►
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
A
Okay,
next,
do
we.
C
A
Corn
for
the
minutes:
next,
we
have
approval
of
minutes
from
February
15th
meeting.
Do
I,
hear
a
motion.
A
We
have
a
motion
in
a
second
all
approval,
say:
aye
hi
opposed
like
sign
minutes
are
approved
first
up
this
morning
we
have
commissioner
stack
and
Mr
Tuggle
to
discuss
the
proposed
replacement
of
our
state
lab.
A
This
is
very
important
to
me.
I'll,
give
you
a
little
background.
I
taught
31
years
for
a
high
University
and
I
taught
microbiology
and
psychopharmacology
and
I
know
the
importance
of
this
lab.
So
I
know
down
here
that
Wheels
turn
slowly.
A
D
Well
good
morning
and
thank
you
Mr
chair
for
the
opportunity
to
be
here
I,
my
apologies
for
my
froggy
voice,
though
I
feel
fine
I'm
not
fully
over
the
laryngitis
I
have
last
week.
So
this
is
a
really
important
topic,
as
you
identified
and
I'm
very,
very
grateful
for
the
opportunity
to
begin
this
discussion
today.
So
I'm
going
to
go
through
a
very
short
slide
deck
and
highlight
that
with
some
additional
comments
and
then
look
forward
to
any
questions
you
may
have.
D
So
this
is
a
photograph
I
took
a
week
ago
of
our
state
Central
laboratory
building
for
any
of
you
who
know
where
Sage
is
it's
right
across
the
street
from
Sage
right
off
the
exchange,
it's
a
30
plus
year
old
building.
It
has
multiple
state
government
tenants.
It
only
has
state
government
tenants
to
my
knowledge.
They
have
the
the
Kentucky
Department
for
public
health,
both
our
division
of
laboratory
services,
which
is
our
much
larger
lab
and
also
our
radiation.
D
D
These
are
some
examples
of
KRS
statutes
that
specify
requirements
that
the
Commonwealth
must
provide
for
through
the
Cabinet
for
Health
and
Family
Services
through
its
department
for
public
health
laboratory
division.
Some
of
these
things
are
really
Central
to
our
operations.
The
biggest
and
most
obvious
now
go
into
some
numbers
for
these
services.
On
the
next
slide,
we
do
all
newborn
screening
for
every
newborn
child
in
the
Commonwealth
of
Kentucky.
There
is
no
in-state
alternative
to
that.
D
If
we
were
unable
to
do
this,
we
would
have
to
send
those
specimens
out
of
state
to
another
Lab
at
substantial,
elevated
cost
and
degraded
turnaround
time
we
also
provide.
We
are
the
only
biosafety
level
3
laboratory
in
the
Commonwealth
of
Kentucky.
To
my
knowledge,
there
are
only
about
200
of
these
in
the
entire
United
States.
The
only
level
higher
is
a
bsl4
and
I
think
there
are
only
two
of
those
one
in
New
York
and
one
at
the
CDC
in
Atlanta.
That's
where
Ebola
patients
would
go
or
be
tested.
D
Otherwise,
these
200
BSL
three
labs
are
the
ones
that
would
do
white
powder
investigations
if
you're
worried
about
Anthrax
or
ricin
or
some
of
those
other
toxins.
I
think
we
can
all
appreciate
the
enhanced
measures
that
have
to
be
taken
to
ensure
that
the
people
running
those
tests
and
the
people
near
them
are
not
exposed
to
those
contaminants.
We
also
do
lead
testing.
We
do
milk
safety
testing.
You
know
for
milk
throughout
the
Commonwealth.
D
We
also
that's
not
on
here,
but
we
are
a
lab
that
can
enable
other
Hospital
labs
and
other
medical
labs
to
be
certified
for
new
tests.
So
we
have
the
ability
to
when
an
outside
lab
brings
on
certain
kinds
of
tests
to
be
the
one
that
verifies
or
validates
the
accuracy
of
their
results
so
that
they
can
go
into
production
for
other
tests.
D
So
we
provide
a
wide
array
of
important
services,
including
genetic
sequencing,
polymerase
chain,
amplification
tests
for
various
conditions,
really
sophisticated,
culturing
and
other
types
of
testing
for
pathogens
that
are
rare,
uncommon
and
for
which
hospitals
and
other
medical
labs
would
not
be
able
to
provide
they'd,
never
have
enough
volume
to
justify
bringing
that
capacity
in-house.
So
you
have
to
have
a
centralized
State
lab
to
provide
those
services.
So
it
is
quite
literally
an
Irreplaceable
service.
I'll
comment.
D
There
are
other
states
in
our
Southern
regions
who,
over
the
last
three
years,
have
had
our
instances
where
their
laboratory,
because
of
data
technology
or
insufficient
capacity,
had
to
reach
out
to
their
border
states
to
provide
testing
services
for
the
residents
of
their
own
State.
And
of
course,
we
work
very
collaboratively
we're
all
here
in
the
public
health
world
and
in
the
public
health
laboratory
world
to
help
and
support
each
other
as
needed.
D
Here's
drilling
down
just
a
little
bit
more
for
the
our
actual
division
of
laboratory
services.
There
are
in
2022
there
were
52
308
newborn
screening
samples
performed,
but
we
test
for
over
well,
not
over.
We
attest
for
55
inborn
errors
of
metabolism.
These
are
both
rare,
but
they
are
also
catastrophic
if
not
found
early.
