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From YouTube: Medicaid Oversight and Advisory Committee 6-16-21
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A
B
B
C
B
A
Our
first
presentation
will
be
upon
medicaid
works
program
and
we
have
commissioner
lisa
lee
department
of
medicaid
services
with
us
and
if
you
would
come
forward,
miss
lee
and
introduce
your
guest
and
introduce
yourself
for
the
record.
D
B
D
D
F
D
D
It
is
for
individuals
who
are
either
blind
or
disabled
and
make
too
much
money
to
qualify
for
medicaid.
So
previously,
individuals
who
had
a
physical
disability
or
medical
disability,
they
had
high
health
insurance
costs.
They
had
a
difficult
time
finding
health
insurance
that
was
affordable
to
them.
Sometimes
they
may
have
been
denied
coverage
because
they
had
a
pre-existing
condition
if
they
work
their
employers
may
not
offer
health
insurance.
D
D
So
the
ticket
to
work
in
incentives,
improvement
act
of
1999
created
an
option
for
individuals
with
disabilities
to
buy
into
the
medicaid
program,
so
individuals
who
would
be
eligible
for
ssi
benefits,
except
for
their
earnings,
was
eligible
for
this
program
and
as
part
of
that
program,
medicaid
could
extend
eligibility
to
eligibility
to
those
individuals
and
could
even
extend
eligibility
up
to
250
percent
of
the
federal
poverty
level.
We
could
medicaid.
D
D
So
again
we
implemented
medicaid
works
in
2007
and
the
reason
that
we
did
this
we
were
approached
by,
I
think
it
was
vocational
rehab.
There
were
a
couple
of
individuals
who
had
medicaid,
they
were
disabled,
they
had
medicaid,
but
they
wanted
gainful
employment
and
when
they
went
to
work
they
lost
their
medicaid
and
they
had
no
additional
health
insurance
coverage.
The
employer,
their
employers
did
not
offer
coverage,
they
were
denied
coverage
because
they
had
a
pre-existing
condition.
D
So
we
created
the
medicaid
works
program,
the
eligibility
criteria
again
an
individual
has
to
be
blind
or
disabled
and
they
have
to
meet
the
social
security
definition
of
an
individual
who
is
disabled
and
they
could
continue
to
be
eligible
for
medicaid,
except
for
their
employment
earnings.
So
again,
back
in
2007
an
individual
had
to
be
disabled
and
they
had
to
have
income
guidelines.
They
had
to
meet
the
income
guidelines
which
was
at
or
below
the
federal
poverty
level.
So
those
individuals
who
were
working,
who
were
disabled,
maybe
made
a
few
dollars
over
the
poverty
scale.
D
They
lost
their
medicaid
benefits
and
again
these
are
individuals
who
really
need
health
insurance
because
of
their
medical
status
for
individuals
between
the
ages
of
16
and
64..
They
also
have
to
meet
resource
standards
for
medicaid,
which
is
four
thousand
dollars
in
personal
assets,
and
only
the
income
of
the
working
disabled
is
counted
in
this
program.
Other
eligibility
categories.
We
count
the
entire
family
income.
This
one
only
counts
the
income
of
the
disabled
individual
and
they
can
have
earned
income
of
up
to
773
dollars.
D
Monthly
and
unearned
income
includes
social
security
workers,
comp
or
veterans
benefits.
So
since
2007
we've
only
had
15
unduplicated
members
enrolled
in
medicaid
works
program,
we
have
five
currently
enrolled
and
they're
all
at
or
below
100
of
the
federal
poverty
level,
which
means
they
do
not
they're
not
required
to.
F
D
A
premium,
and
so
this
this
program
again
has
been
around
for
a
while,
and
I
don't
know
if
it's
had
that
much
attention.
So
since
2014,
since
we've
expanded
medicaid,
I
mean
we,
we
could
look
at
moving
that
population
to
the
medicaid
expansion
population.
We
believe
that
there
are
probably
individuals
who
may
have
qualified
for
medicaid
works,
but
they
just
went
ahead
and
enrolled
in
medicaid
expansion,
because
it
is
is
up
to
138
percent
of
the
federal
poverty
level.
D
In
addition,
we
get
a
higher
match
rate
for
individuals
who
are
enrolled
in
the
medicaid
expansion
population
and
then
again,
house
house
joint
resolution.
57
has
a
provision
for
a
work
group
to
explore
a
bridge
plan.
This
could
be
something
else
that
some
of
those
individuals
who
actually
fall
out
of
the
medicaid
program
and
have
difficult
time,
maybe
finding
a
product
on
the
exchange,
that's
affordable
due
to
certain
regional
differences
in
the
state,
could
benefit
from
maybe
a
bridge
plan.
C
You,
commissioner,
lee
and
seems
like
a
kind
of
unique
niche
product.
If
you
want
to
call
different
medicaid
and
I
certainly
understand
the
need
for
it,
I
guess
the
only
question
I
would
have
is:
why,
wouldn't
you
want
to
fold
this
into
the
medicaid
expansion?
It
would
make
sense
to
turn
to
administration
and
simplicity
of
it,
and
I
think,
maybe
a
lot
of
people.
Don't
look
for
it
and
say
a
lot
of
people.
C
D
D
I
think
that
we
would
need
to
do
some
system
changes
and
just
do
some
eligibility
cr
criteria
for
the
for
our
workers,
who
determine
our
eligibility
process,
make
sure
they
have
the
appropriate
criteria,
but
I
think
it
would
be
a
pretty
simple
move.
As
you
know,
this
probably
came
about
because
of
the
cost-sharing
regulation.
D
The
premium
was
outlined
in
our
call
sharing
regulation,
so
that
probably
brought
a
little
bit
of
attention
to
this
program
and
which
is
a
good
thing,
because
now
we
can
roll
that
over.
Like
you
said
for
administrative
simplification,
it
would
be
a
good
idea
and
we'll
go
back
and
look
and
see
what
activities
we
need
to
undertake
in
order
to
make
that
happen.
Okay,
good.
D
E
2007.,
so
that
was
I'm
thinking
prior
that
was
prior
to
our
medicaid
expansion.
E
D
E
G
Thank
you,
mr
chairman.
I
guess
I've
got
several
thoughts,
but
first
of
all
the
question
first
question
unduplicated
just
that
they
just
weren't
in
it
more
than
once
I
mean.
Is
it
just.
D
Sometimes,
when
you
run
eligibility
numbers,
if
you,
if
you
run
it,
for
example,
month
to
month,
you'll
pick
up
a
whole
num
a
whole
different
number
of
of
individuals,
because
if
an
air
eligibility
runs
month
to
month.
So
if
you
don't
unduplicate
that
over
the
year,
you'll
get
individuals
multiple
times
the
same
individual
multiple
times
so
just
15,
distinct
individuals.
G
I
guess
what
I'm
hearing
in
this
conversation
is
sliding
benefit
scale
like
for
when
we've
talked
about
public
assistance,
reform
or
benefit
cliffs
and
anyway
I
just
and
as
someone
who
worked
with
people
that
had
disabilities,
it
just
didn't
make
sense
that
they
weren't
eligible
for
disability
benefits
if
they
were
disabled.
