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B
B
Here:
okay,
so
now
this
morning,
we're
going
to
have
a
presentation
for
Renee
and
she's,
a
speech
pathologist
and
CEO
of
Associates
in
pediatric
Therapies.
She
is
here
to
discuss
Medicaid
reimbursements
for
Pediatric
therapeutic
services
right
yeah,
Miss
Sager.
Please
identify
identify
yourself
for
the
record
and
members
hold
your
questions
till
after
the
presentation.
Please.
Thank
you.
A
All
right,
can
you
hear
me
now?
Thank
you.
My
name
is
Angela
Renee
sagacer
and
I'm
a
speech
language
pathologist
and
the
owner
of
Associates
in
Pediatric,
Therapy
I
want
to
say
first
thank
you
for
allowing
me
to
be
here
today
to
testify
about
something
that
is
so
dear
to
my
heart,
which
is
children's
services
and
Pediatric
Therapy
I
also
want
to
say
a
big
thank
you
to
my
family.
That's
here
today
supporting
me
as
well
as
several
of
our
patients
and
employees
that
are
sitting
behind
me.
A
A
But
the
issue
was
there
wasn't
a
lot
of
services
in
that
area,
so
this
mother
had
to
drive
over
an
hour
each
way
to
get
her
child
the
services
that
she
needed.
She
would
do
this
for
some
time
until
her
child
then
went
to
school
and
then
eventually
graduated
from
speech
therapy
services
around
fifth
grade.
A
It
was
at
this
time
that
daughter
determined
that
she
wanted
to
be
a
therapist
and
help
change
lives
daily,
I'm,
not
sure
if
you
know,
but
that
story
is
my
story.
We
all
have
a
story
here
today
and
I'm
so
excited
to
be
telling
you
my
story
of
why
I'm
so
passionate
about
early
intervention
care
for
our
children,
because
I
am
a
success
story.
A
If
I
didn't
have
early
intervention
services,
I
might
not
be
sitting
here
before
you
today.
This
was
in
the
80s
and
my
mother
had
to
drive
over
an
hour
to
get
Services
because
we
lived
in
a
rural
town.
We
shouldn't
have
our
kids
40
years
later,
still
struggling
with
the
same
Services.
Yet
we
do.
How
can
we
fix
that?
Our
Commonwealth
needs
us
I'm,
sharing
you
my
story,
because
it's
important
to
me,
as
you
can
see,
I
have
several
kids
myself.
A
A
Something
happened:
sorry,
okay,
so
as
I'm
talking
about
this
with
our
story
apt
opened
in
2007.
A
and
our
purpose
is
to
help
as
many
children
as
we
can
help
and
five
years
ago
we
said
our
10-year
mission
of
being
named
working
really
hard
to
provide
services
for
any
child
who
needs
us
wherever
they
may
be.
So
we've
continued
to
grow
over
those
few
years
to
provide
this
service
for
our
kids
and
in
2007
when
we
started.
One
of
the
reasons
I'm
here
today
is
to
talk
to
you
about.
We
haven't
actually
seen.
Thank
you.
I
just
pushed
enter
right
here.
I.
C
A
Okay,
perfect,
so
our
goal
is
to
help
again
as
many
children
as
we
can,
and
we
really
this
year
was
our
fifth
year
into
the
senior
Mission
and
last
year
we
were
able
to
see
over
300
000
visits
and
we're
going
to
talk
about
how
we're
going
to
help
meet
our
Target
and
we're
going
to
be
able
to
help
touch
Western
and
Eastern
Kentucky
on
top
of
just
the
other
areas
that
we're
at
so
apt
started
in
a
little
rural
area
in
Taylorsville
and
it
started
an
early
intervention.
I
met
my
husband
at
College.
A
A
So
if,
as
soon
as
that
happens,
that's
how
we've
grown
and
spread
just
until
recently
I'm
from
Tennessee,
originally
West
Tennessee
and
went
to
Murray
State,
where
I
met
my
husband,
we
grew
organically
up
until
recently
and
I
brought
on
a
partner
to
help
us
grow
in
Tennessee,
which
is
also
where
I'm
from
the
services
we
provide
are
speech
therapy,
occupational
therapy,
Physical,
Therapy,
behavior
therapy
and
audiology.
