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A
A
A
We
do
have
a
quorum
and
we
are
constituted
to
do
business
first.
Item
on
the
agenda.
Is
approval
of
minutes
I'll
take
a
motion
for
that.
If
anyone
would
like
to
make
that
Motion
in
a
second
all
those
in
favor,
please
signify
for
saying,
aye
motion
carries
and
the
minutes
are
approved,
we'll
move
right
on
into
the
presentations
of
this
time.
The
first
one
is
an
update
on
child
welfare
in
Kentucky.
A
D
A
We
actually,
we
moved
the
agenda
around
a
little
bit
and
you
may
not
have
that
updated
agenda.
We
do
have
you
on
down
just
a
little
bit
there
Rachel.
A
F
There's
a
whole
crew
of
us
up
here
here:
I'm
Eric,
Friedland,
I'm,
Secretary
of
the
Cabinet
for
Health
and
Family
Services,
and
and
if
it's
all
right,
we'll
go
around
and
introduce
everybody.
F
And
behind
me
come
on
up
and.
F
So
we'd
like
to
begin
understand
that
there
are
really
questions
from
the
committee
and
we'd
be
happy
to
take
those
questions.
Certainly,
there
have
been
reports
in
the
media
about
challenges
that
we
face
within
our
child
welfare
system.
I
believe
many
of
us
have
have
testified
about
this
previously
in
other
committee
meetings
and
happy
to
talk
about
what
we've
attempted
to
do
to
address
the
issues
as
well
as
what
we
hope
to
to
do
and
continue
to
learn
as
we
move
forward.
F
I
I
have
just
a
little
bit
with
me.
We
pulled.
A
F
M
F
So
I'll
I'll
do
that.
We
have
many
different
states
and
I
think
we've
said
this
that
are
in
very
similar
situations,
I'll
be
happy
to
send
over
to
the
committee
the
American
Enterprise
Institute,
which
listed
about
11
states
actually
not
including
Kentucky,
that
are
having
very
similar
issues
in
terms
of
what
what
has
been
in
the
media
around
children
in
our
offices,
this
started
saw
a
little
bit
of
it,
probably
starting
about
six
to
eight
months
ago.
Maybe
longer
we.
H
Were
first
began
2022,
seeing
the
occasional
a
youth
that
may
need
to
spend
a
night
in
one
of
our
dcbs
offices,
because
we
were
not
able
to
find
the
appropriate
appropriate
placement
beginning
in
July.
We've
seen
that
Trend
to
that
Trend
increasing
in
2022
so
beginning
in
July
of
2022.
We
began
actively
tracking
the
occurrences
when
we
had
youth
in
what
we
call
a
non-traditional
placement.
So
when
a
youth
had
to
be
boarded
in
a
dcbs
office,
a
hospital,
a
hotel
or
other
type
setting,
so
we've
been
tracking
since
July
2022.
F
F
Sorry
so,
and
it
is
one
that
we
attempt
in
all
sorts
of
ways
to
avoid
this
group
that
I
have
here
so
I
just
want
to
give
you
really
a
a
really
solid
example.
This
group
comes
together
to
discuss
each
child
around
placement
needs
around
placement
possibilities.
F
I
think
I've
testified
before
in
again
that
Aetna
has
been
a
great
partner
with
us
to
try
to
help
us
find
spots,
and
those
of
you
who've
heard
me
testify
before
know
that
I
don't
often
complement
our
mcos,
but
I
I
do
hear
have
helped
us
with
getting
new
providers
in
Kentucky
have
helped
us
with
wrap
around
services
for
kids
in
Therapeutic,
Foster
Care,
so
we've
had.
The
number
is
about
a
we've.
F
So,
since
the
beginning
of
the
year,
those
87
youth
about
a
little
more
than
half
have
ended
up
in
what's
called
Therapeutic
Foster
Care,
so
that
would
be
a
specialized
foster
home
with
Services,
provided
to
assist
that
child
in
the
home
and
assist
the
foster
care
parent
in
dealing
with
what
could
be
those
behaviors
we've
got.
We've
had
about
30
kids
who've
ended
up
out
of
state,
which
is
again
not
what
we
want,
but
we
have
had
real
struggles
with
finding
placement
in
Kentucky.
F
We've
been
working
hard
on
that
we've
worked
with
Medicaid
to
work
on,
what's
called
a
single
case
rate,
where
we
try
to
tailor
a
payment
rate
and
a
service
package
to
the
individual
child.
I
I
was
very
hopeful
that
that
would
have
a
much
greater
impact
than
it
has
had.
Well,
we've
heard
from
our
provider
Community
is
that
it's
hard
to
build
a
a
business
model
on
a
one
by
one
rate,
we've
got
to
think
we've
got
to
look
and
do
something
else.
F
We've
contacted
other
states
and
requested
what
they
are
doing
and
we
haven't
found
the
answer.
Yet
we
continue
to
look.
This
has
been
a
real
challenge
for
us
and,
frankly,
a
challenge
for
social
workers
who
have
to
stay
in
in
offices
who,
who
get
really
I
talk
about
social
workers
as
everyday
Heroes.
This
is
another
example
of
that
and
that
they
will
stay
with
these
kids
oftentimes.
It's
short
term,
usually
a
day.
Maybe
two.
We
occasionally
have
a
kid
who
is
longer
because
we
can't
find
a
placement.
F
H
Who's
with
us
and
we
found
a
placement
and
it
disrupted,
and
he
is,
he
was
back
with
us
I
think,
maybe
in
a
respite
placement
now,
but
this
young
man,
yes,
has
been
with
us
for
a
number
of
weeks
on
and
off.
While
we
try
to
locate
treatment
and
placement
for
him.
F
Here's
the
thread
that
runs
through
all
these
kids
pretty
much
obviously
tremendous
abuse
and
neglect
in
the
home,
oftentimes
sexual
abuse,
oftentimes
physical
abuse,
so
which
leads
to
behavioral
health
issues,
PTSD
issues
and
when
a
child
in
any
facility
hits
or
attacks
a
staff
person
that
that
becomes
a
very
difficult
person
child
to
place,
and
that
is
something
we
when
we
met
and
talked
about
individual
children.
That
was
one
of
the
threads
that
ran
through
most
of
the
children
that
that
we're
seeing
there
are
disruptive
placements.
F
There
are
times
when
that
happens,
but
this
is.
This
is
a
challenge
for
Kentucky
no
question
about
that.
It
is
a
national
issue
that
we
will
continue
to
work
on.
I.
Think
out
of
the
Juvenile
Justice
recommendations
was
a
recommendation
for
state-run
hospital
I
get
nervous
about
that.
We
need
that's
going
to
take
too
long
that
will
take
years.
We've
got
to
find
something
more
quick
and
like
I,
say
I
was
hoping.
F
The
single
case
rate
would
work,
I
think
we're
going
to
have
to
look
at
seeing
if
there
are
ways
that
we
can
work
with
our
provider.
Community
we've
met
with
a
Hospital
Association
numerous
times.
We've
met
with
the
University
of
Louisville.
We've
met
with
peace,
we've
met
with
Norton's,
we've
met
with
UK,
and
we
have
yet
to
find
a
satisfactory
solution,
but
it
is
something
that
we
work
on
actively
every
day
so
I.
This
is
the
team
here.
This
is
the
group
that
works
on
it.
This
is
the
group
that
really
this
is
an
individual.
F
F
This
child
that
we're
talking
about
does
well
in
school,
does
well
on
two
to
one
does
not
do
well
in
in
a
facility
style
setting
and
I.
Don't
know
how
to
say
this
is
a
horrible
history
right.
It's
it's
horrendous,
but.
F
A
What
what
Solutions,
what
are
some,
what
are
some
potential
solutions
that
could
be
offered
for
this
situation,
and
is
there
anything
that
we
can
do
legislatively
to
help
fix
some
of
this.
F
I
think
there,
maybe
what
else,
what
I,
what
we
found
out
in
talking
to
peace
and
what
we
found
out
in
talking
to
some
of
the
children's
psychiatric
hospitals.
They
are
having
difficulty
moving
children
discharging
children
and
finding
a
safe
place
as
well,
so
they
end
up
being
full,
which
is
what
part
of
the
challenge
is.
We
think
we
need
to
look
at
at
rates
in
our
our
prtf
psychiatric
residential
treatment
facilities.
We
are
currently
looking
at
rates
in
our
psychiatric
residential
treatment
facilities.
F
Some
of
our
sister
States
North,
Carolina
I,
think
that's
right.
Georgia
Georgia
has
increased
those
rates.
I
think
we
need
to
look
at
increasing
those
rates.
We
will
come
with
something
hopefully
fairly
quickly
around
that,
but
it's
it's
finding
the
right
rate.
It's
it's
finding.
How
we're
able
to
to
support
our
partners
and
I
also
think
it's
about
finding
working
with
some
providers
around.
F
We
call
it
no
eject,
no
reject
that's
kind
of
a
a
term
that
that
we
we
talk
about,
but
it
is
how
do
we
collaborate
on
Admissions
and
discharge
for
some
of
these
kids?
F
We
are
we're
we're
working
on
something
now
to
see
if
there's
something
we
can
do
there,
but
I
hope
we're
weeks
away,
but
I
don't
know
that
we
will
certainly
share
that
as
soon
as
we
as
soon
as
we
have
it.
F
But,
as
I
said,
the
the
pieces
around
single
case
rate,
finding
additional
Services
to
support
Therapeutic
Foster
Care,
which
is
a
majority
of
where
we've
been
able
to
find
support
for
these
kids.
That's
that's
the
sort
of
thing
that
we
can
use
the
assistance
with
as
we
move
forward,
and
we
will
let
you
know
as
we
move
forward.
H
Most
of
our
most
of
our
youth
are
staying
short
term
in
our
offices.
For,
like
you
know,
one
to
two
days,
we
do
have
the
occasional
youth
that
will
stay
longer,
based
on
our
data.
The
longest
we've
had
a
youth
in
the
longest
number
of
consecutive
days
we've
had
a
youth
in
the
office
is
17
days
now
they
may
have
been
a
break
with
a
respite
for
a
few
days
and
then
they
returned.
A
And
then
I've
just
got
one
more
question
for
right
now
what
services
are
offered
to
these
children
when
they're
staying
in
the
in
in
the
cabinets
buildings.
H
Of
course,
we're
meeting
all
their
immediate
needs
and
making
sure
that
they
are
safe
and
again
meeting
their
immediate
needs,
but
it's
difficult
to
provide
services,
therapeutic
and
Clinical
Services
in
an
office
or
temporary
setting
we're.
Currently,
you
know
having
conversations
now
with
providers
about
some
opportunities
for
that,
but
again
it's
very
difficult
for
continuity
of
care
and
just
assessments
for
those
youth
to
receive
any
type
of
clinical
and
therapeutic
services
in
that
temporary
setting
the.
F
H
Also-
and
there
are
more
rural
in
our
more
rural
counties,
we
have
a
great
relationship
with
a
lot
of
faith-based
organizations
too,
who
support
the
department
again
with
that
was
opportunities
for
showering
and
different
things
activities
engagement.
So
we
do
have
plans
around
each
of
these
youth
when
they're
in
the
office
to
keep
them
engaged
in.
You
know
some
level
of
recreational
activity
and
making
sure
their
basic
needs
are
are
met
for
so
that
that
either
through
different
Partnerships
throughout
the
state.
We
have
that
in
place.
A
H
It
is
usually
you
know
one
or
two
across
the
state
at
any
given
time.
