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A
A
A
I'm
here
we
have
a
quorum
established
to
do
business
and
we
will
just
go
ahead
and
get
started
on
the
agenda.
First,
we
have
representative
brandon
reed
with
some
guests,
I
believe,
to
describe
house
bill
316
to
us
regarding
diffuse,
intrinsic
pontine,
glioma
awareness,
and
I
welcome
you.
Please
introduce
yourselves
for
the
record
and
proceed.
H
I
I
G
Thank
you
for
the
bill
and
thank
you
for
your
testimony
and
I
am
completely
supportive
of
having
a
day
you
know
designated
for
this
and
to
raise
awareness.
My
only
question
to
you,
representative
reed.
This
looks
like
it
requires
the
governor
to
proclaim
this
day
and
I'm
not
an
attorney,
but
I
just
wonder
if
that
raises
a
separation
of
powers
issue
and
if
you
would
be
open
to
removing
or
is
the
precedent
for
legislation
that
requires
the
governor
to
declare
a
day.
H
Now
a
lot
of
the
proclamations
that
we
do
in
the
general
assembly,
and
especially
in
this
instance
in
this
case
we're
we
want
the
executive
branch
to
make
sure
this
proclamation
is
done
so
that
it.
That
is
a
requirement.
G
Follow-Up,
so
are
there
other
other
bills
that
actually
require
the
executive
branch
in
this
way.
A
Okay,
see
no
further
questions.
I
just
want
to
say
thank
you
for
bringing
this
and
thank
you
for
your
testimony,
and
I
agree
that
any
awareness
is
is
a
good
thing
when
we
are
looking
to
find
other
ways
of
research
and
whether
it's
through
funding,
I
I
just
applaud
you.
Thank
you
secretary.
Please
take
the
role.
D
A
A
Next,
we
will
hear
two
bills
by
representative,
bentley
or
ben
representative.
Bentley
is
the
sponsor.
First,
we
will
start
with
house
bill
349.
F
B
A
G
A
Sub
second,
we
have
a
motion
in
a
second
all
in
favor
of
approving
this
sub
adopting
the
sub
any
opposed
all
right.
Thank
you.
Please
proceed
on
the
committee
sub.
F
Thank
you,
madam
chair
lady.
This
summer,
in
the
interim,
we
had
a
task
force
on
severe
mental
illness
and
during
that
task
force
we
found
many
shortcomings
of
our
state
with
people
with
severe
mental
illness.
F
F
In
the
last
sentence
of
the
fourth
says,
the
lack
of
regional
service
providers
has
created
additional
issues
with
continuity
of
care
for
cmhcs,
because
any
provider
can
enter
a
cnc's
region
and
provide
services
that
was
written
in
our
report.
So
our
support
bill
is
hb,
349,
cmhc,
regional
legislative
law,
the
community
mental
health
centers.
As
we
call
the
cmchcs
were
established
by
the
federal
community
mental
health
act,
which
was
the
last
piece
of
legislation
signed
by
john
kennedy.
F
F
The
cmhcs
as
a
behavioral
health,
public
safety
net
are
required
to
respond
to
community
needs,
including
involuntary
psychiatric
hospitalizations
and
for
y'all
202
a
is
where
a
person
has
like
dr
wilner.
There
can
put
a
person
in
an
institute
you're
a
202,
a
yes,
where
I'm
not
as
a
pharmd,
but
these
are
involuntary
emissions,
so
the
crisis
response
to
community
partners
and
the
community
during
our
natural
disasters,
such
as
the
tornadoes
in
western
kentucky,
were
provided
by
these
cmhcs
in
december
21..
F
F
It
should
be
noted
that
krs
210
does
not
list
the
regions
and
the
counties
within
each
region.
However,
the
contracts
issued
to
each
cmhc
from
the
department
of
behavioral
health
and
that's
interesting
because
see
this-
we
had
this
in
that
committee,
the
other
day,
which
is
the
department
overview
services
by
the
behavioral,
and
it
shows
regions
in
our
community
meeting.
Everybody
remember
that
so
they're
still
by
regions
also
the
medicaid
manual
clearly
states
a
community.