A
Over
the
past
five
years,
we've
been
named
best
places
to
work
in
Kentucky
and
I,
don't
take
this
award
lightly.
It
shows
that
we
have
quality
therapists,
who
love
coming
to
work
every
day
and
providing
the
services
for
the
children
of
the
Commonwealth.
We
work
hard
to
build
our
culture,
but
I'm
going
to
talk
to
you
today,
because
I'm
really
afraid
that
we're
losing
ground.
A
Currently,
these
are
the
counties
that
apt
serves
and
I
hope
that
you
see
that
our
goal
is
to
turn
this
map
Green.
Okay,
we
want
to
help
as
many
children
as
we
can
and
I've
talked
to
a
few
of
you
about.
How
can
we
increase?
You
can
see
that
we're
in
Western
Kentucky
as
far
Southwest
as
we
can
go
in
Fulton
and
we're
providing
teletherapy
services
in
the
school
for
children
there,
based
on
some
of
the
incentives
that
the
legislation
put
in
for
Telehealth.
A
So
thank
you
and
you
know
we
also
go
a
far
north
and
south.
In
Kentucky
we
were
in
Eastern
Kentucky
as
a
family.
Last
week
and
I
know,
I've
talked
to
representative
Bentley.
There
is
a
huge
need
there
and
we
want
to
to
be
there
to
help,
but
if
we
cannot
make
some
changes
into
our
funding
population
here
for
the
Medicaid
Therapy
Services
we're
not
going
to
be
able
to
make
some
of
those
grounds
that
we
want
to
make
with
the
kids.
A
So
here's
a
snapshot
of
Apt.
Currently
we
see
over
5000
patients
a
week.
We
are
in
a
variety
of
settings,
so
we
have
clinics
that
patients
come
to
us.
We
also
have
Community
Partners,
such
as
the
kids
club,
which
is
a
pediatric
daycare
for
kids,
with
special
needs,
Down
syndrome
of
Louisville,
a
variety
of
preschools
and
daycares.
We
also
do
a
lot
of
public
schools
in
the
state
of
Kentucky,
as
well
as
private
schools
such
as
Christian
Academy
or
in
some
of
the
Archdiocese
schools,
60
percent
of
our
population.
A
Right
now,
excluding
schools
has
some
form
of
Medicaid
and
we
have
over.
This
is
the
number
I
want
you
to
look
at
guys,
2500
children
waiting
for
apt
services,
not
Statewide.
This
is
apt
services
in
the
state
of
Kentucky
they're
waiting
for
services
at
our
office.
Can
you
imagine
how
many
more
children
are
waiting
across
all
the
other
agencies.
A
Since
2007,
we
have
had
little
to
no
increase
no
increase
in
our
budget.
What
has
happened
so
when
apt
first
started,
we
were
heavy
First
Steps
early
intervention,
but
then
we
also
had
a
heavy
commercial
over
time
with
expanded,
Medicaid
and
we're
all
familiar
with
expanded
medicaid.
Our
population
has
grown
and
it
has
changed.
Therefore,
our
our
demographics
have
changed.
We
are
now
60
plus
percent
Medicaid,
where
before
I
was
a
higher
percentage
for
commercial
insurance,
I've
never
turned
a
child
away
based
on
the
type
of
Revenue
Source
they
bring
to
us.
A
I've,
never
told
a
child
that
they
cannot
come
to
our
office
because
they
have
Medicaid
to
me.
I
want
to
help
every
child,
it
doesn't
matter
their
funding,
but
the
thing
that's
happened
is
where
we
were
able
to
support
a
lot
of
the
Medicaid
funding,
because
we
had
a
lot
more
commercials
since
expanded
medicaid,
now
we're
heavier
Medicaid,
and
that
is
a
concern
for
us.
A
So
I
want
to
tell
you
a
story
about
my
numbers
here.
The
people
cost
in
Revenue,
as
you
can
see
from
q1
of
21
to
q422,
has
drastically
continued
to
increase.
There's
a
lot
of
variables
and
factors
here,
but
the
same
with
our
operating
increases
in
Revenue.
We
know
that
inflation
is
happening
across
the
board
everybody's
wanting
increases
in
salary
to
keep
up
with
putting
food
on
their
table
at
home.
