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sweetcyclepost · 4 years ago

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Basically every state heading off course

1,707 new Covid-19 passings were accounted for Tuesday

Along these same lines, Covid is killing in any event one American all day long.

At any rate 1,707 new Covid-19 passings were accounted for Tuesday, as per information from Johns Hopkins University. That is the most noteworthy every day loss of life since May 14.

site-https://www.un.org/sites/www.iamladp.org/files/webform/after-we-collided-online-2020-full.pdf

Also, it’s simply going to deteriorate, said Dr. Jonathan Reiner, a teacher at George Washington University School of Medicine.

site-https://www.un.org/sites/www.iamladp.org/files/webform/ammonite-2020-full.pdf

“The frightful demise include that we saw yesterday in the United States … mirrors the quantity of individuals who were being tainted three weeks back — half a month prior, in light of the fact that that is the slack,” Reiner said Wednesday.

site-https://www.un.org/sites/www.iamladp.org/files/webform/borat-subsequent-moviefilm-2020-full.pdf

“By and large, half a month back, we were seeing 70,000 to 80,000 (new) cases every day. Recently, there were around 155,000 (new) cases. So in case you’re frightened at the 1,700 passings today, a little while from now, we will see 3,000 passings every day.”

site-https://www.un.org/sites/www.iamladp.org/files/webform/honest-thief-2020-full.pdf

And keeping in mind that a few medical clinics are running out of medical care laborers, the US indeed set another precedent for hospitalized Covid-19 patients — 76,830 on Tuesday, as per the Covid Tracking Project.

Basically every state heading off course

site-https://www.un.org/sites/www.iamladp.org/files/webform/the-war-with-grandpa-2020-full.pdf

As of Wednesday, 47 states had at any rate 10% more new every day cases than this time a week ago, as indicated by Johns Hopkins information.

site-https://www.un.org/sites/www.iamladp.org/files/webform/the-empty-man-2020-full.pdf

Two states are moderately consistent contrasted with a week ago — North Dakota and Iowa — yet that is not saying a lot, since the two states have as of late had horrifying paces of new cases, hospitalizations and passings.

site-https://www.un.org/sites/www.iamladp.org/files/webform/freaky-2020-full.pdf

These lead representatives since quite a while ago opposed veil commands. Presently their states are in emergency.

site-https://www.un.org/sites/www.iamladp.org/files/webform/let-him-go-2020-full.pdf

Just Hawaii has seen in any event a 10% abatement in new cases.

This flood in cross country contaminations isn’t only because of additionally testing.

While new cases have expanded 29% over the previous week, as per Johns Hopkins, testing cross country has expanded uniquely about 11%, as per the Covid Tracking Project.

site-https://www.un.org/sites/www.iamladp.org/files/webform/come-play-2020-full.pdf

Arkansas Gov. Asa Hutchinson said that at his state’s present rate, “1,000 Arkansans could pass on of Covid-19 among now and Christmas.”

Texas authorities have conveyed two portable cooler trucks to Amarillo to deal with the ascent in fatalities.

site-https://www.un.org/sites/www.iamladp.org/files/webform/demon-slayer-kimetsu-no-yaiba-mugen-train-2020-full.pdf

In Illinois, “ICU and non-ICU emergency clinic inhabitance by Covid-19 patients could reach as much as multiple times our past records from the spring.” Gov. J.B. Pritzker said.

“We will keep on observing an ascent in the two hospitalizations and passings from Covid-19 for quite a long time ahead as a result of the contaminations that have just occurred,” he said.

site-https://www.un.org/sites/www.iamladp.org/files/webform/tenet-2020-full.pdf

“In any case, we can change our more drawn out term result. We can spare conceivably a great many lives in the following not many months on the off chance that we make changes right presently to stop this in its track.”

5 hints for facilitating a virtual occasion gathering

A stay-at-home warning began for the current week in Chicago, where city authorities likewise asked occupants not to have visitors in their homes, to drop conventional Thanksgiving festivities and abstain from voyaging.

Comparable measures have been reported over the US in the previous days.

Ohio Gov. Mike DeWine declared a statewide time limitation beginning Thursday that will run from 10 p.m. to 5 a.m.

site-https://www.un.org/sites/www.iamladp.org/files/webform/after-we-collided-2020-online-hd.pdf

In Maryland, the lead representative gave a crisis request viable Friday requiring bars and cafés to close between 10 p.m. furthermore, 6 a.m., aside from carryout and conveyance administrations.

“We are in a war at this moment,” Gov. Larry Hogan said. “Furthermore, the infection is winning. Presently, like never before, I’m begging the individuals of our state to stand together, some time longer.”

Understudies advised to remain at home after occasions

As cases flood over the US, schools and colleges are likewise exploring what their subsequent stages ought to resemble, particularly following a Christmas season that specialists dread will additionally fuel the widespread spread of the infection.

Will undergrads bring Covid-19 home for Thanksgiving?

In Boston, Mayor Marty Walsh said the special seasons are “particularly high danger for undergrads who don’t live at home.”

“Ordinarily, numerous understudies travel to their old neighborhood for Thanksgiving, at that point re-visitation of grounds for the remainder of the semester,” Walsh said.

“We have asked understudies not to do that this year. On the off chance that you return home for Thanksgiving, try not to be getting back to Boston this semester. You ought to wrap up of your learning … distantly.”

Prior this week, Connecticut Gov. Ned Lamont likewise gave direction for out-of-state undergrads who were intending to get back to Connecticut for the occasion.

He said returning understudies should self-isolate for 14 days prior or in the wake of getting back home, get tried for Covid-19 both prior to leaving school and subsequent to returning home, not go to parties and not isolate with any old or in danger relatives.

Immunizations are still months away for a great many people

While there’s incredible information on the antibody front, most Americans likely won’t have the option to get immunized until the center of one year from now.

The Pfizer/BioNTech antibody is 95% viable and has indicated no genuine security concerns, Pfizer said Wednesday. BioNTech said it intends to demand crisis use approval from the US Food and Drug Administration on Friday.

Pfizer's super cool immunization, a 'very complex' circulation plan and a detonating head emoticon

Pfizer’s super chilly antibody, a ‘unpredictable’ dispersion plan and a detonating head emoticon

Another antibody, from Moderna, is 94.5% successful against Covid, as per early information delivered for the current week. The organization says its immunization didn’t have any genuine results.

In any case, wellbeing specialists state Americans should twofold down on security measures, as there will be a lot more sicknesses and passings before an immunization is accessible to the vast majority.

Dr. Francis Collins, overseer of the National Institutes of Health, said there are as yet a few stages required before antibodies get into the public’s arms.

“They will look cautiously to be certain that everything is all together with wellbeing and with viability, at that point they will make a judgment about whether both of these antibodies, Pfizer and Moderna, might be truth be told qualified for crisis use approval,” Collins said.

Don't expect a Covid immunization before December, specialists alert

Try not to expect a Covid antibody before December, specialists alert

The two organizations could get EUAs by ahead of schedule to mid-December, he added.

“On the off chance that these two immunizations do get endorsement, crisis use approval, there will be around 40 million dosages fit to be conveyed in December,” he said.

Individuals will require two dosages of one or the other antibody. “So that is 20 million individuals that can be inoculated and we should ensure that is used for the most elevated danger individuals,” he said.

More dosages will open up each month from that point forward, Collins stated, and there are other immunization up-and-comers that may likewise win endorsement.

“The expectation would be that by April we truly begin to see many individuals getting inoculated,” Colilns said.

“Undoubtedly by the mid year we would plan to have the greater part of America really safe to this and we could begin to consider returning to life as ordinary.”

site-https://medium.com/@mugoaman/1-707-new-covid-19-passings-were-accounted-for-tuesday-30640773c956

#covid

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saraseo · 4 years ago

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cannabisbusinessexecutive · 2 months ago

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Arkansas medical marijuana supporters sue state over decision measure won’t qualify for ballot

Organizers of an effort to expand medical marijuana i n Arkansas sued the state on Tuesday for its decision that the proposal won’t qualify for the November ballot. Arkansans for Patient Access asked the state Supreme Court to order Secretary of State John Thurston’s office to certify their proposal for the ballot. Thurston on Monday said the proposal did not qualify, ruling that its petitions…

#Arkansas #Ballot initiative #medical marijuana

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oselatra · 6 years ago

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Mental health cuts stir controversy

But the DHS says changes won't reduce access to care.

A group of behavioral health providers and patients rallied at the Arkansas Capitol last Thursday to protest reductions in Medicaid reimbursement rates that they say threaten to drive mental health agencies out of business.

Rate changes implemented by the state Department of Human Services on July 1 have resulted in an 11 percent across-the-board cut for some providers, according to Luke Kramer, the director of the STARR Coalition, the advocacy group that organized the protest. The state, he said, appears to be "systematically dismantling" the behavioral health system, endangering thousands of Arkansans suffering from mental illnesses.

"I don't know what the endgame is for the state," Kramer said after the event. "Is it to go to complete managed care? Is it to save money so you can have a press conference saying, 'We've added no one to the Medicaid rolls, and we've saved the state X amount of dollars,' and then turn those dollars back into tax cuts for other Arkansans?"

Governor Hutchinson has set a goal of achieving $835 million in savings in the state Medicaid budget over a five-year period. At an August press event, he celebrated the fact that the state's total spending on the government-funded insurance program remained flat from fiscal year 2017 to 2018. The reduced spending has resulted partly from a variety of "transformation" efforts and partly from a reduction in Medicaid enrollment by over 60,000 beneficiaries. (The rolls will likely shrink by thousands more in the coming months as the DHS phases in the governor's new work requirement for certain adult, nondisabled Medicaid beneficiaries.) Hutchinson and GOP lawmakers intend to pass a new round of state tax cuts in the 2019 legislative session.

Yet calls for reform in behavioral health are not limited to budget hawks. Later this month, the largest behavioral health agency in the state, Preferred Family Healthcare, will withdraw from Arkansas and sell its 45 sites to another provider. Former PFH executives are at the center of multiple federal criminal investigations into alleged bribery schemes that implicate several Arkansas legislators of both parties, four of whom have pleaded guilty. State investigators have separately accused former PFH employees of schemes to siphon millions of dollars from Medicaid through fraudulent billing practices. (PFH, which was formerly called Alternative Opportunities, does business in Arkansas under the names Dayspring, Decision Point and Health Resources of Arkansas; it is based in Springfield, Mo.) According to federal investigators, leaders at PFH embezzled millions of dollars from the nonprofit, which was funded largely by public money.