F
F
Three
hb
349
hcs
provides
the
secretary
of
the
cabinet
for
health
and
family
services.
A
mechanism
to
ensure
services
are
provided
in
a
region
if
the
community
mental
health
center
in
that
region
has
notified
the
secretary
in
writing
that
they
are
unable
to
provide
the
services.
The
secretary
shall
solicit
interest
from
from
the
other
cmhcs
to
provide
the
service.
F
This
bill
does
not
prohibit
a
cmhc
from
providing
services
and
supports
in
counties
outside
its
designated
region.
I
always
cmhc
would
have
to
do
is
to
become
licensed
as
a
behavioral
health
service
organization.
In
order
to
do
in
order
to
do
so,
vhsos
are
similar
to
cmhcs,
but
do
not
have
a
designated
service
area
within
the
state.
F
F
C
A
Motion
and
a
second
on
the
bill,
I
know
that
we
have
someone
else
here
to
speak
on
the
bill.
I
will
allow
him
a
few
minutes
to
come
up
to
the
table
and
state
his
points
and
then,
if
we
have
any
questions,
we
can
take
questions
yes
come
on
up
to
the
table.
E
My
name
is
bart
baldwin
and
I
am
director
of
the
kentucky
health
resources,
alliance
and
lobby
on
their
behalf,
and
I
represent
the
two
of
the
cmhcs
in
the
state,
adonta
and
mountain,
and
we
have
concerns
with
a
part
of
this
bill
that
prohibits
cmhcs
from
requires
them
to
become
a
bhso
to
provide
services
outside
of
their
region,
and
I
just
have
a
few
comments
and
I'll
be
as
brief
as
possible.
E
Just
from
a
patient
perspective.
I
think
that
we
need
to
understand
that
when
a
family
or
folks
are
looking,
for,
you
know,
services
for
a
teenage
daughter,
that's
struggling
with
depression
from
being
isolated
in
the
pandemic
or
an
uncle
who
needs
opioid
addiction,
treatment
or
you
know
any
other
number
of
mental
health
services
they're
not
really
concerned.
If
it's
xcmhc
or
ycmhc
or
a
bhso
or
a
multi-specialty
group,
you
know
they
need
services
and
likely
are
need
them
immediately.
E
E
E
Their
funding
shifted
primarily
to
building
medicaid,
managed
care,
90-plus
percent
in
a
sin,
and
that
essentially
eroded
those
regions
and
limit
to
to
provide
within
a
region
at
that
time,
in
2014
kentucky
expanded
our
ability
for
licensed
medicaid
providers
to
individual
practitioners.
We
created
multi-specialty
groups,
we
created
provider
groups,
we
created
behavioral
health
service
organizations
as
a
separate
licensure
category,
all
with
the
intent
of
improving
access
to
services.
E
Because
we
we
had
at
the
time
essential
health
benefits
were
part
of
the
affordable
care
act,
and
we
were
expecting
that
we
would
have
six
hundred
thousand
plus
new
kentuckians
that
would
have
either
medicaid
expanded
expansion
or
a
plan
on
exchange
that
would
pay
for
these
services,
and
we
expected.
We
would
have
that
many
kentuckians
that
also
that
needed
to
access
this,
so
we
needed
to
increase
our
capacity
to
deliver
mental
health
services
in
2016.
E
Identifying
the
ra.
The
regions
is
not
a
problem
limiting
and
creating
forcing
an
entity.
That's
that
already
has
the
ability
and
the
license
to
provide
all
these
services
to
create
a
duplicative,
licensure
category
and
set
up
separate
billing
systems.
We
already
have
six
mcos,
you
know
they
did
bill
off
a
separate
fee
schedule.
E
E
E
We
have
we've
had
others
that
have
operated
what
outside
of
the
region
before
we
have
cmhcs
that
operate
in
multiple
states,
we
have
cmhcs
that
have
merged,
all
of
which
is
great.
We
have
no
problem
with
that.
In
terms
of
you
know
we're
operating
in
a
managed
care
environment,
and
you
all
I
mean
this
committee,
I
don't
have
to
explain
what
that
is.
