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From YouTube: Administrative Regulation Review Committee (2-14-23)
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A
Welcome
great
place
to
be
eight
o'clock
on
you
know.
First
day
back
yeah
welcome,
Madam
Secretary!
Please
call
the
roll.
C
D
A
C
A
E
11
4080
is
being
amended
to
incorporate
the
latest
version
of
the
free
application
for
federal
student
aid
that
will
be
completed
by
applicants
for
participation.
Grant
programs
administered
by
the
authority
5001
is
being
amended
to
add
four
new
categories
of
non-citizens
to
the
eligibility
list
for
the
grant
programs
administered
by
khea
and
one
category
of
non-citizens
to
the
ineligibility
list
for
consistency
with
the
federal
Pell
Grant
eligibility
criteria.
E
5037
establishes
student
eligibility
criteria
for
the
college
Access
program.
5145
is
being
amended
to
increase
the
maximum
expected
family
contribution
level
necessary
to
demonstrate
Financial
need
for
eligibility
for
the
cap
grant
program
and
increase
the
overall
annual
maximum
award
amount
for
recipients
attending
a
two-year
or
four-year
institution.
The
staff
suggested
amendments
to
these
regulations
amends
various
sections
to
add
and
delete
statutory
citations
comply
with
the
drafting
requirements
of
KRS
chapter
13A
and
make
technical
changes.
A
H
You
Mr
chairman:
could
you
go
into
detail
on
the
new
students
that
are
eligible?
What
is
their
new
eligibility
in
the
first
set
of
eggs
here.
F
And
I
do
apologize.
I
am
pinch
hitting
today
for
our
general
counsel,
who
who
is
sick
and
I
just
found
out
late
last
night.
So
if
I
don't
have
an
answer,
I
will
get
that
to
you
later
and
I'm.
I
apologize
I
am
not
extremely
familiar
with
that,
but
we
just
do
mirror
the
Pell
regulations
for
the
federal
government,
because
we
everything
all
the
state
aid
in
the
state
of
Kentucky,
as
is
with
Most
states,
is
based
on
Pell
eligibility.
H
So
in
in
the
summary
it
stated
you
know:
enlarged
eligibility
for
non-citizens
in
another
committee,
we're
working
on
some
Kia
stuff,
maybe
expanding
that
to
to
others
and
so
I
I
was
just
curious.
If
we're
now
going
to
be
expanding,
key
eligibility
to
non-citizens
is.
F
That
what
this
is
doing
for
non-citizens
I
I,
don't
think
it's
a
large
expansion
and
it
it
isn't
like
it
may
sound
like
everybody
who's.
A
non-citizen
is
eligible
sure.
I
I
F
Subset
of
non
beyond
what
it
is
now
I.
H
A
J
40K
r2150
amends
to
the
late
language
already
and
material
Incorporated
by
reference
update
material
Incorporated
by
reference
for
clarity,
consistency
and
to
comply
with
recent
legislation
and
delete
the
pre-need
cremation
authorization
form.
The
staff
Amendment
amends
various
sections
to
comply
with
Kara's
chapter
13A.
A
A
B
E
This
regulation
is
being
amended
to
set
the
mandatory
probationary
period
for
the
job
classifications
of
Public,
Safety,
telecommunicator,
3
and
Public.
Safety
telecommunications
manager
to
a
12-month
term
delete
eight
positions
that
have
been
abolished
and
had
seven
classification,
name
changes
and
two
new
classifications.
A
Please
identify
excuse
me.
Please
identify
yourself
for
the
record,
sir
good
morning,
I'm
Stafford,
easterling,
general
counsel,
Personnel
Board.
Thank
you
for
being
here.
There
are
no
amendments.
Are
there
any
questions
from
the
members?
B
B
continuing
on
Board
of
Pharmacy
201
kr2,
360,
2380e
and
ordinary
and
two
450
all,
except
for
the
Emergency
regulation.
Have
staff
suggested
amendments.
J
201
kr2360
amends
to
authorize
emergency
departments
to
stock
naloxone,
so
it
can
be
dispensed
to.
Patients
treated
in
emergency
in
the
emergency
department
before
being
discharged
from
the
outpatient
pharmacy
is
closed,
establish
requirements
for
a
pharmacist,
supplying
naloxone
to
an
emergency
department
per
a
physician,
approved
protocol
and
make
KRS
chapter
13A
changes.
J
201
kr2
380
and
the
amended
after
comments
version
amends
to
change
the
definition
of
prescriber
to
mean
any
Kentucky
licensed
physician
or
advanced
practice.
Nurse
practitioner
add
definitions
for
fully
executed
and
protocol
registry
update
the
protocol
registry
language
and
protocol
procedures.
Add
that
a
pharmacist,
not
a
party
to
a
fully
executed
protocol
shall
not
use
the
protocol.
Add
that
a
pharmacist,
utilizing
the
protocol
shall
be
employed
by
or
contracted
with,
the
permit
holder
require
a
fully
executed
protocol
to
be
submitted
to
the
board
for
inclusion
in
the
protocol
registry
before
use.
J
The
staff
Amendment
amends
Section
1
to
add
a
definition
of
protocol
and
amend
sections
to
comply
with
Keras
chapter
13A
201
KR
2
450
establishes
x
actions
constituting
unprofessional
contact
conduct
by
a
pharmacy
permit
holder,
the
amended
after
comments
version
amends
to
add
definitions
for
provision
of
Pharmacy
services
and
safe
practices.
Clarify
the
list
in
section.
J
That
reports
or
refuses
to
operate
a
pharmacy
that
deviates
from
safe
practices
or
a
pharmacy
that
deviates
from
state
and
federal
law
and
regulations
and
make
other
changes
for
clarity.
The
staff
Amendment
amends
sections
to
comply
with
KRS
chapter
13A
and
amend
Section
1
to
define
a
pharmacy
permit
holder.
A
N
N
So
we
are
here
today
to
express
our
strong
support
for
the
amendments
to
the
board
authorized
protocol
regulation,
as
submitted
by
the
Kentucky
Board
of
Pharmacy.
These
are
needed
to
maintain
extended
access
to
Quality
Care
at
pharmacies
across
our
state
and
to
allow
for
quick
and
efficient
response
to
emerging
public
health
challenges.
In
recent
years,
we
have
observed
firsthand
how
new
and
unexpected
Health
threats
continue
to
emerge
and
impact
our
health
care
delivery
system
to
effectively
respond
to
these
challenges.
Our
system
of
care,
including
that
provided
by
pharmacists,
should
be
agile.
N
These
amendments
are
vital
in
achieving
this
necessary
agility.