But while PFH's former leaders may have engineered a way to unduly profit from the system, other behavioral health providers have been barely scraping by, according to Kramer and other advocates. "Most people are just breaking even ... but that was before [the] July [rate changes]," he said. "We're talking about people who are just bleeding money out and having to take out loans."

Still, the PFH scandal raises difficult questions. Are some Medicaid spending categories in the mental health system being exploited by unscrupulous providers? How can the state prevent such abuses from occurring in the future while also funding quality care for the politically vulnerable population of mentally ill Arkansans?

Former U.S. Rep. Patrick Kennedy (D-Rhode Island), a national mental health advocate who headlined last week's rally, said it's all too easy for states to cut mental health services. "Just be honest. It's easy to cut these people, because they don't rank too high in the list of constituent power groups."

DHS spokeswoman Amy Webb disputed the notion that behavioral health reform efforts will reduce access for beneficiaries. The agency is implementing a long-term plan to overhaul the behavioral health system — an effort that predates the scandal at PFH. While rates paid to large behavioral health agencies were reduced on July 1, Webb wrote in an email, rates for individually licensed providers rose by a significant amount. ILPs, such as self-employed psychologists or licensed clinical social workers, can now provide Medicaid-funded services without being a part of a behavioral health agency, she said.

Reimbursement rates for the two types of providers have been equalized. Previously, ILPs were paid $39.28 an hour for individual counseling, while behavioral health agencies were paid $109.20 an hour. Now, both types of providers are reimbursed at $92.76 an hour.

"That has expanded the number of people who can provide behavioral health services," Webb wrote. A fact sheet provided by the DHS said the number of ILPs in the state rose from 31 to 106 from July 2017 to September 2018. Another 61 are in the process of being enrolled.

"The old Medicaid behavioral health system required people to get assistance through a single provider type — the big behavioral health agencies — and there was a moratorium in place for new providers," Webb wrote. "It was a one-size-fits-all system ... without independent checks, meaning that the same providers getting paid to provide services also decided what types of services people needed and for how long. The new system has expanded services, allowed for more providers to step up and offer care to beneficiaries, and now requires an independent assessment rather than having providers deciding what people need."

Webb also said the new system "provides all Medicaid beneficiaries access to substance abuse treatment for the first time."

Ro Garcia, the chief operating officer of Little Rock behavioral health agency Inspiration Day Treatment, said those arguments don't hold up to scrutiny. ILPs in private practice are serving a much different population of clients, according to Garcia. "They're seeing people who come in once or twice a month. We're seeing our folks five or six times a week," he said. "We're talking about the clients that are so ill that they need to come to a day treatment center most days out of the week to stay out of the hospital."

Carol Witham, Inspiration's CEO and founder, said her clients can't afford disruptions in medication and services.. "Substance abuse does not substitute for treatment for the seriously mentally ill." (Witham is also the chairwoman of the STARR Coalition's board.) An independently wealthy philanthropist, Witham said she's now forced to put her own money into Inspiration to keep the behavioral health agency afloat. Other providers don't have that luxury, she said, and are facing the very real possibility of imminent closure.

Witham said she was skeptical that new providers would step up to treat severely mentally ill clients such as hers. "There is no company that's going to come in new and take on what we do for these rates ... you'll lose money," she said. If her clients go without care, she said, the public will bear the cost.

"For this population, you have no choice — the state has to take care of them. You can give them mental health treatment, and keep them on their meds ... or, second, they will be in the criminal justice system ... and your family or my family could be the victim of a crime," Witham said. "And it's a lot costlier for them to go into the prison system than for them to go into treatment." Witham estimated that perhaps 80 percent of her clients "could become violent without taking their medication."

Patricia Gann, one of the DHS officials overseeing behavioral health reform efforts, said in an interview that the DHS was working with providers to help them transition to the new system. Under the old system, she said, severely mentally ill adults had just two options: acute inpatient treatment at a hospital or outpatient therapy at a behavioral health agency. Often, there would be a weeks-long waiting list for outpatient therapy, creating a gap in services.

The new system, she said, allows providers to get Medicaid reimbursement for other levels of care between hospitalization and outpatient therapy, including "therapeutic communities" and "partial hospitalization."

"We've added that higher level of care," she said. "Now we have to work with providers in developing those services in the community."

Some of the recent alarm among providers, Gann said, was the result of claims being rejected due to internal issues with billing. Those rejections were in error, and the DHS has recently corrected the issues, she said.

Gann said the projected behavioral health budget for the 2019 fiscal year does not contain a funding reduction relative to 2017 or 2018. "We added new services and we have the same spend," she said.

This reporting is made possible in part by a yearlong fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund. It is published here courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan project dedicated to producing journalism that matters to Arkansans. Find out more at arknews.org.

Mental health cuts stir controversy

#Mental health cuts stir controversy

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foursproutwealth-blog · 7 years ago

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Trouble In Arkansas: Judge Throws Out Medical Marijuana Licenses

New Post has been published on http://foursprout.com/wealth/trouble-in-arkansas-judge-throws-out-medical-marijuana-licenses/

Trouble In Arkansas: Judge Throws Out Medical Marijuana Licenses

Arkansas voters approved medical marijuana but old-fashioned favoritism by regulators who ignored the rules has stymied the program.

March 27, 2018 3 min read

Opinions expressed by Entrepreneur contributors are their own.

A judge in Arkansas has ruled that the state commission assigned to award licenses for growing legal medical marijuana awarded the contracts in an unfair manner. It’s led to a legal quagmire in Arkansas, one of only two southern states to legalize medical marijuana. For practical purposes, it’s left Arkansans who want to try medical marijuana out of luck for the foreseeable future.

In his decision, Judge Wendell Griffen barred the state Medical Marijuana Commission from issuing any licenses until the situation is sorted out. That may take some time, as Griffen found the commission was biased and did not follow the proper rules when it awarded five contracts to grow marijuana.

“The Court takes no joy in reaching or declaring this conclusion, nor should anyone else treat the conclusion as anything other than disappointing and sobering,” the judge wrote.

Related: What Better Conditions to Raise Money for Cannabis Businesses Means for Marijuana Entrepreneurs

An Exception In The South

Arkansas voters approved legal medical marijuana in November 2016. The state is allowing its use only for specific medical conditions, including multiple sclerosis and to combat the pain and discomfort of cancer treatments. Voters in Arkansas passed medical marijuana legalization by 53 percent.

The state would allow patients to only use marijuana grown in Arkansas. So far, more than 4,700 people have applied to the program, which will require issuance of a state card. Arkansas and Louisiana are the only two states in the South to approve medical marijuana (unless you count Florida as a southern state).

Essentially, the two states are an island of marijuana legalization in the middle of a large swath where marijuana is not legal for any purpose, medical or recreational. That includes Virginia, the Carolinas, Kentucky, Tennessee, Georgia, Alabama, Mississippi and Texas.

Related: How Mainstream Is Marijuana? Cannabis Franchises Are Available in Colorado

Rule Of Law Violated

Griffen, who issued a 28-page order, was ruling on a lawsuit filed by an unsuccessful applicant who wanted to grow marijuana in the Natural State. The lawsuit charged that the application process contained scoring irregularities, bias, conflicts of interest and violation of rules.

Griffen, on the whole, saw it that way, too. He said the process did not respect the rule of law. He stopped the awarding of the five contracts, which was supposed to happen in March. The five applicants had paid $100,000 in fees to apply and put up a $500,000 bond.

The state can appeal the decision, but even marijuana advocates don’t want that. David Couch, the Little Rock attorney who helped get medical marijuana legalized, told the Arkansas Democrat-Gazette he wanted the state just to restart the application process.

That way, medical marijuana patients could legally get cannabis faster, Couch said. Even Griffen noted that no matter what the state chooses to do, the fact that Arkansans will now have to wait even longer for access to medical marijuana “should be unpleasant to anyone concerned about providing relief to people who suffer from serious illnesses.”

Follow dispensaries.com on Twitter to stay up to date on the latest cannabis news.

#Wealth

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foursprout-blog · 7 years ago

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Trouble In Arkansas: Judge Throws Out Medical Marijuana Licenses

New Post has been published on http://foursprout.com/wealth/trouble-in-arkansas-judge-throws-out-medical-marijuana-licenses/

Trouble In Arkansas: Judge Throws Out Medical Marijuana Licenses

Arkansas voters approved medical marijuana but old-fashioned favoritism by regulators who ignored the rules has stymied the program.

March 27, 2018 3 min read

Opinions expressed by Entrepreneur contributors are their own.

“The Court takes no joy in reaching or declaring this conclusion, nor should anyone else treat the conclusion as anything other than disappointing and sobering,” the judge wrote.

Related: What Better Conditions to Raise Money for Cannabis Businesses Means for Marijuana Entrepreneurs

An Exception In The South

Related: How Mainstream Is Marijuana? Cannabis Franchises Are Available in Colorado

Rule Of Law Violated

Follow dispensaries.com on Twitter to stay up to date on the latest cannabis news.

#Wealth

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zeroviraluniverse-blog · 7 years ago

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Arkansas Judge Tosses Licensing Process for Medical Pot Growers

Visit Now - http://zeroviral.com/arkansas-judge-tosses-licensing-process-for-medical-pot-growers/

Arkansas Judge Tosses Licensing Process for Medical Pot Growers

An Arkansas judge on March 21 struck down the state’s decision to issue its first licenses to grow medical marijuana, ruling that the process for awarding the permits and the rankings of applicants were unconstitutional.

Pulaski County Circuit Judge Wendell Griffen granted a preliminary injunction preventing the state Medical Marijuana Commission from awarding cultivation licenses. Griffen last week issued a restraining order preventing the state from awarding licenses to five companies.

Griffen ruled that the process for awarding the licenses violated a state constitutional amendment voters approved in 2016 legalizing marijuana for patients with certain conditions. He ruled the commission’s rankings of the 95 applicants for the cultivation licenses were null and void. Griffen sided with an unsuccessful applicant that had sued the state over claims the process for awarding the licenses was flawed.

In his ruling, Griffen said he “takes no joy” in blocking the state from issuing the licenses.

