►
From YouTube: Medicaid Oversight and Advisory Committee - 6/25/20
Description
Medicaid Oversight and Advisory Committee
Live Stream provided by LRC Staff
A
A
C
A
All
right,
thank
you.
Just
a
couple
of
housekeeping
items
just
remind
everyone
that
please
have
your
mic
muted,
unless
you're
speaking
actually
to
the
group,
and
we
ask
to
use
the
chat
function.
If
you
have
a
question
so
that
we
can
get
it
to
the
queue
and
make
sure
everybody
has
an
opportunity
to
get
the
information
that
they
need,
we
do
have
approval
of
minutes
from
our
last
meeting
that
were
distributed.
If
everyone's
had
a
chance
to
look
at
those.
As
our
motion
to
approve
those
I
make.
A
Any
opposition,
my
life
sad,
then
minutes
are
approved
first
item
on
our
agenda,
its
update
on
the
legend
drug
repository
program
and
mr.
Hadley
and
mr.
gray.
Again,
thank
you
for
your
patience
and
indulgence.
While
we
get
through
these
meetings-
and
this
is
a
new
learning
experience
from
all
of
us-
and
hopefully
we
can
do
mr.
pritter
job
next
time,
but
we
appreciate
you
being
here.
It's
been
a
year
since
you've
been
with
us
and
we
thought
we
had
some
excellent
discussion
last
year
about
this
program
but
they're
putting
the
genom
together.
A
Apparently,
we've
run
into
some
obstacles.
It
was
my
understanding
when
we
finished
our
meeting
last
year
that
you
take
your
Board
of
Pharmacy
to
get
this
program
under
way
just
reminded
the
committee
members.
There
other
states
have
adopted
this
program,
have
realized
significant
savings
in
terms
of
millions
of
dollars
for
a
Medicaid
program.
So
that
is
our
interest,
but
we
had
not
had
any
communication
since
last
year,
just
glass,
but
when
we
reached
out
to
mr.
Hadley
about
this
program,
he
shared
with
us
that
there
were
some
concerns
and
problems.
A
So
we
asked
them
to
come
back
to
the
committee
and
talk
about
those
and
what
we
can
do
to
possibly
move
this
thing
forward,
because
again,
this
day
and
time
when
we
have
so
many
demands
for
them
dollars
from
our
budget
that
any
place,
we
can
look
to
save
some
money
or
generate
new
revenues.
We
want
to
do
that.
So
mr.
Hadley,
if
you
would
police
the
floor,
is
yours.
Thank.
B
B
Number
one
is
drug
disposal,
but
also
it
saves
money
for
the
Medicaid
programs,
so
general
counsel,
antegrade
I
met
with
Justin
Joseph
at
Jonathan
Scott
of
the
Medicaid
program
about
ten
days
following
our
meeting
and
just
to
discuss
ways
that
we
could
use
the
Medicaid
program
to
allow
us
to
create
this
entity.
And
we
didn't.
We
didn't
find
an
answer
that
day
and
we
give
it
a
lot
of
thought
and
conversation
and
really
didn't
come
up
with
a
way
forward.
That
day,
I
followed
up
with
both
gentlemen.
B
You
know.
Maybe,
a
month
later,
no
progress,
so
I
went
to
other
states
to
see
what
they
were
doing.
I
talked
to
John
Rossman
he's
CEO
CEO
of
safe
dunno
rx,
which
is
the
Iowa
repository
drug
problem
program,
and
it
is
a
it
is
under
the
Iowa
Department
of
Health,
and
it
is
a
501
C.
3
corporation,
and
it
is,
it
receives.
Appropriations
from
the
state
of
Iowa
to
the
tune
of
$600,000
a
year
was
the
most
recent
number
that
mr.
Rosman
gave
me
here
until
I
asked
him
when
we
were
talking.
E
B
At
that
at
that
meeting
that
lasted
time
with
men,
I
committed
to
a
medicaid,
viable,
compositor
and
quite
frank.
Frankly,
I
was
not
able
to
find
a
way
to
do
it
and
hopefully
a
friend
of
Medicaid.
We
we've
talked
several
times
and
I
think
they
have
some.
Some
insight
are
some
ideas
that
may
be
able
to
help
us
and
we
have
in
your
packet.
You
have
a
copy
of
the
repository
statute
and
then
there
are
three
different
draft
regulations.
One
is
from
Sullivan
University
College
of
Pharmacy.
B
One
is
based
on
the
Iowa
statute
regulations
and
the
last
one
is
the
one
I
mentioned
from
George
Wang,
based
on
the
Kentucky
statute
and
general
counsel,
anti
D
break
and
the
one
that
we
prefer
is
the
Iowa
version
and
Anthony
can
walk
you
through
that.
If
you
would
like
to
just
get
some
of
the
highlights
from
that
proposed
regulation,.
B
It
has
a
lot
of
promise.
The
the
problem
remains.
Is
it's
finding
the
way
forward
within
Medicaid
and
I?
Think
again,
the
folks
from
Medicaid,
I
think
and
some
insight
that
they
didn't
have.
Last
time
we
spoke
I,
don't
I,
don't
know
that
they
have
a
full
solution.
I
can't
I,
don't
want
to
speak
for
them,
but
I
think
they
have
some
additional
ideas
that
may
be
viable.
G
You
come
back
if
you
look
in
your
packets
that
we
provided
there.
As
director
Hadley
said,
there
are
three
different
models.
We
modified
the
Iowa
model
because
we
felt
like
that
one.
We
are
our
laws
more
closely
than
any
of
the
others,
except
for
the
issues
that
director
Hallie
had
raised.
I
mean
I
won't
go
through
the
entire
regulation.
As
you
can
see,
it's
quite
quite
thorough.
It's
about
eight
pages.
G
Basically,
we
modified
the
definition
to
fit
with
Kentucky
our
k,
RS
language,
of
what
the
different
entities
were
contractor
and
repository
and
all
of
those
are
we
basically
just
shortened
to
some
of
the
standards
and
qualifications
we
took
out.
Some
restraints,
for
example,
I
think
I
will
have
you
know
you
have
to
have
a
valid
driver's
license
to
be
able
to
participate.
We
took
some
of
those
some
of
those
out.
We
did
leave
the
age
restrictions
in.
G
G
What
what
drugs
can
be
accepted
when
they
can
be
accepted
by
we
inventory
requirements
we
kept.
We
also
wanted
to
make
sure
that
the
standards
for
inspecting
the
donating
drugs
were
still
included.
That
is
also
listed
in
our
regulation,
wanted
to
make
sure
that
the
drug
supplies
artifacts
appear
and
stored
securely.
That
was
something
that
was
very
important
to
us.
We
kept
that
as
well.
We
donated
standards
for
donating
the
drugs
and
supplies.
G
You
know
they
have
to
be
prescribed
by
a
healthcare
practitioner
to
be
eligible
to
be
part
of
this
program.
We
also
put
in
language
to
prioritize
the
dispensing
of
these
drugs
to
individuals
first
indigent,
then,
to
individuals
who
have
no
active
third
party
prescription,
drug
reimbursement
coverage
and
then
third
to
any
other
individual
who
is
an
individual
or
uninsured
individuals.
We
kept
those
that
information
in
we
have
record-keeping
requirements
again.
I
talked
about
the
eligibility
to
participate
in
this
program.
G
You
have
to
be
a
resident
and
have
no
reasonable
financial
means
to
pay
for
the
product.
Drug
also
attached
to
the
Iowa
model
are
forms
three
forms
that
we
would
incorporate
into
our
program.
