►
From YouTube: Senate Standing Committee on Health & Welfare (3-16-22)
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
A
Here
all
right,
we
have
a
quorum
and
we're
established
to
do
business.
We're
going
to
go,
I
believe,
in
order
on
these
bills,
we're
going
to
start
first
with
house
bill
240.,
it's
an
act
relating
to
remote
access
to
pharmacy
databases.
Sponsor
is
representative,
danny
bentley,
representative
bentley.
If
you'd
like
to
come
forward,
introduce
yourself,
if
you
have
any
guests,
please
have
them
introduce
themselves,
and
the
floor
is
yours.
D
A
The
matter
passes
the
vote
of
seven
to
zero.
We
have
a
motion
for
consent.
You
have
a
motion.
Is
there
a
second
give
a
second
all,
those
in
favor,
please
signify
by
saying
aye
aye.
Anyone
opposed
matter
goes
on
consent.
Thank
you,
mr
chairman.
Thank
you
committee.
Thank
you.
Congratulations.
Thank
you.
A
E
E
F
F
A
Thank
you
very
much
for
those
who
don't
know,
this
is
a
very
devastating
diagnosis
and
it's
typically
it's
in
children,
and
we
had
a
young
man,
and
I
think
I
made
a
post
of
it
years
ago
that
came
to
visit
us
here
who
had
this
and
within
a
matter
of
my
it
was
a
day
in
the
capital.
I
think
he
got.
It
was
really
kind
of
neat
to
watch
him
go
through
it,
but
in
short
order
he
succumbed
to
this
as
well,
and
when
people
talk
about
gliomas,
they
think.
A
Oh,
this
is
a
brain
issue.
It's
a
brain,
tumor,
it's
more
of
a
diffuse
there's,
no
way
to
extract
it,
surgically
it's
a
non-operative
diagnosis
and
often
terminal
it's
very
difficult
to
deal
with.
So
we
appreciate
you
bringing
this
forward.
Thank.
F
A
A
F
A
Thank
you
all
so
much.
Thank
you
very
much.
I
know
we've
had
a
few
members
join
us
here
from
coming
from
appropriations
and
revenue
we've.
We
want
to
cast
a
vote
on
house
bill.
240.
Are
there
any
members
that
wish
to
cast
a
vote?
Senator
gibbons.
A
A
Next
on
the
agenda,
we
have
house
bill
525
an
act
relating
to
community
health
workers.
The
sponsor
is
chairwoman,
kimberly,
moser
chairman,
if
you'd
like
to
come
forward,
introduce
yourself
and
your
guests
for
the
record.
This
is
a
very
important
topic
that
we've
had
an
opportunity
to
hear
about
in
the
interim
and
has
been
discussed
for
several
years.
I
know
it's
a
point
of
particular
passion
for
you
as
well.
So
if
you'd
like
to
introduce
yourselves
and
begin
your
testimony
when
you're
ready.
G
H
G
Okay,
so
we
do
have
a
committee
sub.
A
I
believe
we
have
a
committee
amendment
and
this
the
reason
we
made
it
an
amendment
is
just
to
make
sure
that
sometimes,
when
we
produce
substitutes
people
think
there's
things
that
are
being
thrown
in
at
the
last.
Second,
that's
not
the
case.
There's
a
committee
amendment
before
us
so
that
we
could
see
it
we'll
roll
it
into
the
bill
once
this
is
completed.
But
if
you'd
like
to
explain
what
the
amendment
does
briefly,
so
that
members
are
aware
absolutely.
G
So
in
in
the
bill,
in
section
five
or
subsection,
five
b,
rather
all
we're
doing-
is
striking
some
language
that
discusses
that
the
cost
incurred
by
an
mco
to
employ
a
community
health
worker
be
an
administrative
cost
right
now
those
are
charged
and
billed
as
medical
costs,
and
so
this
just
makes
it
part
of
the
lmr
mlr.
G
A
The
reason
for
this-
and,
if
you
look
at
you,
can
see
that
lines
eight
through
eleven
on
page
four
deleted
in
that
whole
section
is
deleted
in
their
entirety
and
it's
just
clean
up
language
to
make
sure
that
we're
not
violating
any
federal
laws.
So
with
that
we'll
entertain
an
amen
or
a
motion
on
the
amendment,
you
have
a
motion
there's
a
second
all,
those
in
favor
signify
by
saying
aye
aye.
Anyone
opposed
all
right.
The
amendment
has
been
adopted.
Please
proceed.
G
Thank
you,
mr
chairman,
so
house
bill
525,
simply
discusses
community
health
workers
and,
first
of
all,
just
as
as
background
community
health
workers
are
certified.
Frontline
health
care
workers
with
a
uniquely
close
relationship
to
an
understanding
of
the
community
that
they
serve.
They
serve
as
a
liaison
to
between
patients,
their
healthcare
providers,
social
service
providers
and
the
community.
G
G
Right
now,
one
third
of
kentucky's
population
or
1.6
million
individuals
are
currently
enrolled
in
medicaid
and
we
still
see
high
rates
of
diabetes,
heart
disease
cancer,
and
what
this
does
is
really
targets
the
it's
a
targeted
approach
to
using
our
medicaid
dollars
effectively
for
programs
that
we
know
work
just
by
way
of
history.
The
kentucky
homeplace
study
through
the
kentucky
office
of
rural
health
at
uk
has
successfully
piloted
these
chw
programs
for
nearly
20
years
and
they
show
an
11.30
return
on
investment
for
every
one
dollar
spent
in
medicaid
dollars.
G
So
again,
we
know
that
this
is
a
program
that
works.
This
is
to
be
funded
through
a
either
a
state
plan,
amendment
a
blended
kind
of
braided
funding
model
through
state
federal
and
possibly
public
private
partnership
dollars.
H
Hi
good
morning
and
thank
you
for
hearing
us
this
morning
at
big
sandy
healthcare
we've
employed
chw
since
2017..
We
currently
have
nine
chws
on
our
staff,
who
work
individually
with
patients,
but
also
work
as
part
of
the
patient's
care
team.
H
So
we
work
with
providers
and
sort
of
serve
as
a
liaison
between
the
provider
and
the
patient
in
order
to
extend
the
recommendations
from
the
provider
and
also
to
assist
our
patients
with
with
barriers
that
they
have
in
in
managing
chronic
conditions,
particularly
so
many
of
those
chronic
conditions
are
related
to
social
determinants
of
health,
for
instance,
as
a
provider,
and
some
of
you
are
providers
this
morning
I
know
senator
alvarado,
I'm
sure
you
tell
your
patient
your
diabetes
patients.
I
would
like
for
you
to
eat
a
healthy
diet.
H
I
work
in
eastern
kentucky
big
sandy
healthcare.
We
serve
five
counties,
a
very
rural
eastern
kentucky.
If
you
go
to
gretel
kentucky
the
home
of
yula
hall
health
center,
you
will
not
find
a
grocery
store.
You
will
barely
find
a
convenience
store
and
most
of
those
don't
carry
these
healthy
foods.
So
it's
really
difficult
in
these
food
deserts,
as
we
might
call
them
for
people
to
even
find
those
healthy
foods.
H
When
chws
work
with
patients
at
high
risk
for
complications
of
chronic
chronic
disease,
we
reduce
emergency
department,
visits
and
hospitalizations
and
realize
cost
savings.
Over
a
17-month
period,
our
marshall
university
cohort
reduced
the
number
of
edie
visits
among
enrolled
patients
by
93
percent
and
reduced
total
hospitalizations
by
82
percent.
That
is,
cost
savings.
Folks.
H
We
asked
this
committee
to
find
this
bill
favorable
and
move
it
forward
in
the
legislative
process,
in
the
words
of
the
infamous
hula
hall,
who
I
was
lucky
enough
to
get
to
work
with
for
just
a
few
years
before
she
passed
away.
Last
january,
she
was
probably
eastern
kentucky's
greatest
health
advocate.
We
have
to
fight
like
hell.
H
G
And
and
next
thank
you
so
much
that
that
just
really
helped
explain
this
whole
process.