Since
the
initial
promulgation
of
this
regulation
in
2017,
the
Board
of
Pharmacy
has
amended
the
regulation
three
times
to
ensure
that
Physicians
and
other
health
care
providers
can
effectively
collaborate
with
pharmacists
to
offer
patient
care
services
for
acute
self-limiting
conditions.
N
The
regulatory
burden
associated
with
these
numerous
amendments
is
high
and
moving
Amendment
to
the
regulatory
process
takes
time.
Reducing
our
ability
to
respond
quickly
with
new
public
health
challenges
arise
while
emergency
regulations
can
be
promulgated,
not
all
public
health
matters
rise
to
the
level
of
imminent
threat
to
public
health,
safety
and
Welfare,
and
yet
can
have
devastating
long-term
impacts
on
the
health
of
kentuckians.
In
a
recent
study
published
in
the
Journal
of
General
Internal
Medicine
researchers
found
that
primary
care
physicians
would
need
27
hours
per
day
to
provide
guideline
recommended
care
to
their
patients.
N
Pharmacists
are
highly
educated
and
trained
to
collaborate
with
visions
and
other
health,
Allied
Healthcare
Providers
through
guideline-based
protocol-driven
care
to
help
treat
acute
minor
ailments
and
provide
preventative
health
services.
These
services
are
in
no
way
meant
to
replace
primary
care
physicians,
but
to
address
gaps
in
care
and
public
health
threats
in
a
timely
fashion.
Working
with,
and
not
opposed
to,
our
physician
colleagues,
all
board
authorized
protocols
must
be
authorized
and
signed
by
a
Kentucky
licensed
physician
or
nurse
practitioner,
and
all
documentation
of
care
goes
to
both
the
signing
provider
and
the
patient's
primary
care
provider.
N
If
they
have
one
The,
increased
utilization
of
protocols
also
serves
as
entry
points
to
the
Health
Care
system,
allowing
pharmacists
to
refer
complex
patients
to
Physicians,
who
may
not
otherwise
have
seen
a
provider
with
90
percent
of
Americans
living
within
five
miles
of
a
pharmacy.
Pharmacist
has
long
been
recognized
as
vital
in
efforts
to
promote
Public,
Health
and
Welfare.
Both
the
state
and
federal
governments
have
relied
upon
pharmacists
to
expand
access
to
care
and
save
lives
for
decades.
N
The
regulation
under
consideration
today
was
drafted
by
the
Board
of
Pharmacy,
following
a
request
by
the
department
of
Medicaid
services
regarding
its
needs
to
ensure
members
had
access
to
Pax
lovid
for
the
treatment
of
covet
19..
The
board
responded
by
filing
an
emergency
regulation
that
would
allow
a
Pax
loaded
protocol
to
be
developed
and
approved
for
use
by
collaborating
physicians
and
pharmacists.
N
This
request
came
after
pharmacists
have
worked
diligently
for
the
past
three
years
to
provide
an
estimated
42
million
covet
test,
administer
two
out
of
every
three
coveted
vaccinations
and
save
an
estimated
450
billion
in
health
care
related
costs.
This
focus
on
providing
patient
care
using
a
team-based
approach
has
resulted
in
better
patient
Health
outcomes
and
saved
state
and
federal
resources
and
eliminating
the
list
of
authorized
conditions.
The
board
has
added
language
to
the
proposed
amendment
that
would
strengthen
its
oversight
on
this
team-based
approach
to
care.
N
The
amended
regulation
would
establish
a
protocol,
Review
Committee
and
a
protocol
registry.
We
fully
support
these
changes
while
we
have
implemented
over
200
protocols
across
the
Commonwealth
and
are
not
aware
of
any
complaints
or
cases
concerning
this
care
since
the
Inception
over
five
years
ago.
These
measures
will
further
strengthen
the
safety
of
our
patients
and
ensure
the
highest
level
of
care.
We
applied
the
generalization
assembly's
recognition
of
the
importance
of
Pharmacists
in
providing
access
to
care
to
serve
our
communities.
Pharmacists
are
highly
educated
and
trusted.
N
Healthcare
professionals
that
have
long
been
seen
as
the
first
point
of
contact
for
patients
seeking
advice
and
care
for
self-limiting
conditions
and
preventative
care.
Successful
implementation
of
this
regulation
will
allow
us
to
continue
to
provide
this
care
as
well
as
address
emerging
Public
Health
needs
in
a
timely
manner.
This
regulation
will
expand
the
reach
of
Physicians
and
other
Allied
Health
Care
Providers,
and
increase
access
points
to
the
Health
Care
system
that
patients
May
otherwise
not
have.
N
A
Thank
you
for
your
testimony.
Mrs
Stoltz.
We
also
have
speak
speaker
with
the
Kentucky
Medical
Association.
If
you'll
come
up.
O
Good
morning
Mr,
chairman
and
members
of
the
subcommittee,
my
name
is
Corey
Meadows
and
I
am
Deputy
Executive
Vice
President
of
the
Kentucky
Medical
Association.
Also
head
up.
Our
advocacy
Department
I
appreciate
the
opportunity
to
offer
comments
this
morning
on
this
regulation.
My
testimony
will
be
an
abbreviated
version
of
written
comments
that
kma
submitted
to
the
Board
of
Pharmacy
during
the
comment
period.
O
At
the
outset,
I
want
to
state
that
kma
is
opposed
to
the
concept
of
board
authorized
protocols
overall,
and
we
believe
that
the
regulation
in
any
form
is
not
sound,
Health
policy.
We
believe
that
any
protocols
that
are
approved
by
the
Board
of
Pharmacy
should
be
approved
by
the
general
assembly,
like
they
have
been
done
in
the
past
before
this
regulation
was
done
in
2017.
But
since
the
regulation
pertaining
to
the
board
authorized,
protocols
is
already
in
existence.
O
I
will
focus
my
comments
and
concerns
regarding
what
the
emergency
regulation
is
already
doing,
and
what
the
ordinary
regulation
is
proposing
to
do,
and
they
are
significant
concerns
number
one.
The
emergency
and
ordinary
regulations
are
unnecessary
and
a
dramatic
shift
away
from
previous
kma
and
Board
of
Pharmacy
discussions.
O
This
regulation
was
originally
proposed
and
adopted
in
2017,
as
I
mentioned,
it
was
finalized
after
detailed
discussions
between
the
kma
and
the
board
regarding
quality
and
patient
safety
in
a
variety
of
situations
based
on
those
discussions,
some
issues
were
addressed.