Certainly
you
know
of
of
things
to
do
so
that
the
cmhcs
can
thrive.
E
You
know
survive
and
thrive,
because
when
they
do,
they
can
do
a
better
job
and
provide
more
services
to
those
who
need
it.
So
our
opinion
is
that
it,
you
know
it
by
requiring
this
additional
step,
is
just
a
barrier
to
services
and
puts
up
a
you
know,
a
regional,
an
arbitrary
region.
If
I,
if
I
live
here,
and
I
go
two
miles
down
the
road
I've
crossed
over
into
a
new
region,
I
just
need
services
that
that's
not
relevant
to
me,
who
it
is.
I
just
need
access
to
those
services.
E
You
know
there
are
other
threats
to
the
safety
net.
This
is
not
an
anti-cmhc
comment.
I
mean
I
represent
those
also
work
with
with
other
provider
types.
E
E
You
know
not
this,
you
know
at
a
time
when
we
have
the
mental
health
needs
of
our
citizens
has
never
been
higher.
Our
overdose
deaths
are
back,
you
know
with
a
vengeance
and
higher
numbers.
We
need
to
be
talking
about
how
we
can
work
together
to
expand
access
to
services,
not
create
additional
barriers
and
hoops,
and
I'm
not
even
I
have
not
seen
the
the
committee
sub
my
little
understanding
of
it
is.
E
E
Well,
you
can't
you
can't
do
services
anymore,
because
you're
in
this
region,
you
know,
I
just
think
it
creates
additional
barriers,
and
you
know
it's
unfortunate
that
we
have
to
do
this
and
have
this
discussion,
and
I
really
wish
it
wasn't
before
the
committee
frankly,
but
that's
just
my
own
opinion.
So
that's
all
my
comments.
Thank
you,
madam
chair.
A
Thank
you.
I
appreciate
your
comments,
mr
baldwin,
and
because
of
your
you're,
bringing
your
issues
to
me
it
it
was
on
the
agenda.
Last
week
we
took
an
additional
week
to
really
answer
those
questions
really
kind
of
talk
through
those,
and
my
solution
to
this
is
to
I
mean
a
community.
Mental
health
center
can
still
become
licensed
as
a
bhso
if
they
want
to,
but
the
committee
sub
would
allow
them
to
contract
with
another
cm
cmhc
outside
of
their
region.
A
If
there
is
an
unmet
need-
and
that
was
my
concern
you
know-
are
there
unmet
needs?
Is
this
why
cmhcs
are
going
outside
their
region
to
provide
services?
So
I
think,
in
answer
to
that,
we've
created
a
you
know
we
put
in
a
provision
that
allows
a
cmhc
to
contract
with
another
community
mental
health
center
to
provide
services.
A
A
So
I
mean,
I
think,
that
we
have
created
something
that
is
fair.
It
addresses
the
the
issue
of
access
to
care
and
ensuring
that
so
and
it
also,
as
representative
bentley
pointed
out,
it
allows
any
cmhc
who
is
already
providing
a
service
somewhere
to
outside
of
their
region
to
either
partner
with.
G
E
A
I
understand
I
mean,
but,
as
we
know,
these
regional
centers
are
set
up
to
ensure
a
safety
net.
Yes
for
individuals
who
might
not
have
access
to
other
behavioral
health
services,
and
we
we
do
need
to
make
sure
that
patients
have
that
safety
net.
E
H
A
Set
up
in
1964.
it's
a
federal
provision.
I
mean
we're
we're
kind
of
working
within
the
confines
of
that
and
just
trying
to
make
sure
that
patients
get
the
care
that
they
need.
Do
we
have
any
questions
representative,
westrom.
E
This
particular
issue
has
been
discussed
a
number
of
times
over
the
years
and
felt
like
it
had
been
resolved
way
back
in
2016.
Frankly,
there's
been
a
bill
in
previous
legislative
sessions
that
did
not
get
a
hearing
before
the
committee.
