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A
All
right,
it
looks
like
we
have
members
here,
we'll,
go
ahead
and
call
the
meeting
to
order.
This
is
the
senate
standing
committee
on
health
and
welfare
meeting
number
two.
The
date
is
wednesday
january,
the
19th
of
2022.
Madam
clerk.
Please
call
the
roll.
A
Present
right
we
have
a
quorum
and
we're
constituted
to
do
business.
Before
we
begin,
I
think
senator
howe
has
a
quick
introduction
to
the
guest.
I
do.
D
Thank
you,
mr
chairman,
alex.
I
have
alex
grayson
with
me
here
today.
She'll
be
joining
you
next
year
in
a
medical
school
somewhere.
She's
got
a
couple
in
her
pocket
still
working
through
that
process,
but
she
she's
a
policy
nerd
like
a
lot
of
other
people
in
her
family
and
was
coming
along
today,
just
to
kind
of
check
things
out
before
she
heads
back
to
college
to
finish
up
and
so
welcome,
alex.
A
I
can't
is
she
behind
that
there?
Oh
there,
you
are
right
there
very
good.
I
get
the
masks.
I
can
always
tell
welcome
very
nice
to
have
you
here
and
glad
you're
you're
joining
the
ranks
of
physicians.
Like
dr
berg
and
myself.
We
welcome
you
and
we
we
need
more
physicians.
That's
for
sure.
So.
Congratulations
on
that
and
look
forward
to
talking
a
little
bit
a
little
bit
later
as
well.
All
right,
we've
got
a
quick
agenda
here.
A
We've
got
four
bills
for
consideration:
we're
going
to
start
first
with
the
fourth
item
on
our
agenda
here,
which
is
senate
concurrent
resolution
20..
It's
a
concurrent
resolution
established
in
the
cabinet
for
health
and
family
services,
organizational
structure
operations
and
administration
task
force's
sponsor
is
senator
meredith
senator
meredith.
If
you'd
like
to
begin
your
testimony.
E
Thank
you,
mr
chairman.
I
am
steve
meredith,
I'm
a
state
center
for
the
fifth
district
and
certainly
is
an
honor
and
pleasure
to
get
to
present
for
this
committee,
even
though
I
serve
as
vice
chair,
but
to
have
three
of
the
four
bills
today.
I
truly
am
honored
by
that,
because
I
know
we
have
a
lengthy
agenda
for
our
session
coming
forward
and
I
just
feel
honored
to
be
able
to
present
this
today,
starting
with
concurrent
resolution
20..
E
The
intent
of
this
is
to
appoint
a
task
force
to
look
at
the
operations
of
our
cabinet
for
health
and
family
services,
and
this
is
not
a
criticism
of
anybody.
That's
in
leadership
in
those
positions
or
the
employees
that
are
part
of
it,
but
we
recognize
it
as
a
monumental,
huge
cabinet
for
kentucky,
and
you
can
look
at
the
bill.
The
very
first
page.
E
So
I
hope
to
do
really
a
ground
level
review
of
all
this,
and
we
certainly
want
the
cabinet's
participation
in
this,
but
I
hope
to
make
a
a
change
in
this.
It
will
make
it
much
more
flexible
and
more
dynamic
and
more
responsive
to
our
committees
and
our
constitutions,
people
we
serve
so
that
that's
the
essence
of
this
bill,
mr
chair.
If
there's
any
questions,
I
certainly
would
entertain
them.
E
A
Hi
the
matter
passes
favorably
with
a
count
of
nine
yeses,
no
zero
no's
and
no
passes
it'll
be
reported
favorably
to
the
senate
floor.
Congratulations!
Senator
the
next
on
the
item
on
the
agenda.
We're
going
to
go
to
is
senate
bill
43
an
act
relating
to
legislative
oversight
of
health
welfare
issues
sponsor
against
senator
meredith.
If
you'd
like
to
begin
on
that
bill.
E
Thanks,
sir-
and
I
appreciate
you
on
my
request
to
change
the
priorities
on
this
bill
presentation,
the
reason
I
asked
for
that
is
the
senate
concurrent
regulation,
20
kind
of
leads
into
senate
bill
43,
and
if
you
go
to
the
very
last
page
of
that
bill,
you
see
that
we
would
look
to
repeal
both
our
medicaid
oversight
and
child
welfare
oversight.
Our
intent
is
not
to
destroy
these
programs
whatsoever.
E
Our
real
intent
is
once
we
go
through
this
task
force,
and
hopefully
reorganization
will
actually
elevate
those
two
committees
possibly
to
a
standing
committee,
and
we
all
know
how
beneficial
that
can
can
be,
because
presently,
those
of
us
who
serve
on
these
committees,
usually
particularly
medicaid
oversight.
We
will
we
will
hear
testimony
and
then
we'll
have
to
hear
it
again
in
health
and
welfare,
and
we
develop
kind
of
a
funnel
in
legislation
that
we
can't
get
enough
bills
through
to
take
care
of
all
the
needs.
E
We
have
and
there's
only
so
much
that
we
can
do
when
we're
in
session
like
we
are
today.
You're
gonna
hear
four
bills
and
I'm
sure
we
probably
have
20
30
that
are
off
in
the
wings
waiting
for
for
some
type
of
action.
So
what
this
does
is
actually
anticipate
that
we
will
elevate
again
the
status
of
child
welfare
oversight
and
medicaid
oversight,
possibly
to
standing
committees,
but
to
accomplish
that
then
certainly
these
reporting
functions
that
are
in
this
bill
would
disappear.