So
some
of
the
stuff
just
doesn't
make
a
whole
lot
of
sense,
but
anyway,
I'm
with
with
my
colleagues
just
saying
if
you
can
roll
it
in
and
make
it
simpler,
it'd
be
great,
but
thank
you.
Thank
you,
mr
chair.
A
F
I'll
just
start
by
saying:
currently
we
are
serving
approximately
1
million
664
000
members
that
that's
a
it's
an
increase,
but
36
of
those
enrolled
are
children
across
the
state
either
enrolled
in
medicaid
or
through
the
k-tip
program.
Eight
percent
of
that
total
enrollment
is
the
presumptive
eligibility
that
we
implemented.
It's
a
it's
a
temporary
enrollment
that
we
use
to
streamline
and
make
sure
people
did
not
go
without
healthcare
coverage.
F
During
the
covet
crisis
over
we,
we
have
over
59
000
enrolled
providers
that
we
use
to
serve
our
members
and
our
total
budget
and
I'll
remind-
and
I'm
sure
you
all
are
aware
of
this.
But
we
have
two
appropriation
units
in
our
budget.
We
have
an
admin
and
a
benefits,
but
the
total,
when
you
combine
those
two
appropriation
units,
is
14.7
billion
dollars
billion
billion
with
the
b.
F
So
here's
our
eligibility
experience
it's
a
little
chart.
You
can
see
that
when,
in
march
of
2020,
which
is
when
the
public
health
emergency
began,
we
had
an
increase
in
enrollment,
dramatic
increase,
that's
kind
of
was
was
the
reason
behind
that
is.
We
have
for
the
6.2
percent
f
map
that
we're
able
to
get.
We
had
a
maintenance
of
effort
that
we
had
to
meet
in
order
to
draw
in
that
6.2
and
the
maintenance
effort
was
basically
we
we
had
to
keep
enrollment.
F
They
had
to
be
in
stay
in
enrollment
unless
the
member
was,
you
know
due
to
a
death
of
the
member
or
they
moved
out
of
state
or
the
member
asked
to
be
disenrolled.
Otherwise
we
had
to
continue
providing
that
that
enrollment,
we
didn't
have
what
you
call
the
disenrollments
where
people
would
recertify.
You
know
the
redetermination
process
that
was
not
allowed
during
the
6.2
f
map
and
still
today,
we're
still
getting
the
6.2
percent
fmap.
Today
there
is
a
little
difference
you
can
see.
F
Prior
to
march,
you
can
see
the
ups
and
downs
that's
due
to
those
redeterminations
at
the
end
of
each
month,
people
drop
off
and
they
redetermine.
They
come
back
on.
So
that's
why
you
see
the
real
ups
and
downs
each
month,
but
then,
starting
in
march,
you
can
see
it.
It's
a
steady
incline
and
that's
that's
the
reason
for
that
steady
incline
when,
since
march
of
2020,
our
enrollment
has
increased
26,
26.5
percent
to
be
exact,
350
000
members,
and
that
is
distinct.
F
F
So
when
we
look
at
the
presumptive
eligibles,
we
like
I
said
we
had
a
total
individuals
that
at
any
time
since
march
of
2020
at
any
time
that
they
had
presumptive
eligibility.
Because,
let
me
let
me
back
up
real
quick
to
the
previous
screen
around
october
november.
We
did
get
clarification
from
cms.
They
made
a
decision
that
tradit
that
that
moe,
the
maintenance
of
effort
only
applied
to
non-pe
members,
so
the
pe
members
we
were
allowed
to
start
dropping
them
off.
F
So
at
any
time
so,
back
to
this
screen
back
to
this
slide,
we
had
220,
roughly
228
000
members
that
we've
had
since
march
on
the
pe
program
of
those
29
443
have
qualified
through
the
application
process
for
full
medicaid
69
000,
almost
69
100.
There
has
been
discontinued
and
for
various
reasons,
either
they
moved
to
the
exchange
or
they
went
to
employer
sponsored
health
insurance
or
their
simply
remain
uninsured
at
this
time,
and
then
that
leaves
our
current
enrollment
of
129
454.
F
These
are
the
expenditures,
fee-for-service
expenditures
that
we
paid
have
paid
for
these
individuals.
We
have
spent
in
fee-for-service
312.4
million
majority.
Of
that
I'd
say
I
have
it
written
55.6
percent
of
that
is
is
to
the
hospitals
and
40
42
million,
which
is
roughly
13.5,
is
to
pharmacy,
and
then
physician
groups
is
31.6,
which
was
about
10
percent.
So
those
top
three
account
for
about
eighty
percent
of
the
of
the
payments
that
we
sent
out
to
providers
those
types
of
providers
for
these
pe
members
on
an
average
per
enrollee.
F
F
I
will
point
out,
though,
commissioner,
you
may
there
is
some
behavioral
health,
a
lot
of
behavioral
health
on
the
screen.
If
you
can
see
the
bhsos
and
then
you
have
the
psychiatric
hospital
psychiatric
dpus
community
mental
health,
so
they
are
they're
we're
seeing
a
high
spike
in
in
be
in
behavioral
health
right
now,
and
so
I
just
wanted
to
point
that
out.
F
This
is
the
same
slide
that
I
normally
provide
to
you
guys.
It
shows
our
historical
spin
and
compares
it
to
our
current
budget,
and
you
can
see
we
had
a
22
percent
increase
from
20
20
from
our
actual
spin
in
2020
to
what
our
budget
is
in
2021,
and
I
can
tell
you
we
are
tracking
to
be
under
budget.
It's
it's
close.
It's
going
to
be
anywhere
from
30
to
50
million
is
what
we're
going
to
be
falling
in
under
budget.
F
If
our
projections
are
right,
but
a
large
portion
of
this
you'll
see
is
in
the
restricted
funds,
there
was
a
huge
increase
in
restricted
funds
of
49
from
last
year.
That's
primarily
well
majority
of
that
is
through
the
a
trip
program,
the
hospital
reimbursement
improvement
program
where
they
pay
the
tax.
They
pay
an
assessment
back.
I
just
had
to
have
those
appropriations
in
order
to
make
those
payments.
F
So
that's
that's
where
the
majority
of
that
increase
in
restricted
funds
was
the
point.
Seven
eight
percent
increase
in
general
fund
that
you
see
it's
still
slight
tick
up.
That's
mainly
due
to
the
29
dollar
add-on
for
the
nursing
facilities
that
we
are
going
to
be
implementing
either
this
it's
going
to
be
in
this
week's
cycle
or
next
week
cycle
to
where
those
are
paid
back
all
the
way
to
january.
F
But
we
needed
those
appropriations
as
well,
which
you
all
graciously
funded
in
the
budget
for
us
to
do
so,
and
then
the
federal
funds.
Obviously
the
federal
funds
is
the
the
big
piece
of
the
cake
which
is
25
increase
from
last
year,
but
that's
again
mainly
due
to
a
lot
of
these
directed
payment
programs
in
the
6.2
percent.
Fmap
that
we're
able
to
get
in.
