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From YouTube: Emergency Medical Services Task Force (9-20-22)
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A
I'm
anywhere
at
the
submitting
a
number-
and
we
got
a
pretty
full
agenda
with
a
lot
of
good
information,
I'm
anticipating
that
will
come
forth
and
give
us
a
whole
lot
more
understanding
and
perspective
on
how
we
can
address
the
other
EMS
issues
that
we
discovered
this
past.
This
past
spring
I'd
like
to
go
ahead
and
call
the
roll
sir.
C
D
E
A
Very
good,
thank
you
very
much.
Our
first
person
is
on
the
agenda.
Is
the
talk
about
the
EMS
mental
health
is
Dr
Shuster,
Dr,
Schuster
I
think
you
are
online,
yes,
I
am.
Can
you.
F
A
Me
there
you
are
you,
we
see
you
bright
and
clearly
it's
good
to
have
you
and
the
floor.
Is
yours
go
ahead
and
Dish
yourself?
If
you
don't
mind,
we
all
know
who
you
are
but
go
ahead.
Introduce
yourself.
Thank
you.
Thank.
F
You
so
much
good
afternoon:
I'm
Dr,
Sheila,
Schuster
I'm,
a
licensed
psychologist
and
the
executive
director
of
the
Kentucky
mental
health
Coalition
I
also
serve
as
chair
of
the
behavioral
health
technical
advisory
committee,
which
is
part
of
the
Medicaid
advisory
Council.
I
want
to
thank
representative
Fleming
and
Senator
Gibbons
and
co-chairs,
and
members
of
the
committee
for
asking
me
to
testify
here
are
the
issues
that
we've
had
with
transportation
problems
for
kentuckians
with
behavioral
health
issues,
and
those
would
include
both
mental
health
and
substance
use
disorder.
F
F
These
patients
have
been
evaluated
by
a
mental
health
professional
and
found
to
be
in
need
of
an
on
an
emergency
basis
of
Mental
Health
Services.
The
patients
are
willing
to
go
voluntarily
to
a
facility
which
offers
Psychiatric
Services,
but
are
in
need
of
ambulance
Transportation,
which
is
being
refused
for
a
variety
of
reasons.
F
There
are
problems
with
that
situation
as
well,
which
were
discussed
during
the
2021
interim
session
and
resulted
in
passage
of
House,
Bill
730,
co-sponsored
by
Representatives,
Bray
and
Hebron.
The
patients
that
I'm
describing,
who
are
being
refused
transportation
from
one
facility
to
another
or
from
a
medical
office
to
a
facility
are
patients
who
are
voluntarily
seeking
mental
health
treatment.
F
The
behavioral
health
Tech
made
a
recommendation
to
the
Kentucky
Department
for
Medicaid
services
through
the
Medicaid
advisory
Council
that
the
situation
be
investigated
for
possible
violations
of
parity.
That's
the
federal
and
state
law
that
requires
coverage
for
Behavioral
Health
to
be
a
an
equal
basis
with
that
for
physical
health.
F
Ambulance
drivers
stated
we
don't
have
to
deal
with
mental
health
patients.
They
said
also,
we
don't
get
Medicaid
reimbursement
for
the
transport
or
they
do
not
consider
these
patients
to
be
quote
safe
to
transport.
Unquote.
The
result
is
that
patients
who
are
examined
and
found
to
be
in
need
we're
not
getting
the
transportation
that
they
needed.
Unfortunately,
ongoing
requests
to
DMS
department
for
Medicaid
services
during
the
rest
of
that
year
to
investigate
and
intervene,
we're
never
satisfactorily
answered
nor
action
taken.
F
We
continue
to
monitor
the
situation
at
our
behavioral
health
health
tax
meetings
and
found
that
it
was
also
happening
when
individuals
were
at
a
provider's
office
and
needed
transportation
to
the
psychiatric
hospital.
Again,
the
refusals
were
often
voiced
in
comments
like
we
don't
have
to
carry
those
crazy
people.
F
We
then
began
to
dialogue
with
the
Kentucky
Hospital
Association
when
we
learned
that
they
were
experiencing
problems
with
EMS
transport
and
subsequently
worked
with
them
to
achieve
passage
of
House
Bill
777
in
the
2022
session,
thanks
to
the
primary
sponsor
representative
plumbing
and
for
the
work
that
Senator
Gibbons
did
to
get
that
bill
passed,
we're
grateful
for
the
passage
of
the
law
and
we
hope
to
see
positive
effects.
F
We've
identified
several
other
avenues
of
Intervention,
which
may
be
help
helpful
to
address
the
problem.
First,
we
wonder
if
there
is
possibly
a
lack
of
knowledge
on
the
part
of
ambulance
or
EMS
Personnel
about
how
to
appropriately
respond
to
and
transport
individuals
with
the
behavioral
health
condition.
F
F
I
would
point
out
to
you
that
this
is
analogous
to
what
we
call
the
crisis,
intervention,
team
or
CIT
training.
That
first
was
offered
in
Kentucky
approximately
20
years
ago
to
police
about
how
to
deal
with
9-1-1
calls
involving
an
individual
with
significant
behavioral
health
issues.
That
training
has
gone
Statewide
and
also
includes
training
for
our
state
police.
Another
possible
Avenue
is
around
stigma.
Stigma
around
behavioral
health
issues
could
also
be
a
possible
barrier
to
the
transportation
of
individuals
with
a
behavioral
health
condition.
F
One
last
possible
solution
to
this
barrier
to
access
Services
may
be
found
in
the
regulation.
907
Kar
one
colon
060,
which
has
to
do
with
ambulance
transportation,
section
4
addresses
non-emergency
ambulance
services,
section
Prem,
1
of
that
says
the
non-emergency
Ambulance
Service
to
a
provider
within
the
medical
service
area
shall
be
covered.
If-
and
this
is
the
important
part
for
n
a
the
recipient's
medical
condition-
warrants
does
not
warrant
I'm
sorry
will
be
covered
if
the
recipient's
medical
condition
warrants
transport
by
stretcher.
F
So
I
guess
my
question.
There
is
whether
the
reg
is
giving
some
information
to
ambulance
or
EMS
that
behavioral
health
patients
should
not
be
transported
because,
typically
they
don't
require
transport
by
stretcher.
F
F
Thank
you
very
much
for
the
opportunity
to
give
input
from
the
Behavioral
Health
Community
to
the
EMS
task
force.
We
appreciate
you're
looking
at
these
issues
involving
Behavioral,
Health
and
I'm,
open
to
any
questions.
The
task
force
members
may
have
and
I'm
happy
to
support
your
efforts
in
any
way
that
I
can.
A
Thank
you,
Dr
Schuster
appreciate,
as
always,
your
your
insights
and
perception
on
mental
health
issues.
I
know
you've
been
a
champion
in
this
particular
this
particular
area
and
I
understand
of
what
you're
telling
me
so,
basically,
lack
of
knowledge,
stigma
and
but
potential
regulation
change
that
could
be
in
misinterpreted
right
or
wrong
in
terms
of
that
regulation
and
so
forth.
A
Just
my
observation,
the
first
two
items
you
know
it's
a
non:
it's
an
ongoing
challenge
that
we
have
in
terms
of
moving
the
needle
with
that
and
I
and
I
think
this
task
force,
we'll
we'll,
definitely
look
at
and
see
how
we
can
further
erode
that
beer
or
that
perception
or
taboo
in
terms
of
individuals
that
have
this
type
of
issue
and
so
forth.
I
want
to
ask
you
a
question
and
I
appreciate
going
over
in
general.
A
What's
what
you're
all
looking
at
and
I
know,
collecting
information
is
a
bit
it's
a
bit
of
a
challenge
that
I've
heard
throughout
the
spring
and
and
through
this
task
force.
But
do
you
have
any
indication
all
the
number
of
refused
refusals
or
runs
are
or
give
us
any
type
of
idea
in
terms
of
the
volume
I?
A
F
I
I
wish
I
could
give
you
a
definitive
answer.
I
I
will
say
this
that
we
continue
to
ask
about
this
issue.
Our
Behavioral
Health
technical
advisory
committee
meets
every
two
months
and
you
know
probably
every
other
meeting
I
will,
as
that's
a
limited
number
of
people,
that
you
know
attend
the
behavioral
health
tax
meetings.
F
When
I
ask
specific
people
that
have
reported
in
the
past,
they
will
generally
say
yeah,
we
don't
you
know
it
still
happens
once
there's
too
many
is
an
answer
that
I
get,
which
you
can
appreciate
when
the
hospital
that
doesn't
have
a
psych
service
has
someone
who
voluntarily
is
coming
and
wants
to
get.
F
Services
has
been
evaluated
by
the
local
Community
Mental
Health
Center
is
found
to
be
in
need
of
those
services,
and
then
they
don't
have
a
way
to
get
them
to
the
facility,
and
during
that
wait
the
the
person
May
either
deteriorate
or
become
agitated
or
or
whatever,
but
I'm
I'm.
Afraid
I
have
only
those
anecdotal
stories.
I
don't
have
any
statistics
for
you.
A
Okay,
thank
you,
representative,
Hart.
C
You
might
not
have
this
data,
but
you
when
you
or
compare
compiling
some
of
your
data
on
the
refusals
and
and
do
you
have
a
breakdown
of
of
the
refusals
that
you've
gotten
that
on
as
a
in
a
relationship
to
a
private
service
versus
a
service,
that's
contracted
to
provide
emergency
medical
care
for
a
particular
jurisdiction.
Do
you
have
any
breakdown
on
the
differentiation
between
the
two.
F
I
I
wish
I
did
that's
a
great
question,
representative
Hart,
and
you
know
by
the
time
the
information
gets
to
me.
It's
passed
through,
and
people
are
just
quite
frankly,
so
upset
that
the
the
ambulance
and
again
I
I
understand
your
question
is
you
know,
is
that
a
private
provider
is
that
you
know
from
the
counties
that
from
the
local
jurisdiction
and
I
simply
don't
have
that
information.
If
that's
important,
I
could
certainly
go
back
and
I
should
have
said
this.
F
Also
to
representative
Fleming
I
will
certainly
send
out
an
email
and
ask
people
for
you
know,
let's
say
in
the
last
month,
just
to
give
you
all
some
sense
and
I
would
certainly
ask
that
question.
If
the
question
is,
you
know
what
type
of
Provider
what
type
of
ambulance
provider
was
refusing
to
transport
with?
That
answer
is
that
the
question.
