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B
Here
we
do
have
a
quorum
and
we
will
proceed
next.
Item
on
the
agenda.
Is
approval
of
the
minutes
from
the
August
24th
2023
meeting
I
will
entertain
a
motion
so
I'm
going
to
have
a
motion.
Senator
Meredith.
Second
co-chair.
All
those
in
favor,
please
signify
by
saying
aye
oppose
no
motion.
Carries
minutes
are
adopted
we're
going
to
move
right
into
the
agenda.
Our
first
presentation
today
will
be
on
the
the
Medicaid
waiver
waiting
list.
B
At
this
point
it
is
becoming
more
and
more
of
a
priority
within
the
legislature
to
address
this
issue
and
in
that
endeavor
we
have
invited
representatives
from
Tennessee
here
today
to
talk
about
how
they
were
able
to
do
away
with
their
waiting
list
and
the
process
that
they
went
through
and
and
they'll
also
discuss
some
other
issues
and
with
us
today
is
the
commissioner
Brad
Turner
from
the
Tennessee
Department
of
intellectual
and
developmental
disabilities
and
also
the
Deputy
Commissioner
of
program
operations
from
the
Tennessee
Department
of
intellectual
and
developmental
disabilities.
We've.
D
B
B
G
You
Mr
chairman
good
afternoon.
My
name
is
Brad
Turner
I'm,
the
state
commissioner
in
Tennessee,
for
the
Department
of
intellectual
and
developmental
disabilities,
very
excited
to
be
here
and
I
want
to
thank
you
for
your
engagement
in
this
issue.
I
think.
Sometimes
we
allow
state
lines
to
blur
what's
really
important
for
the
country,
and
this
is
certainly
something
that
Kentucky
should
be
credited
for,
observing,
considering
talking
about
and
actually
moving
forward
with
action.
So
thank
you
for
your
passion
on
that
very
excited
to
be
here
and
I'll.
H
Mr
chairman,
my
name
is
Jordan
Allen
I'm,
the
Deputy
Commissioner
of
operations
for
Tennessee
we're
going
to
run
through
if
it's
all
right
with
you
and
members
of
the
committee.
A
very
short
PowerPoint
presentation
talk
a
little
bit
about
where
we
were
over
the
last
decade
and
decade
plus
and
where
we
are
today
and
some
of
the
efforts
that
we
utilize
for
that.
It's
not
lost
on
me
than
an
after
lunch
power
points.
H
H
The
Tennessee
Department
of
intellectual
and
developmental
disabilities
in
Tennessee
was
established
as
a
standalone
agency
in
2011.
can.
H
Sir,
can
you
hear
me
all
right
for
brief
history?
The
Tennessee
Department
of
intellectual
and
developmental
disabilities
was
established
as
a
standalone
cabinet
level
agency
in
Tennessee
in
2011,
between
2011
and
today,
we've
grown
in
programs
introduced
several
that
are
on
the
screen
here
today
and
we're
serving
about
25,
000
adults
and
children.
H
Statewide
bulleted
are
a
couple
of
the
programs
really
just
to
illustrate
how
the
department
is
supporting
people
living
with
intellectual
or
developmental
disability,
throughout
their
lifespan,
so
from
birth
through
five
years
old
in
the
teis
OR
Early
Intervention
Program,
all
the
way
through
our
HCBS
waivers
that
serve
people
throughout
their
adult
life.
H
The
first
Medicaid
waivers
were
1915
sea
waivers
in
our
state,
of
which
there
were
three.
All
three
are
bulleted
for
the
committee
here
on
the
screen.
The
first
of
those
three
waivers
established
in
1986
was
our
Statewide
waiver,
which
is
an
individually
capped
waiver.
Today
that
cap
stands
at
about
two
hundred
thousand
dollars
a
year,
although
average
expenditures
fall
right
about
90
000.
The
last
of
those
three
bulleted
is
our
family
waiver.
Our
self-determination
waiver
much
lower
cap
targeted
at
young
people
still
mostly
living
at
home
with
family.
H
The
intent
is
to
try
to
preserve
that
family
environment,
to
the
extent
that
we
can
introduce
skill
building
and
programming
that
might
help
that
young
person
not
need
as
intensive
of
long-term
supports
as
they
may
without
services,
and
then
the
one
in
the
middle
there
is
the
congregate
aggregate
capped
waiver
rolls
right
off.
My
tongue
is
a
waiver
that
was
developed
specifically
to
catch
people,
as
we
de-institutionalize
very
thankfully,
forever
in
the
state
of
Tennessee
in
2016.
H
As
you
can
see
here,
these
are
some
of
the
conditions
that
the
waivers
were
built
on
our
1915
sea
waivers
and
I
keep
referencing
that
specifically
because
and
I'll
get
to
it
in
just
one
more
slide,
all
right.
In
2016
we
closed
enrollment
into
our
1915
C
programs
and
opened
enrollment
into
an
1115,
a
demonstration
which
is
a
Managed
Care
demonstration
for
the
HCBS
population.
But
to
give
you
some
idea
of
context
in
our
our
1915
seed
waivers,
the
70
cents
on
every
dollar
is
spent
on
long-term
residential
care
for
that
population.
H
It
generally
assumed
that
most
people
that
entered
those
Services
were
going
to
need
a
lifetime
of
services.
As
a
result
of
that,
we
only
admitted
folks
running
out
of
Appropriations
fairly
quickly
at
about
300
a
year,
which
starts
to
speak
to
the
waiting
list
with
only
300
slots
per
year
as
expensive.
As
the
assumptions
were
that
people
will
be
there
for
a
lifetime
and
need
152
thousand
dollars
a
year
worth
of
services.
H
So
because
of
the
limited
Appropriations
and
the
high
costs
that
I
just
talked
about
that
waiting
list
doubled
between
03
and
2012.
And
you
can
see
it
was
about
5
800
at
that
time.
And
that's
when
we
closed
the
1915
sea
waivers
and
opened
up
our
Managed
Care
demonstration
and
the
waiting
list
at
that
point
was
right
about
6
000.,
the
employment
and
Community
First
choices
program,
which
is
that
1115a
demonstration
that
I
talked
about
the
Managed
Care
administered
program
was
built.
H
I'm
I
apologize
for
my
voice
was
built
on
the
presumption
that
people
needed
to
look
at
competitive,
integrated
employment
options
that
the
state
that
Managed
Care
organizations
that
service
providers
had
the
obligation
to
try
to
equip
people
with
programming
and
the
skills
that
they
needed
to
be
as
independent
as
they
desired.
To
be
and
and
I
know.
That
sounds
very
intuitive
when
we
say
it
out
loud,
but
the
truth
of
it
is
without
getting
on
a
diatribe
about
FIFA
service.
H
Delivery
Systems
fee
for
service
systems
unfortunately
teach
dependence
they
create
long-term
dependence,
because
the
only
incentive
for
the
providers
of
those
Services
is
that
people
remain
as
dependent
as
they
are
when
they
enter
or,
in
the
worst
case
scenario,
become
more
dependent
over
a
lifetime
which
increases
the
rate
of
pay
that
that
the
state
taxpayers
here
in
the
federal
government
have
to
contribute
to
their
care.
So
the
Managed
Care
demonstration
was
launched
in
2016.
H
There
are
five
groups
graduating
in
Acuity
from
four
up
until
eight
and
the
highest
levels
also
concentrate
pretty
significantly
on
long-term
Support
Services
24
7
supports
for
people.
Ecf
choices
opened
in
fiscal
year,
17
with
1700
slots.
So
again,
that
waiting
list
was
right
about
5800
at
that
point,
1700
slots
knocked
it
down
to
about
4
000.
the
following
year:
Appropriations
through
our
legislature
gave
us
another
thousand
slots.
So
that's
roughly
about
3
000
on
the
waiting
list
with
the
people
that
had
joined
the
waiting
list
in
that
year.
H
We
were
right
about
4
000,
but
getting
to
the
point
at
which
we
started
to
consider-
and
this
was
about
the
time
the
pandemic
set
in
the
availability
of
ARP
funds
to
help
fund
capacity.
Building,
which
is
many
of
you
probably
know,
was
one
of
the
foundations
of
the
American
Rescue
act,
and
we
leveraged
that
ultimately
to
eliminate
our
waiting
list.
So
one
of
the
things
I
want
to
call
attention
to
here.
So
by
the
end
of
2022,
we
had
sat
down
with
the
State
Medicaid
agency
in
Tennessee.
H
We
had
through
commissioner
Turner's
Administration
through
the
governor's
office
and
through
the
director
of
TennCare,
or
had
collaboratively
developed
a
goal
to
eliminate
our
waiting
list
by
the
end
of
2023.
Several
efforts
were
engaged
in
that
not
the
least
of
which
was
reaching
back
out
to
every
person
on
that
waiting
list.
Some
people,
in
fact,
like
I've,
learned
on
our
walk-in
as
as
I,
was
meeting
some
of
the
people
here
for
this
hearing.
Many
of
the
people
on
that
waiting
list
signed
up
for
that
waiting
list
because
they
were
told
they
should.
H
They
didn't
actually
have
a
need
for
services
immediately.
It
was
more
anticipatory
and
so
in
the
state
of
Tennessee.
We
we
drew
down
enough
for
2
000
slots,
and
then
we
reached
out
to
every
member
on
that
waiting
list
to
determine
where
they
actually
were
in
their
need
for
Direct
Services.
What
we
found
out
is
of
the
four
thousand
ish
people
on
our
waiting
list.
Less
than
2
000
people
actually
wanted
or
needed
Services
some
had
moved
out
of
the
state.
H
Others
said
just
what
I've
communicated
here
this
morning,
we
were
just
told
by
our
teacher.
We
should-
or
we
were
just
told
by
a
friend,
we
better
get
on
the
list
or
we
may
never
get
service.
Certainly
you
can
understand
that
mindset
with
the
wait
list
you
know
being
so
long
in
so
many
states
and
requiring
so
much
time
before
you
get
on,
but
after
we
did
individual
work
with
each
of
those
folks.
We
were
down
to
about
1950
and
we
were
able
to
eliminate
that
by
the
end
of
2022..
H
One
of
the
things
I
want
to
talk
about
very
quickly
in
these
last
few
slides
is
an
equal
investment,
so
in
addition
to
Appropriations,
in
addition
to
utilizing
ARP
funds
to
eliminate
our
waiting
list
about
five
years
ago,
we
started
really
investing
in
the
research
development
of
training
and
implementation
of
alternative
support
tools,
and
the
premise
for
this
again
is
pretty
intuitive
and
simple,
giving
people
the
opportunity
to
be
as
independent
as
they
desire,
which
is
the
same
desire.
Each
of
us
carry
for
ourselves
for
our
sons
and
daughters.
H
Unfortunately,
people
living
with
disabilities
aren't
always
met
with
that
same
expectation
by
the
people
supporting
and
certainly
have
not
historically
been
met
with
the
tools
that
they
need
to
reach
those
levels
of
Independence.
When
you
survey
people
living
with
or
without
disability,
what
they
want
to
do
is
be
self-sufficient.
What
they
want
to
do
is
Achieve
I,
say
all
this
to
say:
we've
invested
heavily
in
enabling
technology
supports.
H
These
are
sensors,
Smart,
Home,
Tech
technology,
emergency
response
systems,
application
based
technology,
much
like
I
use
to
get
to
this
building
today,
and
certainly
could
not
have
gotten
here
without
my
enabling
technology
on
my
cell
phone
and
then
we
figured
out
a
way
to
to
set
training
up
and
opportunities
for
providers.
Families
people
supported
today
of
the
11
000
people
in
services
in
our
HCBS
system,
roughly
10
percent
of
those
people
utilize
enabling
technology
in
some
way
to
offset
direct
support,
needs.
I.
H
Don't
have
to
tell
this
committee
what
that
means
in
terms
of
budgetary
impact,
but
if
people
on
on
a
10
clip
are
using
less
Services,
then
our
approach
is
to
redec
redirect
those
saved
funds
because
we're
paying
less
for
services,
they're,
less
intense
or
they're
less
frequent,
and
we
redirect
those
to
try
to
help
offset
a
new
waiting
list,
developing
which
inevitably,
at
some
level
probably
happens,
but
to
the
degree
that
we
can
develop.
Programs
implement
tools
and
training
to
help
reduce
direct
Reliance
for
a
lifetime
for
people
with
intellectual
and
developmental
disabilities.
H
G
I
add
I'd
like
to
add
just
one
thing
to
that:
I
think
it's
important
for
committee
here
too,
from
from
what
we
have
done,
that's
been
very
successful.
We're
also
incorporating
this
into
younger
and
younger
age
groups
by
working
inside
the
school
districts,
because
students
already
have
a
vast
amount
of
knowledge
around
technology,
and
so
the
quicker
that
we
can
get
to
the
students
that
might
have
intellectual
developmental
disabilities
inside
the
school
system,
they're
already
familiar
with
how
to
work
technology,
how
to
use
technology.
G
Whatever
that
might
look
like
enabling
technology
allowed
them
to
remain
independent,
as
opposed
to
becoming
more
dependent
on
a
system
that
Frankly
Speaking
has
infinite
needs,
but
finite
dollars
right,
and
so
we
wanted
to
make
sure
that
we
invested
in
areas
that
were
going
to
also
lessen
dependency
and
then,
as
Jordan
mentioned,
free
up
dollars
to
be
able
to
invest
for
those
that
do
have
high
levels
of
medical.
Acuity
may
not
be
able
to
to
Leverage
The
enabling
technology
in
a
manner
that
thousands
of
others
can
do
so.
G
H
So
if
this
program
ultimately
is
successful
for
any
one
person
entering,
then
we
have
provided
that
young
person
with
the
tools
and
skills
necessary
to
not
enroll
in
Medicaid,
we've
diverted
that
person
from
what
I've
already
said
and
I'm
not
trying
to
be
hyperbolic,
but
but
potentially
a
lifetime
of
learned
dependence.
