►
Description
Meeting start 00:00:00
Roll call 00:00:01
DPH Discussion, Dr. Connie White – 00:02:35
Legislator Questions & Comments – 00:31:18
DMS Discussion, Veronica Judy-Cecil – 00:44:08
Legislator Questions & Comments – 01:05:20
Review of Referred Administrative Regulations – 01:23:22
KAHCF Discussion, Betsy Johnson – 01:24:01
KMA Discussion, Patrick Padgett – 01:29:37
KNA Discussion, Delanor Manson – 01:41:56
Legislator Questions & Comments – 01:51:29
A
B
Senator
Douglas
president
Senator
Elkins
Senator
funky
frohmeyer
Senator
nemus
present
senator
tichenor
Senator,
wise
representative
Bentley
representative
bratcher,
present
representative
Bray
representative
Burke,
here
representative
Callaway,
present
representative
Dodson,
representative
Duvall,
representative
Frazier
Gordon,
yes,
representative,
Justice,
representative
Neighbors,
representative
Palumbo,
here
representative
Raymer,
here,
representative
Riley,
representative
Roark.
Here.
C
A
President
again,
we
do
have
a
quorum
and
duly
constituted
business
here.
I
would
ask
to
make
sure
that
you've
got
your
phones
on
silent.
If
you
haven't
done
that
already,
so
we
can
keep
this
meeting
run
as
smooth
as
possible
because
yeah,
but
we
have
a
very
full
agenda
today
and
we'd-
ask
our
presenters
to
please
be
as
concise
as
you
can
possibly
be
immediately.
Following
this
meeting
we
have
veterans
military,
fair
and
public
protection
committee
meeting
that
will
be
next
door.
Several
members
of
this
committee
are
on
that.
A
So
we
want
to
make
sure
we
finish
in
plenty
of
time
with
that.
Our
first
excuse
before
I
do
that.
Let
me
recognize
a
couple
of
new
members
and
that's
centered,
Greg
Elkins,
so
I'm
doing
glad
to
have
you
with
us
and
not
new
to
the
legislature,
but
knew
this
committee
is
representative
Ruth,
Ann
Palumbo
glad
to
have
you
both
this
morning
and
obviously
representing
Palumbo,
is
replacing
the
late
representative
blame
and
Swann
who
passed
away.
We
could
just
have
a
moment
of
silence
in
memory
of
him.
If
you
would
please.
A
A
D
D
First,
is
we
have
selected
the
new
commissioner
for
the
Department
of
community-based
Services
acting
commissioner
Lisa
Dennis
has
been
promoted
to
be
the
commissioner
Lisa
you
all
many
of
you
know
her
she's
testified
numerous
times
in
front
of
different
committees.
She
brings
a
wealth
of
experience,
lived
experience.
She
has
actually
had
positions
and
grown
up
and
come
through
the
department
for
community-based
services,
all
the
way
from
the
local
level
to
the
regional
level,
to
the
state
level.
D
I'm
very
excited
that
she's
agreed
to
be
the
commissioner,
and
hopefully
she
will
I
know
she
will
bring
some
real
implementation
to
some
of
the
things
we've
been
talking
about,
some
of
the
new
things
we've
been
doing
and
I
believe
that
she'll
bring
a
stability
to
the
Department
of
community-based
Services.
That
will
be
very
helpful
to
the
department.
D
Secondly,
the
department
for
Behavioral
Health,
Developmental
and
intellectual
disabilities
and
yes,
that's
one
of
the
longest
names
in
state
government
and
it's
my
fault
because
I
named
it
when
I
was
there
Dr
Katie
Marks,
who
has
been
leading
Kentucky's
core
effort.
The
opioid
effort
on
reduction
actually
began
under
the
Bevin
Administration
and
she
is
agreed
to
be
the
commissioner
of
Behavioral
Health.
She
will
bring
I
believe
a
change
to
the
department,
A
New
Perspective
to
the
department
she
her
her
experiences
in
substance
use.
D
She
also
has
a
background
in
Behavioral
Health
and
will
be
learning
parts
of
the
developmental
intellectual
disability
World,
which
I'm
very
excited
for
her
to
be
there.
She
she
brings
in
energy
that
I
think
again.
Some
of
you
have
seen
her
testify
and
I
believe.
A
level
of
competence
has
me
very
excited
that
she
will
be
joining
us,
but
that
leads
to
the
bad
news
which
is
on
in
a
field
of
folks
with
developmental
intellectual
disabilities.
D
Our
home
and
community-based
waiver
slots
are
now
full
first
time
ever
for
all
of
our
waivers
to
be
full
I
think
there
are
two
tiny
waivers
acquired
brain
injury
and
model,
two
waivers
that
don't
have
waiting
lists,
but
everything
else
does
including
what
is
primarily
the
long-term
care
waiver.
It's
called
Home
and
Community
Based
waiver.
There
are
17
000
over
17
000
slots
for
the
first
time
ever.
Those
slots
are
full
in
August
we
begin
a
new
waiver
year
and
it's
a
lot
of
federal
jargon.
D
But
we'll
have
some
slots
open
up,
but
it'll
be
a
brief
period
of
time,
we'll
be
coming
to
the
general
assembly
during
the
next
budget
session,
I'm
sure
and
requesting
more
slots.
It's
how
it's
how
these
the
slots
are
allocated
each
year
and
each
and
in
in
the
budget
each
year,
and
so
we
will
be
asking
for
more
slots
for
more
folks.
This
waiver
in
particular
and
and
what
we
I
think
have
to
address
and
I'd
be
happy
to
address
this
in
a
full
Committee
hearing,
but
I
just
wanted
to.
D
Let
you
all
know
some
of
the
challenges
we
have
around
children
and
we've.
We've
had
some
of
our
first
public
kind
of
Forums
on
a
children's
waiver
and
we'll
these
are
all
really
really
complex
issues
and
I'm
sure
we
could
have
an
entire
meeting
or
two
or
three
on
waivers
alone.
So
I
wanted
to
to
put
that
out
there
for
everybody
to
know.
I'm
really
excited
about
the
new
Commissioners
I.
D
A
Thank
you
appreciate
that,
and
just
to
follow
up
your
conversation
about
the
the
waivers
I
think,
certainly
that
does
warrant
a
separate,
probably
full
meeting
on
this
still
working
representative
Moser
developer
agendas
for
the
bounce
of
this
year,
but
certainly
the
waiver
programs
are
very
important
to
us
and
something
that
all
of
us
have
a
lot
of
interest
in.
So
we
will
commit
some
time
with
that
in
the
future.
I'm
sure,
but
I
appreciate
that
yeah.
D
E
Good
morning,
everyone
thank
you
for
asking
me
to
come
today.
Dr
stack
had
a
family
obligation,
and
so
he
asked
me
to
come
in
his
place.
One
of
my
joys
of
the
job
that
I
do
have
is
I
get
to
fill
in
for
the
the
commissioner
whenever
that
happens
and
I'm
happy
to
talk
to
you
today
about
what's
happening
in
public
health,
with
the
ending
of
the
national
public
health
emergency.
E
So
our
federal
emergency,
as
as
you
know,
the
the
emergency
ended
in
May
and
our
federal
grants
are
starting
to
run
their
course.
We
have
some
that
are
ending
at
the
end
of
this
month.
We
do
have
in
Disaster,
Response,
Health,
Equity
and
laboratory.
Some
of
them
have
been
extended
another
year,
so
they
will
end
in
June
of
2024,
but
most
of
that
extra,
coveted
funding,
that's
been
coming
our
way
as
a
department
will
end
the
end
of
this
month.
E
We,
as
you
know,
have
done
testing
support
across
the
state
for
the
last
several
years
years,
and
now
that
support
is
really
honed
in
on
our
long-term
care
facilities
about
300
of
those
in
the
state
because
of
the
particular
vulnerability
of
that
population.
We
want
to
assist
those
long-term
term
care
facilities
in
their
ability
to
do
testing
and
so
you'll
see
as
you've
seen
public
testing.
Those
kinds
of
things
have
have
wound
down,
as
as
that
funding
has
has
gone
away.
E
Our
antigen
test
support
is
also
starting
to
wind
down.
We
will
continue.
We
we
have
worked
in
the
past
with
K-12
I've,
been
very
involved
in
the
Kentucky
Department
of
Education
testing
and
making
sure
schools
that
we're
interested
in
having
that
testing
is
available.
We've
offered
that
through
summer
school
this
year,
some
have
taken
it.
Some
have
not
been
interested,
but
we've
done
testing
there.
E
We
have
worked
a
great
deal
in
our
homeless
shelters
to
be
sure
they
have
testing
available,
and
we've
worked
very
closely
with
corrections
to
be
sure
that
testing
is
available.
That's
all
winding
down.
So
now
we're
going
to
be
be
able
to
give
our
testing
resources
to
our
local
Health
departments,
so
they
can
choose
how
in
their
communities
it's
the
best
way
to
use
those
testing
and
continue
with
our
homeless
shelters
and
with
corrections.
So
that's
a
a
relationship.
E
We
had
started
building
right
before
covid
started
in
that
relationship
with
public
health
and
Department
of
Education
is
stronger
than
that
has
ever
been
the
most.
The
responsibilities
for
vaccines
and
treatment
is
going
to
transition
to
the
the
public
Marketplace
as
you're
you're
going
to
see.
This
is
going
to
be
an
infectious
disease
that
will
we
will
have
routine
approaches
for
so
you
can
get
your
vaccines
just
like
you
can
get
your
flu
vaccine,
but
it
will
not
necessarily
be
free.
It
will
be
covered
by
by
your
insurance
program
treatment.
E
You
see
the
commercials,
you
can
get
Pax
loaded
right
now.
The
government
has
bought
a
certain
Supply,
but
when
that
depletes,
it
will
only
be
available
for
uninsured
in
certain
populations,
but
that
will
become
a
part
of
any
kind
of
of
antiviral
treatment
that
you
need
to
get
out
in
the
the
regular
Health
Care
Community
data
collection
and
Analysis
function.
We
still
are
doing
that,
even
though
there's
not
a
daily
report.
If
you've
been
to
the
website,
you'll
see
lots
of
changes,
we
are
still
continuing
to
analyze
our
data.
E
D
Overarching
point
here
is
we're
really
getting
to
an
endemic
stage.
This
is
just
going
to
be
a
regular
part
of
of
our
health
care
landscape
from
here
on
out
moving
into
the
sort
of
the
public
regular
commercial
side
on
vaccines
on
testing
on
reporting
this,
it's
just
it's
just
an
affirmation
that
that
we're
headed
into
a
new
face
and
one
that
is
more
normal
in
terms
of
how
we
look
at
reportable
diseases
communicable
diseases.
It
really
starts
to
to
just
flow
into
our
regular
system.
E
So
we
wanted
to
go
over
with
you
some
improvements
that
we
have
seen.
I
know.
Senator
Meredith
mentioned
that
in
another
committee.
What
have
we
learned
and-
and
that's
something
I
think
public
health
is
very
good
at-
is
stepping
back
from
a
situation
and
we
call
it
hot
washes
or
after
action
look
backs.
What
did
we
learn?
