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From YouTube: Medicaid Oversight and Advisory Committee
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C
C
Here
via
remotely
thank
you,
representative,
sheldon
here
remotely
thank
you,
representative
wilner,
I'm
here
in
the
35th
district.
Thank
you.
Senator
meredith.
A
A
A
A
We
have
a
rather
lengthy
agenda
today,
a
lot
of
territory,
we're
going
to
cover
very
ambitious
agenda,
so
we'll
try
to
move
through
this
as
quickly
as
possible.
Certainly
you
folks,
who
are
doing
this
remotely.
If
you
have
questions,
we
have
the
chat
function,
but
if
you're
overlooked,
for
whatever
reason
feel
free
to
to
speak
up
and
let's
make
sure
we
have
everything
covered
again,
I
remind
you.
A
This
is
the
first
meeting
of
our
interim
and
I'm
sure
a
lot
of
information
be
shared
with
us
today
and
rather
getting
the
minutes
of
the
detail.
We
probably
want
to
keep
in
mind
that
we
can
defer
some
of
this
to
future
meetings
to
get
into
more
detail.
But
with
that
I'd
like
to
jump
right
into
the
agenda,
you
have
the
minutes
which
were
previously
distributed.
Is
there
a
motion
to
prove
as
presented
motion
by
our
co-chairs?
Our
second
second
second
senator
alvarado
also
spread
the
most
about
eye
I'll
oppose
vote.
No
all
right.
A
The
opposition
would
like
that
all
right
all
right.
Thank
you.
Minutes
are
approved
first
item
on
agenda's,
update
from
the
advisory
council
on
medical
assistance,
and
I
believe
ms
barton
is
is
here.
Excuse
me
she's,
justifying
remotely
I.
A
A
F
Thank
you
good
afternoon.
My
name
is
dr
beth
parton,
I'm
a
nurse
practitioner
representing
the
nursing
tech.
I
mean
the
nursing
on
the
medicaid
advisory
council
and
I
currently
serve
as
chairperson
I'd
like
to
thank
the
committee
for
the
opportunity
to
update
you
on
some
of
the
issues
before
the
council
or
as
we're
commonly
referred
to
as
the
mac
do
the
covet
pandemic.
In
the
last,
the
last
in-person
meeting
of
the
mac
was
january
2020.
F
we
didn't
meet
again
until
september
2020
and
that
meeting
and
subsequent
meetings
have
been
virtual.
My
update
to
you
will
include
the
issues
we
have
dealt
with
in
2020
and
2021
at
the
mac
meetings.
Dms
provides
information
requested
by
the
council
provides
presentations
on
various
topics
related
to
medicaid,
and
the
commissioner
provides
updates
to
the
mac.
The
council
also
receives
information
annually
from
each
of
the
mcos
when
they
provide
a
report.
F
F
The
mac
provided
input
on
both
topics
and
it
was
well
received
on
the
issue
of
infant
and
maternal
morbidity
and
mortality.
The
mac
was
pleased
to
offer
advice
and
to
make
a
number
of
suggestions,
because
this
issue
is
a
big
problem
in
kentucky
I'd
like
to
take
this
opportunity
to
prevent
some
of
the
suggestions
we
provided
to
dms
to
this
committee
in
2018,
one
in
11
babies
in
kentucky
were
low.
Birth
weight
kentucky
did
not
meet
the
healthy
people,
2020
objective
of
no
more
than
7.8
percent
of
births
to
be
low
birth
weight.
F
The
max
suggestions
included
extending
medicaid
reimbursement
to
certified
professional
midwives
or
cpms
cpms
are
licensed
and
regulated
by
the
board
of
nursing
and
can
help
to
improve
access
to
prenatal
care,
improved
access
to
access
to
prenatal
care
equals
more
healthy,
moms
support,
senate
bill
92
and
senate
bill
76,
which
were
introduced
in
the
2021
legislative
session
to
remove
certificate
of
need
requirements
for
freestanding
birthing.
Centers
data
shows
that
birthing
centers
improve
access
to
prenatal
care,
reduce
the
rate
of
c-sections
and
reduce
the
cost
of
care
to
medicaid.
F
F
Remove
the
mandate
to
report
marijuana
positive
mothers,
possible
positive
tests,
prevent
women
from
seeking
care
in
the
first
trimester,
which
is
crucial
a
crucial
time
to
help
ensure
a
healthy
pregnancy
coordination
of
prenatal
care
through
the
health
departments.
This
would
assist
both
the
urban
poor
and
rural
mothers.
F
One
issue
brought
to
dms
by
the
mac
was
a
problem
related
to
reimbursement
for
more
than
one
medical
visit
per
day
for
medicaid
recipients,
transportation
for
medicaid
participants
can
be
a
problem,
and
people
will
often
group
medical
appointments.
In
one
day,
for
instance,
a
person
may
schedule
an
appointment
with
their
primary
care
provider
and
with
their
psych
provider.
In
the
same
day,
in
the
past,
only
one
of
these
providers
would
be
reimbursed.
Dms
has
fixed
that
problem,
and
now
participants
may
see
more
within
one
provider.
In
a
day.
F
The
mac
and
tax
have
long
requested,
a
single
drug
formulary
to
be
used
by
medicaid
and
and
all
the
mcos
differing
formularies
caused
confusion
and
delay
in
receiving
medications.
Dms
has
now
implemented
a
single
drug
formulary,
which
is
a
step
in
the
right
direction.
However,
some
problems
related
to
the
change
have
arisen.
F
Medicaid
recipients
were
supposed
to
be
grandfathered
to
allow
them
to
stay
on
their
current
medication,
but
that
has
not
yet
happened.
This
is
a
particular
problem
for
patients
with
mental
illness,
who
are
told
medication
is
not
at
the
pharmacy
because
of
a
glitch.
These
patients
may
not
return
to
the
pharmacy
later
to
get
their
medication,
leading
to
serious
consequences
such
as
involvement
with
the
criminal
justice
system
or
hospitalization.
F
Also,
in
some
cases,
generic
medications
are
no
longer
preferred
which
reverses
a
long-standing
policy.
This
requires
providers
to
switch
medications
or
rewrite
prescriptions.
Since
dms
has
responded
to
the
long-sought
single
drug
formulary,
the
expectation
is
that
dms
will
work
with
the
mac
tax
and
providers
to
remedy
these
issues.
F
A
You
for
your
report
and
dr
pardon
very,
very
thorough,
very
comprehensive
and
just
remind
the
committee
members
that
I
think
until
year
before
last
mack
and
I
routinely
reported
this
committee.
So
we
appreciate
you
in
bringing
us
up
to
speed
and
certainly
helps
us
focus
on
what
we
need
to
do
with
the
upcoming
session.
A
G
One
very
brief
question:
thank
you
for
that
presentation.
Like
some
of
the
comments
you
made
in
there
caught
my
attention,
one
of
them
being
the
marijuana
used
during
pregnancy,
not
wanting
to
report
that
for
fear
of
deterring
people
from
coming
out
and
getting
prenatal
care.
G
Obviously,
there's
a
reason
why
we
want
to
make
sure
that
we
know
who's
receiving
marijuana
during
pregnancy
and
I'm
wondering
if
the
committee
has
reviewed
the
data
and
all
the
negative
outcomes
that
can
happen
to
a
baby
who's
exposed
to
thc
during
pregnancy.
I
mean
I'm
looking
right
now
here
to
you,
know:
massachusetts
general
hospital
for
women's
mental
health.
Talking
about
the
use
of
marijuana,
the
side
effects,
the
risks,
it's
elevated
risk
of
miscarriages,
birth
defects,
developmental
delays,
learning
disabilities
and
kids,
who
are
exposed
to
this
and
obviously
it
gets
stored.
G
It
has
a
half-life
of
eight
days,
gets
stored
in
fat
for
30
days,
so
even
just
a
minimal
use
by
some
others
can
linger
in
in
their
bodies
and
babies
get
exposed
to
that
during
their
entire
embryonic
development.
Was
that
reviewed
by
the
committee
to
say
that
we
want
to
make
sure
I
mean?
That's
astonishing
to
me,
I
just
know
the
negative
effects
that
it
can
have
on
a
baby
and
the
outcomes,
the
long-term
effects
it
can
have
to
say
that
we
don't
want
to
have
that
encouraged
that
they
don't.
G
You
know
for
fear
of
them
not
coming
forward
and
getting
care.
We
need
to
make
sure
that
we
have
an
understanding
of
what's
going
on
during
a
pregnancy,
with
negative
outcomes,
not
only
for
moms
there's,
also
higher
risk
of
ectopic
pregnancies,
impairment
of
fallopian
mobility,
all
kinds
of
things
that
can
happen
during
a
pregnancy
without
exposure.
I
would
think
we
want
to
have
as
much
information
as
possible.
We
don't
restrict
mothers
from
telling
us
our
smoking
status
or
tobacco
use
status
with
all
the
negative
outcomes
that
come
from
that.
F
Oh,
I
don't
disagree
with
anything
that
you've
said
senator
alvarado,
the
point
being
that
they
would
not
have
to
be
reported
as
using
an
illegal
substance,
not
that
they
would
not
be
asked
about
it
by
their.
G
Provider
that
being
reported
now,
I
mean
as
far
as
if
mothers
are
using,
that
I'm
not
aware
of
any
medical
provider
in
the
state
of
kentucky
anything.