If
we
can
intervene
when
they're,
young
and
and
prevent
admission
for
those
for
whom
it's
appropriate
to
HCBS
programs.
So
this
program
focuses
on
the
the
transitional
age,
youth
15
to
22
years
old
goes
in
to
those
that
are
in
school
systems.
H
We
developed
a
kind
of
a
curriculum-based
pro
program,
three
lanes
in
this
one
homework
and
Community.
There
are
Milestones
the
person
supported
and
their
family
choose,
which
of
those
Milestones
that
they
want
to
work
on.
That's
skill,
building
and
utilization
of
technology
to
independently
transport
them
in
your
community
or
to
work
on
pre-employment,
Discovery
or
those
kind
of
things
that
can
help
a
young
person
begin
to
establish
those
building
blocks.
They
need
to
live
an
independent
lifestyle
once
they
graduate.
H
H
I,
don't
think
I
need
to
spend
a
whole
lot
of
time
on
the
Katie
Beckett
program.
I
know
you
have
a
Katie
Beckett
program
here
in
the
state
of
Kentucky.
H
One
of
the
things
I
do
want
to
highlight
very
quickly
is
our
Katie
Beckett
program
has
two
sections
part:
A
is
for
those
families
that
that
their
income
would
would
prevent
them
from
being
able
to
enroll
in
Medicaid
like
a
traditional
Katie
backup
program,
it
allows
those
families
to
enroll
into
Medicaid,
but
the
part
B
program
is
another
Medicaid
diversion
again
we're
investing
heavily
in
diversion
for
those
that
don't
need
it
and
we're,
starting
that
with
our
Katie
Beckett
program
with
children
as
young
as
four
and
five
years
old
in
that
program,
the
building
blocks
of
services
that
can
help
them
avoid
what
we
perceive
to
be
a
learned
dependence
for
a
lot
of
people
once
they
enter
a
lifetime
of
services
in
the
HCBS
Service
delivery
method.
H
That
program
is
ten
thousand
dollars
annually
for
families
we
set
it
up
as
a
health
care
reimbursement
account,
so
families
use
a
credit
card
to
purchase
the
services
that
they
need
up
to
ten
thousand
dollars
a
year.
The
predominant
purchases
are
usually
clinical
supports,
home
modification
and
services.
I
think
that
aren't
Direct
in
home
at
least
the
majority
of
them
aren't
Direct
on
in-home
services.
Respite
supports
that
kind
of
thing,
commissioner,
anything
you
want
to
add
on
that.
One.
G
G
I
want
to
say,
88
of
the
families
that
participate
in
our
program
have
some
form
of
the
HSA
where
they
can
spend
those
dollars,
and
then
they're
are
very
quickly
reimbursed
back
from
from
the
vendor
that
we
use.
We
have
an
amazing
team,
but
parents
have
all
spoken
very
highly
of
the
flexibility
that
it
gives
them.
So,
if
that's
not
something
that's
happening
in
Kentucky,
maybe
something
Mr
chairman
you
and
the
committee
want
to
consider
is
how
do
you
continue
to
give
parents
flexibility
built
around
the
dollars?
G
That
have
already
been
allocated
to
them
through
the
waiver,
because
we
have
found
that
they
have
been
able
to
do
more
and
they're,
also
seeing
stronger,
progressions,
more
Forward,
Thinking,
progressions
and
growth
in
their
child,
because
they're
actually
able
to
have
varying
degrees
of
support
that
the
dollars.
If
they
were
not
available,
the
parents
and
the
families
would
not
have
been
benefits.
Of.
B
If
we
looked
at
a
child
waiver
where
the
kids
would
be
separated
and
and
but
it's
more
of
a
you
know,
I
guess
yours
is
just
more
as
a
dollar
amount
and
certain
Services,
where
and
I
think
we
were
thinking
more
of
along
the
lines
of
the
services
that
our
adults
get,
but
limiting
those
services
to
what
the
child
would
need
right.
Obviously,
they
wouldn't
need
Adult
Day
training
because
they're
in
school
most
of
the
year,
so,
okay
I'm,
sorry,
please
proceed.
H
Yes,
sir
Mr
chairman,
we
have
just
two
slides
left,
so
the
next
and
again
this
goes
to
the
investment
that
we're
making
into
trying
to
provide
tools
and
resources,
training
and
programming
to
people
to
prevent
that
lifetime
of
full
service
dependents,
but
the
flexible
support
rate
and
I
want
to.
In
full
admission.
This
has
not
yet
been
approved
by
CMS.
H
So
I'll
describe
this
as
succinctly
as
possible,
but
in
short,
in
our
1915
C
program,
probably
very
similar
to
the
one
here
in
Kentucky.
There
are
levels
of
Acuity
that
are
gauged
by
assessment.
In
our
program
it
ranges
from
one
to
six,
one
being
lowest
level
of
Acuity,
six
being
someone
that
is
incredibly
medically
acute
or
maybe
medically
and
behaviorally
challenged.
H
But
the
point
is
it
requires
a
ton
of
you
know:
two-on-one
direct
support
almost
all
day
a
ton
of
clinical
wrap
around
the
flexible
residential
support
rate
targets,
not
those
that
are
in
the
highest
level
of
Acuity,
but
allows
for
those
in
the
four
lower
levels
of
Acuity
to
choose
one
of
two
rates.
So
you
can,
let's
say
if
somebody's
at
that
third
level
of
Acuity
level,
three
you
can
choose
to
receive
services
and
the
Staffing
ratios
that
are
required
as
a
standard
per
diem.
H
Let's
just
say
that's
300
a
day
or
you
can
choose
the
flexible
support
rate
which
we
reimburse
the
provider
at
one-third,
less
so
200
a
day.
But
the
expectation
is
that
that
person
is
being
supported
by
independent
measures,
either
enabling
technology
or
natural
support
arrangements
or
they're
they're,
just
not
having
direct
staff
support
for
a
portion
of
the
their
day.
So
it
allows
that
person
to
receive
Services
when
and
how
they
want.
H
It
reduces
the
cost
for
the
provider
agency
by
at
least
one-third
and
in
some
cases
it's
much
more
than
that,
and
then
the
state
takes
that
one-third
that
we've
pulled
out
of
that
rate
shares
a
portion
of
that
with
the
provider
as
an
incentive.
The
portion
that
we
share
changes
based
on
level
of
Acuity,
as
you
would
expect,
the
higher
the
Acuity,
the
more
of
that
savings
we
share,
but
the
State
Banks,
the
rest
of
that
shared
savings,
and
then
we
reinvest
that
shared
portion
into
future
slots.
For
for
folks.
H
H
We
can
create
a
significant
amount
of
savings
that
right
now
is
just
unavoidable
and
built
into
the
system,
and
that
that
Savings,
in
and
of
itself
can
be
used
to
help
combat
another
waiting
list
growing
into
the
thousands
like
we've
experienced
in
Tennessee,
like
you're,
experiencing
here
in
Kentucky
in
the
future.
So
this
is
one
of
the
the
newest
and,
in
my
opinion,
one
of
the
most
creative
approaches
that
we're
taking
to
that
and
if
and
when
CMS
approves
it,
which
I
feel
confident
they
will
you'll
hear
the
party
in
Nashville
from
here.
H
I
bet
final
thoughts,
just
kind
of
thematic
of
everything
we've
talked
about,
there's
always
going
to
be
people
with
disabilities
that
need
our
support,
need
policy
makers
to
be
thinking
forward,
need
advocacy
agencies
need
provider
agencies
to
meet
them
where
they
are
to
help
them
understand.
First
of
all
that
they
can
reach
the
level
of
Independence,
they
can
reach
the
same
expectations
that
you
or
I
or
our
kids,
or
anybody
else
has
for
themselves
and
it's
our
responsibility
to
make
sure
that
we're
providing
the
support,
the
training
and
the
programming
to
get
them
there.
H
That
said,
they'll
always
be
there,
and
so
we
do
have
to
think
forward
as
much
as
possible
and
strategically
about
how
we
can
anticipate
those
enrollments
forever
more
going
forward.
How
we
in
Tennessee
believe
we
can
combat
that
the
best
is
ensuring
that
people
are
only
getting
the
supports,
that
they
want
and
need,
and
not
all
of
the
additional
supports
that
are
typically
built
into
fee
for
service
methodologies
and
two
that
we're
developing
programs
going
forward.
B
So
it's
going
through
that
it's
and
I'm
trying
to
to
compare
it
as
you
were
talking,
and
there
are
a
lot
of
differences,
obviously
so
so
initially
doing
away
with
the
waiting
list
or
cutting
it
down
dramatically.
Arpa
funding
used
for
that
Appropriations
used
for
that.
B
You
all
have
a
you
all
go
into
the
school
system
at
a
younger
age.
We
and
I
know
in
my
part
of
the
state.
Most
parents
don't
even
know
about
waivers
and
it
and
I
run
an
organization.
That's
a
provider,
an
Easter
Seals
affiliate.
You
all
have
I
think
you
all
have
in
Tennessee.
B
So
we
offer
to
be
a
resource
to
go
into
the
schools
at
any
time,
not
to
recruit
folks
to
come
to
our
Center,
but
just
to
educate
families
and
schools.
Don't
really
take
us
up
on
that
and
and
I
didn't
know.
I
had
I
have
a
child
with
a
disability.
B
I
knew
nothing
about
Michelle
P
waver
until
I
went
to
work
at
Easter
Seals,
so
we're
we're
not
doing
a
very
good
job
in
that
area
of
getting
kids
at
an
early
age
and
I
like
what
you
said
about
start
starting
to
Preparing
them
for
life.
You
know
we
have
some
good
programs
in
our
schools.
Don't
get
me
wrong,
but
you
all
being
involved
in
and
then
the
families
knowing
what's
coming
down
the
road
and
what's
available
I
like
that,
the
employment
part
of
it.
B
H
Yes,
sir
Mr
chairman,
so
we're
as
as
indicated
in
the
portion
of
the
presentation
about
the
employment
and
Community
First
choices,
program,
employment,
first,
as
an
approach
to
planning
for
and
delivering
service
and
tendencies
and
employment
for
a
state,
we're
fortunate
to
have
an
executive
order
from
the
governor
Haslam's
Administration,
and
essentially
we
follow
that
marching
order,
which
is
to
assume
that
everybody,
as
at
the
point
at
which
they
become
working
age,
wants
to
work,
wants
to
contribute,
wants
the
satisfaction
of
achievement
in
their
employment.
H
And
so
we
start
from
that
perspective,
we
do
have
an
mou
directly
with
Vocational
Rehabilitation
to
make
sure
that
that
there's,
a
seamless
entry
and
exit
between
funding
sources,
I
can
tell
you
and
and
I
would
bet,
Senator
that
that
you
would
Echo
these
sentiments.
I've
been
in
this
work
for
30
years
and
started
as
an
employment
coach.
H
It's
how
I
got
hooked
in
this
business,
but
I've
never
met
one
person
that
I've
ever
reported
directly
or
a
person
that
was
served
by
the
agency
Iran
or
a
person
since
I've
been
in
this
job
that
cared
where
the
money
was
coming
from.
They
didn't
care
if
it
was
coming
from
VR
or
if
it
was
coming
from
an
appropriation
through
the
waiver.
If
it
was
State
dollars,
what
they
cared
about
is
am
I
going
to
have
to
go
through
all
of
it
again
when
I
leave.
H
Vr
do
I
have
to
start
all
the
way
over
and
learn
you
and
when
I
leave,
you
do
I
have
to
start
all
the
way
over
with
the
agency
that
you're
running,
and
so
we
developed
an
mou
that
helps
eradicate
that
as
much
as
possible
so
to
the
person
supported
to
their
family.
They
know
the
same
person
throughout
their
lifespan
if
they
decide
to
engage
in
pre-employment,
which
we
push
this
beginning
at
15
years
old,
then
by
the
time
they're,
20,
22-23,
hopefully
moving
on
to
their
second
or
third
job
moving
along
a
career
path.
H
They
know
the
same
person
or
the
same
person
can
introduce
them
to
the
agency.
That
will
support
them,
as
they
continue
to
progress.
I'm
not
going
to
sit
here
and
lie
and
tell
you
it's
seamless,
it's
not
it's
still
very
frustrating
Commission
are
going
to
test
to
that
very
directly,
which
is
why
you
mentioned
having
trouble
getting
into
the
school
systems
and
making
sure
there
was
continuity
amongst
the
systems.
G
Chairman
can
I
add
one
thing
to
your
earlier
statement
that
I
think
is
important,
I'm,
also
the
father
of
a
daughter
within
all
developmental
disabilities.
So
the
fact
that
God
saw
in
his
Providence
put
me
in
the
position
is
a
huge
blessing
for
me.
I
think
there's
a
Biblical
mandate
for
us
to
do
this,
and
do
it
the
right
way
and
see
individuals,
Through,
The,
Eyes,
Of,
God
and
so
Through
The
Eyes
of
man.
G
That
makes
a
big
difference
in
how
you
acknowledge
their
dignity,
but
one
of
the
things
that
you
said
is
that
Kentucky's
appears
to
be
having
challenges
like
how
do
we
keep
kicking
down?
The
doors
you
got
to
force
them
down
is
what
we
did
and
one
of
the
things
that
I
can't
stress
the
importance
of
that
I'm
hoping
the
committee
would
consider
and
I'm,
certainly
not
here
from
another
state,
to
tell
you
what
to
do,
but
to
tell
you
how
it
benefited
us
was.
We
are
a
standalone
Department.
G
We
do
not
report
up
to
another
level
of
government.
We
don't
report
to
another
commissioner,
director
secretary.