E
So
we
have
had
hundreds
of
clinics
and
Laboratories
are
now
onboarded
with
our
Kentucky
Health
Information
exchange
and
we've
been
able
to
use
that
quick
access
to
that
data
in
lots
of
different
ways,
not
just
with
covid,
and
so
this
really
makes
things
go
more
efficiently
and
effectively,
and
so
that
is
something
that
came
out
of
the
pandemic.
Our
Kentucky
immunization
registry
has
gone
through
lots
of
changes
again,
changes
that
were
planned
but
have
were
put
on
steroids
during
this
pandemic.
E
It
even
to
the
point
that,
right
now,
you
can
go
to
an
online
public
portal
and
print
out
your
own
personal
immunizations
that
have
been
reported
to
the
registry.
Now,
if
your
provider
didn't
report
it
to
the
registry,
we
don't
have
it,
but
if
your
provider
that
gave
you
that
vaccine
reports
that
to
the
registry,
you
can
access
that
yourself
and
it's
very
easily
accessible
for
your
provider.
E
In
fact,
many
different
providers
put
a
registry
button
on
their
EHR,
and
so
when
you're
in
the
office,
they
can
hit
that
button
and
they
know
what
you've
had
done,
and
so
that
certainly
makes
their
work
a
speedier
and
more
efficient.
So
having
that
child
and
adult
vaccination,
there
is
extraordinarily
helpful,
Public,
Health
warehouses.
We
do
a
lot
of
things
that
aren't
particularly
flashy
and
telling
you
that
we're
stocking
gowns
and
gloves
before
the
pandemic
would
be
kind
of
a
big
yawn,
but
I.
E
Think
all
of
you
that
were
here
know
that
those
stocks
are
critical.
So
we've
been
able
to
expand
our
warehouse
footprint
double
at
least
where
we
now
have,
and
not
only
do
we
have
stocks
of
the
gowns
and
gloves
ventilators
other
resources,
but
we
have
an
excellent
system
for
tracking
that
to
making
sure
that
when
someone
asks
for
something
we,
you
know
you
go
to
the
back
of
the
shelf
and
get
the
stuff.
That's
been
there
the
longest
so
that
we're
sure
that
everything
we've
got
is
current.
It's
crisp,
it's!
E
It
will
be
effective
when
it
needs
to
be
used,
and
this
has
been
a
big
lift
on
our
preparedness
group
and
we're
extremely
proud
of
that,
as
well
as
we've
been
able
to
and
I
know.
This
is
on
the
next
slide,
but
we've
been
able
to
set
up
some
Regional
staging
sites
which
we
were
doing
that
in
response
to
covid.
E
We've
also
in
our
division
of
epidemiology
and
health
planning
are
pulling
together,
a
group
that
we're
calling
the
the
respiratory
illness
team
or
the
the
respiratory
disease
team,
and
that
team
of
epidemiologists
and
staff
will
be
focusing
on
looking
at
things
like
covid,
like
influenza,
influenza
has
been
a
problem
in
the
past,
so
looking
at
influenza.
Looking
at
RSV
RSV
is
not
a
reportable
disease,
but
we
do
have
ways
that
we
can
get
that
data.
There's
a
new
vaccine
for
that
coming
out
relatively
soon.
E
E
As
I
said,
I've
been
around
for
a
long
time,
I
started
with
the
Department
of
Public
Health
and
Women's
Health
in
2009,
so
I've
seen
a
lot
of
a
lot
of
Commissioners
come
and
go
and
a
lot
of
Health
Department
directors
come
and
go
and
I
do
agree
that
I
think
our
relationship
as
a
unit
is
better
than
it's
ever
been
in.
In
my
time
here,
local
public
health
departments
had
their.
We
we've
heightened
the
perception
of
the
local
health
department
and
I.
E
Think
now
we
have,
as
Dr
stack
said
before,
we've
got
61.
We
have.
We
have
a
health
department
at
brick
and
mortar
in
every
County
in
Kentucky,
all
120
counties,
but
they're
divided
into
61
Health
departments.
Some
several
counties
are
grouped
together
in
a
district,
so
we
have
61
Health
Department
directors
and
we
truly
see
them
as
the
chief
Health
strategist
in
their
community,
and
that
relationship
has
been
quite
stellar
and
we
are
moving
together
because
prevent
promote
and
protect
that
that's
not
just
the
department
for
public
Health's
Vision,
but
that
is
Kentucky
public
health.
E
All
the
aspects
of
Kentucky,
Health
and
the
state
see
prevention,
promoting
and
preventing
and
protecting
is
our
is
our
mission.
We
have
done
some
structural
realignment
of
regional
teams,
so
we
have
our
structure
at
the
state,
but
we
have
Regional
folks
and
we've
always
had
this,
but
we've
been
able
to
really
enhance
those
relationships.
E
So
there
is
someone
regionally,
that's
looking
at
preparedness
in
any
in
a
particular
clump
of
counties,
pulling
together
the
hospitals
and
the
health
care
providers
and
the
the
dialysis
centers
and
the
dentist
and
and
all
of
the
people
the
that
that
provide
Health
Care
in
those
regions.
So
when
there
is
a
snowstorm
and
and
we
need,
we
need
to
call
because
we
need
the
the
the
local
government
to
plow
the
road
to
get
to
the
dialysis
person
that
needs
that
all
of
those
things
that
most
people
don't
think
about
this
one.
E
Some
of
the
things
that
we
do,
that
that
cooperation
and
camaraderie
has
already
been
built
and
we're
continuing
to
build
on
that.
So
with
preparedness
and
our
immunization
and
and
all
of
those
other
things
listed
on
the
slide,
we
were
very
excited.
We
just
got
a
new
grant
for
a
Medical
Reserve
Corps
I.
Remember
when
I
was
in
medical
practice
here
in
Frankfort,
I
was
part
of
the
Medical
Reserve
Corps
and
that
kind
of
petered
out,
because
there
wasn't
funding
to
have
somebody
really
Champion
that
and
we
we've
got
some
new
funding.
E
So
we're
really
going
to
work
hard
with
our
local
providers
to
be
sure
that
they
know
in
case
of
emergency.
That's
not
when
you
have
a
training
in
case
of
emergency.
That's
when
you
call
and
say
remember
those
desktop
trainings
that
we
did
well
it's
time
to
kick
that
into
gear,
because
we
need
you.
Workforce
Development
has
been
extremely
exciting.
We
we
are
not
only
looking
at
building
and
bringing
in.
E
E
So
not
only
are
we
trying
to
fill
empty
positions,
but
we're
also
trying
to
develop
our
Workforce
of
the
people
that
are
already
there,
providing
them
with
training
opportunities
as
simple
as
we've
had
several
Excel
spreadsheets
Excel
spreadsheet
is
not
my
strength
but
but
people
to
learn.
How
can
you
take
an
Excel
spreadsheet
and
let
it
work
for
you?
How
can
you
use
word
to
work
for
you
tools?
They
use
every
day
that
they
use,
maybe
just
on
the
surface.
But
how
can
you
take
that
tool
and
make
your
job
easier
and
more
efficient?
E
How
can
we
give
you
more
opportunities
to
get
certificates
at
local
universities,
different
trainings,
where
we're
working
with
tuition
payment
for
some
staff,
with
through
a
grant
that
we've
gotten
from
for
CDC
for
Workforce
Development,
we're
bringing
in
high
school
students
we're
bringing
in
undergraduate
students
we're
bringing
in
graduate
students
and
touring
them
through
our
department?
So
they
can
understand
what
does
public
health
do?
I
usually
tell
people
we
do
everything
from
reviewing
tattoo
parlors
to
whole
genome
sequencing
and
everything
in
between
it's
a
very
varied
group
and
there's
if
you've
got
a
strength.
E
We
probably
have
an
area
where
we
could
use
you
and
we've
been
able
to
work
on
some
internships
that
we've
been
able
to
actually
give
some
stipends
to
students
and
that
that's
been
very
exciting
as
well,
and
a
thank
you
to
the
legislature
for
the
salary
increases
that
have
happened
across
state
government.
We
can't
thank
you
enough
for
that.
Now.
The
person
that
started
working
12
years
ago
is
not
still
making
what
they
made
12
years
ago.
E
That
has
been
crucial
for
our
families
to
be
sure
that
the
families
of
our
staff
are
able
to
have
what
they
need
and
then
we've
been
able
through
the
way
the
the
statutes
are
written
to
do
some
changes
in
local
Health
departments.
Some
of
those
staff
were
making
ten
dollars
an
hour
and
they
could
go
to
fast
food
and
make
15
an
hour.
E
We've
been
able
to
bring
those
folks
to
a
much
more
livable
wage
and
that
allows
us
to
not
lose
that
staff,
because,
if
of
those
of
you
that
own
a
business,
if
you've
got
that
churn
and
you're
training,
somebody
new
all
the
time
that
that
really
depletes
energies.
That
could
be
used
toward
building
your
business
building
your
work,
so
so
that
has
been
just
incredibly
helpful.
We're
thankful
for
the
public
health
transformation
funding
that
has
happened
and
I
think
maybe
the
secretary
can
talk
a
little
bit
more
about
that.
E
The
only
other
thing
that's
not
on
this
list
is
enhanced
relationships.
I
mentioned
that
I
know
we're
talking
to
our
office
of
Health
Equity.
Yesterday
they
put
out
some
rfas
requests
for
a
not
rfps
rfas
rfps
requests
from
lots
of
different
organizations
for
Equity
work,
and
we've
got
47
new
partners
that
we
didn't
have
before
so
the
more
we
as
public
health
can
be
a
part
of
different
agencies,
community-based
organizations
as
well
as
in
our
cabinet
and
in
other
cabinets,
that's
going
to
spread
the
work
and
the
success
of
Public
Health
in
Kentucky.
D
Representative
Moser
were
here
that
happened
really
early
1920
in
20,
I,
think
and
so
all
during
the
whole
time
of
covid
Public
Health
continued
to
move
and
work
on
that
public
health
transformation,
and
this
is
really
something
that's
been
needed
needed
to
happen
for
the
last
20
years
and
I.
Think
through
it
all
a
lot
of
that
transformation
and
the
quickest
way
to
describe
it
is
really
not
looking
at
as
clinical
as
many
of
the
health
departments
have
become
and
look
more
at
at
Public
Health
at
large
and
then
some
of
the
other
things.
E
And
and
I
know
you've
had
presentations
about
this,
but
we
talk
about
the
blue,
the
blue
box
and
green
box.
So
you've
got
the
core
things
that
public
health,
local
public
health,
is
required
to
do
the
things
that
nobody
else
does:
the
preparedness
and
the
Infectious
Disease
investigation
and
inspections
of
restaurants
and
trailer
parks
and
hotels
and
all
of
those
things.
E
And
then
there
are
two
other
things
that
that
we've
added
and
one
was,
was
Wick
and
hands
and
harm
reduction
services
and
looking
at
our
harm
reduction
programs
in
our
health
departments
and
then
there's
the
other
box.
There's
the
green
box
and
those
are
where
that
is
the
work
that
the
local
com
Community
decides:
the
local
Boards
of
Health,
the
local
health
care
strategies
determined
that
in
our
community.
These
are
the
things
that
we
think
we
need
to
address
for
that
overall,
health
of
the
public.
E
So
it's
been
a
it's
been
a
real
mind-changing
concept
and
it's
been
enhanced.