That's
discussed
privately
in
a
medical
setting
that
anyone
says
oh
you're,
using
something
I'm
going
to
report
that
to
the
authorities.
No
one
does
that
in
the
medical
profession,
I
don't
think
we're
allowed
to
unless
that
patient
permits
us
to
do
that.
G
So
I'm
a
little
surprised
that
was
brought
up,
and
that
was
a
recommendation,
because
if
someone
comes
into
the
office
and
says
hey,
I'm
using
cocaine
or
I'm
using
anything,
that's
an
illicit
drug,
an
illegal
drug,
we
don't
rush
out
and
call
the
police
to
tell
them.
Hey.
I've
got
a
patient
here
who's
using
that
it's
all
confidential
information
in
a
medical
office.
G
So
I
would,
I
don't
think
it'd
be
a
good
idea
to
discourage
any
of
that
information
coming
forward.
We
want
to
make
sure
that
our
patients
feel
comfortable
with
the
information
they
tell
us
in
the
medical
office
is
private.
No
one's
reporting
that
to
the
authorities
of
the
police
and
really,
if,
if
they
are,
then
that's
a
violation
of
their
ethics
and
they
can
get
in
a
lot
of
trouble
as
a
medical
provider
for
doing
that,
but
that's
something
that
needs
to
be
known.
G
C
Yes,
thank
you
senator
meredith.
Thank
you,
ms
parker,
for
presenting
today
just
wanna.
Ask
a
quick
question:
did:
did
you
all
offer
any
guidance
towards
the
mythology
and
and
logic
to
be
used
for
senate
bill
50
in
the
and
and
the
pricing
and
dispensing
mythology
methodology?
I
guess
I
should
say
sorry:
did
you
all
provide
anything
to
the
to
the
cabinet
concerning
the
methodology
of
how
to
implement
senate
bill
50.
F
A
Any
other
questions,
if
not,
I
have
a
couple
first,
has
there
been
any
follow
up
with
your
committee
on
the
issue
of
the
the
rap
payments
crossover
payments
for
fqhcs
or
rural
health
clinics?
I
know
that's
been
a
lingering
issue
for
several
years
now.
F
A
Okay,
thank
you.
Another
question
I
have
is
regarding
the
the
low
birth
weight
initiative.
I
certainly
commend
mac
for
that.
I'm
just
curious
as
to
what
data
is
available
and
is
it
is
it
good
data?
I
see.
We've
undertaken
several
initiatives
here,
but
sometimes
I'm
concerned
about.
Let's
take
an
approach
and
I
must
suggest
you
folks
are
doing
this.
I'm
throwing
jello
up
against
the
wall,
hoping
something
sticks.
Do
we
really
have
any
definitive
data
that
tells
us
what
the
primary
issues
are
with
regard
to
local
birth
weight?
A
You
know
you
may
mention
to
access
to
care.
Certainly
that's
always
an
issue,
but
is
that
the
most
pronounced
issue
that
that
you
have
seen.
F
That
is
one
of
the
the
big
issues
as
far
as
access
to
care
and
and
that
that
is
a
problem
in
rural
and
urban
areas.
I
don't
think
that
anybody
has
zeroed
in
on.
F
Why
that's
a
problem,
particularly
in
urban
areas,
where,
where
there
is
readily
access,
the
department
of
medicaid
services
provided
an
excellent
presentation
to
us
at
the
last
meeting,
reviewing
all
the
recommendations
that
the
mac
had
made
and
also
talking
about
some
of
the
things
that
dms
is
doing
and
is
planning
on
doing,
and
I
would
be
glad
or
I
guess
the
commissioner
would
be
glad
to
to
also
provide
that
presentation
to
you,
and
I
think,
commissioner,
isn't
that
available
on
the
dms
website.
Right
now.
F
I
think
that
representative
hepburn's
bill
is
a
good
step
in
that.
A
Direction,
do
you
do
you
think
representative
heffern's
bill
obviously
fills
a
void?
Were
we
without
sufficient
information?
Do
you
think.
A
F
A
I
think
the
bounce
for
agenda
is
going
to
be
with
commissioner
lee
and
glad
to
have
you
joining
us
this
morning
or
this
afternoon.
Sorry
a
lot
of
territory.
We've
asked
you
to
cover.
We
appreciate
your
indulgence
of
our
committees,
but
it's
been
a
while,
since
we've
had
a
chance
to
talk
and
so
we'll
let
you
jump
right
into
it.
The
first
item
is
the
update
on
the
impact
of
covid19
on
our
medicaid
program,
so
with
that,
if
you'll
jump
right
into
it,
we're
all
here.
E
F
E
Okay,
are
you,
are
you
seeing
the
the
presentation
or.
A
I
see
your
cover
medicaid
oversight,
advisory
committee,
your
cover
page.
E
All
right,
I
think,
I
think
we're
good
to
go.
Then
here
we
go
again,
mr
chairman,
we
do
have
quite
a
few
topics
to
go
over,
so
would
it
be
your
preference
that
I
stop
after
each
topic
and
ask
and
questions
answer,
questions
or
go
through
the
entire
presentation
and
then
ask
stop.
A
For
questions
well,
my
original
thinking
was
let
you
go
through
olive
and
then
entertain
questions,
but
we've
got
so
much
territory
to
cover,
I'm
afraid
some
questions.
Also,
let's
do
that.
Let's
start
with
with
do
it
topic
by
topic
and
open
it
up
for
questions.
If
we
could.
E
E
As
we're
all
aware,
the
I
wanted
to
show
you
that
we
have
increased
in
our
enrollment
in
kentucky.
Quite
significantly,
as
you
can
see
there,
there
is
a
national
growth
in
all
medicaid
programs
during
the
co-wood
emergency
period
kentucky.
I
have
there's
a
little
blue
arrow
right
here.
That
indicates
that
kentucky's
about
about
fourth,
third,
third
down
in
enrollment,
we
have
significant
significantly
increased
air
enrollment.
We
are
only
behind
oklahoma
and
utah.
E
E
Currently,
we
have
1.6
million
individuals
and
we
have
broken
this
out
by
children
and
adults
so
that
you
can
see
that
we
have
approximately
we've,
also
increased
approximately
52
000
children
in
the
program,
which
I
think
is
important
when
we
start
talking
about
service
utilization.
E
So
this
is
just
a
depiction
of
the
enrollment
trends
in
the
adults
and
the
blue
line
as
children,
so
you
can
see
that
we
have
increased,
that
enrollment
of
children
as
well,
so
some
key
takeaways
from
the
enrollment
the
impact
code
had
on
their
enrollment,
of
course,
is
that
we
have
enrolled
an
additional
52,
797
children.
E
E
E
Based
on
that
maintenance
of
effort,
we
have,
we
continue
to
qualify
for
our
6.2
increase
in
fmap,
which
has
been
very
beneficial
in
helping
us
remain
within
budget
during
the
the
public
health
emergency,
the
affordable
care
act,
special
open,
enrollment
period
is
running
through
august
15..
Some
of
those
individuals
who
may
have
been
on
medicaid
and
now
maybe
are
returning
to
work
or
or
do
not
qualify
for
presumptive
eligibility,
can
enroll
in
the
special
enrollment
period
and
also
receive
reduced
premiums.
E
During
this
time
frame.
I
wanted
to
talk
a
little
bit
about
eric
service
expenditures.
We
have
been
monitoring
payments
to
providers
based
on
based
on
their
provider
type
we've
been
looking
at
pre
and
post
covered,
so
this
first
slide
is
all
about
mandatory
fee
for
service
expenditures.
E
The
first
column
depicts
the
expenditures
from
july
19
july,
2019
to
february
2020
and
again
from
july
20
to
to
february
21,
to
just
give
us
a
little
idea
of
what
happened
during
covid
and
as
you
can
see,
we've
highlighted
some
of
these
areas.
We
did
have
a
huge
increase
if
this
is
in
the
fee
for
service
again
huge
increase
in
our
laboratory
expenditures,
which
is
not
really
a
big
surprise.
E
That
indicates
that
there
were
some
pregnant
women
who
may
not
have
had
health
insurance,
and
so
that
was
very
happy
to
see
that
we
could
provide
services
to
that
population
during
the
during
the
public
health
emergency
just
some
takeaways
again.
I
want
to
point
out
that
the
information
depicted
in
that
slide
is
based
on
date
of
service.
We
believe
that
that
gives
us
a
better
picture
of
the
actual
utilization
patterns
of
individuals.
E
The
greatest
increase
again
was
laboratory
decreased
with
non-emergency
transportation.
That
is
the
stretcher
transportation.
That
is
not
the
transportation
that
is
provided
by
our
non-emergency
medical
transportation
brokers
through
our
contract
with
the
office
of
transportation
delivery.
A
few
other
notable
changes.
You
can
see
the
increase
in
inpatient
hospital
and
outpatient
hospital.
Again.
E
A
lot
of
these
increase
increases
too,
could
have
been
attributed
to,
or
most
likely
are
attributed
to,
the
fact
that
we
waived
prior
authorizations
through
a
certain
period
of
time
for
for
all
of
our
provider
types.
Those
prior
authorizations
have
been
reinstated,
except
for
behavioral
health
and
substance,
use
disorder,
treatment
providers,
so
you
can
see
here.