Unfortunately,
just
a
few
years
later,
the
board
is
now
proposing
revisions
to
the
regulation
that
would
remove
those
safeguards.
O
Such
a
result
would
be
especially
disappointing,
considering
the
changes
are
unnecessary.
The
board
stated
reason
for
the
amendment
is
to
quote:
allow
pharmacists
to
play
a
more
critical
role
in
public
health
and
to
respond
immediately
to
Public
Health
needs
without
the
delay
of
going
through
the
rule-making
process.
O
This
rationale
ignores
the
fact
that
a
process
already
exists
for
the
board
to
respond
to
the
public
health
emergencies.
It's
called
the
emergency
regulation
process
which,
ironically,
the
board
used
in
relation
to
this
amendment,
and
they
also
used
it
in
in
throughout
the
recent
public
health
emergency.
O
Therefore,
if
it
worked
for
this
amendment,
why
wouldn't
why
couldn't
the
emergency
regulation
process
work
for
quickly
responding
to
Future
Public
Health
emergencies?
Furthermore,
it
begs
the
question:
why
would
the
board
want
to
avoid
the
rule-making
process
to
begin
with
number
two?
The
amendment
lacks
sufficient
parameters
and
transparency
up
until
the
emergency
regulation
went
into
effect.
The
regulation
contained
a
specific
list
of
conditions
for
which
the
board
could
develop
a
protocol.
O
By
having
the
list
in
the
regulation,
the
board
was
required
to
open
the
regulation
and
go
through
the
regulatory
process
if
they
wanted
to
add
new
conditions
to
be
treated
through
these
protocols.
However,
the
emergency
regulation
removed
that
list
and
the
ordinary
regulation
proposes
to
permanently
remove
that
list
from
the
regulation
which,
before
the
emergency
regulation,
there
were
17
conditions
that
were
listed
instead
of
the
list.
O
The
board
now
states
that
protocols
can
be
developed
for
quote
acute
self-limiting
conditions
and
other
minor
ailments,
preventive
health
services
and
disease,
State
monitoring
and
management,
as
deemed
appropriate
by
the
board.
End
quote:
this:
opens
the
door
wide
open
without
listing
the
types
of
conditions
and
disease
States.
The
amendment
allows
the
board
to
develop
and
utilize
protocols
for
a
vast
number
of
medical
conditions
without
opening
the
regulation.
O
In
other
words,
the
board
has
a
blank
check
regarding
prescriber
protocols
allowing
the
development
and
implementation
of
protocols
without
notice
or
comment
to
the
legislature,
relevant
advocacy
groups
or
the
public.
This
action
would
effectively
bypass
you,
the
Kentucky
General
Assembly,
as
well
as
the
regulatory
approval
process
established
by
13A
and
run
counter
to
an
open
and
transparent
rule-making
process,
which
is
the
Hallmark
of
good
government.
Now
I
know
there
are
some
staff
changes,
I
have
not
seen
those,
and
there
was
some
mention
about
chapter
13A.
O
If
some
of
this
has
been
corrected,
that
will
be
certainly
a
positive
step,
but
if
it
has
not,
this
regulation
lacks
transparency.
As
a
result,
the
board's
proposed
approach
could
have
significant
Public
Health
implications.
Any
use
of
protocols
should
be
limited,
evaluated
on
a
condition
by
condition
basis
and
specifically
stated
in
statute
by
you
number
three.
The
proposed
amendment
to
the
regulation
removes
necessary
Education
and
Training
requirements
prior
to
the
emergency
regulation.
The
language
of
the
regulation,
specifically
section
4
required,
subject
matter:
Education
and
Training
requirements
for
pharmacists
participating
in
a
protocol.
O
Kma
believes
such
Education
and
Training
is
a
wise
and
necessary
policy.
Reason
being
under
these
protocols,
pharmacies
can
treat
complex
conditions
and
disease
States,
including
involvement
with
tuberculosis,
opioid
use
disorder
and
HIV.
These
are
serious
conditions
in
which
they
would
be
playing
a
role.
If
the
proposed
amendment
is
adopted,
the
number
of
conditions
and
disease
States
addressed
by
these
protocols
would
likely
increase
in
number.
Given
the
potential
increase,
the
board
should
be
looking
to
expand
current
Education
and
Training
requirements.
O
But
inexplicably,
however,
the
proposed
amendment
takes
the
opposite
approach
and
eliminates
all
subject
matter:
Education
and
Training
requirements
for
pharmacists
participating
in
the
protocol.
The
removal
of
Education
and
Training
should
be
reconsidered
to
ensure
quality
care
and
patient
safety.
I
do
want
to
say
that,
based
upon
the
changes
that
were
made,
we
believe
that
they
are
woefully
insufficient
number
one.
The
protocol
committee
that
has
been
established
the
way
that
we
read
the
changes
that
committee
would
focus
on
procedural
requirements
of
the
protocols,
not
substantive,
a
review
of
the
protocol.
O
In
other
words,
we
do
not
read
that
this
protocol
protocol
committee
could
veto
a
particular
condition
from
being
treated
with
a
board
authorized
protocol.
So
they're
the
way
we
read
it,
they're
just
checking
the
procedure
boxes
to
make
sure
everything
is
in
order,
even
if
they
had
veto
power
or
some
sort
of
a
substantive
overview
of
new
protocols
on
that
protocol
committee.
O
There
are
four
pharmacists,
one
physician,
so
the
idea
that
this
is
true
collaboration,
I
think,
falls
short
of
that,
because
clearly,
The
Physician
would
be
outnumbered,
even
if
they
had
some
sort
of
authority
over
the
protocol.
We
believe
that,
at
the
end
of
the
day,
the
Board
of
Pharmacy
can
still
do
what
they
want
to
also
through
this
process.
They
mentioned
that
there
is
still
a
process
for
the
public
to
comment
regarding
the
development
of
these.
Quite
frankly,
I,
don't
know
where
that
language
is.
A
I
Okay,
thank
you.
I
will
address
some
of
the
some
of
the
comments
and
I'll
turn
it
over
to
our
Council
to
address
some
of
the
some
of
the
rulemaking
processes
that
that
were
mentioned.
But
the
mission
that
Kentucky
Board
of
Pharmacy,
first
and
foremost
is
is
public
and
patient
safety,
and
that's
that's
what
we're
focused
on.
We
do
care
about
the
health
of
kentuckians
and
access
to
care
to
evidence-based
treatment.
Current
clinical
guidelines
and,
quite
frankly
the
the
201
KR
380
as
it's
currently
written,
is,
is
insufficient
oversight
by
the
Board
of
Pharmacy.