If
it
is,
it
is
in
fact
adopted
and
I've
attached.
Those
one
is
the
drug
donation,
repository
program
notice,
a
participation
form.
That
is
what
the
facility
would
fill
out.
That
would
be
participating
in
a
repository
program.
The
board
of
pharmacy
obviously
would
need
that,
so
we
can
have
records.
G
We
would
also
have
a
program
for
the
participant
we
have
to
sign
up
to
participate
in
the
program
to
receive
the
drugs
and
the
individual
donation.
Those
are
basically
the
nuts
and
bolts
of
what
we
have
here.
The
only
thing
that
we
would
need
to
add
would
be
the
input
for
if
there
would
be
any
language,
we
need
to
be
included
in
regards
to
Medicaid.
A
B
C
Can
you
hear
me
yes,
I'm
lethally
I'm,
the
Commissioner
for
the
decayed
services.
We
have
discussed
this
internally.
What
we
have
also
done,
I
personally,
have
reached
out
to
some
of
my
colleagues,
another
state
to
get
information.
I
haven't
heard
anything
back
yet
some
of
our
concerns
related
to
this
IT
cost.
C
How
would
we
build
this
into
the
system
to
track
those
drugs
that
had
been
donated
and
subsequently
given
to
Medicaid
members
a
little
bit
of
administrative
burden,
maybe
on
the
providers
who
accept
those
drugs
and
how
they
track
them
and
store
them
specifically
have
looked
at
the
prescription
drug
repository
program
in
North
Dakota?
They
have
some
pretty
good
information
on
the
drug,
how
they
are
donated,
how
they
are
dispensed.
They
you
have
certain
criteria.
Of
course
it
is
a
volunteer
program
and
they
do
pay
fee
of
$11.50
to
cover
the
cost.
C
The
participant
to
receive
the
drug
that
they
are
uninsured,
have
to
pay
an
$11
and
$0.50
I'm,
assuming
sort
of
like
a
dispensing
fee
for
those
drugs.
So
definitely
I
think
a
little
bit
more
research
that
we
need
to
do
to
find
a
Medicaid
program
somewhere.
That
has
implemented
this
already
see
if
we
can
learn
from
them.
What
worked?
A
E
C
Certainly,
in
things
that
way
and
we'd
be
more
than
happy
to
work
with
the
Board
of
Pharmacy
as
we
move
forward,
we
kind
of
make
sure
how
we
build
that
into
the
Medicaid
program.
I'm,
not
sure
the
donation,
I
would
think
would
go
to
a
pharmacist
in
the
state
and
then
the
Medicaid
member
would
have
to
go
to
that
pharmacy
to
to
get
that
medication.
It
is
a
volunteer
program.
The
program
in
North
Dakota,
for
example,
has
to
maintain
records
of
who
donates
that
medication.
A
Well,
I
appreciate
that,
but
I
do
know,
other
states
have
had
success
with
this
and
it's
not
a
tremendous
some
money
saver,
but
every
dollar
should
count
for
us
this
day
in
time,
because
we're
coming
out
of
this
covert
19
crisis.
You
know
this
legislature
has
2005
and
has
never
moved
forward
and
I.
Think
we've
left
millions
of
dollars
on
the
table
as
a
result
of
that
I
think
it's
a
possible
small
revenue
stream
for
local
pharmacist
UI
like
yeah
I.
A
E
A
Folks
do
but
I
think
this
program
has
promised
just
like
we
did
last
year
if
there's
some
regulations
that
we
need
to
pass.
So
we
can
certainly
do
that
during
the
2021
session,
but
I
really
would
like
to
see
us
move
forward
on
that,
but
I'm
sure
I've
got
other
committee
members
who
want
to
speak
to
this
represent
apprently
I.
Think
you
have
a
question.
E
E
And
when
you
Mary
quit
working
and
they
tried
to
end
up
having
surgery,
they
couldn't
give
$7000,
whether
you
there
are
way
and
the
pharmacy
local
pharmacy
couldn't
take
it
back
and
I.
Just
think.
It's
a
shame
and
I
think
it's
a
I
would
really
encourage
working
out
something
to
save
money
and
to
just
just
the
way
my
mom
taught
me
not
the
way.
So
we
just
I,
don't
think
we
need
to
keep
looking
at
this
program.
I
think
it's
very
important.
D
D
There's
a
whole
lot
of
these
programs
that
never
get
implemented
and
and
that's
there
are
some
very,
however
I-
think
North
Dakota
opportunity
to
discuss
this
with
mr.
Hadley
as
well
as
dr.
Jetson
and
the
key.
The
key
is
is
that
you
know
pharmacies
in
most
of
these
states
or
they're
trying
to
do
all
this
through
charitable
talk
work
where
pharmacies
are
check
donating
their
time
and
effort.
Charity
clinics
are
donating.
D
The
cabinet
of
Health
Family
Services
in
this
case,
maybe
not
be
getting
a
appropriation
to
be
able
to
run
a
program
like
this.
So
there
are
some
barriers,
but
the
way
you're
going
about
it
now
and
I
think
the
way
representative
or
at
least
Senator
Meredith
last
year
was
anticipating
and
I
think
we
all
were
was
trying
to
work
out
something
with
Medicaid
that
allowed
us
to
work
out
what
sounds
very
similar
to
North
Dakota.
D
You
mentioned
that
where
pharmacies
are
more
than
happy
to
jump
on
board
and
take
these
medicines
back
and
then
just
simply
be
paid
to
dispensing
fee
to
rida
Spence
that
to
be
able
to
track
those
drugs
will
be
just
like
we
do
in
a
340b
program,
we
would
put
identifiers
on
those
drugs.
It'd
just
be
a
different
identifier.
So
that's
a
matter
of
a
simple
entry
that
would
then
go
back
to
Medicaid,
so
nothing
simple,
but
but
there
is
a
way
to
do
this.
We
can
get
a
lot
of
fun
and
one
more
thing.
D
My
comments
with
with
I
did
some
quick
numbers:
I
have
access
to
about
50,000
per
scriptures
a
month
that
were
being
filled
in
Kentucky
and
that's
only
five
stores
but
but
I
just
went
through
those
stores
and
I
picked
the
five
things
that
Medicaid
was
paying
me
for
for
the
last
twelve
months,
just
five
things
two
or
three
of
them
were
insulin
products.
The
other
two
were
inhaler
products
which
are
typical
products
that
are
being
returned
of
those
five.
You
pay
your
car.
D
What
you
actually
paid
for
those
medications
was
five
hundred
and
sixteen
thousand
dollars
in
twelve
months.
That's
what
you
paid
for
those
five
just
those
five.
So
what
would
happen
if
you
pay,
you
know,
say
and
I
think
that
represented
about
a
hundred
and
fifty
dispensing
fees.
So
if
you
paid
the
ten
or
eleven
dollars,
you'd
be
out
150
times
ten
dollars
versus
five
hundred.
Fifty
thousand
I
know
that
those
numbers
are
real.
E
D
But
there's
I'm
like
representative
Prunty,
she
mentioned
that
people
will
come
by
and
they'll
say:
gosh
I've
got
these
specialty
cancer
drugs,
especially
inhalers
and
their
boxes
of
insulin,
just
mounds
and
mounds
of,
and
if
we
had
an
opportunity
to
do
that.
So
there's
two
or
three
ways
you
can
go
with
this,
but
having
a
central
agency
like
the
cabinet,
Health
Family
Services,
putting
identifiers
on
there
and
then
reimbursing
your
pharmacies
for
their
trouble
to
dispense
a
drug.
That's
not
going
to
cost
you
a
dime
I!