A
A
So
those
variables
happen
a
lot
in
the
MCO
world,
but
I
want
you
to
note
that
it
continues
to
go
down
and
in
Q2,
because
we
were
increasing
our
rates
for
our
employees
so
that
they
could
continue
to
provide
food
for
their
families.
Our
profit
margins
were
little
to
none
and
in
the
Q4
we
lost
money.
If
we
continue
like
this,
we
will
not
be
able
to
continue
to
cover
our
cost
as
a
company,
so
I
want
to
share
with
you
how
a
dollar
is
spent
at
apt.
A
49
goes
to
our
therapist
salary
and
wages.
Five
percent
goes
to
admin
benefits
29
to
admin,
support
six
percent
for
rent
Four
Cents
for
EMR,
which
is
our
medical
records,
three
cents
to
treatment,
materials
and
other
supplies,
and
then
our
goal
is
to
have
three
percent
op
operating
profit
to
support
future
growth.
So
we
can
continue
to
open
offices
and
areas
and
our
initiatives
of
what
we
want
to
help
children
in
the
Commonwealth
do
so
from
2021.
Our
admin
and
benefits
cost
increased
from
78
cents
to
84..
A
A
A
A
Our
pay
is
not
comparable
to
other
settings
for
therapy
and
I'll
show
you
that
graph
in
just
a
minute,
they're
leaving
the
field
all
together,
we've
heard
Health
Care
is
leaving
in
drones,
they're
changing
to
another
population
like
adults,
because
they
can
make
more
money
in
the
adult.
Setting
apt
is
not
able
to
keep
up
with
inflation
rates,
or
we
do
have
a
few
that
just
want
to
stay
home
with
their
kids
and,
and
that
is
a
small
small
percentage.
I
recently
had
a
therapist
leave
to
go
be
a
wine
taster.
A
I
said,
maybe
I
want
to
do
that
too
some
days,
so
you
know
it
is
what
it
is
I
want
to
show
here.
This
is
the
American
speech
and
hearing
Association.
It's
our
national
report
for
salaries
based
on
2021
apt,
and
this
65
000
is
on
the
high
end
for
us
for
our
therapist
we're
we're
on
the
lowest
end
here
to
provide
quality
care.
We
compare
to
school,
yet
our
therapists
don't
get
eight
weeks
off
a
year.
A
So
I
want
you
to
see
this
because
it's
it's
an
eye-opening,
a
thing
because
prior
you
know,
when
we
started
again,
our
rates
were
the
same
as
they
have
been
since
07.
We
were
able
to
be
a
trend
and
we
were
able
to
pay
competitive
wages.
But
since
15
years
we
haven't
had
an
increase,
we're
not
competitive
anymore,
we're
losing
providers.
A
Okay,
so
here's
the
numbers
2007
89
for
per
steps,
visit,
2023,
89,
epsdt,
8505,
2023
8505.
Our
Medicaid
rates,
which
are
Medicaid
fee
schedule,
have
not
changed
significantly,
plus
or
minus.
Since
2007
2015,
we
saw
a
decrease
every
year.
I
gave
my
employees
increases,
because
if
I
don't
they're
not
going
to
stay,
but
yet
apt
has
not
had
an
increase,
we
have
to
pay
for
mileage
travel
time
training.
All
of
that
epsdt
we're
in
the
community,
we're
paying
for
mileage
and
travel.
A
I
also
have
some
concerns
with
first
steps,
which
is
our
state
Early
Intervention
Program.
These
numbers
should
be
eye-opening
to
every
one
of
you
in
this
room.
If
you
notice
in
2021,
we
had
more
children
eligible
for
services
and
more
referrals
than
the
year
prior,
yet
we
actually
served
less
patients.
We
only
served
4975
in
our
state,
Early
Intervention
Program,
remember,
I,
said
at
my
office
we
see
5
000
children
a
week.
How
is
one
agency
seeing
more
than
the
state
and
our
waiting
list
is
2500
kids
at
just
air
office?
A
This
number
should
be
double
for
our
state
and
I'm
really
concerned
about
our
first
steps
program.
Why
is
the
first
steps
program
losing
so
many
providers?
Well,
one
is
the
the
burden
that
we
were
putting
on
it
with
the
coaching
model.
I
really
think
that
we
should
look
at
the
validity
of
the
coaching
model
and
two
we
have
not
had
a
pay
increase
in
almost
20
years.
