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From YouTube: House Standing Committee on Health Services (2-23-23)
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A
D
A
I
am
here:
okay,
we
have
a
quorum
established
to
do
business
and
so
we'll
just
go
ahead
and
get
started.
The
first
bill
we
we
will
hear,
is
house
joint
resolution
38
we
have
with
US
Representative
Baughman.
If
you
could,
please
make
your
way
to
the
table
and
introduce
yourself
for
the
record
and
as
well
as
your
guest
and
please
proceed.
G
G
So
thank
you
chair
and
to
the
committee
for
hearing
house
joint
resolution
38
today.
This
resolution
came
about
from
EMS
task
force
and
is
really
asking
the
the
Cabinet
for
Health
and
Family
Services
to
evaluate
the
reimbursement
rate
for
emergency
medical
services
and
then
take
the
appropriate
action
to
increase
those
rates
where
possible,
when
possible,
based
on
what
they
learned
through
that
evaluation
and
also
to
submit
a
State
Medicaid
plan.
Amendment
to
cover
treatment
in
place
without
transportation
for
emergency
ambulance
services
and
representative
Fleming
can
offer
some
more
detailed
information
about
the
task
force.
A
We
have
a
motion
on
the
bill
and
do
we
have
a
second
okay?
Do
we
have
any
further
comments,
or
maybe
an
explanation
of
the
rationale
for
this
I
just
think
it's
interesting.
H
Thank
you,
madam
chair,
for
the
question
with
House
Bill
777.
What
that
this
body
approved,
as
well
as
the
Senate
and
and
in
action.
Basically
out
of
that,
we
found
a
lot
of
issues
and
challenges
when
it
comes
to
EMS
infrastructure,
from
Workforce
to
reimbursement
rates,
to
training,
to
you
name
it.
H
It
came
to
service
and
is
a
very
long
process,
but
it
was
very
rewarding-
and
this
is
one
of
the
items
that
came
out
of
this-
is
that
many
of
these
actually,
these
these
EMS
workers
have
not
been
reimbursed
for
over
10
years,
and
so
there
needs
to
be
a
thorough
study
to
figure
out
what
is
going
on
in
terms
of
how
to
compensate
these
individuals
when
they
go
and
treat
somebody
sometimes
if
they
don't
go
to
a
hospital,
they
don't
get
paid.
H
There
are
some
situations
where
they
will
get
paid,
but
for
the
most
part,
that's
more
of
a
minority
amount
of
the
time.
So,
based
on
that
and
based
on
other
things,
we
came
across,
we
really
thought
this
is
a
good
idea
from
the
EMS
task
force
last
year
to
come
up
with,
with
this
type
of
a
process,
to
get
the
cabinet
to
look
at
this
reimbursement
schedules
and
a
lot
of
the
things
that's
coming
through
the
coming
through
the
house.
Also
that
that
sort
of
came
out
of
the
EMS
task
force.
F
You
thank
you.
Chair
I,
had
a
constituent
reach
out
to
me
recently
a
situation
where
her
daughter
needed
to
be
transported,
but
it
wasn't
to
a
hospital.
It
was
for
Behavioral,
Health
Services.
Would
this
resolution
you
know,
identify
solutions
that
would
enable
someone
to
go
to
directly
to
Behavioral
Health
Services
as
opposed
to
a
hospital.
H
Representative,
this
no,
this
resolution
will
not
address
that,
but
your
point
is
well
taken
and
I
appreciate
you
bringing
that
up,
because
that
exactly
the
thing
we
came
across
in
terms
of
transporting
mental
health
patients,
because
sometimes
there's
a
liability
issue
with
that,
and
so
what
we're?
H
What
we're
looking
at
doing
is:
we've
worked
with
k-beams
and
other
I
guess
over
12
other
associations
to
look
at
what
are
the
Alternatives
and
like
Lexington
and
Fayette
County
have
some
alternatives
to
transport
these
individuals
and
I'll
just
use
a
I,
almost
don't
say
this
verbatim,
but
an
Uber
like
type
of
a
process
that,
if
it's
not
in,
if
not
and
they're
endangering
themselves
and
so
forth,
then
they
can
look
at
Alterna
to
transport
that
individual
to
to
get
this
need
to
get
the
sources
that
they
need.
But
I
appreciate
the
question.
I
A
A
L
L
The
cmhcs
is
a
behavioral
health.
Public
policy
net
are
required
to
respond
to
community
needs,
including
involuntary
psychiatric
hospitalizations.
As
we
know,
the
202a
involuntary
emissions
review
nursing
home
emissions
to
some
individuals,
crisis
response
to
Community
Partners
in
a
community
during
natural
disasters
such
as
the
tornadoes
in
Western
Kentucky
and
the
flooding
in
Eastern
Kentucky,
krs-210
485
outlines
the
governors.
The
responsibilities
and
duties
of
the
cmhcs
there
are
14
statutes
included
in
krs-210,
and
the
word
Regional
is
used
a
total
of
13
times.
L
L
It
should
be
noted
that
the
contracts
issued
to
each
cmhc,
but
the
Department
of
Behavioral
development,
intellectual
disabilities,
that
we
know
as
dbhdid
include
the
names
of
each
County
within
that
cmhc
region.
As
you
see
in
the
slide
here,
it
shows
you,
the
regions,
also
the
cmhc
Medicaid
manual
Incorporated
by
reference
and
Medicaid
regulation.
L
In
addition,
other
quasi-garmental
entities
have
their
respective
regions
currently
defined
in
statute
of
Regulation
area
development,
districts,
krs-17a,
child
advocacy,
centers,
922,
Kar,
domestic
violence,
shelters,
krs-209a,
Rape,
Crisis,
centers,
922,
Kar
8..
In
conclusion,
based
on
the
Kentucky
rice
statutes,
cmhc
licensure
regulation,
dbhdid
contract
language
and
the
Kentucky
Medicaid
conditions
of
participation,
the
cmhc
model
is
a
regional
model.
House
Bill
56
confirms
the
cmhcs
as
a
regional
model.
L
On
your
screen,
here
is
the
difference
between
a
cmhc
and
a
bhso.
Hb
56
does
not
prohibit
a
cmhc
from
providing
services
and
supports
in
counties
outside
this
designated
region.
The
cabinet
of
Health
and
Family
Services
May
issue
a
license
to
the
cmhc
to
be
operating
as
a
Behavioral
Health
Service
organization.
L
Bhsos
are
similar
to
cmxs,
but
do
not
have
a
designated
service
area
again.
A
cmhc
license
as
a
bhso
can
provide
services
in
any
County
outside
of
its
designated
region.
Hb
56
simply
lists
in
statute
of
the
counties
included
in
each
of
the
regions,
served
and
supported
by
the
local
cmhc
HB,
and
conclusion
56
affirms
there
is
only
one
Behavioral
Health
Public
Safety
Net,
provided
in
each
region
responsible
for
the
full
range
of
services
in
the
region
and
that
to
chmc
designated
of
that
region.
L
A
Okay,
thank
you
any
comment
from
the
other
gentleman
at
the
table.
Okay,
so
I
I
have
a
quick
question:
I
I
you
you
covered
this
more
or
less,
but
what
we're
trying
to
do
is
maintain
coverage
for
any
unmet
need
outside
of
a
designated
Community
Health
Center
region
and
the
bhso
licensure
will
allow
individuals
who
are
operating
as
a
cmhc
to
go
outside
their
region
to
provide
that
care.
Okay,.
L
A
Yeah,
thank
you.
Do
we
have
any
questions
from
the
committee.
A
Okay,
do
we
have
anyone
speaking
in
opposition?
Oh
what
you
know
what
hang
on
just
a
second
too,
we
do
have
a
committee
sub
that
we
need
to
adopt.
L
A
A
Okay,
but
we
have
a
motion
on
the
bill.
We
have
a
second
okay.
All
right
is
there.
Anyone
here
to
speak
against
the
bill,
I
think
we're
we're
good.
Okay,
all
right
DJ,
please
take
the
role
foreign.
