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From YouTube: Budget Review Subcommittee on Human Resources (10-6-21)
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A
Good
morning,
good
morning
welcome
to
meeting
number
five
of
the
budget
review
subcommittee
on
human
resources.
As
a
reminder,
remote
access
is
allowed
to
all
meetings
for
the
2021
interim
session.
Members
were
provided
a
zoom
link
to
access
the
meeting
remotely
the
meeting
materials
were
put
online
earlier
this
week
and
made
available
for
downloading.
A
B
A
A
You
probably
have
to
pull
those
microphones
closer
to
you
and
yet
turn
one
for
all
of
us
to
hear
members
hold
your
questions
until
after
the
presentation
please.
I
asked
this
group
to
come
because
in
eastern
kentucky,
hepatitis
c
costs
medicaid
a
lot
of
money,
and
I
want
everybody
to
understand.
There's
new
treatment
and
the
severity
of
the
disease
state
so
welcome.
G
H
G
So
first
oops
we're
not
in
the
right
slide
there.
We
are
first
I'd
like
to
acknowledge
that
kentucky
has
made
incredible
strides
in
hepatitis
c
and
continues
to
do
so,
and
I
think
it's
remiss
to
miss
the
opportunity
of
success
in
2018,
senator
julie,
rocky
adams,
sponsored
senate
bill,
sb,
250,
universal
hepatitis
c
screening
for
pregnant
women.
G
Thank
you
and
and
then
also
incorporating
that
bill's
documentation
of
infants
that
the
diagnosis
is
in
their
permanent
medical
record,
perinatal
exposure
to
hepatitis
c.
This
bill
passed
unanimously
by
the
house
and
the
senate
and
came
into
effect
in
summer
of
2018.
G
really
leading
the
way
was
that
kentucky
was
the
first
state
in
the
nation
to
do
this,
and
in
two
years
later
the
cdc
updated
its
recommendations
to
match
the
recommendations
that
kentucky
had
proposed
in
2018
and
in
2021.
The
american
college
of
obstetricians
and
gynecologists
followed
suit,
all
right,
I'm
on
the
right
side
so
and
then
within
the
cabinet.
G
So
one
of
the
things
that
I
really
enjoy
about
working
in
hepatitis
c
is
that
the
virus
is
actually
kind
of
tricky
and
it
first
was
sequenced
in
1989
about
32
years
ago
and
whereby
it
finally,
when
that
happened,
it
finally
got
its
name,
hepatitis
c
versus
non-a
non-b,
and
it
was
confirmed
to
cause
mild
to
severe
liver
infection
in
the
u.s
pre-1989.
G
Most
hcv
infections
were
acquired
through
medical
procedures
so
but
one
sequence:
the
u.s,
initiated
blood
blood
product
and
solid
organ
transplant
screening,
so
that
transmission
mechanism
was
essentially
cut
off.
Even
at
that
time,
when
that
was
cut
off
treatment,
options
were
quite
limited,
but
elimination
was
discussed
and
it
was
that
was
how
exciting
this
was.
G
So
in
the
early
90s,
we
marked
the
beginning
of
the
rolling
opioid
injection
use
endemic
that
we're
still
experiencing,
and
it's
this
endemic
that
is
driving
the
spread
of
hepatitis
c.
So
today,
the
most
common
route
of
hc
hcv
transmission
is
injection.
Drug
use
and
viral
hepatitis
comes
in
many
forms,
but
the
only
way
to
know
you
actually
have
viral
hepatitis
or
any
of
the
hepatitis
is
through
confirmatory
laboratory
testing.
And
lastly,
there
is
no
vaccine
for
hepatitis
c,
but
there
is
a
cure.
G
So
this
slide
is
from
our
kentucky.
Medicaid
claims
data,
I'm
one
of
the
researchers
on
that
project
and
the
increase
in
infection
for
the
three
main
age
groups
that
we'll
focus
on
between
20
and
49
mirrors
that
of
national
trends.
However,
the
rate
of
infection
in
kentucky
is
about
two
twice
as
high
as
the
national
average
and
to
contextualize
this
in
terms
of
injection
drug
use,
young
injectors
tend
to
have
more
social
networks,
as
well
as
tend
to
share
syringes
and
other
items
used
to
prepare
drugs
across
these
networks.
G
And
for
the
hepatitis
c
virus,
the
conditions
for
spread
couldn't
be
better.
The
virus
is
incredibly
durable
outside
of
the
body.
Viability
on
a
syringe
or
in
a
syringe
is
about
63
days,
viability
in
water
containers
and
surfaces
for
up
to
three
weeks
and
viability
on
foils
and
filters
24
to
4
48
to
24
hours
respectively.
G
So
through
the
medicaid
claims
data
analysis,
we
know
that
routes
of
infection
between
men
and
women
are
equal
over
the
lifetime,
so
about
50
50..
However,
young
women
are
disproportionately
impacted
29,
as
you
can
see
in
this
slide
of
all
kentucky
medicaid
recipients
with
hepatitis
c
are
women
of
childbearing
years
and
because
of
potentially
fatal
fatal
liver
infection
can
be
passed
from
mum
to
infant.
This
is
very
concerning,
and
we
see
this
in
the
medicaid
data
as
well.
Within
the
data
set,
there
were
192
individuals
under
the
age
of
10
diagnosed
with
chronic
hepatitis
c.
G
G
And
other
and
the
kentucky
medicaid
data
findings
are
in
support
of
other
research.
This
is
quest
data
from
2011
to
2014,
and
you
can
see
that
overall
hepatitis
c
is
increasing
nationwide,
but
in
kentucky
at
a
much
higher
rate,
so
women
in
nationwide
had
a
22
increase
in
infection
during
this
time,
but
in
kentucky
it
was
213
children
under
the
age
of
two
there
was
a
14
increase
in
kentucky
was
151
percent
and
in
infants
born
to
hepatitis
c
mums.
It
was
68
nationwide,
but
124
here
in
kentucky.
G
G
But
there
is
some
good
news
on
the
horizon
when
we
did
look
at
survivability
survival
probability
of
those
trends
in
hcv
with
direct
acting
antivirals.
We
found
that
those
that
were
treated
had
very
high
survival
rates
versus
those
not
treated,
and
you
can
really
see
survivability
decreasing
at
about
age
50..
All
right.
G
G
H
I'm
danielle
again
so
I'm
a
nurse
practitioner
at
the
hepatitis
c
treatment
centers
in
kentucky
we're
specialists,
so
we're
liver
specialists
and
we've
cured
about
3
000
patients
over
the
last
few
years.
H
What
I
want
to
talk
with
you
all
about,
I
want
to
talk
about
access
to
care,
and
then
I
want
to
tell
you
about
the
disease
process
and
why
we
go
after
patients
to
treat
them
early
access
to
care-wise.
So
access
to
care
is
always
important
in
healthcare
period,
but
especially
with
the
populations
that
are
infected
by
hepatitis
c,
it's
often
a
very
transient
population.
H
Sorry
about
that
guys,
so
it's
a
very
transient
population.
It
affects
a
lot
of
people
that
are
transient
for
a
whole
variety
of
reasons,
but
because
of
that,
you
really
have
to
grab
people
where
they
are
wherever
they
are
interacting
with
the
health
care
system.
So
what
we
have
done
in
our
clinics
is,
we
have
decentralized
our
services
and
we
partner
with
local
health
care
systems
throughout
the
state
to
grab
patients
wherever
they
are
now.
H
Sometimes
that
looks
like
us
contracting
with
a
huge
health
care
system
like
tj
sampson
in
glasgow,
and
sometimes
that
looks
like
us
partnering
with
a
tiny
inpatient
rehab
facility
in
monticello
kentucky,
so
it
can
kind
of
look
like
a
lot
of
things,
but
the
way
we
have
done
this
is
we
have
used
telemedicine
to
totally
expand
our
reach.
Now.
What
you're,
looking
at
here
is
just
an
image
of
me.
Dropping
pins
on
a
map
for
a
couple
of
weeks
of
the
general
locations
of
the
patients
I
was
seeing.
H
This
is
by
no
means
is
by
no
means
inclusive
of
all
of
the
locations
of
our
patients.
This
is
just
me
dropping
pins
on
a
map
when
I
remembered,
while
seeing
patients,
please
keep
in
mind
while
you're
looking
at
this
map.
I
work
for
a
small
family
business
that
employs
less
than
10
people
and
we
are
not
a
huge
academic
facility
with
tons
of
resources.
So
please
look
at
the
reach
you
can
have
when
you
use
telemedicine.
H
So
me
personally,
I
would
ask
you,
please
protect
telemedicine.
Please
protect
telemedicine,
it's
the
best
thing
that
came
out
of
covid
for
sure,
but
what
we
do
and
the
the
other
reason
I
put
this
map
up
here
is
because
I
want
you
to
see
that
the
patients
are
everywhere.