F
This
is
a
a
slide
that
shows
you,
our
2021
budgeted
appropriations-
and
I
did
this
through
may
31st
so
that
we
can
just
be
a
month
understand
that
yeah
we
have
1.5
billion
left
in
my
in
our
budget
remaining,
but
we
do
have
one
month
left
of
expenditures,
and
that
includes
an
mco
payment
that
we're
we're
going
to
be
paying
that
mco
payment
sometime
within
the
next
week
or
two,
but
that
would
be
the
largest
piece
of
it
and
we
also
are
paying
house
bill
8
from
2020
session,
the
ambulance
program,
where
we're
paying
a
directed
payment
through
them
as
well.
F
Through
a
provider
tax,
we
got
that
approval
and
we'll
be
paying
that.
I
think
we've
we've
already
paid
it
this
this
court.
This
month
we
paid
the
payment
all
the
way
back
to
january,
on
that
this
is
a
grow
kind
of
a
graph
that
shows
in
a
comparison
kind
of
to
where
you
can
see
a
correlation
between
eligibility
and
our
expenditures.
F
F
I
just
want
to
point
that
out
this
is
month
to
month,
starting
in
july
of
night
july
of
19.,
you
can
see
that
the
eligibility
had
a
dramatic
increase
and
our
expenditures-
yes,
they
increased,
but
not
at
the
same
correlation
as
our
as
our
eligibles
did.
F
When
I
compare
and
the
the
the
comment
says
june,
it's
supposed
to
say
july
of
19
through
march
of
20,
and
I
compare
that
same
nine
month-
span
of
june
the
20th
to
march
21st.
When
I
do
those
comparison,
we
have
an
18.8
percent
increase
in
eligibles
in
the
monthly
average
and
a
16
increase
in
total
expenditures.
F
F
You
can
see
the
majority
the
biggest
increase
was
in
the
expansion
program
that
that's
kind
of
due
to
the
way
that
we
we
do,
the
pe
enrollment
they're
they're
they're.
In
the
experience
they
don't
get
the
expansion
rate,
but
we
count
them
in
our
expansion
numbers
because
of
they
they
may
or
may
not
qualify
for
medicaid.
So
we
we
need
to
put
those
in
the
expansion
piece
where
they're
above
the
they
could
be.
Above
them.
F
We
don't
know
because
they
could
be
above
the
federal
poverty
level
is
what
I'm
saying,
but
you
can
see
the
the
overall.
I
have
some
numbers
here
that
I
wrote
down.
F
The
biggest
increase
was
68
of
it
was
in
the
expansion
population
on
the
eligibles
29
was
in
the
traditional
and
then
3
was
in
the
chip,
but
we
had
a
total
increase
of
that
that,
just
that
nine
month,
comparison
of
256
million
256
000
members.
F
When
you
look
at
the
pmpm
side
of
things,
when
you
look
at
the
cost
for
those
individuals,
the
pmpm
change,
you
can
see
the
expansion
went
dramatically
down
in
comparison
and
and
that
the
reason
for
that
is
yes,
you
may
have
a
higher
number
of
eligibility,
but
those
individuals
are
have
less
security
levels.
They
may
not
be
receiving
or
may
not
be
seeking
out
the
utilization
that
other
people
and
obviously
when
they
do
get
that
utilization.
They
may
not
be
at
that
level
of
care.
F
That
is,
that
are
the
higher
level
of
the
reimbursement
side
of
things,
so
that
that's
why
that
is
going
down
and
overall
we
had
a.
If
you
look
at
an
aggregate
pm
pm,
even
though
we
had
an
18
increase
in
eligibilities,
our
pmpm
went
down
2.3.
A
Thank
you,
mr
bechtol.
That
was
very
informative.
I
have
a
question
it's
back
on
page
six,
you
mentioned
it's,
the
medicaid
expenditures
benefits
slide.
You
mentioned
a
21
increase
and
I
just
didn't
follow
which
slide?
Are
you
on
it's
page
six
and
it's
the
medicaid
expenditures?
A
F
F
Billion
11.8
billion
compared
to
the
14.4.
That's
a
22.25
increase.
What
we
have
budgeted
this
year
in
fiscal
year
21
compared
to
what
we
actually
spent
in
2020.
A
Okay-
and
my
other
question
may
be
more
for
commissioner
lee
probably,
but
what
is
what
is
the
process
for
people
who
are
enrolled
as
in
presumptive
eligibility
or
through
that
process?
What
what
is
the
process
of
actually
verifying,
whether
they're,
still
whether
they
still
qualify
in
whether
and
I
guess
I
guess
the
word-
would
be
they
at
some
point-
they're
disqualified.
So
what
what
is
that
process?
A
How
long
does
that
take
and
what
what
can
we
expect
to
see
moving
forward,
as
hopefully,
people
are,
you
know
getting
back
to
employment
and
so
forth?.
D
D
So
we
have
been
doing
some
outreach,
some
education
trying
to
move
those
individuals
from
one
category
to
another
since
since
the
presumptive
eligibility
began
so
in
in
march,
when
we
had
the
public
health
emergency,
there
was
a
concern
that
individuals
would
not
seek
treatment
because
they
did
not
have
health
insurance
or
they
had
lost
health
insurance.
So
the
cabinet
itself
has
been
designated
an
entity
to
grant
presumptive
eligibility.
A
And
how
long
are
those
those
periods
that
you're
talking
about
the
pe
periods
or.
D
So,
during
the
during
the
public
health
emergency,
the
pe
period
again
begins
on
the
date
of
application
and
it
will
end,
and
during
the
pe
period
it
ends
two
months
it'll.
So,
for
example,
if
an
individual
applied
and
was
granted
pe
today,
they
would
have
pe.
This
is
june.
16Th,
their
pe
period
would
end
the
end
of
august,
and
then
they
can
have
two
of
those
periods
in
a
year
after
the
public
health
emergency
ends
actually
beginning
july.
G
D
We
have
changed
that
application
process
because
we
were
seeing
a
lot
at
the
end
of
the
tunnel,
so
we
have
changed
the
presumptive
eligibility
period
for
the
public
health
emergency
to
the
traditional
one
month
after
the
application
so
beginning
july,
1st.
If
an
individual
applies
for
presumptive
eligibility,
let's
say
july,
15th
their
presumptive
eligibility
period
would
end
august,
the
30th
the
end
of
august
or
when
they
complete
an
application
and
are
determined
eligible
for
medicaid.
A
C
Thank
you,
steve
for
the
presentation
and
the
information
can't
say
any
surprises
there.
I'm
only
surprised,
maybe
it's
not
as
bad.
If
you
don't
look
at
this,
as
I
thought
it
would
be,
but
about
where
I
thought
it
would
be,
I
would
think
probably
we
would
want
you
back
in
september
to
talk
about
the
budget
for
the
next
year
and
starting
to
firm
up
those
numbers,
but
I
think,
in
light
of
everything,
that's
happened
over
the
last
year
and
a
half
that
there's
a
reasonable
course
of
action.
