►
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
B
A
E
A
Here
all
right
and
before
we
get
started,
I
wanted
everyone
to
note.
I
know
we
have
new
lrc
rules
about
members
attending
remotely.
However
senator
kerr,
I
believe
her
husband
has
recently
tested
positive
for
kovid,
so
I
know
she's
staying
at
home
to
be
safe,
everybody.
We
appreciate
that
and
so
senator
curry
is
attending
remotely
today.
As
a
result
of
that
also
we
got
a
full
house.
I
know
some
might
be
trying
to
find
a
seat
senate.
Actually
the
room
131
annex
room
131
is
the
overflow.
A
A
Real
tight
interim
meetings
are
often
an
opportunity
for
us,
particularly
the
short
session,
coming
up
to
try
to
address
some
of
the
bills
and
things
we
couldn't
get
across
the
finish
line
during
the
longer
session,
and
so
we
want
to
make
sure
that
we
have
an
opportunity
to
to
have
some
discussion.
Some
questions
from
the
members
so
try
to
keep
the
testimony
tight.
Sometimes
the
bills
have
already
been
reviewed
during
the
regular
session.
People
are
familiar
with
it,
but
we
want
to
be
respectful
of
everybody's
time
and
opportunity.
A
The
first
order
of
business
is
approval
of
the
minutes
from
the
june
2nd
meeting.
Do
I
have
a
motion
on
that?
You
have
a
motion
in
a
second
all,
those
in
favor,
please
signify
by
saying
aye,
all
right.
The
minutes
are
approved
all
right.
First
thing:
we're
going
to
take
up
is
we're
going
to
look
at
our
regulations.
First,
it's
item
number
eight
and
there's
quite
a
few
referred
administrative
regulations
on
the
agenda.
A
I've
had
a
chance
to
review
these.
I
know
there's
been
some
discussion.
Some
of
these
are
regulations
we've
discussed
before
and
there
have
been
a
few
changes.
I
believe
there
is
on
902
kar
010
120
as
kentucky
public
swimming
and
bathing
facilities.
There
is
an
agency
amendment
on
that
regulation,
so
for
us
to
consider
that
we
need
a
motion
on
that
agency
amendment.
If
there's
anyone
here
from
the
cabinet
who
may
want
to
come,
yeah
who
can
come
testify
and
talk
about
that
amendment
would
be
great.
A
You
could
come
forward,
identify
yourselves
for
the
record
and
just
we've
had
this
discussion
about
this.
It's
always
was
controversial
in
administrative
regulations
committee
before
and
in
this
committee
as
well.
If
you'd
like
to
introduce
yourselves
and
please
begin
your
testimony
about
what
this
regulation
is
and
what
the
amendment
does.
C
Julie
brooks
regulations
coordinator
for
the
department
for
public
health,
jessica,
davenport
environmental
management
branch
facility
section,
so
the
we
began
the
process
to
amend
our
swimming
pool
regulation.
Probably
last
fall.
We
had
a
number
of
public
comments,
did
a
statement
of
consideration
and
amended
after
comment
version
of
that
regulation.
C
At
the
first
time
it
was
before
a
reg
review.
There
were
some
additional
concerns
raised
by
the
committee
members,
so
we
deferred
the
regulation
made
some
additional
amendments
through
an
agency
amendment
at
that
time,
when
the
regulation
was
before
rig
review
the
second
time
there
was
additional
concerns
brought
by
a
stakeholder
group.
So
this
agency
amendment
before
you
addresses
those
additional
concerns.
C
C
C
C
So
through
some
conversations
with
program
staff,
we
agreed
to
allow
a
facility
that
if
they
have
an
alternative
lifeguard
staffing
plan,
they
could
also
submit
for
a
variance
of
the
safety
requirements.
So
that's
what
this
agency
amendment
does
and
then
the
rest
of
this
brings
our
inspection
forms
in
line
with
those
additional
changes.
A
J
Thank
you
for
bringing
this
before
us,
and
I
just
have
a
quick
question
on
the
alternative.
Lifeguard
plan
staffing
plan
does.
Does
this
still
require
that
a
lifeguard
be
present
at
the
public
park,
our
state
parks
and
public
beaches,
because
I
know
that
there's
a
a
an
issue
with
finding
lifeguards
and
that's
never
been
in
place.
C
A
Any
other
questions,
if
not
we'll
need
to
have
a
motion
to
accept
the
agency
of
emotion.
Is
there
a
second
give
a
second
all,
those
in
favor
of
the
amendment,
please
unified
by
saying
aye,
aye
aye.
Anyone
opposed
right.
The
amendment
has
been
adopted
to
that
any
other
discussion
on
this
regulation
or
any
other
regulation.
That's
before
the
committee,
if
not
we'll
let
the
records
show
that
these
have
been
reviewed
by
the
committee.
Thank
you
very
much,
ladies
for
your
your
time
and
coming
forward.
A
All
right.
Let's
go
back
to
item
number
three
on
the
agenda
that
we're
going
to
talk
about
community
mental
health,
centers
and
behavioral
health
service
organizations.
We've
asked
the
commissioner
mr
wendy
morris
to
come
today
and
and
present
a
bit
of
information,
so
I
think
we've
got
the
commissioner
as
well
as
listener
robbins
from
the
department
for
behavioral
health
and
developmental
intellectual
disabilities.
D
D
All
right,
first,
just
a
very
a
brief
overview.
Community
mail
health
centers
were
established
in
1964
in
an
effort
to
assure
that
a
full
array
of
community-based
behavioral
health
services
were
going
to
be
available
to
the
citizens
of
all
120
counties
here
in
kentucky
and
that's
pursuant
to
krs
chapter
210
and
again
it
provides
services
for
people
for
folks
with
mental
health
substance
use
disorder
as
well
as
developmental
and
intellectual
disabilities.
D
The
cmhcs
are
regional
boards
and
they
are
designed
to
provide
services
to
a
designated
region.
They
are
all
501,
3c,
private,
nonprofit
organizations
and
collectively
they
do
in
fact
serve
all
120
counties.
They
serve
as
our
public
behavioral
health
safety
net
and
work
in
collaboration
with
our
four
state
designated
inpatient,
psychiatric
hospitals,
behavioral
health
service
organizations
were
established
in
2014
in
an
effort
to
increase
the
number
of
providers
that
could
serve
medicaid
eligible
individuals.
D
D
The
communal
health
centers
are
required
to
serve
adults
with
mental
illness,
including
our
very
vulnerable
population
of
people
with
serious
and
persistent
mental
illness
they're
required
to
serve
children
with
mental
illness,
including
those
with
severe
emotional
disability,
they're
required
to
serve
adults
and
children
with
intellectual
and
developmental
disabilities
and
they're
required
to
serve
adults
and
children
with
substance
use
disorder.
It's
also
noteworthy
that
they're
required
to
serve
everyone,
regardless
of
their
ability
to
pay
behavioral
health
service
organizations,
on
the
other
hand,
may
select
one
or
more
services.
D
There's
a
wide
array
of
outpatient
services
they
can
choose
from.
They
may
serve
adults
or
children.
They
may
serve
those
with
a
mental
health
disorder
or
those
with
co-occurring
mental
health
and
co-occurring
substance
use
disorder,
and
while
they
could
choose
to
serve
folks
with
serious
and
persistent
mental
illness
right
now,
only
five
of
the
141
do
they
do.
D
D
It
is
a
different
population,
okay
and
so
what
services
community
mental
health
centers
are
statutorily
required
to
provide
a
full
array
of
services,
including
inpatient,
which
again
they
collaborate
in
function
with
our
state
designated
hospitals,
a
full
array
of
outpatient
services,
partial
partial
hospitalization,
rehab
services,
emergency
services,
consultative
and
education
services
and
services
for
individuals
with
developmental
and
intellectual
disabilities.
D
D
I
do
want
to
mention
crisis
specifically
crisis
units.
I
know
we
get
a
lot
of
questions
about
that.
There
are
currently
19
crisis
units
in
the
state
of
kentucky.
17
are
operated
by
our
community
mental
health,
centers
and
two
are
operated
by
wellspring
in
jefferson
county,
a
bhso
that
does
run
those
services
as
well.
D
We
do
contract
the
department
contracts
with
all
14
community
mental
health,
centers
all
14
are
sub
recipients
and
they
get
general
funds
along
with
our
block,
grant
funding
and
other
revenue
streams
other
grants.
Those
funds
are
allocated
based
on
formula,
so
each
kind
of
pot
of
money
to
for
certain
services
has
a
different
formula.
D
It's
based
in
part
on
how
many
people
are
in
that
region,
the
estimated
number
of
people
with
certain
types
of
illnesses
and
then
their
historical
service
data.
So
if
they've
provided
a
lot
of
a
particular
service
in
the
past,
we
want
to
make
sure
they
have
ample
funding
to
continue
providing
that
service
in
the
future.
D
Others
are.
Other
funds
are
allocated
through
a
notice
of
funding
opportunity
and
all
14
are
medicaid
providers,
behavior
behavioral
service
organizations.
We
do
contract
with
five
of
the
141
again,
those
are
the
ones
that
specifically
offer
services
that
are
for
people
with
serious
mental
illness
or
children
with
serious
emotional
disorder.
We
fund
one
of
those
for
housing,
which
is
specific
for
the
smi
population.
D
Some
might
be
in
statute
or
regulation,
but
they're
all
reflecting
their
contracts.
So
first
they're
contractually
required
to
provide
24,
7,
behavioral
health
service
crisis
services.
Bhsos
don't
have
to
provide
crisis
services.
In
effect,
we
know
several
that
post
the
local
cmac
crisis
number
in
their
office
for
after
after
hours,
because
it's
just
not
a
service
that
they
provide.
D
They
are
the
operators
of
the
national
suicide
prevention
lifeline.
Hopefully,
you've
heard
about
988.
So
that's
now,
988
and
they've
been
doing
that.
For
15
years,
we've
been
building
that
system
they're
statutorily
required
to
conduct
202a
and
645
evaluations
for
adults
and
children
who
need
involuntary
hospitalization.
D
D
They
are
required
to
provide
community-based
services
to
folks
with
idd
intellectual
and
developmental
disabilities,
they're
statutorily
required
to
maintain
a
telephonic
behavioral
health
jail,
triage
system,
they're
the
primary
partners
in
the
implementation
of
assisted
outpatient
treatment,
aot
also
known
as
tim's
law.
They
are
required
to
designate
staff
to
serve
as
a
point
person
for
service
members
veterans
and
their
families.
D
They
serve
as
an
official
voter
registration
site.
They
provide
primary
prevention
services.
I
could
go
on,
but
you
get
the
idea
right.
There's
there's
a
lot
of
stuff
that
they
do
that.
Nobody
else
is
required
to
do
and
that's
why,
when
I
say
they're
our
safety
net
and
that
they
really
function
as
our
local
office
is
because
they
provide
all
those
services
that
no
one
else
does.
D
Okay,
next
is
our
map,
and
I
share
this
map.
Probably
in
every
presentation
I
give
the
different
colors
represent
the
different
each
of
the
14
community,
mental
health,
centers
and
then
overlaid.
I
think
it's
kind
of
hard
to
read,
but
you'll
see
there's
a
number
in
each
one
of
the
counties
of
how
many
behavioral
service
organizations
are
in
each
county
and
they
are
kind
of
scattered
throughout
the
commonwealth
again
in
41
counties.
But
if
you
look
closely
you'll
see
that
40
percent
sit
in
just
jefferson
and
fayette
county.
D
If
you
add
the
numbers
in
kent
and
car
hardin
county
you're
going
to
be
up
to
52,
so
they
really
are
kind
of
clustered
in
those
areas
and
again
the
cmhcs
provide
are
obligated
to
provide
services
to
everyone
in
their
service
area,
their
their
region,
regardless
of
their
ability
to
pay.
D
And
with
that
I
will
turn
it
over
to
tina
to
talk
to
you
about
ccbhc.
G
Certified
community
behavioral
health
clinic
or
ccbhc
demonstration,
in
which
kentucky
is
participating,
and
I
know
you're
already
fairly
familiar
with
the
ccbhc
model,
but
I'll
just
briefly
recap
that
it
it
is
a
new
medicaid
provider
type
and
here
on
the
slide,
you'll
see
what
what
we
think
are
the
three
sort
of
key
elements
of
ccbhc
that
distinguish
it
from
other
more
traditional
service
delivery
models.
The
first
is
that
certification
requires
adherence
to
over
a
hundred
discrete
criteria
that
those
clinics
must
meet
to
be
deemed
certifiable.
G
At
this
time,
cms
has
limited
the
demonstration
to
these
four
organizations
where
awaiting
word
on
whether
we
can
expand
to
to
add
more
clinics
to
the
demonstration
medicaid
just
received
notification
this
morning.
In
fact,
that
the
safer
communities
act
has
extended
kentucky's
demonstration
period
by
four
years,
and
so
it
will
now
run
through
january
of
2028.
So
we're
very
excited
about
that
extension.
G
I
do
also
want
to
mention
that
today,
six
of
our
community
mental
health
centers,
including
three
that
are
participating
in
the
demonstration,
have
successfully
received
ccbhc
expansion
grants
from
samhsa
which
allows
them
to
support
their
readiness
for
this
model.
Others
have
applied
recently
in
the
latest
funding
opportunity
that
samhsa
released
and
are
awaiting
notification
of
funding.
These
grants
operate
outside
of
the
demonstration,
but
are
in
support
of
ccbhc
readiness.
