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B
Present
all
right,
we
are
a
quorum,
we're
constituted
to
do
business.
There's
two
items
on
our
agenda
today
or
bills
for
consideration.
The
first
one
we're
going
to
tackle
is
senate
bill
68.
An
act
relating
to
pharmacy
benefit,
claim
verification
and
declaring
an
emergency.
I
am
the
sponsor,
so
I'm
going
to
come
down
to
the
table
and
let
chairman
meredith
take
over.
C
Thanks
general
appreciate
you
presenting
senate
bill
68
this
morning,
if
you
would
introduce
yourself
for
the
record,
please
proceed.
B
Yes,
I'm
ralph
alvarado
state
center
for
the
28th
district.
It's
my
pleasure
to
sit
before
you
today
to
discuss
senate
bill
68.
This
is
kind
of
a
pharmacy
benefit
manager,
payment,
integrity
bill.
B
B
There
was
some
concerns
last
year
when
this
bill
came
that
the
new
medicaid
pbm
was
just
getting
its
getting
established
and
they
wanted
to
make
sure
that
we
could
get
it
established
before
we
considered
this
bill,
and
so
this
bill
has
been
delayed,
worked
on
in
the
interim
and
had
a
few
changes
to
it,
and
so
this
bill
effectively
requires
the
department
for
medicaid
services
to
procure
an
independent
service
to
ensure
the
accuracy
and
the
integrity
of
medicaid's
new
single
pbm,
as
well
as
the
medicaid
fee
for
service
pbm.
B
B
B
These
monitoring
entities
will
provide
analysis
directly
to
the
general
assembly
so
that
lawmakers
understand
how
the
pbms
are
performing
with
taxpayer
dollars
and
the
monitoring
entity's
work
occur
occurs
after
the
pharmacy
has
been
paid,
so
the
pharmacy
gets
paid.
There's
no
disruption
to
pharmacists
at
all
on
that
and
it's
paid
and
they're
paid
and
the
work
is
done
before
dms
or
the
employee
health
plan
pays
the
pbm.
B
B
I
know
the
first
part
of
it
shows
some
of
the
requirements
for
the
person
that
you're
going
to
be
contracting
or
the
entity
will
be
contracting
with
as
far
as
the
years
of
experience,
and
that
we
want
it
to
be
real
time
that
helps
providers
also
know
so
that
you're
not
having
people
trying
to
retroactively
claim
funds
from
you
and
the
third
section
there
is.
We
don't
want
an
entity
that
performs
annual
retroactive
audits,
which
often
makes
it
difficult
for
providers
in
their
cash
flow.
B
C
Thanks,
sir,
any
questions
from
the
committee,
no
I've
got
a
couple
for
you
central
wise
center
alvarado
sure
it's
been
a
long
journey
since
senator
weiss
goes.
He
started
senate
bill
50.
You
know
three
four
years
ago
and
it's
amazing
how
this
has
evolved,
because
at
the
time
when
we
talked
about
this
and
the
the
thinking
was
particularly
from
department
medicaid,
there's
no
savings
here.
You
know.
D
C
Is
what
it
is
and
we
know
we
never
have
gotten
a
hard
number
on
it,
but
anywhere
between
250
million
half
a
billion
dollars.
So
this
is
a
long
way,
but
I
think
having
and
folks
overlooking.
This
certainly
gives
us
additional
potential.
But
I
particularly
like
the
idea
that
we're
going
to
do
the
kentucky
employee
health
plan
as
well.
Do
you
have
any
idea
what
they're
spending
on
prescription
drugs
have
you
seen
a
number.
B
I
I
haven't,
I
don't
know
exactly
how
much
that
is.
I
know
we've
heard
from
a
lot
of
pharmacists,
some
of
the
pharmacists
I've
talked
to
like
that
concept
as
well
so,
but
I
don't
have
an
idea
of
how
much
that
is.
We
just
I
know,
there's
an
effort
also
in
the
house,
with
a
much
larger
bill
to
include
all
commercial
pbms
and
that's
a
rather
large
bill.
B
I
think
west
virginia
has
done
something
in
that
regard,
but
the
house
is
trying
to
prepare
a
larger
bill
to
cover
cover
all
the
commercial
payers,
but
we
know
that
the
state
employee
health
plan
is
something
that
has
taxed.
You
know
taxpayer
dollars
involved
in
that
as
well,
and
we
thought
this
would
be
a
good
opportunity
to
provide
oversight
and
the
pharmacists.
I've
talked
to
like
the
concept.
C
Well,
you
know,
without
you
know,
quarter
million
people
during
this
pandemic
to
our
medicaid
program,
certainly
I'm
placing
additional
fiscal
constraints
on
our
medicaid
budget
and
that's
expected
and
thank
every
dollar
that
we
can
save,
certainly
help
support
these
folks
as
we
try
to
extend
coverage
for
them.
So
I
think
it
makes
sense.
Senator
wise,
you
have
a
question.
Thank.
E
You,
mr
chairman,
senator
overall,
thank
you
for
the
legislation,
a
question
I
have
got.
It
came
to
me
also
from
from
a
local
pharmacist
in
my
district
about
the
medicaid
auditor
requirement
portion
of
the
bill.
Can
you
go
into
more
detail
about
that?
This
particular
pharmacist
has
some
concerns
about
that.
I'm
not
sure
if
you're
open
to
maybe
having
further
discussions
upon
this
meeting,
but
can
you
describe
a
little
bit
more
about
what
that
is
going
to
do.
B
Sure
so
it's
I
mean,
I
think
this,
the
it's
under
section
one,
and
if
you
look
at
subsection
two,
it
says
to
be
eligible
to
receive
a
contract.
Pursuant
to
this
section,
an
entity
shall-
and
it
goes
into
having
at
least
five
years
of
experience,
reviewing
and
auditing
pharmacy
claims
in
pharmacy
benefit
manager.
Operations
be
capable
of
performing
the
analysis
of
pharmacy
benefit
claims
to
validate
accuracy
and
identify
identify
errors
in
near
real
time.
So
that
would
require
a
certain
amount
of
technology
to
be
able
to
say
we
can
discover
this
quickly.
B
One
of
the
complaints
we've
heard
in
the
past
is
that,
like
any
provider,
really
not
just
pharmacists
is
that
we
do
analysis
a
year
later,
eight
months
later,
and
we
say:
oh,
we
think
we
paid
you
too
much
and
we're
going
to
get
a
check
from
you
or
take
it
out
of
you
at
this
point.
Nothing
frustrates
providers
more
because
we're
very
dependent
on
that
cash
flow
to
maintain
operations,
and
so
it's
we're
trying
to
get
a
real
time.
B
There
are
several
agencies
at
least
a
dozen
that
are
available
that
have
we've
had
similar
procurements
in
other
states
like
ohio
and
minnesota,
where
they've
contracted
with
different
agencies.
Who
can
provide
that
service?
We
want
somebody
who
can
do
it
in
real
time,
not
be
an
entity
that
performs
annual
retroactive
audits
of
pharmacy
benefit
claims
for
the
public,
employee
health
insurance
plan
and
not
be
affiliated
with
common
parent
company
or
holding
companies,
share
any
common
members
of
the
board
of
directors
or
share
managers
in
common
with,
and
it
goes
through.
B
Several
you
know:
insurance
con
contracted
through
krs
18,
a
third
party
administrators
contracted
pursuant
to
18a.
I
think
a
lot
of
this
to
eliminate
a
potential
conflict
of
interest
that
we
would
have
in
some
of
those
agencies
and
they're
going
to
be
granted
full
access
with
contracts
all
that
information.
