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From YouTube: Budget Review Subcommittee on Human Resources (8-17-22)
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A
You
sub
committee
on
human
services
resources.
As
a
reminder.
We
have
new
meeting
protocols
in
place
for
2022
interim
session.
No
remote
attendance
by
members
is
permitted
for
the
2022
interim
session.
All
members
must
attend
in
person
to
be
recorded.
As
present
the
meaning
material
was
put
online
earlier
this
week
and
made
available
for
downloading
at
this
time.
We'll
have
the
secretary
call
the
roll.
C
A
A
A
Kentucky
hospital
association
before
you
folks
start,
I
probably
should
mention
that
we
had
nancy
and
jim
test
five
before
our
medicaid
oversight
committee
meeting.
I
think
a
couple
of
months
ago
about
this
very
subject
in
what
she's
gonna
tell
you
today,
extension
of
a
program
that
we
approved,
I
think
last
session
or
session
before
last,
and
apparently
it
will
require
an
appropriation.
So
that's
why
it's
coming
before
this
committee.
So
with
that
please
proceed.
C
All
right
well
again,
good
morning,
chairman
meredith,
chairman
bentley
and
members
of
the
committee.
We
want
to
thank
you
for
having
us
here
to
talk
about
the
hospital
rate
improvement
program
which
we
refer
to
as
a
trip
which
has
been
a
highly
successful
program,
and
we
want
to
talk
about
an
expansion
of
that
program
today.
C
So,
as
you
might
recall,
for
those
of
you
who
were
here
in
2019,
you
know
the
general
assembly
worked
with
us
to
pass
the
initial
version
of
a
trip,
and
then
there
was
an
important
expansion
in
2021.
C
The
general
assembly
took
a
vital
step
to
help
the
hospitals
with
the
ongoing
going
problem
of
finance
financial
stability
when
it
passed
bam,
carney's
bill,
which
was
house
bill
320..
That
was
the
original
a
trip
program,
and
this
program
has
no
cost
to
the
state
treasury
and
it
allows
hospitals
to
draw
down
federal
funding
so
that
medicaid
reimbursements
for
treating
patients
could
be
paid
at
the
medicare
rate
under
the
initial
bill.
C
C
It
just
allows
the
hospitals
to
draw
on
more
federal
funding
to
cover
the
cost
of
care
that
we
provide
to
medicaid
patients,
and
it's
also
providing
important
resources
for
hospitals
to
improve
quality.
A
portion
of
the
payments
that
hospitals
receive
under
this
program
are
directly
tied
to
an
individual
hospital's
attainment
of
certain
quality
outcome
measures.
C
So
a
trip
is
critical
because,
as
you
can
see
in
these
slides
here,
70
to
80
percent
or
more
of
the
patients
treated
in
our
hospitals
are
covered
by
these
two
government
programs.
Hospitals
simply
can't
continue
to
operate
when
three-fourths
of
the
services
that
they
deliver
are
paid
below
their
cost
to
provide
them.
C
C
Over
the
course
of
the
last
two
years.
We've
also
learned
some
important
lessons
from
a
trip
first,
although
the
funds
were
not
expected
to
sustain
hospitals
through
an
enormously
costly
shutdown
of
elective
services
due
to
the
pandemic,
hr
provided
enough
funding
during
the
crisis
to
present
prevent
hospital
closures
and
hospitals,
contrary
to
what
many
people
believe
did
not
make
money
from
treating
covid
patients
covet
patients
spent
longer
times
under
care.
C
Second,
we
saw
the
need
to
expand
a
trip
into
the
outpatient
setting
to
assist
rural
hospitals.
Today,
hospitals
receive
supplemental
atria
payments
based
on
the
number
of
medicaid
patients.
They
treat
on
an
inpatient
basis,
so
since
urban
hospitals
provide
substantially
more
inpatient
treatment,
it's
natural
that
about
65
percent
of
the
atria
payments
are
being
paid
to
urban
hospitals.
C
C
C
C
Most
areas
of
the
state
have
only
two
commercial
plans
which
cover
80
percent
of
all
commercial
enrollees.
This
gives
insurers
significant
leverage
in
setting
provider
rates.
Many
hospitals,
especially
in
rural
parts
of
the
state,
have
virtually
no
margin
or
even
operated
a
loss
and
that
isn't
going
to
be
sustainable.
C
So,
while
outpatient
a-trip
isn't
going
to
solve
the
problem
of
inflation
or
the
soaring
costs
of
agency
nurses,
it
does
provide
a
source
of
funding.
That's
going
to
directly
benefit
our
patients.
So
we're
asking
for
you
to.
Please
join
us
again
as
a
partner
in
expanding
the
program
through
legislation,
so
that
we
can
draw
down
more
federal
funding,
and
should
the
federal
government
stop
the
program.
A
I'll
start
nancy.
First,
I
appreciate
your
presentation
as
always
your
slide.
Regarding
inflation.
You
know.
We
know
that
we've
seen
40-year
record
high
inflation,
nine
and
a
half
percent,
but
I
would
think
for
a
lot
of
things
we
have
within
the
healthcare
environment
or
even
higher
than
that.
Do
you
have
any
specific
inflation
numbers
for
things
like
drugs.
C
Yeah
drugs
was
on
the
slide.
We
can
pull
that
back
up
again.
These
are
national
numbers,
it
was
very
high,
but
you
know
one
item
that
came
up.
I
was
at
a
meeting
recently.
They
said
the
cost
of
rubber
gloves
240
increase.
C
So
what
does
that?
Look
like
it's
for
over
40
percent?
That's,
as
you
can
see
the
highest
looking
from
february
of
2020
to
2022..
C
So
you're
right,
it's!
You
know
the
overall
cost
and
you
know
we
can
control
that.
So
you
know
those
75
percent
of
our
costs.
You
know
it's
your
labor.
You
have
to
have
your
labor
and
then
you
have
to
have
your
supplies,
and
so
it
makes
it
very
difficult
and
our
rate
increases
from
these
federal
programs.
As
you
can
see
here,
the
medicare
program
you
know,
haven't
kept
up
with
this
they're,
not
keeping
up
with
this.
A
Yes,
I
would
suspect
that
probably
the
inflation
rate
specific
to
the
hospitals
may
be
double
even
tripled
than
the
nine
percent
that
we're
hearing
nationally,
and
I
know
it's
quite
a
challenge.
C
Yes,
we
measured
it
just
in
2020
and
we're
still
in
the
process
of
you
know
looking
at
the
care's
money,
but
we
know
that
in
2020
the
losses
were
2.6
billion
and
there
was
about
a
billion
that
was
not
covered
by
the
cares
funding.
Most
of
the
cares
funding
came
out
in
2020.
There
was
like
one
other
tranche
that
came
out
after
that,
so
you
know
we
are
way
underwater
and
I
have
had
so
many
ceos
tell
me
from
all
across
the
street
the
state
that
they
don't
know
what
they
would
have
done.
A
A
C
You
know
this
year
is
extremely
bad,
because
what
we're
seeing
is
an
increase,
and
I
hear
this
all
the
time
patients
are
sicker
they're
coming
into
our
hospitals,
so.
E
C
Need
more
care,
we
have
this
labor
shortage.
That
is,
you
know.
Everyone
is
very
worried
about
how
we're
going
to
be
able
to
provide
that
care.
Hospitals,
don't
have
the
staff
to
even
staff
all
of
their
beds,
so
we're
very
concerned
about
access,
we're
concerned
about
patient
delays,
and
you
know
hospitals.
You
know
we're
watching
this
nationally.
Even
that
you
know
the
revenues
are
not
coming
back.
C
The
revenues
are
not
sustainable
to
the
acuity
level
and
the
cost
that
we're
providing
so
hospitals
we're
expecting
to
have
a
loss
and
we're
starting
to
hear
that
we're
starting
to
hear
about
layoffs
in
our
own
state.
You
know
hospitals
that
may
be
having
to
shut
beds
down
so
we're
seeing
this
across
the
country
we're
starting
to
hear
about
it
here.
C
A
I
guess
I'm
looking
long
term
as
well.
I
see
this
is
another
stop
gap
so
to
speak.
I
would
hope
that
it
would
address
the
the
problems,
but
I'm
not
sure
addresses
of
long-term
force
and
has
been
any
discussion
about
maybe
a
different
payment
model
for
for
medicaid.
That
specifically
reflects
the
difference
between
urban
rural.
I
know
you
know.
Urbans
get
kind
of
a
bump
up
in
their
payments
because
of
cost
of
living
is
higher
in
the
urban
areas
than
the
same
rule,
but
there's
some
other
factors
that
aren't
taken
into
account.
A
C
C
I
think
the
you
know
the
mcos
have
been
good
partners
in
a
trip,
and
I
will
say
that
when
we
do
the
a
trip
when,
when
you
know
that's
a
that's
an
add-on
and
every
hospital
is
getting
the
same
amount,
that
that's
one
of
the
beauties
of
this
program
is
that
urban
and
rural
are
getting
the
same
add-on.
C
It
is
not
higher
for
urban
than
it
is
for
rural
hospitals,
and
so
that's
a
big
benefit
for
you
know
our
rural
hospitals,
but
you
know-
and
this
is
a
value-based
program,
so
you
know
we
talk
a
lot
about
well,
you
know
we
need
to
move
for
from
fee
for
service.
This
program
ties
a
portion
of
the
payments.