I
So
we
needed
these
necessary
changes
to
ensure
we
had
the
authority
to
to
make
sure
that
pharmacists
were
acting
with
within
their
their
current
scope
of
practice.
I
The
purpose
of
the
protocol
Review
Committee
is
is
both
to
ensure
compliance
and
to
make
sure
that
that
the
protocols
are
appropriate
and
was
meant
to
be
collaborative
I
did
consult
with
both
Board
of
Nursing
and
board
of
medical
licensure
to
get
comments
and
and
they
they
were
okay
with
with
the
the
changes
and
I
wanted
to
ensure
that
that
they
were
involved
regarding
training,
I
think
it's
important
to
know
that
the
expectation
of
the
Board
of
Pharmacy
is
that
pharmacists
are
properly
educated
and
trained
before
implementing
any
protocol.
I
We
have
the
authority
to
act
based
on
a
standard
of
care
approach
and
we
will
act
on
the
standard
of
care
approach
of
the
pharmacist
acting
outside
of
their
Education
and
Training.
The
protocols
are
specific
regarding
the
training.
It
doesn't
need
to
be
part
of
the
regulation
because
it's
part
of
the
protocol,
the
part
of
the
protocol
Review
Committee,
is
to
ensure
compliance
with
the
current
practice
guidelines.
L
There
was
a
mention
of
attempting
to
bypass
the
rule,
making
process
that
certainly
was
not
was
not
the
intent
of
of
this
regulation.
The
intent
was
to
be
able
to
respond
nimbly
to
Public
Health
situations
that
would
not
necessarily
qualify
for
an
emergency
regulation.
A
Thank
you.
Thank
you.
I
know
we
have
several
members
with
questions.
First
will
be
co-chair
West.
Thank.
H
You
Mr
chairman.
My
question
is
for
the
board
first
and
I'm
going
to
have
you
guys
give
me
the
answer
to
this
question.
Then
Mr
Meadows.
If
you
would
give
me
your
version
of
the
answer
to
that
question
so
and
I'm
going
to
kind
of
throw
you
a
softball.
H
So
an
imminent
threat
I
want
you
to
give
me
an
example.
A
real
life
example
of
where
this
would
come
into
play,
I'm
assuming
covet,
would
be
a.
H
G
H
Yeah
so,
for
instance,
in
in
the
states
overall
response
to
covid
the
Board
of
Pharmacy,
you
know
the
the
medications
that
that
flow
through
the
process
to
treat
covid.
What
does
that
look
like
now
and
after
this
red?
If
this
reg
were
to
proceed
forward?
What
would
that
process?
Look
like
after
the
fact.
L
L
L
Help
me
understand
so
so.
Currently,
under
KRS
13A,
we
are
authorized
to
promulgate
an
emergency
regulation
to
respond
to
an
imminent
threat
to
public
health
and
safety.
So
obviously
you're
exactly
right.
Covid
is
a
situation
where
we
did
see
that
threat.
L
In
fact,
we
saw
a
national
Declaration
of
emergency,
and
so
whenever,
whenever
we
approved
the
emergency
regulation
here,
that
was
at
the
request
of
the
Cabinet
for
Health
and
Family
Services
needing
to
be
able
to
provide
Medicaid
patients
with
Pax
lovid,
Pax,
lovid,
obviously
being
a
therapeutic
for
covid-19,
so
that
that's
just
a
situation
how
we
utilize
this
in
the
emergency
setting
in
a
situation
that
would
qualify
as
an
imminent
Public,
Health
Emergency.
I
Something
that
might
most
recently
you
know
both
alcohol
use,
disorder
and
opioid
use
disorder.
Those
would
not
rise
to
the
level
of
emergency
regulation,
but
we've
effectively
implemented
those
protocols.
Now
opioid
use
disorder
was
part
of
the
original
authorized
conditions
and
then
we
ended
up
adding
alcohol
use
disorder
at
a
later
time.
So
those
are
examples
where
we
wouldn't
necessarily
need
to
file
an
emergency
regulation,
but
it's
an
authorized
condition.
That's
really
necessary
for
for
the
people
of
Kentucky.
O
In
response,
I
think
they
very
articularly
laid
out
for
you,
the
process
that
currently
exists
and
why
it
currently
works.
We're
not
sure
why
we
have
to
have
a
middle
ground.
If
there's
an
imminent
threat,
I
believe
the
words
were
used,
then
the
emergency
regulation
process
exists.
I
think
we
can
all
agree
during
the
covid
pandemic,
there
were
no
shortages
of
emergency
regs
to
respond
to
that
Public
Health
crisis.
O
But
essentially,
what
we're
establishing
here
is
a
is
another,
a
third
option
for
the
Board
of
Pharmacy
to
utilize
that
unfortunately,
as
I
mentioned,
takes
away
Education
and
Training
and
bypasses
you
and
that's
the
essence,
as
I
mentioned,
of
transparency
and
good
government.
So
we
do
not
agree
that
there
should
be
a
third
option.
We
think
there
should
be
the
emergency
reg
process,
as
well
as
the
ordinary
reg
process.
M
Thank
you,
Mr
chairman,
it
was
stated
that
I
guess
I
want
some
clarification
on.
What
does
that
mean
that
you
wouldn't
qualify
for
an
e-reg?
Give
me
a
scenario
in
which
you
wouldn't
qualify
for
an
e-brag.
L
Well,
I
think
if
there
was
a,
for
example,
like
let's
say
there
was
an
outbreak
of
a
specific
condition,
but
it
was
limited
to
a
certain
Community.
It
maybe
didn't
impact
all
of
the
citizens
of
the
Commonwealth
I
I,
don't
know
if
that
would
necessarily
qualify
for
for
an
emergency
regulation.
I
mean
it's
a
it's
a
fairly
I
know
working
with
young
Governor
beshears
staff.
It's
a
it's
a
pretty
hefty
burden
that
that
they
want
to
us
to
be
able
to
to
exemplify
that
we
have
a
true
emergency
and
with
covid-19.
L
Of
course,
it's
easy.
It's
impacted
everybody.
We
haven't.
We
have
a
national
declaration,
but
there
are
situations
where
we
might
not
have
that.
You
know
that's
an
extreme
example.
There
are
situations
where
we
might
have
an
outbreak
of
something
and
pharmacists
will
not
be
able
to
participate
in
treatment
if,
if
we
don't
qualify
for
an
emergency
regulation
until
potentially
six
to
eight
months
later,.
M
So
you're
saying
we
could
have
a
specific
outbreak
of
something
and
you
wouldn't
qualify
for
an
e-reg
I,
just
I.