C
But
obviously
what
we're
going
to
do
going
forward
is
is
going
to
be
a
big
big
challenge
for
us,
but
good
numbers.
But
d:
do
you
have
a
feel?
I'm
sure
you
all
work
on
the
budget
for
this
next
period
and
you
don't
have
to
give
me
a
whole
lot
of
detail.
But
you
do
you
have
a
feel
for
where
you
think
enrollment
will
be
where
it's
going.
F
I
do
not
have
a
feel
right
now
to
be
honest
with
you.
We
we're
just
trying
to
close
out
this
year
and
monitoring
that
I
do
depends
on
what
happens
with
the
pe
members
if
they
become
fully
enrolled
and
things
like
that.
But
I
do
I
think
that
we're
we're
going
not
going
to
see
that
spike
that
straight-up
spike
that
we've
seen,
I
think
it
may
level
off
but
I'll,
have
to
do
the
data
and
do
the
trends
and
things
before.
I
can
comment
more
on
that.
I.
C
F
So
I
can
tell
you
I
work.
We
have
bi-weekly
meetings,
I
send
data
to
our
the
eligibility
numbers
weekly
to
director
hicks
and
his
staff,
the
state
budget
director.
I
know
they're
looking
at
it
as
well
as
I
am
because
we're
trying
to
it's
going
to
be
hard
to
try
to
forecast
eligibility
depending
you
know,
based
on
you,
know
we're
going
out
of
the
public
health
when
we
were
in
the
public
health
and
try
to
decipher
how
how
we're
going
to
do
those
trends.
F
C
F
C
F
I
would
prefer
earlier
september,
because
october
I'll
be
honest
with
you,
we
start
building
our
budget
I'll,
be
starting
pulling
data
and
stuff
at
the
end
of
august
and
start
working
on
forecasts
and
trends.
We're
a
huge
program
and.
G
F
E
F
E
Mention
the
6.6
federal
match
money
that
we
were
trying
to
make
sure
that
it
hadn't
stopped.
Yet
I
assume
you're
you're
speaking
with
the
pe
folks
or
is
that
with
the
medicaid
expansion.
F
We
still
have
it
because
the
6.2
percent
half
map
is
tied
to
the
public
health
emergency.
C
F
E
F
I'll
be
honest
with
you,
I
monitor
that
every
week,
but
I
cannot
think
in
my
head
right
now
what
that
number
was.
I
can
get
back
to
you
on
that,
but
it
seems.
E
Just
and-
and
I
want
to
follow
this
in
in
the
in
the
pe
program-
we
we
ended
up
with
about
227
000
that
has
dwindled
down
to
about
129
000
currently
enrolled,
and
those
people
will
actually
roll
off
automatically
just
because
of
the
way
it
works
right.
Okay,
all
right!
I
just
want
to
make
sure
I
understand.
F
F
E
Okay
and
currently
we're
one
six,
four
or
whatever
so
and
okay,
that's
all
I
need
thank
you
so
much.
G
I
think
mine's
more
of
a
request
of
when
you
give
us
an
update.
This
slide,
not
number
nine
where,
where
it
has
the
spike,
maybe
have
a
similar
slide
with
longevity
across
from
from
what
you've
got
here
to
where
we
are,
when
you
report
just
to
kind
of
see
if
it
goes
back
down.
A
D
For
home
and
community
base,
thank
you,
representative
fronty.
We
will
be
receiving
a
10
increase
in
our
fmap
for
our
home
and
community-based
waiver
services
and
what
this
means
is
currently
and
I'm
just
going
to
use
rough
numbers.
I
think
roughly
70
of
our
costs
for
hcbs
programs
comes
from
the
federal
government
they're
going
to
increase
that
to
80,
so
that
10
percent
that
we're
saving
will
be
able
to
put
aside
and
reinvest
into
programs
to
and
strengthen
the
hcbs
program.
So
we
have
to
do
something:
it's
one-time
funds.
D
Only
we
have
to
do
projects
that
will
supplement
not
replace
existing
state
funds.
We
have
to
enhance,
enhance,
enhance,
expand
or
strengthen
our
hcbs
programs,
our
1915
c
waiver
programs.
We
cannot
impose
strict
eligibility,
stricter
eligibility
requirements
than
we
have
now.
We
have
to
submit
a
plan
to
cms.
D
It
was
due
in
june
around
mid-june-
maybe
I
think
june
13,
but
we
requested
a
30-day
extension
so
that
we
could
have
a
very
well
thought
out
plan.
We
have
been
conducting
member
and
provider
surveys
so
that
we
can
have
input
from
a
variety
of
of
stakeholders.
We
had
a
call
with.
I
think
senator
alvarado
and
representative
moser
regarding
some
of
the
funds
and
how
we
can
use
those.
We
did
have
an
internal
work
group
at
the
cabinet
because,
as
you
know,
several
of
the
departments
within
the
cabinet
serve
the
same
population.
D
We
want
to
make
sure
we're
not
duplicating
efforts,
so
we're
doing
everything
we
can
to
make
sure
that
we're
using
these
funds
effectively
and
getting
the
biggest
bang
for
our
buck.
We
will
have
until,
even
though
we
it's
a
one-time
appropriation,
we
will
have
until
march
2024
to
fully
expend
or
spend
those
funds.
So
it's
very
important
that
we
have
a
well
thought
out
plan
that
will
have
some
short-term
gains,
but
we'll
also
have
some
long-term
results
have
helped
us
build
a
solid
foundation
going
forward
good
next
one.
D
So
thanks
to
yeah,
so
we
had
a
an
internal
work
group
and
commissioner
eldridge
with
the
department
of
aging
and
independent
living.
Her
staff
has
actually
took
all
of
the
recommendations
that
we
have
received
created
a
crosswalk
to
identify
common
themes
among
our
providers
and
our
members
as
to
what
they
would
like
to
see
those
funds
used
for
so
we're.
Looking
at
that
and
building
our
plan,
we
do
think
that
it's
quite
a
significant
amount
of
funds.
We
think
about
anticipate
about
104
million
dollars.
D
We're
definitely
going
to
have
to
have
some
oversight,
because
we
have
to
do
quarterly
reporting
to
cms.
Again
I
mentioned
short
and
long
term
goals
and
a
lot
of
money.
But
how
can
we?
How
can
we
get
some
quick
wins
and
then
build
a
solid
foundation
going
forward
for
for
the
individuals
that
we
serve?
D
Some
of
the
things
that
we
have
looked
at
that
were
we're
talking
about
again,
is
bolstering
the
workforce,
such
as
investing
in
training
and
building
a
career
pathway
for
those
individuals
who
come
in
as
direct
support
workers
looking
at
our
rate
methodology
aligning
reimbursement
across
waiver
types,
there's
a
little
bit
of
disconnect
there
right
now.
D
Home
modifications
is
another
big
opportunity.
We
do
have
a
program
that
again
is
administered
by
the
department
for
aging
and
independent
living,
which
is
the
heart
supported
living
that
does
home
modifications,
but
their
funds
are
very
limited.
So
if
we
could
set
aside
some
funds
specifically
for
that,
that
would
help
a
lot
of
our
population.