C
We
have
excellent
engagement
of
our
hospitals
around
these
quality
measures,
but
I
think
you
know
a
trip
has
filled
that
gap,
but
that
is
the
concern,
because
this
has
to
get
approved
from
cms
every
year
and
there's
no
guarantee
that
cms
just
because
they
approved
it
last
year
is
going
to
prove
it
next
year.
If
that
money
were
to
go
away,
you
know
we
would.
We
would
be
in
a
world
of
hurt
in
kentucky.
D
Thank
you,
mr
chairman,
so
I've
got
a
series
of
questions
just
about
the
program
in
general,
so
this
applies
just
to
medicaid
payments,
correct,
correct.
C
D
But
these
are
federal
dollars
as
a
supplemental
for
medicaid.
Yes,
they
don't
supplement
medicare.
No,
when
you
get
the
payment
for
this,
let's
say
you
get
the
successful
payment
and
the
supplement
is
the
payment
you
receive
for
this
higher
than
what
medicare
is
paying.
When
you
add
it
all,
together,.
C
It
is
medicaid,
medicare
pays
us
less
than
cost,
so
the
original
hrep
took
us
between
up
to
from
medicaid
base
rates
which
are
very
low
up
to
medicare,
but
medicare
still
pays
below
cost
and
that's
why
we
now
have
gotten
approval
to
go
closer
to
the
commercial
rate
which
is
higher
than
medicare
in
our
state.
So.
D
Just
use
an
example:
if,
let's
say
if
the
cost
is
100
medicare
is
paying
you
90.
medicaid
is
paying
you
85.,
you
get
a
supplement.
How
much
are
we
talking
about?
Is
it
giving
you
an
extra
twenty
dollars
to
get
you
up
to
105
100
minutes?
What
a
lot
of
medi
I
mean
commercial
rates
are.
Is
it
somewhere
along
those
right.
D
D
D
Remind
people
a
lot
of
people
are
pushing
for
single-payer
systems
government-run
systems.
This
is
the
garbage
you've
got
to
deal
with,
va
medical
centers.
You
talk
to
some
of
the
patients
there
and
see
how
that's
run
a
lot
of
it
and
again.
The
underfunding
of
this
stuff
is
the
concern
for
a
lot
of
these.
Do
you
know
how
many
states
participate
in
this
program
that
you're
aware
of
you.
C
Know,
honestly,
we
are
one
of
the
leaders
in
this
kind
of
a
supplemental
program.
Now
a
lot
of
states
had
them
before,
but
then
the
feds
changed
the
rules
on
it
and
because
in
the
past,
states
would
just
take
get
the
supplemental
payments
and
they
wouldn't
tie
it
necessarily
to
the
amount
of
care
being
provided.
They
would
just
say:
xyz
hospital
gets
x
amount
and
it
wasn't
tied
to
anything.
So,
of
course,
we
did
not
do
that.
C
C
So
it's
not
just
a
made-up
number,
it's
tied
to
the
care
that
they're
delivering,
and
so
you
know
there
are
more
states
that
I
think
are
following
kentucky's
lead.
I
know:
we've
had
a
number
of
states
reach
out
to
us
and
want
to
copy
our
program,
but
I
think
we
are
one
of
the
leaders
in
the
nation
in
how
we're
we're
setting
this
up.
I.
D
To
undercut,
that's
that's
what
happens
I
hate
to
say,
but
that's
the
reality
of
health
care
is.
Oh
and
people
have
figured
out
a
system
that
makes
it
survive.
Let's
get
rid
of
it
this
year.
We
want
to
prove
it.
It
would
just
be
so
much
easier
if
they
just
said
hey,
we'll
just
give
you
the
extra
money,
and
here
you
go
right,
they're
having
to
pay
it
anyway,
but
they
just
find
a
ways
of
of
the
shell
game.
D
C
Well,
I
mean
we
have
to
gather
data
and
steve
bechdel's
here
and
he
can
probably
talk
about
it
they're
in
the
process
right
now
of
gathering
the
data
from
the
hospitals
on
what
the
average
commercial
rate
is
again
we're
going
for
a
percent
of
that.
So
all
that's
going
to
be
costed
out
in
the
in
the
documents
that
they
have
to
submit
to
cms.
So
cms
understands
what
the
potential
payout
is
for.
This.
D
D
And
you
mentioned
that
it's
dependent
one
of
my
questions
was:
it
has
to
be
approved
annually
by
them,
which
is
again
the
shell
game.
Once
enough
states
catch
on
and
start
doing,
this
it'll
shift
again
what
particular
quality
measures
are
they
engaging
you
guys
bars?
Is
it
hedis
measures?
Are
they
using
no
okay.
C
So
it's
it's
a
hospital
inpatient
program,
so
they're
hospital-based
measures
and
so
for
and
we
have
them
broken
out
by
birth.
There's
some
birthing
measures
in
here.
We
worked
closely
with
the
cabinet
to
come
up
with.
You
know
what
we
thought
would
move
the
needle,
so
some
of
them
they
deal
with
reducing
the
readmission
rate
in
our
state,
among
medicaid
patients,
we're
looking
at
sepsis.
C
You
know
identification
and
prevention,
we're
looking
at
certain
infections
within
the
hospitals,
cauti
rates
c
diff
rates,
opioid
prescribing
and
then
one
of
the
things
that
we're
going
to
be
moving
into
and
we've
kind
of
mapped
out
the
measures
over
a
number
of
years,
and
so
basically
hospitals.
We
look
at
what
the
state
average
is
and
for
some
of
these
measures,
if,
if
we
don't
have
a
baseline,
then
we
spend
the
first
year
collecting
the
baseline
data
and
then
we
measure
against
what
is
the
average.
C
So
hospitals
get
credit
if
they're,
if
they're,
better
than
average
hospitals
that
are
below
average,
get
credit
if
they've
moved
towards
the
average
or
they
reduce
that
gap
between
you
know
their
performance
and
what
the
average
is.
And
so
you
know
we're
we've
scaled
these
to
where
you
know
each
year,
we're
going
to
make
them
more
aggressive
because,
as
a
state,
we
want
to
it's
important
that
all
the
hospitals
do
better
and
so
cms
seems
to
like
that
approach.
I
know
when
we
initially
set
a
preprint
in
we
had
suggested
a
three-year
approval.
C
They
said
they
wouldn't
give
us
that,
but
we
sent
them
the
measures
and
showed
them.
You
know
how
we
plan
to
advance
our
quality
metrics
going
forward.
One
of
the
things
that
we're
going
to
start
doing
next
year
is
measuring
for
social
determinants
of
health
and
screening,
medicaid
inpatients
for
that
and
making
referrals.
So
that's
one
of
the
things
that
we're
working
on
this
year
trying
to
get
the
processes
in
place
of
how
we're
going
to
be
doing
that.
So
you
know
we
keep
we're
going
to
look
at
this
program.
C
D
Like
it's
like
an
aco
model
for
hospitals
effectively,
what
this
says
you're
starting
to
gain
the
data
set,
the
baseline
show
improvement
from
what
your
baseline
was
not
necessarily
an
overall
baseline,
but
here's
your
baseline,
you
show
us
improvement.
We'll
reward
you
at
some
point
that
eventually
levels
off
are
all
how
many
of
our
hospitals
currently
qualify.
For
this
I
mean
I'm
sure
some
of
them
probably
don't
meet
the
measures.
Do
we
have
an
idea
of
how
many
of
our
hospitals
I
mean?
Not
all
of
them
are
getting
the
supplemental
payments.
C
This
is
the
first
year
that
we're
doing
this
so
in
the
very
first
year
we
got
approved,
it
was
coveted,
so
cms
didn't
require
that,
but
this
is
the
first
year
where
we're
doing
those
measurements,
and
so
I
have
a
call
quality
staff
at
kha.
The
hospitals
are
using
this
money
to
engage
in.
You
know
education,
we're
bringing
experts
in
to
say
you
know
you're,
you
look
like
you
need
help
in
this
area,
so
we
have
whole
teams
of
people
that
are
going
in
pharmacists
infection,
preventionist
quality.
C
You
know,
experts
going
in
working
with
the
hospitals
in
whatever
area
it
is
that
they
need
assistance
with.
So
that's
where
this
funding
is
is
really
going.
Are
they
all
there?
Today
I
mean
we
only
just
looked
at
first
quarter
data,
but
you
know
we
think
I
mean
I've
never
seen
such
engagement
in
the
years
that
I've
been
at
kha
in
all
the
different
offerings
that
we
are
providing
to
move
the
needle
on
quality.
Well,.
D
If
it's
a
20
increase
on
a
third
of
your
business,
that's
a
that's
a
lot
of
money
and
for
our
hospitals
who
are
struggling.
It's
a
desperate
need
so
be
curious
to
see
how
this
I
mean
this
is
an
aco
model
is
what
it
is
effective
from
what
you're
describing
so
it's
they're
just
setting
up
the
baseline
for
data,
so
we're
gonna,
see
everyone's
gonna
get
potentially
an
award
early
and
then
we'll
just
I'd,
be
curious
to
see
how
many
hospitals
maintain
that
yeah
and
how
we
do.
Thank
you,
mr
chairman.
A
Thank
you,
sir
representative
bentley.
You
have
a
question
comment.
D
Thank
you,
mr
chairman,
considering
the
nursing
shortage.
F
D
Getting
complaints
from
nurses
that
when
the
traveling
nurses
come
in,
there's
not
as
much
communication
or
it's
like
cooking
in
someone
else's
kitchen
or
if
you
bring
a
nurse
in
and
say
she's
from
the
philippines,
and
she
can't
speak
english.