C
That
would
definitely
help
I
mean
what
I'm
going
for
is,
and
it's
not
necessarily
private
versus
government
ambulance
services,
because
there
are
some
private
Services
out
there
that
are
contracted
with
the
local
municipality
to
provide
emergency
care
for
that
jurisdiction.
But
so
my
experience
working
in
the
rural
sector
years
ago,
a
lot
of
times
some
of
these
refusals
are
based
on.
They
have
one
ambulance
for
one
County
and
if
it's
not
an
emergent
medical
need,
then
the
no
refuse
so
that
they
can
keep
the
ambulance
in
the
county
to
provide
the
emergency
medical
care.
C
So
it's
not
as
much
a
private
versus
government,
it's
more
of
somebody
providing
EMS
care
for
like
a
county
or
a
City
versus
a
private
ambulance
services.
That's
mainly
transport,
but
yeah.
If
you
could
get
us
some
data,
I
think
it
would
just
be
give
us
a
good
perspective
on
where
some
a
lot
of
the
refusals
are
coming
from
in
some
aspects.
F
Yeah
I
understand
now
what
you're
saying,
particularly
with
and
I
know
in
the
rural
areas.
We
thought
at
first
quite
frankly
that
this
was
a
rural
issue
only
because
that's
happened
to
be
where
I
was
hearing
about
it
from
providers
in
in
rural
areas,
but
as
we
got
into
it
more,
we
were
certainly
hearing
about
it
in
the
in
the
urban
areas
as
well.
F
I
think
and
I
probably
am
overly
sensitive
about
this,
because
I've
worked
in
this
field,
for
you
know,
40
plus
years,
but
to
have
someone
say:
I'm
not
going
to
carry
those
crazy
people
just
well.
That
would
infuriate
all
of
us.
Yeah
I
mean
that's
uncomfortable,
particularly
when
somebody
comes
and
is
voluntarily
recognizing
that
they
have
an
issue
and
that
they
need
that
care
right
away.
So.
C
Yeah
but
I
think
you
know
what
I
appreciate
your
efforts
for.
Is
it
I
think
you
know
where
I'm
going
with
this,
where
I'm
heading
with
this
is
sometimes
the
refusals
are
made,
because
they've
got
to
keep
a
service
in
a
county
for
emergencies,
but
there
are
some
bad
apples
out
there,
so
I'm
sure
that
you've
experienced
them
both.
So
if
you
help.
A
B
Thank
you,
Mr
chairman
Dr,
Schuster
I.
If
I
may,
Mr
chairman
at
two
quick
questions,
go
right
ahead.
Sir.
Thank
you,
sir.
We
we've
designated
two
different
categories.
We've
talked
about
mental
health
patients
and
behavioral
health
patients.
B
The
two
questions
that
I
have
and
I'll
put
those
out
there
quickly
do
we
have
any
any
information
or
data
regarding
the
refusals
for
mental
health
issues
versus
behavioral
health
issues
and
question
number
two
is:
are
we
talking
mostly
about
transports
from
facilities
and
offices
to
other
facilities
versus
private
homes
or
private
facilities
to
a
facility?
F
You
so
much
Senator
Douglas.
Let
me
answer
the
second
question.
First,
all
of
these
were
either
facility
to
facilitate
the
most
common.
F
Is
that
someone
goes
to
their
local
hospital
when
they're
in
crisis
they
appear
in
the
ER,
they
call
in
the
local
Community
Mental
Health
Center
to
do
an
evaluation,
but
that
hospital
does
not
have
a
psychiatric
unit,
and
when
the
person
needs
that
inpatient
care
in
a
psych
unit,
then
they
need
to
be
transported
to
a
facility
that
same
situation
happens,
sometimes
I've
been
told
by
several
providers
whether
they
were
Physicians
or
nurse
practitioners
that
they
have
someone
who
shows
up
in
their
office
in
their
Clinic
who
needs
transport.
None
of
these.
F
F
So
we
use
that
term
Behavioral
Health
to
to
include
both
of
those-
and
you
know,
I
think
the
topic
that
was
actually
on
the
agenda
was
about
Mental
Illness,
but
some
of
these
are
also
folks
who
come
in
with
an
addiction,
maybe
not
in
an
overdose
situation
but
or
asking
for
inpatient
treatment
for
their
addiction.
So
that's
how
we're
using
the
term
Behavioral
Health
there
does
that
answer
your
question,
sir.
A
B
F
Well,
in
in
terms
of
diagnoses
in
terms
of
people
again
who
are
see
who
need
to
be
rebanded
by
the
court
for
involuntary
treatment,
we
would
think
of
perhaps
as
being
more
likely
to
have
to
show
acting
out
behaviors,
and
that
may
be
where
the
the
term
behavioral
conditions
are
coming
in.
But
the
the
diagnoses
of
the
mental
illness
actually
uses
the
term
mental
illness
or
uses
the
term
substance
use
disorders.
F
There
certainly
are
instances
depending
on
the
severity
you
could
have
somebody
with
a
paranoid,
schizophrenic
schizophrenia
who
may
be
acting
out
because
they're
in
the
in
the
throes
of
a
paranoid
delusion
and
could
be
taking
a
very
aggressive
stance
against
everyone
around
them,
because
they're
part
of
that
delusional
part
of
their
illness,
and
they
would
be
certainly
showing
some
acting
out
behaviors.
F
That,
typically,
is
not
what
we're
talking
about
here.
More
likely,
those
people
would
be
under
court
order
for
an
involuntary
commitment,
we're
talking
about
people
that
are
feeling
so
depressed
that
they're
afraid
that
they
may
commit
suicide,
for
instance,
are
feeling
so
anxious
that
they
feel
like
they
need
inpatient
treatment,
but
are
not
typically,
if
they're
a
threat
to
themselves
or
to
others.
They
meet
the
criteria
for
what
we
call
a
KRS,
202a,
involuntary
commitment
and
I.
Think
that's
what
you're,
probably
describing
as
those
with
with
more
of
the
behavioral
manifestations.
G
Thank
you
Mr
chairman
and
thank
you.
Dr
Schuster,
I,
representative
Hart
I,
think
made
some
really
interesting
points
in
his
question.
He's
got
my
my
wheels
spinning,
but
I
just
wanted
to
clarify-
and
maybe
you
don't
know
the
answer
to
this,
but
in
the
cases
where
someone
with
a
mental
health
or
Behavioral
Health
crisis
was
refused
to
transport.
Were
these
emergency
situations
or
were
they
non-emergency
situations.
F
You
know
that
is
a
really
interesting
question,
because
the
the
stat,
the
regulation
that
I
quoted
to
you
talks
about
non-emergency
and
I
think
maybe
in
somewhere
in
that
regulation,
the
the
definition
of
emergency
is
life-threatening.
F
So
if
you
use
that
definition
of
emergency,
no,
they
are
not
emergency.
They
are
non-emergency
because
they
are
not
life-threatening.
The
person's
life
is
not
on
the
line,
so
to
speak
from
a
mental
health
perspective
from
a
psychological
perspective,
I
would
say
that
some
of
them
get
to
be
emergent
in
the
sense
that
if
they
are
not
taken
care
of
at
the
time,
particularly
if
the
person
is
voluntarily
presenting
themselves
for
treatment-
and
if
that
doesn't
happen,
you
could
see
certainly
deterioration.
F
You
could
certainly
see
someone
becoming
a
much
more
suicidal,
much
more
engaged
in
suicidal
Aviation,
as
we
say,
and
perhaps
devolving
into
much
more
of
what
Senator
Douglas
act
had
asked
about
in
terms
of
some
of
the
behavioral
acting
now,
but
you
know
probably
from
a
strict.
Is
this
a
threat
to
the
person's
life
right
at
that
time?
The
answer
is
probably
no
and
I'm,
assuming
that
that's
the
definition
of
emergency
in
in
these
regulations
and
in
the
medical
parlance.
G
F
I
I
would
think
so
in
terms
of
you
know,
as
I
was
I
remembered,
this
reg
had
been
quoted
way
back
in
2019
and
I
went
to
find
it
and
I
noticed
that
it
was
under
the
non-emergency
and
I
had
that
same
kind
of
I
was
like.
Is
that
what
this
really
is
and
I
don't
know
actually
in
the
EMS
protocols
and
so
forth?
What
they
consider
to
be
I
think
they're
paid
a
different
rate
for
non-emergency
transports
versus
emergency
transports.
G
I'm
just
wondering
if
maybe
some
of
the
parity
concerns
that
you
mentioned
at
the
beginning
of
your
of
your
talk,
could
could
have
to
do
with
this
issue
of
what's
considered
a
psychological
or
a
mental
health
emergency
versus
a
medical
emergency
and
from
a
parity
perspective,
you
know
someone's
psychological
well-being
and
possibly
becoming
suicidal
or
or
becoming
violent
or
aggressive
or
or
beginning
to
decompensate
in
other
ways,
if
maybe
from
a
parody
perspective,
that's
not
something
we
ought
to
look
at,
but
thank
you
very
much.
A
You
excellent
I'm,
sorry
any
other
questions
from
the
task
force
great
well
on
the
last
Point
Dr
shoes
before
I.
Let
you
go
I
think
it
is
a
gray
line
that
we
need
to
be
conscious
of
because
I
suspect
you
know
actually
I've
talked
to
some
First
Responders
police,
firefighters
and
EMS.
It's
it's
sometimes
it's
difficult
to
determine.
Is
this
the
emergency
now
I'm
talking
about
putting
this
in
a
context
of
mental
health?
Is
this
the
emergency
or
is
it
non-emergency?
You
know
they
suicidal.
You
know
it's.
A
It
becomes
a
little
bit
gray
area
and
it
it
it's
going
to
put
a
little
more
burden
on
the
first
responder.
So
we've
got
to
be
careful
and
conscious
of
that,
and
if
we
do
do
that,
go
down
and
defining
that
further,
we
need
to
make
sure
we
support
these
First
Responders
from
a
training
and
education
standpoint
and
making
sure
they've
got
the
proper
equipment.
But
with
that
I
appreciate
Dr
Schuster
coming
in
and
sharing
your
thoughts
and
I'm
sure
we'll
be
talking
down
the
road.
Well,.
F
Thank
you
for
letting
me
testify
in
doing
it
remotely
from
lovely
Somerset
Kentucky.
Actually,
I
do
think
that
the
training,
I
guess.
My
overall
message
is,
let's
be
sure
that
EMS
Ambulance
or
have
the
training
that
they
need
to
know
what
they're
dealing
with
with
these.
