment Bill – Representative Tommy Wren (D – Melbourne) and Senator Bill Sample (R – Hot Springs) co-sponsored a bill that codifies the long-standing tradition of the Governor receiving input from the Arkansas Pharmacists Association before making a pharmacist appointment to the Arkansas State Board of Pharmacy.  Arkansas governors will now be required by law to appoint pharmacist members to the Board of Pharmacy upon the advice and consent of the APA.

Preserving the Professional Independence of a Pharmacist – Sponsored by Senator Johnny Key (R – Mountain Home) and Representative Fred Allen (D - Little Rock), this bill prohibits a third party from interfering with the pharmacists-patient relationship.  It ensures that a pharmacist is not restricted when talking to a patient about their medical needs or options under any medical plan.

The 88th General Assembly was the most successful session for pharmacy in a long time, and I am particularly proud because it was productive for all of the different sectors of the profession.  The APA is grateful to all of the legislators that helped us advance the profession of pharmacy and we are, most importantly, thankful to you the members for interacting with your legislators and letting them know the important role pharmacists play in today's healthcare team.