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From YouTube: Medicaid Oversight and Advisory Committee (11-10-22)
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A
So
good
morning,
everyone
and
welcome
to
the
final
meeting
of
the
interim
and
also
final
meeting
ever
pursuant
to
House
Bill
7
of
the
Medicaid
oversight
and
advisory
committee.
The
our
responsibilities
will
be
reconstituted
and
chairman
Meredith
will
have
some
comments
at
the
end
about
that.
So
with
our
clerk,
please
call
the
roll.
A
C
This
is
not
kind
of
our
thing
sure
so,
but
what
I
can
tell
you
is
this
as
I
understand
the
proposal
and
I
think
I've
seen
a
pre-file
on
it.
Maybe
this
may
be
about
this
I
believe
it.
So
again,
let
me
put
all
those
caveats
in
on
what
I
believe
all
right
about
annual
inspections
on
waiver
providers,
which
it
there
will
be
a
cost
associated
with
it,
to
get
more
surveyors
and
what
I
would
say
to
you
all
this.
C
C
I
do
believe
that
there
are
improvements
we
can
make
to
oversight,
as
we
discussed
at
that
committee
and
so
we'll
we'll
work
on
proposals
that,
as
the
and
I'll
I'll
short
I'll,
try
to
do
the
short
version
of
this
Senator
Meredith,
but
the
waiver
piece
is
in
the
cabinet,
reside
like
the
funding
piece,
sits
in
Medicaid
oversight,
piece
for
the
most
part,
depending
on
which
waiver
either
sits
in
behavioral
health
or
the
department
for
aging
and
independent
living.
C
That's
also
where
the
programmatic
expertise
lies
and
and
the
oversight
piece,
because
this
was
a
couple
of
questions
that
that
subcommittee
sits,
sits
at
different
places
in
the
cabinet.
C
The
I
believe
what
the
I'm
not
going
to
try
to
speak
for
the
committee,
but
I
believe
what
the
committee
saw
was
that
we
had
the
opportunity
to
do
some
consolidation
and
and
probably
put
together
a
better
plan
both
for
how
we
administer
waivers
and
then
how
we
do
that
kind
of
oversight
and
inspection.
C
We'll
work
on
that
I
think
I
told
the
the
committee.
The
first
time
I
was
asked
that
question
is
probably
the
hardest
question,
because
there's
there's
probably
no
right
answer
and
I've
been
at
the
cabinet
long
enough,
where
I've
seen
Medicaid
does
everything
the
different
departments
do
everything
and
everything
in
between
and
I've
been
also
at
the
cabinet
long
enough
to
have
decisions
that
I
worked
on
come
back
to
bite
me,
and
this
is
one
of
them,
particularly
on
the
oversight
side,
because
at
that
point
that
it
was
called
aismr.
C
It
was
the
very
first
waiver
in
Medicaid
and
I
actually
worked
on
the
regulations
for
that.
Because
I'm
old
and
Senator
Meredith
was
teasing
me
a
lot
about
that
I've
been
over
everything
in
the
cabinet
at
one
point
or
another,
he
said
I
was
trying
to
wash
my
hands
of
it.
Unfortunately,
it
means
I
have
to
take
responsibility
for
it.
The
oversight
piece.
C
I
was
working
for
the
office
of
Inspector
General,
then
and
I,
and
the
probably
the
only
time
I
out,
negotiated
Mark
bird
whistle
in
my
life,
but
the
that's
kind
of
why
it's
a
little
and
I
I
think
there's
probably
a
better
recommendation
around
one
one
body
looking
at
it,
but
I
I
think
it's
probably
tied
up
in
the
recommendation
to
the
the
task
force.
Chfs
oversight
task
force
asked
for
on
12
23.
I.
That's
what
I
have
for
you.
A
Well,
thank
you
very
much
and
what
what
are
the
current
rules
around
inspections
of
Residential
Care
Facilities,
because
I
think
that's
really
what
the
issue
yeah
is
I
mean.
Are
these
inspected?
I
think
you
you
mentioned
annually
is
that
is
that
they're.
C
Not
inspected
annually
they're
inspected
on
complaint,
and
then
it
can
go
up
to
three
years
before
we
actually
can
get
into
some
of
that's
based
on
personnel
and
Staffing,
but
it
can.
It
can
be
some
time
before
we
do
it
in
official
inspection
and
oversight,
and
that's
you
know
that
can
be
a
long
time
is.
C
I
think
it's
different
in
different
states
to
be
honest
with
you,
I
think
there
are
some
states
that
have
annual
inspection
for
the
most
part.
We
do
that
with
with
other
health
care
facilities,
but
like
with
hospitals,
if
they're
accredited
and
some
other
Healthcare
facilities,
if
they're
accredited.
That
will
be
a
longer
time
between
when
we
go
in
and
oftentimes.
What
gets
us
in
more
quickly
is
is
a
complaint.
E
A
F
Carroll
yeah
not
really
a
question,
but
I
think
it's
important
for
the
committee
to
understand
that
anytime
that
there
is
an
incident
when
when
it
involves
waiver
Services
there
is
a
report,
that's
submitted
and
it's
not
it's
not
just
a
formality.
I
mean
those
are
looked
at.
There
are
every
Center
has
someone
that
they
contact.
F
That
kind
of
helps
with
oversight
and
someone
that
if
they
need
advice
from
and
I,
don't
remember
their
exact
title
right
now,
but
you
can
always
refer
to
them
on
different
issues,
but
the
reports
are
done,
they're
submitted
and
you
have
to
follow
up
on
them.
You
don't
get
just
a
free
ride,
so
so
there
is
some
pretty
serious
oversight
on
that
and
and
records
are
kept
and
they
review
those
with
every
incident.
So
and
and
despite
everyone's
best
efforts,
the
population
that
we
serve.
F
There
are
going
to
be
problems
from
time
to
time
and
there
are
going
to
be
those
who
have
certain
behavioral
issues
that
you
really
have
to
watch
and
it's
not
always
sometimes
it
can
be
a
difficult
population
to
serve
depending
on
the
individuals
that
you
have
in
your
programs
and
what
their
struggles
are.
So
I
just
want
the
committee
to
be
aware
of
that.
We
don't
operate
a
group
home
but
say,
but
we
have
all
the
other
programs-
and
you
know,
I
see
all
the
reports
that
come
through
and
and
even
minor
stuff.
C
A
G
Thank
you,
Mr,
chairman
Mr
secretary,
thank
you
for
being
here
today.
This
is
when
off
the
subject
somewhat
and
hope
you
don't
mind,
but
they
the
trigger
word,
was
complaint.
So
I
was
triggered
to
ask
this
question
and
and
dumping
I.
Guess
that's
what
you
call
it
when
a
hospital
takes
someone
and
and
drops
them
somewhere.
G
C
So
I
worked
doing
some
homelessness
services
in
Louisville
when
I
was
working
for
the
city
of
Louisville
and
we'd,
see
folks
out
on
the
street
that
we
wouldn't
understand
why
they
were
out
right
that
people
getting
discharged,
homeless,
shelters
and
what,
when
I
came
back
to
the.
H
C
C
The
thing
was
we
weren't
getting
the
complaints,
and
so
what
I've
asked
folks
to
do
is
if
there's
a
complaint,
send
it
to
us,
because
we
do
investigate
those
folks
have
to
receive
the
services
so
that
they're
medically
stable
before
they
can
be
discharged.
Now
it's
a
burden
on
the
hospitals.
If,
if
Nancy
galvani
were
sitting
right
here,
she'd
talk
about
what
a
burden
that
is,
but
it
is
something
that
they're
required
to
do
under
under
Federal
rules.
E
G
An
individual
sending
them
to
that
hotel
room
rode
him
in
in
a
wheelchair,
the
hospital
paid
for
the
hotel
room
and
he
and
the
maids
discovered
him
the
next
day
when,
after
checkout
time
still
sitting
in
the
same
wheelchair
in
the
same
clothes
and
in
the
same
everything
else
that
he
brought
in
I.
Guess-
and
you
know
that's
just
not
that's
just
and
I,
didn't
know
how.
How
often
that
happened
and
and
if
the
complaints
were
followed
up
on,
they.
C
D
I
Thank
you,
Mr
chairman
and
and
thank
you
secretary
I
apologize
for
walking
in
a
little
bit
late,
so
I
I,
don't
know
if
you've
covered
this
and
I'm
I'm
glad
that
Senator
Higdon
asked
his
question
because
that
was
one
question
I
had,
but
on
Personal,
Care,
Homes
and
I.
Don't
know
if
we're
talking
about
all
residential
living
situations,
but
when
individuals
are
moved
out
to
Independent
Living,
what
sort
of
follow-up
is
there
on
the
part
of
the
state?
As
far
as
looking
at
outcomes,
you
know
how
did
that
go
for
the
individual?
C
I,
probably
don't
have
the
cost
analysis
side
of
it
and
they're
two
good.
C
There
are
two
types
folks
who
might
move
out,
but
but
here's
here's,
the
vast
majority,
the
vast
majority
of
folks
who
are
in
personal
care,
who
move
out
to
an
independent
living,
so
I'm
going
to
make
a
guess,
but
my
guess
is
usually
pretty
good
70
to
80
percent
of
those
folks
have
Guardians
State
Guardians
under
aging
and
independent
living,
so
they
are
followed
up.
We
would
follow
up.
We
do
case
management,
we'd
have
normally
monthly
visits,
so
we
we
do.
We
would
do
the
follow-up.
C
This
can
take
us
down
a
rabbit
hole,
but
under
the
Olmstead
decision,
the
Supreme
Court
decision,
we
have
a
it's,
not
a
consent
decree,
because
that's
a
court
ordered
thing,
but
it's
a
it's
an
agreement
that
we
have
with
protection
and
advocacy
to
try
to
get
people
in
in
the
community
as
much
as
we
possibly
can
so
those
folks
that
are
moving
out
of
personal
care.
C
It's
called
the
Sasa
and
I
can't
even
remember
what
that
stands
for
anymore,
but
under
that
agreement
is,
is,
is
kind
of
the
impetus
for
us
to
do
that.
So
we
actually
were
trying
to
end
that
we
and
we
did
for
about
a
week
and
then
I
think
we
were
getting
ready
to
go
to
court.
So
we
we
entered
I
mean
I
just
again
just
so,
you
all
know
what
so
that's
we're
still
under
that,
and
so
we're
we're
still
and
Olmstead
is
like.
C
Have
people
live
in
community
I
know
sometimes
folks,
believe
that,
though
you
know
the
personal
care.
Is
that
Community
right
and
that's
where
folks
get
jobs,
and
so
there's
all
their
arguments
on
either
side
of
this
discussion,
but
because
it's
a
facility
right,
it's
looked
on
as
not
community
and
that's
just
under
the
law.
A
I
And
yeah
I
have
concerns
about
taking
individuals
who
have
no
place
to
live
away
from
their
Community
when
they've
lived,
you
know
for
a
year
or
more
sometimes
in
a
personal
care
home
where
the
supports
are
it.
You
know
I
and
I
understand
the
the
the
issue,
but
you
know
I
I
think
it
would
make
sense
too,
and
you
know
I.
It
sounds
like
it's
really
a
federal
decree
that
this
that
this
happened
so
I,
don't
know
how
to
work
around
that.
I
But
you
know
we
just
need
to
make
sure
that
people
are
getting
the
best
care
and
the
best
supports
that
they
can
at
you
know
the
the
most
the
at
a
place
that
makes
sense
for
the
state
for
taxpayers.
You
know
I
I
would
like
to
take
another.
You
know
hard
look
at
that.
So
thank
you.
J
C
And,
and
so
those
kind
of
regular
is
not
annual
at
this
point,
that
kind
of
regular-
you
know
when
we
go
in,
could
be
up
to
three
years,
we'll
go
in
more
often
on
complaint,
more
often
on
on
investigations
of
of
incidents,
but
that
kind
of
you
know
by
the
book.
Looking
at
the
regs.
What
do
you
have
that?
That
can
be
up
to
three
years
and
we
just
need
more
people,
I
mean
we
just
need
more
people,
we
need.
C
We
need
more
people
inspecting
we're,
we're
we've
got
we're
behind
Okay,
and
so
we've
got
some
real
challenges
and
we're
working
on
it.
But
we've
got
some
real
challenges.
A
You
thank
you.
Mr
secretary,
we'll
call
up.
Miss
Amy
stayed
the
executive
director
of
Kentucky
Association
of
private
providers.
We
also
have
a
quorum,
so
is
there
a
motion
to
approve
the
minutes?
Is
there
a
second
there's
all
in
favor,
please
say
aye
and.
K
A
Opposed
no
and
the
amendment
the
minutes
are
approved,
so
if
you'll
introduce
yourself,
Ms
stayed
and
you
can
proceed.
L
K
Hi,
my
name
is
Amy
stayed
I'm
the
CEO
of
the
Kentucky
Association
of
private
providers.
We
are
a
trade
Association
representing
providers
of
services
through
Medicaid
waivers
to
individuals
with
intellectual
and
developmental
disabilities
I'm
here
today
to
talk
about
br69.
It's
that
pre-file
bill
and
I
want
to
be
really
clear.