“The prospect that Arkansans must now endure more delay before gaining much needed access to locally grown medical marijuana should be unpleasant to anyone concerned about providing relief to people who suffer from serious illnesses,” Griffen wrote.

The attorney general’s office said it was reviewing Griffen’s ruling and discussing it with state officials, but did not say whether it planned to appeal to the state Supreme Court.

Griffen said the process for awarding the licenses was compromised by potential conflicts of interest by commissioners who scored the applications, including one whose law firm represents the owners of one of facilities that was going to receive a license in non-marijuana related matters. Another commissioner is a physician who routinely refers patients to the medical practice of another doctor who is a part owner of a cultivation facility.

The state, however, has said that the applications scored by the commissioners were redacted and did not include any identifying information about the applicants.

Griffen said the state also failed to verify applicants’ assertions that the primary entrance for their proposed facilities would be at least 3,000 feet from school, churches and daycare centers, the distance required by the medical marijuana amendment. He also ruled the commission violated its own rules by failing to evaluate whether people connected with the applications have been affiliated with entities that have had their corporate status revoked for not paying franchise taxes.

Naturalis Health LLC, the applicant that sued over the process, has said it wants an independent evaluator to re-score the applications for the cultivation facilities.

“We’re very grateful for the judge’s decision and look forward to what comes next,” Jay Bequette, an attorney for Naturalis, said.

The five-member commission had already begun reviewing applications for dispensaries to sell medical marijuana with the hopes of awarding the 32 licenses for those facilities as soon as May. A spokesman for the commission said the court’s order was being reviewed to determine the next steps regarding that process.

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#Arkansas #Growers #judge #licensing #medical #pot #process #Tosses #Uncategorized

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oselatra · 7 years ago

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UAMS says more state aid crucial to maintain mission, quality

It needs dollars, STAT.

If you're a patient at the medical center at the University of Arkansas for Medical Sciences, you might not feel the pain that a budget deficit of $39 million represents for the institution as a whole. That deficit is but a drop in the $1.5 billion bucket that is UAMS' total budget.

But the deficit — which was budgeted last year and approved by the UA System Board of Trustees — has, at this point in the fiscal year, risen to $72.3 million. Clinical revenues, while higher this year than last, are not meeting what UAMS leadership describes as an ambitious budget, and joint initiatives with other health systems have required unexpected spending. On top of that, the UA System has told UAMS that it wants its 2019 budget to be balanced.

UAMS has run a deficit for three of the past four years, in 2014, 2015 and 2017. Revenues have tracked upward since 2010, but so have expenses. During his tenure, former Chancellor Dan Rahn, who left this year, begged the UA board to lobby for more state dollars for the institution, which supports five colleges and a graduate school. While the situation is not as bad as it was in 2014, when UAMS had to borrow money to operate, it seems to have again reached a tipping point — especially given that there are only six months left in the fiscal year to make up the $32.5 million gap, keep the deficit at $39 million and come up with a deficit-free budget for FY 2019. UAMS' unrestricted net assets, which it might tap into for emergencies, only amount to $52.4 million.

UAMS can't cut its way to a balanced budget and be the sort of medical center the state can be proud of, UAMS Interim Chancellor Dr. Stephanie Gardner and Senior Vice Chancellor for Finance and Administration Bill Bowes have emphasized. It must raise its revenues. But something's got to give on the expenditure side, and "everything's on the table," Gardner said in an interview last week. The current operating model "is not sustainable," she said.

That means vacant positions are being evaluated for elimination, benefits like vacation days for employees could be reduced and some employees may lose their jobs.

In the wake of a similar budget shortfall at the University of Mississippi Medical Center earlier this year, that hospital eliminated 195 jobs and 85 unfilled positions. When the cuts were announced, UMMC's chancellor told the media, "When you look at academic medical centers like us all across the country ... they are all facing these challenges, these battles." Gardner and Bowes said the same thing.

"We need to try to make sure there's a correction on this $32 million," UAMS' unbudgeted shortfall, Gardner said. "We can't continue like this."

In fact, in his address to the UA board in 2017, former Chancellor Rahn warned of a "death spiral" should the state not increase its appropriation for UAMS.

In an email to all employees before a Nov. 28 "Town Hall" with staff about UAMS' financial difficulties, Gardner stressed that UAMS' annual revenues have "consistently exceeded our expenses," but have "not been enough to meet our infrastructure investment needs.

"With our limited state funding, our dependence on clinical revenue to fund our education and research missions, the rising cost of doing business, proposed cuts in Medicare reimbursement and changes to Arkansas Works and the Affordable Care Act expected next year, we are faced with even greater pressures now."

What the state gives now

Arkansas's contribution to its medical teaching hospital, the institution that turns out a huge number of Arkansas's physicians, is $106.6 million a year. It once allocated $120 million, but the legislature cut the appropriation back after the passage of the Affordable Care Act in anticipation that the health care law would reduce UAMS' cost of treating Arkansas's indigent population. (The ACA, aka Obamacare, did reduce UAMS Medical Center's unreimbursed costs, from 13 percent of its budget to 3.5 percent.) The $106.6 million number sounds like a generous sum until you consider that UAMS must use a great percentage as its match for Medicaid reimbursements. In 2017, the match was $85 million, leaving only $21 million in state support for the rest of UAMS' mission, including education, research and technology development, and clinical services.

Propping up UAMS is the hospital, which provides 77 percent of revenues for all of UAMS.

The $39 million deficit stems from several things: UAMS carries depreciation on its own books, as do all campuses in the UA System. Thanks to a growth spurt in the late 2000s — which included the $130 million Winthrop Rockefeller Cancer Institute (2010), the new $197 million hospital tower (2009) and the Psychiatric Research Institute (2008), as well as the cost of high-dollar medical equipment —UAMS' depreciation stands at $85 million, an amount that represents what it needs to invest in campus facilities and equipment.

You could argue, Vice Chancellor Bowes said, that because depreciation is not a real cash expense, UAMS' budgeted deficit could have been less than $39 million. But, he said, "we have to look at it that way [because] we are responsible for the debt we incur on our projects." It is an expense that is measured collectively against revenues, thus pushing the deficit up.

UAMS will spend $4.5 million this year in debt service on bonds of $45 million to renovate rooms in its 1955 hospital — which is rife with problems in plumbing and structure — for patient use again. UAMS has two other buildings that are nearly 60 years old — the Winston K. Shorey Education Building (1957) and the Barton Research Center (1960).

Another cash expense in the deficit is $20 million that is going to raises at UAMS. Staff (not including faculty) have seen their salaries rise only 1 to 2 percent over the past four years, Gardner said. Because of lagging pay, UAMS annually has had an 18 percent turnover in nurses, she said; UAMS is working to get their pay up to market levels. UAMS also has employees whose pay is only in the 25th percentile nationwide among their peers, Gardner said.

The hospital also had a 2 percent increase in its costs for health insurance coverage for employees. "We absorbed that instead of putting it on employees," Gardner said.

The additional $32 million deficit is due to a shortfall of $15 million in anticipated clinical revenues and unexpected expenses related to the creation of the Accountable Care Organization with Baptist Health to take care of Medicare patients and a second initiative to serve Medicaid patients with behavioral health and developmental disability needs with Baptist, Arkansas Children's Hospital, Arkansas Blue Cross and Blue Shield and Bost Inc. clinics in Northwest Arkansas. The latter arrangement is meant to address the possibility of declining Medicaid dollars if the state hires a managed care company to run its Medicaid program.

Future concerns

Other negatives could impact UAMS down the road: Governor Hutchinson has asked the federal government to approve a waiver that would allow only those who make less than 100 percent of the federal poverty level to enroll in Medicaid; the Department of Human Services has said around 61,000 Arkansans would be removed from the program. UAMS can't predict what that would mean for its bottom line, since where those 61,000 would seek treatment can't be known, but it would surely increase the hospital's unreimbursed costs. Should Congress pass a tax bill with the provision that removes the penalty for not sharing in the country's insurance costs, the Affordable Care Act will be weakened further. And if the Congressional Budget Office is correct and the bill will actually raise taxes on people making less than $75,000 a year, more people may be unable to afford insurance and increase UAMS' indigent care.

Buttonholing legislators

Interim Chancellor Gardner — who is one of two new finalists for the chancellor position after the original two finalists for the job dropped out — says she and other UAMS administrators will seek out legislators one-on-one to make their case that Arkansas's only medical teaching and research institution, its only Level One Trauma Center, needs to take a higher priority in state funding.

UAMS is working to operate as efficiently as it can. "We're trying to look at every aspect of our services and programs we provide, what's critical and what's sustainable," Gardner said. "But we want to be true to our mission, to improve health care in the state."

Gardner says UAMS will reduce expenses by limiting the hiring of new employees and suspending all "reclassifications" — promotions — and "out-of-cycle salary increases." Though UAMS has taken steps to address Medicare and Medicaid reimbursement challenges, to balance the budget for the 2019 fiscal year, "much more action is needed."

Can UAMS catch up without layoffs? "We're looking at everything," Bowes repeated. UAMS can't delete clinical service lines without harming the medical college's ability to train doctors, so even if some programs cost money rather than generate it, they can't be eliminated without harming the teaching mission. But Bowes said leaving vacancies unfilled and doing away with certain contracted services will improve the bottom line.

UAMS leadership also believes the institution can raise revenues by further improvements in administrative functions, like billing, access to appointments to see more patients and cuts to hospital stays. It has contracted with Huron Consulting of Chicago to look at such changes. These strategies aren't new; much the same thing was done in 2015.

Some might argue that shorter hospital stays and more patients could be a negative, if it means patients are released too soon from inpatient care or must spend less time with their doctors at appointments because of pressures on clinics to increase patient load. Layoffs could also hurt operations.

Gardner has said that a solution "will certainly come about from a lot of creative minds providing ideas and being willing to help find solutions." Some of those creative minds could be UAMS employees; a mailbox has been set up so they can give input. While the institution declined to release their emails, it did give a list of employee suggestions: Disallow space heaters. Increase parking fees. Cut catering for meetings. Increase efficiency in collecting patient information. Eliminate the birthday holiday. Decrease length of hospital stays; see more patients. Create frequent flyer accounts to save on travel purchases. Turn off the lights when a room is not in use. Close nonclinical or hospital care during the Christmas holidays. Quit buying coffee.