E
That
doesn't
mean
the
information
disappears,
because
it
still
goes
to
legislative
research,
commission
and
I'll
also
point
out
that
this
doesn't
take
effect
until
january
of
2023,
so
they'll
still
function
like
we
always
have
in
the
interim.
That
information
will
still
be
there,
but
again
in
hopeful
anticipation
that
we
can
change
this
structure.
E
A
F
Thank
you,
mr
chairman
senator
meredith,
and
we
we
spoke
about
this
so
to
make
sure
that
I
understand-
and
I
ask
this
question,
because
I
have
a
a
piece
of
legislation
that
that
is
related.
That
would
require
a
report
to
be
sent
to
the
the
child,
welfare
oversight
and
advisory
committee,
so
so
the
legislation.
The
point
is
to
merge
these
two
into
one
and
move
forward
in
that
capacity.
Is
that
accurate.
A
Very
good,
I
think,
that's
important
to
clarify.
I
know
a
lot
of
members
on
that
committee.
There's
a
lot
of
pride
in
that
committee
and
the
worry
was
that
they
were
diminishing.
I
think,
there's
an
intent
to
elevate
those
moving
forward,
so
we
have
a
motion
from
senator
wise.
You
have
a
second
second
for
senator
adams,
any
other
discussion
that
madam
clerk,
please
call
the
roll.
A
Okay,
again
by
account
of
nine
to
zero,
yes,
nine
yeses,
no
zero,
no's
and
zero
passes.
The
matter
is
expressed
favorably
to
the
senate
floor
next
item
on
the
agenda
is
senate
bill
45
and
act
relating
to
the
medicaid
program.
This
is
a
bill
that
we've
heard
here
before.
I
believe
senator
meredith
and
again
you
are
the
sponsor
so
I'll.
Let
you
begin.
E
Yes,
it
is
it's
the
deja
vu
all
over
again
or,
as
I
mentioned
to
central
west
in
his
education
committee
bill
the
other
day
that
it's
like
groundhog
day
all
over
again
and
I'm
very
appreciative
of
the
limited
amount
of
time
we
have
to
discuss
these
bills
today.
But
I
just
want
to
reflect
a
little
bit
about.
E
What's
happened
to
healthcare,
particularly
in
rural
kentucky,
and
I'm
going
to
go
back
to
2010
with
the
affordable
care
act
which
we
actually
referred
to
as
obamacare
now,
and
you
know
the
intent
of
that
legislation
was
to
provide
universal
coverage
to
to
all
of
our
citizens,
but
it
didn't
pan
out
that
way.
But
kentucky
specifically,
you
know.
Now
we
have
one
in
three
of
our
citizens
are
on
medicaid
through
this
program,
and
I
just
want
to
remind
everyone.
Most
people
here
have
a
health
care
background,
but
how
medicaid
pays
presently?
E
It
only
pays
75
to
80
percent
of
the
cost
of
the
service
costs,
not
charges
at
all,
and
this
creates
a
disproportionate
financial
burden
on
rural
communities,
because
in
10
is.
Why
would
any
government
program
only
pay
75
to
80
of
the
cost?
Well,
the
expectation
is
we're
going
to
pass
that
shortfall
on
to
commercial
pay,
patients
to
private
pay
patients.
That's
one
of
the
reasons
insurance
premiums
are
as
high
as
they
are,
quite
literally,
but
in
rural
communities
we
don't
have
that
opportunity
to
shift
that
cost
so
think
about
it.
E
Adding
more
people
to
the
medicaid
program
increases
that
financial
burden
is
a
proverbial.
You
know
joke
about
raising
watermelons
for
a
dollar
and
trying
to
sell
them
for
50
cents.
Getting
you
a
bigger
truck
and
taking
the
market
doesn't
help
any
and
that's
what
we
are
plus
another
intent
of
the
affordable
care
act
was
to
reduce
any
no
pay.
Everybody
would
have
coverage
that
didn't
happen
either
and
again.
You
folks
know
that
my
background
is
hospital,
so
I
speak
on
behalf
of
all
health
care
providers
but
specific
to
hospital
industry.
E
E
E
So
when
I
came
in
2017,
I
think
the
first
year
I
presented
is
2018
was,
let's
reduce
the
number
of
mcos
from
at
that
time?
Five
to
three
I
wanted
to,
because
the
federal
government
only
requires
two
but
to
kind
of
compromise
and
address
the
issue
of
what
happens
if
we
lose
one
of
the
mcos
like
we
did
back
in
when
the
program
first
started.
You
know
when
governor
steve
beshear
introduced
the
mcos
to
medicaid.
We
had
six.
E
One
abruptly
left
did
create
chaos
throughout
the
medicaid
system,
and
so
we've
been
operating
with
five
that
bill
that
I've
presented
this
year
has
not
advanced
beyond
the
senate,
but
during
the
last
round
of
negotiations
for
these
contracts,
we
did
reduce
it
to
four.
So
I
thought
that
was
very
encouraging,
but
then
it
was
challenged
by
the
insurance
companies
and,
as
you
all
know,
judge
shepard
said
no
we're
going
to
do
six
until
we
get
this
thing
lined
out.
E
So,
instead
of
reducing
the
number
we've
increased,
the
numbers
now
folks
may
think
this
is
just
increasing.
You
know
administrative
headache.
It
goes
far
beyond
that.
You
know
if
you're
a
large
system,
particularly
urban
area,
you
can
afford
to
have
people
who
specialize
in
the
coverage
of
each
mco,
because
every
mco
is
different.
I
know
I've
shared
with
you
folks
before
that.