These
are
the
kind
of
things
where,
if
you
don't
change
a
newborn's
diet
or
take
other
interventions,
they
can
have
irreversible
harm
caused
quickly.
That's
why
it's
required
that
this
be
performed
on
all
newborns
again.
D
It
is
such
a
low
volume
frequency
of
positive
tests
relative
to
the
total
number
that
individual
birthing,
centers
and
hospitals
couldn't
bring
this
in
home
because
in
order
to
validate
each
one
of
those,
55
tests
would
be
just
too
much
burden
of
work
for
for
such
a
low
positivity
rate,
so
it
has
to
be
centralized.
So
this
means
that
for
these
53
308
newborns,
we
provided
nearly
3
million
total
tests
to
support
that
screening
program.
D
Additionally,
this
is
the
biosafety
level
3
laboratory
work,
I'm
talking
about
that's
called
the
federal
select
agent
testing
program
and
there's
a
network
of
these
labs,
and
we
are
one
of
them.
In
2022
we
tested
4024
samples
for
a
total
of
55
755
different
tests.
So
if
you
have
a
white
powder
that
pops
out
of
an
envelope
at
some
government
official,
you
have
to
test
for
a
variety
of
things:
Anthrax
ricin,
perhaps
some
other
bioterrorism
agents.
That's
why
you
have
4
000
samples,
but
55
000
tests,
because
you
have
to
test
for
multiple
different
contaminants.
D
Those
testing
facilities
require
things
like
specialized
hoods
to
keep
everything,
secure
and
isolated
from
the
people
doing
the
test,
often
airlock
type
procedures
where
you
go
through
an
entry
room
and
then
into
a
testing
room
and
then
back
out
through
the
entry
room
and
out
to
the
external
environment.
So
the
contaminants
are
not
spread,
they
are
very
highly
regulated
very
specialized
and
there
is
no
alternative
within
the
Commonwealth
for
those
services
and
then
our
microbiology
Services
include
Advanced
testing
for
bacteria
viruses
that
include
various
specialized
culture
techniques
and
also
genomic,
sequencing
and
you'll.
D
D
So
again,
here's
the
picture
of
the
building
when
I
came
in,
as
commissioner
I
think
we
all
we
all
know,
I
got
a
journey
that
none
of
us
expected.
We
all
shared
that
Journey
when
I
started
on
February
10th,
it
was
just
a
month
later
we
had
our
first
covet
patient
in
my
life
as
a
commissioner
unfolded
very
differently
than
any
of
my
predecessors
along
the
way,
while
being
distracted
by
covet.
D
Iwatch
devices
that,
because
they're
so
old,
bring
rust
with
the
water
and
obviously
we
don't
want
people
to
wash
their
eyes
with
Rusty
water,
decontaminating
showers,
where
whatever
reason
when
they
built
these
there's,
47
or
so
of
them
in
this
building,
they
didn't
put
any
drains
underneath
them.
D
There
are
a
number
of
these
just
inconsistencies
that
make
no
sense,
including
that
those
showers
are
outside
the
laboratory,
and
you
would
never
want
to
do
that.
To
have
the
contaminated
person,
leave
the
secure
lab
and
go
into
a
hallway
you'd
want
to
have
the
shower
in
the
in
the
laboratory
to
contain
the
contaminant.
D
D
It
is,
as
representative
Bentley
commented,
the
wheels
of
state
government
often
move
slowly
in
order
to
address
something
like
this.
We
have
to
have
a
six-year
Capital
plan
for
our
agency,
the
department
for
public
health.
We
have
to
then
have
all
of
our
agencies
roll
up
to
a
cabinet
and
get
into
the
cabinet's
capital
spending
plan,
and
then
the
governor
has
to
look
at
the
totality
of
all
the
needs
for
the
executive
branch,
and
then
you
have
to
get
into
the
governor's
spending
plan
which
is
embodied
in
his
biennial
budget
proposal.
D
It
was
tough,
though,
because
when
I
became
aware
of
the
problems
and
finally
learned
enough
about
the
process
to
start
engaging,
it
was
the
summer
of
2021
in
order
to
start
a
project
like
this,
you
have
to
get
a
feasibility
study
from
a
third
party,
so
you
have
to
go
through
the
finance
cabinet.
Of
course
they
have
procurement
requirements
to
get
these
vendors,
and
so
we
did
that
and
we
did
in
a
really
expedited
manner
from
about
August
until
December
and
just
that
four-month
period.
D
D
You
know
the
hearing
that
it
otherwise
would
have
had
had
things
unfolded
in
a
more
normal
way
where
we
had
this
in
the
process
earlier
in
2021,
where
the
house
budget
committee
had
access
to
that
information
earlier
in
the
process,
but
it
did
make
it
into
the
governor's
proposal,
and
so
you
will
see
this
spring.
This
is
in
the
department
for
public
health
Capital
proposal.
D
It
will
be
in
the
cabinets
proposal
and
it
will
be
in
the
governor's
budget
for
the
2022
biennium
and
so
that
the
final
stop
on
this
train
is
the
legislature,
hopefully
taking
action
on
this
and
again
I'll
share
some
additional
reasons
why
it's
so
important.
So
this
is
clipped
that
little
Central
laboratory
building
that's
clipped
from
the
feasibility
study.
It's
two
or
three
hundred
pages
long
and
anyone
wants
to
read
it.
