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From YouTube: Medicaid Oversight and Advisory Committee (10-13-22)
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A
At
the
same
time,
the
need
for
mental
health
services
is
skyrocketing,
we're
squeezing
the
providers
in
the
system
to
the
brink
of
collapse.
As
you
know,
the
Medicaid
provider.
You
all
heard
this
A
variation
of
this
many
times
so
I'll
try
to
do
it
quickly,
but
you
know,
is
in
a
nearly
impossible
position:
they're
significant
and
costly
statutory
regulatory
contractual
obligations
that
are
non-negotiable,
that
have
to
be
done.
The
reimbursements
do
not
provide
the
necessary
Revenue
to
cover
that
substantial
cost
and
there's
precious
little
if
any
ability
to
negotiate
appropriate
reimbursement
rates.
A
A
little
over
a
year
ago,
in
a
recent
Committee
hearing
here
in
Frankfurt,
Medicaid
officials
made
the
statement
that
they've
heard
from
every
Medicaid
provider
except
podiatrist,
that
they
need
an
increase
in
reimbursement
rates,
I'm
pretty
confident
they've
heard
from
the
podiatrist
by
now.
So
but
I
don't
know
that.
A
A
A
So
due
to
these
factors,
you
know,
providers
really
have
no
ability
to
invest
in
necessary
infrastructure
and
overhead
research
and
development
new
technologies
or
to
maintain
Financial
Reserves.
A
So,
like
I
said,
you
all
heard
this
plight
from
other
folks,
testifying
to
you
before
and
our
Medicaid
recipients
and
our
providers
deserve
better,
which
leads
to
the
question
of.
Why
do
providers
do
it
and
what
would
happen
if
they
can't
any
longer
due
to
waiting
lists
for
services
and
delays
and
accessing
services?
A
It's
already
happening
in
many
cases
that
kentuckians
are
not
being
able
to
access
the
services
they
need.
You
know
when
they
can't
access
the
early
intervention.
Prevention
Services.
They
eventually
access
services
at
some
level,
most
of
the
time,
but
higher
higher
higher
level
and
more
costly
services.
A
What
we're
talking
about
today
in
terms
of
community
and
outpatient,
Behavioral
Health,
you
just
put
it
in
the
context
of
of
the
broader
fiscal
health.
If
we
took
away
primary
care
providers,
it
wouldn't
be
a
big
surprise
that
our
emergency
room
costs
are
going
to
go
up
and
that's
what's
happening
here.
A
These
and
you'll
hear
more
from
examples
specifically
from
these
folks
of
of
how
they
they
are
able
to
provide
services
with
the
family
in
the
community
in
the
school
setting
to
keep
families
together
and
to
keep,
keep
them
from
accessing
much
higher
cost
services
and
avoid
the
trauma
of
that
as
well.
A
If
you
add
state
employees,
you
add
big
pension
costs.
You
have
bureaucracy
that
that
can't
respond
to
changes
in
Services
as
quickly
as
as
providers
can
in
the
end
it
would
just
cost
much
more
than
it
does
now.
A
So
at
this
point,
I'm
going
to
turn
it
over
to
Paula
and
let
her
make
some
comments
and
then
Susan
will
and
then
I
have
a
letter
on
a
read
the
letter
from
Becky
in
your
I
know.
That's
a
specialty
and
a
specific
thing.
I
want
to
read
to
you
all
at
the
end,
then
I'll
have
some
closing
comments.
Paula.
B
Hello,
I
am
Paula,
Garner
I
am
the
president
and
CEO
of
maryhurst
and
I
just
want
to
thank
chairman
Meredith
and
chairman
Elliott,
and
all
the
members
of
this
committee
for
the
opportunity
to
present
on
this
critical
issue
for
children
in
our
state.
B
I
also
want
to
just
take
a
quick
minute
and
have
the
opportunity
to
thank
the
legislature,
and
we've
got
a
couple
of
our
committee
members
here:
Dr
Alvarado
and
Senator
McGarvey,
who
helped
us
to
obtain
additional
support
for
our
5S
residential
program
in
the
last
budget
session.
And
you
know
this
program
is
one
that
serves
kids
from
throughout
the
state.
B
We
serve
kids
and
families
with
the
most
significant
mental
and
behavioral
health
issues,
with
the
goal
of
keeping
them
from
having
to
stay
in
the
hospital
for
long
periods
of
time
or
having
to
go
out
of
state
for
care
and
and
we
we
were
at
a
crisis
point
and
I
came
to
the
legislature
and
and
said
we
we
have
to
have
these
funds
we're
closing
programs.
We
simply
do
not
have
enough
staff
and
you
all
answered
the
call
and
I'm
very
grateful
for
that.
So
I
wanted
to
make
sure
and
and
take
an
opportunity
to.
B
B
We
some
of
you
may
know
that
Mary
Hurst
is
the
oldest
continuously
running
family,
serving
non-profit
in
the
state
with
180
Years
of
Legacy
and
Mary
Hurst
has
has
certainly
evolved
over
those
years
as
the
needs
of
the
community
have
evolved,
and
so
we
are
at
a
point
right
now
where
we
know
that
and
we
are
committed
to
continuing
those
Residential
Services
as
long
as
they
are
needed,
but
we
are
also
very
committed
to
ensuring
that
those
services
are
not
needed
by
getting
to
Children
and
Families
sooner.
B
You
may
know
and
there's
you
know,
there's
a
growing
body
of
evidence
that
shows
that
children
who
can
remain
in
their
home
or
an
alternative
family
setting
have
the
best
chances
to
thrive.
Long
term
I've
worked
at
maryhurst
for
26
years
and
it
has
been
an
absolute
privilege.
B
I
started
as
a
therapist
and
I'm
one
of
the
most
discouraging
things
that
I
witness
is
when,
when
I
see,
abuse
and
neglect,
and
that
cycle
continuing
and
and
I
see
that
when
we
have
the
child
of
someone,
who's
been
in
the
foster
care
system
come
to
us
for
care
because
in
those
cases,
I
know
that
the
system
has
somehow
failed.
Those
families
and
I
know
that
we
can,
and
we
must
do
better.
B
So
in
2014,
with
the
creation
of
the
Behavioral
Health
Services
organization
provider,
type
maryhurst
was
able
to
launch
a
program
that
works
directly
in
the
community
where
we
work
with
Children
and
Families.
You
know
in
the
community,
our
program
is
called
maryhurst
renewal
and
in
this
program
we
come
alongside
families
to
provide
crisis
stabilization
in
home
care,
support
in
schools,
we're
in
over
100
Schools,
currently
public
schools
and
wraparound
care,
and
our
goal
is
to
equip
those
families
with
the
skills
and
the
connection
to
needed
resources.
B
That
kind
of
so
that
we
can
avoid
and
help
them
avoid
transmission
of
trauma
and
abuse
into
the
Next
Generation.
Within
our
renewal
program,
we
provide
individual
family
and
group
therapy.
We
also
provide
behavioral
support,
so
in
the
moment
support
we
have
staff
that
can
go
into
the
school
and
sit
with
a
child
through
the
classes
that
they're
having
a
difficult
time
with,
for
example,
we
provide
case
management,
Behavior,
analysts
and
Psychiatric
Services.
B
Our
program
is
on
track
to
serve
more
than
600
clients
this
year
and
we
currently
have
about
350
active
clients
we
have
trained.
As
I
said,
we've
got
trained
staff
and
clinicians
going
into
over
100
Public
Schools.
We
have
almost
80
clients
pending
admission
and
when
I
talk
to
leaders
from
like
agencies
across
the
state,
they
also
report
having
similar
waiting
lists
right
now.
B
We
just
simply
do
not
have
enough
clinicians
and
staff
to
take
care
of
the
need,
but
I
want
to
clearly
articulate
for
you
the
what
the
program
that
maryhurst
renewal
serves
the
families
they're
the
most
complex
families,
with
the
most
complex
needs.
So
just
to
give
you
a
sense,
I'm
gonna,
I'm
gonna
provide
a
few
data
points.
Sixty
percent
of
them
live
with
a
parent
or
Guardian,
who
has
mental
health
issues
and
that's
by
self-report.
So
we
know
that
that's
probably
understated
36
percent
live
with
a
parent
or
Guardian
who
has
been
incarcerated.
B
One
in
ten
of
those
we
serve
themselves
have
been
involved
with
the
justice
system.
Over
50
percent
of
the
households
are
dealing
with
problems
related
to
alcohol
or
drug
use,
and
70
percent
of
them
are
assessed
as
high
risk
on
the
Pediatric
Aces
and
related
life
events
screener,
so
so
these
are
families
that
are
in
crisis
and
we
are
successfully
helping
these
families
navigate
so
that
the
kids
can
remain
in
the
home,
which
again
is
our
goal.
B
B
Second,
by
going
into
homes
and
schools,
we
eliminate
the
barrier
of
transportation
and
I
do
want
to
note
that
expenses
related
to
Transportation
are
not
covered
by
Medicaid.
We
also,
especially
during
the
pandemic,
heavily
used
Telehealth
and
are
still
doing
that
now
to
again
help
reduce
some
of
those
barriers.
B
B
However,
in
the
eight
years
that
we've
been
doing
these
Behavioral
Health
Services
in
the
community,
we
have
not
seen
a
consistent
investment
in
funding
these
services
in
2021
and
I'm
speaking
about
Mary
Hurst.
Here,
our
average
reimbursement
rate
for
service
is
offered
in
this
program
covered
only
76
percent
of
our
direct
program
costs,
so
that
does
not
include
any
kind
of
administration
overhead
data
collection
to
show
outcomes.
B
B
B
We
are
looking
at
creative,
local
Partnerships
to
find
other
streams
of
funding,
and
we
have
had
generous
Community
Partners
who've
come
alongside
us,
like
the
Kentucky
Association
of
Health
Plans
they've
come
alongside
us
and
they've
helped
us
to
fill
part
of
that
500,
000,
Gap
and
honestly
had
had
that
not
happen.
We
would
not
have
been
able
to
continue
all
of
our
services
into
this
fiscal
year
and
I
know.
B
You
may
be
wondering
if
we've,
if
we've
talked
with
mcos
about
negotiating
rates
and
that
kind
of
thing
and
and
we
have
we
have-
we
have
strong
relationships
with
mcos
and
we
I
consider
them.
Absolute
partner,
I,
know
many
folks
who
are
working
with
nmc
mcos
and
have
great
respect
for
their
leaders,
but
they
have
have
to
point
back
to
the
Medicaid
rate.
B
The
posted
Medicaid
rate
we
also
I
just
want
to
make
sure
and
say
that
we've
been
able
to
do
a
lot
of
Grassroots
events
and
activities
and
volunteerism
with
mcos,
but
it
just
hasn't
resulted
in
any
kind
of
systematic
reform
of
the
rates.
B
We
would
certainly
welcome
an
opportunity
to
come
up
with,
like
one
value-based
program
that
could
it
could
be
implemented
across
all
mco's.
It's
it's
frankly,
administratively
unmanageable
to
do
multiple,
value-based
programs
with
all
the
mcos,
but
again
one
program
that
could
could
spread
across
all
of
them.
I
think
is
something
we'd
like
to
look
into.
B
So
in
closing
I'll
just
say:
we
cannot
sustain
the
current
business
model
and
I've
talked
with
leaders
from
agencies.
You
know
at
different
points
of
the
state
and
they
report
that
they
are
also
on
the
brink
of
closing
either
all
or
part
of
these
services
without
permanent
increases.
These
services
will
go
away
for
thousands,
thousands
of
Kentucky's,
most
vulnerable
children
and
I'm
these
that
can't
be
brought
back
on
it
takes
time
to
build
infrastructure
for
these
services.
So
if
they
go
away,
we
can't
bring
them
back,
and
you
know
the
flip
up.
B
A
switch
and
I
fear
that
this
will
have
negative
impact
that
you
know
could
go
back,
go
into
the
Next
Generation.
B
We
have
an
opportunity
right
now.
Kentucky
has
the
resources.
We
know
that
and
we
have
an
opportunity
right
now
and
it
is
up
to
us.
It
is
absolutely
up
to
all
of
us
right
now
to
ensure
that
these
programs
can
continue
and
and
ultimately
expand,
because
the
need
is
expanding,
I
think
you
and
I
do
it.
I.
Do
thank
you
for
this
opportunity
to
present
and
talk
about
this
important
issue.
C
I'm
Susan
Campbell
Turner
I'm,
with
Children
and
Family
Counseling
Associates
out
of
Harrodsburg.
We
serve
a
lot
of
rural
counties,
I'm
originally
from
breathit
County.
You
can
maybe
hear
that
coming
through
the
accent
there,
but
we
serve
primarily
a
rural
population,
so
I'm
not
going
to
go
into
a
lot
of
the
the
statistics.
As
far
as
what
our
population
looks
like
because
I
think
it's
pretty
similar,
you
know
we're
dealing
with
families
in
crisis.
We
have
family
children
who
have
parents
who
are
in
jail
who
have
mental
health
crises.
We
provide
individual
family
therapy.