However,
it's
established
in
Kentucky,
we
report
report
directly
to
the
governor,
and
when
you
have
that
sort
of
visibility,
I've
got
a
saying
that
I
share
with
people
that
that
diversities
haven't
exceeded
the
table.
Inclusion
is
having
a
voice,
but
belonging
is
actually
having
that
voice
heard.
This
created
a
sense
of
belonging
for
tennesseans
with
disabilities
that
they
have
their
own
Department.
That
actually
represents
them,
and
not
only
they
have
their
own
department.
G
They
have
someone
that
sits
in
the
seat.
That's
apparent
too,
so
the
more
that
you
can
engage,
I,
think
your
communities
of
individuals
in
Kentucky
with
idd
I,
think
it's
going
to
make
this
conversation
that
much
more
robust
and
that
much
stronger,
because
we've
got
a
standalone
Department
would
just
be
something.
I
would
strongly
urge
you
to
consider
in
how
you
do
things.
Is
it's
hard
to
serve
multiple
Masters?
G
So
if
you
have
this
level
of
conversation
at
such
a
smaller
level
that
it
feels
like
it
can't
penetrate
through
the
concrete
ceiling,
that's
probably
true,
because
it
can't-
and
so
just
something
for
you
to
think
about,
because
it
has
worked
wonders
in
the
state
of
Tennessee.
In
the
last
13
years
that
our
population
has
a
voice,
one
in
every
six
tennesseans
has
a
disability,
so
you're
talking
about
a
million
people
that
actually
have
a
seat
at
the
table
with
the
governor,
regardless
of
administrations
and
something
that's
really
benefited.
Our
state.
I
D
First
of
all,
the
weightless
blister
impossibly
long
and
that
there's
until
your
number
comes
up,
you
don't
even
know
if
you're
actually
eligible
for
the
services.
You
don't
know
what
level
of
Acuity
you
have.
So
you
could
wait
for
years
on
this
waiting
list
rise
to
the
top
and
then
be
told,
never
mind,
and
there
may
be
hundreds
thousands
of
people
on
the
list
who
are
bogging
down
so
that
people
who
are
needing
Services
further
back.
It's
just
you
know
so.
Have
you
tackled
that
issue?
We.
G
We
have,
and
Jordan
can
touch
on
that
because
he
just
talked
about
it.
We
were
actually
very
intentional
in
figuring
out
okay,
who
actually
needs
this
and
who
may
need
a
different
level
of
support
that
might
not
be
appropriate
to
be
inside
a
waiver,
so
I'll,
let
Jordan
talk
a
little
bit
more
about
it,
but
that
that
was
one
of
the
first
things
we
had
to
do
was
figure
out.
G
H
Very
much
like
you're
indicating
we
really
took
our
lumps
with
that.
So
we
had
folks
that
had
joined
the
waiting
list
and
all
you
had
to
do
is
make
a
phone
call
to
get
on
it,
and
then
you
were
officially
representing
it.
Holding
the
spot.
I
don't
have
to
tell
you
guys
how
that
feels
to
the
community.
We
represent
how
it
looks
to
the
federal
government,
the
Department
of
Justice
and
others.
H
So
in
the
new
program
that
launched
in
2016
the
Managed
Care
Program,
we
do
all
of
that
screening
and
eligibility
determination
on
the
front
end.
Now
there
may
not
be
Appropriations
to
support
that
person.
As
I
talked
about.
We
were
fortunate
enough
to
get
down
to
zero
on
our
list
at
the
start
of
2023,
but
every
person
on
that
list
qualifies
what
changes
over
time.
Also
is
people's
residence.
G
I
think
the
other
thing
man
if
I,
can
add
to
that
too.
It
also
might
help
with
your
relationship
with
the
school
district,
because
there's
then
confusion
about.
Does
the
child
have
this
disability
or
that
disability
is
an
IEP
required?
What
do
we
need
to
do
on?
How
do
we
educate
that
child?
Because
we
have
run
into
that
to
your
point?
Mr
chairman,
a
lot
of
the
school
districts
didn't
even
know
that
we
were
out
there
and
we're
the
fifth
biggest
department
in
the
state
of
Tennessee.
D
Very
very
helpful
could
I
ask
another
question.
Thank
you
so
we're
going
to
have
you
know
in
any
population
we're
going
to
have
some
percentage
of
people
where
the
Acuity
is
so
high.
They're
never
going
to
be
independent,
they're,
never
going
to
go
to
work,
and
so
what
what's
your
response
to
to
those
individuals.
G
So
I've
got
two
responses
that
number
one
you're
right,
there's
always
going
to
be
people,
and
we
talk
about
that
literally
every
day
about
how
do
we
get
to
the
folks
that
that
we
know
are
going
to
need
State,
Services,
right
and
I?
Think
that's
part
of
the
bigger
conversation
as
well
is
that
these
programs
are
generally
supposed
to
be
safety
nets
and
not
destinations
right,
but
for
some
individuals
they
do
become
destination
because
the
need
is
so
severe
right.
G
I
would
encourage
you,
and
one
of
the
things
that
I
want
to
be
very
clear
on
is
the
winds
have
changed.
Oftentimes
are
winds
to
blow
backwards,
which
is
not
what
you
want
to
do.
We
do
not
need
to
go
back
to
institutions.
I
want
to
be
very
clear
in
my
own
personal
Drive.
I
cannot
imagine
dropping
my
daughter
off
at
an
institution,
because
somebody
told
me
that's
the
best
she's
ever
going
to
do
so.
G
The
fact
that
you
have
a
disability
should
not
be
a
death
sentence.
It
should
not
be
a
prison
sentence,
so
what
we
need
to
do
is
make
sure
that
we
can
provide
the
level
of
care
with
State
and
with
private
providers
to
take
care
of
the
individuals
that
we
know
are
desperately
going
to
need
that
because
they
may
have
no
level
of
Independence
available
and
that's
something
that
I've
been
very
clear
with
to
our
team.
G
That's
something
that
our
my
Governor
has
been
very
clear
to
us
is
figure
out
how
to
get
to
the
folks
that
need
government
in
the
appropriate
role
to
live
their
life,
whatever
level
that
might
look
like
so
Jordan
I,
don't
know
if
you
want
to
add
anything
to
that.
But
that's
something
we
work
on
every
day
is
acknowledging
the
fact
that
there
are
going
to
be
people
that
need
us,
and
we
need
to
make
sure
that
they
do
need
us.
G
H
Yeah,
just
the
logistics
to
that
I
mean
obviously
that
spirit
and
that
understanding
that
we
are
here
to
ensure
that,
regardless
of
level
of
need
that
people's
needs
are
met.
But
we
also
need
to
have
objective
methods
by
which
we
assess
that
Acuity.
In
my
opinion,
that
can't
be
done
by
the
state
that
needs
to
be
contracted
independently,
at
very
least,
remove
the
perception
of
conflict
between
the
payer
and
the
assessor
and
as
we
start
to
get
now
again.
H
This
is
just
me
kind
of
forecasting,
at
least
for
us,
as
we
start
to
get
closer
and
closer
and
more
and
more
into
value-based
payment.
Reimbursements,
I
think
that
those
populations
that
you're
talking
about
do
need
to
be
identified
appropriately,
and
we
probably
need
to
begin
to-
and
this
sounds
terrible,
just
saying
it
out
loud.
H
Those
programs,
the
reimbursement
for
those
programs,
the
identification
of
outcomes,
cannot
be
consistent
with
folks
who
need
to
be
supported
on
a
minute
to
minute
basis
with
suctioning
or
have
such
High
degrees
of
Behavioral
level,
Acuity
that
they're
a
danger
to
the
themselves
or
others
as
soon
as
they're
in
any
setting.
That's
outside
of
Direct
Control,
and
you
know
forever
right
now
within
our
1915c
programs
and
waiver
programs
across
the
country.
Those
levels
of
Acuity
are
mixed
within
the
same
program
and
the
outcome
is
the
same
for
all
of
them.
There
is
none.
G
The
the
last
thing
I'll
add
to
that
that's
important
is
that's
why
what
we're
doing
with
reinvesting
those
dollars
matters
because
for
the
people
that
do
need
it,
we
need
to
make
sure
those
programs
are
funded
and
are
not
second
in
conversation
about.
Do
we
fund
that
it
should
be
a
priority
and
that's
something
that
we've
done
I'm
very
proud
of.
G
B
Thank
you
for
the
question.
I
had
attended
a
Medicaid
conference
in
Virginia
last
week
and
commissioner
Lee
happened
to
be
there
for
a
couple
days.
So
I
had
her
ear,
we're
starting
to
do
things
like
identifying
individuals
and
looking
for
alternative
Services
outside
the
waiver.
I
think
that's
something
that
we
I
think
our
problem
is.
Is
the
scope
like
they
said?
B
Our
cabinet
is
so
large
and
she
deals
with
so
much
I
that
that
idea
of
separating
is
intriguing,
but
but
I
do
know
that
they're
making
some
efforts
to
try
to
do
those
things
and
doing
some
like
some
preliminary
screening.
In
the
beginning,
we've
kind
of
been
back
and
forth
on
that
whether
or
not
screening
is
actually
taking
place
and
I,
don't
I,
don't
think
it
to
to
the
capacity
that
it
should
be.
It's
not
obviously
looking
at
our
numbers.
It's
not
you.
B
H
That,
yes,
sir,
so
the
the
program
that
opened
at
the
time
our
1915
C
programs
closed,
is,
is
under
an
11
15
a
demonstration
waiver
and
is
administered
by
three
separate
Managed
Care
organizations
in
the
state
of
Tennessee
to
to
think
about
it.
H
From
an
organizational
chart
perspective,
we
have
the
State
Medicaid
agency
TennCare
in
our
state,
running
on
a
parallel
line,
with
the
depart
with
the
Department
of
intellectual
and
developmental
disabilities,
running
down
contractually
to
each
of
these
three
mcos,
who
then
contract
with
their
own
individual
networks
for
the
delivery
of
service.
So
it's
the
Managed
Care
organizations
in
this
context
and
I.
Don't
I,
don't
want
to
board
this
group
with
with
the
theory
or
the
premise
behind
managed
care
administration
for
idd
services,
but
I
can
tell
you
that
their
entry
into
this
equation
is
new.
H
Typically
Managed
Care
organizations
deal
with
acute
episodes
of
care,
with
the
expectation
that
someone
is
treated
gets
better
and
moves
out
of
the
system.
It's
you
know
the
design.
That's
been
working,
I
guess,
depending
on
your
perspective
for
years
and
years,
but
long-term
support
services
for
our
population
is
just
that.
Typically,
it's
a
lifetime,
so
the
way
we've
configured
it
is.
H
The
assumption
is
that
Managed
Care
organizations
with
complete
visibility
and
awareness
of
everything
from
emergency
room
visits
and
medical
care
to
prescribers,
that,
with
the
totality
of
that
data,
with
that
continuity
of
data
across
somebody's
entire
treatment
perspective,
not
just
idd
services
but
psychiatric
medical
and
other
that
there
should
be
efficiencies
that
we
can
gain.
There
should
be
insights
that
we
could
gain
and
we
should
be
able
to
make
the
user
experience
for
the
person
supported,
more
seamless
and
and
less
wasteful
on
behalf
of
State
allocations
for
that
we're
new
enough
into
this.
H
Yet
that
I
can't
tell
you
definitively
we've
seen
that
what
I
can
tell
you
is
that
we
are
waiting
through
that
process
with
the
Managed
Care
organizations.
We
have
a
really
good
relationship
with
the
department
presides
in
kind
of
a
an
operational
authority
over
all
of
HCBS
systems,
so
best
practices
ensuring
that
policies
are
implemented
correctly.
H
Ensuring
you
know
if
you're,
if
you
want
to
fight
the
public
narrative,
ensuring
that
insurance
companies
mcos
aren't
just
arbitrarily
reducing
services
for
people,
which
is
the
narrative
again
I
can't
say
that
that
is
or
isn't
our
experience
yet
we're
only
five
years
into
it,
but
that's
where
they
sit
in
that
Continuum.
So
the
other
challenge
that
we've
had
just
for
this
committee,
as
you
begin
to
think
like
most
of
the
country,
is
about
managed
care
administration
is
the
management
or
understanding
of
how
independent
Managed
Care
organizations
will
independently
manage
their
own
networks.
H
H
Of
course,
they
are
but
they're
the
same
contractors
of
your
competitor,
who
are
the
same
exact
contractors
of
the
third
MCO,
and
we
need
to
ensure
that
we're
not
that
we're
all
pulling
in
the
same
direction
or
your
provider
agency,
sir,
could
have
three
completely
separate
sets
of
expectations
for
credentialing
or
expectations
for
equality.
Could
even
be
subject
to
three
different
rates
of
pay
if,
if
the
quality
withholds
for
the
Managed
Care
organizations
in
their
CRA
contract
with
Medicare
are
different,
so
it's
just
those
it's
new
enough
in
the
industry.
H
B
In
all
honesty,
the
thought
of
bringing
mcos
into
this
Kentucky
has
not
had
good
experience
with
our
mcos
and
they
can't
do
what
they
do
now
here.
Well,
our
health
care
outcomes
are
no
better
than
they
were
when
they
started
and
we
get
a
dog
and
pony
show
every
year
from
them,
but
nothing
changes
and
you
know
the
thought
of
them
overseeing
the
waivers
and
those
Services
I
I.
B
Don't
know
about
that
that
that
that
would
be
a
difficult
step
for
me
to
be
able
to
support,
though
the
outcomes
and
the
purpose
I
I
agree
completely,
and
it
would
be
great
if
I
felt
like
they
could
actually
do
that
and
do
it
efficiently
and
do
it
fairly
and
effectively.
I,
don't
think
they
can
and
I
hate
to
be
blind
and
judgmental.
But
I've
got
nine
years
up
here
and
I've
seen
a
lot
and
as
a
provider
I've
seen
a
lot
and
I'm
not
impressed.
