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A
Present
in
the
room,
thank
you.
I
will
next
take
a
motion
to
approve
the
minutes
from
the
june
10th
2021
meeting
got
a
show
motion
from
senator
nemas
and
a
second
from
representative
beckler,
all
in
favor,
say
aye
all
opposed
like
son.
The
minutes
have
been
approved,
so
we've
we're
meeting
today
to
hear
an
update
on
this
on
supports
for
community
living
study.
That's
been
ongoing
and
we
have
people
from
the
department
of
medicaid
services
that
testify,
but
before
we
have
those
folks
take
the
mic
we.
E
E
E
There
were
objections
from
providers
which
delayed
implementation
in
2020,
covet
19,
contributed
to
further
delays
and
lrc
created
a
task
force
that
met
during
the
interim
to
look
at
the
need
for
exceptional
services
in
the
hcbs
waivers
this
year.
A
new
legislative
task
force
has
begun
work
to
develop
recommendations
for
the
redesign
of
all
medicaid
waivers.
E
Kentucky
medicaid
has
stated
that
a
redesign
would
begin
no
earlier
than
2022,
because
plans
affecting
scl
rates
were
repeatedly
made
and
delayed
staff
proposed
to
close
out
the
study.
Without
a
formal
report,
the
committee
could
reassign
the
topic
after
a
waiver
redesign
and
a
new
rate
methodology
have
been
in
place
long
enough
to
evaluate.
E
While
waiting
for
kentucky
medicaid
to
establish
a
new
rate
methodology,
legislative
oversight,
staff
analyzed
and
reported
on
the
scl
rate,
history
staff
also
attended
the
working
group
meetings
that
navigate
held
with
providers
and
dms
to
discuss
their
rate
study
staff,
reviewed
navigant's
findings
and
obtained
feedback
from
providers
staff
monitored
the
meetings
of
the
related
task
forces.
Over
the
past
two
years,
staff
presented
their
main
findings
to
dms
the
dms
response
and
staffs
re
replies
to
their
response
are
on
the
last
page
of
the
memo
in
your
packet.
E
E
Some
services
were
combined
and
some
were
created
by
splitting
an
existing
service
into
other
more
specific
services.
This
happened
mainly
in
2006
and
2014..
The
2014
restructuring
was
phased
in
throughout
the
year.
It
included
designating
the
new
service
array
scl2
to
distinguish
it
from
the
previous
program.
E
E
E
E
G
G
G
G
G
G
Unfortunately,
building
rates
in
this
way
can
be
misleading,
as
wage
data
tend
to
reflect
existing
reimbursement
rates
and
as
a
result,
if
current
rates
are
too
low,
then
wages
and
costs
will
be
artificially.
Depressed
providers
also
expressed
this
concern
to
committee
staff,
asserting
that
the
survey
data
that
they
had
provided
to
navigate
failed
to
accurately
capture
their
costs,
since
placing
the
rate
study
on
hold,
dms
has
also
indicated
that
a
budget
increase
would
likely
be
required
to
bring
rates
for
all
services
up
to
the
highest
rate
currently
being
paid
for
that
service
by
all
waivers.
G
A
D
Thank
you,
mr
chairman,
and
this
this
is
pertinent
to
the
last
comments
you
made.
I,
I
guess
the
concern
with
not
actually
preparing
a
report.
Now
is
the
the
historical
value
of
what
you
all
have
done
as
the
process
moves
forward.
A
All
right
I'll,
ask
one
question
now
and
I'll
also
ask
this
of
the
commissioner
or
one
of
her
staff.
I
think
you
mentioned
that
since
2001
a
required
report,
that's
required
from
the
federal
government
hasn't
been
submitted.
I
think
it
was
along
the
lines
of
setting
out
our
basis
upon
which
we
we
do
the
reimbursement
rates.
Is
that
correct
and
why
hasn't
that
been
submitted
since
2001
and
have
we
had
communications
with
the
cabinet
to
determine
whether
they're
going
to
start
complying
with
that
federal.
G
Requirement
that
is
accurate,
the,
but,
as
dms
responded
up
until
now,
all
of
their
applications
and
amendments
have
been
approved,
despite
not
filing
the
having
the
methods
on
file
and
the
methodology
for
creating
them
and
a
process
renewing
them
every
five
years.
A
Okay
and
to
that
end,
we
noted
that
any
affected
party
can
challenge
the
federal
approval.
Have
we
heard
any
any
mumblings
or
any
is
any
affected
party
reported
to
us
or
to
report
it
to
the
cabinet,
to
our
knowledge
that
they're
gonna
they
intend
to
maybe
challenge
the
approval
not
to.
G
A
Knowledge,
and
has
the
biden
administration
made
any
statements
that
they
might
be
reviewing
previous
federal
approvals,
not
to
argue.
G
A
Okay,
all
right,
thank
you
and
obviously
you
guys
stay
in
the
room,
because
there
will
likely
be
questions
for
you
at
the
end.
But
right
now
is
commissioner
lisa
lee
with
us
remotely.
F
Yes,
I
am
here
remotely
from
my
office.
A
F
I'm
lisa
lee-
I
am
the
commissioner
for
the
kentucky
department
of
medicaid
services
and
I
have
with
me
pam
smith,
who
is
the
division
director
for
community
alternatives,
and
we
also
have
kelly
rodman,
who
is
our
legislative
liaison,
and
we
do
have
a
presentation
that
we
can
go
through
based
on
the
the
the
waiver
and
some
of
the
redesign
activities
and
first
of
all,
I'd
like
to
to.
Thank
you
all
for
your
interest
in
this
very
important
topic
in
kentucky.
F
We
currently
cover
a
total
of
25
917
individuals,
and
I
know
senator
carroll
made
a
comment
that
that
we
have
studied
and
studied
this
and
we've
we've
taken
little
action,
and
I
I
think
that,
as
we
go
through
the
presentation
and
we
talk
about
the
waiver
programs,
we
get
a
general
idea
of
just
how
complicated
the
not
only
the
programs
are,
but
the
complex
medical
needs
of
the
individuals
that
we
serve
are
the
the
individuals
in
our
home
and
community-based
waiver
services
are
some
of
the
most
vulnerable
and
complex
individuals
that
we
serve
in
the
medicaid
program
and,
as
such,
we're
very
careful
anytime.
F
We
make
changes
to
the
to
the
programs
because,
first
and
foremost,
our
concern
is
for
our
members
and
the
services
that
they
receive,
because
everything
that
we
do
here
in
medicaid
is
for
our
medicaid
members
and
we
we
strive
to
make
sure
that
we're
delivering
services
that
improve
the
lives
of
those
that
we
serve.
Because
that's
why
we
are
here.
So
again.
I
do
have
a
presentation
if,
if
I
could
can
I
have
do,
I
have
authority
to
share
my
screen
or
do
I
have
to
have
the
committee
share
the
presentation
for
me.
F
Okay,
let
me
try,
sometimes
technology
is
great
and
when
we
can
what
we
can
do
and
see
if
I
can
get
my.
F
Okay,
fantastic,
so
we'll
go
straight
to.
A
F
A
F
You
so
here,
1915
c,
home
and
community,
based
waivers,
as
you
heard
from
our
previous,
the
previous
presentation.
They
are
designed
to
give
individuals
with
disabilities
on
alternative
institutionalization.
F
We
do
provide
services
that
allow
individuals
to
either
remain
in
their
home
or
community
rather
than
going
to
a
long-term
care
facility
and
the
services
that
are
available,
complement
the
medicaid
program
services.
So,
for
example,
I
like
to
say
that
that
the
medicaid
program
actually
had
has
about.
F
So
again
we
do
have
six
home
and
community
based
waivers.
Those
waivers
are
listed
here
and,
as
I
stated
earlier,
we
have
over
25
000
individuals
in
our
waivers
today
we
have
I've
been
talking
about
the
sel
waiver.
F
As
you
can
see,
we
have
at
the
bottom,
we
have
a
supports
for
community
living
and
we
also
have
the
michelle
p
waiver,
who
serves
sort
of
the
same
individuals
and
that
those
are
individuals
with
intellectual
or
developmental
disabilities,
and
one
of
the
differences
in
michelle,
p
and
scl
is
one-
does
have
a
residential
component
which
scl
does
have
a
residential
component,
but
we
also
have
a
model
waiver
two,
so
that
waiver
is
for
independent
individuals
who
are
vet
independent
for
12
or
more
hours
a
day,
a
required
brain
injury,
long-term
care
and
acquired
brain
injury
programs
are
for
individuals
who
are
18
or
older,
with
an
acquired
brain
injury,
their
hcb
program,
that's
the
home,
and
community
based
waiver
is
for
individuals
who
are
65
and
older
or
individuals
with
any
or
any
age,
with
a
physical
disability.
F
Here's
a
little
graph
showing
how
we
spend
our
money
by
waiver
program
and
the
number
of
individuals
who
are
enrolled
in
the
program.
So
the
left
side
of
the
screen
is
the
population
served.
So,
for
example,
you
can
see
in
the
michelle
p,
we
have
10
212
individuals
and
that
makes
up
39
of
all
individuals
enrolled
in
their
waiver
programs
on
the
right
side
of
the
screen.
You
can
correlate
the
michelle
p
spend
to
342.4
million
dollars
a
year
and
that's
about
36
of
the
spend
in
the
programs.
