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From YouTube: Exceptional Support Waiver Services Task Force
Description
Exceptional Support Waiver Services Task Force meeting located in room 171 of the Annex.
Live Stream provided by LRC Staff
Note from Staff - We experienced a network outage part way through the beginning of the meeting. We will be reviewing the live stream recording and if needed loading a locally saved copy as a secondary source of the meeting.
A
You
announcements
before
we
call
roll
in
front
of
me.
They
gave
me
a
little
cheat
sheet
here.
It
says
please
be
aware
that
this
meeting
is
being
recorded
and
live
streamed
on
lrc's
youtube
channel.
Our
it
staff
will
mute,
audio
and
video,
where
necessary,
to
ensure
the
quality
of
our
recording
the
live
stream.
A
Please
mute
your
microphone
when
you
are
not
speaking
to
avoid
background
noise
and
make
sure
to
turn
on
your
microphone
when
you
are
recognized
to
speak
and
please
use
the
chat
feature
to
notify
staff.
If
you
wish
to
be
recognized
for
a
question
or
a
comment,
so
in
order
to
do
accurate
travel
vouchers,
if
you
are
attending
virtually,
you
should
have
received
an
email
with
your
travel
voucher
attached.
A
Our
meeting
must
adjourn
no
later
than
2
30,
so
that
staff
can
sanitize
and
prepare
the
room
for
another
meeting
at
three
o'clock.
So
all
presenters
were
notified
in
advance.
That
prepared
comments
should
be
limited
to
15
minutes
per
presentation,
and
please
be
cognizant
of
this
time
limit
so
that
we
can
hear
from
everybody
today
and
with
that
being
said,
I
think
those
are
all
of
our
housekeeping
items
and
I
would
like
it
if
the
secretary
would
please
call
the
roll.
A
B
B
A
Go
ahead
and
get
started,
I'm
just
I
have
a
few
opening
remarks,
and
that
is
I'm
really
excited
about
this
task
force.
I
think
that
there
are
some
real
opportunities
here
for
us
to
get
a
few
things
right
and
to
do
a
little
with
the
level
of
excitement
from
people
who
are
on
this
task
force
as
well.
So
I'm
really
looking
forward
to
making
some
good
progress.
A
B
D
B
C
I'm
attending
virtually
and
I'm
a
provider
of
service,
but
I
also
help
with
the
local
self-advocacy
group,
which
chris
is
the
president
of,
and
he
had
asked
for
my
assistance
in
kind
of
helping
with
this.
So
what
I'm
talking
about
is
is
based
on
conversations
that
me
and
him
and
shauna
have
had
so
relative
to
the
transportation
issue
that
chris
first
brought
up.
C
What
we
had
discussed
was
in
the
context
of
kentucky's
transportation
services.
Right
now
are
are
pretty
rough
for
people
with
disabilities.
Essentially,
what
kentucky
has
done
is
created
a
mass
segregated
transportation
system
where
people
are
forced
to
remain
on
bands
with
other
participants
for
sometimes
hours
of
time.
C
One
thing
that
that
chris
and
I
and
shawna
had
discussed
for
this
group
to
maybe
potentially
look
at
exceptional
supports
being
examined
to
include
a
transportation
piece
so
that
people
can
access
additional
funding
for
transportation
need
and
relative
to.
The
second
point,
the
crit
chris
just
made
and
shawna.
If
you're
on
here,
shauna
can
speak
to
this
kind
of
directly,
if
she's
been
able
to
log
in
okay,
so
exceptional
supports
are
not
indicated
to
be
long-term
funding.
C
We
talk
about
catheter
care,
which
chris
mentioned
insulin,
injections,
g2,
feeding
things
like
that
right
now
and
shawna
again.
I
want
you
to
speak
to
this
directly.
You
know
shauna
needs
intense
medical
supports
and
so
she's
operating
under
exceptional
supports
to
have
someone
come
in
and
do
a
skilled
procedure.
C
The
only
funding
mechanism
for
that
is
under
exceptional
supports,
and
this
is
something
that
she's
going
to
need
for
probably
the
the
duration
of
her
life.
However,
we
have
to
go
in
and
do
six
month
authorizations
at
a
time,
and
it
does
present
a
certain
amount
of
anxiety
for
shauna,
not
knowing
that
those
things
are
going
to
be
in
place
long
term
because
they
have
to
be
reauthorized
and
exceptional
supports
by
design
in
kentucky
are,
are
not
instilled
to
be
a
long-term
mechanism,
and
so
it
prohibits
people.
C
In
her
instance,
exceptional
support
pays
for
a
lpn
to
come
into
her
home,
that's
contracted
to
her
residential
agency,
and
that's
the
only
way
that
that's
able
to
exist
because
there's
no
funding
for
nursing
care
in
waivers
and
providers
are
not
required
to
have
nursing
and
they
basically
operate.
Underneath
you
know
unlicensed
medical
unlicensed
professionals,
so
the
only
way
that
those
things
can
happen
is
if
an
lpn
is
contracted
with
to
come
in,
and
providers
have
to
have
funding
for
that.
Otherwise,
you
it.
It
amounts
to.
C
B
B
A
B
B
B
E
C
A
So
in
this
first
section,
we've
heard
so
far
from
chris
we've
heard
from
brandon
and
we've
heard
from
shauna.
We
have
not
yet
heard
from
nicole,
and
so
I'm
looking
forward,
if
nicole,
has
anything
to
add.
But
while
nicole
is
getting
ready
to
speak,
can
we
please
have
chris
shauna
and
brandon
mute
their
microphones
so
that
we
don't
get
any
feedback.
B
C
And
so
chris,
the
the
other
pieces
were
what
we
what
we
talked
about
and
I'll
just
kind
of
run
through
the
big
items,
real
quick,
because
I
know
we're
pressed
for
time.