That
they're
hanging
bags
wrong
and
it's
the
regular
nurses
that
are
keeping
everything
from
going
to
malpractice.
C
Well,
I
would
say
it
certainly
is
a
challenge
to
have
as
many
travel
nurses
in
our
hospitals
as
we
are
having
to
rely
on,
because
you
know
they're
there
for
13
weeks.
You
know
you
have
to
get
them
oriented.
You
know
they
may
not
be,
as
invested
in
the
quality
work,
that
we
are
doing,
that
the
regular
staff
is
doing,
and
then
sometimes
we
have
these
traveling
nurses
that
aren't
really
traveling.
C
They
actually,
you
know,
lived
down
the
street
or
used
to
be
at
the
hospital
across
the
street,
but
now
they're
a
traveler,
so
it's
kind
of
a
mixed
bag
and
what
we're
seeing.
But
we
are
concerned
that
we
can't
continue
to
keep
relying
on
contract
labor,
because
that
doesn't
support
the
quality
processes
that
we're
trying
to
put
in
place
in
our
hospitals.
But
unfortunately
that's
where
we
are
today
until
we
can,
you
know,
make
inroads
into
addressing
that
the
workforce
shortage
and
there's
no
quick
fix
to
that.
C
You
know
we
have
a
number
of
things
that
we're
working
on.
You
know
with
kctcs
council
on
post-secondary
education,
the
chamber,
you
know
in
fact
we're
going
to
be
coming
out
with
a
workforce
shortage
report
kind
of
looking
across
the
state.
How
many
nurses
are
we
short?
How
many
other
professionals
are
we
short
trying
to
work
with
education
around?
C
D
F
A
Probably
the
litmus
test
on
this
will
be
the
number
of
commercials
you
see
on
tv
from
plaintiff's
attorneys,
suggesting
people
call
them
so
we'll
watch
for
that.
But
there
are
no
other
questions
for
nancy
and
jim
we'll.
Let
them
excuse
themselves,
that's
steve
back
to
come
up
to
speak
on
this
as
well,
but
I
appreciate
your
presentation
this
morning
as
always.
Thank
you.
A
A
G
I
would
like
to
thank
the
hospital
association.
They've
been
really
good
partners
with
us
and
around
what
what
ms
galvani
was
saying
we
have.
I
think
I
think
we
are
one
of
the
only
places
in
the
country,
and
I
do
believe
we
are
a
leader
in
this
program,
senator
alvarado.
You
are
exactly
right
as
soon
as
it
gets
figured
out,
they'll
change
the
rules
and
we'll
have
to
figure
out
what
the
new
rules
are
and
and
how
we
assist
our
providers
in
the
new
rural
environment.
G
I've
seen
it
too
many
times,
and
I
agree
with
you
completely,
but
we'll
do
that
and
the
thing
that
I'm
most
excited
about
within
this
program.
Certainly
there
are
not
many
pieces
of
legislation
that
get
passed
and
implemented,
we'll
take
credit
for
the
implementation
that
save
an
industry,
and
I
think
this
piece
of
legislation-
I
I
think
nancy
said
it,
and
I
I
think
it's
fair
to
say
this.
G
This
really
saved
a
lot
of
hospitals
in
in
kentucky
the
the
other
piece
that
I
I
want
to
just
kind
of
expand
on
just
a
little
bit.
G
It's
not
those
of
you
who
are
old
enough
to
remember
lake
wobegon
right
every
kid's
above
average.
It
kind
of
starts
out
that
way,
but
but
here's
what
happens,
the
risk
increases
as
the
years
go
go
on.
So
if
you,
if
you
don't
meet
x
number
of
standards,
you
know
you
get
less
of
this
pie
right,
like.
I
think,
that's
the
fair
way
to
say
that
so
so,
there's
a
risk
based
to
this
and
to
the
quality
pieces
that
and,
as
nancy
said,
we
increased
that
over
time.
G
Actually
something
else
that
I
was
really
excited
about
within
the
cabinet
that
this
allowed
the
opportunity
to
do
is.
G
It
makes
me
worried
that
we're
all
happy
with
it
means
I
you
know,
I
didn't
push
hard
enough,
but
we
actually
are
all
happy
with
it
and
and
I'm
I'm
particularly
excited
about
getting
baselines
for
kentucky
right.
You
asked
about
hedis
measures
and
the
way
I
feel
about
hedis
measures
are
great,
but
it's
like
cheating
to
the
test
right
once
you
know
how
to
get
the
hedis
measures
up.
G
G
This
is
what
I
think
this
is
a
really
good
model
actually
because
and
it's
actually
easier
to
implement
because
of
the
mcos
just
because
it's
a
directed
payment
and
there's
no
need
to
go
all
the
way
down
that,
but
it
actually
makes
it
a
little
easier.
The
I'll
also
say
medicaid
expansion
was
helpful
because
now
more
of
these
folks
who
come
into
the
who
come
into
the
hospitals
and
get
discharged
and
get
the
get,
the
that's,
not
a
rap
payment
supplement
directed
payment.
G
There
have
been
so
many
different
names,
it's
directed
payment
through
the
mcos
and
through
fifa,
so
mostly
mcos
that
this
it's
it's
triggered
by
that.
So
those
are
the
big
pieces.
I
know
what
they
are.
What
the
request
is
is
around
outpatient
and
extended
outpatient.
It
will
have
more
impact
on
rural
facilities
and
it
will
so
it
it's
another
kind
of
big
number.
So
there
we'll
need,
we
will
need.
G
You
know
we'll,
be
happy
to
work
with
you
all
on
what
we
saw
as
as
an
appropriate
appropriation
increase.
If
how
we
may
want
to
extend
that,
because
the
a
trip
statute
itself
will
have
to
be
amended
a
little
bit
to
account
for
an
outpatient
side.
But
I've
said
this
to
the
hospital
association.
G
We
should
do
that
right.
We
should
we
should
be
helping
our
kentucky
providers
and
particularly
if
we
can
move
them
towards
quality,
and
I
think
that's
that's.
That's
the
challenge,
that's
the
challenge.
We
all
have
here
right,
we're
paying
a
lot
of
money
in
medicaid.
How
are
we
moving
towards
quality?
I
am
very
interested
to
see
if
this
program
can
help
us
do
that
and
if
it
does
and
if
it
can,
we
should
be
modeling
this
type
of
program
for
other
providers.
G
How
do
we
work
with
other
providers
to
to
not
put
the
burden
on
the
kentucky
taxpayers,
but
where
we
can
increase
rates
to
to
what
is
appropriate
and
can
drive
quality?
You
can't
ask
for
quality
right
if
there's
no
funding
for
it-
and
this
is
a
this-
is
a
big
incentive
for
quality
right
and
and
the
hospitals
have
been
very
engaged
in
this
and
it's
it's
like.
G
They
say
it's
been
a
lifesaver,
and
so
it's
just
one
of
those
areas
like
senate
bill,
50
and
and
the
single
pbm
where
we
are
leading
the
country,
and
it's
I
you
know
two
examples
right
off
the
top.
So
as
always,
thank
you
for
your
partnership.
Still
steve
did
I
steal
everything.
F
Yeah,
I
don't
know
how
I'm
going
to
follow
that.
I
will
just
say
this:
it's
been,
I
take
a
lot
of
pride
in
working
with
the
kentucky
hospital
association.
F
It's
I
think,
we're
setting
a
standard
for
everyone
on
how
to
engage
stakeholders
and
to
get
their
input
and
to
come
to
a
common
goal
commonplace
and
that's
what
what
makes
this
so
successful
is
that
we
are
working
together
versus
against
each
other
and
unfortunately,
in
in
in
state
government,
sometimes
in
federal
government.
You
work
against
each
other,
but
in
this
case
it
has
been
a
very
open,
transparent.
F
We
meet
each
week
we
set
out
an
hour
each
week
on
wednesdays
to
meet
with
with
the
kha
team,
and
they
have
they
bring
concerns
that
those
that
they
represent
and
we
we
try
to
address
those
concerns.
Now
it's
not
just
setting
the
payments.
It's
also
looking
at
appeals
claims
things
like
that,
but
we
we
do
that
in
a
collaborative
effort
and
it's
it's
been
a
it's
been
a
great
experience
for
me.
I
will
say
the
senator
meredith.
You
asked
in
your
email
or
an
email,
I've
received.
What
are
our
concerns?
F
What
do
we
need
to
implement
this
program
and
it's
it's
very
simple:
we're
going
to
need
cms
approval,
like
everyone
said,
we
have
to
get
approval
to
add
the
out
outpatient.
We
have
to
get
the
approval
for
the
next
year,
the
it
ends
so
far
right
now
the
program
will
end
december
31st
of
this
year,
but
we're
already
in
the
process
of
renewing
for
january
1
of
23..
F
The
second
thing
is
we're
going
to
need
legislative
support.
What
that
means,
what
I
mean
by
that
we're
going
to
secretary
hit
on
it,
we're
going
to
need
some
changes
to
the
statute
as
well,
as
maybe
some
regulations
we're
going
to
draw
support
on
that,
as
well
as
for
this
committee,
here
we're
going
to
need
the
appropriations,
the
budget
appropriations.
F
We
do
not
know
at
this
time,
like
I
said,
we're
still
gathering
the
data,
what
those
appropriations
will
be
just
yet,
but
we
will
be
bringing
that
to
you
all
as
soon
as
as
we
have
a
good
estimate.