Would
you
not
say
so
you
know
so
it
you
know
just
varies
depending
on
you
know
what's
happening,
but
usually
you
know
it.
You
know
two
or
one
two
or
three
at
any
given
time.
F
Is
one
of
those
trends
that
started
in
our
more
rural
offices
and
then
really
spread
to
our
Urban
offices?
We
were
seeing
that
in
in
smaller
offices
across
the
state
first
and
then
in
the
beginning,.
H
Of
this
year,
we
really
begin
to
see
it
in
the
more
urban
areas.
A
And,
of
course,
most
of
our
dcbs
offices
are
located
close
to
a
city
or
town
or
and
a
lot
of
times
in
the
urban
areas,
with
that
being
that
number
of
children,
one
or
two
three
a
night.
Why
does
the
state
not
partner
with
say,
hotel
or
something
to
put
those
kids
up
for
a
night.
H
We
do
that's
one
of
the
options
as
well,
but
depending
on
again,
some
of
these
areas
are
very
rural.
There's
not
always
an
opportunity
for
a
hotel
to
be
nearby
transporting
these
youth
with
some
of
those.
These
higher
needs
and
behavioral
health
issues
can
be,
comp
can
be
at
risk
as
well
and
then
Staffing
becomes
a
can
become.
H
A
issue
is
also
when
you're
in
a
hotel
setting
if
staff
have
to
travel,
long,
distance
back
and
forth,
and
then
there's
sometimes
there's
safety
concerns
and
we
need
to
be
in
a
setting
such
as
the
office
where
we
can
have
additional
supports
around
that
that
youth.
So
all
of
that
is
gone
all
that
goes
into
the
decision,
but
we
have
used
hotels
but.
F
It's
pretty
little
state
parks
yeah
state
park.
It
is
that
is
not
that's
the
exception,
not
the
rule.
When
you
look
at
our
non-traditional
placements,
that's
the
Rarity
and-
and
it
really
is
it's
a
safety
issue
right.
Most
of
these
kids
have
have
acted
out
in
a
way
that
have
disrupted
placements,
possibly
with
fighting
and
so
to
put
that
youth
in
a
hotel
might
also
then
again
caveat
always
social
workers
as
everyday
Heroes,
but
you
then
might
also
put
the
general
public
at
risk.
H
H
F
O
F
Let
me
just
say
that
our
our
social
workers
are
at
some
risk,
no
question
and
that
that's
just
true.
A
Before
we
continue
I'll
I'll
preface
everything
with
this
I
have
no
doubt
about
your
heart
and
where
you
all
stand,
I
know
how
you
feel
about
the
children.
I
know
what
you're
doing
you
care
about
you.
You
are
doing
it
because
it's
a
passion
and
you
want
to
take
care
of
those
that
are
most
vulnerable,
so
I
just
I
just
want
to
say
that
before
we
we
continue,
but
at
this
time
I'll
turn
it
over
to
Senator
Rocky
Adams.
P
P
P
Okay,
so
how
many
Therapeutic
Foster
Care
families
have
come
online
since
last
year,.
I
So
I
don't
know
exactly
how
many
more
have
come
on
board,
but
across
the
state
we
have
many
licensed
beds
so
for
Therapeutic,
Foster
Care
we're
probably
only
about
50
percent
filled,
it's
more
of
the
the
Acuity
of
the
children's
needs
that
foster
homes
and
agencies
feel
like
that.
They
can't
accept
a
placement.
I
Largely
it's
due
to
the
Acuity
of
the
needs.
These
children
have
very
high
needs,
behavioral
needs
and
clinical
needs,
and
a
lot
of
the
therapeutic
agencies
for
both
residential
and
Foster
Care
just
feel
like
they
cannot
therapeutically
meet
their
next
setting.
Now
that
does
not
include
that
number
does
not
include
prtf
beds
or
psychiatric
hospital
beds.
That's
just
Therapeutic
Foster
Care
private
agency
beds
and
residential
beds.
I
F
So
the
issue
is,
if
I
may
sure
that
we
have
probably
made
hundreds
of
hundreds
of
attempted
placements
for
tens
of
kids
I
mean
it
is
that
kind
of
ratio
where
we
have
asked
different
facilities,
whether
they
will
admit
and
they
will
not,
and
we
we've
experienced
that
across
the
board.
F
P
P
P
Not
doing
you're
not
I
mean,
with
all
intents
and
purposes
and
I'm
very
frustrated
here
and
I
know
that
you
all
are
frustrated
too,
but
these
are
all
non-answers.
These
are
non-actionable
items
that
we're
seeing
here
and
I'm
the
first
one
to
say:
if
you
need
some
additional
funds,
if
you
need
some
additional
Authority,
what
is
it
that
you
need
so
that
we
can
help
you
do
your
job
better.
G
That
provider
is
currently
getting
credentialed
and
going
through
their
application
process
in
Kentucky
with
Medicaid.
We
are
hoping
that
they
will
be
ready
to
start
to
serve
some
children
early
in
the
fall
pending
those
approvals
in
that
credentialing
process.
This
will
be
the
first
time
in
quite
a
while
that
we've
had
intensive
in-home
services.
I
think
that
will
help.
That
certainly,
is
one
piece
of
the
puzzle
right.
This
is
a
complex
Continuum
of
Care
and
we're
right.
We
need
to
have
services
at
multiple
levels
of
that
Continuum,
but
we
do
hope
that
that
that
helps.
P
Thank
you
and
thank
you.
Mr
chairman
and
I
will
reiterate
once
again
that
please
let
us
know
what
we
can
do,
because
we
need
to
get
out
of
this
situation
that
we're
currently
in
it's
not
good
for
you
all.
It's
not
good
for
the
child,
it's
not
good
for
our
social
workers
and
and
we
we
need
a
a
paradigm
shift
here.
So
thank
you.
E
Thank
you,
chair,
I
I
want
to
actually
ask
a
question
officer:
Julie
Rocky
Adams.
You
said
that
a
organization
told
you
no,
they
would
not
take
the
child.
E
F
It's
a
good
question,
but
they
they
control
their
admissions,
and
that
is
we
make
referrals.
Is
that
the
right
word?
Okay,
thank
you.
We
make
referrals
and
they
can
choose
not
to
accept
the
referral
and-
and
it's
not
just
one
organization.
It
is
that's
why
I
said
earlier
about
no
no
rejection.
We
we
need
somebody
that
we
can
say
that
to
right.
If
you
don't
do
it
we're
going
to
pull
your
contract,
we
that's
why
we
need
to
come
up
with
another
group
of
folks
that
will
be
able
to
do
that
again.
F
I
thought
the
single
case
rate
was
going
to
do
it,
but
it
didn't
so
we're
going
to
need
to
go
in
another
Direction,
and
so
it's
it's
not
just
one
facility,
Senator
Adams,
to
your
point,
a
lot
of
the
prtfs
that
we've
asked
and-
and
we
don't
have
enough
prtfs
periods-
you
are
correct
in
that
they
haven't
been
taking
these
kids
either.
E
I
would
be,
can
I
make
a
comment.
Thank
you.
I
would
be
very
interested
in
talking
to
them,
because
I
think
most
of
them
come
and
ask
for
funding
from
the
state.
You
know
here
comes
2024
the
budget
year
and
they're,
going
to
start
asking
for
money
and
I
would
like
to
have
the
conversation
with
them
to
see.
You
know
they're
in
business
to
help
children,
but
they
pick
and
choose
who
they
help.
I,
don't
think.
E
C
Thank
you
chair
a
couple
of
questions
and,
and
perhaps
a
comment
as
well,
but
my
first
question
is:
is
there
any
sort
of
common
thread
or
profile
as
to
the
individual,
the
youth
that
fits
the
profile
of
what
we're
talking
about
when
we're
you
know
discussing
children
not
being
able
to
be
placed
staying
in
offices
as
far
as
their
age,
their
race,
their
gender,
their
gender
identity,
the
length
of
time
they've
been
in
foster
care
or
the
length
of
time
that
maybe
that
home
has
had
an
open,
CPS
case
on
them.
H
So
when
we,
when
we
talk
sorry
so
when
we
talk
about
high
Acuity
youth,
Within
dcbs
These
are
you
they
usually
present
with
you
know,
intensive
both
behavioral
and
mental
health
needs
complex
issues
and
they're
likely
to
be
adolescent
adolescence.
Their
average
age
is
15.,
the
majority
of
them.
52
percent
are
male
they're,
likely
committed
to
dcbs
for
dependency.
They
have
DJJ
prior
involvement
or
current
or
prior
involvement.
We
have
seen
a
trend
with
adoption
disruptions,
as
well
as
medically
complex
youth.
H
K
Medical
director
for
Behavioral,
Health
and
Child
and
Adolescence.
K
B
A
Q
K
Q
A
K
K
In
my
opinion,
we
need
more
psychiatric
hospitals
that
can
serve
children
with
autism
or
on
the
autism
spectrum
that
would
solve
another
10
I
think,
but
a
substantial
number
of
these
would
need
residential
or
Therapeutic
Foster,
Care
and
I.
Think
that's
the
issue
that
we
have
is:
what
will
it
take
to
support
those
providers
so
that
they'd
be
more
willing
representative
Hebron
said
to
take
the
more
difficult
child.
K
K
K
J
C
I
am
a
former
foster
parent
with
the
state
for
six
and
a
half
years,
so
the
description
you
gave
me
was
not
a
surprise
to
me,
but
I
think
it's
important
that
people
understand
that
is
kind
of
the
general
profile
of
who
you
are
trying
to
fit
just
so
that
folks
could
put
a
you
know
a
picture
in
their
head
and
as
somebody
who
has
received
several
calls
in
the
six
and
a
half
years,
that
I
was
with
the
state
I've
probably
heard
of
every
scenario
where
kids
have
not
have
burned
every
bridge
right
so
to
representative
Heron's.
C
C
No
one
will
take
this
child
and,
while
I
think
it
merits
a
conversation,
I
think
the
flip
side
to
that
coin
is
is
that
we
need
to
consider
that
program
may
not
want
that
individual
back
for
a
multitude
of
reasons,
and
that
individual
actually
may
not
be
interested
in
going
back
either
talking
to
kids
and
listening
to
some
places
that
were
easier
for
them
and
they
felt
supported
in
other
areas
that
just
were
not
a
good
fit.
C
For
you
know
a
potential
multitude
of
reasons,
I'm
just
curious
about
you
know
what
you
did
bring
some
things
to
light.
That
I
think
are
important
as
far
as
kids
with
the
intellectual
disabilities,
which
I've
had
kids
that
fit
all
of
these
profiles
that
you
speak
of,
but
also
you'd
mentioned
when
I
asked
about
the
profile
about
these
kids
that
are
already
committed
to
the
state.
So
there
has
already
been
a
tpr,
a
termination
of
parental
rights.
C
Unfortunately,
we
got
a
lot
of
people
out
there
that
want
babies
and
that's
great.
We
need
people
who
need
to
want
the
babies,
but
we
also
need
people
who
you
know
will
take
all
our
other
kiddos
and
give
them
a
loving
place
to
land.
So
I'm
just
curious
about
any
data
that
you
all
might
have
for
that.
K
I
K
What
is
wrong,
but
they
will
test
limits,
and
some
of
that
is
part
of
a
system
that
has
failed
to
serve
them
earlier.
You
I,
don't
think
we
should
ever
have
this
conversation
without
take
talking
about
prevention,
early
intervention
support.
We
as
a
system
have
share
a
lot
of
responsibility
for
creating
these
kids,
who
are
now
what
we
call
High
acuity.