K
A
Thank
you
very
much,
and
I
wanted
to
make
sure
that
you
all
came
here
today
because
of
the
topic
of
the
bill
that
we're
going
to
be
discussing,
which
I'm
sure
you
saw
a
lot
of
the
controversy
during
session.
When
we
see
all
these
initials,
I
often
just
think
man.
It
would
be
easier
if
we
just
take.
This
is
a
type
a
provider
b
and
c
we
would
all
probably
okay.
A
We
could
probably
identify
that
in
our
heads
a
little
bit
easier
as
legislators
when
you
see
all
the
acronyms,
I
got
a
few
questions
for
you
just
really
briefly,
just
for
education
for
everybody,
how
are
our
cmhc
regions?
How
are
those
set?
If
you
can
explain
how
those
are
currently
developed.
D
So
that
it
is
all
covered
in
in
statute-
and
I
don't
know
that
I
can
that
I
can
cite
that-
but
the
the
centers
that
are
in
place
now
have
been
in
place
for
all
my
memory
and
I've
been
in
the
field
about
30
years.
I
know
there
were
more
at
one
time
and
a
couple
have
merged,
but
is
any
board
can
come
together
and
you
know
make
a
request
to
the
secretary
to
be
a
community
health
center,
because.
A
D
I,
yes,
I
think
we
need
to
to
define
which
counties
because
again
they've.
It's
been
this
way
for
a
long
time,
and
I
think
that
it's
it's
pretty
ingrained.
But
in
order
to
to
protect
that
moving
forward,
I
think
it
would
be
beneficial
to
have
that
outlined.
D
A
A
So
they
would
be
paid
separately
for
their
services
in
that
regard
effectively
for
that,
okay,
so
those
are
some
of
the
kind
of
the
first
questions
all
right
to
our
members.
We're
going
to
have
a
few
questions.
We've
got
a
big
presentation
on
this
house
bill
349,
so
representative,
wilner.
C
Thank
you,
mr
chairman,
and
you've
covered
some
of
my
questions.
So
thank
you.
Thank
you
for
the
presentation
and
commissioner
morris.
D
J
Thanks
and
you
testify.
C
J
I
want
to
know
about.
I
want
to
know
a
total
that
you
all
get
from
samhsa
and
where.
D
I
K
D
J
Thank
you,
mr
chair,
thank
you
for
your
presentation,
a
lot
of
information
here
and
I
just
I
want
to
go
back
to
the
and
you
know
I
I
know
a
little
bit
about
it.
I
guess
I'd
like
to
know
the
overarching
goal,
and
you
know
you
talked
a
little
bit
about
the
differences,
but
what
what's
the
overarching
goal?
Are
we
looking
to
follow
individuals
with
smi
or.
D
And
so
it's
it's
really
more
evidence-based
practice
and
focus
on
excellence,
looking
at
outcomes
and
looking
at
the
whole
person
as
a
whole
person
and
not
separating
out
their
mental
health.
So
we
really
do
see
this
as
the
way
to
go
forward
and
we've
already
seen
some
really
great
demonstration
of
the
outcomes
we
can
achieve.
J
Okay,
thank
you.
I
I
agree
that
it's
a
fabulous
model
and
you
know
I
know
that
a
lot
of
folks
have
been
advocating
for
this
for
a
long
time,
and
can
you
talk
about
what
the
alternative
payment
model
is.
G
C
My
name
is
leslie
hoffman,
I'm
the
deputy
commissioner
for
the
department
for
medicaid
services
and
we
partner
with
the
department
of
behavioral
health
for
the
ccbhc
demonstration
very
exciting
demonstration,
and
I
also
wanted
to
mention
that
it
also
has
an
outreach
to
the
veterans.
So
that
was
one
specific
thing
that
has
really
come
forth
with
this
particular
project.
C
The
pps
right
that
we
decided
to
go
with
was
the
pps-1
rate
methodology,
which
is
approved
by
cms,
and
it
is
a
daily
per
encounter
pps
rate,
and
then
we
do
a
cost
analysis
and
then
we
do.
Then
we
also
do
a
cost
reporting
and
then
we
do
a
wrap
payment.
So
what
you
may
be
familiar
with
is
the
fqhc
pps
and
ramp.
It's
very
similar
to
that
process.
That
process
may
be
changed
in
the
future,
but
that's
one
we're
going
with
with
the
demonstration
right
now.
Okay,.
C
You
mentioned
unfunded
mandates
and
I
wonder
if
we
could
get
a
list
of
what
those
unfunded
mandates
are
and
how
much
funding
it
would
take
to
accomplish
them.
Okay,.
D
I
understand,
mr
chairman,
that
encounter.
E
C
Each
individual
has
a
difference.
I
don't
have
that
with
me
today.
Each
individuals
is
a
different
rate
based
on
their
cost
report
and
projections.
A
A
Yes,
absolutely,
ladies.
Thank
you
very
much
for
your
presentation.
I
know
we're
going
to
jump
into
the
next
item
on
the
agenda.
This
is
a
good
preface
to
hear
the
cabinet's
perspective
on
kind
of
a
definition
of
what
these
organizations
are.
This
past
year
we
had
house
bill.
349
that
was
proposed,
came
out
of
the
house,
came
to
the
senate
and
I
think
a
lot
of
us
in
the
senate
heard.
I
know
it.
Probably.
A
A
We
just
didn't
have
the
time
really
to
dive
into
this,
so
we
thought
we'd
take
the
opportunity
to
come
into
the
interim
and
have
a
discussion
on
this
bill,
and
so
I
think,
first
on
the
agenda,
we've
got
eric
embry
who's,
the
chief
executive
officer
of
penny
royal
community
mental
health
center,
who
I
think
is
on
remotely
eric.
I
don't
know
if
you're
there.
A
I
am
very
good
and
we've
also
got
with
us:
jennifer
willis
who's,
the
ceo
of
pathways
community
mental
health
center
and
also
provide
bishnoi
the
ceo
of
mountain
comp
care
here
today
who
are
going
to
speak
on
both
sides
of
this
topic,
and
I
thought
it
would
be
great
for
everyone
to
come
in,
and
I
told
everybody
you've
got
10
minutes
or
basically
try
to
get
20
minutes
total
here
for
each
side,
10
minutes
to
present
what
you
liked
about
house
with
349.
A
What
you
didn't
like
about
it,
why
you
thought
it
was
necessary?
Why
you
thought
it
wasn't
necessary
and
to
come
in
and
present
for
that,
and
I
think
everybody
should
have
before
them
house
bill
349
from
this
past
session
and
their
presentations
as
well.
If
people
want
to
refresh
their
memories
about
it,
mr
embry,
if
you
want
to
begin,
if
you
want
to
introduce
yourself
for
the
record
and
begin
your
testimony.
L
Sure
jennifer
willis
and
I
are
going
to
tag
team
this
so
jennifer.
You
want
to
go
ahead
and
get
started
with
the
introduction.
Sure.
M
Obviously
you
all
heard
this
last
session.
We've
already
talked
about
that,
but
we're
here
really
to
talk
about
why
we
feel
like
it's
critical
to
us
as
representatives
of
the
12
community
mental
health
centers
that
support
this
bill
as
well
as
why
we
feel
like
it's
needed
to
maintain
the
the
safety
net
for
our
comm,
our
behavioral
health
centers.
L
Right,
I'm
eric
embry,
I'm
the
current
ceo
of
life
skills,
a
cmac
based
at
bowling
green
kentucky,
former
ceo
of
penelo
center
cmhc,
based
in
hopkinsville
that
merged
with
life
skills
in
january
of
2020
for
administrative
efficiencies,
while
maintaining
services
in
our
respective
regions,
I'm
also
serving
as
the
interim
facility
director
at
western
state
hospital
in
hopkinsville.
At
this
time.
I
want
to
thank
co-chair
alvarado
for
meeting
us
last
month
in
covington,
listening
to
the
importance
of
349
for
his
invitation
to
come
and
testify.
Today.
L
Also,
I
wanted
to
thank
coach
mosher,
who
heard
349
in
her
committee
last
session,
where
it
passed
with
no
opposing
votes.
Following
passage
out
of
her
committee,
it
went
on
to
the
house
floor,
garnering,
75
votes
of
support.
I
also
want
to
appreci
say
that
I
appreciate
the
flexibility
and
being
able
to
testify
remotely.
L
If
you
heard
me
normally,
you
can
tell
that
I'm
dealing
with
covet
19
currently
and
my
voice
is
a
little
off,
so
I
apologize
for
that.
I
was
going
to
start
off
with
a
couple
of
paragraphs
of
what
a
cmac
is.
I
thought
that
was
extremely
important
to
start,
but
listening
to
commissioner
morris's
testimony,
I'm
only
going
to
emphasize
a
couple
of
points
from
that.
If
you
were
to
go
to
the
department's
website
and
read
the
definition
of
a
cmhc,
it
would
talk
about
the
populations
we
serve
in.
L
Our
scope
of
services
are
so
much
more
and
I'll
talk
about
what
we've
been
dealing
with
over
the
past
three
years,
when
a
bomb
detonated
in
downtown
nashville
and
christmas
day
of
2019,
there
was
a
pinterest
center
that
was
communicating
and
working
with
first
responders
to
ensure
that
all
those
individuals
dealing
with
severe
mental
illness
in
our
catchment
area
were
safe,
secure
and
getting
the
treatment
that
they
needed.
L
We
would
begin
working
with
the
department
to
divert
admissions
to
other
psychiatric
hospitals
right
after
ending
that
call
with
commissioner
morse,
the
fourth
cmac
served
by
westminster
hospital.
That's
four
rivers,
funeral
center
river
valley
and
life
skills,
implemented
procedures
that
allowed
us
to
basically
hold
the
line
with
zero
admissions
to
western
state
hospital
over
the
next
six
weeks,
while
still
assuring
the
patients
were
appropriately
cared
for,
and
in
my
opinion,
that
was
a
truly
herculean
feat.
L
Mr
shannon
could
confidently
answer
that
he
would
check,
but
he
was
sure
that
we
were
already
responding
and
we
were
while
that
phone
call
was
occurring.
Funeral
regional
leadership
and
staff
were
at
baptist
health
madisonville,
assisting
those
that
had
lost
loved
ones
and
property.
We
had
others
at
sites
like
dawson
springs,
already
involved
in
the
cleanup
efforts
and
assessing
individuals
dealing
with
the
mental
health
trauma.
Such
events,
we
don't
wait
to
assist
our
communities.
We
leap
into
action
when
needed.
M
Right,
so
how
are
we
different?
Obviously,
commissioner
morris
had
have
spoke
to
this
already,
but
it
is
important
to
to
just
talk
a
little
bit
about
you
know
we
are
the
the
safety
net
providers.
We
are
required
to
provide
all
these
services.
This
is
why
community
mental
health
centers
have
a
different
pay
scale
than
a
behavioral
health
service
organization.
M
It
with
when
community
mental
health
centers
are
working
outside
of
their
regions.
They
are
essentially
working
as
a
behavioral
health
service
organization,
they're
choosing
the
services
they
provide,
so
they
can
cherry-pick
services
that
have
the
larger
profit
margin
and
just
be
able
to
focus
on
those
services
while
not
having
to
provide
the
services
that
we
know.
You
know
we
lose
money
providing
and-
and
that's
worked
not.
It's
worked
for
community
mental
health
centers
to
be
able
to
provide
that
array
of
services
because
our
rates
have
allowed
us.
M
Each
of
us
are
the
crisis,
24-hour
crisis
provider
in
each
of
our
regions,
but
when
you
have
a
community
mental
health
center
who
says
their
community
mental
health
center
operating
outside
of
their
region
and
their
staff
drop
clients
off
at
our
crisis
units
without
any
forewarning,
find
out
that
there's
not
a
bed
available
and
leave
them
anyway
and
tell
staff
that
they're,
not
the
they're,
not
the
crisis
provider
for
that
region,
that's
the
local,
you
know,
and
regional
community
mental
health
problem
they're
operating
as
a
bhso
they're,
not
operating
as
a
cmhc.
M
M
But
we
are,
we
have
a
bigger
issue
with
the
community
mental
health
center,
that's
operating
out
of
region,
bringing
clients
and
more
or
less
dumping
them
on
us
and
leaving
them
for
us
to
take
care
of.
You
know,
since
this
is
the
case,
why
should
they
be
reimbursed
as
a
cmhc?
M
It's
not
really
it's
not
fair
to
cmhcs
and
it's
certainly
not
fair
to
bhsos.
So
you
know
it's
not
fair
to
the
the
citizens
and
the
families
of
kentucky
they
deserve
more.
I
mean
our
our
clients
deserve
better.
Nobody
should
be
dropped
at
a
crisis
unit
and
left
when
no
one's
there.
You
know
when
that
we
don't
have
a
bed
available.
Obviously
we
took
them
made
sure
they
got
placement.
We
did
the
work,
but
again
this.
M
So
currently
we
have
27
counties
that
have
an
as
community
mental
health
center
outside
of
their
region
functioning
in
in
the
local.
You
know
the
local
cmhcs
area,
27
counties
that
are
already
served
and
supported
by
their
designated
cmhc,
eight
of
our
community
mental
health
centers
in
encountering
this
threat
to
maintaining
their
safety
net.
M
So
why
should
you
care?
You
know?
Why
does
anybody
care
everybody
says
all
we
need
is
we
need
more
providers?
We
need
more
providers.
There
is
plenty
plenty
of
people
in
need
of.
In
need
of
services,
there's
no
doubt
about
that
kentucky's
community
mental
health
centers
have
historically
served
a
very
important
function
as
as
training
sites
for
a
full
range
of
mental
health
professionals
and
paraprofessionals.