So
those
are
the
things
that
that
that
we
need
to
implement
and
what
will
be
necessary.
The
other
thing
is,
I
just
want
to
touch
bases.
Yes,
other
states
have
reached
out
to
us.
F
I
think
florida
was
looking
into
it
at
one
time,
I'm
not
sure
if
tom
down
in
florida,
if
he
used
it
or
not,
but
he
was
looking
at
it.
So
we
we
are
a
leader
there,
but
like
senator
alvarado
and
the
secretary
have
mentioned,
if
the
more
that
they
follow
the
more
the
cms
will
try
to
change
change
the
game
on
it.
So
any
questions
that
I
may
be
able
to
answer.
A
Comments
and
questions
first,
I
I
do
appreciate
the
comments
and
very
pleased
to
learn
of
the
relationship
between
the
cabinet
and
our
healthcare
providers,
and
you
all
heard
me
say
before
that
in
my
almost
40
years
in
healthcare.
A
For
many
of
it,
it
seemed
like
we
were
in
an
adversarial
relationship
and
we
shouldn't
be-
and
I
really
sense,
a
subtle
paradigm
shift-
that
we
talked
about
social
determinants
of
health
before,
but
we
would
never
have
really
directed
policy
to
address
those.
It's
like
we're
two
different
silos
we're
working
from,
and
this
is
a
obviously
moving
in
that
direction
and
would
certainly
like
to
see
more
than
that
but
see
when
you
talk
about
legislation.
A
F
Yeah
we
we're
looking,
we
are
pushing
to
try
to
get
this
approved
starting
one
one
of
23..
Now
I
understand
we,
we
wouldn't
make
the
first
payment
until
after
because
we
pay
it
quarterly.
So
we
would
have
to
wait
till
the
first
quarter's
over
and
then
pull
the
data
and
we
wouldn't
be
making
a
payment
until
sometime,
probably
mid-may,
but
we
we
will
need
that
authority
to
do
that.
A
G
I
doubt
it
and
I'm
I'm
not
a
part
of
any
of
those
negotiations,
I'm
very
pleased
to
say
and
and
it
wouldn't
make
any
difference
in
any
way,
because
I
think
really
there's
time
there's
there
would
be
time
in
the
23
and
and
obviously
we
are
not
dictating
to
you
all
you
all.
You
know
you
will
work
with
your
with
the
hospital
association
more
than
us
on
on
that
legislation
and
we'll
provide
the
background.
Of
course,
we'll
provide
the
background,
information
and
support,
but
good.
F
B
More
of
a
comment,
thank
you,
mr
chairman.
It
is
kind
of
scary
when
people
are
saying
they
agree
and
I've
seen
firsthand
recently,
when
my
parents
were
in
the
hospital
that
a
cat
we
had
a
shortage
of
nurses
and
and
my
mom's
like
we
need
our
hospital.
We
need
our
hospital
and
then
the
nurse
in
the
er
was
actually
going
to
louisville
to
to
be
a
traveling
nurse
to
louisville.
B
So
I
see
all
this
and
I'm
very
much
about
our
rural
hospitals,
but
it
bothers
me
to
say
that
medicaid
expansion
helped
because
to
me
I
think
people
need
to
be
working
and
getting
their
commercial
insurance
and
paying
for
it,
because
medicaid
and
medicare
dollars
are
taxpayer
dollars.
So
that's
just
just
an
observation,
so
thank
you,
mr
chairman.
A
Anyone
else
just
a
couple
follow-up
questions.
First,
tell
me
more
about
this
lake
wobegon.
G
Garrison
keith
on
anyway,
I'm
sure
you
know
yeah,
all
children
are
above
average
in
lake
wobegon.
I
forget
what
the
rest
of
the
quote
was.
Dr
stack
told
me
and
and
commented
that
we
were
both
old
enough
to
remember
so.
G
Actually,
yes,
you
know,
I
think,
we're
long
overdue
for
getting
that
done
yeah
and
they
had
several
years
ago
under
dr
hacker.
They
had
who
was
a
commissioner
of
public
health
that
kind
of
got
together
for
lunches
right,
but
that's
not
the
same
thing
as
working
on.
G
And
so
I
feel
like
we
have
that
expertise
within
the
cabinet.
We
should
access
it,
and
this
was-
and
it's
always
better
to
try
to
do
that
when
you
have
a
project-
and
this
gave
the
opportunity
to
have
a
project
for
them
to
work
on
together
and
make
those
recommendations.
So
I'm
kind
of
excited
about
it.
A
Appreciate
your
testimony
this
morning
and
very
encouraging
news
and
looking
forward
to
working
with
everyone
to
make
this
a
reality,
any
other
questions
comments.
If
not
thank
you
for
presentation.
I
love
you.
A
Next,
we'll
have
an
update
from
secretary
freelander.
That's
why
it's
remaining
at
the
desk
there
and
eric
lowery
on
where
we
stand
with
cobit
19
funding
and
the
state
received
the
past
year
two
years
and
I'm
glad
to
have
dr
stack
joining
us
as
well.
So,
gentlemen,
again,
you
know
the
routine
identify
yourself
for
the
record
and
please
proceed
eric.
G
Certainly,
a
couple
of
caveats
before
we
begin
this,
this
funding
is,
is
the
funding
that
came
to
the
cabinet.
This
is
really
not
addressing
overall
state
funding.
This
is
only
this
is
only
related
to
funding,
as
it
specifically
flowed
through
the
cabinet.
So,
given
that
caveat
second
caveat,
I
want
to
give
you
all
is
this.
We,
and
I
know
you
asked
questions
about
what
I'm
worried
about
and
we'll
get
there.
We
really
tried
to
look
at
how
this
funding
came
in.
G
When
was
the
expiration.
You
know
when
was
the
expiration
date
on
the
on
the
grants.
So
what
do
we
spend?
First?
What
can
we
use
it,
for
we
were
trying
to
figure
out
what
was
most
impactful
and
and
acknowledging
that
we
were
all
learning
as
we
went
absolutely.
I
think
I've
testified
in
front
of
either
this
committee
or
other
committees
that
I've
been
in
front
of
we're
we're
going
to
spend
the
next
20
years
figuring
it
out.
I
think
this
is
going
to
be
something
that
gets
studied
for
years.
G
G
So
I
just
kind
of
say
that,
as
kind
of
to
caveat
what
we're
what
we're
talking
about,
so
I
just
wanted
to
kind
of
give
you
all
that
sort
of
as
a
preamble,
the
other
philosophical
piece
we
were
trying
to
do,
which
is
this-
is
mostly
one-time
funding
right
this
or
time
limited
funding.
There's
there's
not
much
in
there
isn't
anything
in
here
that
doesn't
have
a
have
an
end
date
on
it.
G
The
the
dangerous
thing
for
us
to
do
would
be
to
set
up
ongoing
programs
so
that
I
would
come
back
to
you
in
24
or
someone
would
come
back
to
you
in
24-26
and
say:
we've
got
this
gigantic
hole.
Okay,
so
those
are
all
my
caveats
with
that.
You
know.
G
One
of
the
things
we
at
the
cabinet
for
health
and
family
services
are
really
good
at
is
spending
money,
and
so
we
really
have
tried
to
make
sure
because
it
feels
like
these,
these
go
into
communities
that
you
heard
some
of
the
hospital,
those
funds
that
the
hospitals
got
through
through
some
of
the
relief
funds,
paycheck
relief
that
that's
not
in
here,
actually
those
direct
payments
to
healthcare
providers
which
which
are
or
the
industry
none
of
that
is
in
here,
because
it
didn't
flow
through
the
cabinet.
G
So
again
just
another
caveat
for
everybody,
so
these
bills,
and
this
this
funding,
we
wanted
to
give
you
some
idea
of
what
came
in
and
and
where
and
how
we
spent
some
of
this
funding.
So
that's
why
dr
stack
is
here
because
a
vast
majority
of
this
funding
flowed
through
his
department
and
it
actually.
I
I
get
my
committee's
confused,
so
I
apologize
but
there's
so
much
funding
here
that
within
the
cabinet
medicaid's,
the
biggest
dcbs
is
next
and
historically
behavioral
health
was
next
and
then
public
health.
G
This
is
so
much
funding.
It
flipped
those
two,
so
public
health
ended
up
in
this
last
budget
as
being
the
third
largest
department
in
the
cabinet,
so
I'd
and
and
in
a
big
cabinet
it
really.
It
does
take
a
lot
to
change
that
to
change
that
order.
G
So
again,
just
all
those
caveats,
so
these
funds
came
in
all
of
these
and
eric
helped
me
remember
what
all
these
are,
because
I
get
confused
the
preparedness
and
response
supplemental
act
that
is
basically
over,
and
so
we
that
was
a
lot
of
funding
that
went
to
help
steve.
Do
you
remember
which
one
this
one
is?
I
know
eric
you
do.
G
Was
public
health
and
some
of
the
aging
and
independent
response,
so
that
was
supporting
local
health
departments
and
aging
independent
living
to
make
sure
that
we
were
providing
meals,
aging
and
independent
living
and
meals
is
one
of
the
things
that
I
will
tell
you
that
I'm
worried
about.
I'm
worried
about
three
things:
meals
is
one
some
of
that
is
one-time
funding.
So
if
the
demand
keeps
the
same
across
budget
years,
we
will
go
back
to
waiting
lists.
We
had
waiting
lists
prior
to
this.
G
We
don't
have
waiting
lists
now,
but
this
funding
helped
us
not
have
waiting
lists.