E
E
They
may
choose
to
not
do
that,
which
obviously
is
the
intention,
but
because
it
wouldn't
be
financially
feasible
to
become
a
bhso
to
operate
outside
of
their
region,
because
the
fees
the
rates
are
lower
in
general
than
the
cmhc
rates.
They
operate
off
a
different
fee
schedule,
and
so
the
question
is
that
those
folks
that
they're
serving
what
happens
to
them
do
they?
So
obviously
it
would
be
a
disruption
in
services.
E
Would
they
you
know
meet
get
services
immediately,
or
would
they
just
have
to
change
providers?
So
I
don't
know
in
terms
of
what
would
happen
there.
I
don't
think
it
puts
anybody
out
of
business.
I
appreciate
the
question,
but
I
think
it
just
would
change
where
they're
providing
services
just
one
more
question,
would.
E
Well,
like
I
said
the
see
when
we
expanded
in
2014
to
create
additional
licensure
categories
and
different
provider
types
that
could
build
medicaid
because,
prior
to
2014,
we
had
a
very
closed
system
only
cmhcs
and
psychiatrists,
I
believe,
were
the
only
ones
that
could
build
c
medicaid.
We
added
a
licensed
marriage,
family
therapists,
licensed
clinical
social
workers
created
groups
in
order
to
increase
access,
so
those
services
that
they
provide
outpatient
therapy
input.
You
know
individual
therapy
group
therapy
are
the
same
services
that
a
cmac
provides.
So
there's,
not
a
distinction.
I
mean
I.
E
I
will
say
that
the
cmhcs
in
that
safety
net
role
do
have
a
greater
focus
for
those
with
severe
mental
illness
and
that's
important
and
not
trying
to
do
anything
to
limit
that.
But
many
of
the
services
are
the
same
regardless
of
the
licensure
type.
F
E
J
J
Steve
shan
I'm
with
carp-
and
you
know
we're
we're
the
group
they're
all
right
here
who
have
real
concerns
about
this.
I
think
the
access
question
is
great,
get
licensed
as
a
bhso.
You
can
do
that.
I
don't
think
it's
very
hard.
There's
a
lot
of
small
providers
who
have
done
that
the
license
initial
fee
is
750,
500,
thereafter
annually,
250
per
site.
J
So
the
access
question
and
that's
why
we've
given
12
months
after
the
effective
date,
so
they
have
15
months
to
make
a
decision
to
pursue
it
as
a
bhso
and
I'm
the
champion
of
the
regional
model
and
I'll
own
that
we
are
a
regional
model.
You
live
in
lexington,
new
vista
has
accountability
in
their
17
counties
that
other
providers
do
not
have.
J
They
have
to
do
things.
Those
voluntary
commitments,
the
western
kentucky
centers
responded
to
the
tornado
they've
been
on
calls
we're
different
than
other
providers,
and
what
this
bill
intends
to
do
is
protect
that
uniqueness
versus
other
behavioral
health
providers,
because
we
do
things
in
communities
that
other
providers
may
do,
but
don't
have
to
do.
J
I
got
an
email,
a
text
message
on
the
tornado
sit
in
december.
Are
you
all
ready
to
respond?
I
sent
it
out.
The
general
response
from
the
ceos
two
of
which
are
here
today
is
we're
already
there
that's
what
we
do
pathways
in
2012
we're
already
there
that's
the
piece
we
have
to
protect
representative
westrom.
J
We
have
to
make
sure
those
services
are
available
in
times
of
crisis
when
people
need
it,
whether
it's
a
suicide
at
a
school.
I
contend.
There's
one
mental
health
center
in
america,
who's
responded
to
two
school
shootings,
one
they
went
when
that
happened.
Four
rivers,
I
think
their
ceos
online
listening.
They
went
to
both
heath
and
marshall
county.
J
That's
what
we
do
and
that's
what
this
bill
protects.
It
protects
that
ability
to
go.
Representative
wilner's
example
is
a
public
school.
You
can't
go
outside
of
lexington
if
you're
fayette,
county
public
schools
and
open
a
school
in
jasmine
county
unless
it's
a
private
school
or
something
else,
a
different
license
right.
We're
saying
do
what
you
want.
This
license
is
a
regional
license.