C
C
In
2019
we
provided
about
80
percent
of
our
services
in
the
home
schooling
Community
things
have
changed
a
little
bit
with
Telehealth,
maybe
about
10
percent
of
our
services
have
gone
to
Telehealth,
but
we
still
provide.
We
estimate
about
70
percent
of
the
services
that
we
provide
in
the
home
in
the
school
and
the
community.
So,
like
Paula
said,
none
of
that
Transportation
cost
is
reimbursable.
C
So,
just
to
give
you
an
example
and
I'm
not
going
to
again
I'm
not
going
to
repeat
a
lot
of
of
what
Paula
said,
but
as
a
clinician,
so
I
run
the
agency,
but
I
also
see
clients.
So
that's
my
primary
job
is
to
see
clients
and
that's
what
y'all
should
want
me
to
do.
You
don't
want
you
don't
want
me
to
do
other
things.
You
should
want
me
to
be
serving
these
clients
so
last
week,
I
got
a
call
from
a
school
that
I
work
with.
C
Kid
has
made
self-harm
statements,
kind
of
one
of
those
mom's
going
to
take
my
PlayStation,
so
I'm
just
going
to
kill
myself
right
so
they're
going
to
send
it
to
the
hospital
I
said:
let's
not
do
that.
Let
me
come
out.
Let's
see
what
we
can
do
so
I
went
out,
saw
the
kid
saw.
The
parent
talked
to
the
guidance
counselor
crisis
averted
I,
go
back
to
the
office
right
up.
The
note
about
three
hours
of
time
is
spent
doing.
All
of
that
you
know.
Tonkin
moving
I
can
build
for
one
hour
of
that
time.
C
So
when
you
start
to
think
about
how
hard
that
is
for
providers,
it's
like
a
typical
day,
it's
pretty
common
for
me
to
work
about
nine
hours
and
be
paid
about
five
or
six.
Who
wants
to
do
that?
I?
Don't
blame
your
people
for
saying
no
I
don't
want
that.
Job
paperwork
has
never
been
more
burdensome
on
Tuesday
I
spent
three
hours
signing
other
people's
paperwork.
C
Why
am
I
doing
that?
Why
am
I
sitting
around
signing
other
people's
paperwork?
My
program
director,
my
Clinical
Director,
all
have
to
set
up.
We
all
have
to
set
aside
three
hours
every
two
weeks,
just
to
review
and
sign
other
people's
paperwork.
All
of
us
have
more
than
25
years
of
experience,
providing
therapy.
C
Why
why
are
we
sitting
around
doing
that?
While
we
have
a
wait
list
of
people
who
need
these
Services?
You
know.
Why
are
we
doing
that?
But
what
I'm
going
to
just
talk
to
you
just
quickly
about
that
I
know.
Paula's
group
has
probably
having
difficulties
with
all
of
us
are
having
difficulties
with
it
around
the
state
is
audits.
They
are
literally
never
ending
from
the
mcos
literally
every
week
we
get
another
audit.
So
what
I'm
going
to
tell
you
about
is
just.
C
C
Now
in
my
office,
when
you're
talking
about
charts
that
are
four
years
old
I,
we
have
an
attic
and
I
literally,
have
to
climb
the
ladder
pull
out
the
dusty
box,
get
it
down
come
down
copy,
the
data
service,
the
psychosocial,
the
treatment
plan,
all
the
assessments
put
down
a
pile
climb
back
up,
find
the
next
280
times
I'm
entirely
too
old.
For
that,
why
are
we
do?
Why
are
we
doing
this
280
dates
of
service?
So
we
put
that
in
the
mail
on
a
Thursday,
the
next
Monday.
C
We
got
another
audit
request
for
10
full
charts.
My
office
assistant
cried
when
we
got
that
in
the
mail.
It's
what
we
estimate
to
to
be
about
7
000
pieces
of
paper
that
we
now
need
to
copy
and
then
upload
and
send
to
an
MCO
I
have
five
administrative
staff
people
we
are
doing
all
that
we
can
do
to
answer
calls
to
get
billing
out
to
get
this
stuff
done.
So
now,
it's
me
and
Michelle
who
cried
trying
to
put
all
of
this
together
on
the
way
here.
C
C
During
the
first
week
of
August,
we
were
told
that
all
of
our
claims
for
case
management
for
the
month
of
July
were
being
held
for
what
they
called
a
prepayment
audit.
Okay,
now
for
us,
that's
about
twenty
thousand
dollars.
That's
how
I
pay
my
staff!
That's
how
we
pay
our
house
payments
and
car
payments
and
taxes
and
all
the
things
that
we
have
to
do
to
be
participating
members
of
society.
C
So
I
start
calling.
What
can
we
do?
You
know.
I'm
originally
told
that
so
case
management
is
a
service,
that's
billed
monthly,
so
we
build
it.
On
the
last
day
of
every
month,
July
31st
happened
to
be
a
Sunday.
They
were
withholding
all
the
payments
for
that,
because
it
was
considered
unusual
billing
because
it
happened
on
a
weekend.
Okay,
so
that's
that's
what
I'm
originally
told
we
are
told
that
we
have
until
December
to
submit
these
claims
and
that
they
then
have
90
days
to
pay
us
just
to
decide
if
they're
going
to
pay
us.
C
So
we're
talking
about
March
payment,
possibly
for
services
that
we
provided
in
July.
No
business
can
operate
like
that.
You
just
can't
operate
for
it.
So
I
put
in
lots
of
calls.
I
screamed
at
a
lot
of
people.
I
was
not
very
nice
about
the
whole
thing
and
I
apologize.
If
any
of
you
were
people,
I
called
because
I
called
a
lot
of,
and
so
we
were
told
that
they
would
expedite
the
process,
go
ahead
and
start
uploading,
those
records
okay.
So
we
start
uploading
records.
C
We
get
four
records
uploaded
into
the
system
and
I
get
a
call
that
says:
stop
there
was
a
scripting
error.
We
don't
really
need
your
records.
Go
on
about
your
business.
It
took
us
weeks
to
get
payment
today.
I
still
have
one
claim
out
of
that
batch
that
has
not
been
paid
had
I,
not
called
been.
Not
nice.
C
We
still
certainly
wouldn't
be
paid
for
it.
We'd
still
be
kind
of
in
this
Loop.
That
again
seems
never
ending
final
audit
story.
I
could
go
on
if
any
of
you
have
the
rest
of
the
afternoon.
I
could
tell
you
A
lot
of
these
stories,
but
this
one's
pretty
critical
as
well
and
again.
This
isn't
just
us.
This
is
across
the
state.
These
things
are
happening
in
May
of
2021.
C
We
got
an
overpayment
demand
letter
from
one
of
the
mcos
and
at
that
time
I
called
you
and
we
talked
and
I
called
you
representative
one
or
we
talked
because
I
was
like
what
in
the
world.
You
know
so
at
the
same
time
that
we
got
so
that
MCO
had
reviewed
records
and
deemed
zero
percent
of
the
services
that
we
provided
were
eligible
for
reimbursement.
At
the
same
time,
we
had
had
an
audit
from
a
different
MCO
same
time,
frame
same
record,
same
format.
Basically,
and
we
got
a
letter
from
them.
C
We
got
two
letters
saying
we
got
a
96
percent
and
a
97
on
that
audit.
I,
don't
know
why
I
lost
the
three
or
four
points,
but
you
go
from
96
97
to
zero
percent,
same
paperwork
Okay,
so
I
consulted
with
an
external
billing
and
coding
person,
because
I
want
to
make
sure
that
we're
doing
the
right
thing.
We
really
do
want
to
do
what
we're
asked
to
do.
C
We're
very
invested
in
making
sure
that
that
happens,
that
that
person
actually
wrote
the
coding
and
billing
manual
for
the
Children's
Alliance
for
the
state
of
Kentucky
so
reach
out
to
her.
What's
going
on,
she
looks
at
the
records
she
says.
You
should
appeal
this,
because
you're
doing
everything
that
you've
been
asked
to
do
so
I
submitted
several
appeals.
The
last
one,
the
my
final
appeal
was
sent
in
on
December
6th
of
2021
certified
mail.
They
had
30
days
to
reply
to
me
on
July,
the
8th
of
2022
I
got
a
letter
from
them.
C
C
Whatever
today
is
the
13th
of
October,
you
know
we
still
have
not
heard
anything,
so
we
are
10
months
from
our
final
appeal
and
we
are
18
months
since
we
started
the
appeal
process.
So
at
that
point
in
time,
I
really
didn't
have
any
other
choice
but
to
stop
providing
that
service
right.
So
it's
a
Community
Support
associate
service
and
we
now
have
a
wait
list
because
I
don't
know
what
the
expectation
is.
No
education
is
provided
for
providers
to
know.
What
are
we
supposed
to
be
doing?
We,
we
think
we're
doing
the
right
thing.
C
We
hope
we're
doing
the
right
thing,
but
we
get
a
zero
percent.
We
get
a
97
percent.
How
did
those
where
where'd
that
come
from
I
cannot,
as
a
business,
sustain
that
if
I
have
constant
increased
administrative
costs,
I
have
constant
these?
These
audit
exercises
are,
are
constant,
they're,
never
ending
recoupments
when
are
they
coming
I
have
no
idea.
I
cannot
operate
a
business
like
that
as
a
provider.
It
feels
like
we're
in
a
no-win
situation.
The
target
is
not
defined
for
us
and
it
is
always
moving.
C
We
have
no
idea
what's
coming
next,
so
I'll
I'll,
finish.
I
do
want
to
plead
for
you
to
come
to
the
aid
of
the
mental
health
professionals.
We
are
at
a
Breaking
Point.
In
the
past
few
months,
I
have
seen
four
Master's
level.
Clinicians
leave
the
field,
one
of
them's
working
at
Kroger
in
the
meat
department
living
in
a
storage
container.
C
One
of
them
is
working
in
retail.
One
of
them
is
a
bridal
consultant,
and
one
of
them
went
to
be
a
teacher's
aide.
This
is
just
my
little
circle
of
what
I
am
seeing.
This
is
happening
across
the
state.
I
am
thankful
to
be
more
at
the
end
of
my
career
than
the
beginning
of
my
career,
because
I
wouldn't
suggest
that
my
children
go
into
Mental
Health,
there's
no
security
there
and,
while
we're
doing
all
of
that
I'm
seeing
more
need
than
I've
seen
in
the
30
years
that
I
have
been
providing
these
services.
A
Thank
you
all
I
just
want
to
touch
back.
Thank
you,
Susan.
So
much
I
just
want
to
read
briefly.
You
all
have
in
your
packet
a
letter
from
Mr,
stali
and
I
chose
her
to
write.
This
I
was
hoping
to
get
her
to
provide
testimony,
but
given
the
short
turnaround
and
as
Susan,
she
sees
clients,
she
lives
in
Paducah,
Senator.
A
Carol
knows
that's
a
long
track
to
cover
to
get
here
and
back
so
and
I
asked
her
to
just
write
a
letter
because
and
I
can
you
all
have
that
I'm
not
going
to
read
all
of
it
to
you,
but
I
just
want
to
read
it
excerpt
because
as
a
provider,
they
say
they
face
all
these
same
Dynamics.
A
They
build
off
this
same
fee
schedule,
but
I
just
wanted
to
point
out
the
impact
on
this
particular
population
of
very
small
children,
with
autism
diagnosis
with
autism
that
go
on
a
waiting
list
and
have
to
wait.
I
mean
when
you
need
mental
health
services.
You
need
any
help:
physical,
any
health
services.
A
You
need
them
now,
not
a
year
from
now,
not
10
months
from
now,
but
when
your
child,
you
know
we
can
and
I've
just
read
from
her
that
you
know
at
18
months
that
we
can
diagnose
this
as
early
as
at
18
months
of
age,
effective
and
specialized
treatment
can
allow
therapists
to
help
establish
communication
and
social
interaction
to
prevent
the
development
of
a
host
of
challenging
behaviors.
That
left
untreated
can
lead
to
dangerous
outcomes.
A
If
people
can't
access
Services
right
away,
the
challenge
becomes
undoing
those
dysfunctional
Behavior
patterns,
so
she
was
wrote
that
she
recently
began
therapy.
The
child
was
already
five
or
six
rather
than
starting
at
the
age
of
two
is
a
whole
different
ball
game.
She
started
now
a
one
at
nine
a
few
weeks
ago
and
while
they
hope
I
hope
to
have
a
positive
impact
on
this
young
boy's
life,
I,
look
at
him.
A
Knowing
precious
time
has
been
wasted
and
he
had
the
chance
to
act
had
he
had
the
chance
to
access
tree,
but
earlier
on,
there
would
be
a
whole
world
of
opportunities
available
to
him.
That
now
may
not
be
people
with
Autism
can
go
to
school.
They
can
have
friends,
they
can
live
on
their
own
and
their
families
can
go
through
life
without
enduring
the
stress,
worry
and
suffering
that
comes
from
wandering
when
the
next
Crisis
on
their
child
will
occur.
A
That's
on
this
fee
schedule
as
well
and
and
really
has
a
particular
point
with
young
folks.