K
K
H
A
How
many,
how
many
foster
homes
do
we
have
right
now.
A
J
A
I
A
I'm
gonna
switch
gears
just
a
little
bit
while
I've
got
you
up
there
to
ask
you
some
questions.
We've
talked
a
lot
about
Behavior,
Health
and
and
the
the
need
for
more
behavioral
health
programs,
and
things
like
that.
A
J
So
our
Behavioral
Health
fee
schedule,
we
had
two
Behavioral
Health
fee
schedules.
One
was
an
inpatient.
One
was
an
outpatient.
We
combined
those
fee
schedules
and
when
we
did,
we
chose
the
highest
rate
on
each
one
for
the
services.
However,
our
Behavioral
Health
fee
schedule
is
tied
to
the
Medicare
fee
schedule.
We
pay
a
percentage
of
the
Kentucky
specific
Medicare
fee
schedule
so
when
Medicare
changes
their
rates,
air
rates
automatically
align
with
theirs.
F
So
there
was
a
so
there
was
a
reduction
when
Medicare
reduced
and
we
had
talked
about
and
had
talked
through,
that
we
weren't
going
to
reduce
any
rates
and
it
took
a
conversation
actually
I'll
say
I'm
with
home
of
the
Innocents
showing
me
where
that
rate
was.
They
gave
us
a
bunch
of
rate
cells
and
they
showed
where
a
rate
had
declined
and
we
went
back
to
Medicaid
and
and
we
fixed
it.
F
So
there
was
a
period
of
time
when
the
rate
had
declined
and
actually
I
didn't
know,
and
it
wasn't
until
I
heard
from
home
of
the
Innocents
and
actually
Arc
I.
Think
that
brought
that
delight
and
appreciate
them
coming
forward
and
letting
us
know
that
we
needed.
We
had
made
a
mistake
and
needed
to
fix
it.
A
A
I
would
just
say
that
we
we've
known
this
problem
has
been
going
on
since
July
2022.
It's
probably
been
going
on
a
little
bit
longer
than
that
from
from
my
understanding
and
for
us
we're
not
involved
in
it
every
single
day,
so
it's
just
kind
of
coming
to
light
for
us
and
if
we're
talking
about
needing
to
raise
rates
or
we're
needing
to
put
more
investment
into
some
of
these
Services,
whatever
it
may
be,
both
Senator,
Adams
and
I
are
on
the
budget
Committee.
A
In
order
to
put
some
of
these
things
in
that
budget,
we
didn't
hear
anything
about
it.
The
last
time
we
did
a
budget,
we
haven't
heard
anything
about
it
up
until
now
and
I
just
think
that
we
need
to
do
a
little
bit
better
I
think
in
communication
between
all
of
us
in
order
to
benefit
the
children
a
little
bit
more
of
this
state
and
I
think
these
are
our
children
that
are
the
most
vulnerable
of
this
state
and
we
have.
A
We
have
failed
them
in
several
ways
and
I
think
we
all
just
need
to
pull
together
and
start
working
together.
You
all
have
been
very
good
at
working
with
us.
I
can
tell
you
secretary
friedlander,
commissioner,
Dennis
you've
done
a
great
job
with
working
with
us,
and
but
I
will
say
that
the
governor
himself
and
his
administration
has
not,
and
we
need
to
do
better
in
the
future.
P
A
If
not,
we
can
continue.
I
think
you
all
are
pretty
much
there.
The
entire
time,
so
whatever
you
got
next
to
present
will
be.
F
Thank
you
for
thank
you
for
this
hearing.
You
you
and
Senator
Adams
are
correct.
This
is
a
tragedy,
it's
a
tragedy,
and
it
is
something
that
none
of
us
want
and
Senator
Adams
again,
you
are
correct.
We
can't
be
that
state.
These
are
kids.
These
are
kids.
E
Thank
you,
chair,
I,
think
we've
had
three
closing
statements.
Maybe
four:
it's
the
ones
that
like
to
talk.
Thank
you
for
your
remarks,
but
I
do
want
to
say
with
that.
You
know
you
all.
You
all
are
their
front
line
all
these
organizations
that
they
come
to
you
to
have
conversations
and
I
really
do
expect
you
all
to
put
heat
on
these
people
because
they
are,
you
know
it's
not
just
it's,
not
the
parents
that
alone
these
are
Kentucky's.
E
E
I
have
no
doubt
that
Senator,
Adams
and
chairman
me
do
as
well,
and
it
really
does
need
to
be
a
a
part
of
all
of
us
working
together,
but
it
starts
with
you
all
too,
of
having
the
hard
conversations
with
those
organizations,
because
we
need
answers
and
I
made
a
note.
You
know
they're
asking
for
more
money,
but
nothing's
getting
better,
and
so
why
would
we
pay
people
more
if
they're
not
even
able
to
do
the
job
that
they
can
to
help
our
kids
and
our
future?
E
So
just
some
food
for
thought
on
that.
Thank
you
all,
especially
secretary
friedlander.
Thank
you
for
your
partnership
and
this
new
chairman
role
of
mine,
but
I
Echo.
What
chairman
Mead
said
is
it's
not
your
Administration,
that's
doing
it's
the
cabinet,
that
is
the
open
door
and
having
the
conversations
it's
nothing
from
the
governor's
office.
Thank
you.
A
And
I
apologize,
my
co-chair,
Senator
Meredith
got
came
in
late
due
to
a
committee
that
he
was
in
and
I
forgot
to
ask
him
if
he
might
have
any
comments
or
questions.
M
I
know
it's
difficult:
I
do
I,
think
one
of
the
things
concerns
me
in
central
Adams
made
reference
to
it
as
we
put
this
budget
together.
This
next
biennial
I'm,
not
sure,
we've
identified
the
total
needs
of
the
Medicaid
Program
I've
met
with
two
different
groups.
This
morning,
who've
been
complaining
about
their
rates
and
no
increases
for
20
years.
You
know
we
that
particularly
myself
and
Senator.
Carroll
I
have
some
real
issues
about
the
waiver
programs
and
the
number
of
people
we
have
on
the
waiting
list
and
I'm
not
on
appropriation
Revenue
anymore.
M
So
it's
a
little
bit
bothersome
to
me
that
sometimes
I,
don't
know
how
we're
going
to
address
this.
Unless
we
do
it
piecemeal
and
I.
Think
that's
part
of
the
problem
is
your
rob
peter
the
pay,
Paul
and
I'm
not
sure
that's
the
best
approach
either,
and
that's
not
you
folks,
it's
gone
on
for
years
and
years
and
years
and
I
think
we
need
a
very
Frank
candid
assessment
of
where
is
our
Medicaid
Program
I
was
respect
to
each
of
these
services
that
we
offer
in.
Where
are
the
holes?
Where
can
we
establish
some
priorities?
M
I
think
that's
what
most
were
so
vocal
about
the
expansion
of
Medicaid
benefits
is.
How
can
we
do
that
when
we
have
so
many
of
these
other
needs
that
are
out
there
so
I
don't
know
how
we
develop
a
comprehensive
policy
to
try
to
identify
what
those
needs
are
and
address
those
needs
and
I
think
this
is
kind
of
symptomatic
of
it
is
we
know
it's
been
there.
M
We
know
it's
an
issue,
but
we
just
hope
it
doesn't
come
to
light
and
then,
when
it
does,
we
have
to
react.
We
want
to
be
more
proactive
and
I'm,
not
sure
how
we
do
it
and
we
identify
all
the
Medicaid
needs.
We
know
that
we
can't
fund
everything,
but
I
think
the
legislature
should
have
some
input
into
that
process.
As
part
of
that
input,
we
set
part
of
the
responsibility.
M
I
don't
have
any
problem
with
that,
but
we
need
to
know
and
I
think
we
should
have
some
latitude
in
terms
of
what
those
priorities
are
in.
Maybe
it's
a
10-year
plan.
We
knock
off
this
one.
This
behind
you
on
the
forward,
but
I
think
we
really
need
to
know
how
I
think
this
is
appropriate.
Word
underfunded.
Our
Medicaid
Program
is,
and
how
can
we
address
that
and
you
you've
heard
me
a
thousand
times
secretary
about
there's
enough
money
there
to
take
care
of
everyone.
M
If
we
spin
it
the
right
way
and
I'm
not
still
I'm
still
not
convinced
we're
spending
it
the
right
way,
both
from
a
bureaucracy,
standpoint,
administrative
cost
standpoint,
improving
the
health
of
our
population.
We've
got
to
be
more
focused
on
this
and
developing
more
comprehensive
strategies.
How
we're
going
to
address
all
these
shortfalls
and
again
Senator
Adams,
will
quote
me
one
of
my
favorite
sayings.
Is
we
never
measure
the
cost
of
doing
nothing
and
I?
M
Think
if
we
did
we'd
find
out
that
a
lot
of
costs
there
that
we
think
we're
neglecting
but
we're
not
it's
just
showing
up
someplace
else
and
that's
what
we
have
to
do
is
more
comprehensive
approach
to
this
than
we've
had
in
the
past,
but
my
apologies
for
being
late
to
Mr.
Chairman
I
appreciate
the
opportunity.
Thank
you.
A
Thank
you
all
very
much
appreciate
it,
and
commissioner
Dennis
want
to
say
I'm
glad
that
you're
in
your
position,
you've
you've
been
there
a
long
time
and
and
we've
worked
together
on
several
things
and
you're,
always
very
professional
and
always
up
front
and
really
appreciate
the
job
that
you
do.
A
Let's
go
yes,
next
I'm
going
to
ask
Andrea
and
Melinda
if
they'll
come
up
to
give
a
presentation
on
casa
and
if
you
would,
as
you
come
up
just
introduce
yourself
into
the
microphone.
L
R
So,
as
Andrea
said,
Casa
stands
for
court
appointed
special
Advocates.
But
what
exactly
is
that
that
is
a
train
and
supervised
volunteer
that
comes
from
our
community
by
Kentucky
statute?
They
need
to
be
at
least
21
years
of
age.
They
undergo
various
background
checks
that
we
do
on
them.
They
are
screened
and
then
they
go
through
a
30-hour
training.
R
The
casa
volunteer
recommended
eyeglasses.
That
judge
ordered
it.
Within
two
weeks
she
was
moved
into
the
advanced
reading
group
education
and
break
her
out
of
a
cycle
that
she
was
born
into
no
fault
of
her
own.
The
casa
volunteer
is
a
consistent
for
these
children.
They
are
required
to
have
monthly
visits
with
the
child
and
this
little
infographic
sort
of
shows
the
process.
But
ultimately
a
judge
needs
to
appoint
a
volunteer.
R
We
can't
become
engaged
with
a
child
until
the
judge
appoints
a
casa
volunteer
to
the
case,
then,
within
our
local
programs
who
work
to
match
a
volunteer
to
that
child.
We
love
when
we
can
match
a
volunteer
that
is
of
the
same
gender
identity
speaks
the
same.
Language
knows
the
culture
of
a
job,
but
that
volunteer
is
appointed
to
that
child
or
sibling
set.
We
keep
siblings
together
unless
a
sibling
has
perpetrated
on
another
sibling,
and
then
they
get
separate
Casa
volunteers
or
right
now
we
have
an
11
sibling
case.
R
So,
although
my
program
serves
Seven,
Counties
I
think
we
had
kids
in
68
counties
last
year,
so
our
volunteers
are
driving
all
over
the
state
to
see
these
children,
and
so
essentially
the
casa
volunteer
stays
involved
until
the
case
close,
and
that
can
happen
several
different
ways
and
one
difference
is
if
the
case
closes,
whether
it's
adoption
or
return
home.