My
youngest
son
is
a
primary
care
physician
in
my
home
county
and
he
talks
about
you
know.
E
If
you
need
an
order
for
something
like
an
mri,
you
can't
just
order
mri
you
have
to
determine
which
mco
is
covering
it.
Then
he
has
to
be
on
the
phone
with
another
physician
and
say
this
is
this
is
justifiable
and
you
have
to
do
that
sort
of
like
six
times
it's
kind
to
you
on
trying
to
do
your
income
taxes
in
being
mandated.
You
have
to
do
it
six
ways
and
that
insult
to
injury,
having
your
income
taxes
audited
by
six
different
companies
months
afterwards
and
then
recouping
the
funds.
E
I
can't
begin
to
emphasize
the
administrative
burden
it
places
not
just
on
health
care
providers,
but
particularly
those
within
our
rural
communities.
It's
crushing
again,
I
hate
to
have
shares
of
war
sources
with
you,
but
when
I
left
my
hospital
in
2013
small
rural
hospital,
we
had
34
active
staff.
Physicians,
12
of
those
were
family
practice
internal
medicine.
Today
there
are
15
and
only
four
primary
care:
internal
medicine,
physicians,
no
internal
medicine
whatsoever.
E
It's
because
you
can't
make
a
living
in
a
rural
community
when
you've
got
that
kind
of
reimbursement
and
that
kind
of
administrative
burden
again
in
large
systems.
You
can
have
somebody
dedicated
to
each
mco
to
figure
out
how
the
rules
are
played,
but
in
a
rural
setting.
How
can
you
do
that?
It's
impossible?
I
heard
senator
alvarado
talk
about
this,
that
he
hired
two
people
in
his
practice
just
to
follow
this.
This
does
not
provide
health
care.
E
None
of
this
does
this.
Since
we've
been
on
the
mco
model,
we
have
spent
10
billion
dollars
and
have
we
improved
the
quality
of
health
care
in
kentucky?
I
don't
think
we
have
at
that
time.
We
were
49th
in
the
nation.
I
think
we're
44
now,
but
I
don't
think
it's
because
we've
improved
the
quality
care,
we've
improved
some
access
to
care,
but
I
want
to
caution
ken
adding
more
people
to
medicaid
program.
That
is
great.
E
It
provides
people
coverage
they've
never
had
before,
but
that's
not
commensurate
with
access
to
care
and
rural
communities
are
collapsing
under
the
weight
of
this
administrative
burden.
It
makes
no
sense
at
all.
As
you
know,
I'm
covered
government
contract
review
committee
and
a
couple
of
my
guiding
principles
is
operate.
The
state
like
a
business,
secondly,
spend
the
money
like
it's
your
own
and
why
in
the
world,
would
you
hire
six
different
groups?
E
Administrative
program
when
the
federal
government
requires
two
and
we've
compromised
with
three
now
the
excuse
that
I
get
is
well,
the
same
thing
could
happen.
That
happened
back
when
the
program
started,
that
one
of
the
mcos
made
both
and
that's
going
to
create
all
kinds
of
havoc.
Not
if
we're
doing
our
jobs.
E
I
think
it's
a
job,
this
administration
to
properly
vet
those
mcos
have
a
contract
that
bends
in
those
safeguards
and
makes
this
program
secure.
You
know
we
had
no
problem
at
all
turn
our
foster
program
over
to
a
single
managed
care
source.
So
why
is
health
care
any
different?
This
just
adds
additional
administrative
burden.
That
has
no
purpose
whatsoever,
and
I
can
march
literally
thousands
of
health
care
providers
to
this
table
today,
and
you
could
ask
them:
does
this
improve
health
care
they'll
take
it
does
not.
E
Does
this
increase
administrative
burden
of
health
care
it
most
certainly.
Does
it's
not
just
an
administrative
nuisance?
It's
crushing
small
providers,
rural
healthcare
providers
particularly,
and
where
do
we
go
from
here?
We
truly
are.
The
crisis
situation
is
evidenced
by
this
coveted
situation.
It's
not
just
trying
to
improve
profits
for
these
people.
It's
survival
for
these
people
and
we've
taken
some
measures
that
improve
their
reimbursement,
make
more
funds
available
to
them,
but
that
just
lets
them
tread
water.
It
doesn't
raise
them
up.
E
One
of
the
things
we
can
do-
and
we
should
do-
is
reduce
this
unnecessary
administrative
burden
that
adds
nothing
to
quality
care,
reduce
cost
or
make
it
more
affordable
for
average
kentuckian.
So
this
isn't
just
an
ask.
This
is
a
plea
we
have
to
do
something
and
again
I'd.
Ask
you
to
ask
any
health
care
provider
does
having
six
mcls
make
the
medicaid
program
better.
E
If
you
can
find
a
single
one,
that
will
say
yes,
I'll
drop
this
and
I'll
go
back
home
and
do
what
I
did
before
I
came
here,
but
this
is
a
serious
situation.
It's
not
just
because
I'm
from
the
hospital
industry,
it's
on
behalf
of
our
rural
communities,
that's
what's
most
important.
If
we
don't
have
the
structure
in
place
for
our
education
system
and
our
health
care
system,
real
communities
can
survive.
E
E
I
think
it's
really
interesting
that
the
two
largest
lobbying
expenses
of
the
executive
branch
are
to
these
mcos,
and
why
do
they
do
that?
Some
protectionism
there
they're
concerned
about
this
as
well.
I
think
it's
truly
interesting
when
this
was
challenged
back
in
judge
shepard's
court,
that
one
of
those
mcos
used
my
testimony
as
justification
for
why
they
should
be
considered
as
an
mco.