A
A
next
slide
is
a
picture
of
Apt.
Also,
this
is
an
air
company.
We
had
over
70
providers
in
2018
and
today
we
have
less
than
15.
again
I
told
you
that's
how
our
company
started
was
early
intervention.
It's
my
passion,
it's
my
success
story.
I
want
it
to
be
other
children,
success,
success
story
and
I.
Think
this
number
of
shows
is
telling
that
we
have
to
make
a
change
in
the
state
or
we're
going
to
continue
to
lose
providers.
A
Why
are
we
losing
providers-
and
this
is
just
data
I'm
not
going
to
go
into
pictures
for
time
or
information
for
time,
but
it
shows
that
where
we
have
a
lot
of
providers
here
on
the
Matrix
very
few
actually
provide
therapy.
So,
for
example,
I
have
15
providers
at
our
company
and
we
only
see
nine
patients
a
week
for
First
Steps.
We
are
one
percent
of
our
company
as
a
first-up
service.
A
It
should
be
a
larger
percentage,
but
it's
because
of
the
headache
and
the
burden
that
we're
bearing
with
this
new
coaching
model
too
we're
losing
providers,
because
other
states
are
paying
more
Indiana
used
to
pay
less
than
Kentucky
and
this
year
in
2022
they
they
just
increased
their
rate
to
135
dollars
a
visit.
They
were
in
the
lower
80s
again,
Kentucky
was
ahead
of
them
and
now
Indiana
recognized
the
need
for
that.
A
So
what's
happening,
is
we
have
therapists
in
Louisville
who
are
leaving
Louisville
to
go,
get
their
Indiana
license
to
drive
across
the
border
because
they're
making
a
lot
more
money,
so
our
Kentucky
families
are
losing
good
providers
here.
It's
also
happening
in
Western
in
West,
Virginia
West
Virginia
is
paying
more.
We
have
providers
in
Eastern
Kentucky,
who
are
growing
across
the
state
line.
A
Also
on
the
Kentucky
speech
and
hearing
Association
board
I've
been
appointed
to
the
therapy
advisory
committee
that
reports
to
the
Medicaid
advisory
committee
I've
recently
joined
a
rate
study
group
that
oh,
those
are
fun
because
they
take
a
few
years
to
go
through,
and
then
you
know
it's
another
few
years
before
anything
happens
so
I'm
doing
everything.
I
can
I
provide
input
to
our
Kentucky
Physical
Therapy
Association,
as
well
as
the
Kentucky
Occupational
Therapy
Association
I've
enjoyed
meeting
with
several
of
you
in
your
office
as
well
as
Department
of
Medicaid
and
First
Steps.
A
A
A
This
right
here
again,
eye-opening
Kentucky,
is
the
lowest
on
here.
I
said
that
except
Hawaii
was
really
low
too,
but
Kentucky
is
0.30
0.30
national
average
is
1.14,
we're
at
1.30
helping
the
children
who
need
the
services
I
think
we
can
do
better.
I
know
we
can
do
better.
I
know
we
want
to
do
better.
A
We
have
to
take
action,
the
Medicaid
fee
schedule
as
an
association,
a
otpt
and
speech.
We
are
asking
that
you
look
at
the
Medicaid
top
five
CPT
codes.
We
realize
we
might
not
be
able
to
do
every
CPT
code,
but
we're
asking
that
you
look
at
the
top
five
CPT
codes
and
give
a
minimum
of
a
20
increase
in
the
evaluation
code.
So
not
every
code,
every
CPT,
but
the
top
five
that
we
use
daily
epsdt,
which
is
where
we
go
into
the
communities
they
come
to.
A
Our
clinics,
we're
asking
for
twenty
percent
minimum
increase
from
the
8505
that
we've
been
paid
since
it
started
first
steps
we're
asking
for
a
20
increase
since
it's
been
paid
the
same
rate
for
almost
20
years.
This
still
would
not
take
us
to
the
Indiana
rate
level.
That
is
almost
like
a
30
to
40
percent,
but
we
recognize
that
if
we
can
do
something,
it
will
help
keep
some
of
the
providers
here
before
it's
too
late
mcos.
A
We
need
to
increase
their
accountability,
I'm
not
able
to
increase
their
accountability,
but
your
story
you've
been
put
in
this
position
and
you're
able
to
increase
that
accountability.