D
E
A
Yes-
and
we
do
have
some
members
who
are
back
and
forth
between
state
government
and
here
so
we
may
have
others
who
register
votes,
but
House
Bill
56
passes
with
favorable
expression,
15-2
one
pass
and
the
same
should
pass
on
the
house.
Thank.
A
A
H
O
H
Ma'am
chair:
do
you
want
me
to
explain
the
house
committee
sub
first
sure?
So,
basically,
there
are.
There
are
two
main
changes
in
the
in
the
house:
communities.
First
one
was
inherent
inherently
omission
of
of
social
workers,
which
is
in
your
first
section,
so
that's
been
included
in
there.
H
The
other
one
I
think
it
was
in
section
two,
seven,
no
section
section
section,
two
and
number
seven,
and
basically
it
deals
with
having
the
general
assembly,
particularly
two
committees,
Health
and
Family
Services
and
education,
to
review
and
work
with
the
CPE
in
terms
of
regulations
and
making
sure
these
goals
are
accomplished
in
terms
of
what
we're
setting
out
to
do.
So
that's
basically
two
changes
that
that
this
health
committee
addresses
okay,
I
want
to
I.
H
Guess
I
want
to
first
of
all
thank
my
guests
up
here,
because
we've
worked
very
diligently
in
terms
of
trying
to
get
something
really
Innovative
to
address
what
I
think
the
two
main
challenges
we
have
in
this
Commonwealth
education,
Workforce
and
then
Healthcare
work
Workforce,
and
this
is
a
very
Innovative
process.
In
order
to
do
that.
H
Ladies
and
gentlemen,
this
community,
this
is
a
really
Innovative
creative
approach.
Basically,
it's
a
public
and
private
partnership
that
takes
dollars
and
matches
dollars
for
dollar
of
private
funds.
They'll
go
into
into
a
Healthcare
Workforce
investment
fund.
There's
two
buckets
of
the
money
would
go
into
the
first
bucket
is
for
for
for
scholarships.
Over
65
percent
of
the
money
is
going
to
be
allocated
for
those
scholarships.
The
other
bucket
is
going
to
be
up
to
35
percent.
H
That
will
help
in
terms
of
providing
support
and
bringing
on
faculty
as
well
as
those
assets
or
equipments
that
the
faculty
needs
to
help
provide
training
in
order
to
these
individuals
to
get
certification
and
then
as
well
as
a
license.
H
There
is
a
very
strong
language
in
there
that
that
we
want
to
make
sure
that
we
get
a
return
on
our
investment.
So
there's
a
lot
of
accountability.
H
That's
going
to
be
coming
back
to
the
administration,
I'm
sorry
into
the
into
the
general
assembly
and
making
sure
that
our
dollars
are
getting
toured,
what
we
object,
what
we're
trying
to
achieve,
and
that
is
looking
at
knowing
the
health
care,
I,
guess,
occupations
and
and
individuals
throughout
the
state,
but
also
look
at
those
underserved
areas
in
the
Commonwealth
CPE
who's
going
to
be
coordinating
and
overseeing.
This
has
been
instrumental
and
very
helpful
in
getting
this
and
help
shaping
this.
H
This
legislation
they're
going
through
and
look
at
where
those
deficiencies
or
those
needs
are,
and
those
underserved
areas
not
only
in
the
occupation
or
our
health
care
worker,
but
also
regionally,
for
example,
I
know
a
representative
as
a
a
question
a
few
minutes
ago
about
EMS
and
so
forth.
There's
a
there
is
a
significant
need
and
deficiency
in
eastern
part
of
the
state
when
it
comes
to
EMS
workers
and
so
forth,
so
so
that
that
is
going
to
help
quantify
that
there's
been
over.
H
12
associations
have
been
involved
with
this
that
they're
supporting
this.
This
piece
of
legislation
and
I'm
going
to
go
ahead
and
have
Dr
Thompson
sort
of
make
some
comments
and
get
a
little
more
information
about
the
bill.
N
Thank
you,
representative,
Madam
chair,
you
know,
there's
several
things.
I
could
say
about
this
and
not
take
up
too
much
air
in
the
room.
I'll
just
say
a
few
things
that
are
clear
based
on
my
20-something
years
in
healthcare
as
well
as
education.
This
is
a
very
Innovative
bill.
You
know
the
dire
need
for
all
kinds
of
health
care
workers
now.
N
Well.
We
also
look
at
look
at
Predictive
Analytics
and
see
that
it's
going
to
grow
and
if
you
look
at
prescriptive
ways
of
handling,
this
I
cannot
think
of
a
better
legislative
process
than
this.
This
public-private
partnership
creates
on
the
front
end
and
not
the
back
end.
In
other
words
running
you
got
employers
working
with
their
campuses,
developing
what's
needed
for
today,
as
well
as
five
and
ten
years
down
the
road.
N
You
have
an
assessment
process
that
ensures
you
have
what
is
going
toward
quality
as
well
as
quality,
and
be
able
to
know
that
you
are
getting
a
return
on
investment.
It's
an
equitable
process.
It
looks
regionally.
It
looks
within
also
each
of
those
elements
as
we
concentrate
on
where
I'm
from
Clay
County
Kentucky,
as
well
as
from
inner
city
Louisville.
It
concentrates
heavily
on
all
those
areas
that
I
would
argue
that
in
the
past,
we've
always
been
behind
the
eight
ball
along.
We
know
we're
probably
never
going
to
catch
up
with
all
the
needs
that.
D
N
Have
but
I'll
give
you
an
example
from
last
year,
when
the
legislature
appropriated
10
million
for
us
to
build
out
what
I
call
a
beta
example,
and
we
did
this
with
a
collaborative
Health,
Care
Workforce
collaborative
we
have
with
that
10
million.
We
have
49
Partners,
putting
a
lot
more
skin
in
the
game
and
we're
producing
our
numbers
quickly
are
showing
that
this
offers
a
sustainability
effort
that
goes
Way
Beyond.
M
My
name
is
Todd
Lyles
and
I
work
for
LHC.
Our
company
is
a
home
health
company
that
provides
services
nationally,
providing
Home,
Health,
hospice
and
personal
care
services.
In
Kentucky
we
have
52
offices
serving
two-thirds
of
the
state
and
in
our
office
we
see
the
number
one
problem
today
is
Staffing.
We
just
can't
find
enough
Staffing.
We
did
a
study
a
few
months
ago.
M
That
said
nationally,
we
would
be
willing
to
hire
4
000
health
care
workers
across
the
country,
and
we
could
hire
over
350
in
in
Kentucky
alone,
and
this
is
something
that
we've
tried
to
solve.
On
our
own.
We've
raised
wages,
we've
paid
bonuses
for
stay
on
sign,
on
whatever
we
can
do
to
try
to
attract
workers,
and
we
simply
can't
find
them.
So
we
need
a
solution
and
it's
a
solution
that
we're
willing
to
participate
in.
M
This
is
a
public-private
partnership
and
we
think
government
by
providing
the
opportunity
for
scholarships,
we're
willing
to
put
up
our
money
for
to
match
some
of
those
scholarship
funds
to
provide
training
sites
for
the
students
and,
ultimately,
to
provide
job
locations
for
them.
So
we
fully
support
representative
Fleming
in
this
bill
and
look
forward
to
its
Passage.
O
Thank
you
represent
representative
Moser
for
hearing
The,
Spill
and
members
of
the
committee
and
appreciate
representative
Fleming's
leadership
on
this.
Our
story
is
similar
to
Home
Health
I
think
this
committee
is
painfully
aware
of
our
Workforce
shortages
and
long-term
care
nationally.
Over
210
000
positions
were
lost
in
long-term
care
alone,
since
the
kova
19
pandemic
in
Kentucky.
That
represents
a
negative
14
change
in
nursing
facility
employment.
O
We
surveyed
our
membership
and
88
of
our
members
who
responded
to
our
survey,
reported
some
level
of
Staffing
shortage.
75
percent
said
it.
It
was
difficult
to
very
difficult
to
hire
new
staff
and
there
are
over
700
open
state
registered
nurse
aide
positions
within
our
member
facilities.