E
There's
no
risk
in
this
they're
making
profits
they're
very
well
and
if
anything,
it
makes
it
a
symbiotic
relationship.
Helps
providers
also
helps
many
insurance
companies
that
cover
this
makes
it
more
competitive,
reduce
administrative
costs
for
our
state,
because
I
don't
think
we
understand
how
much
it
costs
to
audit
these
mcos
to
make
sure
they're
complying
with
the
regulations,
so
we're
doing
that
six
times
when
we
could
just
be
doing
it
three
times,
so
it
just
makes
good
business
sense
and
again,
if
it
were
your
money,
you
would
do
the
same
thing.
A
You
senator,
I
know
our
practice
when
the
aca
rolled
out
and
we
had
three
physicians.
Four
nurse
practitioners
total
in
our
practice.
We
had
two
full-time
staffers
dedicated
just
to
handle
administrative
burden
from
the
insurance
companies
we
worked
with.
A
That
was
the
difference
really
between
us
having
to
stay
profitable
and
not
having
to
sell
our
practice
out
as
many
doctors
and
medical
practices
have.
I
think
we're
upwards
of
new
docs
are
coming
out.
70
are
employed
at
this
point
just
because
trying
to
do
it
on
your
own
is
impossible.
So
I
appreciate
that
I
know
this
is
a
bill
that
we've
heard
before
I
know
we
do
have
on
the
line
virtually.
I
believe
we
have
commissioner
lee
and
kelly
rodman
if
you're
there.
We
would
like
to
have
your
input.
A
I'd
like
to
be
able,
at
least
when
we're
presenting
this
we've
passed
this
bill
to
the
senate
a
couple
of
times
now.
I
believe
like
to
know
where
we
stand
right
now
in
terms
of
our
contracts
and
if
you
could
kind
of
enlighten
us
as
to
where
we
are
with
that
right
now,
with
our
rfp
processes
with
our
in
the
number
of
mcos,
we
currently
have
and
kind
of
what
situation
we're
in
there.
G
G
Senator
alvarado,
I
think,
with
to
answer
your
question.
We
currently
have
six
managed
care
organizations
the
contracts
we
are
in
some
litigation
right
now,
so
the
rfp
process
is
has
not
started
for
the
next
round.
We
are
waiting
on
that
litigation
to
be
settled.
I
think
it's
important
to
note
the
very
reason
that
we
moved
to
mcos
back
in
2010.
G
That
was
for
budget
predictability,
and
you
know
we.
We
do
have
some
predictability
in
our
budget
because
we
pay
the
mcos
a
per
member
per
month
payment
which
helps
us
plan
for
our
budget
as
we
go
forward.
G
I
think
also
that
it's
important
to
know
that
we
that
we
are
at
the
10-year
anniversary
of
statewide
medicaid
managed
care
in
kentucky,
as
we've
discussed
in
this
committee
before
we
have,
we,
the
the
cabinet,
have
embarked
on
a
project
with
the
university
of
kentucky
to
evaluate
the
effectiveness
of
managed
care
in
kentucky.
G
What
we
are
seeing
in
that
report
is
that
there
have
been
some
improvements.
We
are
mainly
looking
at.
You
know
the
satisfaction
of
our
members.
G
We
do
show
that
members
are
satisfied
with
the
services
they're
receiving
from
the
managed
care
organizations
and,
as
a
matter
of
fact,
this
open
enrollment
period
when
individuals
had
a
chance
to
move
from
one
managed
care
to
another.
Less
than
one
percent
actually
moved
to
a
managed
care
from
one
managed
care
organization
to
another.
G
And
I
think
it's
also
important
to
note
that
medicaid
does
cover
a
lot
of
services
that
commercial
carriers
either
do
not
or
will
not
cover.
So
when
we
look
at
medicaid
and
the
scheme
of
things
and
our
healthcare
delivery,
we
are
a
major
payer
in
the
in
the
healthcare
delivery
and
I
think
that
we
do
share
the
vision
of
a
healthier
kentucky
and
that
we
need
to
work
in
moving
medicaid
from
more
of
a
payer
to
a
driver
of
health
care
policy.
G
Because,
as
senator
meredith
said,
we
do
cover
1.6
million
individuals
in
the
state
of
kentucky.
That's
a
large
number
of
individuals,
one
out
of
every
three
that
we
cover
and
it's
nothing
to
boast
about,
because
that
means
that
those
individuals
live
in
poverty
and
also
going
back
to
senator
meredith's
statement
about
medicaid
paying
75.
I
think
he
said
you
know
75
to
80
of
the
cost
of
care
yeah.
G
I
we
hear
that,
but
without
an
all-payer
claims
database
for
us
to
actually
analyze
the
payments
of
commercial
carriers,
we're
not
really
sure
where
medicaid
lies
in
that
in
that
in
the
scheme
of
things.
As
far
as
payment
goes-
and
I
think
if
you
know
we
really
want
to
reform
the
healthcare
delivery
system,
we
are
going
to
have
to
get
at
the
true
cost
of
health
care.
Like
senator
meredith,
I
do
not
want
any
of
our
rural
hospitals
closing.
G
I
don't
want
to
burden
on
on
any
of
those
communities,
because
we
have
a
lot
of
safety
net
providers
there.
We
have
some
fantastic
medicaid
providers
throughout
the
state
and
we
do
we
want
to
make
sure
that
we
take
care
of
them,
because
you
know
that
my
mantra
is.
The
medicaid
program
was
created
for
the
medicaid
member,
but
we
cannot
take
care
of
our
members
if
we
don't
take
care
of
our
providers
so
I'll
stop
there
take
a
breath
and
see
if
there
are
any
questions
thanks.