We
think
and
also
could
invest
in
technology
and
such
as
computers
tablets.
You
know
telehealth
greatly
expanded
during
during
the
public
health
emergencies,
so
we
could
keep
some
of
those
technology
and
telehealth
provision
in
place.
A
Happy
to
answer
any
questions,
questions
or
comments
related
to
this
topic,
co-chair
meredith.
C
Thank
you
and
you
seem
to
be
excited
about
that
and
I
see
why
you
would
be
and
look
forward
to
the
plan,
but
I'm
just
curious
is
part
of
it.
Are
you
developing
any
performance
metrics
to
to
to
monitor
the
effect
of
these
changes,
because
that's
something
I'm
always
big
into
you
know
I
don't
mean
to
simplify
it
or
suggest
that
it's
just
cavalier,
but
you
know
it'd,
be
great
to
give
everybody
a
laptop,
but,
according
to
reality,
is.
F
C
D
Is
that
that
will
be
part
of
our
plan?
Is:
are
those
metrics
and
how
we
will?
We
will
measure
the
success
or
the
impact
on
the
individuals
that
we
serve
in
the
program
we
definitely
and
I'm
I'm
just
like
you
senator
meredith.
I
want
to
measure
everything.
I
don't
want
to
implement
a
policy
without
having
some
sort
of
baseline
data
to
see.
How
did
that
policy
impact
our
program?
Is
it
good?
Is
it
is
it
getting?
Are
we
getting
the
results
we
want?
So?
Yes,
definitely
we
will
have
metrics
in
that
plan.
C
Well,
good
because
you've
heard
me
preach.
I
know
a
long
time
now
about
I'm
very
pleased.
We're
able
to
provide
this
level
benefits
to
people
that
we're
able
to
do
particularly
in
this
colby
crisis.
But,
aside
from
that,
I
think
the
medicaid
program,
the
expenditures
are
as
large
as
they
ever
should
be.
C
We
have
to
find
a
better
way
to
spend
these
dollars
and
we
have
to
get
improve
the
health
of
our
population,
and
so
that's
probably
my
ultimate
measure
is:
can
we
really
reduce
the
the
state's
financial
obligation
for
this
program,
but
not
forcing
people
off
really
getting
about
the
game
from
employment
and
spending
it
better
than
we
have,
but
very
pleased
to
hear
you'll
be
have
some
performance
metrics
with
that
and
look
forward
to
seeing
that
thank
you
and
by
the
way,
you're
both
doing
a
great
job
appreciate
working
with
you.
B
Thank
you
very
much,
mr
chairman.
So
you
know
we
hear
about
the
incredibly
long
wait
lists
for
waiver
slots
even
for
folks
with
urgent
needs
and
I'm
not
seeing
it,
but
are
any
of
the
additional
funds
going
to
be
used
to
increase
those
waiver
spots.
D
We
we
currently
do
not
have
plans
to
increase
waiver
slots,
because
if
we
increase
the
waiver
slots,
that
would
require
ongoing
funding
and
without
additional
appropriations
to
fund
those
additional
slots.
It's
not
something
that
we
feel
is
would
be
appropriate
for
these.
The
use
of
these
one-time
funds.
We
would
need
ongoing
funding
for
those
slots
just.
B
D
D
We
have
a
regulation.
We
have
a
state
plan
pending
with
cms
right
now,
we've
been
working
with
a
few
providers.
We
have
put
it
on
pause
for
just
a
little
bit
because
there
is
an
opportunity
with
the
hcbs
funding
to
help
us
build
that
pace
program
into
a
very
good
model
to
serve
our
individuals,
but
I
do
not
have
the
cost
of
the
institution
care,
but
would
more
than
happy
to
get
that
and
get
back
to
you.
B
That
would
be
great.
Sometimes
I
feel
like
we're
penny
wise
and
pound
foolish.
You
know
we
try
to
save
a
little
money
on
the
front
end
and
end
up
spending
more
in
the
long
run,
for
people
to
be
in
more
expensive
types
of
care.
Thank
you
very
much.
B
Thank
you,
mr
chairman,
commissioner,
thank
you
for
the
information
today.
Can
you
get
into
in
a
little
bit
more
depth
the
the
crisis
that
providers
are
in
right
now
as
far
as
staffing,
and
maybe
some
of
the
suggestions
or
ideas
that
have
been
kicked
around
with
this
funding?
B
To
alleviate
that
I
mean
we,
it's
obvious
across
the
state,
with
providers
that
the
struggle
is
getting
more
of
a
cri
at
a
crisis
level
each
day
as
more
participants
come
back
to
the
programs,
there
simply
isn't
the
staff
there
to
provide
for
them
those
services.
What
what
are
you
thinking?
We
need
to
do
in
that
area
and
what
ideas
have
been
kicked
around.
D
G
D
G
A
F
F
How
we
projected
that
is
off
all
your
waivers.
We
spend
about
900
and
960
million
a
year
on
our
waiver
programs,
10
of
that's
96
million,
but
we
also
get
the
10
percent
of
other
services,
such
as
rehabilitative
services.
We
get
it
on
home
health
things
like
that.
That
makes
up
the
other
difference
to
get
us
up
to
104,
so
that
104
will
then
be
used,
that
savings.
H
F
We're
going
to
have
to
use
as
our
restricted
funds
to
then
make
the
payment,
so
I
will
need,
but
we'll
put
that
in
our
our
budget.
That's
coming
up
our
our
budget
forecast
once
we
know
how
far,
if
we're
going
to
take
a
two-year
three-year
approach
to
making
these
payments,
because
I'll
have
to
spread
that
out
over
those
years,
but
we'll
be
able
to
turn
around
and
draw
federal
matching
in
on
that
104
million.
So
so
it'll
be
a
substantial
amount
of
money.
Okay,.
A
D
Well,
I
think,
any
time
we
have
to
do
an
rfp
if
we
have
an
existing
one.
It's
just
the
easy
thing
is
always
to
put
that
out
there
right,
but
I
think
that
this
is
too
important
to
just
kind
of
do.
The
status
quo
definitely
want
to
look
for
any
any
areas
that
we
can
strengthen
in
the
contract.
D
I
do
believe
that
this
november
this
november
is
going
to
be
the
10-year
anniversary
of
statewide
medicaid
managed
care.
I
think
that
it's
a
good
time
to
take
a
look
at
what
we
have
received
for
our
money.
I
think
it's
a
good
time
to
to
take
back
sit
back,
reflect
and
identify
what
we
want
going
forward.
The
whole
objective
of
the
medicaid
program
is
to
improve
the
health
status
of
those
we
serve.
So
I
think
it
is
a
good
opportunity
to
sit
back
and
look
at
specific
quality
measures.
D
D
I
would
like
to
have
a
lot
of
thought,
effort
and
energy
put
into
developing
specific,
measurable
goals
that
mcos
must
meet
and
I
would
like
to
have
it
lined
out
year
over
year.
They
meet
them
or
they
get
penalized,
and
I
think
that
it's
definitely
an
opportunity
when
and
if
we
have
to
redo
that
rfp.
C
We
are,
and
I'd
just
like
to
share
a
conversation.