No suggestions provided to the Times suggested administrators should look to their own house to save money. But, UAMS' decision-making in its pay of its administrators has gotten less than favorable attention at times. In 2013, its decision to pay a former CFO, Melony Goodhand, $312,000 simply to be on call for questions after she left the university raised some eyebrows, especially after she quit the job for which she left UAMS and after it was learned that Bowes, her successor, was hired at $270,000. More recently, an anonymous writer to the Times has grouched about the university's contract with College of Medicine Dean Pope Moseley that allows him to spend months in Denmark doing research at the University of Copenhagen while earning $600,000 a year at UAMS. Asked if faculty or administrators might be asked to renegotiate contracts in a way that would save UAMS money, spokeswoman Leslie Taylor replied, "Everything is on the table."

UAMS says more state aid crucial to maintain mission, quality

#UAMS says more state aid crucial to maintain mission #quality

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oselatra · 8 years ago

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The health of a hospital

The Medicaid expansion helped Baxter County Regional Medical Center survive and thrive, but a federal repeal bill threatens to imperil it and its patients.

When Arkansas expanded Medicaid in 2014, Mike Haynes signed up for health insurance for the first time in his adult life. "Before that, I really couldn't afford it," he said. "One income in the state of Arkansas is very tough when you're raising two children. I did it, but I couldn't afford fringe benefits, so to speak. I had to feed my kids and put clothes on them."

Haynes, 63, is a real estate agent in Mountain Home. His children are grown now, but things remain tight. "We're eating bologna, not steak," he said. His wife has multiple sclerosis and can no longer work (she qualifies for the traditional Medicaid program through her disability benefits), and Haynes' income fluctuates dramatically with the housing market. In 2014, "paychecks were few and far between," he said, and he signed up for coverage under the state's Medicaid expansion, which offers coverage to Arkansans who make less than 138 percent of the federal poverty level (that's $16,400 for an individual or $33,600 for a family of four).

A year later, his wife encouraged him to go in for a routine physical, and he ended up being diagnosed with prostate cancer and Hodgkin's lymphoma. "It was an eye-opener, extremely scary," Haynes said. "All of a sudden your whole world changes."

The doctor told him that if he hadn't come in, he had two years left to live. Now, he's in remission after a dozen sessions of chemotherapy. "I can't stress enough how much it meant to me to have coverage," Haynes said. "I knew I wasn't going to lose my house and everything else." Before getting coverage, Haynes had always avoided going to the doctor because he assumed he wouldn't be able to pay the medical bills, and he said he would never have gone in the first place without health insurance.

"Two things saved my life: Obamacare and my wife," Haynes said. "That's the truth."

Haynes has been able to get his treatment at Mountain Home's Baxter Regional Medical Center, recently named one of the top 100 rural and community hospitals in the nation by the National Rural Health Association.

The Medicaid expansion has been just as vital to Arkansas's rural hospitals as it has been to patients like Haynes, said Ron Peterson, Baxter Regional's CEO. The reduction in uncompensated care has led to a $4.2 million annual positive impact for the hospital, Peterson said. "The expansion meant the difference between us running in the red vs. running in the black," he said.

Arkansas is one of 31 states — few in the South — that expanded Medicaid eligibility to low-income adults like Haynes as part of the Affordable Care Act. The state used a unique approach known as the private option — later rebranded "Arkansas Works" — which uses Medicaid funds to purchase private health insurance for the newly eligible population. The federal government pays for most of the costs through funds made available by the ACA.

The ACA's crafters essentially made a deal with hospitals: The ACA cut Medicare reimbursements, but the reduction in uncompensated care through the Medicaid expansion helped offset some of those cuts. Without that offsetting boost, some of the state's smaller rural hospitals might not be able to survive. A hospital like Baxter — the fifth most Medicare-reliant hospital in the nation, according to Moody's, thanks to the community's significant proportion of retirees — would be forced to make dramatic cuts in services without the Medicaid offset. "The expansion of Medicaid through Arkansas Works is one of the key components that's been able to help us through the change in the ACA," Peterson said. "Not just Baxter, but it helps all of rural Arkansas."

The political future of the Medicaid expansion, however, remains dicey. State Sen. Scott Flippo, a Republican who represents the area, campaigned on ending the program and has voted multiple times for unsuccessful attempts to defund it in the Arkansas legislature. Meanwhile, the American Health Care Act, the bill backed by President Trump and passed by the U.S. House of Representatives earlier this month, would end the ACA's enhanced funding for new and returning enrollees beginning in 2020, effectively ending the Medicaid expansion program. Trump won Baxter County with 74 percent of the vote.

Peterson said that he was hopeful that the AHCA proposal would be amended further, but as it stands, the phase-out of the Medicaid expansion "would be devastating to our hospital, and I think it would be extremely bad news for all rural hospitals."

It can be a challenge to explain the value of Medicaid expansion amid the always thorny politics of the national health care debate, Peterson said. "I think that people in Mountain Home really appreciate the hospital and appreciate the services that are provided here," he said, pointing to significant giving from the community to the Baxter Regional Hospital Foundation and the more than 500 volunteers who give more than 80,000 hours of their time every year. "They want to see this hospital succeed. I just don't think they see the tie and the connection with the Medicaid expansion."

Baxter Regional is by far the largest employer in the community, employing 1,600 individuals; its payroll is more than $70 million. Outside of the hospital, opportunities for professionals are few and far between, Dan Greer, a network analyst at Baxter Regional, said. Greer has worked at Baxter Regional for nine years; before that, he worked at the Baxter Bulletin, but lost that job after the newspaper was downsized. "If it wasn't for the hospital being here, I would have been gone," he said.

If the Medicaid expansion ended, Peterson said, "You're looking at easily 200-300 jobs eliminated out of the community. That may not sound dramatic, but it's dramatic in a community of our size."

Baxter Regional's mission is to remain independent and as comprehensive as possible, Peterson said, both of which would also be threatened if the hospital took a financial hit from the elimination of Medicaid expansion. "We believe that having that local input and that local control helps us be more community-driven and make sure we're meeting the needs of the community," he said. "And we try to provide urban medicine in a rural setting. Just because you live in a rural area should not mean you should not have access to quality care."

Baxter Regional offers cardiac surgery, comprehensive oncology services and 30 different specialties; this summer, the hospital will start offering neurosurgery. As a Level III trauma center, the hospital has the resources to provide care for most traumatic injuries.

"You can't measure the value on that," said Dr. Brad Shultz, a physician in the emergency room, where the hospital sees 30,000 patients a year. "The sick, aged population we have, if we didn't have the specialists, we couldn't buy enough ambulances to keep them all transferred."

That transport itself can be a dangerous part of medical care. "Every time they're exposed to a new health care setting, it's adding risk to their situation," Gerald Cantrell, the hospital's paramedic director, said. In nonemergency situations, meanwhile, a multiple-hour drive may discourage patients from seeking the care they need.

"We're fairly isolated," Peterson said. "The next hospital that has all the types of services that we have is at least two hours away."

The hospital has invested in technology to deliver high-quality care to its isolated community. In its intensive care unit, the hospital has an "electronic ICU" that provides 24-7 access to intensive care specialists in St. Louis. Its radiology department was one of the first in the state to use 3D tomosynthesis for mammography, which is more accurate and leads to fewer call backs, and the first in the nation to develop a mobile 3D tomosynthesis unit in a custom-made RV that offers screenings in the community. "It allows us to take the mammography out to where the patient is, and helps us get to even more remote areas than Mountain Home," Peterson said. "We're going to the rural community and bringing that technology to them."

The STEMI program (STEMI is the medical shorthand for a severe heart attack) has a coordinated system in place to communicate between paramedics and the hospital to deliver care as quickly as possible — and crucially, Baxter Regional has the cath labs (diagnostic imaging equipment necessary for the optimal treatment of a heart attack) and specialists to provide an immediate intervention.

"A lot of your smaller rural hospitals won't have cath labs," Peterson said; they can offer only less effective clot-busting drugs. "If we weren't the size hospital that we are and started cutting back, you could see people having a heart attack, getting a drug, and being shipped off and not getting that intervention for three to five hours when they need to be getting it right away."

"Arkansas has the highest mortality rates nationwide for death from heart attack," Dr. Kim Foxworthy, the STEMI coordinator, said. "Our statewide mortality rates would definitely be higher if we did not have the technology and facility here. People are just not going to make it."

Just as important, Peterson said, was the hospital's commitment to outreach. He cited the community paramedic program, which offers direct services to high-needs patients in their homes, and four on-site Community Health Education and Support Houses, which offer services for patients and their families for diabetes, cancer, aging and women's health.

Without the Medicaid expansion, Peterson said, the hospital would be forced to make difficult — and potentially life-threatening — choices about what services to cut. That would impact everyone who relies on Baxter Regional, not just those covered by the Medicaid expansion. Servicing a remote community in the Ozarks with a population that isn't growing, it's unclear how the hospital would make up the funding gap if expansion goes away.

"The numbers do not add up," Peterson said. "Unless you want to abandon people who live in rural America."

Haynes, the cancer survivor who got coverage thanks to the Medicaid expansion, said he remembers years ago having to drive more than two hours to Springfield, Mo., to get to a hospital with an incubator when his daughter was born. "That's a thing of the past," he said. "I received outstanding care here. It's a tremendous service to the community."

Haynes voted in the presidential race for the first time last November and, like most of his neighbors, he voted for Trump. "I felt like we were going to be in the same position no matter what Hillary did, we needed some improvements, and I really just wanted a guy that wasn't involved in politics," Haynes said. He said he has been watching the progress of the AHCA with concern, particularly when the Congressional Budget Office found in March that an earlier version of the bill would lead to 24 million fewer people being covered (the CBO is set to issue a new score for the amended version of the AHCA this week).

"I guess I was naive because when he spoke 'change,' in my mind, I thought 'even better,' " he said. "And then as it moved along and 24 million people weren't going to get coverage, I thought, 'What's going on? Am I one of the 24 million?' "

After he wasn't able to work for a year and half because of the cancer, Haynes has just started back at his job. "It'll get better — the economy is getting better, I'm getting better, so I'm very positive about the future," he said.

Haynes said he's still grateful for President Obama. "I'd vote for the man tomorrow," Haynes said. "I don't play politics. But the man did a lot for me, period. Without Obamacare, I wouldn't be sitting here. How would you feel?"