You
know
mental
health
addiction
issues,
I
think
that
would
go
a
long
way
so
again,
I'm
I'm,
happy
to
be
available
and
I
will
try
to
get
some
answers.
Some
stats
for
you
and
and
answer
representative
Hart's
question
also.
A
Thank
you.
Thank
you
so
much.
Thank
you.
Thank
you
appreciate.
It
have
a
good
day
all
right
thanks
our
our
next
presenters,
two
gentlemen
from
the
Lexington
fire
department.
If
you
don't
mind
making
your
way
up
here
when
you
do
just
go
ahead
and
introduce
yourselves
and
then
go
ahead
and
take
the
floor.
A
H
H
Senator
Givens
representative
Fleming
members
of
the
committee.
Thank
you
all
so
much
for
the
opportunity
to
address
the
EMS
task
force
today,
certainly
we'll
be
respectful
of
your
time,
but
we
are
gratefully
or
very
grateful
for
the
opportunity
to
come
and
talk
a
little
bit
about
what
we
believe
is
a
very
positive
and
Innovative
pilot
program.
H
So,
just
a
little
bit
briefly
about
us,
the
Lexington
fire
department
serves
approximately
326
000
permanent
residents
over
an
area
of
285
and
a
half
square
miles
in
Fayette
County,
where
we
cover
the
merge,
City
County
area.
So
we
are
the
only
Fire
Department
in
the
county.
We
also
provide
specialty
resources
for
use
throughout
the
state
of
Kentucky.
H
So
while
the
vast
majority
of
of
our
over
60
000
calls
every
year
occur
in
Fayette
County,
we
are
a
regional
asset,
as
we
saw
with
our
deployments
to
Eastern
Kentucky
for
flooding
and
Western
Kentucky
for
the
the
devastating
tornado
there.
Currently
we
operate
23
engine
companies,
seven
ladder
companies.
We
have
12
ALS
ambulances,
a
community
paramedicine
pilot
program
that
that,
if
given
the
opportunity,
I
always
like
to
talk
about,
we
do
Hazmat
and
Technical
rescue
and
we're
all
equipped
and
and
can
provide
ALS
service.
H
We
have
an
authorized
strength
of
599
Personnel,
all
of
our
Personnel
through
the
the
course
of
the
recruit
Academy
become
at
least
EMT
Basics,
and
we
have
over
half
of
our
Personnel
320,
who
are
registered
as
paramedics,
so
keeping
with
national
Trends
about
three
quarters
of
our
overall
calls
about
50
000
calls
are
ems
related.
H
So
in
the
spring
of
2021,
Lexington
fire
was
approached
by
Eastern,
State,
Hospital
and,
and
the
discussion
began
about
a
pilot
program
to
transport,
a
subset
of
behavioral
health
patients
directly
to
Eastern
State
Hospital
from
the
scene
of
a
9-1-1.
H
We
had
to
work
through
sort
of
the
legalese
side
of
that,
but
in
the
winter
of
2021
and
mou
was
signed
between
UK
Eastern
State
and
the
Lexington
Fayette
Urban
County
Government
in
the
process
of
identifying
how
we
were
going
to
really
collect
the
data
and
and
identify
whether
this
was
a
useful
thing
for
us
to
do.
Or
not.
H
A
D
Ahead,
the
reason
that
we
were
doing
the
that
subset
of
population
was
because,
prior
to
UK,
taking
over
Eastern
State,
there
was
no
medical
coverage
at
Eastern
State.
So
every
single
patient
that
was
in
a
mental
health
crisis
had
to
go
to
an
ER
to
be
cleared
medically
before
they
could
before
they
could
be
seen
on
a
mental
health
basis.
So
now
that
UK
has
more
of
a
control
of
what's
going
on
in
Eastern
State,
they
have
now
staffed
that
with
medical
personnel
that
can
clear
basic
injuries
yeah.
Thank
you.
H
For
that,
so
we
we
really
developed
this
partnership
through
UK
and
Eastern
State,
and
we
established
some
goals
jointly.
We
wanted
to
ensure
that
patients
that
didn't
require
that
acute
care
were
able
to
go
to
a
place
that
better
suited
their
immediate
needs
and,
and
quite
honestly,
was
probably
the
most
cost
efficient
and
effective
place
for
them.
H
It
reduced
unnecessary,
Hospital
readmits
and
it
creates
an
environment
where
all
parties
can
utilize
the
system
to
the
most
efficient
and
best
ability
and
I
think
that
that
ultimately
will
improve
the
patient
outcome.
People
go
to
where
they
can
get
the
best
help
the
quickest,
so
I'll
turn
it
over
to
Chief.
Bramley
should
talk
a
little
more.
D
So
as
Dr
Schuster
alluded
to
the
point
of
it
is,
is
that
you
know
getting
to
these
patients
in
their
crisis
and
getting
them
the
help
that
they
need
we're.
Just
addressing
that
from
the
e911
side
as
Mark
Woods
who's,
the
chief
nursing
officer
over
at
Eastern
State
preached
to
us
it's.
We
need
to
have
the
correct
intervention
at
the
correct
time
and
that's
where
we
come
in
as
as
9-1-1
providers
is
to
get
those
people
to
the
proper.
D
You
know
level
of
care,
so
we
started
developing
a
training
program
in
the
fall
of
21
working
with
myself
and
with
Eastern
State
to
come
up
with
the
parameters
of
what
we
will
do.
Minor
injuries
were
going
to
be
acceptable,
abrasions,
contusions,
simple
suturing,
that
only
involved.
You
know
one
layer
of
skin
things
that
were
not
acceptable
were
going
to
be
fractures.
Falls
from
Heights
of
you
know
higher
than
three
to
five
feet
or
if
there
was
any
any
indication
that
they
had
ingested
anything
or
if
they
had
tried.
D
You
know
if
they
had
ligature
marks
around
the
neck.
If
they
tried
to,
you
know,
have
a
suicidal
incident.
We
put
that
out
to
all
of
our
providers
within
the
fire
department.
It
was
also
put
out
to
the
police
department
as
well
and
again
as
Dr
Schuster
alluded
to
the
the
CIT
training
most
of
the
Lexington
Police
Department
has
been
through
the
CIT
training.
You
know
to
go
along
with
that,
so
we're
working
hand
in
hand
with
law
enforcement
on
scene
to
identify
these
patients.
D
We
went
live.
We
our
goal
was
to
go
live
in
February
of
22,
but
we
got
delayed
just
a
little
bit
because
of
some
unforeseen
circumstances
that
were
out
of
our
control.
So
we
started
towards
the
end
of
March
is
when
we
actually
went
live
with
this.
That
eastern
state
was
ready
for
us
to
bring
them
patience,
and
so
we've
been
doing
this
now.
D
D
We
hadn't
we
had
problems
with
the
police
on
scene
as
well.
Some
of
them
had
had
the
training,
some
of
them
hadn't
and
so
trying
to
have
that
conversation
about
you
know
where
to
go.
It
was
an
on-seen
thing
pointing
the
finger
at
ourselves.
It
was
a
big
change
for
our
guys.
D
You
know
we
had
a
problem
with.
They
didn't
want
to
go
across
town
if
they
were
on
the
south
side
of
Lexington.
They'd
have
to
go
all
the
way
across
to
the
west
side
of
Lexington
and
when
they're
trying
to
get
off
at
seven
in
the
morning
to
go
home,
it's
a
little
bit
of
a
a
little
bit
of
a
mental
challenge,
of
which
way
you're
going
to
go.
D
The
police,
when
we
had
an
issue
with
the
police
is
their
training
schedules,
are
not
the
same
as
what
the
fire
training
schedule.
Is
we
train
every
day
in
the
Lexington
fire
department,
whether
it's
an
actual
formalized
training
or
it's
an
in-house
training,
so
that
the
materials
there
for
the
guys
to
go
over
those
materials,
the
police
trained
basically
two
times
a
year,
and
so,
if
you
had
some
that
didn't
do
that,
do
the
training.
Yet
they
were
kind
of
behind
the
eight
ball.
D
We
had
a
problem
with
the
hospital
Eastern
Eastern
State
didn't
understand
that
a
patient
has
a
choice
of
which
facility
they
want
to
go
to.
They
assumed
that
once
EMS
arrived
on
scene,
EMS
made
the
determination
of
where
they
go,
so
we
had
to
work
work
through
some
of
those
things
about
understanding,
each
other's
roles
and
backgrounds
and
what
our
knowledge
base
was.
D
We
also
had
to
contend
with
the
patients.
The
patients
know
the
system
better
than
we
do.
They
knew
that
they
go
to
this
particular
facility.
When
we
got
a
problem,
they
didn't
realize
that
eastern
state
was
now
an
option
and
so
trying
to
educate
the
patient
was
going
to
be.
The
is
another
issue
that
we
had
of
trying
to
make
this
work,
and
the
last
problem
that
we
identified
with
was
again
as
Dr
Schuster
alluded
to
is
the
stigma.
D
D
The
data
that
we
collected
so
since
from
the
end
of
March
of
this
year
till
actually
last
week,
we've
had
a
total
of
one
thousand
and
two
transports
for
Behavioral
Health.
Excuse
me
or
I'm.
Sorry,
1593
total
calls
for
service
a
thousand
and
two
of
those
have
gone
to
UK,
whether
it's
Chandler
or
it's
to
the
Good
Samaritan
campus
62
of
those
people
have
been
transported.
Eastern
State
through
this.
Through
this,
this
process,
44
have
been
treated,
have
gone
to
Veterans
because
they're
they
have
the
the
VA
benefits.
D
182
have
been
transported
to
other
facilities
and
303
were
not
transported.
So
to
break
down
any
more
of
the
data
is,
is
that
the
data
is
based
off
the
primary
impression
that's
mandated
by
the
Department
of
Transportation,
as
well
as
National
Highway,
trade,
traffic
and
safety
administration.
Admittedly,
our
data
needs
to
be
a
little
bit
more
finite.
D
We
need
to
break
it
down
and
that's
things
that
we've
discussed
with
the
Eastern
State
of
of
how
can
we
tweak
our
data
to
make
it
a
little
bit
more
descriptive
of
what
we're
doing
so
we're
currently
working
through
that
process?
Va
has
access
to
mental
health
as
well,
and
so
that's
why
you'll
see
some
of
those
patients
who
are
veterans
who
are
going
through
their
Mental
Health
crisis
will
seek
out
the
VA
because
they
know
that
they
have
that
benefit
through
the
VA.
D
Admittedly,
transporting
to
other
facilities
is
a
problem.
