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From YouTube: Administrative Regulation Review Subcommittee (8-8-23)
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A
B
A
Thank
you
with
the
Quorum
being
present.
The
subcommittee
is
duly
constituted
to
do
business.
I've
got
a
new
co-chair
here
today,
he's
subbing
in
for
other
partner
in
crime
in
the
Senate,
but
the
first
matter
of
business
is
approval
of
the
minutes
of
the
last
meeting,
which
was
in
June,
can
I
get
a
motion.
A
B
C
16K
or
9080
E
and
O
amends
to
delete
candidate
application
requirements
to
a
program
change
requirement.
The
preparation
programs
ensure
candidates
complete
the
program
within
three
years
to
five
years
for
all
certification
areas
except
exceptional
children
or
interdisciplinary
early
childhood
education,
which
remains
at
three
years.
Remove
reference
to
the
Kentucky
teacher
internship
program
for
the
deadline
and
annual
observation
requirements.
C
Remove
the
use
of
forms
Incorporated
by
reference
for
institution
recommendations,
modify
procedures
for
obtaining
full
certification
upon
completion
of
the
program,
modify
eligibility
for
provisional
certification,
renewal
of
Administrators
to
include
a
recommendation
from
the
certification
program
and
completion
of
annual
observation
hours,
modify
requirements
for
completing
the
administrator
program
to
obtain
full
certification
and
remove
various
forms.
Incorporate
about
reference.
A
C
101
kr2034
amends
to
authorize
the
appointing
authority
if
sufficient
funds
are
available
to
raise
employees,
salaries
to
five
percent
above
a
newly
appointed
or
former
employee
in
re-entering
the
classified
service
of
the
same
job
classification.
If
the
employee
is
making
less
than
five
percent
above
the
salary
of
the
new
employee
ad
employees
placed
in
lower
pay
grades
due
to
reclassification
or
relay
allocation
or
a
ineligible
for
a
salary
or
pay
increase
due
to
special
duties
until
moved
to
a
job
classification
with
a
higher
pay
grade
than
from
which
reclassified
or
reallocated
authorize
an
appointing
authority.
C
If
sufficient
funds
are
available
to
adjust
the
salary
of
an
employee
on
special
duty
to
the
greater
of
five
percent
or
the
midpoint
of
the
pay
grade
for
the
time
on
special
Duty
authorize,
an
appointing
authority
to
judge
the
salary
of
employees
in
an
office
or
Department
due
to
internal
pay,
Equity
or
sustained
retention
issues,
add
an
employee
forfeits,
a
salary
Advance
If
Leaving
employment.
Within
a
month
after
probation,
authorize,
the
secretary
to
direct
payment
of
a
locality
premium,
permit
the
secretary
upon
written
request
by
appointing
authority
to
authorize
a
sign
on
bonus.
E
101
3045
is
being
amended
to
add
discretionary
compensation,
enhancements,
add
salary
adjustments
at
a
critical
position
premium,
relax
the
limits
on
the
number
of
agency
employees
eligible
for
recognition
Awards
and
make
technical
changes.
The
staff
suggested
amendment
makes
changes
to
comply
with
the
drafting
requirements
of
KRS
chapter
13A
and
make
other
technical
changes.
A
E
This
regulation
is
being
amended
to
make
updates
to
forms
used
by
the
Kentucky
public
pensions.
Authority
established
previously
omitted
processes
and
procedures
for
the
employment
and
medical
staff
reviews
and
make
clarifications.
The
staff
suggested
Amendment
amends
various
sections
to
comply
with
the
drafting
requirements
of
KRS
trip
through
13A
and
make
technical
changes.
The
agency
Amendment
amends
a
statutory
Authority
paragraph
and
section
2
to
add
a
statutory
citation
and
clarify
the
agency's
authority.
K
A
You
all
for
coming.
There
is
a
staff
Amendment.
If
there's
a
motion,
it's
a
motion.
We
got
a
second
without
objection,
so
ordered
there's.
Also
an
agency
Amendment.
There's
an
motion
on
that
make
a
motion.
Second,
without
objections
so
ordered.
Are
there
any
questions
on
the
regulation
from
members
of
the
subcommittee.
A
M
A
C
A
C
201
kr21025
amends
to
correct
a
technical
error.
201
KR
21041
amends
to
establish
licensing
standards
for
initial
applicants,
including
to
require
an
initial
applicant
who
graduated
from
chiropractic
school
more
than
four
years
ago,
to
provide
proof
of
successfully
passing
the
special
purposes
examination
within
the
past
six
months,
unless
the
applicant
submits
proof
of
active
practice,
allow
licensees
to
obtain
continuing
education
from
online
sources
without
limitation,
established
licensing
standards
for
reactivation
and
reinstatement,
including
Provisions
relating
to
proof
of
active
practice
and
update
material
Incorporated
by
reference.
C
The
amended
after
comments
version
amends
to
clarify
a
continuing
education
course
may
not
be
repeated
for
credit.
Within
the
same
renewal
period,
201
Kar
21042
amends
to
clarify
standards
for
continuing
education
reference,
a
new
form
and
delete
obsolete
forms.
The
amended
after
com
comments
version
amends
to
require
an
original
recording
date
for
any
online
program,
be
within
five
years
from
the
date.
From
the
time
the
courses
approved
for
credit
by
the
board
and
update
the
continuing
education
application
to
include
the
original
recording
date
for
any
online
education
program
on
the
application
for
board
approval.
C
201
KR
21075
amends
to
make
a
technical
correction
relating
to
the
number
of
members
appointed
to
the
peer
review
committee.
201
KR
21095
amends
to
allow
continuing
education
requirements
to
be
met
using
online
sources
without
limitation
on
the
number
of
hours
and
uptake
material
Incorporated
by
reference.
201
kr2105
establishes
requirements
for
Telehealth
201
care.
21025
and
075
are
okay
without
further
Amendment.
The
staff
amendments
for
201
KR.
O
A
E
This
regulation
is
being
admitted
to
create
an
additional
opportunity
for
credential
holders
to
earn
continued
competency
credits
and
clarify
the
course
approval
process
for
continued
competency
requirements.
The
staff
suggested
Amendment
amends
various
sections
to
comply
with
the
drafting
requirements
of
KRS
chapter
13A
and
make
technical
changes.
A
E
202-7510
is
being
amended
to
remove
the
requirement
that
all
aircraft
licensed
and
based
in
Kentucky,
providing
of
a
paramedic
on
board
and
add
the
requirement
that
all
aircraft
licensed
in
Kentucky
providing
ALS
Services
have
an
onboard
at
a
minimum,
either
a
paramedic
and
a
registered
nurse
to
registered
nurses
or
a
physician
and
a
registered
nurse.
The
staff
suggested
Amendment
amends
various
sections
to
comply
with
the
drafting
requirements
of
KRS
chapter
13A.
E
202-755
emergency
is
being
amended
to
provide
the
board
a
mechanism
to
temporarily
suspend
a
class
one.
Two
three
six
or
seven
license
that
has
not
been
surrendered
by
an
agency
after
it
ceases
to
provide
continuous
service,
provide
the
board
a
mechanism
to
issue
a
temporary
hardship
license
to
a
county
that
could
otherwise
be
left
without
a
Class.
A
emergency
ambulance
service
require
class
1
agencies
to
schedule
a
minimum
of
one
staffed
ambulance
to
be
staged
in
the
agency's
geographic
service
area
and
allow
Health
Care
Facilities
to
request
that
any
licensed
agency
conduct
a
non-emergency
transport.
A
A
F
On
the
on
the.
A
F
F
Ambulance
Staffing
Simply
Having,
the
Staffing
shortage
of
paramedics
that
are
within
the
state
right
now
to
provide
continuous
service
sure.
Q
I
think
the
necessary
follow-up
question
and
I
guess
we're
we're
having
that
issue
with
emerging
emerging
emergency
emergency
Management
Services
across
the
board
in
every.
But
what
are
we
doing
to
be
able
to
fill
that
Staffing
right
now,
I
understand
the
necessities
of
making
these
amendments
before
us,
but
long-term.
You
know
our
constituents
are
less
safe.
We
don't
have
that
staff.
What
are
we
doing
to
be
able
to
fill
that
Gap.
F
So
I
think
one
of
the
more
important
things
that's
going
on
right
now
is
we're
creating
more
Educational
Opportunity.
So
when
you
look
a
few
years
ago
about
five
years
ago,
we
went
through
a
process
that
made
it
a
bit
more
difficult
to
teach
traditional
paramedic
programs,
but
over
the
past
five
years,
almost
on
a
we'll,
say,
quarterly
basis,
we're
adding
an
opportunity
for
for
paramecs
to
go
to
class
and,
as
always,
we've
got
to
work
on
Recruitment
and
Retention
and
and
quite
frankly,
pay
issues
for
paramedics.
B
R
301
Kar
6001
and
6020
update
definitions
and
requirements
for
personal
flotation
devices.
301K
AR
11020
establishes
procurement
procedures
in
accordance
with
KRS
chapter
45a
relating
to
architectural
and
Engineering
Services.
The
staff
suggested
amendments
for
these
regulations
amid
various
sections
to
comply
with
the
Drafting
and
formatting
requirements
of
KRS
chapter
13A
and
to
make
minor
clarifications.
A
Good
to
see
you
all,
thank
you
all
for
coming
today.
There
are
staff
amendments.
If
I
can
get
a
motion
for
approval
staff
amendments
got
a
motion
in
a
second,
without
objection
so
ordered.
Are
there
any
questions
from
the
members
of
the
subcommittee
off
the
hook
easy
today?
Thank
you
all
for
coming.
Thank
you.
Please
call
the
next
regulation.
B
E
500
2020
is
being
amended
to
add
a
definition
for
government
unit
update
terminology
update
the
sleo
program
administrator
to
internal
investigations,
Branch
at
alternative
methods
to
provide
notice
of
violations
to
the
sleo
and
update
forums.
500
3010
is
being
amended
to
add
definitions.
500
3020
is
being
amended
to
add
definitions
and
update
language
to
reflect
gender
neutral
preferences.
The
staff
suggest
amendments
to
these
regulations,
add
statutory
citations
and
amends
various
sections
to
comply
with
the
drafting
requirements
of
KRS
chapter
13A
and
make
technical
changes.
A
A
I
501
Kar
6150
updates
the
policies
and
procedures
of
Eastern
Kentucky
Correctional
Complex.
The
staff
suggested
Amendment
amend
sections
1
and
the
material
Incorporated
by
reference
to
align
Provisions
with
other
departmental
policies
to
clarify
procedures
and
to
comply
with
the
drafting
requirements
of
KRS
chapter
13A
505-1200
in
emergency,
authorize,
the
creation
of
cell
entry
teams
and
require
emergency
response
teams
in
training
pursuant
to
Senate
Bill
162.
The
staff
Amendment
for
the
ordinarium
in
sections
two
and
three
to
require
the
training
to
include
how.
I
With
juveniles
with
mental
or
physical
disabilities
and
amend
various
sections
to
comply
with
drafting
requirements,
505-1210
emergency
establishes
the
use
of
restraints
and
control
methods
for
juveniles
in
the
custody
of
replaced
with
a
department
1
to
20e
establishes
requirements
for
the
transportation
of
juveniles
in
the
custody
of
the
department.
One
two
thirty
establishes
requirements
for
each
DJJ
facility
to
establish
a
maximum
capacity,
the
ability
to
waive
the
maximum
capacity
adequate
Staffing
levels
and
a
daily
census.
A
O
V
The
Staffing
and
capacity
is
just
to
update
that
to
require
what
facilities
report
to
us.
This
includes
both
our
own
facilities
and
if
there
were
any
facilities
operated
by
any
local
governments,
but
I
just
wanted
to
make
a
comment
about
the
Senate
Bill
162,
because
there
were
some
concerns
raised
last
time
that
somehow
our
regulations
weren't
implementing
those
provisions
and-
and
that
is
just
false.
As
you
all
know,
Senate
Bill
162
develops
a
return
to
original
model
once
that
can
be
done
by
adequately
segregating
males
and
females
high
and
low
risk
offenders.
V
It
appropriates
1.75
million
to
hire
a
design
consultant,
which
we
have
done
and
we
are
working
with
them
and
we
are
moving
to
that
model
and
we'll
do
that.
We
will
develop
that
plan
and
present
it
to
you
as
soon
as
that
plan
is
developed
so
that
you
all
can
improve.