You
all
had
three
mcos
in
Tennessee.
I
B
And
you
all
survived
doing
with
three
mcos:
don't
you
we
do
yeah,
okay,
representative
Decker.
You.
A
A
You
all
told
us,
but
I
had
a
I
want
to
ask
about
a
specific
service
to
see
if
you
fund
it
I
had
a
child
in
my
district,
his
family
contacted
me
because
they
were
confused
as
to
why
they
were
not
going
to
have
any
help
from
the
state
the
child
as
he
grew.
His
disabilities
became
so
severe
that
they
can
no
longer
care
for
him
in
the
home.
No
waiver
was
going
to.
D
A
That
and
there
was
no
residential
program
in
the
state
that
would
could
be
paid
for
by
Medicaid,
and
they
were
at
a
crisis
stage
where
he
was
going
to
be
released
from
the
hospital
and
the
hospital
was
not
going
to
release
him
to
the
family
because
they
had
nowhere
for
him
safely
to
be,
as
it
turned
out.
I
worked
with
a
Cabinet
for
Health
and
Family
Services,
and
actually
it
was
the
commissioner
of
Medicaid
services
who
found
a
solution.
A
H
Yes,
ma'am
a
lot
to
unpack
with
that
question,
but
I
will
say
that
we
see
very
similar
occurrences
as
do
service
systems
across
the
country.
Right
now
that
the
person
that
you're
talking
about
that
demographic
of
service
has
been
thus
far
in
our
history
as
an
industry,
unsolvable,
there's
not
you
know,
aside
from
the
intensity
and
then,
unfortunately,
so
often
the
intensity
needed
through
an
inpatient
setting
long-term
treatment
options
for
people
that
are
falling
in
that
demographic
or
just
overwhelmingly
difficult.
H
So
I've
I've
been
associated
with
several
families
and
people
supported
that
fall
into
that
group,
and
it
is
it's
tragic
and
it's
heartbreaking
and
there
hasn't
been
a
good
option
presented
that
I've
seen
yet
in
30
years
and
so
you're
not
alone
and
Kentucky's
Not
Alone.
The
nation
is
trying
to
figure
that
specific
demographic
out
to
answer
your
question
directly.
We
do
have
General
funds
within
our
budget
that
that
the
commissioner
and
our
Deputy
Commissioner
of
Finance
kind
of
guard
for
emergency
situations.
H
So
if
the
member
that
we're
talking
about
is
a
member
of
Blue
Care
one
of
the
three
in
our
state-
and
there
is
no
appropriate
place
for
placement,
there
is
no
res
Residential
Treatment
Center,
then
Blue
Care,
by
virtue
of
their
contract
with
the
State
Medicaid
agency,
is
required
to
find
placement
by
any
means
necessary,
which
sometimes
ends
up
being
an
individual
private
contract,
and
then
they
individually
negotiate
that
rate
with
the
vendor.
H
We
try
to
do
everything
we
can
to
help
ensure
that
we
can
keep
that
person
as
close
to
their
natural
support
network,
their
family,
their
community
that
they're
familiar
with.
Unfortunately,
sometimes
we're
not
able
to
do
that,
and
you
could
have
of
someone
from
upper
east
Tennessee
in
Greenville
have
to
go
to
Memphis
for
services
and
candidly,
sometimes
worse,
sometimes
leave
the
state
all
together,
but
I
wish
I
wish.
E
J
Mr
naround
providers
in
Kentucky
we
often
lack
providers
to
fill
certain
slot
needs,
and
so
that's
been
a
concern
about
filling
the
slots.
Without
providers,
did
you
all
have
success,
or
what
was
the
outcome
in
seeing
those
types
of
needs
filled
with
like?
Was
there
a
better
result
when
there
was
more
consistent
access
to
those
reimbursement
rates?
How
did
that
play
out
with
you
all.
H
Yes,
so
we
are
first
and
foremost
like
everybody,
the
pandemic,
through
everything
out
of
balance
as
it
relates
to
that
it.
You
know,
for
all
the
reasons
that
we
all
know
you
had
a
pandemic
descend
upon
a
community
that
is
overwhelmingly
at
risk,
much
more
at
risk
than
than
tippo
or
a
neurotypical
community.
H
And
then
you
had
people
working
for
those
agencies
that
just
said
I'm
I'm,
not
exposing
myself
to
that
and
then
exposing
my
family,
so
I'll
throw
the
last
three
years
completely
out
of
context
of
response
to
your
question,
so
we're
very
fortunate.
In
the
state
we
built
a
network
over
about
a
25-year
period,
roughly
450
providers
Statewide,
but
really
200
of
those
are
providers
that
are
24,
7
365
residential
providers
in
our
state
right
now
those
providers
are
strong
in
meeting
the
need:
the
24
7
res
providers,
as
I
guess,
I'm,
offering
perspective.
H
Now,
as
a
former
director
of
an
agency,
you
can
forecast
that
Revenue
pretty
easily
projecting
it
from
year
to
year
is
pretty
static.
You
can
count
on
the
income
that
comes
in
for
that
and
it's
generally
easy
to
hire,
ftes
and
and
to
keep
people
keep
staff
within
the
agency
for
that
portion.
As
we
continue
to
push
more
and
more
into
the
expectation
that
people
should
only
the
people
that
absolutely
need
that
level
of
support
should
be
getting
it
and
people
need
the
opportunity,
at
least
to
consider
an
intermittent
supports.
H
H
Certainly
not
patronizing
this
committee,
but
you
can
imagine
if
you're
trying
to
tell
one
staff
person
I
need
you
to
go
to
4th
Avenue
for
two
hours
and
then
leave
there
and
drive
down
to
South
Street
for
an
hour
and
a
half
and
then,
when
you're
done,
hang
out
at
a
coffee
shop
for
a
couple
hours
and
then
at
7
pm
go
down
to
Cherry
Blossom
and
spend
an
hour
and
a
half
there.
Staff.
Just
aren't
going
to
do
that
in
this
environment.
H
So,
being
completely
candid
with
you
out
the
area
that
we
want
to
focus
the
most
of
our
attention
in
which
is
the
development
of
those
flexible
Services
designed
to
help
people
reach
the
levels
of
Independence
that
they
want
to
reach
are
the
most
difficult
to
staff.
Right
now,
knock
on
wood,
we're
able
to
do
that
fairly
effectively,
but
we
monitor
initiation
of
service
and
network
adequacy
literally
I
get
a
report
once
a
week.
H
That
tells
me
you
know
who
the
where
the
most
egregious
area
or
area
in
the
state
is
and
what
providers
doing
it
the
best
so
we're
concerned
about
it
going
forward.
You
can't
get
to
where
we
want
to
go
where
the
commissioner
wants
us
to
land
and
then
not
ensure
that
that
Network
who's
supposed
to
be
there
to
meet
that
group
of
people
is
strong,
vital,
well
paid
and
well
skilled
to
meet
those
challenges.
G
That
was
he
added.
The
last
part,
I
was
going
to
add
that
if,
if
your
network
collapses,
it
doesn't
matter
how
great
everything
else
is,
you've
got
a
major
problem
because
the
the
Temptation
that
is
to
go
backwards-
and
you
heard
me
reference
a
few
minutes
ago-
that's
how
the
winds
of
Institutions
come
back
is
we
should
just
put
everybody
in
one
big
building
and
it'll
save
the
Staffing
problems.
It'll
save
this
problem
that
problem
it
doesn't
it.
G
Where
it
just
becomes
company
about
companies
making
money
but
you'd
be
foolish
to
not
acknowledge
that.
That's
why
businesses
start
is
because
they're
in
there
to
try
to
provide
services
but
also
make
money
at
the
same
time,
and
so
we
have
intentionally
worked
with
our
providers
to
say
if
we
build
this
program,
here's
the
dollar
value
to
you
to
hire
people
for
you
to
expand
Services,
because
then
we
can
lean
into
them.
To
say.
Look
you've
made
a
lot
of
money.
G
We
need
your
help
here
in
opening
up
Service
delivery
to
representative
Decker's
question
earlier,
a
really
challenging
Market
that
we
can't
find
providers
for.
So
we
like
to
think
that
we
create
the
right
balance
in
holding
providers,
accountability
for
delivery,
but
understanding
that
they're
also
in
business
to
make
money.
So
how
do
we
help
support
them
in
a
manner
that
expands
their
businesses
while
also
serving
more
tennesseans.
J
Just
one
quick
follow-up
in
1115,
a
versus
1915
C
waivers-
are
people
still
able
to
be
offered
11
15.
No
sorry,
1915c
waivers
at
this
point
in
time.
J
Okay
and
the
other
follow-up
question
was
what
does
Staffing
look
like
in
terms
of
for
your
department
for
the
cabinet
to
do
the
oversight
to
make
sure
that
the
providers
are
meeting
the
outcomes
and
expectations,
health
and
safety
qualifications
like
do
you
all?
Have
a
staff
designate
it
towards
that,
and
how
robust
is
that
staff.
G
Yeah
we
do,
we've
got
so
our
department
right
now
a
lot
of
them.
We
still
have
folks
that
work
in
Intermediate,
Care
Facilities,
so
there's
what
about
500
or
so
folks
that
work
in
direct
support
So
inside
our
central
office.
We
probably
have
a
few
hundred
folks
that
are
inside
our
central
office
where
we
are,
but
then
we
also
have
Regional
teams
and
Jordan
can
probably
speak
to
it
a
little
bit
better
than
me.
G
H
Just
that
it's
the
department
that
provides
all
of
the
quality
oversight,
whether
it's
the
1115
or
the
1915c
program,
and
we
do
that
with
annual
surveys.
We
act
on
reports
that
we
get,
and
so
it's
it's
out.
The
staff
that
commissioner
Turner
just
referenced,
that
does
all
of
that
yeah
and
we
have
them
stationed
across
the.
G
State
and
again
I
I'm,
going
to
promise
to
not
be
the
dead
horse
or
German.
Doesn't
ever
kick
me
out
of
the
state
and
doesn't
invite
me
back
at
some
point.
That's
also
the
value
of
having
a
standalone
department
is.
They
know
who
they're
accountable
to
right,
and
so
they
know
that
they
have
to
answer
to
the
department
that
is
responsible
for
Service
delivery
for
individuals
with
intellectual
developmental
disabilities.
G
Providers
know
where
they
have
to
go
to
individuals
that
need
Services,
know
where
they
have
to
go
to
Senator
Carroll,
as
a
parent
may
not
have
heard
about
it,
but
he
can
look
on
the
website
to
say
this
might
be
the
right
front
door
for
me
to
go
into
so
that
has
been
all
very
beneficial
and
and
part
of
that
beneficial
experience
has
been.
The
providers
know
who's
okay,
who
they're
accountable
to
when
they're,
when
they're
having
to
deal
with
those
sorts
of
questions.
You're
welcome.
B
So
we
struggle
with
providers
and
and
having
enough
and
the
cabinet
has
gone
through
a
series
of
reimbursement,
pay
rate
studies
and
that
has
improved
the
legislature
approved
two
10
raises
the
last
two
years
in
in
funding
for
the
various
programs,
and
so
that's
a
struggle.
Ddid
oversees
two
of
the
waivers
Department
of
Aging
and
independent
living
undersea
oversees,
the
other
waiver
that
creates
some
problems
as
far
as
regulations.
B
So
that's
I,
don't
think
that's
very
efficient,
but
I'm
sure
there
were
reasons
they
they
did
that
in
the
past.
So
that's
that's
a
struggle
employment.
We
we
don't
have
enough
we're
an
employment
first
state
too.
We
codified
that
a
couple
years
ago
bill
actually
had
the
honor
of
carrying,
but
we
don't
have
enough
providers
in
that
area.
So
even
in
my
organization,
I
had
to
close
that
program
down
temporarily
because
of
Staffing
we're
getting
ready
to
to
relaunch
it.
B
The
most
important
thing
we
do
and
that's
the
pro
program
we
struggle
with
the
most
it
in
the
13
years
that
I've
been
in
my
organization.
We
have
broke
even
or
maybe
made
just
a
little
bit
two
out
of
13
years.
We
always
lose
money,
we
don't
invest
properly
in
in
services,
but
I
think
as
a
state.
We
have
the
same
goal.
B
We
you
know
we
have
the
adult
day:
training
programs,
we
have
an
adult
day,
Health
Care,
the
community
living
supports,
is
really
growing
and
that's
about
being
out
in
the
in
the
in
the
community,
and
so
there
is
more
of
an
effort
to
get
those
folks
that
are
more
higher
functioning
out
in
the
community
and
then
our
adult
day.
Health
cares.
You
know
more
focusing
on
the
mill
the
medical
care
that
more
severe
disabilities
that
some
of
those
folks
need.
So
that's
kind
of
the
way
we're
structured.
B
We
have
a
strong
family
home
provider,
adult
foster
care
program
in
the
state,
but
I
like
what
you
all
are
doing,
where
the
goal
from
the
beginning
is
Independence
as
much
as
possible,
not
just
understanding
that
you're
going
to
be
where
you
are
forever
and
it
gives
it
gives
family
something
to
hope
for
and
and
so
I
like
the
way
you
are
doing
that
I'm
gonna
have
to
make
a
trip
to
Tennessee,
because
there's
there's
just
so
much
that
I
want
to
try
to
get
straight
in
my
mind
and
compare
on
how
we're
doing
things
and
and
what
we
could
look
at
differently.
E
Thank
you
Mr
chair
and
thank
you
all
for
your
presentation
been
very
insightful
and
I,
particularly
like
the
flexibility
of
the
program.
I
like
that
you've
built
a
semiatric
relationship
with
your
providers.
That's
so
important,
I
think
that's!
What's
missing
so
much
from
the
Medicaid
programs
to
Senator
Carol's
concern
about
the
mco's
managing
the
programs.