It
goes
back
to
our
effort
as
far
as
our
guys
changing
their
mentality
of
it's
like
okay,
I'm,
just
right
down
the
street
from
this
place.
It's
a
hospital,
let's
go,
and
so
we're
actively
training
that
teaching
at
and
redoing
that
to
make
it
a
better
and
it's
the
same
thing
with
the
police
department,
not
all
people
who
are
transport
or
were
transported
because
either
they
didn't
meet
the
criteria.
D
You
had
like
a
a
Facebook
threat
or
you
had
somebody
that
thought
somebody
was
going
to
do
something
to
themselves.
So
it
was
a
third
party
caller
calling
for
this
person
and
once
you
actually
talk
to
the
patient,
then
no
we're
not
really
having
an
issue
here.
You
know
so
that's
kind
of
where
those
people
fell
into
why
they
weren't
transported.
With
that
we're
open
for
any
questions
that
you
might
have.
A
Well,
first
of
all,
gentlemen,
I
want
to
express
my
appreciation
for
your
openness
and
wellness
to
take
the
call
early
on
and
try
to
find
a
solution
at
the
tip
of
the
hat,
for
a
really
fulfilling,
in
fact,
I
think
going
a
little
bit
beyond
to
your
Call
of
Duty
and
and
what
y'all
doing
trying
to
service
the
the
the
the
population
in
Fayette
County.
So
thank
you
very
much
for
doing
that.
It's
very,
very
important,
I
know
it's.
A
It's
sort
of
a
difficult
thing
to
go
through.
I
just
want
to
have
a
couple
of
questions,
and
then
I'll
asked
some
of
our
committee
members.
If
they
want
to
chime
in
you,
I
guess
just
clarification.
You
imagine
early
on
your
slide
a
subset
of
125
patients
on
2020
to
identify.
Could
you
explain
that
is
that
125
out
of
the
5
000
calls?
Oh.
D
A
D
A
D
A
A
D
State
looked
at
the
numbers
when
they
were
looked
at
how
many
patients
had
been
transported
to
UK's,
Behavioral
Health,
and
that's
who
Eastern
State
had
identified
and
that's
when
they
came
with
us
and
says:
what
can
we
do
with
these
patients,
because
these
people
at
this
time
we
can
help
then
the
the
we
can
help
them
the
most
the
fastest?
And
that's
kind
of
that
was
the
springboard
for
us
of
of
trying
to
design
this
program
and
see
how
it's
going
to
work.
Okay,.
A
And
going
back
to
your
last
Slide
the
data
you
have
102
transport
to
the
behavioral
health.
Could
you
give
me
a
little
more
give
us
a
little
more
understanding
of
what
what
those
calls
were
that
went
to
UK.
We.
D
Have
it
broken
down
by
what
the
what
the
primary
impression
is,
so
it's
going
to
be
suicidal
ideations
suicide
attempts,
Behavioral
or
psychotic
episodes
or
a
mental
disorder,
is
how
that's
coded
in
our
EMS
documentation
system.
Okay,.
B
A
D
Sorry,
no
any
of
those
things
can
Encompass
a
wide
variety
of
what
we
encounter.
It
could
be
a
substance
use
disorder.
It
could
be
a
manic,
you
know
manic
session,
it
could
be
you
know
whatever
it
is.
It's
just
we
were
limited.
You
know
by
our
epcr
by
our
documentation
system,
of
how
we
pulled
the
data.
A
Okay
had
a
had
a
moment
there,
I
had
a
question
and
I
know
what,
on
my
mind
for
some
reason:
I
guess
it
had
to
do
with
the
the
transports
of
going
to
to
UK.
You
said
that
it
had
suicide
ideation,
those
sorts
of
things,
so
oh
I
know
what
it
was
when
you
receive
the
call
that
was
a
9-1-1
call.
D
A
D
If
you
want
to
equate
it
to
what
UK
does
UK's
level
one
Trauma
Center
for
Central
Kentucky,
when
somebody's
involved
in
a
high
velocity,
MVC
or
a
gunshot
wound,
we
really
don't
give
them
the
option
of
going
anywhere
else,
because
the
level
one
Trauma
Center
is
the
best
equipped
to
handle
that,
and
that's
one
of
the
things
we
identified
and
had
talked
with
eastern
state
is
is
do
we
want
to
start
when
we're
in
these
situations
that
we
really
don't
give
the
choice?
D
This
is
where
we
go
that
we're
going
to
triage
this
to
the
appropriate
facility,
which
is
going
to
be
Eastern
State.
So
you
know
through
these
through
this
month
it
was
a
combination
of
it
was
the
patient's
Choice.
It
was
the
police
officer
and
the
EMS
provider,
conversing
back
and
forth
of,
what's
going
to
be
the
best
option
for
this
patient,
because
the
ultimate
goal
was
to
get
them
to
you
know
a
level
of
care.
You
know
in
their
moment
of
Crisis
to
get
them
the
care
that
they
need.
So
so.
A
All
right
so,
at
the
at
the
point
of
the
of
the
of
the
situation,
there's
a
collective
collaboration
based
on
input
that
y'all
received
in
observations
that
this
person
needs
to
go
to
X
or
this
person
needs
to
go
to
Y
correct.
Despite
what
the
what
the?
Despite
what
the
patient
says,.
D
A
Okay
and
the
part
that
you
said,
103
not
transported,
you
get
you
rather
the
scene,
and
you
determine
that.
Okay,
it
is
what
it
is
and
and
I
hate
to
say
blunt.
Thank
you
very
much
we're
on
our
way.
Yep.
Okay,.
A
A
So
let
me
ask
sort
of
a
another
data
money
question
reimbursements.
How
could
you
explain
how
this
works
with
your
different
different
transport
scenarios
on
that
last
slide,.
D
The
city
has
a
a
non-compete
that
allows
private
business
to
operate
in
the
city,
so
we
leave
that
for
any
kind
of
private
operation
to
be
able
to
operate
in
Fayette
County,
so
most
of
the
times,
if
it
is
determined
that
medical
necessity
was
not
met,
we
don't
collect
and
we
we
have
to
eat
it.
Okay,
okay,
we're
fortunate
in
the
fact
that
our
run
volume
makes
up
for
what
we
don't
collect.
We
know
that
we
are
not
like
a
lot
of
the
services
in
this
state.
Our
run
volume,
our
run
volume.
C
I
I
I
For
the
year,
you're
going
to
probably
end
up
around
that
50
000
number
1593
of
that
fifty
thousand
it'll
be
a
little
more
by
the
end
of
the
year,
but
this
is
a
subset
of
that.
When
you
pull
this
out,
how
did
you?
How
did
you?
How
did
you
pull
these
out?
These
are
behavioral
health
crises.
These
are
mental
health
crises.
What
designated
the
data
to
make
it
onto
this
page
of
one
call
versus
another?
It.
D
Went
with
the
Department
of
transportation's
primary
impression
codes,
that's
required
by
federal
law
when
we're
dealing
with
our
our
patient
care
reports
and
again,
those
tabs
in
that
were-
are
labeled
as
suicidal,
ideations,
suicide
attempt,
behavioral
and
psychiatric
episode
in
a
mental
disorder,
and
those
were
the
four
items
that
we
pulled.
These
numbers
from.
I
Excellent.
Thank
you
for
that
clarification,
I
would
encourage.
It
looks
like
Dr
Schuster
may
not
be
on
the
call
anymore.
Do
we
know
if
she's
on
or
not
would
staff
be
certain
that
she
gets
a
copy
of
this
presentation
specific
to
those
answers,
the
clarity
and
the
specificity
that
you're
providing
is
something
she
needs
to
understand.
I.
D
J
I
D
Mean
we
have,
though
some
of
those
numbers
are
is
somebody
will
call,
but
there's
no
patient
there.
So
it's
an
unfounded
call.
You
like
I,
said
we'll
have
the
the
spot.
Where
we
do
an
evaluation,
they
don't
meet
the
criteria
or
you
know
they
can
make
their
own
decision
that
type
of
thing,
so
it
is
a
it
is
a
patient
refusal
and
that's.
We
have
to
we
obtain
signatures
on
that.
We
have
witnesses
who's
either
a
family
member
or
a
law
enforcement
officer.
That
is
with
us
that,
yes,
you
know
we're.
H
Seeing
the
exact
numbers
I
would
say
that
those
those
numbers
are
are
very,
very
in
line
with
overall
medical
calls
and
the
non-transport
right.
I
I
D
D
Goes
back
to,
we
are
very,
very
fortunate
for
the
resources
in
the
budget
that
we
have
that
we
are
able
to
provide
that
service,
and
we
know
that
we
are
the.
We
are
the.
We
are
the
white
elephant
in
the
room
when
it
comes
to
what
we
do
and
how
we
do
it
in
a
lot
of
places
and
I
would
say
most
probably
99
of
the
places
in
the
state
of
Kentucky
cannot
operate
the
way
we
operate,
and
we
we
realize
that.
D
But
that's
also
why
we
are
here
is
we
are
trying
to
help
solve
this
problem,
come
up
with
Solutions
and
try
things
that
you
know
that
we
do
have
the
capability
of
doing
that.
We
are
able
to
participate
in
these
pilot
programs
of
trying
to
glean
some
kind
of
information
of
how
we
can
best
assist.
You
know
to
help
the
situation
great.
Thank
you
both.
A
Thank
you
coach
chair.
Let's
see
representative
Hart.
C
This
question
might
be
hard
to
answer
because
you're
all
in
the
preliminary
stages
of
a
pilot
program,
but
you
you
mentioned
how
you
were
kind
of
doing
this
as
a
as
a
model
to
what
way
we
do
trauma
in
the
region.
Do
you
anticipate
or
expect
or
hope?
Maybe
the
outcome
of
this
pilot
program
will
be
able
to
be
administered
as
a
protocol
for
surrounding
areas,
especially
in
the
rural
areas.
I
know,
there's
not
a
lot
of
options
in
the
rural
areas.
H
Just
give
a
brief
answer
and
then,
if
Chief
ramblish
has
anything
he's
probably
far
more
insightful
than
I,
I
will
say
that
it
is
certainly
our
hope
that
this
program
flourishes,
because
ultimately,
our
job
is
to
get
the
patient
to
the
facility
that
can
best
meet
their
needs
as
quickly
as
possible
and
and
I.
Think.
The
downstream
effect,
then,
is
that
hospital
emergency
departments
are
perhaps
less
congested
with
patients
that
oftentimes
take
a
little
bit
longer
to
receive
more
acute
patients.
H
D
I'll
agree
with
Chief
Wells.