How
we
would
move
to
that
Regional
model
that
you
set
forth
in
Senate
bill
162.
and
these
regulations
comply
with
other
parts
of
Senate
Bill
162.
V
You
will
continue
to
see
regulations
about
other
parts
of
162
and
whenever
that
plan
is
implemented
and
drafted,
setting
forth
the
new
Regional
model,
you
will
see
those
regulations.
The
regulations
that
came
to
you
previously
were
how
the
facilities
are
being
operated
now
and
and
that's
they
comply.
They
will
comply
with
162..
They
comply
with
a
provisions
of
162
that
require
the
segregation,
but
those
are
in
separate
facilities
now
not
in
the
same
facility
which
162
envisions
once
we
can
do
that
safely.
V
So
we
just
wanted
to
address
those
comments.
We
are
working
with
DPA.
We
understand
their
concerns.
We
don't
think
the
language
they
proposed
last
time
solves
their
current
problem.
There's
nothing
in
the
regs
that
prohibits
going
to
a
regional
model
when
we
can
do
that
is
set
forth
in
162.
162
requires
that
to
be
done,
and
we
will
do
that,
but
we
are
working
with
DPA
to
address
their
concerns
and
make
their
operation
as
best.
We
can
during
this
time.
A
Thank
you
very
much
for
the
clarify
clarification
look
for
next
month
in
the
future
regulations
and
working
with
you
on
the
future.
There
are
staff
amendments.
If
there's
a
motion
for
approval
of
the
staff
amendments.
Is
there
a
second
that
objection
so
ordered?
Are
there
any
questions
of
the
subcommittee
Senator
Yates.
Q
Thank
you,
Mr
chair,
thank
you
for
being
here.
I
I
know
that
the
juvenile
justice
has
been
an
ongoing
topic
of
concern
debate
and
everybody
on
this
committee
I
think
shares
the
same
overall
concerns
for
make
sure
that
we're
doing
right,
but
also
making
sure
that
the
juveniles
are
safe.
V
Yes,
we
are
with
the
drafting
of
this
reg.
We
have
started
identifying
the
cell
entry
teams,
we
have
started
identify.
We
have
reached
out
to
local
law
enforcement
in
their
emergency
responders
to
enter
into
those
mousse.
We
are
developing
training
with
them
and
we
will,
as
this
reg
move
forward,
develop
that
training
to
how
those
cell
entry
teams
will
be
trained.
They
have
not
yet
been
identified
and
trained,
but
they
will
be
based
on
this
regulation.
V
V
I
would
say
that
that
is
more
of
an
operational
question
and
a
training
question,
as
you
know,
there's
a
lot
of
the
training
we're
revamping,
but
that
is
something
that
is
higher
on
our
priority
list,
because
we
believe
it's
very
important,
so
I
would
say
sooner
rather
than
later.
I.
A
I
have
one
question
that
deals
with
one
in
particular:
regulation:
505,
Kar,
1210
emergency.
It's
under
section
two
number
three
staff
should
not
use
any
Force
related
equipment
other
than
what
is
authorized.
I
just
I'll
give
you
a
second
it's
again:
505
Kar
1210
emergency
under
section
two
number
three
I
was
just
curious
authorized
by
who
is
it
the
department
or
it's.
A
Okay,
okay
and
then
section
six,
it
outlines
an
incident
report
and
I
just
had
a
question:
is
it
just
how
many
staff
is
it
the
one
using
the
device
or
the
agent
is
everyone
involved
when
you
all
are
putting
these
incident
reports
together.
V
So
there
is
one
person
that
would
fill
out
the
incident
report,
but
they
would
take
statements
from
all
of
the
staff
involved.
Often
they
review
the
video
there's
an
interview
with
the
juvenile.
If
there's
any,
if
the
juvenile
has
been
checked
medically,
that
would
be
included.
So
there
is
a
generally
I
guess
the
main
person
involved
or
the
supervisor
would
complete
the
incident
report,
but
that
should
include
statements
from
everyone
involved
in
the
incident
sure.
A
B
L
Kar
17570
emergency
only
temporarily
as
part
of
the
Medicaid
unwinding
initiative,
amends
requirements
for
Medicare
supplement
policies
to
allow
a
guaranteed
enrollment
period
of
63
days
for
eligible
individuals,
age
65
years
or
older,
who
were
enrolled
in
Medicaid
during
the
covid-19
public
health
emergency.
The
staff
suggested
Amendment
amends
various
sections
to
comply
with
KRS
chapter
13A.
A
Advisor
for
the
Department
Benjamin
Siegel
general
counsel,
for
the
Department.
Thank
you
all
for
coming.
Today.
There
is
a
staff
amendment.
Is
there
a
motion
for
approval
of
the
staff?
Amendment
got
a
motion
got
a
second
without
objection
so
ordered.
Are
there
any
questions
from
members
of
the
subcommittee
seeing
none
you
all
free
to
go?
Thank.
B
L
810
4090
amends
requirements
for
owners
of
racing
horses
to
establish
that
if
a
person
owns
five
percent
or
less
of
a
horse,
that
person
shall
not
be
required
to
obtain
a
license
to
establish
that
if
more
than
two
people
own
interest
in
a
single
horse,
then
one
of
the
individuals
shall
be
the
Principal
owner
limit
to
10
individual
owners
or
entities
that
may
own
a
single
horse
and
establish
that
a
less
or
shall
be
licensed
or
eligible
to
be
licensed.
As
an
owner.
L
810-7030
amends
standards
for
the
Kentucky
Thoroughbred
Development
Fund,
to
revise
definitions,
allocate
funds
to
race,
tracks,
authorize
race
tracks,
to
use
funds
for
purses
and
establish
Provisions
for
using
funds
for
advertising.
810
7090
amidst
Provisions
for
the
Kentucky
quarter.
Horse
paint
hoist
paint
horse,
Appaloosa
and
Arabian
Development
Fund
to
revise
definitions.
Waive
mayor
registration
fees
for
Falls
conceived
during
the
2023-2024
breeding
season
extend
conception
year
deadlines
make
the
Kentucky
mayor
residency
requirement.
L
120
days
between
conception
and
embryo
transfer,
until
falling
rather
than
120.
Continuous
days
delete
exceptions
to
the
Kentucky
mayor.
Residency
120-day
requirement
allocate
funds
on
an
equitable
rather
than
a
percentage
basis,
and
update
Incorporated
material
810-8020
amends
medication
guidelines
to
add
levamisole
to
the
list
of
Class
B
drugs
medications
and
substances
suggested
amendments
for
810-4090-7030
and
7090
am
in
various
sections
to
comply
with
KRS
chapter
13A.
P
A
Y
P
R
815
Kar,
4030
and
8010
delete
form
references
to
KRS
164.772,
which
was
repealed
in
2019..
Additionally,
8010
creates
a
licensing
renewal
form
815
Kar
7130
establishes
the
plan
review
requirements,
out-of-state
inspection
processes
and
requirements
for
industrialized
Building
Systems.
The
staff
suggested
amendments
to
4030
and
7130
amend
various
sections
to
comply
with
Drafting
and
formatting
requirements
of
KRS
chapter
13A,
815.
E
A1535060
is
being
demanded
to
remove
the
material
Incorporated
by
reference.
The
language
related
to
KRS
164772
at
a
prorated
schedule
to
the
material
Incorporated
by
reference
add
a
form
to
the
material
Incorporated
by
reference
that
is
required
for
removal.
A
renewal,
clarify
experience,
requirements
for
master
electrician
and
electrician
licenses
and
remove
a
section
that
allowed
for
reinstatement.
Pursuant
to
2018
Kentucky
Acts
chapter
186,
section
2.,
the
staff
suggested
amendment
to
815
10060,
25020,
25060
and
35060
ads
and
delete
status
story
citations
and
amends
various
sections
to
comply
with
KRS
13A
and
mixed
technical
changes.
N
A
Rick
Rand
the
commissioner
of
Department
housing
buildings
and
construction,
Max
Fuller
Deputy
Commissioner.
Thank
you
all
for
coming.
Today.
There
are
staff
amendments.
Is
there
a
motion
for
approval
of
the
staff
amendments
so
movement?
Second,
that
objection
so
ordered.
Are
there
any
questions
of
the
subcommittee?
B
A
R
900
Kar
14010
amends
to
update
terminology
to
comply
with
Senate
Bill
43
from
the
2023
regular
session.
902
Kar
20018
adds
a
definition
for
charge
nurse
and
allows
a
charge
nurse
to
be
on
duty
when
patients
are
undergoing
dialysis.
902
Kar
55015
amends
to
designate
tianeptine
as
a
schedule.
1
controlled
substance,
906
K
ar1210
amends
to
comply
with
legislation
from
the
2022
and
2023
legislative
sessions
to
add
definitions
to
exempt
the
placement
of
permanent
Direct
Care
staff
from
the
requirements
of
the
regulation
and
to
update
material
Incorporated
by
reference.
A
A
L
907
1038
emergency
amends
Kentucky,
Medicaid
Program
hearing
Provisions
to
implement
a
state
plan,
amendment
that
allows
adults
to
receive
Hearing
Services
establish
Audiology
service
limits
through
the
Incorporated
fee
schedule,
increase
the
amount
that
can
be
charged
per
year.
Each
36
months
from
eight
hundred
dollars
to
twelve
hundred
dollars,
clarify
how
hearing
aid
batteries
may
be
provided
clarify
that
new
or
improved
technology
may
be
a
reason
to
reimburse
for
hearing
aid
replacement,
establish
that
service
and
instrument
limits
may
be
exceeded
for
children
under
21
if
medically
necessary
and
update
the
fee
schedule.
L
L
907-1632
emergency
amends
Kentucky,
Medicaid,
Program
Vision
Provisions
to
make
technical
Corrections,
including
for
consistency
with
907-3005
Implement.
A
state
plan
amendment
that
allows
for
adults
to
receive
Vision
Services,
clarify
cost
sharing
requirements
in
order
for
providers
to
deliver
services
on
a
non-medicaid
basis,
clarify
vision,
service
limits
require
that
a
higher
quality
of
frames,
lenses
and
lens
lens
enhancements
be
available.
Clarify
that
contact
lenses
are
covered
and
available,
including
daily
lenses
and
update
the
vision
fee
schedule.
R
I
907-2010,
emergency
045
and
emergency
and
100
in
emergency
all
amend
to
implement
a
continuous
eligibility
requirement
for
children
in
response
to
the
federal
Consolidated
Appropriations
Act
of
2023
907-2075,
an
emergency
amend
to
establish
eligibility
for
individuals
who
were
in
out-of-state
foster
care
and
to
implement
a
continuous
eligibility
requirement
for
former
foster
care
youth.
The
staff
suggested
amendments
for
the
ordinary's
907,
2004507-5
and
100
am
in
various
sections
to
comply
with
the
drafting
requirements
of
KRS
chapter
13A.
A
Thank
you
all
for
coming
today
we
do
have
several
signed
up
to
speak.
I
might
have
our
members
hold
off
till
the
end
once
the
presenters
have
had
the
opportunity
to
speak.
I
know
we've
been
before,
but
we
do
have
an
amendment
we'll
get
on
the
books.
Real,
quick.
There
are
staff
amendments.
Is
there
a
motion
for
approval
of
the
staff
amendments.
Q
A
An
emotion
got
a
second
without
objections
so
ordered.
Would
you
all
like
to
say
anything?
First,
you
want
to
come
back
at
the
end.
A
J
Hi
good
afternoon
my
name
is
Emily
Beauregard
I'm,
the
executive
director
of
Kentucky
voices
for
health
and
I
want
to
thank
the
chairs
and
members
of
this
committee
for
hearing
Our
Testimony.
Today
we
are
here
as
consumer
health
Advocates
to
support
Comprehensive,
Dental
vision
and
hearing
services
for
kentuckians
covered
by
Medicaid,
for
our
health
care
Workforce
and
for
every
single
Kentuckian
who
benefits
when
their
neighbors
co-workers
and
loved
ones
have
the
care
that
they
need.
J
Kentuckians,
face
a
lot
of
challenges
to
good
health
and
to
Economic
Security.
That's
nothing.
New
living
expenses
are
higher
than
wages
for
over
half
of
Kentucky
households.
Nine
hundred
thousand
Kentucky
adults
are
covered
by
Medicaid,
which,
for
an
individual
means
that
you're
making
about
twenty
thousand
dollars
a
year
at
the
very
most
for
a
household
of
four.