For
example,
we
did
have
a
pretty
significant
increase
in
our
licensed
marriage
and
family
therapists,
also,
an
increase
in
the
mental
hospital
expenditures
and
nurses.
E
Always
have
a
hard
time
with
that
word,
but
again
here's
here's
the
remaining
fee
for
service
expenditures.
You
can
see
some
of
the
increases
again
residential
crisis,
stabilization
increase
of
266
percent,
of
course.
That
is
again,
I
think,
attributed
to
the
to
the
prior
authorization
process
not
being
in
place
and
individuals,
definitely
needing
some
of
those
services,
but
we
did
see
a
decrease
in
school-based
services.
Again,
most
of
those
services
are
in
person.
E
So
a
slight
decrease.
Well,
you
know
pretty
significant
decrease
in
those
services
and
then
a
few
others
listed
there
again.
Some
of
our
key
takeaways.
This
again
was
based
on
date
of
service.
The
the
premium
and
postcoded
dates
are
indicated
there.
So
you
can
see
again
great
increase
in
chiropractic
services.
School-Based
services
were
down
the
cmhc
mental
hospitals.
Ambulatory
surgical
was
saw,
an
increase
home,
delivered,
meals
was
an
increase
because
some
of
our
home
and
community
based
white
waiver
providers
were
going
to
see
us
reduced
revenues.
E
So
we
did
submit
an
appendix
k
to
the
center
for
medicare
and
medicaid
services,
which
allowed
us
to
let
those
providers
deliver
those
meals
and
provide
additional
services
so
that
they
could
remain
viable
during
the
pandemic
and
they
received
revenues
again.
The
no
prior
authorization
on
the
mental
health
and
or
behavioral
health
and
suv
is
definitely,
we
think,
attributed
to
the
increases
in
the
cmhc
and
the
mental
hospital.
E
Now
we
get
into
the
mco
encounter
claims,
we've
broken
this
out
very
similarly
to
the
to
the
fee
for
service
claims.
You
can
actually
see
you
know
there
were
some
significant
decreases
in
some
of
the
payments
again
attributed
to
the
the
lack
of
foot
traffic
in
some
of
the
offices,
and
then
you
know
just
some
some
individuals,
even
though
that
we
started
doing
the
the
telehealth
we
expanded
telehealth.
Some
of
those
claims
may
not
hit
the
system
again.
This
is
based
on
date
of
service
and
not
the
date
that
we
paid
the
claim.
E
One
particular
issue
you
can
see
it
is
the
children
with
special
healthcare
needs.
We
see
a
decrease
in
in
that
service.
That
is
a
particular
interest
to
us,
since
we
have
seen
an
increase
in
child
enrollment
during
the
public
health
emergency.
That
means
that
some
of
these
children
who
are
very
vulnerable
are
not
not
receiving
services
or
have
risk
have
diminished
services.
During
the
public
health
emergency,
which
means
they
may
have
a
higher
cost
care
as
we
go
forward.
E
So
we
definitely
need
to
keep
an
eye
on
some
of
these
services,
because
we
do
know
that
that
the
public
health
emergency
is
going
to
have
a
an
impact
on
on
future
the
future
care
of
their
children.
Again,
you
can
see
in
here
a
slight
increase
in
the
chiropractic
services.
Again,
maybe
the
prior
authorization
process
had
something
to
do
with
that
increase
in
the
license:
marriage
and
family
therapists
and
an
increase
in
mental
hospitals.
E
Again,
this
is
just
a
continuation
of
the
mco
encounters
a
decrease
in
preventative
services,
which
is
again
an
indication
of
what
we
may
need
to
look
at
in
the
future.
If
individuals
aren't
getting
their
preventative
services,
they
may
have
increased
health
care
costs
as
we
go
forward.
Residential
crisis
stabilization
unit
has
has
decreased.
E
One
of
the
biggest
concerns,
for
me
again
is
the
specialized
children's
services
clinics.
These
are
clinics
that
provide
sexual
abuse
examinations
for
children.
So
again,
the
covid
has
had
an
impact
on
the
population
that
we
serve
and
particularly
our
children,
and
we
believe
that
definitely
going
forward
that
we
will
see
increased
costs
related
to
treatment
of
of
our
population
due
to
some
of
the
issues
associated
with
with
decreased
utilization
and
decreased
services
provided
to
them
again.
E
Greatest
increase
is
licensed.
Behavior
analysts
in
the
managed
care
arena
of
118
crisis
stabilization
was
down
78
and
preventive
down
73,
which
we
think
is
significant.
We
do
have
a
category
called
unknown
that
could
be.
Mcos
may
be
providing
a
service
that
we
couldn't
really
directly
relate
back
to
our
category
of
services.
For
example,
they
could
have
been
providing
decapitated
payment
to
one
of
their
providers
or
something
like
that,
but
definitely
something
that
we
can
look
at
more
in
depth
if
needed.
E
We
can
see
that
non-emergent
use
of
the
er
went
down
during
covid,
and
this
is
just
basically
the
same
information
depicted
over
age
groups
and
by
by
gender,
but
what
I
would
like
to
do,
what
I
think
would
be
a
good
exercise
is
to
examine
the
non-emergency
use
of
the
er
prior
to
covid
and
then
kind
of
see.
You
know
why
were
individuals
going
to
the
er
then,
and
then
it's
not
increased
as
much.
E
How
can
we
basically
identify
and
determine
what,
if
any
interventions,
we
can
develop
to
ensure
that
individuals
receive
care
in
the
most
appropriate
setting
going
forward?
So
in
other
words,
how
can
we
learn
from
this?
What
can
we
learn
from
this
data
and
turn
it
into
information
that
helps
us
drive
those
policies
that
ensure
individuals
get
the
care
in
the
right
setting
at
the
right
time,
routine,
child
health
exams?
E
I
wanted
to
just
give
this
out
again
to
show
this
because
again,
we
know
that
we
have
an
increase
in
child
in
child
enrollment.
Prior
to
covid,
we
had
174
168,
distinct
children
have
a
routine
child
exam
with
no
abnormal
findings.
E
E
E
This
is
routine
child
health
exams
that
had
an
abnormal
finding
so
prior
to
cova,
there
were
62
943
children
who
needed
to
be
referred
to
to
follow
up
care
after
they
had
their
routine
exam,
and
so,
while
we're
seeing
an
increase
in
enrich
routine
child
exams,
we're
not
yet
back
to
our
pre-covered
levels.
E
So
again,
this
is
a
little
bit
of
a
concern,
because
if
we
have
children
out
there
who
should
have
been
referred
to
corrective
action
or
to
a
specialist
and
they
did
not
receive
that
care
again,
we
may
be
seeing
increased
costs
associated
with
with
the
care
of
our
individuals
going
forward,
and
we
talked
about
tell
talk
about
telehealth
just
a
little
bit
ago.
E
This
is
telehealth
mco
encounter,
so
individuals
who
utilize
telehealth
during
this
period,
you
can
see
that
the
largest
cohort
was
age
18
to
40,
which
aligns
with
the
new
enrollment
trends
of
adults
between
ages,
18
and
64.,
and
you
know
this
cohort
probably
is
more
likely
to
be
a
little
bit
more
technology
savvy
and
utilize
those
services.
E
E
So
if
we
spread
this
out
over
the
data
service,
it
will
look
just
a
little
bit
differently
and
the
big
spike
you
see
here
is
because
the
school
base
changed
their
vendor
and
their
claims
hit
on
this
paid
date
more
in
february
than
than
prior.
E
So
individuals
who
actually
in
the
medicaid
program,
have
actually
had
a
diagnosis
of
covet
and
were
treated
for
covid
in
the
fee
for
service
population.
We
had
18,
839,
distinct
members.
You
can
see
that
the
cost
per
claim
at
the
beginning
of
covid
was
was
dramatically
higher
and
we
did
see
a
decrease,
but
now
that
claim
amount
is
creeping
up
slightly
for
our
fee
for
service
population.
E
In
the
mco
population
we
had
47
188,
distinct
members
treated
for
covid,
the
paid
amount
again
significantly
higher
during
the
beginning
of
covet
drastically
reduced
at
the
end
of
the
coven
or
or
as
as
not
end
of
code.
But
I
wish
we
were
at
the
end
of
coven
but
drastically
reduced
as
the
pan
health
public
health
emergency
has
continued
reimbursement
rates.
We
did
increase
hospital
and
nursing
facility
rates
because
we
know
that
you
know
they
were
on
the
front
line
at
the
beginning
of
the
pandemic
nursing
facilities.
E
We
also
provided
the
cabinet-provided
testing
and
personal
protective
equipment
for
those
facilities,
the
hospitals
we
gave
we
added
an
add-on
to
their
drg
for
individuals
who
were
covered
positive
for
nursing
facilities.
We
did
add
a
270
dollar
per
day
for
covered
positive
patients.
We
extended
their
bed
hold
days
and
we
extended
the
due
dates
for
cost
reports,
and
then
we
currently
have
a
29
per
diem
add-on
rate
for
all
beds,
pending
cms
approval.
We
did
submit
that
in
accordance
with
the
the
bill
that
was
passed.
E
I'm
sorry-
I
don't
have
that
bill
number
with
me
right
now,
but
we
did
submit
that
on
time
and
it
is
at
cms.