The
casa
volunteer
can
request
to
stay
on
that
case
for
a
3
to
six
months
after
so,
although
the
cabinet
is
finished
at
that
point,
the
casa
volunteer
can
stay
to
ensure.
R
So
at
my
program
cast
of
Lexington,
we
do
cover
the
Seven
Counties.
We
are
a
501c3
and
currently,
in
this
fiscal
year,
16
of
our
budget
comes
from
the
state
general
fund.
To
let
you
know
what
that
percentage
looks
like
in
2022
for
the
calendar
year
we
had
247
Casa
volunteers
that
were
actively
matched
on
a
case
and
we
served
671
children
over
our
Seven
Counties
and
in
case
you're
unaware
Casa
volunteers
are
involved
with
foster
care
review
board.
We
are
invited
to
Family
Team
meetings.
R
We
work
with
the
multidisciplinary
teams
in
our
different
areas
of
service
with
the
CAC
and
are
involved
in
all
of
that,
so
Casa
works
with
many
partners.
We
do
receive
a
court
order
by
the
judge
specific
to
that
case,
and
we,
the
report
that
I
mentioned,
does
go
to
the
social
workers
as
well
as
the
gals
and
all
of
the
parties
in
that
case
and
becomes
part
of
the
court
record.
R
We
do
also
by
Statute,
communicate
the
child's
wishes,
through
those
reports
and
with
the
gal,
and
so
we're
sharing
information
and
really
just
another
set
of
eyes.
On
that
case,
and
most
of
our
casa
volunteers
have
one
case,
so
they
can
spend
a
whole
lot
more
time,
dedicated
to
that
one
case
and
the
power
through
that
written
report
is
in
providing
those
recommendations
like
I
mentioned,
whether
that
is
eyeglasses
for
a
child
or
looking
at
return
home
to
the
family,
the
home
of
origin.
R
R
So,
although
we've
been
recruiting
more
Casa
volunteers,
we're
unable
to
serve
as
many
children
to
some
degree
because
it's
taking
more
volunteers
to
serve
those
children,
because
the
length
of
a
case
has
stayed
open
longer,
at
least
in
our
area,
on
the
cases
that
were
assigned,
we
also
have
seen
lack
of
foster
care
and
residential
placements,
and
we've
talked
about
that
at
length
already
I
know.
My
local
program
was
requested
to
provide
snacks
and
wipes
for
children
in
the
office
where
we
serve
so
the
children
could
use
the
wipes
since
there
were
no
showers
available.
R
That
is
not
something
we've
currently
partnered
with,
but
that
definitely
brought
it
to
my
attention
that
there
was
some
concern,
but
bigger
than
that
I
think
one
of
the
things
that
concerns
me
and
that
we've
seen
in
our
program
is
with
the
I
believe
it's
on.
Here,
too.
The
case
acceptance
criteria
and
at
fault
no
longer
being
grounds
that
the
number
of
children
coming
in
is
definitely
decreased.
R
Two
siblings
one
was
sexually
abused,
but
the
one
that
was
not
sexually
abused
did
not
meet
the
criteria
and
so
that
from
my
local
program,
my
staff,
that's
our
largest
concern
right
now,
even
though
we
agree
that
it's
concerning
that
we
don't
have
enough
placements
for
the
children.
We
have
I
think
a
positive
we've
seen
that
social
worker
turnover
is
improving
in
our
areas.
R
I
think
that's
a
great
thing
because,
as
the
more
consistent
we
can
be
with
the
cases,
I
think
is
a
positive
for
everyone,
but
we
definitely
did
see
how
there
was
turnover
over
the
years,
but
now
we're
on
a
trend
of
improvement
there
and
we've
definitely
been
appointed
to
more
cases
that
have
a
previous
word
used
Acuity
issues,
including
substance
abuse
disorder.
Mental
health
diagnosis
is
as
well
as
older
youth
that
have
different
challenges
and
in
some
cases
have
to
consider.
R
Is
that
ideal
case
for
Casa
volunteer
even
I
know
in
one
of
our
counties
we
were
asked
to
go
into
a
home
where
it
was
an
educational
neglect,
so
there
wasn't
cabinet
services
in
there
and
The
Sibling
of
the
child.
We
were
being
appointed,
had
drug
I
mean
drug
gun
charges
and
so
factoring
in
do
we
send
a
volunteer
into
that
home?
So
those
are
some
of
the
trends
we
have
seen
at
our
local
program.
L
L
We
are
the
contractor
of
the
state
general
funds,
so
we
administer
those
funds
to
Costco
Lexington
and
to
all
the
local
Casa
programs
in
Kentucky.
We
are
in
statute,
so
we
provide
technical
assistance,
training
quality
assurance
as
Melinda
mentioned.
Casa
volunteers
have
to
go
through
a
very
arduous
30-hour
of
pre-service
training
background
check,
so
we
in
the
KRS
we
monitor
for
compliance,
and
our
big
issue
is,
and
our
work
is
really
centered
around
building
out
the
casa
Network,
so
I
have
a
couple
slides
that
I'm
really
proud
to
share
with
you
today.
L
That
really
demonstrates
the
investment
by
this
legislature
to
build
out
this
network.
Here
we
were
in
August
of
2015
you'll,
see
I,
think
it's
like
thin
in
the
high
30s
here
by
the
counties
that
were
covered,
and
then
here
we
are
in
today
July
of
2023..
So
this
is
our
growth
plan.
L
You
may
ask
the
question:
why
are
we
not
in
some
of
the
other
counties?
So
the
answer
to
that
is:
we
have
to
be
invited
in
by
the
judge,
so
we
are
making
progress
so
that
we
can
cover
Kentucky
with
Casa
so
that,
as
we
heard
earlier,
when
children
are
placed
in
in
you
know,
residential
foster
care.
We
also
are
about
50
of
our
cases,
our
kids,
who
are
not
in
care.
L
So
we
are
about
family
reunification
when
it
is
safe
to
do
so,
and
about
50
of
our
our
kids
are
not
in
foster
care.
They
are
relative
placement
or
in
the
home
and,
as
you
know,
a
case
can
start
out
being
in
Foster.
Excuse
me
being
not
being
in
care,
but
then
a
child
would
be
moved
to
care.
So
it's
a
little
bit
about
our
growth.
This
is
our
Statewide
data,
just
so
that
you
can
see.
This
is
also
in
our
binary
report.
The
number
of
children
served.
L
Our
active
volunteer
number
hit
a
high
of
13
13.
Actually,
in
2019
covid
we
saw
a
slight
decrease
similar
to
what
we're
seeing
across
the
country
a
little
bit
of
decline
in
volunteerism,
but
with
our
growth
we've
been
able
to
to
net
some
of
that
and
to
remain
remain.
Pretty
constant.
One
of
the
things
I
wanted
to
point
out
here
is
Melinda
noted
is
the
decline
of
AOC
petitions
filed.
That
is
generally
a
good
thing
that
children
are
not
before
the
court.
L
It
has
had
an
impact
on
some
services
that
are
not
happening
to
kids,
who
who
may
still
need
them,
because
it's
not
Court
active
if
you
just
to
compare
these
numbers.
If
you
looked
at
2015
2016
numbers
on
those
AOC
petitions
filed
you're,
looking
at
twenty
four
thousand,
so
you
can
see
that
the
decline.
So
generally,
that's
a
that's
a
positive,
but
we
can
look
at
these
last
three
years
and
look
at
the
impact
that
kovitz
had
and
Reporting.
So
in
terms
of
recommendations
for
improving
child
welfare.
L
L
We
also
want
to
sort
of
brag
about
I
think
we
have
someone
from
Hardin
County
here,
it's
just
a
great
it's
a
very
simple
solution
where
the
dcbs
office
in
Hardin
county
is
partnering
with
a
casa
program
and
they've
identified.
One
staff
person,
who
is
the
Costa
liaison,
seems
pretty
simple,
but
it's
working
really
well.
So
when
a
case
is
closed
or
our
case
is
still
on
a
wait
list,
the
program
gets
a
heads
up
as
to
what
cases
are
a
priority.
L
So
we
think
that's
a
good
pilot,
and
this
is
a
small
one,
but
in
statute
it
lists
CHF.
Employees
cannot
be
a
causal
volunteer.
There
is
an
inherent
conflict
with
a
dcbs
employee,
but
we
believe
that
as
chfs
employee
would
be
a
great
cost
of
volunteer.
So
in
the
next
session
we
will
like
to
like
to
have
some
language
that
strikes
the
word
chfs,
but
just
uses
the
word
dcbs,
because
there
would
be
a
conflict
with
dcbs
but
not
chfs
and
then
in
terms
of
recommendations
for
the
broader
improvements
into
child
welfare.
L
So
we
believe
that
there
should
be
an
increase
in
guardian
litem
fees
for
court
appointed
Council
they're
not
paid
very
much
at
all.
It
impacts
the
cost's
role.
Sometimes
the
guardian
Alum
does
not
visit
the
child
on
the
case.
They
have
multiple
cases
and
essentially
are
doing
this
pro
bono,
so
we
can
see
a
big
benefit
in
increasing
that
that
amount
Melinda
mentioned
a
little
bit.
L
We
didn't
go
into
too
much
detail
about
the
the
new
risk
of
harm
in
the
structural
decision,
making
model
just
working
with
dcbs
about
that
for
some
additional
training
so
that
we're
not
leaving
siblings
in
the
home
and
that
and
that
that
training
is
being
rolled
out
in
every
region.
L
Also,
more
resources
and
support
for
fictive
and
relative
placements
for
removals
that
are
not
core
active
cost
is
only
involved
when
it's
core
active
there's
a
lot
of
resources
that
fictive
can
and
and
relative
placements
need
that
aren't
getting
because
they're
not
Court,
active
and
then
support
for
family
recovery
courts.
I'm,
not
an
expert
on
family
recovery
courts,
but
there's
some
great
work
being
done
in
about
six
or
seven
counties
now.
I
know
that
VOA
is
doing
it's.
L
It's
sort
of
I,
think
it's
very
Casa
like
and
what
drug
court
was
doing
is
is
sort
of
triaging
those
cases
and
there's
there's
some
really
significant
success.
I
know
happening,
judge
Harris
in
Jackson
County,
Clay
County,
so
we
we
think
additional
support
for
family
recovery
courts
should
be
something
that
should
be
on
all
of
our
radar.
L
So
a
little
summary
of
our
budget.
Where
we
were
I
mentioned,
we
were
not
in
the
state
budget.
Until
2016.
we
were
one
of
eight
states
at
that
time.
That
did
not
receive
any
state
funding.
I'm
happy
to
report
I
believe
recently
I.
Think
Pennsylvania
was
the
last
in
West
Virginia.
Every
state
now
funds
their
cluster
program.
So
we're
very
thankful
about
that,
and
this
is
a
history.
L
We
were
at
1.5
each
year,
3
million
in
the
baniel
dipped
a
little
bit
1.42
in
19
and
20
during
covid
maintained
at
1.5,
and
then
an
increase
this
past
year
at
3
million
in
terms
of
looking
forward
ahead
into
25
and
2026,
and
the
fiscal
year
budget,
just
to
kind
of
give
you
Melinda
talked
about
their
16
of
their
program
across
the
board.
Casa
is
about
the
state
funds
about
36
percent
of
all
of
our
operations.
L
So
this
past
year,
2022
Casa
programs
spent
about
7
million
in
expenses,
we're
looking
to
have
some
increased
funding
in
those
two
upcoming
years
for
many
reasons,
one
to
build
out
our
network,
but
the
other.