So
they
can
determine
that
things
are
being
followed
appropriately
by
the
law
and
that
payments
are
being
made
appropriately
as
well.
So
I
think
a
lot
of
it
is
just
to
catch
those
things
the
pharmacist
is
going
to
get
paid.
B
E
Thank
you
senator.
I
know
we've
done
a
lot
of
work.
I
want
to
thank
our
leadership
for
the
work
we've
done
to
create
that
single
pbm
model.
I
think
it's
very
good
for
other
states
to
look
at
with
us.
I'm
not
sure
if
the
cabinet's
on
the
line,
but
also
maybe
the
question
to
you
has-
has
the
cabinet
spoken
to
the
single
pbm
that
we
are
using
about
this
piece
of
legislation.
B
Yeah,
I
don't
know
I'll,
tell
you
the
I
have
a
weekly
meeting
scheduled
with
the
cabinet
we
had
a
meeting.
Last
week
there
were
only
six
bills
assigned
to
this
committee.
This
bill
was
not
commented
on
was
not
mentioned
no
discussion
about
it
at
all.
I
received
a
text
last
night
around
6
pm,
5
30,
6
p.m,
stating
that
oh
yeah,
we
don't
like
this.
We
already
have
someone
providing
some
of
these
services
and
what
they've
informed
me
is
at
the
university
of
kentucky
that
the
pbm
has
contacted
with
uk.
B
To
do
some
of
this
oversight.
If
uk
is
providing
some
pharmacy
services
that
becomes
a
bit
of
a
concern
there.
I
wasn't
aware
of
that.
I'm
not
sure
if
any
of
the
members
of
the
committee
were
aware
of
that.
So,
but
that's
one
of
the
agencies,
then
apparently
the
pbm
has
another
kind
of
auditing
service.
I
don't
know
what
that
entails.
I
don't
know
if
it's
real
time,
I
don't
know
if
they
have
the
experience.
I
don't
know
if
they
you
know,
can
do
things
they're
going
to
do
retroactive
audits.
B
We
don't
have
any
of
that
information.
I
was
made
aware
of
that
last
evening
at
5,
30.
frustrating
for
me,
but
nonetheless
that's
that's
the
information
I
have
as
of
right
now.
Currently,
so
I
don't
know
if
they've
discussed
it
with
a
single
pbm
from
what
I've
heard
is
that
they
know
that
they're
contracted
with
the
state
they're
willing
to
do
whatever
the
state's
going
to
require
from
them
and
and
work
with
us
in
whatever
capacity
that
we
we
determined
the
need
to
do.
Thank
you
senator
sure.
C
Centerwise
alvarado
kelly
rodman,
I
think,
is
virtual
and
centerwise.
Would
you
like
her
to
speak
to
your
question?
Please.
E
F
We've
we've
spoken
to
him.
We
are
aware
they
we've
talked
to
them.
Just
to,
I
think,
clarify
they
are
the
pbm
med
impact
has
a
contract
with
uk
we
do
have
a
separate
contract
with
that's
already
out
there
that
monitors
this.
F
These
types
of
claims
we
testified
in
the
fall
when
this
was
brought
up,
that
we
had
serious
concerns
with
the
issue
we
did
say
earlier
on
that
we
would
have
liked
to
have,
you
know,
have
a
few
more
times
have
more
time
to
make
sure
that
this
would
be
a
bigger
issue.
We
you
know
getting
into
another
contract
does
always
have
us
in
concern,
but
you
know
we
will
do
as
we
are
as
the
legislation
states.
G
Sharon
thank
you
and
I
do
have
a
question
and
I
want
to
first
reflect
back
on
senator
alvarado's
comments
regarding
the
timeline,
because
I
think
those
are
our
very
appropriate
comments.
If
you
look,
staff
provides
us
a
a
front
page:
that's
attached
with
senate
bill
68
and
provides
actions
like
we
often
see
on
the
website
and
other
places
as
the
bill
moves
through
the
process.
G
G
A
week
ago,
we
expressed
some
concerns
and
held
it
for
an
extra
week
and
then
suddenly
yesterday
we
all
start
getting
calls
from
either
the
either
either
groups
that
you've
mentioned
that
have
some
concerns
that
have
come
a
bit
late
in
the
conversation
that
doesn't
that
doesn't
diminish
those
concerns.
But
the
timeliness
is,
is
certainly
in
question
a
couple
of
quick
questions.
Mr
chairman,
thanks
for
the
opportunity
to
say
those
things,
senator
alvarado
say
again
to
us.
B
It's
similar
it's
the
bill
last
year
was
purely
for
the
medicaid
pbm.
It
did
not
include
the
state
employee
health
plan,
okay,
so
it
was
a
similar
bill,
so
it
wasn't.
G
So
now
we
have
the
cabinet
and
others
expressing
some
concerns
and
and
it's
again
not
inappropriate
for
them
to
do
that,
but
it
sure
would
have
been
nice
to
have
had
those
concerns
raised
three
or
four
days
ago
or
a
week
ago,
ms
rodman,
you
mentioned
those
were
raised
back
in
the
fall
share
with
me
again,
no
intent
just
questions
trying
to
understand.
Ms
rodman
help
me
to
understand
the
contractual
arrangements
that
everyone
seems
to
have
in
this
space.
G
F
F
I
I
apologize,
I
understand,
there's
a
timing
issue
here.
You
know
there
are
a
lot
of
bills
that
we
have
to
go
through
and
yes,
we
get
behind
and
I
will
admit
this
was
one
that
fell
through
those
cracks
on
my
hands.
So
I
will
follow
on
that.
One.
H
F
Do
need
to
get
a
little
bit
more
details
on
that
that
that
contract,
because
I
don't
even
know
who
it's
with
so
I
do
need
to
get
more
information
on
that
one
and
get
back
to
the
committee.
F
G
Those
sorts
of
things
well,
I
appreciate
your
statement
that
you'll
certainly
do
whatever
you're
told
to
do
with
regard
to
the
legislation
that
makes
it
through
the
process,
and
I
appreciate
your
response
to
that.
That's
a
very
appropriate
response,
and
so,
if,
if
this
moves
on
then
then
you
may
have
to
take
a
look
at
that.
C
C
All
righty
are
any
of
them
related
to
340b.
Is
that
what's
precipitated
this.
C
How
difficult
life
is
for
all
of
us
right
now,
senator
berg,
you
have
any
question.
K
I
do
chairman
and
thank
you
and
I
I
don't
mean
to
sound
ignorant,
but
you
know
I
was
taught
if
you
don't
understand
something,
ask
a
question,
so
I
am
confused
here.
We
currently
have
contracts
to
oversee
medication,
management
and
distribution.
Is
that
correct?
I
mean
like
when
I
think
of
a
pbm.
K
I
think
of
you
know
somebody
calling
me
and
saying
you
know
this
drug
cost
x,
y
and
z,
this
drug
costs.
You
know
a
b
and
c.
We
think
this
drug
may
work
we'd
like
you
to
try
it.
You
know
that
type
of
stuff.
That's
what
I
think
of
when
I
think
of
a
pharmacy
benefit
manager.
This
is
different.
You're
looking
at
payment
to
pharmacies
real
time
is
that
correct.
K
No,
not
prior
authorization,
I'm
talking
about
pharmacy
benefit
management.
Like
uk,
like
I
had
a
problem
with
one
of
my
prescriptions,
the
pharmacist
called
me.
My
doctor
wrote
a
script.
It
was
non-formulary,
they
didn't
want
to
cover
it.