We
also
submitted
an
appendix
k
for
a
1915
c
home
and
community
based
waivers
that
allowed
us
to
provide
funding
to
to
providers
for
for
delivering
services
that
they
typically
did
not
provide,
such
as
home,
delivered
meds
administrative
regulations.
As
far
as
covid
related
goes,
we
did
submit
907
kr
3300
to
give
us
flexibilities
during
a
public
health
emergency,
and
this
regulation
is
not
only
good
for
a
public
health
emergency.
E
E
We
did
have
to
pull
that
back
based
on
a
statute,
and
I
would
like
to
thank
the
senators
meredith
and
senator
alvarado
for
senate
bill
55,
eliminating
the
co-payments
for
for
medicaid
members,
and
we
are
in
the
process
of
of
amending
our
regulation
to
reflect
the
changes
in
that
here
are
regulations
that
we
have
filed
since
march
of
2020
that
are
not
cobin
related.
I
didn't
know
if
you
wanted
a
listing
of
all
those.
E
A
Thank
you
allow
us
to
take
a
breath
as
well
a
lot
of
information,
very,
very
concise
presentations,
so
I'll
open
up
for
discussion
of
the
committee
members.
Anyone
have
any
questions,
comments,
senator
alvarado
just.
G
Really
briefly,
commissioner,
thank
you
for
that.
It's
a
lot
of
info
and
we
saw
the
reimbursements
that
a
lot
of
those
tie
into
we
see
a
market
decrease
in
the
number
of
actual
visits.
I
guess
is
my
question
in
terms
of
visits
by
physicians
by
nurse
practitioners,
I
would
imagine
I
saw
the
increase
in
the
number
of
views
for
midwives
and
that
sort
of
thing,
as
far
as
and
obviously
during
a
pandemic,
people
probably
felt
more
comfortable
doing
a
lot
of
those
deliveries
in
a
in
a
home
setting.
G
So
I
would
imagine
those
went
up,
but
I'm
curious
about
overall
visits.
Did
we
see
an
increase
in
mental
health
visits
I
mean?
Are
there?
The
numbers
usually
will
follow
that,
but
not
necessarily
depending
on
the
level
of
care.
So
I'm
wondering
if
people
when
they
use
telehealth
they're,
probably
less
comfortable
to
use
higher
codes,
so
they
may
have
less
reimbursement
per
visit.
I'm
just
curious.
The
number
of
visits
reflected
the
same
drop
that
we
saw
in
reimbursements.
E
We
can
definitely
go
back
and
look
at
that.
We
based
on
what
we're
seeing
the
number
of
visits
increased
with
telehealth.
Definitely
we
did
see
a
decrease
in
visits
right
after
the
public
health
emergency
was
declared
because
individuals
were
not
going
into
the
offices
and
it
did
take
providers
a
little
bit
to
get
get
used
to
telehealth
services
and
be
comfortable
knowing
that
they
were
definitely
gonna
get
reimbursed
for
those
telehealth
services.
E
So
we
can
go
back
and
we
can
look
at
the
number
of
visits
as
it
relates
to
pre
and
post
code.
G
Right
I'd
be
curious,
just
in
terms
of
I
know
that
a
lot
of
I've
done,
I
did
telehealth,
which
again
we
helped
get
that
bill
done,
but
I
never
thought
I'd
be
using
it
myself,
but
I
had
to
and
you're
building
levels.
Sometimes
providers
don't
feel
as
comfortable
building
a
higher
level,
because
you
can't
do
as
much
of
an
exam
and
you're
very
limited,
so
you
often
will
build
a
level
three
or
a
two.
Instead
of
a
level
four
kind
of
thing,
I'm
just
curious.
If
that
would
be
nice
to
know,
did
we
see?
G
Do
we
have
less
visits
overall
with
lesser
charges
and
that's
what
we
saw
drop
or
or
not
so
that'll
be
something
just
out
of
curiosity,
I'm
just
curious
about
that.
Thank
you,
mr
chairman.
B
I
do,
mr
chairman,
thank
you.
I'm
gonna
get
the
microphone
over
here
good
afternoon.
Commissioner,
thank
you
for
being
here
today.
I
wanted
to
draw
your
attention
to
slide
number
five.
I
think
it
is
ask
you
about
the
really
the
large
increase
in
the
number
of
people
who
are
who
have
been
eligible
for
medicaid
under
presumptive
eligibility,
and
I
think
if
I,
if
I'm
looking
at
this
correctly
in
january
of
2019,
there
were
2549.
B
B
What
plans,
if
any,
does
the
department
have
to
begin
to
work
these
numbers
down
in
the
form
of
those
people
who
are
no
longer
eligible?
I
know
that
the
the
last
year
when
you
came
before
this
committee,
I
think,
with
secretary
friedlander,
I
questioned
the
the
policy
that
was
adopted
at
that
time
to
automatically
bestow
for
lack
of
a
better
word
presumptive
eligibility
on
on
many
many
people
who
were
on
unemployment
or
who
were
eligible
for
unemployment.
E
So
presumptive
eligibility,
as
you
can
see
in
january
of
19,
we
had
2549
presumptive
eligibility
has
been
around
for
quite
some
time.
We
act
we
had
presumptive
eligibility
for
pregnant
women,
so
presumptive
eligibility
is
a
temporary
medicaid
benefit
for
individuals
who
do
not
have
health
insurance
and
who
have
they
go
to
the
doctor
and
or
and
they
don't
have
health
insurance.
Presumptive
eligibility
is
a
way
to
get
them
into
the
program
quickly
and
allow
that
provider
to
get
paid
while
they're
waiting
on
their
full
medicaid
application.
E
So
if
you
look
at
the
total
medicaid
population
there
in
the
just
under
totals
in
medicaid
you'll,
see
that
our
enrollment
went
from
1.2
million
up
to
1.4
million.
Many
of
those
individuals
previously
were
in
the
presumptive
eligibility
benefit
before
they
moved
over
into
the
full
medicaid
benefit.
So
the
department
and
the
cabinet
has
been
doing
outreach
to
those
individuals
who
enrolled
into
the
medicaid
program
to
help
them
complete
that
full
application
to
move
over
into
the
the
traditional
medicaid
program.
So
we've
increased
our
total
medicaid
to
1.4
million.
E
B
E
E
B
E
We
do
have
a
yeah,
we
do
have
a
significant
number
of
individuals,
our
connectors,
who
typically
assist
individuals
with
enrolling
or
reaching
out
to
the
to
those
individuals.
We
have
some
of
their
dcbs
workers
that
are
also
working
out
to
those
import
to
those
individuals.
Now,
in
the
event
that
a
presumptively
eligible
eligible
individual
applies
for
medicaid
and
they
do
not
qualify,
then
they
are
discontinued
once
they
have
two
presumptively
eligible
eligibility
periods
in
a
year
they
can
no
longer
have
eligibility.
E
So
some
of
these
individuals,
if
they
do
not
complete
an
application,
if
we
can't
contact
them,
for
example-
and
they
have
had
two
presumptively
eligible
periods-
they
will
be
dropping
off
and
they
will
not
be
allowed
to
come
back
on
to
the
system
than
within
the
year.
So.
B
E
We
wouldn't
know
that
unless
we
actually
did
the
application
process
because
medicaid
medicaid
eligibility
is
one
of
the
most
complex
animals
that
I
have
ever
seen,
and
I've
worked
with
med
for
over
20
years.
It
could
be
possible
that
a
few
may
not
qualify,
but
in
that
in
the
event
that
we
help
them
with
an
application.
We
would
definitely
make
sure
that
they
submitted
an
application
on
the
exchange,
because
we
wouldn't
want
them
to
go
to
go
and
ensure.
B
E
B
Just
just
looking
at
the
numbers,
if
we
had
you
know
2500
people
prior
to
the
pandemic
and
now
we've
got
an
increase
of
100.
I
guess
it's
129
000
people
roughly.
I
think
it
would
be
probably
not
a
not
an
unusual
conclusion
that
that
some
of
these
people
or
large
percentage
people
aren't
aren't
eligible.
But,
mr
chairman,
I
appreciate
your
patience.
A
Thanks,
sir,
I
have
two
questions
in
my
queue
here
and
if
I
could
I'd
like
to
limit
the
questions
to
this
those
two
because
we
need
to
move
on,
we
got
a
lot
of
territory
to
cover.
But
first
we
got
a
request
from
representative
sheldon
to
question.
Yes,.
C
Thank
you
senator
briefly,
commissioner
lee.
Thank
you
again
for
being
here
boy.
It
really
jumps
out
at
you,
this
chiropractor
increase.
You
must
have
dived
a
little
deeper
into
that
I'm
just
sitting
there
trying
to
think
of
what
could
cause
something
to
go
from.
You
can
go
back
to
that.
I
don't
know
whether
you
I
can't
remember
exactly.
It
was
like
thirty
thousand
to
like
one
point,
something
million
or
what
was
that
so.
C
E
Yeah,
you
know
I
did.
I
did
look
at
it
and
I
think
again
that
part
of
that
is
is
the
the
lifting
of
the
prior
authorizations,
typically
individuals
who
get
chiropractic
services.
I
think
they're
limited
to
23
or
20
20
visits,
and
then
they
can
only
get
more
if
it's
medically
necessary,
so
lifting
up
that
prior
authorization
definitely
probably
had
something
to
do
with
that,
plus
the
influx
of
individuals
who
are
now
insured.