D
D
One
is
there's
not
enough
space
to
safely
and
effectively
conduct
the
work
we've
grown
in
the
capacity
you
can
imagine
that
the
laboratory
equipment
that
they
had
in
1990
in
the
about
the
time
this
was
built
in
the
laboratory
equipment
we
have
now
is
not
quite
like
the
Stone
Age
is
to
Star
Trek,
but
it's
kind
of
along
that
Continuum.
Our
machines
can
do
stuff.
D
We
could
never
have
imagined
at
the
time
the
current
building
was
built
and
that's
created
real
problems
that
lead
to
the
secondary
issue
here,
which
is
a
lack
of
proper,
proper
stability
of
environmental
conditions.
The
HVAC
systems
that
heat
cool
and
manage
the
humidity
in
the
building
are
not
up
to
the
task.
So
when
you
go
on
our
newborn
screening
lab
providing
those
nearly
3
million
tests
a
year
with
really
quick
turnaround
time
for
the
birthing
centers
in
the
state.
D
There
are
stainless
steel
vents
from
the
machines
up
through
the
ceiling
of
the
building
up
out
into
the
roof,
to
try
to
vent
heat
out,
because
the
building's
HVAC
system
cannot
maintain
proper
temperature
in
there
in
a
different
room,
because
they've
tried
to
calibrate
things
to
to
provide
for
environmental
conditions
when
you
open
the
door,
it's
almost
like
you
open
a
wind
chamber
and
any
loose
papers
on
the
desk
in
the
lab.
Get
blown
around
I.
Think
we've
got
that
a
little
bit
better
now,
but
that's
a
recurring
problem.
D
We
have
a
lab
that
is
called
the
gravimetric
room,
metler
balances
for
those
of
you.
Remember
your
Chemistry
classes
in
high
school
and
college.
It
has
to
have
very,
very
precise
conditions
to
do
that.
Delicate
work.
There
are
dehumidifiers
fans
and
other
devices
in
that
room
to
attempt
to
keep
it
at
the
right
temperature.
D
But
when
we
get
to
the
heat
of
the
summer,
we
can't
maintain
the
right
conditions,
so
the
lab
go
that
lab
goes
offline
within
our
bigger
lab
that
endangers
our
accreditation
by
national
accrediting
bodies,
because
you
can't
be
offline
if
you're,
the
only
state
or
the
only
lab
doing
these
things
in
your
state
and
still
maintain
your
accreditation.
So
there
are
significant
problems
that
cannot
be
fixed
for
the
really
high
Precision
needs
of
the
current
modern
day
equipment
in
the
building,
as
it
currently
exists.
D
One
other
thing
of
note
and
when
I
show
one
of
these
later
slides
out,
there's
a
maybe
the
next
one
yeah.
So
here's
here's
the
plot
for
the
land
that
we're
built
on,
and
it's
small
and
hard
to
see,
but
the
the
gray
area
and
the
top
your
top
right
there
is
the
existing
footprint
of
the
current
lab
and
the
circle
on
the
front
is
the
parking
area.
D
The
proposed
new
laboratory
would
be
that
brighter
white
rectangle
on
the
back.
The
reason
this
is
helpful,
in
addition
to
just
showing
you
where
the
new
building
would
go,
is
that
the
current
building
does
not
have
redundant
HVAC
systems,
which
you
would
never
tolerate
in
a
lab
of
this
sort.
Today,
you
should
have
backup
systems,
so
if
the
primary
goes
down
secondaries
can
take
over.
D
So
this
just
happened
over
the
holidays
that
the
holidays
we
just
concluded
where
we
were
down
to
only
one
operating
Chiller
or
cooler
for
that
entire
big
building
and
they
had
to
bring
in
rental
chillers
and,
thank
goodness
we
were
able
to
get
them.
D
This
was
literally
over
the
Christmas
or
New
Year's
holidays,
so
trying
to
get
on
a
state
holiday
and
get
all
this
stuff
in
on
the
holiday
was
tough,
but
thankfully
we
averted
any
downtime
or
any
machines
going
out
of
Tolerance,
because
if
the
machines
go
out
of
tolerance
or
the
reagents
get
too
hot,
you
either
have
to
discard
stuff
and
or
recalibrate
the
machines
and
revalidate
everything.
So
it's
a
big
deal
by
building
a
new
structure
behind
the
current
structure,
the
new
building
will
become
the
backup
for
the
current
building
and
vice
versa.
D
So
they
will
have
separate
independent
HVAC
system
for
the
new
building.
That
will
have
the
capacities
to
support
the
main
building
in
need
of
a
backup
and
should
the
primaries
for
the
new
building
go
offline.
The
old
building
will
be
able
to
support
the
new
building
because
they'll
interconnect
the
two
HVAC
systems
now
remember,
I
told
you
there
are
other
tenants
in
the
old
building.
D
Some
of
their
needs
are
not
as
intensive
or
precise
as
ours.
Ours
are
the
highest
overall
intensity
for
these
specific
conditions
we
have
to
maintain,
but
they
also
have
to
have
conditions
maintained
for
their
lab,
so
that
redundancy
will
address
a
mission,
critical
failure,
potential
for
them
as
well,
and
also
one
of
the
other
tenants.
D
At
least
we're
aware,
was
in
the
process
of
beginning
to
look
for
outside
space
at
another
facility,
so
the
space
we
would
vacate
would
solve
their
problem
as
well,
because
they
would
be
able
to
expand
into
remodeled
location
within
their
current
footprint.