M
Much
of
kentucky's
current
mental
health
workforce
benefited
from
training
and
supervision
provided
by
community
mental
health
centers,
while
they
were
obtaining
their
advanced
degrees
because
of
the
manpower
needs
and
the
training
and
supervision
structures.
Community
mental
health
centers
are
authorized
to
hire
individuals
with
a
bachelor's
degree
in
mental
health
or
human
services
who
are
working
on
an
appropriate
master's
degree
towards
their
advanced
degree,
providing
very
specific
support
and
intervention
services
under
close
supervision.
M
M
M
M
The
last
of
mine.
I.
M
You
want
to
just
go
ahead
and
wrap
it
up
quickly.
I
just
wanted
to
say
we
are
similar
in
fashion
to
other
quasi-government
entities
that
have
their
regions
defined
in
either
regulation
or
statute,
child
advocacy,
centers,
domestic
violence,
shelters
and
rape
crisis.
Centers
all
have
defined
catchment
areas,
as
do
area
development,
districts,
school
districts
and
health
departments
also
recognized
in
this
manner.
Cmhcs
perform
services
just
as
vital
and
feel
strongly
that
the
state
safety
net,
our
operational
catchment
area
should
be
formally
recognized.
A
Ms
willis,
thank
you
very
much
appreciate
your
testimony.
I'm
going
to
have
the
folks
from
mountain
comp
come
and
present
and
then
afterwards
going
to
have
questions
for
both
sides
on
this.
I'm
sure
if
mr
bishoy
is
here
and
if
you'd
like
to
introduce
yourself
for
the
record,
please
and
again,
I'm
gonna
give
you
10
minutes.
If
you're
going
to
begin
your
testimony.
B
We
are
licensed
as
a
community
mental
health
center
federally
qualified
health
center,
and
we
also
have
a
private
child,
caring
and
child
placing
license.
We
are
carf
accredited.
We
just
received
our
car
accreditation,
the
latest
accreditation
in
may
of
this
year,
and
we
received
the
three-year
accreditation,
which
is
the
maximum
you
can
receive.
We
did
not
have
any
deficiencies
and
all
our
sites
are
appropriately
licensed
by
various
agencies,
so
in
2011,
with
medicaid
managed
care
and
in
2014
with
the
implementation
of
affordable
care
act.
B
A
B
We
have
three
out
of
three
out
of
four
kentuckians
live
in
an
area
with
mental
health
care
shortage
with
more
than
2500
of
those
individuals
receiving
services
from
us.
We
have
38,
outpatient,
behavior
health
clinics,
12,
primary
care,
med
clinics,
seven
residential
addiction,
treatment
facilities,
so
our
staff
have
increased
from
275
to
over
1300.
B
B
B
When
a
domestic
violence
shelter
reaches
out
to
mountain
because
their
local
cmhc
has
a
six-month
waiting
list.
What
should
we
do
if
a
judge
tried
to
run
effective
drug
treatment?
Court
reaches
out
to
mountain
because
of
a
six
to
ten
week,
delay
in
getting
people
into
substance,
abuse
disorder
treatment?
What
should
we
do
when
a
homeless
shelter
reaches
out
to
mountain
because
their
local
cmac
has
not
provided
services
to
the
homeless
in
over
five
years?
B
B
B
B
So
changing
laws
to
throw
up
barriers
for
cmhcs
to
provide
their
services
means
more
waiting
lists
waiting
list
in
other
areas.
Individuals
seeking
mental
health
and
addiction
treatment
will
find
themselves
on
waiting
lists
after
reaching
out
for
help.
Judges
would
get
frustrated
for
lack
of
local
services
with
six
to
ten
week.
Waiting
period
for
drug
court
participant
homeless
and
survivors
of
domestic
violence
will
get
not
get
to
services
or
get
delayed
services.
B
Other
providers
aren't
restricted
to
certain
areas
when
it
comes
to
medicaid,
funded
services,
even
managed
care
companies
are
lim,
are
not
limited
to
certain
areas,
and
in
summary,
I
think
I
would
just
say
that
kentucky
should
not
look
backwards.
We
need
to
look
forward
to
allow
innovation
to
happen.
Let
providers
reach
out
and
try
to
address
unmet
needs.
B
Even
a
limited
level
of
competition
in
healthcare
services
can
reduce
costs,
first
consumers
and
the
state
and
lead
to
more
efficient
services,
and
we
have
a
shortage
of
health
care,
and
earlier
it
was
mentioned
that
we
hire
bachelor's
level
people
every
community,
mental
health
center,
hires
bachelor's
level.
Folks.
A
Thank
you
very
much,
so
a
lot
of
a
lot
of
discussions
on
this,
and
we
were
just.
I
was
just
coming
here
with
the
chairwoman
during
session.
How
this
the
comments
appearing
on
both
sides
were
things
we
heard
from
emails
from
people,
even
in
our
districts,
from
a
lot
of
providers
from
throughout
the
state
as
well.
A
So
the
one
thing
I'm
gonna
I'll,
bring
up
the
question
that
I've
heard
from
from
both
sides
and
I'll
I'll
ask
them
both
to
respond
to
the
different
questions.
Obviously
one
of
the
and
while
you're
there,
mr
bush
I'll,
ask
you.
Obviously
the
the
commentary
is
that
okay
you're
providing
a
service
for
people
that
are
outside
you
guys
are
kind
of
headquartered
in
the
eastern
part
of
the
state.
A
And
then
you
provide
services,
let's
say
in
western
kentucky
and
then
someone
that
you're
providing
services
for
has
a
crisis
or
an
after-hours
emergency
of
some
sort.
The
other
side
is
saying:
hey
we're
the
ones
who
are
getting
stuck
with
having
provide
services
with
someone
that
we
don't
know.
You
all
are
the
ones
who
are
contracted
to
take
care
of
this
person
and,
as
a
doctor
I
know
I've
had
situations
where
I
may
have
had
a
school
nurse
taking
care
of
a
child
in
school.
A
They
prescribed
a
medication
or
treatment,
they
don't
take
call
after
hours,
there's
a
complication
from
that
treatment.
What
happens?
Call
the
pediatrician
on
call
I'm
the
one
who
gets
the
phone
call
and
I've
got
to
figure
it
out
and
I'd
say:
oh,
you
know,
you'd
pull
your
hair
out,
trying
to
figure
out
what
to
do
and
the
liability
is
on
you.
So
maybe
you
could
respond
to
that
because
that
is
the
accusation
from
the
other
side
is
saying
these
guys
aren't
taking
care
of
their
patients.
We're
having
to
do
this.
A
B
Senator
so
we
take
care
of
our
clients
that
we
serve
if
they
go
in
crisis,
they
call
us
our
1
800
number.
The
crisis
line
number
is
on
all
our
brochures,
all
our
forms,
it's
on
our
website
now
the
25,
000
or
so
individuals
we
serve
outside
the
region.
If
they
call
us,
we
do
provide
after
hours
crisis
services.
A
All
right
and
then,
if,
if
ms
willis,
if
you
want
to
come
forward,
I've
got
a
quick
question
for
you
as
well.
If
you
want
to,
if
you
guys
just
want
to
hang
out
because
I'm
going
to
have
lots
of
people
coming
and
I'm
sure
they'll
be
members
of
the
committee
who
will
have
questions
as
well.
But.
L
Can
I
can
I
address
what
was
just
said
with
sure
with
what
would
I
do
if
you
were
to
look
at
a
contract
signed
between
mountain
comp
and
the
christian
county
board
of
education
just
this
month
with
public
information
in
that
contract?
It
specifically
states
they
recognize
that
they
are
quote,
not
the
state
of
kentucky's
designated
provider
in
western
kentucky
for
emergency
or
crisis
responses,
and
then
underneath
that
every
cmac
in
western
kentucky
that's
four
rivers,
funeral
center
life
skills
and
river
valley.
L
L
They
do
contract
with
us
and
if
another
entity
were
to
show
up,
they
would
contract
with
them
as
well,
I'm
sure
with
the
school
system,
they
will
take
anything
they
can
get
and
please
keep
in
mind.
349
does
not
restrict
mount
com
from
providing
those
services;
they
just
have
to
do
it
as
a
bhso.
A
So
I
wanted
to
bring
it
here
before
us
to
let
folks
kind
of
discuss
it
ask
questions
and
then
also
I'm
gonna.
You
know
the
cabinet
is
here.
You
know
I'd
like
to
get
the
cabinets
feedback
on
this
as
well,
where
they
stand
on
this
issue,
because
you
know
the
previous
administration
had
opened
things
up.
We've
got
letters
here
that
I
think
you've
got.
Everybody
should
have
here
from
2016
about
opening
this
up
to
allow
this
to
occur.
A
I
Thank
you,
mr
chairman.
Considering
that
letter
of
june
6
2016
the
last
two
sentences
I
want
to
read
says
we
encourage
cmhcs,
as
well
as
private
providers,
to
collaborate
on
mutually
beneficial
service
provision
decisions
whenever
possible
and
remain
aware
of
the
successful
outcomes
that
benefit
both
communities
and
individuals.
I
I
H
Sherman,
thank
you
and
the
question
you
asked
chairman
alvarado
at
the
very
end.
I
don't
know
that
I
understood
mr
ambry,
the
answer
to
the
question.
If,
if
you
could
repeat
your
question
again,
chair
alvarado
specific
to
the
contract
that
was
entered
into
by
mountain
care
and
local
school
district,
your
question
was:
if
I've
got
it
correct,
why
did
the
school
district
choose
mountain
care,
someone
so
far
removed?
And
mr
embry,
maybe
you
can
answer
that
again
or
someone.
L
Else
the
school
will
take.
You
know
if
another
organization
were
to
show
up
to
offer
services
to
the
student
population.
The
board
of
education's
priority,
of
course,
is
the
mental
health
well-being
of
the
students
that
they
serve.
So
we've
got
a
contract
with
christian
county
board
of
education,
they
employ
their
own
school-based
therapist
and
they
have
a
contract
with
mountain
com.
L
M
Right-
and
I
would
just
like
to
add
to
that
by
saying
in
each
of
our
school
districts
we're
in
every
school
district
within
our
10
counties
and
we
have
multiple
providers
in
each
of
those
school
districts,
bhsos
mountain
comp
as
well
as
pathways,
and
I
just
to
echo
what
eric
said
I
mean
our
schools
are
in
desperate
need.
We
know
that
folks
need
mental
health
services,
so
the
schools
are
desperate
to
bring
in
everybody
they
can
bring
in
to
the
issue
that
I
talked
about,
you
know
it's
it's
difficult
for
us
to
recruit
staff.
M
That's
why
we're
the
training
ground
for
for
folks,
and
so
with
that
being
said,
that's
that's.
Why
I
mean
we?
We
struggle
all
of
us
across
the
board
to
have
enough
providers
available,
so
the
the
schools
want.
You
know
as
many
therapists
as
they
can
have
there
as
many
days
a
week
as
what
what
you
can
provide
them.
So
it's
not
a
matter
of
of
not
not
having
other
providers.
I
mean,
I
don't
think
any
of
us
are
arguing
that
that
it's
a
problem
to
have
competition
from
bhsos
or
or
anyone
else.
H
A
H
We
as
policymakers
are
in
this
space
trying
to
strike
this
balance
between
immediate
need
in
school
systems
and
across
our
communities
for
mental
health.
All
of
the
providers.
We
need
all
hands
on
deck.
Yes,
we
truly
do
our
communities
need
that
coming
out
of
covid
and
facing
the
anxieties
of
today.
H
At
the
same
time,
we
need
longevity.
We
need
to
be
able
to
sustain
operations
in
these
communities
so
that
maybe
those
less
desirable,
less
profitable
services
are
also
provided
and
someone's,
not
cherry-picking.
So
we
need
advice
as
policy
makers.
So,
as
you
come
to
the
table
state
very
clearly
for
us,
the
cabinet's
position
is
that
what,
as
it
relates
to
this
question,.
D
D
Spoken
to
secretary
freelander,
but
I
do
not.
I
cannot
speak
on
his
behalf,
but
I
can
tell
you
please,
okay,
so
we
do
believe
that
cmhcs
going
outside
of
the
region
does
pose
some
level
of
threat
to
the
behavioral
health
safety
net.
If
if
there
is
no
difference
seen
with
reimbursement
and
and
how
they
operate,
bhsos
and
cmhcs,
what
possible
reason
would
those
other
13
cmhcs
have
to
continue
to
be
licensed
as
as
a
cmhc
right,
so
they're
they're
distinctly
different?
D
They
have
distinctly
different
mission,
they
have
distinctly
different
obligation
and
there
are
a
lot
of
things
that
we
need
providers
to
do
for
the
folks
with
serious
and
persistent
mental
illness,
kids
with
serious
emotional
disturbances,
people
with
intellectual
and
developmental
disabilities
and
again
there
are
bhsos
who
do
that
and
I
hope
more
will
come
forward
and
do
that.
We
we
welcome
the
competition.
I
was
at
the
cabinet
in
2014,
when
bhsos
and
multi-specialty
groups
and
new
individual
providers
were
allowed
to
build
medicaid.
It
was
a
beautiful
thing.
D
D
D
You
know
we
people
come
to
us
who
are
really
sick
and
we,
the
cmhcs,
help
screen
those
folks
before
they
come
into
the
hospital
to
make
sure
they
meet
criteria
and
that
they
don't
have
any
other
services
that
they
can
do.
In-Home
services,
same-day
services,
crisis
stabilization
units
and
then
again
now
patients
always
have
choice
if
they
have
another
provider,
but
the
majority
of
our
patients
get
an
appointment
with
the
cmhc
when
they
leave
so
they're
part
of
our
continuum.