So
I'm
going
to
close
I
know,
we've
brought
a
lot
of
testimony
longer
than
I
promised
it
would
be.
But
you
know,
the
good
news
is:
is
that
so
I
want
to
leave
on
a
positive
and
a
request?
The
good
news
is
we
have
a
solution
to
all
this.
A
You
know
you
have
providers
that
you've
heard
from
today
that
are
willing
that
are
trained,
that
are
passionate
about
this
and
want
to
deliver
these
services
to
help
our
our
citizens
and
your
constituents.
You
know
it's
a
simple
there's.
We
had
this
during
the
session.
It
was
a
16.5
million
dollar
request
for
state
general
funds
that,
when
paired
with
Federal
match
and
the
Medicaid
Program
would
enable
a
25
increase
for
the
rates
on
the
whole
fee
schedule,
16.5
million
state
general
fund
hours.
A
A
You
know
we
also
need
to
have
a
mechanism
that,
if
that's
funded,
that
that
goes
through
the
mcos
that
that's
passed
on
to
the
providers.
You
know
I've
talked
with
lots
of
mcos
they're,
not
opposed
to
increases.
You
know
if
they
have
the
funds
to
do
it,
but
the
other
piece
of
it
is
which
is
kind
of
a
unique
situation
where
and
we
just
into
the
second
year
in
a
row
with
nearly
a
billion
dollar
Surplus
in
our
state
budget.
You
know
I've
been
doing
this
for
25
years.
A
Most
of
the
time
I've
been
talking
most
of
the
time.
It's
been
about
money
for
providers
frankly,
and
we
usually
it's
we're,
stretched
thin
we're
making
reductions.
We've
been
through
the
reset
after
recession,
when
we
cleared
out
a
billion
dollars
of
the
budget
just
to
stay
balanced,
but
we're
at
historic
surpluses,
and
we
need
to
address
this
crisis.
A
You
know
we
have
done
over
the
last
several
sessions.
We
have
significant
investment
in
the
in
the
estate,
employee
and
the
teacher
of
pension
systems.
We've
set
our
state
on
a
path
to
reduce
and
it'll,
eventually
eliminate
the
state
income
tax.
We've
had
signifi
hundreds
of
millions
of
dollars
in
significant
Economic
Development
Industries
we've
increased
funding.
A
In
this
past
session
for
K-12
and
universities,
we
increase
wages
for
state
employees,
we've
done
disaster
relief,
funding
for
Western
Kentucky
or
tornadoes
Eastern,
Kentucky
floods,
we've
invested
in
in
dealing
with
the
pandemic
and
the
health
care
and
the
public
health
precautions,
all
of
which
we
absolutely
needed
to
do
as
a
state
and
good
to
meet
the
needs
of
the
citizens
and
to
put
ourselves
on
fiscal
on
a
stronger
fiscal
ground
moving
forward.
But
now
is
the
time
to
address
this
crisis
that
has
not
been
addressed.
So
that's
our
plea
for
you
today.
D
Appreciate
that
appreciate
your
testimony,
it's
been
very
interesting,
Miss
Turner,
also
to
you,
I,
didn't
denote
an
accident
at
all.
You
sound
just
like
one
of
us.
I
probably
should
tell
you
that
we're
going
to
bill
you
for
this
counseling
session.
That
I
hope
you
feel
better.
Yes,
I
do
excellent
presentation.
You
really
did
I've
always
enjoyed
speaking
with
you
and
certainly
we're
looking
for
solutions
to
this,
and
maybe
one
is
that,
since
we
haven't
heard
from
the
podiatrists
we're
paying
them
too
much
and
we'll
reduce
it.
No,
that's
just
a
joke.
D
D
A
B
B
B
I
think
there
was
a
huge
need
before
that,
but
I
do
think
that
the
pandemic
exposed
the
cracks
that
we
already
had
in
our
communities
and
that
and
that
folks,
on
an
individual
and
we
and
in
a
community
level,
have
in
terms
of
needs
for
mental
health.
I
also
think,
and
this
I'm
thankful
for
this
I
think
it
kind
of
destigmatized.
B
You
know
getting
mental
health
in
some
cases,
because
we,
you
know
when
you
saw
other
people
doing
it
and
so
I
think
that
is
part
of
it.
I
mean,
and
certainly
you
had
kids
who
were
not
going
to
school
for
long
periods
of
time.
You
had
social
isolation,
I
mean
you
had
a
number
of
factors
that
I
think
exacerbated
factors
and
needs
that
were
already
in
the
community,
but
they
maybe
just
escalated
those
a
little
bit
more,
and
so
that's
that's
one
answer
I
would
offer.
There
are
many,
but
that's
one
I
would
offer.
D
Well,
thank
you
appreciate
that
Miss
Turner,
your
discussion
about
the
audit,
always
sound
very
interesting
and
in
your
emblem
opinion,
do
you
think?
Maybe
we
better
served
our
Medicaid
Program?
If
maybe
we
only
had
three
mcos
rather
than
six
and.
D
C
C
So
when
we
have
to
even
just
credential
a
new
clinician,
we
have
to
credential
them
with
Medicaid
and
then
each
MCO
has
to
be
credentialed
with
so
we're
talking,
sometimes
six
months
to
get
a
new
clinician.
Yes,.
D
Ma'am,
you
know,
I
think
last
number
I
saw
was
spending
16
cents
of
every
dollar
in
in
America
on
the
administration
of
health
care.
It's
double
what
other
industrialized
nations
are
spending
and
that's
the
source
of
funding
right
there
in
Bart
I
have
to
take
a
little
bit
of
issue
about
our
Surplus.
D
That
came
large
measure
because
the
federal
dollars
were
received
during
the
coven
crisis
and
when
this
recession
hits
and
it's
going
to
hit
we're
going
to
maybe
see
some
Draconian
Cuts
in
spending
and
certainly
don't
want
that
filter
down
to
our
health
care
providers
or
any
service
that
we
have,
and
so
that's
Surplus
that
we
have
there.
We
best
be
protecting
that
plus.
The
other
issue
is
ongoing.
Yeah.
A
I
I
agree
with
you
I'm
Senator
Meredith,
that
that
this
is
an
ongoing.
We
need
a
systemic,
long-term
solution
to
it
that
that
pulling
you
know
doing
something
out
of
a
one-time
Surplus
that,
like
you
said
certainly
Direction
looks
like
that.
That's
not
going
to
be
the
case
every
year,
moving
forward,
no
question,
but
I
think
that
that
we
do
need
this
and
that's
one
of
the
the
things
that
you
know.
D
E
E
Pharmacists,
Primary,
Care
doc,
a
nurse
just
interjected
into
your
testimony,
and
it
applies
to
everybody
across
the
board
in
healthcare
right
now,
under
a
lot
of
the
mcos
and
I've
gotten
to
the
point
where
we
talk
about
reducing
them,
I'm
talking
about
eliminating
them,
I'd
like
to
know
your
opinion,
you've
been
at
this
a
little
while
were
things
better
when
we
didn't
have
mcos
as
far
as
you're
concerned
in
terms
of
your
bureaucracy
and
being
able
to
do
your
job.
Certainly.
C
E
E
And
I
think
that's
true.
You
know
I
preach
it
after
a
while
I
become
part
of
the
wallpaper
here
and
it's
just
so
Alvarado
carries
this
group's
water
and
says
these
things
I
think
it's
important
to
hear
from
real
providers
that
come
here
and
reiterate
what
I
experience.
What
I
see
happen
because
it's
real
and
I
think
you
know
you
have
to
wonder
how
much
of
a
tax
the
mcos
have
become
on
providers
because
they've
become
a
tax
we
don't
take.
E
You
know,
there's
not
money
that
gets
taken
out
from
the
government,
but
we've
established
another
entity
to
take
that
money
away,
and
it's
found
that
it's
taken
away,
not
only
in
these
audits
to
say,
hey,
look,
prove
to
Wes
that
you
didn't
Rob
from
us
before
from
four
years
ago
or
five
years
ago,
or
whatever
these
ridiculous
letters
that
are
1100
Pages
Deep
by
some
of
our
mcos
saying
here's
all
these
accounts
show
us
that
you
didn't
steal
from
us.
If
not,
we
won't
pay
you.
We
want
the
money
back
in
the
future.
E
That's
nonsense!
That's
just
bad!
That's!
Just
bad
business
dealings
by
a
bad
business
partner!
People
want
to
know
why
providers
have
burnout.
This
is
why
providers
have
burnout
is.
What
I
would
argue
is
this
nonsense
is
how
much
time
is
spent,
proving
that
we're
not
thieves
and
I
know
there
are
thieves
within
Health
Care.
Unfortunately,
there
are,
but
we're
basically
burning
out
the
entire
profession
from
top
to
bottom,
in
all
aspects,
by
asking
to
prove
that
they're
not
Crooks
that
they're
not
stealing
and
having
to
do
all
this
incessant
bureaucracy.
E
You
know
Senator,
Meredith
and
I
have
discussed
this
before
that.
There
is
enough
money
in
the
system
now
to
provide
the
care
that
we
need.
There
is
enough
money,
you
take
away
the
time,
that's
required
from
the
ex.
You
know
these
folks
that
are
having
to
spend
their
time
doing
this
and
put
them
into
clinical
care
to
see
patients
and
take
care
of
them
would
take
care
of
this
electronic
medical
records,
which
is
supposed
to
make
things
easier
for
us,
has
become
a
headache.
E
I
can
tell
you,
I
went
from
you
know,
I'm,
a
pretty
people
here
know
me
I
work,
pretty
hard.
I
could
see
25
people
in
10
hours
in
my
office
in
the
past,
when
EMR
came
along,
I
went
to
16
people
in
13
hours,
so
I
spent
three
extra
hours,
I
get
home
at
midnight
instead
of
at
eight
or
nine
o'clock
at
night.
Just
inputting
data.
Why?
For
insurance
companies
and
for
government,
did
it
provide
better
outcomes?
No,
you
didn't.
E
So
all
these
things
are
taxes
on
our
providers
that
we
have
to
understand
and
your
kind
of
testimony
it
kind
of
confirms
that
and
I
would
argue
that
again
we
put
a
lot
of
money
into
Healthcare
we've
expended
Medicaid
by
the
request
of
providers.
We
have
an
expansion
of
Medicaid,
there's
a
lot
more
money.
The
state
is
putting
into
that.
There
is
money.
That's
there
already
we're
finding
ways
that
our
mcos
are
using
those
they're
they're,
finding
ways
to
take
monies
out
behind
the
scenes
that
we
haven't
seen.
E
Pbms
are
an
example
of
that
lots
of
it.
So
you
know
I
appreciate
it
because
you're
real
you
come
in
here,
you
express
the
frustration
and,
like
I
said:
I
could
apply
this
to
every
provider
in
this
system
and
our
mcos
I
know
here.
They've
heard
me
complain
about
it.
A
lot
like
I
said,
but
really
it's
gotten
to
the
point
where
you
have
to
wonder:
are
they
really
even
worth
it
they're,
not
really
providing
us
anything
and
I
think
they
haven't
shown
us
improved
outcomes
over
the
years?
All
they
do
is
create
this.
E
If
people
are
willing
to
go
work
at
Krogers
and
Retail
instead
of
providing
clinical,
that
is
a
sad
State
of
Affairs
and
I
can
tell
you.
There
are
doctors
that
I
know
that
are
now
truckers
frankly
enjoy
being
on
the
road.
You
know,
they're
listening
to
a
radio
show
and
just
being
able
to
you
know
Drive.
E
They
get
paid
well,
not
like
they
did
for
a
doctor,
but
they
had
a
smile
on
their
face
again
and
then
having
to
deal
with
all
of
this,
and
it's
sad
so
thank
you
for
the
rent,
I
miss
chairman,
I
appreciate
it.
You
know
me
I,
can't
let
this
go,
but
it's
real
and
I
think
we
have
to
look
at
this
as
a
tax
we've
created
on
providers.
E
D
Thank
you
Senator
and
you
know
the
interests
of
fairness,
and
so
we
don't
discriminate
we'll
be
charging
you
for
a
counseling
session
as
well.
This.
E
F
Medicare
allowed
will
be
all
right
with
me,
I
I.
Let
me
just
kind
of
piggyback
a
little
bit.
I
can't
not
possibly
rant
any
better
than
the
the
senator
Alvarado
did
he,
but
he
was
right
on
you
know
the
irony
of
it
I
just
couldn't
help.
G
F
Know
as
a
and
Miss
Turner
you're
in
the
trenches,
so
you
understand
and
I
heard
in
your
in
your
voice
and
how
much
it
hurt
to
deal
with
all
these
audits.
You
know
two
or
three
real
quick
questions.
Are
the
audits
desk
audits
or
are
they
tell
us?
Are
they
just
sending
you
random
claims
and
you're
having
to
explain?
You
know
those
claims.
C
F
Yeah
we
see
that
in
every
area
of
Health
Care
and
it's
bureaucracy
at
its
worst
and
now
I'm
gonna.