What
the
subject
matter
of
PR
69
is,
and
that
is
scl
waiver
residential
facilities,
they're
not
actually
facilities,
they're,
called
staff
residences
they're,
not
facility
based
at
all.
These
are
homes
out
in
the
community
they're
in
neighborhoods.
Some
of
you
probably
live
next
to
one.
K
K
I
want
to
preface
this
conversation
with
I,
don't
want
to
say
I,
don't
want
anything
I
say
today
to
be
construed
is
that
providers
are
against
oversight.
There
is
a
tremendous
amount
of
oversight
of
these
programs
and
providers
absolutely
expect
that
to
be
there.
K
Providers
in
this
field
expect
tremendous
accountability,
tremendous
scrutiny,
in
fact,
as
I
think
you'll
see.
These
are
some
of
the
most
scrutinized
services
in
the
state
of
Kentucky
as
they
should
be.
This
is
one
of
our
most
popular
most
vulnerable
populations.
K
There
are
multiple,
unrelated
governmental
and
non-governmental
entities,
actively
supervising
the
provision
of
care
to
this
vulnerable
population
and
that's
common
throughout
the
United
States.
Nearly
every
state
has
multiple
agencies
supervising
these
services
and
that's
because
it
provides
multiple
layers
of
care
or
excuse
me
oversight.
K
All
providers
want
is
for
the
individuals
that
they
care
for
to
be
supported
and
be
happy
and
be
safe.
So
with
that
disclaimer
out
of
the
way
again,
let's
identify
exactly
what
population
and
services
we're
talking
about.
Individuals
with
intellectual
and
developmental
disabilities,
who
would
otherwise
likely
be
institutionalized,
who
have
become
eligible
for
the
S
What's
called
the
supports
for
Community
Living
waiver
program
generally.
They
need
24
7
care,
maybe
they
have
some
alone
time,
but
they
live
in
the
community.
They
work
in
the
community
and
they
receive
services
in
the
community.
K
In
fact,
the
federal
government
CMS
requires
that
these
Services
be
truly
Community
Based,
and
so
that's
why
I
you're
not
going
to
hear
me
saying
words
like
facilities,
because
these
are
homes
they
aren't
facilities.
The
federal
government
requires
that
they
be
truly
community-based,
truly
integrated
into
the
community,
and
Kentucky's
done
really
well
doing
that
and
making
sure
individuals
with
disabilities
truly
become
a
part
of
the
community
that
they
belong
to.
Stl
services
are
non-medical,
I
want
to
be
clear.
These
are
not
MediCal
Services.
This
is
not
nursing
care.
K
One
of
the
many
services
again
that's
available
in
the
SEO
waiver,
is
that
that
24
7
residential
service
that
I
described
to
you
again,
these
are
in
houses
in
the
community,
called
staffed
residences,
they're,
not
facilities,
they're
rental
properties
that
people
pay,
rent
for
and
have
rights,
just
like
any
of
us
would
in
a
rental
situation.
K
K
First,
the
slides
compared
STL
residential
homes
to
nursing,
home
care
and
insinuating
that
those
Services
were
the
same
and
frankly,
they're
not
they're,
not
the
same
service
at
all.
One
is
a
medical
model
for
people
who
really
require
intense
Medical
Care.
The
other
is
a
completely
non-medical
model
for
people
who
just
need
a
little
bit
of
support
and
need
help
with
activities
of
daily
living.
K
A
residential,
an
STL
residential
setting
would
likely
not
be
appropriate
for
someone
who
requires
nursing
level
care
just
like
Nursing
Facility
care
would
not
be
appropriate
placement
for
someone
who
is
eligible
for
the
STL
waiver
and
lives
in
STL
residential
setting.
The
services
just
aren't
the
same.
It's
an
apple
and
oranges
comparison
and
the
PowerPoint
also
addressed
the
oversight
of
sdl
agencies
and,
unfortunately,
that
PowerPoint
did
contain
some
inaccurate
information.
K
Yes,
SEL
residential
providers
are
regulated
by
the
division
of
Developmental
and
intellectual
disability,
cdid
or
beaded
too,
there's
lots
of
acronyms,
but
as
well
as
the
department
of
Medicaid
services,
the
department
for
Medicaid
services
is
the
payor
of
the
services
and
also
has
a
supervisory
role,
and
then
ddid
really
acts
as
the
oversight
they
have
what's
called
qas.
They
are
all
over
the
state.
They're
quality
assurance,
they're,
Regional,
they're
assigned
you
know
a
group
of
providers.
K
They
provide
technical
assistance,
they
provide
advice,
support,
they
help
people
navigate
incredibly
difficult
care
situations,
and
they
also
will
shut
people
down
very
quickly.
At
least
seven
providers
have
been
shut
down
in
the
past
year
that
I
am
aware
of,
and
so
if
they
see
something
that
is
wrong,
ddid
and
Medicaid
will
proceed
to
very
quickly
close
that
provider
to
make
sure
that
no
one
that
everyone
is
getting
the
best
care
possible.
K
Ddid
is
a
provider
resource,
but
that's
not
all
they
are,
and
so
to
characterize
them.
As
simply
a
provider,
resources
or
a
friend
to
kind
of
lend
near
is,
is
just
not
completely
accurate
DD.
They
also
the
PowerPoint,
also
said
that
ddid
was
dependent
on
SEO
providers
and
could
not
be
fully
objective
again.
I
think
that
the
track
record
of
closures
in
this
state,
as
well
as
punitive
actions
against
providers
which
were
completely
warranted
and
fair
and
all
of
those
things
should
have
happened,
will
show
you
that
they
are
completely.
You
know.
K
The
cabinet
is
completely
able
to
be
objective
when
it
comes
to
this
care.
The
cabinet
does
a
great
job
of
putting
the
individual
first,
making
sure
that
their
needs
are
taken
care
of
making
sure
that
they
are
safe
and
well
cared
for
and
just
not
compromise
the
care
of
individual
individuals
with
disabilities.
At
any
point,
annual
surveys
I
have
to
slightly
disagree
with
the
secretary
a
little
bit.
Most
providers
are
surveyed
annually.
K
These
are
certified
providers,
so
they're
not
licensed
by
oig
they're
certified
through
a
different
process
and
again
largely
because
that's
a
non-medical
model.
Some
providers
within
the
waiver
also
are
certified
by
oig
and
that's
because
they
provide
some
Medical
Care
through
other
avenues
as
well,
but
generally,
these
are
certified
providers.
When
a
provider
begins
before
a
home
is
even
open
before
an
individual
with
a
disability
can
even
live
in
it.
K
It's
looked
at
then
45
days
later,
it's
come
back
and
it's
looked
at
then
60
days
later
they
come
back
and
they
looked
at
it
to
make
sure
the
individuals
are
supported.
Additionally,
after
that
generally
annually
they're
re-certified
and
those
certifications
involve
records,
reviews
home
visits
and
things.
Some
people
do
get
to
your
certifications,
but
I'll
tell
you,
providers
don't
like
that.
They
like
it,
they
like
it
when
the
state
act.
They
actually
prefer
it
when
the
state
comes
in
annually.
K
So
that
way,
if
something
is
going
awry
or
if
they're
not
doing
something
quite
right,
it's
noticed
pretty
immediately.
Okay,
also,
there
is
an
whole
process
of
incident.
Reporting
I
talked
about
the
multiple
layers
of
scrutiny.
Here
we
have
each
individual
who
receives
services
in
the
SEL
waiver
has
what's
called
a
person-centered
team
generally.
If
they
receive
the
residential
services
that
will
have
a
residential
provider,
it
will
also
have
other
caregivers
by
law,
these
other
caregivers,
so
the
case
manager,
the
behaviorist,
the
Community
Access
specialist.
K
They
cannot
be
employed
by
that
residential
agency,
so
they're
all
separate
companies,
so
they're
not
beholden
to
one
another.
So
if
an
incident
of
abuse
or
neglect
does
happen,
one
of
those
other
providers
is
required
by
law.
There
are
mandatory
reporters
to
immediately
report
that,
through
a
very
sophisticated
and
well
thought
out
incident
reporting
system
that
the
cabinet
has
established,
and
that
system
sends
immediate
notifications
to
places
like
Adult
Protective
Services
to
the
guardian,
to
the
other
members
of
the
team.
K
The
case
manager
also,
who
is
independent
from
the
residential
provider.
Also
tracks
follows
up
on
remediation
of
any
incident.
Additionally,
Adult
Protective
Services
comes
in
and
then
does
investigations
as
well
as
the
individual's
individual
Guardian
who
can
report
things
independently.
The
individual
themselves
has
a
mechanism
to
report
a
potential
abuse
and
neglect
and
state
Guardians
as
well.
K
All
of
this
to
say
is
that
the
oversight
is
present.
It's
there.
No
system
is
perfect,
but
this
system
works
really
well,
and
it's
taken
a
really
long
time
to
perfect
we've
gone
through
several
iterations
of
incident
reporting
how
to
do
it,
how
to
do
it
well
and
how
the
quick
response
time
from
both
the
cabinet
and
other
providers.
It's
it's
improved
tremendously
over
the
past
five
years.
So
what
I'm
here
to
say
is
this
bill?
We
believe
this
bill
is
just
frankly
not
necessary.
K
We
think
one
we
take
issue
with
the
use
of
residential
care
facility,
one.
These
are
not
facility
services
and
it
doesn't
align
with
the
language
used
in
federal
law
for
waivers.
They
use
habilitation
services
in
the
state
of
Kentucky
and
ourselves
uses
residential
level,
one
and
residential
level.
Two.
K
We
believe
that
requiring
inspections
every
15
months.
We
would
prefer,
frankly,
that
they'd
just
be
done
every
12,
but
currently
the
practice
is
to
inspect
a
certain
percentage
of
all
of
the
residential
homes
and,
of
course,
if
anything
occurs,
that
their
residence
is
immediately
inspected
by
generally
both
ddid
and
the
cat,
and
excuse
me
APS
also
qas,
which
again
are
those
Regional
technical
assistance,
kind
of
supervisors.
They
come
in
and
do
unannounced
spot
visits
at
any
point
in
time
and
generally
several
times
throughout
the
year.
K
These
are
unannounced
and
they'll
check
homes,
they'll
check
on
participants
at
you
know
their
day,
Services
Etc.
We
really
feel
like
if
the
bill
is
implemented
as
written
a
lot
of
those
things
will
go
away
and
that
the
oversight
will
actually
be
less
than
it
currently
exists,
which
is
something
that
none
of
us
want.
We
want.
You
know
we
want
good,
strong
oversight
which
we
feel
like.
K
We
really
have
Additionally
the
bill
proposes
fines
in
it
and
I
just
wanted
to
say
that
currently,
the
department
for
Medicaid
services
issues
recruitments
very
frequently
on
these
services
and
those
recruitments
are
generally
issued
when
services
are
not
provided
with
within
the
parameters
of
the
regulation.
I
want
to
be
clear
that
the
regulation
not
only
outlines
qualifications
to
be
a
provider
that
you
must
be
over
18.
K
You
know
things
like
that
basic
qualifications,
but
the
regulation
really
also
speaks
to
how
you're
supposed
to
provide
these
Services
the
spirit
in
which
you're
supposed
to
do
it.
Person-Centeredness
really
best
practices
are
in
this
regulation,
and
so,
if
there
is
any,
even
minor
violation
for
not
providing
a
service
within
the
framework
of
the
regulation
that
the
payment
for
that
service
is
recouped,
so
the
fines
already
are
there.
They
already
exist.
K
Imposing
an
additional
fine,
which
is
frankly
less
than
recruitment
for
most
Services
is,
is
not
going
to
be
as
punitive
as
the
recruitment
process
that
already
exists,
I've
skimmed
over
a
lot
of
this.
To
try
to
be
brief
because
I
know
you
have
a
packed
agenda,
but
I
really
would
love
to
talk
to
you
individually.
If
you
have
questions
or
answer
questions
now,.
A
K
A
And
so
it
you
on
an
annual
basis.
Most
of
these
yes,
resonances
are
inspected
or
or
if
they're
not
inspected,
they
go
through
a
review
process.
I
think
is
what
you
what
you
had
said
where
the
records
are
are
looked
at
and
and
so
forth.
Would
you
go
into
how
a
resident
is
able
to
report
something
I
think
you
said
there
was
a.
There
was
a
mechanism
that
a
resident
could.
K
I,
don't
have
it
in
front
of
me
and
so
I
can't
tell
you
the
number,
but
there
are
several
different
ways
to
do
this
and
importantly,
all
providers
must
make
the
participants
they
support
aware
of
this
mechanism,
and
it's
got
to
be
available.
They
have
to
make
people
aware
so
that
if
a
participant
feels
like
they're
being
abused
or
neglected,
they
know
exactly
how
to
contact
someone.
K
A
M
M
I,
don't
think
it's
an
indictment
of
the
the
industry
so
to
speak.
I
like
the
requests,
because
it's
an
education
opportunity
for
us
and
certainly
that's
what
has
appeared
today.
I
know
you
know
the
particulars
is
incident,
but
you
know
we
either
have
a
a
problem
or
a
perception
of
a
problem
and
I.