The
other
thing
to
note
is
that
there
was
going
to
be
a
decline
in
federal,
Voca
funding
that
is
ministered
by
the
justice
and
Public
Safety
cabinet,
and
we
want
to
encasa,
as
many
providers
in
this
work
are
very
reliant
on
those
funds.
L
Casa
stems
to
get
impacted
by
that,
so
we
want
to
get
ahead
of
that
problem,
so
this
details,
what
that
increase
would
be.
You
know
we
take
our
stewardship
of
these
dollars
very
seriously
and
we
put
them
to
good
use
to
serve
children
and
to
recruit
volunteers,
and
would
only
ask
for
funds
that
enable
us
to
continue
to
do
that
great
work
and
to
build
out
our
Network.
So
our
request
here
at
the
bottom
is
3.74
million
per
FY
for
each
fiscal
year,
the
next
two
years.
A
First
off,
thank
you
all
for
what
you
do:
I'm
a
big
fan
of
Casa
and
what
the
work
that
you
all
do:
I
think
that
we've
seen
that
outcomes
improve
when
Acasa
workers
help
them
work
with
that
child
I
do
have
just
a
couple
of
questions.
So,
if
you're
in
an
area
that
caseworker
or
that
social
worker,
do
they
have
to
use
you
or
can
they
choose
not
to.
L
If
so,
we're
appointed
by
the
judge
when
there's
a
petition,
so
once
the
judge
makes
the
casa
appointment
order
it,
they
have
to
work
with
Casa.
L
Depends
on
the
county,
some
judges
want
to
appoint
Casa,
they
know,
there's
not
enough
volunteers,
but
they
want
to
make
a
statement
to
say:
I
would
like
a
casa
volunteer
and
they
do
other
programs
use
it
more.
As
a
triage
and
the
judge
will
say,
let
me
know
when
you
have
a
volunteer
and
I'll
give
you
and
I'll
give
you
a
a
case.
So
it
runs
the
gamut.
A
The
reason
I
asked
that
is
I
work
with
ncsl
on
their
in
their
child
welfare
group
and
I
was
speaking
with
a
representative
from
Indiana
a
couple
of
weeks
ago,
and
he
mentioned
that
in
their
state
that
the
judge
is
required
to
appoint
a
casa
volunteer
if
they
are
in
the
area
and
then,
of
course,
the
cabinet
has
to
use
them.
If
that's
the
case,
so
just
that's
the
reason
I
ask
is
because
I
thought
that
that
was
something
potentially
good
to
do
is
to
require
that
you
guys
be
used
in
those
areas.
Well,.
R
L
Yeah
and
they
Indiana
doesn't
have
attorneys,
they
don't
have
a
term
representation
for
children.
So
not
every
child
in
Indiana
gets
a
guardian
item
yeah.
So
it's
a
little
bit
of
I
work
pretty
closely
with
our
state
director
there,
but
they
don't
all
so.
The
Reliance
on
Casa
is
even
more
important.
So.
R
So
my
so
Matt
Breslin
in
Fayette
County,
she
often
says
her
dream
is
No
Child
Abuse
right,
no
child
neglect,
no
child
dependency,
but
the
second
next
best
solution
is
a
casa
volunteer
for
every
child.
But,
as
Andrea
has
said
before,
unfortunately,
even
if
the
money
truck
pulled
up
today,
that
wouldn't
mean
we
could
serve
every
child
because
it's
a
chicken
and
an
egg.
You
have
to
recruit
volunteers.
R
Nationwide
volunteerism
is
at
the
lowest
rate,
it's
been
in
10
years,
but
that
won't
stop
us
we'll
just
work
harder
to
get
there,
but
so
what
we're
seeing?
It's
taking
a
lot
more
staff
time
to
bring
those
numbers
in
to
recruit
the
volunteers
and
then,
of
course,
you
got
to
train
them.
You
don't
get
through
30
hours
of
training,
where
the
majority
of
your
volunteers
work
full
time
immediately.
So
there's
a
bit
of
a
process
there,
but
Andrea.
L
So
when
we
made
this
budget
request
in
this
current
budget
year,
I
said
you
know
if
we
got
an
increase,
you
know
our
goals.
This
first
growth
plan
is
to
be
in
100
counties.
By
next
summer.
We
were
at
like
79,
when
I
asked
we're
at
92,
so
we're
over
halfway
there
and
meeting
our
goal.
We
will
be
working
on
that
growth
plan
to
build
out.
You
know,
25
26.,
you
know
we're
asking
for
the
three
point.
You
know
3.75
rounded
this
per
year,
so
7.5
again
it's
about
the
recruitment
piece.
L
I
will
I
will
note
this,
that
we
are
going
to
be
launching
next
year
2024.
It
will
be
the
40th
anniversary
of
Casa
coming
to
Kentucky,
so
Casa
started
in
Jefferson,
County
and
Nelson
County.
So
we're
going
to
be
doing
a
big
campaign
around
that.
So
how
can
you
become
involved
with
Casa?
You
can
be
a
donor.
You
can
be
a
board
member.
You
can
be
a
judge
who
wants
us?
You
can
be
a
volunteer,
so
it
really
costs
us
a
great
movement.
L
It's
the
everyday
Kentuckian
who
can
make
a
difference
to
the
problems
we've
heard
about
today.
So
we
do,
though,
want
our
growth
to
be
successful
and,
and
it
takes
a
board
and
it
takes
some
business
Acumen
to
create
these
programs.
We
are
doing
some
regionalization
to
help
with
that
expansion.
So
we're
we're
asking
for
you
know
7.5
in
that
next
two
year,
I
think
that
we
could
be
by
2030
I
think
we
can
be
maybe
2028.
We
could
be
in
every
County
and
would
love
your
help
to
to
make
that
happen,
and.
R
A
And
I
am
glad
that
you
mentioned
that
you've
got
to
have
the
volunteers
there
before
the
money.
Is
there
because
I
remember
just
a
couple
of
years
ago
in
one
of
the
budgets,
I
actually
called
and
said
that
we
had
discussed
in
the
budget
conference
committee
about
increasing
your
funding
drastically,
and
you
had
mentioned
that
it
was
going
to
be
hard
to
get
the
volunteers
in
order
to
roll
it
out
that
quickly.
R
So
we
want
to
be
good
stewards
and
hope
that
you
believe
that,
and
also
we
want
sustainable
growth.
So
even
if
an
injection
of
funds
come,
as
you
heard
what
Voca
dollars
decreasing
and
that's
been
the
trend,
we
have
to
look
at
sustainably.
Where
can
we
raise
those
dollars?
And
you
know
that's
a
big
part
of
my
job
looking
to
bring
in
individual
dollars,
but
I
think
that
makes
a
great
model
because
it's
a
blend
between
government
dollars
and
private
dollars.
O
I've
worked
with
Melinda
for
a
long
time,
I
think
he's
a
phenomenal
work
in
Lexington
and
the
Central
Kentucky
area.
No
question
20
of
the
need
scares
me
to
death,
as
we've
talked
about
trying
to
find
enough
volunteers
that
can
come
and
step
in
is
critical,
and
you
want
to
make
sure
that
the
right
Advocates
that
have
the
time
and
effort
to
walk
some
really
difficult
cases,
and
so
it
is
a
it
is
a
sustainable
growth
Challenge
and
it's
a
funding
challenge.
O
I'm
glad
tried
me
to
ask
the
question
about
how
much
money
it
will
take
to
get
there
and
build
up
over
time,
because
I
think
we
want
to
make
sure
we're
we're
building
it
the
right
way
and
we're
bringing
on
the
right
tools
for
match
money
or
other
opportunities
to
help
you
privately
fundraise,
because
I
think
it's
it's
all
those
pieces
together,
the
more
private
money
you
have,
the
more
investment
you
have
in
the
community,
the
more
likely
you're
going
to
have
volunteers
step
up
so
I
just
appreciate
what
you
do.
C
Thank
you
both
for
being
here
today,
I'm
a
huge
fan
of
Casa
I
had
a
kiddo
who
was
fortunate
enough
to
be
assigned
a
casa
volunteer,
and
it
was
one
of
the
probably
the
most
important
relationships
that
this
individual
who
is
in
my
home,
had
and
it
continued
well
after.
C
She
left
my
care
and
is
now
aged
out,
so
I
I
I
just
cannot
express
how
important
I
think
some
of
these
relationships
that
develop
are
I.
My
question,
for
you
all,
is,
is
I
felt.
Like
I
heard,
you
mentioned
something
about
the
model
in
Indiana.
They
do
not
have
gal
so
Guardian
net
litems,
which
are
basically
like
lawyers
for
kids,
while
they're
going
through
Court.
C
Did
you
say
that
they
are
not
on
a
complete
volunteer
basis?
Is
there
a
pay
structure
in
place
for
those
individuals.
L
So
there
are
some
staff
I
think
that
it's
also
based
on
I
mean
there's
also
a
lawsuit
against
the
model
with
Captain
Indiana
right
now,
so
I
wouldn't
recommend
that
we
look
at
that,
but
there
are
some
paid.
There
are
some
programs
that
do
some
paid
advocacy
around
that,
but
the
guardian
items
there
is
some
fee.
There
are
some
opportunities
for
fees,
but
it's
not
across
the
board,
so
they
don't
offer
they
pay
the
guardian
items
but
they're
not
mandatory
in
every
abuse
and
neglect
and
dependency
case.
L
So
some
of
the
Guardians
are
paid,
but
not
across
the
board
because
they're
not
required.
You
know
the
way
I
won't
go
into
the
details
of
capta
states
can
interpret
capta
in
different
ways,
and
there
are
a
few
like
Indiana
that
have
interpreted
that
to
mean
that
there
should
not
be
agency
representation
for
children.
L
L
The
volume
I
think
they
may
have
some
they
have.
They
may
have
some
that
do
a
small
paid
advocacy
model,
but
you
know
in
Kentucky.
I
could
argue
against
that
for
several
reasons.
One:
it's
unbiased
when
you
pay
somebody
to
do
something,
it's
a
little
bit
of
a
different
outcome,
but
they
I
think
in
some
cases
they
they
do
allow
paid
advocacy
with
some
of
their
stuff.
We
we
do
say
that
across
a
staff
person
when
they
take
it
when
they
become
staff,
they
should
take
a
case.
L
So
there
are
some
paid
advocacy
in
Kentucky
I.
Don't
I,
don't
want
to
mention
that
they're
say
that
there's
not!
We
actually
have
a
standard
that
says
it
should
be
10
of
all
your
cases.
So
if
a
case,
if
a
volunteer
drops
a
case
because
they
move
out
of
state
or
they
have
a
health
issue,
a
staff
person
will
pick
up
that.
C
I
would
just
be
curious
about
us
exploring
what
that
looks
like
moving
forward.
It
was
just
stated
that
volunteers
are
you
know,
declining
at
an
all-time
low.
The
same
thing
goes
for
philanthropy,
so,
while
I
appreciate
my
backgrounds
within
the
nonprofit
sector,
I
always
appreciate
a
good
volunteer.
C
It
is
not,
unfortunately,
a
sustainable
model,
and
particularly
for
these
kiddos
who
need
this
care
and
I.
Just
I
would
just
encourage
any
sort
of
dialogue
that
we
could
have
with
you
all
or
with
other
committee
members
about
how
we
can
send
you
to
the
you
know,
to
the
to
the
largest
ability,
because
I
do
recognize.