Pharmacist
calls
you
talks
to
you
directly
as
a
patient
gets
in
touch
with
your
physician.
K
K
That
is
a
service
that
actually,
when
I
first
ran
into
it,
I
found
very
obtrusive,
but
over
time
have
realized.
Oh
man,
they're
right,
I
mean
one
of
the
drugs
I
was
on,
went
from
200
a
month
to
13
a
month
just
by
switching.
So
that's
that's
a
good
service.
I
like
that
service.
This
is
totally
different.
B
K
Of
years
ago,
I'm
aware
of
senate
bill
filthy,
and
I'm
aware
also
that
I've
got
people
writing
me.
You
know
saying
this
contradicts
senate
bill
50.
or
let
senate
bill
50
work
for
a
while.
It's
working,
it's
just
been
six
months,
give
us
some
time.
We
think
this
is
going
to
be
just
another
layer,
so
I'm
trying
to
understand
and-
and
I
apologize
for
not
understanding
this
situation,
but
I'm
really
trying
to
understand.
B
Chairman,
if
I
could
respond,
thank
you.
Thank
you.
So
again,
what
you're,
describing
as
a
patient
and
what
happens
is
a
prior
authorization
process
has
nothing
to
do
with
pbm
payments
to
pharmacists.
So
if
you
read
the
bill,
this
is
a
discussion
of
what
happens
when
you
reimburse
pharmacists
pharmacists
get
reimbursed
based
on
their
medications.
It's
a
totally
separate
thing
than
what
patients
have
to
encounter
with
their
doctors
or
what
doctors
have
to
appeal
for
from
a
pharmacy
through
a
pbm
process
for
prior
authorization.
B
So
traditionally,
what
this
does
is
it's
basically
helping
us
oversee
the
single
pbm
that
we've
established
here
in
the
state
of
kentucky.
If
you're
familiar
with
senate
bill,
50,
then
you're,
I
assume
you're
educated
on
that
topic.
We
have
a
single
pbm
now
for
medicaid
who's.
Providing
oversight,
for
that
is
the
question:
are
they
doing
payments
properly?
Are
they
not
doing
payments
properly?
We
found
out
today
we
have
two
separate
agencies.
B
B
I'm
sure
we'll
get
more
of
information
about
that
here
in
the
next
few
days
as
to
who
does
that
what
oversight
is
being
provided
when
a
again
when
there's
a
payment
being
done,
you
go
for
a
point
of
service.
A
pharmacist
gets
paid
for
that
medication.
Then
the
pbm
gets
paid
afterwards.
So
there's
a
lot
of
transactional
issues,
a
very
complicated,
very
opaque
process
that
we've
tried
to
take
the
lid
off
of
here
in
the
state
in
the
last
several
years
senate.
B
Bill
50
did
a
lot
of
that
and
reformed
a
lot
of
that
for
us.
We've
also
taken
away
mcos
from
having
their
own
pbms
to
manage
a
lot
of
these
things.
We've
established
a
single
pbm
but
who's,
providing
oversight
for
them
to
make
sure
that
those
payments
are
accurate.
What
we
don't
want
to
happen
is
what
we've
happened
in
the
past.
Is
we
issue
a
payment
to
a
pharmacist
and
say:
oh
we've,
overpaid
you
or
oh
we've
underpaid
you
and
that's
happening
and
probably
underpayments
happen
a
lot
more
than
overpayments.
B
Do
for
pharmacists,
but
to
be
able,
instead
of
having
to
recoup
that
a
year
later,
like
we've
seen
as
many
providers
do
in
the
medical
field,
is
to
do
that
real
time
so
that
when
they
as
the
as
the
as
the
everything
is
being
entered
into
for
the
contract,
an
agency
can
have
that
real
time
say:
okay,
the
pharmacist
has
been
paid.
Was
that
transaction
accurate?
C
Just
for
cinderberg's
information,
you
know
senate
bill
50.
The
genesis
of
it
was
appropriate
as
a
payment
that
we
found
that
contrary
to
contracts
with
the
mcos
that
our
independent
pharmacist
were
not
being
paid
appropriately,
they
were
not
getting
their
calls.
They
were
not
getting
the
transaction
fees.
C
So
that's
where
it
started,
and
we
were
told
at
that
point
in
time
that
they're
really
not
a
problem
central
wireless
and
I
both
determine
without
any
real
data
available
to
us
at
anywhere
between
a
quarter
of
a
million
and
a
half
million
dollars
or
500
million
dollars
in
fees.
Really,
we
couldn't
account
for
and
that's
why
we
passed
from
centerville
50.
C
B
C
So
it's
another
check
and
balance
on
this
whole
entire
process
in
the
way
the
destruction
payment,
we're
not
out
any
fees
unless
there's
a
savings
realized
from
recognizing
overpayment
and
underpayment
for
these
services.
So
I
would
just
add
to
that,
but
with
that
center,
danny
carroll,
you
have
a
question
comment.
Thank.
L
You,
mr
chairman,
senator
overall
appreciate
the
bill
couple
things
that
concern
me
and-
and
I
think
the
the
duplication
of
services
is
what
we
need
to
be
concerned
with
right
now,
and
I
guess
I
don't
understand
why
uk
would
be
providing
these
services
for
med
impact,
and
I
I
guess
I
see
the
value
of
them
wanting
someone
to
double
check
the
process
and
the
payments
that
are
going
out.
L
I
think,
with
the
cabinets
contract
with
this
company,
I'd
like
to
know
more
about
that,
and
I
think
it
would
it
might
be
to
to
everyone's
advantage
if,
if,
in
fact,
that
organization
that
that
company
is
basically
providing
the
same
services
not
in
real
time-
and
I
completely
support
the
real
time
aspect
of
this
as
it's
much
more
efficient
in
the
long
run.
L
So
I
don't
have
any
issue
with
that,
but
maybe
we
need
to
find
more
out
about
this
company
in
that
contract
and
if
we
implement
this
process,
we
need
to
make
sure
that
that
contract
is
not
renewed
at
the
end
of
the
the
service
period.
So
we
are
not
having
a
duplication
of
services,
and
I
know
it's
not
any
more
money
to
the
state
to
to
hire
this
new
company.
L
But
the
issue
is
they
would
be
making
money
off
of
the
state
for
services
that
may
already
be
provided
on
the
the
tail
end
of
the
services.
So
if
we
pick
up
one,
I
feel
like
we
need
to
drop
the
other.
I.
C
K
I'd
like
to
explain
my
no
vote,
please,
I
am
sorry
I
I
really.
I
went
through
the
legislation
last
night,
I've
read
my
emails.
I
I
don't
understand
this
enough
and
and
I'm
concerned
this
may
be
just
an
extra
layer
that
we
don't
need
that
we
may
already
have
I'm
gonna
vote
now,
no
now
and
I'll
look
into
this
further.
Thank
you.
L
C
I'm
sorry
senator
we
can't
do
this
during
road
call.
L
C
A
It
sounds
to
me
that
the
meat
of
this
bill
is
live
time,
which
is
always
excellent,
but
what's
disconcerting
to
me
is
that
we
have
these
contracts
that
we,
as
the
legislature,
don't
even
know,
exist,
and
we
can't
get
answers
as
to
whether
or
not
they're
even
live
time.
So
I
vote
I
and
I
want
to
move
the
bill
forward.
Thank
you,
mr
chair.
C
C
B
B
D
Thank
you,
mr
chairman,
and
again
I'm
julie,
rocky
adams,
senate
district
36,
and
I
hope
that
you
all
will
bear
with
me.