That
seems
like
a
sudden,
a
hypothetical
that
would
never
exist,
because,
if
there's
an
outbreak
on
something
I
think
that
there
would
be
an
immediate
engagement
on
that
Public
Health
crisis
through
the
e-reg
process.
M
So
I'm
struggling
with
your
example,
but
second
of
all,
I.
Remember
that
bill
where
we
actually
the
statute,
where
we
actually
laid
out
those
protocols.
That's
I'm,
aging
myself.
Now
was
it
17
or
18
I
forget
and
it
that
was
a
that
was
a
very
challenging
time
because
we
were
allowing,
through
a
leap
of
faith
for
pharmacists,
to
participate.
M
You
know
kind
of
one-on-one
with
that
patient
by
putting
forth
a
very
specific
list
of
conditions
that
we
could
develop
protocols
around
and
that
was
not
taken
lightly
and
public
health
was
really
at
the
Forefront
of
a
lot
of
these
members.
M
Concerns
with
that
bill,
and
so
I
I
feel
as
if
this
is
we've
kind
of
jumped
the
shark
on
that
transparency
and
that
collaboration
on
that
original
process
in
2017
and
so
I
Mr
chairman
I,
have
some
concerns
about
moving
this
forward,
because
I
just
I
I,
don't
think
that
we
have
a
problem
that
needs
to
be
solved
right
now.
Thank
you.
A
Thank
you
senator
so
being
from
the
the
pharmacy
sector.
I,
you
know,
I
know,
we've
had
conversations
on
this
and
I
do
see
a
need.
I
also
think
it's
important
to
recognize
the
fact
that
you
know
in
our
discussions
with
staff
that
you
know
I
asked
you
know
specifically,
did
you
all
have
the
authority
to
do
this
and
they
saw
no
issue.
That
being
said,
I
am
just,
but
one
member
and
my
co-chair
also
has
some
comments.
H
Thank
you,
Mr
chairman
circling
back
a
little
bit,
I'm
gonna
read
from
13A
on
the
requirements
to
have
emergency
reg,
so
emergency
administrative
regulation
is
one
that
a
and
then
there's
a
list.
One
two
three
four
number
four
is
protect:
human
health
and
the
environment.
H
You
could
drive
a
truck
through
that
you
know
that's
a
pretty
expansive
reason
to
have
an
emergency
reg
and
just
because
there's
an
outbreak
of
something
in
a
certain
part
of
the
state
doesn't
mean
you
can't
have
an
emergency
reg
I
think
you
could
have
an
outbreak
in
a
certain
area
and
it
would
still
rise
to
an
imminent
threat
to
to
allow
for
an
emergency
reg,
and
you
know
the
the
comment
about
the
administration
sees
that
as
a
heavy
burden
to
meet
that
status
to
have
an
administrative
Reg.
H
We
got
a
drag
coming
up
where
the
administration
is
saying.
His
press
release
is
good
enough.
It's
met
the
burden
to
have
an
emergency
wreck
so.
H
This
is
a
very,
very
important
issue
and
to
me
we're
forming
an
intermediate
step
that
takes
away
some
transparency
and
and
these
new
protocols
would
not
then
have
to
come
before
this
committee.
There
would
be
that
intermediate
step,
and
so
at
the
very
least,
I
I
would
ask
for
a
deferral
of
this
regulation,
so
it
could
be
discussed
more
and
go.
Go
through
the
process,
a
little
bit
more
and
go
back
and
forth.
So
that
is
my
request
to
the
board.
H
At
this
time.
Mr
chairman.
M
If
we
defer,
what
does
that
look
like
to?
Is
it?
Does
the
Board
of
Pharmacy
get
together
with
the
kma,
and
they
have
conversations?
What
what
do
we
anticipate
this
deferral?
Looking
like.
A
It
sounds
as
if
there's
some
unresolved
issues
on
both
sides.
As
for
what
the
agency
does
from
there
will
be
up
to
them.
I
do
look
forward
to
working
on
this
issue
and,
if
there's
some
resolution
we
can
come
to
with
that
being
said,
is
there
a
motion
for
deferral?
A
A
J
201
kr8016
amends
to
clarify
initial
registration
and
renewal
requirements
and
update
forms.
201
KR
8520
amends
to
create
a
fee
schedule
for
the
registration
of
mobile
Dental
facilities,
including
150
registration
fee
and
a
biennial
75
dollar
renewal
fee
and
the
penalty
fees
for
late
renewal
that
range
from
150
to
225
dollars.
2001
KR
8571
amends
to
clarify
registration
and
expanded
Duty
requirements
for
dental
assistance
and
update
the
delegated
duties
list.
The
staff
amendments
for
these
regulations
all
make
changes
to
comply
with
Karis
chapter
13,
a
Additionally.
The
staff
Amendment
for
201
care.
E
A
A
J
201
KR
2370
amends
to
consolidate
online
and
paper
application
forms
and
update
forms
for
clarity,
electronic
submission
and
to
make
formatting
and
font
related
changes
with
a
substance
of
content
being
left.
Generally
the
same.
The
staff
Amendment
amends
section
2
to
restore
the
previous
language
of
an
application
for
licensure
by
endorsement
lapsing
within
one
year
from
the
date
of
the
application
form
being
filed
with
the
board
office
and
I'm
in
section
one
to
comply
with
Karis
chapter
13A.
A
Yes,
good
morning,
Jeff
Prather
general
counsel,
Board
of
Nursing.
Thank
you
so
much.
There
is
a
staff
Amendment.
If
I
can
get
a
motion
for
approval
without
objection,
so
ordered
there
any
questions
from
the
committee
without
no
further
questions.
Thank
you.
Please
call
the
next
regulation.
Thank
you.
A
A
B
E
301-2-22-3012-221
is
being
amended
to
change
the
closing
date
for
falconry
waterfowl
season
to
last
Sunday
in
February
for
all
species
of
waterfowl,
remove
reference
to
conservation
order
like
these
seasons
and
make
technical
Corrections
3012
228
is
being
amended
to
remove
the
requirements
of
metal
leg
tags
on
harvested
cranes.
The
staff
suggested
amendments
to
these
regulations
amidst
various
sections
to
comply
with
drafting
requirements
of
Karis
chapter
13A
and
make
technical
changes.
G
A
A
H
B
A
E
806-17280
amends
the
requirements
for
internal
appeals
of
the
step
therapy,
exception,
denial
and
establishment,
reporting
process
for
insurers
and
Pharmacy
benefit
managers
to
annually
report.