We're
asking
you
to
hold
them
accountable.
We
would
love
to
see
an
annual
percentage
increase
for
providers
you're,
giving
them
billions
of
dollars
we're
asking
that
they
take
care
of
the
providers,
and
so
several
States
already
do
this.
It's
already
in
several
legislations
that
if
they
provide
an
increase
in
there
every
year,
that's
tied
to
a
CPT
code.
A
We're
also
wanting
you
to
look
at
some
Provisions
that
are
not
necessarily
protecting
us.
There
are
a
number
of
other
issues
such
as
claw,
blacks,
Club,
facts,
recruitment,
Etc,
but
we're
not
going
to
recruitment
with
our
funds
Etc,
but
we're
not
going
to
go
into
that.
A
So
again,
our
solution
is
a
20
increase
for
otpt
speech
for
Medicaid
fee
schedule,
the
epsdt
and
forceps
over
time.
These
are
going
to
be
a
cost
savings
to
the
state.
I
can
guarantee
you
you're,
going
to
have
more
success
stories
just
like
mine
that
are
going
to
get
up
here
and
be
CEOs
of
large
corporations.
One
day
and
they're
going
to
be
able
to
tell
their
story.
A
D
Thank
you,
chairman
Bentley,
real,
quick
and
I
know.
You
mentioned
it
just
a
little
bit
in
the
end
there,
and
that
was
a
great
presentation
by
the
way,
a
lot
of
information
I
can
tell
you
put
a
lot
of
time
into
that,
and
that
gave
us
a
clear
picture
what
the
problem
is
and
how
we
need
to
address
it.
D
Obviously,
the
rate
increases
one
part
of
that,
but
then
also
you
just
touched
on
it.
On
the
end,
the
the
MCO
you.
C
D
D
You
can't
have
one
without
the
other,
in
my
opinion,
and
so
I
would
like
to
hear
more
from
you
on
that.
What
your
ideas
are,
how
to
put
guardrails
on
the
mcos
just
to
make
sure
that
hey
we're
going
to
increase
it
20,
but
mcos
are
all
of
a
sudden
clawing
back
more
and
more
and
more
and
more
and
then
you're
not
getting
the
dollars
at
the
end
of
the
day,
which
is
what
we
would
want
to
do
so.
A
D
Don't
know
if
you
can
get
that
information
to
myself
for
chairman
Bentley
in
the
future,
but
that
would
be
really.
A
A
There
are
so
many
things
that
I
think
we
could
get
together
as
a
group
and
other
our
associations
would
love
to
have
this
conversation.
Our
occupational
therapy,
physical
therapy
and
speech
therapy
associations
of
the
state
could
put
together
a
white
paper
for
you
and
and
give
you
that,
as
well,
probably
within
the
next
week
or
two
okay,.
B
E
Thank
you
Mr
chairman.
That
was
a
great
presentation.
Thank
you.
So
much
and
you
know
I
think
there'll
be
a
lot
of
bipartisan
support
for
making
sure
that
the
mcos
are
taking
care
of
the
providers.
I
know
their
focus
is
on
improving
population
Health,
but
you
can't
do
that
without
the
providers
and
I.
E
This
is
such
an
Urgent
Message
that
we're
hearing
from
you
and
the
loss
of
providers,
not
only
in
these
Early
Childhood
interventions,
but
really
across
the
board
and
I,
would
be
so
interested
and
seen
some
specific
legislative
proposals
that
we
might
be
able
to
work
on
with
you
in
a
bipartisan
way
and
I.
I
well,
I
think,
there's
just
general
agreement
on
this
issue
that
we
need
to
support
you
better
than
we
are
currently.
Thank
you.
Thank
you,
foreign.
B
F
So
sorry
that
I
walked
in
so
late,
but
I'm
so
familiar
with
your
with
your
story
and
your
situation.
So
I
have
no
doubt
that
you
did
an
amazing
job
of
explaining
this.
A
F
Everyone
and
I,
just
you,
know,
want
to
just
relay
my
support.
I
have
had
conversations
with
the
cabinet,
especially
about
the
the
first
steps
issue,
and
so
have
you
had
any
conversations
with
the
cabinet
about.
We
met
with.