This
is
this:
is
a
bill.
That's
been
really
a
labor
of
love
putting
together,
it's
been
quite
a
long
journey
all
during
the
interim,
and
so
my
my
testimony
is
going
to
be
exhaustive
because
we
are
looking
at
a
49-page
bill.
So
I
want
to
make
sure
that
the
committee
has
every
all
the
information
that
they
need
to
make
an
informed
vote
today.
D
So
child
welfare
belongs
to
all
of
us
in
this
room
we
all
play
a
role
in
child
welfare,
so
the
purpose
of
this
bill
is
to
address
various
child
welfare
matters
and
expand
child
abuse
and
neglect
prevention.
Services.
Kentucky
has
led
the
nation
in
child
abuse
and
neglect
for
three
consecutive
years.
D
The
board
will
now
become
the
child
abuse
and
neglect
prevention
board.
This
expansion
is
really,
I
think,
a
dynamic
change
in
how
we
are
doing
things
across
state
government,
and
today
we
have
heather
wagers
who's
going
to
pop
up
at
the
table
with
me,
introduce
herself
and
give
a
few
minute
testimony
on
this
particular
section
of
the
bill.
F
Good
morning
my
name
is
heather
wagers
and
I
am
the
executive
director
over
the
office
of
trafficking
and
abuse
prevention
and
prosecution
for
the
office
of
attorney
general,
and
so
we
are
very
appreciative
of
senator
adams
is
attempt
to
try
to
bring
the
focus
back
to
child
maltreatment.
All
forms
of
child
maltreatment
is
a
problem
in
kentucky.
It's
not
just
one
single
type
of
maltreatment
and
I
looked
at
other
child
victims-
trust
funds
across
the
country.
F
The
majority
of
them
are
focused
specifically
on
all
four
physical,
emotional,
verbal
and
sexual
abuse,
and
so
we
are
an
outlier
and
that
we
have
a
board.
That's
only
focused
on
one
form
of
maltreatment,
ohio,
tennessee,
west,
virginia
indiana,
missouri,
michigan
and
wisconsin
are
some
of
those
that
are
surrounding
states
that
have
off
focus
on
all
forms
of
maltreatment
in
wisconsin.
They
are
leading
the
country
and
attempting
to
reduce
the
incidence
of
abusive
head
trauma.
F
Abuse
of
head
trauma
or
shaken
baby
syndrome
is
the
leading
cause
of
child
abuse
in
the
country.
We're
not
able
to
pivot,
put
forth
preventive
efforts
towards
that
here
in
kentucky
with
this
board.
Until
this
change
comes
about,
and
so
we
appreciate
the
opportunity
to
have
that
expansion-
we
worked
with
the
senator
in
the
summer
and
we
put
the
this
question
to
the
board
and
the
board
voted
that
they
were
very
interested
in
the
expansion
of
the
scope.
F
D
D
This
amendment
to
this
section
is
intended
to
promote
collaboration
with
our
community
partners
and
other
organizations
such
as
the
child
abuse
and
neglect
prevention
board,
previously
mentioned
by
miss
wagers
section
11.
It
amends
krs
199.011,
and
this
expands
the
definition
of
fictive
kin,
and
this
includes
individuals
who
have
an
emotionally
significant
relationship
with
a
biological
parent
sibling
half-sibling
in
the
case
of
a
child
from
birth
to
one
year
of
age.
So
this
change
conforms
with
the
same
definition
of
fictive
kin
in
section
17.,
the
next
couple
of
sections.
D
These
were
all
recommendations
by
the
cabinet
for
health
and
family
services,
so
section
11
was
from
chfs
section.
12
is
two
and
that
amends
krs
to
clarify
that
the
cabinet
has
five
business
days
to
submit
an
affidavit
verifying
if
someone
is
registered
on
the
punitive
father
registry
and
then,
if
we
move
to
section
13
and
14,
these
are
also
chfs.
D
D
D
D
The
cabinet
also
has
conflicting
regulations
among
departments,
so
medicaid
regulations
only
acknowledge
medical
evaluations
by
physicians
within
our
child
advocacy,
centers
and
dcbs
regulations
acknowledge
medical
evaluations
by
physicians,
aprns
and
sane
nurses.
This
provision
is
needed
to
address
the
conflicting
regulatory
standards
for
child
advocacy,
centers
in
chfs
and
finally
compel
the
cabinet
to
adequately
fund
their
services.
D
Otherwise
these
funds
will
continue
to
be
diverted
from
the
child
victims.
Trust
fund
that
is
administered
by
the
child
abuse
and
neglect
prevention
board
that
we
described
in
sections
one
through
nine,
and
I
have
some
folks
from
the
child
advocacy
centers
here
that
are
going
to
do
a
quick
testimony
as
well
and
if
they
could
make
their
way
to
the
table.
H
Thank
you
good
morning
and
thank
you
for
this
opportunity
to
speak
to
you
all
about
the
critical
need
to
fund
medical
services
at
the
kentucky
child
advocacy
centers,
I'm
pam,
darnell,
ceo
of
family
and
children's
place,
which
is
headquartered
in
louisville,
and
our
child
advocacy
center
is
one
of
the
network
of
15
child
advocacy
centers
across
our
state.
There
is
a
child
advocacy
center
in
every
area.
Development
district,
which
serves
all
counties
and
the
child
advocacy
center
at
family
and
children's
place,
serves
bullitt
henry
jefferson,
oldham,
tremble,
shelby
and
spencer
counties.
H
H
When
the
statewide
network
of
cacs
was
created
over
20
years
ago,
the
state
also
established
medical
clinics,
as
medicaid
providers,
to
allow
these
centers
to
be
able
to
use
federal
funds
to
help
support
the
cost
of
medical
services,
but
unfortunately,
medicaid
is
no
longer
a
viable
funding
source
for
these
services.
For
several
reasons.
H
Medicaid
reimbursement
is
five
hundred
and
thirty
eight
dollars.
We
are
very
grateful
to
the
child
victim
trust
fund
program
for
the
one
hundred
dollars
that
it
provides
for
every
exam,
but
the
rest
of
that
is
covered
by
the
cacs
through
private,
fundraising
and
sometimes,
if
there
are
other
state
grant
dollars
available.
J
J
J
Cac
medical
professors
professionals
provide
a
very
specific
type
of
medical
service
for
children
who
have
experienced
sexual
abuse.
We
provide
comprehensive
trauma-informed
developmentally
appropriate
medical
examinations
that
that
really
start
even
before
the
child
ever
enters
the
examination
room
and
and
concludes
long
after
the
child
has
exited
our
building.
What
do
I
mean
by
that?
First
of
all,
in
order
to
do
the
exam,
we
have
to
obtain
a
lot
of
information
from
investigators
from
the
caretaker
for
the
child
themselves,
and
then
we
also
have
to
obtain
a
medical
history,
a
social
history.
J
A
family
history
to
ensure
that
all
the
child's
needs
are
met.
It
also
requires
that
we
assess
the
child
for
injury
infection
and
then
entertain
other
diagnoses
that
might
mimic
abuse,
because
we
don't
want
to
there's
a
lot
of
stakes
in
making
the
wrong
diagnosis
here
and
in
some
cases
we
even
have
to
collect
forensic
evidence
from
the
child's
body.
J
So
the
health
care
provider
at
the
end
of
the
day
has
to
also
be
able
to
communicate
the
findings
and
the
impression
of
that
exam
with
other
community
partners
that
we
work
with
in
order
to
keep
the
child
safe.