The
total
number
of
Step
therapy
exceptions
denied
or
approved,
and
what
category
of
services
were
denied
or
approved
and
make
technical
changes.
The
staff
suggested
Amendment
amidst
various
sections
to
comply
with
the
drafting
requirements
of
KRS
chapter
13,
a
ad
clarifying
language
and
make
technical
changes
and
amends
the
material
Incorporated
by
reference
to
comply
with
the
statutory
requirements
and
make
technical
changes.
E
806-17290
is
being
amended
to
subject
step
therapy
exception,
denials
and
step
therapy,
internal
appeal,
denials
to
the
external
review
process
of
an
independent
review
entity
and
make
changes
to
material
Incorporated
by
reference.
The
staff
suggested
Amendment
amends
section
12
and
the
material
Incorporated
by
reference
to
make
technical
changes.
A
H
A
H
A
B
J
907
kr1680
amends
to
make
participation
permissive
and
allow
reimbursement
for
certain
providers,
regardless
of
Provider
program
participation
and
amend
sections
to
comply
with
KRS
chapter
13A.
Nano
7kr3010
amends
to
clarify
that
only
providers
enrolled
in
the
vaccines
for
children
program
cannot
receive
reimbursement
for
the
cost
of
the
vaccine
if
it
is
readily
available
in
their
enrolled
providers.
A
B
J
911
KR
1060
amends
to
remove
the
provisional
status
process
and
update
material
Incorporated
by
reference
911
KR
1085.
It
means
to
reduce
the
time
frame
from
seven
days
to
48
hours
for
returning
a
form
when
there
is
evidence
of
hearing
loss
update.
The
American
Academy
of
audiology's
guidance
document
include
an
option
for
audiological
centers
to
notify
the
office
of
a
name
change
with
the
modification
form
and
update
references
to
change
commission
to
office.
911
KR
1090
establishes
requirements
for
requesting
an
appeal
by
administrative
hearing
through
the
office
of
the
Ombudsman
and
administrative
review.
R
A
K
A
There
are
no
more
questions
or
comments.
Thank
you
all
for
coming.
Please
call
the
next
regulation
thank.
B
J
921
kr2510
amends
to
increase
the
maximum
benefit
for
rip
Services,
provided
with
Federal
temporary
assistance
for
needy
families,
block
grant
funds
to
eligible
Kentucky
families
who
need
to
relocate
to
accept
or
maintain
employment,
escape
a
domestic
violence
situation
or
prevent
homelessness.
Update
other
program
names
for
consistency
with
other
regulations
in
process
and
update
the
application
for
relocation.
Assistance
to
include
information
pertaining
to
the
housing
crisis.
B
A
A
A
E
907
1026
an
emergency
amends
the
Kentucky
Medicaid
Program
Dental
Provisions,
to
make
technical
Corrections
remove
age
limits
on
many
applicable
services,
update
the
term
direct
provider,
contact,
Direct
provider.
Interaction
to
include
Telehealth
delete
the
definition
for,
and
references
to
the
term
Locum
tenants,
dentist,
remove
the
limit
of
12
Dental
visits
per
year,
establish
additional
requirements
pertaining
to
Orthodontics
and
dental
space.
A
West
we've
received
several
members
of
this
committee
have
reached
out
to
us
several
dividers
in
our
district
I
guess,
there's
been
quite
a
bit
of
confusion
about
some
of
these
regulations
and
why
would
be
an
emergency
sorry,
I.
A
Gotcha
gotcha,
so
yeah
there's
been
quite
a
bit
of
confusion
on
why
you
know
these
regulations
need
to
have
an
emergency
with
them.
I
I
do
appreciate
what
you
you
do
and
what
your
cabinet
does
being
in
the
realm
myself
I,
you
know
fully
understand
and
for
helping
patients
across
Kentucky
I
know
the
providers
that
I've
spoken
with
there's
been
concerns
that
perhaps
the
communication
between
these
e-rags
going
into
effect
and
the
delayed
implementation
of
CMS
has
been
confusing
to
both
them.
The
mcos
and
the
patients
themselves.
A
S
And
I
will
agree
that
the
communication
has
not
been
optimal.
It
has
not
been
what
it
should
have
been
once
the
regulations
have
been
filed.
We'd
have
been
into
discussions
with.
Providers
have
been
contacting
the
department,
particularly
the
dental
Community,
we've
heard
from
several
oral
surgeons
in
addition
to
the
dentist
community,
and
we
have
been
discussing
some
of
the
changes
that
we're
making
to
make
sure
that
we
can
roll
them
out
appropriately.
H
Herman
West,
thank
you
Mr,
chairman
first
question
is:
is
it
safe
to
say
this
is
a
pretty
large
expansion
of
services
in
this
space?
Is
that
correct.
S
I,
wouldn't
necessarily
categorize
it
as
a
large
expansion.
Several
states
do
cover
the
same
services
in
their
Dental.
What
I
would
say
is
that
we
are
doing
this
in
an
effort
to
offset
future
costs.
We
know
that
poor
Dental
Care
is
associated
with
heart
disease,
pre-term
deliveries.
We
know
that
the
cost
of
caring
for
little
infants
that
are
in
the
neonatal
Intensive
Care
Unit
is
extremely
expensive,
and
if
we
can
allow
just
another
dental
cleaning,
some
preventive
services
for
our
pregnant
population,
we
believe
that's
going
to
offset
some
of
those
costs.
S
Hearing
aids,
for
example,
there
is
studies
that
have
Studies
have
been
conducted
that
show
that,
within
a
year
of
getting
a
hearing
aid
when
with
hearing
loss
that
the
the
chance
of
developing
dementia
decreases
by
18
percent,
so
in
addition
to
helping
our
population
with
the
improve
their
Health
Care
status,
the
other
thing
that
we
are
focusing
on
is:
we
know
that
Public
Health
Emergency
is
expiring.
Due
to
covet
is
expiring
in
may.
S
We
do
know
that
we
have
several
individuals
that
will
be
exiting
the
Medicaid
Program,
because
during
the
public
health
emergency,
we
could
not
discontinue
anyone
from
the
Medicaid
Program
unless
they
passed
away,
they
moved
out
of
state
or
they
requested
to
be
disenrolled.
So
what
the
other
piece
of
this
is
the
the
expansion
is
some
of
those
individuals
that
will
be
exiting
if
we
can
catch
them
beforehand.
If
they
need
glasses,
if
they
need
hearing
aids
or
some
dental
work,
we
want
them.
S
Believe
we
have,
we
have
anticipated
initially
about
89
million
dollars,
and
that
is
both
state
and
federal
funds
going
forward.