Think
from
testimony
on
your
behalf
and
Secretary
of
Freeland
or
both
that
it's
really
not
a
problem,
there's
probably
a
perception
but
an
opportunity
for
improvement
as
well.
M
You
know
the
complaint
here
and
I
I
guess
from
your
perspective,
it'd
fall
in
the
category
of
of
perception
of
a
problem.
But
how
would
you
you
know,
don't
mean
to
put
you
on
the
spot
if
you're
uncomfortable
answering,
we
can
talk
properly
about
it.
But
how
would
you
assess
the
situation
and
say
we
can
improve
upon
it.
K
So
if
we're
talking
about
the
particular
situation
with
the
mother,
who
who
excuse
me
I
have
forgotten
her
last
name,
my
names
I'm,
not
good
with
them
with
her
son,
one
I'm
a
mom
to
two,
so
I
would
do
anything
for
my
children,
I
I
they're,
not
faulting,
her
at
all,
I
I'm
sure
she
has
very
legitimate
and
very
serious
concerns,
but
what
I
will
say
and
I
don't
know
a
ton
of
specifics,
because
that
would
be
a
HIPAA
violation,
for
you
know
that
provider
to
tell
me,
but
just
from
the
information
that
was
included
in
her
presentation,
I
can
say
this.
K
It
seems
like
her
son
and
Senator
Meredith.
You
may
remember
this
from
our
task
force.
All
about
these
services
are
what
has
what
we
call
Exceptional
needs.
He
has
significant
behaviors.
K
K
K
The
exceptional
supports
task
force
and
it
existed
in
the
interim
of
2020,
and
we
talked
about
it
a
bit
last
interim
during
the
1915
C
task
force
that
legislative
task
force
actually
talked
exclusively
about
these
individuals
that
are
in
need
of
just
more
intense
support
and
recommended
that
crisis
residential
crisis
services,
community-based
and
transition
Services
be
established,
or
at
least
you
know,
looked
at
how
to
establish
that
first,
obviously,
and
that's
something
that
we
are
strongly
in
favor
of,
we
think
that
that
is
the
real
Gap
in
the
system.
K
Currently,
that
currently
exists
and
really
I
mean
that
requires
funding.
This
is
not
faulting
anybody
for
not
having
established
that
yet
you
know
these
things
take
time
and
they
require
money.
But
really,
we
feel,
like
those
things
being
in
place,
would
have
really
significantly
benefited
this
individual
and
likely
been
able
to
keep
him
in
the
community
while
also
addressing
his
behaviors.
Maybe
if
he
was
in
crisis
any
of
those
you
know
extreme
situations
stabilize
him
and
help
him
find
a
better
residential
provider
that
more
suited
his
needs.
M
That
and
you
know,
I
think
we
identified
a
lot
of
gaps
there,
such
as
the
center
Higgins
question
about
the
you
know,
placing
a
patient
in
the
hotel
room.
I,
don't
think
it's
an
indictment
in
the
health
care
industry.
It's
we're
just
trying
to
deal
with
the
situation,
that's
very
fragmented
with
all
the
holes
in
it
and
we
can
use
these
as
opportunities
to
improve
upon
how
we
do
this
there's
always
opportunities,
and
when
we
get
things
like
this,
it
kind
of
makes
things
Bubble
Up
is
what
may
be
a
priority.
M
I
agree:
I,
don't
think
this
bill
is
the
answer
to
anything.
I
understand
the
intent
behind
it,
but
I
think
it
does
give
us
an
opportunity
to
again
look
at
this
situation
and
find
out
how
we
can
improve
it
from
the
residence
standpoint,
but
also
the
provider
standpoint.
I,
understand,
I'll
appreciate
the
tremendous
burden
we
place
on
Health
Care
Providers,
just
trying
to
do
their
job
and
I've
never
met
a
single
one.
M
That
really
didn't
have
the
best
interests
of
their
patient
or
resin
in
mind,
but
it
becomes
almost
impossible
to
meet
the
standards
that
we
we
expect.
Sometimes
so
I
appreciate
the
education
this
morning
appreciate
the
additional
information
I
think
there
are
some
opportunities
to
do
some
things
secretary.
You
mentioned
again
funding
that
possibly
we
need
more
in
inspectors
and
that's
again
the
way
we
work
probably
conversation
we're
going
to
have
to
have
next
summer,
as
under
budget
review
for
Human
Services.
M
But
if
that's
a
problem,
you
know
we
need
to
be
made
aware
of
it
doesn't
mean
we'll,
have
a
solution,
but
let's
we
can
have
it
on
the
boards
at
some
point
in
time
it
can
be
addressed,
but
I
think
when
the
primary
of
age
of
this
committee
is
we
learn
these
things
and
I
appreciate
your
testimony.
This
morning,
you
as
well
secretary
Lander.
G
Thank
you,
Mr
chairman
Amy
I'm,
just
trying
to
understand
exactly
on
on
how
this
all
works.
So
we
approve,
we
approve
additional
slots.
Every
year
seems
like
these
slots
and
that's
we
we're
just
appropriating
the
match.
These
are
actually
paid
by
Medicaid.
The.
G
So,
okay,
so
is
there
a
daily
rate
or
how
does
that
break
out
what
they.
G
K
It's
like
250
a
day
right
now,
it's
more
because
we've
got
some
really
great
Federal
money
and
coveted
flexibilities,
and
things
like
that
kind
of
in
place
that
has
allowed
the
cabinet
to
very
amazingly
and
generously
increase
these
payments,
but
yeah
it's
about
to
Mid
200s
a
day
and
the
individual
has
to
be.
You
know
in
the
home
that
day.
So
if
the
individual
goes
out
of
town
for
the
weekend,
that
provider
does
not
bill
for
those
Services.
Only
you
know
when
the
individual
has
been
in
the
home.
That
day.
G
The
the
we
talked
about
two,
the
additional
providers
that
they
they
see
in
a
day's
time-
are
those
Services
billed
to
Medicaid
additionally,
or
does
that
come
out
of
the
what
the
SLC
scl.
K
It's
all,
generally
speaking,
there
are
a
handful
of
services
that
do
get
billed
through
Medicaid
State
Plan
generally,
those
are
therapy-based
services,
but
there
is
a
menu
of
services
that
is
very
specifically
billed
through
the
scl
waiver.
That's
residential
case
management,
Community
Access
behavior
supports
supported
employment,
nutrition,
so
I
think
Psych
is
still
in
there.
I
think
it's
like
do
you
know
CCT.
H
K
Clinical
consultants
in
therapy
I
think
there's
some
psych
Services
still
available
through
the
waiver
and
I'm,
probably
missing
something
but
they're
all
built
separately
and
they
have
different
units.
So
residential
is
a
daily
basis.
Some
are
15
minutes.
It
kind
of
just
depends
on
what
the
nature
of
the
service
is
wonderful,.
G
K
All
homes
providers
some
are
owned
by
rental
companies,
but
the
Social
Security
Administration
requires
that
in
Eddie
who
receives
SSI
pay
their
fair
share
of
living
expenses,
and
if
they
don't
it
can,
their
SSI
check
can
actually
be
reduced.
These
rents
are
generally
below
market
value
and
it
covers
all
their
food.
All
the
cleaning
supply
actually
doesn't
even
cover
that,
but
it's
room
and
board
all
the
utilities.
It's
an
all-inclusive
cost,
that's
required.
K
G
K
No,
so
there
is
a
very
concerted
effort
to
make
sure
that
these
rent
payments
are
such
that
the
individual
retains
a
considerable
amount
of
spending
money.
In
fact,
I've
been
having
conversations
a
lot
of
people
in
these
programs
are
under
the
conservatorship
of
State
guardianship.
K
So
there
are
state
workers
that
make
sure
that
they're
being
getting
the
services
they
need
I've
had
lots
of
conversations
with
them,
in
fact
about
the
amounts
of
rent
that
they
will
approve,
and
they
are
very
conservative
and
they
make
a
concerted
effort
to
make
sure
that
individuals
with
disabilities
retain
a
lot
of
the
money
that
they
get
in
Social
Security
and
that's
primarily
spending
money
too,
because
they
don't
have
to
spend
any
money
on
anything
related
to
their
care
or
their
life.
Support.
G
H
N
K
C
Drives
confusion
around
Medicaid
and
it's
true
on
the
child
care
I'm,
not
you
know
the
child,
caring
facilities
and
dcbs.
It's
true
here.
It's
true
for
a
lot
of
different
providers
and
it's
something
that
I,
it's
simple
to
say,
but
it's
so
hard
to
figure
out
in
implementation.
Medicaid
can't
pay
for
room
and
board
like
prohibited.
So
a
lot
of
the
pieces
around
to
your
earlier
question
actually
around.
C
You
know
why
on
Earth
would
a
a
hospital
right
even
pay
for
a
hotel
room
right
well
and
part
of
it
is
because,
because
Medicaid
can't
in
that
situation,
so
it
it
adds
a
layer
of
complexity
around
Medicaid
reimbursement,
particularly
to
those
places
that
are
primarily
residential,
that
you
know
you
all,
and
even
you
know
when
I'm
sitting
thinking
why
on
Earth,
have
we
structured
this
payment
like
this?
Sometimes
it's
because
of
that
prohibition,
so
I
I
just
want
to
put
that
out
there.
It
is.
C
A
Senator
Carroll
he's
thank
you
very
much
to
both
of
you.
I
know,
you'll
be
sticking
around
Mr
secretary,
but
thank
you.
Miss
stayed
for
coming
to
present
to
us
today.
I
know
you
MS
state
lives
in
Boyle
County,
so
she
has
The
Misfortune
of
Being,
my
constituent
as
well.
So.
O
A
A
C
Good
okay!
So
when
we
do
the
caveats
first,
if.
C
This
is
a
very
similar
presentation
to
one
that
we've
given
to
another
committee.
It's
it's
really
close,
but
I
had
a
preamble
before
you
went
into
this
presentation,
and
that
Preamble
is
is,
is
this
at
at
this
point?
You
know
if,
if
we
were
I,
don't
know
how
deep
to
go
the
and
and
it'll
be
in
the
presentation.
The
house
joint
resolution
task
force.
C
57
talked
about
we're
talking
about
benefits,
glyph
right,
so
there's
been
a
lot
of
discussions
around
benefits
cliff
and
when
Medicaid
ends
and
when
the
exchange
picks
up
and
and
that
there's
a
there's,
a
big
difference
in
cost
and
that
that
that's
a
benefits
clip
and
in
talking
with
representative
Moser,
really
I
think
that
the
original
concept
was
around.
How
do
we
extend
the
business
side
of
health
care
right?
C
The
your
employer-based
HealthCare
coverage
down
to
meet
up
with
the
Medicaid
and
and
have
it
have
it
have
a
gradual
drop,
so
you
wouldn't
have
a
cliff
when
we
were
looking
at
it
and
how
we
have
looked
at.
It
is
a
little
more
like
how
do
you
extend
Medicaid
up
to
meet
the
employer,
Health
Care
coverage
right
and,
and
the
reason
for
that
is
there's
something
called
the
advanced
payment
tax
credit,
which
is
where
the
federal
government
essentially
gives
a
tax
credit
to
individuals
that
purchase
on
the
exchange.
C
C
So
that's
how
we
looked
at
it,
because
the
what
you're
a
similar
example
of
what
you're
doing
in
child
care,
where
you're
funding
something
under
a
house
before
499
with
State
funds
to
to
work
on
that
benefits
cliff
on
Child
Care,
would
probably
be
needed
to
hear
in
order
to
make
that
employer
spread
down
to
Medicaid.
C
So
this
is
the
development
we've
done
around
that
there
are
pros
and
cons.
We
are
not
announcing
that
we're
doing
it.
We
we
have
been
looking
at
it
again.
We
I
think
there's
a
a
an
executive
and
legislative
branch
disagreement
about
where
the
authority
is
and
and
I
we
have
talked
about
that
I
think
pretty
extensively,
and
but
I
don't
don't
hear
that
this
is
something
that
is
imminent,
because
it's
not
don't
hear.
C
This
is
something
that
don't
hear
it
that
way,
because
there
are,
there
are
pros
and
cons
and
so
and
they're
significant
and
I.
Don't
we
won't
shy
away
from
that
at
all,
so
this
is
just
if
we
were.
If
we
were
to
do
this.
This
is
what
it
would
take.
So
so
that's
the
spirit
with
which
we're
presenting
today
I
just
want
to
be
clear
about
that.
I
think
it's!
C
It's
helpful
to
start
knowing
start
from
that
perspective,
because
that
that
actually
is
exactly
where
we
are,
there
are
pros
and
cons.
There
are
reasons
and
two
and
reasons
not
to
and
and
pretty
potent
ones
on
either
side.
H
So
house
joint
resolution
57,
was
from
the
2021
session.
We
did
form
a
work
group
that
had
several
represent
representatives
from
across
a
wide
variety
of
organizations.
There
were
representatives
from
chfs,
of
course,
from
the
education
and
Workforce
Development
cabinet,
from
the
retail
Federation
Chamber
of
Commerce
and
two
representatives
from
the
House
of
Representatives
and
the
Senate.