It's
about
forty
one
thousand
dollars
that
makes
programs
like
Medicaid
essential
for
kentuckians,
with
low-wage
jobs
and
even
those
with
relatively
good
paying
jobs
that
don't
have
access
to
benefits.
J
Don't
have
access
to
regular
hours
when
you're
living
paycheck
to
paycheck
and
just
trying
to
make
ends
meet
every
month.
There's
no
extra
to
pay
for
root.
Canals
crowns
glasses,
hearing
aids,
that's
what
we've
been
hearing
from
kentuckians
who
have
been
reaching
out
to
us
in
support
of
these
regulations,
and
you
have
hundreds
of
those
comments
in
front
of
you
now
they
look
like
this.
J
With
a
gray
bar
at
the
top,
we
were
asking
kentuckians
what
they
thought
of
these
regulations
and
hundreds
of
them
submitted
comments
to
us
that
they
wanted
you
to
see
and
the
utilization
numbers
that
we've
seen
so
far
really
speak
for
themselves.
J
I'm
sure,
commissioner
Lee
will
go
over
those
more
closely,
but
we
have
seen
tens
of
thousands
of
people
getting
contact
lenses,
eyeglasses
frames,
bifocals,
trifocals,
220,
cornea
procedures,
more
than
3
000
crowns,
2
000
root,
canals
six
thousand
partial
or
complete
Dentures,
almost
4
000
bike
guards
and
night
guards
and
71
7100
hearing
aids,
and
that's
just
in
the
first
six
months
alone.
These
services
are
life-changing
for
people.
J
Imagine
for
a
moment
how
many
folks,
who
can
now
see
or
can
now
hear
we're
just
powering
through
poor
vision,
dental
pain,
hearing
loss
when
they
were
working
last
year
driving
their
car
Kentuckian
kentuckians
need
these
services
and
they
benefit
all
of
us
and
we're
safer
for
it.
We
have
a
better
Workforce
for
it.
J
We
strongly
support
both
the
regulations
before
you
today,
but
we
also
support
the
need
for
a
legislative
solution
that
would
permanently
increase
access
to
Comprehensive,
Dental
vision
and
hearing
services,
and
we
think
that's
really
important
because
to
really
make
the
most
use
of
these
regulations
or
the
services
covered
under
these
regulations.
There
are
some
other
things
that
we
need
to
also
work
on.
J
We've
all
heard
that
certain
providers
aren't
getting
paid
enough
to
cover
their
costs
and
that
some
Medicaid
members
can't
find
a
provider
to
treat
them.
We
need
to
really
explore
what's
behind
that,
so
that
we
can
Target
that
with
legislation
we
know,
DMS
has
increased
rates
for
a
lot
of
these
Services
they've
gotten
input
from
providers
for
members
of
the
Medicaid
advisory
Council,
but
that's
not
necessarily
trickling
down
to
rates
that
the
mcos
are
negotiating
with
providers.
Mcos
are
allowed
to
pay
rates
that
are
well
below
the
fee
schedule
established
by
DMS
and
in
theory.
J
Another
hurdle
that
you've
no
doubt
heard
about
is
prior
authorization,
the
amount
of
paperwork
and
time
it
takes
for
a
service
to
be
approved,
such
as
a
root
canal.
It's
a
huge
burden
on
providers
and
It
ultimately
keeps
some
providers
from
participating
and
at
the
end
of
the
day,
your
constituents
are
the
ones
who
suffer
Whenever.
There
are
delays
or
denied
care,
so
we
really
need
to
get
back
to
letting
providers
make
the
medical
decisions
that
they
have
been
extensively
trained
to
make
for
their
patients.
J
Those
are
two
of
the
legislative
solutions
that
we
would
love
to
work
with
members
of
this
committee
on
and
keeping
Comprehensive
Dental
vision
and
hearing
services
in
place
for
the
900
000
Kentucky
adults
using
Medicaid
for
their
health
care.
It
won't
just
fill
an
unmet
need
for
treatment.
It's
also
an
important
investment
in
Kentucky's
Workforce
and
it
will
ultimately
improve
access
for
everyone.
J
Until
then
only
coverage
there
was
only
coverage,
substance,
use
disorder,
coverage
for
children
and
pregnant
women,
and
even
that
was
hard
to
find
in
the
first
30
months
after
we
had
a
coverage,
expansion,
utilization
of
SED
Services
increased
700
percent,
but
that
didn't
only
benefit
benefit
Medicaid
members
who
are
struggling
with
opioid
addictions
or
alcoholism.
It
actually
increased
the
supply
of
SCD
treatment
for
everyone
in
all
of
our
communities.
J
So
I
think
if
we
use
our
funds
smartly,
we
can
bolster
Kentucky's
network
of
dentists,
audiologists,
optometrists,
ophthalmologists
and
other
Specialists,
and
really
increase
that
pipeline
of
providers,
even
more
importantly,
enhancing
Medicaid
to
cover
glasses
root,
canals
Dentures,
hearing
aids
for
our
low-income
Workforce.
This
will
boost
our
entire
Workforce.
It
gives
us
a
major
homegrown
Advantage.
An
investment
of
about
two
dollars
per
member
per
month
will
pay
dividends
both
in
savings
and
in
health
outcomes
and
I'm.
Here
with
my
colleague,
Kara
who's,
going
to
talk
a
little
bit
more
about
that
return
on
investment,
hi.
W
Yes,
Kara
Stewart
I'm,
the
director
of
policy
and
advocacy
at
Kentucky
voices
for
health
and
I'm
really
going
to
touch
on
just
some
of
the
things
that
I
heard
from
this
committee.
When
we
talked
about
this
before
in
May,
including
what
Rhett
Bridges
said,
both
about
wanting
to
provide
Health
Care
to
all
kentuckians
and
specifically
about
if
whether
or
not
this
would
help
kentuckians
get
to
work.
W
If
you
had
two
people
sitting
in
front
of
you
applying
for
a
job
and
one
of
them's
got
a
you
know,
a
full
teeth,
full
smile
and
they're
probably
going
to
be
a
lot
more
confident
in
that
interview
of
someone
who's
missing
their
front
tooth,
maybe
in
a
plan
for
that
job.
So,
of
course,
that's
going
to
be
a
part
of
that
and,
of
course,
just
and
of
course,
I
think
about
especially
women
who
are
are
recovering
from
domestic
violence.
W
Have
who
may
have
had
that
too?
It's
knocked
out,
and
how
are
you
ever
really
going
to
recover
from
that
experience
and
that
trauma
without
being
able
to
get
that
repaired
and
I
also
think
about
the
folks
who
are
taking
care
of
some
of
our
kentuckians,
like
our
kentuckians
on
Medicaid
waiver
programs
and
providing
the
care
for
those
folks
in
waiver.
W
Slots
and
I
want
those
folks
to
have
glasses
to
make
sure
that
they're
able
to
provide
that
care,
and
we
know
that
we've
had
tens
of
thousands
of
kentuckians
providing
that
who
haven't
been
able
to
get
glasses
with
these
regulations
and
think
of
all
the
folks
who
are
out
there
driving
before
who
maybe
needed
those
glasses.
If
we
know
they've
shown
up
and
gotten
them
now
how
much
safer
we
all
are
and
then
the
return
on
investment
like
Emily
was
saying
it's
nearly
instant.
W
We
know
that
Kentucky
was
spending
nearly
10
million
a
year,
the
last
three
years
on
emergency
department
visits
for
tooth
pain.
It
was
9.9
million
in
2021.,
that's
a
lot
of
money,
and
we
know
that
most
of
those
are
because
people
needed
root
canals
and
we
know
we've
already
had
2
000
root
canals.
So
that
is
a
very
quick
switch
and
I
know.
I
had
a
friend
who
was
at
my
house
working
and
he
was
having
terrible
tooth
pain.
It
was
terrible,
it
was
laying
on
the
floor
is
miserable.
W
We
were
like
Googling
anything
we
could
to
help,
and
you
know
we
eventually
had
to
go
to
the
ER.
And
what
did
the
ER
do
him?
They
gave
him
three
opioids
three
pills
and
a
prescription
for
an
antibiotic
which
we
went
to
Meyer
and
got
for
four
dollars,
and
he
was
just
as
miserable.
W
You
know
for
it
for
the
next
three
weeks
until
he
could
wait
to
get
into
a
dentist
where
he
had
to
have
800
cash
to
be
able
to
save,
to
get
started
on
the
root
canal
he
needed
so
going
to
the
ER
does
not
fix
your
tooth
pain
problem
it
just
it
opens
the
door
for
other
potential
issues
there.
So
we
can
prevent
a
lot
of
that,
but
making
sure
that
people
have
access
to
to
the
dentist
and
making
sure
that
I
don't
want
to
leave
out
while
I'm
up
here
talking
I
know.
W
We
all
talk
a
lot
about
the
dentist.
I,
don't
want
to
leave
out
hearing
and
vision.
You
all
I
wrote
comments
on
these
regulations.
I
will
email
you
a
copy
of
them.
W
I,
don't
expect
any
of
you
to
read
them
they're,
very,
very
long
with
the
gazillion
citations,
because
there's
so
many
studies
out
there,
hundreds
and
hundreds
of
pages
on
the
other
hundreds
and
hundreds
of
pages
of
studies,
but
they
all
say
the
incredible
effects
of
what
happens
when
you
cannot
hear
and
all
you
know
what
I
learned
all
of
us
are
going
to
have
hearing
loss.
All
of
us.
It's
inevitable.
W
You
know
I
guess
unless
you
die
very
young,
but
it
is
a
matter
of
whether
or
not
you
are
able
to
treat
that
and
at
what
level
it
does
happen.
Exactly.
Thank
you.
Senator
Yates,
so
I
mean
I
I
learned
so
much
about
you
know
when
you
lose
a
tooth
and
your
your
sinuses
can
collapse
and
that
can
affect
other
parts
of
your
your
health.
There
are
so
many
pieces
of
your
body
that
are
connected
to
all.
Of
course,
it's
in
your
head
right
and
we're
imagining
all
we
all
know.
W
Heart
attacks
are
more
likely
when
you're
not
getting
your
teeth,
taken
care
of
and
all
of
these
extra
expenses,
and
so
we
know
that
we
need
to
be
expect
value
from
our
Medicaid
expect
value
from
all
of
our
health
care
services
and
that
these
Services
hearing,
vision
and
dental
are
the
they're,
the
cheapest
most
smart
right
things
to
do
and
they
need
to
be
paid
for
justly
so
that
we
have
the
meaningfully
available
for
everyone
who
needs
them.
I
mean
we
need
to
make
sure
that
our
networks
are
real.
W
That
is
one
of
our
kvh's
strongest
comments
about
these
regulations.
Is
that
the
one
thing
we
would
change
about
them
is
to
say
that
we
need
to
make
these
networks
be
real
and
that
right
now,
DMS
has
over
commercial
Rate
rates
for
most
of
these
services,
but
that
doesn't
mean
the
mco's
pay.
Those
rates
and
DMS
can't
make
those
mcos
pay
those
rates.
W
That's
how
Managed
Care
Works
they
can
decide
they're
the
they're
managing
those
costs,
but
what
we
can
do
is
say
well,
if
the
can,
if
The
Kentuckian
who's
trying
to
go,
see
one
of
these
providers,
maybe
they
try
three,
they
can't
get
in
and
the
time
and
distance
standards
our
laws
require.
Maybe
that
MCO
has
to
pay
for
them
to
see
whoever
they
can
get
in
to
see
and
I
bet.
Maybe
they'll
change
those
networks
then,
and
our
department
of
insurance.
They
got
good
software
to
test
networks.
W
So
we
have
an
agency
who
currently
does
not
test
our
Medicaid
networks.
They
do
our
private
insurance,
but
they
could.
So
that's
our
suggestion
to
changing
these
regulations,
but
we
thoroughly
support
these
regulations
and
again,
like
Emily
said
we
would
like
to
see
the
legislature
take
look
at
this
much
more
thoroughly
and
make
a
permanent
position.
W
I
mean
investing
in
what
is
an
incredible
return
on
investment,
the
cheap
right,
smart
thing
to
do,
for
nearly
a
million
kentuckians
to
be
able
to
hear,
see,
smile,
chew
and
more,
and
we
also
have
a
a
couple
more
folks.
One
who
you
can
see
on
that
screen
he's
just
been
hovering
there
kind
of
awkwardly
looking
at
us,
I'm,
not
sure
the
exact
order
of
who's
going
first
and
next.
J
So
here
you
see
on
your
screen
is
Missy
Newland.