F
F
Those
individuals
can
be
are
the
individuals
on
the
michelle
p
are
first
come
first
served,
but
the
scl
waitlist
individuals
can
be
placed
on
that
list
depending
on
their
need,
and
I
think
at
this
point
I
think
I'm
going
to
turn
it
over
to
the
to
the
resident
expert,
who
is
pam
smith
in
the
department
department
for
medicaid
services,
and
she
can
go
through
the
rest
of
this
slide
and
pam.
If
you
just,
let
me
know
when
you
want
me
to
go
to
the
next
slide,
I
will
advance
for
you.
H
Thank
you,
commissioner.
I
do
want
to
before
we
go
off
of
this
slide
want
to
make
a
comment.
I
know
senator
carol.
We
had
talked
about
before
the
average
time
on
the
michelle
p
waiver
about
that
number,
and
it
just
did
not
get
updated
in
this.
In
this
slide,
we
talked
about
that
that
calculation
and
that
it
does
give
kind
of
a
false
interpretation
of
how
long
individuals
have
been
waiting
on
that
on
that
wait
list.
H
If
you're
going
to
go
to
the
next
slide,
please
so
the
goals
of
of
waiver
redesign
overall-
and
I
think
these
are
going
to
be
these-
will
be
consistent
as
we
begin
waiver
redesign.
I
think
these
are
our
goals,
just
in
general,
to
have
a
stable
waiver
waiver
program
to
serve
our
individuals,
enhancing
the
quality
of
care
that
they
receive,
implementing
consistent
definitions
across
waiver.
H
You
know
we,
we
have
a
set
number
of
funds
or
a
limited
amount
of
funds,
and
we
always
want
to
be
fiscally
responsible
and
make
sure
that
we
are
providing
the
best
services
for
to
as
many
people
as
we
can
for
that
set
amount
of
money
that
we
have.
We
want
to
continue
to
diversify
and
grow
our
provider
network.
H
We
want
to
have
consistent
provider
funding,
and
that
goes
across
all
waivers.
So
we
want
to
avoid
the
interpretation
that
one
group
may
have
better
access
to
services
or
have
access
to
different
different
funding
than
other
programs,
and
we
want
to
optimize
our
case
management
to
support
that
person-centered
planning
that
that
is
person-centered
planning
is
the
center
of
hcv
and
is
critical
to
its
success.
H
Go
to
the
next
slide,
please,
okay,
and
so
now
just
talk
about
where
kind
of
the
redesigned
timeline-
and
this
was
kind
of
touched
upon
in
mr
knowles
and
mr
steven's
presentation-
the
waiver
redesign
began
in
february
of
2017.
The
assessment
report
and
recommendations
came
out
in
august
of
2018..
H
H
One
of
the
stakeholders
said
something
to
us
that
has
rang
true
and
that
we
took
to
heart,
and
I
you
know
I'd,
keep
this
lens
through
everything
I
do
with
the
waiver,
which
is
nothing
about
us
without
us.
H
So
it's
very
important
to
us
that
we
have
that
that
stakeholder
engagement
process
and
that
all
individuals
that
have
a
part
of
the
waiver,
whether
it
be
a
provider
it
be
an
agency
such
as
us
or
one
of
our
sister
agencies,
down
to
individuals
that
are
receiving
waivers
and
individuals
that
are
hoping
to
receive
waivers
and
the
individuals
that
support
them.
H
We
switch
service
authorizations
from
a
third
party
vendor
to
the
state
into
case
manager,
so
this
allows
services
to
begin
quicker
case.
Managers
were
trained
and
were
given
a
set
of
guidelines
and
within
certain
parameters
they
can
approve
services
from
the
beginning
on
the
person's
plan
of
care
services
that
are
more
clinical
in
nature
or
that
fall
outside
of
those
parameters
come
to
staff
at
the
cabinet
to
review
and
approve,
we
streamlined
incident
reporting
and
moved
to
an
electronic
reporting
system
within
our
medicaid
waiver
management
application.
H
We've
had
ongoing
training
for
providers
case
managers
and
our
internal
staff.
We've
expanded
the
mwma
access
to
all
providers.
So
now
not
only
case,
managers
can
be
in
that
system.
All
providers
can
have
access
to
that.
We
updated
the
patient
liability
calculation
from
100
of
the
the
fpr
to
300,
which
essentially
wiped
out
patient
liability
for
all
of
our
participants.
H
The
last
review
that
I
did,
we
had
less
than
50
people
that
still
had
a
patient
liability
and
those
range
from
you
know
they
could
be
as
little
as
one
dollar.
Up
to
some,
we
had
some
that
still
had
significant
patient
liability
amounts
in
the
hundreds,
but
that
those
were
very
few,
as
was
mentioned
earlier,
the
comprehensive
rate
study
and
recommendations
for
the
new
rape
methodology
that
was
completed
and
those
findings
were
published
for
the
next
slide.
Please
we
operationalized
the
1915
sea
waiver
help
desk.
H
This
is
a
help
desk
that
is
staffed
within
my
division
and
in
medicaid,
and
we
answer
both
participant
case
manager.
Family
advocates
calls
from
just
about
anyone
as
well
as
we
operate.
A
help
desk
system
help
ticket
system
where
they
can
email
in
and
we
respond
to
tickets.
H
We
have
completed
a
rewrite
initially
of
applications
and
the
supporting
regulations.
Those
will
serve
as
a
foundation
as
we
continue
waiver
redesign.
We
won't
be
starting
from
scratch.
We
at
least
have
some
things.
Some
work
already
started
there,
such
as
making
definitions,
consistent,
we've
developed
resource
materials
for
providers,
participants
and
internal
staff.
H
We've
we've
become
very
good
at
developing
what
we
call
our
one
pagers
or
quick
reference
guides.
We
try
to
have
those
out
there
for
anything
system
wise
or
to
guide
an
individual,
for
example,
from
I've.
Just
had
my
assessment.
What
do
I
expect
next?
Those
types
of
guides
we've
done
planning
and
implementation
of
mwma
enhancements.
We
continue
to
work
on
mwma
enhancements
and
that
is
both
for
internal
efficiencies,
as
well
as
efficiencies
for
the
for
the
providers
that
allow
them
to
serve
our
members
better.
H
We
formalized
a
grievance
and
appeals
process
and
moved
our
reconsiderations
to
an
independent
third
party,
so
I'm
actually
staff
in
the
office
of
the
ombudsman
at
the
cabinet
conduct
all
of
our
reconsiderations
for
waiver,
and
that
just
allows
so
that
there's
an
absolute
independent
view.
Looking
into
any
denials
that
that
request,
a
reconsideration
and
we've
introduced
updated
service
definitions,
policies,
procedures
in
the
home
and
community
based
and
model
2
waiver
renewals,
we
actually
within
the
last
couple
of
weeks,
received
approval
on
our
model
model.
F
That
is
the
end
of
our
presentation.
A
couple
of
things
I'd
like
to
point
out
is
for
those
the
mwma.
I
know
we
have
a
lot
of
acronyms
here
in
medicaid.
The
mwma
is
their
medicaid
waiver
management
application.
That
is
a
a
computer
module
that
allows
our
waiver
providers
case
managers
to
go
in
insert
case
notes
and
actually
just
just
manage
the
care
of
those
waiver
participants.
F
So
it
is
a
great
tool
that
we
use
for
our
waiver
programs
and
when
we
talk
about
budget
neutrality,
so
the
waiver
redesign
the
the
navigate
study
it
encompassed
more
than
just
rates.
It
took
an
in-depth
look
at
all
of
their
waiver
programs,
all
six
of
them.
They
analyzed
the
administration
of
those
programs.
F
They
also
looked
at
rates
and
methodology
and
when
we
talked
about
you
know,
budget
neutrality
and
if
we
had
implemented
the
the
some
of
the
recommendations
around
rate
reimbursements,
for
example,
in
order
to
to
implement
those
recommendations
within
the
current
framework
and
within
the
current
budget,
we
would
have
have
to
have
shifted
funds
from
one
provider
group
to
another,
and
so
when,
in
january
of
2020,
when
I
came
back
to
medicaid
to
serve
in
this
capacity
as
commissioner,
I
was
approached
by
a
few
waiver
providers
who
were
very
concerned
about
that
approach
of
shifting
funds.
F
And
so
we
decided
to
take
a
pause
and
take
a
step
back
and
see
what
we
could
actually
do
within
the
current
framework,
within
our
current
regulatory
guidelines
and
approvals
from
cms
and
then
look
at
what
we
could
do
going
forward.
As
our
waivers
need
to
you
know,
we
need
to
look
at
them.
We
know
that
we
need
to
make
some
changes
and
do
some
redesigns
always
hampered
by
budgetary
constraints.
F
But
recently
there
has
been
some
an
initiative.
We
have
submitted
a
spending
plan
to
cms,
I'm
not
sure
if
you're
aware
that
there's
a
homeland
community
based
waiver
under
the
harpa
funds
we
have
10
percent
of
our
spend
state,
spend
that
we
can
draw
down
additional
federal
funds
for
our
waiver
programs.
But
it's
a
one-time
spend.
We
cannot,
for
example,
add
waiver
slots
using
that
money,
because
that
would
be
something
that
needed
that
would
need
an
ongoing
funding
but
I'll.
F
Let
pam
talk
about
some
of
the
opportunities
that
this
funding
provides
for
us
and
some
things
that
are
in
our
split
spending
plan
that
we
think
may
help
with
provider
retention
as
we
move
forward
with
our
wiper
programs.