D
D
Yes,
all
of
the
funds
that
the
department
of
behavioral
health
provides,
the
cmhcs
can
only
be
spent
in
their
region.
What
they
do
outside
of
the
region
is,
they
can
build
medicaid,
for
that
which,
I
think
is
separate
from
some
of
the
other
issues
we're
talking
about.
We
restrict
the
the
spending
our
dollars
being
spent
in
their
region.
H
Two
two
quick
questions,
mr
chairman:
if
I
could
thank
you
thanks
for
the
latitude
do
we
have
concerns
about
folks
that
are
currently
being
provided
quality
services
by
the
cmhcs
that
are
operating
outside
of
their
regions?
Do
we
have
concerns
about
those
citizens
having
to
change
providers
having
to
change
the
doctor
they're,
seeing
any
concerns
about
that
non-continuity
of
care?
If
we
move
to
passage
of
a
piece
of
legislation
that
says
solely
in
the
region
in
which
you're
licensed
or
funded.
D
H
D
D
Are
I
can
tell
that
and
and
mountain
provides
exceptional
services
in
their
region?
I
can't
speak
to
the
services
outside
their
region.
What
you've
heard
today,
I
don't
have
any
first-hand
knowledge
of
the
quality
of
services
out
that
read.
I
do
know
the
services
inside
the
region
are
excellent
and
the
people
in
that
community-
I
think
they
were
recently.
You
know,
got
some
award
for
for
being
a
good
employee
or
something.
D
But
but
it's
it's
those
it's
the
and
like
I
said
there
is
because
they
get
a
higher
rate
and
they
can
hire
staff
with
different
qualifications.
It
I'm
surprised
that
bhso's
other
bishops
don't
aren't
concerned
about
that
competition
because
they
have
an
advantage
over
other
people.
Building
that
business
there.
H
A
K
Thank
you,
mr
chairman,
and
you
know
there
are
so
many
different
balances
to
be
had
here
and
commissioner,
this
question
is
probably
going
to
be
for
you.
I
and
I
apologize.
I
heard
in
the
testimony
that
apparently
seven
counties
is
doing
the
same
thing
as
mountain
comprehensive,
but
they
are
doing
it
correctly,
and
it
is.
Is
that
the
case
and
if
you're,
not
the
person,
to
answer
that?
Please.
D
D
K
I
guess
I'm
just
curious:
if,
if
there
are
such
financial
barriers
to
mountain
being
able
to
conduct
this
business
outside
of
their
region
satisfactorily,
how
can
they
why?
Why
is
it?
They
can't
do
it
if
seven
counties
can
do
it,
and
I
I'd
really
like
to
get
that
answer
to
to
kind
of
give
validity
to
what
the
gentleman
says
about
it,
not
being
fiscally
feasible
for
him
to
do
that.
A
I
don't
know
if
you
want
to
introduce
more
more
testimony.
It'll,
be
here,
like
I
said,
for
another
hour,
is
the
the
hard
part
of
that,
but
it's
yeah,
but
they
might
be
again.
These
are
the
questions
that
are
that
need
to
be
answered.
Ultimately,
as
we
move
forward
senator
burke,
I
know
you
have
a
question.
D
Thank
you,
mr
chairman,
and
my
question
basically
is
two
parts:
do
we
feel.
D
D
It's
been
a
long-standing
issue,
but
and
we've
got
we've
gotten
a
lot
of
additional
dollars
from
the
federal
government
and
a
really
nice
allocation
during
the
last
legislative
session,
and
so
we're
hoping
to
move
that
needle,
unfortunately,
we're
now
we're
up
against
this
unprecedented
workforce
issue
which
which
we're
struggling
with
but
yeah,
I'm
sure
there
are
waiting
lists
in
some
areas
for
some
services.
I
know
I
it's
hard
to
get
to
the
dentist
right
now
for
myself.
D
I
they
call
to
cancel
because
the
hygienist
called-
and
I
can't
get
in
for
six
more
months-
that
literally
just
happened
to
our
family.
So,
yes,
our,
I'm
sure
the
bhsos,
the
cmhcs,
our
hospitals,
we
all
struggle
with
some
of
those
issues
which
might
be
causing
weights.
I
think
my
question
goes
to
are.
D
D
I'm
not,
I
guess,
I'm
not
sure
how
to
answer
your
question,
but
I
think
we've
already
heard
testimony
that
there's
a
huge
need.
We
welcome
the
competition
this
isn't
about.
We
want
nobody
but
cmhc.
That's
absolutely
not
what
anybody
is
testifying
to.
We
need
cmhcs
to
be
protected
so
that
we
can
provide
services
to
populations.
Quite
frankly,
nobody
else
wants
to
serve
including
dentists,
right
people
with
intellectual
developmental
disabilities,
people
who
have
paranoid
schizophrenia
and
and
have
explosive.
D
You
know
behaviors
at
times
when
they're
they're
not
getting
their
medication,
people
who
are
acutely
suicidal.
So
we
have
to
make
sure
somebody
is
obligated
to
provide
those
services
because,
quite
frankly,
there
aren't
very
many
five
bhs.
Those
who
are
willing
to
do
that
and
to
my
understanding-
and
I
could
be
wrong-
lots
can
correct
me.
I
don't
think
that's
the
population
he's
serving
outside
school-based
services,
not
taking
care
of
you
know
the
smi
and
the
idd
population.
J
Question
here,
yes,
thank
you,
mr
chair.
Thank
you,
commissioner,
just
as
a
point
of
clarification
when
we
worked
through
some
of
these
questions
during
session,
we
we
did
talk
about
whether
or
not
there
were
unmet
needs
outside
of
regions
and
really
talked
about
the
fact
that
the
state
funds,
the
regions,
yes,
and
if
there
is
an
unmet
need
that
is
established
that
it
it
could
be
met.
N
J
The
entity
agency
should
be
a
bhso
and
that
there
should
be
some
sort
of
approval
or
discussion
within
the
cabinet
so
that
we
we
ensure
that
those
needs
are
being
met,
but
that
the
state
isn't
responsible.
Ultimately
for
paying
for
all
of
those
does.
D
That,
yes-
and
I
appreciate
you
reminding
me
of
some
of
those
conversations
representative,
I
think
that
what
what
the
cabinet
would
prefer
to
do
is
that
there
is
an
ability
in
that
bill
for
for
cms
to
work
collaboratively.
So
somebody
approaches
another
cmac
says
we.
You
know
we'd
like
you
to
come
work
with
our
court
with
the
with
the
school.
With
that
there's
some
conversation
between
the
two
cmhcs
and
that
that's
all
done
kind
of
everybody
knows
it's
happening,
and
so
I
you
know,
I
think
right,
maybe
very
early
on.
J
Yeah
we
did
try
to
have
those
conversations.
It
would
ultimately,
I
think,
be
positive
for
the
state
if,
if
the
chmcs
work
together
and
we
didn't
set
up
some
sort
of
separate
c-o-n,
I
mean
that's
not
what
we
want
to
do,
but
you
know
I
think
that
there
are
some
some
projects
that
are
going
on
within
the
cabinet.
You
know
the
ehr
project
which
we
funded.
J
I
think
that
that
would
better
inform
us
in
terms
of
data
and
and
maybe
what
the
needs
are
and-
and
I
mean
that's-
maybe
a
longer
term
goal,
but
I
think
for
now
this.
This
is
the
language
that
we
kind
of
negotiated
in
in
in
making
sure
that
both
sides
were
heard
and
that
the
needs
that
the
needs
were
being
met.
Yes,
ultimately,
I
think.
O
O
It
really
wasn't
a
safety
net
measure,
but
I
think
it
has
evolved
into
that
and
I
just
want
to
be
very
careful
where
we're
proceeding
with
this,
because
each
community
needs
are
entirely
different
and
if
you
get
a
mandate
from
the
state
that
possibly
it
doesn't
fit
the
situation
in
it
for
a
particular
community
and
it
compromises
the
safety
net.
So
I
think
there's
a
real
fine
balance
between
providing
that
safety
net,
but
also
providing
protectionism
to
the
point
that
they're
not
meeting
the
needs
of
their
community.
O
O
But
theoretically
you
know
we
could
have
a
process
in
place
where
they
couldn't
make
that
decision,
so
I'm
not
sure
we're
heading
down
the
right
path
at
all
and
that's
neither
in
support
or
opposition,
this
particular
bill.
But
I
think
if
the
focus
is
going
to
be
safety
net,
inaccurately
providing
services,
we
need
to
be
thinking
outside
the
box
a
little
bit.
I
don't
think
this
is
going
to
address
this
particular
situation,
nor
any
other
yeah.
You
know-
and
you
know
my
background-
is
hospitals
and
one
point
in
time.
O
It
used
to
be
the
focal
point
for
all
health
care
services
in
the
community,
but
as
certificate
knee
has
been
eroded,
that
safety
net
has
also
eroded
and
now
we're
the
point
that
the
hospitals
don't
know
if
they
can
survive
or
not.
But
again
I
don't
think
that
should
be
a
decision
that's
mandated
by
the
federal
government
or
the
state.
I
think
it
should
be
community
specific
and
we
need
to
get
involvement
more
at
the
community
level
again
using
the
christian
county
situation.
As
an
example.
Is
that
a
good
thing
or
bad
thing?
D
That
I
don't,
I
I
first
and
foremost
am
an
advocate
for
the
people
we
serve
right,
so
I
don't
think
I
would
ever
advocate
that
there
only
be
one
provider.
People
should
always
have
choice
and,
and
things
like
school
systems
and
courts
should
always
have
choice
about
who
they
go
to
for
a
provider.
So
we
want
as
many
providers,
obviously
as
we
can
get
some
of
the
prescriptive
language
in
our
contract
with
the
cmhc.
So
comes
from
the
federal
for
our
block
grants.
D
There
are
very
specific
things
we
have
to
assure
being
provided
in
our
state
to
draw
down
those
dollars
we
get
audited.
We
went
through
that
whole
process
just
a
few
weeks
ago.
We
did
very
well
on
that,
but
they
look
at
every
dollar
what
it
was
spent
on
who
it
went
to
was
it
appropriate?
Did
we
meet
all
of
the
did?
D
We
check
all
the
boxes
on
our
application
and
those
types
of
things,
but
that
again-
and
I
think
mr
embry
spoke
to
this-
that's
why
every
cmac
is
a
regional
board
with
representatives
from
every
county
for
just
that
purpose,
to
make
sure
that
the
counties
and
have
a
voice
in
what
services
are
being
provided.
What
services
are
we
going
to
grow?
What
do
we
need
to
just
you
know,
tick
that
box
to
meet
and
what
things
does
our
county
need?
D
O
O
D
Would
be
the
local
cmhc,
I
don't
think
there's
I
mean
I
suppose
they
could
do
it.
It
did
the
krs
it
it
obligated
to
the
cmhc
qualified
mental
health
professional
from
a
cmhc.
Do
that
evaluation,
but
I
don't
believe
we
have.
I
don't
believe
those
are
being
done
by
anybody,
but
the
local
cmhc.
At
this
point.
B
Our
board
members
are
from
the
five
counties
in
the
big
sandy
area:
development,
district
region.
A
You
very
much
again.
This
is
something
we
could
keep
talking
for
another
hour,
so
we've
got
other
topics
on
the
agenda
and
this
is
what
we
needed
to
be
able
to
air
out
a
little
bit.
So
I
appreciate
the
commissioner,
mr
bishoy,
ms
willis,
mr
embry.
Thank
you
all
for
coming
today.
I'm
sure
it's
not
the
last
of
this
topic.
We're
going
to
be
hearing
about,
I
suspect,
we'll,
be
revisiting
this
up
again
in
the
upcoming
session.
A
I
thought
we
needed
to
just
have
the
opportunity
to
air
this
out,
and
I
appreciate
everybody's
input
really
and
a
lot
of
the
thoughtful
questions
and
I'm
sure
we
have
more
to
discuss
or
maybe
more
to
negotiate
on
this
to
see
if
we
can
come
to
something
if
we're
gonna
be
moving
a
bill
forward.
So
thank
you
all
so
much
for
your
presentations.
I
appreciate
that
we've
got
a
few
more
presenters.
I'm
going
to
have
the
next
topic.
A
I'm
going
to
bring
up
is
something
that
I'm
sure
we'll
draw
a
few
more
questions
from
members
of
the
committee
as
well,
so
I'm
going
to
have
them
come
up
next,
it's
going
to
be.
Regarding
house
bill,
569
consumer
protections
relating
to
kratom
now,
representative
callaway
had
presented
this
bill
and
hopefully
he
is
here
and
we've
also
got,
I
believe,
mack
haddow
who's,
a
senior
fellow
from
the
american
kratom
association.
Also
there's
a
couple
folks.
A
I
think
one
person
in
person,
dr
lindsey
blair
and
then
also
dr
jack
henningfield,
who's
remotely
with
us,
and
then
I've
also
got
the
chief
executive
officer
of
new
day
recovery
center.
Dr
alan
schultz,
who's
also
going
to
be
testifying
remotely
regarding
this
topic.
A
Kratom
is
a
topic
I
think
a
lot
of
us
have
heard
about
people
may
not
know.
I
know
the
house
kind
of
had
a
hearing,
I
think
on
this
during
session
and
had
it,
but
I
don't
think
our
senate
members
have
had
an
opportunity
to
to
discuss
it.
Representative
callaway,
if
you'd
like
to
take
a
few
moments,
if
you'd
like
to
introduce
yourself
your
guests
and
begin
your
testimony.