She
currently
does
receive
Medicaid
for
her
health
care.
She
is
a
caregiver.
She
works
right
now
she
is
working
as
a
housekeeper.
She
has
also
worked
in
healthcare
in
the
past
and
she
has
benefited
from
having
Medicaid,
of
course,
but
is
also
a
need
of
these
services
and
wanted
to
share
her
comments
with
you.
Z
Here
with
chair
Lewis
and
members
of
the
committee,
my
name
is
Missy.
Newland
I
am
from
Grayson
Kentucky
and
I
currently
live
in
Louisville.
These
regulations
are
life-changing
to
myself
and
so
many
others
I
grew
up.
Lower
income
went
to
college
at
30
and
became
a
PRN
occupational
therapy
assistant,
making
30
dollars
per
hour
without
benefits
due
to
a
non-traditional
work
schedule,
because
I
couldn't
afford
daycare
I
qualified
for
Medicaid,
thanks
to
the
Affordable
Care
Act
in
2020,
schools,
closed
and
I
had
to
stay
home
therapy.
Work
ended
because
of
covid
I.
Z
Now
clean
houses
to
make
ends
meet
this
work
pays
the
bills
and
allows
me
flexibility
to
help
my
mom
as
she
keeps
healing
from
pancreatic
cancer.
Clean
takes
its
toll
in
my
body,
but
I
press
on
I'm,
hyper
mobile,
meaning
my
muscles
and
connective
tissues
are
too
weak
to
protect.
My
joints
and
Bones
I
have
fibromyalgia
that
causes
pain,
that
I
must
work.
I
have
dysautonomia,
which
means
my
nervous
system
is
not
regulating
my
heart
rate,
my
breathing
and
other
systems
properly.
Z
Even
though
I
hurt
constantly
and
I
have
constant
headaches
for
my
mouth
issues,
I
show
up
for
work
and
carry
on
as
a
mom
without
any
pain.
Meds
I
had
milk
knife
at
three
that
resulted
in
all
of
my
front
teeth
being
pulled.
My
adult
teeth
didn't
begin
to
come
in
until
I
was
about
11.
I
was
fully
for
my
gummy
smile.
My
nutrition
was
impacted
by
my
tooth
loss
and
I
needed
speech
therapy
to
learn
to
speak
properly.
My
teeth
came
in
smaller
than
most
adults
and
crowded
due
to
a
small
palette.
Z
My
wisdom
teeth
grew
sideways,
caused
cracks
in
my
molars
on
two
sides
of
my
mouth
in
2018.
It
cost
me
hundreds
for
a
root
canal
on
one
of
those
mowers,
because
Medicaid
didn't
cover
it.
I
could
not
afford
a
500
Crown,
so
in
2019
I
lost
that
tooth
when
it
broke
while
eating
in
2020
before
shutdown,
I
was
going
to
have
a
crack
two
field,
but
days
before
the
service
covet
happened
by
the
time
I
was
vaccinated.
It
was
too
late
to
save
the
tooth.
Z
Now
that
tooth
moves
and
food
gets
some
of
gums
when
I
eat
I
have
not
had
it
pulled,
because
I
can't
afford
a
replacement,
even
though
it
hurts
to
eat
my
gums
swell
and
so
are
sore
at
least
I
can
still
choose
some
food.
The
same
tooth
on
the
opposite
side
is
now
hurting
being
bilaterally,
is
to
believe
it's
a
systemic
issue,
and
it's
not
poor
hygiene.
I
brush,
I,
floss
and
I
use
dental
tools
to
try
to
keep
my
teeth
clean
when
teeth,
hurt
or
missing
dot
is
restricted.
Nutrition
starts
to
suffer
I'm.
Z
Just
one
gum
infection
away
from
serious
complications.
When
I
got
Dental
Care,
it
cost
me
money,
I
couldn't
spare
or
resulted
in
other
problems
like
the
time.
An
extraction
broke.
A
second
healthy
tooth
in
half
I
lost
both
of
those
teeth
at
no
fault
of
my
own.
At
20
years,
old
I
enrolled
in
Medicaid
in
2014
and
the
political
Total
War
has
always
had
me
worried
about
staying
eligible
I
went
years.
Z
Barely
using
my
benefits,
as
people
like
me
were
raised
to
not
trust
our
government
to
do
the
right
thing
for
anyone
not
rich
when
it
comes
to
medical
regulations,
I
fear
that
my
Access
to
Health
Care
will
be
taken
away
and
with
my
health
issues,
that's
scary,
I
work
hard.
My
car
is
16
years
old,
but
hanging
on
have
survived
domestic
violence.
I'm
trying
to
do
right
by
my
kids
and
they'll
have
guardianship
in
my
niece,
who
has
developmental
delays.
Z
I've
had
no
chance
to
build
a
savings
for
my
future
or
theirs,
and
I
have
no
retirement.
Sadly,
the
political
tactics
unfortunately
do
work
as
planned.
Many
kentuckians,
not
just
me,
delay
or
don't
use
the
benefits
simply
out
of
fear.
It
will
be
taken
away,
but
because
we
can't
find
providers,
they
can
suffer
critical
health
issues.
Many
can
lose
their
lives
because
of
poor
policies.
These
regulations
could
change
that
exams
do
not
solve
problems,
they
highlight
them.
I
have
dental
and
division
issues.
Z
I
need
coverage
that
fixes
those
issues
pulling
teeth
without
replacing
them
or
saying.
I
have
vision.
Loss
without
glasses
is
not
a
solution.
Comprehensive
Dental
Care
is
Health
Care
having
teeth
is
not
cosmetic.
It
is
vital
to
our
nutrition
and
health.
Please
don't
confuse
mine
and
many
other
Kentuckian
strength
and
resilience
and
ability
to
overcome
adversity
as
a
weakness
or
justification
that
we
will
be
fine,
no
matter
what
the
outcome
of
these
regulations
may
be.
Z
J
AA
Hey
my
name
is
Tiffany
Hayes
I,
just
go
by
Tiff
a
lot
of
the
times,
I'm
an
oncology,
social
worker
I'm,
an
LCSW
and
I'm,
an
oswc
which
is
an
oncology.
Social
worker
certified
before
I
give
my
actual
testimony.
I
want
to
also
say
that
I
have
greatly
benefited
from
Medicaid
services
and
now
I'm
doing
really
well
in
my
life
I
work
in
an
outpatient,
Cancer
Center
in
Winchester,
where
we
serve
patients
from
Central
and
Eastern
Kentucky,
which
are
some
of
the
most
impoverished
counties
in
our
state.
AA
You
guys
probably
already
know
that
it's
not
any
news
to
you.
We
see
numerous
comorbidities
in
our
patients.
Besides,
just
cancer
oral
health
is
probably
one
of
the
most
common
problems
in
our
patients
that
we
Face
barriers
that
we
already
have
getting
dental
care
and
those
barriers
are
almost
unbeatable.
AA
That's
why
it's
important
that
we
not
only
Force
more
barriers
on
preventative,
dental
and
vision
care,
but
we
as
a
state
should
work
harder
to
eliminate
these
problems
in
one
of
the
richest
First
World
countries.
People
should
not
be
going
without
any
kind
of
Health
Care,
let
alone
preventative.
Services
I
have
a
question
to
engage
you
guys,
a
little
bit
more
and
I
just
want
to
know
how
many
of
you
are.
You
know
how
many
of
you
know
someone
with
metastatic
breast
cancer,
or
you
understand
the
weight
of
that
diagnosis.
AA
I'm
getting
a
couple
of
head
nods,
some
unfortunate.
Unfortunately,
you
you
do
it's
one
of
the
most
common
types
of
cancer
that
I
see
in
my
line
of
work
and
I,
can't
tell
you
how
many
people
are
diagnosed
right
at
stage
four,
because
they
didn't
seek
medical
care
before
that,
because
they
were
afraid
that
they
wouldn't
be
able
to
afford
it.
And
at
that
point,
there's
not
a
lot
of
treatment
options
available
in
this
year
alone
about
30
000
people
in
Kentucky
will
hear
the
words
I
have
cancer
and
that's
from
CDC
data.
O
AA
AA
If
anybody
would
accept
her
Medicaid
insurance,
the
only
dentist
who
would
couldn't
get
her
in
for
about
three
months
so
that
held
off
that
treatment,
unfortunately,
because
she
wasn't
26
or
under
so
that
was
the
only
kind
of
patient
that
they
were
going
to
take
with
Medicaid
I
called
several
clinics
in
Lexington
and
hardly
any
of
those
accepted
Medicaid
and
when
I
finally
found
one
that
would
again
about
three
months
before
we
could
get
her
in.
AA
She
was
admitted
to
hospice
yesterday,
just
last
week,
I
faced
the
same
barrier
trying
to
get
a
stage.
Four
lung
cancer
patient
established
with
a
dentist,
because
she's
got
super
loose
teeth,
she's
going
through
treatment.
She
can't
keep
any
weight
on
her
and
without
eating
you
can't
keep
any
weight
on
with
loose
teeth.
AA
You
can't
really
eat
she's
gonna,
wait
until
October
26th
to
be
able
to
see
a
dentist,
and
that's
if
she
lives
that
long
vision
changes
also
come
as
a
side
effect
with
chemotherapy,
which
is
why
it's
important
to
establish
a
baseline
of
one's
eyesight
before
treatment
with
preventative
Optometry
visits
before
beginning
Therapies,
without
preventative
Vision
Care.
We
can't
monitor
eyesight
throughout
treatment
as
well
as
we
would
be
able
to.
If
we
had
been
able
to
establish
a
Baseline.
AA
Please
consider
the
stories
that
I've
told
you
guys
today
in
my
testimony
As,
you
move
forward
with
your
roles
in
lawmaking
for
any
kind
of
Health,
Care,
Services
or
any
kind
of
services
at
all.
These
are
the
kentuckians
who
have
no
voice
and
please
invest
on
the
front
end
so
that
we
don't
have
to
spend
as
much
money
on
the
back
end
of
problems.
You've
already
heard
about
people
going
to
the
ER
for
teeth
problems
and
I
can't
tell
you
how
many
of
my
patients
do
that
too.
AA
A
J
Know
we
we
know
that
there
are
some
folks
back
here
that
are
prepared
to
testify
if
you're
thinking
of
some
of
the
providers
that
are
in
the
room.
A
S
A
H
We
are
going
to
break
things
up
and
we
really
appreciate
the
opportunity
to
speak
with
you
today:
I
I
practice,
dentistry
in
rural
Kentucky,
in
my
hometown,
of
Carlisle
Kentucky
population
1600
and
in
the
smallest
county
in
the
state
Robertson
County.
Also
the
last
County
to
get
fluoride
in
the
water
and
I
really
could
tell
a
difference.
I
was
a
Medicaid
provider
for
13
years.
During
that
time
and
treated
probably
50
to
60
percent
of
my
patients
were
Medicaid
patients.
H
Then
I
became
a
faculty
member
at
the
University
of
Kentucky
College
of
Dentistry
and
mostly
worked
in
public
health,
eventually
becoming
the
division
chief
of
Public
Health
for
the
dental
school
and
in
that
role,
I
explored
access
to
care
issues
for
patients
throughout
the
state,
traveled
from
Paducah
to
Harlan
and
north
and
south,
pretty
much
everywhere
talking
to
patients
and
providers
about
what
we
could
do
to
improve
their
oral
health
and
their
access
to
care.
H
So
my
my
part
of
this
is
to
talk
about
need,
so
I
want
to
start
with
something
that
we
saw,
often
at
UK
in
our
Marshall
County
clinic,
which
is
in
Western
Kentucky.
We
had
a
small
dental
clinic
there,
safety
net
in
the
Marshall
County
Health
Department,
and
it
was
not
unusual
at
six
o'clock
in
the
morning
to
see
10
or
15
patients
standing
in
line
waiting
to
get
in
because
they
had
toothaches
because
they
couldn't
find
anyone
else
to
provide
care
for
them.
They
were
often
had
had
these
toothaches
for
months.
H
Sometimes
it
was
children
and
they
were
so
thankful,
some
actually
in
tears.
They
would
call
to
see
if
they
could
get
an
appointment
if,
if
we
would
accept
Medicaid
and
when
they
found
out
that
we
would
accept
Medicaid
and
we
had
a
walk-in
clinic,
people
would
actually
cry
that
were
so
relieved
to
have
someone
to
care
for
their
child
or
their
grandchild
or
to
relieve
them
of
pain.
