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B
Good
afternoon,
I
hereby
call
this
third
meeting
the
Kentucky
Health
and
Human
Services
delivery
system
task
force
to
order
I
would
ask
everyone
to
silence
your
cell
phone.
If
you
have
not
done
so
already,
we
have
a
lot
of
important
items
to
cover
today,
so
we'll
jump
right
into
it
secretary.
If
you
would
please
call
the
roll.
B
D
B
D
D
Yeah
absolutely
happy
to
happy
to
do
that
and
then,
obviously,
in
that
time,
covid
caused
significant
issues,
and
so
we
found
facilities
that
not
only
voluntarily
closed
during
and
post
covert,
but
we
had
under
my
tenure,
we've
had
five
facility,
involuntary
facility
closures
or
forced
three
involuntary
and
two
forced
voluntary
closures,
and
so
in
that
time
too,
we
have
worked
with
CMS
to
address
how
we
can
recapture
some
of
the
delays.
So
some
of
the
things
that
we
worked
on
significantly
were
around
our
complaint
surveys.
D
Additionally,
this
will
come
as
no
surprise
to
you
all,
but
the
vast
majority
of
our
surveyors
are
required
to
be
registered.
Nurses
and
registered
nurses
are
not
easy
to
come
by
in
this
environment,
so
we've
heard
that
from
every
Healthcare
entity
and
we
are
no
different
in
that
respect,
and
so
we
are
currently
working
and
we'll
get
to
Solutions.
In
some
later
slides
on
how
to
bring
our
outstanding
surveys
into
compliance.
D
So
you
know
one
of
the
things
that
we've
done
is
we've:
we've
looked
at
individuals
that
have
left
our
employment
and
why
they've
left
specifically
around
the
registered
nurses,
which
is
the
bulk
of
of
the
staff
that
we
have
for
the
survey
process
and
many
of
them
retired
after
the
pandemic
or
during
the
pandemic.
Some
took
jobs
outside
of
state
government.
I
read
somewhere
during
the
pandemic,
that
registered
nurses
could
make
as
much
as
three
hundred
thousand
dollars
as
a
traveling
nurse
and
so
obviously,
that's
a
very
a
tough
thing
to
compete
with.
D
Additionally,
there
was,
you
know,
a
lack
of
wages
for
a
significant
period
of
time.
The
workload
is
extensive.
It
is
challenging
in
that
they
are
traveling
all
over
the
state.
They're
spending
nights
away
from
their
families.
They
have
to
as
a
requirement
of
CMA
CMS
have
to
do
off-hour
surveys,
and
so
they
spend
early
mornings
or
weekends
in
facilities
doing
surveys
as
well
as
once
we
start
a
survey
for
a
certification
recertification.
D
You
can't
break
that
cycle,
and
so
what
that
means
is
that
the
surveyor
needs
to
be
there
every
day
until
we
exit
that
facility
and
so
for
some
of
those
involuntary
closures.
I
think
this
isn't,
but
we
had
a
tremendous
amount
of
staff
there
or
even
our
first
voluntary,
and
they
were
there
for
sometimes
30
45
to
60
days,
because
they
work
not
only
once
we've
identified
that
we're
closing
the
facility,
which
takes
a
long
time,
one
of
the
facilities
we
were
in
from
2019
to
2023.
C
D
I
think
I
think
that
this
slide
kind
of
shows
it,
but
I
think
the
next
slide
really
will
help
articulate
what
it
looks
like.
So
we've
had
a
20
turnover
since
the
beginning
of
this
year.
We've
only
been
able
to
hire
six
nurses.
We
have
had
people
that
have
not
made
it
through
probation,
which
is
not
consistent
for
our
office
typically,
and
then
we
have
all
of
our
oig
nurse
Regulators,
which
require
a
higher
skill
set.
We
have
all
those
positions
vacant
currently.
D
D
C
But
the
challenge
of
hiring
nurses
within
a
state
survey
agency
and
within
the
state
has
been
has
been
a
tremendous
challenge
as
I
look
across
our
departments
where
we
need
to
hire,
nurses
has
those
are
the
Departments
that
have
been
challenging
in
terms
of
hiring
commission
for
children
with
special
Health
Care
needs
not
as
severe
as
this,
but
still
pretty
flat,
and
so
these
are.
These
are
the
challenges
that
we've
seen
and
we
continue
to
work
on
it.
C
Many
of
the
things
many
of
the
solutions
we
we
worked
on
for
dcbs
social
workers,
increasing
salaries
to
midpoint,
working
with
temporary
agencies
to
get
them
on
more
quickly,
as
well
as
trying
to
work
on
workplace
environment.
Those
are
all
things
we
are.
We
are
trying
here,
I'm
hoping
we
were
at
the
Nader
I'm
hoping
we
are
at
the
bottom,
but
I
cannot
swear
to
you
all.
It
has
been
a
tremendous
challenge:
retaining
and
hiring
nurses
and-
and
that's
that's
exactly
where
we.
D
Are
and
I
think
one
thing
to
to
share
with
you
all
as
well
is
once
we
hire
these
nurses.
The
training
program
is
a
approximately
a
year.
So
there's
no
quick
fix
for
this.
It's
called
smqt
and
that's
that's
the
training
that
is
required
by
CMS
and
they
have
to
be
certified
in
that
before
they
are
able
to
be
in
a
facility
by
themselves,
and
so
unfortunately,
you
know
it's
not
like
hiring
a
nurse
in
a
hospital
where
there
may
be
a
a
30-day
orientation.
B
I
know
we
do
have
numerous
questions
and
I.
We
could
please
allow
me
to
start.
First
on
your
first
slide,
you
mentioned
that
annual
surveys
were
suspended
during
code,
but
certainly
I
understand
that,
but
was
that
a
CMS
directive,
or
did
that
come
from
the
executive
branch
or
who
made
that
decision.
D
C
It's
High
I
mean
this
is
this
is
the
slide
that
tells
you
what
happened
right?
I
mean
it
absolutely
is.
We
saw
after
you
see
some
up
and
down
right,
but
it
really
is
starting
in
19.
Then
you
look
past
covet
and
it
just
dives
off
the
cliff
and
the
the
challenges
of
bringing
nurses
in
asking
to
go
into
facilities
and
really
at
that
point
our
we
just
couldn't
compete
with
the
pay
scale.
D
And
as
a
nurse
myself,
I've
never
seen
a
more
challenging
environment
for
the
profession,
you
know
we're
just.
Unfortunately,
you
know
nationally
not
not
educating
enough
nurses
to
provide
the
care
that's
needed
in
in
the
country.
You
know
we
certainly
see
it
here
in
the
state
of
Kentucky,
but
it's
not
specific
to
our
state.
It's
it's.
Definitely
a
national
issue.
C
I
think
our
our
salary
structures
and
all
the
state
government
I
mean
we
saw
that
we
saw
across
the
cabinet
right.
We
didn't,
we
saw
declines
in
a
Personnel,
almost
starting
in
2017,
I,
think,
and
so
that
was
a
challenge
just
in
general
to
state
government
employment.
So
you
know
those
curves
looked
similar
to
some
of
our
other
departments.
It
wasn't
until
that
beginning
of
21,
where
it
just
took
on
a
different
character,.
D
And-
and
you
know,
I
want
to
thank
our
surveyors
because
they
do
a
phenomenal
job
they
work
tirelessly.
I
was
at
a
visitation
for
one
of
them,
one
of
their
family
members
last
night
and
three
of
their
co-workers
were
there.
It
was
just
a
really
nice
feeling
because
there
is
a
lot
of
camaraderie
and
they
work
so
closely
and
so
hard
together
and
I.
Think
I'd
be
remiss
if
I
didn't
thank
them
for
the
hard
work
that
they
do.
D
D
You
know
more
at
risk
because
we
were
sending
them
into
facilities
that
we
had
known
outbreaks
in
and
so
I
think
there
was
a
lot
of
burnout
to
be
honest
with
you,
understandably
so,
and
I
think
you
know,
we
tried
to
work
with
them
and
we
offered
additional
ancillary
services
that
we
offered
through
the
cabinet,
but
I
I.
Think
for
a
lot
of
people,
not
just
surveyors
that
were
nurse
nurses
or
Healthcare
professionals,
I,
think
you
know
huge
burnout
curve.
B
I
think
we
tried
to
address
the
in
the
salary
situation
with
the
previous
budget
very
proud
that
we
took
that
initiative,
but
I
think
we
can
make
sure
we
stay.
On
top
of
this
I
appreciate
you
also
mentioning
that
you
kind
of
expedited
on
morning
and
onboarding
of
people.
We
talked
last
year
during
this
task
force
about
almost
having
dual
organizations
with
the
Personnel
cabinet
and
doing
something
in
the
cabinet.
B
So
have
we
done
anything
to
change
that,
because
one
of
the
recommendations
we
have
from
that
task
force
was
for
you
folks
to
get
together
and
find
out
how
we
can
expedite
this
whole
process.
So
are
we
making
Headway
there?
Are
we
doing
things
substantially
different
that
will
be
permanent
in
nature
in
terms
of
getting
people
in
these
vacant
positions?.