So
this
would
make
the
best
use
of
existing
state
property
and
physical
plant,
while
also
addressing
the
needs
of
the
public
health
lab
and
providing
for
more
stability
of
services.
For
all
the
tenants,
the
cost
is
185
million
dollars.
D
A
brand
new
Public
Health
lab
South
Carolina
New,
York
Colorado,
the
city
of
Dallas,
large
Metro
areas,
really
big
ones,
often
will
have
their
own
Virginia
Missouri
South,
Dakota,
Pennsylvania,
Delaware,
Rhode,
Island,
Nevada,
San,
Diego,
Washington,
State,
Montana,
Minnesota,
Houston
and
I
mentioned
Tennessee,
so
I
don't
know
what
happened,
but
there's
a
boom
bust
cycle
of
funding.
That
happens
a
lot
of
times
and
after
major
events
like
we
had
with
covid
people,
recognize
deficiencies
that
need
to
be
addressed
or
provides
the
impetus
or
the
opportunity
to
address
them.
D
The
fact
that
I'm
sitting
before
you
today
seeking
your
assistance
to
get
this
into
the
next
biennial
budget,
so
we
can
move
forward.
I
think
the
fact
that
all
these
other
states
and
entities
are
doing
the
same
thing
hopefully
add
some
additional
external
validation
about.
This
is
apparently
the
cycle
in
the
time
where
people
need
to
update
this
stuff,
and
we
are
not
alone
in
this
and
I.
Don't
think
Kentucky
wants
to
join
the
list
of
folks
who
had
to
send
their
specimens
at
elevated
costs
to
out-of-state
vendors
at
delay
turnaround
time
now.
D
D
54.5
I
apologize
I
put
the
four
in
the
wrong
spot,
but
it
is
a
long
process.
It's
six
years
for
the
capital
planning
process
two-year
biennial
budgets.
The
next
opportunity
is
January
of
2024.
When
the
legislature
does
the
next
biennial
budget.
If
it
is
approved,
remember
if
it's
approved
in
a
budget
in
April
it
won't.
The
money
won't
start
flowing
till
July
when
the
next
biennium
starts
and
then
we
start
a
clock
and
that's
all
acknowledged
that
few
things
progress
exactly
on
schedule
and
government
work.
D
You've
got
a
five-year
Horizon,
so
you're
talking
six
and
a
half
years
before
we
can
occupy
a
new
lab
and
that
building
will
now
be
closer
to
40
years
old,
not
not
over
30
years
old.
So
folks,
we
are
really
at
a
critical
Junction.
I
asked
the
staff
to
also
provide
to
you
on
one
pager
last
year.
This
was
all
moving
so
fast
as
I
acknowledged,
but
last
year
the
budget
committee
chair
asked
for
a
one
pager.
D
To
summarize
the
reasons
why
the
lab
was
necessary,
so
you
should
all
have
I
hope,
a
PDF
that
is
a
one-pager
yep
I,
see
representative
Bentley.
Has
it
that
describes
some
of
this
narrative
that
I
provided
here
in
a
little
more
detail
about
some
of
the
problems
that
the
lab
faces
so
folks,
that's
the
pitch.
I
won't
be
your
commissioner
on
all
likelihood
when
this
is
built
six,
seven
years
from
now,
someone
else
will
cut
the
ribbons.
This
is
really
for
the
Commonwealth.
D
The
Commonwealth
needs
to
have
this
to
support
its
citizens,
and
so
I
appeal
to
you
to
hopefully
navigate
this
with
your
colleagues
and
hopefully
to
celebrate
the
passage
of
a
budget
next
year.
That
includes
this
is
an
important
Capital
project
and
Mr
chair
I'm
at
your
disposal
for
any
questions.
D
Do
we
test,
if
there's
an
indication
for
it
so
like?
If,
if
you
were
concerned
that
the
dust
can
contained
a
bioterrorist,
you
know
content
or
if
you
were
concerned
that
that
you
know
if
there
was
a
public
health
need.
You
know,
and
you
were
worried
about
a
specific
type
of
contaminant
or
lead.
You
know
like
in
dust
in
a
in
a
home,
and
there
were
children
in
that
home
that
had
high
lead
levels.
D
A
D
Yeah,
so
we
do
genetic
sequencing
for
things
like
multi-drug
resistant
organisms.
So
there's
things
like
TB
things
like
there's
a
yeast.
That's
been
a
particular
problem
in
nursing
homes
recently,
so
we
do
investigations
for
that
and
the
one
thing
I
would
comment
on
the
dust
or
the
multi-drug
resistant
organisms
where
we
do
those
Advanced
tests.
It's
where
there
is
a
public
health
indication,
so
our
state
epidemiologies
review
those
requests
and
they
follow
protocols,
and
then
they
use
their
professional
judgment
to
approve.
So
you
can't
just
send
a
specimen
to
the
public
health
lab
you
can.
D
If
you
want
to
just
randomly
test
something
because
you're
curious,
you
have
to
go,
find
a
commercial
vendor,
but
if
there
is
a
public
health
indication
for
it,
a
risk
to
people
in
the
state
that
the
epidemiology
team
feels
is,
you
know
substantiated,
they
are
the
ones
who
have
the
ability
to
authorize
things.
Now
there
are
a
number
of
tests
like
the
newborn
screening
or
for
advanced
culture
technique
weeks
and
things
that
only
we
do
where
the
hospitals
have
a
fast
track.
D
Well
that
one
Mr
chair
I
can
comment
on.