We
are
too
early
into
this.
I
will
say
this
that
the
last
meeting
that
we
had
with
eastern
state
is
even
though
I
I
don't
agree
with
the
the
Outlook
of
the
data
I'm
not
impressed
with
it.
I
think
we
should
be
doing
better
to
be
quite
honest
with
you,
but
they're
tickled
to
death
with
with
the
data
they're
getting
what
they
want
to
see,
and
so
the
talk
is.
D
Is
that
that
we
will
continue
this
and
and
try
to
tweak
it
and
make
it
better,
but
also
to
include
more
of
those
issues,
as
opposed
to
just
limiting
ourselves
to
suicidal
ideation
that
we
will
increase
it
to
you
know.
You
know,
you
know
paranoid
schizophrenic
issues,
you
know
or
any
kind
of
other
mental
health
issues
we
they
they
fully
see
and
anticipate
wanting
to
expand
it
more
is
what
it
is.
So
we're
we're
very,
very
in
The,
Crawling
phase
right
now.
You
know
for
that
model.
A
Thank
you,
representative
I,
just
want
to
I
want
to
ask
a
couple
more
questions.
Just
to
clarify
all
the
calls
that
are
in
your
data
are
911
calls
there
there's
no
non
one
or
no,
not
there's
no
calls
that
are
that
you
make
that
are
911.
A
A
Part
of
that
goal
of
that
bill
is
to
reduce
the
hospitalization
to
get
them
in
a
treatment
plan
and
so
forth
and
I've
got
some
preliminary
numbers
in
terms
of
how
much
how
much
cost
it
would
save
by
doing
that,
but
obviously
more
important,
it's
really
quality
of
care.
Do
you
have
any
information
and,
if
not,
it'd,
be
wonderful?
A
If
y'all
can
look
at
that
down
the
road
in
terms
of
how
you're
not
or
you're
how
you're
helping
out
in
the
process
of
not
having
these
individuals
to
go
and
re-hospitalized
or
even
get
or
get
arrested,
re-arrested.
D
We
do
not
have
we
didn't
bring
that
data
with
us,
but
we're
we
should
be
able
to
pull
that
data
again.
As
we
mentioned
earlier
in
the
presentation,
we
have
the
the
community
paramedicine
pilot
program
RAM
and
that's
specifically
what
they
deal
with.
So
we
do
have
that
that
data
that
we
can
pull
from
them,
because
that
is
one
of
their
main
functions-
is
to
reduce
that
re-hospitalization,
since
we
do
lose
so
much
money.
D
You
know
within
that
certain
time
frame
of
a
patient
being
re-hospitalized,
those
that
that
is
kind
of
the
main
function
that
and
that
kind
of
it
they
leak
into
this
mental
health
portion
of
it
too.
So
we
should
be
able
to
pull.
You
know
some
sort
of
data
out
of
that.
A
Well,
I
appreciate
any
information
we
can
get
we
to
be
great,
even
though
it's
small,
we'll
recognize
them
put
a
footnote
on
it,
but
at
least
it
gives
some
indication
of
what's
going
on
so
I.
Think
about
that
one
more
question
that
is
yes,
I'm
out
and
I
appreciate.
You
know
you
mentioning
that
y'all
y'all
are
different:
different
environment
and
y'all
very
fortunate.
What
you
go
through
I
know:
the
counties
throughout
the
state
have
a
difficult
time.
A
Can
you
Enlighten
Us
in
terms
of
what
differentiate
differentiates
y'all
from
other
folks,
as
your
tax
base?
Is
your
tax
rate?
It's
just
a
more
Workforce.
Could
you
give
us
a
little
bit
of
clarification.
H
I
I
think
there's
there's
several
factors
that
that
have
led
to
our
our
sort
of
uniqueness,
one
being
the
the
Firebase
EMS,
which
is
you
don't
see
everywhere.
So
we
have
an
ample
Workforce
of
599
at
least
EMTs
and
and
the
majority
of
those
paramedics.
So
we
don't
have
difficulty
Staffing
ambulances,
the
the
other
thing
I
think
is
just
the
the
availability
of
resources,
not
certainly
not.
Everybody
has
that
and-
and
a
third
would
be
our
transport
times.
We
typically
only
transport
within
the
county.
H
We
do
go
out
of
County,
occasionally
if
we
happen
to
be
closer
to
Georgetown,
Community
or
Clark
Regional
or
one
of
those
hospitals,
but
by
and
large
we're
talking
about
transporting
from
inside
Fayette
County
to
inside
Fayette
County.
So
40
minutes,
perhaps
for
a
turnaround
on
a
call
when
certainly
some
of
these
more
rural
providers
might
take
their
only
ambulance
in
the
county.
You
know
a
couple
of
hours
to
to
pick
up
a
patient
and
deliver
them
somewhere
in
Fayette
County
to
to
UK
for
the
trauma
or
Eastern
State
for
the
behavioral
health.
D
Right
and
I
think
more
globally.
We
we
applied
for
and
received
numerous
grants,
both
through
the
federal
government
and
state
government,
to
supply
to
have
these
resources
available
and
that's
part
of
our
willingness
to
assist.
Is
we
get
these
grants
because
they
know
that
we're
going
to
come
help
our
Partnerships
with
Eastern
State,
all
the
hospitals
in
in
in
Fayette
County
we're
working
hand
in
hand
with
the
hospitals
on
a
daily
basis
so
that
we're
trying
to
provide
that
best,
Continuum
of
Care,
so
that,
if
there's
an
issue,
you
know
with
patient
care.
D
A
Okay,
gentlemen:
I
want
to
express
my
sincere
appreciation
for
your
will
us
to
come
up
here
and
help
out
Nelly
to
give
us
what's
going
on,
but
also
help
out
the
Commonwealth.
We
have
a
challenge
in
our
rural
part
of
the
state.
A
Y'all
are
fortunate
fortunate
Jefferson
County's
does
a
pretty
good
job,
not
to
say
nobody
else
does,
but
it's
just
we've
got
a
challenge
and
we
need
to
look
at
and
maybe
extract
some
of
your
model
and
what
you
have
going
through
in
terms
of
maybe
we
can
put
this
in
a
in
a
Statewide
approach
with
this
and
I
would
appreciate
down
the
road
if
y'all
could
keep
yourselves
available
to
us
for
our
questions
or
maybe
come
have
y'all
come
back
and
I
wish
you
best
of
luck
in
your
pilot
project,
tip
of
the
hat
and
I
think
you're
doing
a
great
job
and
I'd
really
appreciate
y'all
coming
here.
H
B
A
Okay.
Thank
you,
gentlemen.
Sorry
about
that
Dan
yeah.
We
have
two
more.
Let's
see,
Dr
Middleton
is
there.
He
is.
A
E
Thanks
Senator
Gibbons,
thank
you,
representative
Fleming,
for
having
us
today.
My
name
is
Joe
Middleton
I'm,
the
executive
director
of
Ems
for
Baron,
Medcalf,
EMS
in
Glasgow
and
and
Edmonton
Kentucky,
and
also
serve
as
the
executive
director
of
Ems
for
Hart
County
ambulance
service.
That
is
headquartered
in
Munfordville
Kentucky.
E
A
little
background,
I've
been
in
Ems
for
about
28
years.
25
of
those
I've
served
as
a
paramedic
11
years,
I
spent
on
board
an
aircraft
I'm
also
a
licensed
Advanced
registered
nurse
practitioner
with
a
doctorate
degree
from
Spalding
University.
So
so
thank
you
for
having
us
here
today
with
me.
Today
is
Sean
Estes.
E
He
is
our
assistant
director
and
Chief
Financial
Officer,
just
in
case
when
we,
when
we
get
into
this
discussion,
if
we,
if
we
want
to
delve
deeper
into
numbers
and
and
how,
how
different
Financial
opportunities
have
come
about
and
how
we
make
it
work,
I
guess
changing
gears.
Just
a
little
bit,
we've
been
asked
today
to
discuss
consortiums
of
EMS
or
our
regionalized
approach.
I
bring
to
you
today
a
model
that
was
developed
in
1974
between
Barron
and
Metcalf
counties.
E
It
was
done
by
the
by
by
several
entities
that
were
involved
in
the
time
under
the
direction
of
our
founding
director
director
Michael
Swift
enamel
service
was
established
in
December
of
1974,
was
a
partnership
between
Barron
County,
Medcalf
County,
the
city
of
Glasgow,
the
city
of
Cave
City
and
the
City
of
Edmonton
in
its
creation.
Each
of
these
Partners
were
responsible
for
part
of
the
operational
deficit
that
was
created
minus
the
collections,
so
the
model
was
collections
for
patient
transports.
E
Then
minus
expenses,
then,
whatever
was
left,
was
divided
amongst
the
partners
to
make
sure
that
the
the
balance
broke
even
and
the
and
the
service
remained
solvent.
Early
on
and
in
the
initial
phases
of
development.
The
city
of
Cave
City
opted
out
of
the
agreement
which
left
Baron,
midcalf,
Glasgow
and
Edmonton
as
the
as
the
the
initial
partners.
E
As
I
said,
this
model
has
been
functioning
very
well
in
burning
in
Metcalf
County,
a
population
of
about
47
000
in
Barron
County
population
about
14
000
in
Metcalf
County.
We
currently
are
running
a
call
volume
of
about
13
to
14
000..
We
we
were
up.
Then
we
had
a
decline.
Of
course,
during
the
coveted
Year
we're
now
making
a
return,
so
so
we're
we're
going
to
we're
going
to
come
out
around
14
000
this
year.
E
We
staff
that,
with
five
ambulances
across
the
geographical
distance
during
day
shift,
which
would
be
8
A.M
to
8
P.M
and
we
drop
down
to
four
units
at
night,
8
P.M
to
8
A.M.
We
also
maintain
a
supervisor
when
possible
in
a
Chase
vehicle.
They
are
they're.
They
are
our
11th
man.
E
So
if
there's
a
call
in
that
supervisor
does
step
into
that
role
and
function
as
a
paramedic
and
we
staff
those
as
ALS
units
as
frequent
as
possible
with,
but
but
with
the
paramedic
shortage
that
we
we
experienced
in
South,
Central
Kentucky.
On
occasion
we
have
to
bring
one
of
of
those
trucks
down
to
a
BLS,
but
we
do
maintain
the
majority
of
our
trucks
Als
at
all
times.