The
patients
are
everywhere.
Every
time
I
open
a
clinic
in
a
rural
site.
H
I
usually
have
people
come
up
to
me
that
are
like,
oh
we're
so
glad
you're
here,
but
we
really
don't
have
patience
here
with
hep
c
and
in
kentucky
that's
just
it's
just
not
true.
So
if
you're
not
finding
the
hep
c
patients
in
your
clinics,
I
always
tell
folks
you're,
not
screening
enough
people.
H
I
think
we
all
have
this
image
of
the
person
with
substance
use
disorder
and
we
like
to
think
that
it's
not
someone
that's
in
our
community
but
substance
use
is
the
great
equalizer
and
it
is
folks
in
your
family,
in
your
churches,
at
your
jobs
and
they
are
everywhere
they're
everywhere
and
telemedicine
has
just
really
allowed
us
to
to.
It
totally
destroys
a
transportation
barrier.
H
It
gives
us
access
for
specialty
care
in
places
that
had
no
access
to
it
before
and
it
allows
us
to
interact
with
communities
that
are
in
inpatient
rehab
facilities,
where
they're
already
interacting
with
healthcare
system,
and
we
can
treat
them
while
they're
there,
wherever
they
are
now.
The
reason
we're
so
passionate
and
I
see
a
lot
of
really
really
sick,
liver
patients,
because
I'm
a
specialist
okay,
but
the
reason
we're
so
passionate
about
going
after
people
in
this
way
is
because
hepatitis
c
is
a
progressive
disease.
So
you
start
out
with
acute
hepatitis
c.
H
H
The
other
issue
you
have
here
is
that
once
you
develop
long-term
hepatitis
c,
you
can
get
what's
called
extra
hepatic
manifestations
now.
That
is
just
a
very
fancy
word
of
saying
systems
outside
the
liver
system
being
affected
by
the
disease.
This
is
something
we're
learning
more
and
more
about.
We
used
to
only
kind
of
connect
hepatitis
c
to
cirrhosis,
but
I
could
give
you
an
hour-long
lecture
on
extrahematic
manifestations
and
we
just
don't
have
the
time,
but
I
hope
you're
looking
at
that
list
and
going
man.
H
So
early
treatment
is
really
important.
It
prevents
it
prevents
the
progression
of
liver
disease.
It's
amazing!
It's
like
you
fix
the
problem
before
it
ever
really
exists.
You
get
not
just
you
saw
the
mortality
data
from
michelle
rose
there,
but
it
doesn't
just
increase
their
survivable.
Their
survivability,
but
also
their
quality
of
life
and
patients
are
actually
easier
to
cure.
If
you
treat
them
early
treatment
is
8
to
12
weeks.
It's
got
a
98
cure
rate
that
is
about
as
good
as
it
gets
in
medicine
y'all,
so
it
they're
wonderful
drugs.
H
They
are
very,
very
safe
and
very
well
tolerated,
and
it
always
breaks
my
heart
when
I
see
the
the
very
very
six
erotic
that
knew
they
had
hep
c
for
15
years
roll
into
my
clinic,
because
I
wonder,
if
I
had
gotten
to
you
sooner,
would
you
even
be
in
this
situation?
H
Financially,
I
put
the
financials
up
there
for
you
all
they're,
showing
you,
the
annual
per
person
cost
in
a
non-serotic
versus
serratic
patient
and
then
they're
telling
you
the
cost
savings
annual
per
person
for
a
cured
patient.
So
financially,
it
makes
a
ton
of
sense
too.
The
the
very
severe
liver
disease
patients
are
very
expensive
and
it's
a
lot
of
burden
on
the
health
care
system,
and
once
you
have
cirrhosis,
you
get
to
hang
out
with
a
specialist
for
the
rest
of
your
life.
So
it's
not
just
a
short-term
disease.
H
At
that
point,
treatment
costs
have
dropped
significantly
as
well,
thanks
to
competition
in
the
market
over
78
percent,
and
we
really
look
at
this.
I
tell
people
to
look
at
it
in
infectious
disease
perspective.
When
you
look
at
the
goals
with
hepatitis
c
with
big
organizations,
the
goal
is
elimination.
That
is
how
good
the
drugs
are.
The
goal
is
elimination.
H
How
amazing
are
that
we
live
in
that
world,
but
you
will
never
hit
that
if
you
do
not
go
after
everybody
who
has
hep
c
and
the
people
that
are
spreading
hep
c
in
our
communities.
Right
now
are
the
iv
drug
use
population,
so
we're
kind
of
shooting
ourselves
in
the
foot
if
we
don't
go
after
them.
Thank
you.
I
I
You
know,
I
think
the
single
most
important
thing
we
can
do
is
is
routine
screening
and
testing
again,
you
know
if,
if
you
don't
identify
the
patient
and
know
they
have
the
disease,
you'll
never
treat
the
disease.
The
thing
I
would
tell
you
about
hepatitis
c
is
it's
it's
sneaky,
so
you
know
people
are
asymptomatic.
I
There's
only
one
way.
You
can
know
that
some
people
have
it
and
that's
through
a
blood
test,
so
routine
screening
will
be
critical
because
early
intervention
is
critical.
So
I
would
tell
you
that
if
you
had
to
think
about
it
in
a
certain
way,
think
about
it
like
cancer,
do
you
want
your
cancer
diagnosed
a
month
out
or
a
year
out
so
clearly
the
longer
that
it
goes,
the
more
complications
you're
going
to
have
kind
of
like
they're
talking
about
with
cirrhosis
and
end-stage
liver
disease?
I
It
leads
to
liver
cancer,
so
we
need
early
intervention
and
I'll
tell
you
that
the
standard
of
care
has
changed
just
within
the
last
few
years.
When
you
know
when
I
started,
we
screened
people
who
injected
drugs.
You
know
we
screened
baby
boomers
and
that
was
kind
of
it.
But
now
the
recommendations
are
getting
to
the
point
where
anybody
that's
over
the
age
of
18.
I
You
know
she
goes
three
times
a
week.
She
can
pick
up
hepatitis
c
from
her
dialysis
treatments
right,
there's,
there's
a
machine,
they
unplug
her
and
plug
another
one
up.
This
grandmother
can
get
it.
This
grandmother
can
be
a
baby
boomer.
She
can
pass
it.
She
can
have
hepatitis
c,
not
know
it.
Nobody
ever
screened
her
and
she
passes
it.
You
know
you
have
the
the
young
mother
who
used
iv
drugs
five
years
ago.
She
dropped
it.
She
never
did
it
again.
She
gives
birth
to
a
baby.
Now
her
baby
has
hepatitis
c.
I
Can
you
imagine
having
a
nine-year-old
kid
looking
at
a
liver
transplant
at
10,
you
know,
there's
no
treatments
to
my
knowledge
that
are
approved
yet
for
children
under
the
age
of
12,
13
3..
So
you
know
there
we
go
so
I
mean
that's.
That's
one
great
reason.
So
you
know
the
other
reason
that
I
think
primary
care
can
be
helpful.
Is
we
can
link
patients
to
care?
You
know
they
emphasize
this.
I
When
you
have
that
patient
in
the
office,
you
need
to
do
as
much
as
you
can
nobody's
going
to
have
as
much
contact
with
you
as
your
primary
care
provider
a
lot
of
times
this
we're
the
people
that
they
trust
you
can
send
them
to
a
specialist
they've,
seen
them
one
time,
they're
not
going
to
listen
to
them
a
lot
of
times,
they're
going
to
listen
to
their
primary
care
provider.
So
we
can
link
them
to
care
like
medical,
assisted
treatment
for
their
drug
use,
harm
reduction
programs
and
the
specialists.
C
I
They
have
transportation
issues
that
you
have
to
do
as
much
as
you
can
when
they're
there
and
primary
care
can
help
with
that.
You
know
the
other
thing
we
can
do
is
we
can
grade
the
liver
disease,
so
you
know
there's
blood
tests.
We
can
do
there's
elastography,
which
is
liver
ultrasound
to
gauge
the
fibrosis.
How
far
along
are
they
in
their
disease?
And
you
know
we
just
spoke
of
telemedicine.
I
How
great
is
it
that
the
primary
care
physician
over
here
in
hazard
way
out
in
the
middle
of
nowhere
can
do
these
tests
tell
a
medicine
with
an
expert
and
and
boom?
They
have
all
the
information
that
they
need
to
get.
This
patient
started
on
treatment
and
then
the
other
part
I
would
say
is
we
can
treat
hepatitis
c.
So
there's
a
fantastic
program
that
I
used.
It's
called
camp,
it's
kentucky
hepatitis,
academic,
mentorship
program,
they
trained
us
primary
care
providers
how
to
treat
hepatitis
c.