So
the
part
of
the
requirement
for
this
third
party
is
to
provide
a
cost
estimate,
and,
and
so
they
provided
a
cost
estimate
before,
and
they
have
revised
it
and
updated
it
now,
hopefully,
if
inflation's
already
lower
than
what
they
use.
So
hopefully
that
is
an
overestimate
because
the
lowest
inflationary
number
they
used
was
eight
percent
for
each
of
those
later
years,
and
it
was
double
digits
for
the
first
year,
so
their
estimate
should
be
higher.
D
E
Thank
you,
chairman
Bentley,
real,
quick,
the
185
million.
You
said
a
third
party
who
who
was
the
third
party
Omni.
D
D
F
F
F
Thank
you.
Thank
you.
So,
first
of
all,
I'd
just
like
to
give
a
little
bit
of
an
overview
of
the
Medicaid
Program.
We
currently
cover
1.7
million
kentuckians
over
600
000
children
in
the
Medicaid
and
Chip
program,
which
is
more
than
half
of
the
children.
In
this
state
we
have
649
Medicaid,
649
000,
Medicaid
expansion,
members
enrolled
in
the
department
for
Medicaid
and
in
fiscal
year
2022.
Our
administrative
and
benefits
budget
was
a
totaled
15.1
billion.
F
So
when
we
talk
about
coverage
levels,
when
we
talk
about
individuals
that
we
cover
in
the
Medicaid,
Program
I
think
it's
really
important
to
put
into
context
what
that
federal
poverty
level
means
what
it
looks
like
so
I've
highlighted
in
green
here
the
federal
poverty
levels
for
individuals
who
are
enrolled
in
Medicaid
in
the
expansion
level
and
adults
which
is
at
or
below
138
percent
of
the
federal
poverty
level.
F
So
as
we
look
at
the
average
Kentucky
expenses
I
did
put
in
here,
the
Medicaid
income
limit
for
a
family
of
four.
You
can
see
those
forty
one
thousand
four
hundred
dollars
again
pre-tax,
take
out
tax
housing
utilities,
food
and
groceries
for
that
family,
and
these
numbers
came
from
the
cost
of
living
in
Kentucky.
2023
I
have
the
link
in
there.
F
If
you
want
to
go
and
look
at
it,
and
so
you
can
see
that
the
expenses
for
the
average
individual
to
live
in
Kentucky
totals
forty
three
thousand
two
hundred
and
twenty
dollars,
which
is
more
than
the
federal
poverty
level.
For
someone
to
qualify
for
Medicaid
expenses,
not
included
in
the
total
here
include:
clothing,
Transportation,
auto
insurance,
telephone,
for
example,
miscellaneous
expenses
related
to
school
age.
F
Children
and
I
wanted
just
to
show
this
and
to
pick
this
information
to
to
show
what
the
families
enrolled
in
Medicaid
struggle
with
they
struggle
with
paying
their
bills,
let
alone
dental
vision
and
hearing
services.
F
So,
as
of
January
1st
2023
Medicaid
began
covering
services
for
for
individuals
that
we
did
not
cover
before
we
currently
will
cover
one
pair
of
glasses
or
contact
lenses
per
year
for
our
adult
population.
We'll
cover
hearing
aids,
two
dental
cleanings
per
year,
instead
of
one
for
adults,
root,
canals
crowns
and
dentures,
and
there
has
been
some
misperceptions
about
what
we're
doing
when
we
cover
these
services.
F
For
example,
we
are
not
covering
full
mouth
implants
if
an
implant
is
medically
necessary
and
that
course
of
treatment
is
agreed
to
bond
by
a
member
and
a
provider,
it
has
to
be
medically
necessary
and
we
we
believe
that
these
new
Services
is
one
answer
to
the
workforce
shortages
in
the
state
and
the
low
participation
rates
of
individuals
in
the
workforce.
We
believe
that
giving
them
the
ability
to
see,
hear
and
eat
better
and
smile.
We
want
to
give
individuals
their
smiles
back.
F
We
believe
that
that's
going
to
go
a
long
way
in
giving
them
the
tools
they
need
to
be
successful
in
the
workplace
and
the
reimbursement.
We
talk
about
reimbursement
for
the
new
adult
benefits
will
mirror
the
child
specific
fee
schedule
for
dental
currently
or
prior
to
January
the
1st
of
2023.
We
had
two
separate
fee
schedules.
F
We
had
a
fee
schedule
for
children
that
was
higher
than
the
fee
schedule
for
adults,
so
the
new
adult
benefits
will
mirror
that
child
fee
schedule,
which,
which
means
that
the
providers
will
receive
increased
reimbursement
for
providing
those
dental
services
to
adults
for
Vision
Services.
We
will
cover
glasses
or
contacts
for
individuals
over
the
age
of
21..
F
The
ability
to
read
medical
instructions
is
very
important
for
this.
Population
Medicaid
currently
does
not
cover
or
prior
to
January.
1St
did
not
cover
glasses
or
contacts
for
adults.
It
also
lowers
the
risk
of
infection.
People
with
glasses
are
less
likely
to
be
touching
their
eyes
as
often
so,
and
also
safety
reason
less
Falls.
They
can
see
things
in
front
of
them
and
and
I'll
never
forget.