It's
been
accepted
by
our
local
Health
departments
and
they
have
really
made
this
work
for
the
state,
so
Lessons
Learned,
public
health
and
Health
Care
Professionals,
who
place
themselves
In.
Harm's
Way
are
our
heroes
and
there
are
lots
of
Heroes.
There
are
the
the
teacher
Heroes
and
the
social
worker,
Heroes
and
and
and
I
think
we
again
step
back
and
look
at
the
people
that
really
stepped
up
to
get
us.
E
Through
this
pandemic,
we
were
able
to
remarkably
genetically
sequence.
Covid-19
within
weeks
I
mean
I'm
again
I'm
old
enough
to
remember
when
they
first
did
the
sequencing
for
the
human
genome.
It
took
them
like
three
years
or
something
like
that.
To
do
it.
We
got
vaccines
out
in
10
months,
remarkable
work
on
the
part
of
of
a
lot
of
people.
Monoclonal
antibodies
and
oral
antiviral
treatments
were
out
very
quickly.
E
We
we
had
ways
to
treat
it,
so
we
had
ways
to
detect
it.
We
had
ways
to
vaccinate
against
it
and
we
then
had
ways
that
we
can
treat
it
and
for
that
to
happen
within
that
short
period
of
time
is,
is
really
pretty
amazing.
So
once
a
century
we
we
at
least
we
hope
that
you
hate
to
wish
that
on
the
next
Century,
but
we
hope
it
doesn't
happen
to
us
again
where
we
have
a
novel
or
brand
new
virus
developed
that
we've
not
been
exposed
to
before
as
a
human
race.
E
D
The
only
other
thing
I'd
add
is
this,
and
you
alluded
to
it
earlier
we're
going
to
be
studying
this
for
20
30
years.
There
are
good
decisions
made.
There
were
bad
decisions
made
and
we're
gonna,
probably
parse,
that
out
as
folks
examine
what
was
effective.
What
wasn't
what
had
impact?
What
didn't
I
promise
you?
We
were
going
with
the
best
of
our
knowledge
and
it
changed
over
time
even
within
like
masks
and
no
masks
and
all
that
kind
of
stuff.
D
All
of
that
you
just
go
with
the
best
of
your
knowledge
at
the
time,
which
is
what
we
were
trying
to
do,
but
but
looking
back
we're
going
to
find
places
that
were
more
effective
and
less
effective.
We're
and
and
the
thing
that
that
we
need
to
commit
to
do
is
to
learn
together
and
to
understand
that
we
get
to
learn
together
and
hopefully,
I
don't
want
to
be.
You
know
have
anything
to
do
with
the
next
pandemic.
E
Our
other
Deputy
Commissioner,
Trisha
okeson
I,
remember
one
of
the
first
days
of
the
pandemic.
The
first
thing
she
said
is:
let
me
go
get
the
book
on
H1N1.
If,
for
those
of
you
that
were
around
for
that,
you
know
how,
how
do
we,
what
what
structures
did
we
have?
How
do
we
pull
things
together?
It
was
at
least
some
kind
of
a
blueprint
for
us
to
start
with,
so
we
do
learn
on
these
on
on
these
pandemics
and
try
to
document
that
so
future
Generations
can
see
that
in
laboratory.
E
D
A
E
One
thing
that,
when
I
think
about-
and
it's
kind
of
hard
to
think
back
because
it's
all
kind
of
a
blur,
while
it
was
happening
with
very
little
sleep
and
lots
of
activity,
we
were
getting
every
coveted
test
in
the
state
of
Kentucky
results,
faxed
to
us
on
a
fax
machine,
and
then
someone
had
to
collect
those
and
hand
enter
that
into
a
database
before
we
could
even
know
what
was
going
on
that
took
Untold
hours.
It
diverted
those
people's
ability
to
actually
analyze
the
data.
E
So
one
thing
that
I'm
very
pleased
with-
and
we
still
have
a
little
ways
to
go-
is
our
data
collection
is
going
to
be
much
more
efficient
and
effective
so
that
we're
not
wasting
our
time
and
it
wasting.
Time
is
kind
of
a
harsh
term,
but
it
was
a
waste
of
some
very
competent
people's
times
to
put
this
stuff
into
a
database
when
we
could
have
spent
all
that
time,
making
better
decisions
being
able
to
hone
down
taking
using
the
computers
and
the
analysis
electronic
analysis.
We
have
now
to
be
able
to
know.
E
Where
are
our
hot
spots.
Where
do
we
need
to
go?
What
do
we
need
to
do?
I
think
the
fact
that
we
are
better
prepared
data
collection,
wise
and
Analysis,
wise
and
a
lot
of
this
is
coming
through.
The
CDC
is
doing
a
lot
data.
Modernization
is
the
is
the
biggest
new
buzzword,
because
a
lot
of
the
databases
we
were
using,
we
got
from
the
CDC
and
they
were
woefully
behind
in
their
ability
to
be
up
to
date
with
the
latest.
So
all
of
that's
changing
right
now.
Well,.
A
Opportunity
always
at
rise
to
have
adversity
and
there's
certainly
some
great
opportunities
for
us
in
the
future.
We
saw
it
with
I
think
the
elevation
of
the
Public's
perception
of
Public
Health
and
the
role
they
play
with
the
need
for
Broadband
in
our
rural
communities.
I.
Don't
think
it
would
Advance
this
as
quickly
if
we
had
if
we
had
not
gone
through
this
this
pandemic
and
the
advancement
of
telemedicine
has
certainly
been
a
a
good
result
of
this,
but
I'm
just
hoping
we'll
take
full
advantage
of
this
in
the
future.
A
We
need
to,
if
not
we're
going
to
be
remiss
I
think
the
biggest
challenge
for
any
organization
is
to
fight
complacency.
You
know
if
we
don't
have
another
pandemic
in
10
20
years.
Do
we
forget
about
this?
Do
we
put
that
blueprint
on
the
on
the
book
itself,
like
you
were
talking
about
and
have
to
dust
it
off
again
so
again,
I'm
just
hoping,
we've
got
systems
in
place
that
we
assure
that
we
can
mitigate
the
future
pandemics
and
the
impact
of
it.
A
So
that's
what
I'm
looking
for
another
thing,
I'm
very
concerned
about
is
the
fiscal
impact
because
you're
right
secretary,
this
can
be
around
for
a
long
time
and
we
have
geared
up
to
take
care
of
this.
We're
going
to
lose
Federal
funding.
I
know
we're
pulling
back
a
little
bit,
but
we
still
have
some
expenses
there
they're
going
to
be
here
for
a
while,
so
I'm,
very
curious
of
what
this
is
going
to
look
like
for
our
next
fiscal
budget
for
our
state,
because
I
think
it's
going
to
be
a
little
bit
challenging.
D
That's
a
that's
a
fair
statement.
There
are
three
things,
I
would
say
in
terms
of
kind
of
what
we
learned,
but
we
still
need
to
learn
what
we
still
need
to
do.
One
was
really
kind
of
bringing
the
whole
cabinet
into
the
response,
particularly
the
behavioral
health
side.
We
we
did
that
pretty
early,
but
it
making
sure
we
got
to
homebound
make
you
know.
D
Those
are
those
are
things
that
we
we've
done,
but
not
as
as
for
My
Cat,
From
chfs
perspective
as
a
whole
cabinet,
like
being
in
the
department
for
Behavioral,
Health,
then,
and
and
the
Department
of
Aging
and
independent
living
in
it,
and
really
making
sure
that
that
those
those
groups
were
were
fully
into
the
response.
The
other
thing
is
in
our
emergency
response.
D
Again,
don't
don't
hear
criticism,
but
we
we're
so
used
to
localized
Geographic
responses,
floods,
tornadoes
power,
outages,
the
whole
way
to
conceptualize
a
nationwide
worldwide
in
in
this
case,
in
the
emergent
response,
a
Statewide
response,
I
I,
think
I
think
that's
a
whole
different
concept
and,
and
the
third
thing
that
we
still
probably
need
to
do-
is
it.
It
stretched
our
laboratory,
probably
as
close
to
the
breaking
point
as
possible.
You
all
will
see
a
new
Capital
request
for
a
new
laboratory
and
we
need
it.
E
E
A
G
A
H
E
It
won
was
Health.
Equity
is
one
of
the
areas.
Oops
I
want
to
look
to
make
sure
I,
don't
say
this
wrong:
Health
Equity
Equity
the
laboratory
and
disaster
preparedness.
So
it
was
to
continue
to
be
sure
that
our
disaster
preparedness
plans
are
all
in
place
and
those
organizations
are
are
ready.
The
laboratory
is,
as
the
secretary
mentioned,
to
be
sure
that
we've
got
all
of
our
Laboratory
Testing
as
as
streamlined
as
possible
and
I
was
going
to
add
I'm
going
at
two
o'clock
this
afternoon
to
the
cabinet
Health
Equity
meeting.
E
That's
a
group
that
pulled
together
and
I
I
looked
at
the
agenda
at
the
agenda
last
night
and
just
to
see
who
comes
to
that.
So
it's
the
Department
of
Aging
and
independent
living
and
it's
the
office
of
the
Inspector
General
and
it's
public
health
and
it's
Behavioral
Health
and
it's
the
secretary's
office.
E
We
got
together
to
say:
okay,
not
only
are
we
attacking
covid,
but
how
are
we
going
to
attack
covet
in
places
that's
hard
to
get
to?
How
do
we,
the
the
homeless
vaccinations
where
we
actually
went
into
people's
homes
and
had
you
know
how
do
you
organize
that
with
the
health
department
and
with
the
National
Guard
and
with
all
the
other
different
folks
we
reached
out
in
areas
that
would
not
have
normally
happened
so
that
Health
Equity
work
Group,
which
is
is,
and
the
secretary
is,
is
on
that
group
is
really
making?
D
Again,
if
you
look
at
some
places
in
Eastern
Kentucky
and
some
of
our
more
challenging
counties,
how
do
we
make
sure
that
we
direct
resources
where
they
are
needed?
And
that's
that's
really?
What
we
talk
about
that
as
we
look
at
at
poorer
Health
outcomes
often
related
to
Poverty?
How
do
we
make
sure
that
we're
being
supportive
of
those
communities
all
across
all
across
Kentucky,
from
a
geographic
perspective?
From
from
from
every
every
perspective
we
can
from
populations
that
we
know
are
vulnerable.
A
I
J
I
I
was
curious
if
the
reduction
in
federal
funding
is
anticipated
to
create
any
barriers
to
accessing
vaccines,
particularly
in
the
situations
you
were
just
talking
about
those
High
poverty,
more
rural
areas,
as
we
transition
more
to
a
private
market
and
relatedly
I
was
curious
about
plans
budget
Communications
to
remind
kentuckians
to
get
their
ongoing
covid
booster
every
year.
Are
there
plans
for
that.
D
So
moving
to
the
commercial
Market
there,
there
are
vaccine
programs
within
the
public
health
departments
and
the
federally
qualified
Health
Centers.
Will
there
be
bigger
access
issues
as
we
move
to
a
commercial
system?
Of
course?
Yes
couple
that
with
what
you'll
hear
in
a
little
bit
about
Medicaid
unwind,
the
answer
is
yes
and,
and
we
know
that
and
we'll
have
to
direct
resources.