Pam.
H
We
looked
at
some
some
pretty
basic,
immediate
needs
and
one
is
workforce,
obviously
that
we
need
to
address
there.
There
is
a
critical
workforce
shortage
and
it
won't
matter.
You
know
what
what
do
services
or
what
we
do
with
rates
or
really
anything
else.
We
change
with
the
waivers
if
we
don't
have
providers
there
to
deliver
the
services.
So
we
looked
at
addressing
that
immediate
need.
H
We
also
wanted
to
do
a
feasibility
study
on
potentially
either
restructuring
or
adding
some
additional
waivers
in
the
future.
One
is
for
severe
mental
illness
and
one
would
be
targeted
at
children
and
one
would
be
targeted
at
supporting
individuals
with
chronic
medical
conditions.
So
we
wanted.
You
know,
funds
to
be
able
to
go
to
that
feasibility
study
to
see
what
it
would
take
to
do
that
and
then
lastly,
we
want
to
have.
H
We
would
want
to
have
someone
come
in
to
help
us
with
the
project
management
of
this
there's
a
lot
of
reporting
that
has
to
be
back
to
cms.
We
have
to
report
each
quarter
and
update
to
the
spending
plan
as
well
as
looking
at
our
pace
initiative.
We
wanted
to
bring
in
project
managers
to
look
at
that
as
well
and
to
help
us
support
us,
as
we
continue
with
the
waiver
redesign
task
force
just
to
advance
those
efforts
forward
and
to
help
us
with
you
know,
really
best
practices.
H
What
other
states
are
doing,
that
is
innovative
and
what
we
can
bring
to
kentucky,
and
so
it
will
be
managed
crossed
agency.
So
we
will
have
individuals
from
the
department
for
aging
and
independent
living
our
department
for
behavioral
health
and
intellectual
disabilities,
as
well
as
staff
from
medicaid.
H
That
will
work
on
this
very
large
project
and
we're
looking
forward
to
hearing
back
from
cms.
Our
plan
was
submitted
on
monday
cms
had
said
they
wanted
to
respond
quickly
to
those,
but
you
can
imagine
how
many
plans
from
states
they
got
all
basically
at
the
same
time.
So,
but
we
are
looking
forward
to
hearing
back
from
cms
on
that
on
those
initiatives.
I
Thank
you,
mr
chair,
commissioner,
lee.
I
I
I
think,
as
a
legislative
committee,
we
have
to
acknowledge
that
in
the
21
22
proposed
budget
submitted
to
the
governor,
he
actually
had
in
there
an
additional
250
waiver
slots
for
the
michelle
p
waiver
program,
another
50
slots
for
the
sel
waiver.
Okay,
when
we
adopted
the
budget-
and
I
do
mean
we-
we
got
the
budget-
we
eliminated
all
of
those
requests
by
the
governor.
Now
I
have
constituents,
I'm
sure
you
heard
I'm
sure
everybody
here
has
two
really
wants
more
waiver
slots.
I
We
have
over
10
000
people
on
the
waiting
list
and
yet
we,
as
a
as
a
general
assembly,
didn't
increase
the
waiver
slots
by
one
in
this
past
budget.
I
My
question
to
you
is
this:
as
the
commissioner
of
medicaid
services,
are
you
and
secretary
freelander
going
to
go
back
and
encourage
the
governor
in
the
upcoming
22-24
budget,
to
again
request
waiver
slots
for
the
michelle
p
waiver
program
and
for
the
support
for
community
living
program
and
encourages
general
assembly
to
create
more
waiver
slots
for
the
fiscal
years?
22
well
vote
for
22,
23
and
23
24.
F
Well,
as
we
can
see,
the
waiver
programs
are
definitely
very
important
to
the
population
we
serve.
We
do
know
we
have
a
waiting
list.
D
Thank
you,
mr
chairman,
commissioner.
I
didn't
my
last
statement
was
not
meant
as
a
criticism.
It
was
meant
to
be
factual
and-
and
I
I
believe
me-
I
understand
the
complexity
of
the
balances
that
you
all
have
in
dealing
with
all
this.
From
from
a
parent
perspective
and
from
a
provider
perspective.
D
How
do
you
all
do
you
remember?
Do
you
have
the
number?
How
much
money
was
the
call?
What
was
the
cost
for
the
navigant
study
that
was
done.
F
Thank
you
senator
carol.
I
didn't
I
didn't
by
any
way
take
your
comments
as
criticism.
I
think
they're
just
factual.
I
think
that
the
waiver
programs
are
the
most
complex
programs
to
administer
in
the
medicaid
program.
I
think
we
all
realize
that,
and
I
still
appreciate
your
all's
interest
in
these
programs
and
I
would
have
to
defer
to
pam
regarding
the
rate
how
much
we
paid
navigate.
I
think
that's
your
question.
F
How
much
the
department
paid
navigate
to
conduct
that
study
and
I
think
there
there
definitely
was
a
contract
with
a
set
dollar
amount.
Pam,
do
you
know
right
off
hand
how
much
that
contract
was.
H
For
the
full
three
because
we
did
a
one-year
extension,
I
believe
it
was
around
six
million
dollars,
but
I
can
find
that
out.
That's
just
kind
of
off
the
top
of
my
head.
I
would
need
to
go
back
in
and
look
to
to
get
that
that
dollar
amount,
but
senator
carol,
I'm
happy
to
do
that
and
provide
it
to
you.
Okay
and.
D
And
you
know,
I
appreciate
the
way
that
you,
the
approach
that
you
all
have
taken.
I
think
it
has
been
very,
very
inclusive,
of
all
the
stakeholders
throughout
the
state.
So
so
what
and
the
process
has
been
great-
it's
just
it's
just
the
fact
is:
we're
we're
not
really
making
a
lot
of
progress
and
and
we're
we're
as
as
we
move
along.
There
are
more
and
more
problems.
D
I
guess
that
are
piling
up
as
a
result
of
us
not
making
the
progress,
and
I
and
I
think
you
I
think
there
are
some
excellent
ideas
pending
that
are
being
looked
at
and-
and
I
think
some
things
that
are
gonna
make
the
programs
much
more
efficient
and
the
service
is
much
better
for
those
who
receive
the
services
and
then
also
the
obviously
a
focus
on
providers
to
make
sure
that
there
are
providers,
because
I
think
everyone's
well
aware
that
over
the
last
year
we
have
struggled
in
that
area.
D
We
have
lost
providers
throughout
this
state,
and
you
know
there
really
does
need
to
be
action
taken
in
that
area.
What
what
do
you
all
see
from
the
navigate
study?
How
has
the
focus
changed
as
far
as
what
the
priorities
are
and
and
what
can
we
pull
forward
from
that
study?
That
will
be
beneficial
in
the
next
phase
of
the
the
review
and
the
the
redesign.
F
Well,
I
think
definitely
we
need
to
look
at
our
assessments
and
rate
methodology.
I
think,
for
example,
we
do
not
have
a
child
specific
assessment,
some
of
the
concerns
when
we
start
looking
at
that.
Of
course,
we
want
to
be
very
thoughtful
and
methodical
as
we
go
forward,
because
you
know
their
change
that
any
change
we
make
has
the
potential
to
impact
over
25
000
lives,
and
we
want
to
make
sure
that
there's
no
disruption
in
their
care,
but
it
could
be.
F
For
example,
when
we
implement
a
child
specific
assessment,
we
may
have
children
fall
off
these
waiver
programs
because
they
no
longer
qualify.
That
is
a
really
big
concern
of
ours.
These
children
have
been
receiving.
Some
of
these
children
have
been
receiving
services
for
for
several
years,
so
we
need
to
really
be
careful
when
we
look
at
that
and
implementing,
I
think,
definitely
having
it's
a
consistent
and
rate
methodology
across
provider
types.
F
Currently,
we
do
have
some
reimbursement
methodologies
that
vary
based
on
waiver,
even
though
the
provider
is
delivering
the
services
or
they're
delivering
the
same
service,
which
creates
gaps
in
care
because
some
providers,
if
they're
going
to
receive
more
money,
for
example,
delivering
services
to
an
seo
waiver
participant.
Then
that
leaves
a
gap
in
some
of
our
other
waivers
because
services,
because
those
in
those
providers
want
to
go
to
the
waivers
that
deliver
more
or
pay
for
pay
a
higher
reimbursement.
F
Some
of
the
focus,
but
always
at
first
and
in
front
center,
is
the
member
and
how
we
are
taking
care
of
that
member
and
meeting
their
needs
also,
and
I
think
senator
carol
you
hear
me
say
this
all
the
time
that
my
philosophy
is
medicaid
program
was
created
for
the
medicaid
member,
but
we
can't
take
care
of
our
members
if
we
don't
take
care
of
our
providers,
so
definitely
a
focus
on
assessments
and
reimbursement
and
I'm
not
sure,
pam
and
then
person-centered
care
to
making
sure
that
these
individuals
are
receiving
a
plan
of
care
that
meets
the
needs
tailored
specifically
for
them,
rather
than
having
a
blanket
set
of
services
that
that
can
be
applied
across
the
board
pam.
H
I
would
just
would
definitely
would
agree
about
the
person-centered
planning
we,
you
know
too
many
times
see
providers
falling
into
the
okay
you're
on
the
seo
waiver.
So
I'm
going
to
take
down
this.
This
is
your
menu
of
services.