So
I
appreciate
your
being
here
and
then
now
we
have
dr
zarapata
with
us
from
kctcs
to
talk
a
little
bit
about
the
healthcare
worker
shortage
and
what
we're
doing
this
one
small
piece
to
address
this
issue
absolutely.
C
Thank
you
very
much.
Kctcs
is
excited
to
partner
with
representative
moser
in
developing
the
support
structure.
For
this
much
needed
position.
We
already
offer
a
community
health
care
worker
certificate.
It's
a
six
credit
hour
course.
It's
currently
offered
at
hazard,
but
one
of
the
things
we
pride
ourselves
in
is
spinning
these
courses
up
quickly.
We
can
deploy
this
at
any
one
of
our
colleges
across
the
state,
we're
a
strong
partner
for
the
cabinet
for
health
and
family
services
in
other
areas,
and
we
look
forward
to
working
with
the
cabinet
in
this
initiative.
A
Thorough
explanation
with
that
I'll
entertain
a
motion
on
the
bill.
You
have
a
motion.
Is
there
a
second
I'll?
Second,
very
good.
We
have
a
two
seconds
very
good
again.
This
is
a
matter
of
a
lot
of
passion.
That's
needed
desperately
people
that's
going
to
help
ultimately
navigate
a
lot
of
folks.
I
would
imagine
things
like
this
are
going
to
help
with
you
think
about
things
like
maternal
mortality,
so
many
things
that
we
need
to
improve
on
from
a
standing
that
I
think
a
lot
of
times.
A
A
The
matter
passes
the
vote
of
10-0.
There
is
we
need
to
actually
now
that
we've
got
this
bill
is
amended
and
it's
passed
and
we
need
to
go
ahead
and
roll
that
into
a
committee
sub
for
the
floor.
So
we'll
entertain
a
motion
to
do
that.
We
have
emotions
for
a
second.
We
have
a
second
all,
those
in
favor,
please
signify
by
saying
aye
aye
anybody
opposed
all
right,
so
we
have
the
bill.
Now,
it's
amended.
It's
been
rolled
into
a
sub
now
I'll
entertain
a
motion
for
consent
on
this
bill
as
well.
A
G
A
All
right
and
now
we
have
the
the
bill
that
I
think
will
take
a
bit
more
time
here
in
committee
today
house
bill
777,
I've
had
one
member
said
it
should
have
been
renumbered
666
the
mark
of
the
beast,
because
it
often
has
a
lot
of
a
lot
of
moving
parts
on
this
bill
that
wasn't
mine.
It
was
someone
remember
the
committee,
I
won't
say
who
this
is
an
act
relating
to
emergency
medical
services,
sponsors
representative,
ken
fleming.
A
I
know
we've
got
a
proposed
sub
also
before
us
representative.
So
if,
if
you'd
like
to,
as
you
get
settled
and
have
members
coming
forward,
I
know
there's
a
lot
of
people
that
would
like
to
speak
on
this
bill.
A
We've
got
some
time,
but
in
the
interest
of
time
people
that
come
forward
to
speak,
I'm
going
to
ask
them
to
try
to
keep
their
remarks
as
tight
as
they
can
and
I'm
going
to
try
to
keep.
You
know
we
want
to
watch
the
clock
just
because
there's
a
lot
of
action
going
on
today
here
in
the
capitol
we
want
to
keep
moving,
make
sure
people
can
get
to
other
meetings
as
well.
I
Thank
you,
mr
chairman.
Actually
this
is
the
one
arm
bandit
bill:
777:
okay,
that's
a
bad
joke!
First
of
all,
I'm
ken
fleming,
I'm
the
represent
the
48th
district
in
jefferson,
county
and
part
of
oldham
county
and
what
I'd
like
to
do.
Let
me
go
ahead
and
have
other
folks
introduce
themselves
and
then
I'll
start.
A
Would
you
like
to
before
we
begin
that
there's
a
sub
on
the
bill?
Would
you.
A
All
right,
so
we
have
a
sub
that's
been
distributed.
Everyone
should
have
it
as
pss-1
I'll
entertain.
A
motion
on
that
sub.
You
have
a
motion.
Is
there
a
second
second,
very
good,
all
those
in
favor,
please
signify
by
saying
aye
aye.
Anyone
opposed
like
the
sub
is
before
us.
Please
go
ahead
and
continue
with
introductions.
I
Mr
chairman
and
ladies
and
gentlemen,
the
committee-
I
do
appreciate
you
entertaining
this,
this
particular
bill.
I
know
it's
been
it's
a
difficult
process
going
through
it's
on
egg
sales,
as
the
chairman
has
mentioned
on
a
couple
occasions
and
has
been
but
it's
but
taking
on
any
issue
like
this.
It's
not
an
easy
task
and
it's
a
task.
I
What
that
change
is
a
good
step
forward
in
terms
of
changing
and
looking
at
ems
service
and
so
forth.
Now
some
might
say
this
has
come
along
very
quickly.
That's
not
the
case.
This
has
been
talking
about
for
a
couple
years.
I
just
happened
to
catch
one
of
this
late,
I
guess
late
last
year
and
for
better
force.
I
got
myself
involved
in
this
process,
but
I
got
involved
for
a
couple
reasons.
I
When
I
have
a
friend
of
mine
who
looks
me
in
the
eye
and
says
that
their
mother,
I'm
sorry
their
their
sister
died,
trying
to
wait
for
transport
when
I
have
another
friend
that
his
mother
was
put
on
hospice
and
had
to
wait
in
order
to
find
their
themselves
in
the
final
days
or
even
hours
before
they
pass
on
or
when
I
hear
about
a
particular
transport
of
of
oregon,
barely
making
it
to
oor
to
save
a
life
that
really
affects
me,
and
that
really
gets
me
to
the
heart
of
this
issue,
because
that's
what
this
bill
addresses
in
terms
of
trying
to
attract
and
trying
to
help
out
those
who
are
in
need.
I
I
I
hope
you
received
this:
it's
a
sheet
12
organizations,
in
fact,
there's
13
organizations
that
are
involved
and
the
coordination
cooperation
could
not
have
happened
without
everybody
going
through
and
pitching
their
their
their
ideas
and
thoughts
in
this
process.
I
can
tell
you
over
a
thousand,
if
not
more
than
that
hours
have
been
put
in
this
process
in
order
to
make
sure
this
comes
to
fruition.
I
Let
me
let
me
go
over.
Let
me
go
with
the
over
the
bill
in
particular,
and
then
I'll
ask
my
guests
to
to
comment
on
this.
Well.
I
I
They
have
asked
us
to
see
if
we
can
find
a
new
home
and
so
we're
transferring
this
organization
into
an
independent
anus
agency
and
one
of
them
to
continue
to
function
as
they
are,
with
maybe
one
exception,
and
that
is
handling
complaints,
handling
issues
that
come
up
through
those
operators
who
provides
provide
ambulance
services
to
have
that
they're
handled
by
the
the
cabinet
to
their
oig.
I
The
k-beams
are
still
handled
their
complaints
still
have
the
regulations,
they
were
still
doing
the
their
their
their
duties.
What
they're
doing
now
part
of
this
is
on
the
back
end
of
this
bill.
Section
23
is
a
task
force,
and
I
want
to
stress
this
to
no
degree.
This
task
force
is
put
together
to
look
at
additional
issues
and
situations
and
concerns
that
came
out
of
this
several
months
of
discussion.
I
This
task
force
will
basically
go
through
and
try
to
further
mold
and
shape
ems
services,
because
if
you
are
familiar
with
ems,
we've
got
next-gen
9-1
coming
down
the
pipe
and
we've
got
to
position
our
ems
services
in
order
to
make
sure
that
we're
in
a
good
position.
This
task
force
and
this
bill
will
help
prop
help
in
that
process
and
get
things
forward.
I
So
so,
like
I
said,
this
task
force
is
put
put,
is
putting
it
together
and
it's
a
broad
spectrum
and
that's
what
this
committee
sub
looks
at
in
terms
of
before
when
it
came
out
house.
That's
one
thing
we
added
to
that
and
what
we
added
to
that
is
the
professional
firefighters
and
the
in
the
kentucky
ems
association.
I
Upon
the
request.