That
way,
you
may
see
us
with
how
we
structure
what
our
request
will
be
for
you
all
in
the
next
in
the
next
session,
the
other
in
terms
of
public
Outreach.
D
There
are
some
funds
available
for
that,
but
that,
as
chairman
Meredith
pointed
out,
those
funds
will
dwindle
as
time
goes
on
and
and
certainly
the
covet
boosters
is
important.
I'm
I'm
looking
forward
to
getting
my
next
one
and-
and
so
is
flu
and
some
of
our
vaccine
rates
have
gone
down.
So
we
have
a
lot
of
work
to
do
on
all
vaccines,
children's
vaccines,
just
basically
all
because
we've
seen
those
rates
go
down
over
the
past
couple
of
years,
and
so
there's
a
lot
of
work
to
do
there.
E
And
we
we
another
group
that
formed
during
the
pandemic
and
and
I
I
hate
to
start
mentioning
organizations,
because
I
know
I'll
leave
them
out,
but
we
sent
out
a
lot
of
communications
that
were
from
khsaa
Department
of
Education
the
American
Kentucky
Medical
Association
from
dph
from
it
you
could.
It
was
so
many
different
logos
at
the
bottom.
You
could
barely
read
them,
which
is
a
good
problem,
but
those
people
are
have
been
meeting
regularly
and
they
have
some
funding
for
that
kind
of
stuff
too.
So
what
I?
E
What
I
say
about
public
health
is?
We
know
how
to
pull
people
together
and
we
don't
have
much
money
to
do
something.
But
if
we
could
put
our
dime
in
the
table
and
they
all
put
their
Diamond,
then
we've
got
a
dollar
and
we
can
really
do
some
Outreach,
so
I'm
I'm,
anticipating
that
those
collaborations
will
continue
not
just
for
covid
but
for
RSV
and
for
flu
and
for
those
childhood
immunizations
that
have
really
gone
down
in
Kentucky,
which
is
alarming.
J
Thank
you,
Mr
chairman
I,
want
to
thank
both
of
you
all
for
being
here
and
providing
the
information
that
you're
providing.
Hopefully
we
can
answer
this
question
pretty
quickly.
Has
there
been
much
work
in
the
area
of
how
the
initial
Outreach
to
the
healthcare
providers
can
be
can
be
improved
in
terms
of
a
standard
platform
of
of
how
we
can
get
information
to
you?
J
D
Yes,
I
think
we
Again
part
of
that
Lessons
Learned,
where
we
didn't
have
good
communication,
where
we
could
improve.
We've
looked
in
both
our
health
information
exchange
side,
our
this
is
a
different
system,
but
our
Casper
side,
our
immunization
side,
all
of
those
pieces.
We
know
we,
we
have
improvements
to
make
and
so
get
that
back
and
forth.
Communication
I
was
with
my
primary
care
physician
about
two
years
ago
and
he
was
saying
to
me:
I
need
to
know
the
Genome
of
this
I
need
so
so
I've
heard
it
from
my
primary
care.
E
We
had
great
relationship
with
the
Kentucky
Board
of
medical
licensure
and
the
Kentucky
Medical
Association
kbml
is
very
careful
about
sending
out
mass
emails
because
everybody
wants
you
to
send
information
out
to
every
physician
about
every
project
they
have.
But
they
were
very
helpful
in
working
with
us
to
be
sure
that
the
pertinent
most
important
things
we're
getting
out
to
the
providers
in
the
state
and
the
Board
of
Nursing
as
well.
A
K
K
K
And
you
already
know
secretary
friedlander,
so
we'll
just
Dive
Right
In
wanted
just
to
give
a
little
bit
of
context
to
what's
going
on
from
March
2020
to
now
June
2023.
This
is
a
snapshot
of
our
enrollment
during
that
period
of
time,
honestly,
going
forward,
we're
probably
going
to
do
away
with
looking
behind
and
instead
looking
forward
to
see
what
the
trend
is
going
to
be
going
out.
But
this
is
always
a
really
good
sort
of
you
know
way
to
ground
us
and
exactly
what
happened
over
the
period
of
time.
K
So
in
in
March
of
2020,
we
had
about
1.3
million
people
in
June
of
in
April
of
2023,
which
is
when
we
started
unwinding.
We
had
1.7
million,
so
quite
quite
a
growth.
You
know
what
we
try
to
dig
into
is
how
much
of
that
is
from
continuous
enrollment,
how
much
of
that
is
natural
Trend,
but
it
doesn't
really
matter.
We
just
had
an
in
an
enormous
growth
over
the
period
of
time,
so
just
kind
of
wanted
to
to
alert
you
to
that
time.
K
So
State
Medicaid
agencies
had
to
continue
to
cover
individuals,
regardless
of
their
change
in
circumstance
during
the
public
health
emergency,
which
is
why
you
see
we
have
a
a
growth
in
our
enrollment
over
the
years
so
now
for
our
planning
on
how
we're
going
to
do
that,
because
that's
a
an
enormous
increase
in
what
our
normal
renewal
over
over
12
months,
we
are
prior
to
Public
Health
Emergency.
We
are
required
we're
required
to
do
an
annual
redetermination
of
somebody's
eligibility.
So
now
we're
going
and
doing
that
larger
number.
K
So
we
had
to
come
up
with
a
plan,
and
this
is
just
a
snapshot
of
what
cases
and
by
cases
I
mean
it's
at
the
household
level.
So
sometimes
we're
talking
about
households,
because
in
in
Kentucky
and
in
Most
states
you
do
your
eligibility
determination
based
on
the
head
of
household
generally.
If
the
head
of
household
is
eligible
because
of
income,
the
entire
household,
a
household
can
be
one
person,
it
could
also
be
two
three
four
five.
It
just
depends
on
how
many
people
are
actually
part
of
the
case.
K
So
when
you're
looking
at
caseload
and
individual
numbers,
you
know
you're
going
to
see
a
little
bit
of
of
a
difference
there.
What
I
wanted
to
point
out
on
this
slide
is
this
is
different
for
those
of
you
who
might
have
seen
a
previous
caseload
distribution
slide.
This
has
changed
a
little
bit
and
the
reason
for
that
is
because
we
are
implementing
12
months
continuous
coverage
for
children
as
part
of
our
unwinding.
K
This
is
mandated
by
federal
law
for
State
Medicaid
agencies
to
implement
this
January
of
2024,
but
Kentucky
decided
to
go
ahead
and
do
it
for
our
unwinding
period
so
that
children
that
might
be
redetermined
prior
to
January
2024
have
access
to
that
same
continuous
coverage
for
a
child
that
might
get
determined
after
January
2024.
So
we
just
really
wanted
to
treat
the
children
the
same
throughout
the
unwinding
period,
to
do
that
and
to
implement
that
in
our
system,
because
it
was
something
a
decision
we
made
in
April.
K
D
The
reason
Medicaid
number
numbers
changes
is
because
they're
so
big
and
they
always
change
I,
always
like
to
say
when
I
leave
the
fifth
floor
in
the
Cabinet
for
Health
and
Family
Services
and
by
the
time
I
get
to
the
first
floor.
The
numbers
always
change
a
little
bit
and-
and
you
can
see
these
are
estimates
all
of
these
numbers,
as
we
go
through
the
year,
are
going
to
change
that
I
can
promise
you,
but
you
get
the
general
flow
of
of
of
what
our
review
is
going
to
be.
D
I
do
also
want
to
back
up
one.
This
is
something
that's
going
on
Nationwide,
so
for
for
for
three
years,
nobody
did
any
redeterminations
in
in
Medicaid.
You
had
to
keep
you
couldn't
do
that
you
couldn't
take
people
off
the
rolls
unless
they
passed
or
moved
out
of
state
or
you
would
risk
losing.
What
is
the
what
was
called
the
enhanced
Federal
match
rate
for
Medicaid,
that's
billions
of
dollars,
so
there
really
aren't
any
states.
D
There
aren't
any
states
that
violated
that
provision
just
because
it
was
just
too
big
and
we
didn't
either
so
now
we're
now
we're
unwinding.
Now
we're
doing
the
recertification.
We
have
experience
with
this
in
our
SNAP
program,
where
we
started
doing
recertifications
really
about
a
year
and
a
half
ago
in
in
that
program.
That's
a
food
stamp
program,
formerly
known
as
food
stamp.
That's
snap
and
we
saw
at
the
time
it
it
swamped
our
dcbs
workers
that
you
double
their
workload.
D
D
We
we've
we've,
given
our
connectors
a
little
more
access
within
our
system,
we're
using
private
insurance
agents,
we're
trying
to
do
everything
to
to
not
get
a
huge
backup.
It's
still
you're
gonna.
If
you
call
our
phone
lines,
you're
gonna
have
a
little
bit
of
a
wait.
That's
just
true,
and
so
we
try
to
do
a
lot
of
things
to
make
it
better
and-
and
we
continue
need
to
work
on
that,
but
just
just
to
know
that
this
is
a
huge
increase
on
on
the
staff
of
dcbs.
We've
done
some
hiring.
D
We've
done
a
lot
of
different
things,
but
but
just
know,
you'll
probably
hear
some
constituent
concerns
about
I
call
the
dcbs
phone
line
and
I
was
on
hold
for
40
minutes
yeah,
it
probably
were
I
wish.
I
could
say
we
were.
We
were
doing
better
than
that,
like
our
commercial
Partners,
but
but
it's
a
challenge
and
and
this
edition
of
folks
calling
in
and
talking
to
us
it
just
that's.
It
is
where
we
are
and
I
just
want
to
be
really
clear
about
that.
K
The
the
other
I
to
note
from
that
is
that
you
know
we
are
learning
lessons.
Every
day
we
have
completed
May
renewals,
we're
in
the
process
of
June
and
we're,
and
so
we've
learned
some
lessons
from
that,
so
that,
as
we
move
forward,
we
can
maybe
address
those
including
bringing
on
additional
staff,
because
you
you
saw
towards
the
end
of
the
distribution
plan.
It
is
a
larger
number
and
we
want
to
be
prepared
for
that.
Certainly,
so
here
is
a
snapshot.
K
This
is
of
June
2nd
and,
as
the
secretary
mentioned,
really
it
changes
every
minute
and
the
reason
for
that
is
because
our
sister
agency,
the
department
for
community-based
services,
who
performs
our
eligibility,
determinations
and
redeterminations
you
know
or
doing
cases
every
day.
So
it
really
can
change
in
a
moment.
But
here
is
a
snapshot
of
June
2nd.
K
This
may
look
familiar
to
some
of
those
who
are
on
the
Health
and
Human
Services
delivery
task
force,
because
you
might
have
seen
these
numbers,
but
the
individual
count
and
again
we
were
talking
cases
in
the
last
slide,
but
this
is
the
individual
count,
which
is
the
number
we
have
to
report
to
CMS.
The
individual
count
of
those
who
went
through
or
may
renewal
is
seventy
four
thousand
and
four
of
those
we
were
able
to
approve
37
182
and
unfortunately,
we
did
terminate
34
124.
K
You
see
there,
it
says
passively,
renewed
and
actively
actively
renewed.
The
difference
between
those
a
passive
renewal
is
someone
our
system
can
go
out
and
do
an
automatic
verification
of
their
eligibility.