What
Dr
Alvarado
said
well
they're,
sending
you
all
this
stuff
to
make
sure
you're
not
taking
money
from
them,
and
then
you
said
you
had
the
same
claim
with
two
different
mcos
and
one
said
it
was
great
and
the
other
didn't
okay,
it
leads
right
into
well.
You
know.
F
The
irony
of
all
this
is
is
that
we
have
mcos
that
in
the
last
three
years
have
paid
out
over
a
half
a
billion
dollars
in
settlements
because
they,
the
frauded
Medicaid
in
about
14
States.
That's
just
one
lawsuit,
you
know,
that's
just
one
lawsuit,
it
was,
you
know
it's
up
to
479
million
and
they've
already
put
back
1.2
billion
more
because
they
know
more
is
coming.
F
My
point
is
they
said
the
irony
I'm,
sorry,
the
irony
of
them
sending
you
these
Audits
and
keeping
you
busy
and
keeping
you
distracted
and
eventually
paying
after
six.
You
know
and-
and
let
me
ask
you
this
last
question-
do
any
of
them.
What
is
there
an
MCO
out
of
the
six
that
you
deal
with?
Prime
primarily
I
mean
like,
is
you
you're
number
one
number
two
well.
C
F
C
Should
be
I
should
be
seeing
people
and
so
for
us
in
in
our
rural
area.
I
would
say
the
ones
as
far
as
percentage
of
people,
probably
30
and
30
percent,
with
Aetna
and
well
care.
F
F
I
was
just
curious.
Thank
you
very
much.
It's
seeing
every
single
thing,
but
I
I'm,
sorry
for
all
those
Audits
and
maybe
one
day,
they'll
slow
down
and
take
care
of
their
own
business.
Thank
you.
Thank.
A
You
chairman,
Meredith,
can
I
make
just
a
quick
comment.
Yes,
quick,
please
quickly
on
the
audits,
I
think
one
of
the
things
because
this
came
up
in
child
welfare
oversight
and
advisory
committee
yesterday,
if
you
I'm
going
to
ask
yes
Michelle
with,
is
the
director
of
the
children's
lines,
then
a
nice
testimony
yesterday,
I'm
gonna
ask
her
to
send
that
to
you
all
their
PowerPoint
and
because
it
covers
some
of
the
similar
pieces.
But
one
of
the
things
is
is
all
the
claims
all
these
claims
based
audits.
A
They
all
go
back
through
Medicaid,
you
know
so
I
mean
and
I've
talked
with
Medicaid.
You
know
they
held
off
on
audits
during
the
pandemic.
Cms
is
putting
pressure
on
them.
They
turn
and
put
pressure
on
the
mcos
and
so
we're
seeing
all
this
makeup
time
for
these
audits.
So
it's
kind
of
you
know
it's
the
it's
a
systemic
issue
and
it's
over.
You
know,
but
one
of
the
things
and
I
don't
know.
I
haven't
vetted
this
enough,
but
all
the
claims
end
up
going
back
through
Medicaid
anyway,
you
know.
A
So
why
is
it
that
each
MCO
has
to
do
audits
on
every
provider?
Why
can't
that
claims
database
from
Medicaid
do
some
random
audits
for
a
provider,
and
that
way
it's
one
entity,
not
six
trying
to
do
it.
So
that's
just
a
thought:
I,
don't
like
I
said:
I
just
haven't
vetted
it
enough
to
know
if
that's
realistic,
but
it's
just
a
thought
so
well.
D
G
Yeah
and
I'm
I'm
not
going
to
repeat
the
stuff
about
the
MCO,
so
you
know
one
every
year
they
come
in,
they
tell
us
how
great
they
are
and
there
are
some
that
do
better
than
others,
but
you
know
there's
no
doubt
about
that,
but
folks,
I'm
telling
you
it's
on
us
to
do
something
about
this.
We
can't
keep
putting
this
off
on
the
cabinet
they're
not
going
to
do
it.
So
we
have
got
to
get
some
legislation
passed
to
take
care
of
this.
G
We
are
drawing
we,
we
are
forcing
beating
this
system
down
and
it's
something
we
could.
We
could
have
a
major
impact
on
and
one
MCO
came
in,
we're
going
to
be
great,
we're
going
to
set
the
standard
and-
and
you
all
have
heard
me
say
this-
a
million-
we
do
very
basic
Services.
We
do
ppec
Services,
we
do
epsdt
therapies,
that's
it
took
us
a
year
to
get
payment.
G
I,
don't
know
if
it's
an
interesting
and
I've
you've
heard
me
say
this
before,
where
they
the
longer
they
get
to
keep
that
money,
the
more
interest
they
can
draw
on
it.
But
it's
so
blatantly
obvious,
and
we
got
to
do
something
about
it
and
I
wish
he
could
have
been
here
today.
She
provides
great
Services
down
in
Paducah.
My
organization
is
in
the
process
of
building
an
Autism
Center,
we're
six
months
away
from
opening
it.
We've
been
going
through
the
process
and
negotiating
and
we're
getting
into
private
insurance
as
a
non-profit.
G
We've
never
really
done
this
before,
but
we're
going
through
that
it
is
infuriating.
You
can't
talk
to
anyone
else
to
see
about
what
rates
they're
getting
I've
got
one
MCO
that
wants
to
pay
private
rates
and
for
some
codes
less
than
what
Medicaid
pays.
So,
building
a
business
plan
and
trying
to
figure
out
what
you
need
to
sustain
the
programs,
you
can't
do
it
and
we're
not
going
to
be
able
to
take.
You
know
we'll
be
able
to
take
a
certain
percentage
of
Medicaid
kids.
G
So
it's
a
balance
that
we
have
to
obtain
and
you
can't
get
anything
more
than
Medicaid
rate
from
an
MCO.
That's
that's
the
basic
and
it's
just
not
going
to
happen.
So
all
of
that
is
very
frustrating
we're
six
months
away,
we've
already
got
50
kids
on
our
waiting
list
already
have
50
kids
and
that's
where
you
know.
That's
the
the
struggles
that
we
have
down
in
Paducah
and
that
that
area
with
the
need
down
there
for
Autism,
Services
and
and
the
system
is
it's
an
obstacle.
G
It's
a
deterrent
to
open
up
these
Services
because
of
all
the
bureaucratic
crap
that
you
have
to
go
through
the
constant
denials,
the
constant
you
know,
five,
six
codes
that
we
deal
with
every
other
year.
They
just
forget
what
those
codes
are
and
we
have
to
go
through
the
same
song
and
dance.
You
are
using
the
wrong
codes.
G
That
causes
have
to
spend
time
doing
stuff
like
that
for
no
legitimate
reason,
but
we've
been
through
it
too
went
months
having
to
appeal
fight
it
took
you
know:
seventy
thousand
dollars
that
they
recoup.
We
finally
got
it
back,
but
it
cost
us
probably
20
to
get
that
back
right
and
and
it's
got
It's
every
year
we
go
through
this
same
song
and
dance.
We
have
got
to
do
something
about
this
and
Senator
Meredith
Mr
chairman
that
bill
to
narrow
it
down
to
the
three
best.
G
That's
got
to
happen
that
has
got
to
happen,
Dr
Alvarado,
if
we
want
to
get
rid
of
them,
I'm
I'm
for
that
too,
but
I
I
do
think
it
wouldn't
be
a
bad
idea
to
give
some
of
them
a
chance,
because
we
do
have
a
couple
that
that
are
good
and
they
do
do
try
to
help
and
when
you
need
something
they're
there
and
I
think
they
do
make
an
effort.
But
six
it's
ridiculous
and
I'll
put
that
on
my
bill.
I'm
gonna
have
to
make
a
payment
plan.
I'm.
Sorry.
D
Well,
I'm
going
to
apologize
to
co-chair
Elliott
and
representative
prunty
because
we're
running
short
of
time
we
won't
be
able
to
provide
you
an
opportunity
for
a
counseling
session,
but
maybe
afterwards
we
can
do
this,
but
we
have
two
more
and
please,
let's
be
brief,
because
we've
got
one
more
presentation:
representative
willner.
H
H
Every
every
day,
I'm
hearing
about
the
increased
need
for
mental
health
services
and
I
am
hearing
from
every
agency
every
provider
that
I
talk
to
no
matter
what
type
of
Mental
Health
Center.
It
is
about
professionals,
vacating
the
field
and
Senator
Meredith.
You
talk
a
lot
about
when
we
think
about
the
cost
of
things.
We
have
to
consider
the
cost
of
what
we
don't
do
and
the
cost
of
not
investing
in
the
mental
health
Workforce
is
so
dire.
I
mean
it
fills
me
with
existential
dread.
H
I
mean
I'm,
I'm,
awake
nights,
literally
thinking
about
this
and
you're
right
once
they're
gone,
we
can't
conjure
them
up
magically
and
for
for
you
Susan
who's.
You
know
invested
Decades
of
your
life
into
this
career
and
served
so
many
people
that
you're
willing
to
keep
doing
it.
Despite
these
headaches,
we
can
expect
young
people
coming
in
young
professionals
coming
in
to
be
martyrs
to
the
field
and
we've
got
a
state,
that's
hurting
and
so
I.
Your
proposal
barred
for
the
16
and
a
half
million
dollars,
I
and
I
agree
with
Senator
Carroll.
H
D
E
Just
going
to
say,
there's
we
are
working
on.
Greenwell
is
a
repository
for
a
database
for
Medicaid.
That's
the
company
that
contains
they
don't
do
much
of
that
data.
It's
just
kind
of
in
different
piles.
We're
working
on
an
all-pair
explained
database
bill
that
we're
looking
at
using
them
to
be
able
to
compile
that
information.
To
give
us
the
data
that
we
need
that
our
mcos,
when
we've
asked
them
say
well,
we
don't
know
what
to
improve.
E
E
I
need
to
compile
the
data
we're
looking
at
trying
to
get
that
company
to
use
that,
and
there
is
a
bill
when
I
first
got
here:
one
Senator
Carroll
on
fixing
this
it's
a
thick
Bill
big
one
I've
got
it
in
my
drawer,
it's
still
there,
so
it
would
be
something
to
be
able
to
bring
back
out
and
and
try
to
talk
to
other
powers
that
be
within
the
general
assembly
to
be
able
to
loosen
that
up,
but
I
think
it's
time.
I
mean
this,
has
been
eight
years.
E
I've
been
having
this
discussion
eight
years
in
here
complaining
exposing
a
lot
of
this
stuff,
sometimes
dragging
information
out
of
our
mcos,
to
show
where
they've
been
abusing
the
system.
I'm
tired
of
that
I
mean
at
some
point
you
say:
look
I
got
a
bad
business
partner,
it's
time
to
fire
the
business
partner,
terminate
that
relationship
and
do
something
that's
going
to
work
because
it's
gonna,
it's
just
not
worth
the
mental,
the
mental
health
of
our
providers
and
and
the
sustainability
of
our
providers
across
the
board.
The
burnout
is
from
this.
That's
what
it's
from!
D
G
D
For
being
here,
this
has
been
a
great
discussion
and
very
enlightening,
and
obviously
you've
got
our
attention
and,
as
we
see
for
the
next
session-
and
you
know
since
we're
not
in
a
budget
session,
we're
not
sure
what
we
can
do
this
go
around,
but
you've
got
our
attention.
I
can
show
you
that.
So
thank
you
for
being
here.
Thank
you.
So
much.
D
I'm
going
to
mention
to
my
committee
members
that
I
don't
talk
a
lot
about
this,
but
I
have
a
mind.
Reading
capabilities
and
our
next
presenters
are
thinking.
We
wish
we'd
been
first
on
the
agenda,
so
you
didn't
want
to
come
forward.
D
I
Sure
I'm
Corey
Ewing
c-o-r-e-y-e-w-I-n-g
planned
president
for
WellCare
of
Kentucky.
Thank
you,
chairman
and
committee
members
for
allowing
us
to
come
today.
I'll.
Let
my
teammates
introduce
themselves
I'm.
I
You
well
first
I
want
to
thank
the
ladies
that
presented
before
us
for
what
they
do
provide
to
our
members,
because
they
do
provide
a
fantastic
service
that
many
of
our
members
do
receive
and
need,
and
also
wanted
to
thank
them
for
warming.
The
committee
up
for
us
with
that
I
just
say
thank
you
for
inviting
us
to
speak
today.
We're
certainly
glad
to
share
with
you
some
of
the
things
that
we're
doing
around
the
questions.
I
You
asked
us
to
answer
and
the
initiatives
that
we
are
doing
around
those
and
and
the
associated
outcomes
with
those
next
slide.
One
of
the
things
that
we're
tasked
with
is
making
sure
that
our
members
go
to
the
pcps
for
their
Primary
Care
needs,
not
the
ER,
that's
one
of
the
things
that
we're
definitely
tasking.
That
was
actually
mentioned
in
the
previous
presentation.
I
Overall,
we've
seen
a
lot
of
success
with
that,
but
we
wanted
to
dig
into
the
data
a
little
bit
deeper
and
there's
one
thing
that
we
all
know
exists.
We
just
don't
talk
a
lot
about.
It
is
member
churn.