This story was supported by the nonprofit Economic Hardship Reporting Project, part of an initiative to foster journalism about inequality in the South and the Heartland, and is also courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.

The health of a hospital

#The health of a hospital

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oselatra · 8 years ago

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How the 2017 Arkansas legislature made life worse for you

But it wasn't as bad as it could've been at the Capitol.

Arkansas's legislators were locked and loaded when they arrived for the 91st General Assembly this year, determined to get more guns into public places and take away voting and abortion rights, their evergreen attacks.

Thanks to the legislature, concealed weapons soon may be carried just about everywhere except Razorback games and the University of Arkansas for Medical Sciences. Unemployment benefits were cut, whistleblowers were silenced and charter schools were given advantages over regular public schools. Other legislation was symbolic but ugly, such as an act authored by Rep. Brandt Smith (R-Jonesboro) that aims to stop Sharia, or Islamic ecclesiastical law, from taking over Arkansas's court system.

Some of the silliest bills went nowhere, such as efforts by Sen. Jason Rapert (R-Conway) to wipe Bill and Hillary Clinton's names off the Little Rock airport, to indefinitely delay implementing the voter-approved medical marijuana program and to call a convention of the states to amend the U.S. Constitution to ban same-sex marriage. Anti-immigrant legislation that would have penalized colleges and cities with so-called "sanctuary" policies withered in committee. Rep. Smith, the sponsor of the bill targeting universities, warned that rogue professors might hide undocumented immigrants in their offices and then dump their human waste on campus in the dark of night; surprisingly, this argument did not persuade his colleagues. Rep. Kim Hendren (R-Gravette) proposed banning cell phones from public schools; later, he filed a bill prohibiting teachers from using books authored by leftist historian Howard Zinn. Neither gained traction.

What was good? A little. Conservatives tried to circumscribe the medical marijuana amendment with bans on smoking and edible products, among other roadblocks, but the worst of the anti-pot legislation stalled. Evidently reassured by Governor Hutchinson's promises to make the private option more conservative (read: stingier) down the line, the annual appropriation for Medicaid passed without a major fight — a relief for the 300,000-plus Arkansans receiving health insurance through Obamacare. Pushed by Hutchinson, the ledge directed some of Arkansas's tobacco settlement proceeds to expand a waiver program for the developmentally disabled, opening the door to services for some 500 to 900 desperate families stranded for years on a waitlist. At long last, the state will stop its reprehensible practice of celebrating Robert E. Lee's birthday simultaneously with Martin Luther King Jr. Day, a symbolic but important step forward that was championed by the governor.

Here's our survey of the damage:

GUNS In Glock we trust

The biggest gun-related news this session was the passage and signing of House Bill 1249, now Act 562, which creates a new "enhanced carry" permit that will allow gun owners who have undergone eight hours of additional training — including active shooter training, with a curriculum still to be worked out by the Arkansas State Police — to carry a concealed handgun in many places previously forbidden under the state's concealed carry law, including the state Capitol, public colleges and universities, bars, churches and courthouses. Concealed carry in prisons, courtrooms and K-12 schools is still forbidden, and private property owners, including bars, churches and private colleges, can still prohibit firearms if they choose.

Sponsored by Rep. Charlie Collins (R-Fayetteville), the bill was a far piece from where it started by the time it was signed. Originally, Collins' bill would have solely mandated that public universities and colleges allow faculty and staff to carry concealed handguns. It was an attempt to push back against the state's public colleges and universities, which have steadfastly rejected Collins' and his colleagues' attempts to institute "campus carry" in the past. Amendments to HB 1249 soon pushed it several clicks further toward the broad "guns everywhere" approach favored by the National Rifle Association, and far beyond a potential shooting iron in a well-trained professor's briefcase. Now, anyone with the enhanced permit will be able to carry on a college campus, including into sometimes-contentious student and faculty disciplinary hearings and raucous college dorms.

The passage of the bill spawned some last minute scrambling when the Southeastern Conference expressed concerns about fans coming to college football games carrying heat, resulting in Act 859, a cleanup effort that prohibits concealed carry in college athletic venues. Also exempted by Act 859 were daycares, UAMS and the Arkansas State Hospital, an inpatient facility for the mentally ill. The bill also allows private businesses and organizations to ban concealed carry without posting a sign to that effect. If a private business decides to ban concealed carry without posting a sign, anyone caught carrying a concealed weapon on the premises can be ejected or told to remove their gun if they want to come back. If the concealed carrier repeats the infraction, they can be charged with a crime. Even after the purported cleanup, that still leaves a lot of places open to concealed carry unless those places set a policy forbidding the practice, including most hospitals, mental health facilities and off-campus high school and middle school sporting events. At the signing ceremony for HB 1249, Chris Cox, executive director of the NRA's Institute for Legislative Action, said, "We believe that if you have a legal right to be somewhere, and you're a law-abiding person, you ought to have a legal right to defend yourself." For the NRA, that means the right to be armed everywhere, any time, as long as you don't have a criminal record. Notice Cox didn't say anything about pesky permits or training.

Speaking of law-abiding persons, also of concern when it comes to concealed carry is Act 486. Under the law, the Arkansas State Police is now prohibited from establishing or amending any administrative rule that would revoke or suspend a concealed carry permit unless the holder of the permit was found to be in violation of a criminal offense. While not penalizing a person if they haven't committed a crime sounds like a good idea, the problem is that people can and do go off the rails for a multitude of reasons, many of which have nothing to do with a violation of the criminal code. Before the passage of Act 486, the State Police had broad latitude to revoke or suspend concealed carry permits for a number of reasons, including serious alcohol and drug abuse, dangerous mental illness, or a mental health professional's determination that a permit holder might be a threat to himself, his family or the public. With the passage of Act 486, though, a concealed carry holder who suffers a complete mental breakdown to the point of visual hallucinations can keep on packing right until the moment he or she is admitted at the State Hospital (thanks Act 859!), even if the person's family or a doctor asks the State Police to pull their permit. Ditto with people suffering from substance abuse issues, elderly dementia patients and those who hint they might be capable of suicide or homicide. Under the law, a permit can still be revoked or suspended if the person is caught carrying into a prohibited place like a courtroom or jail, but as seen above, the list of places where handguns are prohibited is dwindling by the year. Otherwise, thanks to Act 486, we just have to wait until that person commits a crime. By then, it's too late.

In the What Could Have Been column, we have HB 1630, by Rep. Clarke Tucker (D-Little Rock), which would have created the misdemeanor offense of "negligently allowing access to a firearm by a child" if an owner failed to secure a loaded gun or left it in a place a child could easily access. Though the bill had exemptions for hunting, sport shooting and use of firearms on a farm and had a sliding scale of penalties, with incidents involving the death or serious injury of a child at the top of the list, it went nowhere.

EDUCATION

Traditional schools took licks, but the worst was kept at bay.

The single worst education bill passed in 2017 was probably Act 542, sponsored by Alan Clark (R-Lonsdale), which requires school districts to sell or lease "unused or underutilized" facilities to competitor charter schools. Charters already had right of first refusal in the event a district decides to sell a building — but after Act 542 goes into effect this summer, a charter can force a district to sell or lease a building, even if the district doesn't want to do so. If a different entity — a nonprofit, say, or a clinic or a business — wants to buy an unoccupied school building instead, that's too bad. Act 542 requires a district to hold on to unused buildings for two years, just in case a charter comes along and wants the facility for itself.

Clark pointed to a situation a few years ago in which the Helena-West Helena School District refused to sell a vacant elementary to KIPP Delta, a charter. But there are good reasons why a district wouldn't want to hand over an asset to a direct competitor: Charter networks tend to weaken districts by bleeding away higher-performing students and public money, and they often enjoy advantages their traditional public school counterparts do not. As some opponents of the bill pointed out, the new law is tantamount to forcing Walmart to sell a store to Target. That's why school superintendents across the state fought the bill and convinced no small number of Republicans to join Democrats in opposing it. In the end, though, it passed the House on a 53-32 vote. Republican legislators also rejected proposals by Democrats Sen. Joyce Elliott and Rep. Clarke Tucker — both from Little Rock, which is seeing unchecked charter growth at the expense of traditional public schools — to impose fairer rules on charters.

Thankfully, the legislature turned down an even worse proposal. HB 1222 by Rep. Jim Dotson (R-Bentonville) proposed a convoluted scheme to divert millions of dollars away from the public coffers (by means of a tax credit to wealthy donors) and toward private schools in the guise of "education savings accounts" to be used for student tuition. A school voucher plan in all but name, the bill would have been devastating to public education. Dotson eventually scaled back the legislation to a pilot program with a four-year sunset, allowing a Senate version of the bill to win passage in that chamber — but many Republicans remain fond of their local school districts, and it narrowly failed in the House.

Meanwhile, legislators expanded an existing voucher program, the Succeed Scholarship. Created in the 2015 session, it uses public tax dollars to pay private school tuition for a limited number of K-12 students with special needs. Parents are required to waive their child's civil rights protections under the federal Individuals with Disabilities Education Act. In the past, the scholarship was open only to kids with an Individualized Education Program, or IEP; now, foster children living in group homes will also be eligible, thanks to Act 894 by Rep. Kim Hammer (R-Benton). Act 327 by Rep. Carlton Wing (R-North Little Rock) will allow a nonaccredited private school to participate, as long as the school has applied for accreditation. And, the appropriation for the Succeed Scholarship rose from $800,000 to $1.3 million — an increase of 63 percent — potentially allowing as many as 200 students statewide to participate.

That bump is especially notable alongside the meager 1 percent increase in the state's overall K-12 education budget for the next two years — far less than the 2.5 percent boost recommended by legislative staff tasked with determining what constitutes "adequate" school funding. A bit more money will be directed to teacher pay and special education, and pre-kindergarten will see an overdue $3 million increase, so the money situation could be worse. Still, with state revenue squeezed hard by tax cuts, and private and charter schools knocking at the door, traditional public schools are clearly not the General Assembly's top priority.