C
C
While
we
go
through
the
Personnel
process,
we've
worked
with
Department
of
personnel
to
identify
where
we
had
our
own
barriers
because
I
have
to
say
we
had
some
some
right,
that's
true,
and
then,
where
the
communication,
where
we
could
improve
the
communication
between
the
Personnel
cabinet
and
the
and
chfs
I,
think
we've
made
improvements.
I
think
they
are
I,
think
we've
learned
some
things
and,
like
I
said
I,
think
you'll
see,
unfortunately
not
in
this
area,
but
in
other
areas
it's
it's
dramatic.
It's
it's
as
dramatic
as
this,
except
going
the
other
way
good.
E
D
B
B
D
Are
trying
to
do
the
maintain
them,
so
we
will
add
them
on
to
the
survey
process.
Now
it
is
a
catch-22
because
it
extends
the
survey
process
significantly
where
you
would
typically
have
a
three
to
five
day:
annual
certification
or
recertification
survey.
We're
now
tacking
on,
in
some
cases,
70
complaints
that
all
have
to
be
addressed,
and
so
that
takes
a
significant
amount
of
time
and
then
it
takes
away
from
our
ability
to
survey
other
facilities,
and
you
know
I
I
came
from
that
industry.
D
You
know
those
are
those
people
are
near
and
dear
to
my
heart.
That
is.
That
is
why
I
got
into
Healthcare.
You
know
my
grandparents
helped
raise
me
and
so
I
take
it
very
seriously,
and
so
it
is,
you
know
we
we
think
about
it
all
the
time
we
take
it
extremely
seriously
and
we're
working
continually
to
optimize
how
we
can
get
out
in
these
facilities
and
address
the
issues.
B
F
Thank
you,
chairman
I've,
had
some
great
input
from
two
very
large
facility
leaders
in
Northern
Kentucky
and
felt
like
the
news
articles
were
so
unfair,
really
acknowledging
that
the
office
has
done
a
great
job
sending
surveyors
in,
even
if
not
for
the
annual
recertification,
there's
been
quite
a
bit
of
visits
and
surveys
in
addressing
these
issues.
So
just
because
the
annual
wasn't
done,
there's
still
been
a
lot
of
oversight,
and
so
that
was
shared
with
me
by
two
separate
facility
operators.
F
In
fact
texting
me
currently,
but
one
of
the
recognitions
is
that
need
for
the
experienced
and
well
trained
and
I
recognize
that
my
my
sister
will
be
upset
my
58
year
old
sister
might
be
that
ideal
person
and
I'm
wondering
if
that's
kind
of
an
a
group
that
we
are
targeting
is
the
60
and
70
year
old.
That
they've
got
that
wisdom.
They've
got
that
experience
and
perhaps
that's
not
the
same
degree
of
taxing
work
that
they
were
experiencing
in
Rita's
case
in
the
ER
for
the
last
23
years.
F
C
Well,
we
have
high
so
again
one
of
the
kind
of
future
pieces,
but
also
relative
to
this
we've
hired
a
recruiter,
I'm,
a
full-time
recruiter
for
the
cabinet
and
they've
been
focusing
on
dcbs
and
the
office
of
Inspector
General
like
that
is
where
we
have
them
aimed
any
Hospital
Association
folks
in
here.
Okay,
so
like
that
is
part
of
what
we
do
right.
We
talk
to
folks
about.
G
G
G
D
D
D
C
I
when
I
was
I,
you
know
I,
think
I've
talked
in
front
of
this
committee
before
I
worked
all
over
the
cabinet.
One
of
the
places
I
worked.
Probably
the
longest
was
the
inspector
General's
office
nine
years
I
was
riding
regulations,
I
actually
got
certified
to
survey
a
dietary.
It's
about
all
I
could
pass
I,
couldn't
figure
out
those
prescriptions,
but
it
it
this
when
fully
staffed.
There
are
more
options
and
and
I
think
if
we
were
even
close
to
fully
staffed,
we
could
think
about
other
options.
C
G
Right
one
more
quick
question:
you
know
when
you're,
when
you're
looking
at
these
team
of
this,
this
team
of
folks
who
are
involved
in
the
inspections
and
the
recertifications,
have
you
considered
partnering
with
dph
at
all
and
the
health
departments
I
mean
they
already
send
folks
in
for
inspections
in
dietary
right
and
and
oftentimes
they're
medically
trained?
If
not,
nurses,.
D
G
C
H
Question
thank
you
Mr
chair.
As
far
as
something
is
a
solution,
I'm
just
curious
when
I
was
looking
at
the
the
vacancy
rates
explained,
the
insufficient
salary
benefits
under
benefits.
I
was
just
wondering,
is
a
solution
option
potentially
for
reimbursement
of
student
loans,
debt
so
I
know
my
mother
was
a
nurse
I
have
several
friends
who
are
nurses,
it's
no
people
who
are
still
paying
on
that
degree
and
they've
been
graduated
for
many
years
now.
D
C
D
C
Well,
you
all
have
already
with
ideas,
and
we
appreciate
that
I
I'm
sure
that
we'll
we'll
have
discussions
moving
forward
there.
There
are
a
couple
of
places
where
I
think
discussions
can
be
fruitful.
I
think
it
is
how
we
support
folks.
Is
there
some
possibility
around
debt
forgiveness
and
what
would
that
look
like
I
think
that
gets
complex
but
I
think
I
think
it's
certainly
worthy
of
exploration
and
then
I
think
they're.
C
You
know
just
some
I
think
we
have
some
discussion
and
we
have
the
nursing
facility
Association
folks,
in
the
room
with
us.
You
know
I.
Think
there's
there's
some
discussion
about
what
do
we
want
to
look
like
right,
even
even
Beyond,
just
the
survey
piece
it
is,
you
know
we
started
a
PACE
program
in
you,
know
and
I
think
that's
really
a
great
kind
of
start.
C
I
B
B
D
I
think
some
of
it
is
it's
a
Personnel
problem
in
the
fact
that
they
have
not
been
uploaded,
because
we
don't
have
the
Personnel
to
actually
spend
the
time
uploading
their
complaint
survey.
So
that's
some
of
it
and
then
some
of
it
is
duplicity
and
the
complaints
themselves
where
we
may
get
this
same
complaint
five
different
times,
and
so
we've
addressed
it
in
upload
and
and
gone
out
and
looked
at
it.
But
we
haven't
uploaded
the
other,
maybe
four
times
so
it
looks
like
we
really
haven't
looked
at
it.
B
I
would
think
that
when
you've
got
that
type
of
backlog,
it
really
applies
the
inefficiency
of
the
whole
process,
and
perhaps
we
can
do
a
in-depth
look
at
at
the
process
itself
as
to
how
it
can
be
streamlined
and
different,
but
appreciate
that
any
other
questions
comments.
If
not
we'll
move
on
our
agenda.
Adam
appreciate
you
being
here.
Thank.
D
B
E
E
J
E
J
Had
the
creation
and
locality
premiums,
these
have
been
targeted
areas,
Odom
County,
for
example,
for
our
Correctional
series.
That's
Department
of
Behavioral
Health,
where
we
had
shortages
there,
Jefferson
County,
there's
a
variety
of
jobs
there
that
was
mainly
dcbs
and
then
all
120
counties
and
those
classifications
listed
are
oig,
related
classifications,
December
of
21.
We
had
pay
increases
for
social
workers
and
family
support,
and
then
we
also
implemented
a
special
entrance
rate
on
July
1
of
22
for
the
social
worker
classifications,
and
that
is
across
the
cabinet.
J
J
Absolutely-
and
we
talked
a
little
bit
about
this
when
oig
was
at
the
table
about
the
interim
hiring
process
to
expedite
hiring
for
social
workers
and
family
support,
we've
also
started
that
with
an
oig.
So
what
that
means
for
us
is
that
we're
automatically
posting
positions
continuously
twice
a
month
that
way
we
can
get
get
the
positions
out
there
without
waiting
for
our
HR
paperwork
right
to
speed
up
that
process.
That's
one
thing
that
we've
done
to
to
expedite
the
process.
We
automatically
do
that
for
them.
J
So
with
that,
we
also
that
allows
us
to
get
those
registers
posted
quickly,
as
well
as
review
those
registers
to
start
the
interim
hiring
process,
which
is
the
temporary
process.
So
we
don't
have
to
wait
for
the
our
traditional
hiring
process.
We
can
get
those
folks
in
the
door
and
start
the
training
while
we
go
through
that
we've
hired
a
recruiter,
and
the
secretary
spoke
about
this
a
little
bit
ago.
J
We
also
did
interviews
this
past
week
for
a
second
recruiter,
so
we're
growing
that
program,
the
main
focus
to
start
has
been
to
attend
colleges
and
career
center
and
other
job
fairs.
She's
doing
everything
from
local
local
Affairs,
she's
she's,
going
to
go
out
to
to
several
of
those
I
know:
she's
got
10
recruitment
events
scheduled
already
and
she's
at
the
fair.
All
this
week,
the
state
fair
along
with
staff.
J
J
We
provide
support,
she's
working
hand
in
hand
with
oig
and
dcbs
to
identify
those
hard-of-field
positions
and
that's
what
she's,
targeting
when
she's
out
at
those
fairs
to
to
to
try
to
help
with
those
areas
and
then
she's
tracking
those
folks
when
she's
getting
names
and
and
phone
numbers
and
information
she's
reaching
out
to
the
Departments
and
saying
hey
I
spoke
with
Susie.