A
Commissioner,
there
are
give
me
a
few
questions
I'll
just
make,
and
I
appreciate
that
last
line.
I
think
that's
very
important,
because
ultimately,
people
talk
about
health
care
like
it's
a
thing,
and
it
is
obviously
a
thing
it's
a
noun,
but
healthcare
is
ultimately
the
people
that
provide
it.
It's
the
knowledge
of
the
individuals.
A
It's
your
nurses,
your
doctors,
your
therapists,
every
orderly
that
works
in
a
hospital
system,
any
person
that
works
in
a
clinic
setting,
that's
what
care
ultimately
is,
and
so
we
talk
about
satisfaction
of
the
members
and
there
needs
to
be
also
consideration
of
the
satisfaction
of
the
providers,
which
has
not
been
good.
I've
been
one
of
those
who've
been
very
vocal,
as
everybody's
heard
in
this
committee
many
times
about
the
dissatisfaction,
then
it
continues
and
people
are
longing
for
the
days
prior
to
mcos.
A
I
talked
to
a
lot
of
providers
who
you
know
weren't
thrilled
with
it
back
then,
but
they
said
it
was
more
predictable
for
them
as
far
as
their
budgetary
things
and
it's
become
less
predictable,
we're
having
to
drive
providers
into
employment
models
that
makes
it
more
difficult.
I
also
want
to
remind
the
members:
you
know
how
we
got
the
situation
with
the
litigation
that
you're
talking
about.
I
mean
we
had
a
reissuance
of
rfps
that
started
out.
A
This
was
done
when
the
current
administration
kind
of
took
office,
and
you
know
there
were
five
contracts
that
were
issued.
There
was
one
individual
from
the
governor's
transition
team
who
was
had
inside
information.
That
was
reviewing
a
lot
of
these
contracts
had
inside
information
regarding
this
stuff
and
then
was
promptly
hired
by
one
of
the
mcos
to
be
part
of
their
consultants
at
a
very
hefty
monthly
fee
to
review
and
help
them
achieve
those
contracts.
A
They
were
one
of
the
ones
that
were
selected
and
then
there
was
lawsuits
coming
in
saying
it
was.
You
know,
and
I
would
argue
it
was
unethical
to
have
that
individual
with
inside
information
from
all
the
mcos
helping
to
get
that
done.
We've
passed
a
law
now
to
outlaw
that
and
make
that
illegal.
So
you
can't
have
a
transition
team
member
with
inside
information
to
be
able
to
do
that
when
it
went
before
the
judge.
A
You
know
we
have
our
judge.
Shepard
here
decided.
Hey
look
we're
just
going
to
include
everybody
and
made
a
decision,
an
executive
branch
decision,
which
I
don't
know
that
he
can
make
but
made
a
decision
to
say
we're
going
to
issue
contracts
for
everyone
which
I
think
is
beyond
his
purview
from
the
judicial
branch
and
everyone
wound
up
getting
contracts
only
to
have
a
counter
suit
come,
which
is
what
you're
currently
involved
in
to
say.
A
Listen,
we
were
offered
so
many
lives
and
it's
it's
become
a
big
mess
and
now
we're
the
situation
where
the
judge
has
come
back
in
and
said.
Well,
let's
go
ahead
and
just
issue
an
entire
rfp,
so
we
have
a
judge
currently
who
is
making
executive
branch
decisions,
which
I
don't
think
you
should
be
able
to
make
instead
of
ruling.
If
something
is
legal
or
not.
A
So
that's
where
that's
where
we
find
ourselves
in
the
current
situation,
not
sure
how
long
it's
going
to
take
for
this,
that
we
have
currently
six
mcos
in
the
mix
and
it's
become
an
absolute
legal
mess,
and
I
think
because
you
have
an
overreach
from
the
bench
we
do
have
a
few
questions.
I
will
start
with
senator
gibbons.
H
Mr
chairman,
thank
you
and
I
want
to
start
with
a
compliment
to
you,
senator
meredith
and
the
work
you've
done
here
and
and
in
doing
that,
it's
been
interesting.
Listening
to
your
testimony
and
commissioner
lee's
conversation
and
the
discussions
that
are
going
on
here,
because
there's
a
bit
of
a
history
lesson
in
this
conversation
that
I
think
can
benefit
us
all.
I
think
it
was
around
september
of
2011.
H
H
The
general
assembly
wasn't
involved.
We
weren't
we
weren't
part
of
the
process.
We
weren't
even
part
of
the
conversation
as
then
governor,
steve
beshear
sought
to
do
do
this
as
a
delivery
mechanism,
largely
to
pull
down
costs
and-
and
commissioner
lee
you
spoke
to
that-
and
I
think
you're
accurate
in
that.
If
we
had
a
graph
of
the
potential
increase
in
medical
costs
over
time
relative
to
what
kentucky's
seen
there
would
probably
be
a
benefit
shown
there.
H
H
H
H
And
you
had
family
members
that
were
part
of
that
administration,
so
it
was
not
like
it
was
something
that
you
were
were
not
passionate
about,
because
you've
been
passionate
about
this
when
we've
had
republican
governors
and
now
democratic
governors.
So
this
is
not
something
you
thought
of
just
the
other
day.
No.
E
Sir,
and
you
know,
I
adopted
a
philosophy
very
early
on
in
my
career
as
a
hospital
administrator
to
always
pursue
symbiotic
relationships,
in
other
words
win-win
for
everyone,
because
I
found
out
that's
the
only
thing
that
works
long
term,
and
I
don't
want
to
leave
the
impression
that
I
have
qualms
with
the
medicaid
program.