And
this
communication
extends
beyond
the
medical
clinic,
sometimes
all
the
way
to
the
courtroom.
J
Many
of
them
volunteer
additional
time
outside
the
exam
room
they
communicate
with
community
partners
so
that
law,
enforcement,
social
workers
and
prosecutors
can
successfully
perform
their
jobs
and
when
our
medical
providers,
pro
medical
professionals,
provide
court
testimony,
they
often
have
to
take
time
away
from
their
other
jobs
and
even
cancel
a
busy
office
to
go
and
testify
in
court.
J
Most
children
who
experience
sexual
abuse
would
not
be
able
to
receive
a
trauma-informed
developmentally
appropriate
medical
exam
by
a
qualified
professional
at
a
cac
if
the
medical
clinics
didn't
provide
them.
This
opportunity,
unfortunately,
as
dr
as
senator
adams,
said
some
of
the
vital
services
that
the
health
care
providers
perform
at
cacs
are
not
outlined
in
our
current
medical
medicaid
regulation,
for
example,
follow-up
examinations,
which
involves
reassessing
an
area
of
concern
that
was
identified
at
another
exam
or
assuring
that
appropriate
treatment
was
completed
or
identifying
additional
necessary
treatment
are
not
covered.
J
J
We
know
that
from
emerging
science
on
adverse
childhood
experiences
that
unaddressed
sexual
abuse
can
lead
to
chronic
health
problems
down
the
road,
including
heart
disease,
cancer
and
obesity.
We
also
know
that
sexual
abuse
victims
can
suffer
low,
self-esteem,
suicide,
attempts,
academic
difficulties
in
school
failure.
They
can
abuse
illegal
substances
and
become
victims
of
prostitution.
J
Sexual
violence,
therefore,
is
costly
not
only
to
the
victim
but
to
the
to
society
and
to
the
commonwealth
and
all
of
us.
According
to
the
cdc,
the
total
lifetime
economic
burden
of
child
sexual
abuse
in
the
united
states
in
2015
was
estimated
to
be
9.3
billion
dollars.
The
work
that
cac
medical
providers
do
provides
more
than
a
diagnosis
on
paper.
J
Not
only
does
it
provide
the
physical
and
emotional
healing
for
the
individual
child
and
their
family,
but
the
medical
professionals,
expert
opinion
is
essential,
is
an
essential
component
of
the
investigation
and
the
court
process,
and
this
ensures
not
only
the
safety
of
that
individual
child
again
but
may
may
protect
other
children
who
are
at
risk
of
abuse
if
a
perpetrator
is
not
stopped.
J
So
in
conclusion,
kentucky
must
fund
this
work
properly
and
senate
bill.
8
helps
to
do
that.
D
Thank
you,
ladies
for
your
testimony,
okay
committee.
I'm
going
to
hustle
through
this
okay,
we're
on
section
17
and
section
17
was
designed
to
clarify
that
abuse
and
neglect
occurs
when
a
parent
or
guardian
does
not
provide
adequate
care,
supervision,
clothing,
shelter
and
education
of
thank
you
of
the
child
and
has
the
financial
means
to
do
so.
This
provision
is
an
essential
piece
of
senate
bill
8
as
it
separates
the
idea
of
poverty
from
neglect.
This
particular
language
is
modeled
after
other
states,
with
similar
provisions
within
the
neglect
definition.
D
So
we
are
the
next
few
sections.
These
are
more
of
conforming
language
type
of
bills
or
housekeeping
items.
So
we're
going
to
expand
the
definition
of
fictive
kin
to
include
an
individual
who
has
an
emotionally
significant
relationship
with
a
biological
parent
sibling,
half
sibling
in
the
case
of
a
child
from
a
birth
to
one
year
of
age.
D
This
can
form
the
next
section
is
conforming
language
as
well.
This
includes
the
state
child
abuse
and
neglect
prevention,
board
and
health
and
welfare
and
family
services
committee
to
the
list
of
entities
that
receive
the
annual
report
of
the
external
child
fatality
and
near
fatality
review
panel
in
section
19..
D
Now
this
section
we
have
people
from
the
voices
for
the
commonwealth,
then
they're
going
to
come
up
and
do
a
little
testimony
too.
This
section
amends
krs
620
to
allow
foster
youth
to
request
to
extend
their
commitment
prior
to
attaining
20
years
of
age
and
opt
in
or
out
of
extended
commitment
up
to
two
times
this
provision
was
developed
in
consultation
with
our
own
foster
youth.
D
Here
in
kentucky
and
former
foster
youth
with
the
voices
of
the
commonwealth,
section
20
adds
new
rights
to
the
foster
children,
as
it
relates
to
their
case
history
with
the
cabinet
placement
connections
to
siblings
and
parents
parenting
their
own
children,
while
in
care-
and
this
was
also
developed
with
the
voices
of
the
commonwealth
and
take
it
away.
Ladies,
please
introduce
yourself
good
morning.
Everyone.
I
I
Excuse
me
the
voices
of
the
commonwealth,
so
I
actually
reside
in
nicholasville,
I'm
not
from
murray,
I'm
just
employed
through
them,
and
I
served
as
a
youth
advocate
on
the
voices
of
the
commonwealth
for
about
three
years
and
during
those
three
years
I
did
a
lot
of
policy
advocacy
specifically
with
the
tuition
waiver
last
year
that
you
guys
have
seen
and
with
the
bill
of
rights
back
in
2018,
and
I
actually
served
as
chairperson
for
about
a
year
and
a
half
of
that
council
and
now.
I
My
colleague
here
has
succeeded
me
as
chairperson,
so
you
will
hear
from
me
in
my
new
role
and
I'm
here
showing
her
the
reins
today
of
how
this
works.
So
in
regards
to
senate
bill
8,
I
wanted
to
speak
on
the
changes
to
the
extended
commitment
statute.
It
currently
states
that
a
youth
who
is
in
foster
care
who
wants
to
extend
their
commitment
to
the
state
of
kentucky
to
the
cabinet
has
until
their
19th
birthday
to
do
so.
So
they
can
extend
when
they're
18.
I
They
can
leave
during
that
year
and
they
have
any
time
until
their
19th
birthday
to
make
the
decision
that
they
want
to
come
back
or
they
can
choose
not
to
extend
when
they're
18,
and
they
still
have
the
option
to
make
that
decision
to
return
to
care
by
their
19th
birthday.
Now
I've
done
a
lot
of
research
before
we
developed
this
request
and
over
half
of
the
states
in
the
united
states
are
actually
offering
similar
to
what
we're
asking
for
and
what
we're
asking
for.
Is
that
that
time
period
be
extended
to
their
20th
birthday.
I
And
the
reason
for
this
is
because
a
lot
of
us
have
personal
testimonies,
where
we
believe
that
the
19th
birthday
is
just
not
enough
time
for
individuals
who
have
been
through
the
foster
care
system
to
really
get
out
there
on
their
own
make
mistakes
and
realize
that
they
may
actually
need
support.
So
in
saying
that
I
actually
spent
nine
years
in
the
foster
care
system
myself
aged
out
at
18,
and
I
did
not
extend
my
commitment
to
the
cabinet
when,
on
my
18th
birthday,
I
did
not
extend
so
I
left
when
I
was
18.
I
I
was
that
hard-headed
18
year
old,
who
had
been
three
years
of
foster
care,
had
my
life
controlled
and
was
ready
to
be
in
control
of
my
own
life
and
my
own
decisions.
