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From YouTube: House Standing Committee on Health Services (2-16-23)
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A
I
kind
of
forgot
about
that
first
week
that
we
had
back
in
early
January,
so
welcome.
Thank
you
for
being
here.
We've
got
a
few
important
issues
to
discuss
and
I
will
go
ahead
and
call
this
meeting
to
order
and
ask
DJ
to
please
take
the
role.
C
C
A
We
have
a
quorum
established
to
do
business
so
again
welcome
to
everyone
if
I
could
just
remind
everyone
to
please
silence
your
cell
phones
and
we
do
have
a
few
members
who
are
also
members
of
state
government.
So
if
you
see
people
running
in
and
out
through
the
meeting,
that's
what
that's
about
so
we
will
just
ask
that
anyone
who
leaves
if
you
need
to
record
a
vote
just
let
us
know
when
you
come
back
as
long
as
we're
not
in
the
middle
of
a
of
another
vote.
D
Thank
you,
madam
chair
I
would
like
to
recognize
Nicole
freeze
here
today,
she's
sitting
in
the
front
row.
Nicole
is
an
RN
who's
participating
in
a
shadow
program
today
to
follow
a
state
legislator
so
that
when
she
begins
to
advocate
for
her
profession,
she
understands
what
happens
in
the
life
in
the
day
of
a
state
legislator.
So
we
want
to
welcome
her
here.
I
gave
her
copies
of
both
bills,
so
she's
read
them
thoroughly.
So
she's
well
versed.
A
E
As
you
know,
we
met
with
you
earlier
to
address
some
continued
concerns
after
the
amended
after
comment
statement
of
consideration,
version
to
remove
the
limitation
of
300
patients
per
provider
and
then
to
also
strike
on-site
for
clinicians
so
that
they
so
that
it
was
just
medical
professionals,
be
available
to
treat
and
take
care
of
patient
needs.
So
it
was
more
to
be
to
allow
the
ntps
and
obots
to
be
able
to
function
a
little
bit
easier
with
the
Staffing
challenges
that
they're
currently
faced
with.
Okay,.
A
Yes,
thank
you
and
I
appreciate
your
work
on
this,
and
the
regulation
has
to
do
with
alcohol
and
other
drugs
and
the
treatment
provided
and
we're
talking
about
the
Physicians
and
practitioners
who
are
treating
addiction,
medicine
and
prescribing
buprenorphine,
so
just
to
clarify
that
these
are
changes
that
we
advocated
for
there
were.
There
was
a
300
patient
cap
on
addiction,
treatment
providers
and
we
don't
do
that
for
other
Medical
Specialties,
and
so
we
thought
it
was
important
to
be
able
to
provide
that
treatment
for
those
patients.
A
So
I
appreciate
your
work
on
this,
and
thank
you
for
the
explanation.
Do
we
have
any
questions
from
committee
members?
Okay,
see?
None
I
will
just
entertain
a
motion
to
approve
the
reg
as
amended
representative
bratcher
and
a
second
representative
Wilner.
Thank
you
so
much
all
in
favor,
please
say
aye
aye
any
opposed.
Okay,
all
right
the
motion
passes.
Thank
you
so
much.
Thank
you.
We
have
two
other
regs
that
have
come
through
the
public
comment
period
and
are
without
any
sort
of
opposition
or
discussion.
Did
all
members
have
a
chance
to
see
those?
A
Are
there
any
questions
all
right
see.
None
I!
Will
consider
those
reviewed
the
first
item
on
our
agenda
today
is
House
Bill
125,
an
act
relating
to
Public
Health
I
would
like
to
at
this
time
invite
representative
Rebecca
Ramer
to
the
table
and
any
guest
I
think
we
have
Mackenzie
Wallace.
Thank
you
very
much
for
being
here.
Please
introduce
yourselves
for
the
record
and
proceed
with
your
discussion.
F
F
So
this
is
a
straightforward,
simple,
but
important
piece
of
legislation.
House
Bill
125
will
require
the
department
for
public
health
to
work
with
the
office
of
dementia
surfaces,
to
incorporate
information
on
brain
health
and
risk
reduction
into
materials.
The
state
publishes
and
distributes
to
the
public
on
heart
disease,
stroke,
diabetes
management.
We
know
that
of
Medicare
beneficiaries
with
dementia.
95
of
those
people
have
at
least
one
other
chronic
condition.
A
A
G
There
was
just
a
minor
change,
so
originally
we
had
these
updated
integrated
materials
being
sent
to
All
61
local
Health
departments
by
the
department
for
public
health.