It's
a
vital
part
of
kentucky
providing
critical
services
to
people
throughout
this
state.
So
my
criticism
is
not
in
the
medicaid
program:
we
need
it.
E
My
criticism
is
an
administration
of
it
and
I
have
nothing
but
respect
for
commissioner
lee
she's
worked
with
us
hand
in
hand
and
I've
enjoyed
that
relationship,
but
she
may
note
that
this
program
gives
the
state
financial
security
also
gives
the
mcos
financial
security,
because
they're
guaranteed
that
they're
going
to
get
at
least
10
percent
of
the
medicaid
dollars,
but
it
doesn't
give
financial
security
to
the
providers.
E
Even
in
my
small
hospital,
a
one
percent
increase
in
what
we
call
our
payer
mix
percentage
of
patients
who
have
commercial
pain
insurance.
A
one
percent
increase
would
improve
our
bottom
line
by
a
hundred
thousand
dollars,
but
we
don't
have
that
opportunity
that
you
have
in
urban
areas
to
increase
that
commercial
pay
base.
E
So
my
issue
is
it's
not
the
mcos
matter
of
fact.
We
heard
testimony
this
summer
from
some
folks
in
colorado
how
they
had
changed
their
mco
program
and
I
think
it
can
work
if
the
appropriate
safeguards
are
in
place.
I
still
think
there's
a
different
model,
better
model
that
senator
alvarado
and
several
of
us
have
talked
about,
but
I'm
going
to
work
with
the
mco
model
to
make
it
even
stronger,
but
I'm
just
saying
that
what
present
structure
with
six
mcos
places
a
disproportionate
financial
burden
upon
rural
providers?
That's
not
fair!
E
You
know,
we've
talked
a
great
deal
about
everybody
being
treated
equal
and
that's
something
that
the
mcos
will
tell
me
constantly
that
they're
treating
everybody
the
same,
but
we
know
that
being
treated
equal
is
not
the
same
as
being
treated
equitably
and
that's
what's
happened
in
rural
communities.
E
This
is
a
disproportionate
burden
on
rural
health
care
providers
that
is
causing
them
to
collapse,
and
this
is
no
exaggeration,
I'm
not
prone
to
exaggeration.
So
again,
I
think
this
can
work.
It's
just
six
or
too
many,
and
just
trying
to
keep
up
with
the
rules
are
virtually
impossible
for
rural
health
care
providers.
So,
commissioner,.
H
Lee
senator
meredith
spoke
to
the
question
and
and
made
the
statement
regarding
disproportionate
financial
impact
and
and
the
weight
of
that
chairman
alvarado
used
the
phrase
and
accurately
so
in
response
to
your
presentation
regarding
satisfaction
of
the
members
chair,
alvarado
raised
the
phrase,
satisfaction
of
providers,
and
so
when
we
think
about
this
system
and
we
we
consider
the
health
of
the
system
as
a
whole.
H
In
light
of
those
concerns
that
he's
raised
multiple
times
in
multiple
sessions
and
the
cabinet's
opportunity
as
the
contracting
entity
in
negotiations
with
this,
these
mcos
is
there
anything
that
precludes
the
cabinet
from
writing
into
the
rfp.
A
flat
statement
of
each
mco
shall
comply
with
this
form.
This
process,
this
pre-authorization
and
this
credentialing
mechanism
can
the
cabinet
do
that
or
not
do
that.
G
The
cabinet
does
have
in
the
current
contracts,
information
and
and
rules
related
to
prior
authorizations.
For
example,
all
mcos
have
to
use
an
accredited
prior
authorization
process
such
as
melamin
or
interqual.
So
we
do
have
some
of
those
provisions
in
the
contracts.
However,
we
do
not
specify
specific
procedures
that
must
be
prior
authorized.
G
We
have
streamlined
some
of
those
processes
by
trying
to
come
up
with
a
form
for
prior
authorization
processes,
but,
as
you
can
imagine
how
difficult
that
is
when
you're
looking
at
you
know
durable
medical
equipment
versus
physician
services,
there's
one
form
is
not
going
to
fit
all,
but
we
can
streamline
those
processes
as
much
as
we
can
and
as
a
matter
of
fact
right
now.
We
we
don't
have
any
prior
authorization
on
behavioral
health
services
or
the
medications
to
treat
behavioral
health
services.
G
We
have
lifted
some
of
the
prior
authorizations
specifically
during
cobit,
and
I
think
that
this
provides
us
an
opportunity
to
look
at
the
prior
authorization
process
and
make
it
streamline
it
and
make
sure
that
we
have
processes
in
place
that
are
actually
resulting
in
quality
care
for
our
providers
and
for
our
members
and
that
they're
receiving
the
services
that
they
need
to
receive.
Without
barriers
to
care.
H
H
These
mcos
are
the
competitors
to
access
us
as
the
customer
and
I've
long
felt
and
and
certainly
don't
have
the
inside
information
and
knowledge
that
you
and
your
colleagues
do.
But
I've
long
felt
that
through
that
contracting
mechanism,
we
have
every
authority
to
say
this
is
what
we're
buying.
This
is
what
we're
paying
for,
and
if
you
can't
provide
it
via
this
structure,
then
you
shouldn't
respond
to
the
rfp.
H
H
C
Thank
you
chairman,
and
thank
you
senator
for
bringing
this
issue.
I
do
have
a
statement
and
then
a
question.
