►
Description
Interim Joint Committee on Health, Welfare and Family Services, conducted remotely.
Live Stream provided by LRC Staff
B
All
right,
well,
I,
think
we
are
all
set
to
in
the
first
medium,
the
interim
Joint
Committee
on
health,
welfare
and
Family
Services,
so
welcome
to
everyone.
I
will
go
ahead
and
call
the
meeting
to
order
and
ask
the
secretary
to
please
take
the
role
and
and
I
should
say
that
when
members
are
answering
the
roll
call,
please
indicate
whether
you
are
in
your
LRC
office
or
if
you
are
working
from
home.
C
C
B
No
sir
I
am
here
from
my
Brantford
office.
We
don't
know,
welcome
okay,
perfect!
Thank
you
just
a
few
ground
rules.
Everyone
should
be
muted
unless
you're
actively
speaking
in
the
meeting.
There
is
a
way
to
do
this.
On
your
on
your
picture
on
your
your
screen,
you
should
be
able
to
do
that.
Please
also
mute
your
cell
phones
and
dogs
and
children.
B
If
you
are
joining
us
from
home,
mark
Pulliam,
the
IT
staff
will
be
commuting
people
in
the
background
or
with
any
background
noise
and
turning
off
video
for
those
who
may
not
realize
that
their
videos
on
mark
will
do
his
best
to
keep
from
televising
anything
embarrassing.
But
please
do
your
part
and
make
sure
to
wear
pants.
If
you
decide
to
stand
up
from
your
computer,
please
use
the
chat
feature
to
notify
staff.
B
If
you
want
to
be
recognized
for
a
question
or
a
comment,
we
will
do
our
best
to
call
on
everyone,
but
if
we
don't
get
to
your
question
for
times
sake,
just
please
text
me
or
email.
Your
question
we'll
get
an
answer
for
you.
This
meeting
will
be
recorded
and
posted
in
various
places.
After
the
meeting
so
welcome
to
the
first
meeting
of
the
Joint
Committee
on
health,
welfare
and
Family
Services
today
is
June
25th
2020.
B
We
are
meeting
completely
remotely
today
in
this
highly
unusual
time.
So
please
bear
with
us
if
there
are
any
technical
difficulties
or
or
anything
unusual.
If
we
talk
over
one
another,
we're
just
going
to
apologize
ahead
of
time,
we're
going
to
try
not
to
do
that.
I
am
working
as
I
said
from
my
Frankfort
office,
but
we
do
have
members
joining
us
from
their
home
offices
and
outside
locations
as
well.
B
We
continue
to
work
diligently
during
this
curve
at
19
pandemic,
trying
to
find
ways
to
innovatively
continue
to
reach
our
constituents
and
find
best
practices
and
solutions
to
our
health
care
issues
here
in
Kentucky.
So
today
we're
going
to
hear
from
many
healthcare
providers
who
are
doing
the
same
and
they
are
finding
creative
ways
to
continue
to
provide
quality
care
to
all
Kentuckians.
B
We're
going
to
hear
about
the
impact
that
this
pandemic
and
the
ensuing
state
of
emergency
has
add,
and
it
considered
that
it
continues
to
have
on
their
practice.
We
will
hear
pros
and
cons
regulations
that
have
been
relaxed
or
adjusted
during
this
time
and
about
plans
to
move
forward
with
or
without
these
changes.
I
just
want
to
thank
everyone
for
joining
us
today
and
for
being
flexible
in
adjusting
to
this
virtual
meeting
platform.
I
appreciate
your
willingness
to
be
here
with
us
today
to
discuss
very
important
issues.
B
Although
we're
all
working
remotely
today,
our
staff
has
gone
to
great
lengths
to
make
this
work
smoothly.
So
thank
you
to
all
of
our
LRC
staff
and,
like
I,
said
just
bear
with
us.
If
we
experience
any
technical
difficulties
or
inadvertently
talk
ever
one,
another
word
we're
all
trying
to
adjust,
so
we
will
go
in
order
of
the
agenda
so
that
our
speakers
know
what
to
expect
I
think
with
that
we
will
go
ahead
and
get
started
on
our
agenda.
B
The
first
item
on
our
agenda
is
regarding
code
19,
hospital
preparedness
and
capacity
and
I
would
like
to
welcome
Nancy
Galvani,
the
president
of
the
Kentucky
Hospital
Association
and
Jim
musser,
the
vice
president
of
policy
for
the
Kentucky
Hospital
Association.
Thank
you
very
much
for
being
with
us
today
and
please
proceed.
E
We're
trying
to
make
sure
we
have
our
technology
correct
here
as
well,
so
sure
woman,
Moser
German
Alvarado.
Thank
you
so
much
for
the
invitation
to
be
here
today.
We
really
appreciate
the
opportunity
to
update
the
committee
on
the
status
of
our
hospitals
and
fighting
the
pandemic,
and
we
really
appreciate
the
interest
that
you
have
in
in
our
hospitals
and
so
we're.
We
have
a
great
story
to
tell
for
you
today.
E
Some
people
might
have
thought
that
hospitals
were
going
to
benefit
from
additional
reimbursement
or
what-have-you
from
the
spread
of
the
virus,
and
that
we
would
be
overrun
with
patients
and,
of
course,
that
is
very
far
from
actuality
that
that
has
not
happened.
So
we've
been
keeping
in
close
touch
with
our
hospitals.
They've
done
a
lot
of
work
to
quantify
the
losses,
and
so
I'm
here
to
report
today
that
Kentucky
hospital
collectively
have
suffered
financial
losses
of
1.6
billion.
E
The
benefits
coming
to
our
Kentucky
hospitals
have
been
coming
more
slowly,
so
only
53
of
the
hundred
and
eighteen
Kentucky
hospitals
have
received
enough
federal
relief
to
cover
their
losses
to
date
and
again,
we're
elite
have
quantified
losses
through
the
end
of
this
month,
so
to
mitigate
the
damage,
as
you
probably
have
read,
many
hospitals
had
to
resort
to
cost-cutting
and
have
had
to
furlough
thousands
of
their
hospital
employees,
both
in
large
and
small
hospitals.
Just
when
we
were
trying
to
fight
this
pandemic.
E
I
E
So
Kentucky
Hospital
Association
has
been
working
very
closely
with
Senator
McConnell's
office
in
our
entire
congressional
delegation
to
try
to
get
HHS
to
spend
more
of
that.
Better
relief
money
to
our
context
off
bills
and
getting
these
losses
covered
is
critical.
I
can't
emphasize
that
enough.
If
we
don't
get
these
losses
covered,
it
really
is
going
to
be
very
damaging
to
the
long-term
sustainability
of
our
Hospital.
So,
as
you
all
know,
the
pandemic
required
hospital
to
shut
down
elective
procedures
for
a
time
and
at
the
same
time
that
we
shut
down
the
elective
procedures.
E
Of
course,
that
was
done
to
make
sure
that
we
had
enough
capacity
to
meet
what
we
thought
would
be
a
surge
of
code,
19
patients,
and
that
really
didn't
happen,
because
the
state
collectively
really
did
an
excellent
job
in
flattening
the
curve
of
the
virus.
But
all
hospitals
felt
an
impact
both
are
large
and
small.
Our
rural
and
urban,
our
hospitals
that
focus
on
physical
health
that
our
behavioral
health,
our
psychiatric
hospitals,
also
felt
the
impact
of
that
response,
and
so
to
be
clear.
E
E
E
When
we
look
at
total
beds,
we
have
about
you,
know
nine
thousand
nine
hundred
fifty
nine
titles
staff
beds.
We
were
able
to
surge
that
to
add
another
ten
thousand
bed,
and
so
it
you
know,
you're
you'll,
be
hearing
from
some
other
hospitals
that
we're
looking
at.
You
know
alternative
spaces
of
where
they
could
add
bed.
So
again,
you
know
we
feel
like
we
were
well
prepared
to
handle
the
surge
you
know
had
that
happen.
E
G
E
E
You
know
we
were
in
close
contact
with
our
hospitals
in
terms
of
what
was
happening
to
volume
and
I
can
report
that
when
the
shutdown
happened,
inpatient
volume
dropped
on
average
about
40
percent
and
the
outpatient
side,
with
with
much
less
on
average,
it
was
down
about
60
percent,
but
in
some
of
the
hospitals
it
was
down
by
as
much
as
90%
I
mean
really
in
so
our
hospitals.
We
just
had
a
handful
of
patients,
sadly
I
hate
to
report
that
patients
have
been
generally
slow
to
return
to
the
hospital.
E
Now
that
the
hospitals
are
available
to
treat
the
non-emergent
cases
and
we're
providing
elective
procedures
again,
and
so
the
volume
that
we're
seeing
now
coming
back
to
the
hospitals
tends
to
be
those
patients
that
were
deferred
where
their
care
had
been
scheduled,
and
then
we
split
off.
So
we
don't
really
know
once
we
get
those
people
through
the
system,
you
know
really
what
is
going
to
be
going
forward
if
people
are
going
to
feel
comfortable
coming
back
to
the
hospital.
E
Also
I
just
want
to
clarify
for
everyone
that
when
we
talk
about
shutting
down
elective
procedures,
we're
not
talking
about
tummy
tucks
or
face
lifts,
these
are
medically
necessary
procedures
that
could
be
postponed.
You
know,
and
what
we
were
looking
at
in
our
guidance,
was
just
putting
it
off
30
days
and
was
basically
that
you
wouldn't
die
or
have
serious.
You
know
organ
failure,
or
something
like
that.
E
These
were
necessary
procedures
that
we're
talking
about
here
and
resuming
elective
procedures
is
important
not
just
for
patients,
because
again
these
are
necessary
services,
but
also
these
are
the
very
procedures
that
are
the
lifeblood
of
hospitals.
They
provides
a
positive
contribution
to
the
hospitals
in
terms
of
finances
that
sustain
a
lot
of
the
other
services
hospitals.
E
Do
it
a
lot,
and
so,
as
are
the
elective
procedures
have
reopened,
the
hospitals
are
reporting
that
their
inpatient
beds
and
their
volume
is
generally
improving,
and
so
we're
looking
at
that,
maybe
back
to
80
to
90
percent
of
precoded
level.
However,
on
the
emergency
department
side,
we
are
still
hearing
that
that
is
about
50
percent
down
from
pre
coded
levels
and
again
we're
hearing
from
our
hospitals
that
patients
are
waiting
longer
to
seek
treatment,
we're
finding
hospitals
that,
as
people
come
in
for
surgery,
it's
more
urgent
surgery
than
that
had
in
the
past.
E
We
heard
stories
that
people
have
died
from
heart
attacks
and
strokes,
who
could
have
been
treated
and
might
have
survived,
but
they
were
too
afraid
to
come
to
the
hospital.
We
also
know
when
talking
to
our
psychiatric
hospitals
that
fewer
patients
are
seeking
care,
even
though
we
know
that
mental
health
needs
have
increased
from
the
pandemic,
and
we
have
partner
with
a
Kentucky
Medical
Association,
to
create
public
service
announcements,
to
try
to
get
the
word
out
to
the
public
that
it
is
safe
to
come
back
to
the
doctor's
office
and
the
hospital.
E
And
so
one
thing
that
you
as
leaders
can
help
us
with
is
helping
us
get
that
message
out
there
that
that
you
know
people
shouldn't
be
putting
off
care
and
that
it
is
safe
to
come
back
for
medical
treatment.
And
one
of
the
very
important
lessons
that
we've
learned
in
the
past
few
months
is
the
tremendous
value
of
telehealth,
because
that
has
allowed
people
to
stay
in
their
home
and
allow
them
to
not
have
to
be
exposed
to
covin.