F
My
first
pair
of
glasses
I
was
an
adult
when
I
got
my
first
pair
of
glasses
and
when
I
put
them
on
I
couldn't
believe
the
bright
colors
that
I
was
seeing
I
could
see,
leaves
on
trees,
and
then
part
of
me
was
so
scared
that
I
had
been
driving
without
those
glasses
and
without
that
Aid,
with
with
my
child
in
the
car,
so
I
was
very
thankful
when
I
was
able
to
afford
glasses
for
myself,
so
our
frames
are
limited
to
fifty
dollars
per
year
per
member.
F
Our
Optometric
technical
advisory
committee
is
talking
to
us
and
making
recommendations.
They
believe
that
that
rate
should
actually
be
increased
for
better
quality
glasses
as
we
go
forward.
So
those
conversations
are
happening.
Lenses
would
be
limited
to
two
per
member
per
year
with
price
and
that's
lenses
for
the
glasses
price,
ranging
from
28
dollars
to
fifty
six
dollars.
Each
Hearing
Services
again
untreated.
Hearing
loss
is
linked
to
higher
rates
of
dementia,
social
isolation,
depression,
anxiety
and
Falls.
F
That
result
in
injury
among
our
older
adults,
and
we
also
have
looked
at
research
that
shows
that
hearing
aids
within
three
years
of
getting
hearing
aids
for
those
individuals
who
begin
experiencing
hearing
loss
within
three
years
of
getting
those
hearing
aids
the
risk
of
dementia,
of
developing
dementia
decreases
by
18
percent
so
again,
providing
these
Services
now
is
going
to
offset
cost
in
the
Medicaid
Program
in
the
future.
F
Our
Dental
Services.
We
know
that
dental
health
is
is,
is
health
care.
We
know
that
various
Studies
have
linked
heart
disease
to
poor,
Dental
Care,
even
preterm
deliveries,
diabetes,
things
that
we
can
prevent
by
covering
at
least
one
additional
cleaning
per
year
for
our
adults.
We
know
that
Kentucky
Medicaid
members
go
to
the
emergency
room
for
dental
services,
for
example,
in
2019
we
spent
not
9.2
million
in
dental
services
in
the
ER
again.
F
Providing
these
Services
is
going
to
offset
some
of
those
costs
in
the
future
and
when
we
do
know
that
NICU
babies,
for
example,
if
if
we
we
cover
We've,
looked
at
information
and
NICU
babies
are
very
expensive
and
if
we
can
prevent
those
pre-term
births
by
delivering
these
dental
services
to
pregnant
women,
that
would
be
fantastic
and
we
cover
over
half
of
the
births
in
this
state
so
again
very
important
to
get
those
dental
services
for
our
adults.
Many
of
you
may
know
we
have
an
epsdt
benefit.
F
It's
called
early
periodic
screening,
Diagnostic
and
treatment
benefit
that
benefit
covers
two
cleanings
per
year
for
children.
It
also
covers
all
of
the
services
that
we're
providing
in
our
adult
population
and
I.
Think
it's
a
little
bit
unfair
for
us
to
when
somebody
turns
21
to
move
them
from
one
cleaning,
I
mean
from
two
cleanings
to
just
one
and
then
not
help
them
take
care
of
their
teeth
that
we
have
been
so
diligent
about
taking
care
of,
as
they
were
children.
F
F
We
have
again
looked
at
various
studies
related
to
dental
care,
and
there
is
a
study
that
shows
that
public
benefit
programs
for
adults
are
financing
Downstream
by
paying
for
invasive
treatment
of
dental
disease,
for
adults
rather
than
preventive
treatment.
That
may
avert
such
disease
in
the
first
place,
and
that's
the
one
other
thing
that
we
want
to
do.
We
definitely
want
to
start
focusing
on
prevention
rather
than
having
individuals
go
to
the
emergency
room
for
treatment.
For,
as
we
said,
these
invasive
Dental
treatments.
F
Currently
since
January
1st
of
2023,
this
is
showing
Humana.
We
have
six
Managed
Care
organizations,
Humana
has
covered
a
total
of
616
services
and
for
a
total
of
92
864
dollars.
F
Humana
for
vision
has
covered
32
776
services
for
a
hundred
and
nineteen
thousand
three
hundred
and
sixty
dollars.
Molina
has
covered
962,
Services,
totaling,
299,
531
and
Aetna
has
for
their
Dental
Services.
You
can
see
they
have
covered
715,
unique
members
for
a
total
of
2
000
or
237
821,
and
you
can
see
the
other
vision
and
hearing
benefits
that
they
have
covered.
United
has
covered
32
claims
for
60
members
for
dental
they've
done
two
hearing
claims
and
166
claims
for
members.
F
We
also
have
well
care
I
didn't
get
their
information
in
here,
but
that
WellCare
has
covered
3542
Services
totaling
over
450,
000.
and
Anthem
has
covered
147
services
for
members
for
a
total
of
54
000
147
hearing
a
thousand
one
hundred
and
seven
individuals,
revisioned
and
86
for
dental.
So
all
total
our
providers
in
Medicaid
have
received
over
1.5
million
dollars
in
reimbursement
for
these
expanded
services
and
vision.
F
Dental
and
hearing
one
provider
I've
noticed
in
Clay
County,
for
example,
one
provider
since
January
1st
has
delivered
four
sets
of
Dentures
to
members,
and
he
has
44
more
in
progress
for
members
in
Clay
County
alone
and,
as
you
can
see
in
this
this
map
the
highlighted
areas.
The
Orange
shows
that
at
least
61
to
80
percent
of
individuals
in
that
county
are
enrolled
in
Medicaid,
so
source
of
funding
and
anticipated
future
costs
funding
is
through
current
Appropriations.