D
Think
that
there's
real
promise
here
and
I
talked
to
dr.,
Jetson
and
and
I
know:
Joseph
I'm,
sorry,
yeah,
I'm,
gonna,
get
it
all
mixed
up,
but
anyway
we
talked
and
and
and
I
feel
like
there's
a
way
forward
and
I
appreciate
the
work
you've
done
so
far
and
look
forward
to
hearing
back
from
you.
Thank
you
very
much.
A
C
And
I
appreciate
the
numbers
are
agreeing
that
there
could
be
some
cost
savings.
I
think
that
the
one
thing
that
we
definitely
need
to
look
at
is
the
administrative
cost.
Will
they
be
offset
by
any
savings?
How
much
is
it
going
to
cost
to
design
our
system
and
look
at
those
kinds
of
things
to
make
sure
that
the
juice
is
worth?
The
squeeze
in
this
case
make
sure
that
we
can
that
we're
going
to
reap
benefits.
C
We
may
have
to
spend
some
money
up
front
to
get
this
started
and
then
how
long
is
it
going
to
take
us
to
get
a
return
on
their
investment?
So
there
will
be
some
administrative
costs
and
I
think
that
that's
what
we
definitely
need
to
look
at
and
explore
that
definitely
Medicaid
is
not
opposed
to
anything.
That's
going
to
be
a
cost
savings
measure
more
than
happy
to
see
what
we
need
to
do
with
the
system,
how
it
all
works
and
what
sort
of
administration
is
involved.
C
B
C
That's
a
great
idea
and
I'm
not
sure
if
it's
being
considered
because
it
would
be
to
use
the
public
health
department's
would
be
really
smart,
because
that
if
we
started
a
program
like
this
I,
don't
think
that
it
would
be
specific
to
just
Medicaid
members.
There
would
be
individuals
who
are
not
enrolled
in
Medicaid
who
could
also
access
the
services.
C
So
I
guess
you
know
that
part
of
the
administration
to
it
has
been
Medicaid
and
the
Board
of
Pharmacy
or
how
at
this
house,
I
think
you
know
that
that
suggestion
of
looking
at
the
pub
at
the
local
health
department's
may
be
worthwhile
to
get
the
broader
audience
again.
It
wouldn't
be
strictly
related
to
Medicaid
members
who
would
receive
those
those
medications
that
were
donated
Thank.
B
C
C
A
A
If
not
appreciate
all
of
you
being
here
today
in
your
willingness
to
take
on
this
project,
I
think
it
does
have
some
very
positive
implications
for
our
Medicaid
program,
but
also
the
recipients
and
that's
Hoover,
we're
all
here.
For
so.
Thank
you
for
your
time
today
and
we
look
forward
to
progress
on
this
and
hearing
back
from
you.
Thank.
B
A
The
fortune
fortune
Commission
Lee
I,
guess
you
don't
get
to
leave
because
you're
next
on
our
agenda,
but
again
mr.
Hadley,
mr.
gray.
Thank
you
very
much
for
participating
today
and
appreciating
in
your
patience
as
we
head
to
lay
this
just
a
little
while,
but
thanks
for
being
here,
and
we
look
forward
to
working
with
you.
Thank
you
mr.
Lee.
Our
next
is
effects
of
copa90
non-medicated,
Roman
and
expenditures.
A
C
Our
double
at
the
beginning
of
this
was
to
make
sure
we
could
get
money
to
providers,
make
sure
that
providers
were
not
overburden,
make
sure
that
that
individuals
can
have
access
to
care
the
event
that
they
were
diagnosed
with
totally
so
one
of
our
first
steps
included
developing
an
1135
waiver
for
the
Center
for
Medicare
and
Medicaid
Services
that
was
subsequently
approved
under
that
waiver.
We
have
the
flexibility
to
suspend
prior
authorization
with
the
exception
of
some
pharmaceutical
drugs.
C
We
can
also
temporarily
enroll
providers
if
they
are
currently
enrolled
with
Medicare
or
if
they
have
been
screened
and
enrolled
with
another
state
Medicaid
agency.
We
thought
that
was
important
in
order
to
bring
a
broader
base
of
individuals
and
providers
into
the
state
in
the
event
that
our
health
care
system
became
overwhelmed.
We
also
were
approved
to
allow
care
in
alternate
setting
in
the
event
that
we
had
to
move
individuals
from
one
facility
for
it
to
another,
for
example,
and
also
as
far
as
provider,
to
do
that.
C
The
hospitals
and
the
long-term
care
facilities
were
starting
to
get
influx
of
patients
so
and
for
hospitals.
We
allowed
an
administrative
day
for
them
to
start
doing
administrative
days,
and
what
this
means
is
an
individual
is
in
a
hospital
and
they
have
been
treated
and
they
no
longer
meet
acute
level
of
care
and
cannot
and
stay
in
their
hospitals
because
they
wouldn't
receive
payment
from
anything
we're
allowing
them
to
keep
those
patients
and
paying
them
an
administrative
day
that
allows
them
to
keep
those
patients
so
that
they
don't
to
transfer
them.
C
For
example,
back
to
a
long-term
care
facility,
they're
allowed
to
keep
those
patients
until
they
become
more
stable
and
can
move
out.
We
also
gave
the
hospitals
a
20%
increase
in
their
DRG
rate
for
totally
positive
patients,
and
we
typically
have
a
dish
payment
that
we
give
to
them
in
payment
with
10%
me
in
September.
We
have
given
that
payment
to
them
Olli.
We
gave
them
that
payment
in
May
in
order
to
get
some
funds
to
the
hospital
long-term
care
facilities.
C
We
have
authorized
the
270
dollars
per
bed
per
day
add-on
for
any
coded
positive
patients
if
they
treat,
we
have
also
been.
We
streamlined
their
eligibility
process
for
long-term
care,
for
example,
long-term
care
patients
or
Medicaid
applications
are
really
quite
complex
because
they
involve
the
assessment
of
assets
and
annuities
and
those
sorts
of
things.
So
we
have
streamlined
that
process
in
the
interim
to
allow
for
self
attestation
so
that
those
patients
could
be
determined
eligible
in
a
quicker
manner
in
order
to
get
funds
to
the
long-term
care
providers.
C
We've
also
been
providing
testing
the
cabinet
hands
in
providing
testing
for
patients
in
resident
patients
and
employees
of
long-term
care
facilities,
and
in
addition,
we
have
increased
the
bed
hold
days
for
Medicaid
patients
from
14
to
30.
So
what
this
means
is
if
a
patient
has
to
leave
the
long-term
care
facility
in
order
to
go
to
a
hospital
Medicaid's.
Previous
policy
allowed
us
to
pay
them
for
14
days
to
hold
that
bed
for
the
Medicaid
patient
to
come
back
in.
C
We
have
also
offered
to
place
accounts
receivable
on
hold
to
providers
if
they
request
the
financial
hardship.
Today,
we've
had
14
providers
submit
affidavits,
saying
that
they
requested
assistance,
so
we
have
placed
their
accounts.
Receivable
we've
weighed
cost-sharing
and
we
have
also
implemented.
We've
always
had
presumptive
eligibility.
Presumptive
eligibility
is
a
is
a
Medicaid
eligibility
program
that
is
time-limited.
C
Currently,
hospitals
can
grant
presumptive
eligibility
to
individuals
who
are
in
the
hospital
that
do
not
have
insurance.
They
can
give
grant
temporary
Medicaid
eligibility,
so
the
provider
receives
payment
and
the
individual
can
receive
treatment
until
they
complete
the
full
application.