I
learned
very
quickly
over
the
next
year
that
it
is
so
hard
when
you
age
out
of
foster
care
without
those
supports
and
those
connections
who
are
going
to
be
there
to
help
you
as
a
young
adult
working
through
your
trauma,
trying
to
go
to
college
trying
to
work
jobs
and
it's
very
hard.
Without
that
extra
support.
I
So
I
actually
requested
to
return
to
care
on
my
19th
birthday
and
I
was
told
no,
I
was
told
no
because
I
was
already
19.
so
therefore
I
did
not
get
the
support
that
I
could
have
gotten
if
I
was
able
to
return
to
care.
Now
with
that
being
said,
the
statue
says
that
it
an
individual
who
recommits
to
the
state,
is
able
to
stay
until
they're
21.
So
I'm
not
understanding
why
we
are
capping
their
decision
to
return
at
age
19
if
you
have
until
your
20th
birthday.
I
If
you
recommit
on
your
20th
birthday,
that's
a
whole
extra
year
of
support
that
you
could
receive,
which
is
vital
to
these
young
people.
If
you
commit
anywhere
between
your
19th
and
20th
birthday,
that's
over
a
year
of
support
that
is
vital
to
these
young
people.
So
I
just
want
to
make
sure
that
we're
setting
up
these
individuals,
these
young
adults,
that
have
been
through
the
foster
care
system
setting
them
up
for
success
to
be
young
adults
and
successful
citizens
for
the
commonwealth.
M
Good
morning
to
all
my
name
is
taylor
trent
and
I'm
the
chairperson
of
the
voice
of
the
commonwealth.
I
personally
have
spent
over
10
years
in
the
foster
care
system.
Speaking
on
behalf
of
the
foster
youth
bill
of
rights,
my
team
and
I
have
heard
feedback
from
many
of
the
youth
currently
in
foster
care
throughout.
The
state
had
mentioned
that
they
felt
as
though
many
of
the
simple
rights
may
need
to
be.
M
Maybe
missing
from
the
document.
My
team
and
I
believe
that
the
amendment
of
the
bill
of
rights
will
help
ensure
that
youth
are
having
quality
experience
in
foster
care
by
giving
them
the
right
to
request
a
placement
where
they
feel
comfortable
and
safe,
allowing
them
the
right
to
participate
in
court.
Hearings
of
siblings
and
half
siblings
ensures
that
they
are
connected
in
every
way
around
them
and
that
nothing
from
them
seems
cut
off.
M
The
parental
rights
clause
allows
foster
youth
who
are
in
care
to
feel
comfortable
in
knowing
that
they
will
not
immediately
have
a
child
removed
from
their
custody
and
allow
them
the
comfort
in
knowing
that
they
will
have
the
right
to
make
parental
decisions
on
their
child's
behalf.
Lastly,
ensuring
that
all
youth
who
exit
care
have
the
right
to
receive
any
and
all
vital
documents
regarding
their
time
in
care
the
health
and
well-being
allowing
youth
to
develop
and
to
ensure
their
identity
when
becoming
a
young
adult
and
their
safety
around
their
own
health.
M
D
Thank
you,
ladies,
that
was
very
nice
very
well
done
and
then
just
to
wrap
it
up
here.
The
last
section,
21
is
just
the
section
on
the
personnel
cabinet
requiring
them
to
update
their
administrative
rags
on
the
kentucky
employee
charitable
campaign
to
include
the
child
victims.
Trust
fund,
which
you
have
heard
me,
speak
about
before
on
the
floor
of
the
senate,
and
then,
lastly,
this
has
an
emergency
clause
on
it.
D
I
think
that
that
is
important
to
put
in
there,
because
it
shows
our
commitment
to
identifying
this
as
such
a
significant
barrier
to
so
many
successful
lives
in
our
commonwealth,
and
so
with
that,
mr
chairman,
I'm
happy
to
take
any
questions
and
if
anyone
has
any
anything
specific
for
my
guests
that
I
have
please
let
me
know
and
they'll
be
happy
to
answer.
B
Senator
adams-
thank
you.
You
know
this,
I'm
a
proud
co-sponsor
of
this
bill
and
really
we're
going
to
hear
a
lot
of
things
this
session
and
I
would
argue,
it's
probably
the
most
important
bill
we
passed
this
year
and
it's
not
the
final
step.
It's
just
the
first
step.
I
think
a
lot
of
us
are
unhappy
with
our
ranking
as
a
state.
We
know
we
have
a
lot
of
work
to
do.
It's
a
big
bill,
a
lot
of
input-
and
I
I
commend
you
for
that.
It's
been
a
lot
of
work
done.
B
I
know,
there's
been
an
interim
task
force,
we're
trying
to
elevate
this.
Obviously,
on
the
level
of
importance.
Our
children
are
most
vulnerable.
I'll.
Tell
you,
as
a
provider
shaking
baby
syndrome,
huge
issue
you
hear
about
it
when
you're
a
pediatrician,
you
see
those
kids
you
find
out
after
the
fact,
they've
got
retinal
hemorrhages
and
damage
their
vision.
That'll
be
permanent,
a
lot
of
times
a
lot
of
times
the
damage.
Obviously
it's
most
of
the
time.
It's
irreversible
just
a
moment
for
parents
who
are
often
good
people
who
have
a
crying
baby,
they're
young.
B
Part
of
my
training
at
uk
was
going
to
these
clinics
to
provide
these
exams
very
delicate
exams,
very
sensitive
children
at
a
very
young
age,
difficult
exams
to
do
sometimes
with
you
know,
the
things
that
you
find
are
devastating
and
it's
important
that
we
provide
adequate
exams
for
these
children
and
often
those
exams
are
what
leads
to
the
information
we
need
to
prosecute
those
who
commit
these
crimes
and
it's
important
that
we
get
these
done
accurately
quickly
and
that
we
have
providers
who
are
willing
to
do
that.
B
G
Mr
chairman,
thank
you,
leader,
adams.
Thanks
for
this
legislation,
your
passion
around
this
topic
is
something
all
of
us
know
and
appreciate
and
applaud,
and
we
need
your
leadership
so
vitally
in
lots
of
places,
but
especially
in
this
place
around
an
issue
as
chair
alvarado
indicated
as
a
super
sensitive
topic
that
we
we've
we've
got
to
get
right.
We've
just
got
to
start
getting
better
at
this.
So
thank
you
for
the
legislation.
G
J
J
They
show
up
in
their
doctor's
offices.
Dr
alvarado,
as
senator
alvarado,
knows
that
that's
how
things
happen,
but
the
comprehensive
exam
is
really
done
at
the
advocacy
center
and
that's
one
of
the
reasons
for
the
the
follow-up,
because
sometimes
the
initial
exam
is
not
the
real,
the
exam
that
the
child
needs
or
the
follow-up
of
what
we
call
a
follow-up
exam
is
really
the
the
more
comprehensive
exam
and
right
now
we
we
don't
really
get
reimbursed
for
for
some
of
that
follow-up
that
we're
doing.
G
G
G
G
Obviously
the
thoroughness
and
the
and
the
knowledge
that
you
have
around
this
sort
of
exam
is
something
that
that
is
housed
mainly
with
you
from
the
way
you've
explained
it,
and
I
applaud
that.
We
need
that
there
I'd
love
for
my
folks
to
have
access
my
providers
to
have
access
to
the
highest
level
of
compensation
that
medicaid
can
provide
for
them
to
do
to
the
limit
of
their
abilities
and
then
pass
it
off
to
you
to
finish
the
process,
because
you
mentioned
earlier
in
your
testimony.
Timeliness
is
critical.