E
Senator
Kerry,
you
know,
I'm
a
numbers
guy
in
population
Tennessee
is
about
7
million
I,
believe
our
population
is
4.3
million,
but
they
have
1.7
million
Medicaid
recipients.
We
also
have
1.7
Medicaid
recipients,
but
they
have
three
mcos.
We
have
six,
so
it
looks
like
RM.
Sales
would
have
the
capacity
to
manage
the
program.
If
you
want
to
go
that
direction,
obviously
I'm
being
facetious,
because
I
wouldn't
want
that
either,
but
just
an
Apple's
Apple
comparison,
but
not
a
question
for
these
guys.
But
for
you
Mr
chair,
is
we
really
don't
have
good
information?
E
You
know
under
this
model
it
looks
like
we
know
how
many
people
on
the
waiting
list.
We
think,
but
we
really
don't
know
the
needs
of
each
of
those
individuals
on
the
waiting
list.
So
we
need
some
type
of
equivalency
scale,
wouldn't
that
be
fair
and
I.
Think
we
get
a
much
better
handle
on
this.
But
do
we
have
any
information
like
that?
That
would
stratified
that,
for
you.
B
Know
we
really
don't
and
that's
that's
part
of
the
problem
with
all
the
children
that
we
have
on
the
way.
Our
waivers
are
the
Michelle
P
waiver
and
it
comes
with
a
certain
list
of
services.
The
scl
supports
Community
Living
waiver
and
it
comes
with
a
residential
component
and
then
the
home
and
community
base,
which
is
more
a
medical
based.
E
B
Those
are
the
three
primary
for
the
population
in
the
the
brain
injury
waiver.
Also,
so
we
we
don't
have
a
grasp
and
I
think
it's
somewhere
around
five
to
seven
thousand
kids
that
that
are
on
the
waiver
and
I
I
told
you
all
that
the
cabinet's
looking
at
the
possibility
of
separating
the
kids
and
in
in
you
know
having
more
flexibility
in
the
services
that
would
be
allocated
to
the
kids
and
so
I
think
that's
a
good
step.
B
If
we
could
get
that
moving,
but
but
Mr
chairman
I,
think
you're,
absolutely
correct.
We've
got
to
know
what
we're
facing
to
to
address
it
and
we
we
honestly
don't
and
I
think
that
really
does
need
to
be
the
first
step.
B
H
G
Mr,
chairman
can
I
add
something
that
I
think
is
important,
especially
knowing
now
what
I
know
the
passion
of
this
committee
too
is.
We
have
also
been
very
intentional
in
trying
to
figure
out.
How
can
we
invest?
Eight
dollars
quicker
and
the
reason
being
is
I
think
everybody
on
this
committee
would
agree
and
I'm
making
a
fairly,
hopefully
nonpartisan
statement
here.
G
Cms
takes
some
time
to
work
with
the
State
dollars
have
given
us
some
immense
flexibility
in
immediately
getting
to
meet
the
needs
so
to
Senator
mayor
this
question
about
we
don't
even
know
where
they
are,
what
the
need
might
look
like.
It
has
allowed
us
to
pursue
that
quicker
because
with
federal
dollars,
obviously,
there's
red
tape
and
strings
that
are
attached
to
it.
G
So
we
were
able
to
take
some
of
those
federal
dollars
in
the
State
dollars,
combined
into
that
diversion
program
and
immediately
start
going
into
an
enrollment
phase
where
we
started
ramping
up
pretty
quickly
because
some
of
those
State
dollars
were
attached
to
that
would
allow
us
to
start
using
them
quicker.
So
I
don't
know
the
flexibility
or
the
budget
ramifications
in
the
state
of
Tennessee
to
create
conversations
around.
What
can
we
do
with
State
dollars?
Our
family
support
program
is
fully
funded
by
State
dollars
and
is
our
longest
running
program.
G
That's
been
around
25
28
years,
All
State
dollars
that
families
can
immediately
have
access
to
in
all
95
of
our
counties.
So
I
want
to
make
sure
to
encourage
the
committee
in
in
your
due
diligence
to
consider
the
state,
investment
and
programs
that
State
dollars
invest
in,
because
that
has
given
us
enormous
flexibility
that
we
would
not
have
been
able
to
enjoy
if
we
relied
solely
on
federal
dollars
because
of
some
of
the
strings
that
are
attached
to
that
and
the
timeline
it
takes
for
them
to
approve.
B
B
But
how
can
we
prepare
a
plan
when
we
don't
know
what
we're
preparing
for
so
I
think
we
need
to
have
some
deeper
discussions
into
that
to
really
ascertain
what
is
the
population
and
you
know
what
are
our
needs
as
we
move
forward
Mr.
K
G
Seconds
real,
quick
on
that.
One
of
the
things
you
might
want
to
think
about
is
working
with
your
Department
of
Education,
around
IEPs
and
certain
things
that
they
do
inside
the
school
district.
Not
all
IEPs
are
the
same.
You've
got
them
for
gifted
children
as
well,
but
that
may
give
you
a
baseline
from
the
jump
around
some
of
the
conversations
you
might
need
to
have
to
your
point.
G
E
I
think
it
makes
it
much
more
manageable.
For
us,
we
can
kind
of
wrap
our
arms
around
it.
Rather
than
just
saying,
we've
got
five
six
thousand
children
on
the
program.
I
think
it
would
help
us
from
a
Workforce
Development
need
to
appreciate
that
you
all
have
a
strong
Network
in
Kentucky
and
I.
Think
that's
what
we
want,
but
we're
going
to
have
to
do
some
significant
Workforce
Development
to
accomplish
this,
but
almost
in
every
profession
we
need
to
focus
on
Workforce
Development.
So
yes,
sir,
and.
B
That
might
require
a
change
in
structure,
because
we
have
you
know
through
through
the
waiver,
you
can
get
Employment
Services
like
with
Michelle
P.
You
get
40
hours
a
week
and
you
can
use
that
in
in
CLS
or
you
can
use
it
in
a
day
program
or
employment.
So,
and
then
you
know
after
before
you
get
to
that.
Then
OVR
handles
the
the
programs
within
the
school
and
the
kids
coming
out
of
the
school,
and
then
they
move
on
and
some
adults
are
serviced
through
OVR,
some
through
waiver.
B
So
it's
really
kind
of
a
separation
there,
and
that
might
be
something
that
we
need
to
look
at.
If
that's
going
to
be
our
Focus,
that
it
needs
to
be
more
streamlined
and
more
consistent
from
school
on
through
adulthood
and
and
who's
addressing
these
issues,
because
it's
kind
of
fragmented
I
think
the
way
it
is-
and
you
know,
and
one
final
thing
I
want
to
say:
we
just
recently
discovered
we
when
someone
passes
away.
That's
on
the
waiver.
We've
been
waiting
to
the
next
the
next
year
to
fill
that
slide.
B
We
just
realized
recently
that
we
can
do
it
immediately
and
you
know
the
cabinet's
taking
some
steps
to
do
that.
But
that's
you
know
we
we've
been
approving
100,
maybe
150
slots
a
year
and
that's
it
we're
not
making
any
impact
at
all
and
that's
and
I
think
that's
the
frustration
that
you
hear
from
this
committee
is
those
numbers
keep
growing
and
we're
not
getting
anywhere
and
and
I.
B
C
B
B
We're
we're
failing
our
folks
here
in
Kentucky
in
the
disability,
community
and
we've
got
to
do
better
and
that
desire
is
is
obviously
within
this
legislature
and
and
we
want
to
move
forward
quickly.
I
think
we're
tired
of
talking
about
it
and
we
want
to
do
it.
B
Okay,
the
next
item
on
the
agenda
is
has
to
do
with
Health
Care
Services
payment
rates
and
and
more
specifically
talking
about
Autism
Services
ABA
Services
Bart.
You
want
to
come
up
with
your
folks
and
if
you
all
would
please
introduce
yourselves
for
the
record
and
you
will
have
the
floor
and
I.
Think
Molly
is
here:
Jeremy
you're
on
Zoom,
correct.
M
You
chairman,
Carol
coach
here
heaven
and
members
of
the
committee,
so
that
was
a
great
precursor
to
our
discussion.
Talking
about
Network
adequacy,
preparation
and
partnership
with
your
providers.
We're
here
to
talk
about
about
that
and
a
narrow
focus
of
ABA
providers
applied.
Behavior
analysis
is
the
is
what
ABA
stands
for
so
and
that's
a
treatment
modality
that
is
very
closely
associated
with
with
folks
with
autism,
and
specifically
young
children
with
autism
you'll
hear
more
about
that.
M
So
you
hear
a
lot
about
it
in
terms
of
young
children
with
autism
and
we'll
focus
on
that
and
that's
kind
of
a
great
need,
but
but
just
note
that
it
is
a
effective
treatment
across
the
lifespan
for
folks
with
multiple
diagnosis
and
in
Kentucky,
we
do
pay
for
and
as
a
Medicaid
provider
pay
for
that
across
the
lifespan
and
acros
diagnosis,
which
is
unique
to
Kentucky,
which
is
a
good
thing
about
our
Kentucky
system,
which
other
states
don't
have
that's
more
narrowly
focused.
M
B
Sure
but
we've
got
to
be
out
of
here
at
three
yeah:
it
is
20
after
and
there's
one
more
presenter,
so
I'm.
L
B
To
split
the
time
you've
got
about
15-20
minutes,
sure.
M
Sure
so
I'm
going
to
be
run
through
it.
Just
to
give
you
a
little
bit
of
background
and
then
Molly
has
some
comments
for
you
that
you
really
want
to
hear
from
her,
and
certainly
the
issues
that
we
heard
about
before
is
I
mean
ABA
is
really
focused
on
maximizing
Independence
and
getting
early
interventions,
so
everything
you
heard
before
is
very
consistent
and
then
we
have
Jeremy
online.
That's
going
to
speak
from
a
parent
perspective,
so
I'll
jump
right
in
you
know.
M
These
are
Medicaid
eligible
Services,
they're,
legally
required
to
be
eligible
and
accessible
to
folks
that
are
on
Medicaid.
You
know
and
folks
that
are
on
Medicaid
majority
of
them.
Able-Bodied
folks
are
working,
so
I
think
that's
one
of
the
things
I
want
to
point
out.
So
this
is
an
issue
of
getting
access
to
services
for
their
child
and
for
their
family,
so
they
can
maintain
their
participation
in
the
workforce.
M
So
just
real
briefly,
we
had
a
bill
House
Bill
159
in
the
2010
session.
That
was
our
first
autism
Insurance
mandate
that
I
worked
on.
It
required
commercial
insurance
companies
to
pay
for
services.
You
all
may
not
know
that
prior
to
that
point,
if
you
had
a
child
is
diagnosed
with
autism,
and
you
went
to
your
commercial
insurance
plan,
you
didn't
get,
there
was
no
coverage
for
you.
M
You
had
had
coverage,
you
paid
your
premiums,
you
didn't
have
that
so
Kentucky
was
the
17th
state
in
the
nation
to
approve
that
it
also
created
a
licensing
board
for
Behavior
Analysis.
So
we
have
a
licensing
board
since
it
was
set
up
in
2011
that
the
state
level
in
2012
I
should
have
mentioned
this
I'm
here
representing
ABA
Advocates,
which
is
a
coalition
of
those
ABA
providers
across
the
state.
We
created
that
in
2012.
M
in
2014
is
when
Kentucky,
as
you
all
may
recall,
expanded
medicaid
the
the
types
of
providers
that
could
become
a
Medicaid
provider
greatly
in
order
to
increase
access
to
Mental,
Health,
Services
and
services,
and
at
that
point,
is,
is
when
licensed.
Behavior
analysts
were
eligible
to
become
a
Medicaid
provider,
credentialed
Medicaid
provider
and
Bill
Medicaid
for
services.
So
prior
to
2014
that
didn't
exist.
M
M
In
2019
we
had
the
American
Medical
Association
published,
finalized
CPT
codes,
which
are
billing
codes
for
ABA,
so
prior
to
that
it
was
kind
of
a
square
peg
and
a
round
hole
trying
to
for
the
billing
perspective,
what
codes
to
Bill
and
since
then
they've
had
their
own
set
of
nationally
approved
billing
codes,
so
jump
into.
What
we
all
know
is,
most
recently
in
the
last
two
or
three
years,
are
significant
increase,
cost
in
the
labor
market
and
wages
to
recruit
and
retain
staff.
M
You
know
nearly
a
couple
years
worth
of
nearly
10
percent
inflation
and
stagnant
flat
rates,
reimbursement
rates,
so
that
has
led
to,
in
many
cases,
reduced
access
to
Services
for
Families
that
need
it
and
waiting
list
providers.
Creating
waiting
lists
and
I
want
to
be
really
clear
here,
since
we've
talked
so
much
the
last
hour
about
waiting
lists.
This
is
not
waiver
waiting
list
where
you
don't
know
whether
or
not
you're
eligible
for
the
service
or
not.
This
is
a
provider
of
ABA.
M
Someone
who
has
Medicaid,
who
has
a
diagnosis,
meets
medical
necessity,
goes
to
access
services
and
there's
not
availability.
So
it's
a
waiting
list,
but
it's
a
different
waiting
list.
So
these
folks
already
you
know
it
would
be
the
equivalent
of
the
assessment
we
talked
about
earlier
for
the
waivers
we
know
everybody
on
that
way.
Wedding
list
is
eligible
and
they're
not
actually
be
able
to
access
Services.
M
You
know
the
average
for
a
while
back.
We
did
a
study
within
the
membership.
It
was
about
nine
months
talking
to
my
peers,
folks,
that
are
with
me
here
today.
That's
a
low
number
of
how
long
they
have
folks
on
a
waiting
list
waiting
for
service
Services.