Q
Yes,
sir,
thank
you
senator
alvarado.
We
appreciate
the
opportunity
to
be
able
to
present
to
the
committee
today
I
am
representative
josh
callaway
out
of
the
10th
district,
and
we
did
carry
house
bill
569
last
year
in
the
house
and
had
a
lot
of
discussion
about
this
particular
subject
of
called
kratom.
Some
people
know
it
as
kratom,
but
you
take
your
pick,
which
one
you
want
to
call
it.
It
is
definitely
something
that
I've
learned
a
lot
about
over
the
last
year.
Q
I
won't
take
much
time
I'd
like
to
get
some
our
guests
that
are
very
knowledgeable
about
this
subject,
to
be
able
to
give
you
as
much
information
as
we
can
get
in
today.
The
bill
that
I
carried
last
year
was
simply
based
upon
safety
for
this
particular
product
that
is
already
currently
being
sold
in
our
state
and
house
bill.
Q
569
did
some
simple
things,
but
important
things
created
an
age
limit
for
this
particular
product
that
stopped
adulteration
of
the
product
and
contamination
which
we
found
out
through
the
studies
that
we
did,
that
that
was
a
lot
of
the
issues
that
we
were
having
throughout
the
country.
It
limits
extraction
levels
as
well
requires
proper
labeling
and
also
creative
fines
for
people
that
violated
those
guidelines
that
we
put
in
place
in
guard
rails.
Q
At
this
point,
the
d.a
and
the
fda
have
not
taken
a
position
on
this
particular
product,
which
is
why
I
felt
it
important
that
we
do
something
and
do
something
immediately,
so
that
we
could
make
sure
that
we
protected
the
consumer
and
also
protected
our
youth
who
have
access
many
times
to
this
particular
substance.
Q
So
with
that
being
said,
I
will
turn
over
to
mack
haddow,
who
has
also
joined
us
remotely,
and
let
him
talk
a
little
bit
and
introduce
the
other
people
that
will
be
talking
and
give
you
as
much
information
as
we
can
as
quick
as
we
can.
Thank
you.
R
Yes,
my
name
is
matt
cado
senior,
fellow
in
public
policy,
with
the
american
kratom
association
and
chair
alvarado
and
chair
moser
and
members
of
the
committee.
Thank
you
for
this
opportunity
to
talk
about
kratom
today,
about
a
year
ago,
we
planned
a
family
vacation
to
disneyland
for
our
11
grandchildren,
and
that's
where
I
am
today.
My
wife
and
I
are
planning
on
celebrating
our
45th
wedding
anniversary
and
I'd
like
to
make
it
to
46.
R
So
that
might
account
for
my
decision
not
being
with
you
today,
and
I
hope
you
understand,
with
respect
to
kratom
and
kratom
was
first
introduced
to
the
united
states.
It
grows
ubiquitously
in
southeast
asia
when
our
soldiers
from
vietnam
came
home
and
they
had
found
it
to
be
a
very
popular
item
over
in
vietnam,
where
they
could
get
through
the
hot
days
in
the
jungle
by
plucking.
R
The
leaves
of
the
crate
and
plant
chewing
on
them
gave
them
increased
energy
and
focus
and
got
them
through
those
hard
days,
and
so
they
self-imported
it
back
to
the
united
states
after
they
came
home.
We
also
had
a
very
substantial
increase
in
the
hmong
population
to
the
united
states
about
the
same
time
period
and
the
hmong
group
has
used
kratom
in
their
diet
for
centuries,
and
so
there
were
mom
and
pop
delis
that
popped
up
around
the
country
and
all
that
fast
forward.
R
Until
about
2009,
when
there
was
a
report
of
nine
deaths
in
sweden
attributed
to
a
powdered
kratom
product
known
as
krypton,
that
got
the
attention
appropriately
of
every
public
health
official
in
the
world,
including
the
fda
and
so
in
2012.
The
fda
implemented
an
import
alert
and
they
began
the
process
of
evaluating
as
best
they
could
the
available
science
on
kratom
and
that
led
in
2016
to
their
recommendation
to
the
drug
enforcement
administration
that
create
them
be
scheduled
as
a
schedule.
R
One
substance
under
the
controlled
substances
act
meeting
the
eight
factors
that
are
required
by
the
csa
at
the
federal
level,
which
are
mirrored
in
large
part
by
each
of
the
states,
the
drug
enforcement
administration
in
an
unprecedented
action.
After
reviewing
the
outcry
from
the
kratom
community
and
scientists
and
consumers
withdrew.
That
recommendation
had
never
done
so
in
the
past.
82.
Previous
times
of
these
kinds
of
recommendations,
they
asked
the
fda
to
provide,
what's
known
as
a
full,
eight
factor
analysis
as
a
complete
scientific
oca,
which
the
fda
did
about
a
year
later.
R
And
after
a
complete,
comprehensive
review
by
the
the
committee
on
drug
dependence
at
the
world
health
organization,
they
recommended
that
there
was
not
sufficient
evidence
to
justify
even
international
scheduling,
which
has
a
much
lower
bar
for
scheduling
that
led
in
this
year.
Secretary.
R
Becerra
issuing
a
letter
with
regard
to
kratom
indicating
that
there
were
significant
knowledge
gaps
about
kratom
and
there
would
not
be
a
pursuit
of
scheduling
a
freedom
going
forward
so
where
that
leaves
us,
and
he
acknowledged
by
the
way
that
much
of
the
safety
data
that
had
been
provided
by
the
fda
and
relied
upon
by
many
people
in
good
bay
was
inaccurate
and
inappropriate.
Given
that
the
deaths
or
the
adverse
events
were
actually
caused
by
poly
drug
use
or
adulterated
kratom
products
or
in
some
cases
contaminated
products.
R
R
None
since
and
since
that
time,
seven
states
have
passed
the
kratom
consumer
protection
act,
which
is
the
framework
outlined
by
representative
callaway,
which
ensures
that
a
consumer
in
this
case
in
kentucky
would
go
into
a
retail
establishment
and
purchase
a
creative
product
and
would
be
relatively
certain
that
it
was
non-contaminated
not
adulterated
and
safe
for
consumption.
And
we
think
that's
the
most
important
thing,
because
we
represent
consumers,
not
the
vendors.
R
We
advocate
for
the
products
that
are
sold
in
the
states
to
be
done
in
a
way
that
is,
is
appropriate
and
highly
regulated
and
that
it
is
safe
for
consumption
and
that's
what
we're
doing
in
the
state
of
ohio,
which
we
hope
will
be
the
eighth
state
to
pass
it
past,
82
to
10
in
the
house.
It's
now
before
the
senate
and
they'll
take
it
up.
This
fall.
There
are
a
number
of
other
states
in
the
same
situation,
including
pennsylvania
and
new
jersey
and
michigan
and
wisconsin,
and
some
others.
R
So
the
the
progress
of
the
understanding
of
the
science
of
kratom
has
gone
forward
directly,
all
with
the
support
of
the
national
institutes
of
drug
abuse.
They
are
funding
more
than
30
million
dollars
in
studies
on
kratom.
It
is
with
the
support
of
the
department
of
health
and
human
services
that
is
working
on
human
clinical
trials
on
kratom.
R
The
us
congress
for
the
past
four
years
has
passed
report
language
in
the
budget
appropriations
bill,
calling
not
to
ban
kratom
but
to
allow
it
to
be
accessible
for
people,
particularly
because
of
the
evidence
that's
being
presented
now
that
people
are
able
to
use
kratom
in
a
beneficial
way
as
a
harm
reduction
tool
to
get
off
of
very
dangerous
opioids
and
there's
a
johns
hopkins
study
that
documents
that
dr
henningfield,
who
I
don't
think
is
on
right
now
and
if
he's
not,
I'm
sure,
he'll
submit
his
written
record
for
you.
R
I
can
give
you
the
details
on
that
research,
because
it
is
phenomenal
when
you
look
at
it.
We
work
with
the
addiction
recovery
community
because
we
know
that,
despite
kratom
not
being
dangerously
addictive
under
the
criteria
that's
established
by
the
controlled
substances
act,
you
can
become
dependent
on
kratom,
it
requires
responsible
use,
and
that
is
key
to
the
labeling
that
we
think
the
states
should
require.
R
So
from
that
standpoint,
we
hope
that
kentucky
will
become
a
state
that
joins
in
this
community
of
those
states
protecting
consumer
protections,
and
I
appreciate
again
the
opportunity
of
having
had
the
the
opportunity
to
present
here
today
and
stand
ready
for
any
questions
at
the
end
of
the
presentation.
So
thank
you.
Q
Thank
you.
Next,
I
would
like
to
refer
to
miss
lindsey
blair
as
an
independent
researcher
that
has
studied
this
subject
as
well
and
then
had
some
testimony
that
you'd
like
to
provide
today.
Thank
you
did
introduce
yourself
for
the
record.
N
Thank
you.
My
name
is
lindsay
blair
and
I
recently
successfully
defended
and
submitted
a
dissertation
to
the
university
of
louisville
school
of
public
health
and
information
sciences,
department
of
epidemiology
and
population
health,
my
dissertation,
which
in
part
contained
analysis
on
kratom
legislation
and
subsequent
opioid
overdose
mortality,
and
I
thank
you
for
this
opportunity
to
share
the
results
of
this
study
as
it
relates
to
this
bill.
So
when
it
comes
to
creating
cradle,
there
are
opposing
views.
N
One
common
view
is
that
kratom
is
a
safer
alternative
for
prescription
and
illicit
opioids
and
it
provides
effective
pain
management
and
it's
a
novel
way
for
people
with
opioid
use
disorder
to
wean
off
of
more
dangerous
drugs.
And
then
the
alternative
view
is
that
cradle
itself
is
a
dangerous
and
addictive
opioid
and
it
may
lead
users
to
more
dangerous,
opioids
and
ultimately,
higher
rates
of
opioid
overdose
mortality.
N
So,
since
2009
six
states,
including
indiana
vermont,
wisconsin,
arkansas,
alabama
and
rhode
island
have
banned
kratom
in
an
effort
to
mitigate
the
addictive
and
dangerous
properties
of
kratom.
So
I
use
it.
We
use
an
interrupted
time
series
analysis,
which
is
the
strongest
method
for
assessing
the
effects
of
a
broad-based
intervention,
such
as
a
state
level
policy,
and
we
evaluated
the
effect
of
these
kratom
bans
in
these
states
on
subsequent
opioid
overdose
mortality
and
we
use
the
overdose
mortality
rates
from
2005
to
2020..
N
So,
in
an
interrupted
time,
series
analysis
a
time
series
of
an
outcome
is
used
to
model
an
underlying
trend,
so
the
pre-intervention
trend
and
it's
interrupted
by
an
intervention
at
a
particular
time,
and
here
the
intervention
is
the
cradle
ban.
So
the
expected
trend
that
would
have
occurred
in
the
absence
of
the
intervention
serves
as
the
counter
factual
to
which
the
impact
of
the
intervention
is
compared.
N
So
before
the
cradle
ban,
we
saw
opioid
overdose
mortality
rates
were
significantly
increasing
in
every
state
except
vermont.
So,
in
the
analysis
we
controlled
for
this
trend
and
we
found
that
rates
continued
to
increase
significantly
in
five
of
the
six
states,
and
I
just
do
want
to
note
that
there
was
no
observed
effect
of
the
cradle
band
in
rhode,
island,
but
rhode
island
was
the
last
state
to
implement
the
ban,
and
there
were
a
few.
N
There
were
only
three
points
following
the
ban
implementation
and
this
result
may
not
hold
with
additional
years
of
opioid
overdose
mortality
data.
So
we
cannot
say
that
definitively
that
the
state
level
cranial
bands
cause
a
significant
increase
in
opioid
overdose
deaths
that
we
saw
in
this
study.
But
I
think
it's
important
to
note
that
banning
kratom
did
not
work
to
mitigate
the
opioid
crisis
in
any
state
where
those
bans
were
put
into
effect.
So
we
did
not
see
rates
decrease
after
the
ban
was
put
in
effect.
N
So,
given
that
cradle
doesn't
meet
the
criteria
for
scheduling
under
the
factories
set
forth
in
the
controlled
substances
act,
then
the
best
protection
for
consumers
is
to
make
certain
that
kratom
is
sold
in
its
pure,
unadulterated
form.
A
R
I'm
sorry
there
must
have
been
some
glitch,
I'm
sorry
for
dr
henning
field,
so
I
assume
he'll
just
submit
a
written
statement
for
the
record
and
be
glad
to
follow
up
with
committee
members.
A
Very
good,
very
good.
I
appreciate
that
this
is
obviously
a
very
representative
callaway
and
I've
talked
about
this
quite
a
bit,
and
I
think
your
original
bill
was
a
ban.
A
It's
interesting
that
the
federal
government
decided
to
make
this
a
scheduled
drug
and
then
remove
that
which
I
don't
think
I've
ever
heard
that
in
my
lifetime
of
a
drug,
that's
been
done
that
so
it
still
is
legal
federally,
but
it
kind
of
leaves
us
open
and
there's
a
lot
of
discussion,
and
I
know
there's
a
lot
of
colleagues
who
don't
like
this
product
and
I
work
in
substance,
use
recovery,
space
and
a
lot
of
people
who
do
not
like
this.
A
So
there
is
a
counter
argument
to
this
and
people
who
support
a
ban,
so
I'm
gonna
have
dr
alan
schultz.
I
think
he's
on
remotely
dr
schultz,
oh
you're.