H
So
the
joint
resolution
basically
directed
the
cabinet
to
establish
a
work
group
to
assess
the
feasibility
of
implementing
a
bridge
insurance
plan
and,
as
a
secretary
had
said,
that
was
just
a
bridge
insurance
plan
to
remove
those
individuals
or
to
assist
individuals
who
no
longer
qualify
for
Medicaid
because
of
their
income
So.
Currently
we
do
cover
adults
from
138,
138
percent
of
the
federal
poverty
level
and
below,
and
when
we
talk
about
138
of
the
federal
poverty
level,
we're
talking
about
18
755
a
year
for
one
person
that
is
pre-tax.
H
So
when
you
figure
in
taxes,
you
get
down
to
maybe
thirteen
fourteen
thousand
dollars
a
year
for
one
person
who
qualifies
for
Medicaid
and
again
before
tax
for
two
people:
that's
twenty
five
thousand
two
hundred
and
sixty
eight
dollars.
So
these
individuals
who
are
on
Medicaid,
if
they
get
a
slight
increase
in
their
their
payments,
their
their
employment,
they
would
just
one
dollar
I,
always
tell
if
it's
one
dollar
to
qualify
for
Medicaid
and
not
to
qualify
for
Medicaid.
H
So
if
they
get
one
dollar
over
that
138
percent
of
the
federal
poverty
level,
they
no
longer
qualify
for
Medicaid
and
it's
very
difficult
for
those
individuals
to
move
to
the
qualified
health
plan
or
commercial
carriers
through
their
employer
because
of
increased
out-of-pocket
expenses
related
to
co-payments,
coinsurance
deductibles
premiums.
So
sometimes,
unfortunately,
some
people
will
forego
a
raise
because
they
may
have
asthma
diabetes
or
some
Health
Care
condition
that
their
commercial
carrier
is
not
covering
in
full
or
does
not
supply
enough
services
for
I
know
that
we
know
diabetics.
H
There's
a
lot
of
talk
about
the
cost
of
insulin
and
it's
very
difficult
for
some
of
these
individuals
to
move
from
Medicaid
and
have
that
high
out-of-pocket
expense
if
they
get
just
a
25
a
month
raise.
So
that
was
the
whole
purpose
of
the
bridge
program.
So
we
did
look
at
the
basic
health
plan.
This
is
a
plan
that
has
that
several
other
states
have
implemented
specifically
New,
York
and
Minnesota.
H
There
are
some
other
states,
Oregon
right
now,
looking
at
a
basic
health
plan,
which
would
be
that
stepping
stone
for
Medicaid
to
the
qualified
health
plan,
so
the
basic
health
plan
would
be
right
in
the
middle
and
help
those
individuals
leave.
So,
as
we
were
working
through
house
joint
resolution,
57,
we
did
engage
with
milliman,
who
is
an
Actuarial
firm
who
assisted
us
with
bringing
up
some
feasibility
and
related
to
implementing
a
basic
health
plan.
H
So
some
of
the
findings
from
the
work
group
was
you
know.
Currently
we
do
cover
individuals
up
to
138
percent
of
the
FPL
and
just
as
I
have
talked
some
of
the
increases
can
result
in
a
sudden
loss
of
eligibility
for
programs
like
Medicaid,
which
would
then
interfere
with
individuals
receiving
their
health
care
services.
H
So
some
of
the
recommendations
from
house
joint
resolution
57
from
the
task
force
was
to
implement
a
basic
health
plan.
Again,
that's
what
we're
talking
about
here,
limit
the
cost
sharing
for
individuals
so
that
it
would
be
more
affordable
for
them
to
move
off
of
Medicaid
and
into
that
bridge
plan
or
that
basic
health
plan
prior
to
moving
into
a
qualified
health
plan
or
private
insurance.
If
they
could
afford
it
or
if
they
received
they
their
employer
offered
Private
health,
insurance
or
employee
sponsored
health
insurance.
H
We
would
have
to
submit
a
plan
to
outlining
all
of
our
basic
health
plan.
Services
to
lrc
by
July
1st
of
2022
has
passed.
We
would
some
of
the
other
recommendations
was
to
work
with
the
Kentucky
stats
to
refine
and
improve
our
benefits,
Cliff
tool
by
September
1st
and
then
to
continue
direct
lrc
to
continue
the
work
group
and
focus
on
the
child,
health
care
benefits,
cliff,
so
basically,
development
of
Kentucky,
the
the
basic
health
plan.
We
would
have
to
submit
a
blueprint
to
HHS
for
certification.
H
So
to
update
on
the
basic
health
plan.
Again,
we
have
engaged
melon
milliman
to
develop
and
help
Implement
a
basic
health
plan.
If
we
move
down
that
route,
we
are
looking
at
data
analysis
trying
to
find
out
exactly.
You
know
what
services
would
be
included
that
sort
of
thing,
so
we
still
have
some
upcoming
work.
The
biggest
task
would
be
the
blueprint
development,
stakeholder
engagement
and
the
public
comment
period,
so
estimated
cost
of
the
program
we
project
that
it
would
cost
238
million
dollars.
This
is
to
operate.
H
Funding
for
the
basic
health
plan
would
come
in
the
in
the
form
of
premiums
by
paid
for
by
the
members
and
the
95
percent
of
the
of
those
premium
subsidies
that
we
would
receive
from
the
federal
government
and
then
again
we
would
have
we
think
available
projected
26.3
million
dollars
in
available
funds,
so
in
the
projected
enrollment
is
between
40
to
75
000
individuals,
and
this
is
based
on
individuals
income
only,
but
it
could
change
due
to
Affordable
employer
coverage.
A
I
Thank
you
Mr
chairman,
and
thank
you,
commissioner.
I,
really
appreciate
all
the
work
that
you've
done.
It
was
I
thought
it
was
a
good
working
group.
We
we
had
some
really
good
discussions.
We
talked
a
lot
about
initially.
My
idea
was,
you
know
how
to
engage
Employers
in
in
participation
in
some
way.
You
know,
I
mean:
can
we
incentivize
employers
to
either
match
the
state
and
federal
subsidy
in
order
to
provide
a
benefit
to
their
employee?
I
You
know
and
and
create
some
loyalty
you
know
to
the
employer
and
also
provide
some
certainty
for
the
employee
and
and
also
you
know.
Part
of
this
process
was
to
look
at
a
benefit,
Cliff
tool,
modeling
program
and
so
I
guess.
My
question
is
I.
You
know,
I
I
haven't
seen
an
update
on
the
type
of
tool
that
we're
using.
I
Is
this
something
that
that
you've
contracted
with
someone
or
you
know
is?
Is
this
pretty
close
to
being
something
that
we
can
use.
C
Yeah
we've
been
working
with
Kentucky
stats
on
some
of
that.
They've
also
had
presentations
from
the
group
from.
C
Sorry
I
was
coughing
and
I
turned
it
off.
Yeah
we've
been
working
with
Kentucky
stats
on
it
and
I
think
we're
getting
closer,
but
we've
also
had
presentations
from
the
Georgia
Center.
C
Knew
Georgia
and
opportunities
was
in
there,
so
we're
continuing
to
work
with
actually
both
parties
at
this
point
to
see
where
we
end
up,
but
we're
a
lot
closer
on
getting
a
good.
It
just
has
to
be
interactive
right.
E
C
It
it
and
the
tool
we
have
currently
was
a
little
clunky
until
we're
continuing
to
work
on.
I
It
right
LOL,
so
you
know,
I
I
know
that
a
lot
of
what
we
talked
about.
Initially,
we
were
trying
to
get
creative
with
some
TANF
funds.
You
know
maybe
unobligated
and
we
can't
pay
for
premiums
out
of
that,
and
so
you
know
I'm.
This
is
the
first
time
I've
seen
these
actual
numbers
and
and
so
we're
we're
talking
about
some
premiums
from
individuals
and
I.
You
know
that
would
be
reflected
in
in
in
in
how
their
benefit
was
modeled
based
on
their
salaries
and
then
the
federal
subsidies
is
there.
I
D
C
I,
don't
know
if
it's
possible,
that's
probably
you
know.
While
you
saw
all
the
ifs
and
caveats
on
you
know,
clearly
we're
not
going
to
get
anything
filed
by
December
22nd.
E
C
22.,
but
it's
proven
difficult
I
mean
I.
Just
honestly,
it
is
how
to
work
around.
C
If
we
did
a
P3
I,
think
we'd
need
to
look
for
funding
and
in
order
to
to
offset
some
of
those
premiums
coming
back.
So
if
we
didn't
get
it
out
of
the
aptc,
we'd
probably
have
to
look
at
it
from
another
source
and
we
just
haven't
really
found
that
source.
D
H
Have
to
establish
a
trust
fund
in
order
to
put
those
funds
into
in
order
to
operate
the
program
going
forward.
M
C
C
As
you
know,
with
the
atrip
program
and
I'm
sorry
I'm
blending
all
sorts
of
initiatives
here,
but
that
hospital
reinsurance
program,
which
you
you
all
passed
and
we
implemented
it's
been
great-
we've
really
helped
hospitals,
I
think
survive
these
past
couple
of
years.
With
that
and
I
think
I
think
you'd
hear
at
the
same
team
in
the
hospital
Association
about
100.
One
of
the
challenges
on
implementing
is
that,
in
order
for
this
to
work
in
Kentucky,
the
hospitals
would
have
to
buy
in
and
that
110
isn't
enough
for
them.
C
Over
and
above
the
Medicaid
rates
and
they've
made
that
they've
made
that
clear
and
that's
why
I
have
discussion.
So
you
talk
about
stakeholders,
of
course,
they're.
Obviously,
a
big
stakeholder
and
and
they're
certainly
more
interested
in
the
at
this
point,
the
the
Medicaid
rate,
which
is
now
equivalent
to
the
average
commercial
rate
that
we
pay
on
a
quarterly
basis.
C
Then
they
then
they
are
about
the
110.,
and
if
we
went
above
110,
of
course,
there
would
be
a
anything
that
you
go
up
above
that
110
and
then
it's
still
negotiated
right,
so
it'll
be
different
for
different
providers,
but
anything
above
that
110
then
just
causes
you
to
have
to
have
to
drive
more
money
into
the
program
to
make
it
work.
M
E
M
What
does
that
do
and
doesn't
that
place
a
disproportionate
burden
on
Rural
providers
to
provide
disservice,
and
that's
probably,
where
these
recipients
are
going
to
be
most
pronounced,
is
in
rural
communities.
So
we're
going
to
have
take
a
different
look
at
that,
but
I
think
you
know
just
on
based
on
this
portion
of
testimony.
I,
don't
know
that
when
we're
close
to
implementing
this
program,
but
something
that
obviously
needs
to
be
be
a
priority
for
a
state
and
try
to
fix
it.
J
Thank
you,
Mr
chairman
I.
Don't
have
a
question
just
a
comment.
I
I
mean
I.
Concur
with
what
my
colleagues
have
said,
but
I
just
know
it's
very
important
to
my
constituents,
because
I
ran
into
so
many
young
women,
single
moms
that
want
to
work,
but
so
I
think
it's
a
very
important
project
that
needs
to
keep
moving
forward
and
appreciate
everybody.
That's
working
on
it
just
and
created
to
keep
doing
so.
Thank
you.
Mr,
chair.
A
Thank
you
and
I
just
had
a
comment,
so
it
looks
like
the
federal
government
will
be
covering
the
cost
of
this
predominantly
as
well
as
from
the
from
the
presentation
that
is
correct
and
that's
obviously
projected,
but,
but
that's
also
good
news,
I
I
would
I
would
think
so.
A
H
So
I
always
start
off
our
budget
presentation
with
our
Medicaid
at
a
glance
as
you
can
see,
we
are
currently
covering
1.69
into
million
individuals.
We
anticipate
that
going
up
to
1.7
in
the
very
near
near
future.
Again
we
cover
a
wide
variety
of
individuals.
We
cover
over
half
of
the
children
in
this
state
over
600
000
children
are
enrolled
in
the
Medicaid
and
Chip
program.
We
cover
adults
up
to
138
percent
of
the
federal
poverty
level,
again
18
754
dollars
per
year
prior
to
tax
after
tax
that
that
number
is
greatly
reduced.
H
We
have
over
69
000
enrolled
providers,
our
total
budget
and
state
fiscal
year.
2022
was
fifteen
one
fifteen
point
one
billion,
and
when
we
talk
about
our
covered
lives
and
Medicaid,
we
always
say
it's
nothing
to
boast
about.
That
means
that
1.7
million
individuals
in
this
state
live
at
or
below
the
federal
poverty
level
and,
have
you
know,
lots
of
challenges
other
than
their
health
care
services?
So
we're
glad
that
we
can
be
here
for
them,
but
again
nothing
to
boast
about
because
they
live
at
or
below
the
poverty
level
and.
C
C
We
can
talk
a
little
more
about
that
through
the
public
health
emergency,
but
the
second
is
who's
coming
on
the
rolls
and
what
we're
finding
is
most
of
these
folks
are
coming
on
with
with
what
is
called
the
expansion
population
and
what
that
means
is
they're,
the
folks
that
have
jobs
but
are
not
getting
paid
enough
to
to
to
fall
outside
and
to
be
above
the
Medicaid,
which
kind
of
relates
back
to
this
basic
health
plan.