M
In
my
opinion,
for
these
these
services
that
folks
are
medically
eligible
for
is
a
is
not
meeting.
We
means
our
state's,
not
meeting
Network
adequacy,
it's
I
mean
I,
know
it's
a
that's
a
complicated
assessment
of
what
meets
network
adequacy,
but
to
me,
there's
no
clearer
picture
of
it
than
every
provider.
I
talk
to
has
a
waiting
list
so
clearly
our
network
is
not
adequate
and
it
goes
back
to
very
much
to
the
resources
and
the
revenue
that
the
reimbursement
rates
for
folks
to
recruit
and
retain
staff.
M
When
you
have
that
stagnant
level,
I
I
had
one
provider
say
it
to
me.
This
way
we
can't
participate
in
inflation.
We
go
by
a
gallon
of
milk.
We
go
by
our
Starbucks
Coffee,
whatever
we're
buying
today
a
car.
You
know
it's
a
lot
more
expensive
today
than
it
was
in
2019.,
it's
more
expensive
to
provide
these
services
today
than
it
was
in
2019,
but
the
reimbursement
is
the
same
name,
and
so
what
happens
is
you're
seeing
a
dwindling
of
the
access
for
folks
and
the
dwindling
of
providers.
M
So
this
is
something
that
you've
heard
from
me
on
in
terms
of
the
entire
mental
health
field
and
Behavioral
Health,
and
this
is
these
folks
bill
off
that
same
fee
schedule
that
you've
heard
from
from
lots
of
groups
on
in
terms
of
the
behavioral
health
outpatient
fee
schedule
that
we're
trying
to
get
increased.
So
so
it's
it's.
So
this
is
kind
of
a
subset
of
that.
So
it's
the
same
thing
I'm,
going
to
let
Molly
speak
real
quickly
and
come
back
for
a
solution
on
this
Molly's.
M
A
good
friend
of
mine,
I've,
known
her
for
years,
she's,
a
licensed,
behavior,
analyst
and
she's
also
got
a
background
in
teaching
and
training,
and
so
she'll
that
she'll
talk
about
and
so
I
wanted.
You
all
to
hear
from
her
in
terms
of
the
potential
the
the
real
negative
impact
of
a
waiting
list.
I
mean
this
is
not
awaiting
us
to
get
Taylor
Swift
tickets.
This
is
not
a
waiting
list.
You
know
to
get.
You
know,
services
that
you
just
want.
This
is
really
critical
for
families.
C
Thank
you
guys
for
having
me
I'm
a
board
certified
behavior
analyst
I'm,
a
licensed
Behavior
analysts
in
the
state
of
Kentucky
I've
been
working
in
the
field
of
ABA
for
23
years.
I
got
my
Master's
Degree
at
the
University
of
Nevada
Reno
and
then
moved
to
Kentucky
in
2012
to
teach
at
Spalding
University
and
later
at
the
University
of
Louisville
across
those
two
universities
myself
and
my
colleagues
produced
about
nearly
a
hundred
Behavior
analysts
and
I
just
want
to
quote
this.
The
demand
for
behavior
analysis
is
high.
C
According
to
a
published
report
by
the
behavior
analyst
certification
board,
there
were
334
job
postings
for
Behavior
analysts
in
2021
in
the
state
of
Kentucky
and
593,
and
20
2022,
representing
a
78
percent
increase
in
the
demand
for
Behavior
analysts.
It's
really
hard
for
organizations
to
recruit
and
maintain
providers
in
such
a
competitive
job
market.
I
know
some
of
our
former
students
are
still
in
Kentucky,
but
many
have
left.
The
state
and
I
know
they're
doing
great
work
wherever
they
are
I'm.
C
before
I
dive
into
more
of
my
testimony,
I
want
to
share
some
quick
facts
about
autism
and
applied
Behavior
Analysis
individuals
diagnosed
with
autism
spectrum
disorders,
often
experience
significant
challenges,
communicating
socializing
and
adapting
to
the
world
around
them.
There
is
a
widespread
support
among
numerous
scientific,
professional
and
governmental
organizations
for
the
use
of
ABA
to
treat
ASD,
including,
but
not
limited
to
the
American
Academy
of
Pediatrics
Association
for
Science
and
autism
Treatment
Centers
for
Disease
Control
and
the
U.S
Surgeon
General.
C
So
this
information
is
known
not
only
to
Scientific
and
Healthcare
communities,
but
also
to
parents
of
young
children
with
autism,
who
are
doing
the
very
difficult
work
of
getting
their
child
diagnosed
and
then
seeking
ABA
Services
only
to
provide
only
to
find
long
wait
lists
across
providers
and
while
their
child
sits
on
the
wait
list,
they
are
missing
out
on
the
opportunity
for
early
intervention.
We
know
that
ABA
therapy
is
most
effective
when
started
early.
Ideally
during
toddler
or
preschool
years,
early
ABA
intervention
focuses
on
teaching
children
how
to
learn
these
prerequisite.
C
Skills
allow
a
child
to
have
the
capacity
for
learning.
This
might
include
paying
attention
when
someone
talks
following
simple
instructions
and
imitating
others
Behavior.
Without
these
foundational
skills,
some
children
simply
do
not
have
the
capacity
to
learn
in
a
non-therapeutic
setting
like
school
or
during
typical
family
interactions.
C
Teaching
these
skills
may
take
thousands
of
learning
opportunities
delivered
individually,
and
this
is
what
ABA
is
uniquely
qualified
to
provide.
Schools
cannot
be
expected
to
do
this,
and
neither
can
parents
ABA,
creates
learning
plans
that
are
uniquely
tailored
to
each
child,
then
delivered
exactly
according
to
how
that
child
learns
and
monitored
to
ensure
progress
is
being
made
if
a
child
has
not
yet
learned
how
to
learn.
They
are
disadvantaged
when
compared
with
their
peers,
who
are
learning
so
many
things.
Just
by
going
through
life,
they
pay
attention
when
a
plane
flies
by.
C
They
listen
when
their
mom
tells
them
that
that's
that
thing
is
called
an
airplane,
and
now
they
have
a
new
word
and
potentially
even
a
new
interest.
Meanwhile,
their
autistic
peer
may
not
even
notice
the
plane
or
if
they
do
notice,
they
don't
know
how
to
tell
somebody
that
they're
interested
in
knowing
what
it
is
and
a
learning
opportunity
is
missed.
These
types
of
natural
learning
opportunities
happen
hundreds
of
times
each
day
with
neurotypical
children
leading
to
Rapid
and
exponential
learning
progress.
This
widens
the
gap
between
children
with
and
without
autism.
C
C
Also,
while
a
child
is
sitting
on
a
waiting
list,
their
challenging
Behavior
will
potentially
intensify
and
become
more
habitual.
We
say
that
behavior
is
communication.
Each
time
a
child
hurts
themselves
to
communicate
that
they
are
hungry.
This
pattern,
solidifies
think
of
tracks
in
a
ski
slope,
the
more
time
skiers
go
over
the
same
track,
the
deeper
it
gets
and
the
harder
it
becomes
to
try
a
different
path.
We
want
to
intervene
on
challenging
behavior
before
the
track
deepens
so
much
that
it
becomes
ingrained.
C
Trying,
A,
New
Path
on
a
slope
is
easier
and
fresh
snow.
Just
like
teaching
a
safe
way
to
communicate,
wants
and
needs
is
easier
in
early
childhood.
Aba
is
still
effective
when
that
child
is
older
and
the
behavior
is
more
ingrained,
but
it's
going
to
be
harder
and
probably
slower
to
encourage
a
new
Behavior,
which
means
that
the
older
child
will
need
more
therapeutic
time
away
from
school,
family
and
friends.
C
Also,
while
the
child
is
sitting
on
the
waiting
list,
the
whole
family
has
to
adjust
to
their
routines
to
accommodate
their
child.
With
autism,
sometimes
this
just
means
buying
Dino
shaped
Tyson
chicken
nuggets,
because
that's
the
only
thing
their
child
will
eat,
but
oftentimes.
It
means
teaching
the
other
children
in
the
family
how
to
keep
themselves
safe
during
their
siblings
meltdown.
C
C
We
know
that
parents
of
children
with
autism
experience
more
stress
than
parents
of
neurotypical
children
and
with
the
increased
prevalence
of
ASD.
These
parents
are
all
of
our
doctors,
they're
our
children's
teachers,
they're
the
pilots
who
fly
our
planes
parent
stress,
impacts.
All
of
us
early
intervention
allows
for
a
partnership
with
a
behavior
analyst
who
can
help
the
family
navigate
more
effective
ways
to
raise
their
child.
Thank
you.
M
So
real
quickly
before
we
were
here
from
Jeremy
I,
just
want
to
say
that
you
know
the
request
here
and
the
solution.
You
all
have
this
in
your
packet
you've
seen
this
you've
seen
a
version
of
this
about
bhso
rates.
It's
a
request
for
a
25
increase
in
those
rates
which
may
seem
large.
But
if
you,
if
you
calculate
the
cost
increase
in
cost
in
the
labor
market
as
well
as
inflation,
it
just
gets
us
back
to
a
reasonable
amount
to
be
able
to
recruit
and
retain
staff.
M
That
is
a
30
million
dollar
state
fund
which
brings
down
70
million
in
federal
dollars
to
increase
these
rates.
Now,
this
30
million
is
not
just
for
ABA.
This
is
the
entire
fee
schedule
that
includes
ABA,
as
well
as
other
outpatient,
Behavioral
Health
individual
therapy
group
therapy,
Psychiatric
Services
Etc.
So
that's
the
total
and
this
this
is
a
a
part
of
that
and
that's
not
to
say
that
other
providers
that
bill
off
other
fee
schedules
such
as
Community
Mental,
Health,
Centers
or
others.
They
need
this
an
increase
as
well.
M
That's
not
included
here,
but,
as
you
can
imagine,
this
Dynamic
of
increased
cost
and
flat
revenue
and
reduced
capacity
to
serve
the
needs
that,
as
needs
are
going
up,
is
consistent
across
many
provider.
Types
I
want
to
shift
real
quick
before
we
wrap
up
to
Jeremy.
Jeremy
Teague
is
on
zoomy,
couldn't
be
here
today,
but
he's
a
parent
of
a
child
with
autism
and
I.
Just
want
to
have
him.
Give
him
an
opportunity
to
make
a
few
statements
to
you.
Thanks.
K
Yeah
thanks
Bart,
thanks
to
the
committee
for
allowing
me
to
to
do
this
at
all,
and
especially
do
it
remotely
we're
dealing
with
a
bout
of
covet
here
in
our
our
household
I
had
intended
to
be
there
in
person,
but
thanks
for
letting
me
do
it
this
way,
I
know
we're
on
a
tight
timeline,
so
I
will
I'll
be
very
brief.
K
Did
just
wanted
to
throw
in
there.
I
did
find
the
waiver
wait
list
conversation
very
interesting
as
the
parent
of
a
child
who
has
been
on
the
Michelle
P
waiver,
wait
list
for
three
and
a
half
years
and
counting
now
so
glad
to
glad
to
hear
those
discussions.
So.
C
K
Excuse
me
so
anyway,
my
name
is
Jeremy.
Teague
I
live
over
in
Marshall
County
in
the
western
part
of
the
state.
I
am
an
engineer.
My
wife
is
a
Courtney.
Is
a
former
special
ed
teacher
in
public
schools
turned
stay-at-home
mom
and
we
have
a
nine-year-old.
His
name
is
Jax,
that's
j-a-x.
That
is
his
full
first
name,
who
is
on
the
autism
spectrum?
He
was
diagnosed
when
he
was
four
and
has
been
in
ABA
for
about
five
years
now
at
at
Bloom
behavior
in
Paducah.
K
So
I
just
wanted
to
very
briefly
cover
a
few
things
from
the
perspective
of
a
parent
who
has
who
has
been
through
this
and
has
seen
what
ABA
can
can
do
for
his
kid
he's
been
in
ABA
Jackson
been
in
ABA
for
about
five
years
now.
K
He
has
other
other
therapies
for
speech,
occupational
therapy
and
things
like
that.
Aba
is
our
definitely
our
number
one
priority
so
much
so
that
we
homeschool
him
so
that
he
can
go
to
Aba
during
the
day
instead
of
school
and
get
the
number
of
hours
that
he
needs,
because
we've.
G
K
What
it
has
done
for
him
since
he's
been
in
it
when
he
was
first
diagnosed.
You
know
we're
talking
about
these.
These
wait
lists
for
getting
into
Services
we
when
he
first
got
diagnosed.
You
know
we
did
a
lot
of
research
and,
as
as
Molly
mentioned,
you
know,
the
thing
you
see
come
up
everywhere
is
early
intervention
and
my
wife,
being
especially
a
teacher,
knows
that
all
too
well
and
dealing
with
with
kids
with
autism
and
other
disabilities
knows
that
as
well.
K
So
we
tried
immediately
trying
to
get
into
some
of
these
programs
and
ran
into
just
that
which
was
well.
You
know
we
got
a
wait
list,
we
got
a
wait
list
everywhere,
you
call-
and
it
was
so
important
for
us
as
parents,
to
get
into
this
I
actually
enrolled
into
a
master's
bcba
program
to
become
an
ABA
therapist
just
so
that
we
could
get
him
those
Services,
knowing
that
we
might
not
be
able
to
get
in
anywhere
at
any
time.
K
So
we
were,
we
were
that
dedicated
to
making
sure
that
it
happened,
because
it
really.
It
really
is
the
thing
for
a
kid
like
Jax
who,
where
he
sits
on
the
Spectrum
and
and
what
his
his
challenges
are.
This
is
it's
the
perfect
thing
for
him
and
Molly
touched
on
a
lot
of
those
during
her.
Her
talk
so
basically
again,
I'm
I
could
talk
about
this
all
day,
but
I
have
to
cut
out
sections
of
this
and
really
what
I?