On other fronts, school legislation was a mixed bag. Elliott's Act 1059, will limit the use of out-of-school suspensions and expulsions for students in grades K-5 — a much-needed reform — but her bid to end corporal punishment failed in committee. (Rural Arkansas still loves the paddle.) One of the better education bills to pass this session was Elliott's Act 1039 which gives teeth to a 2013 law (also by Elliott) requiring dyslexia screening and intervention. Its reporting requirements and enforcement mechanism hopefully will force districts to deliver better reading interventions to dyslexic students. A major accountability bill developed by the state Education Department, Act 930, will overhaul how schools are monitored by the state, though it's too soon to say how the changes will play out. Act 478 by Rep. Bruce Cozart (R-Hot Springs), will require high school students to pass a civics test before graduating; an attempt by Rep. John Walker (D-Little Rock) to impose the same requirement on legislators and state agency heads received a cold reception. A bill by Rep. Mark Lowery (R-Maumelle), now Act 910, will end September school elections and require them to be held concurrent with the November general or spring primary election date. That could spell trouble for future millage votes.

Finally, there's higher education: "Campus carry" dominated the news, but a major change in funding may be just as consequential. Act 148, which originated with the governor's office, creates a funding formula for colleges and universities that ties state money to metrics like graduation rate. HB 1518, now Act 563, a worthy bill by Rep. James Sturch (R-Batesville) requires the Arkansas Higher Education Coordinating Board to create an action plan for addressing sexual assault on college campuses.

— Benjamin Hardy

TAXES

Some help for the working poor and lots of punting.

Give modest credit to Governor Hutchinson. In the 2013 and 2015 legislative sessions, Republican legislators pushed a massive cut on taxes on capital gains and reduced the income tax burden on all but the working poor. This session, Hutchinson provided some relief at the lower end of the tax bracket. Hutchinson pushed through a $50 million tax cut, directed at households with a taxable income of less than $21,000. The cut is misleading, though, as it targets taxable income, which is often far less than salary or adjusted gross income. In fact, Arkansas Advocates for Children & Families pointed out that 48 percent of the overall $50 million cut will go to taxpayers in the top 40 percent of earners, while only 5 percent will go to those making less than $18,000 per year.

Establishing a refundable state Earned Income Tax Credit, tied to the federal EITC, would have been considerably more beneficial to the lower 40 percent of Arkansas earners, who often have no income tax liability, but pay a large share of their income in sales tax. An EITC would have provided a more substantial boost to the working poor at less cost than Hutchinson's cut. Rep. Warwick Sabin (D-Little Rock) and Sen. Jake Files (R-Fort Smith) were behind the EITC proposal, which historically has bipartisan appeal, but they couldn't get support from Hutchinson or enough other legislators.

Hutchinson also supported legislation that exempted all military retirement pay and survivor benefits from state income taxes. The first $6,000 of military retirement pay had been exempt previously. Since most veterans aren't career soldiers and eligible for a pension, the exemption will leave out many veterans (again, an EITC would have been a better avenue). But few politicians on either side of the aisle were going to stand in the way of helping veterans — even though Hutchinson unconscionably larded the measure with unrelated tax hikes. The legislation offset the eventual $13.4 million cost of the exemption by raising the sales tax on candy and soda. Completely unrelated to veterans' retirement income, the bill provided a $6 million tax cut on soft drink syrup, which it paid for by taxing unemployment benefits and digital downloads. So, veterans with pensions got a bump and corporate interests got significant help, while folks downloading books and movies, as well as people in between jobs, got screwed.

In the "could have been worse" column, more credit for Hutchinson: He held at bay lawmakers from his party such as Sen. Bart Hester (R-Cave Springs) who wanted to cut $100 million or more in taxes — threatening essential state services in the process — by creating a commission to consider the future of tax policies in the state.

The commission will have to consider two issues the General Assembly punted on. A bill that would have required out-of-state online retailers to collect sales tax on purchases made by Arkansans stalled in the House, with several Republicans decrying the proposal as a tax increase even though Arkansans already are required to pay the tax by law (few do because it requires self-reporting.) Still, Amazon said it would voluntarily begin collecting sales tax on Arkansas customers beginning in March. Another bill that merely would have referred to voters a proposal to increase the tax on gas to pay for bonds for highway construction failed on similar anti-tax grounds.

— Lindsey Millar

CRIMINAL JUSTICE

Atual reform

Act 423, "The Criminal Justice Efficiency and Safety Act," might be the most consequential piece of good legislation the General Assembly passed. It's a sprawling, omnibus law, with three primary components.

Most consequentially, it introduces swift and certain sanctioning, which means parolees and probationers who commit minor violations of the terms of their supervision will be sent for 45 to 90 days to Arkansas Community Correction facilities, where they will receive rehabilitative programming, instead of being sent to prison for significantly longer stints. Arkansas in recent years has had the fastest growing prison population in the country, fueled largely by parole violators returning to prison. Swift and certain sanctioning is expected to free up as many as 1,600 prison beds and save the state as much as $30-$40 million.

The law also seeks to divert people who commit nuisance offenses because they are high on drugs or having a mental health crisis in public from jail or prison. It establishes Crisis Stabilization Units, regional facilities where people in crisis could go to receive treatment for several days. The law mandates the creation of three such units, but $5 million earmarked in the state budget for the operation of the facilities, paired with significant additional federal money the state expects to draw from Medicaid, could allow for several more CSUs to open. The locations of the CSUs have not yet been selected, but Craighead, Pulaski and Sebastian counties are thought to be leading candidates. Finally, Act 423 also requires law enforcement officers to receive crisis intervention training to help them de-escalate interactions with people amid behavioral health episodes.

The law is the product of 18 months of study and presentations by the nonprofit Council of State Governments, which reported to a Legislative Criminal Justice Oversight Task Force that bill sponsor Sen. Jeremy Hutchinson (R-Little Rock) co-chaired. Hutchinson, co-sponsor Rep. Clarke Tucker (D-Little Rock) and CSG say the new law will save the state money, which can be reinvested in effective criminal justice policies. CSG's justice reinvestment program has successfully been implemented in states across the country.

Of course, whether it's successful here will depend on policymakers seeing the reforms through. One potential stumbling block: CSG recommended that the state hire 100 new parole and probation officers to better supervise the nearly 56,000 people on parole and probation. Current supervision officers handle on average 125 cases. Governor Hutchinson's budget didn't provide for funding to hire 100 new officers, though it did make temporary funding to Arkansas Community Correction permanent, which will at least allow the department to retain the 60 officers it had hired since 2015. That's not enough, Sen. Hutchinson (who is the governor's nephew) said. He hopes a future General Assembly will approve additional funding for more officers using some of the savings generated by Act 423.

A perennial stumbling block for any criminal justice reform is the inevitable violator who commits a serious crime. A significant portion of Arkansas's recent prison growth spike came because of punitive parole policies enacted in the wake of the 2013 murder of a teenager in Little Rock by a serial parole violator. It's natural to think that locking up people who commit crimes for long stretches reduces crime, but research shows it's just the opposite, Sen. Hutchinson said.

"I've had the luxury of studying this for years now. It's hard to wrap your brain around sometimes," Hutchinson said. "Longer sentences do not, in fact, result in lower crime rates. The longer [people are] incarcerated, the greater chance of recidivism they have."

Hutchinson chaired the Senate Judiciary Committee, and many of its members, chief among them Sen. Bryan King (R-Green Forest), were hostile to the idea of moving away from incarceration in certain situations. King introduced the tough-on-crime Senate Bill 177, which would have required anyone with three stints in prison to serve at least 80 percent of any subsequent sentence. Arkansas already has a two-strikes law: After someone commits a second serious violent or sexual crime, he's required to serve 100 percent of his sentence. So King's measure would have mostly targeted low-level property and drug crimes and at huge cost. According to an impact statement, it would have added 5,499 inmates at a cost of $121 million in 2026. The total 10-year cost to the state would have been $692 million, and that's not including the significant cost of building new prison housing. King let the bill die in the House Judiciary Committee after Governor Hutchinson forcefully spoke out against it.

Three other positive new laws: Act 566, sponsored by the odd couple Rep. John Walker (D-Little Rock) and Rep. Bob Ballinger (R-Berryville), has Arkansas opt out of a section in President Clinton's sweeping 1996 welfare reform law that prevents anyone who has been convicted of a felony drug offense from receiving Temporary Assistance for Needy Families benefits. Act 1012, from legislation sponsored by Tucker and Hutchinson, allows someone on probation or parole for an offense that did not involve the operation of a motor vehicle who has a suspended drivers license because of unpaid fines or fees to continue to drive to work or school. Act 539, sponsored by Sen. Missy Irvin (R-Mountain Home) and Rep. Rebecca Petty (R-Springdale), prevents minors from being sentenced to life without parole. Before they become eligible for parole, the new law requires minors sentenced to life terms to serve 20 years for nonhomicide offenses, 25 years for first-degree murder and 30 years for capital murder. Of course, the Parole Board could repeatedly deny parole requests and force someone sentenced to a life term as a minor to spend his life in prison.

The heartbreaker of the session in criminal justice was the failure of Democratic Sen. Joyce Elliott's proposal to require racial impact statements for new criminal justice legislation. The impact statements would have provided research on whether proposed legislation would have a disparate impact on minority groups. Similar bills failed in 2013 and 2015, and this one was substantially amended to merely provide the impact statements as an option, but it died on the House floor. It was another reminder that for many white people, there is no greater insult than suggesting that they or something they do might be racist, even if the bias was unintended. One opponent, Rep. Ballinger, said he did not believe in systemic racism.

— Lindsey Millar

ABORTION

Risking women's health

Women and their bodies were subjected to serious new insults this year by Arkansas legislators practicing medicine without a license.

Among the most egregious laws was the so-called "dismemberment abortion" bill, now Act 45, whose chief sponsors were Rep. Andy Mayberry (R-Hensley) and Sen. David Sanders (R-Little Rock). The bill prohibits doctors from performing what doctors believe is the safest method of second trimester abortion: dilation and evacuation. The alternatives would be something akin to a Caesarean section, in which the belly is cut open to remove the fetus, or an induced abortion, which requires the woman to go into labor to expel a fetus killed by an injection of salt water, urea or potassium chloride into the amniotic sac. Those procedures are what doctors call "high morbidity" — meaning they have a high risk of making patients sick.

Dilation and evacuation is recommended by the World Health Organization, the American College of Obstetrics and Gynecology and the American Medical Association. The difference between those organizations and the Arkansas legislature is that one group does not believe women should receive the best health care possible.

But Mayberry and Sanders and their co-sponsors think D&E, which uses a vacuum, is tantamount to butchery. But hysterectomy and induction abortions accomplish the same end as a D&E and are far less safe.