One
thing
that
the
self-advocacy
group
identified
was
that
the
exceptional
services
should
be
available
for
more
than
just
clinical
residential
or
day
training
sites.
C
D
C
B
C
You
have
some
perceptions
that
are
living
on
their
own,
who
may
either
be
in
their
own
apartment
or
self-directing.
Services
and
personal
assistance
is
a
service
that
if
people
are
wanting
to
live
on
their
own,
there's
no
mechanism
for
them
to
get
enhanced
funding
if
they
require
additional
medical
needs.
Like
shawna,
like
shauna,
is
going
to
have
an
extremely
difficult
time,
moving
out
of
a
traditional
residential
model
to
something
else,
because
she
would
have
to
fit
in
this
box
of
services
that
isn't
really
defined
to
meet
her
needs.
C
And
so
the
exceptional
supports
from
my
understanding
was
meant
to
be
applicable
to
folks
that
don't
fit
into
your
standard
model
of
service,
and
so
people
that
participate
direct,
mainly
two
staff
at
one
time
or
people
living
in
their
home.
That
may
need
two
two-person
transfers
that
that
doesn't
exist.
C
C
People
that
experience
immediate
crisis,
that
the
current
crisis
response
units
aren't
equipped
to
handle,
and
so
the
exceptional
support
should
be
something
that
participants,
families
and
providers
know.
Is
there
as
a
resource
there
shouldn't
be
any
confusion,
what
a
person
can
qualify
for
and
how
long
the
funding
will
be
in
place.
A
A
A
C
No,
it's
it's
more
of
a
definition
of
the
exceptional
support
itself.
Okay,
you
know
certain
services
are
defined
to
be
able
to.
You
can
apply
for
exceptional
supports
for
certain
services,
it's
pre-defined,
but
there
should
be
additional
services
that
you
could
examine.
Exceptional
supports
for,
like
the
personal
assistance
piece
that
we
were
talking
about.
Okay,.
A
C
A
E
E
B
C
C
And
they
can,
they
can
go
through
the
process
of
being
a
subcontractor
for
a
broker,
a
transportation
broker.
However,
that
process
is
so
convoluted
and
extreme
that
a
lot
of
providers
don't
do
it.
You
have
an
existing
framework
of
medicaid-based
providers
throughout
kentucky
that
could
potentially
and
have
the
resources
in
wheelchair,
accessible
vans.
B
C
B
The
question
I'd
like
to
ask
is:
how
can
we
make
this
less
complicated
as
far
as
providing
transportation
for
those
folks,
especially
in
the
rural
areas
that
you're
talking
about
for
a
little
while,
after
I
retired
from
my
previous
career,
I
drove
for
one
of
those
transportation
companies
and
drove
elderly
and
disabled
to
doctors,
appointments
and
such,
and
I
know
those
exist.
How
do
we
make
that
process
less
complicated.
C
So
that
already
is
a
system
that
already
kind
of
I
don't
want
to
say,
rewards
them,
but
it's
more
positive
if
they
subcontract
with
the
least
amount
of
vendors
that
they
can,
and
so
that's
counterintuitive
to
what
we
want
to
accomplish.
The
second
thing
is:
is
that
you
have
to
go
in
and
apply,
then
there's
several
months
of
red
tape
that
you
have
to
slash
through
anyone
else
who
is
providing
transportation
in
certain
counties
can
can
automatically
deny
your
ability
to
provide
transportation
services
so
like
in
lexington.
C
C
I
don't
know
if
that's
still
the
case,
but
I
know
it
was
a
few
years
back,
but
the
funding
mechanism,
by
which
the
transportation,
the
non-emergency
medical
transportation
works,
is
the
biggest
hindrance
coupled
with
the
red
tape
that
a
provider
would
have
to
go
through
in
order
to
provide
it.
But
you've
got
like
I
said:
you've
got
the
existing
network
there.
It's
just
heavily
underutilized.
F
F
we
employ
about
8
000
people
serve
180,
000
people
annually
about
1
in
25
kentuckians
and
significantly
we're
led
by
300
volunteer
board
members
to
chart
the
course.
I
say:
community
health
centers
make
communities
better
through
exceptional
services,
good
jobs
and
extraordinary
volunteer
leadership.
F
The
other
piece
about
mental
health
centers
we've
been
involved
in
the
scl
program
and
its
predecessor
the
aismr
program,
since
it
started.
Do
we
go
way
back
on
this?
I
was
an
seo
provider.
When
I
worked
for
a
living
now,
the
association
I
talk
about
stuff
we've
been
talking
about
this
issue
going
back
to
1991.,
I
have
a
memo
that
we
submitted
in
1991
of
the
need
for
an
exceptional
support
mechanism
high
intensity.
F
I
attended
meetings
in
99
on
this
issue.
I
got
notes
of
those
meetings.
We
submit
a
proposal
in
2003
in
collaboration
with
bluegrass,
now
new
vista
children's
view
program,
using
a
tool
to
come
up
with
a
plan
to
2017.
There's
the
exceptional
protocol
we're
under
now,
so
we've
been
active
in
this
issue
for
31
years.
I
personally
have
been
active
in
this
issue
for
23
years,
more
significantly,
individually
or
families
been
active
in
this
issue
for
a
lifetime.
F
We
need
to
figure
out
how
to
make
this
work
for
them,
not
for
me
not
for
my
members,
but
for
the
individual
server
can't
turn
paper
with
a
mask
on
sorry
about
that.
One
thing
we
did.
I
talked
about
this.
We
did
a
survey
of
300
plus
seo
providers,
seo
recipients
individuals
in
the
early
2000s,
using
the
tool,
the
icap
and
came
up
with
a
tiered
reimbursement
methodology
and
submitted
that
we
have
that
information.