So,
during
the
current
emergency
we
have
requested
that
the
state
cabinet
for
Health
and
Family
Services
he
allowed
to
be
qualified
entity
to
grant
presumptive
eligibility.
So
we
are
allowing
individuals
to
come
into
the
program
temporarily
again.
C
This
allows
providers
to
receive
payment
for
treatment
and
it
allows
individuals
to
get
treated
so
it's
temporary
eligibility,
but
we
have
that
in
place
to
enroll
in
video.
So
along
those
lines,
the
other
thing
that
we
did,
of
course,
I
think
a
lot
of
them
didn't
even
talking
about
telehealth.
We
have
encouraged
the
use
of
telehealth
so
that
our
providers
can
continue
to
receive
payment.
We
have
released
some
guidance
on
well
child
check.
C
Once
once
we
get
our
children
back
in
school,
we've
also
allowed
case
managers
in
there
:
community-based
waivers
to
deliver
help
telehealth
services
to
their
members
in
their
homes,
and
we
are
also
allowing
licensed
behavioral
health
providers
to
deliver
services
by
until
a
health.
With
the
exception
of
residential
substance,
these
disorder
treatment
and
residential
crisis
services.
C
C
Those
providers
in
our
fee
for
service
population
filled
thirteen
thousand
six
hundred
and
forty
nine
dollars
in
telehealth
services
in
May,
which
is
the
lace
latest
complete
set
of
data.
We
saw
that
dump
that
thirteen
thousand
we
jumped
to
three
point:
nine
million.
So
definitely
a
lot
of
expenditures
in
the
telehealth
world
managed
care
organizations
in
January.
Twenty
twenty
we've
noticed
that
there
is
a
three
hundred
and
seventy
eight
thousand
dollars
billed
in
January
2020
for
telehealth
in
May
of
twenty
twenty,
the
managed
care
organizations
report,
nineteen
million
dollars
in
the
delivery
of
telehealth
services.
C
So
it's
birth
budgetary
impacts,
the
additional
twenty
percent
add-on
for
the
DRG
in
the
hospital.
We've
only
noticed
about
a
four
hundred
and
eighty
three
thousand
dollar
payment
for
hospitals
related
to
that
20
percent
add-on.
But
we
believe
a
lot
of
that
is
due
to
system
changes,
delaying
that
implementation
and
that
since
May
15th
only
we've
seen
four
hundred
and
eighty
three
thousand
one
thing
that
we're
definitely
keeping
an
eye
on
in
the
activation
of
prior
authorization.
C
So,
prior
to
coated,
we
had
certain
certain
services
that
would
require
prior
authorization,
and
we've
noticed
that,
prior
to
coated,
we
had
those
plans
that
required
prior
authorization.
We
had
about
five
thousand
per
month
that
came
through
the
system
beginning
in
May.
We
started
noticing
about
ten
thousand
of
those
planes
coming
through.
That
did
not
that
required
prior
authorization,
but
because
we
relaxed
that
they
didn't
have
to
have
it.
We
have
seen
an
increase
in
one
particular
revenue
code,
which
is
for
semi-private
London
board
prior
to
the
emergency.
C
Those
revenue
codes
were
being
build
around
150
thousand
dollars
per
month.
That's
what
Medicaid
was
cleaning
out
since
the
emergency.
Their
initial
analysis
shows
that
that
went
from
150
thousand
dollars
per
month
to
6
million
dollars.
So
this
is
a
little
bit
of
a
concern
with
the
prior
authorizations.
We
want
to
look
into
those.
We
have
had
a
discussion
with
our
managed
care
organizations
and
we'll
be
allowing
them
to
reinstitute
prior
authorizations,
beginning
August
1st,
with
the
exception
of
behavioral
health
and
substance,
use
disorder,
treatment
services,
so
they
will
give
a
notice
to
the
providers.
C
We
are
allowing
them
to
implement
those
prior
authorizations
again
again
with
Co
red
everything
is
fluid,
we're
monitoring
the
situation.
You
know
that
anytime.
If
the
health
care
system
becomes
overwhelmed,
we
may
have
to
work
at
those
prior
authorizations
and
we
may
have
to
pull
those
back
at
some
point.
We
have
also
increased
our
non-emergency
medical
transportation
costs
by
$700,000.
C
As
far
as
Medicaid
enrollment
we
have
since
March
the
2nd
of
2020.
We
have
increased
our
Medicaid
enrollment
by
one
hundred
and
sixty
four
thousand
two
hundred
and
seventy
four
individuals.
Now.
Seventy
seven
thousand
of
those
are
involved
in
our
presumptive
eligibility
and
the
reason
that
we
have
that
many
and
presumptive
eligibility
is
individuals
who
are
enrolled
in
Medicaid
in
traditional
Medicaid
are
assigned
to
a
managed
care
organization
unless
they
are
in
a
long-term
care
facility
or
they're
in
in-home
Atheneum.
C
So
we
started
enrolling
those
presumptive
eligibility
individuals
in
a
fee-for-service
program
in
order
to
offset
cost
that
would
be
issue
associated
with
capitation
payments
community
organizations.
So
those
individuals
in
the
community
program
with
assistance
of
eligibility
are
enrolled
in
fee-for-service
and
then
I
think.
C
One
thing
that
I
would
like
to
say
also
it
like
to
talk
about
is
the
6.2
percent
increasing
I
know,
there's
been
some
questions
as
to
why
the
Department
for
Medicaid
Services
didn't
just
automatically
give
all
providers
an
increase
in
their
reimbursement
rate,
6.2
percent,
but
that
6.2
percent
went
basically,
and
you
know
it's
an
effective
means
of
providing
fiscal
relief.
Work
for
state
Medicaid
agencies
because
of
increased
enrollment
because
of
expenditures
related
to
total
treatment
and
testing,
and
we
believe
that
that
6.2
we
have
given,
for
example,
the
long-term
care
providers
in
the
hospital.
C
Kentucky
does
meet
all
that
criteria
right
now,
for
example,
we
have
to
maintain
eligibility
standards,
not
charge
premiums
and
cover
any
cost,
any
cost
associated
with
coding.
So
that's
that's
one
of
the
reasons
that
the
6.2
percent
we
didn't
give
an
across-the-board
right,
because
we
didn't
think
it
was
imprudent.
We
don't
know
what
our
budget
is
going
to
be
like
in
2021.
C
We
do
know
that
in
2020
we
will
be
fine,
we'll
be
able
to
meet
our
budget,
but
there
are
so
many
unknowns
for
2021
right
now
that
we're
just
not
sure
what
that
is
going
to
look
like.
We
continue
to
monitor
our
budget
and
the
expenditures
related
to
coding
and
then
I
think
the
person
talked
to
about
the
increase
of
telehealth
and
how
useful
it
is.
So
one
thing
that
we're
also
doing
is
we're
looking
at
when
we
emerge
from
this
emergency.
C
A
Thank
you.
A
lot
of
numbers
Edison,
but
I
appreciate
you
a
very
proactive
approach.
The
it
looks
like
you
did
a
lot
of
work
in
anticipation,
what's
going
to
happen
with
coab
in
nineteen,
but
again
a
lot
of
numbers
I'm
trying
to
summarize
this,
but
again
that
put
words
into
your
mouth:
the
increased
cost
from
Cove
in
nineteen
everything
we
have
talked
about,
including
the
expansion
of
154,000
ditional
people
that
that
caught
us
should
be
covered
by
the
6.2
percent.
That
the
federal
government
has
a
lot
of
to
us
is
up
there.
I,
don't.
C
Think
I
don't
think
that
it
will
be
covered
by
the
six
point.