I
I
have
four
providers
in
my
clinic
that
can
treat
hepatitis
c.
We
do
all
the
diagnostics
we
get
everything
together
and
only
if
they're
really
complicated
do
we
send
them
to
a
specialist.
A
lot
of
times
they're
grade
zero
grade
one,
and
we
can.
We
can
treat
them
right
there
in
the
office
again
capturing
that
patient
and
doing
as
much
as
possible
while
they're
there
is
key.
I
So
what
can
legislatures
do
so?
You
know
making
the
hepatitis
c
screening
a
quality
measure,
so
healthcare
is
continually
moving
towards
quality
of
care,
not
quantity
of
care.
You
know
money
talks,
the
rest
walks
when
you
make
it
a
quality
measure.
Payments
are
tied
to
that.
I
think
that's
a
great
way
to
encourage
providers
to
do
the
screening,
because
a
lot
of
times,
unless
you
tie
money
to
it,
it
doesn't
happen.
I
I
You
know
supporting
primary
care,
educa
education
programs
like
camp.
I
think
that's
a
fantastic
thing.
I
would
describe
this.
As
you
know,
health
care
is
a
battle.
If
it's
anything
we've
seen
in
the
last
18
months,
it
was
a
battle
before
covet.
It's
a
battle.
Now,
when
you,
when
you
put
everything
on
a
handful
of
specialists,
it's
like
having
a
hundred
men
fighting
the
battle
with
a
thousand
in
reserve.
I
We
need
to
mobilize
as
many
people
as
we
can
and
I
think
that
primary
care
can
help
get
you
extra
soldiers
to
fight
that
battle,
and
then
the
next
thing
I
would
say,
expand
harm
reduction
programs
through
primary
care
offices.
Harm
reduction
has
been
great.
Where
I
live,
you
know
we
have
the
health
department.
You
have
needle
exchange
from
10
to
2
on
monday,
wednesday
and
friday.
You
know,
but
our
clinic
is
open.
8
a.m
to
9
00
p.m.
I
Every
day
of
the
week
I
mean
it's
just
natural:
it
would
be
much
easier
to
get
these
people
harm
reduction
and
do
needle
exchange
in
a
setting
like
that,
because
the
needle
exchanges
are
really
limited,
though
they're
appreciated,
and
I
know
that
harm
reduction
can
be
a
controversial
topic.
You
know
my
day.
Job
was
diabetes
and
treating
diabetics,
and
so
I
watched
people
suffer
who
had
a
hard
time
getting
needles
and
syringes
and
I'll
tell
you
just
politically
incorrect.
I
was
one
of
those
people
who
said
my
diabetics
can't
get
needles
in
syringes.
I
Why
are
we
giving
it
to
drug
addicts?
I
don't
understand
it,
but
I
educated
myself
and
what
that
led
to
was
to
see
to
follow
it
through
to
its
logical
conclusion,
which
is
it
only
gets
worse
if
you
don't
give
them
clean
needles
if
they
share
needles
and
spread
hepatitis
c
I'll.
Take
you
back
to
the
young
woman
who
has
a
child?
I
What
did
that
child
do
wrong?
So
that's
that's
when
I
changed
my
opinion
on
harm
reduction
and
I
think
expanding
upon
it,
making
it
easier
to
access,
which
I
think
primary
care
would
be
a
good
place
to
do.
It
is
key,
and
then
you
know
any
funding
to
identify
hepatitis
c
patients
and
link
them
to
care.
I
That
would
definitely
help
plug
people
in
to
get
them
to
diagnosis
and
treatment.
And
then
last
but
not
least,
I
would
say,
is
removing
the
prior
authorization
from
hepatitis
c
medications.
I
if
anybody
in
here
is
a
doctor
or
a
pharmacist.
You
know
that
you
hate
prior
authorizations.
You
know
you
hate
it.
It's
the
veins
of
your
existence,
so
you
know
we
know
what
we're
doing.
I
think
that
anybody
that
treats
hepatitis
c
knows
it's
nuanced.
Each
patient
is
different.
There's
certain
medication
for
certain
patients.
I
don't
think
we
would
prescribe
the
medication
incorrectly.
I
There
is
a
place
for
pas,
but
in
this
case
again,
when
you
have
those
patients
in
front
of
you
and
you
need
to
treat
them,
then
you
need
to
do
as
much
as
possible
and
and
a
delay
with
a
pa.
You
may
lose
that
patient.
You
may
not
see
them
again.
You
may
not
be
able
to
get
the
medication
to
them.
So
I
appreciate
the
time
and
we
thank
you
and
if
you
have
any
questions,
be
feel
free
to
ask
and
if
you
have
any.
A
Okay,
thank
you
all
for
your
presentation
and
keeping
it
brief.
First
of
all,
we
have
a
question
from
representative
frazier.
B
Yeah,
thank
you
so
much
for
being
here
today.
I
I
found
your
presentation
very
enlightening
and
frightening.
At
the
same
time,
I've-
and
while
you
were
speaking,
I
was
also
corresponding
with
our
emergency
medical
director
and
our
coroner,
and
I
was
asking
about
what
processes
they're
utilizing
and
the
coroner
does
not
test
for
hepatitis.
B
It's
only
for
the
drugs
of
abuse
and
our
ems
is
not
drawing
any
type
of
lab
work
on
their
runs,
and
so
I'm
very
concerned
that
our
numbers
may
even
be
more
than
what
you're
telling
us,
and
so
I
would
just
like
to
get
your
thoughts
on
that,
and
you
know
that
to
me.
That
seems
like
an
obvious
place
where
we
need
to
implement
some
screening,
because
these
are
the
people
that
are
truly
on
the
front
lines
not
taking
away
from
anything
with
primary
care,
because
I'm
supportive
of
that
as
well.
G
When
we
compare
that
too,
so
that's
just
the
medicaid
population
and-
and
there
was
the
last
modeling
study
that
was
done-
the
modeling
study
estimated
about
forty
four
thousand,
so
there
is
considerably
more
infection
than
than
what
we
know.
We
have
never
found
a
good
way
to
screen
young
men,
so
we
see
women,
young
women
disproportionately
impacted
because
we
are
screening
them,
hopefully
at
pregnancy.
G
H
Yeah
these
populations
that
are
affected
by
hep
c
are
generally
folks
that
are
hard
to
capture
with
survey
data,
so
she
has
all
the
numbers,
I'm
not
a
numbers,
lady.
I
just
treat
patients,
but
I
will
tell
you
that
logically,
our
numbers
are
probably
much
higher
than
what
we
see.
I
C
B
I
D
H
Yes,
yes,
you
can
humans,
don't
develop
immunity
to
hepatitis
c.
That's
why
we
don't
have
a
vaccine
for
it
well,
one
of
the
reasons,
but
but
you
would
be
shocked
at
how
few
people
get
reinfected
it.
It's
kind
of
amazing,
because
you
know,
logically,
you
know
with
with
substance
use
that
people
relapse.
That
is
the
reality
of
substance
use
and
do
I
treat
people
with
three
infections?
Yes,
but
way
less
than
you
would
ever
think.
G
That's
the
kind
of
thing
just
sorry
to
just
add
to
that.
There's
been
quite
a
number
of
international
studies
on
reinfection
and
the
reinfection
rate
is
very,
very
low
and
the
studies
were
actually
done
in
drug-using
populations,
and
so
the
idea
that
you
can't
treat
someone
until
they're,
sober
or
long-term
sober
is
actually
not
true.
G
D
Thank
you.
Thank
you
for
that
answer
and
then
my
second
question
goes
back
to
cost
of
efficacy,
and
I
mean
clearly,
it
looks
like
there's
a
need
for
screening
in
the
broader
population.
Clearly,
the
treatment
is
very
efficacious
when
this
treatment
first
came
out.
I
was
at
the
va
at
that
point
and
I
think
we
were
averaging
the
thousand
dollars
a
patient.
D
Where
are
we
now
and
even
at
the
eighty
thousand?
You
know
I'm
an
imager,
I'm
not
a
body
imager,
thank
god,
but,
but
you
know
poor
to
hypertension.
Cirrhosis
is
part
of
hypertension,
a
pedocellular
carcinoma.
I
have
lived
and
breathed
this
for
years
and
years
extremely
expensive
diseases
and
what
we're
taught
you
know
as
imagers
is
everybody
with
hepatitis
c
eventually
will
develop
hepatocellular
carcinoma,
it's
just
a
matter
if
they
live
long
enough
to
get
it
or
if
they
die
die
from
the
disease
process.
H
I
I
can't,
I
don't
know
specific
numbers,
but
we
can.
We
can
I'm
sure
we
can
get
them
for
you.
I
they
just
published
some
new
data
showing
how
drastically
the
costs
have
decreased.