F
F
There
is
a
long-term
living
initiative
summit
in
2006
to
discuss
this
issue.
We've
talked
a
lot
about
this,
it's
time
to
move
forward
and
do
the
right
thing.
The
current
protocol.
We
have
dated
march
1.
2007,
clearly
says:
exceptional
supports
are
for
the
sole
purpose
of
ensuring
the
health,
safety
and
welfare
of
the
waiver
recipient.
F
We
endorse
that
100
percent.
We
think
that
has
to
be
the
focus.
That's
going
to
generate
the
outcomes
we
need
to
have
accomplished
if
the
current
system
worked.
Why
would
he
be
here
today?
Clearly,
there's
concerns.
There's
some
positive,
there's
two
great
things
about
it:
one
it's
based
on
the
individual
for
residential
support
for
day
programs,
as
mr
griffin's
reference,
it's
not
all
services,
but
it's
driven
off
the
team
and
the
individual
is
not
driven
off
the
regulations
or
services
they
participate.
F
They
help
develop
the
plan
they
get
supports.
They
should
have
confidence
in
that
plan.
It's
going
to
meet
their
needs
in
the
community.
That's
a
good
way
to
approach.
That's
a
good
start.
The
second
piece
is,
the
providers
of
those
services
can
feel
confident.
They're
going
to
be
those
services
are
going
to
be
viable
that
they
can
provide
the
services
to
generate
quality
outcomes
for
people,
tangible
outcomes,
changes
in
their
lives,
but
not
go
broke
in
the
process.
That
has
to
be
a
real
concern.
F
F
F
I
approach
the
people
direct
services
at
the
mental
health,
centers
11
members.
I
heard
things
like
I
heard
the
recruitment
issue.
They
come
back
and
look
at
what
you
spent.
Maybe
you
had
a
plan
to
pay
someone
more
money
and
they
worked
overtime
had
to
pay
overtime.
That
wasn't
part
of
the
plan
that
may
have
been
recouped.
Other
dollars
were
recouped,
great
fear
of
having
those
dollars
recouped
or
things
like
it's
a
lengthy
process.
F
F
We
acknowledge
the
plan
needs
to
have
checks
and
balances.
We
acknowledge
it.
Just
can't
be
here.
You
go
a
pot
of
money,
do
whatever
you're
going
to
do.
We
buy
checks
and
balances.
We
accept
that
we
have
concerns,
though,
do
those
checks
and
balances
to
make
sure
plans
are
approved.
People
get
the
services.
F
F
F
That's
a
real
concern,
folks,
who
need
exceptional,
supports,
need
to
get
it
shouldn't,
be
dependent
on
the
ability
to
submit
adequate
documentation,
investing
energy
and
like
managed
care
prior
authorizations
if
you're
reluctant
to
get
it
approved,
you're,
probably
not
going
to
submit
it,
do
something
else.
That's
a
concern.
Are
people
not
accessing
services,
so
the
first
opportunity
of
four
I
see
before
us:
let's
make
the
process
less
onerous,
share,
accountability
and
tangible
outcomes
focus
on
the
individual,
but
make
it
less
onerous,
so
it
works
for
the
provider.
F
F
F
I
think
that
conversation
will
generate
better
outcomes
for
the
individual.
You
may
get
a
plan
that
the
state
feels
good
about.
Has
accountability
providers
can
do,
but
it
meets
the
individual's
needs
as
opposed
to
just
a
yes
or
no,
because
what
happens
now
is
if
there's
a
no,
you
start
the
whole
process
over
and
what
happens
to
the
individual
while
you're
waiting
through
that
process.
So
again
the
first
one
take
unless
owners
maintain
accountability.
F
Second,
one:
let's
have
a
dialogue
about
the
approval
process
to
see
what
can
happen.
The
third
item
we
talked
about
is
a
length
of
time,
and
you
heard
this
from
the
previous
group
and
they
were
exact,
correct
on
this
issue.
They
nailed
it
pretty.
Well,
certain
services
are
going
to
last
a
long
time.
F
F
F
You
kind
of
turn
in
and
out
of
that
exceptional
support.
You
get
it.
You
do
a
little
bit
better,
you
might
lose
it.
You
get
it
again,
six
months,
so
every
other
rotation
you
may
get
it
again
and
lose
it
for
a
while.
That's
not
beneficial!
It
doesn't
accomplish
the
objective
of
focus
on
the
individual's
health,
safety
and
welfare.
So
how
can
we
do
that?
So
I
think
the
third
thing
is
go
to
a
six-month
plan
in
a
pretty
easy,
maybe
not
easy
as
the
right
word,
but
a
methodology
for
a
six-month
renewal
beyond
that.
F
That
is
much
more
meets
the
needs
of
the
system,
but
doesn't
require
a
huge
amount
of
documentation
and
support
and
effort
to
get
it
done.
So
you
go
to
18
months,
and
you
forget
about
your
months.
I
go
back
to
shauna.
Ishana
needs
an
lpn
today
she
may
need
one
for
a
long
time.
Why
do
we
have
to
submit
the
paperwork
again
and
again?
But
the
third
option
we
talked
about
was
go
beyond
go
beyond
just
six
months,
a
year
initially
and
then
maybe
an
expedited
review
process
for
the
next
six
months.
F
You
get
18
months
worth
of
services
and
then
see
where
you're
at
folks
who
get
exceptional
supports,
have
pretty
significant
challenges
in
their
lives.
They
want
to
live
in
the
community.
We
want
to
make
sure
the
system
allows
them
to
do
that,
and
not
have
this
clock
running
that
we're
all
panicked
about.
So
again.