This
is
what
you
get
and
not
focusing
on
what's
important
to
the
participant
and
really
what
what
they
want
to
do
and
how
they
want
their
services.
H
So
really
incorporating
that
and
then
really
my
my
big
thing
is
making
sure
that
each
while
each
population
is
unique
and
there
are
going
to
be
some
services
that
are
unique
to
the
individual
scene,
just
that
equal
access
to
service-
and
you
know
equal
opportunity
among
each
of
the
individuals,
regardless
of
what
reason
they're
on
a
waiver
but
that
they
have
you
know
equal
access
to
providers
and
equal
access
to
services,
and
that
there's
not
any.
That
feel
like
that.
D
One
more
quicker
j
and
just
to
get
a
little
bit
too
more
specific
into
one
service.
I'm
hearing
from
case
managers
that
oftentimes
their
responsibilities
are
continuing
to
grow
and
grow
and
grow,
and
there
are
concerns
that
they
feel
like
that.
They're
not
able
to
provide
the
quality
of
services,
maybe
that
they
have
in
the
past
because
of
all
the
increased
demands
on
them.
Are
you
all
addressing
that?
Have
you
had
conversations
about
that?
And
it's
getting
more
and
more
difficult
to
hire
case
managers
and
especially
with
all
the
added
responsibilities
that
they
have.
H
We
have
specifically
been
looking
at
case
management
over
the
last
the
over
the
last
year.
During
the
pandemic,
we
we've
seen
some
very
innovative
case
managers
and
we've
also
seen
where
we
have
some
big
holes
in
case
management,
where
we
need
to
we've
realized.
We
need
to
step
up
the
training
and
the
support
of
the
case
managers,
and
I
think
two
we're
going
to
look
at
is
there
a
cap
we
need
to
put
on
how
many
individuals,
a
case
manager
can
have
on
their
caseload.
H
H
What
that
number
is
exactly
I
I
can't
say
off
the
top
of
my
head
right
now,
but
I
think
we're
also
looking
at
a
way
for
you
know,
value-based
payments,
and
is
there
something
we
can
do
in
particular
with
case
management
on
the
acuity
of
the
individual?
H
They
have
so,
for
example,
if
they
have
someone
that
that
has
more
needs
like
there
are
no
natural
supports
or
they
you
know
the
natural
supports,
really
lack
understanding
or
aren't
able
to
help
the
waiver
individual
that
they're
they
have
to
be
more
involved,
that
they
could
have
a
lower
case
load
and
that
they
could
receive
a
different
reimbursement
for
that
individual
versus
someone
who
has
a
strong
natural
family
supports,
and
really
it
is
just
more
of
a
coordinating
their
services
and
a
touch
base.
You
know
once
a
month
is
everything
going?
H
Okay?
What
else
could
I
get
you
so
really
looking
at
how
we
have
casement
case
management?
Structured,
it's
a
difficult
job,
but
it
also
is
one
of
the
most
important
jobs
in
waiver
because
they
are,
they
are
the
connection
between
everything.
D
I
agree
with
that
completely
and
I
appreciate
both
of
you
so
much
for
always
being
willing
to
answer
questions
and
being
available
when
you
are
needed
and
you
have
a
very
difficult
job,
but
obviously
from
the
number
of
times
that
you
all
testify
before
committee.
D
There
is
a
lot
of
interest
in
moving
these
programs
forward
and
making
sure
that
we're
providing
efficient
and
quality
services
so
know
that
you
have
the
support
within
the
legislature,
and
I
appreciate
your
priorities
and
I
I
truly
do
thank
you
for
what
you
do
and
from
from
a
provider's
perspective
and
also
from
a
legislator.
D
The
priorities
are
are
correct.
I
think
within
the
state-
and
there
is
I
agree,
there's
a
financial
component
that
does
have
to
change
and
I
think
we
can
only
be
so
effective
until
that
component
gets
caught
up
with
the
ideas
that
we
have,
and
so
I
think
that's
where
we're
struggling
right
now,
but
I
will
stop
there.
Mr
chairman,
thank
you
so
much
for
indulging
me.
Thank.
C
C
My
question
is:
what
have
we
seen
since
coveting
covet
was
really
really
devastating
on
some
of
the
infrastructure
that
we
have
in
place
to
take
care
of
folks
and
what
changes
you're
seeing
and
as
we
come
out
of
covit,
to
make
sure
that
that
important
infrastructure
is
still
there
and
also
a
little
primer
for
me
on
how
we
pay
for
these
services,
what
percentage
is
general
fund
money
and
what
percentage
is
federal
funding.
H
Can
probably
answer
most
of
those,
so
it's
federal
is
about
70,
so
about
70
cents
of
every
dollar
is
federal
and
30
census
state.
As
far
as
the
infrastructure
and
the
providers.
What
we've
seen
on
the
positive
side
we've
seen.
Some
providers
be
really
innovative
and
it's
been
inspiring
because
I
think
it's
going
to
shape
how
we
go
forward,
for
example,
telehealth
and
the
place
that
it
can
have
in
the
home
and
community-based
programs,
some
of
the
remote
patient
monitoring
those
types
of
programs.
H
So
I
think
it's
going
to
shape
how
we
move
forward.
We
are
really
starting
to
look
now
on
as
far
as
providers
and
we
have
lost
some
providers.
Unfortunately,
hopefully
we're
going
to
be
able
to
bring
them
back,
but
we
are
really
now
just
starting
to
get
deep
into
the
analysis
of
the
services
that
were
utilized
during
the
pandemic.
H
Our
providers,
some
of
them,
stepped
up
and
actually
started
providing
additional
services,
because
we
were
able
to
allow
that
through
appendix
k.
So
we're
really
starting
to
look
into
that
and
to
see
you
know
what
we
need
to
do
differently
and
you
know,
hopefully
we
can
get
some
of
our
providers
back
because
unfortunately
we
did
lose.
Some
of
our
smaller
are
smaller
providers
before
we
have.
A
Any
more
questions
we're
going
to
allow
our
final
presenter
to
present
so
amy
stayed
welcome
home.
You
can
leave
the
legislature,
but
this
is
always
your
home
amy
identify
yourself
for
the
record,
and
you
have
the
floor.
J
Thank
you
so
much.
Mr
chair,
my
name
is
amy
stade.
I
am
the
executive
director
of
the
kentucky
association
of
private
providers.
Representative
jenkins,
harbor
house
is
a
cap.
Member
cap
is
a
statewide
nonprofit
organization,
trade
association
representing
1915
sea
waiver
providers,
who
provide
services
to
individuals
with
intellectual
and
developmental
disabilities,
primarily
through
the
supports
for
community
living
in
the
michelle
p
waiver,
but
to
a
certain
extent
also
through
the
home
and
community-based
waiver
cap
members.
J
Just
moved
through
this,
many
of
you
have
heard
this
already,
so
I'm
just
going
to
apologize
for
repeating
it
numerous
times.
I'd
also
be
remiss
if
I
did
not
thank
the
former
representative
jonathan
gell
for
sponsoring
the
resolution
that
has
brought
us
here
today
to
that
necessitated
this
program
review.
He
is
probably
not
watching
this,
but
I
thought
I'd.
Thank
him
anyway.
J
Covered
19
has
had
a
significant
impact
on
waiver
providers.
As
you
all
heard,
we
were
struggling
before
the
pandemic.
In
2018,
scl
waiver
providers
received
the
first
rate
increase
they
had
in
14
years
that
rate
increase.
Still
many
of
the
reimbursement
rates
are
still
lower
today
than
they
were
in
2006.,
so
we're
providers
are
making
do
with
you
know:
2000
lower
than
2006
rates
in
2021
cost
of
doing
business
and
wages
a
may
2021
cap
survey.
J
So
this
is
a
little
old,
but
may
2021
cap
survey
revealed
that
kova
19
has
impacted
waiver
providers
significantly
in
two
ways:
revenue
and
workforce.
91
percent
of
our
respondents
reported
that
they'd
experienced
a
significant
revenue
reduction
specifically
related
to
the
coven
19
pandemic.
They
reported
an
average
loss
revenue
of
682
000.
J
That's
significant
for
a
provider
that
operates
on
a
paper-thin
budget
providers,
also
reported
the
majority
of
providers
reported
that
they
also
were
experiencing
significant
workforce
problems.
I'll
tell
you
since
may,
when
this
survey
was
done,
we're
in
all
out
crisis
right
now,
86
percent
of
providers
report
that
they
cannot
hire
qualified
individuals
despite
offering
sign-on
bonuses,
etc.
J
J
Only
2.8
percent
of
waiver
providers
report
that
they're
fully
staffed
50
percent
of
proprietors
providers
report
that
they're
critically
understaffed
and
I'd
say
since
may
that's
increased.
Respondents
have
also
reported
that
they
have
an
average
of
22
000
per
pay
period
in
just
in
overtime
related
to
the
pandemic.
Again,
that's
significant
when
you've
lost
revenue
and
have
increased
overtime
costs.
J
Our
waiver
providers
have
struggled
for
years
to
recruit
and
retain
qualified
direct
support
professionals.
It's
not
a
new
problem.
We've
been
talking
about
this
for
years,
but
now
we're
at
a
critical
level
in
2019,
kentucky's
average
dsp
turnover
rate
was
47
percent,
that's
higher
than
the
national
average
of
42
it's
still
high,
regardless
nationally,
but
we're
still
higher
than
the
national
average.