We
have
a
federal,
Hub
and
other
databases
available
to
us
to
be
able
to
verify
somebody's
income,
citizenship
a
whole,
a
whole
bunch
of
different
databases.
K
If
we're
able
to
go
and
verify
with
those
databases,
the
member
actually
has
to
take
no
action
because
we've
been
able
to
determine
them
eligible,
and
that
means
they'll
just
get
that
notice
of
Eligibility
nothing
further
for
them
to
do.
Sometimes,
when
we
do
that,
even
if
it
is
a
passive
renewal,
we
can't
verify
everything
and
they'll
drop
to
what's
called
a
request
for
information,
so
we'll
send
them
a
pre-populated
form
that
tells
them
exactly
what
it
is
that
we
need
from
them.
K
You
know
either
the
income
information
came
back,
saying
different
than
what
the
person
reported
just
you
know
a
whole
host
of
reasons,
so
they'll
get
that
request
for
information.
That
means
they
have
to
take
action,
even
though
they
were
identified
as
a
passive
application.
They
have
to
take
action
before
the
end
of
May,
for
the
May
renewals,
the
actively
renewed
are
are
individuals
where
their
Medicaid
Eligibility
has
some
other
components
that
are
necessary,
like
resources
and
assets,
information
that
we
can't
go
out
and
and
automatically
Ping
On
the
databases
available
to
us.
K
So
they
get
what's
called
a
a
renewal
packet
that
packets
a
couple
of
pages
long.
It
requires
just
somebody
additional
information,
it
really
again
is
pre-populated
and
just
as
for
the
gap
of
information,
that's
necessary
for
us
to
make
that
redetermination.
So
that's
the
difference
between
passive
and
active.
D
Some
new
information
we,
we
ran
the
folks
who
lost
eligibility
against,
what's
called
a
third
party
liability
list,
meaning
checking
to
see
if
they
have
other
insurance
about.
27
percent
of
these
folks
have
now
some
other
health
care
coverage,
so
we're
asking
that
to
to
kind
of
understand
that
who's
moved
from
Medicaid
to
private
insurance
or
or
Medicare,
and
so
that
that
number
I
think
it's
good
news
is
about
27
percent
and
then
that
reinstated
piece
I
think
we're
up
over
3
000
now.
D
K
D
And
in
the
interest
of
speed,
this
just
gives
you
an
idea
of
kind
of
the
Outreach
that
we've
done.
We
actually
one
of
the
Managed
Care
organizations
said
that
a
couple
of
folks
that
they
called
said.
Why
do
you
keep
calling
me?
So
we
really
have
tried
to
do
a
lot
of
different
things
with
Outreach
and
just
just
to
know,
sort
of
some
of
how
we've
done
that
and
that's
what
this
slide
is
about.
D
And
then
this
just
gives
you
some
of
the
the
renewals
and
again
what
it
looks
like
for
the
for
the
month.
Coming
up,
it's
going
to
take
us
probably
a
quarter,
maybe
four
months,
five
months
to
really
get
a
handle
on
what
this
is
going
to
look
like
in
terms
of
folks
that
come
back
in
folks
that
lose
coverage
trying
to
understand
who
continues
to
have
health
care
coverage
in
a
different
way.
D
So
this
impacts
budget
because
it'll
it'll
impact
the
number
of
eligibles
so
there'll
be
a
lot
of
things
that
we
are
juggling
heading
into
the
next
legislative
session,
particularly
relative
to
the
Medicaid
budget
and
they're.
Just
a
lot
of
balls
in
the
air,
and
one
of
the
biggest
things
that
that
relates
to
Medicaid's
budget
is
how
many
eligibles
are
there,
and
so
we
had
predicted
I
think
kind
of
internally.
You
know
a
couple
hundred
thousand,
but
it
looks
like
it
may
be
higher
than
that.
D
But
then,
if
you
look
one
month
to
the
next
in
terms
of
what
the
total
number
enrolled
in
Medicaid,
it
may
be
more
closer
to
our
projections.
It's
just
there's
a
lot
in
the
air
right
now.
This
is
our
first
month
bear
with
us.
We
report
this
every
month
happy
to
do
it,
there's
a
website.
It's
the
Kaiser
Family
Foundation
that
has
kind
of
a
running
total
on
this
and
all
the
states
report
we're
about
middle
of
the
pack
in
terms
of
folks
losing
coverage
is
what
it
looks
like
to
me.
D
So
you
can
look
at
that
site.
We
will
report
to
you
and,
and
let
you
know
the
challenges
that
that
we
see
moving
forward,
but
but
they're
they're
a
lot
of
them
we're
learning
with
every
other
state,
but
some
states
have
had
hundreds
of
thousands
of
folks
who
have
been
disenrolled
and,
like
I,
say
we're
we're
about
we're
about
the
middle
on
that.
So
just
just
to
let
you
all
know
and
we'll
see
how
we
go.
Other
states
took
different
approaches.
D
We
really
tried
to
put
those
folks,
we
thought
might
be
ineligible
in
our
first
couple
of
months,
but
we
won't
know
until
we
actually
get
through
get
through
this.
So
again,
just
this
is
what
it
is.
You
see
a
lot
of
terminations
for
not
returning
information.
That
is
also
the
experience
across
the
country
and
will
continue
to
to
work
on
that
again,
just
sort
of
letting
you
know
what
our
outreaches
have
been
there
I'm
trying
to
in
interest
of
time.
D
Chairman
Meredith
moved
through
some
of
this
and
then
let
you
know,
we've
had
some
enrollment
pick
up
a
little
bit
in
our
qualified
health
plans.
That's
the
the
state
benefits,
but
not
very
many
right.
It's
it's
it's
kind
of
hundreds,
not
thousands.
We
were
hoping
for
a
bigger
uptake,
but
we
just
we
haven't
seen
it
but
we'll
report
on
this
too.
Just
like
the
third
party
liability
piece,
just
like
the
re-enrollments
we
will.
D
K
And
just
as
as
folks
roll
off
of
Medicaid,
because
they're
ineligible,
if
they
are
eligible
for
a
qualified
health
plan,
we
have
specific
approaches
around
those
individuals
to
help
connect
them
to
choosing
a
plan
so
that
there's
no
Gap
in
their
coverage
or
as
little
Gap
as
possible.
So
not
only
is
the
state
doing
that
the
Medicaid
Managed
Care
Organization
very
proactively,
making
sure
that
individuals
understand
they
can
choose
that
option
if
they
don't
have
any
other
coverage
options
available
to
them.
K
So
this
is
a
slide
that
just
reflects.
We
put
a
lot
of
things
in
place
for
the
public
health
emergency,
and
so
no
now
a
lot
of
those
flexibility
flexibilities
have
ended.
We
were
able
to
extend
some
and
some
we
put
permanent
permanently
in
place
like
the
Telehealth.
You
know
that
was
we
discovered
that
there
were
lots
of
policy
changes
we
could
make
around
Telehealth
and
working
together
with
the
legislature
and
legislation
that
was
passed.
We
did
put
those
permanently
into
place
in
our
regulation
and
in
our
state
plan.
K
So
there
are
some
things
extended:
we're
continuing
to
watch
that
the
most
the
I
think
the
critical
piece
we
want
to
make
sure
a
lot
of
providers
know
is
that
during
the
public
health
emergency,
they
were
allowed
to
use
platforms
that
were
non-hippa
compliant,
so
like
Face,
Time
and
the
office
of
civil
rights
is
going
to
go
back
to
enforcing
HIPAA
compliant
Platforms
in
August.
So
providers
who
have
been
using
that
as
as
a
way
to
do
tell
Health,
they
just
need
to
make
sure
they're
using
a
compliant
platform.
For
that.
D
And
Telehealth
again
it
is.
It
is
one,
that's
really
important.
For
years,
we've
talked
about
Health
Care
in
rural
areas,
and
what
can
we
do
in
transportation
is
always
the
biggest
issue,
I
think
across
the
state.
So
hopefully,
Telehealth
has
been
available
in
many
ways
for
years,
and
we
just
got
pushed
to
adopting
a
more
robust,
Telehealth
reimbursement
structure.
More
robot
product
got
used
to
it.
D
Everybody
got
used
to
it,
so
we
probably
jumped
ahead
20
years
in
Telehealth
and
and
it
really
does
address
a
lot
of
issues
around
around
health
and
Rural
Health
rural
Health
appointments.
A
lot
of
the
transportation
challenges
that
folks
face
so
we'll
we'll
continue
to
explore.
How
that
can
work
Broadband
again
is
is
critically
important
for
for
the
dissemination
of
strong
Telehealth.
So
all
of
these
things,
as
you
all
know,
are
interrelated,
but
it's
an
important
piece
that
that
I
think
is
is
definitely
worth
talking
about
quickly
again.
D
There's
a
phase
down
of
the
fmap
again
I
think
that's
probably
going
to
provide
us
some
relief
as
we
look
into
the
next
two
years
for
the
Medicaid
budget,
because
that
none
of
us
budgeted
this
wasn't
budgeted
in
the
general
assembly's
budget
wasn't
budgeted
in
Medicaid.
So
there
will
be
some
funds
going
into
the
next
biennium.
That
should
be
helpful
again
with
all
the
balls
in
the
air,
around
eligibility
and
unwind
and
and
and
some
of
some
of
the
other
changes.
K
Yeah,
our
website
has
a
lot
of
resources
on
it.
We
are
keeping
a
weekly
update
of
the
numbers
around
and
winding.
We
have
resources
on
there
for
providers
for
Advocates
stakeholders,
anyone
who
may
be
helping
support,
Medicaid
members
through
their
renewal.
We,
we
really
have
tried
a
very
broad
approach
to
just
working
with
organizations
across
the
state.
Our
providers
have
been
extremely
helpful
and
and
have
a
desire
to
help
members
going
through
that
make
sure
they
understand
it.
K
We
took
some
actions
like
putting
the
redetermination
date
on
Kentucky
HealthNet,
which
is
the
system
that
providers
go
in
and
verify
eligibility
so
that
they
can.
When
the
member
comes
in
that
they
can,
you
know,
have
them
check
that
and
again
you
know
lots
of
flyers
for
providers
to
hand
out
or
for
Advocates
to
use
in
communicating
with
with
Medicaid
members
across
the
state.
D
So
maybe
it
wasn't
a
horrible
decision
Wheels,
but
but
it
is
a
wheel
seat.
That
is
absolutely
true.
We've
tried
to
be
really
targeted
about
how
we
communicate
this,
both
both
the
members
and
and
providers,
because
that
that's
really
it's
that
relationship.
That's
going
to
make
the
difference.
I
think
the
broader
campaign
in
this
in
this
case
isn't
going
to
have
the
same
impact.
We've.
Let
our
you
know.
All
our
community
providers
know
we've
let
we've
let
individual
providers
know
our
Managed.
D
A
A
A
lot
of
tremendous
economic
push
and
pull
on
this.
That
I'm,
not
sure
we've
factored
in.
We
haven't
talked
about
the
impact
of
inflation
at
all
on
this
program,
so
I
think
then
the
next
fiscal
ask
for
the
budget
is
going
to
be
a
little
bit
alarming
and
I've
always
been
a
position
that
we
can
control
this.