Oh
there,
you
are
alan,
very
good
if
you'd
like
to
come
forward,
introduce
yourself
it's
good
to
see
you
and
introduce
yourself
for
the
record
and
provide
your
testimony.
P
Yeah
I'm
dr
alan
schultz.
I
own
a
residential
treatment
facility,
an
outpatient
facility
in
lexington
new
day
recovery
been
in
the
business
since
2003
started,
treating
opiate
addiction
at
that
time,
with
a
form
of
vivitrol
that
was
made
in
a
pharmacy
in
chicago,
so
I've
been
been
around
a
few
times.
P
Okay,
I
am
going
to
say
I
do
not
believe
that
we
should
address
kratom
as
a
toxic
substance
or
a
substance
that
causes
damage
to
the
human
body.
I
agree
purifying
it
takes
that
risk
out,
and
I
agree
that
that
a
lot
of
the
problems
that
arose
from
kratom
use
that
we
saw
from
a
medical
perspective
were
caused
by
impurities.
P
But
what
I
want
to
be
crystal
clear
about
is
we're
talking
about
an
addictive
drug
period,
end
of
sentence.
Now
we
can
call
it
a
natural
substance.
We
can
say
that
indigenous
people
use
it
true
for
cocaine
as
well
tobacco
opium,
the
indigenous
people
that
use
kratom
generally
chew
on
three
to
four
leaves
during
the
time
they're
using-
and
these
leaves
are
big,
so
three
leaves.
But
let
me
explain
some
to
you:
the
leaf
weighs
about
10
milligrams.
P
P
P
P
Now
we'll
talk
about
prevalence,
kratom
started
out
at
2017,
I
believe
about
estimated
of
5
million
people
were
using
it,
and
it's
now
up
to
16
million
imports
exceed
50
million
doses
in
a
year,
and
if
you
look
in
the
numbers
of
people
who
use
kratom,
you
get
different
numbers,
but
one
I
picked
out
of
a
research
paper
shows
that
48
of
the
people
use
it
for
pain,
22
of
the
people,
use
it
for
anxiety
and
ptsd
and
10
use
it
just
to
increase
their
energy
level.
P
So
let's
talk
about
kratom
as
far
as
the
substance
in
it.
That
is,
I
consider
dangerous.
There's
two
substances
metrogene
and
7-hydroxymetrogenine
or
metrogenite.
It's
like
kratom.
It
has
different
pronunciations,
but
first
off,
I
want
to
say
that
7-hydroxymetragenide
is
16
times
more
potent
than
morphine.
Okay,
it
directly
binds
to
the
opiate
receptor
directly.
P
Now,
how
can
you
say
a
medication
that
binds
to
the
opiate
receptor
and
stimulates
it?
It's
not
addicting.
There
is
no
medicine
in
the
world
that
you
can
say
binds
to
the
opiate
receptor
and
stimulates
it
does
not
cause
positive
reinforcement
and
that's
what
we're
seeing
here.
I
see
patients
every
day
and
I
have
talked
to
many
people
in
the
recovery
industry
and
also
in
drug
court.
P
P
We
in
the
treatment
industry
consider
kratom
to
be
a
relapse.
It's
not
unusual
that
most
drug
courts,
including
fayette
county,
consider
kratom
a
relapse
and
the
judge
will
order
additional
treatment.
We
see
it
as
a
relapse
plain
and
simple
now
the
treatment
for
kratom
addiction.
This
is
where
it
really
gets.
Interesting.
Suboxone
is
a
treatment
for
kratom
addiction,
okay,
so
it's
obviously
something
that
stimulates
the
opiate
receptors,
because
if
suboxone
makes
the
withdrawal
go
away,
you've
got
an
opiate
stimulation.
P
We
have
had
to
increase,
not
increase,
I'm
sorry,
we
have
had
to
add
kratom
to
our
drug
screens
simply
because
the
problem
we
see
with
it
now
a
lot
of
people
say
harm
reduction.
Okay,
harm
reduction
is
not
a
medication
in
a
gas
station.
Okay,
that's
not
harm
reduction.
Harm
reduction
is
done
by
professionals
with
fda
approved
medications
that
can
help
people.
You
can
get
kratom
in
a
gas
station.
Okay,
that's
not
harm
reduction.
P
Compared
to
other
opiates,
the
one
thing
kratom
doesn't
do,
and
it's
really
good
is
it
doesn't
depress
your
respiratory
drive.
Okay,
doesn't
do
that,
so
overdoses
are
not
going
to
happen
for
the
most
part.
I
would
suspect
anybody
who's
had
an
overdose
that
it's
not
due
to
creativeness
due
to
something
else,
but
that
doesn't
mean
it's
not
addicting,
okay,
and
we
talk
about
people
switching
from
heroin
to
kratom
as
if
that's
a
good
thing,
and
I
guess
it
is.
But
what
about
the
people
who
start
with
kratom
and
end
up
at
heroin?
P
I
mean
it
goes
two
ways
guys
this
is
a
gateway
drug.
By
definition,
it
is
a
gateway
drug.
You
will
see
an
increase
in
overdoses.
I
saw
her
study.
Yes,
you
do
see
a
slight
increase
in
overdoses,
but
I
want
to
remind
this
committee
that
when
we
took
oxycontin
off
the
market
and
we
closed
down
the
pain
clinics,
what
did
we
see
an
increase
in
overdoses?
P
P
I
I
just
think
it's
crystal
clear
and
I've
gone
over
the
pharmacology
and
maybe
you
all
can
ask
me
some
more
questions
and
I'm
open
to
answering
any
questions.
But
please,
dr.
A
Schultz,
thank
you
appreciate
that,
like
I
said,
I
know
this
is
a
topic
that
I
think
a
lot
of
us
have
heard
about,
and
we,
if
we
go
to
legislative
conferences,
you
hear
states
that
have
done
this.
There's
the
american
association's
come
and
talked
to
a
lot
of
legislators,
and
so
I
think
for
a
lot
of
us
that
we're
not
around
this.
We
haven't
seen
it
purchased
or
used,
or
you
don't
hear
about
it.
It's
kind
of
a
nebulous
topic,
so
this
provides
everybody.
A
I
think
a
little
bit
of
the
base
of
what
this
is
and
your
arguments
are
the
things
I
hear
from
other
providers
in
substance
use
recovery.
Also
who
say
this
is
a
problem.
This
is
not
a
good
drug
and
there's
some
who
advocate
banning
it
as
well.
So
so
that's
good,
I
thought
we'd
have
an
opportunity
to
air
it
out
here.
I
know
representative
bentley,
you
have
a
question
or
comment.
I
P
Do
you
mean
if
you
mean
if
you
were
addicted
to
a
kratom
and
trying
to
come
off.
P
I
I
I
N
That
it's
a
it's
if
it
affects
the
opioid
receptor,
then
it's
an
opioid.
It's
a
it's.
P
N
N
P
Same
thing
can
be
said
about
suboxone
in
its
pure
form,
low
doses,
work,
high
doses,
make
you
sick
and
suboxone's
controlled,
and
yes,
I
did
make
the
mistake
of
saying
it.
I
should
say
an
agonist
anyway.
R
So,
mr
chairman,
mr
chairman,
could
I
can
I
just
add
one
additional
item
here.
Dr
schultz
obviously-
and
I
disagree
strongly
on
the
science-
and
I
would
ask
you
to
rely
upon
the
scientific
record
from
the
national
institutes
on
drug
abuse
on
the
pharmacologic
action
and
the
addiction
liability
of
kratom.
They
are
inconsistent
with
dr
schultz's
conclusions,
which
are
understandable,
given
the
outdated
science
that
was
originally
promoted
by
the
fda.
But
the
truth
is
the
pharmacological
activity
of
the
two
alkaloids
metrogene
and
7-hydroxymetrogene
are
partial
agonists.
That's
why
they
don't
go
to
the
respiratory
system.
R
They
also
do
not
go
to
the
center
of
the
brain
that
gives
you
that
reinforcing
high
that
drives
people
back
to
the
addiction,
and
so
that's
critical.
When
you
look
and
evaluate
this-
and
this
is
in
the
science
we'll
be
glad
to
submit
these
scientific
records.
I
respect
the
fact
that
there
are
concerns
in
the
community,
but
if
any
physician
were
to
treat
a
patient
who
presents
with
a
kratom
dependency
with
narcan
or
suboxone,
that's
not
the
appropriate
treatment
for
a
dependency
that
is
from
the
caffeine
coffee
plant.
R
R
Right
so,
dr
schultz,
I'm
not
asking
you
to
agree
with
me.
I'm
asking
you
to
look
at
the
science
and
then
one
last
point:
thailand
correctly
dr
schultz
had
said,
had
banned
it,
but
last
year
they
removed
the
ban
because
they
looked
at
the
new
science
and
that's
happening
in
the
other
countries
too.
P
A
R
I
You
know
relapse
was
an
interesting
word
used
too.
The
most
addicting
dragon
on
the
man
is
nicotine
yeah
and
we
see
relapse
lid
all
the
time
yeah.
So
I
don't
know
if
that's
really
a
good
argument
or
not,
and
just
the
point
you
know
when
you
do
go
to
a
gas
station,
you
can
buy
this
free.
You
can
also
get
gas
and
if
you
got
into
your
lungs
it
could
really
hurt
you
lipid
pneumonia,
so
consider
that
toxicity
also
thank.
A
You
representative,
next
senator
berg,.
C
C
You
said
that
we
could
be
relatively
certain
that
we
have
a
product
that
is
free
of
contaminants,
and
you
know,
as
a.
R
So,
thank
you
for
that
question,
and-
and
this
is
a
critical
issue-
currently,
the
manufacturers
of
kratom
in
an
unregulated,
unregulated
setting
do
not
test
for
contaminants
under
the
kratom
consumer
protection
act.
They
would
be
required
to
test
for
all
contaminants
and
they
would
reduce
them
down
to
the
levels
required
by
the
fda.
So
I
gave
you
the
qualified
answer.
R
The
fda
preaches
that
you
can
be
relatively
safe
under
the
standard
for
botanical
products
for
contaminants
they
and
they
simply
make
the
point
that
you
can't
eliminate
to
zero
risk,
but
you
certainly
wouldn't
have
a
prokaryotic
product
that
would
create
a
health
hazard
to
the
individual
patient
if
or
consumer.
If
the
consumer
protection
act
were
in
place
and
the
manufacturers
are
required
to
predict
to
produce
an
independent
certificate
of
analysis
documenting
that
they
me
they're,
compliant
with
the
kentucky
law,
if
it's
enacted
and
that's
what
works
in
other
states,.
J
Thank
you,
mr
chair,
and
thank
you
everyone
for
this
discussion.
Yes,
we
did
start
having
this
discussion
in
the
session.
As
a
reminder,
the
original
bill
was
a
ban
and
the
more
we
talked
about
this,
the
more
we
realized
that
you
know.
This
is
a
product
that
is
already
in
gas
stations
it's
already
out
in
the
markets
and
at
the
very
least,
while
the
fda
and
nida
are
deciding
how
to
handle
this.
J
We
should
we
thought
at
least
regulate
this,
to
keep
it
out
of
the
hands
of
minors
and
and
and
impose
some
penalties
for
retailers
who
were
not
following
the
law.
I,
dr
schultz,
if,
if
the
issue
of
kratom
is
so
crystal
clear,
why,
in
your
opinion,
has
the
fda
and
nida
not
made
a
decision
about
how
to
schedule
kratom
or
not
schedule
it.
P
P
P
Suboxone
is
basically
a
partial
agonist
identical
to
kratom.
If
that's
the
argument
and
it's
controlled
so
there's
a
lot
of
concerns
about
those
possibilities,
because
what
we're
seeing
now
is
people
dying
from
drugs
that
are
contaminated
by
fentanyl
and
that's
not
kratom.
I
don't
mean
that.
So
it
is
scary
to
see
these
type
of
issues.
R
So
chair
moser,
if
I
could
just
add
an
additional
item
of
consideration
by
naida
and
the
fda,
and
that
is
the
science,
not
the
pressure
from
any
advocacy
group
or
group
of
consumers,
but
rather
the
outcome
of
the
science,
and
we
will
share
with
you
the
scientific
research
on
the
addiction
liability
done
by
the
national
institute
on
drug
abuse
where
they
concluded.
There
was
no
significant
addiction
liability
and
the
new
scientific
articles
that
show
the
harm
reduction
potential,
which
is
why
the
director
of
nida
is
so
so
a
great
advocate
for
kratom.
R
We
think
those
are
the
kinds
of
considerations
that
ought
to
be
done,
and
the
bottom
line
is
that
this
evolving
science-
and
this
is
why
the
secretary
of
health
and
human
services
today
says
that
kratom
is
not
a
candidate
for
scheduling
based
on
the
current
science
and
that's
the
important
point
that
we're
making
here.
If
everything
that
dr
schultz
says-
and
I
accept
in
good
faith-
he's
doing
it
honestly,
based
on
his
experience
and
research.
If
what
he
was
saying
were
true,
this
would
be
a
scheduled
substance
at
the
federal
level.
R
A
A
In
time
and
try
to
read
them,
but
I
don't
always
trust
retrospective
analysis,
I
prefer
prospective
studies
to
say
we
did
this.
We
gave
this
here's
the
outcome
and
we
you
know
we
geared
it
and
you
have
that
to
go
backwards
and
try
to
predict
something
based
on
the
past
and
try
to
read.
The
tea
leaves,
no,
no
pun
intended
going
backwards
on
that,
I'm
not
a
real
big
fan
of
so
that
would
be
something
I
think
would
be
welcome
for
the
committee.