You
know
you
should
see
her
come
through
so
she's
trying
to
track
those
and
reach
out
to
those
applicants
to
make
sure
that
they
do
apply
after
she
has
those
conversations.
J
So
another
area
that
we've
worked
on
in
HR
is
to
hire
we've
hired
a
classification
on
compensation
compensation
specialist
and,
with
this
it's
to
help
us
evaluate
our
job
classifications
to
meet
our
agency
needs.
We
recently
were
able
to
implement
a
new
oig
series,
we've
implemented
and
made
upgrades
to
our
audiologists.
We
have
issues
there,
sometimes
or
not-
all
that's,
not
sometimes
all
the
time
with
in
that
area,
as
well
as
sorry
I
lost
my
train
of
thought.
The
other
classifications
we've
been
oh,
the
epidemiologists
for
public
health.
J
So
having
that
compensation
specialist
who
was
our
power
employee,
the
Personnel
cabinet,
she
truly
understands
the
compensation,
the
classification,
so
she
can
work
hand
in
hand
with
those
departments
and
our
partner
with
the
Personnel
cabinet
to
make
the
need
of
changes.
We've
implemented
the
employee
educational
assistance
program
for
the
first
time
this
fall.
J
We've
we've
received
a
lot
of
interest
so
that
you
know,
as
as
secretary
spoke
to
a
while
ago,
we've
that'll
be
good
for
our
oig
folks
and
it's
it's
I
think
we've
had
20
people,
which
is
not
a
large
amount
approved,
but
we
have
a
lot
of
interest.
A
lot
of
folks
asking
questions
so
really
expecting
to
see
an
increase
in
that
next
year
and
I've
received
a
lot
of
emails.
Saying
thank
you
for
doing
this.
J
I'm
so
excited
about
the
opportunity
to
be
able
to
go
back
to
school,
so
we're
hoping
that
will
help
us
maintain
and,
of
course,
if
we
pay
for
their
education,
they're
required
to
work
for
us
for
six
months.
So
it
allows
us
to
be
able
to
keep
them
on
hand
as
well.
We
sent
out
a
survey
to
all
employees
asking
you
know.
What
do
you
need
from
us?
J
What
can
we
do
for
you
and
we
had
an
overwhelming
response
for
leadership
and
management
program,
so
we're
implementing
a
Leadership
Academy
and
that's
going
to
start
in
October
we
had
over
200
applications
for
employees.
That
said,
I
need
Management
training,
so
we
continue
to
grow
our
staff
and
then,
of
course,
we're
reviewing
the
hiring
process
to
identify
areas
where
hiring
can
be
expedited.
J
J
C
Had
six
700
vacancies
in
dcbs
and
we're
down
to
like
about
150
now
so
there
are,
there
are
some
real
dramatic
improvements,
I
think,
unfortunately,
I
can
never
remember
which
committee
I
was
in
front
of
or
what
what
I
was
hearing
but
I
think
it
was
this
one.
With
a
quarter
pointed
special
Advocates
came
and
talked
a
little
about
that
they've
actually
seen
in
the
field
and
I
I
didn't
I
didn't
ask
him
to
do
it,
I
promise,
but
they
can
see
the
turnover
going
down
to
dcbs.
C
They
can
see
more
workers
in
dcbs,
not
that
there
aren't
tremendous
challenges.
As
you
all
know,
that's
what
that's
I
think
the
last
time
I
was
here.
We
were
talking
about
some
of
the
tremendous
challenges
there,
but
we
are
making
progress
and
I
think
you
can
see
that
across
a
lot
of
our
departments.
That's
what
I
was
saying.
It's
kind
of
a
tale
of
two
different
Tales.
J
J
So
you
can
see
a
number
of
positions
we've
had
for
this
year,
the
number
of
separations
and
retirements
and
those
turnover
rates,
and
then
our
second
slide
focuses
on
the
nursing
positions
again
for
23
and
what
our
turnover
rates
have
been
in
those
classifications
and
those
classifications
are,
of
course,
across
the
cabinet,
not
just
oig.
The
nurse
consultant
inspectors
and
the
university
consultant
inspectors
is
what
we've
utilized
in
the
past
and
oigs
other
numbers
would
be
encompassed
in
that
those
calculations.
B
J
J
J
B
B
You
know
as
co-chair
of
government
contract
review,
you
see
a
lot
of
contracts
for
agency
nurses
and
that's
a
very,
very
expensive
proposition
and
looks
like
we
could
shift
those
resources
into
recruiters
from
the
Personnel
cabinet
and
find
those
folks
to
fill
those
positions,
because
that's
not
a
good
way
to
spend
money
and
we're
being
in
competition
with
every
other
health
care
provider.
When
we
do
that
sort
of
thing,
so
that's
an
intriguing
proposition
and
I
hope
that
personal
cabinets
following
your
success
with
the
with
that
particular
model
needs
to
be.
B
F
Yes,
chairman,
thank
you.
There
has
been
tremendous
confusion
as
recently
as
Saturday
at
a
family
picnic
about
the
requirements
of
employment
for
health
care
workers
and
whether
that
health
care
worker
is
a
federal
employee,
a
state,
employee
or
an
employer
for
a
hospital
Network.
What
are
the
current
requirements
for
mandates
of
covid
vaccinations.
C
E
C
F
F
C
B
H
Yes,
thank
you,
chair,
going
back
to
the
employee
educational
assistance
program,
so
this
this
is
an
area
where
you
guys
are
already
starting
to
look
at.
How
can
we
with
people
that
we
already
have,
and
these
if
I
heard
you
correctly?
This
is
for
folks
who
might
be
LPNs
to
help
pay
for
them
to
go
back
to
school.
To
get
their
RN
is.
Is
there
anything
that
we
can
do
to
go
up
River
a
little
bit
more
because
I'm
also
concerned
about
if
all
of
our
LPNs
start
moving?
H
Are
we
creating
a
new
Gap,
so
I'm
just
wondering
if
there's
any
conversations
around
getting
people
in
to
begin
with
and
getting
them
on
the
track
to
become
an
LPN
right
so
like
just
keep
going
up
River
a
little
bit
further,
so
that
we
don't
create
a
new
problem?
So
that's
the
first
question
and
then
the
second
question
is,
is
how
did
you
guys
come
up
with
the
six
months,
so
I'm
curious
about?
How
much
are
we
paying
for
people
to
go
back?
J
Let
me
answer
that
part:
there's
a
regulation
for
around
educational
assistance
that
specifically
sets
out
their
requirements,
and
it
says
that
an
employee
must
stay
with
us
for,
for
with
the
state
government
for
six
months.
They
can
change
agencies,
they
just
have
to
remain
an
employee
of
state
government
or
we
we
should
collect
the
money
that
we
paid
depending
whether
you're
working
on
a
bachelor's
or
a
master's.
It's
three
courses
potentially
could
be
two
depends
on
their
educational
course,
and
this
is
not
just
limited
to
LPNs.
J
H
B
J
As
far
as
fftl's
versus
our
interim
hold
on
I've
got
some
numbers
for
you:
I
can
find
them.
The
numbers
that
we
provided
today
are
full-time
field
positions.
Those
are
Merit
positions.
We
have
approximately
three
five.
Approximately
500
fftl
positions
were
federally
funded
positions
that
are
unclassified
that
are
also
filled
as
well.
C
But
you're
also
thinking
about
true
non-merit.
So
let
me
get
you
that
number
right
I
consider
fftl
right
they're,
not
in
the
Merit
system,
but
they're,
not
I,
don't
think
they're.
What
you're
looking
at
in
terms
of
non-merit
right,
you're,
talking
about
the
cabinet,
secretaries
and
and
division
directors
and.
E
C
C
I,
don't
I,
don't
think
so.
Remember,
I
was
a
married
employer
for
a
very,
very
long
time
and
some
of
those
protections,
particularly
you
know
around
around
the
times
that
we
are
in,
are
important
for
them
and
and
we're
important
I
think
it's.
You
can
look
at
salary
structure
and
benefit
structure
and
we've
all
had
the
conversations
around
retirement
and
all
of
those
things
and
what
what
works
and
what
doesn't.
C
Certainly
there's
been
some
discussion
around
child
care
and
what
can
we
support
that
way?
But
but
those
are
those
are
the
challenges,
I
think
every
employer
faces
and
then
it's
what's
the
flexibility
within
a
merit
system.
For
that
hiring
we've
tried
to
do
the
interim
hires.
We've
we've
tried
to
get
folks
in
the
door
so
that
we
can
get
them
through
the
rest
of
the
process,
but
I
know
that
that's
not
necessarily
the
best
solution
that
you
were
looking
for,
but
that's
that's
probably
my
best.
My
best
answer
well.
B
Again,
purpose
of
the
question
is
If:
it
creates
obstacles,
it
may
be
their
unnecessary
obstacles
because
it's
a
it's
an
old
old
system
been
around
for
years.