We
should
sure
we'd
be
glad
to
put
them
on
there
to
get
their
value
input.
In
addition
to
that,
we've
also
put
in
there
the
whoever
the
co-chairs
or
this
task
force
will
be
give
them
the
option
in
case
we
miss
a
stakeholder
to
have
them,
come
in
into
the
fold
and
go
through
and
and
address
and
help
their
help
their
situation
situation
out.
So
that's
what
it
is.
I
The
other
thing
I
want
to
mention
actually
a
couple
of
things
I
want
to
mention
is
that
this
bill
also
looks
at
transporting
or
helping
out
organ
procurement
organizations
when
they
transport
right
now
they
get
caught
in
traffic.
They
have
a
difficult
time,
as
I
explained
the
very
beginning
of
this.
This
helps
satisfy
that
by
giving
them
a
little
more
of
more
flexibility
in
doing
that.
I
The
other
thing
which
I
know
is
more
of
a
morally
a
sticky
wicket
and
that's
the
certificate
of
need,
and
we
understand
that
that
it's
that's
an
issue
that
we
have
to
address.
There's
several
provisions
in
that
certificate.
Need
you
look
at
excess,
lower
costs
and
those
sorts
of
things
one
provisions
is
basically
having
having
access
to
those
to
transporting
people
from
point
a
to
point
b.
I
I
With
that,
mr
chairman,
I
would
like
to
have
I'm
making
sure
I'm
not
missing
anything
off
the
top
of
my
head.
No,
that's
about
it!
Oh
I
know
there
is
one
thing
I
knew
there's
something
about
that
is
the.
When
we
transfer
transferred
or
looking
at
transferring
k-beans
to
the
independent
agency,
we
made
sure
that
the
employees
are
taken
care
of
when
I've
gone
through
murders
and
acquisitions
and
rewards
reorganizing
companies
I'll
make
sure
that
we
basically
are
we
improving
the
service.
I
Are
we
improving
the
product
and
second,
are
we
taking
care
of
employees
and
making
sure
that
that
they
they
are
satisfied
from
the
from
a
benefit
standpoint?
As
far
as
as
far
as
pay
those
sorts
of
things,
but
that
also
includes
with
that
as
well.
So
with
that,
I
don't
know
who
wants
to
mr
chaney:
do
you
want
to
go
or
actually
or
actually,
let's
miss
yeah?
Let's
go
first.
K
Thank
you
so
good
morning,
chairman
alvarado,
thank
you
so
much
for
allowing
us
to
be
here
today
to
support
senator
representative
fleming's
bill
and
I'd
like
to
echo
that
this
is
not
a
new
issue.
Kha
began
studying
this
issue
back
in
2019
when
I
had
hospitals
all
across
the
state.
K
Calling
me
talking
about
how
the
needs
of
their
patients
were
not
being
met
and
we
did
a
survey
and
we
found
out
the
average
wait
time
for
patients
to
be
transported
was
seven
hours,
but
many
were
waiting
days
and
you
know
many
unfortunately
passed
away.
So
we
set
up
a
task
force
and
we
met
with
not
just
representatives
of
hospitals
but
long-term
care.
We
had
the
kentucky
board
of
ems.
K
We
understand
staffing
issues,
staffing
shortages,
hospitals
have
staffing
shortages,
but
our
purpose
was
to
outline
a
problem
that
is
growing
and
to
make
you
aware
of
the
efforts
to
address
this
and
the
need
for
house
bill
777,
and
I
I'd
like
to
stress
that
this
is
a
compromise
and
there's
no
group
here
that's
getting
100
of
what
they
want
in
this
bill,
but
we
think
it's
an
important
step
forward
to
addressing
the
matter.
K
I'd
also
like
to
reiterate
what
representative
fleming
said,
and
that
is
this
is
not
a
hospital
problem.
It's
not
an
ambulance
problem.
It's
not
a
local
government
problem.
It's
a
patient
problem,
it's
the
patients
who
are
suffering
here
and
I
think
we
all
understand
that
we
can't
simply
do
things
the
way
we've
done
in
the
past
in
the
face
of
people's
lives
and
health
being
in
the
balance,
so
we
appreciate
being
part
of
the
coalition
of
all
the
different
organizations
that
are
supporting
this
bill
and
we
strongly
encourage
you
to
pass
this
bill
today.
J
J
J
That
issue
this
bill
takes
a
big
step
forward
in
creating
this
task
force
dealing
with
k-beans
to
start
that
so
from
a
holistic
perspective,
and
then,
when
you
couple
it
with
the
bill
that
you
all
just
unanimously
approved
here
with
representative
moser
with
525,
we're
we're
starting
to
deal
with
this
this
personnel
issue.
But
our
fundamental
interest
in
this
bill
is
getting
getting
k-beams
to
the
point
where
we
can.
J
We
can
talk
about
certification,
training
of
paramedics
and
emts,
that
is,
that
is
another
small
part
of
the
problem
which
this
bill
does,
and,
secondly,
enabling
our
local
officials
to
serve
those
that
they
are
supposed
to
be
serving
when
it
comes
to
their
health
and
safety
needs.
That
is
fundamentally
the
role
of
city
of
city
governments
without
having
to
go
through
a
certificate
of
need
process,
and
so
that
exclusion
is
in
there.
J
This
has
been
quite
the
roller
coaster
and
we're
only
halfway
through
the
ride,
but
but
but
we
have
worked
in
earnest,
as
I
mentioned,
with
with
several
groups
on
this,
and
we've
come
together
and
fallen
apart.
Multiple
times
on
this
on
this
language,
and
it's
no
small
feat-
and
I
hope
you
all
appreciate
the
fact
that
these
12
organizations
have
come
together
and
agreed
on
language
that
addresses
the
issues
and
moves
the
ball
forward,
not
only
for
city
governments,
but
for
the
constituents
that
we
all
serve
serve
together.
J
Our
cities
and-
and
you
all
all
of
your
constituents
from
a
patient
perspective
with
that
I'll
I'll,
wait
and
probably
have
an
opportunity
to
comment
later.
G
G
G
It's
there
are
funding
streams
that
we
don't
all
quite
understand,
and
I
think
that
that's
why
it's
really
valuable
to
have
this
task
force
to
be
able
to
continue
these
conversations
and
really
help
us
understand
how
to
how
to
best
facilitate
care
for
the
patients
in
kentucky
kentucky
is
one
of
two
states
who
have
a
c-o-n
process
for
ambulance
services
and
we're
trying
to
get
a
better
understanding
of
how
the
states
who
don't
have
con
for
ambulances,
how
they
make
it
work,
and
I
think
it's
a
really
valuable
conversation
and
we've
we've
come
to
a
good
place.
G
Like
nancy
said,
no
party
in
this
stakeholder
group
is
100
happy
with
the
the
current
bill,
but
I
think
it's
a
very,
very
positive
move
in
the
right
direction.
So
thank
you,
mr
chair.
C
Mr
chair
members
of
the
committee,
it's
great
going
forth
because
all
I
can
pretty
much
say
is
ditto
on
everything
that
was
said,
but
I
do
want
to
emphasize.
This
has
been
a
major
work
and
it's
still
work
in
progress,
but
a
lot
of
compromise,
a
lot
of
a
give
and
take.
But
it's
a
excellent
first
start,
and
it's
going
to
get
us
where
we
need
to
be
so
that
we
can
address
some
of
the
the
more
complicated
issues
moving
forward
with
crafting
and
recreating
ems
in
kentucky.
I
And
mr
chairman,
I'll
I'll
finish
up
and
I'll,
give
you
an
example
I
for
about
six
years,
I
was
a
member
of
a
board
of
national
board
of
directors
and
two
of
those
years.
I
was
president
and
we
represented
over
160
firms
over
300
employees
from
throughout
the
nation.
I
My
firm
was
only
15.,
so
I
was
a
small
potato
in
that
grand
scran
scheme
of
things,
but
I
made
policies,
decisions
and
and
implemented
tactics
that
I
knew
wasn't
really
beneficial
to
my
firm,
but
I
knew
at
the
end
of
the
road
that
we
will
be
better
off,
because
incoming
tide
raises
all
boats,
and
I-
and
I
think
that
each
member
that
participated
in
this
process
took
on
that
role.