I've
had
with
a
couple
of
mcos
already
specific
to
rural
healthcare,
because
you
know
that's
where
my
passion
lies,
and
I've
heard
ever
since
I've
been
here
that
they
say
it's
important
to
them,
but
there's
never
ever
any
evidence
that
it's
important
to
them,
and
I
would
like
to
see
them.
C
Some
have
some
kind
of
accountability
for
developing
a
strategy
to
help
put
health
real
health
care
providers
in
place,
because
it's
just
such
a
struggle
always
has
been
about
they
get
more
pronounced
now,
and
I've
asked
a
very
basic
question
and
dr
alvarez,
senator
alvarado
was
privy
to
yesterday
is
for
them
to
answer.
C
The
question
is:
why
would
any
health
care
provider
choose
to
go
to
a
real
community
unless
you
have
an
emotional
attachment
to
that
area
and
feel
it
may
be
like
a
calling
like
a
mission
and
if
they
can't
answer,
then,
then
that
then
real
health
care
is
really
not
important
to
them.
We've
got
to
find
some
way
to
change
the
dynamic
in
this
thing,
and
I
think
we
really
have
to
think
outside
the
box
and
we
haven't.
C
We
haven't
done
that,
but
if
we
want
kentucky
as
a
whole
to
thrive,
we
have
to
build
up
our
rural
communities.
We
can't
just
do
it
in
the
in
the
urban
areas
or
expect
people
to
move
from
the
rural
urban
areas.
It's
not
going
to
work
that
way.
We
need
a
strong
economic
foundation
for
this
entire
state,
and
I
think
you
know
the
cornerstones
of
that
is
our
education
system
and
our
healthcare
delivery
system
and
healthcare
delivery
is
struggling,
madly
right
now
and
I
don't
think,
there's
a
real
appreciation
for
that.
Presently.
D
I
appreciate
those
comments.
As
you
may
know,
I
have
a
soft
spot
too
for
rural
communities,
because
I
was
born
and
raised
in
eastern
kentucky.
I
know
some
of
the
challenges
that
that
population
faces
and
I
believe
that,
as
we
look
at
quality
measures,
it
does
make
sense
to
break
them
out
by
region.
What's
what
we
may
want
to
improve
in
eastern
kentucky
may
not
be
what
we
want
to
improve
in
central
kentucky.
D
It
gets
complicated,
but
I
think
that's
what
we
have
to
do
and
I
would
also
like
to
see
some
quality
measures
based
on
adults
versus
children
and
we
have
the
hedis
measures
that
we
can
look
at,
but
is
that
what
we
really
want
to
look
at
for
kentucky,
and
is
it
really
moving
the
needle?
And
we
need
to
look
at
something?
That's
really
going
to
move
that
healthcare
needle
and
again,
something
that's
very
specific,
measurable
and
you
know
kentucky
specific.
C
C
And
you
know
what
I
have
advocated
for
for
some
time
is:
is
higher
payments
for
rural
healthcare
providers
because
they're
dealing
with
a
a
much
less
compliant
patient
population
than
you
do
with
commercial
pay,
patients
and
there's
just
a
larger
percentage
of
them.
But
the
argument
I
get
back
from
the
mcos
is
we
pay
them
all
the
same?
That's
equality,
that's
not
equity
and
doesn't
recognize
how
difficult
it
is
to
recruit
a
health
care
provider
to
rural
kentucky.
C
If
you
have
a
disproportionate
number
of
medicaid
medicare
patients-
and
I
think
that's
going
to
be
taken
into
account
and
we're
really
never
going
to
improve
the
health
of
our
state
unless
we
get
the
providers
at
the
point
of
service
and
it's
just
not
there
tele
health
health
has
some
great
potential
for
us,
but
it's
not
going
to
solve
all
of
our
problems
and
we've
got
to
take
a
deeper
dive
on
this
thing
and
I
think
truly
make
a
commitment
to
rural
communities
in
turn,
we'll
generate
a
return
on
that.
I'm
confident
we
will.
H
Thank
you,
mr
chairman.
Thank
you
all.
So
you
make
a
good
point.
It's
10
years,
it's
you
know
you
kind
of
look
back
and
you
go
in
that
it
has
gone
by
quick
yeah
and
I
think
it's
a
good
time
to
reflect.
You
know
when
we
first
rolled
all
this
out.
The
the
promise
was
it's
going
to
improve
health
care
for
the
state,
it's
going
to
improve
our
health
care
outcomes
and
I
think
it'd
be
good
if
you're
going
to
be
opening
it
up
for
an
rfp
to
show
those.
H
When
you
look
at
past
experience,
which
of
those
mcos,
you
know
some
of
them
have
been
here.
The
full
10
years
show
us
how
you've
improved
health
care
outcomes
and
their
management
of
of
that
care,
and-
and
I
bring
it
back-
I
know
senator
meredith
and
I
sound
like
a
broken
record.
We
talk
about,
and
we've
shared
this
idea
with
you
guys,
I'm
just
going
to
repeat
it
again
to
your
point
about
regional
improvements,
because
it
is
a
difference.
H
We've
looked
at
colon
cancer
screening
rates.
We
know
western
kentucky's
done
really
really.
Well,
I
mean
central
part.
Eastern
kentucky
still
has
room
to
grow,
but
we've
really
improved
our
overall
state
ranking
so
you're.
Looking
at
you
know
hey
if
you're
in
the
purchase
region
boy,
the
number
is
almost
80
plus
in
terms
of
colon
cancer
screenings
eastern
kentucky's
in
the
50s.
H
So
we've
got
room
to
really
improve
there,
the
whole
state's
improved,
but
we
want
to
get
ourselves
to
move
up
even
higher
to
help
reduce
a
lot
of
that
and
we're
going
to
see
the
outcomes
for
that
in
another
five
or
ten
years.
If
our
death
rates
come
down
and
people
being
able
to
get
those
things
done,
but
the
other
thing
is
to
collaborate
with
our
health
departments,
and
I
I
know
again,
steve
and
I've
talked
about
this
numerous
times.
H
You
know
the
ads
or
something
to
with
our
area
development
districts
to
kind
of
know,
a
lot
of
those
needs
and
start
tying
those
guys
together
to
make
it
much
more
regional.
I
think,
if
you
let
the
insurance
companies
do
it
on
their
own,
it
just
becomes.
It
gets
too
granular
they're
not
used
to
getting
down
to
that
nitty
gritty
level,
but
it
might
be
good
for
that
and
just
to
start
having
that
show
us
the
improvement,
see
what
they've
done
like
you're
right.
H
I
think
the
hedis
measures
is
what
we've
you
know,
it's,
what
the
feds
are
kind
of,
requiring
we
get
used
to
that
with
medicare,
and
but
is
it
really
moving
the
needle
to
your
point
and
it
might
be
a
good
time
to
reflect
on
that
is
to
start
saying:
okay,
some
of
you
that
have
been
here
a
while
show
us.
You
know
you've
been
getting
paid
for
this
management
for
10
years.
How
have
we
improved
ourselves?
Are
our
rates
better?