We
wanted
to
add
that
the
department
for
aging
and
independent
living
will
take
the
sort
of
other
side
of
the
coin
and
they'll
make
sure
that
these
materials
are
getting
out
to
our
area
agencies
on
aging
and
our
senior
centers.
As
we
know,
those
are
very
you
know,
common
places,
especially
in
our
Rural
and
underserved
areas,
to
get
information.
A
C
C
A
G
Thank
you,
madam
chair
first
bill.
If
I
may
have
one
moment
of
privilege,
I'm
going
to
embarrass
some
first-year
law,
students
that
are
here
with
me
today,
I
Mentor
them
they're
at
the
University
of
Louisville
Brandeis
School
of
Law,
and
they
are
sitting
in
the
audience
with
me
today,
Andy
and
Lily.
So
please
feel
free
to
come
up
afterwards
and
impart
some
words
of
wisdom
on
them.
Thank.
A
A
H
A
J
A
A
Most
of
us
have
been
touched
by
cancer
in
in
one
way
or
another,
and
we've
seen
our
our
loved
ones
go
through
the
devastating
effects
of
chemotherapy
and,
unfortunately,
Kentucky
still
ranks
as
number
one
in
the
nation
in
lung
cancer.
We
also
have
abnormally
High
rates
of
other
Cancers
and,
of
course,
chronic
diseases
that
we
hear
a
lot
about
and
I
think
most
of
us
have
experienced
a
situation
where
we
were
prescribed
a
medication
and
didn't
work.
A
We
needed
another
type
of
medication
to
really
figure
out
what
worked
for
us,
and
so
this
is
really
the
Crux
of
this
bill.
We
know
that
oftentimes,
these
treatments
are
historically
the
best
treatments
for
a
category
of
cancer
or
even
medications
for
other
diseases,
but
they
are
not
targeted
treatments
for
specific
for
a
patient-specific
genetic
genetic
makeup
or
their
biomarker.
A
So
we
we
need
to
better
understand
how
patients
respond
to
medications,
what
their
biomarkers
are
and
how
they
metabolize
medications
and
that's
what
this
will
do.
This
testing
allows
for
precision
or
targeted
treatment,
less
trial
and
error
and,
of
course,
less
of
the
devastating
side
effects
that
we
see
and
premature
death.
We
know
that
these
biomarker
and
pharmacogenetic
tests
are
evidence-based.
They
are
standards
of
care
for
many
cancer
patients
and
others,
and
they
must
be
medically
necessary
in
order
to
be
prescribed,
but
the
insurance
coverage
is
failing
to
keep
pace.
A
This
testing
analyzes
a
patient's
tissue,
blood
or
other
biospecimen
for
their
biomarker
biomarker
testing,
helps
helps
the
helps
the
Physicians
and
practitioners
who
are
treating
patients
to
best
determine
the
the
right
treatment
for
the
patient.
This,
of
course,
results
in
improved
quality
of
life,
better
health
outcomes
and
reduces
the
overall
cost
of
treatment.
A
House
Bill
180
requires
health
benefit,
benefit
plans
to
cover
biomarker
testing,
ordered
by
a
healthcare
provider
for
the
diagnosis,
treatment,
management
or
monitoring
of
a
patient's
condition
and
there's
currently
limited
and
disparate
coverage
for
biomarker
testing
because
of
a
lack
of
consistent
insurance
coverage,
and
not
only
that
that's
for
everyone,
but
it
especially
affects
the
minority
populations,
Medicaid
eligible
populations
and
Rural
populations
where
there's
less
access
to
this
care.
So
this
puts
certain
populations
at
a
significant
disadvantage.
A
At
this
time,
I
will
hand
it
off
to
I,
don't
know
who
would
like
to
go.
First.
I
I
I
So
at
that
point,
I
had
a
biomarker
test
performed
on
the
tissue
from
my
lung
nodule,
which
came
back
positive
for
a
biomarker
called
egfr
Exon
19,
basically
meaning
that
somewhere
along
the
way
that
Gene
stopped
working,
allowed
the
lung
cancer
to
grow
by
having
that
biomarker
testing
performed
I
qualified
for
tigriso,
which
is
a
targeted
therapy
or
Precision
medicine.
To
treat
my
cancer
had
I
not
had
the
biomarker
testing
done.
I
would
have
been
treated
like
a
typical
lung
cancer,
patient,
most
of
which
are
smokers
and
put
it
been
put
on
chemotherapy
and
immunotherapy.
I
If
I
would
have
chosen
that
route
of
treatment,
my
life
expectancy
and
my
quality
of
life
would
be
much
decreased,
not
only
do
I
have,
but
did
I
have
biomarker
testing
done
at
diagnosis,
my
type
of
cancer,
it's
not
a
matter
of.