J
J
Yes,
the
staffing
requirements
are
different
and
they
get
cost-based
reimbursement
for
medicaid.
The
fee
schedule
is
higher
1999..
I
agree
with
bart.
We
need
to
look
at
that.
The
mcos
don't
pay
it
that's.
The
difference
rates
are
higher
as
a
cmhc,
because
historically
dollars
were
driven
through
medicaid
to
support
those
crisis
services
as
well,
and
not
increase
state
general
fund.
C
Thank
you,
madam
chair,
and
you
actually
asked
my
question
with
that
last
one,
but
this
has
been
a
good
discussion.
A
good
debate
on
this
bill
and
where
I
kind
of
find
myself
coming
down,
is
I'm
a
fan
of
the
regional
model.
I
think
that
ensures
the
safety
nets
for
everyone,
I'm
a
pharmacy
provider
myself.
C
If
I
fill
eight
prescriptions,
five
to
six
of
them,
I
might
break
even
or
lose
money.
I
live
off
those
two
or
three
where
you
can
make
money
and
I
think
that's.
The
problem
is
when
you
go
from
one
region
to
another
and
you're
looking
for
maybe
those
high
reimbursement
items,
that's
smart,
business-wise!
I
don't
blame
you
for
doing
that.
C
I
don't
blame
anyone
for
doing
that,
but
at
the
same
time
it's
taken
away
from
that
that
regional
facility
that
regional
cmhc
that's
already
there
in
place
and
it
it
it
does
not
allow
them
to
provide
the
services
they
need
for
the
citizens
in
that
region
and
that's
a
big
concern
of
mine.
So
thank
you
very
much,
madam
chair.
I
I
I
just
want
to
ask:
do
you?
Do
you
believe
in
the
like
the
family
tree,
I
mean
the
regions
are
on
the
map
that
representative
bentley
showed.
What's
the
point
of
having
those
if
you're
not
going
to
function
under
them,
it's
almost
like
kids
are
coming
against
the
parents
to
ask
for
independence
or
something.
A
All
right,
thank
you.
One
last
question:
is
there
any
concern
about
the
patients
who
might
be
displaced
by
any
of
these
centers
who
are
operating
outside
of
their
regions
now
and
need
to
be
absorbed
by
existing
community
mental
health?
Centers.
A
J
And
that's
why
we
built
in
the
12
months,
so
there's
ample
time
to
transition.
No
one's
going
to
be
left
without
services.
The
cmhcs
will
know
this
is
going
to
take
place.
They
will
gear
up
and
be
prepared
to
meet.
Those
needs,
ideally
there'll,
be
an
interface
between
the
two
conversations
about
what
it
looks
like.
Some
of
these
folks
are
school-based
services,
we're
seeing
the
family
anyway
we're
seeing
the
kids
in
summers
perhaps
or
some
other
services,
so
we'll
figure
all
that
out
and
that's
why
we
went
with
the
additional
12
months.
A
Right
well,
thank
you.
I
do
think
that
the
committee
sub
really
helps
accomplish
that
piece
and
and
really
creates
an
assurance
for
those
patients.
So,
yes,
representative,
bentley.
F
Lady
chairman,
I
have
one
comment
of
the
14.
The
12
of
them
are
in
support
of
this
and
if
they
stand
up
I'll
show
you
who's
here
today.
F
These
people
are
in
support
of
this
bill.
Most
of
them
are
ceos.
Two
you
all
can
sit
down
now,
two
be
being
a
pharmacist
for
a
chain
for
a
hospital
and
anywhere
else.
When
another
license
came
along,
whether
it
be
clear,
does
everybody
understand
what
clea
is
clinical
laboratory?
I
could
do
cholesterol.
F
F
A
D
I'm
certainly
in
support
of
sticking
with
this
regional
model
and
and
look
forward
to
seeing
this
through,
but
you
mentioned
the
pension
and
some
of
the
folks
that
would
be
in
how
would
this?
Because
it
seems
if
you
had
both
licenses,
your
staff
would
still
be
eligible
for
the
state
pension
houses
how's.
This
whole
thing
going
to
affect
that.