I
They
understand
the
overall
objective,
the
long-term
objectives
in
terms
of
doing
that,
and
I
commend
for
each
one
of
the
people
that
I
that
I
worked
with
and
admire
and
respect
that,
and
I
look
forward
to
working
with
them
in
the
future,
no
matter
what
capacity
I'm
in
and
making
sure
that
we
deliver
health
services
and
because
we
want
to
put
people
first.
Thank
you,
mr
chairman.
A
Thank
you,
okay,
so
I
think
what
we're
gonna
do
next
before
we
start
taking
questions
is
here
there's
several
people
that
have
come
here
to
speak
on
this
bill,
so
I'm
gonna
have
them
come
forward
and
and
while
they're
coming
forward,
I
know
we've
got.
I
think
we've
got
jim
henderson
here,
who's,
the
is.
With
the
association
of
counties,
judge
reagan,
taylor
judge,
o
covington.
A
We
have
chris
runyon
here
with
scott
county
ems
director.
So
if
you
all
would
like
to
come
forward
first
and
while
they're
coming
forward,
I
want
to
remind
members.
This
is
the
third
version
of
this
bill.
That's
been
filed
this
year,
so
this
has
been
worked
on.
I
think
we
had
one
initial
version.
A
That
was,
I
don't
know
if
it
was
withdrawn,
but
a
second
bill
was
filed,
and
now
this
is
the
third
iteration.
What
I've
been
told
there
were
13
stakeholders
at
total
working
on
this
bill
from
the
beginning,
and
there
are
11
that
are
okay
with
it
a
couple
now
that
are
not
satisfied
with
where
the
bill
is
at
so
again,
I
think
that's
why
we
want
to
bring
it
forward
to
get
a
full
discussion
on
it.
L
Receive
chairman
alvarado
thanks,
so
much
obviously
we're
probably
one
of
those
one
or
two
groups
that
was
mentioned.
I
think
it
would
be
best
to
hear
from
people
who
actually
are
in
the
business
of
being
responsible
for
providing
ems
today
from
the
county
perspective.
So
I'm
going
to
let
judge
covington
talk
just
a
little
bit.
First
then,
I
think
judge
taylor
will
take
it
and
then
judge
covington's
ems,
director
and
I'll
kind
of
wrap
it
up.
N
Chairman
committee,
thank
you
all
for
having
us
and
allowing
us
to
speak
to
this.
We'd
all
agree
that
ems
service
is
one
of
the
most
important
functions
of
of
local
government,
county
governments,
currently
supply
or
responsible
for
about
90
counties
in
the
state
by
either
having
a
service
themselves
or
a
direct
contract
or
a
taxing
district.
N
We
take
great
pride
in
scott
county
and
our
ems
service
and
we're
an
outlier.
We
have
an
interlocal
agreement
with
the
city
and
we've
we've
functioned
together
and
operate
the
ems
service
together
and
the
county
government
manages
it.
The
funding
is,
is
split
evenly
we
have
over
75.
Last
few
years
we've
had
over
7
500
calls.
Last
year
we
had
over
8
200
calls
it's
a
huge
important
service
to
our
community,
and
we
take
great
pride
and
with
all
that
work
and
all
the
counties
that
are
involved.
N
We
really
feel
like
there's
two
things
that
this
this
bill
needs
to
consider
and
we
want
to
address
and
consider
right
now
in
section
8,
if,
if
a
city
wants
to
bypass
the
current
process
and
create
its
own
ems
service,
this
duplication
would
create
a
problem.
In
my
mind,
without
having
all
parties
at
the
table
and
and
trying
to
come
to
an
agreement
and
having
dialogue
about
that
before
going
forward
a
few
years
ago
in
our
own
community,
our
local
fire
department
leadership
wanted
to
start
a
fire-based
ems.
N
Then
only
one
local
government
has
to
sign
off
on
that
and
there's
118
hospitals
in
the
state
and
113
of
them
are
inside
city
limits.
So
most
likely
county's
voice
would
not
be
included
in
that
process,
and
we
just
think
it's
really
important.
We
have
the
vast
majority
of
the
skin
in
the
game
right
now
and
and
our
voice
in
the
county's
voice
and
expertise
in
this
process
should
be
part
of
that
consideration.
N
M
M
While
I
appreciate
the
work
that's
been
spent
on
this
bill,
I
don't
think
a
lot
of
people
fully
understand
how
much
this
impacts
counties
and
even
though
some
people
are
saying
this
issue
has
been
worked
on
for
two
to
three
years.
I
know
county
officials
were
only
recently
brought
into
the
discussions
within
the
past
few
weeks.
M
M
M
M
I
always
hear
here
in
frankfort
discussion
about
how
expensive
it
is
because
of
all
the
duplications
of
services.
Why
would
we
want
more
duplication
in
a
county,
especially
where
ems
the
ems
need,
is
being
met?
In
my
county,
the
officials
who
are
best
at
making
that
determination
are
the
local
elected
county
officials.
M
M
M
M
M
D
D
D
Unfortunately,
there's
some
potential
for
some
real
negative
impact
there,
as
well,
just
with
with
what's
already
been
mentioned,
that
the
county
government
not
having
a
voice
at
the
table
as
to
what
happens
with
ems
inside
their
county.
So
I
hope
you
would
strongly
consider
that
you
know
ems
is
a
unique
animal
and
it's
been
doing
it
for
33
years
and
it's
not
uncommon
for
me
to
have
conversations
with
folks,
and
they
say
you
know,
I
don't
know
how
you
do
what
you
do.
I
couldn't
do
it
and
it's
true.
D
We
are
a
unique
profession,
but
the
challenges
that
come
along
with
that
and
the
training
and
the
the
demands
of
the
job.
Frankly,
this
this
adds
undue
stress
to
us
trying
to
do
that
job
within
having
to
worry
about
what
could
happen
with
the
future
and
not
and
being
completely
silent
on
the
issue
not
being
able
to
come
to
the
table
to
discuss
those
issues
as
they
arise
in
our
counties.
So
hope
you
will
consider
amending
that
language
to
allow
county
governments
a
voice
in
those
conversations
as
we
move
forward.
L
Chairman
alvarado
again
thanks
for
the
opportunity
to
let
the
county's
voice
be
heard
today.
I
think
these
gentlemen
have
captured
the
essence
of
what
we
hoped
to
convey
today.
I
think
everybody
who's
been
involved
in
this
process
has
good
intentions
and
wants
to
try
to
get
to
the
same
place.
It's
just.
We
can't
all
seem
to
get
there
in
the
same
way,
right
now
as
a
way
to
bring
closure
to
our
testimony
I'll
wrap
up
with
a
couple
of
comments.
L
L
Some
of
our
concerns
are
probably
unfounded
in
jefferson
county
and
maybe
in
the
urban
pockets
of
northern
kentucky,
and
maybe
in
lexington.
Some
of
the
things
we've
raced
here
may
not
really
apply
in
those
places
where
you
have
large
cities
running
full-time
ems
and
fire.
All
together
I
mean
most
counties
would
like
to
be
able
to
offer
that
kind
of
service
in
the
rural
areas,
but
you've
heard
from
two
county
officials
that
actually
represent
two
of
the
largest
counties
in
the
state.
L
But
what
about
my
friend
judge
casey
ellis
back
here
in
the
room
who,
who
represents
owen
county
a
county
of
11
000
that
recently
lost
the
service
that
it
was
getting
from
saint
elizabeth
hospital
out
of
northern
kentucky,
because
it
just
wasn't
profitable
and
so
now.
Judge
ellis
is
putting
hundreds
of
thousands
of
dollars
into
an
ems
service,
because
nobody
else
will
do
it
and
there
are
over
40
counties
in
the
state
that
don't
have
a
hospital.
L
The
ems
service
in
those
counties
is
the
only
source
of
emergency
care
that
people
have
and
that
role
often
falls
to
the
counties.
There
are
just
vast
differences
between
the
rural
and
urban
counties
on
how
this
legislation
applies.