G
B
Thank
you
very
good
and
and
senator
gibbons
it's
and
the
process
may
have
changed.
It's
been
a
while,
since
I've
worked
uk
er
when
I
was
a
resident,
I
know
that
we
would
often
have
cases
of,
and
this
may
get
a
big
graphic,
but
children
would
come
in
there's
a
concern
of
a
sexual
abuse
or
sexual
assault
of
a
child
that
you'd
have
to
do
a
preliminary
exam
to
collect
evidence,
be
a
rape
kit
that
you
would
do
to
be
in
the
presence.
B
Typically,
of
law
enforcement
that
could
be
taped
signed
off
on
passed
on.
To
make
sure
no
evidence
was
tampered
with.
A
referral
then
would
be
made
to
an
advocacy
center
for
more.
You
know
in
in
there.
Unfortunately,
things
that
occur.
A
more
detailed
exam
is
done.
There's
concerns
about
things
like
vaginal
penetration.
B
Is
there
an
intact
hymen
or
not?
Photographs
are
taken
of
that
as
evidence.
Those
are
pretty
high
resolution.
Photography,
that's
done
of
those
kinds
of
things.
Those
are
things
that
can't
be
done
in
ers
in
doctor's
offices.
If
someone
could
come
someone's
brought
a
child
to
me
says
I'm
concerned
that
this
has
happened
to
my
child.
You
do
a
preliminary
examination.
You
do
some
of
those
things,
but
to
take
those
kinds
of
photographs
collect
that
kind
of
evidence.
B
Do
those
detailed
exams
are
difficult
to
do
so
often
you
see
these
children
after
the
assault
has
occurred
as
a
referral
from
a
primary
care
doc
or
an
er.
B
Things
have
settled
down,
but
obviously
the
the
information
that's
collected
there
is
is
of
crucial
importance
really
for
cases
that
are
being
brought
against
perpetrators
to
make
sure
that
justice
is
done
and
it's
something
that
we've
seen
I've
seen
too
much
in
my
career.
The
doctors
have
seen
too
much
in
their
career
and
again,
that's
why
I
think
this
will
be
the
most
important
thing
we
do
this
year,
senator
howe.
N
N
J
Well,
I
do
think
that
that's
a
challenge,
and
so
recently
or
over
the
years
I
mean
since
when,
since
I
started
they
all
the
children's
there,
there
is
a
national
accreditation
for
children's
advocacy
centers
and
the
majority
of
our
children's
advocacy
centers
are
accredited.
There
are
certain
requirements
that
they
have
to
meet
and
some
of
those
requirements
are
centered
around
provider
training.
So
the
providers
that
work
at
children's
advocacy
centers
have
to
have
a
certain
number
of
training
hours
in
child
abuse
and
child
sexual
abuse.
J
We
also
we
just
got
done
in
december,
providing
a
eight-hour
course
to
our
providers
around
issues
of
updates
and
updates
on
sexually
transmitted
infections,
and
you
know,
medical
finding
updates.
So
we
we
do
frequent
trainings
to
make
sure
that
people
are
qualified
that
work
at
children's
advocacy
centers.
It
is
a
challenge
to
find
people
to
to
do
the
work
and
part
of
that
challenge,
though,
has
to
do
with
the
time-consuming
nature
of
the
process,
and
you
know
if
you're
in
private
practice
or
your
work
somewhere
else.
J
It's
often
difficult
to
you
know,
take
that
time
to
do
these
exams
and,
as
I
said,
part
of
it
is
also
because
it's
not
just
the
exam.
It's
the
the
after
the
after
work
that
you
have
to
do
the
calls
you
have
to
make
to
the
investigators
and
prosecutors,
and
then
you
know
if
you
have
to
go
and
testify
in
court.
So
it's
all
that
other
work
that
you
have
to
do.
In
addition,
that's
time
consuming.
N
Thank
you.
That's
kind
of
the
lead
for
my
my
question,
I'm
assuming
that
another
reason
that
we
have
trouble
getting
qualified
people
to
senator
gibbons
point
in
my
area.
We
don't
have
a
center
even
more
the
rule
areas.
This
isn't
serviced
as
centrally,
even
as
it
is
in
your
areas,
it
takes
a
lot
more
time.
H
I
would
agree
that
it
would
and
right
now
in
kentucky
the
last
number
I
heard
in
the
whole
state.
We
have
four
board
certified
forensic
pediatricians
with
the
forensic
specialty,
and
so,
as
dr
sugerman
has
so
well
said,
it's
really
difficult
to
get
people
to
want
to
do
that
work.
You
know,
and
often
people
want
to
do
it
and
they
volunteer
a
lot
of
their
time
because
they
don't
get
paid
for
some
of
the
additional
time.
H
So
it
is
really
difficult
work
to
sit
in
here
and
then
to
have
to
do
these
exams
for
kids
who've
gone
through
some
of
the
things
you
and
I
will
never
know,
and
I
will
also
add
if
I
can.
Our
state
legislature
was
very
forward-thinking
back
in
the
late
1980s
and
the
early
90s.
When
the
state
legislature
mandated
we
would
have
a
child
advocacy
center
in
every
region
of
our
state,
and
it
would
be
wonderful
if
we
could
talk
about
how
do
we
increase
for
those
areas
that
still
don't
have
good
access.
B
N
N
So
thank
you
so
much
for
your
hard
work
in
bringing
this
it's
something
that
is
just
incredibly
incredibly
needed
and
and
really
touches
a
lot
of
our
areas
in
our
society.
I
have
a
couple
of
questions
going
to
the
fictive
ken
inclusion.
Thank
you
for
doing
this.
N
N
D
D
I've
listened
to
the
the
foster
kids
talk
about
their
one
goal
in
so
many
instances
is
to
get
back
with
that
family
in
some
way
shape
or
form
they
have
to
heal
that
family,
and
so
we
just
feel
that
this
expansion
is,
is
the
smartest
and
most
compassionate
way
to
keep
that
family
together
and
start.
The
healing
thank.
N
You,
mr
chairman,
one
more
if
it's,
okay
and
you
were
discussing
the
inclusion
of
moderate
risk
into
cabinet
involvement
for
a
preventative,
a
preventative
intervention
model.
I
guess
is
that
sort
of
thing
and
I
apologize
if
I
put
you
on
the
spot
here,
I
don't
intend
to
I
read
through
this
and
I
didn't
really
think
about
it.
Until
I
started
listening
to
your
presentation,
has
there
been
any
discussion
on
touching
the
drug
abuse
aspect?
N
So
many
of
the
cases
that
we
see
in
the
court
system,
I
would
say,
probably
off
the
cuff
number
80
or
more
the
the
core
ideology
of
this
and
the
cause
of
this
is
a
drug
issue
and
it's
a
very
going
to
be
a
very
difficult
challenge
for
our
social
workers
to
go
in
on
a
preventative
model
where
they
need
to
address
the
drug
issue
when
the
parents
are
going
to
be
naturally
denying
or
hiding
the
underlying
drug
problem,
and
I
just
wondered
if
there
was
any
discussion
on
how
to
to
address
the
drug
abuse
issue
that
that
is
so
prevalent
in
these.
D
You
know,
and
I
think
that
to
answer
your
question
not
specifically,
but
generally
that's
part
of
the
reason
for
the
expansion
of
that
to
include
moderate
is
so
that
you're
not
getting
them
at
the
absolute
depths
of
despair
that
you're
starting
you're,
starting
to
identify
that
family,
who
has
an
opportunity
to
be
healed
through
addiction,
recovery
services
or
what
have
you
that
that
we
can
start
to
rather
than
just
blow
the
family
up
here,
we
are
we're
trying
to
keep
them
together,
we're
going
to
try
to
get
them
the
services
that
they
need,
we're
going
to
try
to
get
them
the
help
that
they
need
and-
and
I
think
by
opening
up
that
definition
to
moderate-
will
really
help
us
start
to
influence
these
families
in
a
positive
way,
rather
than
having
the
most
dramatic
outcome
for
them,
which
is
separation.