But
what
we're
seeing
is
the
folks
that
are
coming
on.
H
And
so
just
a
little
snapshot
of
our
budget
today
you
can
see
the
21
22
actual
what
we
have
budgeted
for
23
and
24,
based
on
General
funds,
restricted
federal
funds
and
the
total.
So
you
can
see
a
slight
increase
each
year
as
we
go
forward
back
to
this
one.
So
you
can
see
our
budgeted
for
2023
is
15.2
billion.
H
Today
we
have
spent
4.9
billion,
that's
about
32
percent,
so
we
do
think
that
we're
on
track
to
be
and
stay
within
our
budget
through
this
state
fiscal
year,
barring
any
unforeseen
tragedies
our
Medicaid
benefits
budget
is
broken
out
by
several
areas.
You
can
see
that
Managed
Care
is
the
biggest
piece
of
the
pie
here
and
if
you
look
down
in
the
left
hand,
corner
you'll
see
that
fee
for
service
is
about
three
billion
dollars.
That's
our
individuals
in
long-term
care
mainly
are
individuals
in
long-term
care
facilities
and
our
waiver
program.
H
So
that's
less
than
about
10
percent
of
our
population.
That
accounts
for
almost
21
percent
of
the
costs.
In
the
Medicaid
Program
again,
approximately
22
percent
of
our
Managed
Care
payments
are
related
to
directed
payments.
These
are
those
payments
that
we
as
the
department
and
in
collaboration
with
this
agency
too
this
this
body.
We
have
set
payments
for
mcos
to
pay
certain
providers.
When
we
do
that,
that
is
called
the
directed
payment.
H
We
are
directing
the
mcos
to
pay
those
providers
a
certain
amount
of
money
when
we
do
that,
we
have
to
receive
approval
from
CMS
on
an
annual
basis.
We
also
tie
quality
measures
to
those
directed
payments
and
you
can
see
that
in
20
you
can
just
see
the
payments
from
20
to
23.
the
hospital
rate,
Improvement
program
or
atrip.
You
can
see
that
that
is
resulted
in
2022
that
resulted
in
over
one
billion
dollars
in
in
additional
cost
and
reimbursement
going
to
the
hospital
providers.
We
have
our
ambulance
Assessment
program
2022.
H
We
also
have
six
Medicaid
waiver
programs
and
they
experienced
a
90.9
million
increase
in
total
expenditures
in
state
fiscal
year,
2022
I
think
in
the
first
presentation
you
heard
Miss
State
talk
about
some
of
the
additional
funding
and
reimbursement
that
is
going
into
the
waiver
programs
based
on
rules
at
the
federal
level
and
some
of
the
flexibilities
that
we
have
due
to
the
public
health
emergency
that
allows
us
to
increase
payments
to
those
providers
and
then,
president,
in
the
request
for
our
presentation,
we
had
a
request
to
talk
about
anticipated
future
Appropriations
right
now.
H
We
believe
that
the
only
way,
the
only
Appropriations
that
we
would
need
in
the
future,
if
there
is
legislation
in
the
2023
session
that
directs
Medicaid
to
increase
provider,
reimbursement
or
add
Services,
we
will
need
an
additional
Federal
fund
appropriation
for
State
fiscal
year
2023
due
to
the
increased
6.2
percent.
Federal
Federal
matching
I
forget
exactly
what
fmap
stands
for,
but
that's
the
federal
funds
that
we
get
to
cover
services
in
the
Medicaid
Program,
but
we
are
currently
receiving
6.2
percent.
C
So
you
saw
a
trip
and
what
that
meant
right.
A
lot
of
that
flowed
to
bigger
Urban
hospitals
because
it
really
is
based
on
inpatient.
C
So
the
reason
you
saw
so
much
more
money
going
to
the
universities
is:
they
have
also
that
same
reimbursement
methodology
for
outpatient,
so
I
know
that,
and
we've
been
working
with
the
hospital
Association.
We
are
all
you
know
we're
in
we're
in
step
with
them
holding
hands
whatever.
However,
that,
however,
you
want
to
say
that,
but
that
would
also
be
essentially
doubling
what
we
would
do
for
inpatient
for
for
hospitals
except
outpatient,
Senator
Meredith.
C
This
a
lot
of
your
questions
around
parole
and
assistance
in
the
rural
outpatient
would
would
flow
the
opposite
direction.
You'd
have
a
lot
more
funding
on
that
outpatient
side
go
into
rural
hospitals
than
you
have
on
the
inpatient
side,
so
this
would
balance
out
that
reimbursement
methodology.
So
that's
why
we
put
it
out
there.
It's
it's!
A
big
number,
so
we
would
need
some
appropriation
flexibility
with
that
and
as
always,
what
what
we've
said
to
a
lot
of
providers
and
again
I
I,
think
I've
said
it
here.
C
I'll
probably
say
it
at
every
committee:
I
I
speak
to
if
we
find
and
can't
find
the
the
state
matching
funds,
not
general
fund
to
to
help
our
providers
with
reimbursement
rates,
I
feel
like
we
should
take
advantage
of
it,
and
so
that
outpatient
is
a
way
to
do
it
because
the
hospitals
pay
the
state
match
on
it.
C
So
I
just
say
that
for
you,
that's
what
that!
That's!
What
that
top
one
means
and
I
just
wanted
to
like
be
as
clear
as
possible.
H
So
Public
Health
Emergency
related
changes
that
did
have
an
impact
on
the
budget.
We
were
asked
to
present
some
of
these
and
whether
they
were
mandatory
or
optional.
So
you
can
see
one
of
the
biggest
changes
is
the
nursing
facility,
29
add-on
per
bed,
and
that
was
mandatory
per
the
state
budget.
Bill
we
paid
the
long-term
care
facilities,
an
extra
144
million
dollars
in
Medicaid
reimbursement
in
2022.
We
believe
that
we
will
be
on
target
to
either
meet
or
exceed
that
that
dollar
amount
as
we
move
forward
to
move
to
2023.
H
So
you
can
see
that
254
million
dollars
has
been
added
to
the
Medicaid
budget
from
20
20
to
to
current,
based
on
that
nursing
facility
add-on.
We
also
provided
nursing
facilities,
a
270
dollar
add-on
for
coveted
positive
patients.
You
can
see
that
number
spiked
in
2021.
It
was
reduced
in
2022
to
7.6
million.
To
date
we
have
spent
3.3
million
and
we
think
that
you
know
we
we're
on
target
to
either
meet
or
exceed
what
we
reimbursed
in
22
22
with
that
270
dollar
add-on.
H
Of
course,
that
is
an
optional
change,
coveted
bed
Reserve
increase.
We
did
that's
an
optional
change.
We
did
increase
the
number
of
days
that
facilities
could
hold
their
beds
when
individuals
went
into
a
hospital
before
they
they
returned
to
the
nursing
home.
We
also
did
a
hospital
drg
or
diagnosis
related
grouper.
We
have
a
20
percent
discharges.
This
is
in
our
fee
for
service
area,
and
you
can
see
that
that
was
an
additional
overall
14.5
million
dollars.
Of
course,
that
is
optional.
H
Also,
we
did
make
some
other
Public
Health
Emergency
related
changes
that
we
believe
would
have
a
small
impact
if
any
on
the
budget.
So
one
of
the
changes
that
we've
made,
that
is
mandatory
per
Federal
rules,
is
our
maintenance
of
Eligibility
effort.
You
may
also
hear
that
referred
to
as
as
may
just
as
maintenance
of
of
effort,
but
it
is
the
maintenance
of
Eligibility
effort
or
maintenance
of
enrollment.
You
may
hear
it
as
maintenance
of
enrollment,
but
it's
maintenance
of
Eligibility.
H
Basically,
the
federal
government
says
that
we
have
to
maintain
coverage
for
anyone
who
is
in
the
program
that
was
in
the
program
beginning
with
a
public
health
emergency
until
the
public
health
emergency
ends.
So
therefore,
our
enrollment
has
not
been
changing.
We
have
it
kept
individuals
enrolled
in
the
program.
The
only
way
that
we
can
remove
someone
from
the
Medicaid
Program
is
if
they
request
to
be
disenrolled
if
they
move
out
of
the
state
or
if
they
pass
away.
H
If
we
do
not
maintain
the
eligibility
through
the
public
health
emergency,
we
would
have
to
return
all
of
the
enhanced
funds
that
we
have
received
thus
far
for
and
that's
that
6.2
percent
for
operation
of
the
program,
some
other
flexibilities
that
were
optional
was
Telehealth.
We
have
always
had
Telehealth
services
available
and
we
do
pay
parity.
H
Air
Telehealth
services
are
reimbursed
at
the
same
rate
as
the
provider
would
receive
if
they
were
seeing
an
individual
in
person,
but
with
covid
with
some
of
the
foot
traffic
that
was
reduced
in
those
provider
offices,
we
found
that
there
was
an
increase
in
Telehealth
Services,
particularly
with
Behavioral
Health.
We
do
plan
to
keep
many
of
the
optional
Telehealth
Services.
We
are
work
that
were
not
in
place
prior
to
to
the
public
health
emergency.
For
example,
we
have
to
ensure
that
providers
deliver
services
on
a
HIPAA
approved
platform
during
covid.
H
Those
platforms
were
relaxed
a
little
bit
to
allow
services
to
be
provided
by
Zoom
or
teams
or
FaceTime.
So
we
are
still
waiting
on
recommendations
for
from
the
federal
government
government
to
see
if
we
can
continue
those
platforms
again,
we
waived
a
requirement
on
the
limit
of
inpatient
beds
to
25
for
critical
access
hospitals.
We
waived
a
face-to-face
visit,
New
Physicians
orders
and
medical
necessity,
documentation
for
individuals
who
had
to
replace
some.
H
C
What
I
want
to
say
is
there
are
things
that
we
learned
through
this
public
health
emergency
and
things
that
got
implemented.
That
I
think
are
really
good.
The
Telehealth
piece
on
the
behavioral
health
side,
in
particular
and
in
a
lot
of
different
places,
has
been
very
important,
and
it's
probably
taken
us
forward
20
years
where
we
should
have
been
already
the
the
second
piece
on
that
not
on
here,
but
we
waived
prior
authorizations
on
substance
use
and
Behavioral
Health.
C
When
we
look
at
the
impact,
it
has
been
relatively
insignificant.
So
that
is
something
we're
we're
looking
to
keep
it
on,
because
we
know
we
know
we
have
so
many
challenges,
particularly
around
substance
use
that
it
would
feel
counterproductive
to
the
point
of
almost
foolish
to
put
prior
authorization
back
for
substance
use
in
particular
and
behavioral
health,
because
we
know
we
know
what
we're
seeing
so
there
are.
There
are
those
kinds
of
changes
that
we
didn't
even
know.
C
We
could
do
we
didn't
know
and
we
did
it
and
I
think
it
is
actually
an
improvement
that
we
know
we
can
carry
out
over
the
long
term.
So
there
are
some
learnings
that
we've
had
and
I
think
they're
really
really
positive.
C
So
I
just
wanted
to
say
that
and
and
happy
to
take
questions
on
the
budget
side
of
it.
A
M
When
I
came
to
sin
in
2017,
our
Medicaid
budget
was
10
billion
dollars
and
I
said
then
that
it's
as
large
as
it
ever
should
be,
and
I
still
take
that
position,
that
15
being
as
large
as
it
ever
should
be
I
think
the
Hallmark
of
any
Governor
I,
don't
care
which
part
it
is,
should
be
how
many
people
we
have
on
medical
assistance.
You
know,
40
percent
of
our
population
on
medical
assistance
is
nothing
to
be
proud
of
proud
that
we're
able
to
provide
that
service.
M
But
again
it's
nothing
to
be
proud
of,
and
I
think
we
have
to
work
diligently
to
get
people
back
to
gain
from
employment,
but
also
improve
the
health
of
their
population
and
I.
Think
that
lack
of
accountability
on
the
proof
of
Health
populations,
where
we
miss
a
great
opportunity,
I
agree
with
you
wholeheartedly.
Covid
was
certainly
a
learning
experience
for
us.
M
I
brought
some
new
opportunities
like
Telehealth,
which
we
had
been
hesitant
to
do,
but
I
think
it
also
emphasized
how
fragile
the
health
care
delivery
system
is,
particularly
for
Rural
Kentucky
and
continues
to
be
and
I,
don't
know
how
long
we
can
continue
this
game
of
of
growing
watermelons
for
a
dollar
and
you
can
only
sell
them
for
50
cents.
So
how
is
Medicaid
expansion
going
to
place
additional
Financial
burdens
on
the
the
fragile
state
of
the
delivery
system?
M
I'm
concerned
about
the
well
I'll
celebrate
the
50
men
that
we've
realized
from
single
Source
PBM.
Doing
that
a
particular
sense
of
when
we
first
talked
about
it.
Everybody
said
no,
no!
No!
It's
going
to
cost
us
millions
and
millions
and
obviously.
E
M
So
what
good
does
it
do
to
say
we're
going
to
provide
you
with
this
coverage,
but
you
can't
find
coverage
that
having
Health
Care
coverage
is
not
commensurate
with
having
Access
to
Health.
Care
has
became
more
pronounced
and
you
know,
as
Dr
stack
acknowledged.