H
So
I
wanted
to
talk
a
little
bit.
That's
that
just
really
had
an
impact
on
me,
seeing
the
patient
standing
in
line
hour
after
hour,
and
knowing
that
really.
The
only
thing
we
could
do
for
them
was
to
extract
their
teeth,
because
Medicaid
wouldn't
pay
to
have
a
root
canal
and
the
patients
were
grateful
to
have
an
extraction
and
I
was
grateful.
H
That
they
could
have
the
infection
removed
because
I
knew
it
was
causing
them
great
suffering
and
I
also
know
that
it
contributes
to
a
number
of
poor
health
outcomes,
some
of
which
Kentucky
is
pretty
famous,
for
we
have
very
high
rates
of
diabetes
and
heart
disease,
strokes
and
all
of
these
problems
oral
poor
oral
health
and
infections.
Oral
infections
contribute
to
those
and
increase
the
risk.
H
H
H
H
Many
people
become
socially
isolated
because
they
don't
have
teeth.
Kentucky
has
the
highest
rates
of
tooth
extractions
for
people
65
and
older
in
the
nation
is
ranked
fifth
for
adults
who
have
had
all
of
their
teeth,
removed,
we're
the
worst
in
the
nation
for
edentialism,
meaning
all
teeth
extracted.
H
H
They
often
have
great
need
and
have
a
lot
of
difficulty
finding
providers
and
often
end
up
relapsing
back
into
substance
abuse
because
they
have
a
toothache
and
they
need
to
get
rid
of
that
pain.
So
it's
very
important
that
we
have
providers
that
provide
the
care
and
also
in
terms
of
finding
a
job
they
need
teeth
so
providing
Dentures
root,
canals
crowns
and
implants
very
important
for
kentuckians
and
substance
abuse
care.
H
H
A
2016
survey
of
the
oral
health
of
Kentucky
children
found
that
Kentucky
kids
fared
poorly
in
comparison
with
the
rest
of
the
nation.
The
study
found
that
41
percent
of
Kentucky
children
had
untreated
cavities,
with
up
to
53
percent
of
kids
in
Eastern
Kentucky
having
untreated
cavities
a
county
level
study
found
pockets
in
Kentucky
where
the
children
had
as
high
as
70
percent
untreated
decay.
H
H
I've
met
with
a
number
of
dental
providers,
Medicaid
dental
providers
throughout
the
state-
and
they
report
that
since
covid,
the
rate
of
Decay
and
Urgent
needs
in
children
has
expanded.
As
one
Medicaid
dentist
told
me
a
month
ago,
the
need
is
overwhelming.
We
simply
can't
meet
the
demand
for
Pediatric
Care.
We
don't
have
enough
Medicaid
providers
in
the
state
because
it
just
isn't
financially
sustainable
to
be
a
Medicaid
provider
anymore.
H
H
H
S
Thank
you
so
much
for
the
opportunity
to
speak
to
you
today.
In
Kentucky
we
have
a
rich
Heritage
in
Dental
education
and
patient
care.
That
dates
back
to
the
1800s
I
did
the
math
in
between
the
University
of
Kentucky
and
the
University
of
Louisville.
We
have
198
years
of
dental
education
between
us
and,
we
hope
to
add
you
Pike
very
shortly.
S
We've
provided
care
to
thousands
of
thousands
of
patients
over
that
198
combined
total
years
for
University
of
Louisville,
we
treated
upwards
of
50
000
Medicaid
patients
in
the
past
year
and
added
up
with
the
University
of
Kentucky's
totals
that
Dr
okerson
was
so
kind
to
to
talk
to
me
about
we're.
Looking
at
about
ninety
thousand
give
or
take
a
little
bit
it's
about
90
000
patients
that
we've
treated
over
the
past
year.
S
These
folks
would
probably
not
be
able
to
receive
dental
care
if
it
wasn't
for
the
dental
schools
acting
as
the
safety
net.
Four,
the
fact
that
we
just
don't
have
enough
providers
in
Kentucky,
that's
no
secret
to
anyone
and
we're
in
many
cases
the
quarter
Last
Resort
for
those
patients,
it
is
a
mutually
beneficial
relationship.
I
will
say,
because
these
patients
offer
our
students
many
many
clinical
experiences
that
they
need
for
their
training,
so
it
works
out
and
it
benefits
all
of
us
as
part
of
their
training.
S
Our
students
learn
about
responsibilities
of
dental
professionals
and
the
ethical
obligations
that
we
have
as
a
profession
that
must
provide
care
to
all
of
society,
even
those
for
whom
patient
payment
is
difficult
or
impossible.
We
still
have
that
obligation.
It's
been
said
over
and
over
again,
you
can't
go
to
the
emergency
room
and
get
dental
care.
You
have
to
see
a
dentist,
there's
no
other
option
that
makes
it
a
little
difficult
when
people
can't
pay
for
it.
S
S
Almost
all
of
them
continue
to
need
student
loans
to
be
able
to
pay
for
dental
school
and
the
associated
expenses
of
living
for
four
years,
while
you're
in
school
working
during
dental
school
seems
like
a
good
idea.
Yeah
we'll
pick
up
a
part-time
job
and
pay
for
part
of
this.
It's
completely
impractical.
The
curriculum
demands
are
so
difficult
for
these
students.
That
working
is
just
not
really
a
good
option.
So
student
loans
are
essential
for
these
students
when
they
complete
their
education.
S
They
walk
out
the
door
with
an
average
of
three
hundred
thousand
dollars
of
debt
pause
and
reflect
on
that
for
a
second
and
that's
the
average.
We
got
plenty
of
folks
that
have
more
than
that,
if
you
think
about
three
hundred
thousand
dollars
as
the
average,
this
debt
load
keeps
folks
who
stay
here
in
Kentucky
from
being
able
to
participate
in
Medicaid
practices.
They
simply
can't
do
it.
S
They
find
themselves
in
untenable
Financial
situations
because
of
the
low
reimbursement
rates
and,
despite
their
best
intentions,
to
fulfill
their
ethical
obligation
that
we
have
as
a
profession.
They
simply
can't
do
it.
They
can't
help
us
treat
this
incredibly
underserved
and
Incredibly
vulnerable
population.
AB
Thank
you
for
the
opportunity
also
and
I
can't
share
anything
better
than
what
you
heard.
As
far
as
the
need
for
our
population.
You
heard
two
patients
you
heard
Pam.
You
heard
it's
an
enormous
problem
that
we
have
here.
That's
not
getting
any
better
and-
and
we've
got
to
address
this
problem
and
I
want
to
give
you
a
little
bit
different
slant
on
this,
because
it's
affecting
the
entire
population
and
the
profession
in
different
ways.
AB
So
what
we
see
that
General
dentists
cannot
manage
a
Medicare
practice,
because
every
time
someone's
in
the
chair
they're
losing
more
than
they're
gaining
they're
losing
mom,
so
they're
fading
out.
Therefore,
the
patients
don't
have
any
place
to
go.
So
we
are
the
University
of
Louisville
University
of
Kentucky
and
probably
soon
to
be
the
University
of
Pikeville,
become
the
safety
nets
and
so
we're
seeing
an
increase
in
the
safety
nets.
But
it
also
means
that
patients
are
traveling,
sometimes
hundreds
of
miles
to
get
care
because
they
they
just
don't
live
there.
AB
So
this
is
affecting
us,
but
it's
affecting
us
in
another
way.
Also
they'll
have
to
look
at.
We
are
State
University
of
Louisville
University
Kentucky
receives
State
funds
for
a
dental
education
program,
95
of
the
money
that
we
get
from
the
state
is
involved
in
teaching
dentists,
teaching
students
to
be
dentists.
That's
the
educational
program,
95
percent,
the
University
of
Kentucky.
We
feel
it's
very
important
that
we
have
influence
and
treat
out
in
the
out
in
the
rural
areas.
AB
So
we
have
three
fixed
clinics
and
several
mobile
clinics
out
there
treating
patients
that
are
Medicaid
patients
in
Marshall,
County
98
of
that
population
is
Medicaid
patients
and
so
we're
seeing
how
this
is
affecting
the
UK
College
of
Dentistry
budget.
The
state
supplies
some
some
money
for
these
Rural
Company
there's
these
rural
sites,
but
it's
the
same
situation
as
you
see
with
the
dentist
out
there.
It's
not
nearly
enough
to
cover
it,
so
any
any
loss
of
that
Revenue
to
balance
the
buzz
it
has
to
come
from
the
College
of
Dentistry.
AB
AB
I
I've
got
some
figures
here,
just
at
the
University
of
Kentucky
that
data
that
the
last
year
what's
happened
during
the
physical
year,
2023
UK
provided
more
than
care
for
more
than
we
had
more
than
37
000
Medicaid
visits.
Our
gross
charges
for
the
Medicaid
visits
were
12.
Excuse
me
14.2
million
dollars
for
these
services.
AB
After
Medicaid
adjustments,
UK
CD
received
4
million
4.1
million
dollars
for
these
services.
It
represents
30
percent
of
what
the
normal
fee
is.
We
understand
that
we're
not
going
to
get
the
normal
fee,
but
30
percent
Falls
way
below
the
ability
to
even
break
even
it
doesn't
cover.
The
cost
of
sterilization
doesn't
cost
the
cost
of
supplies.
It
sort
of
doesn't
cost
to
take
the
care
of
of
the
salaries
of
of
individuals
who
are
treating
the
caretakers
they're,
not
even
the
dentist.
AB
So
we
have
a
hard
time
trying
to
sustain
sustain
ourselves,
even
with
the
focus
on
capturing
operational
efficiencies
and
efficient
and
become
more
efficient
in
Dental
Services,
which
we
are
working
on
right
now.
We're
expected
that
we're
going
to
grow
more
and
in
the
fiscal
year
2022
and
2023
or
23
we're
probably
going
to
well.
We
had
an
increase
of
18
of
the
patients
coming
to
the
College
of
Dentistry
on
Medicaid
18
increase,
and
it's
probably
going
to
go
up.
A
Appreciate
all
you
all
for
coming
we'll
hold
questions
to
the
end.
That
should
there
be
any
again,
thank
you
all
for
coming
all
this
way.
Next
up,
we
have
looks
like
the
Kentucky
Primary
Care
Association,
Molly,
Nicole
Lewis.
K
Good
afternoon
I'm
Molly
Lewis
with
the
Kentucky
Primary
Care
Association.
Thank
you
for
having
me
I'll,
be
brief,
but
Kentucky
Primary,
Care
Association
represents
the
community-based
whole
patient
care
providers
across
the
state.
We
have
30
federally
qualified,
Health,
Centers
and
then
rural
health
clinics
and
last
year
took
care
of
over
a
million
unique
patients.
So
it's
a
significant
provider
and
across
the
state
and
an
important
part
of
this
discussion.
K
So
when
I
say
this,
so
what
we
do
in
con
as
an
association
is
we've,
while
typical
for
the
52
Primary
Care
associations
across
the
country
that
participate
in
a
program
under
the
Bureau
of
Primary
Health
Care
are
unique
to
federally
qualified
Health
Centers.
We
also
take
care
of
or
including
our
membership
rural
health
clinics
because
collectively
they're,
both
in
underserved
areas-
and
we
know
we
have
a
lot
of
that
here
in
Kentucky
and
when
I
use
the
term
whole
patient
I
mean
the
whole
patient.
So
it's
required
within
the
scope
of
services.
K
It's
not
just
your
body,
but
also
your
mind:
mental
health,
behavioral
health.
You
know
teeth
ears,
eyes
and
also
just
kind
of
Life
Transportation
food
housing
assistance
with
the
Justice
program,
whatever
is
impacting
our
well-being
and
that
of
our
patients.
K
Are
we
also
as
one
of
our
member
services?
We
have
a
clinically
Integrated
Network
and
so
together
we
contract
for
what
the
insurance
providers
or
carriers
for
services
we
have
with
11
different
plans,
and
it
includes
all
six
Managed
Care
organizations
we
as
part
of
that
Network.
We
have
about
480
000
and
with
redeterminations
it's
going
down
to
about
420
000
Medicaid
patients.
K
It
might
be
helpful
to
understand
that
at
stake
for
those
four
hundred
and
twenty
thousand
four
hundred
plus
thousand
paid
Medicaid
beneficiaries,
it's
about
two
billion
dollars
in
premiums
going
to
the
Managed
Care
organizations.
So
there's
a
lot
at
stake
and
we're
all
really
invested
in
helping
to
have
cost
effective.