H
I
mean
yes,
more
people
have
got
an
insurance
card
in
their
pocket
and
that
accounts
for
a
little
bit
of
a
you
know,
uptick
on
ratings
and
rankings
as
a
state,
but
really
we've
got
bigger,
bigger
needles
to
move
and
so
it'd
be
worth
looking
at
all
those
things
I
think
and
having
that
be
part
of
the
discussion
and
again
maybe
start
thinking
outside
the
box
of
linking
the
health
departments
in
somehow
and
looking
at
some
of
those
models
I
know
oregon
does
that
and
they
claim
to
have
had
a
very
good
experience
from
the
beginning,
but
anyway
I
just
wanted
to
mention
that.
H
I
appreciate
you
guys
looking
at
that,
and
it
is
a
10
year
anniversary.
I
didn't
they
didn't
don
them
until
you
mentioned
it.
I
thought
that
is
it's
gone
by
quickly,
but
thank
you
all
for
that.
B
Thank
you
very
much.
I
guess
I
really
want
to
add
my
voice
to
the
accountability
choir
for
the
mcos
and
add
my
voice
to
what
I'm
hearing
from
senator
alvarado
and
senator
meredith,
and
we
have
had
the
mcos
for
10
years,
and
you
know
frankly
what
I
mainly
hear
and
I
think
what
a
lot
of
us
hear
from
the
mcos
are
problems.
The
providers
have
issues,
have
problems
with
the
mcos.
B
Patients
have
access
issues
and
barriers
to
care
because
of
the
mcos,
and
you
know
it
has
been
10
years
and
I
guess
some
questions
that
I
would
have.
Are
we
sure
that
the
mcos
are
really
the
best
way,
the
most
effective
way
to
deliver
medicaid
services
across
the
state
with
all
of
the
regional
different
differences
that
have
already
been
brought
up?
B
And
you
know
this
is
this-
is
an
oversight
committee?
I
would
love
to
see
the
data
to
show
that
the
presence
of
mcos
and
our
medicaid
delivery
has
moved
the
needle
on
any
health
metrics
across
the
state.
I'd
love
to
see
that
in
urban
areas
and
rural
areas
and
by
you
know
the
types
of
health
metrics.
E
Not
sure
what
part
of
the
choir
I
am,
but
but
I'm
going
to
jump
in
here
right
after
representative
wilner,
I'm
not
sure
where
that,
where
I
fit
in
but
hey
I
just
want
to
she.
Could
she
said
it
very
well,
I'm
just
going
to
be
a
little
bit
more
directed,
there's
a
lot
of
states
that
don't
use
mcos,
okay
and
and
and
that's
something
that
we
I
love
that
that
you're
willing
to
look
at
you
know,
I'm
not
saying
that
you
want
to
eliminate
him.
E
I'm
just
saying
it's
not
a
it's,
not
a
a
foregone
conclusion
that
you
wouldn't
come
to
a
conclusion
that
that
maybe
we
we
we
have
better
ways
and
and
other
things
to
do,
but
so
that
thought
and
then
I'd
love
to
get
your
thought
on,
and
I
would
like
to
comment
a
little
bit
on
what
senator
meredith
said
about
paying
the
rural
hospitals
maybe
a
little
differently.
I
think
that's,
probably
something
that
medicaid
matter
of
fact
I
know
is
something
that
medicaid
is
kind
of
used
to
doing
in
other
areas.
E
F
E
Yeah,
I'm
surprised
to
hear
that
it
doesn't
happen,
but
but
anyway,
I
just
want
to
throw
that
out
there
last
thing,
because
I
know
senator
meredith
wanted
to
ask
it.
I
can't
believe
he
didn't.
What
do
you
think
about
three
mcos
instead
of
five.
D
I
don't
think
the
number
of
mcos
matter,
as
well
as
the
delivery
of
healthcare
service
and
making
improvements
in
our
population.
E
D
E
F
F
D
And
then,
if
I
could
go
back
to
your
hospital,
the
question
about
the
hospital
and
we
are
implementing
the
hospital
reimbursement
improvement
program,
so
we
believe
that's
going
to
get
some
money
into
the
hands
of
those
hospitals,
they'll
be
being
paid,
the
average
commercial
rate
we
have
the
approval
for
one
year.
We
just
submitted
a
three-year
request
to
cms
and
we
do
have
some
quality
measures
in
in
the
pre-print
that
we
had
to
submit
and
those
quality
measures
were
created
in
in
collaboration
with
the
medical
directors
from
the
cabinet
and
kha.
G
G
D
House
bill
108.
We
do
follow
the
department
of
insurance
guidelines,
so
I
think
that
house
bill
108,
just
codified
that
for
medicaid
to
make
sure
that
we're
we're
following
those
guidelines
from
doi
for
cohen.
C
C
I
house
bill
183
is
going
to
be
truly
a
godsend
for
for
rural
hospitals,
but
I've
kind
of
had
an
epiphany
here.
It's
sort
of
like
you
know,
saying:
we've
got
medicaid,
the
patient
has
medicaid,
so
they
have
access
to
care.
No,
no,
they
don't,
but
it's
the
same
way
with
with
rural
hospitals,
real
health
care.
Just
because
you
have
a
rural
hospital
now
doesn't
mean
you
still
have
access
to
care.
What
I
think
the
focus
really
has
to
be
on
is
primary.
Caregivers.
C
F
I
can
say
something
on
that:
one
that
we
did
last
year.
We
saw
that
coming
providers,
you
know
we
needed
more
providers
out
in
the
in
the
workforce
and
we
did
an
enhanced
gme
program
where,
as
a
graduate
medical
expenditures
where
we
paid
them
100
percent
of
their
residential
cost
at
one
time
it
was
a
lower
amount.
It
was
capped
at
like
30
percent
or
40
percent,
but
we
got
approved
through
cms
to
do
100
of
those
residential
costs,
and
we
did
that,
for
that
reason
alone
is
to
try
to
get
now.
F
C
Well,
I
shared
with
a
group
yesterday
that
you
know
in
my
30
years
being
hospital
ceo
whenever
I
bring
a
health
practitioner
in
to
recruit
them.
Invariably,
the
number
one
question
was
what
percentage
of
the
patient
population
is
medicaid,
because
they
know
that
it's
a
large
number
that
they're
going
to
have
to
work
harder.
It's
a
non-compliant
group,
but,
secondly,
they're
not
going
to
be
paid
as
much
as
the
commercial
pay
patients.
C
So
why
work
yourself
to
death
when
you're
urban
counterparts
can
we
can
make
much
more
money
and
the
quality
life's
a
little
bit
easier
and
practically
mess
a
little
bit
easier?
So
that's
why
I
think
it's
important
to
really
give
a
focus
on
that
and
encourage
people
and
cinemas
people
to
come
to
rural
communities
and
the
same
which
we're
going
to
realize
by
improving
their
health
will
more
than
pay
for
what
we
need
to
do
sure.
There's
an
investment
on
the
front
end
of
it,
but
long
term.