Two
I
think
it
brought
help
offset
some
of
the
state
cost
because
it
will
reduce
the
state
share
that
we
have
to
pay.
We
are
going
to
have
increased
costs
due
to
coding,
but
the
six
point
two
will
allow
us
to
draw
down
more
federal
dollars
than
what
you
would
have
absent.
That
six
point:
two
percent.
A
A
A
D
A
Need
to
have
twenty
high
petals
that
are
beyond
financially
distressed
and
that's
grown
from
in
12
to
20
years.
Representative
Bentley
pointed
out
to
us,
but
the
long-term
care
industry
has
had
a
comparable
financial
challenge
and
now
I'm
not
sure
that
they
have
fully
recoup
their
costs
or
can
prepare
for
this.
Maybe
it
would
be
curious
of
what
how
many
dollars
additional
dollars
we
have
given
to
the
long-term
care
industry
just
to
kind
of
keep
track
of
track
of
this,
but
with.
F
You
senator
appreciate
it,
commissioner,
thanks
for
your
presentation,
I
did
have
one
question
that
I
think
another
I
don't
know.
The
senator
wise
is
a
member
of
the
committee.
I
think
he's
tuned
in
watching,
but
he
wanted
this
question
posed
and
so
I'm
gonna
read
his
question
that
he
wanted
to
make
sure
that
was
got
an
answer
for
that.
F
A
lot
of
the
MC
Oats
are
paid
typically
a
lump
sum
pans,
a
contract
on
the
state
when
you
know
I
think
either
annually
or
every
other
year,
but
they
and
then
use
those
funds
to
obviously
help
to
pay
off.
You
know
funds
and
things
for
constituents
of
Kentucky
and
on
issues.
The
past
six
weeks,
I
know,
there's
been
a
lot
of
the
dental
offices
have
been
closed
throughout
the
state
and
so
on.
Very
few
claims
were
paid
by
the
MCO
s
in
this
regard.
F
On
the
dental
side
of
it
and
I
guess
this
question
was
work.
Where
are
those
funds
now
I
mean
a
lot
of
dental
offices
could
use
telemedicine
people
had
dental
issues
and
needs
a
lot
of
that
was
put
on.
You
know
that
was
put
in
the
backside.
I
think
even
their
volumes
now
are
not
quite
where
they
need
to
be,
and
so
this
question
is
worth:
where
are
those
funds,
those
movie
touted
his
profits
to
the
M
cos
this
past
year?
F
C
So
the
the
managed
care
organizations
are
paid
a
per
member
per
month,
capitation
payment
for
the
members
that
they
serve.
We
are
watching
and
looking
at
the
expenditures
to
see
where
they
go.
We
know
that
a
lot
of
providers,
not
only
the
dental
community
but
a
lot
of
providers,
every
traffic,
the
managed
care
organizations-
are
still
spending
pretty
much.
The
capitation
payment
we've
seen
the
big
increase
in
telemedicine.
C
So
while
it
may
not
be
going
to
the
dental
and
community,
it
is
going
to
other
places
and
in
the
event
that
at
the
end
of
the
year
this
would
not
be
a
bonus
for
them
or
it
wouldn't
be
a
any
kind
of
profit
because
all
of
the
managed
care
organizations
are
held
to
a
90%
MLR,
which
means
any
of
their
capitation
payment
that
they
don't
spend
on
services
and
they
only
have
10%
annually,
so
anything
less
than
90
percent
of
their
capitation
payment.
That's
not
spent
on
services
has
to
come
back
to
the
cabinet.
F
So
follow
senator
if
I
could
interesting
point
I
know
that
there's
been
I've
talked
to
a
lot
of
our
EMS
guys
locally.
They
have
remarked
how
much
less
volume
they
have
and
that
a
lot
of
people
would
have
been
concerned
about
going
to
emergency
rooms
for
care
because
of
COBIT
19,
and
so
people
have
had
heart
attacks
and
strokes
and
things
at
home
and
talking
to
some
of
our
paramedics,
at
least
in
my
district,
have
said.
You
know
they
normally
have
quite
a
few
runs
that
they
say
are
not
necessarily
emergency.
F
People
just
have
transportation
needs
or
want
to
get
to
the
ER,
but
the
runs
are
making
now
are
they're
less
but
they're
more
intense
right,
they're
people
with
higher
acuity
of
needs.
Have
we
seen
I
guess
with
less
ER
runs
I
mean?
Are
we
gonna
see
some
savings
and
some
of
those
things
I
mean
in
terms
of
that?
That
brings
up
a
curiosity
to
say:
if
we're
gonna
see,
savings
on
ambulance
runs
on
ER
visits
because
we've
seen
less
volume
there,
or
are
we
just
shifting
that
cost
into
other
other
factors?
I.
C
Think
there
definitely
is
some
cost
shift
and
I
think
that
at
the
end
of
the
year
we
can
do
some
analysis,
we're
not
even
at
the
end
of
the
years
we
go
forward
because
we
have
been
asking
the
managed
care
organizations.
What
are
your
expenditures?
What
are
you
seeing?
Because
we
definitely
want
to
make
sure
that
we
have
a
viable
provider
network
when
we
emerge
from
this
emergency,
and
there
is
some
concern
on
Medicaid
part
that
some
of
our
providers
may
close
their
doors.
C
C
That
was
one
of
the
things
that
Medicaid
fee
for
service
that
we
put
into
place
was
that
hardship
if
the
provider
was
recently
we're
going
to
recoup,
for
example,
if
they
had
funds
that
we
were
recouping,
we
allowed
them
to
sign
an
affidavit,
and
we
have
stopped
recruitments
on
any
providers
who
are
out
in
the
community
who
are
experiencing
a
hardship.
So
we
have
had
communications
from
dental
providers.
C
We
have
funds
and
fees
into
our
program.
For
example,
to
give
to
providers
in
the
event
that
the
cost
shifting
is
happening,
if
we
can
identify
that
and
in
supplement
other
ways,
we
can
do
that,
but
I
think
that
it
does
lend
itself
to
a
broader
discussion
on
the
role
of
Medicaid
and
the
in
the
delivery
of
healthcare
services.
A
C
We
need
all
of
the
management
organizations
submit
encounter
claims
to
us
be
telling
the
services
that
they
have
spent,
and
we
look
at
that
compared
to
our.
We
know
exactly
how
much
capitation
payment
we
paid
them.
We
look
at
the
amount
of
capitation
versus
the
amount
of
medical
services,
and
then
we
allow
a
10%
admin.
So
any
difference
in
that
would
come
back
to
the
cabinet.
A
Well,
I
appreciate
your
action
in
asking
them
not
to
recoup
during
this
period,
but
I'm
hearing
from
several
providers
across
the
state
that
there
has
been
just
tremendous
recoupment
efforts
on
the
part,
the
MCO
s,
but
that's
something
I
think
we
need
to
talk
about
for
another
day,
but
just
want
to
put
that
on
your
radar
a
bit.
Do
we
need
to
have
some
discussion
about
them?
Are
there
any
questions
regarding
this
particular
agenda
item
before
we
move
on
to
our
last,
if
not
again
to
mr.
C
So
this
okay
I
know
we're
over
on
time
or
getting
close
to
time.
So
I'll
go
through
this,
not
real,
quick
but
just
enough
to
touch
base
so
I
think,
first
of
all,
just
to
give
a
little
level
set
with
Medicaid
managed
care.
Currently,
40
states
use
a
capitated,
managed
care
model,
and
you
can
see
that
Kentucky
is
one
of
those
35
states
that
does
utilize
a
managed
care.