E
19:00
and
people
have
generally
responded
well,
I
think
they
like
having
telehealth
and
a
lot
of
the
waivers
that
we
received
were
very
key
to
allowing
us
to
provide
telehealth
Medicare
had
a
lot
of
restrictions
that
they
listed
to
even
allow,
for
example,
telehealth
to
be
provided
for
a
normal
phone
line,
and
so
we
would
like
to
certainly
work
with
the
legislature
in
looking
at
very
many
waivers
that
we
would
like
to
keep
in
place
going
forward,
but
in
particular,
specifically
around
telehealth
and
and
I.
Just
thought.
E
I'd
mention
a
couple
of
the
things
that
we
think
are
very
important
to
keep
in
place
going
forward
and
that's
allowing
providers
to
provide
telehealth
to
patients
in
their
home.
Sometimes
there's
been
regulations
requiring
patients
to
be
in
certain
locations
and
also
to
allow
telehealth
to
be
provided
both
in
rural
and
urban
areas,
because
sometimes
it
was
restricted.
E
We'd
like
to
be
able
to
use
telehealth
to
monitor
patients
in
their
home
and
we'd
like
more
and
more
services
to
be
covered
by
telehealth
and,
for
example,
Medicare
had
a
lot
of
restrictions.
They
added
80
services
to
the
types
of
services
that
could
be
provided
through
telehealth,
so
we
maintain
those
expanded
services
and
then.
E
Would
like
to
require
all
payers
to
cover
and
reimburse
for
telehealth,
including
our
Medicaid
MCO
s,
and
to
follow
the
Medicaid
rules
for
that.
So,
while
there
will
be
a
number
of
issues
moving
forward,
we
certainly
want
to
keep
telehealth
in
place
and
because
we
know
that
that
has
been
very
helpful.
So
I'll
stop
at
that
point
and
we're
happy
to
take
any
questions.
B
H
Thank
you
not
just
I.
Just
before
we
started
and
I
appreciate
that
testimony
just
to
let
our
members
know
we're
going
to
try
a
little
something
a
little
bit
different
this
year.
Obviously
we're
gonna
have
a
little
bit
more
time
today,
just
because
we're
not
having
to
deal
with
kind
of
keeping
our
rooms
clean
and
having
to
get
done,
but
we've
been
instructed
I.
H
Think
most
of
our
chair
people
have
been
instructed
to
try
to
get
these
meetings
done
in
about
an
hour
and
a
half
which,
for
those
of
you
who
are
veterans
of
Health
and
Welfare,
know
that
is
gonna,
be
a
very
difficult
task,
because
we've
had
some
meetings
that
have
gone
marathons
in
the
past.
So
we're
trying
to
keep
our
meetings
as
tight
as
possible.
H
So
we're
not
overlapping
testimony
and
hearing
the
same
thing
in
two
different
committees
for
those
of
you
who
are
members
of
health
and
welfare
and
not
members
of
Medicaid
oversight
and
want
to
hear
about
that,
would
encourage
you
to
stick
around
for
those
meetings
in
the
future
to
be
able
to
hear
information
on
Medicaid
oversight
to
get
some
of
that
information,
because
it'll
be
going
back
to
back.
But
we
just
want
to.
H
Let
our
members
know
that
that's
what
we're
gonna
be
trying
to
focus
on
is
to
try
to
divide
and
conquer
on
those
issues
that
were
not
all
focused
on
Medicaid
issues
and
health
and
welfare,
and
also
the
members
of
the
press
that
are
following
that
sometimes
would
listen
to
health
and
welfare
and
then
cut
out
for
Medicaid
oversight.
You
may
want
to
stick
around
for
both
committees
to
be
able
to
hear
information
regarding
those
issues.
H
So
thank
you
guys
for
the
testimony
on
that
information
for
our
hospitals.
Obviously
the
biggest
constraint
I
think
we've
got
we'll
hear
some
testimony
on
the
pandemic
field.
Hospitals
a
little
bit
later
on
the
things
that
we're
hearing
about
there
were
several
hospitals
that
were
risk
of
closing
as
a
result.
How
many
hospitals
right
now
do
we
have
in
the
state
that
are
at
risk
for
closing?
Have
we
lost
staff,
or
are
we
at
risk
of
losing
staff
right
now
and
just
kind
of
wondering
about
that?.
E
Previously,
we
would
consider
our
vulnerable
I
won't
say
that
they're
at
risk
of
closing,
but
their
their
finances
are
such
that
they're
in
a
vulnerable
situation.
They
fit
a
lot
of
the
criteria
for
hospital
to
have
generally
closed
across
the
country.
There's
been
a
number
of
different
outside
groups
that
look
at
hospitals
that
are
vulnerable
to
closure
and
that
that
number
tends
to
be
around
18
to
20
23
hospitals
in
Kentucky.
E
So
certainly
this
Tobit
pandemic
again,
if
those
Hospital
losses
are
not
covered
from
the
shutdown,
you
know,
that's
just
gonna
speed
up
the
process,
I
guess
it's
what
I'm
gonna
say.
So
it's
very
key
that
we
get
those
losses
covered.
But
then
again
you
know
we
don't
really
know
what
the
long-term
impacts
gonna
be.
We
don't
really
know
what
volume
is
gonna
look
like
going
forward
again
the
volume
that
we're
seeing
right
now.
E
H
How
about
staff
I
know
some
other
states
or
are
opened
up
in
a
different
level
of
opening,
and
we
are
here
in
Kentucky
and
I've
heard
from
people
who
have
threatened
to
leave.
They
go
to
neighboring
states
for
work.
Have
you
all
encountered
or
seen
that
or
of
people
for
the
most
part
stuck
around
and
are
just
waiting
for
things
to
read?
As
far
as
staff
I
have.
E
Not
heard
that
staff
is
deleting
the
state
and
we
have
talked
to
our
hospitals,
we
were
hearing
that
and
no
one
has
reported
that
I
will
say.
We
know
that
there's
other
states
that
are
trying
to
recruit
people
from
other
states
actively
because
they're,
you
know
that
I've,
Arizona
and
Texas
are
the
current
states
that
are
looking.
You
know,
they're
sending
that
information
out,
because
they're
they're,
you
know
having
spikes
and
they
have
a
staffing
problem.
So
we
are
always
worried
about
that.
But
I
have
not
heard
of
Kentucky
staff,
leaving
the
state.
J
E
J
Yes,
hello,
everyone
thank
you
for
the
great
presentation
and
I'm
so
excited
about
the
recommendation
for
continuation
of
telehealth
waivers.
We
heard
the
same
thing
yesterday
from
the
personnel
cabinet
and
state
government
and
I
think
there
will
be
a
tremendous
amount
of
support
for
this
I'm,
hoping
of
course,
that
it
will
include
extending
the
waivers
for
behavioral
health
services
as
well,
and
my
question
is:
is
this
something
that
you're
going
to
need
legislative
help
to
make
this
happen?
E
Actually
are
starting
to
go
back
and
look
at
the
telehealth
statute
in
the
state
to
determine
that
answer.
To
be
honest
with
you,
a
lot
of
it
will
depend
upon
what
Medicare
does.
They
said
a
lot
of
the
standards,
but,
of
course
our
state
laws
talked
about
coverage
for
life
private
commercial
payers,
so
we
are,
we
believe
we
need
to
relook
at
that
to
see
if
we
do
need
additional
legislative
changes.
Thank.
C
F
F
Regardless
of
the
pandemic
or
not,
I
think
it
has
provided
health
care
access
to
a
lot
of
folks
that
generally
could
not
get
to
a
provider.
I
think
we
definitely
have
to
work
on
whether
it's
regulation
statute
whatever
and
make
sure
that
we
keep
these
waivers
in
place.
I
know
in
our
communities
where
I
live,
that
in
the
rural
areas
that
I'm
sure
in
the
urban
to
a
lot
of
folks
just
cannot
get
to
a
provider,
and
this
has
created
access.
B
J
Yes,
can
you
hear
me
thank
you
and
thank
you
for
your
presentation,
what
a
catastrophe
for
our
hospitals
and
for
our
Kentucky
citizens
who
have
been
sick,
but
my
question
has
to
do
with
the
ACA
and
on
others
movements
to
repeal
it
and
put
something
else
in
place,
and
would
that
be
helpful
for
your
hospitals
or
should
we
keep
it
in
place
or
what?
What
are
your
thoughts
on
continuing
and
expanding
the
AC.
E
Of
course
we
support
coverage,
and
that
is
critical.
We
support
the
Medicaid
expansion
that
has
been
so
important
in
this
pandemic
forth,
with
people
losing
their
jobs,
and
we
appreciate
that
the
cabinet
has
been
at
the
forefront
and
you
know
allowing
people
to
be
presumptively
eligible,
so
our
hospitals
definitely
support
making
keeping
the
coverage
in
place.
We've
Kentucky's
done
a
good
job
with
that.
H
On
telehealth
I
do
want
to
make
the
comment
that
we
did
pass.
The
General
Assembly
did
pass
a
really
good
bill
a
couple
of
years
ago
and
it
provides
pay
parity
when
it
comes
to
commercial
payers.
On
that
issue,
I
had
a
discussion
earlier
today
with
some
of
our
Medicaid
MCO
s
and
we're
hoping
have
continued
discussions.
I
think
they've
seen
the
benefit.
H
Well,
here's
some
more
testimony
later
on
today
about
that
as
well,
and
hopefully
they
will
be
able
to
to
find
that
some
of
the
things
that
you've
asked
about
about
locations
of
individuals
and
where
that
is
can
be
provided.
I
think
we
settled
that
in
the
law
that
as
long
as
you're
licensed
in
the
state
of
Kentucky,
you
could
be
anywhere
in
the
world
to
provide
services
for
people
and
I.
H
Think
we've
seen
a
tremendous
that
that
really
that
program
has
been
put
on
steroids
and
we're
gonna
have
a
whole
section
today
to
talk
about
that.
I
thought
I
wanted
to
talk
about
two
of
the
things
we're
gonna
hear
a
little
bit
about
the
pandemic
field,
hospitals
just
now
in
retrospect
and
I
guess
in
for
future
education,
there's
been
the
suggestion
that,
in
the
event
that
we
needed
a
quick
surge
or
you
know,
we
had
to
have
the
capacity
to
handle
very
sick
patients.
E
To
sort
of
do
a
debriefing
to
figure
out
how
we
could
do
things
better
in
the
future,
so
you
know
I,
certainly
don't
have
the
answer
to
that.
But
that's
one
of
the
things
we
want
to
do
is
say:
what
did
we
do
right?
What
could
we
have
done
better?
What
might
be
a
better
approach
in
the
future?
I
do
know
that
in
some
areas,
our
hospitals,
actually,
you
know
designated
Possible's
a
scope
at
hospitals.
E
H
I
know:
we've
got
a
hospital
right
now,
that's
not
up
and
running
it's.
You
know
out
an
Eastern
Kentucky
Belafonte,
a
hospital
that
I'm
sure
we
have
been
available
with
lot
of
bed
space
and
a
structure
and
a
facility
that
could
have
been
used
in
that
purpose.
The
second
question
I
have
is
regarding
some
news
that
came
out
yesterday
regarding
a
negotiated
settlement.
It's
very
important
that
we
knew
was
going
to
be
a
massive
budgetary
item.
It's
been
a
lawsuit.
H
That's
been
around
that
I
know
of
since
2009
that
we
were
looking
at
a
potential
cause
of
over
400
million
dollars
and
I
know.