We
see
members
that
move
throughout
the
MCO
universe,
but
we
wanted
to
take
a
hard
look
at
those
that
have
actually
been
with
us
for
a
Consolidated
number
of
years.
We
picked
2016.
I
as
our
Baseline
year.
Nothing
special
about
2016.
We
just
thought
six
years
was
a
good
time
frame.
So
if
you
look
at
the
graph
there
on
the
left,
it
shows
a
pretty
pretty
consistent
downturn
in
ER
visits,
and
this
is
just
for
Primary
Care
visits
and
the
inverse
is
also
true.
On
the
other
graph,
we've
seen
a
uptick
in
average
PCP
visits
every
year
over
the
Baseline
year.
So
definitely
an
interesting
Dynamic,
but
that
can't
happen
without
consistent,
Care
Management
and
a
strong
network
of
providers
to
send
those
members
to
so
next
slide.
I
I
You
know
it
was
kind
of
interesting.
I
saw
the
trend
that
we,
when
I
got
here
to
Kentucky
I,
saw
a
very
this
same
Trend
when
I
was
a
hospital
CEO,
what
a
really
strong
adoption
in
Telehealth
until
the
pandemic
hit,
but
once
it
hit,
we
saw
a
tremendous
increase
in
use
and
I
think
we
all
see
what
it
can
do
for
our
members
and
the
residents
of
this
state
and
we'll
it's
not
going
anywhere.
It
is
now
probably
a
permanent
part
of
our
provider
and
Healthcare
delivery
tool
belt.
I
So
thank
you
for
the
work
there
and
then
I
just
again
to
emphasize
that
I
want
to
talk
about
two
studies
that
kind
of
really
strengthen
the
argument
for
Telehealth
Deloitte
did
a
study
a
few
years
ago,
because
a
lot
of
people
asked
do
Medicaid
beneficiaries
even
have
access
to
a
digital
device,
so
they
can
participate
in
Telehealth
Services.
Well.
I
Deloitte's
studies
show
that
86
percent
of
Medicaid
beneficiaries
have
a
smartphone
and
right
at
70
on
a
tablet,
so
not
that
vastly
different
than
the
general
population
and
then
just
as
recent
as
this
summer,
Journal
of
American
Medical
Association,
did
a
similar
study,
specifically
around
Behavioral
Health
Telehealth
in
rural
counties.
So
what
they
showed
is
there
was
about
a
14
increase
in
post-discharge
visits
with
that
behavioral
health
population,
just
because
of
Telehealth.
So
again,
thank
you
guys
for
the
work
you've
done
around
Telehealth.
We
fully
support
it
next
slide
appointment,
availability.
I
This
is
also
something
you
guys
wanted
to
hear
about.
The
only
place
that
we
were
under
95
percent
on
appointment
is
those
calls
that
are
returned
within
30
minutes
after
hours.
Next
slide.
I
We
have
a
significant
amount
of
interaction
with
rural
providers,
because
a
little
over
75
percent
of
our
membership
lives
in
rural
Kentucky.
So
we
had
to
have
to
spend
a
lot
of
time
with
those
folks
and
I.
Don't
have
to
tell
you
guys
about
the
hospital
right
Improvement
program,
you
already
know
it,
but
because
of
the
mcos
being
here,
the
federal
payment
limit
is
higher.
I
I
We
also
have
multiple
quality
bonus
payments
that
are
available
11
for
physical
health
and
six
through
Behavioral
Health,
but
what
we're
most
excited
about
and
I
promise
I
didn't
talk
to
the
previous
presenters.
Before
we
came
in
here
we
actually
have
just
launched
a
value-based
Contracting
initiative.
That's
upside
only
no
risk
for
Behavioral
Health
Providers
and
there
are
going
to
be
initiatives
within
that
where
they
can
earn
extra
dollars
and
we've
really
been
out
pushing
it
hard
in
their
in
the
rural
communities.
I
J
Good
morning
esteemed
committee
I
want
to
thank
you
for
the
honor
and
privilege
to
be
able
to
come
and
present
our
data
outcomes
and
our
value
proposition
as
an
MCO
and
so
I
very
much
appreciate,
Senator
Carroll
and
Senator
Alvarado's
commentary
in
the
previous
presentation.
What
we
aim
to
do
today
is
talk
to
you
guys
about
population,
health,
health,
equity
and
quality
outcomes,
as
we
try
to
be
good
partners
for
our
providers
and
for
the
state,
and
so
our
number
one
way
of
helping
our
members
is
our
Care
Management
Programs.
J
It
is
how
we
connect
to
our
members,
it's
a
way
of
life
for
us,
and
it
is
the
number
one
tool
that
we
can
use
to
impact
our
members,
and
this
is
very
different
than
what
a
provider
does
a
provider
sees
a
patient
impacts,
the
care
of
one
patient
at
a
time,
our
care
members,
our
Health
Equity
programs
and
our
quality
programs
impact
swaths
of
patients
swads
of
members,
and
that
is
its
own
unique
value.
Proposition
Care
Management
data
analytics
tool
we
have
developed
internally,
which
is
Kentucky
Market
Centric.
J
We
use
this
every
day
as
a
data
driving
tool
to
help
intentional
outcomes
and
one
of
the
outcomes
that
we've
had
is
in
our
diabetes
program.
Inpatient
visits
per
thousand
down,
26
ER
visits
per
thousand
down,
27
percent,
very
big
numbers,
our
healthy
weight
program
in
page
patient
down,
33
percent
in
ER
visits,
23
and
so
two
very
basic
elements
of
improving
the
overall
health
of
a
Kentucky
citizens.
J
High
impact-
something
that's
really
important,
probably
also
alluded
to
in
the
previous
presentation-
are
complex,
medical,
Pediatric,
Care
Management,
the
site
of
service.
For
these
members
very
important.
We
want
to
decrease
where
they're
getting
care
and
increase
where
they
should
be
getting
care.
And
so,
if
you
look
at
inpatient,
ER
ambulance,
land,
air
and
water
down
anywhere
from
41
to
73
percent
er
only
down
five
percent,
but
a
place
that
we
continue
to
assess
every
day.
J
But
what's
really
important
to
highlight
is
where
they're
getting
care
increase
from
anywhere
from
four
all
the
way
up
to
75
percent
home
office,
outpatient
hospital,
fqhc,
rhc
and
cmhc.
So
we
are
able
to
help
navigate
our
members
of
the
Commonwealth
to
the
right
section
of
care,
which
is
not
necessarily
something
a
provider
can
do
on
their
own
next
slide.
Please
Improvement
in
the
member
Health
Care
Management
continued
something
that
we
have
realized
is
we
do
know
what
we
need
to
improve
on.
J
We
need
to
improve
on
Health,
Equity
population,
health,
quality
and
readmissions
is
a
big
part
of
that,
and
so
we
have
a
readmission
reduction
task
force
that
meets
monthly,
but
the
work
is
done
daily.
We
have
a
daily
algorithm,
that's
claims
based
and
clinical
based.
We
run
that
list
every
day
and
we
reach
out
to
100
of
our
discharged
members.
J
We
may
be
the
only
MCO
that
does
that
and
what
is
the
impact
of
that
readmission
reduction
task
force
we've
been
able
to
reduce
readmissions
in
a
lot
of
our
high-end
medical
conditions
from
sepsis,
hypertension,
respiratory
failure
and
COPD
diabetes.
Readmissions
are
doubt,
but
what
I
will
call
out,
most
importantly,
is
in
that
bottom
right:
bottom
right
for
you
guys
as
well
mood
disorder,
readmissions,
schizophrenia,
readmission
and
alcohol
related
disorder,
readmission
anywhere
from
two
to
five
percent.
J
J
Not
only
do
they
touch
members
where
they
are
for
Care
Management
care,
Gap
closure,
they're,
quite
agile,
and
being
able
to
Pivot
during
crisis
when
we
had
a
special
nutrition
formula
crisis
where
phenylketonuria
patients
needed
to
have
their
formula,
and
we
had
confusion
from
the
formula-
remember
a
form
of
being
switched
from
Pharmacy
to
DME
our
case
managers
pivoted
quickly.
We
were
able
to
help
100
families
in
a
very
short
time,
and
you
know
PKU
children.
They
have
to
have
that
special
formula.
J
Otherwise
they
will
be
in
a
hospital
with
a
deathly
condition,
very
important
to
be
agile
in
that
nature
and
then
Senator
Carroll.
We
want
to
thank
you
for
alerting
us
about
the
infant
formula
crisis.
We
activated
our
team
right
away
and
we
were
able
to
help
a
hundred
families
very
immediately
and
I
think
these
things
are
important
right.
It's
we're
not
just
improving
quality
but
we're
meeting
members
where
they're
at
for
the
needs
that
they
need,
because
Health
often
goes
beyond
just
medical
care,
and
we
understand
that
at
WellCare
Kentucky.
J
What
I
will
call
out
is
when
you
impact
members
in
such
a
deep
way,
they
tend
to
want
to
gravitate
to
this
work.
Brook
Hall,
along
with
Mike
Burns,
Were
Heroes,
but
Brooke
Hall,
was
a
Medicaid
beneficiary.
She
was
helped
by
well
care
in
the
past.
Her
children
benefited
subsequently.
She
became
a
care
manager
in
our
program
and
now
she
is
actually
a
supervisor
on
our
team.
She
has
grown
into
that
role,
she's
committed
and
it's
a
great
story
for
us
to
tell
next
slide
place.
J
We
continue
to
really
use
that
tripod
method,
Quality,
Health,
Equity
and
social
determinants
of
health
and
population
Health
with
case
management
to
really
Drive
outcomes.
We
have
put
a
lot
of
investment
time
and
effort
into
our
quality
team.
It's
50
staff,
strong,
they
identify
care
gaps,
we
lovingly
call
them
quippus,
quality
practice,
advisors,
they're,
based,
regionally
and
geographically
based
on
need
and
where
our
members
are
so
their
member
and
provider
facing
they're
responsible
for
two
to
four
hedis
metrics.
J
They
design,
Implement
and
operationalize
these
metrics
in
partnership
with
providers
they're
not
meant
to
be
any
administrative
burden
to
these
providers.
They're
actually
meant
to
be
of
assistance,
and
we
continually
assess
those
programs
and
these
members
these.
They
also
work
with
the
member
to
really
understand.
Are
they
getting
the
benefits
they
need?
Are
they
getting
the
experience
they
need?
They
send
cap
surveys.
J
They
follow,
follow
up
with
each
member
when
there
is
a
deficiency
in
that
cap
survey
and
we
Outreach
the
members
during
times
of
Crisis
during
the
floods
during
the
tornadoes-
and
this
is
something
that
we
use
all
of
this
data
to
drive
and
assess
programs
going
forward,
particularly
in
the
sdoh
Arena
food,
housing,
homelessness
and
transportation,
which
I
will
discuss
in
some
later
slides,
as
Corey
alluded
to.
J
We
understand
the
administrative
burden
that
behavioral
health
providers
are
facing,
our
medical
providers
are
facing
and
in
lieu
of
trying
to
partner
with
them,
we
have
come
up
with
some
quality
initiatives
to
help
them.
We
have
25
new
Behavioral
Health
initiatives
in
this
coming
year.
We
agree
that
covet
has
unmasked
uncovered
and
really
shown
us
the
real
prevalence
of
depression,
anxiety,
substance
use
disorder
and
it's
gotten
worse.
J
We
100
acknowledge
that,
and
so
some
of
the
things
that
we
want
to
work
on
now,
non-compliance
regarding
post-discharge,
follow-up
from
Behavioral,
Health,
adherence
to
antipsychotic
or
antidepressant
medication,
metabolic
monitoring.
We
know
these
medications
can
have
side
effects
and
then
members
with
opioid
prescription
from
multiple
providers.
We
do
think
that's
the
space
that
there's
tremendous
opportunity
for
improvement.
We
have
a
bonus
payment
program
and
let
me
tell
you
a
little
bit
about
this
bonus
payment
program.
Why
it's
it's
important!
J
If
providers
perform
screening
for
Target
percentage
of
members,
we
pay
a
bonus
payment,
there's
two
thresholds
81
and
85
percent
quite
High.
However,
in
addition
for
every
screening,
even
if
they
the
provider,
fails
to
reach
those
thresholds,
we
still
pay
them.
So
this
is
actually
a
Glide
path
to
Performance
Excellence
start
with
participation.
J
First,
then
we
get
to
Excellence
right,
and
so
this
is
how
we
show
that
we're
a
good
provider
member
partner,
and
then
we
also
have
the
same
type
of
formula
for
physical
health
around
childhood
obesity,
breast
cancer
screening,
cervical
cancer
screening,
immunizations
and
obesity.
So
I
think
when
you
think
about
all
of
our
programs
kind
of
in
aggregate,
it's
well-intentioned,
well
thought
of-
and
it's
meant
to
be
member
facing
member
outcome,
but
also
in
partnership
with
the
provider
next
slide.
Please
I
would
like
to
talk
more
about
substance
use
now.
J
I
think
this
is
something
that's
very
important.