Our
networks
are
not
presently
adequate,
even
though
the
mcos
tell
us
that
there
are.
But
when
are
we
going
to
try
to
address
this
inadequacy
in
payment
and
we
have
that
opportunity
if
you
got
50
million,
you
know
50
million
here,
50
million
error,
and
suddenly
you
start
to
address
that
problem.
M
But
we
have
to
do
that
and
we're
not
making
that
effort.
I
still
say
a
great
opportunity
in
improving
the
health
of
the
population.
I
think
there's
Millions
upon
millions
of
dollars
in
savings
there.
But
again
we
don't
have
a
system
in
place
really
to
hold
the
people
who
have
that
responsibility
accountable
and
I
wish.
M
We
did,
but
also
the
administrative
burden
that
we
place
on
providers
and
much
of
the
testimony
we've
heard
throughout
this
summer,
with
our
communicated
oversight,
but
also
our
Task
Force
is
is
crushing
providers,
particularly
in
the
smaller
providers,
and
when
are
we
going
to
try
to
address
that
and
make
this
part
of
this
entire
equation,
which
we
should
we
spend
two
to
three
times
as
much
as
other
industrializations
on
Health
Care
and
that's
inexcusable.
It's
because
we
have
too
much
administrative
expense
in
Kentucky.
M
We
lack
toward
reform,
which
is
also
very
I,
think
disproportionate
burden
on
Rural
providers
and
we've
got
a
bit
of
accountability
in
the
system
which
we
haven't
done,
but
we're
not
taking
I
think
an
overall
view
of
this
of
how
we
can
really
make
this
program
work
and
we
can't
but
I,
don't
think
we're
being
aggressive
enough.
H
Don't
think
that's
a
question
that
I
can
answer
in
this
form.
I
think
there's
a
lot
that
goes
into
the
Medicaid
payments,
but
when
I
look
at
Medicaid
as
a
program
again
we're
covering
1.7
billion
people
in
this
state.
Typically,
commercial
carriers
negotiate
their
reimbursement
rates
based
on
the
volume
of
individuals
that
they
serve
the
more
individuals
that
they
serve
the
lower
their
reimbursement
rates
and
again,
I
think
without
an
in-depth
study
on
how
Medicaid
really
does
compare
to
commercial
carriers.
We
know
we're
getting
the
commercial
rate
in
the
hospitals,
but
sometimes
I.
H
E
M
Not
adequate,
we
know
they're
not
adequate.
We
only
pay
a
percentage
of
cost
and
there's
no
one
to
ship
that
cost
to.
So
that's
the
Paradigm,
the
problem
that
we
that
we
face
and
it's
it's.
It's
growing
I
appreciate
your
discussion
about
the
outpatient
payment
rate
that
we've
got
to
do
for
for
hospitals
that
will
benefit
rural
hospitals,
so
I
hope
our
committee
members
are
paying
attention
to
that.
We
really
need
that
legislation
in
this
next
session
to
get
that
accomplished
and
that
will
help,
but
that's
not
going
to
cure
the
problem.
M
You
know
always
I'll
focus
on
administrative
expense
as
well.
We
heard
a
presentation
and
appropriation
Revenue
last
week
about
our
Kentucky
employee
health
plan.
Administrative
costs,
I
believe,
is
about
three
and
a
half
percent,
but
on
the
Medicaid
side,
we're
spending
close
to
15
16
percent
for
Administration
in
this
program.
M
C
I
do
and
I
do
appreciate
your
perspective
and
and
share
a
lot
of
it.
The
other
piece,
particularly
around
rates
and
services
Medicaid,
covers
things
that
waivers
right.
Who
else
covers
those
kinds
of
services?
It's
it's
Medicaid.
If
it
wasn't
for
Medicaid,
there
wouldn't
be
Services
right
for
individuals
with
with
significant
developmental
intellectual
delays
right
those
waivers.
Nobody.
C
That
nobody
else
covers
substance,
use
to
the
extent
that
Medicaid
covers
and-
and
you
can
even
say
the
same
thing
about
a
lot
of
Behavioral
Health
pieces.
Now,
that's
that's
the
interface
between
private
and
public,
and
you
know
what
what?
What
is
safety
net
there's
a
whole
lot
of
discussion
around
that
as
well,
but
it
it
is
just
also
to
acknowledge,
particularly
when
talking
about
services
and
rates,
that
there
are
services.
C
C
M
To
another
point,
you
know
part
of
the
discussion
we
had
was
the
number
of
commercial
insurance
companies
that
provide
coverage
in
Kentucky
and
there's
only
two,
but
yet
we
have
six
willing
to
write
Medicaid.
M
Why
is
that?
Well,
the
answer
is
quite
obvious
that
the
profit
margin
for
them
is
much
greater
on
the
Medicaid
Program
than
this
commercial
insurance.
Why
would
we
let
anybody
participate
in
the
men's,
Care
Program,
if
they're
not
also
providing
a
commercial
insurance
policy
for
the
general
public?
Why?
Why
did
we
allow
that.
C
Do
that,
like
an
answer
to
you,
I
I,
because
we
haven't
required
it
and
I
I'm
I
think
it's
a
I
I'm
all
for
encouraging
folks
to
to.
M
E
C
That
the
other
point
where
I
make
this
is
where
we
talk
about
the
single
PBM
and
that
we've
been
able
to
increase
the
dispensing
fee
up
to
the
10
50,
whatever
it's
supposed
to
be
per
per
prescription
and
I
I
knew
we
had
gone
too
far
when
I
saw
at
a
large
commercial
chain.
I,
don't
know
if
I
said
it
to
you.
I
meant
to
a
picture
of.
We
welcome
Medicaid
patients
and
I
thought.
Oh
we've
gone
too
far,.
A
Have
sir,
thank
you.
Thank
you.
Thank
you.
What
has
the
number
been
for
general
fund
savings
shifting
to
a
single
PBM.
C
Have
that
I
was
just
since
it
was
budget,
sure,
I'm,
sorry,
I.
A
Took
no,
no,
that's
I
was
just
following
up
on
your
on
your
statements,
so
Senator
Alvarado
has
a
question.
Thank.
P
You
Mr
chairman,
and
thank
you
all
just
on
this
discussion
and
I
know:
we've
had
these
discussions
privately,
but
I'm
going
to
put
them
out
now
publicly
Mr
secretary,
so
I
like
in
a
lot
of
the
budgetary
issues
to
be
like
if
you
owned
a
home
right.
P
The
first
thought
wouldn't
be.
Let
me
added
another
room
to
the
house,
because
I
have
extra
money
come
in,
you
I
think
the
normal
thing
would
be
I'll
fix
the
roof,
I'll
fix
the
plumbing
fix
the
HVAC
fix
the
floor.
It's
got
the
hole
in
there.
We've
got
people
waiting
on
Michelle,
P
waivers
that
are
have
been
waiting
for
years.
I
mean
I
was
just
approached
not
even
a
week
or
two
ago
saying
please.
My
kid
is
still
waiting.
P
I
was
hanging
out
candy
for
trick
or
treat-
and
this
is
a
kid
that's
been
waiting
for
years-
can't
get
off
of
it
a
lot
of
money
every
year,
but
it's
never
enough
for
that.
We've
talked
about
providers
not
getting
paid
enough.
Seventy
percent
of
the
docs
I
know
now
are
basically
owned
by
Hospital
systems
and
they're
employed,
so
I
mean
the
days
of
when
you
know
the
profit
margin,
I
had
per
visit,
and
that
was
a
really
tight.
P
Medical
Practice
was
about
two
dollars
a
visit,
so
they
made
on
Medicaid
four
people
an
hour,
eight
bucks
an
hour,
that's
what
I
mean
as
a
doctor
gross
that's
without
the
taxes
I
had
to
pay.
You
saw
folks
as
a
service
to
your
community
and
the
people
that
needed
it.
Those
are
all
probably
gone,
but
if
you
want
to
know
what
a
comparable
rate
would
be,
I
wouldn't
say,
commercial
rates
were
not
going
to
match
that
Medicare
rates.
Maybe
if
you
can
achieve
to
that
role,
Indiana
does
a
lot
of
that.
P
They've
hit
Medicare
rates
with
their
Medicaid
Program
doctors
there
like
hey.
This
is
awesome.
This
is
great
and
you
can
attract
a
lot
more
docs
to
the
state
and
providers
to
the
state,
if
you're
having
something
comparable
to
that,
so
I
would
argue
increasing
those
rates,
reducing
Michelle
P
waiver
slots.
P
You
know,
I
talked
about
dental
visits
and
dental
reimbursement
for
providers.
Lots
of
opportunities
to
fix
our
house
currently
before
we
build
on
an
addition.
Do
I
want
to
have
an
extra
room.
I
think
we
all
would
like
to
see
extra
Services.
We
all
want
to
see
those
things
done,
but
we
got
to
go
into
proper
order,
and
so
when
this
announcement
came
out
with
the
extra
funding
I
mean
I
had
those
providers
who
would
say
hey
this
would
be
something
I
would
do.
P
Why
would
I
want
to
do
those
if
I'm
not
getting
paid
adequately
for
the
other
services
that
are
there
right
now,
so
I
would
just
argue
I,
don't
think
I
disagree
with
wanting
to
expand.
It.
Add
the
house,
the
addition
to
the
house.
We
have
problems
with
the
house
right
now.
Let's
fix
that,
let's
reduce
it.
It
would
be
a
dream
to
be
able
to
say:
let's
get
down
those
waiver
rates,
get
people
back
on
and
get
get
that
list
down
to
zero.
P
First,
then,
we
add
on
these
extra
services
for
folks
that
are
out
there,
I
mean
our
EMS
provider.
Is
another
group,
I
mean
EMT,
you
know
we
talk
to
them
in
our
communities
and
they
don't
have
enough
funding
to
provide
transportation,
and
that
leads
to
lots
of
cascading
problems
within
the
Health
Care
system
too.
So,
as
as
savings
are
found,
and
it's
great
that
we've
got
those
we're
going
to
hear
more
about
that
here
and
not
all
of
it's
been
used.
P
So
I'd
like
to
know
what
we're
planning
to
use
the
other
remaining
amounts
that
are
still
there,
because
I
would
argue,
we
may
have
to
tell
you
what
to
do
with
those
funds,
and
that
would
be
something
I
would
like
to
see
if
we're
not
going
to
do
it
for
the
things
to
fix
the
current
home,
so
I
just
wanted
to
put
that
out
with
the
question
I
would
have
is
if
we
have
a
certain
amount,
that's
been
you
that
we
have
coming
in
from
pbms
we've
allotted
it
for
some
expansion,
there's
remaining
amounts.
C
So
I
we've
had
this
discussion,
so
okay,
so
I
is,
is
it's
where
where's
the
whole?
You
know
I
mean
there
are
a
lot
of
them.
Clearly
missing
teeth
is
a
huge
piece
to
Kentucky
and
also
about
getting
back
to
work
right
same
with
hearing
same
with
vision.
It
I
hear
what
you're
saying
and
it
could
be
a
difference
in
emphasis.
The
the
medic
getting
up
to
Medicare
rates
for
Physicians
is
is
a
big
dollar
amount
same
with
same
with
eliminating
waiting
lists,
I'm
happy
to
provide
that.
C
So
it's
it's
a
lot
about.
What
can
you
do?
Yeah
that
can
be
sustainable
and
we've
had
that
discussion.
I,
think
I've
had
the
discussion
here
and
and
at
Health
and
Welfare
I
I.
You
know
I,
don't
like
doing
stuff
that
that
isn't
sustainable,
right
and
and
I
feel
like
this
is,
and
so,
but
again
we
get.
We
get
to
have
disagreements,
that's
that's
part
of
this
process
and
which
I
welcome.
P
But,
to
your
point
also
I
mean
this:
the
purpose
of
Medicaid
is
to
handle
those
populations
and
other
commercial
insurance
rate.
Don't
don't
provide
that.
So,
if
that's
the
main
core,
if
those
are
the
folks
that
they're
the
the
people
that
have
the
most
problems,
that
Medicaid
was
designed
for
Let's
help.
Those
folks
is
my
argument.
That
would
be.
My
plea
is,
if
you
have
people
on
those
waiver
lists
that
have
been
waiting,
I
mean
for
years.
We
struggle
to
get
that
number
down.
P
Let's
target
that
first,
even
if
we're
not
going
to
get
them
all
off,
but
I
would
say
reduce
that
by
a
thousand
people
would
be
a
dream
to
get
those
many
folks
out
there
and
it's
going
to
be
sustainable
to
be
able
to
help
those
folks
out.
That's
my
two
cents.
That's
all
I
want
to
say
thank
you,
Mr
secretary.
Thank
you.
I
Thank
you,
Mr
chairman
and
yeah
I
mean
this
is
a
big
conversation
and
and
Senator
Alvarado
covered
a
lot
of
what
I
wanted
to
say
about
just
improving
increasing
reimbursement
to
Providers.
The
government
governor
recently
announced
that
we
are
expanding
Medicaid
for
dental
and
vision.
I
Don't
we
already,
oh,
is
that
in
the
next
okay,
all
right
well,
I
mean
I'll.
Let.