If
it
comes
back,
it
will
return
and
progress.
At
that
point,
the
doctors
will
want
to
re-biopsy
or
re-biomarker
test
that
tissue
to
see
if
there
are
any
other
new
genetic
markers
that
have
developed.
That
would
qualify
me
for
a
different
tki
or
additional
treatments
to
Target
into
that
therapy.
I
So
not
only
is
this
important
in
guiding
my
treatment
plan,
but
it's
also
allowed
me
now
to
live
for
38
months
since
diagnosis,
with
now
the
life
expectancy
of
five
to
seven
years.
So
it
is
a
big
difference
and
it
is
extremely
important.
Luckily,
for
me
my
husband
and
I
are
both
educated
and
our
researchers
and
know
this
is
what
needs
to
be
done,
but
people
that
are
of
different
ethnicities
and
economic
levels
should
be
entitled
to
the
same
treatment
that
I
receive.
So
thank
you.
J
Right,
thanks
again
for
the
opportunity
to
be
here,
we're
also
represented
here
today
by
the
American
Cancer
Society
and
American
Lung
Association,
and
a
few
patient
advocacy
groups.
That
I
would
like
to
briefly
mention
the
breath
of
Hope,
Kentucky
and
stages,
and
also
the
heel
collaborative
that
drove
up
here.
Two
gals
from
Georgia
I
come
from
a
background
of
Family
Practice
I've,
been
in
practice
for
36
years
and,
unfortunately,
I've
seen
a
lot
of
cancer
and
I've
seen
a
lot
of
families
affected
by
cancer.
J
I
became
more
intimately
involved
in
the
oncology
space
back
in
2016
when
I
joined
a
thoracic
oncology,
disease
management
team
as
a
primary
care
representative
for
their
work.
At
the
time,
I
didn't
know
what
a
lung
cancer
screen
was.
I
found
out
that.
Finally,
we
had
something
that
could
make
a
tremendous
difference
in
the
lives
of
our
patients
that
were
at
risk
for
smoking
or
at
risk
for
cancer,
and
that
had
lung
cancer.
We
started
going
after
it
and
we
have
made
a
tremendous
difference.
J
We've
built
a
very
aggressive
and
busy
lung
cancer
screening
program,
we're
going
after
it
and
we're
finding
it
in
the
early
stages.
We
find
over
70
percent
of
lung
cancer
now
in
stage
one
equally
as
important
and
equally
great,
really
is
that,
even
when
we
find
cancer
in
the
later
stages
stage,
three
and
stage
four,
we
can
make
a
tremendous
difference
with
those
patients.
J
J
The
good
news
is
is
that
these
patients,
many
of
them,
have
a
targetable
mutation
and
do
respond
to
Precision
medicine
and
targeted
therapies.
Even
the
patients
we
find
through
our
lung
cancer
screening
program
have
these
same
targetable
mutations
oftentimes
and
can
respond
to
targeted
Therapies
we're
making
a
tremendous
difference
with
these
folks.
This
treatment
can
be
miraculous,
as
Leah
has
alluded.
We
have
patients
now
that
are
5
10
15,
even
20
years
out
from
their
cancer
diagnosis
with
late
stage,
lung
cancer
stage
three
and
stage
four.
J
They
have
no
evidence
of
disease
and
most
of
those
patients
are
able
to
say
that,
because
of
targeted
therapies
because
they
had
biomarker
testing,
we
didn't
used
to
have
many
certain
lung
cancer
survivors.
They
didn't
have
a
strong
advocacy
group
because
they
didn't
live
long
enough
to
be
an
advocate
and
those
that
did
were
so
sick
and
so
beaten
down
from
their
treatment
that
they
weren't
able
to.
If
they
wanted
to.
J
We
now
have
a
very
strong
advocacy
movement
in
lung
cancer
screening
space,
their
voices
are
loud
and
strong
and
their
numbers
are
growing
and
I.
Think
that's
why
you're
beginning
to
hear
more
about
lung
cancer,
biomarkers,
lung
cancer
screening,
it's
getting
some
of
the
same
attention
that
it
deserves.
Now
that
colon
cancer
and
breast
cancer
gets
Leah
Phillips
is
here
as
a
result
of
her
targeted
therapy.
J
I
want
to
mention
a
gal.
That's
become
a
friend
of
mine
through
this
advocacy
work
that
I've
done
Chastity
Harney.
She
was
diagnosed
with
adenocarcinoma
stage
3C
when
she
was
40
years
old.