Recently
in
the
last
few
years
so,
like
I
said,
the
costs
have
dropped
about
78,
it's
hard
for
me
to
tell
you
like
the
exact
cost,
because
it's
not
very
transparent.
H
On
my
end,
but
I
will
say
this
kentucky
did
a
really
wonderful
thing:
they
used
to
have
fibrosis
restrictions
where
they
would
not
treat
people
until
they
had
very
serious
liver
disease
and
it
was
a
nightmare.
It
was
a
nightmare
as
a
provider,
so
those
have
gone
away
and
that
has
made
our
lives
significantly
easier
and
it's
probably
saved
a
heck
of
a
lot
of
money
because
the
patients
that
are
young
that
we're
curing
you
never
deal
with
the
portal
hypertension.
You
never
deal
with
the
cirrhosis.
They
you
stop
it
in
its
track.
H
G
I
did
want
to
add
to
the
comment
about
hcc
when
we
were
looking
at
the
medicaid
data.
We
also
were
looking
for
other
disease
states
in
progression,
hcc
we're
seeing
about
1.2
percent,
so
that
is
what
national
studies
have
also
found.
I
I
And
if
I
could
comment
just
real
quick,
you
know
I
would
tell
you
as
far
as
prior
authorizations
and
medicaid
and
everything
restructured
in
july,
I
would
say
just
on
a
primary
care.
Level
of
getting
medications
that
are
specialty
has
become
very
difficult,
now
medications
I
prescribed
before
for
hepatitis
c
and
other
disease
states.
I
It's
always
the
prior
authorization
is,
they
need
to
see
a
specialist
and
then
we're
in
covid
and
everything
else,
and
it's
four
months,
five
months
you
know
and
we're
in
a
rural
area,
it's
hard
to
get
them
to
lexington
or
louisville
wherever
the
specialist
is
at.
So
that
has
been
a
new
roadblock
that
I
have
ran
into
in
primary
care.
H
And
it's
not
just
in
primary
care.
I've
had
issues,
and
I
am
the
specialist
they're
like.
Are
you
a
specialist?
I
was
like
yes,
I'm
a
specialist.
Please
give
me
this
meds
and
it's
I've
had
issues
with
patients
who
were
very,
very
ill
and
it
delays.
It
delays
the
treatment
and
you
really
just
want
to
throw
it
at
them
before
they
decompensate
and
have
issues
it's
hard.
The.
G
Three
big
barriers
that
were
removed
from
medicaid,
starting
in
2018,
the
fibrosis
requirement
was
eliminated,
sobriety
was
eliminated
and
then
in
2020
the
need
for
specialists
under
for
what
they
call
uncomplicated
disease
state.
So
no
hiv,
no
hepatitis
b
and
not
advanced
liver
scarring,
could
be,
can
be
treated
by
primary
care
providers.
A
C
Thank
you,
mr
chairman.
Thank
you
all
for
presentations.
I
made
a
few
notes
here,
as
we
were
talking,
and
I
think
one
of
those
was
just
answered
by
just
your
explanation
on
treatment
course.
I
know
when
I
was
in
clinic,
I
remember
probably
10.
15
years
ago
there
was
commercials
on
tv
saying,
go,
get
check
for
hepatitis
c
and
then
come
into
the
I
saw
a
commercial
on
tv
doctor
should
get
screened.
I'm
like
are
you
have?
Do
you
have
any
of
these
risk
factors?
No,
we
don't
need
to
do
that
for
you.
C
That
was
my
mentality
at
the
time.
We've
come
a
long
way.
Obviously,
with
that-
and
you
know,
there's
a
lot
of
people,
even
we
think
of
iv-
drug
abuse,
I
think
of
people
with
homemade
tattoos.
I
mean
simple
things
that
you
know
it's
pretty
common
in
kentucky.
You
see
a
lot
of
folks
have
done
those
they
share
a
needle
somewhere.
They
get
something
injected
they
can.
They
can
contract
it
that
way,
two
things
telehealth,
this
state's
been
pretty
advanced.
I
think
we
have
the
telehealth
stuff
laid
down
before
covet
hit.
C
C
I
wanted
to
go
back
to
the
to
your
slides
from
norton's
on
the
infection
issues
and
there's
two
things,
one,
I'm
glad
we
have
these
committees
that
we
have
different
chairmen
and
we
try
very
hard
to
cover
different
topics
to
make
sure
we
hear
about
these
things,
because
there's
not
enough
time
in
health
and
welfare
alone,
so
we're
able
to
cover
a
lot
of
this
information
so
having
this
discussion
a
bit
more
in
depth
on
hepatitis
c.
Here
is
great.
One
of
them
was
the
increase
in
women.
C
I
mean
I'm,
I'm
surprised
to
see.
I've
always
considered
this
more
of
a
you
know,
and
I
guess
more,
maybe
my
own
bias
of
thinking.
Well,
it's
you
know.
I've
been
a
prison
doctor
before
I've
seen
a
lot
of
young
men
in
prison,
and
you
think
about
guys.
You
know
we
would
check
them
all.
They
had
a
lot
of
hep
c
there
again
a
lot
of
the
tattoos
iv
drug
use
to
see
this
many
women.
This
is
before
we
passed
the
bills
to
require
screening
during
pregnancy.
C
Maybe
if
you
could
comment
on
why
women,
obviously
children-
I
think
I'm
sure-
is
from
that-
the
second
little
little
blip
here,
it's
small
but
catches.
My
attention
is
the
very
next
slide
on
dual
diagnosis
of
hcv
and
opioid
use.
The
fact
that
if
you
go
to
the
next
one
at
the
very
very
left,
zero
to
nine
year
olds
that
we
actually
have
a
percentage,
a
significant
percentage
of
some
amount
of
having
opioid
use,
disorder
and
hepatitis
c
at
that
age
range.
C
Maybe
if
someone
could
comment
on
that
as
well,
because
that's
stunning
to
see
that
their
kids,
that
young
already
with
opioid
use
disorder
in
our
state
and
hepatitis
c,
would
suggest
that
there
may
be
iv
drug
abuse
issues
at
that
young
of
an
age
range.
Maybe
if
you
can
comment
on
both
of
those
topics,
thanks.
G
Women
typically
learn
how
to
inject
through
their
partners
and
early
on
they
pay
for
their
drugs
by
giving
their
partner
some
portion
of
the
jab
and
either
before
or
after
so
you
have
that
kind
of
needle
sharing
they're
exposed
to
a
lot
of
violence
and
and
economically
they
are
just
incredibly
vulnerable,
and-
and
so
we
really
see
that
across
patient
populations
and
in
young
women
in
terms
of
in
terms
of
the
zero
to
nine,
we
couldn't
dial
down
into
whether
it
was
neonatal
abstinence
syndrome.
G
C
All
right
that
that
that
clarify,
that
was
scared
me.
I
thought
man
if
it's,
that
young
and
they're
already
using
those
things,
do
you
think
the
numbers
are
better
as
far
as
screening,
because
we're
doing
a
better
job
of
screening
as
providers
I
mean
clearly
that
sounds
like
it's
improved
and
again
it's
just
from
where
we
were
early
on
where
it
was
like.
G
So
under
sb
250,
all
women
in
kentucky
should
be
screened
during
each
and
every
pregnancy
if
they
are
not
there's
no
way
again,
as
we
say
that,
there's
no
way
to
know
if
the
infant
has
acquired
h3hcv
through
perinatal
transmission,
I
think
screening,
infants
or
up
to
two
is
a
really
complicated
topic.
G
Part
of
it
is
that
oftentimes
the
children
will
be
lost
to
care
or
lost
a
follow-up,
and
so
and
if
there's
no
disclosure
that
the
mum
had
hepatitis
c
or
that
screening
was
missed,
then
we
don't
know
to
screen
the
infant.
So
so
I
think
screening
rates
in
women
are
definitely
improving.
I
don't
think
that
we
have
the
whole
mechanism
dialed
in
for
screening,
children
and
and
what
that
should
look
like.
B
Thank
you,
mr
chairman,
thank
you
all
for
the
presentation
as
a
pharmacy
provider.
I
I
hear
you
on
the
the
pas
a
lot
of
times,
we'll
do
a
lot
of
work
with
the
doctor's
office,
which
is
right
next
door
to
us
to
to
get
that
paperwork
through
only
to
find
out
that
has
to
go
to
specialty
pharmacy,
which
is
owned
by
the
pbm
that
makes
that
decision,
but
anyway,
that's
another
battle
for
another
day.
Thank
you
for
the
information
it's
this
is
obviously
very.
Concerning
here.
B
We've
heard
a
lot
about,
I
guess
from
the
public
health
or
the
medical
perspective
on
what
we
should
do
and
you
all
listed
several
examples
of
things
that
would
make
the
process
easier
as
as
the
legislature,
if
you
all
suggested
one
thing
that
we
could
do
as
a
legislature
to
help
on
this
issue.