F
We
have
saved
money
through
reduced
expenditures
resulting
from
implementation
of
Senate
bill
50
when
we
move
to
a
single
Pharmacy
benefit
manager.
Those
drug
rebates
are
not
revenues,
but
they
do
reduce
our
expenditures,
which
allows
us
to
cover
these
services
in
our
current
Appropriations.
The
cost
of
covering
these
Services
is
about
36.8
million
dollars
going
forward
with
the
bulk
of
that
31
million
being
Federal
stun
federal
federal
funds
and
5.6
million
being
State.
We
do
expect
this
services
to
ramp
up
over
time
and
we'll
continue
to
monitor
utilization.
F
So
as
far
as
sustainability,
we
do
believe
that
there
are
going
to
be
fewer
ER
visits
related
to
dental
pain.
Again,
the
previous
slide
showed
approximately
nine
million
dollars
per
year.
Studies
have
linked
dental
services
to
reduce
costs
for
diabetes,
congestive,
heart
failure,
asthma,
COPD
coronary
artery
disease,
chronic
kidney
or
renal
disease,
and
these
are
all
things
that
are
impacting
a
large
scale
and
killing
kentuckians
unrelated
oral
health
conditions
lead
to
other
diseases
and
either
and
even
death.
F
The
one
thing
that
we're
excited
about
is
the
ability
to
identify
oral
cancers
earlier
on
and
get
treatment
for
those
individuals
and
thanks
to
House
Bill
525.
We
know
that
this
that
improving
the
health
status
is
not
simply
just
providing
Services.
It's
also
education
and
beginning
in
July,
1st
of
2023
dentists
will
be
able
to
employ
and
Bill
for
community
health
workers
that
will
allow
them
to
provide.
Thank
you
very
much
representative
Moser
for
sponsoring
that
bill.
F
We're
very
excited
about
it,
but
the
community
health
workers
will
be
able
to
provide
Outreach
and
education
to
individuals,
and
the
dentist
being
able
to
bill
for
them
will
cut
down
on
their
no-show
visits,
which
we
hear
complaints
about,
and
we
we
believe
this
can
be
covered
without
any
additional
state
fund.
Appropriations
and
I
I
have
a
link
in
here
to
an
article
that
I
read
that
I
thought
was
very
timely.
Just
earlier
last
week
an
article
was
on
msn.com
and
I
think
this
female
was
also
focused
on
The
Today
Show.
F
She
was
37,
she
had
no
teeth
whatsoever,
and
these
are
just
some
comments
from
that
article.
Her
worsening
oral
health
affected
all
aspects
of
her
life,
her
mental
health
relationships,
job
prospects
and
overall
well-being.
Small
problems,
like
cavities,
became
a
big
problem
that
required
visits
to
the
emergency
room
again
if
she
had
had
access
to
oral
health
care
and
dental
care
for
her
cleanings.
This
probably
would
not
have
been
a
big
issue
for
her.
F
She
worked
in
service
industry,
jobs
such
as
bartending,
and
that
did
not
offer
dental
insurance
and
she
could
not
afford
to
get
regular
checkups
for
fillings
or
cavities,
and
she
says
she
was
miserable
and
add
that
to
the
mental
health
toll
that
it
takes
on
a
when
you're
afraid
to
smile.
So
that's
one
thing
that
we
want
to
do
with
these
expanded
benefits.
Is
we
want
to
give
individuals
their
smile
back?
We
want
them
to
be
able
to
go
out
and
get
in
the
workforce
and
be
comfortable
in
job
interviews.
F
We
want
them
to
be
able
to
hear
questions
and
respond
appropriately
and
so
again,
you
know
there's
a
lot
of
stigma
that
comes
with
having
bad
teeth
and
if
we
can
help
those
individuals
in
the
Medicaid
Program.
This
is
the
right
thing
to
do.
We
want
to
give
those
smiles
back.
We
want
to
have
individuals
enter
the
workforce
and
again
this
is
just
one
answer
to
increasing
Workforce
participation
we
have.
F
Yesterday,
for
example,
we
had
a
meeting
with
several
representative
representatives
from
Kentucky
youth
Advocates,
the
Kentucky
oral
health
Coalition,
both
teaching
hospitals
from
the
universities,
UK
and
uofl
dental
schools.
All
of
them
are
very
supportive
of
the
services
that
we
are
delivering
now
and
several
providers
were
on
the
call
the
Kentucky
Primary
Care
Association.
The
support
that
came
from
those
47
individuals
on
that
call
was
very
heartwarming
and
we
can't
wait
to
continue
to
give
the
smiles
back
to
many
kentuckians
I'll
be
happy
to
answer
any
questions.
Thank
you.
G
Their
motion-
thank
you,
Mr
chair
and
thank
you,
commissioner.
It's
always
good
to
hear
your
updates,
I
and
I'm
very
pleased,
of
course,
about
House
Bill
525
and
getting
community
health
workers
embedded
in
some
of
these
critical
areas
and
and
really
start
addressing
the
social
determinants
of
access
to
care.
Why
why
folks
don't
access?
G
But
my
question
is
and
I
would
like
to
work
on
on
this
with
you,
because
I
understand
the
importance
of
dental
care
and
I
guess
I'm
concerned
that
the
this
recent
expansion
is
a
one-time
expenditure
or
so
it
seems,
is
there
a
plan
for
sustaining
the
cost
incurred
or-
and
the
second
part
of
my
question
is
about
increasing
reimbursement
rates
for
dentists
and
I.