But
yes
it
it.
It
does
jump
out
at
you.
So
yes,.
C
C
It
was
simply
just
the
the
lifting
of
the
pas
that
that
did
this
and
you
know
that's
a
yeah,
that's
a
big
jump,
but
a
lot
of
friends
in
the
business
I
just
had.
I
didn't
didn't
see
that
coming
so.
Thank
you
very
much.
D
Yes,
thank
you,
mr
chair.
Thank
you,
commissioner.
It's
it's
nice
to
see
you.
This
was
a
very
thorough
presentation,
but
I
do
have
a
quick
question.
I'm
just
really
going
to
follow
up
on
on
an
earlier
question
about
presumptive
eligibility
and
in
looking
at
slide.
Five
again,
it
looks
like
all
of
the
all
of
the
folks
who
were
eligible
for
medicaid
under
presumptive
eligibility,
with
the
exception
of
3
414
people
were
eligible
for
medicaid,
so
not
that
many
people
really
are
rolling
off.
Is
it?
D
E
E
Presumptive
eligibility
period
during
the
during
the
public
health
emergency
right
from
the
date,
the
individual
applies
for
the
application
and
it
ends
on
the
second
month
following
the
month
of
application.
So,
for
example,
if
someone
applied
for
presumptively
presumptive
eligibility
today,
they
would
be
eligible
today
through
july,
through
the
end
of
july.
If
they
didn't,
if
they
did
not
complete
an
application,
then
they
would
be
disconnected
discontinued.
D
Well,
yeah,
I
mean
the
overall
increase
in
in
medicaid
recipients.
We
had
you
know
an
increase
of
131
833
people.
Here
I
mean
those
are
not
even
unduplicated
individuals
who
may
have
rolled
off,
but
yeah.
You
know
the
cost
to
the
state
for
the
increase
in
medicaid.
A
Yes,
commissioner,
I'd
like
to
suggest
that
you
pull
those
numbers
together
for
us.
I
did
receive
the
report
for
this
last
quarter
and
by
my
very
brief
calculation
looks
like
our
room
was
up
about
13.3
percent
and
if
we
extrapolate
the
rest
of
this
year,
it
looks
like
we're
going
to
be
up
about
8.6
in
expenses,
but
I
think
it'd
be
beneficial
for
the
committee.
If
we
could
do
a
deeper
dive
on
this
in
a
future
meeting,
because
with
the
budget
coming
up,
we
want
to
know
exactly
where
we
are.
F
E
Sure
so,
a
maintenance
of
effort
is
a
qualification
at
the
federal
level.
That
individuals
who
are
enrolled
in
medicaid
at
the
beginning
of
the
pandemic
cannot
move
to
a
lesser,
a
lesser
level
of
eligibility
enrollment,
and
they
cannot
be
disenrolled
from
the
program
unless
they
are
deceased
or
they
request
to
be
disenrolled
or
they
move
out
of
state.
However,
that
that
that
maintenance
of
effort
does
not
qualify
to
the
presumptively
eligible
population,.
A
All
right,
thank
you
again,
committee,
just
a
wealth
of
information
here,
I'm
sure
there's
some
other
questions
out
there.
I
would
recommend
that
each
of
you,
if
you
have
questions,
send
them
to
us
and
we
need
to
do
a
follow-up
on
this
one
at
a
future
meeting,
because
again,
a
lot
of
information
with
that
it's
cut
discussion
off.
We've
still
got
a
lot
of
territory
to
cover.
Commissioner,
if
you
would
please
continue.
E
Okay,
so
next
on
the
agenda
is
the
legislative
implementation
update
and
I
I
think
there
were
some
specific
bills.
I
know
there
were
some
specific
bills
that
you
wanted
to
wanted
us
to
address.
So
before
I
address
those,
I
did
want
to
take
talk
a
little
bit
about
our
managed
care
directed
payment
program
so
with
the
mco
final
rule,
which
is
governed
by
42
cfr.
E
438
cms
basically
states
that
if
a
if
a
state
medicaid
agency
directs
directs
an
mco
to
pay
a
specific
amount
of
reimbursement
to
a
provider,
that's
considered
a
directed
payment.
So
what
we
have
to
do
when
we
implemented
senate
bill
50,
for
example,
and
some
others
we
have
to
send
a
preprint
to
cms.
It's
not
really
a
state
plan
amendment,
but
it's
a
pre-print
saying
this
is
how
we
are
directing
the
mcos
to
pay.
E
This
is
what
they're
going
to
do
and
cms
states
we
have
to
have
quality
measures
associated
with
those
with
those
directed
payments.
So
it's
not
as
easy
as
us
just
saying.
Okay,
then
you
have
to
pay
this
mco.
You
have
to
pay
this
provider
type.
This
x
amount
of
dollars,
for
example
the
1064
dispensing
fee
that
we're
going
to
discuss
with
senate
bill
50
is
covered
under
that
directed
payment.
So
I
just
want
to
give
a
bigger
picture
and
it
could
be.
E
You
know,
maybe
again
at
a
future
meeting,
that
we
talk
a
little
bit
more
about
those
directed
payments
and
how
we
can
actually
utilize
those
to
drive
quality
so
with
senate
bill
50
and
before
I
get
into
senate
bill
50.
I
know
that
there
was
some
noise
this
morning,
maybe
last
week
or
earlier
this
week
that
started
about
the
340b
portion
of
senate
bill
50..
I
heard
that
you
know
we
did
have
a
presentation.
We
had
been
talking
to
the
providers.
E
There
was
a
little
bit
of
confusion
that
we
were
changing
the
logic
for
340b
pricing
for
the
single
mco
pbm.
We
are
not.
We
are
definitely
in
compliance
with
senate
bill
50
as
it
relates
to
340b.
E
What
we
are
doing
is,
since
we
are
following
the
fee
for
service
reimbursement
logic
that
vm
fee
for
service
reimbursement.
Logic
for
340b
means
that
the
340b
pharmacies
will
get
the
1064
dispensing
fee.
However,
the
other
criteria
related
to
the
acquisition
cost
is
not
applicable
to
to
the
340b
pharmacy.
So
I
wanted
to
get
that
out
there
before
we
get
into
this.
But
of
course,
senate
bill
350
requires
us
to
to
establish
a
single
preferred
drug
list
and
a
single
pbm
for
each
mco.
E
We
did
establish
the
single
pdl
back
in
january,
you
heard
dr
parton
say
that
there
were
a
few,
a
few
individuals
who
were
losing
or
who
had
some
disruption
in
medication
due
to
some
differences
between
the
pharmacy
and
the
fee
for
service
pdl,
but
we
are
straightening.
Those
out.
We
haven't
heard
a
lot
of
information
about
that.
Since
we
have
were
first
alerted,
we
did
contract
with
the
single
pharmacy
benefit
manager,
which
is
med
impact
we
contracted
with
them.
On
december
31st.
E
We
will
be
transitioning
all
six
mcos
to
the
single
pbm.
On
july,
the
21st
again
we've
been
holding
routine
meetings.
We've
updated,
updated
the
reimbursement
methodology
to
align
with
their
fee
for
service
program.
E
The
formulary
is
going
to
be
aligned
across
mcos
for
all
managed,
medicaid
managed
care
lines.
The
pa
and
the
claims
processing
is
going
to
be
via
the
one
entity,
which
is
you
know,
med
impact.
We
are
aligned
aligning
the
pharmacy
network.
Pharmacists
will
have
one
bin
and
one
pc
and
group
number
for
all
pharmacy
planes.
We
do
have
pricing
transparency.
Dms
has
determined
the
reimbursement.
E
Mcos
will
continue
to
manage
the
medical
benefit,
for
example,
the
physician
administered
drugs
and
the
inpatient
services
for
individuals
who
require
those
medications
and
med
impact
will
manage
the
outpatient
pharmacy
benefit.
On
behalf
of
the
mcos
again,
we've
been
engaging
with
the
mcos.
We
have
had
several
web
webinars
for
providers.
E
E
E
Member
provider
communications
will
definitely
be
going
out
prior
to
this
change-taking
effect,
and
we
have
submitted
our
pre-print
with
cms.
We
are
still
having
conversations
with
them.
We
do
not
anticipate
any
issues.
They
were
aware
that
this
was
coming
before
we
actually
submitted
it
now.
One
thing
again:
the
mcos
do
have
a
higher
dispensing
fee
for
compound
medicaid
fee
for
service
does
not
so
some
of
those
pharmacists
that
have
compound
drugs
will
may
see
a
reduction
in
their
dispensing
fee.
E
E
So
I
think
that
this
is
again.
This
is
a
a
very
something
that
the
entire
country
is
looking
at,
because
we
are
one
of
the
only
the
only
state
that
is
implementing
a
single
pbm
for
our
managed
care
organizations
and
allowing
the
the
department
to
set
those
rates
and
oversee
the
in
the
the
pbm
and
the
mcos
are
paying
the
administrative
costs
for
those.
So
I
think
that
the
big
question
as
we
go
forward
is:
how
are
we
going
to
evaluate
the
impact
of
senate
bill
50
on
the
medicaid
program?
E
You
know
we,
we
can
definitely
look
at
expenditures.
We
can
look
at
the
number
of
enrolled
pharmacies
on
our
quality
measures
on
our
pre-print.