Why
is
this
happening
because
dsps
have
low
wages
and
it's
emotionally
and
physically
demanding
work?
J
This
has
a
significant
impact
on
the
lives
of
the
individuals
with
disabilities.
A
recent
research
from
the
council
on
quality
and
leadership
has
shown
that
high
turnover
in
fact
affects
the
health,
safety
and
welfare
of
individuals
with
disability
and
leads
to
increased
instances
of
abuse
and
neglect
emergency
room
visits
and
mental
health
crisis.
J
Dsp
workforce
also
affects
an
individual's
ability
to
access
waiver
services.
If
there's
no
workforce.
There's
no
services
to
your
question,
senator
thomas,
you
asked
about
waiver
slots
and
waiver
slots
are
so
important.
They
are
so
important
so
that
people
have
access
to
services,
but
I'll
tell
you.
If
you
allocated
10
000
waiver
slots
today
about
50
of
them
could
get
filled
because
of
the
critical
workforce
shortage.
J
J
This
workforce
shortage
has
obviously
also
had
an
impact
on
providers,
so
we're
operating
with
critically
low
staffing
levels,
significantly
increase
overtime
costs
as
a
result
of
that
with
significantly
reduced
revenue
and
also
there's
a
really
significant
cost
associated
with
frequently
onboarding
employees.
We
have
to
run
background
checks
on
every
employee.
Absolutely
we
should
have
to
do
that.
We
have
to
do
drug
screens
and
we
have
to
do
the
training.
J
J
J
Obviously,
we've
got
a
significant
impact
on
waitlists
too,
like
I
said,
providers
have
turned
down
referrals
despite
having
capacity,
and
we
cannot
meaningfully
address
our
wait
list
until
we
ensure
that
we
have
enough
dsps
to
support
the
services
and
the
only
way
to
address
dsp
workforce
is
wages
right
now.
Kentucky's
dsps
make
about
ten
dollars
an
hour,
while
that
may
have
been
sufficient
in
2018.
J
The
rate
does
not
support
that.
The
only
way
to
increase
wages
is
to
increase
the
reimbursement
rates,
because
these
providers
are
100,
medicaid,
funded,
there's
no
other
reimbursement
stream.
For
the
majority
of
these
providers,
they
have
no
other
way
to
bring
in
income
so
that
they
can
raise
wages
and
if
we
don't
attract
quali,
a
quality
workforce
care
is
going
to
suffer,
and
I
also
want
to
stress
there's
a
lot
of
talk
about
cost
containment,
etc
in
kentucky
home
and
community-based
care.
Is
the
alternative
to
institutionalization
institutionalization
costs
about
twelve
hundred
dollars
a
day.
J
The
waivers
cost
about
two
hundred
and
fifteen
dollars
a
day
for
the
same
level
of
care.
The
waiver
itself
is
the
cost
savings
kentucky
created
the
waivers
to
save
money.
It's
not
a
question
about
of
whether
or
not
we're
going
to
provide
this
care.
This
population
of
people
will
always
need
care
and
assistance
from
the
state
of
kentucky.
It's
a
question
of
how
we're
going
to
provide
the
care.
J
Are
we
going
to
choose
institutionalization,
which
is
not
effective,
is
not
what's
best
for
the
individual
and
is
going
to
get
us
in
a
world
of
trouble,
probably
with
the
department
of
justice
and
it's
way
more
expensive,
or
are
we
going
to
choose
the
community-based
care?
That's
215
dollars
a
day
and
better
for
everyone
involved.
J
I
just
urge
all
of
you
to
consider
some
long-term
funding
for
these
programs.
We
have
to
increase
the
rates
to
increase
the
wages
and
that's
also
going
to
involve
regular
cost
of
living
adjustments.
Like
I
said
we
got,
a
stl
got
a
rate
increase
in
2018.
here
we
are
three
years
later
and
we
need
more
money.
It's
just
not
effective
for
providers
to
have
to
come
to
you
all
and
you
don't
want
to
have
to
deal
with
it
every
two
years.
J
You
don't
want
to
you,
don't
want
to
have
to
deal
with
another
20
million
budget
proposal
every
two
years.
Any
rate
structure
needs
some
regular
evaluations
of
the
validity
of
the
rates
and
the
ability
to
increase
them
regularly
for
cost
of
living.
I'll,
take
any
questions
you
all
might
have.
Thank
you.
J
Yes,
I
can
go
into
that
a
little
bit
if
you'd,
like.
J
Sure
so
I
was
on
the
right
review
committee
and
participated
in
the
navigant
report,
so
I
can
talk
a
little
bit
about
what
went
on
behind
the
scenes,
and
this
is
not
a
criticism
of
anyone.
J
The
commissioner
or
mrs
smith,
at
all
they
weren't,
largely
weren't
involved
with
this
pam
smith
was
but
not
not
a
criticism
of
her
at
all.
These
comments
are
directed
towards
navigant.
We
one
were
not
allowed
to.
It
was
not
open.
We
were
not
allowed
to
tell
anyone
outside
of
the
five
eight
people
that
were
in
the
work
group.
What
was
discussed?
What
was
talked
about
so
we
couldn't
submit.
I
wasn't
allowed
to
solicit
feedback
from
my
members
about
what
was
being
discussed
about
the
rate
that
would
affect
them.
J
Providers
were
not
able
to
accurately
report
their
costs
of
doing
business
just
by
the
way
that
the
questions
were
asked.
Additionally,
when
providers
did
accurately
report
their
costs
of
doing
business,
navigate,
frequently
responded
to
them
and
said
no,
it's
impossible
that
you
spend
this
much
money
on
this
admin
task
or
it's
impossible
that
you
spend
this
much
money
on
transportation,
revise
your
answers
and
send
them
back
to
us.
So
when
people
were
honestly
reporting
the
money
that
it
spent
to
run
their
programs
navigate
told
them
that
that
was
not
okay,
you
know.
J
F
Thank
you
as
far
as
the
budget
neutrality
in
the
in
the
in
the
study
that
was
conducted,
I'm
not
sure
what
the
previous
administration
stated,
but
it
most
likely
had
something
to
do
with
operating
within
the
current
budgetary
combines
of
what
we
have
allocated
to
the
current
waivers.
But
I
think
ms
smith
was
definitely
involved
in
the
bulk
of
the
budget
study.
So
I
think
I'll
have
to
defer
to
her
for
her
comments
on
this
question.
H
Thank
you,
commissioner,
so
I
just
I
want
to
provide
a
little
bit
of
context
too.
So
the
reason
that
individuals
who
were
on
the
rate
study
were
asked
not
to
share
the
information
that
was
was
brought
forward
was
to
prevent
so
without
context.
A
lot
of
the
a
lot
of
the
discussions
may
not
have
made
sense
and
could
have
been
misinterpreted
by
other
individuals.
H
H
As
far
as
the
survey
there
were,
there
was
a
pilot
group,
a
pilot
study
that
was
done
with
a
group
of
providers
that
provided
services
in
all
of
the
waivers,
as
well
as
there
were
multiple
trainings
and
then
I
actually
was
privy
to
and
and
have
the
data
that
was
submitted
as
part
of
the
rate
study
and
the
communications
and
so
amy.
H
If
there
were
any
providers
that
were
told
to
change
their
answers,
I
would
love
to
see
that
communication
from
them,
because
I
I
did
not
see
any
of
that
in
what
I
what
I
saw
in
the
responses
from
from
navigant.
So
I
you
know
definitely
would
be
interested
in
seeing
that-
and
I
I
will
say
the
rate
study
was
very
hard
for
a
lot
of
our
providers
there.
There
were
a
lot,
in
particular
the
smaller
providers
that
really
didn't
have
the.
H
I
think
the
right
word
it
was,
they
didn't
have
the
expertise
and
hadn't
really
hadn't
really
participated
in
in
a
rate
study.
It
was
a
very
it
was
a
comprehensive
study,
but
there
was
a
lot
of
information
that
it
asked
for,
and
so
you
know,
I
think
we
battled
some
of
that
as
well.
But
you
know
we
definitely.
H
I
would
love
amy
to
hear
the
if
you
have
any
providers
that
have
that
communication
and
you
know
any
other
feedback
as
we
go
into
looking
at
that
again,
to
not
make
some
of
the
same
mistakes
again
and
just
to
better
the
process
as
well.
I
Mistade
I
appreciate
the
and
the
importance
that
you've
placed
upon
this
study
and
and
your
remarks.
I
will
tell
you
that
I'm
beginning
to
hear
a
similar
theme
here
in
this
committee.
I
Last
month
we
heard
from
the
restaurant
industry
and
their
refrain
over
and
over
again
was
we
have
a
labor
shortage
here,
it's
caused
by
wages.
We've
got
to
do
something
this
month,
it's
medicaid
and
the
same
refrain.
I
We
have
a
labor
shortage
due
to
wages.
You
got
to
do
something
okay,
so
I
got
a
question
for
you
and
then
I
want
to
come
back
and
I
got
a
tough
question
for
miss
smith.
I
want
to
probe
what
do
you
want
us
to
do
what
what
he
wants
to
do
to
address
the
wages?
J
Absolutely
so
I
think
it's
important
to
remember
that
restaurants
and
well,
they
have
been
through
the
ringer
with
covid,
and
I
certainly
sympathize
with
that
industry.
They
can
raise
prices
to
increase
revenue
to
pay
their
employees
more
medi.