We
just
want
to
make
sure
we
get
it
right
and
every
patient
life
matters,
whether
it's
one
in
louisville
awaiting
transport,
from
a
facility
to
another
facility,
or
it's
a
guy
laying
in
a
fence
row
on
the
back
of
his
farm,
with
his
leg
cut
with
a
chainsaw
waiting
for
an
ambulance
to
get
there.
L
Those
are
equally
important
lives
and
we
just
want
to
make
sure
we're
not
accidentally
trading
one
for
the
other
and
finally,
I'd
like
to
address
what
I
would
like
to
call
a
honest
mischaracterization
of
caico's
role
in
this.
I
hope
that's
what
it
is.
That's
been
floating
around
and
fueled
by
a
few
folks
here
over
the
recent
days,
shelly
hampton
and
I
were
at
our
very
first
stakeholders
meeting
on
this
issue
on
february
the
10th.
L
L
L
Language
unintended
consequences,
the
misery
of
almost
every
bill,
the
in
fact,
the
bill
language
that
we're
talking
about
did
not
reflect
the
spirit
of
the
discussion
on
the
two
most
significant
issues
where
counties
were
raised
raised
caico
did
not
oppose
the
bill
in
the
house
in
hopes
that
these
issues
could
be
addressed.
We've
consistently
shared
our
concerns.
We've
worked
to
find
resolution.
L
We
did
not
back
up
from
our
support
of
this
bill.
The
support
we
offered
involved
specific
county
concerns
that
were
not
captured
in
the
bill
language.
The
two
issues
that
have
been
addressed
today,
our
partners
at
the
judges
association,
the
master's
association,
have
worked
alongside
us
to
educate
members
in
an
attempt
to
find
a
solution.
Our
fixes
are
actually
very
reasonable,
common
sense
solutions
that
just
simply
the
honor
the
spirit
of
our
discussions,
I
really
don't
understand
why
we
can't
just
get
it
right
like
it
was
supposed
to
be.
L
Unfortunately,
this
is
what
happens
when
people
are
rushed
to
pass
something
here.
There's
a
lot
in
this
bill.
That's
good!
There's
a
lot
wrapped
up
in
one
bill.
Why
not
break
out
the
parts
that
everybody
agrees
with
and
pass
those
parts
separately
counties
would
rather
us
not
pass
a
bill
than
to
pass
one
that
doesn't
get
it
right.
There
are
good
things
in
this
bill.
Why
don't
we
vote
on
those?
The
last
two
weeks
for
us
have
actually
felt
kind
of
like
a
game
of
gotcha,
and
maybe
they
got
us.
L
If
so,
then
we
have
learned
a
valuable
lesson
about
this
place
and
counties
will
come
out
of
this
experience,
much
better
prepared
for
the
next
issue.
Mr
chairman,
I
appreciate
you,
along
with
many
others
on
this
committee.
You've
always
been
a
gentleman
to
me
both
in
this
role
at
caico
and
in
my
previous
role
as
simpson
county
judge.
As
it
stands
today,
counties
just
cannot
support
house
bill
777.
Thank
you.
A
Thank
you,
gentlemen.
We
have
two
more
people
who
want
to
speak
and
I'm
going
to
have
them
come
forward
at
this
time
and
I'm
going
to
ask
them
to
keep
their
testimony.
We
have
we're.
Gonna
have
several
questions
and
comments.
Jim
duke
is
here
and
paul
phillips.
If
you
both
would
like
to
come
forward,
ask
you
both
to
try
to
keep
your
testimony
please
to
three
minutes
or
less.
If
you
can
so,
we
can
have
an
opportunity
for
questions
and
discussion.
A
We
knew
this
is
going
to
be
a
a
tough
topic.
So
if
you'd
like
to
introduce
yourself
for
the
record,
please
and
and
begin.
A
E
My
name
is
jim,
duke
I'm
a
paramedic
I've
been
in
this
business
since
1982,
when
senator
emery
hired
me
for
my
first
job
in
ems
in
ohio
county
when
he
was
judge
executive.
E
Since
then,
I've
always
had
a
warm
spot
in
my
heart
for
county
government
and
their
their
roles
and
struggles
in
operating
ems
services,
especially
in
the
rural
parts
of
kentucky.
Where
I
come
from.
Since
then,
I've
been
involved
with
the
kentucky
ambulance
providers
association
as
in
their
leadership
team,
since
for
the
last
20
years,
I've
also
been
involved
with
the
operation
of
other
county
services
throughout
western
kentucky.
E
I
want
to
reinforce
that
the
kentucky
ambulance
providers
are
very
much
concerned
about
the
viability
of
our
ambulance
services
across
kentucky.
We
feel
this
bill
will
protect
those
services
and,
just
like
the
judge
from
scott
county
said
a
moment
ago,
a
large
portion
of
the
services
in
kentucky
are
provided
by
county
governments
and
city
county
governments.
E
E
We
see
this
bill
house
bill
777
as
a
cooperation
between
several
different
groups
to
help
keep
ems
viable
in
kentucky
moving
forward.
We've
got
problems
in
kentucky
with
destination
issues.
We've
got
problems
in
kentucky
with
transport
time
issues.
These
problems
are
not
widespread
throughout
the
entire
state,
however
they're
there
and
we
need
to
address
them
and
to
do
so,
we
need
your
help
and-
and
we
feel
like
this
bill
is
a
good
move
forward
to
help
that
happen
and
senator
alvarado.
I
think
I've
stayed
under
my
two
minutes.
If
not
I'm
I'm
finished,
you
are.
A
Right
at
it,
thank
you,
sir,
because
I'm
watching
people
don't
think,
but
I've
got.
I
got
the
shickle
in
me
now
I'm
starting
to
watch
everybody's
testimony
in
here,
so
very
good,
mr
phillips.
If
you'd
like
to
begin
as
well,
we
I
think
we've
got
a
letter
also
that
you've
distributed
all
members
should
have
that
in
their
packet.
So
if,
if
some
members
want
to
make
sure
that
they've,
if
they
have
to,
they
can
read
that
at
their
leisure
as
well.
Thank
you.
O
Yes,
sir,
thank
you
and
I'll
either
speak
quickly
or
keep
it
brief.
I
am
paul
phillips.
I
am
the
regional
director
for
global
medical
response,
which
is
the
parent
company
of
american
medical
response,
lifeguard
emergency
medical
services
and
air
evac
life
team,
all
of
which
operate
in
the
state
of
kentucky
first
off.
Thank
you
for
allowing
me
to
speak
on
behalf
of
amr
and
lifeguard,
and
I
I
appreciate
the
effort
that
has
gone
in
to
crafting
this
bill.
As
was
said
earlier,
it
was
no
small
feat.
O
Our
frontline
responders
have
nothing
less,
have
been
nothing
less
than
heroic
in
these
times
of
need,
especially
in
light
of
the
coven
19
response
and
you've
all
seen
it
spotlighted
with
the
response
to
the
tornadoes
in
western
kentucky
on
december
10th.
However,
our
commonwealth
cms
system
is
facing
a
crippling
workforce
shortage
at
this
time.
It's
a
long-term
issue.
That's
been
brewing
for
over
a
decade.
O
Of
course,
the
pandemic
exacerbated
the
issue,
but
it's
still
there.
American
medical
response
and
lifeguard
ems
appreciates
the
continued
public
support,
as
well
as
the
support
of
our
legislator.
Legislature.
Over
the
past
few
years,
the
work
shortage
workforce
philadelphia
has
been
particularly
impactful
in
rural
kentucky.
Lifeguardium
ems
currently
serves
the
counties
of
harlan
pike,
leslie
floyd,
knott
and
mcgoffin,
and
I
can
personally
attest
to
these
strapping
struggles
house
bill.
O
Nonetheless,
while
the
bill
enables
cities,
counties
and
hospitals
to
obtain
a
c-o-n
through
a
non-substantive
review
process,
it
does
not
expressly
allow
those
entities,
the
flexibility
to
contract
those
services
through
a
state
licensed
ambulance
provider.
This
would
limit
the
ability
to
contain
cost
and
capital
expenses
receive
the
expertise
needed
to
establish
a
service
that
is
compliant
with
all
state
and
federal
laws
and
provide
the
most
economic
solutions
for
the
citizens
of
kentucky.