We
were
made
aware
I
think
yesterday
that
Senator
McConnell
was
able
to
provide
some
I
guess
a
negotiated
settlement
through
the
federal
government
to
settle
that
lawsuit
and
that
battle
fortunately,
hopefully
take
a
lot
of
the
burden
off
of
the
state
going
forward
budgetary,
wise
and
then
also
it
provides
some
relief
for
our
hospitals,
hoping
you
might
be
able
to
comment
on
that
briefly.
E
Okay,
wasn't
a
party
to
that
litigation?
It
involved
I
think
about
58
hospitals.
So
we
are
very
pleased
that
we
want
to
thank
both.
The
governor
and
Senator
McConnell
worked
very
hard
to
get
the
federal
government
to
pay
the
federal
share
of
that
settlement.
That's
very
important
and,
as
many
of
you
know
meant,
the
Medicaid
program
does
not
cover
anywhere
near
cost,
and
that
was
an
old
lawsuit.
E
Where
you
know
years
ago,
when
actually
went
back
to
2007,
where
the
cabinet
would
supply
means
like
across-the-board
arbitrary,
what
they
call
budget
neutrality
cuts-
and
it
was
it
was
very.
Very
some
hospitals
were
only
getting
paid
like
50
percent
of
their
cost.
It
was
very
bad,
and
so
the
hospitals
had
gone
and
filed
administrative
appeals
asking
the
cabinet
to
reconsider,
and
then
it
ended
up
in
litigation
and
to
Corps
found
in
favor
of
the
hospital.
E
B
Thank
you
very
much,
I'm
glad
you
asked
that
question
Ralph
our
senator
brought.
Excuse
me
that
was
my
question.
So
I
don't
see
any
further
questions
I
do
want
to.
Let
folks
know
members
know
that
if
you
want
to
join
the
Medicaid
oversight
and
advisory
committee
meeting
following
this,
you
will
need
to
log
out
of
this
particular
meeting
and
get
a
log
in
for
that
meeting,
and
you
just
need
to
send
Hillary
or
Chris
a
an
email
for
that
log
in
next,
and
thank
you
so
much
Nancy
and
Jim.
B
We
really
appreciate
your
expertise
and
and
certainly
look
forward
to
supporting
you
in
any
way
that
we
can
to
to
rectify
this.
You
know
really
damaging
situation
for
you
all
in
hospitals
across
our
state,
and
certainly
we
have
a
lot
of
interest
in
working
on
telehealth.
So
thank
you.
I
appreciate
your
testimony
today.
B
L
Thank
you
representing
Mosier
I
am
here
can
can
you
hear
me
make
sure
I,
techno,
okay,
yeah
right
perfect?
Thank
you,
know,
co-chaired
the
committee
for
having
us
here
today
as
well
the
members
of
the
committee.
We
appreciate
the
opportunity
to
come
and
light
you
on
the
situation,
rural
health,
glad
to
see
our
partners
from
KJR
here,
it's
good
to
hear
from
then
to
kind
of
what
I
want
to
provide
you
with
is
a
backdrop
of
our
membership
and
the
breadth
of
services
that
they
provide
to
kind
of
drive.
L
The
impact
of
I
have
two
CEOs
here
with
me:
they're
going
to
talk
about
their
situations
and
and
what
they've
been
facing
in
a
pandemic
like
to
stress
the
importance
of
our
membership
and
what
they
provide
to
the
health
of
the
Commonwealth
and
our
membership.
We
include
51
independent
rural
health
clinics
and
27
federally
qualified
health
centers,
with
a
combination
of
that
we
have
sites
and
over
90
plus
counties
in
the
state.
So
a
great
lot
of
those
120
counties
that
we
have
here.
L
As
far
as
patient
lives,
we
treat
over
1
million
patients
per
year
in
the
Commonwealth
over
350,000
thousand
of
those
are
Medicaid
lives
and
for
our
FQHCs
and
and
some
of
our
RHCs
they
treat
those
patients,
regardless
of
their
ability
to
pay.
They
have
a
sliding
scale
that
if
you
can't
afford
your
treatment,
then
your
treatment
is
still
provided
to
you,
so
they
don't.
They
don't
turn
anyone
away
and
have
not
turned
anyone
away.
During
the
pandemic.
They
provided
essential
care
for
many
many
Kentuckians
the
breadth
of
services.
They
offer
aren't
just
primary
care.
L
They
aren't
just
you
know
an
office
visit
with
your
doctor.
They
provide
dental
services,
they
have
behavioral
health
services,
substance
use
disorder,
treatment,
many
cases
there
are
pediatric
practices
and
OBGYN
practices
and
provide
that
valuable,
valuable
care
for
that
community
and
a
lot
of
times
we've
heard
from
the
Hospital
Association
how
they
head
of
the
vulnerable
hospitals,
our
centers,
operate
in
counties
that
don't
have
a
hospital
for
an
example,
one
of
our
FQHCs
primary
plus.
When
the
Bellefonte
clinic
went
out.
They
took
over
the
ob/gyn
services
in
Carter
County,
as
well
as
in
Mason
County.
L
They
set
up
tents
if,
instead
of
patient
flow,
instead
of
telehealth
services,
just
to
be
able
to
provide
that
care
and
a
lot
of
cases
they've
seen
an
80%
decline
in
their
revenues
and
they've
still
been
able
to
operate
and
provide
that
care.
Touching
on
that
on
the
telehealth
that
others
have
talked
about,
we
we
agree
with
what
the
Hospital
Association
says
as
far
as
keeping
those
things,
those
flavors
in
permanently
as
they've
been
a
great
benefit.
L
We've
seen
our
telehealth
services
explode
and
in
a
lot
of
cases
it's
the
only
way
that
we've
been
able
to
provide
care,
especially
on
rural
services
and
especially
the
telephone
contact,
because
the
broadband
connectivity
about
the
state
and
I
do
just
want
to
mention
that
the
we've
been
great
partners
with
the
Department
of
Public
Health.
They
have
been
very,
very
valuable
to
our
members,
providing
tbe
and
guidance
and
and
all
sorts
of
support,
so
we
do
appreciate
our
partnership
with
it
with
the
Department
of
Public
Health.
L
So
what
I
want
to
do,
then,
is
turn
it
over
to
to
our
CEOs.
We
have
Sally
Jordan
from
health
point
and
she's
in
Covington,
as
well
as
some
other
locations,
and
then
we
have
Mike
Stanley
from
grace
health,
so
I'm
gonna
go
ahead
and
ask
Sally
to
present
her
testimony.
So
as
you
get
a
first-hand
view
of
what
our
clinics
and
what
our
health
centers
have
been
experiencing,
thank
you
for
the
opportunity.
Emma.
K
Both
chairman,
Alvarado
and
I
have
been
advocates
of
telehealth
for
improving
access
to
care,
so
we
were
well
equipped.
Our
providers
evaluated
patients
on
their
schedule
to
determine
the
type
of
visit.
Each
patient
would
need
first
true
telehealth
via
the
electronic
medical
record
system,
our
secondly,
a
face
to
face
or
third,
a
telephone
call.
K
Patients
were
contacted
to
reschedule
their
visit.
Based
on
the
providers
assessment,
we
did
close
one
clinic
site
based
on
the
primary
care
providers
assessment
of
an
unusually
high
volume
of
how
risk
patients,
because
that
was
an
internal
medicine
clinic.
We've
also
adjusted
service
delivery
by
creating
a
temporary
lab
draw
site
at
one
of
our
clinics
and
implementing
CDC
guidelines
there,
as
well,
particularly
patient
separation
and
social
distancing.
K
We
able
to
identify
gaps
in
care
and,
as
a
result,
we
incorporated
the
inclusion
of
patient
vital
signs
into
the
lab
draw
visit
protocol
in
order
to
ensure
providers
had
additional
clinical
data
to
support
telehealth
visits,
since
our
patients
were
not
coming
in.
We
communicated
this
to
our
patients
through
phone
and
patient
portal.
Local
media
and
social
media
for
the
first
five
months
ended
May
31st
of
this
year,
total
visits
decreased
twelve
thousand
five
hundred
and
sixty
eight
are
twenty
four
percent.
K
From
prior
year,
total
in
person
visits
decreased
by
39
percent
from
prior
year
and
for
the
same
time,
period.
The
first
five
months
of
2020
total
patient
visit
revenues
decreased
two
million
seven
hundred
and
eight
thousand
are
thirty
to
thirty
two
percent
from
prior
year.
As
for
staffing
grace
health
had
reduction
and
our
flex
and
hours
from
lack
of
patient
visits,
but
we
had
no
mandatory
furloughs.
K
We
were
unable
to
provide
medical
or
dental
services
at
these
sites
from
March
through
May
grace
health
lost
at
least
4600
anticipated
visits
at
these
school
site.
It's
now
our
emergency
management
team,
like
I,
said,
followed
the
CDC
guidelines
for
adjustments
that
we
implemented
what's
called
table
ready,
it's
an
application
that
allows
us
to
then
text
messages
to
patients
when
they
arrive
in
the
parking
lot,
so
they
do
not
have
to
walk
into
the
clinic
to
check
in
for
their
visit.
K
K
K
We
are,
we
also
work
closely
with
our
local
health
departments
and
hospitals
on
we
were
receiving
PPE
from
the
state
until
May,
at
which
time
we
no
longer
qualified
due
to
low
volume
of
kovat
cases.
However,
as
you
well
know,
we
have
begun
to
see
an
increase
in
cases
overall
and
an
increase
in
cases
that
are
requiring
hospitalization
through
the
cares
act.
K
We
will
need
to
purchase
for
generators
to
assure
safe
storage
of
testing
supplies
and
vaccines,
because
over
the
past
year,
we've
had
two
natural
flooding
disasters
that
it
caused
outages
on
multiple
clinic
sites,
which
causes
temperature
fluctuations
and
the
storage
unit,
and
would
result
in
the
loss
of
these
supplies
and
vaccines,
and
then
the
paycheck
protection
program
alone
was
utilized
and
adequate
to
bring
back
employees
that
are
able
to
return.
However,
with
patient
visit
volumes
remaining
low
and
revenues
decrease,
the
amount
is
not
adequate.
Moving
forward.
K
Further
school-based
health
FTEs
will
return
only
if
schools
open
in
the
late
summer
or
early
fall,
though
in
closing
and
over
ninety
Kentucky
counties.
Community
health
centers
with
over
four
hundred
and
forty
sites,
are
meeting
the
challenges
of
kovat
19.
Therefore,
community
health
centers
are
one
of
your
most
valuable
assets
for
managing
any
pandemic,
and
if
I
can
answer
any
questions
that
you
might
have.
B
M
B
M
Be
I
will
be
super
brief
and
you
feel
free
to
interrupt
me
if
I'm
going
too
long,
but
I've
just
prepared
some
comment.
So
hopefully,
Family
Care
is
a
federally
qualified
health
center.
We
operate
in
Boone,
Kenton,
Campbell,
Jessamine
counties,
we
have
six
main
locations
and
twenty
school-based
locations.
We
serve
forty
thousand
patients
a
year
through
130,000
visits.
We
provide
medical,
dental,
women's
health,
mental
health
and
substance
use
treatment.
M
85%
of
our
patients
are
at
or
below
the
federal
poverty
level
of
our
40,000
patients.
25,000
are
Medicaid
recipients
and
8,000
are
uninsured.
We
valued
the
the
guidance
that
we
receive
from
the
state
and
local
health
department's
we've
had
great
working
relationships
with
them
all
along,
but
it's
been
very
strong
and
helpful.
Through
the
pandemic.