The
third
action
12
months
x,
value
review,
maybe
another
six
months
get
18
months
worth
of
services.
I
think
that's
fair.
F
There's
tools
out
there
commercially
available
tools
that
we
can
use
become
very
adept
at
be
successful
with
that
gives
you
an
idea
what's
taking
place,
as
I
said,
early
on
in
2000
or
so
brad
hill,
who
was
one
of
the
authors
of
the
inventory
for
client
and
agency
plan
of
the
icap
came
to
kentucky,
spoke
to
consumers,
families
providers.
You
know
the
whole
world
was
invited
to
participate
in
that
that's
one
tool.
F
The
icap
still
available
I've
been
meeting
with
medicaid
staff
a
couple
years
ago,
talking
about
the
icap
for
a
different
way,
with
michelle
p
waver.
It's
still
out
there.
The
american
association
of
intellectual
development
disabilities
has
the
cis
support.
Tension
is
failed.
It's
a
good
tool,
that's
one!
At
one
time,
kentucky
usa
was
the
nc
snap.
North
carolina
support,
needs
assessment
profile.
Now,
if
you're,
not
in
north
carolina,
it's
the
dd
snap,
that's
a
good
tool.
It's
still
out
there.
We
use
that
tool
for
a
while
and
added
on
a
one-page
healthcare
one.
F
Everyone
gets
a
healthcare
screening
tool
now,
there's
tools
that
are
available,
I
think
tools,
a
standardized
tool,
that's
reliable
and
valid,
helps
you
direct
where
the
services
ought
to
be,
and
you
end
up
with
a
recommendation
that
meets
the
person's
needs.
Okay,
I
think
you
have
a
tool,
it
may
address
the
onerous
process
and
it
may
address
the
time
process
because
one
you
can
see
what
changes
year
to
year
based
on
that
tool
and
how
it's
used.
So
I
think
we
need
to
select
a
tool.
F
B
F
A
dialogue
for
denials-
primarily,
we
think
this
needs
to
change
and
then
your
focus
on
the
individual,
not
the
ability
of
the
provider
and
I'm
a
provider
guy
represent
providers
who
submitted
the
documentation.
You
want
the
decision
to
be
based
on
the
conversation
with
the
individual
and
the
team.
I
don't
know
what
I
submitted
as
a
provider.
F
Third
go
to
a
12-month
process
for
approval,
so
the
plans
typically
run
a
year.
You
go
to
12-month
for
the
exceptional
supports,
and
then
you
add
on
the
16
six
months,
again
kind
of
an
expedited
renewal
for
that
period.
You
look
at
where
you're
at
in
18
months,
and
I
think
you
pick
a
tool.
I
think
we
need
to
have
a
standardized
system
to
make
it
work.
F
Those
are
the
four
things
that
came
out
of
the
conversation
I
had
with
folks.
We
then
talked
about
the
work
of
the
task
force
and
I
admire
you
for
doing
this.
This
is
a
again
29
years.
We've
been
at
this
conversation
and
we
made
progress
in
certain
areas,
but
there's
certain
things.
I
think
that
help
us
with
our
deliberation
going
forward.
I
have
four
of
those
one
you
got
to
remain
focused
on
the
person.
You
got
to
focus
on
that
individual
fourth
intensity
scale.
E
B
F
Migration
away
from
some
services
and
some
people,
we
don't
want
that
to
happen,
so
you
gotta
acknowledge
going
in
if
that's
a
guiding,
if
we
gotta
get
away
from
the
budget
neutrality,
the
budget
neutral
perspective
of
the
waiver
to
make
sure
there's
adequately
funded
for
exceptional
support,
so
people
can
do
this.
The
system
can
do
this
and
you're
not
penalized
you're,
not
telling
our
medicaid
partners.
Here
you
go,
commissioner.
Lee
spend
the
same
amount
of
money,
but
do
more
with
the
same
amount.
That's
not
viable
hasn't
worked.
F
They
also
think
you
have
a
conversation
about
the
populations
that
need
an
exceptional
support.
I
think
those
are
real
things
we
need
at
least
think
about.
I
think
you
heard
some
from
shauna
the
issue
around
medically
frail.
I
have
health
care
needs
that
exceed
what
most
people
have
that's
a
real
issue.
F
They
also
they
gotta
talk
about
aging
in
place.
A
lot
of
people
in
the
seo
program
been
there
for
a
long
time.
I
know
my
own
experience
with
aging.
You
cost
more
money
than
you
did
when
you
were
younger.
You
know
my
parents
required
more
support.
My
mother-in-law
required
more
support.
You
know
my
kids
will
tell
you.
I
require
more
support,
it's
going
to
cost
more
money.
We
can't
ignore
that
piece.
We've
got
to
at
least
talk
about
that
and
have
that
conversation
you
got
folks
with
challenging
behaviors
in
the
seo
program.
F
If
medicaid
can
pay
for
part
of
it,
it'd
be
better
off
of
medicaid,
you
spend
30
cents,
28
cents,
whatever
the
match
rate
is
now
versus
a
dollar.
There
are
people,
but
what
is
that
piece?
We
also
have
a
lot
of
folks
who
are
involved
with
the
criminal
justice
system.
I
had
a
conversation
a
couple
years
ago
with
the
chief
of
police
of
a
town
in
kentucky
who
knew
the
person
specifically,
who
calls
every
day
and
the
message
that
he
said.
We
need
a
secure
unit
that
person
can
go
and
stay
for
a
long
time.
F
Don't
think
that's
the
answer,
but
it's
a
conversation,
criminal
justice
involvement
and
folks
with
co-occurring
mental
illness.
We
need
to
talk
about
those
people.
Those
last
three
may
have
some
overlap,
but
it's
just
not
going
to
be
one
fix
for
everybody.