We
do
have
a
you
know,
a
chicken
in
an
egg
situation,
and
that's
certainly
not
okay,
for
the
kids
that
are
waiting,
who
could
really
benefit
from
having
a
casa
advocate
so
yeah.
L
And
I
would
say
the
the
value
with
Casa
when
a
child
knows
that
the
person
is
there
not
because
they're
compensated,
but
because
they
generally
care
about
them
as
an
individual
as
a
person
as
a
child.
It
creates
a
relationship
there
that
maybe
the
paid
advocacy
piece
would
would
put
into
question
a
little
bit
but
I
understand
what
you're
saying
and
we're
looking
at
like
I
said:
there's
opportunities
where
sometimes
that's
needed,
but
our
bread
and
butter
really
is
around
around
the
advocacy
model.
Yeah.
R
Yeah
and
I
think
there
are
ways
to
strengthen
that.
So
one
thing
that
we
rolled
out
at
our
local
program
the
year
before
last
is
a
volunteer
gas
assistance
fund.
So
as
we
look
to
remove
barriers
to
make
our
volunteer
Corps
representative
of
the
children
and
families,
we
serve
we're
trying
to
reduce
those
barriers
right
and
when
we
have
volunteers
that
were
asking
to
commit
five
to
ten
hours
a
month
of
your
own
time
and
drive
three
and
a
half
hours
across
the
state
each
month.
That's
something
we
put
in
place.
R
Do
we
have
enough
money
to
fund
all
of
our
volunteers?
Absolutely
not
that's
privately
raised
dollars
going
and
they
have
to
request
it.
There's
no
assessment
done
if
they
ask
for
it,
they
receive
it,
but
I
think
there
are
measures
that
could
be
put
in
place
that
also
don't
lead
to
paying
the
volunteers
to
reduce
some
of
those
barriers
with
more
funding.
A
Well,
thank
you
all
very
much
for
being
here
this
afternoon
and
giving
us
an
update,
appreciate
all
that
you
do
great.
D
I,
just
I
just
knew
I
was
going
to
get
since
you're
down
the
road
at
the
old
Home
Depot
just
come
on
over
another
another
day.
Thank
you
for
having
me
and
to
both
the
chairs.
Thank
you
for
including
the
court
system,
as
well
as
to
the
task
force.
I
would
be
remiss
to
not
also
introduce
our
new
Administrative
Office
of
the
board
director
Katie
Comstock,
that
is
with
us
today,
as
well
as
our
new
executive
officer
for
family
and
juvenile
Services
Ashley
Clark.
That's
going
to
assist.
D
Sure
can
hang
it
no
I'm
just
kidding
so
thanks
to
the
chairs,
as
well
as
the
task
force
like
to
introduce
our
new
Administrative
Office
of
the
courts
director
Katie
Comstock,
who
is
here
with
us
today,
as
well
as
our
new
executive
officer
for
family
and
juvenile
Services
Ashley
Clark
who's
going
to
be
kind
enough
to
go
through
the
slides
for
us.
So
we
are
here
to
just
provide
sort
of
an
overview
of
the
relationship
that
we
have
with
the
wonderful
people
that
sit
behind
me.
D
I
said
it's
not
like
we're
at
a
wedding,
we're
just
one
side
of
the
family
was
on
one
side
back
there
and
the
other
side
of
the
family
was
on
the
other.
We
worked
very
closely
with
the
cabinet,
as
well
as
with
Casa
and
our
partners,
so
I
think
you
all
will
get
a
really
good
feel
of
what
that
looks
like
and
to
open
up
for
any.
Obviously,
any
questions
that
you
may
have
so
go
ahead
to
the
next
slide.
D
Just
to
start
off,
as
many
of
you
are
familiar,
the
administrative
office
of
the
courts
does
provide
a
a
rather
complicated,
sometimes
role
within
child
welfare.
We
do
support
citizen
foster
care
review
boards.
We
have
approximately
700
volunteers
across
the
state
and
those
boards
are
able
to
to
review
the
cases
of
kids
that
are
in
out
of
Home
Care,
due
to
abuse,
neglect
and
dependency,
as
well
as
those
cases
that
and
specifically
may
be
considered
dependent
that
are
also
those
status
cases.
D
So
we
definitely
connected
with
a
testimony
from
the
cabinet
in
regards
to
the
cases
that
they
see
on
that
high
Acuity
and
and
the
complexity
of
those
particular
cases.
We
support
the
legal
training
around
the
dependency,
neglect
and
abuse
cases
which
are
specific
for
those
Guardian
ad
items.
So
the
conversation
that
has
happened
around
that
particular
group
of
of
in
that
entity
for
the
for
the
state
has
been
very
interesting.
D
We
have
established
most
recently
through
the
Commission
on
mental
health,
a
dependency
neglect
and
abuse
work
group
they
will
actually
in
within
weeks.
Probably
I
must
say
they
are
the
fastest
moving
work
group
of
the
commission.
So
we're
very
excited
about
that.
We'll
have
recommendations
to
bring
back
to
this
particular
group,
as
well
as
others
interested
in
the
Child
Welfare
space
for
legislative
recommendations.
D
So
we're
excited
about
what
they're
going
to
bring
that
entity
is
also
involved
with
an
initiative
with
the
Department
of
community-based
Services
and
stakehold
folders
called
Upstream,
which
hits
on
exactly
the
conversation
about
moving
things
back
to
prevention
and
the
relevance
on
working
in
the
space
of
prevention.
How
can
we
do
what
we
call
a
sequential
intercept,
mapping
to
be
able
to
look
at
each
contact
point
in
the
child
welfare
system
and
potentially
come
up
with
a
a
different
response
that
it
doesn't
always
require?
D
Obviously,
as
you
know,
removals
and
petitions,
and
sometimes
even
detailed
investigations,
so
that
has
just
those
conversations
have
just
begun
and
that
mapping
has
just
begun
and
I
would
assume.
This
group
would
probably
be
interested
at
some
point
in
hearing
how
that
how
that
work
is
going,
and
then
we
also
are
involved
with
our
title
4E,
which
is
really
from
the
cabinets
lens.
It's
all
of
those
individual
children
that
are
eligible
to
receive
reimbursement
if
they
are
in
out
of
Home
Care
with
community-based
services.
D
For
us,
it
is
making
sure
that
the
forms
are
completed
as
they
should
that
eligibility
is
is,
is
something
that
the
court
can
can
verify
and
make
sure
that
that
reasonable
efforts
has
been
made,
and
so
we
have
a
a
complicated
relationship
when
you
try
to
explain
it,
but
it's
pretty
easy
when
we
implement
it
and
that's
that
we're
able
to
really
provide
a
reimbursement
opportunity
for
the
court
system
on
training
and
administrative
supports
to
foster
care,
View
Board,
as
well
as
our
judges
and
the
court
function,
and
so
our
role
is,
as
you
know,
and
and
I,
think
that
everyone
is
aware
that
the
administrative
office
of
the
courts
is
a
support
arm,
and
so
we
provide
that
type
of
assistance
to
the
judges
across
the
state
through
foster
care,
View
Board
through
our
stakeholders
around
practice
and
process.
D
We
do
not
dictate
we
provide
support
and
we
also
are
do
a
lot
of
work
with
those
entities
around
form,
development,
around
policy
development,
and
many
of
you
are
familiar
with
our
family
court
rules
and
really
being
able
to
do
problem
solving
as
as
issues
or
things
occur
locally.
That,
potentially
we
want
to
have
you
know
another
layer
of
conversation
about
next
slide,
specifically
with
community-based
Services.
We
do
the
foster
care
review
board
process.
D
I
want
to
give
a
shout
out
to
community-based
Services
they've
been
present
when
we
have
our
cfcrb
regional
forums
and
one
of
the
greatest
things
that
they
bring
are
actual
answers
to
our
community
members
to
our
families,
on
how
to
access
services
and
resources
and
supports,
and
so
we
don't
just
get
the
complaints
at
those
particular
forums.
We
actually
get
connections
and
we
get
Partnerships
with
our
families,
and
so
we
do
a
lot
a
lot
of
work
with
community-based
services.
D
We
have
have
connections
with
their
I
twist
application,
we're
able
to
utilize
those
resources,
we're
able
to
make
sure
that
we
have
judicial
participation
at
their
review
requirements
and
make
sure
that
the
Children's
Bureau
really
hears
from
the
court
perspective
and
lands
on
the
cases
that
they
are
reviewing
and
that
we
have
some
real
intentionality
about
that,
and
then
I
did
mention.
Also
the
title
IV
there's
a
lot
of
collaborative
education
opportunities
in
that
space.
D
We
also
provide
it
feels
like
we
should
have
offices
like
you
guys
sure
you
don't
want
to
rent
a
space
and
in
the
AOC
we
have.
We
spend
so
much
time
in
being
able
to
build
our
collaboratives
the
family
treatment
courts.
That
Casa
mentioned
is
something
that
Volunteers
of
America
has
done
a
really
wonderful
job
in
being
able
to
expand
that
program.
D
They're
moving
into
the
chairs
particular
jurisdiction
into
Lincoln
and
Pulaski
they've
also
are
looking
to
expand
into
a
couple
of
more
of
our
communities
and
that
growth
into
areas
like
Madison,
County,
down
to
I,
want
to
say.
Hardin
county
is
really
a
great
partnership
for
the
local
court
and
the
Volunteers
of
America,
and
then
they
work
directly
with
community-based
services
to
provide
that
intense
case
management
and
treatment,
resources
and
the
courts
have
been
very
intentional
in
community-based.
Services
has
been
a
great
partner
in
us
all.
D
Moving
towards
more
of
a
recovery
oriented
system
of
care,
the
concept
of
whatever
door
you
come
in
you're
able
to
get
the
supports
resource
first.
Access
to
hopefully
make
your
contact
with
the
system,
which
is
never
we
all
know,
is,
is
never
great
at
least
potentially.
An
opportunity
to
get
to
where
you
need
to
be
I
did
mention
the
Commission
on
mental
health
and
Upstream.
D
They
are
active
participants
in
all
of
those
groups
and
cannot
thank
the
secretary
for
his
commitment
with
the
commission
and
for
those
of
you
that
were
able
to
attend
our
Summit
back
in
in
in
may.
We
had
over
a
thousand
attendees
and
it
was
an
amazing
event
and
we
could
not
have
done
it
with
other
cabinet
support
and
and
partnership
and
all
of
your
participation.
So
we
thank.
We
thank
everyone
for
that
with
Casa.
D
We
too
have
a
great
relationship
and
and
was
really
thrilled
to
sit
back
and
watch
that
presentation,
because
when
I
came
around,
they
were
still
scraping
and
trying
to
figure
out
how
to
even
get
get
them
going
and
what
could
be
done
in
the
state
and
it's
really
powerful
and
I
give
a
shout
out
to
to
Andrea's
leadership
and
the
fact
that
she's
been
able
to
move
the
state
as
she
has.
We
invite
them
to
our
cfcrb
review
meetings
and
they
are
always
there.
D
The
cost
of
volunteers
are
always
present,
always
active
and
are
always
sharing
information
that
the
volunteers
are
dependent
upon,
and
they
are
also
involved
in
our
local
community
forums
again
as
a
resource
for
those
Community
Partners,
and
we
are
able
to
just
connect
people,
then,
instead
of
having
to
wait
and
figure
out
other
ways,
and
then
we
share
data-
and
you
know
constantly,
as
well
as
the
opportunity
for
Casa
to
be
able
to
get.
You
know
things
like
record
checks
done
and
things
like
that
for
their
volunteers,
and
then
we
do
a
lot
of
training.