We
quickly
responded
to
the
community
needs.
M
We
began
modified
operations
and
testing
for
kovat
19
on
March
14th
added
drive
up
and
walk-in
testing,
we're
very
thankful
for
the
PPE
that
the
state
provided
to
us
until
we
were
able
to
secure
our
own
channel
of
supplies.
Well,
we've
been
able
to
provide
services
and
carry
on
our
mission.
Our
financial
stability
has
been
greatly
impacted.
The
cost
of
provides
services
has
increased.
At
the
same
time,
our
volume
and
reimbursement
have
gone
down,
I
think
to
stop
in-person
routine
visits
had
the
biggest
impact
on
our
organization.
M
While
we
were
able
to
quickly
get
telehealth
up,
Medicare
and
commercial
payers
reimbursement
reimbursed
much
less
than
they
do
for
face-to-face.
We
were
thankful
that
we
were
able
to
receive
our
Medicaid
PPS
rate
for
the
telehealth
visits,
so
many
of
our
patients
preferred
to
come
in
person
and
we
were
not
able
to
let
them
help
also
didn't
address
childhood
immunizations.
M
M
M
The
provider
director
relief
fund
was
a
lifeline
for
us,
our
revenues
down
one
eight
million
or
17%
over
the
same
period
in
2019,
and
that
was
even
though
we
were
running
well
ahead
of
2019
in
February,
so
those
few
months
have
had
a
huge
impact,
we're
concerned
about
volumes
and
revenues
into
next
year,
as
we
probably
won't
have
access
to
that
large
amount
of
funds.
Our
organization
received
2.4
million
dollars
between
federal
grants
and
the
direct
release
funds.
It's
our
hope
that
Medicaid
will
continue
to
pay
the
PPS
rate
for
telehealth,
including
non-video.
M
It's
also
been
extremely
beneficial.
That
FaceTime
was
a
permitted
mode
of
video.
Other
forms
we
tried
to
use,
we
found
were
cumbersome
for
patients
and
they
just
didn't
know
how
to
use
the
technology
and
would
just
give
up.
So
the
telephone
only
visits
also
helped.
We
do
have
concerns
about
the
ability
of
payers
being
able
to
operate
their
own
telehealth.
Both
Amit
will
further
reduce
our
volume,
but
also
for
continuity
of
care.
M
M
B
A
B
B
C
J
Thank
you
so
much
I
wanna
thank
the
primary
care
centers
and
the
qualified
health
center.
She
works
so
hard,
there's
so
many
patients
that
need
it.
You're
our
safety
net,
so
I
was
through
all
so
thrilled
to
hear
that
the
Kentucky
Hospital
Association
is
supporting
Medicaid
expansion
and
the
Affordable
Care
Act,
and
would
like
to
ask
you
the
same
question.
J
M
We
planned
on
continuing
to
serve
our
mission,
of
course,
but
it
was
going
to
put
us
in
some
financial
risk
and
and
potentially
cut
some
services
to
be
able
to
continue
doing
that
with
the
loss
of
coverage
with
those
patients
either
not
seeking
care
once
they
didn't
have
coverage
or
with
the
the
uninsured
you
know
having
to
pay
and
then
likely
most
of
those
patients
don't
pay
and
then
certainly
expanding
it
further.
We
are,
of
course,
support
of
us.
M
We
saw
a
huge
increase
when
it
was
expanded
in
the
number
of
patients
seeking
care,
and,
interestingly
enough,
that
first
year
of
expansion,
we
saw
patients
who
got
coverage
for
the
first
time
that
had
so
many
problems
and
now
are
being
seen
routinely
and
have
those
problems
under
control,
and
our
fear
is
if
it's
rolled
back
and
they
lose
coverage.
They'll,
stop
seeking
care,
they'll,
get
sick,
end
up
in
hospitals
and
actually
increase
the
cost
of
health
care
in
the
Commonwealth
anyway.
L
Representative
Barzini
add
to
that
represented
motors,
or
if
it's
okay,
if
I,
add
to
that
okay
yeah
Association
wide
our
Medicaid
population,
that
we
treat
runs
anywhere
from
forty
to
eighty
percent,
and
so
it
would
be
a
significant
impact
if
we
were
to
lose
Medicaid
expansion
for
that
population,
as
well
as
for
our
federally
qualified
health
centers.
That
would
create
a
lot
of
people
that
are
uninsured
and
the
grant
money
that
they
get
from
the
federal.
L
It
helps
that,
but
it
doesn't
cover
all
the
expenses
to
treat
uninsured
folks
and
with
their
current
situation,
of
of
their
mandatory
funding
from
the
federal
government
being
in
question
right
after
November
it
would.
It
would
really
make
a
substantial
impact
on
all
of
our
members
Association.
Why.
B
H
Just
really
briefly,
I
know
in
preparation
for
this
meeting.
There
was
some
discussion
about
some
antibody
testing
that
was
going
on
in
some
of
our
rural
health,
centers
and
primary
health
centers
in
rural
areas,
and
some
of
those
statistics
were
very
interesting
and
was
insurers.
Mr.
Stanley
are
fun
of
you.
Can
I
have
that
information
available
to
present
I
know
it's
kind
of
preliminary.
It's
only
a
small
sampling
of
patients,
but
I
thought
it
was
very
interesting
and
I
was
wondering
if
you
had
that
available
to
present.
K
What
we
did
is
we
did
as
much
research
as
we
could
on
those
that
had
the
best
you
know
test
results.
We
decided
to
go
with
salera,
so
we
are
actually
purchased
those
directly
from
them
and
reagents
the
challenges
it
was.
It
was
in
great
demand,
though,
we're
not
receiving
the
reagents
like
we
hoped,
because
they're
going
to
those
areas
that
have
you
know
greater
outbreaks,
so
I
we
feel
like
we
did
choose
a
better
system
since
it's
in
such
high
demand.
H
Testing
for
codeine
already,
my
understanding
was
been
about
almost
300
kits
that
have
been
done
and
tested
on
people
at
least
what
I
was
informed
of,
and
at
least
half
of
those
had
positive
antibodies
already
and
I
wasn't
sure
if
you
had
that
information
here,
but
that's
what
was
disclosed
to
me
so
I'm.
That's
why
I'm
curious,
if
in
a
small
sampling
for
seeing
that
what
that
indication
could
be
on
a
larger
scale
for
our
state,
you.
M
Is
Sally
Jordan
my
I'd
like
to
add
that
we
did?
We
have
not
tested
patients
yet
we're
still
waiting
for
guidelines
for
how
to
treat
patients
and
and
what
to
do
what
protocols
to
follow
once
there
is
more
research,
but
what
we
did
do
was
we
did
the
Abbott,
not
the.
We
did
the
Abbott
lab
test,
not
the
time
of
service
test,
but
we
did
the
Abbott
blood
test
and
we
tested
a
hundred
of
our
employees
who
were
working
with
Kovac
patients,
coping
positive
patients
and
working
in
our
offices
and
all
came
back
negative.
M
That
test
was
done,
starting
mid-may,
I'm,
sorry,
starting
end
of
April
all
the
way
through
mid-may,
so
it's
just
a
small
sampling,
but
that
was
across
all
counties
where
we
operate
again:
Boone,
Kenton,
Campbell
and
Jessamine.
So
we
thought
that
was
interesting.
We
had
expected
that
there
would
be
at
least
some
positives,
but
there
weren't
at
the
time.
I
know.
H
There
are
other
members
of
your
organization
that
have
have
given
me
different
results
for
their
region,
which
I
think
they're,
probably
a
bit
more
in
the
eastern
part
of
the
state
that
they
were
surprised
to
get
they
had.
They
claimed
at
least
from
what
they
had
reported
to
me
about
half,
but
again,
if
it
hasn't
been
a
system-wide
effort,
they'll
probably
get
pockets
of
results
based
on
that.
I
was
just
curious
if
you
all
had
any
data,
but
I
appreciate
that
and.
L
Senator
Alvarado,
we
do
have
a
continuous
feed
from
hersa
or
on
all
our
association
wide
testing,
and
we
can
send
that
to
you
after
the
meeting
as
well
as
we've
taken
some
surveys.
There
are
rural
health
clinics
that
that
aren't
part
of
the
her
sedated
only
the
FQHCs
are.
We
can
send
that
to
you,
representative
Moser
versus
the
committee,
if
you'd
like
I,.
H
Think
it's
important
for
the
you
know
for
the
press
to
know
that
also,
just
in
terms
of,
if
we're
you
know,
there's
a
lot
of
focus
on
vaccinations,
hopefully
being
ready
by
the
end
of
the
year
started
the
next
year.
But
if
people
have
an
antibody
response
already
and
they
have
a
positive
IgG,
which
is
the
type
for
you
know
previous
and
old
exposure,
those
people
are
effectively
vaccinated
and
that's
it
be
an
indication
at
least
of
parts
of
the
state
as
to
how
many
people
were
already
affectively
have
a
vaccine.
H
That
would
make
a
big
difference
to
give
us
an
idea
of
where
we're
at
as
a
state.
So
I
was
just
curious.
Emily's
been
a
lot
of
questions
about
the
quality
of
the
testing
and
that
sort
of
thing.
But
if
it's
a
legitimate
test,
we've
got
some
results.
I
think
it's
just
important
to
get
that
information
out
there,
but
yeah.
That
would
be
great.
If
you
have
some
of
that
information.
We'd
appreciate
that
yeah.
L
And
I'll
answer
that
question
for
the
Association:
we've
actually
started
a
network
of
purchasing
and
and
reaching
out
to
different
vendors
and
trying
to
get
those
PPE
supplies
for
them.
So
for
our
association,
where
we're
trying
to
stockpile
and
prepare
for
the
next
way
were
that
to
come,
we
hope
it
doesn't
the
word
to
come.
We're
trying
to
get
that
done.
L
You
know,
as
a
union,
as
I
mentioned,
the
Department
of
Public
Health
was
a
great
partner
for
us
and
they
were
really
very
beneficial
for
us.
In
the
beginning
of
the
pandemic
and
providing
those
supplies,
it
was
a
bit
hectic
getting
them,
but
but
they
were,
they
were
very
valuable,
but
we
decided
as
the
Association
to
try
to
make
our
own
back-up
plan
and
not
have
to
rely
solely
on
the
state
reserves.
B
M
M
M
We
might
not
be
aware
of
something
that's
going
on
and
then,
of
course,
we
are
worried
about
that,
taking
business
away
from
us,
we're
already
seeing
patients
self-select
to
stay
home
and
not
see
care
because
they're,
afraid
of
being
exposed
and
we're
afraid
that
we'll
just
further
reduce
our
volume
and
then
our
revenues
and
our
ability
to
continue
operating
at
the
level.
We
are.
M
L
I'm
not
sure
how
many
of
the
NCOs
are
doing
it
right
now.
I
think
that
that's
that
at
least
a
couple
are
we've
seen
it
more
in
the
commercial
realm
where
they
operate
their
own
telehealth
network,
and
it
is
valuable
in
some
way,
but,
like
Sally
said
it,
it
does
hinder
that
that
continuum
of
care
and
having
their
actual
primary
care
provider
get
all
that
essential
information.
G
Well,
I
appreciate
my
fans,
questions
to
Medicaid
expansion
and
I
I
do
want
people
to
get
care
access
to
care.
You
all
have
any
anecdotal
comments
on
on
the
sale
dilemma
to
see
Medicaid
Waiver
because
as
a
former
PT
who
did
home
health
disparity,
I
saw
where
the
minimal
requirements
of
20
hours
a
week.