So
it
was
a
big
deal
and
and
there's
some
one-time
funding
in
the
budget
this
year
to
help
with
meals
and
so
we'll
continue
to
not
have
any
waiting
lists
through
this
budget.
We're
very
confident
of
that,
but
the
next
budget
there'll
probably
need
to
be
some
supplement
there,
the
families
first
again,
these
are
all
these
are
all
the
pieces
that
came
through
some
of
that
economic
security.
That
was
some
of
the
enhanced
reimbursement
for
families.
G
I
think
pebt
and
some
of
those
things
that
came
through
there.
We
had
a
little
bit
of
the
the
a
little
bit
of
the
payment
protection
act.
Some
of
these
other
things
that
came
through,
I
mean
you
know
we
spent
it
on
vaccines.
We
spend
it
on
vaccine
clinics,
we
spend
it
on
I.t
solutions.
G
We
spent
it
on
enhancing
our
our
ability
to
respond.
We
spent
it
on
vaccines
in
schools.
We
spent
it
on
ppe
that
we
provided
to
health
care.
We
had
a,
I
don't
mean
to
steal
what
you're
gonna
say
dr
stack,
but
we
went
from
a
a
warehouse
about
this
size
to
a
warehouse
about
this
size.
We
went
from
a
maybe
less
than
a
week
supply
of
ppe.
G
To
now
we
can
we,
we
have
a
supply
of
ppe
that
won't
expire,
that
we'll
be
able
to
respond,
and
we
use
it
to
respond
to
things
like
floods
and
tornadoes.
G
So
it
is,
it
has
come
in
as
something
that
has
beefed
up
our
ability
to
respond
to
emergencies,
so
all
of
these
pieces
have
come
through.
Some
of
these
are
longer
than
others,
and
you
can
see
at
this
point
we
have
about,
and
I
know
this
is
like
just
a
crazy
number,
but
we
have
about
a
billion
left
to
spend,
but
that's
over
the
next
couple
of
years
actually
goes
out
to
24..
G
G
We
have
supplemented
child
care
with
a
lot
of
funds
to
support.
We
now
have
grant
programs
for
folks
to
open
up
small
child
care.
We
have
some
matching
grants
for
industry
to
open
up
child
care.
We
have
some
grants
for
child
care
to
assist
with
some
capital
facility
improvement,
sorts
of
things
we've
taken
away.
Co-Pays
we've
increased
the
percentage
of
folks
who
can
participate
in
child
care
to
help
folks
get
back
to
work,
and
so
we
there's
a
lot
that
has
been
provided
to
child
care.
G
When
this
ends
the
next
budget,
there
will
be
a
need
for
additional
child
care
funds,
we'll
size
that
for
you
we
don't
quite
have
it
yet
we
are
working
on
it,
but
but
that's
a
real
concern
of
all
the
concerns
right.
The
meals
is,
is
not
it's
millions
right,
so
I
don't
want
to
downgrade
that,
but
child
care
is
much
more
than
that.
G
That's
going
to
be
the
biggest
hole
to
fill
no
question
about
it,
and
I
think
you
know
I
I
believe,
we've
we've
spent
funds
in
a
way
that
helps
people
stay
open
but,
as
you
saw
with
the
hospitals,
the
cost
of
wages
for
individuals
to
go
and
actually
provide
care
in
child
care
is
probably
well
it's
across
industries
right,
but
child
care.
It's
particularly
acute.
G
You
know
you
how
you
are
able
to
bring
folks
in
who
might
otherwise
be
able
to
go
to
go
to
a
an
amazon
or
somebody
else
right.
That's
a
challenge!
You
want
to
see
people
get
these
early
childhood
education
certificates.
Again,
that's
that's
a
challenge,
so
you
you
actually
put
more
on
folks
in
child
care.
So,
while
many
child
we
didn't
have
as
many
child
care
facilities
clothes
as
we
were
worried
about
in
the
beginning,
many
are
still
not
operating
at
their
license
capacity
just
because
they
can't
get
staff,
so
I
think,
moving
forward.
G
If
I
had
to
target
a
big
area
that
big
area
is
child
care,
so
I
know
all
sorts
of
discussions
about
how
to
do
that.
You
know
universal
pre-k.
However,
we
want
to
do
it.
It's
just
know
that
coming
up
is
probably
a
pretty
big
down
payment
there,
and
I
just
I
just
that's
one
of
the
ones.
That's
the
biggest
one
I
wanted
to
target
for
you.
We
spent
a
lot
of
money
in
public
health
also
with
our
labs
and
improving
laboratory.
G
The
the
third
thing
that
I
would
tell
you
that
that
what
the
pandemic
has
revealed
is.
We
need
a
new
laboratory,
it's
15,
20
years
old
over
30
years
old
and
health
care
right.
How
much?
G
How
much
equipment
do
we
use
for
30
years
in
healthcare
and
some
of
the
equipment
is,
is
really
old
and
the
design
is
old
and
the
building
is
old
and
was
it
designed
perfectly
when
you
know
you
learn
more
over
30
years,
we
should
learn
how
to
build
a
better
lab
right
and
we
have
and
a
lot
of
people
have
so
that's
a
capital
request
that
will
be
made.
But
if
there's
so,
there
were
three
things
for
me.
G
The
third
thing
is,
is,
I
would
say,
we
have
a
desperate
need
for
a
new
lab
next
eric
this
just
shows
you.
We
spent
a
lot
on
subs.
You
know,
there's
this
piece,
that's
substance,
abuse,
there's
a
lot
that
went
for
community
mental
health.
I
think
we're
going
to
see
some
more
of
health
community
mental
health
funding
and
mental
health
funding
on
coming
through
education
bills,
as
well
as
we're.
G
There
are
more
grants
available
to
us
based
on
some
of
the
emergencies
we've
seen.
So
that's
that's
going
to
be
the
need
ongoing
is,
we
know.
Behavioral
health
needs
we're,
seeing
it
all
over
the
place,
seeing
it
in
schools,
seeing
it
all
across
healthcare.
I
can
tell
you
I'm
seeing
it
in
my
cabinet
right,
the
folks
that
I
work
with
many
of
us
are
tired,
and
so
it
just
it's.
G
You
know
it's
been
a
flood
ice
storm
covid
for
a
long
time
monkey
pucks
avian
flu
tornado
flood,
I'm
waiting
for
the
locusts
and
the
frogs.
I
hope
we
don't
get
them,
but
it's
like
what
else,
and
I
don't
want
to
say
that,
so
you
can
see
how,
where
the
funding
has
gone
again,
a
lot
of
that
epidemiology
and
laboratory
capacity
eric
and
again
this
just
this
just
breaks
it
down
a
little
more
for
you.
G
G
We'll
have
we're
still
waiting
to
see
how
long
the
public
health
emergency
goes
out,
but
that's
really
not
in
the
figures,
but
you
should
know
it's
there
as
budget
subcommittee
next
slide
again.
This
just
goes
through
where
we
spent
specific
dollars.
G
G
You
all
may
go
through
this
thanks
eric
and
just
you
may
have
other
questions
right.
It's
just
a
lot
to
take
in
and
we're
happy
to
to
come
back
at
any
time
and
go
through
these
slides
with
you.
We're
just
about.
We've
got
another
couple
of
acts.
Yeah,
like
I
say
if
I
went
through
all
of
these
with
you
all
we'd,
be
here
until
the
next
subcommittee
hearing
I'm
supposed
to
testify
at
so
I
hope
this
is.
G
This
is
helpful
to
you
all
again
we're
just
we're
just
trying
to
show
you
where
everything
is
we
wanted
to
make
sure
you
could
see
where
the
expenditures
are
and
happy
to
answer
any
questions.
A
A
A
A
You
know
I've
always
professed
that
with
our
medicaid
dollars.
If
we
improve
the
health
of
population
and
move
people
to
gain
from
employment,
as
representative
prenty
has
said,
there's
dollars
available
to
us
right
there
for
these
other
services
that
we
that
we
have,
but
I
don't
think
we've
traditionally
had
that
mindset.
I
see
public
health
dr
stack
as
much
as
a
potential
revenue
generator
as
it
is
an
expensive
reduction
and
I
think,
there's
an
opportunity
for
that.
A
If
the
same
thing
that
good
that
came
out
of
colbit,
it
was
elevation
and
the
importance
of
public
health
in
our
state,
and
I
think
we
should
build
on
that
in
public.
Health
should
take
a
stronger
role,
not
just
with
our
governmental
programs,
but
within
our
society
in
total.
How
we
do
that?
I'm
not
certain,
but
I
think
we
invest
those
dollars
in
public
health,
we're
going
to
see
return
on
them
and
I
think
that's
where
we
have
to
look
at
all
of
our
tax
dollars.
A
D
Thank
you,
mr
chairman
and
secretary,
thank
you
for
the
presentation
on
the
child
care
component
of
this,
and
it's
good
to
hear
that
you
all
are
are
gathering
data
on
a
plan
for
the
future.
For
this
two
questions,
how
are
you
all
approaching
that
are
as
far
as
models
on
child
care
and-
and
I
asked
that
as
you're
aware
of
the
task
force
that
we
have?
That's
that's
a
large
component
of
that.
So
my
second
question
is:
when
will
you
have
that
prepared?
G
We're
working
on
that
now
eric.