D
A
A
I'll
also
say
that
I
I,
really
one
of
my
focuses
now,
is
on
Prevention
Services,
because
I
believe
that
the
best
way
for
us
to
help
this
state
and
to
help
families
is
to
hold
them
together.
To
begin
with,
and
as
we've
heard,
that
we're
number
one
in
abuse
and
neglect
in
the
country,
a
large
portion
that
is
due
to
neglect
and
many
of
those
families,
it's
not
that
they
don't
want
to
take
care
of
their
children,
it's
if
they
can't.
A
They
lack
the
resources
in
order
to
do
it,
and
so
I
really
appreciate
you
focusing
on
those
Prevention
Services
to
hold
these
families
together
and
I
hope
that
we
can
have
a
greater
discussion
with
us
as
a
legislature,
use
the
courts
and
the
cabinet
in
order
for
us
to
all
collaborate
together
in
order
to
do
that
and
Roll
Out
programs
that
really
work.
Thank
you.
A
N
N
Everyone,
my
name,
is
John
holder
I
represent
the
Kentucky
Board
of
EMS
I
have
with
me
Mr
Eddie
Sloan,
the
deputy
director
for
the
board
as
well.
We
appreciate
the
opportunity
to
be
here.
Obviously
there
are
several
challenges
that
face:
Emergency
Medical
Services
in
the
Commonwealth
reimbursement
would
be
toward
the
top
of
that
list,
and
so
we
genuinely
appreciate
this
task
force
and
all
the
effort
and
time
they're
putting
into
exploring
potential
solutions
to
those
challenges.
N
Going
to
work
this
computer
together
back
up
just
one
there
we
go
good
deal.
We
have
a
small
presentation
here
that
that
kind
of
may
help
make
our
point,
like
I,
said
figure
this
out
together.
N
One
of
the
issues
that's
being
discussed
is
reimbursement
for
treatment
in
place
via
Medicaid
we'd,
like
to
present
a
little
bit
on
what
treatment
in
place
looks
like
what
the
perspective
is
from
the
EMS
standpoint,
and
these
are
a
few
of
the
examples
that
we've
pulled
pulled
from
our
data
at
the
top
there.
You
have
treatment
with
refusal
of
Transport.
This
is
typically
what
people
think
of
when
they
talk
about
treatment
in
place.
N
This
is
when
an
ambulance
crew
will
go
to
someone's
residence
or
to
a
scene
for
an
acute
injury
or
illness,
provide
some
form
of
treatment,
and
at
the
end
of
that
treatment,
the
patient
says,
I
appreciate
it
very
much
and
then
declines
transport
which
causes
a
problem
for
for
EMS
reimbursement
that
we'll
get
to
here
in
a
little
bit.
Next,
we
have
treatment
without
transport
necessity.
N
Occasionally,
a
patient
will
present
some
some
risk
to
accrue
and
it
becomes
necessary
for
the
for
the
law
enforcement
agency
to
transport
that
patient.
Then
we
have
evaluation
with
no
treatment
necessary.
These
are
the
best.
These
are
when
someone's
not
hurt
or
ill
and
there's
nothing
to
treat
which,
which
is
great
for
the
patient.
We
appreciate
that
public
assist
that's
a
big
one.
As
of
late.
We
do
a
lot
of
lift,
assists
a
lot
of
going
to
people's
homes
and
assisting
them
with
things
where
they're
not
necessarily
injured.
N
They
just
need
a
hand,
and
we
love
to
do
that
kind
of
thing,
but
again
it
doesn't.
It
doesn't
end
in
a
transport
and
finally,
we
have
patient
deceased,
and
this
is
not
as
clear
because
it
may
seems
if
an
EMS
crew
responds
to
a
deceased
patient
and
there's
a
potential
to
to
help
that
person.
Obviously,
they
pull
out
all
the
stops
and
they're
they're
using
multiple
medications,
all
of
their
skills,
Advanced,
Airway
treatment,
think
things
of
that
nature
and
at
the
end
of
the
at
the
end
of
the
encounter.
N
Unfortunately,
sometimes
those
people
cannot
be
revived
again.
No,
no!
No
transport
occurs:
that's
another
treatment
in
place.
So
all
that
being
said.
What
that
basically
boils
down
to
is
15
of
the
time
when
an
ambulance
responds
we're
not
transporting,
and
that
number
has
been
pretty
steady
over
the
last
several
years
and
the
graph
here,
just
kind
of
breaks
down
that
15
percent
you'll
see
the
the
big
red
portion.
There
are
refusals
that's
by
far
the
biggest
and
and
creates
a
little
bit
of
a
problem
now
in
regard
to
Medicaid.
N
Specifically,
that
15
percent
obviously
is
a
is
a
very
important
number,
but
fewer
of
those
will
be
Medicaid
patients
and
there's
several
reasons
for
that.
Obviously,
in
different
geographical
regions
of
the
state,
there
are
different
different
different
amounts
of
Medicaid
patients,
but
also
a
lot
of
times.
N
If
a
patient
refuses
it's
because
they're
trying
to
to
not
incur
the
the
the
ambulance,
transport
Bill
and
sometimes
with
our
Medicaid
patients,
it's
not
as
big
of
a
concern
to
them
on
the
scene
and
we've
moved
on
here
to
the
increasing
incidence
of
treatment
in
place
and
basically,
what
we
wanted
to
show
everyone
at
the
task
force.
Is
that
there's
an
increase
in
these
type
of
incidents
going
on?
N
We
saw
a
pretty
big
bump
in
2020
around
the
covet
time
when
patients
really
weren't
wanting
to
be
transported
to
the
hospital
that
continued
on
into
2021,
and
then
we've
seen
a
a
little
bit
of
a
decrease
in
2022.
this
year.
Obviously,
it
remains
to
be
seen
what
those
numbers
will
look
like,
but
annualizing
the
data
up
until
this
point
it
looks
like
those
numbers
are
going
to
be
at
least
that
much,
if
not
more,
just
to
kind
of
share
a
little
bit
about
what
that
costs
to
an
EMS
agency.
N
We
pulled
the
data
on
all
the
medications
that
were
given
on
a
treatment
in
place
call
in
the
last
couple
of
years,
and
this
is
what
we
came
up
with
and
we
want
to
just
kind
of
show
what
that
is
costing
these
agencies.
The
number
you
see
at
the
bottom
there's
the
last
couple
of
years.
That's
for
supplies
alone.
That's
that's
for
the
medications
and
the
supplies
that
were
being
used
in
these
incidents.
N
They
don't
that
number
doesn't
reflect
paying
Personnel
maintenance
costs
to
supplies
ambulances,
diesel
fuel,
all
that
sort
of
thing,
and
it
is
a
conservative
number,
because
we
want
to
be
careful
with
that,
go
ahead
to
the
next
one,
if
you
don't
mind
and
again
so
this
leads
us
kind
of
to
our
to
our
issue
a
little
bit
when,
in
regards
specifically
to
Medicaid
as
of
right
now
without
transport,
there's
no
reimbursement
for
those
runs,
and
so
these
agencies
are
sending
these
crews
out
they're,
providing
this
care
they're
using
these
supplies,
these
skills,
the
training
that
they've
gotten
and,
at
the
end
of
the
day,
there's
no
reimbursement
for
that
which,
which
causes
a
little
bit
of
a
of
a
concern.
N
But
this
is
my
favorite
slide
of
the
deck
here.
This
is
the
exciting
part,
so
the
good
news
is.
However,
it's
our
estimation
that
to
allow
reimbursement
from
Medicaid
on
these
types
of
runs
really
is
a
win-win
for
everyone,
and
it
may
not
seem
like
that
when
you
talk
about
reimbursement,
finding
another
Avenue
to
pay
someone
to
do
something.
N
However,
we
believe
that,
if,
if
we're,
if
we
can
interject
on
these
scenes
and
keep
these
patients,
these
low,
Acuity
patients
from
being
transported
to
the
emergency
department,
it
will
actually
be
much
more
cost
effective
to
do
so
as
it
stands
right
now.
If,
if
you
think
about
the
information
we've
just
presented
to
you,
EMS
crews
are
incentivized
to
transport.
These
patients,
even
the
lower
low
Acuity
patients
Because
by
the
time,
you've
gone
out
and
you've
done
all
these
things.
N
If
you,
if
we
can
spend
a
smaller
amount
for
an
ambulance
crew
to
handle
these
low
acute
patients
on
scene
without
transporting
to
a
facility,
we
can
end
up
saving
money
in
the
long
run.
Some
of
the
benefits
here,
I'm,
obviously
not
going
to
go
over
all
of
these.
This
is
a
lengthy
slide.
We
want
to
be
respectful
of
your
time
here,
but
it's
a
benefit
for
the
patient,
obviously,
because
there's
a
decreased
health
care
cost.
N
That's
that's
not
the
best
route.
It's
not
the
best
best
route
for
the
patient,
and
it's
certainly
not
the
best
route,
sometimes
for
the
Emergency
Department
staff
as
well.
So
if
there
were
Avenues
to
maybe
treat
in
place
and
and
get
those
folks
more
appropriate
care
in
a
different
way,
I
think
that
would
absolutely
be
beneficial.
N
Moving
on
to
that
Center
column,
there
facilities
again
this
one's
fairly
straightforward.
If
we
can
keep
those
low,
Acuity
patients
out
of
our
emergency
departments,
who
are
having
the
same
staffing
issues
as
as
EMS
services
are
having,
that
will
take
the
burden
off
them
as
well.
Decrease
crowding
I'd
also
like
to
mention
that
we
can
decrease
Ed
wait
times
by
doing
that
by
keeping
that
population
out
of
the
emergency
departments,
and
we
can
also
improve
inter-facility
transfer
times.
N
I
know
that's
been
a
topic
of
discussion
as
of
late
and
if
we're
keeping
these
low,
Acuity
Patients
Out
of
the
Eds,
then
one
they're
not
being
overcrowded
and
if
we're
not.
If
the
ambulance
Crews
aren't
spending
time
transporting
patients
that
maybe
didn't
have
to
be
transported,
they're
they're
more
available,
which
is
which
is
fantastic
for
for
those
facilities
as
well.
And
obviously
this
is
good
for
EMS
agencies,
again
we're
incentivized
to
transport
low,
Acuity
patients
right
now,
but
it
would
be
better
if
we
had
other
options
go
ahead
to
the
next
one.
N
Forward
a
little
bit
just
a
point,
we'd
like
to
make
from
a
board
standpoint,
obviously,
on
the
left
there
we
have
a
report
from
1966
to
accidental
death
and
disability
report,
which
was
kind
of
the
Catalyst
for
modern
EMS,
and
every
good
EMS
personnel
has
probably
heard
of
this
report
at
least
read
it
once
or
twice
and
in
that
time
we're
a
fairly
young
profession.
If
you
think
about
it.
N
In
less
than
60
years,
we've
gone
from
transporting
patients
from
from
you
know,
car
accidents
putting
them
in
in
vehicles
just
to
move
them
from
here
to
there
to
some
of
the
treatments
were
that
are
being
done
in
the
field
are
pretty
impressive
in
that
in
that
time
frame,
but
looking
from
there
on,
if
you
look
at
the
right
side
of
this
slide,
you'll
see
you
know
tiered
response
models
where
we're
sending
supervisors
out
in
cars
before
the
ambulance
gets
there.
Community
paramedicine
crisis
code
response,
Services,
emergency,
triage
treatment
and
transport,
the
et3
model.