That's
700,
open
state
registered
nurse,
a
positions
within
our
member
facilities.
Nurse
aides
are
the
backbone
of
long-term
care.
O
So
we
greatly
appreciate
representative
Fleming,
including
nurse
aides
in
House
Bill
200,
because
we
also
firmly
believe
that
the
more
nurse
aides
we
have
the
stronger
our
nursing
pipeline
will
be
in
Kentucky,
so
I
do
appreciate,
representative
Fleming
and
representative
Mosers
and
members
of
this
committee.
Thank
you.
H
And
ma'am
chair
I'll
just
conclude
by
saying
that
this
basically
simple,
what
simply
does
it's
this
bill,
kickstarts
career
paths
for
all
Kentucky
kentuckians
interested
in
healthcare
career,
and
it
puts
a
jet
pack
on
the
Healthcare
Training
pipeline,
so
I.
Thank
you
very
much
be
more
happy
to
entertain
your
questions.
Okay,.
A
A
I
I
love,
p3s
I,
like
creating
Partnerships,
so
I
appreciate
all
of
your
work
on
this.
We
are
keenly
aware
of
the
healthcare
workers
shortage
in
Kentucky
and
I
know.
Last
year
we
passed
a
an
expansion
of
the
land
forgiveness
program
and
this
is
a
little
bit
different,
targeting
a
different
population
of
health
care.
Worker
and
I
I
agree
that
this
increases
the
pipeline,
the
potential
pipeline
for
those
health
care
workers.
So
thank
you
very
much
for
all
of
your
work
appreciate
it.
We
do
have
a
couple
of
questions.
Representative
Bray,
oh
representative,
Bentley,.
L
Thank
you
chair
lady
Dr,
Aaron
Thompson,
our
protocols
and
agreements
with
Physicians
necessary
for
this
to
work.
N
No,
it's
not
necessary,
but
it
would
be
desired.
Is
the
way
I
see
it,
I
mean
because
what
you
have
here
is
within
a
hospital
or
ambulatory
setting
outpatient.
All
of
those
you
know,
Physicians
are
a
key
element
to
this
conversation
right,
but
the
and
they
fully
buy
into
it,
because
much
of
this
focuses
on
what
really
makes
those
settings
work
beyond
what
positions
do,
and
so
they're
very
much
and
even
me,
being
with
Baptists
I
can
tell
you.
Our
positions
are
excited
about
this
sort
of
action.
N
It's
not
required
that
that
is
in
place,
but
it
is
desired.
If
for
them
to
do
it
and
I,
don't
think
we'll
see
a
problem
of
them
not
wanting
to
do
it.
A
Okay,
do
we
have
any
further
questions
from
the
committee
all
right,
seeing
none,
we
have
a
motion
in
a
second,
so
DJ.
If
you
could,
please
take
the
role.
D
E
D
I
A
P
A
A
Q
Good
morning
Madam
chair
and
the
committee,
so
my
name
is
Steve
bratcher
Representative,
Steve,
bratcher
and
I've
got
the
oig
here
for
helping
talk
a
little
bit
about
this
bill.
So
I
got
Adam
Mather
yep.
Q
We
should
have
everybody
here
that
should
be
able
to
explain
this
lengthy
Bill
Okay,
so
so
this
is
basically
a
Casper
cleanup,
Bill
and
there's
about
four
criteria
to
it.
One
is
that
Casper
can
be
used
to
exchange
with
other
partners
and
federal
programs,
so
across
state
lines,
and
then
the
other
one
is
there
are
some
eggs
there's
an
exception?
That's
in
there
for
non-profits.
Q
So
if
there's
a
non-profit,
Health
Clinic,
that's
prescribing
medication,
they're
they're
exempt
from
having
to
use
the
Casper
system
and
then
there's
a
some
language
that
that
clarifies
the
requirement
for
a
practitioner
or
pharmacist
who's
authorized
to
prescribe
or
dispense
controlled
substances,
and
they
must
have
an
active
Casper
account.
I
think
before
there
was
some
confusion
about
that.
Q
There
was
two
different
accounts:
you
have
to
go
on
and
get
one
account,
and
then
you
have
to
get
the
actual
Casper
account
and
I
think
this
outlines
the
clears
up
some
confusion
that
it
is
a
Casper
account
you
have
to
have
and
then
there's
some
minor
changes
that
were
other
changes
that
were
deleted
out.
The
out-of-date
language.
Q
R
The
last
one
is
obviously
hydrocodone
drugs
with
hydrocodone
and
then
move
from
a
schedule
three
to
a
schedule
two,
so
we
just
clean
sorry,
we
just
cleaned
that
language
up.
Okay,.
A
L
Turned
it
off
that
first
Federal,
could
you
explain
that
a
little
better
sure.
R
So
so
we
have
unfortunately,
as
it
currently
stands,
we're
unable
to
share
with
the
hospitals
on
military
bases,
the
VA
clinics
and
hospitals,
and
so
this
will
allow
us
to
participate
with
those
Federal
Partners.
Well,.
L
R
I
would
have
to
get
back
with
our
you
know
with
our
Casper
team,
but
you
know
we're
working
on
the
modernization
project
will
be
finalizing,
so
that's
probably
something
we
could
put
in
the
phase.
One
of
the
phases.
L
E
A
A
E
A
House
Bill
200,
yes,
okay!
Thank
you
all
right.
Okay,
I
will
make
my
way
to
the
table
and
invite
my
guest
to
the
table
while
I
hand
over
the
gavel
to
my
co-chair
representative,
Dodson.
S
A
A
Thank
you
thank
you
for
being
here
and
we
do
have
a
committee
sub
which
we
need
to
adopt.
S
A
Okay,
thank
you
so
today
we're
talking
about
prior
authorization,
which
is
a
process
that
health
insurance
providers
employ
to
determine
medical
necessity
for
coverage
of
a
test,
treatment
or
procedure.
It's
a
Time
intensive
process
by
which
a
physician
must
submit
their
rationale
for
prescribing
a
certain
test
or
treatment
to
get
in
permission
from
the
insurance
company
to
provide
the
care
that
they
know
that
their
patients
need
Healthcare
Providers,
spend
years
training
to
determine
the
best
course
of
treatment
for
their
patients.
A
Prior
authorization
delays
Care
by
often
days
or
longer.
It's
it's
an
expensive
and
time-consuming
layer
of
bureaucracy
to
Health
Care.
Both
doctors,
offices
and
insurers
have
full-time
staff
just
to
deal
with
obtaining
prior
authorization
or
utilization
reviews
and
to
get
these
approvals
to
and
and
these
expenses
ultimately
get
passed
along
to
all
of
us
as
patients.
So
I
I
would
just
like
to
relay
a
quick
story
and
I
know.
A
Dr
Taylor
has
stories
of
her
own
being
in
in
private
practice,
but
two
days
ago,
I
had
a
constituent
join
me
in
my
office,
who
described
his
situation
as
a
hemophiliac.
He
started
seeing
spots
in
his
left
eye.
He
it
was
determined
that
he
needed
emergency
surgery
for
a
detached
retina.
A
His
surgery
was
successful,
but
there
was
a
good
chance
that
he
could
have
had
serious
outcomes.
He
could
have
been
blind,
and
so
the
delay
in
in
obtaining
the
prior
authorization
has
clear
Health
outcomes
and
they're
they're,
not
usually
positive,
you're,
going
to
hear
that
the
federal
government
has
begun
work
to
fix
this
problem
as
well,
which
highlights
really
the
overall
problem.
If
the
feds
are
talking
about
this.
A
Clearly,
it's
a
problem
and
but
part
of
what
they
say
in
their
comments
in
their
opinion
in
this
proposal,
is
that
they
encourage
states
to
go
ahead
with
their
plans
to
to
deal
with
prior
authorization
and
and
and
all
of
these
types
of
exemptions
for
for
providers,
so
so
they're
actually
encouraging
states
to
go
ahead
with
what
their
plans
to
do.
This
I
also
have
a
letter
from
CMS.
We
we
asked
the
question
about.
You
know
what
what
is
it
that
you
are
encouraging
states
to
do?