Would
you
have
any
estimate,
I
know
we're
working
on
with
dcbs
they're
they're,
looking
at
the
the
difference
between
cover
and
copay
right,
they're,
also,
looking
at
the
difference
between
moving
to
85
percent
of
average
median,
you
know
all
those
initials
which
is
an
increase,
and
what
that
difference
is
the
other
piece
that
I
think
is
is
probably
not
in
here,
but
I
think
we
should
give.
G
You
is
the
what's
called
the
new
market
basket
right
where
we
look
at
what
the
costs
are,
because
I
think
wages
have
gone
up
right.
So
we
need
to
take
a
look
at
that.
I
we're
probably
a
couple
of
months
away
as
my
best
guess
at
least
thanks
eric,
but
I
think
we're
probably
a
couple
of
months
away,
but
we
will
get
you
that
as
soon
as
we
have
yeah.
D
And
I
would
ask
that
you
all
kind
of
keep
that
in
a
broad
picture,
so
for
for
our
purposes
as
we
start
narrowing
down
making
policy
from
the
legislative
point
of
view
that
that
you
know
this
can
be
more
of
a
collaboration
with
with
legislative
executive
branch
as
we
make
those
decisions.
I
don't,
I
don't
think
by
any
sense
in
that
task
force
or
we
made
any
decisions
in
any
way
or
going
in
trying
to
be
open-minded
about
all
of
it
in
the
approaches.
D
The
mixed
model
approach,
not
many
fans
of
universal
pre-k
for
various
reasons,
but
everybody
has
the
same
goal:
quality
and
making
sure
we
have
the
the
facilities
to
provide
sufficient
child
care
quality,
child
care
across
the
whole
state.
So
it's
good
to
hear
that
that's
going
to
be
valuable
to
our
committee,
and
I
appreciate
you
bringing
that
up
today.
G
What's
going
on
with
that,
for
those
of
you
that
don't
know,
there's
a
fund,
that's
set
up
kind
of
a
trust
fund.
That's
set
up
that
businesses
can
apply
to
to
help
supplement
the
cost
of
child
care
for
their
employees,
and
so
we're
we're
looking
at
how
to
do
that.
And
what
does
it
look
like
our
regular
ccap
payment,
I'm
sorry
to
use
initials.
Does
it
look
like
a
regular
child
care
payment
model
through
dcbs
and
then
what
would
let
that
look
like?
G
And
how
do
you
apply
and
is
it
first
come
first
served,
there's
there's
a
lot
to
work
out,
but
we
are.
I,
I
think,
that's
a
really
interesting
model
and
appreciate
that
the
general
assembly
put
funding
in
for
that.
B
Thank
you,
mr
chairman,
thank
you
for
a
great
presentation
and
for
the
incredible
work
that
you
guys
are
doing
under
very
dire
circumstances.
For
a
long
time,
I
hear
the
weight
of
the
work
you're
doing
I
I
I
hear
it.
I
feel
it
and
I
appreciate
it.
I
want
to
echo
the
chairman's
emphasis
on
public
health
and
how
important
those
investments
are,
and
I'm
really
you
know,
like
the
chairman,
really
glad
to
see
us
moving
in
that
direction
and
I
feel,
like
that's
gonna,
have
a
tremendous
benefit
for
kentuckians.
B
In
the
long
run
you
mentioned
school.
Mental
health,
which
you
know
is
a
huge
passion
of
mine,
and
you
know
how
do
we
treat
our
kids
where
they
are
and
they're
in
school,
and
so
how
do
we
get
the
resources
there,
as
we
think
about
resources,
move
mental
health
resources
moving
into
schools?
B
G
G
G
They
are
heroes
and
a
lot
of
this
I
used
to
be
over
family
resource
centers
and
again,
you
know
I've
been
over
everything
just
about
in
the
cabinet,
but
but
they're
fantastic
and
we're
the
only
state
in
the
country
again
another
place
where
we
are
leading
the
nation
in
having
these
family
resource
centers
in
almost
every
school
in
the
commonwealth,
and
so
that
collaboration
between
among
family
resource
centers,
sometimes
local
health
departments,
sometimes
comprehensive
care.
G
Centers
school
districts,
school
nurses,
school
behavioral,
health,
all
of
those
partners
that
that
that
can
be
brought
to
bayer.
G
That's
how
you
start
to
bring
more
into
the
schools,
and
you
all
pass
some
funding
for
that,
and
so
that
will
be
a
collaboration
and
has
been
and
has
been.
Is
that
helpful.
G
One
thing
I
did
that
both
of
you
all
raised
about
public
health-
and
this
is
again
a
thank
you
to
the
general
assembly,
but
even
through
all
of
this
representative
moser
had
a
public
health
transformation
bill
that
went
through
the
general
assembly
a
couple
of
years
ago
that
work
has
proceeded
and
in
the
last
budget
it
was
funded.
So
thank
you
for
that,
because
part
of
what
does
public
health
do
and
what
is
the
impact
on
local
communities?
G
A
lot
of
that
is
tied
up
in
the
public
health
transformation
piece
about
really
paying
more
attention.
I'm
not
going
to
do
it
justice,
dr
stack,
paying
more
attention
to
community
health
right
writ
large
and
and
making
sure
that
that's
what
the
local
health
departments
focus
on
local
health
departments,
just
like
every
everybody
else.
G
Some
are
better
funded
than
others,
and
so
there
are
challenges
out
there
dependent
upon
which
you
know.
Is
it
a
single
health
department?
Is
it
a?
Is
it
a
district
health
department?
You
know
all
of
those
things
that
that
are
true,
but
I
think
I
hope
that,
as
you
said,
they
they
they
feel
far
more
valued
and
and
far
more
as
an
important
piece
and
understood
than
perhaps
they
have
been
in
previous
years.
B
G
Because
it
was
hard
to
describe-
and
it's
not
as
though
more
money
went
into
medicaid,
but
the
change
in
the
f
map
rate
means
that
the
amount
of
general,
the
amount
of
dollars
that
are
not
federal,
is
actually
less
to
get
the
same
amount
of
revenue,
because
the
federal
participation
is
increased.
So
it's
that's
why
it's
zero
there,
but
I
didn't
want
to
say
it
doesn't
exist
because
it
does
and
it's
a
big
deal,
but
it's
hard
to
define
as
more
money
coming
just
because
it's
actually
less
money
that
needs
to
be
used.
A
B
This
is
kind
of
I
don't
know
if
it's
esoteric,
but
it
child
care.
It
came
to
me
that
many
well
a
couple
years
ago,
I
had
a
constituent
ask
me
about
client.
It
was
a
hair
salon
and
she
had
a
client
who
had
child
care
paid
for
and
she
was
a
stay-at-home
mom
on
public
assistance.
It's
dude
does
the
cabinet
pay
for
child
care
for
moms
to
stay
home
on
public
assistance
or.
G
G
A
I
guess
it's
point,
I'm
a
little
bit
concerned
about
who
we
may
have
left
behind
and
that's
not
a
criticism
of
anybody,
but
obviously
crisis
and
points
you
in
different
directions
and
I'm
very
proud
of
what
we've
done
for
the
in
the
hospital
association
looks
like
we've
got.
It
may
be
unstable
ground.
I'm
not
sure.
A
We've
made
comparable
efforts
with
our
long-term
care
facilities
because
they
truly
are
in
a
financial
crisis
and
I'm
not
sure
how
we're
going
to
address
that
but
needs
to
be,
but
also
we've
talked
for
years
about
the
number
of
waiver
slots
that
we
have
and
adult
protective
services
you
know.
Are
they
standing
in
the
wings
and
outpatient
behavioral
health
that
we
really
haven't
given
a
lot
of
attention
to?
A
But
I
think
that's
something
that
collectively
we
need
to
give
some
consideration
to
and
try
to
identify
what
those
priorities
are
for
our
next
session
and
obviously
the
next.
My
annual
budget,
which
will
be
here
before
we
know
it,
but
we've
still
got
some
some
weaknesses
and
you
folks
are
aware
of
that.
But
I
think
we
need
to
truly
be
cognizant
of
that
and
give
some
attention
to
it,
but
I
appreciate
that
covet
has
kind
of
brought
all
of
us
together.
A
It
has
pointed
a
lot
of
weaknesses
within
our
social
and
medical
infrastructure
and
that's
a
good
thing.
We're
trying
to
address
those,
but
we've
still
got
a
lot
of
work
to
do
as
well,
but
senator
alvarado.
You
have
a
comment.
D
Question
just
one
quick
question:
so
I'm
trying
to
like
you
said
going
through
all
the
deny
tests
going
through
all
the
numbers-
and
I
know,
there's
a
lot
of
federal
restrictions
on
cares
funds
and
that
sort
of
thing
we're
looking
for
a
new
lab.
How
much
money
would
a
I
mean
I'm
looking
at
the
cares
funds.
We've
got
what
100
and
almost
200
million
dollars
in
the
epidemiology
and
laboratory
capacity
remaining.
D
Is
there
no
way
we
can
use
some
of
those
funds
redirected
for
a
new
lab?
We
require
a
waiver
from
the
federal
government
to
get
that
allotted
to
be
able
to
use
those
funds
for
that
purpose,
because
we
talk
about
not
wanting
to
use
these
funds
for
recurring
expenses,
a
new
lab
would
be
a
one-time
investment,
ultimately
in
medical
infrastructure,
for
the
state
that
we
could
use.
E
Senator
you
so
cares.
Funding
is
over
at
this
point,
so
that's
all
been
expended
and
had
to
be
expended
or
lost
cures.
Funding
could
have
been
used
for
a
lab.
Arpa
funding
is
not
yet
expense
is
fully
expended
that
could
be
used
for
a
lab.