In
Kentucky,
like
we
have
a
readmission
reduction
task
force,
we
have
an
opioid
task
force
as
it
was
alluded
to
earlier.
There
is
a
tremendous
amount
of
data
that
exists
in
the
mcos
where
we
use
that
data
and
we
use
it
wisely
and
intentionally
we're
assessing
that
data
daily,
sometimes
multiple
times
a
day
when
it
comes
to
substance
abuse.
We
create
report
cards
for
our
members
on
the
risk
of
continued
opioid
use.
J
Members
who
are
compliant
with
pharmacotherapy
and
who's
receives
counseling
members
who
have
prescription
for
Narcan,
because
that
is
a
direct
correlation
with
if
you're
going
to
have
inpatient
utilization
or
ER
utilization,
and
so
we
identify
our
members,
we
reach
out
to
them
and
we
put
them
in
the
right
place
for
the
right
level
of
treatment.
And
so,
if
you
look
at
our
percentage
of
medication,
assisted
therapy
by
month,
always
greater
than
70
percent
for
the
most
part
going
back
to
2019,
that's
an
industry
standard.
We
would
understand.
J
J
You
will
see
in
this
slide
here
members
with
opioid
prescription
members
per
thousand
huge
Decline
and
sustained
performance
over
time
since
that
time,
and
then,
if
you
look
at
the
bottom,
15-day
Supply
and
30-day
period
and
31
day
supply
and
a
62-day
period,
also
significantly
down
when
you
think
about
members
per
thousand
so
great
work.
This
happens
not
in
isolation.
It
happens
in
partnership
with
fqhcs
Behavioral,
Health
entities
providers
in
the
field
and
with
our
case
managers
next
slide.
Please
went
to
rap
substance,
abuse
disorder
with
a
bow.
J
If
you
look
in
March
of
2022
as
I
called
out
before,
with
the
Advent
of
our
opioid
task
force
committee,
you
will
see
members
with
oud
in
the
last
180
days,
also
going
down
so
significant
impact
there
and
Narcan
prescriptions
in
March
of
21
going
up.
J
So
you
see,
number
of
new
diagnosis
is
going
down
utilization
going
down
and
prescriptions
of
Narcan
going
up
all
really
when
you
wrap
it
up
significant
impact
to
the
members
in
Kentucky
who
have
substance
use
disorder
and
in
addition
to
that
part
of
our
success
is
being
able
to
reach
a
macro
amount
of
members
and
we've
done
that
through
Telehealth.
As
Corey
alluded
to
earlier,
there's
been
a
number
of
studies.
J
There's
a
study
here
from
the
center
by
Medicare
CMS
data
published
in
the
American
Medical
Association
of
Psychiatry,
which
I
believe
to
be
a
very
reputable
Journal
that
showed
the
lower
odds
of
experiencing
a
medically
treated
overdose
when
using
Telehealth.
So
the
stigma
of
using
Telehealth
and
Behavioral
Health
has
been
dismissed
as
not
accurate.
Now
I'd
like
to
now
pass
the
presentation
to
Darren
Levitz,
who
is
our
director
of
member
performance,
yeah.
K
Thank
you,
Dr
Pell,
great
numbers,
especially
during
the
pandemic.
Thank
you,
esteem
Academy
members
for
allowing
me
to
present
on
some
of
our
efforts
to
improve
our
member
Health
in
the
way
that
we
we
do,
that
is,
is
through
Community
engagement
in
the
way
that
we
know
that
we're
successful
is
by
measuring
outcomes
which
I
think
is
very
unique
to
to
Wellcare.
K
K
So
we
take
the
time
to
work
with
them
to
find
out
what
other
needs
that
they
may
have,
and
we
are
proud
that
we
do
provide
those
resources
on
the
spot
to
them.
You
see
that
the
through
our
numbers
that
over
17
000
people
called
in
last
year
and
we
provided
over
forty
two
thousand
resources
to
to
those
recipients.
K
So
you
know
that
sounds
great,
but
so
what
we
gave
them
resources.
Well,
we
measured
those
outcomes.
We
measure
the
programs
that
we
provide
to
our
communities
and
we
see
that
providing
these
resources
that
they
are
five
and
a
half
times
more
likely
to
visit
their
PCP
after
receiving
Services
they're
1.4
times
more
likely
to
have
a
better
blood
sugar
test
and
that
they
are
1.7
times
more
likely
to
improve
their
overall
functional
status
so
being
able
to
measure
those
outcomes
is
something
that's
very
profound
and
I
think
unique
to
Wellcare.
K
One
thing
when
I
began
working
with
the
community
engagement
team
about
three
years
ago
was
to
take
a
new
approach
and
I
said
to
the
team
and
I'll
say
to
this
committee.
If
I
was
to
say
today
that
we
were
going
to
do
a
food
insecurity
program,
does
anybody
have
a
problem
with
that?
Well,
that's
like
asking.
Is
anybody
against
motherhood
or
apple
pie?
K
No
one's
gonna
shake
their
head
at
that,
but
I've
lived
in
Kentucky
my
entire
life
and
in
those
51
years,
as
you
guys
know
that
Western
Kentucky
is
very
different
than
Eastern
Kentucky.
In
fact,
all
120
counties
are
very
unique
into
themselves
and
have
very
unique
needs,
so
we
began
not
just
going
with
hunches
or
hey.
This
sounds
like
a
good
idea,
but
let's
use
the
data
to
drive
what
type
of
programs
we
put
in
each
of
those
120
counties.
K
So,
let's
go
through
a
couple
of
quick
snapshot.
Examples
of
those
Hotel
Inc
who's,
the
long-standing
partner
of
ours.
They
provide
a
safe
and
stable
home
environment
for
people
and
in
working
with
them
for
people
who
are
facing
homelessness.
We've
seen
a
10
reduction
quantifiable
results,
10
percent
reduction
in
ervits
and
18
reduction
in
flu
related
visits
with
welcome
house
which
helps
with
transition
people
from
housing,
uncertainty
to
housing,
stability.
Again.
Another
important
need
within
that
County.
K
22
percent
of
those
members
have
found
and
maintained
housing,
which
we
know
is
essential
to
improving
Health
they're,
not
going
to
see
their
PCP.
If
they're
worried
about
not
having
a
place
to
live,
we've
seen
a
48
of
those
members
subsequently
visited
their
PCP.
So
again,
we
know
that
if
we
provide
stable
housing
options
that
those
people
are
in
turn
going
to,
quantifiably
live
better
in
healthier
lifestyles.
J
Thank
you
Darren,
so
this
is
a
very
important
slide
for
us.
This
is
our
foundational
slide
of
how
we
think
about
social
determinants
of
Health
population
health
and
how
we
use
our
data
to
drive
outcomes
and,
as
Karen
alluded
to
about
food
insecurity.
Food
insecurity
has
a
lot
of
different
faces.
Just
like
every
county
has
a
different
need.
Food
insecurity
can
show
up
as
hunger
a
very
basic,
primitive
need.
Then
it's
sustainable
food
source.
Do
you
get
food
Monday
to
Sunday?
Do
you
get
it
breakfast
lunch
and
dinner?
Is
it
hot
or
cold?
J
Can
you
get
it
in
time
for
when
you
need
it,
then
the
next
step
is
food.
Is
medicine
food
prescription,
which
is
a
very
much
invoke
thing
now,
medically
tailored
meals?
Can
you
get
a
meal
for
your
particular
condition,
hypertension,
diabetes,
obesity,
so
on
and
so
forth,
and
then
the
Panacea
food
literacy?
Do
we
Empower
people
to
pick
and
choose
the
food
that
it's
appropriate
for
them?
Is
it
accessible
all
the
time
and
they
don't
have
to
worry
about
hunger?
J
And
then,
if
you
have
all
of
those
things,
then
you
can
start
to
worry
about
what
comes
underneath
social
inequity,
institutional
inequity,
living
conditions,
behavioral
risks,
disease
and
injury,
things
that
worry
all
of
us,
and
then
we
talk
about
policy,
and
so
we
really
think
about
this
in
a
multi-access
format,
food
insecurity
on
one
access,
Solutions
on
another
access,
and
then
these
social
determinants
Health
on
a
y-axis.
And
then
we
use
our
data
to
point
through
where
we
want
to
put
resources,
programs,
emphasis
and
then
measure
for
outcomes.
Next
slide.
J
Please
and
so
thinking
about
that
foundation,
and
that
framework
we'll
talk
about
some
partners
that
we've
used
in
the
past
black
soil
Kentucky,
it
reconnects
black,
Kentucky
members
with
cultural
heritage.
It
provides
fresh
food
for
Mo,
the
moms
initiative,
meal
prescription
and
delivered
meals,
and
what
is
important
about
black
soil
is
we
think
that
you
have
to
pick
Partners
who
are
going
to
create
Sustainable
Solutions,
not
a
solution
at
one
point
in
time,
which
is
where
we
tend
to
think
about
how
we
want
to
do
things
need
more
Acres
food
is
medicine.
J
They
provide
40
weeks
of
fresh
food
with
meal
kits
for
pregnant
women.
We
think
maternal
hair
is
a
maternal.
Health
is
a
tremendous
place
for
improvement
for
us
and
when
we
think
of
our
role
as
an
partner,
we
think
of
the
convener
model.
People
who
are
very
knowledgeable
about
Community
Health
needs
assessments
understand
that
the
convener
model
is
connect,
acting
two
partners
to
accelerate
and
amplify
Health
outcomes,
so
need
more.
Acres
was
connected
to
Hotel
Inc,
which
we
had
discussed
in
the
previous
slide.
J
So
we
could
do
some
pilot
projects
for
our
Refugee
population,
and
so
that
is
one
of
the
roles
that
we
can
play
as
an
MCO
as
a
good
partner
and
then
fresh
RX
for
moms
continuing
to
promote
healthy
food
habits
and
sustainable
food
sources
for
our
moms,
and
we
don't
just
go
out
and
ascertain
Partners.
We
embed
this
work,
this
culture
with
our
care
managers
to
really
address
for
homelessness,
address
for
Housing
address
for
food
insecurity,
and
some
of
the
projects
that
we've
done
is
really
helping.
Our
refugees
really
find
360
degree
wrap-around
Services.
J
So
this
ends
our
core
presentation.
If
the
committee
would
like
us
to
present
additional
information,
we
would
be
ready
to
do
that.
J
A
K
A
D
K
Sure
so
the
data
that
we
use
on
this
one
is
a
couple
things
number
one.
We
were
looking
at
Health
factors
which
a
lot
of
times
are
we're
simply
economic.
You
know:
where
do
we
see
the
greatest
incidence
of
poverty
where
we
know
that
there's
going
to
be
greater
needs?
We
are
actually
taking
that
to
another
level.
G
K
We
we
do.
We
have
a
number
of
of
programs
that
we
work
with
our
well
care
works
is
one
such
example,
where
we
provide
and
work
with
our
community-based
partners
and
members
directly
to
provide
them
with
job
training,
to
provide
them
with
resources
of
how
to
interview
how
to
write
a
resume
basic
Financial
skills,
how
to
open
a
checking
account
how
to
balance
that
how
to
apply
for
credit
and
other
life
skills
that
they're
going
to
need.
One
story
that
I
like
to
tell
is
I
came
to
the
senior
leadership
team.
K
Last
year,
when
we
were
discussing
our
value-added
benefits
and
I
said,
I've
got
to
evaluate
a
benefit
that
I
want
to
suggest
it's
going
to
cost
us
anywhere
from
a
quarter
of
a
million
to
half
a
million
dollars,
and
it's
probably
not
going
to
get
us
a
single
member.
I
said:
okay,
Darren
tell
us
all
about
it,
and
I
said
we
need
to
provide
state
issued
ID.
Now
you
scratch
out
and
say
what
does
state
issued
ID
have
to
do
with
Healthcare?
Well,
without
an
ID,
you
can't
get
that
checking
account.
K
You
can't
rent
an
apartment
apply
for
a
loan,
get
a
job,
any
number
of
basic
things
that
we
probably
all
take
for
granted,
but
something
as
simple
as
a
state
ID
could
make
those
problems
go
away
and
help
them
graduate
through
that
system
and
eventually
get
out
of
the
Medicaid
system.
So
we
have
a
number
of
programs.
Educational
programs
such
as
providing
people
with
with
GED
starting
earlier
a
value-added
benefit
that
we
had
this
year.
K
We
noticed
that
many
of
our
members
fell
behind
in
their
education
during
the
pandemic,
so
we've
provided
hot
spots
and
free
internet
for
a
year.
We've
provided
tutoring
sessions,
virtual
and
in
person
for
people
all
these
things
to
help
them
get
those
building
blocks
so
that
they
can
become
productive
and
they
can
graduate
out
the
system
and
become
self-reliant.
Those
are
just
a
few
examples
from
what
member
experience
does
to
help
software.
For
that.
K
That
is
the
job
of
our
community
engagement
team.
We
go
through
literally
thousands
of
meetings
throughout
the
state
to
make
sure
that
they
understand
what
resources
are
available.
Sometimes
they
get
the
opportunities
to
present,
sometimes
when
they
hear
those
those
applicable
concerns,
they're
able
to
stand
up
and
say
we
have
a
solution
for
that.