Isn't
that
something
that
the
personal
cabinet
and-
and
you
folks
could
have
a
discussion
about-
is
how
can
we
maybe
amend
the
Merit
system-
change
the
Merit
system
to
make
this
a
little
bit
more
fluid
and
make
a
little
bit
more
attractive
and
efficient
for
recruiting
people.
C
I
feel
like
in
that
the
the
Personnel
cabinet
has
been
looking
at
that
I
think
they're
coming
forward
with
some
proposals
and
certainly
have
looked
at
comp
and
class
for
a
while.
Now
so
I
I
you're
right.
It's
an
it's
an
old
system
in
many
ways,
but
I
think
it
is
certainly
worthy
of
discussion.
I
I
believe
the
department
of
personnel
has
been
looking
at
how
to
do.
E
B
E
K
Again,
just
a
quick
overview
of
the
Medicaid
Program.
We
currently
serve
1.6
million
members,
that
was
as
of
July
the
31st.
We
have
over
600
000
children
in
the
Medicaid
and
Chip
programs,
that
is
over
half
of
the
children
in
this
state.
We
always
say
that's
nothing
to
boast
about,
because
those
children
live
at
or
below
the
federal
poverty
level.
We
have
614
expansion,
members,
that's
as
of
July
31st.
Also.
We
have
over
69
000
enrolled
providers
that
includes
both
in-state
and
out-of-state
providers
and
in
state
fiscal
23.
Our
expenditures
were
16.8
billion.
A
K
Hospitals
can
receive
up
to
the
average
commercial
rate
we
do
have
to
have
some
quality
measures
tied
to
those
REM
those
directed
payments.
We
also
have
directed
payments
for
ambulance.
We
have
a
university
directed
payment
which
is
for
in
the
teaching
hospitals,
so
total
expenditures
you
can
see
in
directed
payments,
totaled
8.5
million
to
those
specific
provider
types
there.
We
all
billion
8.5
billion
dollars
for
those
providers.
We
also
have
a
directed
payment
for
some
durable
medical
equipment
codes
and
basically,
what
a
directed
payment
is.
We
have
a
fee
schedule.
K
We
contract
with
Managed
Care
organizations
manage
Care
organizations
can
contract
with
providers
for
specific
rates.
Sometimes
the
Managed
Care
organizations
will
follow
our
fee
schedule.
Sometimes
they
pay
May
pay
more
or
less,
and
what
a
directed
payment
does
is
allows
us
to
give
those
providers
more
money
through
a
directed
payment.
That
means
the
Managed
Care
organizations.
We
we
give
that
money
to
the
Managed
Care
organizations
and
direct
them
to
pay
the
a
certain
fee.
We
have
to
have
approval
from
CMS
to
do
this,
and
typically,
we
have
to
have
this
approved
every
year.
C
K
C
I
have
lovely
arguments
with
the
mcos
all
the
time
about.
We
have
taken
risk
off
of
them
with
these
directed
payments,
and
then
they
talk
about
how
that
this
is
impacted,
particularly
on
the
Senate
bill,
50
the
PBM
side,
because
they
say
they're
paying
more
for
pharmacy
and
they're,
seeing
some
of
their
Pharmacy
Trends
going
up.
So
it's
it's
a
lovely
back
and
forth
with
them.
I
think
the
first
year
it
was
the
way
the
directed
payments
were
done
is
that
it
was
included
in
the
mlr
and
I.
B
I
understand
where
they
would
come
from,
but
I
don't
think
that
they
have
really
done
anything
to
generate
that
additional
Revenue
stream
and
most
these
director
payments
a
result
of
legislation
that
we
had
passed
so
we've
rewarded
them
for
legislation.
We've
passed
even
though
they're
doing
nothing
we're
trying
to
enhance
payments
to
Providers
which
we're
doing
but
they're
not
getting
the
full
amount
of
the
payment.
So
it's
you
know
we
need
to
have
additional
discussion
about
that.
Thank.
K
You,
and
so
we
have
a
variety
of
fee
schedules
in
the
Medicaid
Program.
We
have
listed
those
fee
schedules,
the
update
occurrence
comparison
to
Medicaid
and
regulation.
Here,
typically,
Medicaid
develops
fee
schedules
based
on
three
methodologies:
either
a
percentage
of
Medicare
based
on
some
comparison
to
other
states,
for
example.
K
If
there
is
not
a
Medicare
fee
schedule
and
there's
also
a
methodology
called
relative
value-based
system,
that's
takes
into
account
the
relative
value
of
services
that
are
the
amount
of
time
and
effort
that
goes
into
a
specific
code
and,
as
you
can
see,
we
have
the
update
occurrence
on
here
and
I
would
like
to
point
out
that
when
you
see
that
it's
updated
annually
on
one
one,
for
example,
we
do
update
those
procedure
codes.
We
add
new
codes,
we
do
not
necessarily
increase
the
rates.
K
Behavioral
Health
Services
I
would
like
to
point
out
two
Behavioral
Health
Services
and
the
dental
fee
schedule.
We
used
to
have
two
fee
schedules
for
the
dental
fee
schedule.
We
had
an
adult
fee
schedule
and
we
had
a
child
fee
schedule.
The
child
fee
schedule
was
higher
than
the
adults.
We
increased
those
rates
many
years
ago
to
see
if
we
could
get
more
providers
into
the
program.
We
didn't
see
a
huge
uptick
when
we
increased
those
provider,
those
rates
for
children.
K
Recently,
when
we
amended
the
adult,
Dental
fee
schedule
and
enhanced
some
of
the
procedure
codes,
we
moved
all
of
those
procedure
codes
to
the
child
fee
schedule
rate,
so
there
was
a
slight
increase
for
some
specific
codes
in
the
dental
program.
Likewise,
in
the
behavioral
health
program,
we
had
two
fee
schedules.
We
had
one
for
inpatient
and
we
had
one
for
outpatient
and
we
combined
those
fee
schedules
and
which
resulted
in
a
rate
increase
for
some.
It
was
either
inpatient
outpatient.
K
We
just
took
the
highest
code
on
each
one,
the
highest
rate
and
made
that
the
new
code
going
forward
for
both
inpatient
and
outpatient.
So
one
fee
schedule
now
also
the
rural
health
clinics
and
federal
federally
qualified
Health
Care
Centers
have
a
different
payment
methodology.
They
are
paid
on
a
prospective
payment
system
rate.
They
receive
100
percent
of
the
cost
for
doing
their
business.
They
do
receive
an
increase
every
year,
based
on
a
Medicare
economic
index,
our
hospitals.
We
talked
about
Community,
Mental,
Health
Centers.
K
Some
of
those
are
cost-based
providers
such
as
the
Community
Mental
Health
Centers,
our
certified
community
behavioral
health
centers
also
cost
based.
We
only
have
I
think
four
of
those
right
now
that
is
through
a
demonstration
Grant,
where
the
certified
community
behavioral
health
centers,
will
be
paid
on
that
prospective
payment
system
rate
very
similar
to
the
to
the
fqhcs,
the
federally
qualified
Health
Care
Centers
and
Rural
Health
Care
Centers.
C
Psychiatric
residential
treatment
facilities,
those
are
rates
that
haven't
been
increased
in
a
while,
and
that's
that's
if
I
was
going
to
point
to
one
that
needs
it
like
now,
those
those
would
be
because
it
it
helps
kind
of
the
back
door
out
of
our
acute
psychiatric
hospitals
for
kids.
So
this
is.
This
is
the
way
to
maybe
hopefully
clear
up
some
more
space
for
them.
K
So,
as
we
talk
about
provider
text,
we
have
some
providers.
For
example,
the
hospital
reimbursement
Improvement
program
is
funded
through
a
provider
tax
with
the
hospitals.
There
are
certain
provider
type
types
that
can
pay
a
tax.
For
example,
dental
providers
could
pay
a
tax
and
receive
increased
reimbursement
because
I
think
the
secretary
has
said
in
several
meetings.
You
know
we
don't
we
we
don't
care
what
we
pay
you
as
long
as
we
can
get
the
state
match.
K
If
we
can
get
those
funds
from
the
state
match,
we'll
be
more
than
happy
to
increase
rates
and
the
hospitals
definitely
took
us
up
on
that
and
they
pay
a
tax
to
get
those
enhanced
payments
and
they
they
can
be
up
to
five
percent
of
Revenue.
It
has
to
be
a
flat
tax
across
the
board,
for
example,
and
it
has
to
be
applicable
to
every
single
provider
in
that
class,
so
every
single
Hospital
would
have
to
pay
has
to
pay
that
tax.
C
For
that
and
there
we
have
some
good
examples
that
we
started
with
and
it
just
the
challenge
is
it's
a
broad-based
tax,
and
so
even
those
folks
who
may
not
accept
Medicaid
would
have
to
have
to
have
that
have
to
pay
that
tax,
and
that
was
many
years
ago
when
those
broad-based
tax
taxes
were
in
place.
A
lot
of
folks
were
like
I,
don't
take
Medicaid,
why
am
I
getting
taxed,
and
that
was
that
was
the
real
challenge
of
of
implementing
that
on
a
on
a
broad
basis.
B
C
So
that
you
have
a
limit
on
the
amount
this
I'm
going
to
get
into
the
weeds
and
Steve
Bechtel,
who
is
our
our
you
know?