100
medicaid
providers
have
no
ability
to
charge
more.
They
can't
charge
the
medicaid
program.
They
have
no
way
to
increase
revenue
unless
medicaid
increases
the
rates,
because
again
most
of
these
providers
are
100,
medicaid
funded.
So
to
answer
your
question:
what's
the
solution?
J
Actually,
last
session
representative
reilly
filed
a
bill
that
I
worked
with
him
to
draft
that
would
increase
that
would
work
to
increase
dsp
wages
to
15
an
hour,
so
the
way
that
that
was
accomplished
was
through
a
rate
increase.
That
providers
were
then
required
to
pass
75
percent
of
that
increase
on
to
the
direct
support
professional
workforce.
You
ask
why
75
percent
that
extra
25
percent
one
allows
them
to
increase
their
wages
of
their
management
staff.
J
So
we
don't
deal
with
rage
compression
issues,
because
when
you
increase
the
bottom,
you
have
to
increase
everyone
and
just
the
way
that
that
legislation
defined
the
direct
support
professional
that
was
necessary.
Additionally,
it
allows
them
to
pay
for
the
increased
payroll
taxes
that
come
as
a
result
of
increasing
wages,
so
that
providers
did
not
actually
experience
a
revenue
reduction
as
a
result
of
raising
wages.
J
We
plan
to
maybe
find
someone
to
sponsor
similar
legislation
this
year
or
work
with
the
general
assembly
on
a
budget
appropriation
that
would
require
providers
to
pass
along
75
percent
of
a
rate
increase
to
increase
wages.
I
I
I
H
So
let
me
answer
in
two
ways:
one
I
will
say
the
reason
you
saw
that
from
navigate
is.
That
was
the
direction
that
we
were
given
by
the
leadership
in
place
at
that
time
is
that
that
was
all
that
we,
that
was
what
we
could
do,
was
essentially
rearrange
the
marbles.
Is
it
a
viable
option?
No,
it's
it's
not
a
viable
option,
and
I
think
that
we
have
you
know.
H
We've
spoken
in
some
of
the
other
testimonies
that
that
we've
done
before
some
of
the
other
committees
is
that
we
have
to
have
additional
funding.
Our
wait
lists
continue
growing
our
you
know
the
while
you
know
miss
state
talked
about
how
long
it's
been
since
the
seo
providers
have
received
a
rate
increase.
H
Some
of
the
other
six
waiver
providers
have
not
had
an
increase
in
over
10
years,
some
of
them
up
to
15
years
and
in
fact
some
of
the
providers
on
the
hcb
side
actually
had
a
had
a
rate
decrease
when
services
changed
in
2016
in
that
waiver.
So,
no
I
mean
funding
is
essential
and
and
just
rearranging
the
marbles
or
rearranging
the
tiles
to
the
puzzle,
it
they
won't
fit,
and
it
has
to.
In
order
for
us
to
improve
these
programs,
funding
increase
will
have
to
be
a
component
of
it.
A
Thank
you.
So
I
have
a
comment
and
if
anybody
will
like
to
respond
good
and
then
I've
got
a
litany
of
questions,
I'll
ask
maybe
some
of
them
and
then
reach
out
to
director
rodman
with
with
other
questions,
and
it
seems
to
me
that
that
a
rate
increase
is
certainly
part
of
the
equation.
There's
no
doubt
about
that.
I
mean
there's
no
getting
around
it.
They
don't
these.
These
providers
don't
sell
widgets,
they
don't
have
other
sources
of
income,
it's
medicaid
reimbursement,
so
we
have
to
do
our
part
once
again
in
the
general
assembly.
A
So
that's
a
criticism
of
the
general
assembly
there's
also
in
a
short
term.
We
can
get
something
done
immediately
when
I
talk
to
providers
in
my
district,
when
I
talk
to
restaurant
owners
in
my
district,
when
I
talk
to
any
employer
in
my
district,
I
say:
what's
going
on
how's
business,
tell
me
what's
up,
they
all
say
the
same
thing
and
there's
no
different,
not
one
difference.
They're,
all
seeing
the
same.
Eight
bar
every
time
we
can
walk
outside
today
go
to
any
business
in
frankfurt
and
the
owner
will
say
we'll
sing
the
same.
A
A
The
second
thing
we
can
do-
and
this
was
this-
came
from
an
owner
in
one
of
my
in
my
district
of
a
business
in
my
district,
she
said
I
had
20
interviews
scheduled
yesterday.
This
was
last
week,
so
it
would
have
been
that
was
yesterday
was
early.
Last
week
I
had
20
scheduled
she
said
jason,
how
many
things
showed
up.
I
said
12
13..
A
A
She
said
in
tennessee
and
some
other
states,
employers
can
log
into
the
unemployment
system
and
say
I'll
use
myself
as
an
example
as
if
I
were
a
hypothetical
job,
applicant
jason
nemes
had
an
interview
didn't
show
up
that
goes
into
jason,
nemes's
application.
I
lose
my
unemployment.
Those
people
who
are
not
showing
up
to
interviews
should
lose
their
unemployment.
A
That's
what
it
is
designed
to
do
it's
even
worse
in
this
world,
where
we're
talking
about
the
providers,
because
they
have
upfront
costs,
whereas
the
owner
I
was
talking
to
had
time,
maybe
maybe
a
little
bit
of
research.
These
providers
have
background
checks.
They
have
real
costs
that
they've
they've
already
put
into
that
applicant
and
then
the
applicant
doesn't
show
up
because
they
want.
They
don't
want
the
job.
A
Stop
the
federal
kicker
and
allow
employers
to
report
dishonest
fraudulent
people
who
should
not
know
should
no
longer
be
on
unemployment.
It'd
be
pretty
simple,
and
I
would
say
that
the
last
thing
we
do
not
have
a
labor
shortage
in
kentucky.
We
do
not
have
a
labor
shortage
in
kentucky.
It's
not
even
close.
Our
workforce
participation
rate
in
kentucky
is
abysmal.
On
the,
in
the
best
of
years,
we've
got
to
get
our
people
working
they're
eligible
to
work,
they're
qualified
to
work,
they're,
smart
enough,
they're,
physically
able
they're
not
working.
A
This
is
this
is
able-bodied
age-working.
Folks,
our
workforce
petition
participation
rate
is
one
of
the
worst
in
the
country
with
covid
it's
much
much
worse.
So
we
can.
We
can
address
those
issues
very
quickly
and
I
think,
rather
simply
the
longer
term
harder
thing
is
the
increase
in
the
rate.
We
also
have
to
do
that.
I
have
a
question
if
I
might
for
miss
miss
smith,
I
don't.
This
is
a
different
different
issue.
A
I
don't
know
what
this
means,
so
I
wrote
it
down
and
I'm
gonna
probably
mess
up
a
little
bit
of
what
you
said
so
clear,
so
make
sure
I
don't
do
that.
You
said
something
like
we
used
to
have
100
of
liability
and
now
it's
300
of
liability
for
participants
and
that
wiped
out
their
liability.
I
don't
have
it.
I
don't
have
any
idea
what
that
means.
So
help
me
understand.
H
It
okay,
so
part
of
when
an
individual
applies
for
waiver.
It's
it's
similar
to
if
they're
in
a
nursing
facility,
they
their
income
standards
are
are
higher
than
just
being
on
traditional
medicaid,
but
as
part
of
that
they
calculate
they
could
be
on
medicaid,
but
have
a
patient
liability
which
means
they
are.
You
know
this
much
above
what
the
standard
is
so
say,
for
example,
and
I
don't
have
the
numbers
I
wish.
I
had
the
numbers
right
here
in
front
of
me.
H
Let's
say
before
it
was
they
could
have
730
a
month.
If
the
individual
was
going
to
be
on
waiver
and
say
they
had
1200
a
month,
they
would
have
to
pay
that
other
500
in
liability
to
essentially
get
them
down
to
what
that
that
100
percent
of
the
federal
of
the
social
security
of
what
that
rate
that
that
is
that
they're
allowed
to
have
that
allowance,
we
increased
it
300
to
300
percent,
which
essentially
means
you
know
using
my
example.
They
could
have
like
20,
100
and
2100
dollars.
H
You
know
it's
math,
I'm
sorry,
but
they
could
have
that
much
more
before
they're
gonna
have
to
contribute.
So
in
the
past
anybody
was
having
to
when
they
hit
that
700
threshold.
If
any
income,
above
that
they
were
having
to
pay
that
inpatient
liability.
So
we
had
individuals
that
again,
they
had
a
patient
liability,
sometimes
as
low
as
a
dollar,
but
in
some
of
the
waivers
in
particular
like
brain
injury
where
they
had.
H
It
was
an
individual
who
had
worked
before
so
they
had
more
resources,
they
were
paying
patient
liabilities
of
you
know
up
to
fifteen
hundred
dollars
or
two
thousand
a
month
for
their
services,
so
it
really
and-
and
it
did
not
allow
when
you
think
about
today's
economy
and
what
you
know-
housing
cost
and
what
utilities
cost
the
700
you
know
allowing
them
to
have
that
much
in
income
did
not
really
afford
them
to
be
able
to
pay
for
safe
housing
to
be
able
to
pay
for
their
utilities.
J
Absolutely
so,
just
if
we're
talking
about
our
run-of-the-mill
direct
support,
professional,
it
is
someone
who
is
over
the
age
of
18
who
can
pass
a
criminal
background
check
and
a
drug
screen.