C
First
of
all,
my
statement
is
I
I
know
that
you
see
this
from
a
rural
healthcare
perspective
and
I
see
this
from
an
urban
healthcare
perspective,
and
I
would
like
to
remind
everybody
in
this
room
that,
even
though
I
understand
thoroughly
thoroughly
that
our
rural
health
care
providers
and
and
systems
are
in
danger
and
struggling,
I
just
want
to
remind
you
that
our
urban
health
care
systems
are
as
well
at
this
point
I
am,
I
personally
was
trying
to
get
an
appointment
for
a
family
member
semi-emergent
at
uofl
outpatient,
setting,
1200
patients
behind
hundred
one
thousand
two
hundred
patients
in
front
of
this
child.
C
So
I
just
wanna,
let
you
all
know
everybody
is
struggling,
and
then
I
have
a
question
you
know
I
understand
we
have
six
mcos
each
one
of
them
have
different
rules
for
prior
authorization,
different
rules
for
what
they'll
cover
what
they
won't
cover.
It
is
extraordinarily
confusing
for
health
care
providers.
I
heard
a
number
once
that
the
average
physician
office
in
the
united
states
spends
an
annual
100
000
on
billing
on
billing,
trying
to
get
insurance
companies
to
pay
the
providers
for
their
services.
C
Can
we
not
somehow
standardize
this
so
that
to
take
the
burden,
not
just
off
of
the
medicaid,
which
I
understand
is
a
third
of
the
population,
but
to
take
the
burden
off
the
private.
You
know
the
people
who
have
to
build
private
payers
as
well,
which
is
actually
much
harder,
much
more
time
consuming
and
designed
intentionally
designed,
not
to
reimburse
so
I'm
just
asking
as
a
novice.
Basically,
why
are
we
not
addressing
this?
On
the
larger
picture,.
A
Well,
that's
a
I
mean.
Is
it
directed
to
the
senator,
I
mean,
or
is
it
a
global?
That's
a
question
for
I
think
for
another
yeah,
it's
a
global
question
for
other
bills,
perhaps
to
consider
and
that's
something
you
could
probably
tackle
if
something
you're
passionate
about.
I
know
the
senator
meredith
is
address
this
with
medicaid.
This
is
a
bill.
We've
addressed
multiple
times
when
it
comes
to
medicaid
directly.
In
that
regard,
senator
meredith.
You
want
to
address
that.
E
I
will
now
use
a
quote
from
magatma
handy
that
you
know
the
world
is
large
enough
to
take
care
of
everyone's
needs,
but
it's
too
small
to
handle
everyone's
greed
and
unfortunately,
we
have
too
many
people
making
exorbitant
profits
on
the
misfortune
of
others
and
that's
what
they
do.
You
may
remember
several
years
ago,
the
attempt
to
have
a
universal
bill
couldn't
be
more
simple
than
that
could
not
accomplish
it
because
again,
the
idea
is
not
to
make
this
system
easy.
E
I
think
it's
actually
a
misnomer.
It's
not
managed
care
organizations,
it's
managed
cash
organization,
and
you
know
I
heard
reference
earlier
about
the
not
doing
pre-admission
for
mental
health,
and
I
understand
now
that
the
mcos
are
going
back
and
auditing
mental
health
providers
and
taking
those
funds
away
from
them,
because
they
know
that
to
appeal.
Those
is
virtually
impossible.
E
E
But
for
this
particular
program,
I
think
we
have
this
opportunity,
even
with
the
things
that
we've
attempted
to
pass,
such
as
single
source
credentialing
again,
how
could
it
be
any
simpler
than
just
one
source
for
credentialing,
but
we
haven't
able
to
accomplish
that
yet
and
when
I
talked
to
mcil's
about
that-
and
they
said
well,
there's
the
system
that
you
put
together
doesn't
meet
our
needs.
Well,
it's
not
about
your
needs,
it's
about
the
needs
of
our
constituents
and
our
providers,
and
sometimes
we
forget
that
the
healthcare
providers
are
indeed
our
constituents.
E
And
again
I
ask
you
to
bring
one
person
this
table
this
healthcare
provider
to
say
this
is
a
workable
situation
for
them.
They'll
tell
you
no,
it
is
not
now
you
know
to
the
issue
again
about
the
financial
security
for
the
state.
I
think
this
bill
doesn't
touch
that
you
still
have
that
financial
security
and
stability
with
three
mcos
versus
six,
so
provider,
satisfaction
and
constitutional
satisfaction.
E
I
think
it's
still
there,
but
the
cost
that
we're
putting
in
this
program
is
not
sustainable,
is
going
to
collapse,
the
health
care
system
in
rural
kentucky
and
then
what
do
we
do?
We've
got
a
whole
new
set
of
problems
to
deal
with
and
there's
enough
money
to
take
everybody
fairly.
We
do
it
from
the
standpoint
of
a
symbiotic
relationship,
but
it
does
not
exist
in
issue
and
that's
what
I'm
pushing
for.
E
A
F
Like
to
vote
and
explain
my
vote,
please
receive
I.
I
appreciate
you
bringing
this
bill
forward
again
and
I'm
gonna
do
all
I
can
to
get
it
passed
coming
from
the
perspective
of
a
small
provider.
F
F
Seventy
hundred
thousand
dollars
recruitment
that
adds
up
pretty
quickly,
and
then
you
find
yourself
having
to
spend
additional
time
fighting
to
get
to
keep
that
money
or
get
it
back
and
the
system
is
inefficient
and
I
have
no
problems
with
supporting
the
mco
model,
but
it
can't
be
efficient
for
the
state
to
manage
either
the
way
it
is
and
we're
not
controlling
it.
