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From YouTube: Senate Standing Committee on Health Services (2-15-23)
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A
If
not,
we
will
need
a
motion,
a
second
to
approve
this
regulation
motion
back
motion
by
Central
funky
Fort
Myers,
taken
by
Senator
Douglas,
also
Fair.
The
motion
vote
I
I
in
the
opposition.
All
right.
Thank
you.
That
regulation
passes
moving
on
our
agenda.
The
first
item
we
will
hear
is
Senate
Bill
23.
Excuse
me:
Senate
Bill
12
an
act
relating
to
physician,
Wellness
programs
in
the
sponsor
Center
Donald
Douglas
Senator
Douglas.
If
you'll
proceed,
the
table
we'll
proceed
with
your
bill.
A
B
Good
morning,
Mr,
chairman
and
good
morning,
command
members,
we
wish
to
present
Senate
Bill
12.
Today
it
is
an
accurating
to
physician.
Wellness
I
know
that
a
lot
of
this
isn't
on
very
many
people's
Radars.
But
this
is
something
that's
really
really
important.
B
Think
this
is
what
Senate,
Bill
12
will
do
and
I'm
going
to
turn
this
over
to
Dr,
Jones
and
and
let
her
proceed.
C
C
According
to
the
agency
for
Health
Care
research
and
quality
burnout
is
a
long-term
stress
reaction
marked
by
emotional
exhaustion,
depersonalization
and
a
lack
of
a
sense
of
personal
accomplishment.
Physicians
and
other
health
care
workers
have
an
increased
risk
for
experiencing
burnout
due
to
the
demanding
nature
of
their
work.
Research
has
confirmed
that
upon
matriculation
to
medical
school,
medical
students
are,
on
average,
more
emotionally
well
adjusted
than
their
age
matched
peers.
C
C
C
Physician
burnout,
if
left
unchecked,
will
continue
to
have
a
negative
impact
on
patient
care,
physician
health
and
health
care
cost
due
to
the
stigma
associated
with
Physicians
and
those
in
the
medical
field
seeking
treatment
for
themselves.
Many
Physicians
and
health
care
workers
are
less
likely
to
seek
and
receive
help
from
mental
health
issues.
C
For
example,
a
study
in
the
Mayo
Clinic
proceedings
found
that
Physicians
working
in
a
state
where
the
initial
renewal,
medical
licensing
applications
probes
too
broadly
about
mental
health,
history
or
20,
20
percent,
more
likely
to
be
reluctant
to
seek
help
to
begin
addressing
the
issues
and
concerns
associated
with
The
Physician
burnout
epidemic
kma
strongly
supports
Senate,
Bill
12..
The
importance
of
everyone
seeking
to
optimize
their
mental
health
with
counseling
is
being
highlighted
more
and
more
understanding
that
brain
health
and
learning
effective
ways
to
mentally
process.
C
C
It
would
ensure
that
a
record
of
a
physician's
participation
in
a
wellness
program
is
confidential
and
has
additional
legal
protections
that
should
provide
further
encouragement
to
Physicians
to
seek
help
when
needed
and
if
imbalances,
the
appropriate
role
of
the
medical
board,
Hospital
systems
and
health
insurers
to
protect
the
public
safety
for
an
impaired
physician
with
the
public
need
to
encourage
Physicians
to
seek
help
for
issues
that
may
be
causing
high
levels
of
stress.
That
can
be
successfully
addressed
through
a
physician
wellness
program
prior
to
impairment.
A
Before
we
get
into
questions,
I
want
to
thank
Senator
Douglas
unto
you
for
bringing
this
to
the
Forefront,
and
a
lot
of
healthcare
professionals
are
facing
just
tremendous
struggles
like
we've
never
seen
before
and
I
think
Physicians.
We
have
a
tendency
to
forget
that
you
you
pay
such
important
role
in
this
and
I.
Think
historically,
Society
has
viewed.
Physicians
is
almost
god-like
that
you're
above
these
day-to-day
problems
and
honestly
you're
not,
and
we
certainly
need
a
gentler
Kinder
world
to
live
in
and
make
sure
we're
taking
care
of
each
other
appropriately.