K
High
value
care
and
we
the
way
that
you
create
savings,
is
by
helping
patients
get
healthy
and
the
way
that
you
help
patients
get
healthy
is
by
taking
care
of
the
whole
patient,
and
so
I
really
thank
you
all
for
spending
time
to
take
to
think
about
Beyond,
just
the
traditional
concepts
of
medical
care
or
physician
care,
and
to
take
into
consideration
the
reimbursement
methodologies
necessary
to
sustain
health
care.
K
Because-
and
as
everybody
has
mentioned
before
me,
when
we
have
healthier
individuals,
we
have
less
health
care
costs
and
we
have
more
productive
citizens
who
can
contribute
to
their
communities.
A
lot
of
our
members
they
employ
part
of
being
a
community-based
provider,
is
to
employ
they're
they're,
not
just
patients
but
they're,
also
their
employees.
So
it's
all
integral
and
related
I
just
wanted
to
touch
briefly.
That
of
last
year,
our
federally
qualified
Health
Centers.
We
have
better
data
for
that
took
care
of
a
hundred
had
153
000
patient
visits.
K
Dental
visits
for
over
60
76
000
unique
patients
had
Dental
visits,
and
when
you
talk
to
our
members,
they
have
wait
lists
of
over
300.
So
what
Dr
Stein
was
mentioning
about
wait
list
and
what
Emily's
testimony
those
are.
K
Those
are
real
and
it's
hard
to
access
care
because
there's
so
many
patients
in
need
of
services,
so
many
patients
in
pain-
and
we
know
from
like
the
rules
of
moral
hazard-
it's
not
when
when
people
have
different
levels
of
insurance,
it
creates
a
chilling,
a
factor
on
how
we
access
care
and
if
you
don't
think
a
service
is
going
to
be
covered.
You'll
be
taken
care
of
at
our
member
services,
regardless
of
your
ability
to
pay,
but
there's
an
inclination
and
a
human
dignity
where
necessarily
people
don't
necessarily
seek
out
preventative
care.
K
And
so,
if
it's
not
covered,
there's
it
there
isn't
a
tremendous
amount
of.
It
wasn't
recognized
as
a
need
before
him,
because
people
weren't
coming
because
they
didn't
recognize
it
as
a
benefit
or
something
that
would
be
covered
or
that
they
were
entitled
or
eligible
for
so
I.
Think
that
that's
part
of
what
we're
seeing
here,
for
example,
Grace
Health,
representative
Lewis,
and
they
serve
at
12
different
locations,
clay,
Leslie,
Knox,
Whitley,
Bell
and
Laurel
counties.
K
Last
year
they
decided
to
expand
Beyond
just
their
school-based
services
and
to
also
include
Adult
Services
and
for
their
for
all
of
their
patients,
regardless
of
their
of
the
school
children.
They
did
this
because
it
was
part
of
helping
their
patients
collect.
You
know
all
get
healthier,
and
it
was
also
done
in
the
wake
of
not
having
very
stable
regulations
or
reimbursement
methodologies.
They
just
committed
that
they
were
going
to
help
make
it
work.
K
Just
since
the
beginning
of
the
year,
they've
had
over
75
patients,
75
of
the
patients
that
have
been
examined
have
had
tooth
decay,
and
70
of
them
have
been
on
Medicaid,
checkups
and
cleanings
are
taught
us
to
be
standard
of
care
every
six
months.
I
bet
most
of
you
all
have
had.
You
know
cleanings
every
six
months.
K
In
addition,
the
enhanced
benefit
through
the
Medicaid
Program
and
through
these
regulations
hasn't
enhanced.
The
benefit
creates
access
to
two
savings,
such
as
two
saving
services
or
indentures
Grace
Health.
That
I
just
mentioned
they've
already
restored
78
people's
Smiles,
so
those
are
people
who
can
attend
an
interview
confidently
and
go
to
bed
without
pain.
O
K
Just
think
that
this
is
an
example
that,
despite
the
instability
of
the
benefit
currently
in
terms
of
why
we're
here,
kpca
is
committed
to
helping
to
resolve
this
issue
with
you
all,
and
we
hope
that
you
will
look
to
us
as
a
stakeholder
who
can
help
do
some
problem
solving
and
get
creative
in
terms
of
access
points.
A
G
Thank
you,
hi
Alicia,
Watley
I'm,
with
Kentucky
youth
advocates
in
the
Kentucky
oral
health
Coalition.
So
thank
you
for
the
opportunity
to
speak
to
the
committee
today.
I
will
also
be
brief.
I
think
that
a
lot
of
what
I
have
to
say
today
has
been
shared
by
others,
so
I'm
here
on
behalf
of
the
Kentucky
oral
health
Coalition,
if
you're
not
familiar
we're
a
Statewide
group
of
citizens,
oral
health
providers,
parents
and
other
folks
who
really
just
have
a
goal
of
achieving
optimal
oral
health
for
all
kentuckians.
G
We're
here
today
to
speak
in
support
of
the
dental
expansion
regulation,
and
we
think
that
really
this
is
what
is
best
for
the
people
of
Kentucky
prior
to
the
first
expansion
of
these
benefits,
which
was
at
the
beginning
of
2023
adults.
Accessing
Medicaid
benefits
were
really
severely
limited
in
the
options
for
care
that
they
had
for
both
treatment
and
also
routine
care.
So
many
of
them
were
only
accessing
one
cleaning
per
year
and
and
also
simple
tooth
extractions
when
a
problem
did
a
rise
for
them.
G
So
for
many
years
this
has
been
a
reality
for
our
most
vulnerable
kentuckians.
It's
shaped
a
landscape
of
oral
health
in
our
state,
with
limited
care
options
and
unnecessary
tooth
extractions,
as
you've
heard
from
many
others
today,
the
need
for
comprehensive
dental
benefits
has
been
well
established
in
Kentucky.
It's
no
secret
that
we
are
in
the
bottom,
five
on
many
oral
health
indicators
and
we
also
have
more
more
adults
over
the
age
of
65,
with
no
natural
teeth
than
any
other
state.
G
This
proposed
regulation
that
we're
discussing
today
aims
to
address
this
lack
of
treatment
options
for
folks
around
the
state
for
covering
Services,
both
restorative
and
preventive.
The
restorative
Services
include
simple
things
like
fillings,
but
also
dental
implants
and
dentures,
and
it
also
would
help
to
ensure
that
adults
have
those
two
cleanings
per
year,
which
is,
of
course,
what
is
recommended
on
a
dental
visit
schedule.
So
we
believe
that
the
Medicaid
expansion
that
we're
talking
about
for
adults
is
really
just
a
first
step
to
improving
oral
health,
but
also
overall
health
of
the
population.
G
Here
in
Kentucky,
oral
health
conditions
and
lots
of
natural
teeth
significantly
impacts
the
overall
health
of
your
body,
and
it
can
lead
to
increased
risk
for
other
complications.
We
know
that
in
Kentucky
our
Medicaid
eligible
adults
are
already
experiencing
significantly
higher
rates
of
the
diseases
that
are
linked
to
poor
oral
health.
These
include
things
like
cardiovascular
disease,
oral
cancers
and
substance
use
disorder.
Their
ability
to
effectively
manage
their
disease
is
made
considerably
more
difficult
by
a
lack
of
access
to
necessary
oral
health
care.
G
G
It
strongly
is
relying
on
access
to
care
for
adults
on
Medicaid
in
our
state,
and
we
know
that
other
states
that
offer
comprehensive
adult
Medicaid
dental
benefits
do
see
a
reduction
in
their
ER
costs
for
dental
visits
each
year
and,
as
you
heard
earlier,
visiting
the
dentist
or
visiting
the
ER
for
a
dental
issue
is
rarely
ever
solved
in
the
ER
and
continues
to
be
a
problem
for
that
patient.
G
One
of
the
goals
that's
outlined
by
the
Kentucky
oral
health
Coalition
is
improved
access
to
care
for
all
kentuckians,
but
we
know
that
access
to
care
is
a
complex
issue
and
it
means
a
lot
more
than
just
what
is
outlined
on
your
health
insurance
plan.
So
we
also
know
that
Kentucky
has
experienced
significant
Workforce
challenges
and
the
dental
care
field
is
really
no
exception
to
this
issue.
G
We
have
many
kentuckians
who
have
had
difficulty
finding
a
provider,
have
those
long
wait
times
or
are
traveling
many
miles
outside
of
their
local
area
to
get
care
we
are.
We
were
very
pleased
to
see
that
there
was
some
re,
some
increased
reimbursement
rates
that
went
along
with
the
expanded
benefits,
which
ended
more
than
20
years
of
stagnant
rates
for
our
dental
providers,
and
these
rate
increases
were
absolutely
necessary
for
dental
providers
across
the
state
and
we
believe
they
should
be
retained.
G
G
This
expansion
can
offer
an
important
first
step
towards
providing
Comprehensive
Dental
Care
for
kentuckians
and
addressing
the
growing
oral
Health
crisis
that
currently
leads
to
absenteeism
at
work,
costly
ER
visits
and
higher
rates
of
disease
and
substance,
misuse
and
I
think
that
some
of
this
was
shared
by
Molly
a
moment
ago.
But
we
also
have
one
of
our
Coalition
members,
who
is
Dr
Kayla
fields
and
she
is
from
Grace
health.
G
So
I
just
wanted
to
share
a
couple
of
things
from
her
that
she
submitted
some
written
testimony
to
us
because
she
is
with
patients
today
and
couldn't
be
here
in
person.
But
she
was
born
and
raised
in
Hyden
Kentucky
and
currently
lives
in
London.
So
she
is
serving
the
Southeastern
Kentucky
area.
As
you
heard,
many
of
their
patients
are
on
Medicaid
and
many
are
experiencing
High
rates
of
tooth
decay.
G
So,
since
the
beginning
of
the
expansion,
they've
provided
many
many
sets
of
dentures
and
are
still
in
progress
for
several
folks
in
the
area,
and
she
also
wanted
to
share
just
some
of
the
experience
that
she's
had
treating
patients.
G
A
A
T
T
So
after
I
finish,
if
you
have
any
questions,
let
me
know
and
I'll
try
to
clarify
some
of
the
from
a
private
practitioner's
standpoint,
fqhcs
and
primary
cares
and
Rural
health
clinics.
Don't
have
the
same
problem
that
private
practitioners
do.
We
don't
get
wrap
payments.
We
get
only
Medicaid
payments,
so
those
Medicaid
fees
are
low
fees
in
2006.
I
was
the
one
that
started
doing
Ram
clinics
in
Kentucky.
We
started
those
on
weekends.
We
started
with
18
chairs
in
Pike
County.
T
When
we
quit
in
2014
we
were
seeing
1300
patients
a
weekend
in
2010,
Karen
Kelly
came
to
me
and
she
said
we
need
to
do
this
for
the
recovery
patients
so
I
started
working.
The
problem
was
getting
funding
to
do
dentures
and
restore
people
in
recovery,
so
in
2017
I
got
my
first
grant
for
eighteen
thousand
dollars.
I
went
through
it
in
three
months
and
that
was
just
recovery
patients.
T
So
when
we
got
this
Medicaid
expansion,
I
thought
this
was
the
greatest
thing
on
earth.
That's
happened
to
the
people
of
Eastern
Kentucky.
You
know
they're
going
to
get
their
glasses,
their
hearing,
their
Dentures,
their
partials.
We
can
save
teeth
instead
of
having
to
pull
all
the
teeth
and-
and
then
it's
the
the
dentist,
there's
no
dentist
there
to
to
take
the
Medicaid
because
the
fees
are
so
low.
T
T
So
of
all
they
got
all
the
dentists
have
quit
right
now,
at
Redbird,
we're
drawn
from
Seven
Counties
I
have
got
over
a
hundred
and
fifty
Dentures
started
and
there's
all
kinds
of
hurdles
to
this.
It's
not
just
do
a
denture
and
get
paid.
You
got
to
seat
that
denture.
T
If
that
patient
loses
the
medical
card
in
the
process,
we
don't
get
paid,
I
had
a
patient
that
went
to
jail
just
before
we
seated
the
Denture
and
we
didn't
know
she
went
to
jail
and
then,
when
she
got
out
she
came
and
got
the
Denture
when
we
submitted
to
Medicaid,
we
didn't
get
paid,
and
luckily
commission
Lee
helped
us
with
it,
but
there's
all
kinds
of
hurdles
that
goes
on
that
you
know
it's
not
being
told.