Well
enough,
through
contracts
with
them.
We've
talked
about
this.
For
years,
we've
talked
about
legislation
to
to
set
certain
standards
that
hasn't
happened.
F
The
three
best
mcos,
that's,
who
we
keep
and
and
then
some
of
these
issues
may
go
away
on
their
own
based
on
that,
but
we
have
got
to
get
this
bill
passed
and
we've
got
to
provide
some
relief
to
the
burden
that
that
providers
are
are
in
encountering
not
just
in
workforce
issues
but
also
in
financial
issues,
because
the
system
is
it's
designed
to
take
money
back
away
from
the
providers
and
that's
just
unacceptable.
Thank
you,
mr
chairman.
E
I
vote
I
of
course,
but
last
session
we
passed
a
bill,
the
tif
bill
for
the
west
end
of
louisville,
and
during
that
discussion
debate
I
asked
what
are
we
doing
for
our
rural
communities
where
poverty
is
still
crushing
many
of
our
counties,
and
I
received
a
commitment
then
from
several
senators,
that
whatever
we
can
do
to
help
rural
kentucky
we'll
do
and
I'm
telling
you.
This
is
not
a
small
bill,
a
small
task.
E
C
A
The
matter
passes
favorably
with
a
vote
of
nine
yeses,
no
zero
no's
and
zero
passes
and
it'll
be
reported
favorably
to
the
senate
floor.
Thank
you
very
much.
Senator.
We
appreciate
your
work
on
all
these
bills.
Thank
you,
mr.
A
Are
welcome
to
stay
on.
We
appreciate
your
testimony
and
answering
some
of
our
questions
as
well.
The
last
item
on
our
agenda
is
senate
bill
100,
which
is
an
act
relating
to
essential
caregivers
and
declaring
an
emergency.
The
sponsor
is
senator
julia
rocky
adams,
senator
adams,
if
you'd
like
to
make
your
way
forward
and
introduce
yourself
and
begin
your
testimony
whenever
you're
ready.
I
Thanks,
mr
chairman,
I
hated
to
interrupt
the
senator
meredith
show,
but
I'm
very
pleased
that
you
have
allowed
this
bill
to
be
heard.
At
today's
committee
meeting,
I'm
julie,
rocky
adams,
state
senator
from
district
36.
I
senate
bill
100
is
the
essential
caregivers
bill.
The
purpose
of
this
bill
is
to
establish
an
essential
caregiver
status
for
family
members,
guardians,
friends
and
other
individuals
who
would
be
allowed
to
visit
residents
in
long-term
care
facilities,
assisted
living
communities
and
state-run
mental
health
hospitals
under
certain
safety
protocols
established
by
the
cabinet
for
health
and
family
services.
I
So
this
legislation
is
really
closely
modeled
after
the
essential
caregiver
provisions
that
were
included
in
the
2021
regular
session
house,
bill
1
and
the
2021
special
session
senate
bill
2.,
really
the
only
difference
in
this
language
versus
that
is
that
we
added
in
mental
health
hospitals
that
are
state-run
so
that
that's
the
only
adjustment
to
this
language,
the
essential
caregiver
provision
included
in
senate
bill
2
is
set
to
expire
on
january
31st
of
this
year,
which
is
why
this
legislation
has
an
emergency
clause
on
it.
A
I'm
going
to
read
an
email
senator
that
I
got
this
morning
that
I
think
is
poignant
for
this
bill.
It's
in
support
of
this
bill
and
I'm
not
going
to
disclose
a
person's
information,
I'm
not
sure
how
much
they
want,
although
they,
I
think
there
might
be
watching
this
today.
A
This
is
what
she
says.
My
father
has
been
an
inpatient
at
eastern
state
hospital
five
months
due
to
a
dementia
related
event
that
resulted
in
an
altercation
with
his
neighbor.
He
has
delusional
dementia
and
paranoia
patients
who
have
been
admitted
to
state-run
hospitals
are
denied
access
to
nursing
homes,
which
is
the
level
of
care
that
he
needs.
A
My
issues
are
two-fold
number
one
he's
being
denied
visitation,
as
are
all
patients
at
state-run
mental
health,
mental
health
hospitals
in
kentucky,
as
the
saying
goes,
mental
health
care
is
healthcare,
and
these
patients
obviously
deserve
the
same
rights
as
any
patient.
I
understand
the
impetus
to
keep
them
healthy
due
to
the
communal
nature,
and
yet
we
truly
kill
mental
health
patients.
By
denying
the
option
of
visitation,
I
contacted
every
surrounding
state.
The
conservative
and
the
progressive
and
they've
allowed
visitation
in
their
state-run
hospital
since
march
of
last
year.
A
If
the
issue
is
not
escalated,
my
fear
is
patients,
like
my
father
may
die
having
never
seen
their
families
again
and
number
two.
I
would
also
like
legislation
issued
requiring
that
medicaid
and
medicare
accepting
nursing
homes
in
kentucky
cannot
outright
deny
mental
health
patients
access
the
stigma
still
attached
and
the
stories
told
about
these
patients
has
to
cease
and
won't
cease
in
absence
of
legislation
they
are
simply
not
even
considered.
Patients
like
my
father
are
stabilized,
are
not
violent
or
unmanageable.
A
They
do
not
deserve
being
left
utilizing,
costly
resources
when
more
appropriate
means
are
available,
and
I
think
that's
very
poignant
from-
and
I
got
that
this
morning,
and
I
thought
I
would
read
it
here
today
about
the
importance
of
this.
I
thank
you
for
bringing
this
forward.