We
have
you
know,
access
and
provider
network
and
how
many,
how
many
providers
will
stay
in
the
network
based
on
these
payments?
Yes,
but
what
else
do
we
need
to
look
at
and
as
we
go
forward,
the
preprints
are
are
good
for
one
year.
E
So
as
we
move
forward,
what
kind
of
quality
measures
do
we
want
to
put
in
place
as
we
continue
this
process
and
continue
to
to
to
use
utilize,
the
single
pbm?
So
again,
I
would.
E
I
would
look
to
this
committee
to
help
us
design
some
sort
of
report
that
we
can
get
baseline
data
now,
so
that
we
can
look
at
going
forward
to
look
at
the
impact
of
this
program
or
this
the
senate
bill,
so
that
we
can
definitely
tell
how
it's
impacting
the
program
and
again
when
we
look
at
this,
we'll
need
to
take
into
consideration
senate
bill
51,
which
removes
the
prior
authorization
for
medicaid
assisted
treatment
for
sud.
So
how
do
we?
How
do
we
put
that
in
there
too?
E
So
again,
looking
to
this
committee
to
help
us
identify
what
you
want
to
look
at
to
see
how
this
the
senate
bill
impacted
our
our
program
going
forward
house
bill.
8
is
a
ambulance
provider
assessment
program
this
it
was.
We
have
gotten
approval.
We
received
approval
on
march
31st
to
implement
the
ambulance
provider
assessment
program,
and
this
program
is
going
to
be
we'll
use
this
to
reimburse
up
to
the
available
provider
tax
on
medicaid
transports
only
for
all
kentucky
ground
ambulance
providers.
E
So
I
think
that's
very
important
to
note
there
cms
did
approve
the
the
pre-print
back
to
january
1st
of
2021.
We
have
it
approved
through
december
31st
of
2021
we're
currently
working
with
the
ambulance
providers
and
and
other
stakeholders
to
to
finalize
this
and
request
an
extension
through
2022
total
estimated
increase
in
reimbursement
to
these
providers
or
47.4
million.
E
E
Gross
revenues
are
reported
only
for
transports
originating
in
kentucky
their
quality
measures
in
this
pre-print
of
reducing
ambulance
response
times
and
increasing
the
number
of
certified
ems
practitioners
again.
Quality
measures
that
we
can
look
at
to
help
drive
quality.
And
how
do
we
look
at
those
one
forward,
year
to
year
implementation
timeline?
The
provider
should
see
their
first
payment
june
2021
and
the
provider
tax
is
due
to
the
to
the
department
of
revenue
in
august
of
2021.
E
house.
Bill
183
is
the
hospital
rate.
Reimprovement
improvement
program
hrip
so
on.
Cms
did
approve
a
revision.
The
whole
purpose
of
this
to
move
those
hospitals
to
the
average
commercial
rate
for
payment
to
increase
the
revenues
generated
for
our
hospitals
continue
goals
of
improvement
include
two
metrics
related
to
opioid
use.
Given
the
given
the
the
magnitude
of
this
issue
in
the
state
so
currently
prescribing
opioid-related
adverse
respiratory
events.
E
Cms
has
approved
this
our
a
trip
program
retro
back
to
july
1st
of
2020.
It
is
approved
through
june
30th
of
2021
and
the
department's
working
with
kha
and
others.
We
did
work
with
them
to
to
revise
and
submit
a
request
for
a
three-year
approval
process
for
the
acr
that
was
submitted
in
may
on
may
11..
We
did
work
with
kha.
E
We
collaborated
with
their
leadership
as
well
as
our
medical
directors
within
the
cabinet
to
establish
what
we
believe
are
some
very
good,
concrete
quality
measures
going
forward,
and
we
definitely
look
forward
to
evaluating
this
program
and
the
impact
it's
going
to
have
on
not
only
for
our
providers
but
our
members
implementation
timeline
on
april
15th,
the
providers
received
their
first,
their
41
payment
of
246
million
april
30th.
E
They
received
another
of
248
and
we
will
be
processing
payments
on
may
26
for
250
million
and
then
again
in
august
for
another
250
million
to
the
hospitals
house,
bill
278
personal
care
attendance.
Of
course,
this
requires
the
department
to
accept
employment
of
temporary
cover,
19
personnel
care
attendance
as
fed
meeting
the
training
for
state
registered
nurse.
E
We
this
morning
we
have
been
communicating.
The
cabinet
has
been
communicating
with
with
ms
johnson,
with
the
kentucky
association
of
health
care
facilities.
E
E
We
believe
we
may
need
to
do
a
waiver
because
of
the
requirements
outlined
in
the
federal
statute,
but
we're
still
having
a
little
bit
of
conversation
about
that
to
make
sure
that
that's
the
the
way
that
we
definitely
need
to
go
because
definitely
looking
at
the
communication
and
the
bill
to
make
sure
that
we
understand
the
intent
and
we
just
want
to
move
forward
and
make
sure
that
we
are
in
compliance
with
federal
regulation.
So
can
give
an
update
on
that
later.
E
If
needed,
house
joint
resolution
57
establishes
the
work
group
to
assess
the
feasibility
of
implementing
implementing
a
bridge
insurance
program
very
excited
about
this
work
group.
Our
first
meeting
is
to
be
held
in
july.
E
We
have
sent
out
a
poll
requesting
the
members
that
are
identified
on
this
work
group
to
respond,
so
we
can
get
that
meeting
on
the
books,
and
I
think
that,
with
this
work
group
establishing
the
the
looking
at
the
bridge
insurance
plan,
I
think
that
the
presumptively
eligibility
presumptive
eligibility
population
that
we
have
been
serving
will
be
a
good
good
data
data
source
for
us
to
look
at
you
know
if
those
individuals
are
uninsured,
why
are
they
coming
into
the
program?
E
What
services
are
they
using
and
that
could
help
us
identify
needs
of
a
bridge
program
going
forward?
This
is
a
listing
of
the
work
group
members
and
now
I
will
stop
there
on
the
bills,
because
we're
at
our
next
topic.
A
E
I
can
give
you
an
update.
I
believe
that
the
single
source
credentialing
has
stated
that
we
that
we
are
to
terminate
our
contract
with
the
vendor
that
we
currently
contracted
with.
So
we
are
in
the
process
of
fulfilling
the
obligations
of
438.
A
All
right,
thank
you
appreciate.
It
have
a
question
from
first
representative
sheldon.
C
C
The
methodology
first
of
all
yeah
the
1064,
was
a
fantastic
win.
I
think
that
was
something
that
that
certainly
is,
is
going
to
be
great
for
for
everybody,
and
I,
including
the
taxpayers
of
kentucky,
so
we've
been
down
that
road.
C
What
I
want
to
ask
you
specifically,
is
we
had
a
ptac
committee,
a
pharmacy
technical
advisory
committee
that
presented
what
they
felt
would
be
the
best
methodology
and-
and
I
quite
agree
with
it,
and
it
actually
deals
with
the
cost
of
goods,
not
necessarily
the
dispensing
fee,
and
we
we've
all
spent
a
lot
of
time
talking
about
the
1064,
and
we
should
have
that's.
C
That
was
the
big,
the
big
number
right,
but
but
but
going
back
to
the
cost
of
goods
we
were
going
to
use
and
we
would
just
all
throw
around
this
lesser
than
logic.
Terminology
right.
C
Those
of
us
in
the
business
know
what
that
means,
and
so
I
don't
know
very
many
industries
that
we
say
you
can
use
the
cost
of
our
goods
and
you
can
take
five
different
ways
to
figure
it
out
and
take
the
lowest
one.
I
think
that's.
I
just
want
everybody
to
know
how
that
what
that
means.
So
so
we
let
you
know,
obviously
we're
used
to
dealing
with
that
with
with
contracts,
so
so
that
was
something
that
even
the
ptac
committee
agreed
to.
C
But
what
they
didn't
agree
to-
and
I
agree
with
it-
is
including
mac
as
part
of
your
lesser
than
logic,
because
we
already
have
nadak.
We
have
federal
upper
limit
ful,
we
have
wac
wac
wholesale
acquisition
costs
and
we
have
usual
and
customary.
We
have
four
different
ways
to
determine:
cost
nadac
was
the
most
recently
developed
in
2013.
C
It's
used
by
33
states.
That
alone
is
being
would
be
enough
to
determine
the
cost
and,
oddly
enough
out
of
the
five,
the
fact
that
you
included
mac
again,
that
was
not
in
the
recommendation.
That
is
the
only
cost
of
goods
for
drugs
that
pbms
actually
get
to
determine
and
provide
you
a
list
of.
So
I
can
understand,
probably
why
they
got
put
in
there
and
and
I'd
like
to
for
you
to
consider
and
I'll
stop
right
here,
because
this
is
a
big
long
committee
and
a
lot
of
things.
C
So
I
would
like
for
you
to
consider
we
have
a
month
and
a
half
it's
a
push
of
a
button
to
to
I
mean
I,
I
know
it's
not
that
hard.
I
think
mac
is
an
archaic
way
of
dealing
with
things
it's
been
around
since
the
late
70s
and
it
really
came
from
a
federal
program.
C
There's
real,
there's
a
lot
more
better
ways
to
determine
and
nadac
is
determined
by,
as
you
know,
a
database
that
that
is
fed
every
day,
and
we
actually,
I
think,
they're,
going
to
use
that
in
surprise
billing
for
the
doctor,
so
a
very
similar
database.