There is no exception for incest or rape in the law. And, like previous laws passed by legislators who think their particular religious beliefs give them the right to control women, the law particularly harms women who can't afford to travel to a more broad-minded jurisdiction to exercise a legal right.

Another evil of the law is that it allows a spouse, parent or guardian to bring a civil suit against the abortion provider if the woman has "received or attempted to receive" dilation and evacuation. That means, according to abortion rights activists and Mayberry himself, a husband can stop an abortion. He may have committed rape. A parent may have committed incest. Doesn't matter.

Rep. Charlie Collins (R-Fayetteville) and Sen. Missy Irvin (R-Mountain View) brought us the bill that became Act 733, the so-called "sex-selection abortion ban." Despite the fact that there is zero evidence that Arkansas women are dashing into abortion clinics because they've determined the sex of their fetus and don't like it, the bill has the potential to create an huge burden on the doctor provider.

Say a woman has had prenatal tests to see if her fetus has a genetic disorder. She learns there is a disorder and, by the way, the sex of the fetus. Her doctor must ask if she knows the gender of the fetus. If she answers that she does, the abortion must be delayed, because this new state law requires the doctor to "request the medical records of the pregnant woman relating directly to the entire pregnancy history of the woman." No abortion may be performed until every chart for every pregnancy generated by the woman's ob-gyn (or ob-gyns) and staffs and hospitals, every record generated during every trip to the ER she may have had to make, is supplied and reviewed by the abortion provider. Not only could that take a lot of time and generate a mountain of paperwork — what if the woman already had five children? — but it would also notify, perhaps against the woman's will, her doctors and their staffs that she is seeking to obtain an abortion.

The bill does not state what information in those records would suggest that the woman was hell-bent on not having another boy or girl.

"Why are physicians and the clinic made to be an investigative party into a woman's motives to have an abortion?" asked a spokesman for Little Rock Family Planning, the state's only clinic that offers abortion up to 21 weeks.

Rep. Robin Lundstrum (R-Elm Springs) and Sen. Scott Flippo (R-Bull Shoals), like Mayberry and Sanders, introduced what's called a model TRAP law (targeted regulation of abortion providers) meant to end abortion by imposing stricter inspection regulations on clinics. The bill allows the state Department of Health to make yearly trips to inspect clinic records and "a representative sample of procedures"; to regulate all aspects of the clinic "without limitation," and to collect an annual fee of $500.

While purporting to be a bill to protect women's health, the new law, Act 383, is designed to let the state shut down a clinic for facilities violations not spelled out in the legislation. It's not clear what violation would close the clinic. Towel on the floor? Out of paper towels? Scoop left in the break room freezer's icemaker?

As it happens, Little Rock Family Planning is inspected frequently, more than the once every year that the law already called for. The health department inspected the clinic four times in 2016, citing such things as discolored ceiling tiles and a chair with rips. The clinic's spokesman said some inspections are instigated by complaints from the anti-abortion protesters that picket outside.

The vague language of Act 383 "has potential for abuse. We don't know if we would be singled out and treated differently, if our license could be suspended for even minor paperwork violations," the spokesman said.

— Leslie Newell Peacock

TRANSPARENCY

The public's right to know took one step forward, two steps back.

Arkansas's robust Freedom of Information Act came under assault in 2017 as never before, with legislators proposing at least a dozen new exemptions to the open records law. Thanks to SB 131, now Act 474, by Sen. Gary Stubblefield (R-Branch), security plans of the State Capitol Police are no longer disclosable to the public; Stubblefield's reasoning was that someone seeking to do violence at the Capitol might request such plans, but the law is written so broadly that virtually any record of the Capitol police could fall under the new exemption. Stubblefield's SB 12 (Act 541) created a similar exemption for schools, including colleges and universities. HB 1236, now Act 531, by Rep. Jimmy Gazaway (R-Paragould), prevents the disclosure of a body-cam or dash-cam recording of the death of a law enforcement officer.

Thankfully, though, many anti-FOIA bills failed. The most significant was SB 373, by Sen. Bart Hester (R-Cave Springs), which proposed exempting attorney-client communications and work product from the FOIA if the client is a public entity. The force behind the bill was the University of Arkansas. The problem with this idea — aside from the fact that attorney-client communications can already be shielded on a case-by-case basis, by order of a judge — is that a public entity could declare almost any record exempt simply by emailing that record to its attorney. Had it passed, this loophole could have swallowed the entire FOIA.

On the bright side, Rep. Jana Della Rosa (R-Rogers) managed to pass HB 1427, now Act 318, to require candidates to file their monthly finance reports electronically, rather than on paper. HB 1010, now Act 616, by Rep. Warwick Sabin (D-Little Rock) extends the same requirement to political action committees and other groups. This matters because a searchable electronic database will make it much easier for the public to track contributions made to candidates and PACs, as well as their expenditures.

However, the legislature quashed an effort to shine a light on the darkest regions of campaign finance when it rejected HB 1005, by Rep. Clarke Tucker (D-Little Rock). The bill would have required disclosure of "electioneering" spending, meaning advertisements by independent organizations, nominally unaffiliated with any candidate, that dodge ethics laws by scrupulously avoiding the use of phrasings like "vote for" or "vote against." A growing number of states recognize that such ads — which have proliferated tremendously in recent years and comprise hundreds of millions of dollars in spending nationwide — are de facto campaign commercials and require them to be reported as such. Not Arkansas.

— Benjamin Hardy

ANTI-LGBT

Threats stalled.

The legislature still shows animus toward people who don't fit its definition of normal, but Arkansans lucked out when three anti-LGBT bills failed. Two so-called "bathroom bills" that targeted transgender children and adults and another that would have let doctors refuse to perform a procedure if it offended their "deeply held beliefs" did not make it into law.

But the legislature also blocked a bill that would have corrected an injustice. SB 580, by Sen. Joyce Elliott (D-Little Rock), would have provided for the automatic listing of both parents' names on the birth certificates of children of married same-sex couples, an important factor in establishing inheritance and other matters. In a marriage between a man and a woman, the names of both parents are listed on a child's birth certificate, even in cases of surrogacy or artificial insemination. Arkansas is the only state that treats children of same-sex parents differently in this regard, seemingly in violation of the U.S. Supreme Court's 2015 ruling that struck down bans on gay marriage nationwide. Elliott's bill would have fixed the problem, but when SB 580 came before the Senate Judiciary Committee, vice-chair Sen. Linda Collins-Smith (R-Pocahontas) said same-sex parents could make a will if they wanted to ensure their kids get an inheritance.

Besides the children of same-sex couples, Collins-Smith doesn't much like transgender people, either. She introduced SB 774 to require that people had to use public bathroom or changing facilities that corresponded with the sex as listed on their birth certificates, and that the governing body of the public entity had to make sure the law was enforced. Little Rock Convention and Visitors Bureau director Gretchen Hall and Verizon Arena General Manager Michael Marion told Collins-Smith in a hearing on the bill said they could not see how it would be possible to know what was on the birth certificate on the thousands of people who might answer the call of nature at an event. "It's your job to find a way," Collins-Smith snarled. Collins-Smith pulled down the bill when she realized it was not going to pass.

The House passed a bill introduced by Rep. Bob Ballinger (R-Berryville), who also had his mind on bathroom use, to expand the state's indecent exposure law. State law already says it is a crime to expose one's genitalia with intent to gratify sexual desire; Ballinger's bill would have made it a crime simply to expose genitalia in front of a person of the opposite sex. (Maybe it's common practice to inspect genitalia in bathrooms up in Berryville.) Though the House vote for the bill was 65 to 3, the bill went down the Senate Judiciary Committee drain, as Collins-Smith's did.

Governor Hutchinson, who did not want Arkansas to suffer economically as North Carolina did when it passed its "bathroom bill" (since partially repealed), was relieved.

Another ugly bill was introduced by Rep. Brandt Smith (R-Jonesboro): the Health Care Freedom of Conscience Act, which would have allowed doctors to refuse to administer health care services that offended their "deeply held beliefs." Smith had in mind both reproductive rights and transgender reassignment surgery. There was no support for the bill from medical professionals, and state Surgeon General Dr. Gregory Bledsoe spoke against it, saying, "If you're a member of any sort of minority group ... these sorts of bills send a message that threatens you."

—Leslie Newell Peacock

AVERAGE ARKANSANS

Workers, consumers and other enemies of the state got a raw deal.

Governor Hutchinson deserves some recognition for passing a modest income tax cut for working people this session, even if it wasn't quite the boost for the poor that he claimed (see Taxes, page 15). But in almost every other way, the average Arkansan got screwed by the 2017 session.

Start with Act 986, by Rep. Laurie Rushing (R-Hot Springs), which will outlaw private class-action lawsuits under the Deceptive Trade Practices Act — a cornerstone of consumer protection law. Such suits are a powerful deterrent against businesses that intentionally scam customers in various small ways, such as false advertising or misleading promotional offers. Preventing consumers from bringing claims as a class gives the unscrupulous a freer hand to prey on the unsuspecting.

Act 606, by Rep. DeAnn Vaught (R-Horatio), provides a boon to corporations by allowing an employer to sue a worker who records a video or takes photos in the workplace "and uses the recording in a manner that damages the employer." In other words, it will stop whistleblowers from documenting unethical or illegal practices, such as animal abuse at factory farms. Animal rights organizations refer to it as an "ag-gag" bill.

Maybe the biggest prize for big business, though, was the "tort reform" measure that was referred to the 2018 ballot, Senate Joint Resolution 8. Sponsored by Sen. Missy Irvin (R-Mountain Home), it proposes a new amendment to the state constitution that would place ceilings on the noneconomic and punitive damages that may be awarded to a claimant in a civil suit. Attorney contingency fees would also be capped, at one-third of the net recovery. In short, this would sharply limit the ability of someone who was grievously harmed by an act of medical malpractice to seek compensation in court. SJR 8 sparked a bruising fight in the legislature, with a few Republicans breaking ranks to speak forcefully against abridging the right to a trial by jury. But business interests — especially nursing homes — have been pushing tort reform for years, and the measure proved unstoppable. Unless Arkansas voters reject it in 2018, that is.