She
has
three
children,
she
underwent
biomarker
testing
and
she
also
had
a
targetable
mutation,
egfr
mutation.
She
received
targeted
therapy
through
Precision
medicine.
She
just
had
her
four-year
scan
of
her
brain
just
last
week
and
she's
clear
of
disease.
J
These
are
the
kind
of
stories
that
we're
hearing
more
and
more
just
remarkable
life
stories.
Chastity's
daughter
got
married
the
same
month
that
my
daughter
got
married
last
October.
She
would
not
have
been
able
to
see
her
daughter's
wedding
most
likely
if
she
hadn't
received
this
biomarker
testing
and
precision
medicine
therapy.
J
This
technology
exists.
It's
evolving
policy
needs
to
keep
up
with
the
change
it's
exciting.
It's.
It's
really
changed
the
way
that
we
look
at
cancer
that
we
treat
cancer.
These
are
medical
advances
that
need
to
be
embraced.
They
need
to
be
available
for
all
individuals.
They
should
not
be
available
for
some
and
not
others,
as
we
find
out
more
and
more
technology
and
more
and
more
processes
that
we
can
use
to
improve
the
lives
of
patients
at
risk
for
and
with
lung
cancer.
We
should
develop
policy
and
legislation
to
support
this
progress.
J
K
So
in
terms
of
the
cost
savings
I
know
we
talked
about,
you
know
the
benefit
to
patients
to
be
able
to
get
in
the
Forefront
of
treatment
and
really
identify
things
that
are
going
to
work.
Instead
of
going
the
traditional
route.
Can
you
someone
speak
to
the
amount
of
cost
savings
that
it
benefits
in
order
to
catch
this
early
and
to
be
able
to
treat
with
Precision
medicine,
as
opposed
to
allowing
it
to
go
on
in
the
traditional
form.
A
A
You
know
to
give
someone
back
their
life
and
to
eliminate
years
of
of
dangerous
side
effects,
long-term
chronic
Health
diseases
and
and
problems
as
an
outcome
of
of
their
either
diagnosis
or
their
treatment.
But
we
did
get
a
health.
We
do
have
a
health
benefit
mandate
statement
and
the
fiscal
impact
actually
came
back
that
it
is
not
expected
to
materially
increase
the
total
cost
of
Health
Care
in
the
Commonwealth.
So
it
is
not
expected
to
raise
any
insurance
premiums
and
it
is
also
not
expected
to
materially
increase
administrative
expenses
of
insurers.
A
So
that
was
wonderful
news
this
morning,
because
you
know
we
are
working
with
our
insurance
providers
and
we
are
are
trying
to
get
this
right.
We
I
think
have
an
opportunity,
as
a
legislature,
to
to
really
have
an
impact
on
on
patient
care.
It's
an
exciting
opportunity,
it's
one
of
the
exciting
parts
of
of
being
here
and
having
opportunities
to
really
make
a
difference
in
the
lives
of
of
our
citizens,
and
so
it
was.
A
L
J
Well,
you
can
certainly
do
it
in
that
order.
It's
best
to
initially
do
the
biomarker
testing
to
find
out.
If
a
patient
has
a
targetable
mutation,
it's
better
to
wait
those
two
to
three
weeks.
Sometimes
it
takes
a
little
bit
longer
than
that,
but
you
certainly
don't
want
to
wait
much
longer
than
that.
The
problem
is:
if
you
jump
right
into
radiation
therapy
and
chemotherapy,
you
can
upset
the
immune
balance
of
the
body
and
the
drugs
can
be
less
effective.
M
Thank
you,
Mr
chairman
I
was
just
wondering
if
this
Bill
say
you
do
a
routine
work
up
like
so
many
of
us
should
and
you're
asymptomatic,
you're
you're,
showing
no
signs
of
a
mass
on
Imaging
nor
hyperplasia
whatsoever.
Will
this
bill
still
cover
routine
periodic
biomarker
testing
just
in
lieu
of
being
healthy
and
staying
on
top
of
the.
J
A
If
I
could
just
add,
this
bill
also
covers
pharmacogenetic
testing,
which
is
a
less
expensive
way
of
determining
whether
or
not
a
patient
will
respond,
a
certain
way
to
a
medication
or
respond
positively,
and
so
this
can
be
used
in
other
cases,
with
psychiatric
meds,
heart
disease.
You
name
it
if
you,
if
you
determine
that
the
patient
responds
well
to
say
a
psychiatric
Med,
we
can
eliminate
the
need
for
again
this
trial
and
error,
this
period
of
instability
in
a
person's
life,
and
you
you
get
the
right
treatment
at
the
right
time.