Nursing
is
a
real
thing.
We
need
to
acknowledge
that
in-home
supports,
may
change
as
you
get
older.
We
need
to
acknowledge
that
and
challenging
behaviors
there's
a
thing.
We've
got
to
at
least
talk
about.
F
Also
put
my
provider
hat
back
on.
There
can't
be
an
expectation
that
a
provider
supports
someone
in
the
community
and
not
believe
as
a
provider
there'll
be
sufficient
resources
to
do
that
going
forward.
You
just
can't
operate
very
long
with
that
premise
that
if
I
used
to
be
back
in
the
glory
days
that
I
was
told
you
make
enough
money
off
client
one
through
nine,
you
can
lose
someone
ten
one
through
nine
is
a
challenge
now.
So
if
10
is
more
expensive,
there
needs
to
be
enough
money
to
support
number
10
in
that
process.
F
In
conclusion,
we've
been
talking
about
this
for
a
long
time.
I
think
this
is
an
opportunity
to
have
a
real
conversation
and
come
up
with
recommendations
that
again
focus
on
the
individual
allows
the
commonwealth
to
feel
good
accountability.
Their
federal
partners
to
feel
good,
that
is
accountable
system
and
providers,
can
do
the
work
they
want
to
do
and
not
be
at
risk
of
losing
money.
A
A
I
mean
it's
it's
because
I
think
this
is
such
a
dynamic
space
in
which
to
work,
and
so
you
it's
hard
to
put
guardrails
up
on
a
dynamic
situation,
but
at
the
same
time
you
need
to
put
guard
rails
up,
but
you
also
have
to
have
to
have
that
flexibility
and
that
flexibility
is
so
key,
because
each
person
is
an
individual
and
they
each
have
their
individual
challenges.
And
so
you
know
those
are
really
challenging
parameters
in
which
to
work.
A
I
guess
one
of
the
things
that
I
want
to
ask
you
about
is
you
know
the
bevin
administration
spent
a
whole
lot
of
money
on
this
navigant
study
and
trying
to
determine
who
was
in
what
waiver?
Should
they
even
be
in
that
waiver?
What
were
the
services
available
within
that
waiver
because
we
were
operating
in
these
silos.
A
And,
to
be
honest,
I
don't
even
know
whatever
came
from
that
contract,
but
I
guess
my
question
to
you
is:
were
they
on
the
right
track?
As
far
as
allowing
for
this
flexibility
are,
we
are
we
going
to
like
a
only
one
waiver
and
then
we'll
figure
out
all
these
different,
a
la
carte
items?
I
I
mean
I
I
guess
what
what
is
it
that
we're
kind
of
generally
looking
for
in
order
to
serve
the
individual.
F
Yeah
yeah,
I
wish
I
had
that
answer.
Yeah,
that's
a
great,
but
but
I
think
this
is
an
opportunity
to
have
that
conversation.
The
navigate
report
was
robust
covered
a
lot
of
stuff.
It
did
initially
look
at
consistent
language
across
waivers
sounds
kind
of
silly,
but
that
really
makes
a
difference.
So
the
service
is
called
the
same
thing:
try
to
get
rates
consistent
across
the
waiver,
so
you
know
there's
really
six
waivers.
B
F
There's
a
model
two
waiver
which
eventually
depended
that
wasn't
part
of
navigant
but
there's
two
brain
injury
waiver
there's
a
home
and
community-based
waiver
there's
michelle
p
waiver
and
the
seo
waiver.
I
think
this
group
is
the
sco
yeah
right,
but
they
kind
of
make
consistent
language
across
those
five
try
to
get
consistent
rates
for
services
across
those
five,
because
if
the
service
definition
is
comparable,
the
premise
was
the
rate
ought
to
be
comparable.
So
that
was
a
good
conversation
to
start
to
go
down
that
road.
F
I
think
that
was
a
state
cms.
Has
this
budget
neutrality,
rule
okay,
can't
spend
more
personal
facility,
I
mean
the
community
can't
spend
more
than
an
icf
or
an
institution
or
a
nursing
home.
So
there's
that's
the
that's
their
big
picture,
okay,
but
this
was
budget
neutral.
You
know
it's
kind
of
like.
If
you
got
a
piece
of
pizza
with
eight
slices,
you
can
do
what
you
want
to
pizza,
but
the
bottom
line.
You
still
have
a
large
pizza,
but
I
get
an
extra
large
pizza.
F
F
A
F
How
do
we
get
to
a
place
that
really
meets
the
person's
needs
and
just
meets
their
needs?
I
mean
we
all
want
a
lot
more
stuff,
but
maybe
if
you
focus
on
need,
you
can
accomplish
that
and
see
what
it
looks
like
you
know,
it's
a
residential
rate.
That's
that's
the
big
expensive
piece,
so
there's
a
lot
of
conversations
about
residential
day
program,
but
but
I
think
you
got
to
look
at
what
people
really
need.
I
think
you
got
to
add
nursing
to
it
and
that
can't
be
done
for
free.
B
F
F
F
So
I
think
that's
a
different
population,
but
I
think
this
is
a
place
to
start
the
conversation
and
what
can
we
do
to
make
it
viable
and
work
for
the
individual,
but
it
really
worked
for
the
individual
and
the
provider
believes
they're,
confident
they
can
do
it.
I
think
we
can
get
a
system
that
meets
those
needs.
I
still
go
back
to
a
tool.
A
F
F
If
the
basic
package
was
thirty,
six
thousand
dollars,
staff
resident
was
eighty
five,
it's
more
than
that
now,
but
that
was
a
level
six
and
within
that
you
had
the
flexibility
to
figure
out
how
to
make
it
work.