A
That's
kind
of
fragile
to
begin
with,
in
terms
of
being
able
to
provide
services
and
when
you're,
only
getting
75
to
80
percent
of
your
costs.
To
begin
with,
seeing
more
patients
doesn't
exactly
make
a
good
business
model
for
financial
viability
for
health
care
providers.
So
this
is
a
lot
of
things
he
said
push
and
pull
on
this.
But
how
do
you
see
the
program
truly
in
in
the
long
run?
D
Absolutely,
and
certainly
not
quickly
enough
and
I
think
two
things
one.
The
reason
we
ran
the
third
party
liability
piece
was
to
see
who
had
actually
converted
so
27.
We
probably
want
more,
but
again
just
to
let
you
know
that
that
there
is
some
movement
there.
Probably
not
enough
I'll
agree
with
you
on
that
absolutely,
but
we'll
keep
an
eye
on
that
and
we
will
keep
reporting
to
you
all
on
that,
because
I
think
it's
an
important
number
and
so
we'll
we'll
see
where
that
goes
over
time.
D
It
reimburses
hospitals
at
the
average
commercial
rate
so
but
the
hospitals
pay
the
difference
in
and
so
we're
not
actually
taking
any
of
the
taxpayers
money
from
the
general
fund
to
to
fund
that
piece.
I
think
it's
a
good
model
I've
talked
to
a
lot
of
different
providers
to
try
to
get
that
done.
It's
it's
hard,
it's
complicated
and
so
we're
we're
still
in
some
of
those
discussions.
D
D
So
it's
how
we
do
that
when
we
talk
about
rates,
then
oftentimes
it's
more
general
fund
and
expands
Medicaid
rather
than
contracts,
and-
and
so
it
you
know
this,
but
it
is
it
is.
It
is
a
complicated
thought
process.
That's
not
the
word
I'm
looking
for
algorithm
system
there,
that's
the
right
word
how.
D
L
D
D
K
The
difficulty,
too
is
the
case.
Mix
is
different
across
the
12
months,
so
we
didn't
just
take
all
Medicaid
individuals
and
and
distribute
them
evenly.
We
we
have.
We
have
prioritized
populations
differently
within
the
unwinding
period,
so
it
is
hard
to
take
one
month
and
extrapolate
it
because
of
that
reason
we're
just
you
know
the
the
reason
their
eligibility
might
change,
for
instance,
if
they're
65
and
older
and
now
eligible
for
Medicare
they're
in
the
first
six
months
of
the
unwinding
period,
so
that
it's
it's
it's
really
hard
to
project.
K
K
F
F
Their
insurance,
so
that
they're
covering
their
insurance
and
is
there
something
that
we
legislators
can
do
to
promote
that
gradual
move
off
of
Medicaid,
perhaps
over.
You
now
know
you've
achieved
income
at
this
level
and
we
want
to
help
you
bridge
it.
But
but
our
objective
is
to
get
off
of
the
taxpayer-funded
Medicaid
and
get
on
your
own
funded
care
of
insurance.
Two.
D
Things
you
see
some
of
that
up
and
down
in
these
numbers.
These
are
really
our
projections
of
the
folks
we're
going
to
bring
into
actually
check
their
eligibility.
So
so,
when
you
look
at
these
numbers,
some
of
these
are
it's
actually
kind
of
a
very
simple
explanation
in
terms
of
why
these
numbers
fluctuate.
D
You
know
some
of
this
has
those
that
first
downturn
like
in
July
and
August.
Think
about
that
also,
as
our
Workforce,
some
of
our
folks
go
on
vacation,
some
of
the
folks
go
on
vacation,
so
we
kind
of
brought
that
number
down,
particularly
after
the
first
two
months.
So
we
could
could
work
on
that
when
you
think
of
November
and
December,
there
are
a
lot
of
vacations
in
there
and
to
try
to
do
a
high
volume
during
that
time
period,
probably
not
a
great
idea
for
us
to
even
try.
D
D
Think
it's
what
that's
as
much
an
economic
development
question
and
and
getting
folks
to
living
wage
jobs
and
supporting
folks
being
able
to
do
that
as
as
a
Medicaid
question,
so
I
I
think
as
with
all
these
systems,
it's
going
to
take
all
of
us
not
only
working
on
the
health
care
side,
because
I
think
the
health
care
is
important
to
people
have
chronic
conditions,
and
things
like
that
that
we
can
support
them
to
be
well
enough
to
work.
But
then
there
have
to
be
the
jobs
for
them
that
have
health
care
coverage.
J
D
Yeah
and-
and
there
are
folks
actually
a
lot
of
folks
in
Medicaid
who
have
disabilities?
Yes,
who
may
like
the
folks
on
the
waiver
program,
the
the
folks
who
are,
it's
called,
there's
a
whole
set
of
eligible
folks
who
are
called?
Who,
who
are
it's
a
category
so
I
apologize
for
for
how
this
sounds,
but
this
was
done
in
six
age,
blinded
disabled,
it's
called
ABD
and
those
folks
who
probably
are
not
going
to
get
employment
easily
and
may
not
have
options
that
category
in
particular
of
Medicaid
eligible
recipient
I.
J
Again,
I
know
the
answer
and
I'll
I'll
wait:
I'll,
wait
for
your
answer
and
and
you're
exactly
right
in
what
you're
describing.
However,
that's
a
very,
very
small
portion
of
the
Medicaid.
You
know
I
I
rail,
against
trying
to
use
a
small
percentage
to
justify
the
great
percentage
I
I
I
just
wanted
to
bring
that
out.
Once
may,
I
have
asked
one
last
question:
if.
J
D
That
that's
the
27,
that's
that's
what
you
ask
is
absolutely
right,
which
is
why
I'm
going
to
try
to
give
you
all
and
why
we're
going
to
run
for
those
folks
who
that
thirty,
four
thousand,
that's
why
we
ran
the
third
party
liability.
So
you
can
know
the
27
of
those
right
are
actually
getting
some
kind
of
third-party
Insurance
we're
going
to
keep
track
of
that.
It
I
think
it's
an
important
number
as
policy
makers
for
you
all
to
know,
and
an
important
number
for
us
to
track.
A
Senatorberg
before
you
ask
your
question,
let
me
just
give
the
community
a
brief
agenda
update
here,
we're
not
going
to
hear
number
five
budget
Bill
request,
80
we're
not
going
to
do
that
this
session,
when
we're
getting
late
in
the
hour.
I
want
to
make
sure
that
we
cover
the
refer
to
administrative
regulations,
just
simply
any
questions
and
then
we'll
end
with
our
presentations
from
the
folks
from
Kentucky
Association
Healthcare
facilities,
Kentucky,
nursing
association
and
kma.
So
just
wanted
to
make
you
aware
of
that
so
Senator
Berg.
L
L
H
L
Of
us
in
this
room
could
afford
a
20
000
annual
deductible
and
it's
not
doable,
and
that
is
one
of
the
problems
when
we're
looking
on.
What
do
we
do?
How
do
we
balance
this?
How
do
we
maintain
a
Health,
Care
System,
but
still
maintain
access
to
that
Health
Care
System?
It
is
a
much
more
complicated
question
than
just
expecting
people
to
get
a
job.
Most
of
these
people
already
have
jobs.
L
Is
this
a
point
for
us
to
collect
good
quality
data
as
to
whether
or
not
having
people
on
Medicaid
in
the
long
term
is
a
better
Financial
solution
for
the
state
than
not
having
them
insured
at
all,
I
mean
you
would
think
this
may
be
an
opportunity
now.
I
know,
there's
confusions,
because
we're
coming
out
of
a
pandemic.
That's
going
to,
obviously
you
know,
but
it
seems
to
me
like
we
should
take
advantage
of
this
point
to
try
to
figure
out
what
is.
A
It
going
to
do
Senator
with
all
due
respect,
I
think
you're,
asking
the
philosophical
question
here
and
I
think
it
should
be
on
the
purview
of
this
presentation.
I
think
it's
weren't
further
discussion,
but
I
don't
think
that's
a
fair
question
to
present
at
this
point
in
time,
particularly
with
the
limit
time
amount
of
time.
We
have
I.
Think
all
of
us
agree
with
your
points
but
I'm
going
to
ask
if
we
could
let's
move
on
and
have
this
discussion
at
a
different
time
or
maybe
off.
D
Absolutely
but
but
but
I
would
like
to
say-
and
it
probably
is
worthy
of
a
presentation
at
a
future
meeting.
We
work
with
our
University
Partners
there's
something
called
a
State
University
partnership
and
we
talk
to
them
about
what
it
is
that
we
might
like
to
see
them.
Their
Graduate
Studies,
look
at
right
and
so
there's
room
for
that
kind
of
discussion
on
what
what
we
might
ask
them
to
look
at.
But
that's
that's
a
whole
big
different
discussion.
A
D
M
A
Be
available
questions
afterwards,
our
last
presentation,
as
it
mentions
with
the
Kentucky
Association
Healthcare
facilities,
Kentucky
Nurse,
Association
Kentucky
Medical
Association
I've,
asked
those
folks
to
come
forward,
but
as
they're
coming
forward,
ask
our
committee
to
take
a
look
at
the
consideration
referred
administrative
regulations
which
you
had.
There
are
several
that
are
there?
Are
there
any
questions
or
concerns
or
comments
about
in
those
regulations?.
A
N
Hello,
my
name
is
Betsy
Johnson
I'm,
the
president
of
the
Kentucky
Association
of
Health
Care
Facilities.
Thank
you,
chair
Meredith,
the
members
of
the
committee
for
having
us
today.
We
appreciate
the
opportunity
to
be
here
with
our
colleagues
and
arms
arms,
the
Kentucky
Nurses
Association
and
the
Kentucky
Medical
Association
to
discuss
the
challenges
that
Kentucky
Health
Care
Providers
are
facing.
After
covet
19.
N
N
I
hope
it
isn't
lost
on
anyone.
I
don't
think
it
is
that
we
cannot
take
care
of
our
elders
without
the
people
in
our
facilities,
facilities
are
reducing
their
census.
Facilities
are
closing.
Wings
Our
member
facilities
are
trying
to
manage
during
this
time
of
Workforce
shortage
crisis.
It
is
simply
having
an
impact
on
the
health
care
Continuum
in
Kentucky,
and
what
it
simply
means
is
that
people
are
not
getting
served.
N
And
on
top
of
that,
meanwhile,
in
Washington
DC
we
are
facing
a
federal
Staffing
mandate.
I
did
receive
an
email
from
our
National
Association
CEO
this
morning,
Mark
Parkinson.
He
informed
us,
the
the
Biden
Administration
said
this
new
rule
and
hope
you
can
still
hear
me.
The
new
rule
was
supposed
to
come
out
today
because,
as
a
chair
Meredith
said
this
we're
at
the
first
day
of
summer,
they
said
it'll
be
issued
at
the
end
of
spring.
N
We
do
not
expect
that
rule
to
come
out
today,
and
in
fact,
thankfully,
our
National
Association
believes
their
lobbying.
Efforts
are
working
to
explain
to
both
the
centers
for
Medicare
and
Medicaid
services
and
the
Biden
Administration
that
there
simply
aren't
the
people
to
comply
with
this
Staffing
mandate.
So
stay
tuned.