What
would
that
be.
H
Yeah,
I'm
not
sure
whether
to
pick
the
screening
or
the
pa,
I'm
torn
between
the
both
of
those
both
of
those
would
be
really
key
areas.
B
Great
and
we've
got
one
more
quick
question
representative
frazier
kind
of
touched
on
this:
the
opioid
settlement
money.
Are
you
all
able
to
to
use
that
in
addressing
this
issue?
Is
that
something
that
that
can
be
done.
F
Thank
you
chair
and
echo
cinnamon
great
presentation.
I
appreciate
you
all
being
here
today
and
I
have
just
a
little
bit
of
interest
in
rural
health
care,
I'm
certainly
proponent,
of
using
the
op
code
funds
for
this.
I
think
it
makes
sense.
I
mean
there's
obviously
a
relationship
here,
but
you
made
the
statement
about
additional
medicaid
funding
and
I
found
it
kind
of
interesting
that
we're
already
spending
15
billion
this
next
year
on
medicaid
funding,
and
I
found
out
that
in
kentucky
what's
everybody's
responsibility
is
nobody's
responsibility.
F
F
I
have
not
found
that
very
bewildering
chairman,
given
that
they're
responsible
for
the
health
of
our
population,
but
they're
not
addressing
this
critical
issue,
so
my
position
is:
the
money
is
already
there
within
the
medicaid
program
they
should
be
addressing
this
and
that
they
had
not
been
more
proactive
about
it
is
is
very
disturbing.
I
wouldn't
use
as
an
impediment
to
try
to
get
an
additional
funding
for
you
folks,
but
it
goes
back
to
accountability
for
healthcare
dollars.
F
B
Thank
you,
mr
chairman,
thank
you
all
for
a
good
presentation
today.
You've
given
us
a
lot
of
information
to
process
and
think
about
in
light
of
all
that
information,
I'm
gonna
boil
this
down
to
one
question:
what
happens
if
kentucky
doesn't
become
more
aggressive
in
identifying
and
treating
hepatitis
c.
H
H
Hep
c
like
with
diabetes
and
renal
disease
and
cardiovascular,
it's
a
catalyst,
and
so
it's
not
just
the
liver,
you're
worried
about
you're,
going
to
have
poor
outcomes
in
a
variety
of
areas
of
health
and
kentucky
is
has
a
lot
of
people
with
comorbid
conditions.
I'm
sure
you're
all
aware
of
that.
So
it's
particularly
problematic
for
our
population.
B
Thank
you,
mr
chairman.
I
don't
have
a
question.
I
do
just
have
a
comment,
kind
of
an
overarching
comment,
as
I
have
a
sister-in-law
who
survived
hep
c.
So
I'm
grateful
for
treatments
and
that
sort
of
thing
to
me
it's
a
bigger
issue
of
needing
public
assistance
reform.
I
think
if
we
had
public
assistance
reform
in
her
life,
I
feel
like
she
might
have
been
more
productive
and
maybe
may
not
have
turned
to
drugs,
so
I
just
put
that
out
there
since
medicaid's
under
the
cabinet.
So
thank
you,
mr
chair.
D
G
It
really
depends
on
the
payer
and
and
what's
been
negotiated
with
that
pair,
but
the
actual
baseline
cost
is
is
very
limited.
It's
not
forty.
G
When
I
last
priced
it,
it
was
about
fourteen
dollars
for
an
antibody
test,
and
then
that
was
rolled
into
a
quantitative
pcr,
and
that
was
another.
Fifty
wow.
G
It's
a
fairly
inexpensive
test
and
you
want
to
keep
that
testing
algorithm
together,
where
you're
doing
the
antibody
and
it's
what's
called
a
reflex
and
it's
reflex
at
the
lab
level
so
that
so
that
if
a
patient
does
have
a
active
virus
or
viremia,
then
the
the
test
will
we'll
have
a
diagnostic
test.
We'll
have
a
diagnosis.
A
C
treatment
and
the
research,
it's
amazing
to
me
that
they
could
find
anything
to
stop
most
of
us
in
the
room,
know
transcription
translation
and
that
new
drug
stops
at
translation.
Am
I
correct?
That's
amazing,
to
me
as
a
pharmacist
they
can
do
the
research
and
do
that.
So
there
is
hope
and,
like
you
all
say,
we'll
be
working
on
the
pas
and
quality.
Thank
you
all
for
coming,
and
that
would
really
reduce
a
lot
of
money.
F
Another
question
just
a
brief
comment,
mr
chair
and
again
a
great
presentation,
and
this
is
such
a
serious
issue
and
we
we
need
to
move
this
up,
but
I
just
want
to
comment
chairman
that
the
mco's
not
having
a
plan
to
address
this.
It's
an
epic
failure
on
their
part.
Since
again
they
are
best
responsibility
of
improving
the
health
of
our
population,
and
there
needs
to
be
some
accountability
this.
They
need
to
be
on
front
of
this
and
tell
us
how
we
can
get
this
issue
resolved.
Thank
you.
A
A
J
All
right,
thank
you,
chairman,
bentley
and
and
committee
members.
My
name
is
adam
mather,
I'm
the
inspector
general
for
the
cabinet
problem,
family
services
and
in
my
purview,
is
the
casper
program,
which
is
the
kentucky
all
scheduled,
prescription
electronic
reporting.
J
Sure,
yes,
so
just
a
quick
definition
of
casper
casper's,
kentucky's,
prescription
drug
monitoring
program,
casper
track
scheduled
two
through
five
controlled
substance.
Prescriptions
dispensed
within
the
state,
as
reported
by
pharmacies
and
other
dispensers,
and
provides
a
tool
to
help
address
the
misuse,
abuse
and
diversion
of
controlled
pharmaceutical
substances.
J
Just
a
little
bit
about
the
state
fiscal
year,
2021
casper
operations
we
have
had
over
10.5
million
controlled
substance,
prescriptions
reported
to
the
system
over
36.4
million.
Let
me
I'm
gonna.
I
see
they're
starting
to
share
the
screen,
so
I
will
make
sure
they
get
on
the
right
here.
We
go
so
we're
on
slide
three,
if
you
can
zoom
to
that,
please
perfect!
Thank
you!
J
J
If
I
could
get
the
next
slide
please
so
this
is
a
visual
of
the
topper
scribe
controlled
substances
by
a
therapeutic
category
and
you'll
see
the
top
two
are
gabapentin
or
the
brand
name
is
neurontin
and
then
hydrocodone
brand
names
are
lord
tab
or
vicodin
that
followed
shortly
by
oxycodone
and
percocet
brand
name,
oxycontin
and
percocet,
and
then,
if
you'll
switch
to
the
next
slide,
please.
J
So
this
gives
you
a
visual
of
casper
features
and
then
collaborations
that
we're
doing
to
be
proactive
in
our
work
to
slow
down
and
hopefully
end
the
opioid
crisis
within
the
state
of
kentucky,
and
so
we'll
go
into
those
a
little
more
in
depth.
But
you
can
see
there's
some
really
quality
work,
that's
being
done
on
behalf
of
the
casper
team
and
collaborating
partners,
and
I
think
dr
white
and
dr
travis
can
speak
a
little
bit
more
on
that
as
well
as
van.
J
If
you'll
turn
to
the
next
slide,
we'll
go
on
a
little
more
in-depth
overview
of
some
of
those
enhancements
that
we've
done
so
the
opioid
overlaps.
So
this
identifies
overlapping
opioid
prescriptions,
and
this
is
you
know,
for
potential
misuse
or
abuse
from
patients,
and
this
the
next
one
is,
is
really
critical,
as
we're
bordered
by
seven
states
informed
interstate
data
sharing.
J
So
this
allows
us
to
share
prescribing
information
among
states
around
us
and
throughout
the
entire
country,
and
then
we
have
direct
messaging,
and
that
is
a
secure
message
portal
that
will
send
casper
information
to
important
entities.
J
If
there
is
prescription
pets,
stolen
doctor
shopping,
anything
that
would
rise
to
the
level
of
what
would
be
suspect
for
any
misuse
or
abuse
of
any
schedule,
two
through
five
drugs
and
then
lastly,
on
this
list
is
the
find
help
now
link
and
that
is
shown
on
every
patient
report
that
helps
prescribers,
define
and
share
with
their
patients,
where
there's
an
opportunity
to
get
help
if
it's
needed
and
you'll
notice
an
asterisk
next
to
the
informed
interstate
data
sharing
and
the
direct
messaging,
and
that
was
funded
100
through
the
how
rogers
grant
and
so
we're
very
appreciative
of
that,
and
then,
if
you'll
turn
to
the
next
slide,
please
so
I
won't
go
into
each
of
these.