I
believe
that
would
be
allowable
the
other
grants.
The
cdc
grants
cannot
be
used
because
they
are
allowable
for
very
specific
purposes
under
the
cdc's
parameters,
and
so
they
can't
be
used
for
major
capital
projects,
and
so
they
have
attempted
to
make
some
additional
funds
available
for
some
capital
projects.
E
G
D
So
if
you'll
go
back
to
slide
six,
the
chrome
virus
aid
relief
and
economic
security,
this
was
specific
to
the
cares
act.
The
the
state
over
received
not
only
these
awards
to
the
existing
programs
we
have,
but
the
state
also
received
the
current
virus
relief
fund,
the
large
part
of
money
that
the
state
could
determine
best
way
to
respond
to
the
pandemic.
D
Much
like
the
state
fiscal
recovery
fund
and
the
american
rescue
plan
of
that
coronavirus
relief
fund,
the
cabinet
that
received
319
million
dollars,
which
we
fully
expended
and
those
are
the
dollars
that
dr
stack
is
referring
to.
So
so
pull
up
slide.
Number
nine,
if
you
don't
mind
and
it
again
meets
quran
writers,
response
relief,
supplemental
appropriation,
acts,
act,
okay,
so
you've
got
257
million
dollars
of
an
award
there
for
epidemiology
and
lab
capacity,
and
we've
expanded
61.6
million
so
that
it's
almost
not
quite
200
million
but
195.
Something
like
that.
D
Can
we
not
use
some
of
those
funds
for
a
lab?
No
sir,
those
are
the
cdc
grants
that
dr
stack
was
referring
to
that
a
large
capital
project
like
that
would
not
be
an
allowable
unless
we
get
a
waiver
from
the
feds.
Yes,.
E
So,
to
put
that
in
context
that
grant
what
the
cdc
and
the
other
federal
agencies
did,
they
took
existing
grants
that
were
already
in
place
for
different
from
different
agencies
and
used
those
to
really
juice
them
up
during
the
covet
response.
So
there
is
an
existing
underlying
grant
called
cdc,
expanding
lab
capacity
elc,
which,
which
is
much
much
smaller.
You
know
in
the
magnitude
of
a
couple
million
dollars
over
a
couple
years,
spending
plan
that's
normally
given
to
to
our
lab
or
to
our
kentucky
department
for
public
health
and
all
the
states
get.
E
You
know
a
grant
of
some
sort
that
was
markedly
expanded.
The
the
the
first
tranche
of
that
was
largely
spent
on
providing
community-based
testing
when
we
did
that
in
the
very
earlier
days
of
the
pandemic,
the
current
money
is
for
staff.
A
lot
of
that
went
to
support
local
health
departments
for
testing,
also
for
it
system
upgrades
and
improvements.
E
But
that's
that's
the
specific
part
of
money.
I
was
referencing
that
the
federal
government
has
not
demonstrated
an
interest
or
willingness
and
allowing
you
to
use
a
massive
chunk
of
money
for
a
major
capital
project.
They
have
historical
restrictions
on
what
they'll
allow
from
those
grants
to
be
used
for
that
kind
of
spending.
G
E
And
the
distinction
I
was
making,
there
are
a
lot
of
different,
like
eric
lowry,
had
mentioned
different
specific
funding
sources
for
certain
things,
the
the
cares
funding.
The
big
cares
funding
like
that,
the
legislature
and
the
governor
had
and
the
arpa
funding
that
the
legislature
and
the
governor
have
and
work
through
that
can
support
local
jurisdictions.
E
You
know
for
infrastructure
improvements,
a
variety
of
different
things,
that's
more
pluripotent,
and
that's
that's
obviously
the
remaining
arpa
money
that
the
legislature
will
determine
in
the
next
session,
how
to
use
the
last
bit
of
that
arpa
money.
Those
funds
can
be
used
for
things
like
that.
I
believe,
but
these
other
grants
the
ones
I
have-
and
I-
and
this
is
a
cabinet
level
lens
on
this.
So
I
look
at
an
agency
kind
of
level
lens.
E
They
have
very
specific
grant
deliverables
for
certain
things
that
have
to
be
done
or
certain
things
that
can't
be
done.
So,
for
example,
we
had
a
grant
last
year
that
was
large
134
million
dollars
to
support
coveted
testing
in
k-12
schools
very
specific
to
that
could
not
be
used
for
other
purposes
and
it
was
either
use
it
for
that
or
don't
use
it,
and
we
expended
probably
about
96
plus
percent
of
that
last
year,
supporting
k-12
schools
and
got
out
and
provided
well
over
a
million
tests
across
all
that.
E
So
it's
different
than
last
year,
but
there's
still
money
being
used
and
we're
confident
we'll
use
up
that
134
million
dollars
before
we
reach
the
end
of
its
spending
authority
for
it
for
the
lab.
If
I
can
just
real
briefly
comment
on
this,
the
laboratory
is
more
than
30
years
old
and
part
of
the
challenge
when
it
was
built.
We
didn't
have
laboratory
technology
like
we
do
now.
The
new
machines
generate
heat
and
humidity
in
ways
that
old
technology
did
not.
E
I
I
just
want
to
leave
you
with,
because
it
will
be
some
future,
commissioner,
who
is
the
one
who
cuts
the
ribbon?
It
will
not
be
me.
It
is
a
five-year
time
frame
from
design
to
move-in
and
that's
optimistic
and
all
of
us
have
our
skepticism
about
how
efficiently
those
capital
projects
can
move,
and
now
we're
talking
the
next
biennium.
So
a
year
and
a
half
to
two
years
from
now
it'll
be
seven
years
down
the
road.
The
lab
will
be
almost
40
years
old.
E
Every
single
newborn
born
in
the
commonwealth
has
its
newborn
screening
testing
done
there
53
to
54
000
live
births
a
year.
There
is
no
in-state
alternative,
it
would
have
to
be
shipped
out
of
state
to
a
contracted
lab
at
substantial
added
expense
and
delayed
returns
and
turnaround
times.
If
we
have
white
powder
investigations
anthrax
in
the
mail.
Someone
thinks
there's
ricin
or
sarin
or
things
like
that.
We
have
the
only
biosafety
level
3
lab
in
the
entire
commonwealth.
There
is
no
state
alternative,
it's
one
of
only
200
such
labs
in
the
country.
E
There
are
other
things
too,
environmental
testing,
certain
kinds
of
things
that
are
provided
to
support
people
across
the
state,
the
water
testing
that
will
be
done
in
eastern
kentucky
in
the
floods.
Our
state
lab
has
a
role
in
helping
to
coordinate,
or
at
least
support,
some
of
that
and
then,
of
course,
other
providers
come
into
augment
when
we
need
to
so
for
the
next
biennium.
E
However,
it's
funded,
and
it
was
proposed
this
last
budget
as
a
135
million
dollar
30-year,
I
think
bond
funded.
You
know,
capital
project
I
just
have
to
urge
it
is.
It
is
a
severe
and
very
short-term
operational
threat
to
the
commonwealth
that
that
laboratory
has
already
certain
functions.
It
cannot
consistently
maintain
like
fine
particle
analysis
for
soils
and
other
particles.
E
We
can't
do
that
some
days
in
the
summer,
because
the
room
cannot
maintain
proper
temperature
and
humidity
because
it
gets
too
hot
in
the
building
and
there's
inadequate
environmental
controls.
So
I
just
I
urge
your
your
thoughtful
consideration
that
there
are
many
important
needs
in
the
state
that
public
health
lab
is
an
irreplaceable
mission.
Critical
need-
and
I
just
I
urge
your
consideration
a
year
and
a
half
when
the
next
budget
cycle
comes.
G
And
and
what
I
didn't
do
a
good
job
and
I
think
senator
avo
alvarado
this
may
help
and
and
and
also
representative
funny.
This
may
help
if
you
go
to
that
second
slide.
G
What
we
have
listed
there
are
the
grants.
The
big
grants
right
there's
cares:
there's
carissa,
there's
the
consolidated
appropriate.
All
of
these
different
big
buckets
of
grants,
the
subsequent
slides
break
each
one
of
those
big
buckets
down
to
the
smaller
ones.
So
senator
alvarado
cares
right.
That's
what
dr
stack
was
referring
to
is
six
and
seven
and
then
there's
another.
So
then
we
head
into
another
big
bucket
of
grants,
that
is,
that
consolidated
response
release
of
carissa
right.
G
D
Have
we
approached
our
federal
delegation
about
trying
to
loosen
some
of
this
up?
That's
what
I'm
doing
right
now
on
my
phone.
That's
why
I'm
asking
I
mean
really
I
mean
if
it's
cdc
grants-
and
you
know
the
federal
government
can
come
back
in
and
say
yeah
you're
going
to
allow
it
for
this
purpose.
Have
we
tried
that.
E
D
D
A
Well,
you're
here
certainly
not
a
direct
agenda
item,
but
it
has
variance
on
this
and
sort
of
a
budget
review
for
human
services
resources
and
we
are
going
to
have
a
special
session
we'd
be
remiss.
We
didn't
talk
a
little
bit
about
the
floods
in
eastern
kentucky
and
what
have
you
folks
observed
in
terms
of
needs
on
staffing
and
infrastructure
and
any
other
needs
that
we
may
have
to
give
consideration
to.
G
So
we
all
know
the
western
kentucky
tornado
and
its
impact
right.
We
many
of
you
have
seen
experienced.