So
I
would
like
to
see
if
there's
any
way
you
me-
and
maybe
we
could
have
a
meeting
separately
and
talk
about
you
know
what
we
could
do
about
that.
E
Senator
we,
we
sure,
can
send
our
sheldon.
You
know
the
the
thing
about
us
going
forward
in
the
method
that
we
did
is
ease
of
implementation.
We
were
looking
at
what
is
the
easiest
thing
that
we
can
do
to
get
this
in
place
right
now,
and
I
should
have
said
when
I
was
giving
that
update
on
senate
bill
50.
This
is
our
first
step
to
reforming
the
pharmacy
benefit
program
we
actually
wanted
to
do.
We
were
looking
at
a
tiered
re,
tiered
administrative
immigration
fee.
E
We
really
were
looking
at
that
and
but
the
ease
of
it
we
have
to
do
a
survey.
We
have
to
do
all
sorts
of
things,
so
we
really
look
at
this,
as
the
very
first
step
in
improving
your
pharmacy
benefit
would
definitely
look
forward
to
to
meeting
with
you
and
talking
about
the
future
and
what
we
need
to
do
to
continue
to
make
these
improvements.
And
again
this
is
the
first
step,
and
this
was
ease
of
implementation.
C
A
Commissioner
lee,
I
think
we
all
appreciate
the
time
and
effort
you
put
into
senate
bill
to
50
and
we're
glad
to
see
it's
finally
come
to
fruition.
I
know
there's
still
some
concerns
that
we'll
have
to
address
over
the
long
term.
Only
common
I
would
have
is,
I
probably
share
representative
shelton's
concern
about
mac.
A
A
I
don't
know
that
they're
they're
substance
in
nature,
one
being
that
they're
concerned
about
the
july
one
implementation
date.
You
know
my
thinking
on
that
it
could
be
december
first
of
next
year
and
still
would
be
too
soon,
but
one
of
the
things
they
they
suggested.
This
could
be
a
challenge
for
people
who
rely
on
prescription
medications.
So
I
don't
see
that
logic.
Do
you
see
anything
that
suggests
that
that's
going
to
be
an
issue.
E
But
I
think
that
the
mcos
that
you
probably
received
a
letter
from
the
kentucky
association
of
health
plans
regarding
some
of
their
concerns.
We
did
respond
to
that.
The
department
did
respond
to
that
to
that
letter
and
while
we
we
appreciate
them
expressing
their
concerns,
our
viewpoint
is:
we
have
a
plan
to
move
forward
with
july
1..
We
need
to
make
that
happen
and
we
expect
them
to
participate
which
they
have
been.
E
They
have
been
at
the
table,
their
I.t
staff
have
been
here,
so
we
expect
to
take
every
effort,
make
every
effort
to
ensure
that
there
are
no
disruption
of
services
in
this
program
come
july.
First.
A
You
may
reference
that
letter
and
I'm
reading
for
myself
and
the
second
point
is
a
concern
about
maybe
increasing
the
cost
of
medicaid
program.
I
think
that
was
very
interesting
that
you
know
we
saw
from
the
very
beginning
that
there's
a
potential
savings
of
maybe
half
a
billion
dollars
by
heading
this
direction.
So
I
discount
that
issue
and
hope
that
everyone
else
would
as
well.
I
have
a
question
from
representative
prenty.
A
F
Okay,
commissioner
lee,
I
appreciate
your
presentation
and
just
have
a
question
for
us
bill
8.
my
I
had
a
city
council
member
approached
me
recently
about
the
fact
that
they
weren't
going
to
be
the
ambulance
service.
They
didn't
know
how
they
could
keep
going
if
they
could.
They
contact
your
office
to
see
how
that
the
changes
that
are
coming
forward
from
house
bill
8
will
affect
them
positively.
Can
they
check
with
somebody.
E
Absolutely
and
I
believe
that
we
have
about
137
providers
enrolled,
so
absolutely
they
can
contact
me
or
they
can
contact
us,
steve
bechtel,
who
is
who
has
been
working
tattoo,
steve,
bechdel
I'll,
send
you
information
and-
and
I
would
be
remiss
if
I
didn't
say
that
as
far
as
senate
learned,
that
the
hard
work
and
the
hardest
senior
deputy
commissioner
veronica
judy
cecil
and
dr
fatima
ali,
they
have
been
very
instrumental
in
making
sure
that
goes
forward.
So
so
yes,
okay,.
F
Is
apparently
right
now
they
have
requested,
and
I
would
also
like
to
have
an
update
on
how
108
pascal
108
is
going
to
be
implemented.
G
Thank
you,
mr
chairman,
commissioner,
just
quick
question.
I
know
we've
whenever
we've
had
new
rollouts
anything
that
requires
information,
technology
or
I.t
issues
when
it
comes
to
medicaid,
there's
always
glitches.
Obviously,
and
that's
another
thing,
I've
heard
from
fears
from
a
lot
of
the
mcos
are
worried
about.
Is
this
going
to
roll
out?
Are
there
plans
for
dry
runs?
Are
there
going
to
be?
Are
there
guideposts
that
we
already
have
in
place
for
that
in
terms
of
plans?
If
so,
do
we
have
any
idea?
G
E
Yes,
we
we
are
doing
testing,
we
will
be
doing
a
testing
definitely
before
this
rolls
out.
We
also
have
plans
to
have
a
war
room,
basically
when
on
come
july,
1st,
so
that
we
can
ensure
that
providers
have
a
a
direct
contact
that
they
can
call.
Members
can
also
call
we,
so
we
can
divert
any
issues
as
they
as
they
happen,
but
I
think
that
our
90
days
no
question
asked
you
know,
pa
those
those
kinds
of
things
that
we're
putting
in
place.
E
As
far
as
senate
bill
50
is
concerned,
I
think
that
we
have
a
plan,
and
I
think
that
that
we
will
be
able
to
execute
this
as
smoothly
as
as
we
can,
and
there
may
be,
as
you've
indicated
one
or
two
hiccups,
but
we're
doing
everything
that
we
can
to
prevent
any
unintended
consequences.
E
Our
waiver
house
bill
352,
in
the
2020
session,
of
course,
directed
the
department
to
create
an
11
15
for
substance,
use
disorder,
treatment
for
eligible
incarcerated
individuals.
So
we
have
here's
the
timeline
of
that
waiver.
It
has
been
completed,
it
is
submitted
to
cms.
We
are
pending
their
approval.
Hopefully
we
have
been
in
contact
with
them.
They
we've
had
a
few
meetings
that
they
have
had
to
cancel.
E
I
think
they're
going
through
some
internal
reorganization
at
cms,
but
it
is
currently
pending
current
some
current
pending
state
plan
amendments
and
preprints.
We
did
make
some
changes
to
reimbursement
for
school-based
services.
E
This
is
part
of
the
expanded
care
in
school
that
allows
schools
to
bill
for
services
for
a
medicaid-eligible
children
who
do
not
have
an
individualized
education
plan,
currently
they're
limited
to
the
to
billing
for
prior
to
expanding
they
were
limited
to
so
this
will
allow
them
also
to
draw
down
some
administrative
funds
based
on
administrative
claiming
activities,
and
they
will
also
need
to
be
submitting
a
cost
report,
which
means
they
will
be
getting
the
cost
of
coverage
for
those
providing
those
services
to
children.
E
We
did
submit
a
mandatory
mit
coverage
spa.
That
was
something
that,
even
though
we
were
covering
it,
because
cms
made
some
changes,
we
had
to
update
our
state
plan.
We
did,
you
can
see
the
case
mixed
nursing
facility
rate
add-on
of
29
program
for
the
all-inclusive
care
for
the
elderliest
pending.
We
do
have
a
k-chip
spa,
you've
heard
today
from
from
dr
parton
about
some
of
the
issues
related
to
maternal
mortality.
E
We
believe
that
we
can.
The
the
cages
fought
to
cover
pregnant
women
between
185
to
200
percent
of
the
fpl
is
is
very,
would
be
very
beneficial
because
these
children
are
going
to
be
eligible
for
k-chip
as
soon
as
they
are
born.
We
do
receive
an
eighty
percent
f
map
for
those
for
those
individuals,
so
we
do
have
receive
a
higher
f
map
for
those
women.
It's
going
to
be
a
very
small
population
and
we
do
notice
based
on
some
of
the
individuals
that
have
been
coming
into
the
program.
E
We
do
believe
that
that
that's
something
that
we
we
should
move
forward
with.
We
do
have
a
pharmacy
pre-print
for
2019,
2020
and
21
that
is
associated
with
the
two
dollar
dispensing
fee.
We
just
had
to
get
get
all
of
those
to
cms
and
get
those
approved
they're
still
with
cms.
E
Don't
anticipate
any
issues
with
those.
Of
course,
we've
got
the
single
pbm
prep
print
and
we
have
a
durable
medical
pre-print
that
associated
with,
I
think
the
the
the
mcos
paying
90
of
the
of
the
fee
schedule
for
certain
dme
products,
and
so
that
again,
as
a
preprint,
we
had
to
have
quality
measures
in
it.
E
E
E
D
Thank
you,
mr
chair.
Sorry,
it
was.