Medicaid
budget
Guru
will
probably
not
be
happy
with
me
explaining
it
this
way,
but
basically
the
hospitals,
it's
the
difference
between
what
they're
getting
a
Medicaid
rate
and
then
that
average,
commercial
rate.
That's
that's
what
we've
done
so
between
that
that
Medicaid
rate,
the
average
commercial
rate
they're
paying
the
state
share
of
that
difference,
so
that
then
produces
the
the
funding
to
do
the
directed
payment.
C
This
is
good
news
is
a
majority
of
that
outpatient
is
going
to
go
to
rural
providers
as
opposed
to
the
majority
of
the
inpatient,
went
to
the
more
of
the
urban
providers,
because
it's
based
on
the
number
of
inpatient
beds.
We're
still
looking
at
that.
We'll
get
you
a
report
when,
when
we
know
but
I
I
think
it's
going
to
be
a
I
I,
anticipate
it
being
a
very
successful
program,
particularly
from
the
perspective
of
keeping
rural
hospitals
open.
B
B
B
B
K
We
just
listed
some
legislation,
both
state
and
federal.
Regarding
the
provider
tax
in
case
there
was
interest
and
further
analysis
of
those
of
that
legislation.
Again,
Federal
requirements
has
to
be
broad-based,
uniformly
imposed
and
it
does
not
hold
the
taxpayers
harmless
again,
just
more
Federal
requirements.
This
we
list
those
provider
types
that
are
eligible
to
pay:
a
provider,
tax,
Physicians,
home
health
care
agencies,
outpatient
prescription,
drugs,
Services
performed
by
Managed
Care
organizations
again
listing
of
those
provider,
types
that
can
pay
a
tax
and
receive
some
directed
payments,
or
you
know,
pay
that
state
match.
C
It's
actually
the
other
way.
I've
gone
to
those
groups
really
gone
to
those
groups
and
say
please
talk
to
the
hospital
Association
I
think
their
experience
is
good.
I
think
your
experience
would
be
good,
but
we
just
we
just
haven't-
had
any
takers,
the
only
real
other
taker
that
we've
had
the
ambulance
providers,
and
that's
that's
really
been
about
it.
On
that
uptake.
C
K
Anyway,
speaking
of
scl,
that's
one
of
our
waiver
programs,
the
supports
for
community
community
living.
You
know
the
CMS
states
that
we
have
to
have
an
approved
or
a
sound
rate
methodology
program.
We
are
in
the
midst
of
the
rate
survey.
We
hope
to
have
that
completed
for
the
waiver
program.
Soon,
waiver
waiver
providers
did
receive
some
increased
funding
both
through
appendix
K
and
through
the
budget
Bill
during
the
covid
public
health,
emergency
and
So.
Based
on
the
provisions
from
CMS,
we
have
to
continue
that
rate
increase
going
forward.
K
C
Before
we
get
to
questions,
Lisa
and
I
were
at
the
same
conference
last
week
and
your
initial
question
around
you're
right.
Basically,
the
person
that
gets
the
rate
increased
is
the
one
that
you
know
it's
a
squeaky
wheel,
right,
I,
don't
you
know
I
don't
mean
that
disrespectfully,
but
it,
but
it
is,
and
there
are
some
states
now
that
we
talked
to
a
few
that
are
looking
at
how
to
do
do
what
you're
asking?
C
How
do
we
do
this
on
a
comprehensive
and
regular
basis
so
that
we
don't
have
one
here
and
one
here
and
one
here
which
is,
which
is
what
we've
done
here
and
I
think
there's
some
examples
from
other
states.
Was
it
Iowa
am
I
going
to
call
it
right
where
they've
taken
a
more
Global
approach
and
I
I
think
there
may
be
some
examples
for
for
this
committee
on
on
how
we
might
go
about
doing
that,
I
I
was.
C
It
was
news
to
me
frankly
at
this
conference,
so
I'm
I'm
interested
to
pursue
some
of
that
and
see
what
other
states
are
doing
there.
There
are
a
variety
of
them
there.
Some
are
more
based
looking
at
Cost
Containment,
some
are
more
based
on
looking
at,
like
equal
provider
and
regular
increases
to
keep
the
the
Health
Care
environment
healthy.
So
it's
it.
C
It's
across
the
it's
different,
depending
on
which
state
you're
in
most
of
the
northeastern
states
are
Cost
Containment
based
I,
think
more
of
the
I
would
say
it's
kind
of
central
States
like
the
Iowa's
and
the
and
the
Dakotas
they
have
a
their
approach
is
slightly
different
about.
What
is
that?
How
do
we
do
this
kind
of
umbrella,
where
we
get
all
the
providers
at
once,
and
not
just
one
by
each
I
will
we'll
be
happy
to
research.
The
examples
I
know
you'll
want
us
to
and
we
will
certainly
provide
them.
K
And
we
have
been
working
with
our
technical
advisory
committees.
For
example,
we
have
almost
22
technical
advisory
committees,
ranging
from
hospitals,
dental
providers,
a
whole
arrange
of
advisory
committees,
Behavioral
Health,
and
sometimes
it's
not-
that
big,
broad
increase
across
all
procedure
codes.
We
have
asked
some
of
our
our
technical
advisory
committees
to
if
there
are
certain
codes,
if
there's
just
a
few,
a
handful
of
codes
that
you
could
increase
and
that
would
have
an
impact
on
the
pro
on
the
population
that
we
serve.
What
would
those
increases
be?
B
One
of
the
last
two
sessions
we've
had
a
lot
of
discussion
about
dental
rates
and
that's
kind
of
ongoing,
and
that's
folks
who
I'm
still
hearing
from-
and
you
know
particular
rural
communities,
it's
difficult
to
offer
that
benefit.
If
you
don't
ever
provide
the
service
and
that's
what's
kind
of
generated
this
topic
today
is
how
do
we
make
that
decision
within
this
this
vacuum,
that
we
have
without
understanding
the
impact
it
has
on
everybody
else?
B
So
if
other
states
are
doing
it
in
more
comprehensive
holistic
view,
I
would
certainly
would
be
interested
in
that
and
I
think
we
do
a
better
job
but
say
you
folks,
sometimes
save
us
some
time.
I
would
hope.
At
least
there
would
be
some
justification
for
what
we're
doing
right
right
in
the
have
to
pick
winners
and
losers.
L
C
Sure,
right
now
we're
we
are
looking
at
increasing
rates
that
the
rates
haven't
been
increased
in
decades
it's
been
a
while,
and
so
that
has
really
impacted
the
development
of
that
level
of
care.
I'm,
not
sure
we
even
have
any
brtf2s
at
this
point.
I
don't
think
we
do
so
there
there's
a
lot
of
work
to
be
done.
There.
C
L
K
Typically,
if
there
is
a
rate,
change
providers
should
receive
notification
prior
to
we
have
been
looking
when
we
look
at
our
rates.
For
example,
we
don't
want
to
decrease
any,
we
would
like
to
increase,
but
if
there
is
some
sort
of
an
increase
or
decrease,
they
should
receive
notification
and
we
do
have
the
technical
advisory
committees
that
they
can
come
to
and
bring
their
concerns.
They
can
also
reach
out
to
the
department,
but
typically
they
should
receive
a
notice,
and
then
we
can
have
some
conversation
and.
C
An
example,
though,
when
this
was
unintended,
we
had
a
what
we
have.
Some
of
our
rates
are
pegged
to
Medicare
and
so
Medicare
took
some
rates
up
and
some
down
and-
and
we
got
surprised
with
the
behavioral
health
rate
that
went
down
a
little
bit
and
we
didn't
catch
it,
we
fixed
it
once
we
found
out,
but
that
was
provider
feedback
that
got
us
there
so
when,
when
they
sent
us
that
message
back
that,
hey,
you
cut
a
rate
and
we
didn't
I
mean
I
hate
to
say
it.
C
B
C
C
E
C
As
opposed
to
volume,
we've
got
a
long
way
to
go
bets.
Actually
what
I
would
suggest
if
I'm
not
here
and
what
I
would
suggest
if
I
am
here,
is
I.
Think
that,
because
of
what
we're
doing
with
directed
payments,
where
there's
a
quality
measure
piece
of
it
because
of
the
quality
measures
that
we
have
in
the
mcos
because
of
the
quality
measures
that
the
fq,
the
federally
qualified
Health
Centers,
have
to
meet,
I
and
I
I
think
it
would
be
really
good
for
us
us
to
really
talk
about.
C
What
is
that?
What
does
quality
look
like?
What
are
those
indicators
that
we
want
to
work
on
together
to
actually
improve
the
health
of
kentuckians?
You
you
talk
about
it
all
the
time,
so
we
we
don't
have
alignment
across
those
measures
and
I
I
think
it
would
make
sense
for
us
to
have
that
discussion.
What
is
it
that
we
want
to
see
improved
and
focus
our
efforts
there,
not
you
know,
I.
C
C
B
Well,
that's
a
good
example.
I've
talked
to
those
folks
who
really
like
the
work
that
they've
done
I
think
there's
real
value.
They
want
to
impressed
me
most
about
it.
Is
they
kind
of
developed
the
quality
Criterion?