I
will
tell
you
that,
within
the
first
day
after
the
flooding
in
eastern
kentucky
in
the
cabinet
for
health
and
family
services,
we
had
more
staff
impacted.
G
We
had
more
individual
offices
impacted,
we
had
more
health
care
infrastructure
impacted
by
these
floods
than
we
did
with
the
tornado
it.
It
was
a
factor
of
two
or
three.
So
this
is
a.
This
is
a
big
event.
I
know
those
of
you
who
know
folks
who
reside
in
the
impacted
areas.
They
saw
water
in
places.
They
never
saw
water
before
right.
Somebody's
home
had
been
there
100
years
and
they'd
never
seen
water,
and
they
got
flooded.
G
I'll
also
say
this:
I
joke
about
frogs
and
locusts
right,
but
the
the
the
continuous
impact
on
staff
right
and
the
continuous
impact
on
public
health
staff
and
the
folks
who
are
in
that
emergency
operations
center
they've
been
doing
it
again
and
again
and
again,
I
think
they've
been
open,
more
they've,
then
they've
been
closed
in
three
years.
You
can
look
into
people's
eyes.
G
You
can
probably
look
into
my
eyes.
You
can
probably
dr
stack
size,
we're
tired,
it's
okay.
We
we
rise.
We
rise
to
the
challenge
and
we
do
that's
what
we're
supposed
to
do,
but
I,
I
would
not
be
portraying
impact
on
staff
correctly.
If
I
didn't
tell
you,
it
has
had
an
impact
and
I
can
see
it,
I
I
got
a
little
more
involved
in
this
one
than
some
of
the
other
ones.
It's
not
it's
not
a
reflection
on
dr
stack,
but
I
felt
like
we
needed
to
be.
G
I
needed
to
be
closer
to
it,
just
because
we're
getting
tired.
I
don't.
I
think,
though,
to
everyone's
credit.
Our
response
was
fast.
Our
response
was
impactful.
We
if
you
know
the
emergency
operations
center
and
I'm
going
to
get
a
little
too
deep.
I
think,
but
they're
set
up
in
basically
what
they
call.
What
do
you
call
those
sections?
Yeah
yeah
emergency
support
functions,
I
think
of
them
as
sections
there's
1
through
14
yeah
we're.
G
So
the
the
public
health
response
is
called
esf8,
so
write
just
a
tiny
bit
of
that
director
schlinker
who's,
going
through
like
some
of
the
first
big
ones
in
the
transition
from
director
dawson
to
directors,
linker
fantastic
job,
I
have
to
say
fantastic
job,
but
now
we've
done
it
two
three
four
times
we're
starting
to
get
a
rhythm
down
all
its
own,
in
in
emergency
response
and
and
the
folks
who
have
done
it
several
times
are,
are
working
on
that
we
as
a
cabinet
in
in
the
esf8
arena.
G
We
also
have
volunteerism,
which
helps
with
some
of
the
volunteers.
It's
a
different.
It's
a
different
group.
I
hope
I
think
our
our
response
has
been
a
little
more
coordinated
and
a
little
more
comprehensive,
but
but
we
can
always
do
better
and
that's
the
piece
that
I
challenge
my
folks
about
you
asked
about.
Behavioral
health
there's
been
a
transition
from
office
of
through
the
years
we
now
embedded
folks
who
were
from
the
department
of
behavioral
health
in
with
the
esf8.
G
I
think
that's
good,
I
think
that'll
have
you
know,
connections
to
comprehensive
care,
centers
in
connection
to
longer
term
behavioral.
Health
supports
that
I
think,
will
pay
benefits
in
the
long
run
and
I
think
paid
benefits
to
the
staff
that
were
sitting
there.
I
think
they
were
able
to
to
receive
some
some,
not
formal,
behavioral
health
support,
but
from
folks
who,
who
who
had
a
strong
idea
of
what
they
were
doing.
I
think
we
need
to
continue
to
build
that.
G
I
I
had
a
meeting
with
representative
bratcher
yesterday
and
some
fire
chiefs
about
how
we
need
to
enhance
that
response
and-
and
we
will
and
we
will
and
we'll
we'll
work
on
it
together.
I'm
sorry,
dr
stack
I'll
dr
stakstein,
the
public
health
team
has
done
response
after
response.
After
response
big
responses,
small
responses,
you
know
what
how's
the
water
testing:
when
can
a
restaurant
open?
Is
the
food
that's
being
served
safe?
G
Are
we
doing
disease
monitoring
in
the
shelters,
all
of
those
kinds
of
things
that
the
staff
is
doing
or
do
we?
You
know
who's
moving
out
of
a
health
care
facility
who's?
Does
the
hospital
have
potable
water
all
of
these
things
right
and
they
and
they
all
have
to
do
it
at
pace?
I'm
sorry,
dr
tech,
would
you
like
to
add
some
more.
E
E
I
I
am
consider
myself
very
privileged
to
serve
alongside
them
and
I
reached
out
to
senator
meredith
when
I
was
in
his
backyard
visiting
his
territory,
but
next
week
I
will
have
been
to
all
61
local
health
departments,
as
of
next
tuesday
and
70
some
counties
to
go
to
all
the
different
health
departments
across
the
state
we
regularly
convene
calls.
I
see
them
all
as
partners,
there's
no
state
or
local.
There's
kentucky
public
health
collaborating
through
this.
E
So
I
will
back
up
to
say
my
heart
goes
out
to
the
people
in
eastern
kentucky,
so
I
went
out
there
last
week
and
I
went
to
knott
and
perry
and
lecher
and
brethren
and
a
couple
others
that
we
passed
through
briefly,
it's
very
very
difficult
to
convey
the
devastation
and
the
difficulty
that
that
communities
face
ahead.
E
E
We
have
used
the
resources
you've
seen
on
these
slides
to
support
public
health
across
the
state.
Almost
130
million
dollars
has
gone
out
to
local
health
departments
to
support
their
workforces
and
their
needs
over
the
20
20
21
and
22
calendar
years.
We
have
really
worked
in
partnership
and
open
collaboration
trying
to
build
teams.
E
The
people
in
eastern
kentucky
the
people
in
western
kentucky
with
the
tornadoes
their
lives
were
upended
many
lost
their
lives.
The
the
disaster
is
not
yet
over.
For
many,
they
are
living
it
to
the
present
time,
the
first
responders
and
the
caregivers
who
try
to
help
those
who
are
subjected
to
it
also
have
their
form
of
trauma.
That
goes
along
with
that
and
that's
very,
very
difficult
too,
and
I
think
we
need
to
attend
to
and
try
to
make
sure
we're
supporting
the
responders,
as
well
as
supporting
the
people
they're
responding
to
to
help.
E
C
E
No
one
wants
to
go
through
a
massive
layoffs,
because
the
support
for
that
dissipates
and
what
you've
given
is,
is
ample
and
and
is
providing
that
ability
and
that
hope
that,
in
the
years
ahead,
we'll
be
able
to
rebuild
the
public
health
and
hopeful
the
public
health
system,
and
I
hope
that
the
health
of
the
public
will
follow
and
improve
in
some
ways
with
a
more
robust
public
health
system.
Here
here.
B
Thank
you,
mr
chairman,
thank
you
for
this
report
and
sobering,
not
surprising,
so
we
saw
in
western
kentucky
that,
after
the
initial
crisis,
there
was
an
ongoing
huge
need
for
continued
behavioral
health
mental
health
services.
B
It
seems
entirely
predictable
that
that's
going
to
be
the
case
in
eastern
kentucky
as
well
and
secretary
friedlander.
We
talked
about
this
after
western
kentucky.
How
do
we
make
sure
that
those
resources
are
available
for
the
community
mental
health
centers
for
others
intervening?
You
know
on
the
ground,
the
the
local
comp
care
centers
to
make
sure
that
they
have
the
resources
they
need
in
an
ongoing
way,
and
I
I
just
you
know
for
the
members
of
of
this
committee.
B
I
hope
that
when
we
do
have
our
special
session,
we
can
make
sure
that
those
ongoing
needs
for
mental
health
services
will
somehow
be
addressed
in
our
appropriations.
G
I
want
to
give
you
a
little
bit
of
a
a
really
good
story
about
that
when
the
floods
came
through
eastern
kentucky,
some
of
the
folks
who
reached
out
and
provided
support
and
counseling
and
crisis
counseling
services
are
the
folks
that
came
from
western
kentucky
because
they
had
just
experienced
it.
So
there's
a
there's,
a
lot
of
that
and
a
lot
of
those
kind
of
stories
of
of
community
supporting
communities,
local
health
departments
providing
personnel
to
assist
who
were
going
into
these
areas
to
help
sister
health
departments
and
sister
communities.
G
So
there
are
a
lot
of
those
stories
and
I
think
it's
it's
really
powerful
about
how
we
as
kentuckians
right
really
do
do,
go
out
of
our
way
to
help
each
other
right
and
that's
that's
what
we
should
do.
A
Thank
you
for
presentation
this
morning.
You've
made
references
a
couple
times
too
that
the
plague
of
frogs
and
locusts-
and
you
know
history,
is
a
great
teacher
and
if
you
remember
the
reason,
those
happens
because
the
leaders,
the
people,
wouldn't
hear
the
word
of
god.
So
maybe
if
we
pray,
we
won't
have
to
worry
about
the
frogs
and
locusts
but
appreciate
the
presentation
this
morning
and
looking
forward
to
continuing
our
work
together.
Thank
you
have
a
blessed
day
before
we
adjourn.