You
know
volunteering
going
to
school
or
working
were
minimal
to
try
to
put
people
on
a
path
toward
self-sufficiency.
You
have
any
comment
on
whether
that
would
be
beneficial
in
this
realm
and
it's
not
that's.
G
B
All
right
we
can
just
touch
base
about
that
later
or
you
can
have
a
discussion,
offline,
I'm,
okay,
I,
really
appreciate
this
conversation
and
there's
a
lot
more
to
talk
about,
I,
know
and
I.
Don't
need
to
cut
anyone
short.
You
know,
I
think
that
there
are
a
lot
of
things
that
we
can
do.
It's
like
to
do
and
a
bolster
the
care
that
we're
providing
in
world
health
care
setting.
So
I
look
forward
to
working
with
all
of
you.
Thank
you
very
much
for
your
presentations.
B
Today
we
are
going
to
move
on
to
pandemic
field
hospitals.
Now
we
have
with
us
Martin
the
director
of
government
relations
for
the
University
of
Kentucky
and
Barry
Swanson,
the
chief
procurement
officer
for
UK,
and
also
Shannon
Rickett,
the
assistant
vice
president
of
government
relations
for
University
of
Louisville.
Thank
you
all
for
being
here,
I'm
going
to
go
ahead
and
mute
myself
and
the
floor
is
yours.
A
A
We've
been
asked
to
talk
about
the
coab
in
19,
alternative
care
aside
that
UK
healthcare
constructed
in
another
field
house
back
earlier
in
the
spring
I
think
when
I
first
want
to
do
is
make
a
few
remarks.
We'll
walk
you
through
the
timeline
and
then
we'll
be
happy
to
answer
any
questions
you
have
associated
with
this
alternative
care
site
that
we
developed
I,
guess
to
begin
with.
A
We're
thankful
that
we're
here
discussing
why
we
had
excess
capacity
as
opposed
to
trying
to
justify
for
while
we
were
not
prepared
and
we
were
overrun
by
Kovac
19
cases.
I
think
that
might
be
one
of
the
most
important
things
that
we
take
out
of
this
discussion
is
that
we
were
proactive
based
on
a
lot
of
information.
A
Uk
health
care
was
founded
in
57
under
the
leadership
of
former
governor
a.b
Chandler.
After
a
series
of
studies
demonstrated
that
there
was
a
crushing
unmet
health
care
need
in
the
Appalachian
region
of
Kentucky,
from
that
UK
health
care
has
grown
into
a
level
1
trauma
center.
It's
the
largest
academic
medical
center
in
the
state.
It's
comprised
of
two
hospitals
with
887
acute
care
beds.
A
A
A
As
we
begin
on
the
timeline
of
this
project,
as
the
cobra's
19
virus
began,
hitting
the
United
States
in
the
late
winter
months,
UK
healthcare
began
looking
at
the
data
and
projections
to
get
the
best
guesstimate
of
how
we
would
be
impacted.
We
used
every
available
tool
which
included
the
Center
for
Disease
Control,
helping
Human
Services
the
state
cabinet
for
Health
and
Family
Services
UK
infectious
disease
professionals,
UK
public
health
professionals.
We
consulted
with
just
healthcare
and
st.
Joe
Hospital,
as
well
as
the
Fayette
County
Health
Department.
A
At
that
point,
we
did
inform
the
Beshear
administration
of
our
plans
to
construct
400
additional
beds.
These
beds
were
going
to
be
a
bit
unique
and
that
they
would
be
transition
beds
from
sick
patients
once
they
begin
their
recovery.
It
would
be
transitioned
to
this
facility,
so
they
could
transition
back
into
the
community
I.
D
Okay,
Thank
You
Bart.
Thank
you
for
the
opportunity
to
appear
today
and
to
present
my
comments
on
on
the
process
that
was
utilized
to
set
up
our
our
field
hospital
here
in
Lexington,
as
fart
said
after
the
decision
was
made
to
to
pursue
this,
the
request
came
to
my
office,
the
procurement
division,
my
role
as
chief
procurement
officer
to
do
the
contracting
or.
C
D
D
Worked
with
you
know
we
did
our
due
diligence
did
the
research
we
ultimately
were
working
with
six
suppliers
that
were
requested
information
from
them.
We
we
narrowed
it
down
to
two
suppliers
and
ultimately
selected
EDS
as
the
only
truly
turnkey
solution
that
would
meet
our
needs,
the
other
finalists.
We
would
take
some
easing
of
various
parts
and
pieces
together
which
we
thought
was
risky
and
we
never
really
did
get
a
firm
estimate
from
them.
So
so
really
I
came
down
to
EDS
as
as
the
clear
winner
of
the
project.
D
D
We
got
the
make
sure
we
got
out
of
insurance
certificates
in
place.
We
check
to
make
sure
all
the
business
filings
were
in
place.
We
signed
a
contract
on
April
2nd
and
they
start
a
construction
on
April
3rd
and
it
was
operational
on
April
and
and
we
ultimately
into
his
operation
on
the
10th.
The
contract
coffer,
it
was
a
30-day
contract
with
rights
attorney
with
72
hours
notice.
A
Thanks
Barry
I
think
at
the
end
of
the
day,
we
were
fortunate
that
UK
helped
did
not
utilize
any
of
the
additional
400
beds
we
constructed
once
we
got
a
little
deeper
into
the
timeline
of
the
pandemic.
As
Barry
said,
the
decision
was
made
not
to
renew
for
an
additional
period
of
time
beyond
the
original
contract.
The
total
spend
to
date
on
that
project
is
about
7.3
million
dollars.
A
B
C
My
presentation
is
pretty
short,
I'm
Shannon,
Rickett
assistant
vice
president
for
government
relations
at
the
University
of
Louisville,
and
we
are
here
today
to
talk
about
the
field
hospital
in
Louisville
that
was
set
up
at
the
fairgrounds
U
of
L.
Health
did
not
play
an
active
role
in
setting
up
hospital.
C
We
were
aware
of
its
location
and
capacity
and
capability,
but
not
participate
in
the
development
or
operation
of
the
site.
At
the
time
it
was
unclear
how
pervasive
the
coronavirus
might
be
in
Metro
Louisville.
We
understand.
We
understood
that
if
our
health
system
or
other
health
system
in
the
Commonwealth
became
over
well
patience
that
their
resources
as
a
field
hospital
would
be
available.
Thankfully,
due
to
social
distancing
from
efforts
of
Public
Health
U
of
L
Health
did
not
have
to
transfer
patients
did
the
Louisville
film
hospital.
B
H
H
C
H
Part
of
the
information
that
we're
hoping
to
get
is
to
find
out
who
made
that
decision
to
do
the
one
except
obviously
UK
called
the
shot
in
Lexington.
Dr.
capilouto
did
it's
what
it
sounds
like,
but
I'm
trying
to
find
out
it
in
Louisville?
If
that
who
made
that
decision,
when
it
was
made,
how
much
money
was
being
spent?
Where
did
that
money
come
from
and
that's
what
we're
kind
of
curious
about
as
well?
C
A
Thank
you
for
the
question.
Senator
Alvarado,
good
question,
I
think.
Let's
take
a
worst-case
scenario
here.
If,
if,
in
fact
we
do
not
get
any
reimbursements
from
FEMA,
it
would
be
a
loss
to
UK
health
care,
it
would
not
impact
students
UK
help.
There
are
no
general
fund
dollars
in
the
university
side
of
healthcare.
Healthcare
is
a
self-sustaining
entity,
so
so
it
would
be
a
loss
to
UK
healthcare
and
it
would
be
an
operational
loss.
It
would
not
impact
students
in
any
level.
H
I
think
that's
a
perception
that
people
had
out
there
was
those
funds
were
gonna,
be
paid
for
by
taxpayers
and
I
guess
the
Louisville
facility.
If
the
National
Guard
had
made
that
decision
and
again
the
concern
there
becomes,
if
it's
a
state
decision
who,
on
the
state
level
and
if
their
State
dollars
being
used
for
those,
what
I
would
encourage
everybody
to
do
again?
There's
a
lot
of
other
hospitals
outside
of
the
Fayette
County
border
yeah,
the
hospitals
in
Georgetown.
H
Instead
of
it,
you
know
having
to
generate
that
if
it's
a
loss
to
the
healthcare
system
and
then
that
was
I
think
a
lot
of
the
concern
that
people
wanted
to
have
that
those
questions
answered
so
I
appreciate
you
guys
testimony
and
willingness
to
come
and
at
least
provide
us
a
few
questions
there.
A
few
answers.
O
H
H
H
So
that's
the
question
that
we
I
guess
that
people
want
to
know
is
who
called
the
shot
and
was
that
decided?
I
mean
a
lot
of
that.
Just
depends
and
again
a
lot
of
taxpayers
are
concerned
about
state
dollars,
but
FEMA
is
federally
funded
from
federal
tax
dollars
that
people
pay
as
well,
and
so
that's
what
a
lot
of
the
the
concerns.
H
If
you
have
an
idea
when
that
was
decided,
it
sounds
like
UK
signed
a
contract
on
April
10
I'm,
looking
at
the
graphs
here,
what
we
were
at
that
time,
if
it
was
done
after
the
fact
before
the
fact
I
mean
the
longer
this
went
on,
it
became
clear
that
a
lot
of
the
projections
weren't
going
to
be
accurate
on
this.
So
that's
the
curiosity
that
I
have
and
I
think
a
lot
of
people
Nui.
O
B
C
I
O
C
Me
now,
yes,
we
can.
Thank
you
very
much
senator
lady
dr.
Alvarado,
if
I
kind
of
concurrent
everything
you're
saying
about
this
and
I'm
really
a
little
bit
confused,
we
have
real
hospitals
going
in
debt,
yet
we
are
putting
money
elsewhere.
That's
not
producing
I'd
like
to
know
what
the
total
costs
were.
I
want
to
egg
you
avail
and
you
okay.
If
mr.
C
Mayes
were
sailors
to
me
and
presented
yeah,
I
mean
I'm
25
me
and
presented
I
know
it's
been
to
me
and
the
news
media
says
7
me
and
I'd
like
to
know
what
the
truth
is
to
what
was
really
true
cost.
Or
you
know.
If
we
don't
take
care
of
the
rural
hospitals,
there
won't
be
heaters
to
the
major
hospitals
and
they'll
all
Palmer
things.
A
year
ago
it
was
like
12,
rural
hospitals
that
were
having
problem,
and
today
the
Association
from
the
hospital
has
had
it
up
in
the
20s.
But
it's
gotten
worse.
D
Yeah,
the
there
was
one
additional
large
expenditure
beyond
the
built
house
set
up
and
that
was
to
purchase
the
oxygen
manifolds
that
were
required
for
the
facilities.
Some
three
hundred
twenty
one
thousand
dollars.
We
own
those
we
have
those
we
are
going
to
use
those
in
the
healthcare
enterprise,
so
so
that
investment
was
made
for
the
field
hospital,
but
that,
as
a
reef
that
is
now
and
asked
that
at
the
university
kentucky,
the.
G
D
C
C
O
Hospital
at
the
fairground,
so
yeah,
the
Army
Corps
of
Engineers,
put
a
proposal
together:
425
million
we
spent
I
think
roughly
two
something
and
I
don't
have
the
final
figures,
so
two
million
all
this
stuff
that
we
did
receive.
We
have,
we
still
have
and
will
stay
with
the
state
and
in
in
reference
to
the
rural
hospitals.
This
was
not
to
tend
to
tract
or
take
away
from
any
of
the
existing
hospitals.
This
was
purely
an
emergency
sense
to
help
the
to
have
patient
throughput
when
there
was
additional
beds
needed
in
more
acute
care
settings.