What
do
you?
What
do
you?
A
What
what
sorts
of
comments
would
you
like,
and
what
we
received
back
was
it
was
in
regard
to
the
question
we
asked
for
question.
We
asked
for
comments
for
consideration
for
future
rulemaking
and
ask
whether
or
how
gold
carding,
or
this
exemption
for
prior
authorization
exemption
programs
could
reduce
provider
and
payer
burden
and
improve
services
to
others.
So
clearly,
this
is
a
recognized
situation.
A
So
obviously,
CMS
recognizes
this
as
a
as
a
burden,
so
what
house
bill
134
will
do
it
will
allow
insurers
to
evaluate
a
health
care
provider's
experience
with
obtaining
prior
authorizations
over
the
previous
six-month
period.
It
will
provide
an
exemption
then
to
those
providers
if
from
prior
authorization,
if
they
have
demonstrated
an
approval
of
90
percent
or
better
of
their
applications
for
prior
authorizations.
A
We
don't
want
this
to
get
out
of
hand.
We
have
worked
with
the
insurance
plans
to
tighten
up
some
of
the
language.
There
are
actually
one
one
provision
that
the
committee
sub
added
was
to
say
that
if
a
physician
is
part
of
a
review
process,
we
had
that
the
they
had
to
be
the
similar
of
similar
or
the
same
specialty.
We
know
that
that's
not
always
possible,
and
so
we
said
when,
when
possible.
A
So
you
know
again,
this
will
ensure
that
health
care
providers
who
are
providing
medically
necessary
care
will
have
this
burden,
lifted,
saving
health
care
costs
and
will
ensure
that
patients
have
no
delay
in
their
care.
This
is
one
more
step
in
creating
efficiencies
and
addressing
the
high
cost
of
Health
Care
and
health
health
provider.
Burnout
kentuckians
shouldn't
have
to
worry
if
they'll
have
access
to
the
treatments
and
medications
that
were
prescribed
by
their
doctor.
S
And
we
also
have
a
doctor
on
Zoom
that
wants
to
speak
as
well.
So
before
we
take
any
motion
for
the
bill,
we
will
have
them
come
up.
Is
there
any
final
comments.
T
You
thank
you,
representative,
Moser
and
chairman
I,
appreciate
the
time
I
just
wanted
to
share
a
few
comments
from
the
Kentucky
Medical
Association
survey
that
we
conducted
earlier
in
the
fall
with
some
comments
from
Physicians
across
the
state
and
just
want
you
to
be
aware.
82
percent
of
physicians
in
our
survey
said
that
there
were
a
lot
of
issues
with
prior
authorization
delaying
to
their
patients
care
and
changing
their
course
of
treatment
for
their
patients.
T
They
also
stated
that
81
of
the
prior
authorizations
delayed
the
access
to
care
for
all
these
patients
and
some
of
the
examples
that
they
provided
I
found
very
interesting.
They
stated
that
delay
in
care
often
adds
to
the
time
my
patients
are
in
pain,
because
Diagnostic
and
therapeutic
procedures
are
being
delayed
several
times
each
week.
I
have
to
change
my
treatment
plan
from
what
I
consider
to
be
optimal
because
of
these
denials.
T
The
other
stories
that
were
shared
were
a
good
example
of
what
impact
this
has
on
our
patients,
who
are
losing
quality
of
life
and
having
delays
in
their
time
with
their
family
and
missing
work.
So
some
of
the
examples
that
they
shared
was
one
was
really
difficult.
It
was
that
a
patient
drowned
due
to
a
low
blood
sugar,
while
they
were
waiting
for
a
prior
authorization
on
a
continuous
glucose
monitor
that
would
have
told
them
that
their
blood
glucose
was
low.
M
K
Thank
you,
Mr
chairman.
Let
me
start
out
with
saying
love
the
bill
hate
prior
authorization.
Think
it's
the
dumbest
thing
personally
had
a
wrist
injury
needed
to
see
an
orthopedic
doctor
had
to
have
an
X-ray
done.
No
reason
why
the
doctor
knew
that
the
X-ray
wasn't
going
to
show
anything.
It's
a
tissue
injury.
They
tell
me
hey,
you
got
to
have
this
X-ray
done
anyway.
Insurance
won't
approve
it.
So
I've
got
to
have
the
X-ray
done.
K
Knowing
good
and
well
I've
got
to
have
that
to
see
the
orthopedic
guy
and
so
then
got
to
have
a
CT
scan
done,
can't
have
a
CT
scan
done
until
I
see
the
orthopedic
guy.
So
meanwhile,
instead
of
just
getting
the
CT
scan
in
the
first
place,
because
my
doctor
knows
that
that's
what
I
need
I've
got
to
jump
through
all
these
hoops
and
that's
driving
up
the
cost
of
my
health
care.
It's
a
pain
in
my
hand
in
and
it's
an
issue,
but
then
at
the
same
time,
I'm.
K
A
I
appreciate
that
question
very
much
because
I
wanted
to
touch
on
this
yeah.
This
just
actually
dropped
this
morning
so
and
it's
something
that
we
have
requested.
It's
been
in
the
works
for
a
while.
So
in
this
statement
it
says
that
the
department
of
of
insurance
analysis
included,
use
of
data
and
statistics
from
the
Kaiser
Family
Foundation
America's
health
insurance
plans,
Texas
Association
of
health
plans
and
an
Actuarial
judgment.
A
You
see
that
all
of
the
data
came
from
the
health
insurance
plans.
We
don't
have
any
input
from
Health,
Care,
Providers
or
any
entities
who
hire
entire
Departments
of
folks
to
work
on
this.
A
So
you
know
we
have
a
snapshot
from
DMS
that
says
You
know,
despite
the
utilization
increase,
the
cost
actually
went
down.
I
would
I
would
say
that
if,
if
we
get
to
a
neutral
position
on
this,
that
the
cost
I
I
believe
it'll
be
offset
by,
you
know
the
the
patients
won't
have
any
delay
in
their
care.
They
won't
have
those
additional
health
care
costs.
We're
going
to
see
this
time
time
consuming
and
expensive
burden
be
lifted
from
not
only
our
providers
but
from
the
health
insurers
themselves.
A
They
have
entire
Industries,
who
do
nothing
but
utilization
review,
and
that's
who
you're
going
to
hear
from
I?
Think
evacore
is
here
and
that's
all
they
do.
So
if
we
have,
we
have
businesses
built
around
this.
Clearly
this
is
a
money
making
Venture
for
for
those
entities
or
they
wouldn't
be
in
business.
So
I
guess.
The
other
thing
that
I'd
like
to
mention
is
that
researchers
estimate
that
waste
in
health
care,
including
the
administrative
costs
like
prior
authorization,
amounts
to
245
billion
dollars
per
year
or
2497
dollars
per
person
in
the
U.S.
A
So
I
I
think
that
you
know
we
have
this
wide
range.
This
huge
range
of
potential
expenses
and
I
think
the
question
is,
or
the
answer
may
be,
that
we
don't
really
know.
But
if
we,
if
we
see
snapshots
of
data
and
and
these
cost
estimates
of
waste
which
prior
authorization,
it
creates
some
guidelines
we
and
and
guard
rails.
A
K
Thank
you.
You
answered
the
question
because
I
mean
in
my
mind,
if
I'm
not
having
to
take
three
tests
just
to
see
a
doctor
and
to
get
where
we
know
this
is
going
to
go,
I
mean
I
can't,
but
the
zero
to
46.5
I
don't
understand
that
right
and
then
you
mentioned
the
waste
and
I
realized.
You
know
this
isn't
the
time
to
talk
about
Health,
Insurance
liability
and
all
of
that,
but,
my
goodness,
we
prescribe
so
many
unneeded
tests
and
this
this
does
get
get
too
headed
in
the
right
direction.