E
E
Member
was
appointed
by
the
agency
in
which
they
representative,
for
instance,
Barron
County,
had
three
seats
appointed
by
the
judge
executive,
the
city
of
Glasgow
had
three
seats
appointed
by
the
mayor
of
Glasgow,
Metcalf
County
had
one
seat,
Edmonton
had
one
seat
and
the
T.J
Sampson
Hospital
board
of
directors
had
two
seats.
Each
one
of
those
seats
represented
10
percent
of
the
operational
deficit.
They
were
billed
that
deficit
on
a
monthly
basis.
E
We
move
forward
a
little
more
and
we
came
to
the
Advent
of
a
Metcalf
County
ambulance,
taxing
district
and
a
Barron
County
special
purpose
ambulance,
taxing
district
with
that
that
removed
the
the
the
contributions
that
were
coming
from
the
city
of
Glasgow
and
the
city.
Edmonton,
keep
in
mind
that,
prior
to
these
taxing
districts,
the
ambulance
service
was
a
line
item
on
each
of
the
governmental
entities
budgets.
E
So
they
were
collecting
their
tax
base
and
then
dispersing
money
to
us
as
a
budgetary
line
item
upon
the
establishment
of
the
taxing
districts,
those
two
taxing
districts
absorbed
the
cost
that
was
being
paid
by
the
counties
of
Barron,
the
counties
of
Metcalf,
the
city
of
Glasgow,
the
city
of
Edmonton,
the
Metcalfe
County.
Taxing
district
took
care
of
Metcalf
and
Edmonton.
E
E
We
also
continued
for
a
short
time
in
that
in
that
what
we
refer
to
as
a
deficit-based
billing
that
did
not
work
so
well
in
the
model
that
we
were
using
with
the
when
we
moved
from
the
10-seat
representation.
So
now
we
went
to
what
we're
referring
to
as
a
budget
based
billing.
What
we
do
is
we
create
our
budget.
We
write
our
budget
that
goes
before
the
budget
committee.
The
budget
committee
then
reviews
our
budget
on
the
line
item.
We
then
take
that
to
the
full
board.
E
E
What
we
did
was
we
take
historical
data
of
what
operational
expenses
are
in
Barron
County
operational
expenses
are
in
Metcalfe
County
and
we
we
do
a
a
calculation
on
the
percentage
of
what
the
overall
deficit
is
going
to
be
for
operation.
In
that
particular
County.
We
calculate
that
through
expenses
based
on
station
shares,
for
instance,
if
they're,
that
liability
insurance
that's
going
to
be
divided
between
corporate
Glasgow
stations
and
and
Metcalf
County
station,
if
it
is
an
expense
directly
related
to
a
Glasgow
station,
it's
created
into
them.
E
If
it's
suspense
directly
to
medcaf
Candy
station,
it's
created
to
them.
We
keep
a
historical
data
so
that
if
we
do
have
an
outlier
that
doesn't
directly
impact
the
next
budget
say
if
there's
there's
a
hundred
thousand
dollar
expense
in
Metcalf
County.
That
was
that
we
didn't
prepare
for
then
that's
not
going
to
immediately
change
those
those
reference
points
and
what
those
percentages
are
for
what
their
cost
of
operations
are
in
that
partnership,
TJ
Sampson
assumed
20
off
the
top
of
that
operational
deficit,
for
instance.
E
E
We
were
fortunate.
This
past
year
is
TJ
Sampson
elected
to
move
their
partnership
to
25
percent.
So
the
taxpayers
of
Metcalfe
County
and
the
taxpayers
of
Barron
County
automatically
get
a
25
savings
off
the
cost
of
doing
business
by
TJ
Sampson
SharePoint.
E
To
give
you
a
reference
for
some
of
the
numbers,
Barron
County's
SharePoint
for
last
fiscal
year
was
67.6
percent.
Medcalf
counties
was
32.4
percent,
so
our
overall
collections
was
4.1,
six
4.8
million
dollars
and
we
had
a
budget
of
5.4
million,
so
the
share
partner
based
basically
resulted
in
1.2
million
coming
from
our
partners.
Tj
Sampson
paid
256
000
of
that
Barron
Kenny
paid
635,
000
of
that
and
Metcalfe
County
paid
384
000.
E
again.
One
of
the
one
of
the
issues
that
we
Face,
along
with
a
lot
of
other
providers
across
the
state
is,
is
specifically
related
to
collections.
We
are
very
high
high
population
of
Medicare
and
Medicaid
patients,
which
do
not
reimburse
at
the
same
rate
as
as
third
party
payers,
so
we
have
to
have
we
take
assignments,
and
we
also
we
have
a
fair
share
of
write-offs
based
on
based
on
those
contractual
agreements.
E
Our
model
works
really
well.
It
has
worked
well
since
I
said
before
since
1974
over
the
course
of
the
years
we
have
had
to
make
a
few
tweaks
one
of
the
things
since
January
1st
of
2020,
when
I,
when
I
came
in
as
the
executive
director
was
to
develop
a
Consortium
and
include
this
in
a
partnership
with
with
heart,
Kenny
Ambulance
Service
hard
candy
ammo
service
is
operated
as
a
completely
separate
entity
with
its
own
staff,
its
own
equipment,
its
own
supplies.
E
But
what
we
do
is
we.
We
try
to
negotiate
every
single
thing
that
we
purchase
consumables
and
non-consumables
vehicles
and
and
reusables,
so
that
we
can
get
the
best
price
points.
For
instance,
over
the
course
of
the
last
year
between
the
between
the
Three
Counties.
We
we
have
ordered
eight
ambulances,
so
so
we
in
doing
it
in
this
manner,
we
get
the
luxury
of
getting
the
bulk
purchase
at
a
little
bit
of
a
reduced
rate
versus
buying
one
or
two
ambulances.
E
Here,
one
ambulance
there,
the
the
next
eight
ambulances
have
been
ordered
for
the
Three
Counties
and
we
got
some
cost.
Sharing
cost
savings
on
that
that
each
County
and
the
taxpayers
of
those
counties
are
going
to
are
going
to
going
to
recognize
and
it's
going
to
reveal
to
them.
E
That
is
a
quick
snapshot
of
what
we're
doing
in
Baron
in
Metcalf
counties.
I
I
am
open
to
any
questions
you
have
and
if
you
want
to
sit
down
and
further
dig
into
how
we
do
things,
I
am
more
than
glad
to
because
historical
data
shows
that
that
what
we're
doing
is
functioning
and
and
is
working
in
our
geographical
area.
A
You
went
over
a
lot
of
things
in
terms
of
cost
allocation
and
budgeting
and
I
and
I
appreciate
what
you've
gone
through.
I
just
want
to
get
a
clear
clarify
when
you
look
at
the
allocation,
does
cost
based,
or
are
you
looking
at
number
of
calls?
You
are
based
on
that
that
that
cost
allocation?
What
were
you
basing
the
allocation
on.
E
The
call
strike
the
cost
calculations
are
based
specifically
on
use
on.
A
E
So
if
that
station
uses
this
consumable,
it
is
expensed
to
that
station
that
County
telephone
bill
is
divided
amongst
stations
and
usage.
Electrical
bill
based
on
a
station
is
assigned
to
that
station
and
that
county
of
usage,
so
the
expenses
that
we're
looking
at
we're
not
just
looking
at
a
cost-based
expense,
we're
looking
at
the
global
expense
of
how
much
it
costs
to
operate
that
service
that
station
in
that
area,
Okay.
A
So
it
includes
indirect,
direct
and
calls
and
all
that
good
stuff.
E
A
Sir
okay,
okay
I
personally
I
would
like
to
sit
down
and
talk
a
little
more
about
that,
not
because
I'm,
a
gated,
a
dated
person
but
I
want
it
but
I
think
which
what
you're
describing
is
to
me.
It's
it's
intriguing
and
I.
A
Think
in
our
past
conversations,
particularly
with
the
Mr
with
Eddie
Stone,
he
talked
about
realization
and
if
this
is
going
to
be
pursued
any
further
I
think
what
you
have
presented
at
least
gives
an
idea
of
what
we
need
to
think
about
in
terms
of
how
that
might
happen.
If,
if
it
all
happened
so
but
I
appreciate
that
y'all,
there's
committee
members
have
any
questions.
Yes,
you
do
coach
chair,
Givens,
yeah
you're,
the
four.
I
Foreign,
thank
you
in
a
moment
of
personal
privilege,
Dr
Middleton,
Mr
Estes.
Thank
you
both
for
what
you
do
in
my
community
in
in
my
Senate
District
meeting
the
needs
of
people
on
the
front
line
and
in
moments
of
crises,
and
it's
perfect
that
you're,
following
with
your
presentation,
the
Lexington
presentation,
totally
different
set
of
circumstances,
totally
different
funding
model,
totally
different
geographic
region
being
served.
I
Colleagues
in
the
on
the
committee
I
want
you
to
to
think
about
what
these
gentlemen
have
described
to
you,
because
all
of
us
have
communities
at
home
that
fit
from
the
knowledge
of
how
to
combine
up
to
Three
Counties.
Now,
when
we
include
heart
Medcalf
and
baron,
we've
got
some
consolidation.
A
Consortium
is
the
word
you've
used
in
a
rural
community
and
and
Dr
Middleton
has
done
a
wonderful
job
explaining
about
50
years.
I
For
those
of
us
that
are
in
the
room,
we
can
be
ambassadors
for
a
model.
That's
working
a
model,
that's
been
refined
a
few
times,
it's
gone
through
two
or
three
different
iterations,
now
of
of
board
directors
and
control
and
the
way
it
operates.
But
this
is
successful.
This
works.
This
meets
the
needs
in
a
largely
rural
community,
where
we
have
Geographic
spread,
trying
to
meet
those
needs
of
those
citizens,
and
so
compliments
to
both
of
you
on
what
you
do
and
thank
you
for
your
leadership.
I
A
You
any
questions
like
I
said:
I
would
like
to
sit
down
and
talk
with
y'all
a
little
more
and
if
you
are
willing,
have
Mr
Stone
I
assume
you
know
Mr,
okay
and
I'm.
I
assume
you
might
be
talking
to
him,
but
I
I
would
be
nice
to
if
y'all
can
consider
nothing
fancy
but
put
together
like
a
little
white
paper
or
some
type
of
structure.
A
How
you
see
this
mic
working
and
we're
in
cooperation
with
Mr
Stone
in
terms
of
what
they
that
might
help
us
at
least
as
committee
address
the
the
situation
going
on
in
the
counties.
That's
we
see
a
lot
of
the
challenge
that
we
have.
We
want
to
make
sure
we
address
those.
So
I
appreciate
your
willingness
to
do
that.