O
O
This
is
a
tremendous
benefit
to
these
areas
that
simply
cannot
directly
or
indirectly
support
an
ambulance
service
on
their
own.
This
opportunity
must
be
preserved,
public-private
partnerships,
shared
risk
and
financial
resources,
and
innovative
collaborations
are
what
is
needed
to
begin
to
solve
this
problem.
O
Amr
and
lifeguard
would
firmly
support
such
change
for
the
benefit
of
healthcare
facilities,
government
jurisdictions
and,
of
course,
the
people
that
we've
all
talked
about
today,
which
are
our
patients.
I
sincerely
appreciate
your
consideration
and
support
of
this
requested
amendment
and
ems
in
general,
and
I
again
appreciate
the
opportunity
to
bring
our
request
to
you
this
morning.
Thank.
A
You
very
much
all
right,
so
I'm
looking
at
the
clock,
I'd
like
to
get
everything
concluded
here
by
no
later
than
11
30
and
we've
got
a
few
members
who
are
going
to
have
questions
so
everybody
who's
testified.
You
may
be
called
up
to
come
and
answer
questions
and
for
comments,
and
this
is
kind
of
a
bill.
That's
going
to
be
somewhat
in
flux,
I'll
start
off.
A
First,
everybody
should
have
a
copy
of
an
amendment
that
I've
prepared
and
that
as
people
come
up,
I'd
like
to
hear
their
comments
and
their
thoughts
on
this
because
I
think,
being
involved
in
some
of
these
discussions
and
hearing
some
of
it.
The
worries
about
the
potential
of
negative
consequences,
the
potential.
What
could
go
wrong
and
the
worries
of
that
can
happen,
and
I've
heard
the
counter
of
that
is
well.
A
We've
got
this
task
force
in
section
23
that,
if
you
haven't
looked
at
the
composition,
has
six
members
of
the
general
assembly
that
will
be
part
of
that
task.
Force.
Secretary
of
the
cabinet,
the
inspector
general,
the
chairman
of
k-beams
and
then
you've
got
obviously
a
mayor
of
a
city
county
judge.
That
would
be
involved
with
that.
P
I
think
I
understand
that
there's
different
needs
in
the
rural
and
urban
areas
and
that
this
bill
may
have
a
separate
impact
on
rural
areas,
but
I
can
tell
you,
as
a
healthcare
provider
in
urban
areas.
This
is
desperately
desperately
needed.
I
mean
our
transportation
issues
and
our
patient
wait
times
seriously
impact
patient
care.
P
I
think
I
think
the
pandemic
brought
that
a
little
bit
to
the
forefront
with
some
really
really
bad
bad
stories,
but
this
has
been
an
issue.
Patient
transport
bed
turnaround
for
a
long
long
time,
and
so
I
just
want
to
say
I
appreciate
you
all
addressing
this.
Thank
you.
A
Thank
you
senator,
and
I
think
that
comes
down
to
that
inaction
really
isn't
a
very
good
option
for
us.
I
don't
think
things
are
going
very
well
right
now.
We
all
know
that
the
question
is:
what
does
a
solution
look
like,
and
sometimes
you
don't
want
to
necessarily
fear
of
negative
outcomes
to
paralyze
us
to
not
do
anything,
because
we
do
need
to
move
forward.
Senator
meredith.
Q
But
I
think
one
of
the
things
that
we
haven't
discussed
in
much
detail
here
is
just
mentioned
in
passing
earlier
about
the
ms
workforce
shortage,
and
that
is
a
significant
part
of
this
problem
that
we're
going
to
have
to
address,
and
I
hope,
as
we're,
formulating
the
budget
that
we
will
look
seriously
at
appropriating
some
dollars
directly
to
paramedic
ems
training,
because
we
know
we
need
it.
We've
done
it
with
nursing.
I
think
we
need
to
do
with
paramedics
and
ems
as
well,
and
I've
heard
the
number
thrown
out
of
10
million.
Q
I
don't
think
that's
an
unreasonable
number
and
I
thought
we
had
the
funding
there
to
do
it.
But
another
thing
struck
me
about
this,
that
you
know
a
problem
that
becomes
everybody's
problem
becomes
nobody's
problem
and
I
don't
know
how
we're
going
to
craft
legislation
to
address
120
counties
and
424
municipalities
in
kentucky.
It
can't
be
done
and
well.
I
appreciate
some
folks
have
compromised
on
this.
Obviously
we
don't
have
everybody
at
the
table
yet,
and
I'm
to
the
point
that
personally,
I'm
not
sure
we
shouldn't
do
away
with
this
certificate
need
process
altogether.
Q
That
is
a
little
bit
outdated,
I
think
was
originally
formulated,
was
meant
to
keep
from
duplication
services,
because
the
state
and
federal
government
had
to
pick
up
those
costs,
and
we
no
longer
have
to
do
that.
It's
got
a
different
role
right
now
and
that
role
is
to
protect
existing
services
within
communities,
and
we
should
do
that,
but
I
think
that
responsibility
needs
to
fall
back
to
the
counties
in
the
cities
respectively.
Q
Each
of
us
are
different
wildly
different
and
I
don't
feel
comfortable
making
a
policy
decision,
that's
going
to
affect
them
prestenberg
and
it
affects
my
home
county
differently
and
I
really
think
we
need
to
get
serious
consideration.
This
is
do
away
the
certification
process
altogether
and
let
those
health
care
decisions
be
made
at
the
county
level,
because
you
folks
in
the
best
position,
determine
what
those
needs
are,
and
I
it
brings
people
to
the
table.
Q
You
know
I'm
a
little
bit
disturbed
that
we
hear
that
our
county
may
get
into
the
business
and
it's
going
to
hurt
the
the
county
ambulance
service
to
me.
That's
unfavorable,
you
know
why
would
any
hospital
want
to
do
that
to
the
harman
county,
because
we
don't
sit
down
at
the
table
to
talk
about
these
things
until
we're
forced
to
do
it?
So
I
think
you
know
we're
being
asked
to
be
a
mediator
in
this
situation.
Q
We
shouldn't
be
every
county
is
different
and
we
should
respect
that
and
make
that
responsibility
go
back
to
the
county
level
to
determine
what
the
healthcare
needs
of
your
community
are
and
how
you're
going
to
address
those
needs.
So
I
wish
we
would
give
serious
consideration
that
it's
provides
ownership
for
the
problem
at
the
local
level.
That's
where
it
should
be,
but
sure
that's
my
comments.
C
But
I
want
to
make
sure
that
I
understand
so
so.
The
issue
with
this
from
the
hospital
association
is
that
the
lack
of
transports
when
when
patients
need
to
go
from
one
hospital
to
another,
the
wait
time
so
so
that
is
the
most
emergent
issue
that
we
have
correct.
Yes
or
no.
You
don't
have
to
get
into
detail,
yes,
okay
and
with
this,
so
so
with
private
services.
C
Are
those
services
not
expansive
enough
through
the
commonwealth,
to
be
an
option
b
if
the
local
service
is
not
going
to
be
able
to
make
it
in
an
acceptable
time?
There's
not.
Is
there
another
entity
available
throughout
the
entire
commonwealth
that
they
could
call
if
they
were
given
that
latitude
to
provide
these
transports.
K
K
K
So
there's
a
need
for
additional
capacity,
and
I'd
like
to
point
out
that
there
is
already
the
opportunity
for
counties
and
anybody
that's
opposed
to
have
a
voice
in
the
process
in
the
c-o-n
process.
The
non-substantive
review
process
is
not
an
automatic
approval.
It's
under
con,
it's
just
you
get
a
faster
decision
and
I'll
read
you
from
the
regulations
that
say
if
an
application
is
granted
non-substantive
review
status
by
the
office
of
inspector
general
any
affected
person.
That's
anybody,
city
county.
K
Anybody
who
believes
the
application
is
not
entitled
to
non-substantive
review
status
or
who
believes
the
application
shall
not
be
approved,
may
request
a
hearing
by
filing
a
request
for
a
hearing,
and
then
that
hearing
is
held
according
to
a
regulation
that
governs
all
con
hearings.