D
You
know
I
think
one
of
the
mantras
of
this
session
needs
to
be
loud
and
clear
to
all
of
us,
including
Physicians,
that
Mental
Health
Care
is
health
care.
We
no
longer
can
separate
the
two
because
they
are
too
intimately
and
intricately
associated
with
each
other,
and
if
you
are
not
mentally
healthy,
you
are
not
going
to
be
physically
healthy.
D
I
really
appreciate
your
discussion
of
the
administrative
burden
that
is
just
taking
the
life
out
of
our
health
care
providers
right
now
it
is
overwhelming
it
is.
It
is
just
to
the
point
where
why
am
I
doing
this?
Why
am
I
spending
half
my
time
trying
to
defend
my
practice
of
medicine,
to
people
who
don't
have
never
practiced
medicine,
who
don't
understand
medicine
who
are
looking
at
some
sort
of
Regulation
and
thing?
D
C
D
They're
already
struggling
with
administrative
burdens,
they're
already
struggling
with
reimbursement,
they're
already
struggling
with
patient
populations,
that
they
don't
have
the
ability
to
offer
them
everything
they
need.
The
last
thing
they
need
is
to
be
criminalized
for
what
they're
trying
to
do.
C
C
D
D
F
Thank
you,
Mr
chair,
Mr,
chairman
and
Dr
Jones.
It's
good
to
see
you
today.
Dr
Jones
is
from
my
district
and
she
and
her
husband,
Dr
Sean
Jones
are
two
of
our
finest
citizens
in
Paducah
and
the
work
that
they
do
for
the
community
and
in
the
medical
field
is
very
much
appreciated
and
you
all
make
a
difference,
not
just
in
our
part
of
the
state
in
the
state,
but
I
know
your
your
husband
is
out
of
the
country
providing
services
today
that
are
badly
needed.
So
thank
you
all
for
everything
that
you
do.
F
My
question
has
to
do
with
on
on
page
one
section
section,
one
2B
and
the
question
the
question
about
substance,
abuse
or
mental
health
issues,
I'm,
assuming
that
that
should
that
be
divulged
in
any
of
these
meetings,
that
that's
the
section
that
would
cover
and
and
how
would
in
practicality?
How
would
that
work
if,
during
one
of
these
sessions,
that
it
is
determined
that
there
is
a
substance
of
use
problem
or
there
is
a
true
mental
health
issue?
How
would
that
be
resolved?
B
Thank
you,
Senator
Carol.
If
you
look
down
in
section
four
of
the
bill,
that
really
is
the
physician
that
comes
Under,
The,
Physician
obligation
part
this.
This
bill
does
not
does
not
cover
the
impaired
physician.
It
simply
covers
the
burnout
position.
We
already
have
instructions
as
to
what
we
do
when
we,
when
we
find
a
colleague
who
is
impaired
or
if
we
find
ourselves
impaired.
This
does
not
impact
that
in
any
way.
So,
if
that
information
is
the
bulged,
then
that
information
has
to
be
followed
through,
as
we
followed
up
on
very.
D
A
Bus
from
cinderberg
all
sustainable
motion
of
Rhode,
Island
Post
vote,
no
sorry
wrong.
Committee,
I'm
still
in
government
contract
with
emote;
yes,
the
quarter
votes
really
Senator.
D
And
thank
you
I
think
I
think
this
is
worthy
of
attention.
Thank
you.
F
A
Vote
is
eight
eyes
no
Nays
the
bill
passes
of
favorable
expression.
Congratulations
appreciate
you
being
here
this
morning.
A
B
Foreign,
thank
you
so
very
much.
This
is.
This
is
my
initial
time
assuming
the
chair
and
and
I've
been
I've
been
told
that
I
need
to
be
good
and
I
need
to
learn
how
to
use
this
thing.
B
Just
for
the
record,
just
for
the
record.
Could
you
please
identify
yourself
and
introduce
yourself
to
to
the
committee
and
to
the
people
here
in
the
committee.
B
Senator
Senator
Meredith.