That's
what
I
would
suggest
at
this
direction.
We're
going
to
go
with
the
healthcare
providers
is
had
them
tell
us
what's:
quality
because
I
think
all
reputable
Health
Care
Providers
want
to
do
a
good
job
and
a
little
bit
resent
those
who
do
not
do
a
good
job
and
skirt
the
issues.
B
So
that's
something
we
continue
to
or
any
other
questions
or
comments
about
this
particular
topic.
If
not
we'll
move
on
to
our
our
last
topic
for
this
for
today,
which
is
update
on
waiver
programs
and
commissioner
Lee.
Thank
you
always
appreciate
you
in
your
presentations
now.
I
can't
get
this
down.
E
E
M
We
are
the
Statewide
trade
Association,
representing
providers
who
support
individuals
with
intellectual
and
developmental
disabilities
through
special
Medicaid
programs,
called
1915,
C
waivers
I'm,
Steve
already
introduced
himself,
but
just
as
a
baseline.
For
those
that
don't
know,
Kentucky
has
six
1915
sea
waivers,
two
brain
injury,
waivers
the
acquired
brain
injury
waiver
and
then
the
acquired
brain
injury,
long-term
care
waiver,
the
home
and
community-based
waiver,
which
typically
serves
our
65
plus
population,
but
also
serves
individuals
with
significant
Health
needs.
M
The
model
2
waiver,
which
is
for
our
vent
dependent
population,
the
Michelle
P
waiver
for
individuals
with
intellectual
and
developmental
disabilities.
That
waiver
has
a
cost
cap
and
an
hour
cap.
So,
generally
speaking,
individuals
can
only
receive
about
40
hours
of
services
per
week
through
that
waiver
and
then
the
supports
for
Community
Living
waiver,
which
is
also
for
individuals
with
intellectual
and
developmental
disabilities,
but
is
really
a
24
7
care
waiver
and
importantly
includes
residential
component,
which
the
Michelle
P
waiver
does
not
so
again.
M
M
M
M
M
M
We're
seeing
providers
actively
get
out
of
the
residential
business
faster
than
we
can
add
them
back
and
particularly
with
one
model
called
the
staffed
residence
model.
We
are
incredibly
grateful
for
the
support
of
the
general
assembly.
You
all
included
funding
in
the
last
budget
without
your
support,
I'm
really
not
sure
where
we'd
be
today.
It
was
incredibly
important
for
our
providers.
M
So,
like
I
said,
we've
had
two
interim
task
forces,
2020
and
2021,
so
recognizing
the
importance
of
our
1915c
waiver
Services,
the
general
assembly
established
these
two
task
forces
to
make
findings
and
make
right
recommendations.
Most
recently
was
the
1915c
home
and
community-based
task
force,
which
you
Senator
Meredith
were
a
part
of,
and
during
that
they
made
it
was
a
bipartisan
legislative
task
force
and
they
made
six
important
findings
and
15
recommendations.
M
More
than
10
000
eligible
kentuckians
were
waiting
for
waiver
services
that
there
was
a
well-documented
direct
support,
professional
Workforce
crisis,
part
of
that
was
caused
by
low
funding
for
wages
and
there's
some
other
policy
recommendations.
So
in
response
to
these
findings
recommendations,
the
general
assembly
did
Grant
these
Services
a
rate
increase
in
the
last
budget,
so
that
was
a
phased
in
20
rate
increase,
while
also
preserving
a
50
rate
increase
for
certain
residential
services
that
had
existed
since
the
beginning
of
the
pandemic.
M
That
was
just
to
ensure
that
those
providers
didn't
receive
a
rate
cut
I'm,
not
going
to
go
through
all
the
recommendations
they're
in
your
packets,
but
some
of
the
recommendations
were
to
enact
legislation
to
establish
residential
crisis.
Services
enact
legislation
to
establish
a
waiver
service
for
participants
with
exceptional
support
needs
direct
the
Cabinet
for
Health
and
family
services
to
ensure
continued
access
to
cognitive,
cognitive,
rehabilitative
Services
through
our
ABI
waiver,
which
has
recently
become
a
really
big
issue.
M
Wait
lists
I
know
everyone
has
a
lot
of
concern
about
the
waitlist
numbers,
as
do
we
just
these
are
current
as
of
July
7th,
so
some
of
these
things
have
changed
so,
for
example,
the
home
and
community-based
waiver
no
longer
has
a
wait
list
on
August
1st
that
waiver
renewed.
So
all
1094
of
those
members
will
be
receiving
notification.
That
slots
are
available.
That
process
takes
some
time.
M
I
I
wouldn't
be
able
to
tell
you
if
all
1000
have
gotten
that
notification
yet,
but
they're
working
through
that
list,
but,
generally
speaking,
there
are
about
11
000
people
waiting
for
services
and
Steve
is
going
to
talk
a
little
bit
about
this
in
a
minute
specifically,
but
eliminating
this,
the
waitlist
is
not
solely
about
funding.
That's,
that
is
a
big
part
of
it,
but
there
are
some
administrative
things
that
I
we
could
do
to
help
move.
This
along
first
would
be
to
standardize
waitlist
management
policies
across
all
of
the
waivers.
M
M
So
if
an
individual
with
a
disability
suddenly
loses
their
parents
and
they
need
some
place
to
live,
they
can
apply
for
an
emergency
slot
which
the
cabinet
holds
some
slots
back
to
use
for
this
emergency
purpose.
That
allows
them
to
immediately
access
the
slot
if
they
meet
the
criteria
and
the
scl
waiver
is
the
only
waiver
that
has
this
emergency
criteria.
N
Steve
Shannon,
with
carb
I've,
been
working
with
a
group
out
of
Louisville
arms
actually
came
to
pass
in
2003
or
four
when
there
was
concerns
with
waiver
rate
cuts
at
that
point
and
they've
kind
of
got
reinvigorated,
primarily
over
the
HCB
waiver
that
never
had
a
waiting
list
and
now
did
have
a
waiting
list.
So
that
group
is
looking
at
what's
the
next
step
and
I
took
it
upon
myself
and
I.
Think
the
group
decided.
What
does
it
look
like
to
address
the
waiver?
N
What's
the
cost
Associated
so
really
I'm
going
to
talk
briefly
in
my
PowerPoint
with
more
details
is
in
your
packet.
If
you
want
to
meet
one-on-one
I'd
love
to
do
that
and
go
through
that,
but
just
give
you
an
overview
of
the
numbers
based
on
some
basic
assumptions
that
were
made.
But
this
is
what
it
looks
like
right
now.
N
The
HCB
waiver
now
is
zero,
so
I
would
ignore
that
one,
but
it's
going
to
grow,
there's
no
reason
to
think
it
got
to
a
thousand
relatively
short
period
of
time
a
year
or
so
that's
going
to
happen
again.
The
Michelle
P
at
50
placements
per
year,
2191
number
8398,
will
get
services
168
years
the
current
50
a
year
SEL
65
years,
so
the
last
person
gets
served.
Scary
stuff.
You
know
we
we
had
this
interesting.
N
There
was
an
initiative
in
2000
to
do
the
waitlist
stuff
bill
was
introduced
and
there's
two
members,
the
general
assembly
were
co-sponsors.
Representative
bratcher
resident
Palumbo
were
actually
co-sponsors,
look
at
the
SEO
waiting
list
in
2000
and
they
funded
slots.
So
thank
you.
What
I've
done
is
just
prepared
a
model
to
eliminate
the
waiting
list
in
two
years,
an
X
biennium,
hugely
expensive,
probably
a
holistic,
a
four-year
model
or
a
six-year
model.
I
can
do
an
eight
year
model,
but
the
point
is
one:
we
need
to
have
some
plan.
N
I
think
the
wait
list
needs
to
be
addressed
aggressively
and
the
waitlist
management
needs
to
be
strategic,
so
we
know
what's
going
on,
because
names
will
be
added.
The
numbers
that
you're
looking
at
are
based
on
July
7th
numbers
numbers
have
changed
since
then
and
they
will
continue
to
change.
Prior
experience
has
taught
us
that
if
you
fund
a
lot
of
slots,
waitlist
actually
increases
because
people
now
think
I
need
to
get
on
there,
because
there's
hope
for
me
getting
services.
N
N
again,
this
is
just
flat
numbers
I'm,
not
adding
this
projected
growth,
but
there
will
be
more
people
added
to
it
and
and
basic
assumptions.
I've
looked
at
is
the
first
year
you're
not
going
to
serve
everybody
who
gets
Award
of
the
slot.
It's
just
not
realistic
to
think
they're
going
to
have
in
July
if
you
fund
a
thousand
people,
a
thousand
people
getting
services
so
the
first
year,
I
phase
it
in
over
a
12-month
period
and
it's
just
dividing
it
by
12.,
so
July
you'll
have
12
months
of
service.
N
Some
people
won't
get
Services
till
June
they'll
have
one
month
in
that
year.
It
lowers
the
overall
cost
for
the
first
year,
the
second
year
of
the
biennium.
You
repeat
that
second
year,
you
have
a
full
year
of
those
people
from
25,
and
then
you
phase
in
again.
So
that's
how
that's
just
a
basic
premise.