There's,
pre-authorizations
and
I
know
one
of
the
big
things
that
Derek
has
talked
to
me
about
is
implants.
T
Most
patients
can't
reach
that
implant.
Point
they've
got
to
meet
certain
prioritizations
from
the
mcos
and
Medicaid
if,
if
the
mouth
is
not
in
a
healthy
state
or
if,
if
every
single
tooth
is
decayed
or
if
they
have
diabetes
or
they're
a
smoker
they're
not
going
to
get
implants,
but
it's
there
for
the
ones
that
is
missing
one
tooth
or
if
we've
got
a
patient
that
can't
function
with
dentures
that
we
can
put
two
implants
in
and
snap
Dentures
on.
T
So
it's
when
you
start
trying
to
manage
everything
just
because
it
says.
Oh
there's
an
implant,
they
don't
need
implants.
It's
not
that
simple
Dentistry
is
not
black
and
white.
There's
many
gray
areas
in
this,
and
that's
one
thing
that
that
it's
hard
for
you
guys
to
understand
and
I.
If,
if
the
commission
or
the
Met
Department
Medicaid,
would
allow
a
dentist,
that's
practiced
Medicaid
for
years
to
help
them
devise
a
system
and
set
this
pre-authorizations.
T
It
would
help
tremendously
because
they
don't
know
what
we're
seeing
out
here
and
we're
seeing
so
many
patients
that
don't
even
qualify
that
can't
qualify
for
it.
Senator
Stivers
has
helped
tremendously
with
us.
He
connected
me
with
Jennifer
Hancock,
and
we
now
do
the
Freedom
House,
so
we're
doing
we're
taking
care
of
all
the
girls
I
get
a
call
when
I
pull
into
the
parking
lot.
T
Here's
day
one
of
the
Freedom
House
girls
is
in
distress
and
swelled
and
can't
open
her
mouth
and
so
now
I
had
to
tell
them
what
to
do
and
I'll
be
back
tomorrow
to
take
care
of
it.
But
this
goes
on
constantly
with
us,
and
so
we've
got
pictures
everything
we
can
show
you
it's
how
much
this
is.
Expansion
is
helping,
and
a
funny
thing
I
want
to
beg
is
please
don't
declare.
This
deficient.
I
know
that
this
is.
This
is
a
work
in
progress.
T
T
They
have
got
the
best
fees
in
the
whole
United
States
with
Medicaid,
so
it's
possible
and
as
John
F
Kennedy
said,
he
said.
Let
us
not
seek
a
republican
answer
of
the
Democrat
answer,
but
the
right
answer:
let
us
not
seek
to
fix
the
blame
on
the
past.
Let
us
accept
the
responsibility
of
the
future.
These
people
are
our
future.
Eastern,
Kentucky
and
Derek
knows
we're
suffering
up
there
after
Cole's
gone,
our
people
are
our
resources
and
we
can't
throw
them
away.
We've
got
to
get
them
back
into
job
markets.
T
I'll
play
essay,
so
I
beg
you
to
fix
this
expansion,
so
it's
acceptable
and
workable.
It
can
be
done
things,
don't
just
don't
happen.
They're
made
to
happen.
T
T
I
have
30
year
old
girls
and
20
year
old
girls
and
16
year
old
girls,
and
some
that
representative
Rogers
has
sent
us
up
there,
that
we
put
dentures
in
and
and
they're
functioning
they're
getting
their
kids
back
from
from
Child
Protective
Services.
One
of
them
is,
is
a
manager,
a
dollar
store.
Now
so
there's
a
lot
of
success
stories.
T
T
So
the
way
we
overcome
it,
we're
writing
grants
and
we
get
from
private
institution
grant
money
and
that
subsidizes
us
to
help
us
do
it.
Nobody
in
in
Bell
County
is
taking
medicaid
and
doing
Dentures.
We
get
them
all.
Nobody
in
Clay
County
can
do
so,
and
it's
only
because
we
got
the
grant
money
and
when
that
grant
money
runs
out,
we
have
to
stop
so.
T
This
Medicaid
expansion
is
is
actually
a
vision,
I
think
it's
Andy
beshear's
vision
and
it's
a
vision
to
make
healthier
kentuckians
and
it's
the
beginning,
but
you
guys
can
make
it
a
reality
and
that's
what
I
beg
you
to
do
today
and
if
you
got
any
questions
for
me
from
a
private
practice.
Standpoint
hit
me
with
them
now,
I'll
be
out
up
front
and
honest.
A
Thank
you,
Dr
Collins.
In
the
sake
of
time,
some
of
our
members
are
running
behind
on
them.
Some
appointments,
I'm
gonna.
Just
commissioner.
If
you
want
to
come
back
up
Carrie
did
you
want
to
say
anything:
okay,
I
saw
Josh
earlier,
commissioner.
If
you
want
to
come
back
up
and
then,
if
any
of
our
members
have
any
questions
or
comments
in
general,
representative
Frazier
will
go
to
you.
First.
U
Being
here
today,
and
thank
you
for
all
of
the
comments
and
in
in
my
private
life,
I
am
a
practicing
audiologist
and
so
I
would
like
to
just
make
some
comments
from
the
provider
standpoint
and
and
a
lot
of
the
workforce
investment
comments
that
have
been
made.
A
question
that
I
have
as
a
provider
is,
you
know.
I
would
traditionally
send
those
people
through
the
Office
of
Vocational
Rehabilitation.
U
U
Another
comment
that
I
have
is:
how
is
this
information
shared
with
the
mcos,
because
the
pre-authorization
aspect
of
it
each
MCO,
has
a
different
process,
and
so
they
use
different
modifiers.
They
use
different.
U
It's
just
each
one
is
different
and
and
I
guess
the
the
end
of
that
story
is
I.
I
have
seen
many
patients
I
have
yet
to
be
paid
on
one
and
I.
My
vendor
invoices
are
approaching
twenty
thousand
dollars,
and
so
I
can't
afford
to
have
a
Medicaid
patient
in
my
chair,
and
you
know,
I
do
I,
am
a
Medicaid
provider
and
I've
provided
hearing
tests
and
hearing
services
all
over
the
state.
U
But
if
I
can't
this,
the
wheel
has
to
be
greased
to
keep
turning
and
if,
if
these,
if
claims
aren't
paid
for
providers,
then
you
know
I'm
trying
to
make
a
decision
can
I
continue
to
be
a
Medicaid
provider,
even
though
I've
been
doing
all
of
these
other
services
for
you.
So
so
these
are
just
general
comments.
I
agree
with
the
need.
I
agree
with
the
outcome.
I
agree
with
the
benefits
of
it,
but
you
know,
providers
have
to
be
the
the
providers
are
carrying
the
burden.
U
I
guess
is,
is
just
my
general
takeaway
and
any
solution
to
that
fact
and
I'm
happy
to
be
a
part
of
that
solution.
Just
like
the
gentleman
from
Redbird.
So
I
would
encourage
mcos,
perhaps
or
the
cabinet
to
to
work
with
providers,
because
because
we
do
have
the
heart,
we
have
been
seeing
these
patients
and
making
we
we
want
to
to
see
them
Thrive
it's
best
for
all
of
us,
so.
X
Thank
you,
I
really
appreciate
your
comments,
your
questions,
representative,
Frazier
Gordon,
and
we
can
meet
offline
and
be
more
than
happy
to
meet
with
you
walk
through
some
of
those
issues
so
that
we
can
correct
those
concerns
and
those
payment
methodologies
with
the
Managed
Care
organizations
and
address
those
issues
to
get
those
resolved
and
before
I
open
up
for
questions.
I,
guess
I
would
also
like
to
thank
everyone
that
came
here
today
in
support
of
these
regulations.
X
We
heard
a
lot
of
support
for
the
enhanced
services
that
we're
providing
for
adults,
and
we
know
that
these
are
medically
necessary.
We
know
that
your
constituents
that
our
members
actually
need
these
services,
but
we've
also
heard
some
issues.
We've
heard
access
issues,
we've
heard
reimbursement
issues
and,
as
Dr
Collins
said,
those
are
issues
we
can
work
on
and
we
can
correct,
but
taking
away
Vision,
dental
and
hearing
services
for
adults
is
not
going
to
remedy
that
situation.
It's
not
going
to
grow
a
network
again.
These
are
very
vital
services.
Y
I've
got
several
questions
if
you'll
allow
me
some
Grace
and
Mr
chair
I'll
have
a
question
for
you
too,
in
just
a
moment,
but
back
in
may
we
heard
this
testimony.
We
were
told
you
had
a
I,
don't
know:
35
million
dollars,
excess
funds
that
you
felt
could
cover
these
additional
expenses,
and
these
were
found
deficient,
not
because
of
the
need
for
it,
but
because
of
the
way
it
was
addressed
and
the
way
it
was
going
about
and
you
you
overrode
those
deficiencies.
Y
You
push
forward
with
this
program
and
we
have
been
told
today
that
we
are
The
Keeper
of
the
purse
strings.
So
how
much
money
have
you
spent
of
that
35
million
dollar
access
here
to
date
on
these
expanded,
Services
you've
taken?
We.
X
Y
X
So
today
we've
spent
our
providers
have
received
15
million
dollars.
The
third
we
had
39
million
dollars
allocated
for
these
Services
total
that
is
federal
and
state.
So
out
of
the
39
that
we
had
15,
so
that
leaves
we've
spent
15
million.
No,
no.
X
Y
Million
okay-
and
this
has
not
been
an
ongoing
I-
mean
this-
these
regs
have
not
just
popped
up
since
May
when
they
were
found.
Efficient,
been
talk
of
this
and
everything
because
they
were
brought
up
right
after
we
ended
session
have
and
Mr
chair.
This
is
a
question
for
you
is
this
administrative
regs
committee,
or
is
this
Appropriations
and
revenue
committee
or
budget
review
of
Health
and
Family
Services
committee?
Y
Y
It
was
found
efficient
because
of
the
improper
way
in
which
this
has
been
expanded,
and
this
is
spending
the
funds.
This
is
a
revenues
issue.
It
should
be
taken
to
budget
review
of
Health
and
Family
Services
for
Appropriations,
and
that's
where
this
all
boils
down
to
this
is
a
mismanagement.
We've
told
you
want
problem
solving.
You
want
resolutions,
you
want
to
seek
the
right
answer.
Well,
the
proper
way
to
get
funding
is
to
go
through
Appropriations
and
revenue
through
the
budget
review
of
Health
and
Family
Services.
Y
So
we
can
expand
these
regulations
and
that's
what
we've
talked
about
already
in
here.
So
these
were
found
deficient
you're
going
to
operate
regardless,
but
to
come
in
here
and
pull
in
our
heart
strings
were
to
be
said,
we're
the
keepers
of
the
purse.
We
are
not
the
keepers
of
the
purse.
That's
Appropriations
and
revenue
committee
am
I,
correct
on
that
Mr
chair,
so
I
just
want
to
you
know.
You're
doing
end
runs,
and
you
you
want
to
you
know,
make
us
appear
to
be
the
villains
and
we're
not.
Y
Y
It
starts
costing
more
money,
that's
Appropriations,
and
that
is
not
what
this
committee
is
for,
and
we
have
been
through
this
time
and
time
again
and
I
just
feel
for
all
these
other
presenters
today,
because
they've
been
led
to
believe
by
someone-
and
it
sure
wasn't
us
that
we
are
the
keepers
of
the
purse,
and
that
is
simply
not
true.
Y
So
and
and
we've
been
asked,
you
know,
let's
seek
the
right
answer.
The
right
answer
is
found
through
following
the
right
procedures
and
that's
what
we're
facing
today
and
my
name
was
called
out
earlier.
I
want
to
explain.
Maybe
a
deficiency
I
had
in
my
understanding,
but
I
I
think
I'm,
pretty
clear
on
the
understanding.
Y
The
way
this
works
and
you
don't
expand,
Services,
that's
going
to
cost
more
Appropriations
without
going
through
the
proper
budgetary
items
and
that's
exactly
what's
what's:
what's
happened,
we've
been
through
this
before
it's
deja
vu,
except
this
time
you
come
loaded
with
bear
with
with
all
the
others
that
I
feel
like
you
have
inappropriately
LED
them
to
with
some
wrong
ideas
of
how
this
this
works
and
I'm
just
very
disappointed
in
you,
I'm
just
going
to
be
honest,
I
have
we've,
we've
told
you
our
intent.