C
Okay,
I
think
I'll
just
go
ahead
and
go
through
that
go
through
the
presentation,
I,
don't
again
I
guess
you
know,
like
you,
said,
gender
marital
things
that
they
these
are
things
that
we
learn
as
we
go
forward
national
statistics.
Most
states
have
you
know:
7
managed
care
organizations
on
average
Kentucky
is
below
the
average
with
5.
C
Current
I
do
have
a
little
bit
of
a
background,
I
think
in
order
to
know
how
we
got
to
where
we
are
today.
It's
good
to
know
the
background
and
I
think
that
this
this
next
conversation
or
the
slide
depict
that
Kentucky
has
been
operating
in
some
sort
of
manage
risk-based
managed
care
since
1997
I
think
that
we
can
take
from
this.
These
next
few
comments
that
I
made
that
Medicaid
Medicaid
managed
care
is
constantly
evolving.
C
So
many
of
you
may
have
remembered
back
in
1986
Kentucky
operated
a
primary
care
case
management
that
was
called
impact.
We
moved
to
a
risk-based
managed
care
partnership.
In
1997
we
divided
the
state
up
into
eight
region.
We
had
two
providers
or
two
managed
care
organizations
bid
on
those
regions,
regions
three
and
five
were
operationalized
Region.
Three,
of
course,
was
known
as
the
passport
region
and
five
was
Kentucky.
Health
Region
five
could
not
operate,
they
could
not.
C
They
were
not
profitable,
so
they
folded
and
we
were
left
with
one
managed
care
region,
because
no
one
else
would
have
been
in
the
state,
because
the
particularly
Eastern
Kentucky
was
viewed
as
too
unhealthy.
Then
we
went
statewide
managed
care
in
2011.
Again
we
had
the
eight
regions,
but
Passport
only
operated
in
region
3
and
then
in
2013
all
MCS
began
operating
statewide,
including
region
3.
C
We
currently
have
five
NCO
contracts
with
Aetna
anthem,
Humana,
passport
and
wealth
care.
The
original
contract
expired
in
June
on
June
30
2020.
We
have
extended
that
contract
until
December
31st
of
2020
the
current
in
the
current
contract.
We
did
make
a
few
changes
for
the
six-month
period,
of
course,
the
contract
term
transitioned
from
June
30th
through
December
31st.
C
We
removed
references
to
the
Kentucky
health
language,
Mirman
Kentucky
health
with
the
1115
waiver
that
required
certain
Medicaid
members
to
work
or
volunteer
in
order
to
maintain
their
Medicaid
eligibility.
It
also
eliminated
vision
and
dental
benefits
for
adults.
The
medical
loss
ratio
adjustment
period
has
been
extended
to
the
extension.
One
change
that
we
heard
from
providers
was
that
the
timely
filing
period
for
Medicaid
managed
care
organizations
was
different
from
our
fee
for
service,
which
is
365
days
or
a
year.
C
If
you
can't
see
my
slides
I'm
going
to
go
ahead
and
skip
over
some,
because
I
have
some
that
depict
the
average
Medicaid
enrollment
and
expenditures
we
we
spent
in
2019,
we
spent
roughly
7.5
billion
dollars
in
our
many
paid,
managed
care
organizations,
and
we
spent
roughly
3
million
in
our
fee
for
service
population.
Now
that
equates
to
about
70%
of
our
population
being
in
managed
care,
which
is
again
as
7.4
million
so
about
roughly
10%
of
our
population,
which
is
in
fee-for-service
accounted
for.
Almost
30%
of
the
Medicaid
cost
in
2019.
C
Their
average
member
per
month
has
remained
steady
with
our
managed
care
organizations
in
2019
the
average
fee,
for
it
was
it
was
roughly
under
$500
and
compared
to
the
individuals
who
are
enrolled
in
fee-for-service,
the
per-member
per-month
was
over
$2,000,
though
some
key
contract
enhancements
and
programmatic
changes
that
we
made
to
the
2021
contract,
the
timeline.
Of
course
we
had.
We
released
our
RFP
January
10th
2020
proposals.
When
we
received
on
February
7th.
We
then
experienced
the
coded
state
of
emergency,
but
trying
to
get
back
to
business
as
usual.
C
We
did
issue
contracts,
May
28
knows
those
contracts
were
issued
to
Aetna,
Humana,
Molina,
United
and
well
care.
Those
were
awarded
May
29.
We
have
a
current
anticipated
start
date
of
janeway.
First
2021
the
significant
changes
in
the
2021
MCO
contract.
We
have
one
MCO
supporting
Kentucky
youth
serving
their
foster
children.
It's
called
Sky
supporting
Kentucky
youth,
so
one
MCO
will
be
delivering
care
for
children
enrolled
in
foster
care
and
those
who
are
dually
committed.
Again
we
room
references
to
Kentucky
health.
C
The
contract
term
has
been
changed
because
originally
we
and
those
contracts
were
set
to
start
July.
The
1st
of
this
year,
but
you
are
aware,
the
Reaper
current
process
that
happened
so
that
has
pushed
out
the
start
date
to
January
1st
2021.
The
contract
does
require,
or
does
include
for
additional
two
year,
renewal
periods
and
optional
renewal
period.
C
Pharmacy
language
has
been
amended
and
beefed
up
a
little
bit.
We've
added
references
to
the
Kentucky
statute,
specific
to
Senate
bill
5
to
require
MCS
to
comply
with
all
requirements.
In
that
Senate
bill.
We
have
changed
language
to
ensure
that
the
state
can
claim
and
maximize
rebates
on
position
administered
drugs.
We
result
revised
the
cycle
in
which
drugs
are
reviewed
for
a
preferred
drug
list.
From
three
years
to
annually,
we
have
removed
the
MCO
PBM
ability
to
charge
hidden
fees.
C
We've
also
inserted
language
so
that
the
department
can
have
more
input
or
more
more
leverage
with
subcontractors
we
can
deny
or
approve
any
subcontractor.
Also
cut
contractors
must
have
appropriate
training
and
education,
and
the
NCOs
must
share
their
third
floor.
Their
third-party
liability
information
with
their
subcontractors
we've
also
increased
quality
expectations.
We
expect
the
NCOs
to
support
Kentucky
goals
and
transforming
the
Medicaid
program.
We
have
expanded
requirements
for
ongoing
monitoring
of
performance
and
address
the
outcome
to
identify
means
for
adjustment.
C
We've
changed
the
utilization
management
criteria
so
that
it
can
so
that
it's
transparent
we've
amended
specifics
for
telehealth
based
on
pay,
rs200
5.5
591,
and
we
also
have
inserted
that
medical
necessity
criteria
must
be
based
on
scientific
evidence.
We
don't
want
the
MCS
coming
to
us
with
with
homegrown
criteria,
for
example,
to
develop
prior
authorization.
There
has
to
be
something
that
is
actually
validating.
C
It's
related
to
provider
services.
We
have
inserted
a
requirement
to
be
consistent
with
k,
RS
200,
5.5,
3
2
for
one
credentialing
verification
organization.
We've
added
topics
to
education,
requirements
for
providers,
updated
information
related
to
the
provider
network
to
comply
with
k,
RS
3,
o
4.17,
a
5
15
we've
also
inserted
language
stating
that
the
MC
OS
cannot
automatically
enroll
providers
in
any
other
product
offered
by
the
MCO
as
far
as
termination
of
providers.
We
expect
them
to
give
us
an
exit
survey.
C
When
a
provider
is
terminated,
we
want
to
know
why
they
were
terminated
and
they
have
to
give
notice
to
the
department.