I
It
then,
but
you
know,
I'm
interested
in
you
know
kind
of
the
same
thing.
I
mean
we
have
providers
who
are
willing,
but
the
reimbursement
has
not
been
adjusted
for
I,
don't
even
know
how,
a
year,
many
years,
10
years
it
hasn't
been
increased
at
all,
and
so
you
know
it's
back
to
that
same
argument
about
how
do
you
get
coverage
for
people?
You,
you
improve
what
your
providers
are,
are
being
reimbursed
and
and
increase
their
willingness
to
participate.
They
can't
go
to
work
and
volunteer
every
day.
So
that's
my
two
cents.
Thanks.
H
The
restroom
presentation,
thank
you,
vision,
being
a
dental
adult
benefits,
so
Medicaid
currently
limits
coverage
of
vision,
hearing
and
dental
for
adults.
We
have
to
cover
a
broad
array
of
services
for
children
under
21
due
to
the
early
periodic
screening,
diagnosis
and
treatment
benefit
or
the
epsdt
benefit.
We
did
add
some
new
services
or
we
will
be
adding
new
services
to
promote
Workforce
participation
and
improve
overall
health.
So
I
will
tell
you
that
just
recently,
I
received
after
this
announcement
was
made.
I
did
receive
an
email
from
a
dentist
in
Eastern
Kentucky.
H
Who
was
very
grateful
that
these
Services
were
being
added.
He
told
me
that
he
treats
a
lot
of
individuals
with
substance
use
disorder
and
that
their
oral
hygiene,
their
teeth
just
just
horrendous.
He
did
send
me
a
picture
of
an
individual
who
had
been
in
recovery.
He
did
have
to
pull
her
teeth.
He-
and
this
is
one
of
the
the
great
dentists
that
we
have
out
there
committed
to
the
Medicaid
Program.
He
helps
this
individual
he
reached
out.
H
He
got
grants
he
for
her
to
have
dentures
and
then
she
was
able
to
smile
and
she
got
a
job
and
she
is
in
recovery,
and
those
are
the
success
stories
that
we
want
to
hear
and
we
think
that
we
are
going
to
be
hearing
as
we
move
forward,
because
we
currently
do
not
cover
Dentures
for
adults.
We
cover
Dentures
for
children
under
21.,
so
beginning
January,
1st
of
2023.
We
will
be
covering
two
cleanings
per
year
for
adults,
because
we
only
cover
one
cleaning
per
year.
H
Now
for
adults
we
will
be
covering
root,
canals,
crowns
and
Dentures.
We
want
to
help
individuals
have
that
smile.
We
want
them
to
be
able
to
keep
their
teeth
instead
of
just
paying
for
extractions.
We
will
be
covering
hearing
aids,
which
is
something
that
we
we
could
have
been
covered
under
the
durable
medical
equipment,
with
some
changes
that
were
made
at
the
Federal
level,
so
that
is
allowable.
We
will
also
be
covering
glasses
or
contact
lenses
for
individuals
over
age,
21.
H
and
the
reimbursement
for
new
dental
benefits
will
mirror
the
child
specific
fee
schedule
for
dental.
So
what
this
means
is,
we
currently
have
two
different
fee
schedules
for
children:
I
mean
for
for
dental
services.
We
have
one
for
children
and
one
for
adults.
The
child
Dental
fee
schedule
is
higher
in
for
most
cases
for
most
procedures,
then
the
adult
we
increase
that
a
few
years
back
in
hopes
to
increase
access
for
dental
services
for
children.
H
This
is
just
a
national
study
that
was
done.
That
shows
Medicaid
reimbursement
as
a
percentage
of
private
insurance
for
child
dental
services,
and
you
can
see
that
Kentucky
is
the
highest
reimbursement
for
a
for
child
dental
services
in
the
country.
The
average
is
for
Medicaid
reimbursement
for
dental
services
is
about
61.4
percent
of
private
insurance.
This
is
a
decline
from
2017,
but
basically
Kentucky
is
the
highest
at
104.8
percent
of
the
federal
fee
of
the
commercial
fee
schedule
for
dental
services.
H
State
Medicaid
coverage
of
dental
benefits
Kentucky
has
expanded,
such
as
to
align
with
some
of
our
neighbors,
such
as
Illinois
and
Ohio,
who
cover
a
very
wide
array
of
adult
Dental,
Services,
again
designed
to
help
individuals
with
their
oral
hygiene.
We
also
know
that
oral
health
is
directly
related
to
some
other
health
conditions,
such
as
heart,
disease,
Coral
or
poor.
Oral
health
can
also
lead
to
spontaneous
miscarriages
in
pregnant
women.
H
It
is
a
very
important
service
and
when
we
want
to
treat
the
entire
person,
we
have
to
look
at
their
oral
hygiene
also
and
make
sure
that
we
are
doing
what
we
can
to
help
them
improve
their
overall
health
and
dental
is
a
huge
piece
of
that.
Just
wanted
to
show
you
some
of
the
top
10
dental
procedure,
codes
that
were
billed
to
Medicaid
into
the
2021
session.
The
top
code,
of
course,
is
orthodontic
treatment
and
then
cleanings
for
children,
and
you
can
see
that
cleanings
for
adults
are
numbered
on.
H
So
when
you
look
at
the
count
of
Medicaid
members
actually
using
these
Services,
you
can
see
that
only
203
000
individuals
in
Medicaid
went
to
get
their
teeth
cleaned
in
2021
the
the
savings
from
a
house
bill
or
Senate
bill
50.
As
the
secretary.
O
H
D
D
Q
Q
Okay,
I
just
wanted
to
focus
on
a
little
bit
of
the
good
news
for
for
a
second
and
that
you're
talking
about
the
huge
impact
of
the
Telehealth
expansion
and
the
huge
well,
what
what
may
be
a
huge
impact
of
down
the
line
of
waiving
the
prior
authorization
for
medication,
assistant,
treatment
for
substance,
abuse
and
I
was
so
struck.
When
you
said
we
didn't
know,
we
could
do
this,
and
so
I'm
just
wondering
if
this
experience,
if
there
are
other
things
that
you've
thought.
Q
C
I
think
those
are
the
biggest
ones
that
we
have
seen
I.
Think
then,
following
up
on
that.
Well,
it
really
is
about
how
we
proceed
into
the
future
or
on
on
on
rates
and
structures
and
where
our
next
piece
is
I
think
those
are
just
the
reason.
I
say
we
didn't
know,
we
could
do
them
and
let
me
just
be
clear
about
that
and
you
always
you
all
will
I
mean.
That's
that's
part
of
the
interaction
of
this
committee
as
well.
C
You
know
we
had
always
heard
that
it
was
a
budget
Buster
right
same
thing
for
single
PBM
right.
Oh
it's
a
budget
Buster.
We
can't
do
it,
we
can't
do
it,
we
can't
do
it
and
hopefully
we
were
able
to
figure
that
out
together
and
it
was.
C
We
were
figuring
out
together
a
couple
of
years
ago,
because
I
think
it'd
been
stonewalled
for
many
years
and
decided
to
take
a
risk
and
that
risk
proved
worth
it
and
I
would
say
the
what
we've
done
on
no
prior
authorizations
for
substance
use
and
Behavioral
Health
is
a
risk.
It's
going
to
go
through
the
roof
right.
That's
what
we
hear
it's
going
to
go
through
the
roof,
what
really
didn't
go
through
the
roof,
so
we
were
able
to
do
it.
Telehealth,
oh
it'll,
horrible
it'll,
be
horrible
care
right,
it'll
be
horrible
care.
C
Well,
we
found
out
it
wasn't
horrible
and
it
was
really
helpful
and
particularly
in
rural
areas,
where
we
didn't
have
the
type
of
Highly
qualified
providers,
Specialists,
I'm,
sorry,
whoops,
don't
talk
with
your
hands
Eric
the
Specialists
that
we've
been
able
to
to
bring
to
bear
in
places
where
we
didn't
have
them
before.
And
you
all
know,
transportation
is
a
huge
issue
right
and
so
we're
looking
at
that
we're
looking
at
Transportation,
absolutely
there's.
There's
the
non-medic
non-emergency
medical
transportation.
That
I
think
we
we
need
to
think
about.
C
C
C
We
thought
it
would
just
be
impossible
because
of
cost
or
complexity,
and
we've
been
able
to
do
some
of
that,
and-
and
we
just
need
to
continue
to
look
look
for
those
opportunities,
I
think
again,
some
of
the
things
that
we're
talking
about
reimbursement.
How
do
you
make
it
sustainable?
All
of
those
kinds
of
things
are
are
challenges,
but
those
are
the.
There
are
good
news.
There's
a
lot
of
good
news
here,
I
think
Senate
bill
50
that
we
didn't
think
we
could
do
that
now.
C
We've
been
able
to
do
and
actually
show
a
savings
for
the
rest
of
the
country.
Right.
We
are
the
leader
here
for
the
rest
of
the
country.
They
are
looking
for
to
us
for
how
we
do
this
right.
That's
a
great
story
and
it's
a
story
of
partnership
right
and
I.
Think
that's!
That's
also
I
I
I,
like
that
part
of
the
story.
O
O
Q
Totally
different
topic,
but
thank
you
for
that
wonderful
answer.
You
mentioned
the
number
of
Medicaid
recipients,
adult
Medicaid
recipients,
who
are
employed.
The
percentage
and
I
missed
that.
Could
you
say
that
percentage
again.
H
National
studies
show
that
of
the
Medicaid
members
who
can
work
but
are
not
working.
Only
seven
percent
of
the
population
who
can
work
are
not
working,
so
the
vast
majority
of
the
Medicaid
members
are
working.
Other
members
may
be
taking
care
of
of
individuals,
but
that
National
study
shows
that
seven
percent
are
not
working.
Q
C
That's
in
the
expansion
side
of
Medicaid
has
a
job.
They
have
to
have
some
sort
of
income
in
order
to
be
considered
in
that
part
of
the
population.
We
can
get
you
that
number.
Unless
Steve
you
have
it
at
the
top
of
your
head.
Okay,
we
can
get
you
that
thank.
A
P
A
Yeah
Senator
Alvarado
thank.
P
You
Mr
chairman,
so
to
your
point,
Mr
secretary
I
mean
all
the
things
we
were
scared
to
do.
Telehealth
prior
author
mat,
PBM
reform,
all
initiatives,
representative,
Moser
and
I
I
mean
members
of
our
of
the
general
assembly
kind
of
push
for
a
lot
of
those
things.
P
So
I'm
glad
you
mentioned
that
because
there's
others
that
will
be
watching
this
committee
hearings,
who
are
still
scared
to
move
on
to
the
things
reduction
to
the
number
of
mcos
people
are
worried
about
that
I
think
that's
a
good
idea
that
Senator
marath
has
proposed
several
times.
Apcd
we've
talked
about
tort
reform.
We
have
a
lot
of
lawyers
who
think
that's
impossible.
We
can't
do
that.
It'll
destroy
the
judicial
system,
all
frightened
of
change
when
it's
present
in
so
many
other
states.
P
You
know
prior
off
just
across
the
board
to
reward
doctors.
All
those
things
are
ideas,
I,
think
that
can
save
time
and
money
to
your
point
on
Senate
bill
50,
not
only
for
the
country
but
for
commercial
payers
in
this
state
and
if
it's
reflected
within
Medicaid,
what
can
be
done
also
on
a
commercial
side.
P
So
yes,
the
whole
country
is
going
to
watch
and
say,
hey
they're,
going
to
look
at
these
numbers
and
say
we
need
to
do
the
same
thing,
but
then
also
for
the
remainder
I
mean
this
Supply
is
just
beyond
Medicaid.
Folks
is
our
commercial.
You
know
a
lot
of
people
are
worried
about
the
cost
of
Health
Care,
and
where
is
it?
This
is
one
of
the
things
that's
increasing
the
cost
of
health
care
and,
if
it
produces
it
for
you
that
can
be
passed
on
to
Consumers
as
well.
So
all
those
things
are
important.
P
I
appreciate
that,
and
sometimes
fear
holds
us
back
fear
of
change
and
a
lot
of
good
ideas,
a
lot
of
things
that
we
bring,
that
none
of
us
want
to
see
things
that
destroy
the
system
of
health
care,
but
I
think
ideas
that
are
needed
and
so
happy
to
hear.
You
say
that
and
like
I
said,
we've
we've
got
some
other
ideas,
we're
hoping
to
get
through.
So
we're
hopeful
that
now
that
that
barrier,
it's
always
good
to
be
cautious,
but
not
to
be
as
fearful.
So
thank
you.
A
Thank
you,
and
so
we
have
a
90-day
notice
as
to
when
the
public
health
emergency
will
end
from
the
federal
government.
Is
that
right.
C
I
think
the
way
well
I
know
the
way
there
was
budget
is
we
were
expecting
the
public
health
emergency
to
go
away
last
March,
yes
right!
So
we're
right
at
that
window
of
if
they
were
gonna
end
it
in
January.
We
should
start
to
know
because
it's
60
days
so
we're
starting
to
see
some
federal
noise
that
maybe
it
gets
extended
another
three
months
but
I
I,
don't
I've
worked
for
government
a
long
time,
I,
don't
believe
it
until
I
have
the
paper
signed.