B
B
O
B
I
think
you
know
one
question
that
I
would
have
is,
and
we
heard
a
little
bit
about
the
hospital
capacity
and
preparedness
from
the
kaj
earlier,
and
so
you
know,
given
all
that
we
know
now
about
this
virus
and
of
course
we
didn't
know
anything
about
it
a
few
months
ago.
So
you
know
the
preparedness
you
know
is
understandable
to
some
extent,
but
now,
knowing
what
we
know,
do
you
anticipate
that
UK
and
you
they'll
have
the
capacity
to
deal
with
any
secondary
spike.
A
A
Should
we
get
that,
for
example,
one
of
the
things
that
was
told
to
me
yesterday
now
that
we
we
see
and
have
some
experience
with
this-
is
that
we
could
actually
double
bed
some
of
the
pavilion
a
of
the
hospital
to
increase
our
bed
space.
So
there's
some
things,
we've
looked
at
and
we've
learned
in
this
process
that
that
we
should
be
better
able
to
handle
the
spike.
Should
we
see
one
in
the
fall.
B
All
right
very
good.
Well,
thank
you.
This
has
been
informative,
I
appreciate
your
input
and
your
your
testimony,
and
we
all
know
where
to
find
you.
If
we
have
any
other
questions
so
thanks
we
are
going
to
move
on
because
we
are.
We
need
to
be
wrapped
up
by
three
o'clock
and
we
have
a
pretty
extensive
presentation
on
telehealth.
So
I
am
going
to
welcome
Paul
Brophy,
the
executive
director
for
employer
in
individual
United,
Healthcare,
I
kind
of
botched
that
United
Healthcare
Kentucky
executive,
director,
Kevin
Crawford
external
affairs
for
United
Healthcare
Kentucky.
B
We
also
have
with
us
dr.
Brent
right,
the
president
of
the
Kentucky
Medical
Association
and
dr.
Sheila
Schuster,
a
licensed
psychologist
in
the
executive
director
for
Kentucky
mental
health
coalition
and
then
Donna
vino
is
the
program
manager
for
Kentucky
telehealth
program.
We
also
have
Robert
hood
the
executive
director
for
the
awesome
office
of
health
data
and
analytics
in
the
cabinet
for
Health
and
Family
Services,
so
I'm
not
exactly
who
there,
who
wants
to
go
first.
I
know
Donna
that
you
have
a
a
point,
as
does
dr.
B
Q
And
then
we
will
talk
about
how
we
have
approached
telehealth,
since
the
program
was
moved
within
the
cabinet,
where
we
have
seen
benefits
of
telehealth
the
behavioral
health
programs
within
the
state
and
to
Medicaid
Services
within
the
state,
and
probably
end
up
making
a
few
recommendations
at
the
end
of
the
presentation.
If
that's
all
right
so
quickly.
In
2000,
we
know
that
a
Kentucky
child
health
board
was
established
by
the
General
Assembly
in
and
its
primary
purpose
was
just
certification
of
for
the
practice
of
telehealth.
Q
In
2018
Senate
bill
112
was
passed
with
an
effective
date
of
July
1
2019,
so
that
moved
telehealth
within
the
state
entity
from
being
a
board
to
being
a
program
within
the
cabinet
for
Health
and
Family
Services
on
July
1
2019
was
when
that
transition
actually
happened.
Along
with
that,
the
emergency
regulation,
Medicaid
parody
for
reimbursement,
was
established
for
telehealth
services.
On
that
same
day,
secretary
Myer
at
the
time
placed
the
program
in
the
office
of
health
day
and
analytics.
Q
Q
We
added
staff
relative
to
a
clinical
specialist
that
had
been
playing
for
quite
a
while
to
assist
with
telehealth
programs
moving
forward
any
implementation
of
it.
As
a
based
on
the
past
legislative
session,
July
15th,
approximately
the
division
of
telehealth
services
will
be
formally
established
for
via
Senate
bill
1
2
3,
and
we
anticipate
a
division
director
being
hired
and
Advisory
Council
being
established
in
the
next
quarter.
So
telehealth
was
placed
within
this
department
for
for
several
reasons,
one
with
telehealth,
especially
precoded
and
enduring
koban
privacy,
is
an
important
matter.
Q
Hipaa
regs
are
important,
obviously,
and
how
we
approach
telehealth,
what
types
of
procedures,
practices,
tools,
etc
that
make
sense
make
sense
to
the
program
are
all
important.
So
that's
why
the
chief
privacy
officer
exists
in
the
same
organization
along
with
Donna
and
the
telehealth
program.
In
addition,
health
information,
which
is
in
the
bottom
of
that
Andrew
Brett
Bledsoe,
is
my
deputy
that
is
K
high
or
Kentucky
health
information
exchange.
Q
Someone
asked
the
question
about
when
you
have
a
provider
seeing
a
patient
who
they
do
not
know
and
do
not
have
their
records
from
their
EMR
or
EHR
system.
How
do
you
get
that
background
k?
High
the
K
high
E
provider
portal,
which
has
been
revamped
with
the
the
platform,
has
come
up
10
years
a
decade
in
technology.
That's
where
you
can
see
the
clinical
information
as
a
provider
with
a
patient
in
front
of
you
and
give
them
the
best
service,
as
they
just
state
their
symptoms.
So
to
speak.
Q
Also,
how
do
we
measure
the
effectiveness
of
telehealth
and
how
effective
is
it,
and
we've
heard
wonderful
stories
about
think
that
outcomes
from
using
telehealth?
But
how
do
we
measure
it
from
from
long
range
improvement
in
health,
hopefully,
reduction
in
transportation
costs,
overall
efficiency
and
access
to
health
care,
and
that's
why
analytics
is
sitting
there
surrounding
this
program
so
that
we
can
come
out
with,
hopefully
the
full
package
in
promoting
telehealth
consistency
across
the
Commonwealth.
Q
Since
that
is
the
primary
medical
program
overseeing
within
the
cabinet,
delivering
care
and
using
telehealth,
so
Donna
and
I
sat
down
July
1
last
year
and
said-
and
we
said
well,
let's
first
look
internally
at
the
cabinet
at
programs
that
where
we
could
use
telehealth
to
potentially
reduce
expense
or
create
more
access
until
we
met
with
each
Commissioner
of
each
of
the
departments
about
various
options
and
opportunities
for
telehealth.
Second,
we
said:
there's
a
lot
to
be
done
out
there.
Q
We
actually
had
12
objectives
for
the
program
going
forward
and
then
those
12
objectives
we
said
we're
going
to
need
some
help
from
the
outside.
So
this
has
been
literally
a
very
good
partnership
of
various
departments,
cabinets
within
state
government,
as
you
can
see,
listed
on
the
infamous
steering
committee,
along
with
external
participants
from
associations
and
other
important
members
of
the
healthcare
community
in
Kentucky.
Q
So,
looking
at
the
steering
committee
at
a
high
level,
we
said:
okay,
we've
got
multiple
objectives,
multiple
subjects,
the
only
way
we're
gonna
get.
This
done
is
with
workgroups
and
literally
either.
Work
groups
have
been
staffed
from
volunteers
throughout
the
state
who
have
come
from
subject
matter,
expertise
in
various
areas,
and
you
can
see
this
list
of
the
ten
workgroup
that
are
to
be
established
or
have
been
established.
Those
groups
met
this
week.
Q
Recommendations
around
telehealth
and
all
this
was
pre
coded
19,
so
I
got
to
turn
it
over
to
Donna.
Let
her
talk
a
little
bit
about
the
work
groups
that
have
already
occurred,
and
then
we
will
lead
into
a
discussion
about
kovin
and
our
behavioral
health
services
and
toven,
and
our
medicaid
services.
N
Thank
you
so
so
much
one
of
the
workers
that
was
established
back
in
February
is
the
school-based
physical
and
behavioral
health
work
group
and
it
was,
is
led
by
either
stone
and
she
works
for
Jefferson
County,
Public
Schools.
It
has
five
subcommittees:
communications
data,
implementation,
service
coverage
and
reimbursement
and
technology.
N
We
want
to
make
sure
that
we're
covered
in
terms
of
business
associate
agreements
as
individuals
go
out
and
buy
their
HIPAA
compliant
applications.
Looking
at
criminal
criminal
penalties.
We
want
to
make
sure
that
people
understand
that
there
is
privacy
and
security
penalties
if
they're,
if
they
don't
adhere
to
those
and
that
also
there
is
an
anti
kickback
statute
and
a
stark
law
that
everyone
needs
to
understand.
Also
providing
information
like
etiquette
checklist
and
informational
tools
and
educational
tools.
N
If
they
need
specialty
care,
they
could
go
into
the
health
department
and
their
community,
which
would
save
them
a
trip
of
transporting
them
to
medical
centers
and
they
could
link
to
their
specialists
through
the
tow
through
telehealth
technologies.
We're
also
looking
at
libraries
who
are
working
with
Veterans
Affairs
try
to
determine
what
would
be
an
opportunity
for
the
libraries
and
the
veterans
to
be
able
to
connect
to
their
services.
N
Okay,
then
we
have
the
policy
development,
workgroup
and
prior
to
kovat
the
program,
and
it
was
about
I
guess
july.
2019
decided
that
we
needed
to
look
at
all
statutes
and
regulations
that
deal
with
telehealth
and,
as
we
were
getting
beginning
to
put
all
those
together,
we
have
a
document,
that's
about
21
pages
long,
and
even
though
we
have
a
parody
law
in
the
state
that
says,
coverage
and
reimbursement
shall
be
at
the
same
rate
as
face-to-face
service.
N
So
we've
got
a
document
of
like
I,
said
21
pages
there
and
we've
already
you've
already
done
about
all
those
statutes,
and
we
hope
that
document
will
be
very
helpful
as
we
move
forward,
though
this
this
workgroup
also
put
together
a
lot
of
information
in
terms
of
the
correct
coding
across
all
payers,
because
it's
all
different.
So,
if
you're
trying
to
do
analytics
from
the
back
end,
you're
you've
got
garbage
from
the
front
end,
because
you
don't
have
any
consistency
and
ER
das,
billing
or
I'm
sorry
coding,
so
we're
looking
into
that
as
well.
N
This
week
we
had
three
workgroups
convened
the
local
health
department,
workgroup,
which
I'm
leading
that
one,
the
workforce,
development,
education
and
outreach
work
group
which
diana
vice
hush,
is
a
nurse
that
we
just
hired
she's
a
telehealth
clinical,
specialist
and
masters
in
informatics,
and
an
educator
at
was
an
educator
at
BCTs.
So
she
brings
our
BTC.
I'm,
sorry
be
CTC
and
she
brings
a
lot
of
a
lot
of
knowledge
been
in
telehealth
for
about
25
years.
So
she
brings
a
lot
of
knowledge
to
our
program.
N
Q
Information,
and
in
that
she
said,
you
know,
I
really
am
very
interested
in
making
sure
the
benefits
of
telehealth
are
known
and
then
we'll
talk
about
where
the
application
of
it
has
been,
and
she
stated
very,
very
adamantly
that
telehealth
has
allowed
us
to
overcome
the
barriers
related
to
transportation.
Work
schedules,
childcare,
acute
anxiety
and
many
times
the
depression
that
comes
with
a
face-to-face
visit
and
having
to
get
to
the
spa
of
the
visit
or
the
encounter,
and
that
the
no-show
rate
has
certainly
decreased.