So
we
do
work
very
closely
with
governments
and
other
community-based
organizations
to
make
sure
that
those
resources
are
well
promoted
and
understood.
D
H
Bear
with
me
here
for
a
second,
if
you
would
I'm
just
trying
to
so
prior
to
these
presentations
that
we've
had
all
interim
my
idea.
My
my
main
source
of
information
about
mcos
was
the
provider
concerns
that
we've
heard
from
this
committee
that
we've
heard
from
many
people,
testifying
that
many
of
us
have
had
Direct
experience
and
certainly
hear
from
our
constituents.
But
then,
when
I
hear
the
presentations
from
the
mcos,
what
I
get
really
is
a
picture
of
a
broad?
H
J
A
representative,
that's
a
fantastic
question:
I'm
a
practicing,
pulmonary
critical
care,
physician
and
my
wife
is
a
psychiatrist,
and
so
I
very
much
understand
the
role
of
the
provider
in
dispensing
Health
Care
to
members
one
at
a
time,
but
the
drivers
of
Health.
What
Senator
Meredith
has
alluded
to
the
things
that
drive
bad
outcomes
is
not
always
that
medical
condition
it
could
be
a
living
situation.
It
could
be
a
ride,
it
could
be
a
domestic
situation
and
the
safety
social
net
that
the
mcos
provide
is
broader
than
delivering
the
health
care.
J
We
are
here
to
enable
the
healthcare
piece,
but
we're
also
here
to
provide
everything
around
it.
So
the
provider
can
dispense
the
health
care
piece
and
they
don't
have
to
worry
about.
All
of
that.
Other
stuff
that
comes
with
taking
care
of
the
drivers
of
Health
right,
I
I
do
feel
like
when,
let's
use
a
diabetic
patient
right,
a
diabetes
patient
needs,
a
podiatrist
needs
an
endocrinologist
needs.
A
primary
care
physician
might
need
some
health,
coaching
and
counseling
and
then
needs
medically
tailored
meals
provider.
J
A
physician
cannot
do
that
by
themselves,
especially
if
they're
on
pen
and
paper
still
right,
and
so
our
Care
Management
Programs
are
technology
based,
Health,
Care
tools,
our
connections
to
nutritionists.
We
provide
everything
else,
and
so
the
credit
for
the
outcome
is,
you
know
on
everybody
right
it's.
It
is
an
interdependent
model
that
you
need
to
get
that
outcome.
It
cannot
just
be
based
on
the
provider
and
there
are
opportunities
for
improvement.
Absolutely
we
own
that
piece,
but
I
do
think.
K
Thank
you
and
I'll.
Add
to
that.
You
know
there
there's
there's
an
old.
You
know
kind
of
yarn
within
Healthcare
that
you
know
you're
not
going
to
see
your
PCP
if
your
basic
needs
are
aren't
being
met,
and
we
know
that
if
you're
worried
about
making
rent,
we
know
that
if
you
know
you
don't
have
food
in
in
there,
you're
not
going
to
go
and
get
your
your
annual
dental
checkup.
K
It's
just
on
your
list,
you're
not
going
to
get
your
mammogram
you're
not
going
to
do
those
checkups
and
a
lot
of
times,
and
we've
worked
with
some
great
partners
with
within
the
Kentucky
Center
for
excellence
of
rural
Health.
When
gas
was
up
to
five
dollars
a
gallon,
you
know
we
had
conversations
with
Dr
Fran
feltner
down
there,
who
told
us
that
there
are
mothers
who
are
making
the
decision.
You
know
specialist.
You
know
we're
30
60
100
miles
away.
You
know
they
couldn't
afford
to
drive
there.
K
Sometimes,
during
the
best
of
times
when
gas
got
to
five
dollars
a
gallon,
they
were
making
decisions.
Do
I
feed
my
family
or
do
I
go
to
an
appointment?
Well,
you
know
what
that
mom's
gonna
decide
every
time
so
as
an
MCO
to
go
through
and
provide
grants
to
them
to
say,
let's
make
sure
people
are
going
there.
You
know
through
the
generosity
of
this
committee.
You
know
prescriptions
are
no
cost
to
Medicaid
members,
but
if
they
can't
get
to
the
pharmacy
they're,
not
helping
them
sitting
on
those
shelves.
G
Thank
you
Mr,
chairman
and
gentlemen.
Thank
you
and
and
before
I
I.
Ask
my
question
to
make
my
comments
in
my
experience.
Well,
care
is,
is,
is
at
the
upper
end
of
as
far
as
mcos
go
and
and
I
know
that
you
all
are
aware
of
the
conversations
that
we
have
in
these
committees.
Mike
is
here
and
Mike
is
a
tremendous
asset
to
your
organization.
I
want
you
to
know
that,
from
my
perspective,
in
interactions
with
him
it
it
seems
in
in
building
on
what
representative
willner
asked.
G
Does
it
not
and
I'm
not
saying
that
you
all
you
all
do
these
things?
It's
it
it's
different
with
each
MCO,
but
it
it
limits
the
the
the
requirements
that
the
mcos
put
on
providers-
the
and
please
forgive
me
sometimes
asinine
things
that
are
pulled
are-
are
counterproductive
to
to
you
all
success
when
you
look
at
all
these
other
things
that
you're
doing,
because
that's
at
the
base
of
the
service
and
if
providers
can't
maximize
their
efficiency,
their
effectiveness,
that's
going
to
limit
you
all
success.
You
all
are
in
an
industry.
G
That's
not
very
well
respected
in
this
Commonwealth
by
many
in
this
legislature
and
if
things
don't
change,
there's
a
decent
chance
at
some
point.
We're
going
to
get
enough
support
that
some
of
you
are
going
to
be
gone,
and
that's
that's
just
the
hard
facts.
Do
you
all
see
that
the
industry
is
succeeding?
What
do
you
all
do
to
to
cut
through
some
of
this
red
tape
for
providers
and
I?
Understand
accountability
completely,
got
no
issue
with
that,
but
but
it's
just
ridiculous.
G
Some
of
the
Hoops
that
in
some
of
the
requirements
I
mean
you
all
heard
it
this
morning-
that
that's
just
that's,
there's
no
excuse
for
that.
No
one
can
justify
that.
So,
what's
your
response
to
all
these
things,
the
reports
that
you
all
get
what
makes
well
care
different
in
this
area
and
if
you,
if
we
were
limited
to
three
mcos,
what
would
make
you
all
different
in
in
addressing
all
these
issues
that
we
get
every
meeting
we
have.
I
Absolutely
there's
room
for
improvement,
but
I
will
tell
you
the
ultimate
goal.
You
know
as
soon
as
I
got
here
and
I
and
I
will
tell
you
guys
and
I.
You
know,
I,
don't
try
to
just
throw
this
out
there,
because
I
think
it's
going
to
be
great
to
hear
I've
been
a
Managed
Care
two
years,
I
was
a
hospital
administrator
for
in
hospital
Administration
20
years
and
a
hospital
CEO
for
the
last
eight
of
those.
So
I've
heard
the
stories
I
was
on
that
side.
I
I
used
to
meet
with
mcos
myself,
absolutely
I
think
there's
a
symbiotic
relationship
and
one
that
can
improve.
But
in
regards
to
the
actual
the
specific
comments
we
heard
this
morning,
the
audits
we
do,
we
don't
enjoy
those
any
more
than
anybody
else.
I
Currently,
there's
there's
for
Behavioral
Health.
There
is
no
PA
process,
but
we
are
held
accountable.
We
get
audited
by
DMS
and
CMS.
What
are
you
doing
to
manage
these
dollars?
Well,
that's!
Well,
since
there's
that
we
have
the
only
place
we
can
look
is
on
the
back
side.
So
we
do
not
want
to
be
an
administrative
burden
and
honestly,
the
First
Health
System
I
met
with
when
I
came
to
Kentucky
in
February
was
Owensboro.
Health
I
went
out
with
their
leadership
team
and
he
asked
me
the
CEO.
There
said
how
do
you
define
success?
I
I'm
like
when
you
don't
say
my
name
because
typically
I've
been
in
your
chair
and
when
we're
talking
about
mcos,
it's
usually
not
in
a
good
lot.
So
I
want
to
be
the
smallest
administrative
burden
and,
quite
honestly,
would
prefer
not
to
be
one
for
the
providers
on
this
committee
and
sitting
in
this
room.
So
there's
absolutely
room
for
improvement
in
ways.
We
can
work
together
to
get
better
and.
G
I
appreciate
that
it's
just
it's
a
step
forward,
two
steps
back
and
it
it
just
doesn't
make
any
sense
that
that
we
can't
streamline
some
of
those
processes
and
standardize
some
of
those
processes
and
and
really
the
cabinet.
We've
talked
about
this
shoot
for
years.
We
need
to
be
consistent
with
with
the
standards
and
the
requirements
for
each
MCO.
We
shouldn't
have
six
sets
of
rules
and
again
I.
Could
click
play
the
tape
in
six
months
when
we
have
other
meetings
play
it
again,
it's
the
same
conversation
and
and
it
and
it
never
changes.
F
J
J
No,
absolutely
I
see
it
my
wife's
a
practicing
psychiatrist
and
she
has
a
large
team
of
lcsws
and
we
see
the
same
problem.
She
works
for
an
off-for-profit
and
it
it's
a
tremendous
burden.
It
causes
burnout.
I
also
think
that
we
have
an
issue
of
new
Behavioral
Health
therapists
providers
coming
into
the
industry.
More
are
retiring,
less
are
coming,
and
so
there's
a
lot
of
different
Nuance
to
solving
that
problem.
J
This
is
one
Nuance
that
we
have
to
solve
for,
but
we
also
need
to
solve,
for
how
do
we
get
new
folks
to
come
into
that
industry
that
are
going
to
stay
for
20
years,
and
so
there's
a
lot
of
different
things
to
solve,
for
there.
F
Yeah,
just
generally
speaking,
you
spoke
of
like
a
tripod
earlier
right,
where
the
members
are
always
going
to
be.
First
there's
nobody
in
here
going
to
deny
that
right,
but
I
I
would
challenge
you
Chris,
maybe
you're
the
you're,
the
guy
in
charge,
I
prom,
go
to
a
quad,
go
to
a
quad,
put
the
providers
in
in
in
some
in
some
level
of
importance,
because,
what's
going
on
here,
there's
a
difference
between
managing
care
and
providing
care
and
you're
managing
care.
F
But
when
it
comes
to
providing
care,
that's
going
to
fall
apart.
If
you
don't
get
rid
of
the
barriers
when
it
comes
to
receiving
payment
reimbursements
that
are
way
lower
than
Medicare
allowables
in
many
of
your
services
and
used
to
years
ago
and
I
think
the
doc
will
will
attain
to
this,
is
we
used
to
think
if
we
got
Medicare
allowable?
That
would
be
that
would
like
our
cost
right.
We
would
think
well
we'll
we'll
we'll
link
by
now
we're
seeing
and
well
care
quite
honestly,
you're
you're
well
below
Medicare
allowables
online
services.
F
F
Second
third-
maybe
third
and
fourth
just
put
it
in
the
in
the
equation
and
say
you
know
what
providers
should
be
paid,
maybe
within
30
days,
at
a
reasonable
reimbursement
and
when
they
call
about
prior
authorizations
or
or
other
questions,
they
should
have
a
support
team
on
your
staff
that
picks
the
phone
up
and
talks
to
them
and
makes
it
happen,
because
it
sounds
to
me
like
in
every
other
area
of
your
company
to
say
something
positive.
It
is
happening.
You
know
you
are
getting
some
good
data.
F
You
are
getting
some
things,
but
what
you're
doing
and
that's
why
the
same
complaints
exist
year
after
year,
because
we're
literally,
we
feel
like
the
mcos,
are
getting
to
that
to
that
level,
just
right
at
the
end,
washing
their
hands
and
go
okay,
we've
managed
it
now.
You
all
provide
it.
Good
luck!
That's
what
it
feels
like.
So
thank
you
very
much
and
I
hope
you'll
put
some
emphasis
on
that.
Please.
Thank
you.
D
Thank
you,
representative
Shelton
last
question
comment
for
Sentry
Alvarado.
E
Thank
you,
Mr
chairman.
Thank
you
all
for
presentations.
I
got
a
few
questions
for
you
on
the
the
membership
and
er.
The
very
first
slide
you
showed
us
I
mean
how
much
of
that
a
big
drop
in
ER
visits,
big
drop
in
PCP
visits
and
I'm
appreciate
that
it's
data
and
you're
going
to
report
the
data,
but
that's
all
a
result
of
the
pandemic.
Clearly
I
mean
a
lot
of
people
were
scared
to
death
of
going
to
ER
visits.
E
I
E
The
members
access
to
Providers
the
next
decide
that
you
got.
You
know
you
guys
are
showing
that
an
appointment,
availability
everybody's
come
in
here,
saying:
they're
Meeting
those
I,
don't
believe
that
and
I'll
be
perfectly
honor.