A
S
P
P
L
L
So
many
years
and
two
weeks
ago,
I
had
carpal
tunnel
syndrome
from
a
Whole
Net
phone
waiting
on
PA,
so
Pas
when
you
get
them
sometimes
I've
had
patients
come
in
documented
that
a
trade
name
wouldn't
cause
them
a
rash
and
a
generic
wood
where
their
face
swelled
out,
where
you
wouldn't
recognize
that
patient
and
not
be
able
to
PA
to
a
trade
name
to
say
that
person,
misery
and
I've
had
Pas
changed,
antipsychotic
drugs
or
that
person
wants
to
commit
suicide,
yeah,
so
I'm
white-headed
because
of
Pas.
Thank
you.
S
So
the
one
comment
I
would
like
to
make
so
these
in
these
audits
that
are
done
twice
a
year.
Is
that
correct
that
will
prevent
any
fraud
if
they
go
in
and
see
that
they're
working
within
the
parameters
of
care
given
so
there's
some
safeguards
there
to
make
sure
a
physician
is
prescribing
or
doing
adequate
care,
so
I
really
like
that
provision
of
the
bill.
So
thank.
M
M
S
So
representative
Moser,
if
you'll,
hang
tight
for
just
a
moment
and
I
have
several
that's
coming
to
the
desk
and
I
would
just
like
to
ask
each
of
you
to
make
it
brief.
We've
got
to
get
on
the
house
floor
here
shortly,
but
please
give
us
your
testimony.
We've
got
Scott,
Brinkman,
Tom,
Stevens,
hope,
McLaughlin.
J
R
V
Foreign
good
afternoon
am
I
coming
through
okay
on
audio
okay.
Wonderful!
V
V
I
apologize,
my
name
is
Dr
Eric
gracious,
I
am
a
board
certified
pediatric
oncologist
and
I'm,
the
chief
medical
officer
for
evacore
healthcare,
and
we
do
medical
Benefit
Management
in
all
50
States,
including
Kentucky
and
I'm.
Here,
to
talk
about.
You
know
maybe
to
correct
some
of
the
misperceptions
that
that
I
hear
in
the
testimony.
V
That's
that's
come
before
in
some
of
the
comments
and
questions
and
I
I
have
no
doubt
that
some
of
the
stories
we
heard
happened
and
they
make
me
sad
and
they
make
me
cringe
because
they're
not
what
this
process
is
designed
to
do
you
know
the
truth
is
that
this
this
conversation
is
a
lot
more
complicated
than
the
original.
The
initial
presentations
might
lead
you
to
suspect.
You
know
prior
authorization
began
decades
ago
as
a
mechanism
to
control.
V
You
know,
spending
around
very
high
cost
Services
which
for
the
time,
wouldn't
even
register
today.
He
would
never
even
think
about
them
today,
and
you
know
over
time
it
has
evolved
into
and
really
quite
a
different
model.
The
people
that
are
doing
this
work
well
and
they're
doing
this
work
in
a
modernized
fashion
are
focused
on
improving
patient
quality
and
it's
really
about
applying
evidence-based
medicine
accurately.
V
As
a
matter
of
fact,
I
even
heard
in
the
comments
from
the
from
the
medical
association,
one
of
the
Physicians,
even
admitting
that
the
care
plan
changed
after
the
conversation
because
of
a
conversation
around
evidence-based
medicine.
That's
that's
actually
good
for
that.
Patient,
because
what's
happening
is
medical
evidence
is
continuing
to
evolve
at
an
ever
increasing
rate
and
there's
you
know,
there's
a
published
study
back
in
2011
that
looked
at
the
doubling
time
of
medicine
over
a
period
of
years
and
I
will
keep
it
brief.
V
But
you
know
using
the
rate
of
rise
over
three
different
time
points
and
modeling
that
forward
to
2020.
Medical
knowledge
was
doubling
every
73
days,
so
gold
carding
in
itself
is
based
on
a
flawed
premise.
It's
based
on
the
premise
that
any
physician
anywhere,
no
matter
how
good
they
are,
no
matter
how
hard
they
try
and
keep
up
with
the
changes
in
evidence-based
medicine
in
blind
spots
creep
into
your
knowledge
that
you're
unaware
of
that's.
V
Why
they're
blind
spots
and
the
effective
fire
authorization
serves
to
fill
that
not
fill
those
knowledge
gaps
for
the
benefit
of
patients
and
I,
hear
stories
about
delays
and
Care
again,
like
the
ones
that
were
shared
that
make
me
cringe,
but
I
think.
We
also
need
to
understand
that
prior
authorization
removes
delays
in
care
when
patients
are
going
down
the
wrong
path.
V
One
of
the
things
that
happens
during
a
prior
authorization,
as
evidenced
by
our
Kentucky
Medical
Association
colleagues,
is
that
sometimes
care
is
redirected.
It's
not
stopped,
and
that
is
not
done,
based
on
cost.
That's
based
on
adherence
to
evidence,
and
sometimes
that
redirection
the
evidence
says
you're
doing
something
more
costly.
You
know
we'll
use
the
Imaging
results.
The
Imaging
example
provided
earlier.
V
We
very
commonly
will
look
at
a
request
and
I've
done
this
myself,
where
a
request
has
come
in
for
a
CT
scan
of
the
head
of
a
young
child
with
a
new
headache,
and
the
evidence
is
really
really
clear.
The
best
study
for
that
patient
is
an
MRI.
A
young
Shop
with
a
new
headache
is
always
a
reason
to
get
Advanced
Imaging,
but
you're
wasting
time
and
letting
the
patient
get
sicker
by
playing
around
with
x-rays
and
CTS,
and
so
by
redirecting
to
that
MRI
we're
saving
weeks,
sometimes
in
that
patient's
care.
V
So
it's
it's
more
complicated
than
prior
authorization
causes
delays,
sometimes
Physicians
cause
delays
well-intentioned
but
they're
delays.
So
this
is
really
focused
on
the
patient
and
then,
when
you
focus
on
the
gold
carding
itself,
the
the
impact
here
is
not
I'm
going
to
challenge
this.
The
assessment
on
the
Zero-
that
is
just
not
what
we
have
seen:
gold
carding,
Is,
Not,
A,
New
Concept.
It's
been
tried
in
the
past
and
what
happens
is
almost
any
physician.
If
you
tell
them
here's
the
mark,
you've
got
to
get
to
either
achieve
this
goal.
V
You're
looking
for
or
to
avoid
this
consequence,
you
don't
like
you
can
do
it
for
a
short
period
of
time,
but
once
the
oversight
is
gone,
you
know
behavioral
regress
and
so
that
that's
just
that's
just
natural
human
behavior.
So
it's
it's
really
about.
How
do
you
have
the
right
controls
in
in
place
and
you're
looking
at
20
cases
over
a
six-month
period?
You
know
for
when
you
know
you're
making
hundreds
of
decisions
a
day.
It's
it's
really
a
tiny
sample
size.
V
So
it's
it's
not
it's
not
very
effective
and
when
you
think
about
the
threshold
for
a
minute,
this
is
a
conversation.
That's
come
up
in
in
multiple
States
and
as
a
physician,
I
tend
to
see
it.
It
sounds
good
on
paper.
You
hear
90
you're,
like
that's.
Oh,
that's
a
good
score!
That's
that's
an
A
on
my
algebra
test.
You
know
every
physician
in
the
room
got
over
90
their
whole
life
to
get
into
medical
school,
to
get
through
medical
school
to
do
everything
else.
V
But
when
you,
when
we
were
talking
about
this
in
another
state,
I
had
a
representative
say
you
know,
I've
heard
you
know,
I
saw
this
bill
and
I'll
save
you
a
ref,
because
I
I
hate
this
bill.
It's
a
I
was
a
little
shocked
and
I
said.
V
Okay,
tell
me
why,
and
she
said
well,
it
sounds
to
me,
like
the
medical
association
is
telling
me
that
I
need
to
pass
a
law
that
says
Physicians
can
mess
up
10
of
their
decisions
and
I
don't
get
to
care
about
that,
and
that
was
really
quite
shocking
for
me,
but
it
really
it
was
very
telling
to
how
this
sounds
to
the
average
person
who
just
wants
Health.
They
just
want
to
get
better.
V
They
want
to
have
optimized
health
and
move
forward,
and
when
you
take
that
a
step
further,
a
10
error
rate
I
mean
in
patient
care.