In
addition,
they
also
have
to
know
it
notify
the
enrollees
and
that
has
to
coincide
with
timing
of
the
provider
termination.
We
don't
want
a
member
out
there
who,
for
example,
may
have
a
primary
care
provider
who
was
terminated
and
they
don't
know
until
it's
time
for
them
to
have
to
schedule
an
appointment,
so
they
have
to
give
notice
to
their
members
case
management.
We
revised
the
contract
to
include
a
population
health
management.
C
Corrupt
program
to
hold
the
MCO
is
accountable
for
addressing
here,
name
the,
for
example.
We
don't
want
to
just
again
it's
going
back
to
Medicaid
role
in
the
delivery
of
health
care.
We
don't
want
to
just
pay
for
services,
we
want
to
pay
for
improvements
in
services,
so
we
want
to
hold
them
accountable,
the
dressing
the
healthcare
needs.
We
want
to
make
sure
our
members
get
the
appropriate
care
that
they
require.
C
We
also
have
cific
conditions
and
populations
for
final
priority
based
on
the
highest
needs
in
the
tamil
mail,
for
example,
we
know
that
diabetes,
heart
disease,
asthma.
Those
are
some
of
the
high
highs
things
in
the
Commonwealth.
We
want
to
make
sure
that
they
have
plans
of
care
to
address
those
issues
and
make
sure
individuals
are
receiving
treatment
for
the
conditions
that
they
have.
C
As
far
as
reporting
the
Institute.
We
want
the
NCOs
to
participate
with
the
department
and
develop
a
package
of
reports
that
is
consistent
across
MCO
s,
so
we
want
comparable
data.
We
want
to
be
able
to
to
compare
apples
to
apples
with
their
NCOs.
We
know
that
Medicaid
data
is
very
complex,
sometimes
in
the
way
that
you
pull
and
report
data.
While
it
may
look
the
same
on
paper,
what
went
behind
those
reports
to
pull
that
data
into
that
report
may
have
some
slight
difference
that
excuse
one
or
the
other.
C
So
we
want
to
make
sure
it's
all
consistent
and
we
did
insert
some
telehealth
reporting
requirements.
We
beefed
up
at
remedies
for
violation,
breach
or
non-performance
in
the
contract.
We
expanded
language
to
define
the
department's
write
and
decisions
in
addition
to
the
NCM
responsibilities,
and
we
have
inserted
language
stating
the
MCO.
S
must
maintain
a
30
million
dollar
performance
bond
throughout
the
life
of
the
contract,
a
few
payment
strategies
that
we
have
inserted
into
the
new
contract.
C
We
described
the
department's
risk
adjustment
model
and
indicate
that
supplemental
pass-through
payment
and
payments
related
to
the
health
insurance
premium
fee
will
not
be
risk.
Adjusted.
We've
indicated
that
the
department
may
and
its
discretion
and
subject
to
CMS
approval,
implement
medical
loss
ratio,
incentive
programs
that
which
the
MCO
may
reduce
its
allowable
MLR.
But
again
we
want
this
is
so
that
we
can
make
sure
that
our
members
are
receiving
services
and
we
want.
We
want
to
see
results.
C
We've
also
added
language
to
allow
the
Department
of
the
department
to
develop
and
require
the
MCO
to
participate
in
a
value-based,
pain
and
I.
Think
with
that
that
you
will,
in
my
my
presentation,
I'm
sorry
that
you
couldn't
see
the
slides
I'll
be
more
than
happy
to
forward
them
to
you,
I
think
they
are
on
line
and
if
I
could
open
it
up
to
discussion
and
see.
If
you
have
any
questions
for
me,.
A
Yes,
this
will
encourage
committee
members
to
follow
your
presentation.
It
was
sent
out
with
the
email
this
morning
and
you've
done
an
excellent
job
with
this.
You
know,
wealth
of
information,
greatly
appreciated
and
I'm
thinking
that
possibly
we
need
to
have
a
follow-up
on
this
as
well,
because
there's
so
much
information
that
you've
given
us
today
and
appreciate
that
the
work
you're
doing
so
if
we
could
invite
you
back
to
a
future
meeting,
I
would
appreciate
that
opportunity,
a
lot
of
questions
and
let
me
start
with
center
Alvarado.
F
Thank
you
so
mission
er
thanks,
actually
pleased
to
see
a
lot
of
the
things
you
put
in
this
and
I'm
looking
at
your
PowerPoint
here
and
a
lot
of
the
things
that
we're
incorporating
in
these
contracts
and
I
guess
not
so
much
a
question,
but
just
an
urgency.
I
mean
I.
Think
for
the
last
10
11
years
now,
we've
it's
been
a
lot
of
everybody's
heard.
F
Looking
at
value-based
payment
models
is
to
put
innovative
things
like
accountable
care
organizations
together,
which
I
think
might
be
able
to
work
well
with
medicated
and
sanitizes
providers
in
a
lot
of
the
credentialing
issues,
the
bills
that
we
passed,
obviously
as
a
General
Assembly
in
the
past
that
you're
looking
to
put
into
this
so
I'm
encouraged
by
seeing
a
lot
of
the
things
that
are
here.
I
would
just
encourage
to
really
be
a
stickler
in
enforcing
these,
because
if
they,
if,
if
they're,
not
enforced,
you
know
we're
gonna,
you're
gonna,
hear
from
us.
F
So
obviously
in
this
committee
and
I
think
we've
even
told
the
new
players
that
are
in
the
market
like
Molina
United
Healthcare.
It's
an
opportunity
for
them
to
I
think
established
a
good
relationship
with
providers
in
the
state
and
the
ones
that
have
already
been
here
that,
if
I
think
I've
done
quite
a
few
improvements
to
try
to
improve
their
reputations,
I've
encouraged
them
also
to
say.
Consider
this
a
reset
and
to
start
moving
forward
in
a
positive
way,
but
really
encouraged
by
a
lot
of
the
things
that
are
in
here
and
like
I,
said.
F
C
The
Medicaid
population,
out
of
all
the
population,
ninety
percent
is
designed
to
manage
care
organizations
and
ten
percent
is
in
for
service
the
long-term
here
and
the
home
and
community-based
waiver
programs.
So
10%
of
our
population
accounts
for
almost
30%
of
the
cost
in
Medicaid
and
the
90
percent
accounts
for
about
70%.
Okay,.
E
D
Yes,
thank
you
chairman
and
commissioner
Lee.
What
a
great
job
appreciate,
knowing
quite
versed
and
it
sure,
helps
us
moving
forward
a
couple
real,
quick
question:
you
were
able
to
award
the
MCO
contract,
obviously
without
I,
guess
them
knowing
what
PBM
they're
gonna
be
working
with.
Can
you
give
us
a
timetable
on
if
the
RFP
have
gone
out
for
the
PBM
and
if
so,
when
you
expect
them
back,
and
when
do
you
plan
to
announce
the
single
PBM
that
we'll
be
working
with
our
five
inches.
C
D
Well,
thank
you
very
much.
I
know
that
there's
gonna
be
a
lot
of
discussion
on
what
single
PBM
you
know.
You'll
use
I
just
want
to
we
put
in
Senate
bill
50.
Some
language
could
have
been
a
little
stronger,
I
think,
but
we
we
did
what
we
needed
to
do,
but
we
were
very
concerned
about
using
a
single
PBM
that
had
any
type
of
relationship
with
any
of
the
MCO
s
any
kind
of
common
ownership.
That
kind
of
thing
and
I
believe.