E
You
guys
are
going
to
say
we're
meeting
it
I'm
going
to
say
I,
don't
I
call
BS
on
that
as
a
provider
I've
got
people
within
your
guys's
Services
I
can't
find
Specialists
willing
to
see
folks,
and
these
are
people
you
know
towards
even
closer
to
Louisville,
to
places
where
I
provide
services
try
to
find
a
GI
specialist
two
months,
two
and
a
half
months,
three
months
to
see
a
GI
person
primary
care.
People
call
me
all
the
time:
hey
Doc,
who
would
you
recommend?
E
Yeah,
listen
I,
don't
have
an
appointment
for
a
year
as
a
primary
care
provider.
So
a
lot
of
these
numbers
I,
don't
believe
them.
I
know
people
that
do
audits
on
this
privately,
that
are
not
insurance
companies
that
are
not
that
are
just
Patient
Advocates
who
have
data.
That
shows
that
none
of
this
is
true
and
again
all
the
mcos
have
come
in
here
saying:
we've
got
great
networks.
I,
don't
believe
that
I
think
you
guys
need
to
go
talk
to
some
of
the
folks
on
the
ground.
E
You
might
have
people
that
call
on
your
behalf
to
say:
hey
can
I
get
an
appointment,
all
that
I,
don't
know
how
that
works,
but
I
tell
you
I'm
a
practicing
doc
I
saw
somebody,
you
know,
needs
a
GI
appointment,
they've
got
them
set
up
for
December
and
I'm
like
they
need
to
be
seen
now
for
the,
and
they
said
well,
that's
that's
the
soonest
they
had
for
this
individual.
So
this
isn't
accurate.
I
know
we're
hearing
it
from
all
the
members.
E
Not
just
you
guys,
not
just
to
call
you
guys
out,
but
that's
none
of
that
stuff
is
accurate.
I,
don't
think
it's
really
true
and
I
think
you
need
to
go
out
there
and
talk
to
a
lot
of
the
folks
and
there's
other
advocacy
groups
who
are
going
to
have
their
own
data.
That
shows
that's
just
not
not
accurate.
On
that
I
know
you
had
the
the
improving
member
Health
Quality
team,
the
one
where
you
said,
you're
kind
of
rewarding
doctors
for
doing
filling
out
forms
and
doing
that
kind
of
assessment.
E
I
got
a
packet
from
you
all.
It
had
eight
patients
in
there
with
a
form
to
fill
out
saying
we
were
worried
if
you
fill
out
this
many
of
them.
One
of
the
eight
was
my
patient,
the
other
seven
I've
never
heard
from
before,
don't
know
who
they
are
shredded
them
all
threw
them
away,
because
I
had
only
one
person
that
was
there.
I'm
thinking
do
I
need
to
spend
the
time
to
fill
this
out.
E
They
don't
know
who
my
patients
are
or
not
I'm
in
long-term
care,
but
some
of
those
folks
are
there
long
term
and
I'm
going
to
be
their
main
Primary
Care,
Doc
and
I
see
them
every
month
and
I
do
that
stuff,
but
are
those
eight
that
I
received
in
the
packet
from
you
all?
Only
one
of
them
was
actually
my
patient
now
am
I
going
to
call
to
say:
hey.
Can
you
quit
no
I'm
not
going
to
take
the
time?
I?
Don't
have
the
time
frankly
to
call
and
say:
can
you
fix
this?
E
Can
you
make
sure
of
it,
because
we've
seen
these
kind
of
programs
before
I'd
rather
see
you
go
to
an
ACO
model,
which
is
what
we've
been
doing
now
for
goodness
20
years?
Medicare
has
done
a
lot
of
that
stuff
where
you
can
bring
in
providers
and
say
if
you're
going
to
be
a
missed,
Network
show
us
how
you
can
reduce
these
costs
and
do
that
stuff
instead
of
saying
here,
fill
out
a
form
for
me,
make
sure
you
cover
these
things
documented
in
your
record.
E
J
Very
much
respect
your
commentary.
I
would
wholeheartedly
agree
on
two
things
right,
so
there
is
member
churn
I,
think
the
data
doesn't
always
matriculate
down
to
the
provider
in
a
timely
fashion.
So
I
think
that's
that's
an
issue
when
you
go
to
ACO
model
attribution
is
at
the
beginning
of
the
year,
so
that's
you
would
alleviate
that
issue.
So
we
would
highly
support
that
and
then,
in
terms
of
the
specialist,
we
also
see
that
as
well.
I
think
what
we
would
say
is
members
have
access
to
those
Specialists.
J
E
Sure
and
that's
why
you
had
that
you
had
the
slide
that
said
appointment,
availability,
that's
why
those
numbers
to
me
are
not
I
mean
I'd,
see
them
clinically
I
can't
get
people
into
specials.
I
have
a
hard
time
finding
folks
that
are
willing
to
a
lot
of
factors
for
that.
On
the
sud
front,
on
efficacy
tools,
we
just
passed
a
bill.
Recently
we
were
getting
rid
of
prior
authorization
for
mat
right
for
medications
to
treatment.
E
A
lot
of
some
of
our
legislators
were
concerned
that
people
were
just
writing
prescriptions
of
Suboxone,
giving
them
out
a
lot
of
diversion,
no
mental
health
being
provided.
We
passed
a
law
requiring
mcos
now
to
start
tracking
that
and
reporting
that
to
the
licensing
board,
for
both
the
Board
of
Nursing
and
the
board
of
medical
licensure,
I'm
curious.
If
you
guys
have
been
doing
that
I
mean
as
you're,
seeing
you
got
providers
that
they're
doing
the
right
thing
and
some
who
aren't
are
we
reporting
that
information
to
the
respective
boards?
Now
we.
J
E
And
I
I
said
I
know
you
guys
don't
want
to
be
the
ones
to
report
that
I'm
gonna
have
to
be
contacting
our
boards
to
make
sure
because
I'll
be
curious
to
see
what
those
numbers
look
like
I
mean
what
was
reported
off.
The
record
for
me
was
from
multiple
not
just
not
not
you
all
multiple
different
mcos
on
the
order
of
60
of
our
providers,
weren't
doing
any
mental
health
that
they
could
track
or
see.
E
I
found
that
surprising,
but
I
I
don't
have
the
data
to
look
at
so
I'll
be
I'll,
be
talking
to
the
boards
to
kind
of
get
an
idea
where
we're
at
on
that,
because
they
need
to
start
make
sure
that
they're
following
regulations,
other
thing
I'll
say
it
and
I
I
know
Mike
right
now
was
mentioned
earlier.
When
I
first
came
here,
you
guys
were
the
worst
performer
of
all
the
mcos,
so
you
guys
have
made
a
lot
of
strides.
It's
been.
E
You
know
it's
been
10
years
for
a
lot
of
this
stuff,
so
I
know
we
hear
about
a
lot
of
the
efforts
being
made
on
trying
to
improve
all
this
stuff.
Again.
The
data
overall
from
our
as
a
state
as
a
where
we
stand
from
where
we
were
10
years
ago.
We
really
haven't
moved
at
all
and
that's
been
the
argument
we've
had
we've
brought
in
all
the
mcos.
You
guys
have
improved
a
lot.
I
think
you've
responded.
E
You
were
I,
think
threatened
by
a
previous
administration
to
be
removed
entirely
as
a
provider,
because
the
the
job
you
were
doing
was
not
good.
You
made
a
lot
of
strides
I
commend
you
for
that,
so
things
are
improving,
but
just
in
terms
of
that
I
mean,
maybe
you
can
comment
for
a
lot
of
these
plans.
All
these
things
that
we're
doing
hey
we're
going
to
try
to
improve
all
these
different
things.
E
So
I
would
charge
you
with
that
I
mean
as
you're.
Looking
at
you
know,
making
some
of
these
improvements
on
diabetes
and
outcomes.
That's
what
we've
been
when
we
had
expanded
medicaid.
All
these
promises
for
mcos
was
thousands
of
new
jobs.
All
this
Improvement
in
health
care
outcomes.
Things
are
going
to
be
great.
What
we've
had
is
an
added
level
of
bureaucracy
and
frustration
for
providers
and
really
no
improvement
in
overall
outcomes.
For
folks,
which
is
my
concern,
so
you
guys
have
improved
I'll.
E
E
We
just
want
to
start
seeing
some
results
on
some
of
these
things
and
I
know
it's
tougher
and
it's
gonna
have
to
be
some
different.
Innovative
ways
to
work
with
local
governments
and
providers.
Really,
instead
of
a
retroactive
angle,
is
to
look
at
an
ACO
model.
Where
you
say:
here's
where
your
current
Baseline
is.
We
want
to
get
you
here,
we'll
reward
you
financially.
If
you
push
this
because
if
they're
allowed
to
be
the
ones
to
be
Innovative
and
do
their
own
things
to
improve
the
outcomes,
you'll
have
a
lot
more.
E
Buy-In
providers
be
willing
to
work
with
you
more
than
to
say
yeah.
You
did
all
this.
We
we
think
you're
robbing
from
us
proved
was
that
you
didn't
I
mean
those
things
are
not
just
not
good
approaches,
and
you
guys
are
both.
You
know,
provide
active
provider
previous
provider,
you
know
that's
what
I
would
encourage
you
to
look
for
if
you're
going
to
be
Innovative
on
this
stuff.
Thank
you,
Mr
chairman
appreciate
it.
D
Thank
you
just
a
quick,
anecdotal
experience.
As
you
know,
my
son
is
a
primary
care
physician
in
Grayson,
County
and
I.
Think
he's
seeing
everybody
in
Grayson
County,
because
people
come
to
him
saying
I
see
your
son
ran
into
a
couple
last
week
as
a
matter
of
fact.
At
the
event
this
is,
is
Dr
Meredith
your
son
I
go.
J
D
D
We
have
an
appointment
with
him
first
week
of
February,
so
he
reminds
me
that
any
doubt
that
you
know
if
you,
if
you
believed
in
averages,
no
one
would
ever
drown
in
the
Rio
Grande
River,
because
average
death
is
like
three
feet
so
yeah
I
think
this
number
is
a
little
bit
suspect,
particularly
for
real
communities.
I
think
it
can
be
skewed.
I
said
Alvarado
would
be
the
last
word,
but
I
I'm
going
to
yield
that
to
Center
Carroll.
Thank.
G
You
Mr
chairman
one
thing:
I
want
to
close
out
with
you
know
you
all
looking
at
all
these
programs
and
services
that
you
do
to
benefit
your
your
members
going
through
the
process
of
starting
a
new
program,
a
service,
that's
badly
needed
in
this
Commonwealth
and
that's
Autism
Services.
There's
no
help
from
you
all
you.
It's
an
adversarial
relationship.
There
are
competing
interests.
G
It
would
be
great
that,
as
someone
trying
to
set
up
a
new
business
that
I
could
rely
on
mcos
to
come
in
and
help
to
ensure
that
that,
as
a
provider,
I
could
sustain
that
program,
and
it
seems
in
this
field.
There
are
a
limited
number
of
providers
and
it
is
we
need
far
more
than
we
have
in
this
Commonwealth.
G
It
seems
that
it
would
benefit
mcos
also
to
to
be
a
resource
rather
than
an
adversary
in
helping
people
who
want
to
open
up
businesses
for
a
lot
of
different
reasons:
employment,
poverty
because
it
provides
jobs.
Our
Center
alone
will
provide
probably
40
jobs
in
our
community,
ABA
being
a
one-on-one
type
therapy.
Why
do
you
want
to
do
anything
like
that?
Wouldn't
that
be
a
good
investment
of
your
money.
G
Yeah
and
I'm
I'm
not
talking
about
just
me.
There
are
lots
of
folks
here.
I
mean
you've
heard
these
folks
talk
about
how
they're
going
to
end
up
closing
their
doors.
If
things
don't
get
better,
would
it
not
be
worth
your
time
to
with
all
of
these
places?
What's
going
on
what's
going
on?
Why
are
you
going
to
close
your
doors?
G
What
can
we
do
to
support
you
and,
and,
like
representative
Sheldon
said,
make
it
a
more
of
a
partnership
than
than
being
about
this,
because
from
from
the
provider
perspective
looking
at
mcos,
it's
all
about
this,
and
and
that's
why
there's
such
disdain
for
most
great
people
that
work
within
the
mcos,
some
of
the
finest
people
that
I
deal
with
work
for
mcos
and
I
love
the
communications,
but
the
system,
the
Normandy,
the
The
Profit,
you
guys
just
don't,
have
a
lot
of
credibility
and
and
we
need
to
change
that
or
you're
likely
going
to
be
gone.
D
You
and
thank
you
for
your
presentation.
Yes,
one
thank
our
committee
members
for
your
attendance
this
morning
and
participation
as
well.
Our
next
committee
meeting
is
November,
10th,
Believe,
It
or
Not
it'll
be
the
last
one
of
this
interim
session
and
co-chair
Elliott
will
be
chairing.
So
we
will
look
forward
to
that
again.
Thank
you
for
your
presentation
and
I'm
sure
we'll
be
talking
more
in
the
future.
Thank
you.
We
stand
adjourn.