If.
E
Of
the
things
that
we
we
are
very
cognitive
of
is
taxpayers
and
county
lines.
We
we
do
everything
we
can
to
ensure
that
taxpayers
do
not
cross
the
county
line
to
provide
service
in
another
County.
We
know
that
that
a
lot
of
the
stigma
with
the
regionalized
approach
is
Kentucky
has
120
counties
and
that's
120
different
local
governments.
So
so
we
are
trying
to
find
an
attitude
to
maintain
the
confines
of
that
local
government,
while
also
trying
to
find
a
cost-effective
approach
to
providing
a
a
more
broad
spectrum
opportunity
in
in
emergency
Healthcare.
A
A
Okay,
our
last
presented
is
Mr
Bechtel
and
commissioner
Lee
I
hope.
I
pronounced
your
name
correctly.
Good
they're
we're
going
to
talk
a
little
bit
about
the
Medicaid
ambulance,
reimbursement
I'll.
Just
let
the
committee
know
we
had
a
conversation
with
them
a
couple
days
ago.
It
was
very,
very
insightful.
A
Hopefully
we
will
cover
those
some
of
those
things
up
you
covered
in
our
meeting
a
couple
days
ago,
but
looking
forward
to
your
presentation,
if
you
don't
mind,
we
sit
down,
make
sure
your
light
is
green
on
your
microphone
and
introduce
yourself
so
y'all
go
ahead
and
and
have
the
floor.
Thank
you,
commissioner.
K
And
I
really
do
appreciate
being
here
today.
I
think
I
learned
something
new.
Every
time.
I
come
to
one
of
these
committee
meetings
and
today,
as
we
talk
about
ambulance,
Transportation
I
know
it's
it's
a
it's
an
issue
that
we're
talking
about,
but
it's
not
only
an
issue
just
for
the
Medicaid
population.
It's
an
issue
Statewide,
but
as
Medicaid
covers,
approximately
one
out
of
every
three
members
makes
Medicaid
a
major
player
in
helping
resolve
some
of
these
issues,
foreign,
so
basically
Medicaid
coverage
for
ambulance
services.
K
Transportation
is
also
to
an
appropriate
medical
facility
other
than
the
hospital,
and
also
documentation
has
to
be
in
the
file
from
the
attending
physician,
noting
the
medical
necessity,
the
absence
of
a
hospital
emergency
room
in
that
medical
service
area
and
delivery
of
emergent
care
to
the
patient.
K
We
do
provide
non-emergency
Ambulance
Service,
that
is
transportation
within
the
medical
service
area.
If
the
member's
medical
content
condition
warrants
Transportation
by
a
stretcher,
if
the
member
is
traveling
to
or
from
a
Medicaid
covered
service,
excluding
Pharmacy
services,
and
if
the
service
is
the
least
expensive
available
for
the
members
needs,
we
will
allow
for
and
reimburse
for
transportation
outside
of
the
medical
service
area.
If
all
the
items
in
the
above
non-emergency
or
the
medical
service
area
are
met.
K
If
the
medical
service
required
by
the
member
is
not
available
in
their
medical
service
area,
and
if
the
member
is
referred
by
a
physician-
and
we
just
listed
here
a
few
rates
for
our
basic
life
support.
For
example,
we
have
provide
a
base
rate
of
82.50
and
then
we
add
three
dollars
per
mile
and
then,
if
there
are
more
than
one
individuals
transported
at
the
same
time,
we
have
additional
rates,
so
the
reimbursement
rates
are
outlined
in
907k
or
106.1,
and
all
payments
are
contingent
upon
a
statement
of
medical
necessity.
K
We
do
have
a
Managed
Care
directed
payment
program
for
some
of
our
ambulance
providers.
Basically,
what
a
Managed
Care
directed
payment
is
is
that
the
department
for
Medicaid
services
pays
Managed
Care
organizations
a
capitation
fee.
The
Managed
Care
organizations
are
to
cover
all
services
outlined
in
their
contract
for
their
members.
In
the
event
that
the
department
requests
that
the
mcos
pay
additional
funding
to
certain
provider
types
such
as
an
ambulance
providers,
we
have
to
do
what
we
call
a
directed
payment.
K
We
have
to
submit
that
to
CMS
on
an
annual
basis
and
we
have
to
have
quality
measures
outlined
in
our
directed
payment
for
those
providers
to
receive
additional
reimbursement,
and
only
those
providers
who
meet
the
quality
measures
would
receive
that
enhanced
reimbursement
from
the
Managed
Care
organizations,
Steve
has
been
Steve.
Bechtel
has
been
very
instrumental
in
assisting
the
ambulance
providers
with
that
directed
payment
program
and
I
will
turn
over
the
rest
of
the.
J
Rest
of
them
so
the
the
ambulance
program,
we
call
it
APAP.
For
short,
it's
ambulance
provider,
Assessment
program,
it's
a
result
of
House
Bill
8
from
the
2020
session,
and
it
was
submitted
to
CMS
back
in
on
I.
Think
back
in
2021
on
March
31st
of
2021.
We
received
the
approval
from
CMS
and
it
authorized
an
enhanced
payment
program
for
ground
and
ground
ambulance
services
reimburses
up
to
the
available
provider
tax
funding
on
Medicaid
transports.
J
Only
so
Kentucky
stakeholders,
which
included
the
department
for
Medicaid,
as
well
as
the
Kentucky
Ambulance
Association,
as
well
as
and
I'm.
Sorry
I,
don't
know
the
acronym
but
K
beams,
not
for
sure
from
some
familiar
with
the
exact
wording
of
that.
But
it's
k-beams
we
have
members
there.
We
decided
that
the
following
goes
that
we
were
going
to
achieve
were
to
provide
enhanced
reimbursement
for
qualifying
ground
transports,
as
well
as
promoting
access
to
high
quality
care
and
reduce
unnecessary
spending.
J
The
provider
tax
funding-
that's
how
it's
it
is
funded
on
the
on
the
state
side
is
the
we
do
a
5.5
percent,
a
collection
of
of
Provider
tax
and
those
collections
are
for
emergency
ground
transports
from
all
payers,
not
just
Medicaid,
but
the
the
taxes
on
all
pairs.
But
the
enhanced
payments
is
paid
on
Medicaid
transports.
Only
the
quality
measures
for
the
program
that
that
commissioner
Lee
mentioned
is
to
promote
access
to
high
quality
Care
by
reducing
the
response
times
and
to
increase
the
number
of
certified
EMS
practitioners.
J
The
first
year
of
the
program
was
like
I
said
calendar
year:
2021,
it
does
require
an
approval.
Every
year
the
annual
add-ons
are
applied
to
the
historical
utilization
to
determine
an
interim
payment,
and
then
we
pay
them
monthly
and
then
a
final
reconciliation
to
the
actual
utilization
will
be
performed
after
the
appropriate
claims.
Adjudications
have
have
occurred,
which
is
normally
about
a
year
because
they've
got
a
year
time
and
filing
of
those
claims.
J
So
we've
been
paying
about
3.8
million
a
month
out
to
the
out
to
all
of
the
ambulance
providers
and
calendar
year
21.
The
total
payments
that
we
paid
out
was
just
over
45
million
and
through
and
on
calendar
year,
22
now
I'm
I'm
saying
calendar
year
because
that's
the
year
of
the
program.
J
Cms
requires
those
to
be
on
the
same
time
frame,
but
on
calendar
year
22,
which
is
through
August
of
22
we've
paid
about
just
shy
of
30
million
dollars.
Year
to
date,
we
were
one
of
the
first
states
in
the
nation
we
kind
of
are
proud
of
that.
J
We're
one
of
the
first
states
in
the
nation
to
kind
of
implement
this
type
of
payment,
and
I
will
remind
you,
this
supplemental
payment,
the
45
million,
and
so
far
this
year,
the
29
million
that
is
above
and
beyond
the
rates
that
we
mentioned
just
a
second
ago.
This
is
above
and
beyond
those
normal
rates.
This
is
this:
is
the
add-on
payment
so
to
speak?
J
J
And
that's
that
is
it
for
the
for
this
presentation.
I
will
say
that
we
are
looking
at
another
program
right
now
that
we're
running
against
a
wall
with
CMS,
so
to
speak
on
getting
approval,
we're
looking
at
a
CPE
which
is
a
certified
public
expenditure,
GT
Arrangement,
intergovernmental
transfer.
It's
where
it's
for
publicly
owned
providers,
we're
looking
at
doing
a
cost
report,
type
of
basis
of
a
payment
to
get
them
back
up
to
their
cost.
J
The
problem
that
we're
having
and
where
we're
where
we're
having
issues
is
that
indirect
cost
of,
like
the
direct
the
cost
around
the
9-1-1
Service,
as
well
as
fire
and
police.
Those
CMS
does
not
recognize
those
people
as
enrolled
providers
and
so
they're
saying
that
the
the
roadblocks
we're
getting
is
that
they're
not
part
of
the
medical
transportation
of
that
of
that
of
that
member?
And
so
we're
going
back
and
forth.
J
We
have
a
meeting
tomorrow,
I
meet
with
Jim
Duke,
the
Ambulance
Association,
as
well
as
Joe
Pruitt,
and
we
we
have
a
a
meeting
that
we
meet
every
two
weeks
on
Wednesdays,
where
we
talk
about
that
program
and
what
else
we
need
to
do.
J
We,
we
received
a
response
back
from
CMS
last
week,
wanting
more
questions
about
the
program,
we're
going
to
be
talking
about
our
responses
to
that
and
those
questions
tomorrow
and
then,
following
back
up
with
CMS,
we
we're
back
and
forth
with
CMS
been
doing
so
since
about
August
of
last
of
2020.
So
it
just
seems
like
it's
a
it's
been
a
never-ending
story
on
that
program.
We
just
can't
can't
get
anywhere
with
it,
but
we
are
diligently
working
to
try
to
work
toward
approval
of
that
program.
So.
I
So,
commissioner,
Lee
and
Mr
Bechtel,
thank
you
both
for
your
your
presentation
and
Mr
Bechtel,
something
you
just
said
prompted
a
it's
rare
that
I
offer
a
smart
alec
remark,
and
this
is
not
directed
at
you
at
all.
But
when
CMS
says
that
9-1-1
is
not
a
vital
part
of
medical
transport.
I
Tell
CMS
that
you've
got
a
legislator
that
wants
to
Route
all
the
911
calls
to
the
CMS
phone
number
and
let
them
then
decide
if
it
matters
or
not.
That's
crazy!