We
do
believe
a
rule
will
be
issued,
but
we're
hoping
that
they
will
listen
to
the
the
skilled
nursing
facilities
across
this
country
that
are
struggling
to
find
that
work,
Force
and
I
want
to.
Thank
you
know.
Unfortunately,
money
is
important
and
I.
N
Think
secretary
friedlander
mentioned
this
as
well.
I
cannot
thank
this
body.
Chair,
Meredith,
chair
Moser
members
of
this
committee.
House
and
Senate
leadership
for
listening
to
us
during
the
covid-19
pandemic
and
implementing
the
29
Medicaid
rate
add-on
effective
retroactively
back
to
January
of
2020.
That
is
still
in
place
and
supported
by
both
this,
the
legislature
and
governor
beshear,
and
we
want
to
thank
governor
beshear
for
announcing
a
couple
weeks
ago
that
we
will
be
receiving
a
what's
called
an
inflationary
adjustment.
N
They
have
agreed
to
do
that.
But
meanwhile,
then
my
members
were
calling
me
and
like
Betsy,
that's
great
if
you
can
get
rebasing
of
our
Medicaid
rate,
which,
by
the
way,
has
not
been
rebased
since
2008
and
I
know
it's
a
complicated
formula
about
what
it
they
look
at
the
cost
reports.
So
they
haven't
looked
at
the
cost
reports
since,
since
2008
that's
a
long
time
ago,
I
was
at
Medicaid
in
2008.,
so
that
was
a
very
long
time
ago.
N
So
what
they're
going
to
do
is
look
at
the
2022
cost
reports
which
will
reflect
what
it
really
does
cost
to
operate
a
skilled
nursing
facility
and
then
rebase
the
rate
July
1
2024,
but
Meanwhile.
My
members
were
telling
me
we
can't
really
wait
another
year.
So
that's
when
we
started
having
these
discussions
with
the
department
for
Medicaid
services
and
that's
why
they
agreed
to
to
look
at
the
inflationary
right
and
and
were
able
to
give
us
a
significant
increase.
Starting
July
1
of
2023
and
I
know
we're
out
of
time.
A
C
Thank
you,
chairman
Meredith
members
of
the
committee
for
for
having
us
here
this
morning.
My
name
is
Patrick
Padgett
I'm,
the
Executive
Vice
President
of
the
Kentucky
Medical
Association,
and
we
represent
the
Physicians
of
the
state
throughout
the
state
and
all
Geographic
areas
and
all
Specialties
I
appreciate
the
opportunity
to
come
in
and
speak
this
morning
about
the
state
of
the
physician
Community.
As
we
come
out
of
covid
and
I
I
have
some
things
to
say,
but
I
think
the
number
one
statistic
that
I
can
show
you
about.
C
C
So
that's
a
that's.
A
big
loss
and
Physicians
not
only
treat
patients
and
try
to
maintain
their
health
and
and
make
them
healthier
and
make
them
more
productive,
but
they
are
an
economic
driver
in
the
state.
According
to
a
recent
study
by
the
American
Medical
Association
on
average
Physicians
bring
about
1.9
million
dollars
a
piece
of
economic
activity
to
a
region.
So
when
we
lost
590,
Physicians
Kentucky
lost
over
one
billion
dollars
in
economic
impact.
C
So
what
would
it
take
to
improve
the
situation?
We
actually
did
a
member
survey,
as
first
member
survey,
we've
done
in
nearly
10
years
to
talk
about
a
number
of
issues
with
our
members
and
ask
them
how
they
felt
and
we
used
a
national
group
like
so
many
others.
Do
that
work
with
other
associations
and
other
groups
to
to
help
us
with
the
survey
and
actually
conduct
a
survey.
We
did
that
last
fall
and
we've
surveyed
all
of
our
members
and
I
think
they.
C
They
had
some
very
interesting
things
to
say
about
what
was
going
on
in
the
practice
of
medicine
at
that
time
before
I
talk
about
that,
I'll
just
say
that,
according
to
our
survey,
the
responses
that
we
got
back
around
63
percent
of
Physicians
right
now
consider
themselves
to
be
employed
and
not
in
private
practice
as
a
business
owner.
That's
a
big
change
from
what
medicine
used
to
be
just
10
years
ago.
When
we
did
that
survey,
it
was
just
the
opposite.
C
It
was
about
40
percent,
who
were
employed
and
60
percent
who
were
in
private
practice.
So
that's
been
a
big
change
in
medicine.
In
that
time
we
also
asked,
however,
various
questions
about
what's
going
on
in
their
practices
and
the
physician
well-being
and
the
state
of
physicians
in
Kentucky
and
right
now,
according
to
Physicians
about
44
percent,
are
experiencing
more
stress
now
than
before
the
pandemic,
but
it's
manageable
and
doesn't
impact
their
quality
of
life
or
their
professional
life,
which
is
which
is
good
and
I.
C
Think
we've
all
experienced
a
lot
of
stress
through
the
pandemic.
However,
23
percent
say
that
they're
experiencing
more
stress
and
having
a
difficult
time
managing
that
stress
and
it
is
impacting
their
professional
satisfaction
and
their
work.
That's
nearly
a
quarter
of
physicians
in
the
state.
So
if
we
have
10
000
Physicians,
that's
around
23
to
2500
Physicians,
who
are
experiencing
stress,
that's
impacting
them.
C
We
took
that
number
and
we
wanted
to
do
something
about
it
and
we
actually
started
a
program
where
we
provide
free
and
very
private
counseling
to
Physicians
who
who
say
that
they
need
it.
We
worked
with
the
with
our
local
medical
societies
to
set
up
these
programs,
and
we
appreciate
the
passage
of
Senate
Bill
12
during
the
last
session,
sponsored
by
Dr
Douglas
that
helped
protect
those
programs
for
Physicians
and
we
hope
to
expand
on
those
programs
in
the
future.
C
According
to
our
survey,
81
percent
of
Physicians
said
that
prior
authorization
delays
access
to
necessary
care
for
their
patients,
sometimes
often
or
always,
and
of
those
61
percent,
said
that
the
main
prior
authorization
problem
was
trying
to
get
and
obtain
prior
authorizations
for
medications
that
Physicians
believe
their
patients
need.
47,
said
Imaging
and
30
percent
said
procedures.
C
Now
administrative
work
is
something
that
we
all
have
to
deal
with.
No
matter
our
profession,
but
what's
different
I
think
for
Physicians
is
the
need
to
constantly
reiterate,
explain,
cajole
and
follow
up
with
those
who
have
not
seen
or
treated
the
patient
so
that
the
patient
can
obtain
the
care
that
the
physician
knows
that
he
or
she
needs
this.
Ongoing
burden
also
keeps
Physicians
of
all
Specialties
from
treating
more
patients
and
places
in
administrative
barrier
between
the
physician
and
the
patient.
C
I
think
you
heard
Dr
White
earlier
talk
about
they're,
trying
to
develop
procedures
to
save
time
within
the
cabinet.
If
there's
another
Public
Health,
Emergency
and
Physicians
are
always
looking
to
try
to
save
time
so
that
they
can
treat
more
patients
and,
unfortunately,
that
administrative
burden
is
just
becoming
overwhelming
for
Physicians.
C
Of
course,
the
impact
on
Physicians
mirrors
the
impact
on
patients,
stress
disruptions
in
their
personal
and
professional
lives
and
the
overwhelming
frustrations
they
experience
when
they
must,
for
whatever
reason,
for
whatever
change
has
been
made,
they
might
be
on
a
drug
for
a
long
time
and
then
suddenly
they
have
to
go
through
this
prior
authorization
process
again,
because
there's
been
some
change
within
the
health
insurer
that
they
have
and
then
the
physician
has
to
go
back
through
and
explain
that
this
patient
has
been
on
this
medication
for
a
long
time.
It
works.
C
I
think
the
frustrations
that
Physicians
have
and
an
example
of
what
they
deal
with
was
recently
highlighted
in
an
article
as
a
national
article
that
actually
precipitated
a
congressional
hearing
around
one
insurer
who
it
wasn't
with
prior
authorizations.
I
would
call
it
post
authorizations
the
the
care
had
already
been
provided,
and
then
the
claims
submitted
for
payment
and
this
insurer
would
take
those
claims
and
batch
them
into
batches
of
claims,
and
then
they
would
just
be
denied
by
a
computer.
Essentially,
that
would
be
picked
them
out
and
deny
these
claims.
C
C
Oh,
we
also
shared
the
story
of
one
physician
earlier
this
year,
who
was
a
pediatrician
and
had
a
young
girl
in
her
office
as
a
patient,
and
the
girl
later
drew
a
picture
of
the
of
the
physician
who
she
was
supposed
to
draw
a
picture
of
her
hero.
So
she
drew
a
picture
of
the
physician
and
rather
than
the
physician,
using
a
stethoscope
or
even
giving
the
patient
a
shot.
C
C
We
hope
to
keep
working
on
that
and
perhaps
talk
about
doing
some
some
additional
legislation
next
year
to
see
if,
if
we
can
get
something
passed,
that
would
relieve
that
burden,
not
just
for
Physicians
but
for
patients
as
well.
We
want
to
continue
to
support
physician
Wellness
again.
Senate
Bill
12
was
very
helpful
and
we
hope
to
build
on
that.
C
So
we
would
like
to
at
least
explore
the
possibility
of
having
some
state-funded
residency
programs
here
in
Kentucky
to
try
to
get
Physicians
more
Physicians
trained
here
so
that
they'll
stay
here
three
years
ago.
I
would
have
come
here
to
say
that
Kentucky
badly
needed
more
Physicians
and
unfortunately
the
Situation's
only
gotten
worse,
and
we
really
need
to
work
to
not
only
bring
in
more
Physicians
but
keep
the
ones
that
we
already
have.
C
I.
Think
all
of
this,
my
dad
would
say,
is
a
kind
of
sounds
like
a
sad
country
song,
but
there
is
a
country
song
that
I
think
is
applicable
to
Physicians,
and
there
was
a
song
that
was
written
as
probably
his
most
famous
song
by
Waylon
Jennings
back
in
the
1970s,
and
it
was
a
song
that
was
a
lament
about
what
country
music
had
become
up
to
that
time
and
in
the
song
He
said
simply.
We
need
to
change
for
Physicians
I
Echo
that
lament
right
now
in
the
practice
of
medicine.
C
A
G
Good
morning
my
name
is
delanor
Manson
I'm,
the
CEO
for
the
Kentucky
Nurses
Association
Kentucky
nurses,
foundation
and
the
Kentucky
nurses,
Action
Coalition
I've
been
in
this
position
for
about
seven
years
and
I
bring
to
this
position.
27
years
as
a
Navy
captain
in
the
United
States
I
want
to
say
that,
on
behalf
of
the
Nurses
Association,
the
only
organization
that
represents
every
nurse
in
the
state-
that's
90,
000
nurses,
and
it's
still
not
enough.
I
want
to
again
thank
you
for
the
opportunity.
G
Nurses
comprise
53.3
percent
of
the
health
care
Workforce
engine,
but
when
most
people
think
of
nurses,
they
think
of
nurses
who
work
in
hospitals
and
nurses
work
in
so
many
other
places.
Only
46
percent
of
all
nurses
work
in
hospitals,
others
work
in
long-term
care,
Corrections,
Hospice,
Home,
Care
and
many
are
independent
practitioners.