Speaking of abridged rights, the legislature also referred a proposed amendment that would enshrine a voter ID requirement in the Arkansas Constitution. The hard truth is that House Joint Resolution 1016, by Rep. Robin Lundstrum (R-Elm Springs), will likely pass in 2018 given the state's electoral trends. Never mind that proponents of voter ID can't cite any documented instances of voter impersonation in Arkansas, and never mind the evidence that such measures elsewhere have resulted in voters being disenfranchised — voter ID has become gospel to Republicans, aided by President Trump's falsehoods about rampant fraud in the 2016 election. Redundantly enough, the legislature also passed a voter ID bill in addition to the referred amendment, Act 633 by Rep. Mark Lowery (R-Maumelle).

Arkansas's status as the worst state in the nation for renters went unchallenged. A bill by Sen. Blake Johnson (R-Corning), now Act 159, softened but preserved the state's unconscionable, one-of-a-kind criminal eviction statute, which courts in several counties have deemed unconstitutional. Thanks to the lobbying efforts of the Arkansas Realtors Association, Arkansas also remains the only state in which there is no minimum habitability standard for rental property. HB 1166, by Hot Springs Republican Rushing, purported to address that deficiency, but the bill's proposed standards were pitifully weak — limited to electricity, water, sewer and a roof — and it may have limited renters' meager rights in other ways, so it's best it failed.

Legislators' sympathy for landlords didn't translate to protecting small property owners railroaded by the oil industry. House Bill 2086, an effort by Rep. Warwick Sabin (D-Little Rock) to more carefully examine the use of eminent domain by pipeline companies, was drafted in response to the construction of the Diamond Pipeline, which will carry crude oil across the length of Arkansas from Oklahoma to Memphis. It failed to get out of committee.

Currently, unemployment benefits in Arkansas cover workers for a maximum of 20 weeks, which is a shorter span than any surrounding state except Missouri (also 20 weeks). Act 734 from Rep. Lundstrum will soon reduce that coverage time to 16 weeks ... and reduce weekly benefits checks paid to laid-off workers. This is despite the state's unemployment trust fund having amply recovered from the recession (it now contains around $500 million) and unemployment levels at record lows. So why trim benefits now? Simple: Employers want more money for themselves.

There was at least one good piece of consumer legislation, though, sponsored by none other than Sen. Jason Rapert (R-Conway). Act 944 aims to close a loophole exploited by payday lenders, which were driven out of Arkansas some years ago by a ban on high-interest loans but recently have been creeping back into the state by charging astronomical "fees" in place of interest.

And some bad measures failed, the most obnoxious probably being HB 1035 by Rep. Mary Bentley (R-Perryville). The bill would have prohibited SNAP recipients from using food stamps to purchase items the state Health Department deems unhealthy, such as soda; it stalled in the face of opposition from grocery stores and others. House Bill 1825 by Rep. John Payton (R-Wilburn), which went nowhere, would have seized lottery winnings from citizens who have received public assistance from the Arkansas Department of Human Services. And, efforts to chip away at workers compensation failed this time around. Got to leave something for 2019.

—Benjamin Hardy

How the 2017 Arkansas legislature made life worse for you

#How the 2017 Arkansas legislature made life worse for you

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oselatra · 8 years ago

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MJ FAQ

A primer on the Arkansas Medical Marijuana Amendment.

Who can get a prescription?

Well, technically, no one.

Doctors can't prescribe marijuana as they prescribe other drugs, because the substance is still considered to have "no accepted medical use" by the U.S. Food and Drug Administration, despite ample scientific evidence to the contrary. Instead, a doctor will sign a document certifying that a patient "has a qualifying medical condition and the potential benefits of the medical use of marijuana would likely outweigh the health risks for the qualifying patient," as stated in the amendment. The Department of Health will then issue a "registry identification card" to the patient, permitting him or her to obtain cannabis from a dispensary. The card, which is valid for one year, will cost a fee that is yet to be determined.

The amendment specifically lists 12 qualifying medical conditions: cancer, glaucoma, HIV/AIDS, hepatitis C, amyotrophic lateral sclerosis (Lou Gehrig's disease), Tourette's syndrome, Crohn's disease, ulcerative colitis, post-traumatic stress disorder (PTSD), severe arthritis, fibromyalgia and Alzheimer's disease. However, it also includes any "chronic or debilitating disease or medical condition or its treatment" that results in one of the following symptoms: "cachexia or wasting syndrome; peripheral neuropathy; intractable pain, which is pain that has not responded to ordinary medications, treatment, or surgical measures for more than six months; severe nausea; seizures, including without limitation those characteristic of epilepsy; or severe and persistent muscle spasms, including without limitation those characteristic of multiple sclerosis." The state Department of Health can also add other conditions to the list, and the public may petition it to do so.

Where will medical marijuana be available?

The Medical Marijuana Commission will initially distribute 32 dispensary licenses in Arkansas. As of the date of this article's publication, the commission was still considering how best to geographically distribute those 32 initial licenses so as to minimize coverage gaps. It will likely subdivide the state into several areas (by congressional districts, perhaps) and give out a certain number of licenses within each subdivision. The amendment specifies that no county can contain more than four dispensaries and says the businesses cannot be located within 1,500 feet of a school, church or daycare, but other details about their placement are left up to the commission — and to local governments.

The citizens of a city or county may prohibit dispensaries and cultivation facilities from operating within their borders by means of a local election, just as they can do for alcohol. It's quite likely some of the state's more socially conservative communities will vote themselves "dry" — which will further limit access. The amendment also allows cities and counties to enact "reasonable zoning regulations" to apply to dispensaries, "provided that these zoning regulations are the same as those for a licensed retail pharmacy."

What if I don't live near a dispensary and I'm too sick to travel?

The amendment allows for a "designated caregiver" to obtain a registry identification card from the Department of Health, thus allowing the caregiver to purchase marijuana for a qualified patient and deliver it.

Who's going to be growing all this pot?

The Medical Marijuana Commission will initially award five cultivation facility licenses statewide, and these growers will presumably supply the bulk of the marijuana distributed in the state. Issue 6 also allows for dispensaries to cultivate up to "50 mature marijuana plants at any one time plus seedlings." However, the commission plans to charge much higher licensing fees to dispensaries that choose to cultivate marijuana, which seems likely to discourage small-scale cultivation and benefit the five big growers. The amendment does not allow patients or caregivers to grow their own marijuana.

How much will it cost and what sorts of products will be available?

This is to be determined — by supply, demand and regulation. Price is a concern for patient advocates, who say licensing fees on dispensaries and growers may drive up costs and make the drug prohibitively expensive for low-income patients. Neither private insurance nor Medicaid will pay for cannabis, and the amendment does not contain price controls or financial assistance for the poor. (It's possible dispensaries could choose to offer marijuana at discounted rates to low-income patients, as has happened in some other states.)

The Department of Health will require marijuana to be labeled with its strain, its producer and its concentration of THC and CBD, among other information. Aside from the plant itself, it is not yet clear exactly what other products — such as extracts or concentrates — state regulators will allow to be sold in Arkansas. In states like Colorado, edibles are a big part of the medical (and recreational) marijuana business, but critics worry those products appeal to kids. On the other hand, it's in the interest of patients to provide a drug delivery mechanism that doesn't require smoking the stuff.

Can a qualified patient live out of state?

Draft regulations being prepared by the Department of Health require a valid Arkansas driver's license to obtain a registration card. However, the amendment does allow for reciprocity with other jurisdictions that allow medical marijuana. An out-of-state patient with his or her state's equivalent of a registry identification card can patronize an Arkansas dispensary, provided his or her condition qualifies under the Arkansas law.

If I'm a qualified patient, can I lose my job or be evicted for marijuana consumption?

No. But there are always gray areas.

The amendment prohibits employers, landlords, schools, professional licensing boards and others from discriminating against individuals based on their status as a qualifying patient. However, some jobs — such as those involving heavy machinery — come with their own rules regarding the use of medications that could affect the operator's mental state. Chris Burks, a labor lawyer in Little Rock, said that it should be an "easy fix" for employers to amend their policies to accommodate medical marijuana in the workplace because prescription drugs are already covered. "Most places will want to revise their employee handbooks ... but most handbooks need a little work, not a lot," Burks said.

As for rental property, the amendment does allow a landlord to forbid a qualifying patient to smoke marijuana on the premises, as long as the patient is not prohibited from ingesting it by other means.

Will people still be arrested for possessing or selling weed?

Yes, sadly. Possession and distribution of cannabis outside the strictures of the amendment remain illegal, and the many Arkansans whose records have been blemished by a criminal marijuana offense will get no relief from this change in law. That being said, local law enforcement policies regarding small-scale marijuana possession vary from jurisdiction to jurisdiction, and it remains to be seen whether the new medical marijuana law will change how local police and sheriff departments handle arrests.

At the state level, Bill Sadler, a spokesman for the Arkansas State Police, said the agency is waiting for clarity from the legislature. "It would not be prudent to start making policies with respect to how this law would be enforced — with respect to any traffic stops, individuals who may exhibit signs of being impaired by marijuana, what documents would be necessary [for a patient to have in the vehicle] — until we have the facts from the General Assembly," Sadler said. "These are issues that have got to be cleared up, and we believe that before the end of the session, we'll have a pretty good idea."

How do I get into the dispensary or cultivation business?

Becoming a cultivator isn't easy. An applicant must prove he has $1 million in assets, $500,000 in cash and pay an application fee of $15,000. The annual licensing fee is $100,000. The five cultivation licenses will be awarded on a merit-based system according to a rubric that has yet to be finalized by the Medical Marijuana Commission. (See accompanying main story for more details.)

Dispensaries are somewhat more doable. For those dispensaries that plan to grow plants, the initial license fee is $25,000; for stores that merely sell the product, it's $2,500. The application fee for both types of dispensary is $7,500. Licenses will be awarded by a lottery system, though applicants must meet minimum requirements before being considered.

Both types of businesses come with in-state residency requirements and a long list of other minimum qualifications.

What happens to the taxes and fees associated with marijuana?

State sales tax generated by marijuana is allocated for specific purposes under the amendment. Ten percent will pay for the operations of the Department of Health and ABC (regulating a new industry takes additional staff, which costs money) and the Medical Marijuana Commission. Ten percent goes toward workforce training programs at the Department of Career Education, 50 percent will support vocational and technical colleges, and the final 30 percent goes into state general revenue. Licensing and other fees collected by the commission, the Department of Health and ABC will also fund the regulators' operations.

MJ FAQ

#MJ FAQ

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