Arkansas water quality rules, urgent care access changes held for further review by lawmakers

Yahoo

14-05-2025

Water quality rules will be taken up by lawmakers later this summer. (U.S. Department of Agriculture Natural Resources Conservation Service/Flickr)
An update to Arkansas' surface-water quality rules was pulled from the Legislature's Joint Public Health Committee's agenda Wednesday to give lawmakers more time to consider it.
Meanwhile, a Department of Human Services rule, which would change state Medicaid rules to allow recipients up to two urgent care visits a year without a doctor's referral, was sent to a subcommittee for further consideration after multiple legislators expressed concern about whether the text of the rule could have unintended consequences.
The changes to Rule 2, which contains the water quality standards for rivers, lakes and other surface waters in the state, were brought before the committee by the Department of Energy and Environment's Division of Environmental Quality.
States such as Arkansas that have been authorized to administer the federal Clean Water Act are required to undergo this review every three years to update existing water quality standards.
Committee chair Sen. Missy Irvin, R-Mountain View, said Rule 2 would likely receive its own hearing in June or July, separate from the committee's other business.
The regulation containing Arkansas' existing water quality standards was already long, and the current review introduced a number of changes. DEQ is making cadmium and ammonia standards — which are from 1986 and 1999, respectively — more stringent to match the standards set by the EPA in 2016 and 2013 for those pollutants. Additionally, DEQ included standards for five new pollutants not currently in the regulation.
These pollutants — benzene, ethylbenzene, phenol, toluene and xylene — can have a wide variety of detrimental effects on human health. The standards are 'health-based,' the division said in its documentation, and are meant to protect the health of humans and wildlife exposed to the state's surface waters.
'I think [committee members] needed more time to review it,' Irvin said after the meeting concluded. 'There were a lot of public comments, as well as comments from other state agencies and constitutional offices — so a lot of questions.'
The Arkansas Department of Transportation and Arkansas Game and Fish Commission submitted feedback during the public comment period earlier this year. While ARDOT questioned when the new standards would become applicable to permit holders and how the change from a fecal coliform bacteria standard to an e. coli standard would affect permits, AGFC continued its requests to designate more waters in the state as 'Extraordinary Resource Waters' in order to protect vulnerable and endangered species.
The agency made a similar request in 2020, during the last triennial review.
A proposed amendment to a DHS rule aiming to hasten access to urgent care clinics for Medicaid recipients was referred to the Human Services subcommittee.
Representatives from the department said the goal of the change was to divert patients from emergency rooms when there were other treatment options available. The need for a referral was a barrier to this when medical care became necessary after hours and a referral could not be obtained.
The rule would allow Medicaid recipients with a primary care provider to go to an urgent care clinic twice a year without a referral, while those 'who are not yet assigned' a PCP would be allowed to go up to four times. Referrals would be required after the number of yearly visits are exhausted.
Some lawmakers instantly took issue with the rule's language. Rep. Aaron Pilkington, R-Knoxville, said he was opposed to the change due to concerns it would remove incentives for Medicaid recipients to obtain a primary care provider.
'It seems like this flies in the face of what the Legislature has been doing the last decade, trying to get more people to have an assigned PCP who is someone who can actually be the quarterback of their care,' Pilkington said.
Research has found people with a PCP tend to have better health outcomes than those without one, according to the U.S. Department of Health and Human Services.
'We want to preserve the bond between a patient and their PCP,' said Nell Smith, DHS' deputy director of medical services. 'That's why we still require a PCP referral [after a certain number of visits]. We don't want to shift care onto urgent care clinics.'
However, Smith said, when these patients need care outside of business hours, they're being sent to the emergency room because of difficulties obtaining referrals.
'It's a fine balance, I'll give you that,' Smith said.
Sen. John Payton, R-Wilburn, appeared to take issue with requiring referrals for urgent care clinics at all.
'This referral process can really slow down medical care,' he said, explaining how one of his employees was 'sitting at home' in pain because of the wait to see a specialist. That employee visited the emergency room twice while waiting for an appointment, Payton said.
'I think we should be evaluating whether or not the urgent care clinic is capable of diagnosing and treating more than we worry about how the patient got there and whether they were referred or not,' he said.
While he understood trying to get Medicaid recipients to get an appointment with a primary care provider, Payton said urgent care clinics also had licensed physicians and nurses capable of treating and diagnosing conditions.
Irvin cautioned that it was important the department make its definitions within the rule clear after multiple lawmakers also asked questions about how the rule defined an emergent care clinic. She said many PCPs offer day clinics for these purposes and it was important that the rule didn't cause them to be 'skipped out on.'
Irvin ultimately moved the rule to the joint Human Services subcommittee for further consideration. The subcommittee is headed by Pilkington.
The agency received no public comments on the rule.