It
wasn't
dead
on
to
the
person,
it
wasn't
their
specific
situation,
but
can
you
get
them
into
a
tiered
model
and
look
at
that?
That's
a
way
to
start
in
the
process
and
you
go
from
there.
I
think
at
some
point
a
conversation
between
the
michelle
p
and
the
scl
waiver.
F
B
F
Okay,
two
and
three
residential,
even
a
staff,
residence
or
otherwise.
You've
got
forty
two
thousand
dollars
for
a
staff
resident
or
fifteen
for
like
in
a
home
with
somebody
else,
maybe
that
the
residential
piece
makes
the
sale.
The
general
fund
makes
it
michelle
p
or
the
other
services,
not
residential
or
michelle
p,
but
I
think
he
got
to
move
in
that
direction.
Okay,
you
know
I
like
the
individual
model,
but
it
I
don't
want
to
think
people
aren't
getting
it.
F
That's
the
only
concern
yeah,
but
if
you
had
a
tear,
maybe
you
can
say
okay.
This
is
what
you're
eligible
for.
Let's
talk
about,
how
we're
going
to
spend
that
money
kind
of
a
pds
model
yeah?
How
can
you
do
that
and
make
sure
that
people's
needs?
They
don't
live
in
a
staff
resident?
They
don't
live
in
a
supervised,
24,
7
home.
They
don't
get
as
much
money.
For
that.
A
F
It's
it's.
The
existing
parameters
for
the
seo
service
is
in
regulation.
Okay,
so
you
gotta
fit
in
the
rates
in
regulation.
Okay,
I
think
the
residential
rates
173
day,
you
know
whatever
the
number
is:
that's
what
you
get
that
doesn't
support
everybody.
Okay,
so
the
exceptional
support
is
really
not
a
waiver.
F
It's
a
piece
of
the
scl
waiver
that
some
folks
make
application
to
and
get
additional
funding
to,
support
that
person.
Okay,
and
that's
why
and
it
was
done
because
you
know
one
one-size-fits-all
is
really
one-size-fits-none
and
that's
kind
of
where
the
seo
was
at
this
point.
She
had
someone
who
required
one-on-one
staffing.
F
F
E
E
And
I
I
just
want
to
make
that
public
that
you
have
been
a
you've
been
a
gentleman
and
and
the
things
you've
done
have
been
amazing.
But
I
want
to
touch
on
the
waivers
a
little
bit.
So
what
listening
to
you
seemed
like
you
focused
on
making
it
less
onerous,
making
sure
there
was
good
dialogue
with
all
the
parties,
and
then
I
think
you
mentioned
the
12-month
process
which.
F
F
A
B
F
A
D
Okay,
perfect
so
just
quickly,
my
name
is
amy
stade.
I
am
the
executive
director
of
the
kentucky
association
of
private
providers.
I
just
wanted
to
thank
you
all
for
allowing
me
to
present
today
and
to
be
and
for
allowing
me
to
be
a
member
of
the
task
force.
I
really
appreciate
it.
I
really
appreciate
the
opportunity
to
talk
about
this
incredibly
important
topic
that,
as
steve
so
eloquently
pointed
out,
we've
been
talking
about
for
a
very
long
time
and
still
haven't
quite
worked
through
cap.
D
As
we
call
it
is
a
trade
association
representing
1915
c
waiver
providers.
Our
advocacy
primarily
covers
the
supports
for
community
living
and
the
michelle
p
waivers,
but
are,
but
our
members
do
provide
services
and
other
waivers.
We've
got
about
105
business
members
that
are
individual
businesses,
my
members
employing
about
9
000
kentuckians
and
support
around
10
000
individuals.
So
you
know.
B
F
D
Two
fundamental
questions
about
exceptional
support
services-
one
I
asked
them.
Does
the
current
exceptional
support
system
provide
seo
participants
the
individuals
with
disabilities
that
are
being
served
with
the
support
they
need?
The
overwhelming
response
was
no,
it
did
not.
The
individuals
served
that
need
exceptional
support,
don't
if
still
don't
get
the
support
they
need.
The
second
question
was:
does
the
current
exceptional
support
system
adequately
adequately
support
providers
to
provide
care
to
individuals
with
significant
care
needs?
The
overwhelming
response
was
no.
D
D
D
So
in
the
definition
section,
an
exceptional
support
is
a
service
that
is
requested
by
the
participant
and
the
participants
team.
It's
due
to
an
extraordinary
circumstance
related
to
health,
safety
and
welfare
psychiatric
issue.
But
it's
a
service.
That's
provided
in
excess
of
the
upper
payment
limit
for
the
service
and
it's
got
to
meet
the
assessed
needs
of
the
participant
next
slide.
B
D
These
exceptional
supports
are
typically
approved
for
six
months
and
they're
per
they're
generally
provided
in
excess
of
the
upper
payment
limit
or
the
unit
limit,
meaning
that
they're
the
established
reimbursement
rates
or
units
that
you
can
build
exceptional
supports
or
services
that
you
can
bill
more
for
or
provide
more
units
for
next
slide.
Please.
D
D
Typically,
we
are
seeing
that
these
services
are
being
utilized
by
residential
agencies
to
provide
one-on-one
supervision,
and
I
put
that
note
in
there
that
if
the
residential
service
receives
exceptional
supports
rate
increases
aren't
allowed
for
any
of
those
other
services.
So
if
you're
getting
it
for
residential
to
provide
one-on-one
care,
none
of
those
other
services
would
be
eligible
to
receive
increased
enhanced
rates
under
the
exceptional
support
system.
D
Also,
as
you
see
below
certain
services,
can
ask
use
the
exceptional
support
process
to
ask
for
increased
units.