So
you
go
to
a
full-blown
hearing
in
front
of
a
hearing
officer.
Each
party
shall
have
the
opportunity
to
present
its
case,
make
an
opening
statement,
call
and
examine
witnesses.
Offer
documentary
evidence
into
the
record
make
a
closing
statement
cross-examine
witnesses.
K
There
is
already
a
process
in
place
for
anyone
to
oppose.
If
a
county
is
concerned,
what
a
hospital's
doing
they
can
go
to
a
public
hearing,
that's
already
the
process,
but
what
we're
talking
about
and
what's
been
suggested
is
that
a
hospital
should
have
to
run
around
and
get
a
bunch
of
letters
signed
before
it
can
even
file
an
application.
K
That's
adding
a
lot
of
extra
red
tape
and
think
about
some
of
our
systems
and
I'd
like
to
point
out
in
this
bill.
The
exception
for
hospitals
is
very
narrowly
written.
The
only
exception
to
con
is
for
a
hospital
to
transport
patients
out
of
its
hospital.
It
can't
go
anywhere
else,
it's
out
of
its
hospital.
So
if
a
hospital
system
wanted
to
have
an
ambulance
to
go
through
its
various
hospitals,
it
has
to
file
for
non-substantive
review.
Well,
if
you're
saying
elizabeth
medical
center,
for
example,
that
has
four
hospitals
and
adjoining
counties.
K
What
are
you
gonna
get
eight
letters
before
you
can
even
file
an
application.
You
know
that
doesn't
make
sense.
It's
bad
public
policy.
When
there's
already
a
process,
it's
called
a
public
hearing
that
you
can
go
through
under
non-substantive
review.
It's
the
same
hearing
that
you
would
get
informal
review,
there's
already
a
process
to
hear
anybody,
who's
opposed
to
an
application.
C
And
in
just
a
final
are,
are
we
certain
that
expansion
or
other
services
is
going
to
solve
the
problem?
I
mean
I
I
see
at
the
base
of
this.
You
simply
can't
get
enough
paramedics
and
emts.
I
don't
care
how
many
services
you've
got
if
you
can't
staff
them.
That
is
the
core
of
this
issue
is.
Do
you
agree
with
that?.
K
That's
part
of
the
issue,
but
I
will
say
reiterating
senator
meredith's
cons.
You
know,
comment
48,
other
states
don't
have
certificate
of
need.
Hospitals
are
not
out
to
get
everybody
in
the
ambulance
business,
but
hospitals
have
no
option
today.
If
they
can't
move
their
patients,
there's
nothing.
They
can
do
and
that's
an
issue.
When
I
looked
at
tennessee,
it's
a
c-o-n
state,
but
it
does
not
review
ambulances.
K
G
And
mr
chair,
if
I
could
just
take
a
moment
to
address
the
staffing
issue
and
thank
you
senator
meredith,
for
your
comments,
we
fully
understand
that
staffing
is
an
issue
and
this
bill
does
not
directly
seek
to
address
the
staffing
issue,
but
we
do
have
other
legislation
which
is
hopefully
coming
to
this
side
of
the
the
chamber
to
your
chamber
soon.
That
will
address
specifically
the
health
care
worker
in
a
loan
forgiveness
program,
additional
scholarships
and
training
for
a
long
list
of
health
care
providers,
including
emts
and
paramedics.
G
So
we
we
are
working
on
this
issue.
I
would
just
like
to
reiterate
what
nancy
said
that
this
agreement
for
the
hospitals
is
really
specifically
tailored
to
move
a
patient
to
a
different
level
of
care
between
facilities
between
hospitals.
There
is
no
nothing
in
this
legislation
that
would
allow
a
hospital
ambulance
service
to
go
outside
of
of
of
that
their
jurisdiction
and
provide
9-1-1
services.
Now
I
I
mean
I
have
a
bit
of
an
issue
with
and,
and
I
greatly
respect,
caico
and
their
concerns-
don't
get
me
wrong.
G
G
You
know
and
I'll
just
once
again
talk
about
the
con
process,
I
initially
advocated
for
eliminating
ambulance
coin
altogether.
I
think
that
this
is
a
self-correcting
issue.
I
think
that
the
free
market
would
certainly
help
dictate
with
interlocal
agreements
and
everyone
working
together.
This
is
a
problem
that
can
be
solved.
This
is
a
first
step
and
I
think
that
you
know
we
can.
We
can
certainly
continue
these
conversations
in
the
task
force.
Thank
you,
mr
chair.
E
Thank
you,
mr
chairman,
and
thank
you
representative
from
fleming
for
bringing
this
thankless
important
subject,
but
my
question
is
with
you,
mr
chairman,
and
you're
most
knowledgeable
and
respected,
but
could
you
answer
why
we
need
an
amendment
to
with
a
sunshine
clause
when
we
can
come
back
and
do
this
anyway,.
A
Well,
it's
again
it's
a
it's
a
it
was
an
option
and
I
think
you're
going
to
hear
some
other
options.
So
this
is
just
I
wanted
to
put
this
on
the
table.
We've
had
meetings
about
this
outside
of
this
room
that
I've
talked
to
all
the
groups
involved,
and
you
hear
the
opposition
and
so
there's
concern.
A
You
know
if
there's
a
solution
we'd
like
to
have
it
like
to
have
these
groups
come
to
a
solution,
but
if
there
isn't,
the
option
is
to
consider
passing
this
with
a
sunset
so
that
we
are
all
forced
to
come
back
and
he
gives
this
bill
an
opportunity
to
work,
because
some
of
the
worries
about
what
potentially
could
happen.
So
he
said:
okay
that
will
flush
out
if
it
blows
up
and
doesn't
work
well,
then
we'll
be
forced
to
come
back
and
have
to
readdress
this.
A
R
K
R
Okay,
you
had
mentioned
something
about,
you
had
studied
tennessee
and
there
were
just
a
small
number
of
hospital
run
services.
Where
were
those?
Do
you
recall
what
areas
of
tennessee
those
were
located
in
you.
K
Know
I
can't
tell
you
entirely
some
of
them.
I
recognize
vanderbilt
had
five
licenses
with
several
children's
hospitals.
They
seem
to
be
systems
larger
systems,
but
I'm
not
familiar
with
where
all
they
were.
But
I
just
looked
at
the
als
and
the
bls
services
in
terms
of
who
had
the
license
and
just
looked
at
the
composition.
A
Chairman
kim
before
we
have
our
last
question,
mr
henderson,
you
may
want
to
come
to
the
table
just
to
make
sure
we've
got
everybody
up
here.
If
there's
any
other
discussion,
just
grab
a
chair
and
pull
it
on
up
that
way,
we
can
have
all
members
of
the
table.
Senator
givens.
S
Chairman
alvarado,
thank
you
for
the
chance
to
ask
a
question.
Thanks
for
your
leadership
in
this
robust
discussion,
we've
had,
I
want
to
start
by
thanking
everyone
involved
on
both
sides
of
the
issue,
especially
my
legislative
colleagues.
The
two
here
at
the
table,
but
particularly
representative
hart,
as
I
had
a
member
of
leadership,
talk
with
me.
In
fact
this
morning,
as
we
were
discussing
this
legislation
and
some
of
the
ideas
that
you
brought
to
the
table
and
the
last
few
moments,
apparently
were
game
changers.
S
In
addition,
I
think
the
the
ceo
in
question
is
interesting
in
and
of
itself,
and
so
the
first
change
that
I'm
going
to
suggest
we
consider
actually
goes
to
the
task
force
on
page
58,
mr
chairman,
if
we,
if
we
do
move
changes
into
the
process,
I
would
encourage
that
we
have
a
new
a
under
the
charges
for
the
task
force,
because
we
we
charge
task
forces
to
do
specific
things
and
they're
measured
by
the
things
they
do,
and
I
think
senator
meredith
spoke
to
this
beautifully.
S
S
It
looks
to
me
to
be
something
that
we
absolutely
should
do
not
withstanding
any
section.
Nothing
within
any
section
or
subsection
prohibits
any
person
city
county
from
entering
into
a
contract
or
agreement
with
a
licensed
ground
ambulance
service.