J
If
I
could
just
wrap
up
and
and
agree
with
you
and
also,
I
would
like
to
add
that
that
science
is
critically
important
for
the
researchers
and
for
the
fda
and
for
nida
to
determine
how
to
handle
this,
not
legislators.
J
I
think
our
job
is
to
protect
consumers
and
for
the
meantime,
in
the
meantime,
I
think
the
very
least
we
can
do
is
to
put
some
regulations
around
this
product
to
protect
the
youngest
individuals
who
might
be
accessing
this.
While
the
fda
and
nida
makes
a
decision,
I
don't
like
legislators
being
in
the
position
being
put
in
the
position
of
determining
whether
or
not
something
is
a
medication
or
whether
or
not
something
should
be
completely
banned.
So
I'll.
J
I
you
know,
I
just
want
to
add
that
I
I
think
that
this
is
an
important
issue,
as
are
other
drugs
that
have
come
before
our
committee
and
our
legislature,
and
I
think
that
the
fda
and
nida
ought
to
take
a
stand
on
this.
We
have
one.
K
Thank
you,
mr
chairman
and
representative
callaway
from
a
law
enforcement
perspective
on
this.
What
what
would
the
someone
who
is
under
the
influence
of
kratom,
what
symptoms
or
what
traits
would
they
exhibit.
Q
Q
I
too,
run
a
transitional
living
home.
I
deal
with
addicts
every
day
of
my
life.
That's
what
I
do,
and
I
am
not
at
all
sitting
here
advocating
for
anything
in
particular,
except
for
that
we
have
a
product
that
has
no
guardrails
on
it
at
all
and
it
needs
them.
There's
more
studies
that
I
want
to
do,
I'm
not
saying
that
it
doesn't
have
good
uses
for
lots
of
things.
I've
had
thousands
of
people
that
have
literally
reached
out
to
me
over
this
particular
issue
when
I
filed
the
ban.
A
Thank
you,
representative
callaway.
Thank
you
all
again.
We
could
talk
about
this
for
a
lot
longer,
and
I
appreciate
your
approach
on
it
and
I,
and
I
know
that
it
was
actually
a
clause
in
the
bill
that
was
a
trigger
that
if
the
fda
or
the
dea
made
this
a
scheduled
drug,
that
it
would,
we
would
honor
that
from
the
dea.
A
So
I
I
appreciated
that
part
of
the
bill
as
well,
but
I
thought
we
needed
to
have
this
discussion
and
obviously
a
lot
of
passion
and
a
lot
of
providers
who
have
had
experience
and
are
concerned
about
that
for
patient
safety.
So,
thank
you
all
so
much
for
your
time.
We've
got
two
more
two
more
presentations.
We're
just
going
to
hear
testimony.
I'm
not
going
to
have
any
questions
on
them,
so
they
can
come
and
present.
A
If
you'd
like
to
come
forward-
and
I
think
dr
martha
mather
and
rachel
lucinski
are
here
as
well-
or
I
think
I
guess
miss
lucinda
might
be
remotely-
is
that
correct,
she's
in
remotely
but
you'd
like
to
come
to
the
table,
introduce
yourselves
a
lot
of
10
minutes
for
testimony
on
this
topic.
You
can
introduce
yourselves
and
begin
your
testimony.
S
Thank
you,
mr
chairman.
This
is
not
about
tea,
leaves
or
anything
along
those
lines.
So
hopefully
this
will
be
an
enlightening
discussion
about
which
I
think
I
really
think
it's
more
of
a
life-saving
discussion
that
we'll
have
with
you.
I
just
want
to
express
my
appreciation
for
coming
and
testifying
before
you
today.
I'm
gonna
go
ahead
and
introduce
my
my
guest,
martha
and
then
I'll
have
rachel
who's
online
she'll
introduce
herself
as
well
hi,
martha.
C
Mather,
I
should
I
should
correct
that
I'm
not
a
doctor,
but
I
am
very
enthusiastic
about
all
the
mental
health
talk
today.
I'm
the
ceo
of
uofl
health
peace
hospital
in
louisville.
S
E
S
Great,
thank
you
rachel.
Thank
you
martha.
What
we
are
we're
here
today,
basically
to
present
to
y'all
a
tool
called
safe
kentucky.
It's
a
one:
click
away,
app
for
k-12
students,
teachers
and
parents
to
have
24
7
access
that
will
serve
two
purposes.
The
first
purpose
is
to
have
access
to
a
mental
health
professional
that
will
provide
some
life-saving
intervention
services
and
then
two
it
provide
a
report
for
school
and
safety
concerns.
S
Some
time
ago.
I
I
reached
out
to
utah
and
they
were
very,
very
helpful
and
gave
me
a
very
good
understanding
of
what
safe
ut
which
this
product,
or
so
this
service
is
model
after
after
of
and
we
had
our
meeting
early
january
and
martha
was
kind
enough
to
attend
and
she's
been
on
board
ever
since,
and
so
she's
basically
going
to
be
the
the
backbone
to
get
this
product
up
and
running
in
a
in
a
nutshell,
we're
looking
at
doing
a
pilot
project
with
some
schools.
S
We
had
a
meeting
with
the
commissioner
of
the
part
of
education
today,
he's
enthusiastically
excited
about
this.
We've
talked
to
several
school
districts,
they're,
really
considering.
By
doing
this,
once
again,
it's
going
to
be
a
pilot
project
and
hopefully
have
it
fully
implemented,
hopefully
sometime
next
year,
which
I'll
introduce
a
bill
and
then
also
some
funding
mechanism.
What
I'd
like
to
have
martha
to
do
is
give
sort
of
a
little
details
about
that
and
then
have
rachel
give
what
her
experience
experiences
have
been,
and
some
of
the
information
she's
come
across.
C
Thank
you,
representative
fleming,
and
thank
you
to
the
committee
for
having
us
today.
The
safe
ky
app
is
a
wonderful
opportunity
for
our
communities
to
offer
short-term
behavioral
health
crisis,
intervention
to
students,
families
and
educators
24
hours
a
day,
seven
days
a
week,
365
days
a
year
at
no
cost
to
the
user.
C
This
could
be
through
talk,
text
or
chat
and,
as
representative
fleming
mentioned,
there's
also
a
school
safety
feature
where
concerns
of
potential
violence
can
be
reported,
and
now
more
than
ever,
senator
owens
mentioned
earlier
that,
following
a
global
pandemic,
we
need
to
ensure
access
to
behavioral
health
care,
which
this
initiative
will
offer
it's
important
for
everyone,
especially
our
kids,
to
know
that
they're
not
alone
and
that
behavioral
health
challenges
are
are
very
very
common.
C
So
we've
been
working,
I've
been
working
closely
with
rachel
and
her
team
at
safe,
ky
utah
rolled
this
out
about
seven
years
ago
and
they've
had
some
very
successful
outcomes.
It
took
them
about
seven
years
to
get
to
the
entire
state
of
utah.
So
representative
fleming
mentioned
that
we
would
want
to
pilot
this
in
a
couple
of
school
districts.
C
E
It's
absolutely
my
pleasure,
like
martha
and
representative
fleming
have
mentioned.
Safe
ut
was
born
out
of
legislation
in
the
2015
general
session
in
utah,
and
it
was
created
to
address
a
crisis
that
was
affecting
the
state
of
utah,
where
suicide
is
the
leading
cause
of
death
for
youth
in
our
state
ages,
10
to
25
at
ages,
10
to
24
years
old.
E
What
we've
seen
in
utah
last
year,
we
had
more
than
30
000
chats
that
were
submitted
with
more
than
one
or
excuse
me
more
than
one
million
back
and
forth
message
interactions
with
users.
We
know
that
students
are
always
on
their
smartphones,
and
so
this
is
a
wonderful
way
to
meet
youth
where
they're
at
increase
access
to
these
services
and
reduce
stigma
around
health.
Seeking
behavior,
we
had
more
than
298
life-saving
interventions
for
students
that
were
at
imminent
risk
of
attempting
suicide.
E
So
that's
almost
300
students
in
utah
that
are
still
with
us
today
because
of
the
services
and
safe
ut.
When
we
look
at
the
school
safety
or
school
tip
feature,
we
see
that
the
leading
tip
that's
submitted
far
and
away
is
concerns
of
suicide,
but
our
second
tip
that's
submitted
is
about
bullying
and
then
subsequently,
potential
school
threats
are
acts
of
violence.
E
So,
in
the
2020
to
2021
school
year
we
had
256
planned
school
attacks
or
potential
threats
of
violence
that
were
reported
and
prevented
from
taking
place
because
of
the
collaboration
with
our
mental
health
professionals,
school
administrators
and
law
enforcement
officials,
when
it's
necessary.
So
we
have
more
than
850
000
students
in
the
state
of
utah,
with
access
to
the
app
that's
almost
95,
of
our
public
schools.
E
90
of
all
of
our
schools
in
the
state
that
over
the
last
seven
years,
have
opted
in
and
chosen
to
be
part
of
this
incredible
collaboration
and
life-saving
service.
We're
happy
to
answer
any
questions
and
and
really
commend
the
incredible
work
of
martha
and
her
team
and
and
representative
fleming
on
addressing
mental
health
and
school
safety
concerns
in
kentucky.
A
Thank
you
all
very
much.
I'm
impressed
it's
256
that
I
was
just
commenting.
That's
that's
an
eye-catching
amount
of
things
that
were
thwarted,
potentially
that's
obviously
in
today's
environment
and
what
we're
seeing
nationally
is
tremendous.
So
I
appreciate
that
any
other
comments
from
you
all
night.
If
there's
any
questions
or
comments,
representative
bentley.
I
I
have
a
question
four
years
ago
I
had
the
same
bill
and
I
used
president
vickers
from
utah
who's,
a
good
friend
of
mine,
and
we
brought
it
up
and
the
state
of
kentucky
wouldn't
supply
the
money.
Remember
that
kim
or
any
support
have
you
already
talked
to
the
cabinet
or
any
of
them
to
get
support.
S
Thank
you
representative.
Let
me
just
sort
of
explain
how
that's
gonna,
how
it's
gonna
work.
Basically,
what
we're
doing
is
that
we're
talking
to
foundations
here
locally
and
peace,
uofl
peace
is
going
to
help
provide
these
the
the
personnel
and
costs
to
provide
those
mental
health
counselors
then,
through
very
strong
relationships.
S
We
have
and
we've
got
pretty
good
commitments,
thus
far
from
the
foundations
to
help
provide
money
initially
get
this
thing
going
and
then,
when
it
comes
to
the
spring,
as
I
mentioned,
I'm
going
to
introduce
a
bill
we're
going
to
basically
help
complete
the
funding
of
this
next
year
and
then,
in
addition
to
that,
set
things
up
for
full
implementation
in
full
funding.
The
following,
which
is
the
second
half
of
our
fiscal
year.
You.
S
S
Already
this
is
the
this
is
uofl
piece
that
they
will.
They
will
be
providing
that
and
it's
not
really
a
call
center.
But
it's
going
to
be
mental
health
professionals
that
provide
this
martha.
Do
you
want
to
explain.
C
Well,
so,
through
the
smartphone
and
through
the
as
we
work
with
university
of
utah
and
building
the
app
for
kentucky,
we
would
have
24
hours
a
day,
seven
days
a
week,
a
licensed
therapist
on
the
other
end,
to
answer
the
the
calls
or
texts
or
chats
coming
in.
Thank.
I
A
Thank
you
all.
Well,
very
good,
that's
it's
an
exciting
topic
and
I
know
it's
been
out
there
for
a
while.
So
I
appreciate
you
all
bringing
light
to
this
and
hopefully
we'll
see
some
legislation
moving
in
the
upcoming
well.
S
Thank
you
and
I
want
to
compliment
just
let's
call
out
utah
and
rachel
and
her
group
they've
been
very,
very
instrumental.
They're
gonna
basically
walk
hold
our
hands
and
walk
this
whole
thing
through,
so
we
can
make
sure
we
have
the
best
service
out
there
as
possible.
So
we're
really
excited
about
this.
Once
again,
this
is
a
life-saving
measure,
metal.
A
Chairman
moser
was
just
mentioning
we,
you
know
we
fund
poison
control
centers
in
this
state
through
norton's.
I
think
for
and
that's
in
our
budget
every
year,
and
I
think
it's
something
we
need
to
start
considering
also
on
this
topic,
moving
forward
all
right.
Thank.
A
And
the
other
question
that
I
think
also
needs
to
be
you
know,
988
is
the
new
number
we've
got
for
mental
health?
Does
this
tie
into
that
at
all
I
mean
as
far
as
an
opportunity,
or
is
it
going
to
be
completely
separate?
Has
there
been
discussions
about
that.
S
There
has
been
discussion
about
it,
we'll
continue
to
talk
about
it,
but
it's
going
to
augment
it's
going
to
complement
that
with
what
they're
doing.
I
know
the
well
senator
rise
was
here,
but
you
know
there's
a
bill.
We
passed
several
years
ago.
The
school
resiliency
safety
act
in
there
and
then
one
of
the
sections
it
talked
about
using
different
tools.
One
of
those
different
tools-
I've
mentioned
is
mobile,
and
this
is
what
this
with
this
falls
in
the
and
the
playing
server.
S
So
I
really
think
I
really
think
it's
going
to
be
a
very
much
of
a
complimentary.
In
fact,
it's
going
to
enhance
because
remember
988
in
a
tough
situation
or
remember
the
the
suicide
line.
It's
hard
to
remember
those
numbers.
All
you
got
to
do
is
look
at
your
phone
and
you
hit
it
and
you're
gone
talking
to
somebody.