A
A
cabinet
on
the
30
last
week
and
talked
to
them,
and
they
are
also
aware
that
I'm
talking
to
you
guys
today,
yeah
we,
we
have
a
lot
to
work,
a
lot
of
work
to
do
there,
because
the
issue
is
we're
losing
providers
A
because
of
payment
and
and
if
you
add
more
work
to
their
caseload,
why
would
they
want
to
do
that
service
if
it's
easier
to
provide
it
somewhere
else,
and
so
we
have
to
decrease
the
burden
you
know
across
across
all
providers
like?
How
can
we
decrease
paperwork?
A
A
So
we
talked
to
them
and
they're
listening
now,
I
think
that
they're,
seeing
that
these
numbers,
like
I,
shared
today,
they're
eye-opening
again
the
state
served
4
900
patients
last
year
and
our
office
sees
5
000
a
week.
And
so,
if
that's
not
eye-opening
right,
then
I
don't
know
what
is
and
we
have
over
2500
children.
And
when
you
were
in
our
facility,
you
saw
a
children
that
should
be
in
the
first
steps
program
coming
into
our
Clinic
they're
coming
into
our
Clinic,
because
there
is
not
enough
providers
providing
early
intervention
services
right.
B
Any
other
questions
from
the
committee
Renee
I
have
a
question.
Why
do
you
explain
the
coaching
program
more
to
us.
A
So
the
coaching
program
is
where
you
go
into
the
home
and
it
is
a
different
model,
so
you're
coaching,
the
parent
you're
not
supposed
to
necessarily
take
in
toys.
Hands-On
therapy
is
it's
more
of
a
coaching,
the
parent
to
be
the
therapist
and
giving
the
parent
strategies
which
we
agree.
That
coaching
can
be
good
right
as
parents.
We
all
need
some
coaching
and
education,
but
that's
not
the
whole
model.
We
believe
that
the
whole
model
should
should
Encompass
more
than
just
coaching
I.
A
Do
think
that
that's
a
big
piece
of
it,
while
other
states
also
do
coaching.
The
training
is
nothing
like
what
Kentucky
has
put
on
it.
Kentucky
has
spent
quite
a
you
can
do
the
research
there's
some
grants
that
uofl
is
working
on
uofl
received
this
Grant
and
they
the
states
provided
a
few
million
millions
of
dollars
to
this
coaching
training
and
it's
an
investment
and
I'm
sure
that
the
intentions
are
good,
but
I
think
it's
went
a
little
too
far,
so
where
I
think
coaching
can
be
beneficial
to
the
families.
I,
don't
think.
A
That's
the
whole
picture
as
a
therapist
there's
other
things
that
we
can
do
to
help
the
child
and,
if
you're
not
supposed
to
bring
in
those
activities
and
work
with
the
Kids
Hands-On,
sometimes
they
just
need
Hands-On,
especially
if
you're
teaching
a
child
how
to
walk.
You
know
the
therapist
may
want
to
put
their
hands
on
them.
They're
not
supposed
to
in
this
model.
So
I
think
that
there
is
some
areas
that
we
can
do
better
in
the
state
to
make
it
a
little
less
obstructive
there
and
more
therapeutic
for
the
child.
Okay,.
B
G
G
Thank
you,
Mr
chairman
I,
just
want
to
ask
you
a
quick
question.
You
you
said
about
the
percentage
increases
and
that's
great
and
that's
a
pretty
powerful
number.
Could
you
translate
that
to
dollars?
Because
if
you
go
through
and
it
increase,
what
does
that
mean
to
the
budget
in
terms
of
all
that
stuff,
because
now
in
your
profession,
but
we're
also
looking
at
other
professions
in
terms
of
mental
health
in
terms
of
nurses
or
whatever?
G
A
Okay,
so
I'm
going
to
answer
this
question
to
the
best
of
my
knowledge
based
on
the
information
I
have
received,
but
knowing
that
I
don't
know
how
much
the
federal
dollar
is
contributing
to
the
state
dollar,
so
I'm
going
to
tell
you
the
the
large
amount
of
number
and
then
that
would
really
deter
I.
Think
you'd
have
to
do
a
cost
analysis
to
see
like
is
that
90
from
the
federal
match
or
what
the
match
is.
I
can't
tell
you
the
match,
because
that's
out
of
my
limit,
but
four
First
Steps.