Find
me
a
clinic
find
me
a
hospital
find
me
a
nursing
home,
find
me
anybody
that
thinks
even
a
two
percent
error
rate
in
patient
care
decision
making
is
safe
or
good
or
acceptable.
V
V
So
the
net
impact
on
the
administrative
burden
is
to
increase
it
further.
So
this
this
is
there's
things
we
can
do
and
we
would
love
to
partner
in
helping
to
reform
prior
authorization.
This
just
isn't
delay
and
I
want
to
give
the
other
folks
at
the
table
a
chance
to
speak
and
I'm
happy
to
say
around
for
questions.
So,
thank
you
so
much
for
your
time
and
thank
you
especially
for
allowing
me
to
participate
remotely
as
a
due
to
some
emergency
I
wasn't
able
to
travel
today.
S
Y
And
I
guess
I'm
up
next
on
this
one.
This
is
somewhat
the
easy
part
I
get
to
say
we
haven't
seen
the
committee
sub,
so
we
don't
know
exactly
what
we're
speaking
to,
but
I
will
get
a
copy
and
do
what's
necessary
to
to
analyze
that
I
will.
My
my
chore
is
to
bring
to
your
attention
the
fact
that
we
do
have
Federal
rules
in
the
process.
Y
It's
my
understanding
that
the
public
comment
period
ends
in
March
of
this
year
to
deal
with
prior
authorization
issues
and
those
Federal
rules
are
going
to
deal
with
response
time
frames
for
pas
a
much
more
detailed
analyzes
of
the
reasons
for
denials,
an
electronic
process
for
requests
and
decisions
and
annual
reporting
mechanisms
to
to
really
keep
an
eye
on
it.
So
I
I
think
that
the
effective
date
of
those
regulations
were
going
to
be
sometime
in
the
25
2025
2026
range
and
Off
Script
just
a
tab.
Y
But
I
would
like
to
take
a
a
personal
note
on
this.
I
was
hospitalized
four
times
last
June
for
some
very
serious
health
issues
and
I
was
terrified.
When
the
doctor
told
me
that
one
of
my
surgeries
was
going
to
change
and
I
thought,
okay,
great
well,
I
was
on
the
table
and
I
was
a
little
concerned
about
how
long
prior
authorization
was
going
to
take.
Y
J
Right,
thank
you.
Mr
chair
appreciate
that
I'm
just
going
to
identify
a
few
points.
First
of
all,
we
appreciate
the
opportunity
we've
been
working
with
chairwoman
Moser
on
this
for
really
over
a
year
now,
also
with
representatives
of
the
Kentucky
Medical
Association
and
most
recently,
we
did
provide
written
comments
to
the
bill.
We
haven't
seen
the
committee
sub,
but
we'd
be
happy
to
share
that
with
staff
members
of
the
committee,
so
that
that
can
be
shared
as
well,
so
that
we
can
help
refine
this.
We
aren't
opposed
to
prior
authorization.
J
It's
a
major,
it's
a
major
issue,
but
we
are
opposed
to
the
bill.
So,
having
said
that,
I
just
want
to
hit
on
a
few
highlights,
as
members
of
this
committee
are
aware,
Kentucky
has
a
significant
number
of
people
that
are
in
Medicaid
right
now.
J
That
number
is
in
the
area
of
38
percent
of
citizens
of
the
Commonwealth
as
a
result
of
expansion
during
the
public
health
emergency,
55
percent
of
the
members
of
Medicaid
or
55
percent
of
Kentucky's
children
are
in
Medicaid
today
and
one
of
the
elements
that's
unique
about
this
bill
versus
any
of
the
bills.
We're
aware
of
any
place
else
in
the
United
States
right
now
where
gold
carding
has
been
implemented,
particularly
Texas,
which
is
the
only
state,
that's
really
done.
Something
along
these
lines
is
that
this
bill
would
include
Medicaid.
J
It
would
also
include
chip
that
is
not
any
of
the
other
bills.
So
I
take
note
of
this,
because
Texas
has
had
a
really
difficult
time
implementing
this
bill.
It's
sort
of
a
Swiss
cheese
combination
of
different
things,
with
lots
of
holes
in
it
as
a
result
of
that
what
was
supposed
to
be
a
relatively
quick
implementation,
it's
just
an
I.T
turnaround
in
fact
was
a
15-month
process.
They've
only
just
activated
their
gold
carding
program
exclusively
for
commercial
insurance
in
October.
J
We
really
don't
have
any
data
back
yet
I'm
in
regular
communication
with
Texas
trying
to
get
information
on
it,
but
when
you
think
about
what
we're
proposing
to
do
in
Kentucky
is
not
just
commercial
insurance,
but
also
Medicaid
and
chip.
That
is
a
much
bigger
lift
and
the
deadline
for
implementation
of
this
bill
is,
or
at
least
was
before
the
committee
sub
I
haven't
seen.
That
was
January
1
of
2024,
and
that's
just
it's.
It's
not
a
realistic
expectation.
I
would
say
if
you
were
strictly
looking
and
I
would
defer
to
Dr
gracious.
J
But
if
you
were
looking
at
exclusively
commercial
coverage,
18
months
would
be
a
reasonable
time
frame.
Next
thing
that
I'd
like
to
to
add
there
also
House
Bill
134,
does
have
restrictions,
particularly
in
section
five
on
Health
Plan's
ability
to
recruit
recoup
inappropriately
paid
funds
through
the
Medicaid
Program.
So
we're
concerned
about
that.
We
think
it's
probable
that
would
lead
to
litigation
pretty
quickly,
and
we
also
have
concerns
about
self-funded
plans
which
you're
probably
aware
under
erisa
those
are
preempted.
J
They
are
also
not
covered
by
this
bill,
so
you're
also
going
to
have
dual
operation
of
systems
internally,
where
somebody
could
walk
in,
for
example,
could
be
a
third
party
administrator
program
that
Anthem
runs
they're,
also
going
to
have
an
Anthem
card,
and
so
it's
going
to
be
another
situation.
We're
going
to
have
more
administrative
abrasion
related
to
this
on
behalf
of
the
patient
and
I
think
I'll
pass
it
on.
If
there
are
any
specific
questions
now,
I
was
going
to
let
Scott
go
ahead
and
speak
unless
you
thanks.
Yes,.
X
I
just
want
to
make
one
point,
and
that
is
chairwoman.
Moser
correctly
points
out
that
the
federal
rules
and
there's
actually
three
Federal
rules
that
were
published
in
December
of
last
year.
X
The
federal
rules
do
not
prohibit
the
States
from
proceeding
with
a
prior
authorization
legislation,
but
the
reality
is
your
health
plans
are
only
going
to
have
one
PA
system,
they're
not
going
to
have
a
state
system
in
a
federal
system
and
to
go
forward
and
require
our
plans
to
start
to
implement
House
Bill
134,
knowing
that
the
federal
rules
are
out
there
for
comment
now
with
effective
dates
of
January.
1
2026
strikes
me
as
requiring
our
health
plans
to
incur
administrative
expense.
X
That
really
is
not
necessary
because,
yes,
states
can
have
their
own
laws,
but
under
the
supremacy
clause,
the
United
States
Constitution,
the
rules
published
by
CMS
will
have
precedence
over
any
state
laws
or
regulations,
and
also
point
out
that
there's
two
parties
to
the
system
that
whatever
systems
in
Dr
gracious,
pointed
this
out.
Whatever
systems
that
the
the
plans
come
up
with
to
comply
with
House,
Bill,
134
and
or
the
federal
rules,
the
providers
are
going
to
have
to
have
the
same
systems
they're
going
to
have
to
have
the
apis
that
speak
to
each
other.
X
Does
it
make
sense
at
this
point
in
time,
knowing
these
Federal
rules
have
been
published
in
the
last
two
months
to
require
our
Kentucky
Health
Plans,
to
start
to
implement
very
complicated,
very
expensive
system
configurations
to
comply
with
household
134,
knowing
that
ultimately
they're
going
to
have
to
do
the
same
thing
to
comply
with
the
federal
rules
and
the
federal
rewards
do
take
priority
under
anything
that
the
state
does.