So
while
they
are
being
reimbursed
the
same
rate,
they
can
ask
for
more
units
be
provided
and
those
are
consulted
clinical
and
therapeutic
services,
coaching
personal
assistance
and
respite
next
slide.
Please.
D
D
Two
and
we're
seeing
a
lot
of
this
are
individuals
who
require
a
high
level
support.
This
is
an
individual
who
generally
might
have
a
co-occurring
mental
health
condition
they're
receiving
one-on-one
supports
in
a
residential
setting.
These
are
these
are
individuals
with
really
intense
support
needs
in
this,
the
third
category
of
individual.
These
are
people
who
actually
lost
access
to
services
as
a
result
of
the
state's
transition
from
sdl1
to
scl2.
B
D
Unit
caps
on
services,
like
behavior,
supports
psychological
services
when
we
transitioned
to
scl2,
we
combined
behavior
services,
psychological
services
and
nutrition
services
into
a
service
called
cct,
it's
clinical,
consulting
and
therapeutic
services,
and
we
put
up
and
I'll
talk
a
little
bit
about
this
later,
but
we
put
a
pretty
low
unit
cap
on
that
and
people.
A
lot
of
people
lost
access
to
the
services
that
they
received
under
stl1.
D
D
So,
after
consultation
with
my
members,
we
kind
of
identified
several
problems,
so
the
first
of
which
is
the
way
that
the
current
regulations
are
written
providers
are
deterred
from
agreeing
to
support
an
individual
with
intense
support
needs.
So
what
does
that
mean
right
now?
The
way
that
the
referral
system
works
in
the
scl
waiver
is,
if
you
are
a
provider
and
you
send
out
a
referral,
and
you
accept
that
referral
that
individual
you'll
do
an.
D
Visit
that
individual
will
come
to
live
with
you
if
six
months
down
the
road
you
realize
that
you,
this
is
an
individual
has
very
intense
support,
needs
that
your
agency
just
is
not
equipped
to
support.
You
can
institute
a
30-day
notice
of
involuntary
termination,
so
then
you
send
out
referrals
to
other
providers.
D
Until
someone
will
accept
that
referral
and
as
we've
kind
of
noticed
in
the
stl
system,
once
an
individual
who
has
maybe
extreme
behaviors
or
is
incredibly
violent,
is
identified
and
kind
of
pegged
as
someone
who's
very
hard
to
serve
or
someone
who's
violent.
No
one
will
accept
that
referral,
and
so
then,
a
provider
who
has
admitted
that
they
are
not
equipped
to
care
for
this
person
that
the
staff
isn't
safe,
that
the
individual
is
not
safe.
In
this
instance,
have
no
mechanism
to.
D
D
F
D
F
D
This
whole
system
called
lois,
and
these
are
called
these
are
lack
of
information
requests,
so
a
provider
will
the
case
manager
will
submit
all
of
the
documentation
that
the
whole
big
packet
and
then
these
medicaid
or
dd
medicaid
will
send
in
these
lois
saying.
Can
you
clarify
this,
or
can
you
clear
this
up
or
your
salary
calculations
are
quite
right,
that
kind
of
delay
the
whole
process.
D
Meanwhile,
a
provider
may
be
providing
exceptional
supports
already,
and
the
thing
about
this
is
that
these
lois
delay
the
start
date
and
there's
no
mechanism
to
back
date.
The
start
date
of
the
exceptional
support
to
when
the
team
you
know
originally
submitted
the
documentation.
These
lois
can
really
slow
down
the
process
and
create
a
lot
of
created.
A
lot
of
issues
for
providers.
D
Something
else
that
I
think
brandon
may
have
alluded
to
is
this:
the
long-term
supports
after
stabilization,
so
seo
providers
have
called
it
they're
victims
of
their
own
success.
So
what
happens?
Is
someone
will
apply
for
and
receive
exceptional
support?
So
let's
say
this
individual,
you
know
lives
in
a
residential
setting,
gets
one-on-one
staffing
in
a
residential
setting
and
gets
you
know
intense
behavior
support
services
and
that
person
is
now
stable,
but
that
person
also
comes
to
rely
upon
these
services.
D
B
D
Someone
described
it
as
you
need
a
skilled
grant
writer
to
make
the
case
that
a
participant
will
regress
if
the
exceptional
supports
are
removed,
and
that's
so
true,
it
takes
a
lot
of
time
to
just
continue
the
services
on
administrative
burden
to
just
justify
continuing
the
services
that
are
keeping
people
stable
and
the
services
that
people
need.
It's
a
it's
a
big
problem
for
providers,
as
I
mentioned
earlier,
with
the
consultive
clinical
and
therapeutic
services
under
scl1,
there
were
no
caps
on
these
services.
D
We
certainly
wouldn't
advocate
going
back
that
way.
I
think
that
there
was
probably
a
lot
of
not
prudent
using
of
state
resources
during
that
time,
but
right
now
those
units.
So
again
it's
that's
a
bundled
service,
so
you
have
to
split
the
units
allocated
every
year
between
behavior
supports
psychological
services
and
nutrition
services,
and
it
is
capped
at
160
units
a
year.
These
units
are
15
minute
units
and
so.
F
B
D
F
D
This
arbitrary
formula,
so
this
formula
is
not
based
on
anything
mathematical.
It
is
the
result
of
a
negotiation
between
the
cabinet
for
health
and
family
services
and
providers,
and
essentially,
what
the
regulation
says
is
that
you
cannot
the
exceptional
rate
reimbursement.
The
exceptional
supports
reimbursement
cannot
exceed
two
times
the
upper
payment
limit,
which
is
the
right
so
for
residential
one
services.