Y
So
we
couldn't
Act,
so
don't
don't
don't
be
misleading
the
people
on
the
other
end
of
these
cameras
and
what
your
intents
have
been-
and
this
is
very
frustrating
and
I
I
know
I
can
see
your
your
just
chomping
at
the
bits
to
speak
so
go
ahead,
but
I
would
like
to
reserve
my
right
for
rebuttal,
Mr
chair.
M
No
and
and
I
I
kind
of
like
just
to
maybe
where
we
are
kind
of
how
we
got
here
today.
Obviously,
these
regs
were
filed
initially
sometime
back
last
year.
Obviously
Senate
Bill
65
was
filed,
it
was
passed
and
the
language
of
that
bill
gave
us
the
opportunity
to
refile
these
bills
if
they
were
substantially
different
and
I.
Think
I'm,
probably
on
the
record.
M
The
last
time
we
were
here
saying
that's
my
interpretation
that
these
new,
these
regulations
that
were
filed
are
currently
before
us
today
were,
in
fact,
substantially
different
and
complied
and
compiled
complied
with
Senate
Bill
65,
and
that's
how
we
got
here
today
and
we
took
those
actions
and
we
changed
those
fee
schedules
and
we
are
in
compliance
with
simple
65.
and
these
things,
as
obviously
has
been
proven
here
today,
directly
affect
and
have
had
a
massive
effect
already
on
the
health
of
the
people
of
Commonwealth
of
Kentucky.
M
Now
we
can
argue
about
where
we
go
from
here
down
the
road,
but
this
was
based
on
an
appropriation
that
had
already
occurred
now,
future
Appropriations.
We
know
all
how
that
process
needs
to
go,
but
the
appropriation
that
we
deal
with
today
was
already
made
and
was
properly
followed
that
process.
So
that's
that's
how
we
got
here
today,
and
so
we
feel
that
we
are
moving
forward
with
these
and,
like
I,
said,
there's
room
for
conversation
about
where
to
go
from
here,
but
we
feel
that
we
have
complied
with
Senate
Bill
65.
M
Q
First
of
all,
thank
you
and
it
did
in
fact
pull
on
my
heartstrings
as
it
should
any
Kentuckian.
Q
We
watch
us
year
after
year,
the
number
one
worst
in
the
nation,
the
number
fifth
worst
in
the
nation,
and
then
we
get
into
arguments
over
technically
who
should
be
moving?
What
forward?
Well
I'll
tell
you
before
I
ran
for
office
like
most
people
at
home,
you
just
beg
that
we
do
our
job
and
move
something
forward.
So,
first
of
all,
thank
you
for
your
leadership.
I've
been
pushing
forward.
I.
Think
that
we've
seen
a
massive
effect
with
these
numbers.
I.
Think
every
member
of
this
committee
forget
the
partisan
politics
and
political
games.
Q
Q
So
thank
you
for
bringing
this
forward
and
for
people
watching
at
home,
who
also
feel
that
way
be
mad.
When
people
talked
about
what
technicality
says,
we
can't
do
this
because
it
can
be
done
if,
if
we
want
to
get
it
done,
we'll
do
it
in
the
budget
we'll
do
it
in
the
right
committees.
Q
It'll
get
passed.
If
we
want
to
because
we
do
control
the
legislative
body
starts
in
the
house.
Does
control
the
purse
and
the
budget
is
your
moral
compass.
What
is
your
priorities?
So?
What
we've
seen
is
this
little
bit:
investment
with
a
85
percent
Federal
reimbursement
having
a
great
economic
impact
within
the
Commonwealth
of
Kentucky.
Not
only
is
the
compassionate
things,
the
right
thing,
you're
getting
people
back
to
work.
Q
Q
Look.
We
all
have
the
same
goal
as
a
healthier,
better,
stronger,
more
stable
Kentucky,
and
it
starts
by
investing
in
the
people
and
We
Know
by
just
a
15
match.
It
works
so
today,
I,
don't
think
anything's
going
to
happen
through
administrative
rigs,
I
don't!
But
I
do
think
that
it's
so
important
that
we're
talking
about
this
because
I'm
sitting
here
with
my
colleagues,
regardless
of
your
partisan
you're,
going
to
care
about
your
people,
you're
going
to
hear
that
this
has
worked
and
then
so
when
we
do
pass
that
budget
hold
us
accountable.
Q
Y
I
just
want
to
follow
up
my
point:
is
you
had
a
whole
session
of
bringing
this
to
budget
review
and
you
didn't
and
a
day
after
session
was
over,
you
dropped
these
regs.
You
knew
exactly
what
you
wanted
and
you
didn't
act
during
the
proper
time,
but
we
could
have
got
this
in
the
budget,
and
that
is
the
sad
part.
Y
That
is
the
sad
part
that
is
all
about
this,
and
you
know
it
when
I
don't
want
to
be
accused
playing
partisan
politics
because
I
believe
that's
what's
been
done
on
us
and
I,
don't
appreciate
it
and
I've.
You
know
it.
Y
I've
in
a
roundabout
way,
told
me
to
put
my
money
where
my
mouth
is
I'm,
going
to
tell
this
cabinet
with
their
money
where
their
mouth
is,
have
a
full-fledged
Bill
written
ready
to
go
someone
to
carry
it
and
put
it
before
the
budget.
Review
Committee
of
Health
and
Family
Services
put
it
before
a
r
and
do
it
the
proper
manner,
because
you
have
failed
to
do
so
to
this
point
and
that's
why
it
was
found
efficient
the
first
time.
So
don't
don't
try
to
whitewash
this
or
whatever?
You
know.
Y
We
have
people
out
there
needing
this,
but
they
don't
need
it
for
six
months
and
then
it
go
away.
They
need
it
for
the
rest
of
their
life.
We
need
to
look
at
this
and
make
this
sustainable
program,
so
we
can
carry
on
and
you're
not
putting
it
in
the
proper
manner
which
it
can
be
done
so
so
do
it
the
right
way
in
the
way.
H
Y
So
anyway,
I
just
I
felt
like
I
need
to
say
that
and
and
make
sure
that
you
know
we
don't
end
up
with
this
with
you
know
in
this
way,
if
we
start
this
President,
this
state
will
be
broke
within
about
how
many
more
meetings
we
got
for
this
year's
up,
because
every
cabinet
in
the
state
of
Kentucky
is
going
to
try
to
do
it
the
same
way
and
expand
their
budgets,
expand
their
things
and,
and
we
won't
have
the
means
to
do
it.
Y
X
Representative
Bridges
I've
been
working
for
the
Department
for
Medicaid
services
for
20
three
years
and
in
those
23
years,
I've
done
practically
everything
in
that
department
from
answering
the
800
lines
talking
to
our
members
to
drafting
policy,
and
we
did
not
have
to
request
Appropriations.
We
had
that
money
in
this
year's
budget.
We
are
going
to
be
under
budget
and
I
have
never
ever
misled.
X
Anybody
in
my
23
years
in
Medicaid
and
I
will
not
do
so,
and
I
really
don't
appreciate
the
fact
that
you
indicated
that
we
have
been
misleading
people.
Everyone
in
this
Arena
today
that
came
to
testify,
has
seen
this
entire
thing:
Play
Out
In,
This,
Very
Room
in
this
forum.
They
are
here
in
support
because
they
are
concerned
that
individuals
are
going
to
lose
their
benefits.
A
Very
passionate
committee
meeting
today,
I
wanted
to
let
everybody's
voice
be
heard.
I
have
a
couple
questions
and
a
comment:
have
you
all
since
the
May
meeting
you
know
these
are
the
e-rags
that
we're
primarily
talking
about?
They
were
found
efficient.
Of
course,
ordinary
regs
will
be
coming
up
in
a
future
meeting.
A
I
do
have
some
questions
on
some
of
the
more
costlier
procedures
and
as
I
promise
in
the
interim
to
people
like
Kara
and
Emily
I've
done
my
best
to
to
research
this,
and
you
know
it's
kind
of
those
things
once
you
find
more
answers,
you
find
more
questions
and
on
things
that
we
can
improve
on
or
do
different
and,
of
course,
Medicaid
being
Medicaid.
It's
a
very
comprehensive
issue.
A
You
know,
as
we
go
to
a
budget,
do
we
look
at
you
know
something
like
rebasing,
maybe
to
get
provider
rates
up
I'm,
not
necessarily
in
favor
of
putting
a
lot
of
things
in
statute
just
because
I
believe
the
cabinet
should
have
the
authority
and
the
flexibility
I
think
putting
things
in
statute
can
make
things
too
rigid,
especially,
is
medical
advances
happen
such
as
you
know,
Dentures
being
3D
printed
now,
I
mean
it's
a
different
world
than
what
it
used
to
be.
A
I
just
think
there
needs
to
be
a
conversation
we
all
need
to
get
to
the
table.
We
need
to
include
all
the
groups
that
are
here
today.
It
is
a
very
passionate
issue
and
I
do
think.
There's
a
way
forward.
I
was
with
the
Senate
President
and
the
governor
yesterday
in
Clay
County,
and
we
awarded
Monies
to
over
three
million
dollars,
I
believe
to
clean
water
initiatives.
A
Non-Profits
in
the
community,
County
governments,
City,
governments,
tourism
and
I
mean
it's
not
a
red.
You
know
Medicaid
patients,
they
can
be
Republican,
they
can
be
Democrat.
It's
not
a
red
blue
issue,
but
I
do
think
it
requires
all
of
us
to
come
to
the
table
and
I.
Think
that
starts
with
getting
everybody
through
the
table,
so
I
mean
I
would
be
I
would
make
the
commitment
to
you.
A
I
won't
make
the
same
obligations
to
my
other
committee
members
or
anybody
I
serve
within
the
house
or
Senate,
but
myself
personally,
I
would
love
to
sit
down
with
you
and
have
these
meetings
and
put
in
contacts
with
the
chairs
of
these
committees
to
make
something
happen.
That's
what
I
want
to
see,
and
you
have
my
commitment
on
that
I'm
sincere
on
that
what
I
don't
want
to
see
and
I
know
we're
in
election
year.
What
I
don't
want
to
see?
A
Is
this
made
to
be
a
political
football
I,
don't
want
to
poison
the
well
and
leave
patients
and
providers
holding
the
bag.
I
think
we
can
make
a
difference
if
we
need
to
make
a
difference.
Maybe
we
don't
get
everything
we
want
on
either
side
should
that
be
just
rate
increases
or
expanding
some
services
and
waiting
to
see
on
others,
I,
don't
know
what
that
looks
like
again,
you
have
a
lot
more
experiences.
Arena
than
I
do
I'd
be
honored
to
work
with
you
on
it.
A
A
Thank
you
great
testimony
from
everybody
today
again,
these
These
are
the
e-rags
and
there
will
be
ordinary
wrecks
in
the
future.
That
being
said,
moving
on,
please
call
the
next
regulation
department.
R
If,
under
a
lease
agreement,
it
also
amends
to
add
Hearing
Services
by
a
licensed
audiologist
as
a
wraparound
service
benefit
to
prohibit
program
funds
from
being
expended
for
modifications
to
rental
properties
that
cost
over
twenty
five
hundred
dollars
to
update
in-person
face-to-face
contact
requirements
between
the
case
manager
and
eligible
individuals
to
allow
virtual
face-to-face
contact
as
an
alternative
to
phone
contact
during
any
month.
An
in-person
face-to-face
contact
does
not
occur
to
add
to
the
requirements
for
service
providers,
who
are
also
an
employee
of
the
recipient
to
make
involuntary
termination
permissive
instead
of
mandatory.
O
AC
AC
N
L
922
d180
amends
Provisions
for
child
care
providers
to
register
and
participate
the
child
care
assistance
program
to
provide
for
non-compliance.
Issues
noted
during
the
federal
monitoring
of
2022
established
that
only
relatives
of
children
in
care
will
be
approved
as
registered
child
care
providers
and
update
into
Incorporated
material.
The
staff
suggested
a
momentum
in
section
2
to
clarify
that
cabinet
approval
for
certification
for
age-appropriate
CPR
and
first
aid
training
Shelby
based
on
research-based
scientific
best
practices.
A
There
is
a
staff
amendment.
Is
there
a
motion
for
approval
of
the
staff
Amendment
without
objection,
so
ordered
any
questions
from
members
of
the
subcommittee
seeing
none
we
are
at
the
end.
Thank
you
very
much.
Thank
you
we're
at
the
end,
we
have
a
rock
star
staff
here
in
the
administrative
regulations.
Thank
you
all.