Now
before
we
begin
there
is
a
proposed
Senate
substitute
to
Senate
bill
29..
If,
if
there
aren't
any
questions,
we
need
to
approve
this
Senate
sub,
are
there
any
questions?
B
B
A
Thank
you,
Mr
chair,
I'm,
speaking
first
on
Senate,
Bill
29,
which
very
specifically
is
limiting.
The
number
of
mcos
administer
our
Medicaid
Program,
and
it
was
purely
by
coincidence
that
your
bill
preceded
in
mind,
and
we
talked
about
bureaucracy
and
administrative
burden,
because
it
is
crushing
for
most
health
care
providers,
and
we
see
it
usually
in
fiscal
terms,
but
we
really
don't
look
at
it
in
terms
of
the
the
mental
health
aspect
of
it,
and
it
truly
is
crippling
I
happen
to
see
an
article
just
recently
as
well.
A
That
talked
about
a
third
of
the
Physicians
are
leaving
their
professionals
because
of
the
the
sense
of
loss
of
ownership
for
what
they
do
in
this
box.
We
were
talking
about
addition.
You
know
we
spend
over
16
cents
of
every
dollar
in
health
care
on
Administration
and
that's
double
what
an
industrialized
nations
spend
and
it's
just
gotten
totally
out
of
control,
but
I
want
you
to
do
some
very
simple
math.
For
me.
A
The
first
problem
is
noting
that
Medicare
and
Medicaid
only
pays
75
to
80
cents
on
the
dollar
of
cost.
Not
charges
cost.
A
How
many
patients
must
a
provider
see
before
they
go
broke,
offset's
a
rhetorical
question,
but
it
truly
is
frames
a
situation
when
we
think
in
terms
of
charges
and
quite
candidly
charges
become
irrelevant-
it's
cost.
Now.
How
do
you
make
up
that
shortfall
if
your
health
care
provider,
you
hope
and
pray,
you
have
a
larger
percentage
of
commercial
payer
mix
that
will
offset
those
lost
reimbursement.
A
You
know
when
Medicare
and
Medicaid
was
developed
in
1964
it.
Originally,
it
was
designed
to
pay
101
percent
of
cost
that
one
percent
being
small
profit
margin
that
Health
Care
Providers
were
able
to
accumulate,
but
very
quickly.
The
federal
government
realized
that
they
couldn't
afford
the
program
that
they
himself
had
invented.
So
we
started
continuing
to
redefine
cost
and
when
I
first
came
into
the
business
in
the
mid
70s.
A
At
that
time,
hospitals
specifically
were
getting
about
90
cents
on
the
dollar
of
cost,
but
it
was
workable
because
commercial
insurance
companies
kind
of
recognized
that
and
would
pay
us
more
than
Medicare
and
Medicaid.
So
we
could
be
profitable,
but
over
the
years
that
percentage
of
cost
reimbursement
got
less
and
less
and
less.
A
A
Well,
don't
feel
bad,
you
can't
answer
it.
No
one
else
can
either
I
asked
this
in
government
contract
review
just
a
couple
of
months
ago
is
why
do
we
have
six?
You
know
in
the
history
of
our
Managed
Care
program.
At
one
time
we
had
six,
then
one
left
unexpected,
so
we
had
five.
Then
we
went
back
to
six
this
last
round
of
contracts.
We
went
back
to
five,
so
what's
the
magic
number,
why
do
we
have
the
number
that
we
have
well,
not
27
one
at
two?
A
A
You
do
the
math
in
Kentucky
we're
about
three
quarters
of
a
million
per
MCO,
and
we
know
that
insurance
is
a
risk.
Business
and
part
of
the
explanation
I've
been
giving
this
while
we
have
six
is
to
spread
the
risk.
Well,
it
looks
like
that.
Risk
is
minuscule
when
you
compare
what
other
states
are
doing,
but
the
impact
of
that
is
not
minuscule.
A
A
Now
I've
been
asked,
and
many
people
who've
been
in
this
committee-
know
that
this
is
about
the
fourth
year
I
presented
this
bill
and
we
haven't
accomplished
this
goal
yet,
but
I've
been
asked
well,
we
need
to
work
with
the
mcos.