A
H
Attention
to
this,
thank
you.
Thank
you.
I
just
like
to
state
that
as
pieces
of
legislation
like
this
that
make
me
very
proud
to
be
on
this
committee,
because
it's
life-changing
and
Leah
your
testimony
was
so
powerful.
Thank
you
for
coming
today,
so
at
this
time,
if
you
guys
would
just
stand
up
and
I
want
to
have
Tom
Stevens
come
and
give
him
a
few
moments
to
speak.
Okay,.
J
N
Good
morning
Mr
chair,
sorry,
sorry,
my
name
is
Tom
Stevens
and
I
am
the
President
of
the
Kentucky
Association
of
health
plans.
First
thing,
I'd,
like
to
say,
is
just
take
note.
The
association
is
not
opposed
to
House
Bill
180.
What
the
association
does
want
to
do
is
make
sure
that
their
appropriate
guard
rails
on
the
legislation
so
that
it
isn't
misapplied.
We
certainly
appreciate
the
opportunity
to
be
here
and
express
our
concerns
on
the
bill.
N
We
agree
that
biomarker
testing
is
an
important
tool
and
our
members
cover
many
biomarker
tests,
consistent
with
medical
necessity
and
clinical
guidelines
and
a
conversation
before
this
hearing
started
this
morning,
in
particular
with
just
one
of
our
six
major
members.
They
indicated
that
their
numbers
over
the
last
year
show
a
hundred
thousand
biomarker
tests
that
were
done
just
in
Kentucky.
N
N
N
We
asked
the
committee
to
pause
consideration
of
the
bill
today
to
allow
time
for
this
important
information
about
testing
costs,
in
particular
the
fiscal
notes,
assessing
the
program
costs
to
the
Kentucky
employees,
health
plan
and
Medicaid
before
moving
forward
and
with
that
I'm
going
to
turn
this
over
to
my
colleague,
Scott
Brinkman,
who
has
a
few
other
remarks
on
the
proposed
changes?
I'm.
O
O
Go
we'll
note
that
this
is
a
a
mandate
bill
and
also
note
that
the
proponents
talked
about
the
efficacy
of
the
testing
in
in
the
context
of
cancer.
So
what
we
propose
is
to
add
some
parameters
to
the
legislation,
specifically
that
the
testing
mandated
pursuant
to
House
Bill
180
be
limited
to
testing
in
furtherance
of
detecting
signs
of
cancer
or
cancer
related
health
condition.
O
We
also
suggest
that
the
medical
and
scientific
evidence
that's
used
to
determine
medical
necessity,
be
narrowed
a
little
bit
to
the
categories.
One
is
consensus
statements
and
one
is
Medicare
local
coverage
determinations.
There
tends
to
be
a
fairly
wide
variance
in
terms
of
the
evidence
that
is
derived
from
those
two
categories,
so
we
suggest
that
we
limit
to
the
FDA
approved
categories
that
are
set
forth
in
section
two
of
the
bill
and
also
relative
to
FDA
approved
or
cleared
tests.
O
That
there'd
be
a
demonstration
that
it
that
those
tests
do
materially
improve
health
outcomes.
Finally,
we
propose
that
the
effective
date
of
the
legislation
be
moved
from
January
1
2024
to
January
1
2025,
simply
because
it
is
a
mandate
and
that
would
allow
both
the
plans
and
the
providers
to
configure
their
systems
to
accommodate
the
legislation.
To,
hopefully,
you
know,
cut
down,
hopefully
eliminate
any
abrasion.
O
If
you
will
or
confusion
if
this
bill
becomes
becomes
law
and
again
to
allow
both
both
the
plans
and
the
providers
to
configure
their
systems
to
accommodate
the
the
Mandate,
that's
embodied
in
House,
Bill
180.
So
again,
I
want
to
really
very
carefully
and
strongly
we're
not
opposed
to
the
bill,
but
because
it
is
a
mandate,
we
think
the
best
policy
is
that
anytime,
there
be
a
mandate
that
it'd
be
very
narrowly
tailored
to
the
the
result.
O
That
is
salt,
and,
in
this
case
clearly
of
the
testimony
by
the
proponents
is
that
this
is
a
test
that
is
very,
very
effective
in
terms
of
possibly
detecting
signs
of
cancer.
So
we
think
that
it
would
be
appropriate
that
it'd
be
limited
to
to.
You
know
attempts
to
determine
if
there's
evidence
or
signs
of
cancer
or
cancer
related
conditions,
plus
the
other
suggested
parameters
that
just
outlined.