L
You,
mr
chairman,
thank
you
all
for
the
presentation
and
and
made
some
comments
a
couple
weeks
ago
about
the
commonwealth's,
the
need
that
we
have
as
a
commonwealth
to
deal
with
some
of
the
basic
issues
in
our
state,
child
abuse.
Being
one
of
those
where
senator
alvarado
chairman
alvarado,
mentioned
that
we
are
the
worst
in
the
country
and
so
leader
adams.
I
can't
compliment
you
enough
for
this,
and
this
is
just
one
of
those
areas
that
we
we
must
focus
on
as
a
state
as
well
as
substance
abuse
poverty.
L
All
the
other
issues
that
unfortunately
define
us
as
a
state
when
the
reality
of
it
is
we
have
so
much
to
offer
in
this
commonwealth.
We
have
got
to
deal
with
these
basic
issues
before
we
do
anything
else,
and
so
I
commend
you
for
that
with
the
child.
Advocacy
centers
and
I've
had
the
opportunity
over
the
years
through
my
career,
to
work
with
the
centers,
and
I
understand
the
value
of
them
as
an
investigator.
I
can't
stress
enough
the
value
of
having
a
trained
physician
to
do
these
exams.
L
L
My
question
is,
I
know
these
centers
are
regional
and
I
know
in
our
area
there
is
a
concerted
effort
to
reach
out
to
all
counties
in
the
region
to
make
sure
that
those
services
are
available
and
that
the
people
in
those
counties
know
it
is
that
something
that
that
some
of
the
centers
struggle?
With
with
what
senator
gibbons
stated?
L
You
know
those
services
are
available
to
the
residents
of
his
county.
I
know
they
might
have
to
travel
a
couple
counties
over,
but
how
how
much
emphasis
is
is
put
in
each
center
on
the
the
efforts
to
reach
out
to
educate
the
the
families,
the
communities
of
that
region
on
the
services
that
are
provided.
H
So
I
can
add
that
child
advocacy
centers
across
the
state
have
family
advocates
that
help
support
and
help
make
sure
families
know
what
the
process
is
and
sort
of
walk
along
with
them
through
the
entire
way.
Caroline
rochelle
is
the
head
of
the
network
of
child
advocacy
centers
of
kentucky,
and
she
could
not
be
here
today.
I'm
sure
have
no
doubt
she
could
probably
answer
that
much
better
than
me,
but
each
child
advocacy
advocacy
center
does
have
family
advocate
staff
or
time
of
staff
that
really
helps
those
families.
The
bigger
question
of
how
do
we?
H
H
So
maybe
that
will
help
with
some
of
the
questions.
Does
that
help.
J
I
think
that
I
think
your
point
is
well
taken
and
I
think
that
senator
gibbons
senator
how
all
you
all
have
good
points,
and
I
think
that
that's
really
one
of
the
challenges-
that's
it's
probably
a
financial
challenge,
as
well
as
just
a
geographic
challenge,
but
I
think,
as
as
we
as
we
are
able
to
serve
more
children,
hopefully
with
more
money.
I
mean
one
of
the
things
we
really
need
to
do
is
think
outside
of
the
box.
J
You
know
every
county
is
required
to
discuss
their
sexual
abuse
cases
at
a
multi-disciplinary
team,
so
those
teams
should
know
that
the
children's
advocacy
service
centers
exist
and
what
their
services
are,
but
but
reaching
out
to
people
that
are
have
transportation
issues
are
farther
from
those
centers
is
a
challenge
that
you
know
we
we
need
to
address
and-
and
I
think
you're
right
in
in
this
day
and
age,
it
may
be
the
time
to
really
rethink
how
people
are
gonna
get
to
us,
and
maybe
there
there
are
some
some
models
where
there's
more
mobile
units
or
outreach
units,
and
that's
something
that
each
center
really
has
to
start
to.
L
B
C
Thank
you,
chairman,
alvarado,
and
appreciate
the
testimony.
This
morning
I
met
with
some
of
your
people
yesterday
and
really
seen
a
great
education,
and
I
reminded
them
that
you
know
supposedly
mark
twain
said
that
when
the
world
came
to
an
end,
he
hoped
to
be
in
kentucky
because
everything
happens
20
years
later-
and
you
mentioned
this
happened
in
1980
in
1990-
well
we're
right
on
schedule.
It
looks
like,
but
I
will
commend
you
on
your
ask.
C
Quite
truthfully.
I
think
it's
too
small
and
the
reason
I
say
that
is:
we've
had
a
lot
of
ask
during
this
interim
session.
We
never
measure
the
cost
of
doing
nothing,
and
I
think
if
we
did
it
would
be,
we
would
be
staggered
by
it.
I
think
you've
got
to
be
bold.
We
have
to
be
aggressive
in.
I
see
no
reason
in
the
world
not
to
do
this
2
million,
because
again
it's
a
match,
which
means
our
portion
is
going
to
be
one
six
hundred
thousand.
C
I
can
assure
you,
there's
places
in
the
state
government
we'll
spend
that
within
an
hour
and
have
no
return
on
investment
whatsoever.
So
I
understand
what
you're
doing
I
would
hope.
This
is
just
a
start
that
we
could
certainly
broaden
this
network.
We
need
to
there's
not
a
better
investment
than
in
our
children,
and
I
know
from
inappropriate
use
of
services.
It
happens
every
day
that
they're
going
to
ers
when
they
could
be
coming
to
you
folks
and
the
cost
of
that
will
it.
We
could
address
that
we'd
be
amazed
at
what
we
could
fund.
B
K
A
Senator
rocky
adams,
I
served
on
the
interim
task
force
with
you
and
this
is
an
excellent
compilation
of
all
those
meetings.
It's
very
comprehensive
and
I
commend
you
on
your
dedication
to
the
children
and
the
safety
of
the
children
of
the
commonwealth,
and
you
are
to
be
highly
commended
for
this
work.
Thank
you.
F
E
E
B
Aye
and
I'm
gonna
explain
my
vote
as
well
that
actually
the
matter
passes
11
to
zero.
But
again
we
talk
about
a
lot
of
things
in
the
general
assembly.
The
most
long-lasting
investment
we
make
is
in
our
children
and
if
our
children
suffer
trauma
of
any
type
that
extends
for
generations-
plural,
because
their
children
often
will
suffer
them.
We
know
the
consequences
of
this.
This
needs
to
be
our
main
focus
as
a
general
assembly
is
getting
this
right.
This
is
a
great
bill.
It's
the
first
step,
not
the
last
step.
B
So
we
begin
with
this
and
I
hope
to
see
more
of
this
coming
forward
and
I
hope
to
ascend
in
our
rankings
where
we
become
the
safest
place
where
kids
can
be
raised,
we're
trying
to
make
it
the
best
place.
You
know
for
lots
of
other
reasons,
but
the
safest
place
for
children
to
be
raised
needs
to
be
kentucky.
B
The
matter
passes
eleven
to
zero
it'll
be
reported.
That
will
be
the
senate
center.
Congratulations.
Thank
you
all
for
your
attention
today.
There's
no
other
matters.
We
stand
adjourned.