If
you
look,
we
didn't
mandate
it,
but
we
sure
strongly
encourage
that.
D
We
try
to
find
a
single
PBM
that
had
no
business
relationship
so
that
we
didn't
have
that
out
there.
So
I
just
wanted
to
mention
that
another
question,
if
you,
if
you
will
chairman
on
the
single
PDL
with
Commissioner
Lee
I,
suspect
that
single
PDL,
this
is
going
to
really
help
us
when
it
comes
to
supplemental
rebates.
D
Okay
and
then,
lastly,
in
our
questions
you
I
know
you've
got.
You
must
feel
like
the
way
the
world
on
you
and
we
we're
sorry
to
be
pounding
on
this,
but
I
just
want
to
put
some
your
predecessor.
We
ran
into
an
issue.
I
just
want
to
bring
it
to
your
attention
so
that
you
can
be
watching
board
you.
You
probably
will
anyway,
but
it
was
hot
that
one
thing
with
a
year
before
you
got
there,
maybe
two
years
before,
where
the
MLR
was
kind
of
I.
D
Don't
know
what
word
to
use,
but
was
was
I,
don't
say
monkey
around
with
by
the
MCO
bottom
line
is,
is
that
they
move
services,
that's
money
that
should
have
been
in
services
over
to
the
men's
side.
That
was
picked
up
by
our
Medicaid
commissioner
at
that
present
time,
and
they
were
they
had
to
pay
seven
eight
million
dollars
back
to
the
state
of
Kentucky.
When
that
happened
so
I.
That
kind
of
follows
up
on
senator
Alvarado's.
You
know
comments
about.
We
have
really
got
to
watch
that
kind
of
thing
and
I
was
sitting.
E
E
E
D
D
E
A
These
meetings
to
an
hour
in
30
minutes
and
we're
an
hour
and
fifteen,
so
you've
done
a
commendable
job
and
I
think
Commissioner
Lee.
You
got
a
lot
of
credit
for
that
because
you
become
so
well
prepared.
I
have
one
final
question,
but
before
we
get
into
that,
I
would
like
you
to
talk
a
little
bit
about
the
transition
to
the
new
MC
OS.
You
know
we
have
one
particular
we
got
300,000
people
that'll
be
moving
to
a
new
one
and
how
are
we
assuring
that?
We're
not
creating
a
bureaucratic
nightmare
for
healthcare
providers?
C
But
I
believe
a
lot
of
this
will
be
contingent
upon
the
outcome
of
the
protest.
Probably
not
something
I
can
really
talk
about
right
now,
because
don't
know,
but
that
the
contract
does
have
a
very
specific
detailed
outline.
I'd
be
more
than
happy
to
just
pull
that
piece
out
of
that
contract
and
send
it
to
you
by
email,
sender,
Meredith,.
E
C
I
think
that
Medicaid,
if
you
look
at
what
Medicaid
does
and
how
big
we
are,
Medicaid
currently
covers
almost
1.5
million
people.
We
have
56,000
providers,
we
have
a
12
billion
dollar
budget.
Medicaid
needs
to
be
more
of
a
pair
of
services.
We
want
to
see
results,
we
want
to
identify
populations
that
need
help
and
we
want
to
see
improvements.
We
need
to
get
a
baseline
set
of
information
on
how
how
our
health
status
is.
Today.
We
know
that
Kentucky
is
usually
right
at
the
bottom
of
everything.
C
We
want
to
start
elevating
our
health
status,
and-
and
this
goes
back
to
what
this
committee
is
saying
and
that
holding
these
managed
care
companies
accountable.
We
want
to
establish
some
baseline
information
on
what
their
membership
looks
like,
and
we
want
to
see
some
improvements
for
the
money
that
we're
paying
and
if
we
don't
see
improvements
we
want
to
know.
Why
is
it
because
all
the
other
states
are
improving
at
the
same
rate?
We
are
so
our
goal
and
I
think
I
may
have
told
you
guys.
C
This
I
believe
that
the
Medicaid
program
was
created
for
the
Medicaid
member.
We
have
a
responsibility
to
assist
those
individuals
who
are
very
vulnerable.
They
have,
some
of
them
have
had
their
very
they
have
comorbidities.
Their
healthcare
status
is
not
not
as
great
as
some
of
the
other
population.
We
want
to
increase
their
health
status.
We
want
to
help
elevate
them,
make
sure
that
they're
receiving
their
medications
that
they're
adhering
to
their
their
medication
regime.
We
want
to
just
elevate
that
status.
C
E
Thank
you
very
much
for
that
explanation
and
I.
Explanation
and
I
greatly
applaud
that
and
I
hear
the
word.
Accountability
for
NCOs,
but
I
think
we
also
have
to
build
an
accountability
for
patients
and
when
they,
when
they're
able
you
know
what
I'm
saying
so
foundation
for
a
healthy,
Kentucky
I
think
has
those
things.
A
Mr.
Lee
I
appreciate
your
philosophy
behind
this
and
certainly
embrace
it
I'm
sure.
Mostly
its
committee
members
do
as
well
I've
said
since
I
came
to
Senate
in
2017.
That
I
think
the
Medicaid
budget
is
as
large
as
you're
never
seen,
because
we're
working
on
peak
getting
people
back
in
the
game
for
employment,
whether
they
get
health
insurance
through
their
employer,
and
we
really
focus
on
improving
the
health.
We
can
reduce
this
budget
and
I
think
focusing
on
the
Medicaid
recipient.
It's
certainly
the
right
approach.
One
things
that
concerns
me,
though,
is
access
to
care.
A
It
doesn't
matter
if
you
have
health
care
coverage,
if
you
don't
have
health
care
providers
to
provide
that
service,
and
we've
talked
ad
nauseam
today
about
the
impact
on
rural
health
care
and
how
fragile
the
system
is.
So
that's
but
I
hope
it
continued,
have
further
dialogue
on,
because
it's
something
very
near
and
dear
to
most
of
us
and
just
like
you,
we
want
the
best
for
the
Medicaid
recipient,
and
you
know
one
point:
five
million
dollar
one
point:
five
million
people:
it's
not
a
number.
There
should
be
a
source
of
pride
for
Kentucky.
A
Again,
that
was
as
big
as
it
ever
should
be.
We
need
to
work
very
hard
to
build
the
economy
of
this
state
to
get
people
in
a
game
of
unemployment
and
reduce
that
number
and
I
think
that's.
A
measure
of
success,
for
us
is
reducing
the
Medicaid
recipients
through
gainful
employment
and
improving
the
health
of
our
population.
If
we
have
not
done
that,
then
we've
not
been
successful.
Many
of
us
but
appreciate
you
being
here
today
and
I
know
you
put
a
lot
of
time
and
effort
in
presentations.
A
That's
you
know
again,
I'd,
ask
committee
members
to
make
sure
you
look
at
these
slide
presentations
that
were
put
together,
and
we
certainly
would
like
to
have
you
back
in
the
future
meeting
to
talk
more
detail
about
some
of
these,
but
you've
done
an
excellent
job
today
and
you
certainly
have
our
full
support
with
that.
I
would
ask
if
there
any
community
members
we
have
not
accounted
for
so
far.
A
Hearing
none
that
I'll
advise
you
that
our
next
scheduled
meeting
is
July
of
29th
and
well
certainly
send
out
the
agenda
two
weeks
beforehand.
But
if
there's
no
other
business
appreciate
everyone's
participation
today
and
particularly
you
Commissioner
Lee,
and
wish
you
the
best
going
forward
and
anytime,
we
can
be
of
assistance,
please
don't
hesitate.
Call
upon
us
likewise,.