D
The
upper
payment
limit,
the
reimbursement
rate
is
a
hundred
and
around
189
dollars
a
day,
just
to
contrast
that
the
per
vm
for
an
icf,
which
is
you
know,
the
institutional
kind
of
care
equivalent
or
other
option
to
community-based
care.
That
per
diem
is
1200
a
day.
It's
a
little
more,
but
I
rounded
down
it's
twelve
hundred
dollars
a
day.
D
F
D
D
Cost
less
than
you
know,
ics
level
care,
so
we've
got
a
lot
of
play
in
there
to
to
work
with
to
meet
those
requirements.
But
if
you
look
at
this
calculation,
it's
impossible
to
figure
out
and
where
providers
report
that
they
try
to
figure
it
out
and
then
medicaid
often
will
come
back
and
say
no,
no,
no!
You
calculated
this
wrong
here.
D
Here's
the
calculation
and
then
medicaid
just
have
to
figure
it
out,
and
the
providers
just
have
to
trust
that
it's
right,
and
so
I
really
thought
it
was
important
for
the
group
to
see
this
actual
formula
and
see
how
it
is.
It
is
the
result
of
a
negotiation
and
not
based
on
any
sort
of
cost
data
provided
by
providers
next
slide,
please.
D
B
B
D
That
a
lot
more
costs
go
into
providing
care
in
running
a
business
than
hourly
pay.
This
makes
no.
This
doesn't
allow
providers
to
work
in
the
cost
of
overtime,
which
is
a
massive
issue
in
this
population.
Right
now,
sdl
providers
are
struggling,
there's
a
huge
workforce
crisis.
They
cannot
hire
anyone
because
they
don't
frankly,
they
don't
have
the
money
to
pay
staff
15
an
hour
which
is
pretty
much
the
going
rate
right
now.
Sel
providers
don't
make
enough
to
pay
staff
that,
and
it's
incredibly
difficult
to
find
qualified
staff
to
serve
these.
D
B
D
D
D
D
If
you
can
you
scroll
to
the
top,
please
again,
so
they
are
reimbursed
for
these
seven
people
in
total
798
thousand
dollars
a
year,
and
this
company
spends
1.2
million
dollars
to
support
these
seven
people-
and
this
is
just
not
in
in
these.
These.
This
company
cannot
refer
out
these
individuals.
You
know
they're,
clearly
bleeding
money,
they
they've
stated
they
often
you
know
and
can't
support
them,
and
they
they
have
nowhere.
D
No
one
will
take
the
referral
so
here
they
are
just
stuck
losing
400
000
a
year,
and
these
are
businesses
that
operate
on
really
papers
and
margins,
and
we
can't
expect
our
provider
partners
provide
care
at
such
a
significant
loss
and
without
giving
them
any
options.
It's
it's
tough
and
I
can.
This
is
just
an
overview
of
all
the
different
costs.
You
know
kind
of.
I
wanted
to
contrast
it
again
against
that
previous
slide.
That
showed
just
the
just.
The
wages
I
mean
this
is
really
the
costs
that
go
into
providing
care.
D
D
So
I'll
just
run
through
our
recommendations
really
quickly,
because
I
know
we're
running
out
of
time,
so
one
overwhelmingly
cap
members
believe
that
we
need
to
establish
a
higher
level
of
care,
while
also
retaining
our
exceptional
support
system.
So
what
we
would
do
in
under
this
scenario,
we'd
establish
a
higher
level
of
care
for
individuals
whose
support
needs
are
just
greater
than
what
can
be
provided
in
residential
level.
One
residential
level
two.
This
would
not
be
icf
level
of
care.
It
would
be
in
the
middle
of
those
two.
D
D
D
We
need
to
simplify
the
exceptional
support
billing
procedures,
they're
pretty
complex,
and
it
leads
to
a
lot
of
frustration
from
providers
and
we
need
to
overhaul
the
stl
referral
system
to
ensure
providers
are
not
deterred
from
accepting
a
high
intensity
referral.
We
need
to
increase
the
consultative,
clinical
and
therapeutic
service
unit
limits
so
that
participants
have
access
to
the
services
they
had
access
to
under
sdl
one,
and
we
need
to
establish
an
exceptional
support
rate
for
case
managers,
because
at
the
end
of
the
day
case,
managers
are
compiling
all
this
documentation.
D
A
D
A
Okay,
I
think
that's
that's
very
interesting.
One
of
the
things
I
like
about
your
presentation
is
I
like
how
you
have
the
recommendations
on
the
back,
because
I
think
that
you
know
this
is
kind
of
the
beginning
of
the
conversation,
even
though
the
conversation
has
been
ongoing
for
years
and
years,
and
I
think
when
we
have
the
opportunities
to
make,
I
think
progress
in
this
space.
A
A
So
I
think,
as
we
continue
this
conversation,
a
lot
of
it
is
going
to
be
kind
of
bandwidth
is
what
all
of
the
individuals
can
handle,
but
just
because
I
think
we're
presented
with
bandwidth
challenges
doesn't
mean
that
we
still
don't
have
opportunities
to
create,
create
a
more
conducive
space
to
those
who
are
reliant
on
these
exceptional
support
services.
And
so
I
really
appreciate
your
testimony
and
I
also
know
that
we
will
engage
you
further
in
a
lot
of
these
conversations.
A
A
I
have
been
told
that
I'm
supposed
to
make
a
couple
of
closing
statements,
and
first
is
any
members
need
to
be
added
to
the
attendance
roll
call,
anyone,
anyone,
okay,
invite
members
to
submit
suggestions
for
agenda
items,
either
topics
or
presenters,
and
if
we
could
get
those
to
chris
on
the
lrc
staff,
that
would
be
great,
and
so
anybody
on
this
call
that
had
was
noodling
on
something
that
we
discussed
or
wants
to
expound
upon.
Anything
that
we
discussed.