A
If
you
did
a
20
increase
you're
looking
about
a
three
million
Statewide
based
on
the
services,
they
provide
3
million
for
all
providers.
That
would
be
the
increase
amount.
Now,
a
lot
of
that
fun
would
come
from
federal.
So
that
would
be
my
guess
there.
It
would
be
around
three
epsdt
is
around
is
less
than
a
million
Statewide
it's
around
600
and
something
thousand
that
would
be
the
increase
total
again.
Some
of
those
funds
would
be
Federal,
matched
so
I'm,
not
for
sure
exactly
what
the
state
would
based
on
the
budget.
A
A
How
many,
how
many
CPT
codes
for
9257,
whatever
were
used
last
year,
so
I
did
ask
for
some
of
that
data,
but
did
not
receive
that
so
I'm
not
able
to
give
you
on
the
flat
5
CPT
codes,
but
the
others
First
Steps
around
three
million
I'm
guessing
I'm
guesstimating,
based
on
how
many
children
they
served
at
the
89
times
20.
So
if
you
take
every
child
gets
18
visits
every
six
months
times.
Two:
that's
how
I
did
the
math
on
that
I?
Don't
know
if
that
helps
you
any.
G
No
and
I
appreciate
you
going
through
the
exercise
in
terms
of
the
calculations
and
foremost,
because
I'm
very
chairman,
I'd
love
to
see,
or
at
least
make
a
request,
the
lrc
and
we
can
talk
offline
to
get
a
general
idea
of
what
that
means
in
dollars
across
the
board
regards
to
the
health
provider
that
we
look
at
Inc
dealing.
What
we're
dealing
with
with
a
Medicaid
reimbursements,
because
I,
don't
think
that's
done,
and
we
need
to
get
a
better
idea
because
I'm
hearing
it
out
from
her.
G
But
you
know,
I,
have
this
Workforce
issue
going
initiative
going
on
and
we've
got.
That's
that's
only
one
equation.
The
other
equation
is
this
reimbursement
because
it
affects
your
your
pipeline
in
terms
of
getting
therapists
in
there
from
a
from
a
not
only
from
a
from
a
salary
standpoint,
but
also
from
an
environment
standpoint
and
doing
that
so.
But
thank
you,
I
appreciate
it.
Yeah.
D
Building
yeah
and
just
another
Point,
you
know
representative
Fleming's
exactly
right,
looking
at
the
whole
picture
and
you
know
what
it
costs,
because
you
know
you
have
to
you
have
to
budget
for
the
entire
program.
Obviously,
and
that's
why
I
think
it's,
it
is
important
that
we
look
at
the
mcos
some
more
because
you
know
I
don't
understand.
Today.
D
You've
asked
for
like
a
20
raise
or
20
increase,
but
if
we
can
reform
the
mcos
and
more
of
the
current
dollars
are
actually
going
to
the
providers
instead
of
the
mcos,
keeping
that,
if
there's
a
way
to
to
put
guard
rails
in
where
providers
at
the
current
levels,
it
may
not
be
the
20.
Maybe
it
is
maybe
that's
what's
needed,
but
it
might
not
be
and
that's
just
things
that
we've
got
to
look
at
across
the
Spectrum.
Thank
you.
E
Thank
you,
representative,
chairman
Dr,
Bentley
I,
just
I
agree
with
what
my
colleagues
are
saying
that
we
need
to
look
at
the
whole
picture,
but
I
also
want
to
say
how
important
early
intervention
is,
and
the
research
is
so
robust
on
that
and
what
we
pay
on
the
what
we
don't
pay
on
the
front
end.
We
end
up
with
that
multiplier
effect
and
paying
much
more
in
all
kinds
of
ways
on
the
back
end
of
that,
and
that
can
be
hard
to
calculate.
E
B
B
Thank
secretary
glisten
for
coming
I
recognize
her
because
she
worked
hard
for
children
when
she
was
secretary
and
before
we
adjourn
members.
Please
know
we'll
meet
next
week.
February
15th
we're
going
to
try
to
have
a
meeting
every
week
for
this
committee
and
in
the
future,
we'll
be
discussing
a
new
lab
for
Kentucky,
so
we'll
be
the
first
to
present
it
so
I
hope
that
everyone's
here.
So
thank
you
now.
The
next.