Let's
try
to
standardize
these
processes
that
we
all
have
to
deal
with,
and
there
are
numerous
you
know.
Let
me
read
this
a
few
to
you.
You
know
each
you
have
to
have
a
contract
with
each
one
of
them.
A
There's
credentialing
reconvention
information
for
each
one
of
them,
request
for
prior
authorization
process,
billing
claims
and
services
are
all
different
documentation.
Requirements
are
different
and
the
way
you
communicate
with
the
the
mco's
insurance
companies
they're
all
different
and
their
interpretation
of
the
policies
and
regulations
they're
all
different
and
when
you
undergo
quality
assurance
and
payment
odds,
they're
all
different.
A
Now
again,
if
you're
a
large
system,
it
certainly
creates
a
financial
burden
for
you,
but
at
least
you
have
the
resources
to
address
it
and
show
you
in
rural
Kentucky,
it's
not
there
and
I'm,
not
talking
just
about
rural
hospitals.
We
heard
testimony
this
summer
from
a
provider
buys
Mental
Health
Services
rural
provider
to
five
counties
noted
that
she
had
an
audit
which
is
expected,
and
the
audit
came
back
no
issues
whatsoever.
A
A
How
can
any
business
survive
in
that
kind
of
circumstances,
particularly
in
the
rural
community,
because
we
we
have
to
take
care
of
this
fortunate
share
of
of
Medicaid
patients
and
growing
worse
every
day.
Let
me
show
you
just
some
Android
comments
from
you
from
small
providers
when
we
increase
their
administrative
staff
from
7
to
11.
A
After
invitation,
Managed
Care
quadrupled
our
administrative
billing
staff,
since
invitation
Managed
Care
received
on
average
600
MCO
audits
per
year
from
2011
or
2018-2021
in
fiscal
year,
2022
received
over
2100
MCO
audits,
completing
four
different
types
of
bondage
from
six
different
mcos.
As
soon
as
I
complete
one
I'm
being
asked
by
another
to
provide
medical
records
for
the
audit,
it's
a
moving
Target.
We
never
know
what
the
rules
are
and
just
when
we
learn
the
rules,
the
mco's
change
them.
We
must
respond
to
multiple
audits
from
different
mcos.
A
At
the
same
time,
administrative
burden
continues
to
grow
and
it's
multiplied
with
every
MCO.
We
must
work
with
completed
one
audit
for
a
specific
treatment
service
and
received
100
again.
The
next
week
completed
another
same
service
MCO
one
to
pay
nothing
on
December
6
21.
We
sent
send
a
request
for
an
independent
review
to
appeal.
An
audit
filing
recoup
for
services
received
a
letter
from
chff
on
July
of
22..
A
We
need
consistency
across
the
board
having
to
implement
rule
six
different
ways,
and
it's
not
that's
the
conflict
that
we
deal
with
now
again.
Our
attempts
to
try
to
resolve
this
and
work
with
the
mcls
one
of
the
simplest
things
I
think
we
could
have
done
should
have
done
is
single
Source
credentialing.
We
passed
that
legislation
just
says
one
application
is
all
you
got
to
fill
all
of
our
mcos
won't
abide
by
that,
even
though
it's
legislation
that
we
passed,
why
won't
they
do
that
because
there's
no
leverage
to
make
them
do
it.
A
They
want
to
do
it
their
way.
Now,
I,
don't
like
the
MCO
model.
It's
it's
it's!
No
surprisingly.
Anyone
I
think
there's
a
better
way
to
do
it,
but
I
know
that
you
bridge
too
far,
but
in
the
meantime,
can't
really
reduce
the
administrative
burden.
That's
Falling
in
our
Health
and
Care
Providers,
particularly
for
Rural
communities,
but
also
our
urban
communities
that
have
to
take
care
of
this
portion
share
of
Medicaid
patients
as
well.
A
Yeah
I
see
no
justification
for
six
personally
I'd
like
two
but
I've
kind
of
yielded
on
this
one
I.