It's
absolutely
crazy!
Please
don't
you're
welcome
to
use
my
name
if
you
need
to,
but
you
can
simply
say
a
legislator
is
quite
perplexed.
How
9-1-1
and
the
fees
associated
with
it
can't
be
considered
part
of
the
medical
transport
Network.
That's
crazy!.
J
Those
are
the
other
two
states
that
that
has
been
having
some
issues,
we're
all
trying
to
get
the
same
type
of
program
implemented
and
off
the
ground
and
we're
all
getting
the
same
response
from
from
CMS,
but
to
the
point
that,
where
CMS
issued
an
issue
brief
just
about
two
weeks
ago
detailing
some
of
this
issue,
so
part
of
the
questions
and
responses
that
I
mentioned
to
you
that
we're
going
to
go
over
tomorrow
with
with
the
group,
we
call
them
the
work
we
call
ourselves.
J
The
work
group
is
how
we
address
that
issue
brief,
based
off
our
program.
You
know:
how
is
that
issue
breathed?
Are
we
addressing
the
the
key
topics
that
they
are
bringing
up
in
that
issue?
Group
and
I
I
completely
understand
what
you're
saying
Senator
Givens
I
don't
know
either
how.
J
Saying
that
in
order
or
maybe
maybe
I.
K
Brief,
there's
I
haven't
gone
in
depth
into
that
issue
brief,
but
there
is
some
discussion
about
local
funds
versus
State
funds
and
federal
funds
and
making
sure
that
all
of
those
funds
are
aligned
appropriately
based
on
the
service
that's
being
delivered,
but
I
think
that
issue
brief
would
provide
a
little
bit
more
insight
into
the
thought
process
that
CMS
is
thinking
right
now,
so
that
we
can
kind
of
look
at
those
issues
and
see
where
we
may
need
to
go
from
there,
but
I
think
just
a
summary
of
that
issue.
I
Respect
thanks
also
for
the
work
that
you
and
and
commissioner
Lee
have
done
around
House
Bill
8
and
the
supplemental
payment
program
talk
to
me
about
how,
at
a
high
level,
30
000
foot
level,
not
deep
in
the
Weeds
about
how
the
process
works,
the
tax
of
5.5
percent
is
applied
to
all
services,
Medicaid
and
non-medicaid,
that's
paid
by
the
ambulance
company
County,
whatever
the
entity
may
be.
It's
collected
by
the
cabinet.
Okay,.
I
I
C
J
We're
basing
it
off
historical
data
that
we've
gathered
from
the
we've
worked
through,
like
I,
said
Jim,
Duke
and
them
of
Ambulance
Association
they've
helped
us
been
great
Partners
to
where
they
were
able
to
get
the
data
for
us
from
each
ambulance
provider
so
that
we
can
come
up
with
what
the
per
what
what
amount
we
would
be
the
interim
payment
amount.
We
would
be
processing
on
a
monthly
basis
to
that
provider.
I
K
I
have
I
have
been
working
for
the
Department
for
20
years.
I
had
a
small
break
of
of
about
four
years
and
I
know
they
have
not
been
changed
since
I
have
been
back
since
2020,
so
I'm,
not
sure
previous.
If
they
had
been
changed.
I
I,
don't
think
they've
been
changed
in
a
long
long
long
long
time
is
my
understanding,
this
Medicaid
reimbursement
rate
question
and
it
not
be
changed
it
not
being
changed
as
a
percentage
of
cost.
Do
we
have
an
idea
what
this
rate
represents
for
these
ambulance
services?
No.
I
Mr
Beckley
go
ahead.
Here's
the
creative
challenge,
I've
got
for
you
with
the
provider
tax
funds
and
the
Medicaid
match
rate
and
the
reimbursement
question
I.
Don't
you
don't
need
to
answer
it
now,
but
I
want
you
to
think
on
this
there's
a
way,
there's
a
way,
I
think
to
magnify
these
monies
Again
by
pushing
them
through
this
Medicaid
reimbursement.
I
Let's
get
our
heads
together
on
this:
if
we
raise
this
Medicaid
reimbursement
rate,
a
substantial
amount
which
we've
got
the
latitude
to
do
and
Medicaid
is
going
to
reimburse
it
and
then
we
tax
it
and
then
we
draw
it
down,
I
think
there's
a
magnifier
opportunity.
We
may
be
missing
right
now,
based
on
some
other
experiences
in
other
sectors
of
government,
where
we've
been
able
to
do
this,
think
about
it.
Let's
talk
about
it,
but
we
need
to
take
a
look
at
raising
these
Medicaid
reimbursement
rates.
I
I
I
K
Would
definitely
have
to
get
approval
from
CMS
and
most
likely
through
an
11
15
waiver
that
would
allow
us
some
sort
of
flexibility
to
try
or
to
demonstrate
that
that
model
would
be
cost
effective
and
it
would
have
to
be
through
a
waiver,
because
the
current
rules
from
CMS
or
the
federal
regulations
governing
our
reimbursement
does
not
allow
us
to
reimburse
for
that
place
of
service
by
those
provider
types.
So
it
would
have
to
be
through
an
11
15
waiver
of
some
sort.
Would
you
be
open
to
pursuing
one?
We
would
be
open.
I
I
One
thank
you
for
that
openness
to
pursue
one.
Could
you
come
back
at
the
next
meeting
in
a
month
and
give
us
an
update
on
your
willingness
to
pursue
it?
We
I
think
it's
worth
investigating
to
see
as
a
payment.
We
have
other
states
that
are
doing
it,
we're
told
so,
let's
see
if
we
can't
provide
another
means
of
Revenue
there,
then
the
last
question
on
that
same
thought
in
the
MCO
space
commissioner
Lee.
This
is
where
I'm
really
vague
the
mcos
can't
they
provide
that
treatment
in
place.
Option
already.
K
There's
no
capitated
payment
for
it.
Currently.
What
we
would
have
to
do
is
allow
them
to
do
that
as
a
I
believe
and
Steve
will
have
to
correct
me
if
I
misspeak,
but
we
would
have
to
do
that
as
a
value
add
service
and
they
would
be
able
to
submit
that
cost
so
that
we
could
consider
it
as
part
of
their
spin
towards
medical
expenses
so
that
it
we
could
number
one
include
it
in
their
calculation
of
their
medical
loss
ratio,
because
the
mcos
are
held
to
a
90
medical
loss
ratio.
K
So
we
would
have
to
include
it
in
their
medical
loss
ratio,
and
then
we
would
have
to
look
at
those
costs
in
relation
to
their
capitated
payment,
their
capitation
rates
to
make
sure
that
we
continue
to
provide
sound
capitation
rates
for
them
to
deliver
those
Services
sure.
I
And
it's
easy
for
me
to
sit
up
here
and
say
this
is
sensible
and
logical
and
should
be
pursued.
That's
easy
for
me
to
say,
but
I
would
think.
In
my
limited
knowledge,
I
would
think
that
an
MCO
that's
getting
a
per
member
per
month.
Amount
of
money
is
if
they
can
keep
that
member
out
of
the
ER,
because
the
ER
got
an
iv
at
home,
provided
by
professionals
who
get
reimbursed
there.
There
would
be
some
savings
to
the
MCO.
I
would
think.
K
And
we
can
talk
to
the
Managed
Care
organizations.
I
know
they
operate
in
other
states
and
they,
if
they're
doing
this
in
other
states,
they
can
tell
us
how
they're
doing
it
and
again
that's
one
of
the
benefits
of
having
Managed
Care
organizations
in
our
state.
They
have
more
flexibility
than
we
do
in
the
fee
for
service
program
when
we
want
to
change
a
policy,
so
we
are
definitely
open
to
discussing
with
them.
Also
thank.
J
I
To
we
had
a
presentation
that
Indiana
was
doing
this
didn't
we
we've
got
a
clear,
a
clear
signal
that
Indiana
is
doing
some
treatment
in
place
and
getting
their
their
emergency
medical
professionals
reimbursed
for
it.
In
addition-
and
this
is
a
bit
of
a
stretch
but
in
addition
I
think
during
the
pandemic,
we
expanded
some
scope
of
practice
temporarily
for
some
folks
that
gave
paramedics
of
authority
in
hospitals
to
do
things
that
were
reimbursed
on
Medicaid.
A
I
just
want
to
have
a
clarification.
Is
there
anybody
no
I
just
want
a
clarification.
We
talked
to
the
other
day.
You
mentioned
how
the
providers
aren't
being
reimbursed
if
there
is
no
service
to
delivered
at
the
at
that
particular
situation.
Is
this
11
15
we'll
address
that.
A
Okay,
so
if
they
so
so,
they
are
basically
this
11
15
won't
address
the
that
run
to
that
location
right
and
if
there's
no,
if
they've
deemed
to
be
nothing
to
be
delivered,
then
their
their
Sol.
Basically.
K
Well
again,
I
think
that
the
the
issue-
brief
policy,
briefs
and
CMS
May
address
some
of
that.
So
we'll
get
that
information
and
summarize
it
for
you
and
provide
that
information
to
you
great.
C
That
you're
going
to
provide
as
a
summary
about
is
that
related
to
the
the
ongoing
surveys
for,
like
the
ground
base
ambulances
where
they're
collecting
data
for,
like
the
cost,
to
get
an
exact
cost.
K
Not
sure,
but
we'll
we'll
definitely
look
at
that,
it's
related
to
States
requesting
a
federal
funding
to
assist
with
Transportation
outside
of
our
normal
delivery
that
we
have
outlined
in
regulation
and
our
state
plan.
All.
A
Okay,
I
do
not
see
any
other.
Oh
thank
you
do
not
have
any
other
questions,
but
I
do
need
I'd
like
to
have
a
motion
on
the
minutes.
Is
there
a
motion?
I'll
approve.
Second,
no
proof:
oh
okay,
motions
to
further
minutes
have
carried.
Thank
you
very
much
appreciate
your
time
and
effort
and
know
what
y'all
do
and
we'll
loop
back
to
you
and
I
appreciate
Senator,
genovan's
question
and
so
we'll.
Let's
follow
up
with
you
as
well.
A
So
anyway,
next
meeting
is
going
to
be
the
October
18th
at
3,
P.M
and
Senator
co.
The
co-chair
give
as
well
we'll
manage
that
and
one
of
that
note.
A
Oh
I
need
to
note
that
the
response
on
the
certificate
of
needs,
burden
of
proof,
questions
in
your
packets
and
that's
came
from
the
oi
G.
So
make
sure
y'all
take
note
of
that.
Okay,
Express.