Q
We
had
a
report
from
the
University
of
Louisville
yesterday
in
their
tella
telecare,
as
it
relates
to
behavioral,
since
they
stated
it
was
down
and
down
into
the
single
digits
now,
and
the
outcome
of
a
telehealth
visit
certainly
surpasses
the
fact
of
no
visit
or
no
session.
The
fact
that
that
did
not
require
masks,
obviously
for
a
telehealth
visit
and
that
certain
individuals
with
illnesses
or
disabilities,
who
struggle
with
some
of
the
new
norms,
are
able
to
receive
the
services
they
need
to
receive
without
that
anxiety.
Q
Finally,
it
is
a
very
efficient
and
effective
model
and
it
has
become
preferred
by
many
who
receive
behavioral
health
services,
so
we're
going
to
talk
about
two
primary
areas
where
it
has
been
applied
in
behavioral
health
and
that
will
be
for
in
and
outpatient
services
related
to
behavioral
/
mental
health.
And
then
we
will
also
talk
about
issued
agreement.
Q
Q
Relapses
are
just
going
to
happen,
and
so
telehealth
has
become
a
very
important
tool
that
can
be
available
for
su
D
treatment.
Individual
therapy
as
an
adjunct
to
the
medication
therapy
group
therapy
in
residential
settings
where
su
D
is
treated
along
with
therapists
being
at
an
off-site
location
but
yet
being
able
to
conduct
is
obviously
a
benefit,
reduces
exposure,
decoded
and
other
types
of
encounters.
Q
The
prevention
training
by
pharmacists
to
federally
qualified
health
center
patients
has
been
done,
along
with
the
prescriptions
that
follow
after
that
being
mailed
to
their
homes,
peer
support
being
done
via
Telugu
on
telehealth
and
then
finally,
the
typical
mutual
aid
groups,
where,
where
peers
can
talk
with
each
other
individuals,
can
talk
with
each
other
in
various
support
groups,
and
we
have
found
that
actually
with
using
telehealth
and
teleplay
for
these
types
of
services.
People
with
common
experiences
are
able
to
talk
almost
globally
with
other
individuals
and
sometimes
we're
more
open
than
they
are.
Q
N
Okay
actions
and
guidance
related
to
telehealth
during
the
Cova
19
period
we
talked
earlier
I
think
it
was
Nancy
who
said
that
we
really
want
to
keep
all
these
Medicaid
waivers
and
and
executive
orders
and
bills,
and
whatever
went
through
to
provide
enhanced
services
in
place.
So
I'm,
not
gonna,
read
each
one
of
these
that
we
have
three
different
pages
with
us.
That
Medicaid
did
put
in
place
will
flip
on
through
because
I
know
where
we
don't
have
much
time.
But
I
will
tell
you
that
what
we
did
and
the
program
was,
we
went.
N
So
we're
looking
at
Medicaid
claims
data
right
now
and
we
we
looked
at
three
minutes
of
services
using
telehealth,
which
was
pre
covered
and
it
was
1
million,
ninety-three
thousand
nine
hundred
and
ten
dollars.
And
then
we
looked
at
three
months
of
services
using
telehealth
during
cope
at
19
and
it's
up
to
thirty
one
thousand,
seven
hundred
thirty
one
thirty
1
million
seven
hundred
and
ninety
one
thousand
five
hundred
in
TN,
and
we
looked
at
our
top
providers
using
telehealth
and
those
are
the
the
order
said
that
they
come
in
the
community.
N
Mental
health
centers
were
first
and,
of
course,
our
behavioral
health,
especially
groups
of
organizations,
yet
vhss
we're
second
and
third
physician
groups
and
so
on
and
so
forth,
and
then-
and
that
was
for
our
MC
OS.
This
one
is
for
fee-for-service,
so
fee-for-service
for
the
first
three
months,
which
was
pre
Kovac,
West,
95
thousand
six
hundred
and
eighty
six
before
three
months
of
services
using
telehealth
during
kovat,
nineteen
was
six
million
nine
hundred
fifty
three
thousand
five
hundred
and
seventy-five
again,
we've
looked
at
the
top
providers.
You
see
telehealth
for
fee-for-service.
N
The
number
one
thing
that
we
have
on
our
plate
is
the
reputation
for
encouraging
the
use
of
telehealth
is
connectivity,
and
you
have
already
said
it
so
many
times
to
give
you
some
statistics
in
Kentucky
Kentucky
runnings
fortieth
in
the
state
for
broadband
access.
In
total,
there
are
177
internet
providers
in
Kentucky
there
are
250
7,000
people
in
Kentucky
without
access
to
a
wired
connection
capable
of
25
megabits
download
speeds.
N
There
are
561,000
people
in
Kentucky,
they
have
access
to
only
one
wired
provider,
leaving
them
no
option
to
switch
and
another
hundred
and
forty
two
thousand
people
in
Kentucky,
but
don't
have
any
wired
internet
providers
available
where
they
live.
So
how
are
we
going
to
expand
the
access
to
health
care
using
telehealth
that
we
don't
have
the
foundation
in
in
the
state
of
Kentucky
I
know
we
have.
We
have
Kentucky
wired
and
we're
working
with
them
right
now,
but
that's
the
middleware,
so
we've
got
to
get.
N
We've
got
to
get
the
first
mile
connected
to
them.
We've
got
to
get
the
homes
connected,
but
that's
our
that's
our
big
thing
and
the
other
thing
moving
on
down
is
our
policy
and
regulations.
So
you
know:
we've
got
to
look
at
those
and
we've
got
to
make
changes
in
those
for
the
licensure
boards
to
be
able
to
accommodate
using
telehealth.
B
Okay,
I
completely
agree.
Thank
you,
I'm,
so
sorry
to
cut
you
off,
because
I
know
that
this
is
important
information.
It's
something
that
we
all
need
to
know,
though,
like
I
said,
we're
gonna
make
all
these
slides
available
to
everyone,
and
maybe
we'll
have
you
back
another
time
to
elaborate
which
we
have
more
information
from
the
workgroups
yeah.
Thank
you
so
much.
Thank
you.
Okay,
so
I'm
gonna
move
on
to
the
rest
of
the
group.
If
dr.
P
Right
Thank,
You
chairwoman,
moser,
chairman
Alvarado
and
members
of
the
committee
I've
got
prepared
remarks.
I,
know,
I,
know
we're
in
the
overtime
right
now,
so
I'm
gonna
be
keeping
those
prepared,
remarks
down
and
try
to
hit
the
highlights.
So,
if
you
will
bear
with
me
as
I
move
through
this,
you
know
if
you
think
about
Kobe
19.
You
know
how
many
people
were
really
thinking
about
telehealth.
You
know
it
was
in
unique
sectors
that
people
were
talking
about
the
unique
aspects
of
telehealth,
but
when
Kobe
19
hit.
P
What
that
really
showed
us
was
that
telehealth
became
personal
protective
equipment
and
with
social
distancing,
physicians
had
to
rethink
their
practices
completely,
because
what
we're
taught
to
do
is
to
see
patients
in
a
one-on-one
setting
face
to
face
and
what
happened
with
Kobe
19
the
best
way
to
face
that.
Paradoxically,
ironically,
was
we
needed
to
keep
patients
away
and
what
telehealth
did?
If
you
look
at
the
history
of
the
state
of
Kentucky,
we
have
some
very
progressive
legislation.
P
P
Several
topics
included
the
utilization
of
telehealth
services
and
more
than
300
physicians
completed
our
survey
with
nearly
every
corner
of
the
state
participating
in
a
wide
variety
of
specialties
represented
and
the
results
showed
their
dramatic
increase
in
patient
visits
conducted
via
telehealth,
approximately
74
percent
of
physicians
indicated
using
telehealth
during
the
pandemic,
despite
only
10
percent.
Having
used
the
service
on
a
regular
basis
before
this
represents
a
remarkable
shift
in
the
way.
Physicians
and
other
health
care
providers
deliver
care.
P
But
it's
been
mentioned
here
before
and
I'm
glad
I
have
a
friendly
audience
here
today
we
really
need.
We
were
only
able
to
do
this
because
we
had
help
with
restrictive
state
and
federal
rules,
and
even
when
we
get
came
into
the
later
stretches
of
the
concern
with
co19,
we
found
that,
despite
using
telemedicine
and
despite
the
lessening
of
regulations,
we
needed
to
still
connect
with
patients,
because
there
are
patients
out
there.
They
do
not
have
the
technology
to
connect
both
audio
and
video
to
their
physicians.
P
But
we
do
have
that
technology
in
the
form
of
bones
and
there
was
a
simple
solution:
let
patients
use
their
phones
and
but
at
no
time
did
anyone
cover
phone
calls
and
KMA
and
other
stakeholders
got
together
and
pushed
insurance
insurers
to
loosen
their
rules
so
to
the
greatest
extent
possible
and
cover
patients
talking
to
their
physicians
over
the
phone
to
their
credit.
Public
and
private
payers
eventually
recognized
this
fact
and
allowed
greater
use
of
phones
for
telehealth
services.
Physicians
and
patients
responded
and
started.
P
Connecting
all
it
took
was
common
sense
approach
operating
outside
of
the
box
during
a
crisis
and
as
a
result,
we
learned
a
few
simple
things
that
can
improve
health
of
our
citizens
and
ensure
better
care
for
the
future.
You
know
mentioned
regulatory
hurdles.
The
things
that
we
we
need
to
have
help
with
and
look
at
monitoring
going
forward
is
removing
you
know
certain
HIPPA
restrictions
has
allowed
platforms
such
as
Apple
FaceTime,
Google
hangout,
to
move
forward
with
providing
this
type
of
care,
honoring.
True,
payment,
parity,
removing
Geographic
restrictions.
P
You
know
the
real
question
is:
are
we
going
to
continue
to
use
telehealth
as
we
move
through
the
coronavirus
emergency,
and
we
are
hopeful
and
committed
to
advocating
for
such
changes,
because
there's
so
much
potential
not
only
to
increase
convenience
for
patients
but
to
keep
people
healthy
to
save
the
system,
costs
that
help
those
in
rural
areas
as
well
as
urban
settings?
Who
may
not
have
the
opportunity
to
see
a
physician
in
person?
This
is
not
about
removing
people
from
care,
but
it's
about
bringing
expertise
to
the
patients
who
need
it
within
traumatic
times.
P
Innovations
arise
that
address,
need
and
I
hope
you
use.
The
telehealth
is
an
innovation
which
will
continue
long
after
the
challenges
of
koban
19.
After
all,
the
motto
of
the
state's
coronavirus
activity
is
healthy
at
home.
What
better
way
to
be
healthy
than
to
provide
health
care
to
your
home
from
your
physician,
be
a
commonly
used
technology
in
the
form
of
telehealth
weather
and
the
pandemic
or
beyond
everyone.
Mosher
that
completes
my
remarks.
I'm
happy
to
answer
questions
and
speak
more
to
the
physician
perspective
on
on
this.
P
B
You
very
much
dr.
Wright.
We
look
forward
to
working
with
Kay
MA
and
all
of
our
providers
on
on
best
practices
moving
forward.
It
sounds
like
we
all
know
that
we
need
to
expand
telehealth.
So
thanks
for
that,
I
know
that
we
still
have
dr.
Schuster
and
and
United
Healthcare.
So
dr.
Schuster,
do
you
want
to
give
us
a
real
brief,
little
overview
of
behavioral
health
and
that
you've
seen.
I
I
They
got
none,
no
PPE
from
state
agencies,
so
they
had
to
go
immediately
to
telehealth
and
they
went
from
zero
use
of
telehealth
to
as
much
as
75
to
85%
of
their
patients,
and
we
heard
that
across
the
board
that
it
was
not
unusual
to
see
low
percentages
of
patients
initially
using
telehealth
and
then
growing
to
in
some
cases
as
many
as
90%
of
current
patients,
and
we
saw
all
ranges
of
Ages,
we
saw
ranges
of
presenting
problems.