So
I'm
a
proponent
of
that
amr
amendment
being
worked
into
some
changes.
S
If
we
do
those
the
last
change
that
I'll
have,
I
think,
goes
to
the
core
of
the
conversation
and
staff
has
been
very,
very
skilled
in
assisting
with
thoughts
around
this,
and
this
is
not
a
fully
formed
idea,
mr
chairman,
but
I
would
love
the
chance
to
engage
in
a
conversation
on
page
29.
Briefly,
there
at
the
bottom
of
29
is
the
the
heart
of
the
question
about
the
city
or
county
that
city
or
county
peace.
S
S
The
cabinet's
already
started
engaging
me
in
the
conversation
and
that
that
effort
would
have
to
disprove
what
the
non-sub
review
has
approved,
and
so
I
I
appreciate
the
work
everyone
has
done.
The
chairman's
admonition
a
moment
ago,
in
a
very
positive
way,
was
that
maybe
everybody
or
maybe
someone
else
said
it.
Maybe
this
is
the
point
in
time
when
everybody
gets
in
the
room
for
an
hour
and
a
half
together
or
three
hours
together
or
five
hours
together,
most
those
best
decisions
are
made
after
eight
hours
of
no
water,
no
restroom
breaks.
A
A
We
pass
it
with
a
sunset
clause,
which
is
one
option,
one
which
I
don't
think
will
be
done
before.
The
end
of
session
is
to
get
rid
of
con
altogether,
which
I
think
is
what
happens
in
most
parts
of
the
country
and
for
those
who
worry
about
how
that
would
work.
I
would
argue
you
would
have
plenty
of
examples
of
how
that
works,
but
senator
given
said
that
does
set
some
precedent.
A
For
other
things
sounds
like
senator
gibbons
has
a
a
proposal
that
may
have
some
merit
as
well.
It
might
be
worth
considering,
and
those
are
all
the
things
I've
had.
Other
members
you've
seen
me
have
some
conversation,
others
who
are
concerned
about
not
moving
this
forward
quite
yet
and
maybe
giving
us
another
week
to
work
on
it.
We've
got
at
least
at
least
two
more
weeks,
and
we
could
always
call
special
meetings
as
well.
A
If
we
need
to
as
long
as
we
have
the
time
to
do
that
and
get
the
room
to
do
that,
but
that
might
be
the
the
best
approach.
Senator
adams.
T
Thank
you,
mr
chairman,
and
I
know
that
there's
you
know
I
can
hear
some
consternation
in
your
voice
on
this
issue.
First
of
all,
I'd
like
to
thank
the
bill
sponsors
for
bringing
this
and
and
I'm
prepared
to
vote
yes
on
this
bill
today,
but
in
deference
to
our
colleague
on
this
committee
and
the
proposal
that
senator
gibbons
made,
you
know,
I
would
think.
Maybe
we
have
the
opportunity
to
take
one
last
look
at
it.
I
do
think
this
bill
has
the
votes
to
pass
in
committee
today
from
what
I
understand.
T
Let's
go
ahead
and
take
a
look,
but
this
is
kind
of
directed
at
the
testimony
that
I
received
from
caico,
and
that
is
it's
not
about
you.
It's
about
the
patients
and
it's
about
transporting
that
patient
to
the
place
where
they
need
to
be,
and
it's
not
about
anything
other
than
that
and
I
think
sometimes
we're
losing
that
patient
in
this
whole
conversation
and
that
person
cannot
be
lost.
T
L
E
L
Would
also
like
from
what
I
would
refer
to
as
senator
obi-wan
kenobi.
E
Givens
with
his
wisdom
and
with
his
foresaw.
L
On
this
issue,
with
going
forward
the
proposal
as
it
is.
E
E
Once
again,
the
most
respected
senator
givens
and
I
have
to
disagree-
we've
been
kicking
this
around
for
14
years
and
we're
going
to
kick
it
around
another
week
and
then
we're
one
of
sunset
claws
to
kick
it
around
some
more.
I
think
we're
here
to
make
decisions
I'd
like
to
vote
today
and
if
you
want
to
hold
it
up
a
little
bit
longer
to
put
a
committee
or
floor
amendment
on
it.
Then
that's
an
option.
P
Honestly,
I
too
would
prefer
to
vote
today.
I
think
this
is
a
really
important
patient
care
issue
and,
to
begin
with,
and
to
end
with
the
patient
comes
first
and
when
we
have
people
waiting
literally
sometimes
days
to
be
transported
and-
and
you
know
not,
every
one
of
these
is
an
actual
crisis.
Medical
emergency
like
somebody's
gonna
die.
P
Some
of
them
are,
I
mean
some
of
them
actually
are.
We've
had
surgeries
performed
at
hospitals
in
this
state
that
aren't
equipped
to
perform
those
surgeries
because
we
couldn't
transport
patients.
Okay,
we
also
have
mental
health
crises,
patients
that
need
to
be
in
an
appropriate
facility
that
are
waiting
72
hours
in
an
emergency
room
guys.
No,
it's
not,
okay.
I
know
it's
not
perfect.
I
know
they're
people
who
are
thinking
they're,
gonna
lose,
but
in
the
meantime
we
have
a
real
issue
here.
R
Thank
you,
and
thanks
to
everybody,
that's
worked
on
this.
This
has
been
an
issue
that
lasted
longer
than
the
14
years
that
senator
nemo
spent.
Before
I
moved
back
from
chattanooga,
I
was
working
with
my
local
folks
in
home
over
ems,
and
I
have
a
different
view
on
patient
care
and
this
of
being
about
the
patient
and
parts
of
my
really
really
really
really
rural
areas.
R
My
concern
is
that
if
we
do
this,
there's
going
to
be
some
areas
that
are
so
disaffected
that
it
may
collapse
our
emt
system
completely,
and
that's
why
I
think
we
need
to
stop
and
take
another
quick
look
at
this
before
we
move
forward.
I
understand
the
issues
on
both
sides,
but
but
but
this
is
an
issue,
my
local
hospitals
and
most
of
my
mt
are
in
favor
of
this,
and
I
would
be
voting
to
take
this
out
of
committee
today,
but
I
think
that's
something
that
we
probably
need
to
take
a
quick
look
at.
A
A
We've
got
a
clause
from
gmr
I'd
like
to
have
all
of
your
opinions
on
that
clause
and
there's
been
a
member
who's
expressed.
Some
support
of
that
sounds
like
senator
gibbons
has
a
proposal
senator
if
you'd
like
to
be
able
to
if
you
have
that
in
writing
is
to
either
get
that
to
those
at
the
table.
I'd
like
to
get
your
feedback
on
that.
A
A
This
is
normally
I
get
all
these
folks
that
are
state
and
local
people,
most
of
the
time
that
are
here
before
me
in
this
committee,
which
is
a
little
bit
different,
but
that's
what
I'm
going
to
charge
all
of
you
to
do.
This
is
sit
down.
These
are
the
top
you've
heard
all
the
testimony.
Almost
everybody
spoke
on
this,
and
this
is
good.
This
is
kind
of
the
whole
committee
airing
out
their
opinions
and
their
positions
on
it,
and
I
think
you
know
this
is
a
committee
that
is
about
patience.
A
First,
we
tend
to
pass
a
lot
of
non-partisan
legislation
here
that
is
targeted
towards
improving
the
health
care
and
the
outcomes
of
people
in
our
state,
and
that's
really
the
paramount
importance.
So
I'm
going
to
charge
all
of
you
to
do
that,
get
together
cover
those
topics
and
then
come
back
with
a
report
by
this
friday
right
very
good.
A
A
I
need
to
have
some
kind
of
plan
of
action
or
some
resolution
as
far
as
agreement
from
all
parties
on
this,
and
if
they
can
come
back
with
an
agreement
on
it
that
we
can
all
be
agreeable
to,
then
we
can
look
forward
towards
taking
action
later
on,
because
we
still
have
a
couple
more
weeks
to
get
it
done.
Thank
you
all
right.
Thank
you
all
very
much
for
participation.
Thank
you
all
for
being
here
today.
I
appreciate
all
the
testimony.