U
Great
pressure,
but
just
want
to
let
you
know
I
will
be
quick,
so
again
hope
McLaughlin
with
Anthem
Blue,
Cross,
Blue,
Shield
and,
first
of
all,
I
want
to
say
that
Anthem
supports
efforts
to
streamline
prior
authorization
and
is
continuously
modernizing,
improving
and
when
appropriate,
removing
PA
requirements
for
certain
services.
U
Anthem
has
developed
a
number
of
innovative
programs
that
reduce
prior
authorization
burden
for
qualifying
providers
that
are
in
value-based
contracts
and
have
a
proven
track
record
of
following
evidence-based
medicine.
One
of
those
programs
we
started
in
2018
prior
off
pass
and
it's
expanded
to
Kentucky
and
allows
providers
to
waive
PA
for
a
number
of
outpatient
CPT
codes.
U
Anthem
is
also
engaged
in
developing
new
technology,
aimed
at
reducing
prior
authorization
turnaround
times
and
overall
burden.
For
example,
Anthem
developed
an
ai-powered
tool
that
researches
an
electronic
electronic
medical
record
for
medical
necessity
terms
and
if
those
terms
are
found
can
recommend
approval
of
the
prior
authorization
request.
Another
example
is
anthem's
work
with
health
level,
7's
DaVinci
project,
which
is
in
the
process
of
finalizing
data
standards
for
a
prior
authorization,
application
program,
interface
or
API.
U
That
providers
can
link
to,
as
others
mentioned,
CMS
is
working
on
implementing
a
series
of
three
major
rules
over
the
next
three
years
that
will
change
prior
authorization
across
the
country.
Implementing
a
program
of
the
scale
outlined
in
House,
Bill
134
will
likely
prove
to
be
difficult
as
carriers
and
providers
work
to
implement
these
new
rules.
U
Cms
has
advised
that
states
should
align
their
rules
with
CMS
Health
Care
is
a
complex
and
volatile
business
for
this
Committee
in
the
Commonwealth.
To
act
on
this
now
would
be
premature
with
the
work
ongoing
at
the
federal
level
and
will
serve
only
to
increase
the
challenges
and
complexity
within
the
system.
U
Advocates
might
say
that
the
pending
rules
encourage
go-karting
programs.
That's
true
I
agree
with
that,
but
these
rules
encourage
carriers
not
states
to
take
action
on
this.
At
this
time,
with
this
in
mind,
we
ask
you
to
vote
no
on
House
Bill
134
in
its
current
form,
and
we
remain
open
to
working
with
the
kma
and
the
sponsor
on
this
important
issue.
Thank
you.
W
Make
I
want
to
piggyback
off
what
Dr
Grace
said
just
30
seconds
of
your
time.
If
you
don't
mind
so
Dr
gracious
mentioned
in
his
statement
that
medical
knowledge
is
moving
extremely
fast
right,
and
so
he
cited
at
the
University
of
Iowa
real
quickly.
W
Record
Matthew,
director
of
ever
core
Health
Care,
that
medical
knowledge
changes
or
doubles
every
73
days,
so
I
just
want
to
put
some
stats
very
quickly
behind
that
change.
So
just
in
2019
alone,
the
national
comprehensive
Network
nccn,
which
is
a
not-for-profit
profit,
leading
Cancer
Center
I'm,
just
in
2019
alone,
issued
170
guideline
updates
across
54
cancer
types
and
18
new
oncology
drugs.
W
This
is
highlighted
by
a
recent
study
by
the
a
group
called
doximity,
which
is
the
largest
Physician
Network
in
the
United
States
about
80
percent
of
doctors
are
part
of
this
network
and
when
they
were
pulled
together,
two-thirds
of
Physicians
report
feeling
overwhelmed
by
the
amount
of
information
they
have
to
keep
up
with
with
all
these
new
changes,
so
I
just
wanted
to
throw
that
and
just
finally
one
more
thing.
We
have
to
also
remember.
W
First
and
foremost,
prior
authorization
is
a
patient
safety
tool,
but
we
also
need
to
come
to
the
realization
that
there's
an
incredible
amount
of
wasteful
Health
Care,
someone
which
was
mentioned
in
this
testimony,
but
I'll
just
cite
a
journal
of
the
American
Medical
Association
2019
article.
That
said,
wasteful
Health
Care
spending
is
estimated
to
be
as
high
as
935
billion
with
a
B
dollars
on
an
annual
basis.
That's
25
percent
of
Total
Health
Care
spending,
so
I
just
wanted
to
put
those
stats
on
provide
a
little
bit
more
information
from
what
Dr
gracious.
S
K
U
Want
me
to
start
well,
one
thing:
one
thing
I
want
to
point
out
is
that
there
is
no
other
state
aside
from
Texas
that
has
implemented
a
program
of
this
scale.
There
are
some
other
states
that
have
implemented
programs
or
passed
legislation
like
Louisiana
that
has
mandated
that
insurers
adopt
prior
authorization
programs
themselves.
U
You
know
totally
open
to
having
that
conversation.
You
know
Anthem,
especially
and
I'm
sure
other
health
plans
as
well
have
prior
authorization
programs,
gold,
carding
programs
in
place
in
terms
of
the
cost.
You
know
it
is
hard
to
to
get
a
good
estimate
on
this,
because
this
is
a
new
process,
and
you
also
don't
know
how
many
we
can
make
estimates,
but
we
don't
know
how
many
Physicians
are
actually
going
to
hit
that
90
threshold
on
everything.
U
U
In
addition
to
that,
fiscal
notes
are
as
well
it's
concerning
that.
This
bill
applies
to
both
Medicaid
and
to
the
Kentucky
employees,
health
plan
and
there's
no
fiscal
note
attached
to
it,
and
so
I
think
that
you
know,
as
the
bill
moves
forward
in
the
process.
I
think
that
that
would
be
an
important
piece
of
information
for
the
legislature
to
have
in
front
of
it
before
they
made
a
decision
on
this
legislation.
Tom
did
you
have
anything
to
add.
K
And
then
just
one
follow-up,
I
guess
it's
more
of
a
statement.
The
prior
authorization
process
as
a
patient
is
extremely
frustrating
from
a
hospital
perspective.
It's
extremely
frustrating
from
the
pharmacist's
perspective.
It's
apparently
frustrating,
but
so
whatever
recommendations
you
all
have,
can
you
please
give
those
to
us
so
that
we
can
do
a
better
job
and
get
rid
of
these
stupid
things?
Q
Yes,
thank
you
chair.
This
is
for
the
Dr
gracious.
What
standards
do
you
use
when
you're
determining
whether
service
or
medication
should
be
approved,
I
mean?
Is
there
a?
Is
there
a
guideline
or
standard
who
gets
approved
and
who
does
it
in
the
time
frame?
Certainly.
V
Thank
you
for
the
question,
so
I
I
will
speak
for
our
approach
and
we
again
we
represent
a
large
number
of
Health
Plans,
including
many
in
Tennessee.
That
I
think
my
colleague
from
Anthem
would
agree
that
their
process
is
very
similar.
V
Our
guidelines
are,
are
based
on
he'd,
be
evolving
scientific
evidence,
so
they're
specific
to
patients,
conditions
and
they're
a
they're,
an
accumulation
of
the
medical
knowledge
that
is
coming,
whether
that's
coming
from
a
an
organized
body
like
the
American
College
of
radiology
or
the
national
Comprehensive
Cancer
Network,
or
it's
an
accumulation
of
evidence
from
a
variety
of
different
sources
and
published
in
a
in
one
format.
Those
evidence-based
guidelines
are
publicly
available
on
our
website
as
our
as
it
is
from
US
Health,
Plans,
they're
they're
shared
freely
and
those
are
the
those
are.
V
Those
clinical
standards
are
the
basis
upon
which
that
medical
necessity
review
is
performed.
The
people
doing
those
and
I
do
want
to
challenge
the
the
mischaracterization
that
was
shared
earlier
about
the
quality
of
the
people.