J
But
I
think
you
can
see
that
there
is
a
huge
amount
of
collaboration
that
is
done
not
only
within
our
agency
but
throughout
the
state
and
nationally,
and
so
you
can
see
how
some
of
the
work
that
we
are
able
to
participate
in
has
really
helped
to
work
with
agencies
as
they're
as
they're,
trying
to
slow
down
the
opioid
use
within
the
state
and
in
the
country,
and
I
know
we're
on
a
time
crunch,
so
I'm
trying
to
move
quickly
chairman
and
so,
if
you'll
turn
to
the
next
slide,
we'll
we'll
go
through
that.
J
So
currently
we're
in
a
modernization
program.
Casper
was
originally
built
in
2005
and
has
has
gone
through
numerous
iterations
through
the
process.
The
goals
of
of
the
casper
modernization,
which
is
a
cms
funded
initiative,
90,
cms
and
10
general
funds-
is
really
to
improve
it.
To
bring
it
up
today
to
improve
this,
the
screen's
design
and
usability
to
what
we're
used
to.
L
J
Sorry
about
that,
I
got
cut
off.
I
apologize,
I
don't
know
what
happened
there
and
then
can
you
hear
me
chairman?
Yes,.
A
J
Okay,
sorry
about
that,
and
then
you
know
overall
improved
performance
from
the
from
the
program
itself
and
then,
if
I
could
get
to
the
next
slide,
please
so
we'll
talk
about
funding.
Funding
streams
include
cms,
which
I
mentioned,
that
they
provided
us
two
two
million
dollars,
and
that
is
for
the
modernization
of
casper,
and
that
is
a
90-10
federal
estate
match.
J
And
so
currently
we
are
at
the
federal
spend
thus
far
as
of
916
was
629
000
and
the
state
spend
was
69
000
and
then
the
how
rogers
grant
funding
for
the
past
three
federal
fiscal
years
at
approximately
or
roughly
under
three
million
dollars,
and
so
we've
provided
both
updates
to
both
the
how
rogers
grant
and
cms
and
they
require.
I
know
cms
requires
a
quarterly
report,
so
we've
been
providing
that
as
well.
J
If
I
could
get
the
next
slide,
we'll
kind
of
go
and
thank
you
go
into
the
progress
so
in
partnership
with
developers
and
business
analytics
project
managers,
we're
successfully
engaged
in
developing
activities
around
new
and
innovative
ways
for
people
to
to
look
at
the
information
and
get
accurate
data
so
that
they
can
prescribe
appropriately
and
dispense
appropriately
and
then
regular
progress.
Demonstrations
are
held
with
the
with
the
software,
for
we
have
annual
reminders,
patient
requests,
reports
and
status
of
requests.
J
J
So
in
the
last
budget
bill
there
was
a
in
there
there.
There
was
ask
for
a
rfp
for
a
similar
product
to
to
look
into
and
so
to
see
if
there
was
a
vendor
that
would
provide
a
consistent
product
similar
to
casper.
J
What
we
currently
have
meeting
the
state's
requirements
and
on
march
11,
20
20
2021
chf,
is
issued
the
rfp
to
solicit
vendor
proposals,
and
that
did
take
a
little
bit
longer,
just
because
it's
a
very
intricate
system,
and
so
it
took
us
a
while
to
build
out
all
the
components
that
we
would
need
to
be
required
through
those
vendors
and
that
rfp
closed
on
may
12,
2021
and
the
current
process.
It's
still
open
and
it
very
still
moving
to
the
process.
J
So,
unfortunately,
we're
not
really
able
to
answer
very
many
questions
about
that
and
I'll
turn
it
over
to
dr
white,
because
I
think
she
can
talk
to
some
of
the
proactive
approaches
that
we've
work
through
and
after
that.
If
dr
dr
travis
would
share
a
little
information
and
then
if
you
have
questions
we'll
open
it
up,
I
think
van
is
always
been
a
real
asset
and
helpful
to
work
with
through
the
casper
program
and
can
help
answer
some
of
those
questions.
Please.
L
Thank
you
adam.
In
a
reading,
an
article
in
one
of
my
ob
gyn
journals,
because
that
is
my.
My
training
is
ob
gyn.
There
was
an
article
about
how
they
were
monitoring,
women
that
were
discharged
from
the
hospital
after
delivery
and
the
amount
of
opioids
they
were
sent
home
in
with,
and
it
seemed
excessive
to
me.
So
I
was
had
a
conversation
with
the
casper
epidemiologist
and
said
gee.
L
I
wonder
what
we
are
doing
in
kentucky
within
a
couple
of
days,
dr
baroness
had
given
me
a
report
on
the
number
of
opioids
that
were
that
were
prescriptions
that
were
filled
by
women
who
had
had
uncomplicated
vaginal
deliveries
in
cesarean
sections,
and
it
was
very
eye-opening.
Looking
at
that
trend,
we
were
at.
We
were
concerned
about
medicine
left
over
in
medicine,
cabinets
and,
as
you
all
are
all
aware,
diversion
they
could
be
stolen.
L
They
could
be
used
in
an
overdose,
and
so
we
we
took
that
information
and
shared
this,
not
only
with
the
oig,
with
with
adam
about
our
concern
about
some
of
our
hospitals
prescribing
very
high
doses
and
what
that
effect
might
have
in
our
women
so
adam
and
I
have
tagged
along,
have
done.
Some
phone
calls
with
some
of
the
hospitals
that
are
prescribing
very
high
high
amounts
of
opioids
and
if
we
don't
have
enough
results.
L
Yet
to
give
you
a
report,
we
have
just
started
doing
that,
but
we've
gotten
great
reception
and
and
some
some
very
good
response
from
the
hospitals
to
try
to
make
sure
that
those
providers
are
not
sending
these
women
home
with
large
amounts
of
opioids.
We've
shared
this
information,
our
kentucky
perinatal
quality
collaborative
here
at
the
at
the
cabinet.
We
share
that
information
with
the
sos
program
that
kha
has
the
statewide
opioid
stewardship
program
and
they're
interested
in
helping
us
spread.
L
This
information
and
we've
also
reached
out
to
some
other
states
about
what
we've
done
and
other
states
are
interested
in
sharing
this
methodology
because
they
want
to
look
at
this
issue
in
their
state.
So
this
is
turning
into
us,
a
national
project
that
we
were
able
to
use
the
casper
epidemiologist
to
develop
this
for
us
with
this
in
a
matter
of
days,
it's
extremely
helpful
and
we
plan
to
continue
to
monitor
this
over
every
year.
L
Another
pro
another
project,
the
department
of
public
health,
has
we
we
were
responding
to
several
years
ago,
a
large
pain
clinic
in
louisville
closed,
and
there
was
concern
about
what
was
going
to
happen
with
those
dis
placed
opioid
patients,
and
we
realized
that
when-
and
someone
said
earlier
today,
I
believe
it
was
senator
meredith
that
if,
if,
if
the
problem
is
nobody's
problem,
then
that
makes
it
everybody's
problem,
we
didn't
have
a
statewide
plan.
What
do
we
do
with
displaced
opioid
patients?
L
So
we
pull
together
a
group,
the
boards
of
medicine,
dentistry
nursing,
ems,
pharmacy,
the
kentucky
primary
care
association,
vans
group
in
the
office
of
drug
control
policy,
the
aprn
and
certified
nurse
midwife
group
kma,
the
pharmacist
association
hospital
association,
dea,
the
poison
control
center
and
a
whole
host
of
members
belong
to
this
group
that
are
in
the
cabinet
to
try
to
figure
out.
What
do
we
do
when
there
is
a
closure
and
what
happens
to
those
patients
and
van
can
take
it
from
there.
K
We've
had
kind
of
a
change
in
in
kentucky
in
the
last
couple
years,
and
that
is
the
dea
and
other
enforcement
agencies
have
gotten
to
contact
us
before
they
go
in
for
an
enforcement
action
which
we
used
to
always
chase
our
tails,
and
we
would,
after
the
fact,
try
to
figure
out
what
to
do.
But
there's
a
small
group
of
us
that
have
been
charged
with
that
information.
K
They'll
come
to
us
a
few
days
before
an
action
is
going
to
be
taken
on
a
provider
or
a
pharmacist,
and
then
the
day
of
that
action,
they'll,
actually
contact
adam
with
the
name
of
that
provider.
So
within
hours
we
can
do
a
report
and
see
how
many
patients,
this
provider
is
taking
care
of.
What
are
the
mmes
of
opioids
that
this
provider
is
prescribing.
K
K
So
it's
really
helped
us
to
respond
in
a
very
proactive
manner
and
get
resources
in
place.
The
dea,
ksp
and
other
enforcement
agencies
have
been
really
really
good
to
work
with
us
and
actually
post
signs
at
clinics
provide
information
through
social
media
through
local
media.
You
know
if
you're,
a
patient
and
and
need
help
call
this
number.