K
Thank
you,
and
can
I
make
a
comment,
mr
chairman,.
K
Thank
you,
we
did
have,
we
do
have
and
we
will
have
a
skilled,
labor
shortage.
Fortunately
you're
not
asking
for
much
in
skilled
labor,
but
for
the
comment
on
unemployment.
K
I
agree
with
you,
mr
chairman,
but
until
we
address
the
training
and
education
of
our
skilled
employees,
we
are
continually
going
to
have
a
disconnect
between
job
openings
and
the
skills
to
fill
those
job
openings.
Fortunately,
and
unfortunately,
that
you
can't
find
employees
that
you
don't
need
those
kind
of
skills.
So,
mr
chairman,
your
point
to
these
type
of
jobs
is
true.
Thank
you.
D
Thank
you,
mr
chairman,
and
just
follow
up
on
the
the
comments
that
you
made
from
the
perspective
of
this
topic.
We,
you
know,
we
have.
We
serve
about
750
children
and
adults
in
our
organization
in
west
kentucky
and
paducah,
and
we,
when
we're
fully
staffed,
we
have
about
maybe
a
little
over
100
full-time
part-time
pr
employees,
not
including
those
that
we
contract
with.
D
D
We
we
advertise
our
positions
and
it's
through
one
of
the
the
national
services
where
you
have
to
pay
a
fee
for
every
look
that
it
gets
well,
we
would
get
hundreds
of
looks
and
we
were
getting
to
where
we
were
paying
a
few
thousand
dollars
for
these
ads.
So
I
had
to
stop
it,
so
I
can't
afford
to
advertise
because
we
get
all
of
these
hits
that
we
have
to
pay
for,
and
then
none
of
them
show
up.
D
D
You
cannot
compete
about
that
and
then
you
have
a
governor
who
gets
out
and
touts
how
great
our
economy
is
when
the
government
is
footing
the
bill
for
the
economy,
that
that's
that's
not
reality,
and
it
can't
last
and
it's
very
frustrating
to
hear
those
things
when,
as
an
employer
you're
struggling
to
get
through
each
day,
we've
got
families
that
don't
have
child
care
today,
because
we've
got
a
classroom
closed
because
people
are
getting
paid
to
sit
home
and
our
governor
wants
to
brag
about
that.
That
kentucky's
economy
is
booming.
D
Well,
of
course,
it's
booming.
When
the
government
is
giving
you
money
to
go,
spend
every
day,
it's
going
to
be
booming,
there's
going
to
be
a
price
to
pay
for
all
of
this,
and
it
is
our
children,
our
grandchildren,
who
are
going
to
pay
the
price
and
we
are
doing
a
disservice
at
the
state
level
and
certainly
at
the
federal
level.
With
the
decisions
that
are
being
made
today
and
mr
chairman
I'll
get
off
my
soapbox.
B
You,
mr
chairman,
so
as
I
listen,
I
guess
the
question
would
be
to
to
the
commissioner
or
director
smith
either
one
from
the
navigate
report
study
that
was
done.
F
I
wouldn't
say
that
we
gained
zero
from
that
report.
We
have
implemented
some
some
recommendations
that
we
could
within
the
current
framework
of
our
operations,
but
we
do
have
some
other
recommendations
and
that's
one
of
the
reasons
we're
having
this
convert
these
conversations
here
today,
because
there
were
recommendations
on
assessments.
There
were
recommendations
for
other
other
things
within
those
waivers.
F
So
I
do
think
that
we
we
did
get
something
out
of
that
report
and
and
if
nothing
else
again,
these
conversations
that
we're
having
today
are
very
important
to
to
moving
the
healthcare
needle
of
those
members
that
we're
serving
in
the
waiver
programs,
and
it's
also
highlighted
some
of
the
issues
that
we
have
surrounding
assessments,
for
example,
and
I
would
defer
to
director
smith
as
she
has
some
additional
comments
to
make
about
the
navigant
report
and
the
benefits
that
we
did
receive
from
that
report.
H
I
think
that
that
you're
right
on
target
that
we
you
know
we,
I
think,
we're
hampered
by
the
fact
that
at
that
time,
that
it
was
the
focus
was
on
essentially
shifting
the
pieces
of
the
pie
around.
But
I
think
we
learned
a
lot
of
good
information
from
that.
They
essentially
helped
us
reform
our
stakeholder
engagement
process.
H
They
there
were
a
lot
of
recommendations
that
I
think
is
in
towards
the
end
of
the
presentation.
If
you
look
that
we
did,
we
have
implemented
some
of
those
as
we
could
and
I
think
it
gives
us
a
a
point
from
we're,
not
starting
from
zero
as
we
look
to
continuing
to
reform
those
going
forward
to
reform
the
waivers-
and
I
just
I
wanted
to
give
you
a
little
more
information
on.
H
I
pulled
up
our
fmap,
our
plan
that
we
submitted
to
cms
and
to
talk
about
the
the
network,
and
I
wanted
to
just
share
one
thing
that
I'm
really
excited
about
one
we're
dedicating
35
of
that
of
those
dollars
to
our
workforce
and
provider
development.
H
So
you
know
that
will
include
addressing
you
know
some
of
the
kind
of
one-time
incentive
and
recovery
payments,
but
what
we're
looking
at
for
growth
is
developing
a
central
employee
registry
to
where
we
can
have
where
individuals
that
are
doing
participant
directed
services
as
well
as
providers,
can
go
and
look,
and
we
can
build
a
base
of
of
eligible
employees
that
can
be
hi
that
can
facilitate
hiring
as
well
as
looking
senator
carol.
You
made
me
think
of
this.
H
When
you
were
talking
about
career
fair,
is
that
you
know
we?
We
want
to
engage
in
those
that
a
lot
of
times
when
you
hear
direct
support
professional
immediately.
Somebody
thinks
of
a
certified
nursing
assistant
or
a
personal
service
attendant
at
a
hospital.
These
jobs
are
so
much
more
than
that.
I
mean
you.
You
are
directly
involved
in
the
most
intimate
parts
of
somebody's
lives
and
you
are
directly
responsible
for
them
being
able
to
engage
in
the
community
and
advance
their
goals.
H
So
we
really
want
to
to
focus
on
that
and
really
we
want
to
advance
that
as
a
job
and
how
important
that
job
is,
and
some
of
that
knowledge
and
those
studies
came
directly
from
that
navigate
work
group
and
the
stakeholder
sessions
and
the
the
individual
work
groups
that
we
had
that
were
comprised
of
providers.
So
I
do
think
that
it
gave
us
a
lot
of
valuable
information.
So
I
don't
think
that
it
was
a
waste.
B
Thank
you
all
for
your
answer
and
I
I
want
to
get
to
a
bigger
point
with
that
question
and
I'm
glad
we
did
get
some
information
that
was
productive
for
our
six
million
dollars
and
I'm
I'm
not
picking
on
this
particular
study.
B
But
I
have
to
begin
to
to
ask
the
question:
just
how
much
are
we
as
a
state
government
spending
on
hiring
outside
companies
to
do
reports
at
millions
and
millions
and
millions
of
dollars
a
year
and
we're
getting
zero
return?
Essentially,
we
might
get
a
little
good
information
here
a
little
bit,
but
is
that
worth
six
million
dollars
that
we
could
have
used
to
pay
the
providers
more?
You
know,
and-
and
it's
not
I'm
not
picking
here
on
this
cabinet,
because
this
is
just
one
study
of
untelling.
B
How
many
has
been
done,
the
last
three
four
years
across
state
government?
The
question
is:
is
that
really
a
good
use
of
taxpayer
dollars
when
we
have
the
the
cabinet
that
we're
just
talking
with
today?
B
That
needs
more
funding
when
we
got
state
employees,
it's
a
need
of
cost
of
living
adjustments,
and
you
know
we
really
have
to
narrow
down
our
focus
on
how
we're
spending
the
tax
dollars
and
make
sure
we're
spending
wisely
and-
and
I
think
we
need
to
take
a
look
at
all
these
outside
groups,
because
it
sounds
to
me,
like
the
the
groups
doing
the
outside
so-called
reports
or
studies
are
the
ones
that's
benefiting
the
most
from
this,
and
it's
just
a
observation
and
comment.
Mr
chairman
representative
blanton,
the.
A
Newly
constituted
legislative
oversight
committee
might
take
that
up
exp
and
you
talk
about
other
cabinets.
You
know
you
and
I
have
a
lot
of
involvement
in
the
justice
and
public
safety
cabinet,
and
it
appears
that
there
are
quite
a
bit
of
those
representative,
jenkins
and
senator
house
next,
representative
jenkins,.
C
Thank
you,
mr
chairman.
I
want
to
offside,
say,
amen
to
what
you
just
talked
about
representative
blanton,
I
just
and
commissioner
smith.
You
kind
of
addressed
this.
I'm
afraid
that
if
people
were
watching
this
committee,
they
would
think
that
any
breathing
person
that
didn't
have
a
criminal
background
check
is
appropriate
to
work
in
these
facilities,
and
that's
just
not
true.
C
It
takes
someone
very,
very
special
to
work
with
our
one
of
our
most
vulnerable
populations.
So
it's
beyond
just
lack
of
of
the
workforce
issues
and
there
are
workforce
issues.