G
I
appreciate
the
opportunity
to
review
what
the
Nurses
Association
has
done.
Pre-Pandemic,
post-pandemic
and
I
will
be
quick.
I
will
not
go
through
everything
that
we
have
done,
but
we
have
been
pretty
busy
pre-pandemic.
There
was
a
nursing
shortage.
The
pandemic
did
not
cause
the
nursing
shortage.
On
average,
the
Kentucky
nurse
is
53
years.
Old
nurses
in
the
rest
of
the
country
are
42.
G
G
While
the
pandemic
was
certainly
nothing
that
Healthcare
or
nurses
could
have
predicted,
the
Nurses
Association
quickly
assessed
the
need
and
volunteered
to
address
the
challenge.
Through
its
11
Statewide
chapters,
nurses
met
the
identified
workforce
management
opportunities
by
coming
together
to
talk
about
what
is
it
that
we
could
do
to
address
those
issues,
and
we
did
that
in
September
of
2021..
G
In
the
midst
of
the
pandemic
k
a
responded
vigorously
to
the
disasters
to
support
the
communities
in
need
in
December,
when
the
tornado
raged,
Western,
Kentucky
k
a
was
there,
we
provided
shoes,
water,
food,
glucose
monitors,
blood
pressure,
cuffs
and
more.
We
were
on
the
ground
climbing
through
the
rubble
and
wiping
away
the
tears
when
the
July
2022
flood
hit
Eastern
Kentucky
k
a
was
there,
we
paid
for
licenses
for
every
nurse
in
the
affected
area
to
help
sustain
and
maintain
their
livelihoods,
also
providing
clothes,
food,
water
and
more
for
residents
in
2020.
G
When
the
communities
needed
testing
k
a
was
there,
we
began
collaboration
with
the
health
departments
and
we
provided
tests
in
the
most
vulnerable
areas
and
and
for
the
most
marginalized
people
who
did
not
have
resources
to
get
to
testing
beginning
in
November
2020.
We
and
we
continue
to
present
to
doing
mobile
testing
events,
we've
done
over
300
to
56
unique
sites,
and
we
have
presented
over
twenty
thousand
testing
20
000
tests.
G
G
G
G
We
also
provided
listening
session.
We
did
more
than
60
listening
sessions
and
the
most
important
things
about
the
listening
sessions.
Is
we
answered
questions
about
those
who
needed
to
know
what
they
needed
to
do
to
make
good
decisions
related
to
just
testing?
We
provided
accurate
information
and
we
built
on
the
fact
that
most
people
think
and
Trust
nurses.
As
you
well
know,
the
Gallup
poll
has
validated
that
nurses
are
the
most
trusted
profession
in
the
world
and
that
has
been
for
20
years
straight
in
2020
when
the
vaccine
came
into
being.
G
We
participated
in
Staffing
and
recruiting
volunteers
for
luvax
that
was
in
Louisville.
We
had
people
from
all
over
the
country
coming
to
Louisville
to
find
out
how
we
did
the
very
first
drive
through
vaccination
clinic
I
always
staffed
it.
We
trained
our
individuals.
The
knee
was
instrumental
in
training
over
7
000
volunteers
to
include
pharmacists,
Physicians,
researchers,
retired
nurses,
student
nurses,
Nursing
School
faculty.
G
G
So,
in
looking
at
the
post-public
health
emergency
opportunities,
I
hear
from
colleagues
and
patients
daily
that
they're
tired
of
covet
and
the
covet
vaccines,
it
is
essential
that
I
state
that
covet
is
not
dead.
While
the
public
health
emergency
has
ended
with
the
Declaration
see,
the
CDC
recommends
that
individuals
ages,
six
and
older
receive
an
updated
bivalent
covet
vaccine,
regardless
of
whether
they
have
previously
completed
their
monovalent
primary
series.
G
Only
17
percent
of
kentuckians
have
received
the
bivalent
and
which
is
the
vaccine
that
can
come
combat
the
current
predominant
covet
virus
strain
of
Omicron
Omicron
currently
makes
up.
The
majority
of
all
coveted
infections
covet
is
not
tired
of
us.
In
Kentucky,
30
to
60
people
die
a
week
of
covet
and
a
thousand
a
week
die
in
the
United
States.
One
of
the
most
effective
ways
to
combat
covet
at
this
point
is
to
get
a
bivalent
vaccine.
G
So
where
do
we
go
from
here?
We
need
to
leverage
the
trust
that
the
community
has
in
nurses
and
that
we've
earned.
While
we
participated
with
the
covet
pandemic,
we
need
to
partner
with
state
and
local
officials
to
develop
community-centered
plants
to
identify
needs
and
to
develop
those
Partnerships.
G
We
need
to
address
ongoing,
increasing
vaccination
needs
and,
as
we
heard
from
the
secretary,
that's
not
just
covet,
but
all
vaccination
needs,
and
when
you
need
to
use
what
we
learned
when
we
did
the
testing
in
the
vaccination
clinics
and
the
success
that
we've
had,
we
also
need
to
work
on
the
workforce
shortage.
It
is
essential.
The
survey
that
was
done
by
the
American
nurses
Foundation
identified
that
60
of
the
nurses
nationally
state
that
they
plan
to
leave
their
jobs
in
the
next
six
months.
G
That
is
not
what
we
found
with
the
kbn
survey
in
October
of
2022.
However,
I
think
it
is
something
that
we
need
to
be
aware
of
that
nurses
are
considering
leaving
their
jobs
and
the
profession.
Kentucky
is
one
of
the
11
states
that
has
not
received
Federal
funding
for
Workforce
Center,
and
we
were
just
in
Washington
last
week
meeting
with
our
legislators
to
talk
about
how
can
Kentucky
maintain
and
get
access
to
Workforce
Center
funds.
Nurse
retention
must
also
be
a
priority.
G
G
A
O
C
O
Okay
and
just
to
follow
up
really
briefly,
I
have
a
question
from
a
doctor
who
knew
that
this
was
coming
on
and-
and
she
just
asked
that
I
mentioned-
that
employed
doctors
who
were
not
able
to
operate
and
run
their
practices
during
the
shutdown
and
and
everything
was
closed.
While
the
hospitals
were
empty
and
preparing
for
for
the
pandemic
Onslaught.
How
do
we
make
it
easier
for
independent
doctors
to
become
independent
so
that
they
have
more
flexibility
to
be
able
to
provide
for
their
patients?
Do
you
have
any
suggestions
for
that?
I
know.
C
Is
a
big
question
and
it
gets
to
the
point
of
of
Physicians
being
employed
and
why
they're
employed
I
think
that
for
Physicians
to
actually
go
out
and
open
a
medical
practice
is
daunting
right
now,
especially
for
Physicians
who
are
coming
out
of
residency,
they
have
very
little
background
and
training
in
that
and
I
think
they're,
they're,
they're
kind
of
taught
that
they're
going
to
come
out
and
and
be
employed.
We
used
to
do
a
a
seminar
back
back
in
the
day.
C
L
I
personally
had
an
experience
last
week,
three
days
on
the
phone
trying
to
get
reauthorization
for
a
medication
that
had
already
been
authorized
for
a
year
and
then
they
go
back
and
rescind
the
authorization
can't
even
tell
you
why.
So
you
don't
even
know
what
you
need
to
present
to
them
to
get
it
done.
It's
horrible
I,
so
respect
representative
Mosher
for
bringing
this
forward
and
I
really
really
hope.
We
can
work
on
this
next
session
because
if
you
want
to
remove
administrative
burdens
from
Physicians,
that
is
a
great
place
to
start.
L
There's
something
even
more
important
that
I
want
to
relay
to
you
and
to
this
committee.
I
have
had
the
opportunity
to
talk
to
first
and
second
year,
medical
students
at
University
of
Louisville,
where
I
went
to
medical
school.
They
have
asked
me
to
come
and
talk
to
them
about.
What's
happened
in
the
session,
what
laws
were
passed?
How
will
it
impact
them
and
guys?
This
is
what
they're
telling
me
and
I
don't
know
how
to
respond.
L
E
L
Need
you
to
stay
here,
we
are
going
to
lose
more
and
more
Physicians.
If
people
in
this
state
don't
wake
up
and
realize
that
they
have
their
own
ethical,
moral
obligations
to
their
patients-
and
you
can't
put
them
in
a
bind
where
they
can't
practice
medicine
the
way
they
think
it
it
has
to
be
done
and
I
am
just.
This
is
a
warning
guys,
a
big
warning
when
entire
classes
of
medical
students
tell
me
they
have.
E
M
A
F
My
age,
all
right,
I
I,
do
I
find
so
much
appreciation
that
you
have
provided
us.
The
depth
of
information
and
the
engine
in
our
nurses
well
said:
I
thought
that
was
fantastic.
My
mom's
a
nurse
for
54
years,
Mr,
Paget,
Miss,
mansion
and
also
secretary
Freelander,
I
I,
believe
in
preparing
your
body
for
what
was
kind
of
the
onslaught
and
sort
of
that
natural
battle
to
the
coveted
infection.
F
We
didn't
address
that
at
all
in
what
was
the
Public
Health
Department's
efforts
to
guide
people
on
natural
approach,
but
then
also
the
piece
that
you
had
shared
Eleanor
Manson,
that
the
nurses
also
became
a
very
trusted
Resource
as
well
Mr
Paget.
We
need
to
change
more
time
with
the
patient,
so
my
question
comes
back
to
how,
then
is
the
information
offered
to
me,
the
patient,
so
that
I
really
understand
the
vaccine
injury
reports
that
I
really
understand
how
to
make
my
most
informed
decision?
F
We
don't
know
the
ingredients
and
the
vaccines.
So
how
do
we
accomplish
that
in
order
to
make
a
decision
of
whether
we
get
a
covid
booster
or
whether
we
even
get
a
coveted
vaccine
for
the
first
time
and
what
difference
would
it
make,
and
how
does
that
compare
with
taking
your
own
Health
in
your
own
hands
and
be
proactively
healthy,
knowing
you
might
get
covered,
but
you
can
overcome
it?
How
is
that
being
conveyed?
I
didn't
hear
that
addressed
much
in
outcomes
and
results
by
taking
your
own
proactive
approach.
G
I
want
to
start
by
saying
that
that
that's
what
we
did
with
the
listening
sessions
is
that
we
went
to
the
community
wherever
the
community
was
whether,
where
they
worship
where
they
live,
where
they
work,
and
we
answered
the
questions
that
they
asked,
we
didn't
necessarily
provide
them
with
a
great
deal
of
information.
Initially,
it's.
What
do
you
want
to
know?
So
when
they
ask
those
questions,
those
were
the
answers
we
gave
them
related
to
what's
in
the
vaccine,
how
was
it
made
those
things
that
were
most
on
their
minds.
F
G
A
Thanks
for
information,
appreciate
it
and
appreciate
our
presenters
today
done
an
excellent
job.
I
know
you've
been
rushing
on
the
end
of
you
folks,
but
appreciate
what
you
bring
to
our
committee
and
we
look
forward
to
working
with
you,
our
committee
members.
Our
next
meeting
will
be
Monday
July
24th
at
one
o'clock.
P.M
agenda
will
be
forthcoming,
appreciate
everybody's
participation
today.
Thank
you.