Our
poison
control
center
has
stepped
up
and
said,
we'll
feel
those
calls
of
displaced
patients
and
the
kentucky
pain.
Doctors,
association
have
stepped
up
and
said,
we'll
take
care
of
these
folks.
K
The
board
of
medical
licensure
has
has
worked
with
us
on
release
or
relaxing
some
language,
so
these
patients
can
be
taken
care
of
because
even
if
a
provider
is
is
doing
some
nefarious
things
often
they
have
very
legitimate
pain
patients
within
their
practice
or
if
it's
a
buprenorphine,
they
have
very
legitimate
people.
Receiving
medications
for
opioid
use
disorder
within
their
within
their
practice,
and
we
want
to
make
sure
those
folks
are
not
turned
to
the
streets
seeking
heroin
ending
up
with
fentanyl
and
then
ending
up
a
statistic.
J
M
Thank
you,
mr
chairman.
Thank
you
for
this
opportunity
and
members
I'm
going
to
speak
first.
As
my
tenure,
I
was
privileged
to
serve
on
the
board
of
medical
licensure
from
2007
2018..
I'm
going
to
first
share
how
invaluable
casper
is
to
the
board's
function.
Then
I'm
going
to
make
some
comments
as
a
private
practitioner
what
it
means
to
me.
M
M
One
of
the
board's
investigators
has
notified
an
investigator
immediately
contacts
casper
for
one
of
the
many
investigators
that
they
have
the
pharmacist
and
that
oig
person
then
checks
the
records
of
the
prescribing
position,
that
of
whom
they're
concerned
and
pull
some
reports
that
we
can
use
as
a
board
to
have
an
expert
of
similar
expertise,
review
those
charts
and
then
frequently
that
pharmaceutical
representative
will
actually
join
the
investigator
in
the
field
and
sometimes
they'll
even
testify.
When
the
during
the
position
facing
a
dismal
action,
you
know
just
a
snapshot
of
how
casper
worked.
M
M
I
checked
on
during
the
board
that
time
after
house
bill,
one,
the
board
got
377
investigations
involving
prescribing
controlled
substances
and
every
time
the
board
gets
a
complaint.
We
are
obligated.
I
say
we
they
are
obligated
to
investigate
that,
and
it's
done
in
conjunction
with
representative
of
the
casper
odyn's
oig,
so
we
had
377
cases
of
which
314
had
distraction
as
a
result,
this
might
actually
use
involves,
try
to
position
education.
It
may
take.
This
may
take
some
distraction,
but
it
usually
involves
some
education
that
prescriber
has
to
have
it
appropriately.
M
No
question
that
if
it
wasn't
for
casper
and
the
their
representatives,
the
pharmaceutical
investigators,
the
board
would
have
never
been
able
to
face
the
upward
crisis
as
it
did
if
they
were
able
to
really
control
or
ride
during
the
opioid
crisis
by
it
would
have
been
not
possible
without
the
casper
and
the
pharmaceutical
investigators.
M
M
We
were
able
to
get
tremendous
pharmaceutical
investigators
to
come
and
talk
as
well
as
van
ingram,
to
give
a
lot
of
information
to
private
physicians
about
how
to
prescribe
opioids.
What
to
do.
They
operates.
Their
expertise
was
invaluable,
but
this
physician
is
consulted.
Somehow
I
guess,
because
my
children
are
brought
up
inadvertently
and
being
drug
taking
and
screaming
into
being
somewhat
of
an
oprah
investigator
expert.
So
I
frequently
get
charts
to
review
somebody's
been
opioids
for
years.
M
I
can
get
10
years
of
opioid
reports
from
oig
or
from
casper
and
help
determine
what
kind
of
opioid
that
person
should
be
on
or
how
to
tape
or
whatever
the
other
thing
that
casper
does
now.
Is
it's
invaluable
to
me?
As
a
physician,
I
can
get
a
reverse
casper.
I
can
check
with
casper
to
see
if
anybody's
prescribing
my
prescriptions
without
my
without
my
knowing
if
they
got
hold
of
my
prescription
pad.
So
I
can
do
a
reverse,
casper
and
see
who's
prescribing
they
also,
I
can
get
a
report
card.
M
I
can
determine
casper
can
tell
me
what
my
prescribing
factors
are
compared
to
specialties
in
my
area
of
the
same
specialty.
Tell
me
how
I'm
doing
one
of
the
most
valuable
things.
So
if
they
have
been
able
now,
when
you
get
a
casper,
you
get
something
called
meq.
That's
morphine
equivalence
or
med
morphine
equivalents
per
day.
M
A
Equipment,
this
is
chairman,
bentley
we're
right
now
time.
Could
you
sum
up
here
in
a
minute
or
so.
M
The
importance
of
that
is
that
you
have
to
hurt
everything
to
morphine.
Morphine
is
one,
for
instance.
Hydromorphone
is
four
times
one.
So
if
a
position
on
how
to
convert
it,
they
can
get
that
when
they
get
a
casper,
it's
right
on
their
meq
and
you
can
tell
if
you're
over
prescribing,
then
you
should
and
get
a
report
card,
so
I
think
it's
invaluable
to
the
practicing
physician
as
well
as
the
board.
Thank
you,
sir.
A
Thank
you
doctor
we're
going
to
start
questions
now.
First,
one
is
from
senator
julie,
adams
electronically.
So
senator
adams
are
you
there.
D
Thank
you
again
and
thanks
chairman
real
quickly:
do
we
have
and
I'm
not
sure
which
of
you?
I
should
be
addressing
this
question
too,
but
is
there
a
way
to
proactively
cultivate
our
casper
data
to
identify
over
prescribers
in
this
state
in
in
a
in
a
more
timely
manner?
Are
we
doing
that,
and
can
we
do
that.
M
D
M
D
M
J
Yeah
and
and
kentucky
board
of
nursing
controls
the
aprns,
and
you
know
the
model
I
think,
has
changed
too
to
where
we're
seeing
aprns
used
utilized
a
little
more
on
the
face-to-face
interactions
with
patients.
J
You
will
see
an
increase
in
apr
ends
over
physicians,
but
I
think,
as
you
look
at
how
you
know
the
medicine
is,
has
progressed,
we're
seeing
a
lot
more
face-to-face
interactions
with
aprns,
it's
becoming
a
more
popular
way
to
utilize
them.
So
so
obviously
they
wouldn't
be
prescribing
more
because
they
are
interacting
more
with
the
patients.
F
Thank
you,
chairman
bentley.
I
guess
I'm
a
little
bit
confused
by
the
scope
of
this
discussion.
You
know
appears
to
be
that
we're
being
sold
on
the
importance
of
casper
and
I
think
all
of
us
have
that
understanding
and
we're
very
appreciative
of
the
program
and
think
it's
a
valuable
tool
for
our
practitioners.
But
I
thought
we
were
going
to
speak
specifically
about
the
status
of
the
rfps
and
where
we
are
with
that
and
we
just
touched
base
with
it
and
again
rfp
were
closed.
F
May
I
believe
that
they
told
us-
and
here
we
are
october-
is
our
go
live
date
of
december
31st,
it's
going
to
be
impossible
if
we
do
see
a
change
in
this,
but
that's
what
I
thought
we
were
discussing
today
and
would
just
be
really
would
like
to
have
some
more
information
about
how
this
process
is
going
and
again.
If
it's
closed
in
may,
we've
had
five
months
to
review
these
rfps
and
where
are
we?
Why
haven't
we
made
the
decision?
F
You
know,
I
think,
the
intent
our
legislative
intent
with
the
budget
bill
was
to
look
at
better
ways
more
efficient
ways
to
possibly
do
this.
We
know
that
casper
needs
to
be
updated
and
there
may
be
other
alternatives
out
there.
That
are
less
expensive,
but
I
really
don't
understand
why
we're
not
having
to
focus
on
that
portion
of
it.
Rather
than
again
the
benefits
of
casper,
which
we
all
recognize.
J
Senator
meredith
to
answer
your
question.
You
know
it
did
close
as
far
as
any
vendors
coming
in
to
the
process,
but
we
can't
discuss
what
happens
after
that
until
the
process
is
closed
per
the
per
the
guideline.
So,
unfortunately,
we're
not
at
liberty
to
kind
of
discuss
where
we're
at
within
the
process
once
it
once
the
it
fully
close,
it
close
to
vendors
being
able
to
apply
for
the
rfp,
but
we
can't
discuss
where
we're
at
in
the
process.
Well,.
F
You
know
I
hear
that
a
lot,
particularly
when
I'm
in
government
contract
review
that
every
time
we
have
an
rfp,
we
can't
talk
about
anything
and
I
think
that's
intentionally
used
to
lock
out
legislators
from
any
discussion
this
whatsoever.