What
I've
seen
my
wife
and
I
have
seen
with
this
child?
K
Is
we
had
we
had
a
kid
who
was
clearly
quite
intelligent,
but
it's
all
in
there,
but
he
can't
get
it
out.
So
we
watched
him
go
from
this
kind
of
introverted.
You
know,
I,
it
doesn't
interact.
A
lot
with
people
doesn't
really
engage
with
folks
with
peers.
To
now
he
is
I
mean
he's
kind
of
the
Class
Clown
of
of
his
of
his
group.
There
he's
very
you
know
this.
This
vibrant
happy
child.
D
K
No
problems
now
communicating
what
he
wants,
what
he
needs.
He
can.
You
know
he
can
talk
to
to
in
phrases
more
or
less,
but
his
communication
has
improved.
So
much
he's
been
able
to
improve
things
like
you
know,
even
stuff
like
fine
motor
skills
and
things
like
that
that
he
struggled
with
when
he
was
young
and
I
I
can
see.
K
Had
we
not
gotten
him
into
this
at
a
very
early
age,
we
would
definitely
not
be
where
we
are
today,
because
it's
it's
really
really
important
that
they
start
early
and
and
we've
seen
that
with
him.
So,
basically
for
me,
as
a
parent,
you
know
we
we
ultimately
as
parents.
We
want
our
kids
to
be
okay
when
we're
not
there
to
take
care
of
them
right.
So
that's
how
my
wife
and
I
kind
of
view.
K
This
is
what
do
we
need
to
do
to
make
sure
when
we're
not
there
that
he
can
take
care
of
himself
in
the
world,
and
so
ABA
is
an
excellent
program
to
help
those
kids
learn
the
things
they
need
to
learn,
not
just
the
not
just
the
communication
stuff,
but
the
social
skills,
and
things
like
that
too,
just
to
be
able
to
get
along
in
the
world
I
mean
some
of
you.
It
sounds
like
I'm,
not
alone,
being
a
parent
with
a
child
with
this,
but
in
the
room
there.
K
But
if
you
don't
know
the
challenges
are,
are
there
and
there's
a
lot
of
them
and
they're
things
you
wouldn't
think
of
normally,
unless
you've
actually
dealt
with
it
every
day
and
it
is,
it
is
pretty
difficult,
but
it's
really
tough.
As
a
parent
to
watch
this
sweet,
smart,
creative
kid
struggle
with
everything
every
day
and
sending
him
to
Aba.
We
know
that
that's
getting
better
every
single
day
and
there's
a
safety
aspect
of
this
too.
It's
not
just
being
able
to
get
along
into
the
world
I
mean
Jax.
K
Has
a
nice
bonus,
Behavior
called
elopement,
which
is
pretty
much.
What
it
sounds
like
and
that
is
he
will
run
with
no
regard
for
his
safety
and
he
loves
roads.
So
we've
had
some
interesting
close
calls
in
in
our
days
with
him,
but
they've
worked
on
that
with
him
as
well,
and
now
we
can
go
to
the
grocery
store
with
him
and
he'll
push
the
Carter
around
instead
of
trying
to
take
off
down
the
road
and
run
down
the
yellow
line,
so
anyway,
there's
a
whole
lot
to
it.
K
So
anyway,
our
whole
thing
as
parents
is
knowing
that
we're
doing
everything
we
can
every
day
to
make
sure
that
he'll
be
okay,
if
we're
for
some
reason
not
there
to
to
take
care
of
him
so
kind
of
to
wrap
it
up,
haven't
been
through
this,
knowing
how
poor
how
important
the
access
is,
how
important
the
services
without
delay-
just
you
know,
I
just
encourage
us
to
do
everything
we
can
to
make
sure
that
you
know
every
child
and
family
who
needs
it
is
able
to
access
it.
K
So
I
guess
that's
my
story.
If
anybody
has
questions
for
me
at
any
point,
I'm
happy
to
answer
them,
or
even
after
this
you
can
certainly
contact
me,
but
I
will
wrap
it
up
and
and
let
us
move
along
so.
B
N
I,
don't
know
why
you
didn't
put
Joy's
closet
up
front
but
but
I'll
yield
to
the
chair.
Thank
you,
chairman
I,
just
I
wanted
to
say,
I
completely
agree
and
I'm
thankful
that
Bart
there
is
there
to
talk
about
the
importance
of
that,
but
I
I
just
want
to
make
sure
that
all
of
us
legislators.
We
remember
that
all
of
these
Medicaid
reimbursement
rates
need
to
go
up
and
we
need
to
make
sure
we
we
have.
The
rates
reflect
what
the
obligations
of
those
organizations
are.
N
The
bhsos
are
valuable
and
their
rates
do
need
to
go
up,
but
the
cmhcs
that
serve
all
of
our
different
counties
around
the
state
from
one
end
to
the
other,
also
need
to
go
up
and
I'm
biased
to
cmhgs,
but
but
they
have
a
specific
Mission
and
a
few
statutory
obligations
as
as
a
safety
net
provider
and
they've
got
a
lot
of
extra
load
that
they've
got
to
haul
and
services
that
they
are
obligated
to
provide
that
no
one
else
can
provide
all
of
them
need
their
rates
improved
and
increased,
because
all
of
our
people
are
counting
on
it.
O
Thank
you,
chair
and
I'll,
be
just
as
brief.
Thank
you
very
much
for
your
testimony.
Mr
Teague,
thank
you
for
yours,
I'm
well,
versed
in
autism,
spectrum
disorder
and
the
challenges
of
of
all
of
it
and
I
have
just
two
thoughts
on
this:
one,
that
age
group
between
three
and
seven
three
and
eight
it's
most
effective
and
so
combining
ABA
with
OT.
You
get
far
more
bang
for
your
buck.
O
If
you
will,
from
the
kids
perspective
during
that
time
than
you
do
after
and
so
prioritizing
that
time
I
think
is
one
important,
but
then
two
it's
not
just
a
rate
problem.
It's
a
Time
issue,
ABA
Works
several
hours
every
day
consistently.
That
is
not
something
that
most
people
can
just
drop.
It
is
an
intensive
investment
on
behalf
of
that
parent
to
make
it
happen
and
for
somebody
to
provide
that
service.
So
it's
not
just
in
my
opinion
to
be
curious.
It's
not
just
a
financial
thing.
O
It's
also
how
many
people
are
going
to
do
this
long
term
and
how
many
people
can
actually
do
and
provide
their
kid.
That
accessibility
in
general
I
mean
his
wife
is
a
state
at
home.
I
get
it
I
mean
I
I
know
families
have
done
that
and
are
making
light
decisions,
not
not
because
of
it
financially,
because
they
have
to
have
the
amount
of
time
and
dedication
to
make
it
work.
L
M
Obviously
we're
here
to
talk
about
the
financials
end
of
it
and
make
that
request,
but
but
we
hear
you
and
there's
no
question
that
it
is
a
commitment
and
it
is
different
than
many
other
services
in
terms
of
that
time.
Commitment
and
and
work
with
the
families
I
mean
I'm.
You
know,
Molly
can
certainly
speak
to
that
better
than
I
can.
But
this
isn't
like
this
is
the
only
issue
that's
going
to
solve
all
the
problems.
M
E
Thank
you,
Mr,
chair
and
I
just
want
to
make
the
comment.
I
think
it's
kind
of
very
ironic
that
the
fiscal
ask
here
is
30
million
very
close
to
the
projected
savings
from
Senate
bill.
50.,
it's
going
to
be
used
for
the
services
and
Central
Westfield's
correct
we're
going
to
hear
this
from
everyone
and
I
think
we've
got
to
establish
some
priorities
and
quite
truthfully,
I'd
rather
see
those
priorities
be
with
our
children.
E
B
I
like
that
idea,
there
is
a
complete
other
side
of
this
that
I
wanted
to
get
into,
and
that's
the
private
insurers,
the
the
Kentucky
Association
of
Health
Plans
declined
to
testify.
But
there
is
a
representative
here
to
answer
questions
we're
not
going
to
have
time
for
that
and
I
do
want
to
mention
that
I
asked
the
Department
of
Insurance
to
come
in
and
they
declined
to
come
in,
which
is
very
disappointing.
B
That
a
state
agency
refused
to
come
and
testify
before
this
committee,
but
there's
a
whole
other
issue
with
private
insurance
and
and
I
I
say
this
because
I'm
going
through
this
process
with
my
organization,
we
just
opened
up
a
center.
We've
got
four
kids
right
now
about
eight
or
nine
staff
trying
to
negotiate
private
insurance
rates
is
an
absolute
nightmare.
We
thought
Medicaid
and
mcos
was
bad.
Some
of
the
some
of
the
private
insurers
want
to
pay
less
than
Medicaid
rates
for
certain
codes
in
this
Commonwealth.
B
So,
just
just
to
throw
that
out
there
most
centers
are
having
to
be
careful
to
balance
out
the
number
of
Medicaid
kids
with
the
number
of
private
insurance
to
be
able
to
make
sure
that
they
can
sustain
their
services
and
I'm
still
learning
a
lot
about
this
I
know
nothing
yet,
but
it's
been,
it's
been
an
experience
getting
the
center
together
and
get
any
opening,
and
in
Paducah,
where
Bloom
is
there's
another
organization,
that's
started
providing
ABA
and
then
there
was
another.
They
lasted
just
a
very
short
time
and
they
closed
their
program
down.
B
We
have
95
kids
on
our
waiting
list,
we'll
be
able
to
serve
maybe
30
35
of
those
keep
in
mind,
it's
one
to
one
so
for
every
kid
there's
a
staff
member
in
one
in
every
36
or
every
37
kids
right
now
is
diagnosed
with
autism
on
the
Spectrum.
So
that's
what
we're
facing
Bart!
Thank
you
all
so
much
for
being
here
for
the
testimony
Jeremy.
Thank
you.
We're
going
to
have
to
hurry.
You
all
have
in
your
packets,
the
dcbs
half
year
block
grant.
B
Please
review
that
when
you
get
a
chance,
we
are
not
going
to
hear
from
the
cabinet
today.
We
may
call
them
back
at
a
different
time,
but
know
that
that's
there
and
I
would
ask
that
you
please
review
it.
The
final
presentation
is
from
Joy's
closet.
This
is
a
program
that
I
learned
about
down
in
the
Hopkinsville
area.
B
Had
the
pleasure
of
meeting
with
these
folks
and
it's
pretty
impressive
program
that
has
to
do
with
foster
care,
support,
services
and
I
hope
members
can
stay
like
maybe
five
minutes
to
give
these
folks
20
25
minutes.
Please
and
I'm.
Sorry
I
do
this
every
meeting,
but
this
is
just
good
stuff
and
I
like
to
get
my
money's
worth
when
I
drive
from
Marshall
County.
Ladies,
please
introduce
yourselves
for
the
record
and
you
have
the
floor.
P
P
I
apologize,
it
always
says
Senate,
because
it's
a
joint
committee,
so
my
name
is
heather
gray,
I'm,
the
founder
and
executive
director
of
Joy
closet,
and
this
is
Tracy
Wells,
our
assistant
director
and
then
also
online.
We
have
Melinda
shamansky,
who
is
our
programs
director
and
also
formerly,
was
with
the
cabinet
herself.
So
if
I
get
this
done,
we
currently
serve
and
go
above
and
beyond
for
nine
counties.
These
are
the
nine
counties
here.
Q
Sorry
these
are
the
counties
that
we
go
above
and
beyond
for,
but
we
will
serve
anybody
that
is
willing
to
to
come
to
us.
So
in
just
the
two
years
that
we've
been
open,
we've
served
over
600
children
and
about
220
families.
P
These
are
the
current
statistics
that
are
released
in
the
Dr
report
each
month.
It
is
one
month
behind
so,
as
you
can
see,
there's
approximately
375
children
and
not
near
that
many
families
and
Christian
County
alone,
which
is
where
our
foster
closet
resides.
There
are
130
children
and
only
about
50
families.
P
These
statistics
also
do
not
include
those
families
that
fall
under
kinship
care
with
custody
or
guardianship
of
a
non-birth
child
of
their
own.
We
also
serve
those
families
and
go
above
and
beyond
for
those
in
those
non-counties
and
then
also
serve
those
outside
of
the
nine
counties
so
kind
of
what
is
a
foster
closet
I'm
going
to
play
this
video
if
it'll
work,
hopefully
the
sound's
not
on
right,
then
Maybe,
okay,
I
can't
see
the.
P
P
This
is
currently
7
500
square
feet
that
we
go
above
and
beyond
for
these
children
we
give
a
hand
up
instead
of
hand
out
when
they
come
to
us.
We
want
to
make
sure
that
they
feel
special,
valued
and
loved
and
through
everything
that
we
do
for
them,
we
make
sure
that
they
have
everything
that
they
need
for
ages,
0
to
17
years
old
I
personally
have
fostered
actually
in
the
state
of
Tennessee.
P
So
that
was
a
great
welcoming
experience
to
hear
them
earlier,
but
during
my
experience
as
a
foster
parent
I
received
that
child
that
literally
the
shoes
on
her
feet
were
two
sizes
too
small,
and
we
had
to
go
to
multiple
locations.
Multiple
stores
purchase
out
of
pocket,
because
there
is
money
for
clothing
for
a
voucher.
P
However,
that
takes
months
to
get
so
we
had
to
go
to
multiple
locations
and
get
all
the
items
that
she
needed
so
that
she
can
not
only
fit
in
with
her
new
sisters
at
our
house,
but
she
could
also
fit
in
with
her
peers
at
school,
so
a
foster
closet
eliminates
that
need
to
go
to
multiple
stores.
It
also
eliminates
the
need
to
spend
money
out
of
your
own
pocket.