You
know
I
mean
it
looks
like
we
need
to
really
do
some
rebasing
for
many
areas,
bhsos
and
so
forth.
So
on
the
sustainability
plan,
do
you
all?
F
We
did
complete
a
state
plan
Amendment
pending
CMS
approval,
so
that
that
is
our
sustainability
plan
continue
to
monitor
the
services
as
we
go
forward
as
far
as
rates
we
did
increase,
we
heard
a
lot
of
feedback
from
particularly
from
oral
surgeons.
So,
as
part
of
our
moving
forward,
we
have
increased
some
specific
rates
for
oral
surgeons
and
general
dentists.
G
C
Thank
you,
Mr
chairman.
Thank
you,
commissioner,
Lee
great
presentation
and
I.
You
know
I
was
when
I
saw
this
on
the
agenda.
I
was
just
thinking
about
I
think
there
can
be
a
tendency
to
think
of
vision
and
dental
and
hearing
as
somehow
separate
from
health
care
and
you've
done
such
a
compelling
job
now
and
previously
about
explaining
how
it's
all
connected
and
I
I.
F
This
absolutely
I
think
education
is
definitely
key
and
we
we
have
our
first
annual
Medicaid
2020
annual
report
was
recently
released
and
we
hope
to
add
to
that
as
we
go
through
different
iterations
of
that
report
and
add
some
of
the
information
specifically
that
you're
talking
about
and
how
we
have
impacted
the
workforce,
individuals
who
are
moving
out
into
the
workforces.
We
go
forward
so
absolutely
and
we're
also
working
with
Kentucky
Primary
Care
Association
to
develop
some
informational
materials
for
our
members.
A
F
Again,
that
would
be
a
decision
between
the
provider
and
a
member
and
I
can
give
you,
for
example,
my
my
personal
experience
when
I
was
younger.
Of
course,
I
was
raised
in
Eastern
Kentucky,
we
were
very
poor.
I
was
faced
with
a
decision
to
either
have
a
root
canal
or
pull
a
tooth
could
not
afford
a
root
canal
so
pulled
a
tooth
years
later.
F
I
go
to
a
dentist,
he
does
an
x-ray
of
my
mouth
and
he
shows
me
that
my
teeth
at
top
are
shifting
they're
falling
down
because
I
didn't
have
a
tooth
where
I'd
had
it
pulled.
My
teeth
were
all
shifting,
and
so
he
told
me
that
if
I
didn't
have
a
at
the
op
at
the
time,
a
four
tooth
bridge
that
I
I
would
have
to
I
would
lose
most
of
my
teeth.
So
faced
with
that,
I
could
not
afford
that
four
tooth
bridge
I
didn't
know
what
I
was
going
to
do.
F
I
ended
up
somehow
finding
out
about
the
University
of
Kentucky
School
of
Dentistry
I
went
there
had
a
four
tooth
Bridge.
It
took
forever
to
have
the
only
difference
between
that
and
the
dentist
that
I
had
seen
before
was
the
University
of
Kentucky
allowed
me
to
pay
payments,
and
so
that's
how
I
had
my
four
toothbrush
four
tooth
Bridge.
So
in
today's
world,
there's
an
implant
and
if
somebody
has
a
tooth
pulled
and
they're
experiencing
those
same
issues,
an
implant
would
be
cheaper
than
a
four
tooth
Bridge.
F
So
those
are
the
sorts
of
of
and
there
there
could
be.
You
know
various
medical
conditions
for
some
reason.
Somebody
could
not
wear
a
partial
or
something
like
that.
But
again
it
would
have
to
be
medically
necessary
and
we
would
look
at
all
of
those
cases
and
it's
again
we're
not
paying
for
full
mouth
implants.
A
When
I
was
at
UK,
I
took
several
classes
at
the
dental
school,
pathology
and
physiology,
and
they
taught
us
that
no
one
should
lose
a
tooth
anymore,
and
that
was
19
Jurassic
Park
days,
so
not
in
1975.
They
were
saying
that
you
know
you
should
never
lose
a
tooth
pops
out.
Stick
it
back
in.
We
saw
that
at
UK
basketball
game
many
years
ago,
but
implants
are
interesting
things
they
run
about
a
poem
about
thirty
five
hundred
dollars.
A
You
know
and
I'm,
like
you,
I'm
from
Eastern
Kentucky,
where
my
family
believed
in
pulling
all
their
teeth
and
getting
dentures,
and
that
scared
me
to
death
when
I
was
younger.
So
I
put
a
lot
of
money
in
my
mouth
enough
to
buy
new
cars.
Put
it
that
way.
Other
thing
is
on
sb50.
We
should
be
thankful
for
that,
build
okay.
It
gave
you
a
lot
of
extra
money
to
do
these
good
things
for
people,
but,
like
representative
Moser,
we're
concerned
about
that
money.
So,
okay,
so
any
other
questions
from
the
members.
A
Okay,
so
thank
you,
commissioner,
Lee
for
being
here
before
we
adjourn
members.
Please
note
that
we
will
meet
next
week,
March
1st
for
our
final
meeting
and
then
Dr
Fordham
will
get
a
hold
of
all
of
us
for
our
visit
to
the
lab.
Okay
or
I
will
I
don't
put
all
on
ourselves.
So
the
next
item
is
German.
Do
I
have
a
motion.