N
All
of
these
are
our
treatment
in
place
models,
and
we
think
this
is
a
wonderful
opportunity
now,
in
regard
to
Medicaid
reimbursement,
for
these
It's,
a
Wonderful
opportunity
to
demonstrate
a
more
efficient
and
cost
effective
model
to
to
find
folks
Healthcare
options
that
are
less
costly
and
more
appropriate
go
into
the
next
one,
and
so
anyway,
that
wraps
up
about
treatment
in
place.
We,
we
think,
there's
some
options
there
to
spend
funds
more
appropriately
and
keep
the
cost
down
in
the
long
run
in
regard
to
reimbursement
as
a
whole.
N
The
last
data
we
had-
and
admittedly
it's
a
few
years
old
emergency
transport
across
the
Commonwealth,
the
cost
of
that
ranged
anywhere
between
350
and
750
dollars
and
again,
that's
not
what's
being
charged.
That's
the
cost!
That's!
What's
costing
an
ambulance
crew
to
go
on
those
on
those
specific
runs
and,
as
mentioned
here
currently
Medicaid
reimburses
approximately
10
percent.
N
So
for
our
EMS
agencies
every
time
they
turn
a
wheel
on
on.
One
of
these
specific
runs
with
a
with
a
patient
who
has
Medicaid
they're
losing
roughly
90
percent
of
their
cost
and
that's
significant,
especially
over
the
long
term,
and
that's
that's
been
going
on
for
for
quite
a
while.
If
you'll
see
here,
the
reimbursement
rates
have
been
the
same
for
the
last
10
years.
N
So
this
is
a
wonderful
opportunity
to
go
ahead
and
look
at
maybe
changing
some
of
that
I'd
be
remiss
if
I
didn't
bring
up.
Workforce
shortages
and
I
know
again
I'm
not
going
to
belabor
this
point
because
I
know
it's
been
discussed
in
depth,
but
if,
if
you
have
low
reimbursement,
if
you're,
if
you're
losing
money
when
you're
providing
a
service,
it's
difficult
to
do
much
about
things
like
wages
and
and
better
equipment,
and
things
like
that,
this
specific
slide
I
thought
was
quite
impactful
and
I
wanted
to
share
it.
N
If
you'll
notice
that
light
blue
column
on
the
right
hand
side
this
these.
This
is
the
number
of
certified
EMS
Personnel
that
we
have
in
Kentucky.
Unfortunately,
the
dark
blue
column
to
the
left-
that's
the
number
that
is
actually
that
are
actually
working
they're
using
their
skills
and
trading
in
the
Commonwealth
of
Kentucky.
N
Furthermore,
we
are
losing
more
EMS
Personnel
every
year
than
we're
training.
We
can't
replace
them
as
fast
as
we're
losing
them.
There's
been
a
bunch
of
surveys
done
to
try
to
just
discern
exactly
what
the
cause
is
wages.
Is
it
at
the
top
of
that
list
and
again
it's
difficult
to
increase
your
wages
and
improve
wages,
if,
if
we
don't
have
the
reimbursement
to
make
those
funds
available,
so
I
thought
that
was
interesting
to
pass
along,
so
wrapping
it
up.
Basically,
if
if
reimbursement
is
unavailable
for
services,
who's
demand
is
steadily
increasing.
N
N
But
if,
if
we
can't
afford
to
keep
those
ambulance
Crews
on
the
road,
it's
it's
going
to
be
difficult
to
go
and
do
some
of
these
things
without
some
method
of
reimbursement
and
again,
if
we
can
spend
eighty
dollars
on
on
an
ambulance
run
to
keep
a
patient
from
going
to
the
emergency
department
and
incurring
thousands
of
dollars
worth
of
of
of
treatment.
Then
that's
a
win
for
everyone
and
with
that
we'll
take
any
questions.
Q
N
Q
You
I
couldn't
agree
with
you
more
that
we
would
have
huge
benefits
to
the
state
and
to
addressing
the
high
cost
of
health
care.
If
we
looked
at
some
programs
like
treating
in
place,
I
I
know
all
about
the
ever
utilization
of
the
Eds
and
the
high
cost,
and
you
know
I
mean
it's.
Q
It
is
a
problem,
so
I
know
as
a
former
flight
nurse
there's
a
great
deal
of
coordination
with
the
hospital
when
you're
out
in
the
field
and
do
you
feel
pretty
protected
in
making
decisions
about
not
to
transport
and
are
there
any
liability
concerns.
N
That's
a
great
question:
that's
fantastic
question.
There
are
some
liability
concerns,
however,
with
any
kind
of
treatment
in
place
with
most
most
EMS
agencies
in
the
state.
You
do
so
under
medical
Direction
with
a
physician
I
mean
that's
kind
of
how
we
envision
this
moving
forward
when
these
decisions
are
being
made,
they're
not
being
made
in
a
vacuum,
obviously,
and
so
yeah
there
are
some.
There
are
some
liability
concerns,
but
at
the
end
of
the
day,
working
with
our
physician
partners,
I
think
that
it's
still
a
safe
route.
Okay,.
Q
Yeah
I
mean
that's,
that's
really
all
I
I
think
it's
a
great
program
makes
a
great
deal
of
sense.
Yeah
I
hope
we
can
work
something
out.
It's
it's
a
good
program
thanks,
yes,
ma'am.
O
Thank
you
Mr
chair
and
thank
you
for
your
presentation,
I'm
very
familiar
with
Lexington's
paramedicine
program.
What
other
but
I'm,
not
familiar
with
the
rest
of
the
state?
Are
there
other
communities
that
have
a
paramedicine
like
Lexington's
program
like.
A
N
Is
something
that
has
been
in
a
pilot
for
several
years?
The
board
is
actively
trying
to
bring
that
out
of
out
of
pilot
program
to
make
a
steady
certification.
Community
paramedicine's
been
very
interesting
in
that
the
specific
model
is
very
diverse
and
we're
seeing
that
happen.
How
many
Community
parent
medicine
programs
do
we
have
currently.
Do
you
remember
eight
to
ten
we'll
go
with
eight
to
ten
and
each
one's
different
and
they're
they're
feeling
the
need
of
their
individual
communities.
N
We
have
some
that
are
looking
to
specifically
keep
Hospital
admin,
readmissions
down
and
they're
being
very
successful
at
that
we
have
some
that
are
are
essentially
the
et3
model
they're
going
out
and
trying
to
discern
if
the
patient
actually
needs
an
ambulance
or
not
because
obviously
of
staff
and
concerns
so
yeah,
there
are
multiple
places,
doing
community
pain,
medicine,
and
once
we
bring
this
out
of
pilot,
we're
really
hoping
that
that
takes
off.
N
O
Lexington
I
was
on
Lexington
Council
for
a
long
time,
so
we
helped
with
the
pilot,
helped
administer
the
pilot,
put
a
lot
of
general
fund
dollars
towards
the
program
and
we
have
a
social
worker,
a
police
detective.
You
know
two
paramedicines
EMS
in
our
program
and
the
goal
was
to
reduce
our
high
flight
to
just
running
people
to
and
from
the
night
buses.
O
O
O
N
O
I
would
be
interested
in
seeing
a
better
pilot
me
with
that
in
mind
outside
just
Lexington,
because
I
think
I
do
think
it's
one
of
the
best
programs
for
that,
and
then
two
on
this
last
Workforce
impact
slide
is
this:
is
this
only
those
that
have
that
the
board
of
license
doesn't
that
the
board
of
EMS
does
not
license.
O
A
Thank
you
all
for
being
here
today,
really
appreciate
your
presentation
and
we
look
forward
to
working
with
you
as
we
move
forward.
Yes,.
A
J
J
So
again
we
all
know
what
house
joint
resolution
38
stated:
treatment,
triage
and
transport.
The
department
for
Medicaid
services
has
submitted
a
state
plan
Amendment.
It
was
submitted
on
July
the
14th
of
2023.
We
are
proposing
an
effective
date
of
January
1st
of
2021
that
will
allow
transportation
to
locations
other
than
hospitals.
Medical
Services
have
to
be
medically
necessary
and
regulation
updates
will
be
necessary,
alternate
destinations.
J
Again,
we
submitted
a
state
plan
Amendment
on
July,
the
14th
of
2023,
with
an
anticipated
start
date
of
January
1st
2024
EMS
providers,
May
Bill
Medicaid
for
services
rendered
at
the
scene
of
an
emergency
call
that
does
not
result
result
in
patient
transportation
again,
medical
necessity.
We
have
procedure
codes.
You
can
see
that
the
reimbursement
rate
is
going
to
be
linked
to
the
already
existing
rates
for
basic
life
support.
They
will
not
get
mileage
because
there
has
been
no
transport,
but
they
will
receive
services
for
rendering
care.
J
We
expect
our
Managed
Care
organizations
to
follow
suit
with
the
fee
for
service
program
increase
in
ambulance
reimbursement.
We
were
asked
to
to
analyze
this.
We
do
have
a
directed
payment
approval
with
the
center
for
Medicare
and
Medicaid
services
that
allows
ambulance
providers
to
get
increased
reimbursements.
They
do
pay
the
state
match.
It's
about
a
five
percent
5.5
State
match
that
those
ambulance
providers
pay.
J
There
are
two
quality
measures
associated
with
that
directed
payment,
and
what
a
directed
payment
is
is
a
payment
in
which
we,
the
department
for
Medicaid
services,
direct
the
Managed
Care
organizations
to
pay
a
certain
percent
to
the
providers.
We
do
have
two
quality
measures:
that's
based
on
Federal
Regulations.
We
have
to
promote
High
access
to
high
quality
Care
by
reducing
ambulance
response
time
and
increase
the
number
of
certified
EMS
practitioners.
J
So
far
in
2021
ambulance
providers,
172
ambulance
providers
across
the
state
received
45.3
million
dollars,
in
addition
to
their
regularly
scheduled,
submitted
claims
for
reimbursement
in
2023
this
year.
So
far,
they've
received
28.4
million
dollars.
In
addition,
they
do
have
a
supplemental
payments
are
358
for
emergency
transports
and
101
dollars
for
non-emergency
transports.
Last
week,
the
department
for
Medicaid
services
received
approval
from
CMS
to
implement,
manage
Implement
mobile
crisis
intervention.
J
As
part
of
that,
we
do
have
a
new
definition
with
the
two
person
team
that
will
include
a
behavioral
health
practitioner
when
emergency
individuals
go
on
site.
The
other
thing
that
we
will
be
doing
as
part
of
that
is
have
a
behavioral
health
health
crisis
transport.
You
heard
how
Behavioral
Health
can
be
somewhat
tricky,
so
we
will
have.
This
is
in
10
to
use
between
facilities.
They
will
be
able
to
transport
to
a
23
hour
crisis
observation
and
they
will
be
able
to
transport
to
inpatient
psych
hospitals,
provider,
eligibility
requirements.
J
They
just
have
to
meet
the
requirements
established
in
the
administrative
regulations,
state
requirements.
The
vehicle
will
have
to
be
staffed
by
two
individuals,
a
driver
and
a
support
staff,
and
they
will
have
to
have
availability
every
day
all
day
for
the
entire
year
and
they
will
have
to
go,
have
annual
staff
training
and
any
questions
on
that
done.
A
Well,
you
did
a
good
job
and
we
appreciate
you
being
here
appreciate
what
you
do.
You
have
a
huge
task
in
that
department.
That
is
a
beast
and
so
appreciate
the
work
you
do
over
there
as
well
with
that.
Our
next
meeting
is
August
22nd
at
3
P.M
right
here
in
this
room.
With
that
all
entertain
a
motion
to
adjourn.