We
anticipate
some
of
those
costs
to
be
offset
by
reduced
emergency
room
utilization.
Currently
we
pay
over
nine
million
dollars
a
year
for
adult
Dental,
Services
conducted
or
performed
in
the
emergency
room.
We
believe
some
of
those
costs
will
be
offset
and
again
going
back
to
the
dementia.
S
I
would
have
to
go
back
and
just
just
double
check.
The
minutes.
I
know
that
we
have
been
in
discussions
with
Medicaid
advisory
Council.
Since
the
regulations
have
been
filed.
We
have
also
had
several
I
think
very
productive
discussions
with
the
dental
technical
advisory
Council.
We
have
had
some
recommendations
from
the
optomet
Optometry
technical
advisory
Council,
their
recommendation
Center
on
a
course
medical
necessity
and
quality
of
glasses.
If
you
look
at
the
regulation,
you'll
see
that
frames
are
limited
to
fifty
dollars.
S
I
think
my
last
pair
of
glasses,
that
I
bought
cost
over
seven
hundred
dollars.
So
fifty
dollars
for
a
pair
of
frames
is,
as
you
can
imagine
what
the
quality
of
those
frames
would
be.
So
we
are
having
discussions
and
and
again
I
think
the
communication
could
have
been
much
better,
but
now
that
we're
having
these
communications
we're
not
only
talking
about
the
services
that
we're
hoping
to
deliver
now
we're
also
talking
about
specific
reimbursements.
I
know
one
of
the
biggest
complaints
from
our
provider.
S
Community
is
reimbursement
so
instead,
instead
of
looking
at
Big
broad
sweeping
across
the
board
changing
room
in
in
reimbursement,
we
are
looking
at
very
specific
codes,
specifically
related
to
preventive.
We
have
also
discussed
with
their
Managed
Care
organizations
and
they
have
agreed
to
increase
their
cost
to
the
Medicaid
fee
schedule.
H
D
S
Not
to
me
I
think
that,
on
some
of
the
committee
meetings
there
was
an
expression
for
example.
Last
week
this
week,
sorry
my
days
are
running
together,
an
expression
of
us
moving
us
being
the
department
for
Medicaid
services
moving
forward
with
the
regulations
without
input
from
some
of
the
general
assembly.
H
That's
that's
our
unders,
that's
my
understanding
as
a
member
of
this
committee
that
that
other
members
have
expressed
clear
objections,
not
to
really
not
in
essence
to
it,
the
the
break
itself
or
what
it's
attempting
to
do.
But
the
idea
I
believe
a
lot
of
this
money
came
from
savings
associated
with
sb50
and
the
PBM
Senator,
wise's,
Bill
and
I.
H
Think
the
general
idea
was
we
want
to
say
and
where
this
money
flows
to
and
to
piggyback
on
what
you
were
saying
that
we
hear
complaints,
pretty
consistent
complaints
that
we,
you
can't
find
providers
now
to
provide
the
services,
because
the
reimbursement
rates
are
too
low.
So
we
should
take
a
deep
dive.
Maybe
look
at
that
first
before
we
do
this
wide
expansion
and
that
that's
that's
what
I'm
hearing
on
my
side
but
I'll
I'll
hold
off
for
right
now
and
I
think
we
have
other
questions.
M
Thank
you,
Mr
chairman
and
I'm,
just
going
to
Echo
what
chairman
West
said.
Most
of
the
feedback
that
I've
gotten
on
this
Medicaid
expansion
has
been
from
the
provider
Community.
You
know
they're
struggling
now
with
with
these
low
reimbursement
rates,
and
they
said
you
know
we
don't
even
want
to
take
Medicaid
patients
anymore,
because
it's
just
we're
not
adequately
compensated
for
the
care
that
we're
providing
so
I'll
just
Echo.
M
Those
sentiments
that
looking
at
expanding
those
reimbursement
rates
for
our
current
providers,
rather
than
expanding
the
what
is
allowable
I
think
is
maybe
a
good
place
to
start.
Thank
you.
Mr
chairman.
A
Thank
you
Senator
and
I'll
Echo
those
comments
as
well.
You
know
Eastern
Kentucky,
where
I'm
from
you
know,
I
in
preparation
of
the
day,
I
reached
out
to
a
lot
of
my
dental
friends,
and
you
know
if
you
look
at
the
statistics.
Yes,
you
can
cite
that
you
know.
75
are
you
know
accepting
Medicaid,
but
most
of
them
are
not
accepting
new
programs
they're
breaking
even
at
Best,
in
most
cases
losing
money.
It's
a
loss
leader
in
some
in
some
areas.
A
Transportation
is
a
major
concern
in
Eastern
Kentucky
as
well
all
across
the
state
really,
and
so
we
are,
you
know
essentially
generating
Healthcare
deserts.
I
talked
to
some
optometrists
and
you
know,
while
they,
you
know,
probably
participate
more
so
than
anybody
else.
I
guess
there
are
concerns
and
you
brought
some
up
dealing
with
the
lenses.
A
I
know
on
the
contact
lenses
they're
only
eligible
I,
think
for
like
one
for
each
eye
every
year,
the
hard
ones-
and
it's
just
you
know
not
really
idea
for
ideal
for
patient
care
and
then,
if
you
look
at
the
reimbursement
rates
when
you're
looking
at
the
rest
of
the
market
on
your
Medicaid
rates
versus
your
commercial
and
Medicare
rates,
you
know
there's
significantly
lower
I.
Believe
I
was
cited.
I
believe
rates
have
not
been
increased
in
over
15
years
and
done
a
lot
of
Wagers
farther
than
that.
A
So
well,
I'll
echo
my
colleagues
position
that
we
support
I
also
support,
but
we
understand
what
you're
trying
to
do.
It
might
be
a
better
way
of
using
this
money
to
to
get
there.
D
A
T
Thank
you,
Mr
chair,
there's,
a
number
number
of
issues
and
questions
I.
Have
you
stated
that
it's
not
a
great
expansion,
but
you
said
the
cost
is
89
million
dollars.
I
will
tell
you
that's
a
great
expansion,
I
fight
bills,
asking
for
a
few
hundred
thousand
dollars
for
certain
really
needed
items
and
This
falls
into
what
I
think
is.
Appropriations
of.
I
T
You
don't
have
that
Authority
just
flat
out
that
as
a
general
assembly,
you
can
call
it
reappropriation
of
funds,
but
reappropriating
is
appropriating
funds
and
while
there
are
some
good
intentions
here,
we've
talked
about
reimbursements,
I,
think
in
lower
population
areas
there
will
be
those
that
will
refuse
to
offer
this
service
because
of
reinforcements
have
not
been
adjusted.