P
Not
only
do
we
have
clothes
and
shoes
and
toys
and
all
the
items
that
you
need,
but
we
also
have
a
community
partner
that
provides
beds
to
all
of
our
families
in
the
non-counties
that
we
serve
if
they
need
one
as
well
as
long
as
they're
part
of
our
program.
We
expanded
to
children
in
crisis
about
a
year
ago
now,
so
we
also
have
Partnerships
within
our
communities
that
we
serve,
that
they
can
refer
an
individual
or
a
child
to
us
as
long
as
they
are
not
able
to
meet
the
need
there.
P
So,
like
Salvation,
Army
Sanctuary
house
our
school
system,
if
the
Family
Resource
Center
is
not
able
to
provide
services,
then
we
do
that
as
well.
Outside
of
that,
we
also
provide
events
all
throughout
the
year.
So,
if
you
think
about
it,
taking
a
family
of
five
to
a
movie,
theater
is
going
to
be
pretty
expensive
on
a
cheap
movie
day.
You
might
get
ten
dollars
a
ticket,
so
that's
50
bucks
right
there
and
then,
if
you
think
about
adding
in
popcorn
and
drinks
and
things
like
that,
that's
going
to
get
pretty
costly.
P
Q
I'm,
actually
a
foster
parent
myself
and
we,
my
husband
and
I,
got
our
first
placement
in
January
of
this
year.
It
was
a
newborn,
so
when
I
was
called
for,
the
newborn
I
got
a
call
that
morning
I
went
to
the
closet
straight
after
the
call
and
I
was
able
to
grab
everything
I
needed
I.
Q
We
do
have
children
of
our
own,
but
it's
been
about
12
years
since
I've
had
a
newborn,
so
I
was
able
to
go
and
grab
everything
off
the
shelves
right
there
that
I
needed
from
bassinet
to
formula
to
close
to
to
everything,
and
then
I
picked
up
the
baby
that
afternoon
so
I
definitely
know
how
needed
the
resource
is
to
be
able
to
go.
I
didn't
spend
you
know,
I
didn't
have
to
spend
any
of
my
own
money.
Q
I
didn't
have
to
spend
a
lot
of
time
because
it
was
one
stop
went
there,
got
everything
I
needed
and
then
I
was
ready.
Car
seat
feet
and
I
was
ready
to
go
pick
up
the
baby.
So
it
is
such
a
huge
need,
and
in
every
Community
where
we
have,
you
know,
foster
children,
which
is
every
community.
So
we
just
see
a
need
for
satellite
closets
everywhere
and
we're
super
excited
that
we
already
have
our
first
satellite
closet,
getting
ready
to
Launch
soon
in
Trigg
County.
P
I
Introduce
yourself
please
I'm,
Melinda
shamanski,
thank
you
for
allowing
me
to
to
join
on
Zoom
as
well.
I
would
have
liked
to
be
there
in
person,
but
for
health
reasons,
I
just
can't
at
this
time.
As
Heather
said,
I
was
worked
for
the
cabinet
for
29
years.
I
I
I
cannot
express
how
much
joy
closet
has
impacted
all
the
foster
parents
in
our
region,
as
Tracy
said
they
can
come
to
the
closet
and
get
everything
that
they
need
in
one
stop,
rather
than
scrambling
and
going
to
separate
stores
to
get
the
items
that
they
need,
and
rather
than
spending
the
time
having
to
go,
get
those
items
they're
able
to
spend
time
with
that
child.
Getting
them
settled
in
getting
to
know
them
and
just
making
that
child
feel
feel
at
home.
I
It
ranges
from
a
hundred
dollars
for
an
infant
to
290
dollars
for
a
teen,
and
if
any
of
you
have
children,
you
know
that
does
not
buy
a
whole
lot.
That
does
not
include
bedding
cribs
car
seats,
personal
hygiene
items,
all
the
things
that
those
children
need,
so
Joy
closet
has
been
a
huge
asset
to
the
communities
that
we
serve
and
I
have
had
first
hand.
P
I
I
We
have
a
really
hard
time
with
placing
teens
in
foster
care,
because
we
don't
have
enough
foster
homes
that
will
take
them,
so
oftentimes
they're
placed
in
facilities
or
residential
centers
and
when
they
leave
foster
care,
they
do
not
have
a
positive
role
model
or
a
support
system.
So,
through
this
Mentor
program,
we're
able
to
provide
those
support
systems
for
them
in
Kentucky
over
500
teens
aged
out
of
foster
care
each
year
without
Sable
ties
or
caring,
adults
teens
with
no
connections
are
at
a
higher
risk
of
poverty.
I
Pregnancy,
incarceration,
prostitution,
substance
abuse
and
unemployment,
71
percent
of
females
who
age
out
of
foster
care,
will
be
pregnant
by
the
age
of
21.
81
percent
of
males
who
age
out
of
foster
care
will
end
up
in
the
Justice
Center
and
60
percent
of
young
adults
who
age
out
of
foster
care
experience,
homelessness.
Those
are
huge
numbers.
I
I
Roles
of
non-familial
adults
in
the
lives
of
at-risk
children
have
been
shown
to
be
beneficial
in
increasing
resiliency
and
success,
and
statistics
show
that
youth
and
mentoring
programs
have
been
recorded
to
have
increasing
self-esteem
ability
to
maintain
positive
relations
with
other
adults
and
decisions,
making
ability
and
career
choice
processes.
I
R
S
Am
so
I
didn't
really
grow
up
with,
like
a
lot
of
support
around
me,
so
I
feel
like
it
was
a
good
opportunity
for
me
to
have
like
an
extra
support
system
and
like
any
time
that
I
like
needed
anything
I
to
like
constantly
blow
up
my
social
worker's
phone
or
anything
like
that.
Just
have
like
more
support
than
I
did.
R
S
S
S
P
P
I
love,
okay:
how
do
I
go
to
the
next
slide?
There?
We
go
sorry
anyway,
I
apologize
for
the
lag.
If
you
would
like
to
see
that
and
there's
also
that
one
on
our
website,
alongside
of
another
mentor
and
mentee
pair
as
well,
that
you
can
check
out
and
so
that
program
has
officially
launched
and
has
been
successful
since
January,
and
we
also
have
two
other
Visions.
One
is
a
Hope
House,
as
you
all
may
be
aware
of,
there's
a
huge
need
for
children
to
have
a
place
to
go
until
placement
has
been
found.
P
If
you
can
imagine
on
the
worst
day
of
your
life,
I'm
sure
that
you
probably
would
not
appreciate
to
have
to
sleep
in
any
of
those
locations,
so
we
are
working
diligent
diligently
to
establish
the
Hope
House
if
you've
ever
heard
of
the
Isaiah
117
houses
that
were
established
in
Tennessee.
Originally,
how
ironic,
then?
P
It's
the
same
exact
model,
we're
just
changing
the
name
of
it,
so
that
we
weren't
not
we're
not
under
their
umbrella,
and
we
could
have
it
under
the
joy
closet
umbrella
because
we've
obviously
established
a
huge
presence
in
our
communities,
and
so
this
will
be
for
removal
day
when
the
child
is
removed.
They'll
go
directly
to
the
house,
they'll
never
go
to
the
office,
they'll
never
go
to
the
state
parks
and
they'll
never
go
to
the
local
hotels.
P
The
workers
will
stay
with
them
as
they
off
have
to
do
as
or
already
the
worker
stays
with
them.
A
security
guard
stays
with
them
as
well
as
a
sitter,
so
those
will
remain
in
place,
but
we
will
have
volunteers,
including
peers
of
their
their
own
ages.
That
will
come
and
entertain
them
and
play
with
them
and
try
to
take
the
load
off
from
the
day.
So
this
will
be
a
full
functioning
house.
There
will
be
nobody
that
resides
there.
P
If
placement
takes
a
long
while
to
find
such
as
the
young
girl
13
year
old
girl
back
in
May,
that
they
were
having
a
hard
time
finding
a
placement
for
so
she
slept
between
the
dcbs
office
floor,
the
local
state
parks
and
the
local
hotels
for
just
shy
of
four
weeks.
If
you
can
imagine
four
weeks
so
clearly,
she
needed
a
place
to
go
until
they
could
find
a
placement
The
Hope
House
would
provide
that.
So
there's
no
determination
of
how
long
they
can
stay
it's
just
until
placement
is
found.
P
We
also
have
the
safe
house-
and
currently
these
are
the
statistics
from
school
year
before
last.
However,
they
haven't
really
changed
if
you
can
see,
there's
approximately
350
homeless
students
within
this
school
year,
133
of
them
were
from
Christian
County,
which
is
where
Joy
closet
is
located,
and
so
we
are
working
on
establishing
a
safe
house,
a
location
for
these
children,
teenagers
to
go
to
that
they
can
stay
the
night
at
until
Services
can
be
put
into
place.
We
do
not
have
a
number
of
days
that
they
can
stay
there.
P
P
What
a
family
could
look
like
to
help
them
break
generational
cycles
and
curses.
So
that
is
our
other
Vision.
This
is,
we
do
have
a
location
we're
working
on
for
this
vision,
we're
working
on
getting
some
last
final
details
before
we
release
the
location,
but
at
Max
Capacity
it
will
be
able
to
house
109
children
and
teenagers
that
are
in
crisis
or
homelessness
so
kind
of.
How
can
you
all
help
there's
a
need
for
sharing
the
support?
P
P
You
are
not
aware,
and
that's
what
we
have
found
in
the
non-counties
that
we
serve
as
well
until
Joy
calls
it
came
and
shared
the
reason
of
why
we're
doing
what
we're
doing
they
were
unaware,
but
now
that
they
are
aware,
we
have
grown
exponentially,
we're
already
up
to
seven
employees
at
just
two
years
of
being
in
operation
that
are
paid
on
salary
staff.
One
of
those
came
on
staff
at
five
months
in
operation.
P
P
Every
Community,
as
trustee
said,
needs
a
foster
closet,
a
place
that
can
be
supportive
of
the
Foster
and
kinship
families
and
children
that
are
in
the
cabinet's
custody
and
in
custody
or
guardianship
of
a
non-birth
child
as
well
or
both
birth
parent
as
well.
We
also
need
help
establishing
connections
and
partnership
within
the
late,
the
within
the
state
and
local
area,
so
I
feel,
like
this
committee,
can
also
help
with
that
as
well.
P
So
this
is
the
where
we're
located
at
any
point.
If
you're
in
the
area,
we
would
love
to
give
you
a
tour
of
our
facility
as
representative
Petrie
and
Dawson
and
Thomas,
and
also
Senator
Westerfield,
can
tell
you
you
cannot
really
grasp
it
until
you
actually
see
it
with
your
own
eyes
to
see
how
much
God
has
expanded
and
expanded
and
expanded
again.
What
was
supposed
to
be
just
us
volunteering
a
couple
days
a
week
to
give
back
to
the
Foster
community,
has
now
turned
into
our
full-time
passion.
P
They
can
actually
come
as
often
as
they
need
us.
We
do
not
have
set
limits
on
the
number
of
times
they
can
come
and
Shop.
We
do
have
set
limits
on
the
number
of
times
they
can
get
socks,
underwear,
shoes
and
coats
just
because
those
are
the
socks
and
underwear
are
brand
new,
and
so
we
had
a
few
taking
advantage
of
that.
So
that's
every
three
months,
which
is
still
pretty
generous.
Thank
you.
Thank
you.
J
Very
quickly,
how
can
you
explain
your
funding
model
and
what
is
your?
Are
you
all
a
non-profit?
How
does
that
work?
We.
P
J
B
N
Chairman
thanks
so
much
for
having
Joy
closet
on
I'm,
so
thankful
for
for
the
team
there
Heather
and
her
staff
for
the
work
that
they're
doing
and
what
she
just
said
there
at
the
very
end
is
what's
so
important.
There
was
clearly
a
need
and
clearly
a
gap
there
and
joy.
Closet
has
filled
that
and
continues
to
fill,
that
space
and
I
assume
that
that
same
need
exists
in
every
other
community,
around
Kentucky
and
so
I.
N
B
Committee
members,
there
are
two
proposed
regular
regulations
in
your
packet.
Are
there
any
questions
on
those
it?
Someone
from
the
cabinet
could
please
come
up.
I've
got
a
question
on
zero
zero.
Two
180-
and
this
is
a
requirements
for
registered
relative
child
care
providers
in
the
child
care
assistance
program.
B
And
and
just
quickly,
I
want
I
just
want
to
understand
this
how
this
works.
So
my
understanding
is
that
if
there
is
a
relative
that
is
caring
for
a
child,
there
is
a
way
for
that
relative
to
apply
for
child
care
assistance,
and
you
all
don't
have
to
get
any
great
detail.
That's.
F
Correct:
okay!
Yes,
it
is
it's
only
it's
a
small
number
that
currently
do,
but
if
they
would
like
to
it
is
a
possibility.
Okay,
I.
F
If
it's
needed
for
federal
compliance,
we
had
Federal
monitoring
review
a
year
or
two
ago.
That
said,
we
needed
to
make
a
number
of
changes
that
have
been
in
in
process
in
this
administrative
regulation.
We
are
specifying
that
registered
providers
need
to
be
related
to
the
child
and
there's
specifications
on
what
that
has
to
be,
and,
for
example,
if
it's
a
sibling,
they
have
to
be
living
outside
of
the
house
of
the
child.
Things
like
that,
but
because
they
are
a
relative,
we're
able
to
decrease
some
of
the
non-safety
requirements.
B
B
We,
if
they're
on
our
own,
are
no
other
questions.
We
will
consider
this
reviewed
by
the
committee.
Our
next
meeting
will
be
on
Wednesday
October,
the
25th
at
1
pm
in
this
room,
and
we
will
stand
adjourned.
Thank
you
so
much
for
staying
this
afternoon
and
again
I
apologize.
We're
adjourned.