I
will
not
deny
that,
but
the
fact
that
for
these
very
very
specialized,
very,
very
vulnerable
populations
that
folks
are
working
with
the
fact
that
we're
paying
ten
dollars
an
hour
is,
I
think,
something
we
should
all
be
very
concerned
about.
C
I
will
say
that
we're
just
coming
out
of
a
pandemic,
one
that
the
likes
of
which
we
have
never
seen
before,
and
I
think
it's
changed
a
whole
lot
about
the
way
we
do
business.
The
way
government
does
business
the
way
private
industry
does
business.
C
Things
have
just
changed
and
I
guess
I
think,
a
little
bit
more
of
our
fellow
kentuckians
that
I
think
folks
are
making
the
best
decisions
they
can
for
their
families
and
themselves,
and
we
know
that
women
have
been
a
big
casualty
of
this
pandemic,
that
we
have
more
women
unemployed
ever
before,
and
it
could
be
that
they
are
thinking
that
that
lower
income
job
is
not
worth
what
they,
what
it
costs
them
to
put
their
kids
in
child
care,
and
so
there
I
think,
there's
a
change
that
has
come
through
our
our
our
communities
and
we
should
offer
each
other
a
little
more
grace,
sometimes
than
where
we're
doing
here.
C
There
is
a
problem.
The
problem
is
very
complex.
The
child
care
industry
has
been
decimated
and
in
many
parts
of
the
state
there
is
a
still
a
huge
need
for
that.
You
can't
go
back
to
work
if
you
don't
have
a
safe
place
for
your
kids
if
you've
been
unemployed
for
a
period
of
time
and
a
lot
of
our
folks
have-
and
there
have
been
problems
with
unemployment,
you
don't
have
the
clothes
that
you
need.
You
may
have
to
buy
a
uniform,
you
may
have
to
buy
clothes.
C
C
I
look
for
the
day
that
we
have
everyone
employed
who
is
employable
but
boy,
these
positions
we're
talking
about
today,
ten
dollars
an
hour.
I
hope
that
we
can
do
something
to
move
that
needle
so
that
we
have
people
who
want
to
be
in
those
jobs
who
have
that
heart
for
those
jobs
and
that
you
all
have
the
applicants
that
you
need.
Thank
you,
mr
chairman,.
B
Thank
you.
This
question
is
from
miss
and
forgive
me
I'm
still
on
the
learning
curve
on
some
of
this.
The
people
you
you
represent
does
that
include
your
small
service
providers
in
our
rural
areas.
B
Have
we
seen
a
decrease
in
the
number
of
of
those
providers
that
are
able
to
make
it
increase
demands
of
covid
on
their
services?.
J
B
J
Well,
it's
complicated,
so
there
are
provisions
in
place
if
you're
a
residential
provider,
for
example,
you
can't
just
close
down.
There's
you
have
to
give
notice
to
the
state,
and
actually
you
have
to
keep
in
operation
in
in
business
until
every
single
last.
One
of
the
individuals
that
you
serve
has
received
another
residential
placement.
J
This
is
difficult
sometimes
because
a
individual
agencies
who
serve
some
very
high
needs
individuals
often
cannot
find
placements
for
them.
So
sometimes
what
happens?
Is
individuals
are
reinstitutionalized,
which
is
obviously
not
best
for
the
individual
and
not
great
for
the
commonwealth,
because
it's
a
lot
more
expensive,
so
they
either
go
to
another
provider
or
they
get
reinstitutionalized,
which
obviously
the
state
tries
to
avoid
at
all
costs.
J
They
only
do
that
when
it's
the
only
option
available,
but
during
covid,
when
you
know,
providers
have
closed
down,
it's
been
incredibly
difficult
to
find
referrals
and
make
referrals
because,
as
I
stated
earlier,
agencies
while
they
have
capacity,
don't
have
the
workforce
to
take
on
anyone
new.
So
we
have
had
situations
where
some
providers
have
had
to
remain
open
longer
than
you
know.
They
would
have
liked
or
anticipated
to
make
sure
that
those
individuals
are
cared
for
during
the
referral
process.
B
What
happens
in
the
gap
when,
as
my
understanding,
the
the
providers
have
to
give
a
60-day
notice,
I
believe
to
the
it's
30
days,
30
days,
what
happens
if
they're
not
placed
in
that
30
days,
they
can't
close
down
if
they
don't
have
the
funds
to
operate.
Where
do
they?
Where
do
they
get
help
in
that
gap?.
J
That's
a
great
question:
that's
that's
a
big
question
mark.
Obviously
the
cabinet
for
health
and
family
services
tries
its
best
to
help
providers
find
referrals
the
case.
Managers
on
the
team
try
their
best.
Everyone
tries
their
best,
but
if
there's
not
a
referral,
it's
really
difficult.
H
Amy,
can
I
help
you
a
little
bit
yeah
with
that,
so
we
actually
assign
there
will
be
assigned
staff
within
either
within
medicaid
or
within
one
of
our
sister
agencies,
depending
on
what
waiver
an
individual
is
in,
but
we
work
directly
with
the
provider
and
with
the
case
managers
and
helping
them
to
find
placement
for
those
individuals,
but
every
single
from
the
moment
that
we
get
notified
because
they
have
to
notify
us.
H
First
from
the
moment
we
receive
that
notification,
their
staff
engaged
with
them,
sometimes
going
on
site
participating
in
person-centered
team
meetings
meeting
with
family
members
to
facilitate
getting
them
placed
in
a
different
in
a
different
residential
setting
or
even
with,
even
if
it
is
not
a
residential
service.
It
is,
for
example,
an
adult
day
service,
or
you
know,
or
somebody
that's
providing
attendant
care,
but
we
follow
them
from
the
time
we
get
notice
of
discharge
to
when
they
receive
services
from
another
agency.
A
H
Our
home
and
community
based
providers
right
now
are
the
ones
that
we
have
had,
so
that
is
comprised
of
adult
days
and
some
of
the
home
health
agencies.
But
we
are
down
to
150
enrolled
providers
to
serve
about
thirteen
thousand
people
right
now
and.
A
Are
those
in
partic,
I
know
in
louisville
for
adult
day
care,
there's
an
there's
a
lot
more
coming
online.
I
know,
there's
a
c-o-n
process,
the
c-o-n
process.
I
don't
know
if
it's
keeping
anybody
out
or
not.
I
don't
know,
but
so
is
it?
Is
it
louisville?
It
doesn't
seem
like
that's
a
problem
in
louisville.
There's
plenty
of
providers
in
louisville
for
adult
daycare.
So
is
that
a.
H
A
H
It
it
varies,
you
would
so
we've
most
recently,
for
example,
with
brain
injury,
we're
having
trouble
with
providers
in
fayette
county,
and
so
it
kind
of
it
varies.
So
we
have
sometimes
we
have.
It
is
the
more
rural
areas.
Sometimes
it
you
know
is
the
far
western
region,
far
eastern
region,
that
we
have
issues.
H
It
really
depends
on
what
the
provider
type
and
in
the
waiver-
but
you
know
it-
it's
been,
it's
really
sporadic,
there's,
not
a
there's,
not
a
set
pattern,
and
so
for
the
adult
days
they
don't
have
to
go
through
the
c-o-n
program,
so
that
does
not
cause
a
barrier.
I.
A
D
Sherman,
the
only
final
comment
to
make
is
we
have
this
discussion
about
pay
and
not
not
just
in
this
area,
but
in
every
area
there
are
obviously
hundreds
of
millions
of
dollars
federal
dollars
coming
down
to
help
in
this
area.
D
You
know,
and
my
concern
is
that
as
we
do
this
and
we
as
we
make
these
investments
and
it
is
nice-
I
got
to
walk
around
yesterday
and
hand
bonus
checks
out
with
federal
money.
It
was
great
our
pay
scale.
We
bumped
our
pay
scale
up
in
in
this
area
for
dsps
in
teachers
we
bumped
both
of
those
areas
up
pretty
significantly.
D
So
I
don't
think
this
is
a
problem.
We
can
buy
our
way
out
of
right
now
so
but
the
money
was
there,
that's
what
it
was
for.
My
concern
is
that
that
these
organizations
that
in
a
couple
years
you
know
they
they
play
the
game
of
this
artificial
economy
that
we
have,
and
so
the
market
is
not
dictating
pay
it's.
Basically
the
federal
government,
that's
dictating
pay
and
when
all
this
funding
goes
away
in
a
year
and
two
years
what's
going
to
happen,
then
what?
D
If
these
organizations
aren't
able
to
keep
up
revenue
to
be
able
to
pay
these
pay
scales,
what
do
we
do
then?
And
I
know
with
some
of
them-
some
of
the
funding
goes
out.
Maybe
two
three
years
in
child
care,
that's
kind
of
what
they're
looking
at,
and
I
hopefully,
if
they're,
more
federal
dollars
that
amy-
and
I
were
just
talking
about
that-
that
when
they
come
down,
it
will
be
over
a
period
of
years
where
the
impact
will
be
controlled,
but
there
is
no
guarantee
with
that.
A
Any
other
comments
from
any
of
the
presenters
all
right
while
we
were
here,
I
just
want
to
read
a
text
message:
a
provider
from
louisville
texted
me,
and
he
says
please
convey
that.
I
have
many
employer
employers,
employees,
employers,
who
have
many
opens
openings
and
10
percent
of
the
applicants
show
up
it's
government
competition.
Our
businesses
are
competing
against
the
government
anyway,
thank
you
and
we
are.