We
saw
it
on
the
mental
health
side
as
well
as
on
the
substance,
use
disorder
side.
I
We
had
problems
with
very
young
children
and
I
think
everybody
would
would
say
that
the
elderly,
especially
with
limited
technology
patients
with
limited
cognitive
abilities
patients
with
paranoid
symptomatology,
were
reluctant
to
talking
to
a
screen
patients
with
language
and
cultural
barriers.
Some
of
our
patients
on
the
autism
spectrum,
certainly
homeless,
patients
had
difficulty
connecting
the
major
barriers.
As
we
know
in
Kentucky,
is
the
lack
of
reliable
internet
connections
and
that's
not
just
a
rural
area
problem.
I
Unfortunately,
the
other
thing
is
that
many
of
our
patients
have
limited
phone
minutes
or
data
on
their
phones
and
particularly
when
schools
we're
going
using
internet
capability
and
so
forth,
they
had
to
choose
between
using
their
limited
minutes
to
get
their
kids.
Some
instructions
were
not
available,
then,
to
connect
with
telehealth
services.
We
had
some
patients
who
were
reluctant
to
use
it,
and
we
had
some
concerns
about
privacy
and
confidentiality
when
a
kid
is
in
the
middle
of
a
home
setting
and
trying
to
talk
about
very
sensitive
issues,
that
was,
that
was
a
problem.
I
There
have
been
some
billing
and
reimbursement
issues,
but
largely
they've
been
overcome.
I
guess.
The
the
word
from
the
behavioral
health
community
is
that
telehealth
is
a
critically
important
tool
in
the
toolbox.
It's
not
necessarily
a
one-to-one
substitute.
You
still
have
to
do
lab
work.
You
still
need
face-to-face.
I
Excuse
me
face-to-face
and
some
some
settings,
but
if
you've
got
working
technology,
you've
got
a
willing,
client
and
you've
got
a
willing
provider.
You
can
typically
use
it.
We
also
found
that
there
were
some
for
whom
they
opened
up.
Adolescent
boys,
for
instance,
really
like
communicating
with
their
therapist
via
telehealth.
That's
a
unknown
entrusted
means
of
communication.
For
them
it
certainly
helped
address
transportation
issues,
lack
of
childcare,
difficulty
taking
time
off
from
work
and
so
forth.
I
I
think
we
need
to
be
careful-
and
you
mentioned
chairman
Moser
the
health
disparities,
because
telehealth
could
actually
drive
those
disparities
greater.
We
worry
about
rural
Kentuckians
being
left
out.
We
worry
about
those
in
poverty
who
don't
have
access
to
broadband
or
don't
have
access
to
smartphones
or
phones
with
with
more
data
or
minutes,
and
those
who
have
limited
English
proficiency,
who
have
a
difficulty
using
telehealth,
so
I
think
we
need
to
be
careful
about
those
overwhelmingly.
Our
clients
liked
it
and
I.
Think
dr.
Wright
would
agree.
I
think
the
hospitals
would
agree.
I
The
no-show
rate
has
practically
disappeared.
The
same
day.
Cancellations
have
practically
disappeared,
so
in
terms
of
getting
services
to
people,
telehealth
has
been
really
a
godsend.
We
have
had
clients
and
family
members
express
their
appreciation
to
the
Nami
group
through
our
consumer
peer
drop-in
centers,
particularly
with
telephone
and
I,
think
whatever
we
can
do
to
keep
telephone
as
a
covered
modality.
I
would
really
urge
us
and
we're
certainly
here
to
work
with
all
the
legislators
to
make
sure
that
that
happens.
I
I
think
we
need
to
gather
more
information
systemically
we're,
comparing
this
with
no
telehealth
and
now
telehealth
during
covin.
What
will
happen
when
we
start
opening
up
and
then
people
need
to
wear
a
mask
I
think
people
would
prefer
telehealth
to
coming
in
and
wearing
a
mask
shouldn't
be
very
difficult
to
do.
Psychotherapy
see
a
person's
face
and
you
can't
read
their
expressions
and
so
forth.
I
We
worry
quite
frankly
about
the
increased
needs
for
behavioral
health,
post,
Ovid
I.
Think
we've
all
heard
the
stories
about
increased
depression
and
anxiety
about
substance,
use
disorder,
people
in
recovery
who
have
not
been
able
to
stay
in
recovery
and
I
think
the
PTSD,
but
some
of
our
frontline
workers.
So
we
really
need
this
tool
to
be
available.
I
We
need
to
make
sure
that
the
license
your
board
they're
not
putting
requirements
in
the
get
in
the
way
we
need
to
make
sure
there's
not
that
a
requirement
for
an
in-person
first
visit,
but
behavioral
health
I
think
the
dad
and
I
think
the
outcomes
and
I
think
patient
satisfaction
as
well
as
provider.
Satisfaction
would
say
that
it
has
been
an
absolute
godsend
and
I
think
has
really
helped
address.
B
Absolutely
thank
you
dr.
Schuster,
and
we
will
absolutely
follow
up
with
you.
I
don't
know
if
Senator
Meredith
had
to
jump
off
to
chair
his
meeting
he's
been
extremely
patient
with
us.
We
are
probably
going
to
be
kicked
off
here
pretty
soon,
but
I
see
Kevin,
Crawford
I,
don't
know
if
called
burpees
here,
but
if
you
can
just
kind
of
summarize,
maybe
what
you're
seeing,
but
we
do
need
to
do
this
really
quickly.
Sorry,
yeah.
F
So
Turin
Moser
this
is
Paul
Brophy.
Can
you
hear
me?
Okay,
all
right
so
first
off
my
associate
Kevin
and
I
would
like
to
thank
chairman
Alvarado,
the
rest
of
the
members
of
the
committee
to
allow
us
to
speak
to
you
just
for
a
couple
of
minutes
regarding
telehealth
telemedicine
and
just
as
a
quick
footnote.
We
won't
comment
anything
due
to
Medicaid
because
of
the
RFP
protests,
so
not
real
quickly
and
I'll.
Try
to
summarize
some
of
my
prepared
comments,
so
telehealth
and
telemedicine
are
often
used
interchangeably
right,
but
we'll
use
the
term
telehealth.
F
We
are
referring
to
using
technology
to
provide
health
care
and
services
at
a
distance,
and
we've
heard
a
couple
of
things
about
modalities
this
afternoon.
So
for
us,
telehealth
does
include
all
types.
So
synchronous,
though,
is
real
to
two-way
interaction
and
then
asynchronous
so
store-and-forward
take
technology
where
we're
using
apps
and
mobile
phones
to
transfer
information.
We
also
use
the
term
telehealth
to
encompass
all
types
of
care.
So
at
you
know
healthcare.
F
When
we
talk
about
telehealth,
we're
talking
about
telemedicine,
tell
a
psyche
and
tell
it
pharmacy
services
and
as
one
example
of
the
services
priek
ovid,
we
had
approximately
a
thousand
of
our
in-house
doctors
using
telehealth.
Today
we
now
have
fourteen
thousand
so
from
what
we've
seen
so
far.
Telehealth
is
absolutely
here
to
stay,
even
when
we
get
back
to
normal
virtual
visits
are
expected
to
surpass
1
billion
by
2021
we're
seeing
adoption
across
all
spectrum.
F
Regarding
telemedicine,
we
have
two
methods
connecting
with
doctors.
Now
patients
are
called
to
make
an
appointment
and
that
appointment
will
will
likely
be
a
telemedicine
appointment.
We
also
offer
and
have
for
many
years,
a
comprehensive
national
virtual
network
of
physicians
that
can
help
consumers
when
they
need
care
immediately
without
an
appointment.
We
obviously
call
these
virtual
visits
and
I
wanted
to
point
this
out,
because
it's
very
simple
for
a
patient
to
make
an
appointment.
Patients
can
see
and
speak
to
a
doctor
anywhere
anytime
mobile
device
or
computer.
F
No
appointment
is
necessary
and
a
visit
usually
takes
less
than
20
minutes.
Doctors
are
able
to
diagnose
a
wide
range
of
non-emergency
medical
conditions
and
prescribe
medications
if
needed.
About
70%
of
these
visits
are
related
to
colds
fevers
and
the
cost
is
typically
around
50
dollars
on
average
versus
190,
Virgen
care
or
or
upward
of
1,700
for
any
ER
visit,
as
I
mentioned
before,
we
also
have
Telus
site
capabilities
that
are
worth.
F
Early
claim
data
indicates
a
significant
shift
in
use
of
telehealth
for
behavioral
health
care,
normally
about
2%
of
all
behavioral
health
claims
optim
receives
or
for
telehealth
by
the
end
of
March.
We're
going
to
estimate
that
about
33%
of
our
behavioral
health
care
through
optim
will
be
through
a
teller
help
visit.
We
do
also
services
to
patients
seeking
treatment
in
community
mental
health
centers
through
our
genoa,
pharmacy
service
and
I
want
to
mention.
We
actually
have
nine
Genoa
pharmacies
here
in
the
Commonwealth.
I
also
want
to
mention
our
remote
patient
monitoring
capabilities.
F
Remote
patient
monitoring
allows
frequent
engagement
with
people
who
need
a
bit
more
care.
This
typically
involves
sending
out
equipment
to
our
patients
like
thermometer,
scales,
iPads,
etc.
So
we
can
collect
health
information
for
patients
to
monitor,
comply
with
medications
and
sure
we
have
an
early
warning.
If
health
is
deteriorating,
we
tailor
this
technology
to
clinical
pathways
to
match
the
patient
and
their
condition.
So,
while
Koba
19
struck,
we
we
identified
patients,
we
felt
should
not
miss
any
doctor
care.
Think
about
diabetics.
F
As
an
example,
we
sent
them
remote
monitoring
kits
to
ensure
they
got
their
prescriptions,
but
he
would
stay
healthy
when
the
doctors
offices
were
closed.
So
I
mentioned
the
Teachers
Retirement
System.
This
is
a
very
important
partner
to
us
here
in
the
state
and
they
began
pushing
for
telehealth
services
years
ago.
It's
been
a
strategic
goal
for
TRS
to
increase
virtual
visits
and
telehealth
telehealth
EULA's
ation,
especially
for
those
retirees
in
rural
areas
that
we've
all
been
talking
about
today
to
ensure
access
to
care
and
providers.
So
these
efforts
included
newsletters
mailers
campaigns.
F
B
Absolutely
thank
you
so
much
and
I
appreciate
your
brevity.
I
know
that
you
know
everything
that
kind
of
got
squished
here
at
the
end,
but
I
would
love
to
I
think
they're
going
to
be
plenty
of
opportunities
to
talk
to
all
of
our
health
care
providers
and
our
our
third-party
payers
in
the
future,
about
about
telehealth
and
and
all
that
we
can
do
to
really
bolster
this
or
patients.
So,
thank
you
very
much
for
being
here
and
thanks
everyone
for
your
patience
where
we're
gonna
wrap
this
up
quickly.
B
C
B
Thank
you
think
what
else
it
did
not
record
their
presence.
Okay.
Well,
thank
you
very
much.
We
are
going
to
move
it
into
the
Medicaid
oversight,
advisory
committee
right
now,
I
think
so.
I
will
entertain
a
motion
to
adjourn,
see
no
further
business
and
I
want
to
thank
everyone
again.
Thank
you.
Okay.