Doing
this
work
and
I
neglected
that
in
mind,
opening
comments,
the
people
that
we
employ
are
experienced,
clinicians,
all
of
whom
have
multiple
years
of
real
world
active
clinical
practice
in
their
specialty.
V
If
they're
a
physician
is
a
nurse,
a
genetic
counselor,
a
physical
therapist,
and
it
is
those
people
who
are
taking
the
clinical
information
that
is
provided,
whether
that's
in
writing
or
by
phone
and
applying
the
evidence
to
that
and
determining
how
does
the
patient's
care
align
with
that
approval
decisions
are
often
extremely
fast.
The
overwhelming
majority
of
our
decisions
happening
with
in
under
one
day
the
ones
that
take
a
little
longer
are
the
times
where
we
need
to
exchange
information.
The
patient
is
more
complicated.
V
There
may
be
information
that
wasn't
shared,
but
these
are
all
expert
people
who
maintain
active
State,
licensure,
active
board,
certification,
active
continuing
medical
education
and
has
significant
experience
managing
the
patient's
condition.
These
are
not
unqualified
people.
These
are
not
bureaucrats.
These
are
clinicians
they're,
experienced
professionals
who
are
focused
intensely
on
making
sure
patients
get
the
right
care.
Thank
you.
Q
Thank
you
just
one
more
comment:
I
think
your
numbers
might
be
a
little
bit
off.
You
said:
935
billion
was
your
cost,
but
there's
a
1.9
million
is
what
you're
the
people
that
are
card
carriers
for
Anthem.
If
you
multiply
by
that
times,
12,
which
is
what
representative
O'hare
mentioned,
then
it'd
be
24
million,
it
wouldn't
be
935
billion,
so
I
don't
know
what
you're
referring
to
on
that
and
then
the
also
notice
on
Anthem
that
I
wasn't
concerned
with
the
that
number.
Q
J
W
Was
the
question
around
if
they,
if
the
rule
was
implemented
and
then
it
was
withdrawn?
To
my
knowledge?
No,
there
were
about
13
states
that
yes,
last
legislative
session
that
tried
to
implement
or
brought
forward
introduced
legislation
around
gold
carding.
They
varied
a
little
bit,
none
of
them
passed
and
I.
Think
once
once
these
lawmakers
understood
the
the
impacts
they
they
ultimately
did
did
not
pass
into
law.
All.
S
L
I
want
to
explain
my
answer,
my
vote.
This
is
very
confusing.
Some
points
that
are
talked
about
evidence,
evidence,
evidence-based
medicine
and
medical
knowledge
changes
so
quickly.
You
know,
I
went
down
to
see
where
they
made
the
Coast
Guard
Cutters
and
they
don't
put
I.T
in
them
to
the
last
three
days
because
it
changes
so
quickly.
L
L
We
got
people
dying
if
they
do
that,
we
got
to
stay
with
evidence-based,
take
care
of
the
care
of
the
people
in
rural
Kentucky,
okay,
some
Pas
or
they're
going
to
die
on
us
I've
been
there
I've
been
50
years
behind
the
counter,
so
I
vote
Yes,
but
I
do
have
these
concerns
and
I
think
it
needs
to
be
refined
a
little
bit
and
then
on
the
10
percent.
We
maybe
need
to
refine
that
a
little
bit
representative,
because
a
lot
of
us
work
on
zero
percent.
L
Q
K
Representative
Bray
explain
my
vote.
Please
I'm
a
yes
like
I,
said:
I
mean
anything
we
can
do
to
move
the
direction
of
eliminating
needless
useless
stupid
tests,
whether
it's
for
prior
authorization
or
whether
it's
for
medical
malpractice
liability,
whatever
the
need,
may
be
I'm
for
it.
It
is
a
little
concerning
that.
We've
got
a
impact
statement
that
is
so
wide,
but
there
is.
There
are
good
things
that
we
can
do
so.
I
vote,
Yes.
C
I'd
also
like
to
explain
my
vote.
I'll
be
voting.
Yes,
I
do
share
concerns
both
about
the
90
threshold
and
also
about
the
forthcoming
regulations,
which
will
or
recommendations
from
the
federal
level
and
finally,
without
a
fiscal
note
and
our
decreasing
budget
I
am
concerned
whether
or
not
the
state
of
Kentucky
can
absorb
the
increased
possible
costs
that
may
come
along
from
expanding
this
at
a
Statewide
level
for
people
on
the
kehp
and
Medicaid.
Z
I
have
a
yes
with
reservations.
If
I
could
explain
so
I
would
like
to
see
some
actual
numbers
Anthem
mentioned,
removing
they
have
been
actively
working
to
remove
some
of
the
PA
I'd
like
to
see
which
ones
they're
talking
about
I'd
just
like
to
see
some
activity
and
I
would
also
like
to
to
work
towards.
Z
How
can
we
incentivize
carriers
to
move
in
that
direction
versus
more
legislation
if
we
could
just
some
kind
of
incentivation
incentivizing
option
and
I
I
too
Express
the
90,
though
I
was
assured
that
that
number
is
usually
really
a
lot
higher,
but
hearing
the
conflicting
testimony
here
today,
I'd
like
to
see
some
kind
of
numbers
to
back
up
one
way
or
the
other.
But
yes.
D
AA
AA
This
topic
is
very
very
important.
I've
worked
in
healthcare
for
many
years,
I've
done
a
lot
of
Pas
in
my
time
and
they
are
a
hassle
I'm,
not
I.
Don't
have
white
hair
like
another
representative,
but
they're
a
hassle
and
I've
seen
a
lot
of
patients
that
have
been
hospitalized
because
a
PA
Was
An
approved
timely,
so
but
I
think
we've
got
some
more
work
to
do
so,
I'm
gonna
know
for
today.
Thank
you.
E
F
P
My
yes
vote,
I'm,
a
yes
on
the
bill
and
I
do
just
want
to
express
my
solidarity
with
the
frustration
about
not
being
able
to
see
committee
Subs
in
a
timely
way.
That's
hard
on
committee
members
as
well
and
I
know
it's
hard
on
members
of
the
public.
So
that's
not
aimed
at
this
Committee
in
particular,
but
it's
been
a
it's
been
a
problem,
but
yes
on
this
good
Bill.
Thank
you.
I
I
S
A
You
thank
you
and
I.
I.
Don't
normally
do
this,
but
if
I
could
just
address
some
of
the
comments
about
the
the
Medicaid
cost,
I
cited
one
example:
I
I
should
have
said
during
testimony
that
we
have
asked
DMS
for
all
of
those
numbers
and
we
weren't
able
to
get
those
so
I'll
keep
working
on
that,
but
the
for
the
snapshot
in
time
for
those
two
years
during
covid
when
the
regs
were
relaxed,
it
showed
a
decrease
in
cost.
A
So
I
I
mean
you
know,
that's
real
life
example
and
then
just
the
last
thing-
and
there
are
other
things
we
could
talk
about,
but
the
90
and
10
that's
for
prior
authorization.
That
is
not
an
error
rate
so
that
10
percent
was
misconstrued
as
an
error
rate.
Now
I
I,
you
know,
I
know
that
most
Physicians
and
other
health
care
providers
who
prescribe
treatments
often
have
a
99
percent
rate.
A
I
mean
it's
it's
very
common
and
a
lot
of
times
that
10
percent
is,
you
know
it's
not
approved
the
first
time
and
it's
approved
on
appeal,
so
that
counts
as
a
non-approval.
So,
and-
and
just
the
last
thing
is,
I
am
absolutely
willing
to
work
with
the
insurers
on
this
I
know
that
there
is
a
lot
that
we
can
do.
A
The
federal
government
is
working
on
interoperative
inner
interoperability
and
streamlining
these
services,
and
we
don't
want
to
interfere
with
anything
that
that
they're
working
on
so
yeah,
if
we
can,
if
we
can
work
on
a
an
infrastructure
that
jump,
starts
this
process
and
just
lifts
some
of
this
burden.
That's
what
we're
looking
to
do
so.
I
really
appreciate
everyone's
support.
Thank.