J
It's
a
good
question.
The
the
regulation
of
bhso
allows
you
have
an
executive
director
program,
director
could
be
the
same
person
and
they
can
be
employed
or
contract
employees,
so
they
can
have
a
relationship,
get
a
bhs
license,
go
out
of
region
and
have
a
contractual
relationship
with
the
cmhc,
because
this
clearly
permitting
regulation
they
can
contract
employees
and
then
they
can
participate
in
krs.
D
So
I
guess
what
I'm
asking
is:
if
they
have
a
dual
license,
do
they
not
qualify,
maybe
other
than
the
other,
the
other
license
to
to
stay
in
the
pension
system
or
does
phsos
have
to
use
contract,
labor
bhso's.
D
J
D
A
A
G
E
D
G
A
Okay
house
bill
349,
as
amended
by
the
committee
sub,
passes
with
favorable
expression.
The
same
should
pass
on
the
house.
Thank
you
and
then
representative
raymond.
Would
you
like
to
register
a
vote?
We
can't
do
it
concurrently.
So
if
you'd
like
to
register
a
vote
on
316,
yes,
please
count
me
as
a
yes
thank
you
so
much
and
then
representative
sharp
did
you
have
a?
Would
you
like
to
register
a
vote
on
house
bill
316.
F
I
believe
I
did
316.
it's
349
as
a
yes.
A
Oh
349.,
my
my
bad.
Thank
you!
Okay!
Okay,
thank
you!
So
much
representative
wow,
I
just
combined
a
lot
of
words.
Representative
bentley.
You
have
another
bill
to
present
house
bill
364..
A
Okay,
thank
you
we're
having
a
hard
time
hearing
you
as
you
turn
away,
but
those.
F
F
I
felt
that
real
kentucky
should
be
supported,
so
we
wrote
the
bill
that
if
you
had
fifty
five
thousand
or
less
people
in
your
county
that
you
could
come
to
the
cabinet
for
economic
development,
if
you
needed
money
for
your
people,
for
your
structure
or
through
our
new
medical
techniques,
a
new
mri
came
out.
So
it
took
me
probably
about
18
months
to
get
20
million
dollars
put
into
that
fund,
and
I
think
all
of
you
can
relate
to
that.
F
F
F
My
vote:
okay
and
bellefonte
right
now,
where
our
plan
is
to
make
it
half
psychiatric
hospital
with
a
detox
center
which
eastern
kentucky
needs
and
rehab
residents
gosh.
We
need
it.
So
that's
the
reason
I
had
to
repurpose
the
bills
because
they're
repurposing
the
hospital.
So
that's
all
I
have
related
chair.
Ladies
thank.
A
C
Yes
and
matt
comment
on
the
bill.
I
want
to
thank
representative
bentley
for
his
work,
as
he
mentioned
the
the
previous
version
of
this
bill.
Pineville
hospital.
They
got
a
million
dollar
loan
from
so
it's
at
one
percent.
So
it's
it's!
It's
a
bill,
that's
needed
and
has
been
put
to
use
in
my
community.
So
I
thank
you,
representative
bentley
and
I'm
yes,.
F
Yes
with
comment:
yes,
please,
first
off
representative
bentley,
I
want
to
thank
you
for
bringing
this.
I
know
you
have
put
a
lot
of
hard
work
into
this
and
it
needs
to
be
duly
recognized,
and
I
know
that
our
our
community
in
eastern
kentucky
is
really
going
to
benefit
from
this
and
appreciate
what
you've
done.
D
G
G
A
Yes-
and
I
just
I'd
like
to
echo
my
colleagues
comments,
thank
you
very
much
for
this
work
for
this
bill.
I
especially
like
the
piece
that
creates
an
incentive
for
hiring
individuals
in
in
these
regions.
So
I
appreciate
the
effort
and
the
bill
and
it
passes
with
favorable
expression.
A
Okay,
all
right
house
bill
364
passes
with
favorable
expression.
The
same
should
pass
on
the
house.
Thank
you
so
much.
I
believe
that
is
all
the
business
we
have
and
we
are
adjourned.