So
the
first
year
is
less
expensive
because
you're
phasing
people
in
takes
time
to
get
people
identified
time
to
get
people
eligible
time
to
identify
case
manager,
plan
for
services
all
stuff
that
our
agencies
do
now.
N
You
can't
do
a
lot
of
people
quickly,
so
you
phase
it
in
over
time.
That
makes
a
different
number.
It
lowers
that
number
go
ahead
and
I
use
the
existing
match
rate,
so
that
may
change
as
well,
but
that's
the
existing
match
rate
go
ahead,
and
that's
just
how
it
looks
if
you
look
at
if
you
get
enrolled
in
July,
you'll
have
12
months
worth
of
services.
If
your
person
rolled
in
June
for
that
fiscal
year,
I'll
have
one
month
worth
of
service,
that
lowers
your
cost
go
ahead.
This
is
it
down
and
dirty.
N
My
PowerPoints
in
your
packet
is,
has
many
more
slides
to
go
over
what
this
looks
like,
but
essentially
If.
You
eliminate
the
waiting
list,
the
next
biennium.
Again,
that's
12
724
people
with
the
HCB
at
a
thousand.
Again,
that's
a
different
number
now,
but
that's
what
it
was
when
we
did
this.
It
seems
a
big
lift.
That's
6,
362
people
a
year
fiscal
year,
25
a
total
cost
of
almost
220
million
dollars.
219
million
dollars
state
general
fund
using
the
existing
match
rate
about
61
million
dollars
the
second
year.
N
623
million
dollars
is
what
it
would
cost
and
again
there's
a
big
jump,
because
that
second
year,
all
those
people
from
25
are
getting
a
full
Year's
worth
of
services
and
the
second
Cadre
of
people
get
phased
in
over
time.
So
the
first
year
you
phase
it
in
second
year
all
those
people
get
12
months
worth
of
service.
I'm
a
first
year
person
I
get
phased
in
year,
two
I
get
the
full
year
Amy's
a
second
year
person.
N
She
gets
phased
in
the
second
year,
not
the
full
year
in
biennium,
so
that
approach
again
two
years
to
eliminate,
runs
about
840
million
dollars.
State
general
fund
is
about
233
million
dollars,
a
huge
lift.
Is
it
realistic
to
double
almost
double
the
size
of
our
waiver
capacities
in
two
years,
perhaps
not
perhaps.
N
With
me,
the
next
model
is
four
years,
so
you
just
just
divided
by
four
right,
so
you're
gonna
do
half
the
waiting
list
in
the
next
biennium
and
we
understand
General
assemblies
can't
obligate
future
General
assemblies
to
spending,
but
the
model
would
be.
Can
we
do
this
in
four
years?
And
you
look
at
those
numbers,
you
serve
less
people
and
it's
important
to
remember.
These
are
individuals
we're
talking
about
just
not
people
on
a
wait
list.
They
are
real
live
people,
so
you
go
down
to
about
31
3200
people.
N
In
the
first
year
your
costs
are
up
in
half
kind
of
intuitive
you're.
Going
from
two
to
four
years.
Costs
will
drop
in
half
110
million
dollars
to
serve
those
people
about
thirty
one
and
a
half
million
state
general
fund
dollars
and
then
the
next
year
it
jumps
to
311
and
that's
86
million
dollars.
So,
overall
that's
going
to
cost
you
116
million
dollars
when
you
get
the
federal
match
and
that
serves
6,
362
people
half
the
waiting
list.
N
Next,
one
is
six
years:
73
million
dollars,
but
again
you're
serving
2
121
people
you're
not
serving
63.62
you're
serving
fewer
people,
and
that
may
be
a
realistic
plan.
Still
that's
going
to
cost
neighborhood
of
77.78
million
dollars,
I'm
going
to
tell
you,
candidly
cabinet
staff
will
have
a
much
more
accurate
number
than
I
have,
but
I
took
the
existing
rates.
N
The
average
cost
per
year
gross
it
up
by
the
10
and
10
people
got
so
I
think
my
average
numbers
are
good
right
and
just
divided
counted
months
for
the
first
year,
but
I
think
that
staff
will
be
more
accurate.
Your
staff
will
have
probably
a
more
precise
number
than
mine.
This
is
just
again
the
arms
group.
This
is
what
it
looks
like.
Can
we
do
this
going
forward
and
in
terms
of
state
general
fund
eliminated
in
two
years?
233
million
dollars?
Is
that
feasible,
I?
N
Don't
know
truthfully,
I
like
to
tell
you
there's
sufficient
capacity.
I
do
believe
as
more
people
are
served,
more
providers
will
expand
because
there's
an
opportunity
to
serve
more
people
when
the
scl
Michelle
B
wyvern
increases
by
50
people.
Some
select,
which
has
been
driven,
they
kind
of
manage
their
own
program,
hiring
people,
you
don't
know
how
much
you
only
get
one
or
two
people
you're
not
going
to
Gear
Up
larger
numbers
providers
should
gear
up
again,
Amy
agrees
with
that
and
should
gear
up
to
serve
more
people.
N
M
It
was
enacted
in
the
beginning
of
the
public
health
emergency.
It
began
becoming
phased
out
when
the
public
health
emergency
ended
and
will
be
completely
phased
out.
On
November
11th
of
this
year,
Kentucky
has
used
the
appendix
K
process
to
make
significant
changes
to
the
way
our
waiver
services
are
provided,
and
they
also
use
the
appendix
K
process
to
implement
the
house
bill.
One
rate
increase,
so
the
rate
increase
from
the
budget
Bill
two
years
to
last
budget.
They
used
the
appendix
K
process
to
do
that.
M
They
were
directed
by
the
federal
government
to
use
this
process
to
implement
that
rate
increase,
but
I'm
going
to
come
back
to
why
this
is
important,
but
it's
because
it
is
really
important.
That's
not
the
traditional
way
that
states
Implement
rate
increases
again.
This
was
the
Federal
guidance.
We
got
we
sort
of
do
what
they
tell
us
to
do,
but
it
is
going
to
become
important
in
just
a
moment
again:
2022
House
Bill
one
rate
increase.
M
It
was
a
phased
in
20
rate
increase
for
all
waivers
all
services,
and
it
made
that
50
percent
rate
increase
for
certain
Residential
Services
permanent.
The
20
was
phased
in
July
1
of
22.
The
initial
10
percent
was
effective,
July
1
of
23
effective
the
federal
approval
on
that
ended
up
taking
some
time,
and
so,
while
that
rate
was
effective,
providers
couldn't
actually
bill
that
first
10
increase
until
of
about
about
March
of
this
year.
M
So
again
you
you
all
appropriated
a
portion
of
that
to
fund
the
first
two
years
of
the
rate
increase
from
the
last
budget.
Again,
the
Cabinet
for
Health
and
Family
Services
has
been
in
the
process
of,
like
commissioner
Lee
said,
in
the
process
of
establishing
a
verified
rate
methodology
which
is
required
by
the
federal
government.
We
have
to
have
one
we've
been
undergoing
this
since
about
2017.
M
in
the
fall
of
2022,
the
Cabinet
for
Health
and
Family
Services
completed
the
rate,
study
and
rate
and
issued
rate
recommendations.
They
release
those
rates
in
draft
form,
posted
them
on
their
website
and
did
receive
some
feedback
at
the
time.
It
was
estimated
that
the
rate
study
would
be
fully
implemented
by
Fall
2023,
but
that
has
unfortunately
not
come
to
fruition
and
to
finalize
the
rate
study
just
so.
Everyone
has
an
idea
of
what
the
steps
are.
The
Cabinet
for
Health
and
Family
Services
must
complete
at
a
minimum
the
following
steps.
M
They
would
have
to
amend
all
of
the
waivers
submit
each
amended
waiver
for
public
comment.
Respond
to
the
public
comments,
obviously
seek
legislative
approval
to
increase
their
reimbursement
rates
as
well,
submit
each
amended
waiver
to
CMS
for
approval
of
the
proposed
rates
and
the
rate
methodology
and
then
promulgate
new
administrative
regulations
reflecting
those
rate
changes.
M
So,
as
I
mentioned,
the
rate
increase
that
was
included
in
the
budget
is
tied
to
the
American
rest
or
excuse
me
is
tied
to
appendix
K,
which
expires
on
November
11th.
There
have
been
concerns
expressed
about
what
happens
to
that
rate
increase
when
November
11th
comes
around
in
appendix
k
expires.
So
there
has
been
this
conversation
that
appendix
K
could
be
extended
for
an
additional
six
months
after
after
it
expires.
M
While
that
is
true,
the
federal
government
kind
of
threw
all
states
for
a
loop
on
August
2nd
when
it
released
a
State
Medicaid
director's
letter
that
Medicaid
director's
letter
outlined
that
several
things
about
how
States
one,
how
states
can
ask
to
have
their
appendix
K
extended
and
what
items
from
their
appendix
K
they
can
extend.
What
that
letter
said
is
CMS
will
only
approve
these
extensions
for
items
in
appendix
K,
which
the
state
demonstrates
that
it
will
make
permanent
and
will
make
permanently
include
in
its
waivers.
The
way
the
state
does.