Also
so
I
I've
really
got
some
problems
with
this
Mr
chair.
K
Thank
you
for
being
here
today
and
as
a
provider
that
already
participates
in
the
hearing
program
and
I.
Do
it
because
I
have
a
heart
for
children
and
I
know
how
important
it
is
and
I
do
totally
applaud
the
stats
that
you
have
recited
regarding
prevention
of
dementia
and
the
importance
of
hearing
it
at
all
ages,
so
I'm,
very
supportive
of
that,
but
in
just
as
an
example
of
how
things
are
in
practice
and
what
you're
asking
a
provider
to
do
right
now.
K
The
fee
schedule
for
a
hearing
aid
is
eight
hundred
dollars
per
per
device,
so
I'm
asked
to
purchase
that
device.
Have
it
set
on
my
accounts,
receivable
send
in
a
copy
of
that
receipt
with
my
claim,
while
I'm
waiting
for
it
to
get
approved.
Then
after
weeks
of
resubmissions
I,
finally
get
it
approved.
I
then
have
to
contact
the
patient,
get
the
patient
in
and
then
I
cannot
submit
it
for
payment
until
after
the
patient
is
fitted.
K
So
that
device
has
been
sitting
on
my
accounts
receivable
for
months
and
then
I
have
to
wait
another
couple
of
months
before
I
actually
receive
payment,
so
I
go
in
the
hole
every
time.
I
do
it,
but
I
do
it,
because
I
have
a
heart
for
children
and
I
know
how
important
it
is.
So
those
are
just
things
that
need
to
be
worked
out
and
I.
Think
it's
just
another
example
of
maybe
it's
the
cart
before
the
horse.
We're
not
we're
not
it's
a
good
initiative,
but
it's
just
we.
K
A
H
S
The
department
for
Medicaid
services
has
approximately
22
technical
advisory
committees,
those
committees
hold
meetings,
sometimes
every
other
month,
sometimes
every
quarter
and
in
most
meetings
we
do
talk
about
specific
policies
and
we
ask
for
input
regarding
policies
that
we
can
make
to
improve
access
to
improve
the
delivery
of
services.
Most
often
the
recommendations
that
we
get
are
centered
around
reimbursement
or
administrative
procedures.
S
So
we
have
asked
for
input
so
while
they
have
provided
some
input
on
that
when
we
delivered
these
when
we
promulgated
the
regulations,
the
technical
advisory
committees,
now
the
dental
specifically
led
by
Dr
babowski
are
digging
into
the
policies
now
they're,
actually
looking
at
ways
to
make.
All
of
these
Services
work,
they're
looking
at
ways
to
improve
the
health
status
of
the
state
of
this
Co
of
the
state
of
Kentucky
by
focusing
on
preventive
oral
health.
So
we're
having
some
great
conversations
right
now,
I'm
glad
we're
having
them
I
wish.
S
H
H
Thank
you
so
so
under
13,
a
if
you're
going
to
do
an
emergency
rig,
you
have
to
provide
documentary
evidence.
What
documentary
evidence
did
the
cabinet
provide
to
move
this
reg
forward
and
and
show
that
there
was
an
immediate
threat
to
Public
Health
or
you
know
that
it
should
have
an
emergency
status.
S
Well,
we
believe
that
improving
the
health
status
of
individuals
through
the
vision,
hearing
and
Dental
Programs
are
very
important,
for
example,
again
going
back
to
poor
oral
health
and
pregnant
women
resulting
in
pre-term
deliveries,
poor
oral
health
contributing
to
heart
disease,
diabetes,
things
that
we
know
are
killing
individuals
in
the
Commonwealth.
We
think
it's
very
important
to
be
able
to
try
to
identify
those
procedures
up
front,
do
what
we
can
to
prevent
those
costs
and
those
health,
health,
health
diseases,
those
those
Health
Care
statuses
from
being
worse
in
the
future,
for
our
adult
population.
H
D
H
H
H
H
Okay,
yeah
so
I'm,
actually
looking
at
it
right
here,
the
documentary
evidence
presented
was
the
governor's
press
release
a
copy
of
the
statute
itself.
H
I,
don't
even
know
what
this
is
like
a
a
page
out
of
a
handbook
of
some
sort,
I
just
felt
that
was
kind
of
lacking.
You
know
that
that
was
there
was
something
lacking
there
to
show
that
this.
This
was
an
emergency
and
I'll
just
wrap
up.
I
I
think
this
is
I.
Don't
think
this
is
a
small
thing.
This
is
a
huge
expansion
and
I
think
what
we're
hearing
on
our
side
is
that
that
the
general
assembly
wants
to
have
a
say
in
that
expansion.
H
We
want
to
have
a
say
in
how
you
know:
38
million
dollars
is
allocated
or,
as
representative
Bridges,
clearly
states
appropriated
we're
appropriating
funds
and
and
we're
appropriating
funds
in
an
area
where
there's
been
tremendous
complaints
about
reimbursements
already
so
I
can't
speak
for
the
entire
general
assembly,
but
I'm
sure
some
of
our
members
would
probably
say:
let's
get
the
reimbursement
thing
fixed
first
before
we
start
throwing
money
down
this
hole,
but
at
the
very
least
the
general
assembly
should
have
a
say
first,
so
I'll
give
back
to
you.
C
Thank
you,
Mr
chairman.
This
is
just
another
example
of
Governor
brashear's
complete
and
total
dismissiveness
towards
the
general
assembly
he's
the
governor
of
the
executive
branch
of
the
Commonwealth,
not
the
Supreme
potentate
of
4.5
million
people
who
live
here
I'd
make
the
motion
myself
but
I'm,
going
to
defer
to
my
colleague
in
the
Senate
co-chairman
West
can't
wait
to
vote.
H
Thank
you
Mr
chair.
If,
if
it
is
an
order,
I
would
make
a
motion
of
deficiency
for
907
KR
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907
KR
1026,
907,
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907,
kr1038,
907,
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A
C
T
I'd
like
to
vote
I
and
with
a
little
explanation,
this
is
definitely
an
Appropriations
measure.
This
is,
and
the
timing
of
this
is
very
unusual.
T
Usually
we
get
these
when
we're
not
in
session.
We
are
in
session,
we
can
make
statute,
we
can
make
Appropriations
and
yet,
rather
than
bring
it
to
the
general
assembly
or
to
a
legislator
and
general
assembly
I've
not
seen
one
bill
filed
to
address
this,
and
this
is
the
time
to
do
it
and
I'm
very
disappointed.