I
don't
see
how
giving
us
some
kind
of
timetable
is
a
violation
of
rfp
process,
and
it
certainly
appears
that
nobody's
wanting
to
make
a
decision
on
this,
particularly
if
we
want
this
done
by
december
31st
and
I
think
that's
a
proc
to
suggest
that,
because
rfp
is
out
there,
nobody
can
talk
to
us
about
this.
A
B
A
B
I'll
be
quick,
who
actually
does
the
inputting
of
data
into
casper?
Is
it
the
pharmacist
or
is
it
the
doctor.
M
B
J
So
it
really,
unless
it's
done
electronically,
dr
travis,
not
to
interject,
but
unless
it's
done
electronically,
we
would
have
no
way
of
knowing
it's
really
more
on
the
dispensing
side
that
we
that
we
are
able
to
understand,
what's
actually
being
dispensed,
because
if
someone
gets
a
prescription,
dr
travis
writes
a
prescription
on
a
pad
and
they
never
get
it
filled.
Then
there
is
no
real
issue
there.
J
M
M
B
I
mean
what,
whether
it's
the
inputting
of
the
correct
prescription
or
the
dispensing
to
the
actual
person
that
the
prescription
was
written
to
I'm
trying
to
understand
if
it's
a
fail-safe
system
or
if
when
they
are
when
they're
modernizing
this,
is
this
something
that
we
need
to
take
care
of,
because
what
is
our
error
rate.
M
J
So
so
there
is
an
error
rate
and
it's
it's
very
low.
We
are
working
on
the
monitor.
B
J
A
very
low
mean
it
varies,
it
could
be
one
percent
of
all.
It
could
be
two
percent
three
percent
somewhere
in
that
range.
It
it.
It
really
does
vary
because
they
check
it
daily.
So
I'm
sorry,
I'm
getting
a
lot
of
feedback,
so
yeah
it's
hard
for
me
to
say
like
it
is
specifically
this
all
the
time,
because
one
day
the
traffic
changes
depending
on
the
day
and
so
that
that
can
lead
to
higher
error
rates
or
lower
error
rates,
but
it.
J
Between
one
one
to
three
percent-
and
that
could
be
just
a
failure
on
they
need
to
to
re
re-query
the
information.
A
J
A
It's
my
turn
now
I
reckon
but
senator
meredith
you're
going
to
get
asked
another
question
here
in
a
minute.
First
of
all,
on
ftes
I
looked
at
the
national.
What
did
they
call
it?
The
ttac
pdmp
policies
and
kentucky
has
31
full-time
employees
where
the
national
average
is
five.
J
Yeah,
yes,
so
most
states,
I
think,
there's
a
handful
of
us
now
that
five
total
states
that
have
their
own
systems
so
the
rest
of
the
cis
are
third-party
systems
yeah
it
would.
It
wouldn't
show
up
that
they're
they're,
our
staff
percent.
A
J
J
A
lot
of
that
is
a
lot
of
that
is
through
grant
money
that
we
receive,
so
it's
not
out
of
general
funds.
J
A
J
Which,
which
section
are
you
referring
to
chairman.
A
I'm
referring
to
a
casper
bill
that
I
sponsored
secretary
glsen
helped
me
with
it
where
if
a
person
goes
to
emergency
room
and
they
have
a
high
incidence
or
inclination
for
opioid
misuse
as
a
female,
then
that
information
would
go
to
a
pediatrician
or
ob
gyn
to
help
reduce
a
substance
abuse
baby.
We
know
those.
We
know
those
babies
two
years
ago
cost
us
ninety
thousand
dollars
and
probably
a
hundred
thousand
dollars
a
year
now.
A
J
Sure
I
have
read
the
bill
and
I
did
not
read
it.
As
you
have
stated
it
hi
everybody
yummy
yeah.
That
would
be
very
helpful.
Sir.
A
This
is
to
require
certain
hospitals
to
report
positive
toxicology
screens
to
the
cabinet
for
health
and
family
services,
permit
federal
prosecutors
and
agents
to
use
casper
permit
practitioners
or
pharmacists
to
review.
Casper
reports
of
birth
mothers
or
potentially
drug
exposed
infants,
remove
the
pilot
program
relating
to
real-time
electronic
monitoring
and
make
other
technical
corrections
to
amend.
J
One
is
reviewing
data
on
controlled
substances
that
have
been
reported
for
the
birth
mother,
of
an
infant
who
is
currently
being
treated
by
the
practitioner
for
neo
for
nas,
or
has
symptoms
that
suggest
perinatal
drug
exposure
and
then
the
other
provision
that
I'm
aware
of-
and
these
are
both
functions-
that
we
feel
call
under
k
high,
which
is
the
kentucky
health
information
exchange
because
we're
a
dispensary
dispensing
program,
not
a
health
information
program
in
in
the
second
one.
J
The
second
provision
that
I'm
aware
of
is,
in
addition
to
the
data
required
by
subsection
five
of
this
section,
a
kentucky
licensed
acute
care,
hospital
or
critical
access.
Hospital
should
report
to
the
cabinet,
all
positive
toxicology
screens
that
are
performed
by
the
hospital's
emergency
department
to
evaluate
the
patient's
suspected
drug
overdose.
And
I
will
say,
we
are
working
with
k
high.
J
In
fact,
we've
drafted
a
letter
that
we
will
send
out
on
behalf
of
oig,
to
help
institute
that
that
statute
within
k
high,
but
we
don't
have
a
mechanism
within
casper
that
we
would
be
able
to
do
that.
A
F
J
A
E
Proceed,
this
would
be,
I
guess,
along
the
same,
questioning
hello,
miss
mather.
I
appreciate
your
present
presentation
and
I've
called
several
times
and
talked
to
you.
You've
always
been
just
super
informative,
and
I
appreciate
that
I
really
do
a
couple
quick
questions.
A
minute
ago
there
was
some
question
about.
You
know
how
many
errors
come
through
the
casper
reporting
system
and
how
that
works.
But
basically
all
this
you
know
most
every
all.
E
The
softwares
that
exist
in
pharmacy
today
have
an
integrating
piece
to
it
that
at
the
end
of
the
day-
and
you
know
it's
different
for
each
pharmacy,
but
we
have
to
download
that
data
and
send
it
straight
into
casper,
at
least
within
24
hours.
It's
pretty
solid
rock
solid
and
of
course
we
try
to
even
go
further
than
that
required
because
a
minute
ago
somebody
had
mentioned
that.
Well,
they
wrote
a
prescription
and
we
wouldn't
even
know
if
that
got
filled
unless
they
dispense
it,
which
makes
good
sense.
E
But
there
shouldn't
be
anybody
writing
prescriptions
unless
they've
gotten
a
waiver,
because
all
controlled
prescriptions
have
to
be
electronic
right
since
january
1
this
year.
So
my
question
is:
have
you
seen
a
tremendous-
and
this
may
not
be
one
that
you
could
maybe
answer
so
I'll,
be
fair
about
this?
Have
you
seen
a
lot
of
waiver
submissions
from
providers
for
for
not
you
know
not
wanting.
You
know
not
wanting
they're
not
able
to
comply
to
the
electronic
requirement
that
we
passed
in
january.
E
J
We
had
we've
seen
about
a
thousand,
and
those
are
from
a
lot
of
them
are
from
smaller
non-profit
entities
that
the
software
would,
you
know,
kind
of
them
as
far
as
performing
day-to-day
operations.
So
we
have
seen
them
we
review
them.
We
have
a
team
that
reviews
them.
You
know
we
are
encouraging
them
and
trying
to
figure
out
ways
that
they
can
comply,
but
but
we
have
seen
about
a
thousand
waivers.
E
Okay,
I
appreciate
that
I
was
just
curious
on
how
much
of
that
kind
of
I
knew.
We
obviously
all
expected
some
of
that
to
happen,
and
I
understand
that,
but
I
know
the
technology
is
little
to
to
very
inexpensive
these
days,
to
be
able
to
to
do
that.
So
hopefully
we'll
get
more
and
more
of
them
come
on
board,
but
thank
you
so
much.
A
Much
that
concludes
our
questions.
I
had
talked
to
commissioner
lee
and
I'm
going
to
talk
to
her
by
phone
because
we're
running
out
of
time
it
was
a
question
I
had
directly
for
her
on
the
how
they
priced
the
methadone.
A
So
thank
you
all
for
your
presentations
today,
but
before
we
adjourn
members
again,
please
note
that
remote
access
will
be
allowed
to
all
meetings
for
the
interim
members
will
be
provided.
Zoom
link
to
access
the
meeting
remotely
and
the
meeting
materials
will
be
made
available
online
for
downloading
our
next
and
last
meeting
for
the
interim
session
is
scheduled
for
november.
The
16th
members.
Please
note
this
meeting
date
falls
on
a
tuesday
rather
than
a
wednesday.