M
That
is
that
before
November
11
2023,
the
state
of
Kentucky
must
prepare
and
submit
waiver
amendments
for
each
of
our
six
1915c
waivers
outlining
what
changes
it
wishes
to
make
permanent.
Hopefully
in
that
would
be
in
that
20
percent.
The
house
bill
1
rate
increases
that
were
granted
by
the
legislature
and
to
be
clear.
If
the
state
does
not
do
this
on
November
11th,
that
rate
increase
will
expire
and
the
rates
will
go
back
to
what
they
were
in
2019.
M
now,
normally
this
wouldn't
be
concerning.
If
we
were
using
the
traditional
appendix
K
process
to
extend
the
appendix
k
it
it's
a
difficult
task
to
prepare,
but
it
doesn't
necessarily
take
a
long
time.
These
waiver
amendments
require
a
public
comment
period
which
takes
a
while
these
public
comment
periods.
You
know,
generally
speaking,
I
think
we
can
get
it
done,
probably
in
a
two-month
period
of
time,
but
we're
on
a
deadline
and
if
we
don't
get
that
submitted.
M
M
These
I
know
I've
kind
of
thrown
a
lot
at
you,
and
this
is
not
an
exhaustive
analysis.
You
know
of
our
waivers.
These
are
kind
of
just
the
biggest
issues
today,
but
you,
the
legislature,
conducted
two
task
forces
and
we
still
didn't
get
time
through
all
those
to
kind
of
fully
examine
everything
in
our
waivers,
because
there's
a
lot
to
talk
about
these
waivers
are
a
tiny
part
of
the
Medicaid
budget,
but
to
the
over
30
000
people
that
are
enrolled
in
the
waivers.
M
G
G
Are
there
any
CMS
rules
that
would
preclude
doing
some
sort
of
an
assessment
and
communication
to
the
members
who
are
on
the
wait
list
and
a
referral
to
other
services
if
they're,
appropriate,
I
I
just
feel
like
you
know,
there's
so
many
people
on
the
wait
list
who
aren't
ever
communicated
with
they?
Don't
they're
they're
not
really
vetted
as
to
whether
or
not
this
is
appropriate
and
it
you
know
it
just
gives
them
false
hope,
and
it
leads
to
frustration.
N
Don't
know
specifically
what
the
answer
is
to
that
I.
Think
it's
a
great
question.
That's
a
real
key
part
I.
Think
waitlist
management
have
some
idea.
You
know
Ideal
World
if
it
was
permissible.
You'd
have
an
idea
of
if
it's
one
through
ten,
what
that
person
is
going
to
cost,
and
you
can
actually
come
in
your
budget
proposal
right
for
twelve
dollars.
We
can
serve
seven
people
for
fourteen
dollars.
We
can
of
11
people
because
they
have
less
support,
needs
I.
N
Think
they
tried
to
do
that
and
there
was
some
concerns
expressed
that
Medicaid
staff
couldn't
make
that
decision
on
the
Michelle
P
waiver.
That
was
maybe
four
or
five
years
ago,
and
they
were
having
evaluations
groups
of
a
hundred
and
that
had
a
stop
because
I
think
CMS
says
you
can't
make
that
determination.
Do
they
get
a
placement?
It's
probably
a
better
Medicaid
question,
but
some
idea
who
they
are,
what
their
needs
might
be.
N
N
I
know
people
who
are
shocked
when
they
get
communication
that
you're
on
the
waitlisters.
When
did
that
happen?
Well,
they
probably
went
to
an
event
someplace
and
filled
out
a
form,
but
I
still
think
it.
That's
part
of
understanding
what
it
looks
like
and
that's
part
of
the
Strategic
approach
to
weightless
management.
I
think
so
you
know
who
they
are.
Is
it
possible
at
some
point
to
have
kind
of
a
super
wait
list
that
applies
people
to
the
right
waiver
when
they
become
available
and
what
are
their
needs?
N
The
SEO
has
an
emergency
and
Urgent
other
waivers.
Don't
you
know?
So
if
you
know
someone
who
gets
on
Michelle
P
today,
they're
going
to
be
at
the
bottom
of
that
list,
and
maybe
they
become
an
emergency
for
the
SEL
at
some
point,
I
think
it's
it's
it's!
Those
are
good
questions.
I
think
it
needs
to
be
done,
I
think,
obviously
what's
permissible,
and
and
how
do
we
make
sure
that
it
meets
the
needs
of
the
individual
on
the
list?
N
G
E
M
And
part
of
the
problem
is
that
specifically,
with
these
wait
lists
is
that
they
sort
of
operate
in
silos
and
there's
not
a
ton
of
information
about
the
waivers
out
there
anyway
to
the
general
population,
obviously
for
children
on
the
waitlist,
which
is
going
to
heavily
be
the
Michelle
P
waiver
wait
list.
There
are,
you
know,
epsdt
through
schools,
therapies
and
things
like
that
available
to
those
children
for
adults,
there's
not
a
ton
out
there,
because
again,
these
are
non-medical.
Services
support
services
that
we're
talking
about
that.
M
N
G
M
There
are
criteria
for
all
of
the
waivers
about
who
would
be
applicable.
One
of
the
issues
with
the
Michelle
P
waiver
is
that
there's
not
an
accurate
pediatric
screening
tool.
That
waiver
was
really
designed
for
adults
and
we
have
a
tremendous
amount
of
children
who
need
services
on
that
waiver
that
we
don't
necessarily
have
a
tool
that
appropriately
addresses.
But
you
can
just
apply
to
be
on
the
wait
list.
N
Yeah
all
the
map,
tan
I,
think
the
number
and
a
physician
and
APRN
a
PA,
a
a
qualified
intellectual
development,
disability
specialist
can
sign
off
yes,
this
person
and
that
moves
you
forward.
It
doesn't
necessarily
move
you
to
the
top
interesting.
Some
families
are
scared
because
you
really
have
to
meet
level
of
care
for
an
institution,
and
some
families
are
scared
to
do
that
form.
Because
does
that
mean
my
child
is
going
to
go
to
an
institution?
I,
don't
want
that.
You
know
it's
it's
it's,
it's
really.
Are
they
eligible?
Not?
M
G
G
E
G
G
I
I
just
want
to
talk
for
a
minute
about
just
the
the
reallocation
of
the
waiver
slots
when
an
individual
dies
or
relinquishes
their
spot
I
mean
that
seems
like
an
easy
fix.
Do
we
just
need
to
apply
for
a
federal
some
federal
approval
to
do
that
or
again?
Are
there
so
many
convoluted
strings
attached
that.
M
M
B
Yeah
I
think
what's
missing
from
this
discussion,
and
it's
not
particularly
from
the
Michelle
P
waivers
or
any
other
way
where
we
have
is
the
costs
associated
with
doing
nothing,
correct
and
I
wish.
There
was
some
way
we
could
identify
that
and
that,
and
still
could
provide
a
substantial
portion
of
this
funding
if
we
could
identify
those
costs
so
shifting
your
resources,
and
we
need
to
do
that
in
some
point.
N
And
I
kind
of
figured
that
question
was
coming.
Sir
State
psychiatric
hospitals
there's
some
folks
there
with
intellectual
developmental
disabilities,
get
admitted
to
those
because
that's
that's
where
they
need
to
be.
They
may
not
meet
that
criteria.
Involuntary
commitment,
my
understanding
is
sometimes
there's
a
202b
process
as
an
involuntary
commitment
for
people,
intellectual
disabilities.
Those
requests
have
increased,
so
that's
a
possibility.
N
I
think
there
there's
other
pieces
of
the
social
system
that
gets
interacted
when
people
struggle
when
families
struggle
you
may
see
it
I,
don't
think
law
enforcement,
maybe
increase
hospitalizations
increase
visits
to
ERS
for
some
people,
perhaps
could
it
be
that
mom
or
dad
has
to
quit
work
because
they
have
a
22
year
old,
son
or
daughter,
or
they
have
to
cut
back
on
their
hours.
That's
that's
another
cost
offset.
That
is
a
real
thing
that
people
have
to
encounter
when
their
kid
is
no
longer
in
school.
N
N
Think
and
I've
heard
you
say
many
point:
what's
the
cost
of
inactivity
essentially
and
I
think
those
are
places
where
those
costs
will
show
up
we'll
see
those
costs
we'll
see
those
costs,
perhaps
accessing
Pediatric,
Services,
more
hopefully,
or
even
other
Primary
Care
Behavioral
Health
Services,
for
some
people
may
increase
when
you're
trying
to
figure
that
out
it's
it's
a
unique
population
that
needs
supports.
We
know
they're
going
to
need
support
for
a
very
long
time.
I
have
a
proponent
of
a
waiver
for
people,
who's
really
mentally
ill
I.
N
Think
it's
a
similar
situation
for
those
folks.
There
is
a
work
group
looking
at
Children's
waivers,
so
I
think
it's
it's
a
it's
an
opportunity
to
stop
and
wonder
figure
out.
What's
the
next
step,
but
I
think
there
are
some
places.
Can
we
cover
the
full
cost?
I
could
obviously
should
say
yes,
I,
don't
know
if
that's
a
realistic
answer,
but
we
can
help
offset
some
of
those
costs
and
provide
better
services
to
the
individual
as
well.