F
Amen
I'll
say
this,
though,
on
the
hospital
reimbursement
program
house
bill
183,
you
know,
was
house
bill
320,
and
then
we
went
to
the
average
commercial
rate
which
came
house
bill
183,
and
we
worked
collaboratively
with
the
kentucky
hospital
association
on
that
and
one
reason
why
we
wanted
to
do.
That
was
for
the
rural,
because
we
were
hearing
a
lot
from
rural
hospitals
that
they
were
geared
to
go
under
and
if
they
did,
we
we
couldn't.
We
couldn't
provide
the
access
of
care
to
our
members.
F
So
that's
one
of
the
reasons
why
we
really
went
out
with
cms
and
say:
hey.
We
really
need
this.
This
reimbursement,
like
commissioner,
said
we
have
it
approved
for
one
year
we
have
been
making
those
payments.
We
made
those
payments
the
end
of
april
and
first
of
march,
first
of
may
to
go
back
to
july
1st.
We
got
approved
for
state
fiscal
year
21
and
we
we
have
completed
those
payments.
We
made
the
last
payment
last
week
and
those
are
those
hospitals
should
have
that
money
caught
up
to
date.
F
Now,
on
house
bill
183,
we
have
submitted
to
cms,
like
commissioner
said
back
in
may,
the
pre-print
and
we've
asked
for
a
three-year
approval
versus
a
one-year
approval,
but
we
did
have
substantial
amount
of
quality
initiatives
which
ten
percent
of
the
total
pay
is
tied
to
quality.
C
And
I
do
appreciate
the
effort
you
put
in
with
the
hospital
association
to
get
that
done,
but
can't
emphasize
its
importance
enough
and
people
don't
understand
that
you
know
when
you
lose
a
hospital
real
community
it'd
be
like
louisville
losing
ups
or
ge
or
ford.
It's
that
kind
of
economic
impact
and
it
can't
be
discounted
and
in
rural
communities
they're
not
asking
for
a
handout.
We're
asked
for
a
hand
up,
but
that's
the
foundation
of
building
a
strong
economy.
A
rural
community
is,
you
have
to
have
good
schools.
F
And
unfortunately,
sometimes
payment
of
the
money
of
a
trip
doesn't
help.
So
what
we
had
to
do
with
king's
daughters
is
work
with
uk
to
try
to
do
that
where
they
they
took.
Ownership
of
king
daughter,
king's.
F
So
we
did
work
with
them
on
that,
as
well,
so
to
get
them
implemented
as
a
university
type
hospital.
So
we
we
do
see
what
you're
saying
on
the
rules
and
it's
important
to
us
as
well,
and
so
I
just
want
to
make
sure
you
understand
that
that
we
we
we
need
the
providers
out
there
or
we're
not
going
to
be
able
to
serve
our
members
appropriately.
H
Yeah
one
of
the
things
so
this
discussion
just
kind
of
sparks
more
ideas.
The
residency
funding
is
huge
for
graduate
medical
education
and
again
the
statistic
that's
been
used
for
years
and
it
continues
to
be
even
to
this
day
is
eight.
Eighty
percent
of
people
will
wind
up
practicing
within
an
80
mile
radius
of
where
they
do
their
training
for
residency,
not
from
med
school
med
school
is
just
kind
of
a
you
know.
You
have
matched
everybody's
heard
about.
H
You
become
a
resident,
you
go
off
somewhere,
but
once
you
get
into
residency,
you're
earning
a
salary
you're
getting
used
to
the
you
know,
kind
of
the
the
services
that
are
around
you
and
the
resources
around
you.
You
become
a
custom,
you
get
job
offers
and
people
typically
stay.
I'm
a
case
in
point.
I
came
from
an
urban
setting,
come
to
kentucky,
got
kentucky
fight,
and
you
know
I'm
in
a
rural
setting,
and
I
love
where
I
live,
and
people
I've
taken
care
of
there.
H
That's
pretty
much
true
for
most
physicians,
and
at
least
so
it
that's
of
huge
importance,
is
keeping
that
gme
funding
after
this
one
year
is
done.
If
we're
allowed
to
keep
that
model
great,
if
we're
not
maryland's,
had
an
interesting
model
for
a
lot
of
their
hospitals
for
reimbursements
and
I've
talked
to
the
kha
about
that,
and
they
said
it's
worked
better
for
rural
than
it
has
for
the
urban
setting,
but
they
almost
budget
those
hospitals
and
say
here:
is
your
medicaid
budget
up
front
boom?
Here's
all
the
money!
H
First
of
the
year,
here's
your
budget
make
it
work,
go
work
with
local
health
departments
and
it
incentivizes
those
hospitals
to
say
how
do
I
keep
people
out
of
the
hospital?
How
do
I
work
better
in
outpatient
settings?
How
do
I
address
a
lot
of
those
issues
and
so
now,
if
they
want
to
admit
everybody
and
put
them
all
in
the
hospital
great,
it
comes
out
of
that
pot
of
money.
H
That
pot
of
money
disappears
now
you're
they're
working
out
of
in
the
red
having
to
provide
that
care,
and
then
you
can
also
track
quality
measures.
On
the
back
end
of
that
they
said.
That's
worked
better
for
rural
areas,
not
as
well
for
urban.
There's
got
to
be
some
measures
in
there
to
make
sure
that
transferring
people
inappropriately
and
passing
off
expensive
things
based
on
costs
only,
but
that
might
be
a
model
worth
exploring
and
it's
kind
of
an
interesting
idea,
because
I
think
it
would
be
easier.
H
I
think
if
you
have
a
good,
ceo
and
a
good
cfo,
they
can
make
a
budget
work
if
they
know
how
much
they
have
and
what
they
have
to
work
with.
They
can
make
that
work
for
their
community
and
help
do
a
lot
of
their
own
quality
measure
check
on
their
own.
So
just
another
idea,
I
wanted
to
throw
out
there
that
once
you
know
if,
if
there's
a
time
expiration
they
like
to
continue,
you
know
commercial
reimbursement,
that's
great,
but
if
that
runs
out
it
might
be
something
else
to
look
into.
G
G
F
H
What
some
hospitals
will
do
is
if
they,
if
they
want
someone
they'll
enhance
their
salary
during
residency
and
say
we'll
pay
a
little
bonus.
But
you're
going
to
owe
us
this
many
years
back
in
service
that
works.
If
people
are
going
to
stick
around
they'll
sign
up
and
they
already
almost
get
an
employment
guarantee
once
you're
done
with
residency
and
that
that
often
works
and
there's
certain
fields
where
a
lot
of
employers
are
doing
that.
F
But
I
will
say
if
I
made
one
more
thing
the
commissioner
is
going
to
say
here:
I'm
a
talker
okay,
but
my
daughter
she's
going
to
be
an
opt.
She
wants
to
be
an
optometrist
she's
enrolled
in
the
university
of
pikeville.
She
goes.
She
starts
her
first
semester
in
august,
but
you
you
mentioned
that
a
lot
of
people
don't
go
into
the
rural
areas,
my
daughter's
from
central
kentucky
and
she
has
a
desire
to
go
and
serve
in
in
the
under
par
under
the
impoverished
area
of
eastern
kentucky.