I
was
just
looking
down
the
list
and
and
wondering
if
you
had
mentioned
the
1115
waiver
for
the
for
medicaid
during
incarceration,
can
you
do
you
have
any
sort
of
update
on
on
that
waiver
that.
E
D
Page
before
with
the
I'm
trying
to
keep
up
okay,
okay,
thank
you.
Thank
you.
E
E
Well,
I
think
you
know
any
time
that
we
we
have
to
amend,
or
we
have
to
to
to
reprocure
as
an
opportunity
for
us
to
look
to
that
contract
and
you
know
strengthen
it
in
any
way.
We
can,
and
I
think
that
it
would
be
a
good
exercise
and
something
that
we
would
want
to
do
very
thoughtful
and
methodically
as
we
move
forward,
rather
than
rushing
to
do
the
same
thing
that
we
have
now.
A
E
A
A
Another
issue
hanging
out
there
is
that
our
against
some
community
health
centers
that
do
not
have
contracts
with
molina
and
the
providing
service
have
been
for
some
time
and
they're
building
a
pretty
good
accounts.
Receivable
here
and
I
think
they're
attempting
to
provide
the
service
in
good
faith.
But
molina
doesn't
seem
to
be
negotiating
a
good
faith,
and
so
is
that
part
of
a
consideration
in
awarding
these
contracts.
E
E
So
if
again,
if
anybody
had
any
of
the
the
providers
have
issues
they
need
to
reach
out
to
me
they
can
reach
out
by
phone
or
by
email.
I
am
in
the
office,
so
they
can
reach
out
to
me
phone
or
email.
A
Well,
you
know
my
numerous
conversations
that
I've
had
in
these
committee
meetings
always
talking
about
being
fair
and
equitable,
and
it
just
boggles
my
mind
that
an
mcl
will
present
a
contract
to
a
provider
and
say
here,
sign
it
or
else,
and
then,
when
the
tables
are
turned,
you
can't
get
them
to
come
to
the
table
and
supposedly
one
of
molina's
issues
is
well.
We
just
don't
have
time
to
to
negotiate
the
rates
on
this.
Well,
if
you
don't
have
the
time
that
means
you
don't
have
the
resources.
A
So
how
much
substance
does
financial
viability
play
into
awarding
those
contracts
and
the
reason
I
asked
that
question,
I'm
sure
you
read
humana's
opinion
or
the
response
to
the
judge's
original
ruling
that
you
know
fewer
mcos
that
are
financially
stable
may
be
better
than
having
a
bunch
of
mcos
where
you
don't
have
that
type
of
stability.
So
that's
a
concern
as
well.
E
I
believe
that
the
financial
liability
is
covered
under
the
department
of
insurance's
purview.
E
A
Well,
I
know
why
everybody
hates
to
go
through
this
process
yet
again,
a
third
time
in
less
than
18
months,
but
I
think
it
does
force
an
opportunity
to
strengthen
the
expectations
to
the
mco.
So
again,
I'm
encouraged
to
really
look
at
the
rfp
and
see
if
we
can't
tighten
that
up
and
get
a
good
service
and
last
question
I
would
have
is
the
judge's
opinion
which
I
have
not
read,
but
does
it
impact
the
the
single
mco
for
our
foster
care
and
child
services?
A
G
G
Commissioner,
I
know
we've
been
aligned
on
the
medicaid,
you
know
getting
rid
of
the
co-pays
for
medicaid,
and
so
I
would
suggest
perhaps,
since
the
bill
has
been
proposed
by
the
chairman,
at
least
at
least
for
two
sessions
now
in
a
row
to
reduce
the
number
of
mcos.
G
That
would
be
a
consideration
for
this
next
rfp
process.
I
think
it's
you
know,
there's
quite
a
few
of
us
that
think
that
less
would
be
better
and
it'd
be
addition
by
subtraction.
G
So
it
might
be
worth
looking
into
that
to
consider
at
least
that
proposal,
because
I
think
it
will
probably
likely
come
back
again
in
the
future
for
us
and
if
that's
going
to
be
something
the
general
assembly
is
going
to
consider,
it
might
be
worth
having
the
cabinet
in
their
next
process
to
take
a
look
at
it.
I
do
think
this
approach
that
the
the
judges
issued
is
the
cleanest
really.
I
think
it
would
have
been
a
legal
mess.
G
I
know
we
still
have
a
lot
of
legal
headaches
and
you
probably
can't
comment
a
lot
on
what's
going
on
out
there,
but
it
would
have
been
a
mess
trying
to
deal
with
letting
everybody
in
it
was
a
bad
message
to
have
an
rfp
process
and
not
have
anyone
excluded.
I
think,
if
we're
going
to
do
it
again,
I
know
it's
going
to
take
longer
it's
expensive,
but
it's
going
to
be
cleanest
from
a
legal
standpoint.
G
Maybe
we're
taking
a
look
at
we're
going
to
have
at
least
experience
with
all
six
of
these
mcos
for
this
past
year
to
take
a
look
to
see
how
they've
operated
and
how
they've
done
things,
and
I
think
the
molina
care
issue
that
the
chairman
talked
about.
Also,
I
think,
is
important.
Just
if
you
know
they've
assumed
a
company
they've
assumed
passports,
debts
and
they've
assumed
those
contracts.
They
need
to
honor
those
contracts.
G
So
there's
past
payments
that
are
due
some
in
the
hundreds
of
thousands
to
millions
of
dollars
to
some
of
these
providers
and
they
need
to
be
able
to
come
and
and
make
good
on
that
if
they've
assumed
that
companies
responsibilities.
So
I
think
that's
important
and
I
think
everything
that
these
companies
do
in
the
next
process.
I
know
we
take
a
look
at
past
performance
and
how
they've
worked
with
the
state
and
that
can
affect
the
next
contract.
G
I
will
have
an
example:
if
they're,
not
good
players,
now
in
just
a
one
year
span
of
time,
I
don't
expect
to
be
good
players
in
the
long
run.
So
those
are
the
two
things
I
had.
I
think
he
asked
them.
It
was
the
foster
care
issue,
the
molina
carry
issue
and
just
to
keep
in
mind,
you
know
it's
a
recommendation.
We've
had
before
about
getting
rid
of
co-pays,
we
passed
it
into
law,
we're
considering
reducing
the
number
of
mcos.
G
I
would
strongly
urge
you
to
consider
that
to
reduce
the
number,
I
think
we
can
get
the
services
we
need
to
get
accomplished
for
the
state
by
having
fewer
and
letting
them
know
that,
if
they're
not
going
to
play
nice
with
kentucky
that
we
don't
have
to
do
business
with
them,
if
they're
not
going
to,
you
know
honor
their
obligations.
Thank
you,
mr
chairman.
I
appreciate
it
thanks.
A
Senator
I
think
it's
interesting.
I
made
a
reference
to
humana's
appeal
to
the
judge's
original
decision
and
a
lot
of
their
arguments
for
not
having
six
mcos
with
the
same
arguments
we
presented
in
these
committee
meetings
about
it,
creates
additional
bureaucracy
and
expense
to
our
commonwealth.
So,
yes,
we
would
certainly
welcome
that
change,
but
also
wonder,
commissioner,
is:
do
we
build
ourselves
in
any
flexibility
that,
if
there's
another
payment
model
out
there
and
they're
all
evolving,
you
know
such
as
asos
seem
to
really
have
a
lot
of
interest
right
now.
A
That's
fair
appreciate
that,
thank
you.
You
know
when
that
becomes
final.
I'm
sure
we'll
have
another
discussion
about
this.
Is
that
this
committee?
So
I
thank
you.
Anyone
else
have
any
questions
comments
for
the
commissioner
lee.
B
E
You
are
correct.
We
have
been
we've
actually
surveyed,
some
of
our
providers,
we're
working
with
our
stakeholders.
We
have
formed
an
internal
work
group
because
you
know
medicaid
does
work
with
our
department
for
behavioral
health
and
our
department
for
aging
and
independent
living
in
order
to
administer
those
those
hcbs
programs.
So
we
do
have
an
internal
work
group
to
look
at
all
of
the
recommendations
that
we
have
received
from
our
stakeholders
and
move
forward
again
in
a
thoughtful
manner.
E
On
what's
best
for
our
members,
we
are
not
heavily
considering
any
any
recommendation
that
requires
additional
funding,
because
the
hcbsf
map
is
a
one-time
infusion,
so
we're
not
again
heavily
considering
anything
that
would
need
funding
in
the
future.
B
And
a
follow-up
to
that
is,
as
you
know,
any
spending
plan
of
or
any
spending
of
american
rescue
act
funding
requires
legislative
approval.
So
are
you
working
through
the
process
to
get
an
informal
legislative
approval
of
that
spending
plan
before
it's
submitted.
E
B
E
A
If
there
are
no
other
questions
comments
and
commissioner
lee,
we
certainly
appreciate
the
amount
of
time
you've
dedicated
to
this
afternoon,
and
we
continue
to
work
with
you
going
forward
and
building
a
strong
medicaid
program
for
all
of
our
recipients.
There's
no
other
business
would
like
to
remind
committee
members.
Our
next
meeting
will
be
june.
16Th
at
three
o'clock.
You
know,
follow
the
health
and
welfare
interim
committee
meeting.
So
if
there's
no
other
business
come
before
this
committee,
we
will
stand
adjourned.