That's
what
that's
what
it
takes.
It's
an
easy
access.
A
Look
forward
to
that
in
the
upcoming
session,
and
we
have
one
more
presentation
briefly
on
healthcare,
workforce
shortages.
I
know
the
nancy,
galvani
and
betsy
johnson
are
here
that,
regarding
a
topic
that
I
think
that
is
front
and
center
for
us
right
now
in
healthcare.
F
Okay,
well,
I
just
want
to
thank
you,
chairman
alvarado
chairwoman,
moser
members
of
the
committee
for
having
us
today,
and
so
I'm
just
going
to
cut
to
the
chase.
The
bottom
line
for
hospitals
is
that
our
costs
are
skyrocketing.
Health
care
workers
are
retiring
in
large
numbers
and
not
enough.
People
are
entering
into
the
health
professions
to
meet
the
growing
need,
and
so
the
crisis,
as
you
all
know,
has
been
in
the
making
for
a
while
kova
19,
exacerbated
it
and,
of
course,
there's
no
quick
fix.
F
F
We
just
did
a
survey
of
our
hospitals
and
we
found
that
in
2019
kentucky
hospital
spent
88
million
on
nursing
contract
labor
and
in
just
the
first
six
months
of
2022.
That
number
has
skyrocketed
to
489
million.
That's
400
million
dollars
more
being
paid
for
travel
nurses
just
from
january
through
june.
That's
an
increase
of
455.
F
F
F
F
Further,
more
than
18
percent
of
hospital
nurses
are
expected
to
retire
over
the
next
10
years,
and
that
number
is
even
higher
for
psych
nurses,
the
percent
is
36
percent
and
or
in
recovery
nurses,
nearly
28
with
more
experienced
nurses
retiring
fewer
entering
the
workforce.
We
have
an
aging
population.
F
We
also
think
it'd
be
very
beneficial
for
educational
authorities
to
increase
the
number
of
high
schools
offering
health
career
training
so
that
students
have
the
opportunity
to
earn
certificates
and
sit
for
national
exams,
including
lpn
training
at
the
high
school
level.
This
would
allow
students
to
enter
the
workforce
immediately
and
then
further
advance
their
career
through
additional
training.
F
M
A
T
Yeah
I
sent
it
to
sent
to
diane,
but
it's
fine,
it's
fine
and
we'll
make
sure
that
you
all
have
it.
So.
First
of
all,
we
stand
with
our
partners
at
the
kentucky
hospital
association.
T
T
It
was
interesting
that
there's
a
lot
of
mental
health
talk
about
today,
because
one
of
the
reasons
why
we're
struggling
is
because
our
our
workforce
is
having
mental
health
issues.
There's
burnout,
post-traumatic
stress
disorder
from
cover
19,
retirements,
child
care
issues,
transportation
issues
and
then,
of
course,
we
are
competing
with
non-health
care
sectors
that
can
raise
their
prices
and
pay
their
workforce
more
because
we
are
very
medicaid
dependent.
T
I
heard
commissioner
lee
say
yesterday
that
70
of
the
medicaid
seventy
percent
of
residents
are
covered
under
medicaid
and,
as
you
all
know,
that's
the
lowest
payer.
We
are
also
dealing
with
the
medicaid
rates
that
have
not
kept
up
with
increased
costs.
Currently,
the
federal
government
is
threatening
medicare
cuts
to
skilled
nursing
facilities
and,
of
course,
president
biden
has
indicated
that
he's
going
to
have
a
mandate,
mandatory
staff
ratios
for
skilled
nursing
facilities
and
we
simply
don't
have
the
workforce
to
comply
with
that.
T
When
you
do
get
the
presentation,
we
have
slides
that
show
some
quotes
from
some
of
our
members
indicating
the
costs
that
they
have
expended
to
to
do,
geo-fencing
and
other
things
to
try
to
attract
workforce
and
and
to
little
or
no
avail.
We
also
have
and
I'm
trying
to
go
fast,
because
I
know
you
are
tired
and
I
want
this
to
stay
on
your
radar.
I
don't
want
you
all
to
get
like
not
understand
the
importance
of
this
issue.
T
There's
been
a
significant
decline
in
nursing
home
employees.
We
have
lost
4,
347
jobs
since
the
beginning
of
the
pandemic
of
march
2020
and
the
entire
that's
just
skilled
nursing
facilities,
the
entire
long-term
care
industry,
which
in
kentucky
has
also
assisted
living
in
personal
care,
there's
been
a
job
loss
of
5505
individuals,
jobs
and
then
I
have
a
really
great
graph
and
I
meant
to
talk
to
nancy
about
this
beforehand.
I
wish
you
could
see
this
I'll
make
sure
you
get
in
front
of
you.
T
We
are,
according
to
the
bureau
of
labor
statistics,
the
only
sector
in
health
care
that
has
not
recovered
at
all
in
our
workforce.
Ambulatory
services
have
increased
4.2
percent
hospitals.
According
to
the
bureau
of
labor
statistics,
0.4,
we
are
at
negative
61
of
our
workforce
and
for
those
of
you
all
who
have
been
a
nursing
facility
is
a
calling.
We
have
a
hard
time
attracting
people
and
I
agree
with
nancy.
We
need
to
start
the
high
school
level
level.
T
I
just
had
a
board
member
tell
me
that
the
the
person,
the
one
person
that
was
doing
training
for
medication
aid
and
the
community
college
in
northern
kentucky
left.
So
we
have
nobody.
That's
going
to
be
able
to
train
for
medication
aids
up
in
northern
kentucky
through
the
community
college
system,
so
we
have
to
figure
out
how
to
get
training
for
high
school
students.
A
lot
of
jobs
and
long-term
care
do
not
require
a
college
degree.
T
You
can
get
certified
right
out
of
high
school,
so
I
would
like
to
work
with
the
hospital
association
and
with
you
all
on
that
issue,
and
also
we
appreciate
the
passage
of
house
bill
282.
We
worked
closely
with
the
hospital
association
on
that
staff
agency
use
has
gone
as
just
skyrocketed
since
the
pandemic
costs
are
unaffordable.
T
We
have
you
know
we're
that
that
law
just
went
to
effect
recently
we're
going
to
be
tracking
it
very
closely
we're
encouraging
our
members
to
file
price
gouging
complaints
with
the
attorney
general's
office.
If
that's
what
they're
seeing
and
meanwhile,
we
want
to
work
with
our
staff
agencies
to
ensure
that
they're
charging
appropriate
rates,
but
also
to
get
these
people
back
as
employees
of
long-term
care
facilities,
because
we
know
continuity
of
care
means
the
world
for
for
quality
health
care
services.
T
So
I
spoke
really
fast,
but
I
want
to
make
sure
that
you
all
got
that
information
before.
A
T
A
Thank
you.
I
speak
fast
too.
Everybody
knows
that
I'll
tell
you
of
all
the
topics
we
heard
about
today.
This
is
probably
going
to
be
the
thing
that's
most
front
and
center,
we're
all
used
to
showing
up
to
an
er
and
having
someone
take
care
of
you.
Something
happens,
that's
what
we're
used
to
in
america,
we're
used
to
that
in
our
state
and
our
communities-
and
I
remind
everybody-
this
is
a
team
effort
that,
when
we
have
health
care
anymore,
that
you
know,
doctors
that
do
surgeries
need
to
have
surgical
techs.
A
The
time
is
coming
very
soon,
as
we
start
seeing
everybody
exiting
quickly
and
more
than
we
have
coming
in
where,
if
you
have
to
have
a
surgery
done,
a
procedure
done
something
done
to
work
up
a
potential
tumor
or
a
potential
cancer,
or
something
that's
risky
for
your
loved
one
or
placement
of
a
loved
one.
You
know
I
can't
you
know
I
can't
take
care
of
somebody
at
home.
A
I
need
to
have
a
facility
for
them
to
go
to
those
days
are
coming
quickly
to
an
end
and
they
were
going
to
say
I
have
nowhere
to
send
somebody.
What
am
I
supposed
to
do
and
it's
going
to
be
we're
full.
We
have
no
more
room
and
it's
not
dependent
on
how
many
physical
beds
people
talk
about
healthcare
being
a
right
and
they
think
it's
talking
about
a
bed
or
an
iv.
Tube
healthcare
is
ultimately
professionals
and
people
with
knowledge
and
skills,
and
we
don't
necessarily
have
the
right
to
someone
else's
labor.
A
If
they're,
not,
we
fight
a
war
over
that
issue
and
there's
a
lot
of
people
out
there
that
have
these
abilities
that
are
saying
I'm
done.
I've
had
enough
because
we've
relied
on
the
good
will
of
a
lot
of
these
folks
to
make
the
system
work
and
that
goodwill
is
quickly
escaping
us.
So
this
is
the
biggest
topic.
I
think
one
of
the
biggest
issues
at
hand
in
our
state
in
our
country.
H
Yes,
thank
you
for
being
here
and
talking
very
quickly.
We
could
talk
on
this
all
day,
maybe
all
week
because
we're
having
not
only
shortages
in
the
healthcare
shortages
and
everything
welding
anything.
So
we
need
to
focus
on
training
our
own
with
our
own
people,
because
I
don't
see
how
you're
getting
with
a
national
nursing
shortage.
I
don't
know
how
you're
getting
travelers,
even
the
construction
trades
can't
get
travelers
coming
in
to
build
things.
So
the
high
school
focus
is
fantastic.
That's
what
we
need
funding
is
not
the
answer.
H
I'm
not
saying
you
don't
need
funding,
but
the
people
is
the
answer
we
have
to
get.
The
people
have
y'all
looked
at
the
nortons.
What
norton's
has
done
with
the
registered
apprenticeship,
how
they
are
training
their
people,
because
that
offsets
somewhat?
That
gets
the
high
school
student
or
other
people
into
the
programs?
Because
then,
then
you
we
don't
need
state
funding.
The
hospital
is
funding
that
and
they're
paying
the
people
as
their
registered
apprenticeship,
which
is
which
norton's
helped
kentucky
start.
H
The
first
registered
apprenticeship
for
health
care,
more
than
just
nurses,
others,
and
then
this
administration
pushed
them
away.
So
they
had
to
go
straight
to
the
feds
for
it
we
need
to
emulate
that
kind
of
stuff.
You
talk
about
emt,
bullitt
county
did
the
same
thing
with
apprentice
in
in
bringing
people
in
and
the
only
problem
we're
having
in
bullitt
county
with
our
emts
is
people
are
taking
our
train,
which
we
train
them
taking
them
away
from
it,
paying
them
more.
So
that's
something
I
think
you
need
to
focus
on.
I'm
tr.
H
Sorry,
mr
chairman,
I'm
trying
to
talk
fast,
but
I
think
we
do
have
alternatives.
It's
going
to
take
time.
Thank
you.
Thank
you.
K
Thank
you
all
for
the
presentation
how
much
of
this
crisis
has
been
created
by
having
clinics
on
every
corner
and
from
the
hospital
perspective
and
just
from
the
industry
as
a
whole?
I
mean
over
the
last
20
years.
I
I
mean
I
don't
know
what
the
numbers
are.
I'm
sure
they're
huge,
that
there
are
clinics
everywhere
which
takes
extra
staff
to
be
able
to
to
run
the
clinics.
Therefore,
it
creates
a
shortage
within
the
hospitals.
K
So
sometimes
do
hospitals
hurt
themselves
by
continuing
to
open
clinic
after
clinic
that
requires
more
staff,
because
I
would
venture
to
say
that
the
hospitals
are.
The
the
hospital
organization
are
probably
serving
more
people
with
more
staff
because
of
all
the
clinics,
but
yet
there's
a
shortage
within
the
hospital
help
me
understand
that
relationship
in
these
studies.
I.
F
Think
what
you're
seeing
is
an
aging
population
there's
a
demand
for
more
services,
and
so
yes,
people
are
wondering
well,
how
are
hospitals
opening
more
services
what's
to
meet
their
patient
needs?
But
staffing
is
obviously
an
issue
now
the
people
that
are
working
in
a
hospital,
you
know
they're
very
highly
trained
the
nurses
that
you
know,
depending
upon
the
unit
you're
working
in
if
you're,
labor
and
delivery
you're
very
highly
trained
in
that
or
you
know,
cardiac
cath
or
you
know
icu
versus
you
know,
maybe
in
a
clinic
it's
a
different
skill
set.
F
K
I
just
I
think,
sometimes
maybe
we
look
at
it
in
a
way
that
you
know
where
it's
not
really,
because
we're
falling
behind
over
what
we've
had
the
care
that
we've
had
to
provide
in
the
past,
we're
not
keeping
up
with
what
you
just
said
with
the
future
demand,
and
so
that's
really
and
it
just
came
to
light
the
other
day.
K
O
Thank
you
very
briefly
appreciate
your
presentations
as
always,
and
particularly
the
rapid
fire
man.
You
delivered
it,
but
I
don't
want
you
to
think
that
or
discount
the
importance
of
this.
I
know
nancy
we've
got
you
scheduled,
I
think,
to
meet
with
our
budget
review
subcommittee
for
human
services
to
talk
about
the
enhanced
reimbursement
for
outpatient
services
and
the
reason
it's
coming
to
budget
review
is
it's
going
to
require
an
appropriation
which
is
kind
of
a
technicality
and
betsy?
O
I
think
we've
got
you
pegged
for
a
medicaid
oversight
to
presentation
sometime
the
next
month
or
two
months.
It's
obviously
going
to
have
an
impact
on
our
medicaid
program,
so
you'll
have
an
opportunity
to
deliver
it
in
a
much
slower.