Think
three
three
is
a
regional,
reasonable
amount
in
your
quest.
So
that's
intended
this
bill
is
to
direct
the
Medicaid.
Then,
when
we
do
contract
renewal
to
only
have
three
manscure
organizations
and
that's
the
intent
of
my
bill,
Mr
chair
entertaining
questions
folks
might
have.
B
Before
we
get
started
with
that,
Senator
Meredith
I
I
have
to
jump.
I
have
to
jump
on
that
on
that
same
train.
In
my
medical
practice,
I
went
through
the
same
thing.
We
went
through
an
audit
both
my
colleague
and
I,
an
extensive
audit
at
which
there
were
absolutely
zero
deficiencies,
zero
deficiencies
found.
Six
weeks
later,
we
went
through
a
very
similar
audit,
both
of
us
and
during
that
period
of
time
our
mcos
were
holding
well
over
120
thousand
dollars.
B
Why
we
have
no
idea?
The
mine
was
released
before
my
colleagues,
so
I
understand
what
you're
saying
and
what
you're
saying
is
is
very,
very,
very
real
for
members
of
the
committee.
So
with
that
being
said,
if
there
are
any
any
comments
or
questions,
I'm
happy
to
Central
Berg.
D
D
If
we
limit
them
to
three,
are
we
putting
at
any
risk
the
the
breath
of
coverage
that
we'll
be
able
to
offer
in
this
state?
Do
we?
Oh?
Are
you
absolutely
assured
that
there
are
three
mcos
that
will
stand
up,
that
will
that
won't
have
more
control
over
us
than
weed
over
them
that
can
actually
service
the
entire
state?
A
You
know
each
each
of
our
mcos
have
a
Statewide
Network.
Presently
we
heard
testimony
this
summer
about
their
Network
adequacy,
which
that
was
kind
of
interesting.
They
all
said
they
got
95
percent,
but
ironically,
under
a
testimony
from
Dr
stack,
our
Commissioner
of
Public
Health,
he
said
95
cents,
not
really
there,
but
again
these
are
Statewide
corporations.
You
know:
we've
invested
responsibility
for
our
own
state,
employee
health
plan
under
one
provider
and
Statewide.
They
do
that
and
I've
heard
the
horror
stories
about
what
happens
if
we
lose
one
MCO
again.
A
The
numbers
I
gave
you
in
terms
of
the
coverage.
Lives
per
capita
suggests.
That's
not
going
to
happen
if
we
originally
vet.
That,
but
I'll
remind
you
is
two
three
years
ago
that
we
decided
that
our
foster
care
program,
even
though
it
was
a
covenant
under
managed
care.
We
would
limit
that
to
one
group
to
do
that.
So
I,
don't
think
this
places
our
state
at
risk
at
all
anything
I
think
has
the
potential
to
enhance
it.
Another
point
I
didn't
make.
A
Is
we
talked
about
the
cost
of
providers
but
think
about
the
cost
to
our
state
to
have
to
audit
six
different
mcos
negotiate
those
contracts
with
them?
So
there's
this
administrative
burden
there
that
shouldn't
be
and
I'm
not
talking
about
just
saving
just
a
little
bit
of
money.
I
think
when
you
look
at
the
total
cost
of
thing.
This
will
truly
save
our
Commonwealth
and
our
providers,
millions
of
dollars
that
we
can
redirect
to
provide
care
to
patients.
D
E
From
Meyer,
thank
you,
Senator
Meredith,
for
bringing
this
forward
I
feel
so
passionate
about
a
Wellness,
Revolution
and
I.
Think
part
of
it
is
a
financial
Wellness
Revolution,
and
my
question
is
relative
to
the
waste
aspect
that
we
see
so
often.
How
will
we-
and
perhaps
this
bill
doesn't
address
it,
and
this
is
in
a
different
section
of
our
code.
But
how
do
we
monitor
the
waste?
A
There
is
a
a
what
we
call
a
MCO
scorecard
that
measures
things
such
as
recipient
satisfaction,
provider,
satisfaction,
you
know,
Financial
strength
and
things
of
those
natures
and
those
are
supposed
to
be
taken
into
consideration
whenever
we
score
the
contracts
when
they're
they're
awarded
as
whether
the
information
is
valid
or
not,
I
really
can't
attest
to
it.
Because
again,
one
of
the
measures
is
Network
adequacy.
They
say:
they've
got
95
percent
I
think
that
number
of
suspects,
so
it
kind
of,
is
what
it
is.
F
Thank
you,
Mr
chairman
and
I
won't
go
through
all
of
this,
but
as
a
the
leader
of
a
small
provider
that
provides
Therapy
Services
for
kids
through
epsdt,
we
provide
prescribed
pediatric
Extended
Care
Services,
which
is
Child
Care,
Educational
Services
for
medically
Fragile
Kids,
and
we're
getting
ready
to
open
up
an
Autism
Center
to
do
ABA
therapies.
It
is
a
constant
battle
with
not
being
paid
the
proper
amount
and
not
having
the
proper
code,
which
are
very
limited
codes
right
now
we
have
an
MCO
that
owes
our
organization
about
fifty.
F
Sixty
thousand
dollars
can't
really
get
a
clear
answer
on
why
they're
not
paying
when
the
other
ones
are.
It's
just
a
constant
issue
and
there
seems
to
be
a
disconnect
between
the
the
mco's
comments
every
time
they
come
before
committee
about
their
patients
and
how
they
care
about
their
patients.
Well,
who
takes
care
of
their
patients?
It's
the
provider
and
that
relationship
is
an
adversarial
relationship
that
does
nothing
to
help
the
providers
care
for
those
that
they
serve.
F
It
makes
no
sense
that
that
the
relationship
is
what
it
is
when,
when
we
are
actually
the
ones
that
are
responsible
for
these
outcomes-
and
they
don't
give
us
the
support,
they
tie
up
all
of
their
all
of
our
time
on
administrative
responsibilities
that
that
don't
allow
us
to
thrive
to
grow,
to
provide
quality
services
and
time
after
time
we
bring
this
up.
We
go
through
this
every
year
with
the
mcos,
the
same
song
and
dance
and
nothing
changes.
F
This
has
got
to
be
the
year
that
we
get
this
bill
passed
and
get
this
number
down
to
where
it's
manageable,
where
we
can
start
standardizing
some
of
these
processes
that
are
so
detrimental
to
the
success
of
the
providers
in
caring
for
their
patients,
wherever
that
might
be
whether
it's
medical
therapies,
whatever
we've
got
to
do
something
about
this,
this
has
got
to
be
the
year.
The
cabinet's
not
going
to
do
this.
F
If
it's
going
to
happen,
it's
going
to
be
our
body
that
does
it
and
we
need
to
get
this
happen
to
get
this
going
this
year
and
make
it
happen.
Senator
mayor,
thank
you
for
all
your
efforts
on
this
and
I
I'm
with
you.
110
percent
and
I
feel
confident
we
can
get
this
through
the
Senate
and
we're
going
to
need
to
work
on
the
house.
Thank
you,
sir.
Thank
you.
Mr
chairman.
B
B
If
not
can
I
can
I
hear
a
motion,
or
is
there
a
motion
motion.
B
D
Explain
my
vote
please.
This
is
going
to
be
a
really
tough
vote
for
me,
because
I
totally
agree
that
this
is
what
we
need
to
do.
I
totally
agree
that
for
our
health
care
providers,
we
have
got
to
streamline
what
they
are
responsible
for,
presenting
two
insurance
companies
to
to
to
get
paid
for
their
work.
I'm
just
concerned
that
this
bill,
which
isn't
actually
going
to
do
that.
A
D
Single
provider
credentialing,
if
this
bill
included
that
you
all
have
to
get
together
and
come
up
with
reasonable
criteria
and
use
them
across
the
board
that
you
have
to
share
your
audit
data
with
each
other.
You
can't
just
put
that
burden
on
the
health
care
providers
themselves.
I
would
be
so
a
hundred
percent
I
would
be
literally.