C
So
we
don't
have
that
paper
signed
yet
so
it
would
just
we're
in
a
wait
and
see
mode
on
that
right
now.
It's
scheduled
for
for
January,
okay,.
H
Is
our
room
by
12,
30.
I
think
this
is
our
last
our
last
presentation,
our
last
topic,
so
we
were
asked
to
present
on
transitioning
members
in
from
Managed
Care
organizations
to
fee
for
service
who
are
covered
by
other
insurance
or
third-party
liability.
So
we
have
identified
approximately
approximately
90
000
individuals
who
are
enrolled
in
managed
care
who
also
have
other
insurance
that
has
been
identified
in
our
system.
H
So
what
this
means
is
mcos
are
required
to
report
and
verify
their
third
party
or
individuals
who
have
other
insurance
and
sometimes
their
data
file
errors.
So
some
of
that
information
is
not
as
accurate
as
it
should
be.
H
We
don't
believe
we're
still
looking
into
some
of
those
data
transfers
files
and
getting
some
information
from
our
mcos
to
see
where
the,
where
we
believe
the
errors
may
be
or
how
accurate
the
information
is,
and
we
do
believe
that
in
fee
for
service,
we
have
a
robust
and
accurate
system
for
identifying
those
individuals
with
other
insurance.
We
would
could
reduce
administrative
burden
on
some
of
their
providers,
particularly
for
those
individuals
who
may
have
Medicare,
because
not
all
insurance
covers
everything
that
Medicaid
does
so,
particularly.
This
is
true
for
Behavioral
Health.
H
So
if
a
provider
delivers
a
service
to
someone
who
has
Medicare
or
maybe
even
commercial
insurance,
and
that
insurance
doesn't
cover
that
benefit,
they
that
provider
has
to
submit
a
denied
claim
to
Medicaid
in
order
for
us
to
consider
paying
the
claim
to
make
sure
that
we're
the
payer
of
Last
Resort.
So
in
those
instances
where
commercial
or
Medicare
does
not
cover
Services,
we
have
a
bypass
list
that
makes
sure
that
they
can
send
that
claim
directly
to
this
to
our
system
rather
than
having
to
file
a
claim
with
another
insurance
company
unnecessarily.
H
We
do
think
there
would
be
some
cost
savings
because
of
the
capitation
rate
versus
the
claim,
expenditures
that
we
have
examined,
and
we
would
also
leverage
our
Integrated
Health
insurance
premium
payment
program.
This
is
a
program
in
which
Medicaid
pays
premiums
for
individuals
who
have
Commercial
Insurance
rather
than,
and
then
we
we
pay
the
wraparound
services
for
those
individuals.
Basically,
we
pay
the
premium,
and
then
there
are
other
insurance
company
is
responsible
for
the
bulk
of
their
cost,
except
for
services
that
are
not
covered
by
their
commercial
insurance.
H
We
would
exclude
those
members
in
serving
Kentucky
youth.
Those
are
our
foster
care
children
who
are
enrolled
with
Aetna
in
the
sky
program,
so
they
would
be
excluded
from
that
third
party
liability,
just
just
to
give
you
just
a
graphic
on
States
who
are
that
already
carve
out
individuals
who
are
in
who
have
other
insurance
from
their
fee
for
service
into
if
an
individual
has
other
insurance
and
they're
enrolled
in
Managed
Care.
These
states
carve
them
out
and
put
them
in
fee
for
service.
C
And
so
we
were
rolling
down
this
road
to
pull
folks
to
pull
the
folks
in
third
party
liability
from
the
mcos
right
into
into
fee
for
service,
and
so
I
talked
about
getting
over
my
fears.
But
now
here's
some
place
where
I
have
to
tell
you
where
I'm
still
scared,
and
it
was
the
argument
for
at
least
delay,
which
was.
Are
you
sure
you
want
to
do
this
at
the
time
you're
probably
going
to
do
Medicaid
unwind
and
that
sent
a
chill
will
be
quite
honest.
C
Medicaid
online
could
begin
in
in
in
February.
That's
redetermination
for
hundreds
of
thousands
of
people
a
month
for
Medicaid
and
I
will
tell
you
I'm
scared
to
death
of
it.
It
is
a
huge
undertaking
for
dcbs
and
eligibility
workers
across
the
Commonwealth.
C
I
am
very
I,
am
not
transparent
with
y'all.
If
I
don't
tell
you
I
I'm
the
the
increase
in
workload
and
how
I
know
we're
struggling
with
our
lines
and
responses
on
snap
and
damn
and
all
sorts
of
things
adding
that
on
top
has
me
extremely
nervous,
and
that's
we'll
still
look
at
this,
and
there
was
some
concern
about.
C
Does
our
data
match
their
data
and
do
we
know
why
it
doesn't
match
and
I
didn't
want
to
introduce
something
else
and
I'll
own
it
that
that
could
have
upset
a
system
at
the
time
when
that
system
was
going
to
be
upset
and
so
I
I'll
own
it
I
still
will
maintain
I.
Believe
it's
a
good
idea.
It
just
might
not
be
a
good
idea
right
now
and
I
just
want
to
be
completely.
You
know,
so
you
know
why
I
I,
like
the
idea
but
I
just
I,
couldn't
see
it.
C
A
C
Sending
Meredith
if
I
may
and
then
I'm
sure
you
will
speak
on
this.
What
I
will
say
to
you
all
that
this
is
just
years
of
being
around
Medicaid?
So
don't
don't
hear
this
as
any
one
Administration,
any
one
party
any
you
know
this
is
this:
is
more
executive
legislative
area
right,
any
general
fund
dollar
that
comes
out
of
Medicaid
this
year
next
year?
C
What
we've
done
too
often
is
say:
well,
we
can't
pay
these
rates
anymore
right,
I,
I
implore,
you
all
to
think
about
by
leaving
funding
in
Medicaid,
even
if,
even
if,
even
if
it
looks
like
a
sizable
chunk
moving
forward,
what
you're
doing
from
a
structural
perspective
is
making
that
next
binding
of
budget
a
whole
lot
easier
to
do
than
if
you're
trying
to
replace
dollars
that
are
sitting
there.
Now
that
you're
just
going
to
have
to
replace
in
a
year
or
two,
that's
that's
awesome.
Sorry
can.
A
We
identify
can
we
identify
and
accredit
the
number
of
general
fund
savings
from
the
extension
of
the
public
health
emergency.
O
C
Is
what
is
that
number
we're
working
on
it
right
now?
I
personally
believe
that
we
are
up,
probably
over
a
billion
in
federal
funds.
I
mean
that
was
the
Kaiser
estimate.
I
think
that's
not
a
bad
estimate
when
you
look
at
a
month-to-month
basis
on
the
extension
of
Public
Health
Emergency,
it's
probably
in
the
neighborhood
of
50-ish
million
a
month.
It
changes
from
month
to
month
it
changes
based
on
the
it
changed
on
a
lot
of
based
on
a
lot
of
different
things,
but.
P
C
M
Just
someone
you
don't
have
to
answer
my
question:
no
just
to
acknowledge
and
secretary
freelander's
concerned
apprehension
about
the
new
territories
venturing
into
the
unknown,
but
I'll
share
with
you
that
the
a
coward
dies,
a
thousand
deaths,
but
a
very
man
dies
about
one.
So.
A
C
Absolutely
and
if
I
may
Aetna
and
the
sky
program.
M
Chair
for
we
proceed,
I
know
we're
going
to
start
losing
members
just
want
to
acknowledge
again,
which
you
started
our
meeting
with
this
kind
of
historic
moment
that
this
is
the
last
meeting,
Medicaid
oversight
because
of
legislation
we
passed
the
last
session
and
that
doesn't
mean
that
these
duties
and
responsibilities
are
going
to
go
away.
We're
just
looking
at
formulating
them
in
a
different
committee,
possibly
and
on
the
Senate
side.
We
already
have
a
committee,
that's
going
to
be
families
and
children
and
I
think.
M
The
discussion
we've
had
today
emphasized
the
need
to
elevate
the
responsibility
of
this
committee
to
a
standing
committee
level
because
we
overwhelm
Health
and
Welfare
with
with
so
much
from
both
child
protective
services
that
we
have
in
in
Medicaid
oversight.
But
I
want
to
thank
everyone.
Who's
participated
on
Medicaid
oversight
over
the
over
the
years
and
Senator
Alvarado
used
to
be
chair
of
this
as
the
representative
Moser
and
did
a
great
job.
M
But
you
know
we
really
tackle
some
sorts
of
issues
here
and
we
need
really
to
look
at
something
different
and
one
of
the
recommendations
that
came
out
of
our
task
force.
The
task
force
for
looking
at
reorganizing,
Health
and
Welfare
is
to
look
at
ourselves.
Is
there
a
better
way?
We
can
do
it
more
efficient
way
to
do
it.
M
So
that's
why
this
committee
will
be
going
away,
but
we'll
be
bringing
it
back
in
form
of
a
standing
committee
and
at
least
I
know,
that's
going
to
happen
on
the
Senate
side
and
I
hope
the
house
side,
but
again
just
one.
Thank
you,
everyone
for
their
contributions
to
Medicaid
advisory
and
oversight,
and
also
the
staff
who
does
such
an
Adventist
job
I
know
they'll
be
kind
of
repurposed
as
well,
but
I
really
want
to
acknowledge
that
and
how
invaluable
they
are
to
us
and
doing
our
work.
M
But
I
didn't
want
this
historic
moment
to
go
away
without
acknowledging
that
this
is
an
important
work
that
we
do
here
and
thank
you
all
that
you
do
and
from
my
party
note,
is
representative
prunty
who
will
be
leaving
in
this
term
and
she's
been
a
great
friend
but
a
great
resource
on
this
committee
as
well,
and
just
want
to
wish
her
the
best
in
the
future.
M
A
You
and
I
would
Echo
those
comments
very
well
said
into
my
colleague,
representative
princi.
We
have
enjoyed
serving
with
you
and
wish
you
well
and
with
that
you
can
introduce
yourself
and
please.
L
L
And
we
appreciate
the
opportunity
to
come
before
you
today
and
Senator
Meredith
appreciate
your
comments.
There
were
the
the
last
group
to
sit
in
front
of
this
committee,
so
hopefully
we
we
go
out
on
a
high
note
here.
L
We
know
that
you've
heard
from
each
of
the
other
five
Medicaid
Managed
Care
organizations
throughout
this
interim
session
on
the
the
topics
that
are
on
the
screen
right
now
and
we
will
be
speaking
to
that
same
agenda.
However,
as
it's
been
referenced,
we
are
unique
in
that
we,
in
addition
to
the
the
contract
that
we
hold
to
provide
traditional
Medicaid
services
to
people
in
Kentucky.
L
We
also
hold
a
second
contract
for
supporting
Kentucky
youth,
which
serves
children
who
are
in
out
of
Home
Care,
Juvenile,
Justice
custody,
former
Foster
Youth
and
those
who
have
been
adopted
from
foster
care.
It's
a
program
that
we
are
really
proud
of,
and
we're
going
to
weave
some
some
points
and
some
outcomes
through
each
of
the
topics
today,
as
we
work
through
our
presentation
very
quickly
to
be
mindful
of
your
time,
so
Kelly
is
going
to
give
a
quick
overview
of
sky
as
we
kick
off
here.
Thank.
O
You
Paige
so
as
she
mentioned,
we
were
selected
as
a
single
Source
contract
to
manage
the
sky
program,
which
essentially
means
those
children
receive
their
Medicaid
coverage
through
Aetna.
But
in
addition
to
covering
their
Medicaid
benefits,
we
provide
a
really
high
touch
approach
to
Care
Management.
So
we
certainly
wanted
to
call
that
out.
O
This
approach
really
helps
Children
and
Families
navigate
all
of
the
systems
that
they're
involved
in
and
make
it
easier
for
them
to
get
the
resources
that
they
need
prior
to
joining
Aetna
when
they
were
awarded
this
contract,
I
came
from
the
provider
side.
I
worked
as
a
provider
of
these
children
for
12
years,
so
I'm
really
passionate
about
this
program,
passionate
about
doing
things
differently.
O
That
will
yield
positive
outcomes
for
these
kids
and
as
I
talk
about
Sky
I,
always
like
to
ground
folks
in
what
our
purpose
is
in
that
program,
and
it's
to
incorporate
those
youth
voice
and
choice
into
every
decision
that
we
make
here
at
Aetna
to
improve
those
long-term
Health
outcomes
for
those
kids
to
achieve
safety
and
permanency
and
then
to
reduce
psychotropic
polypharmacy.
As
our
system
involved,
youth
tend
to
be
prescribed.
O
Psychotropic
medications
disproportionately
and
as
I
talk
about
Sky
I,
always
talk
about
a
success
story
to
really
ground
folks
and
forsake
a
time
I'll
be
quick
with
this
one.
But
this
is
a
kiddo
that
has
been
placed
in
psychiatric
residential
treatment
and
has
been
in
that
setting
for
quite
some
time.
We
see
that
with
the
Acuity
of
our
youth
that
they
tend
to
languish
in
more
of
an
inpatient
setting,
which
you
know,
results
in
children
not
getting
to
really
live
a
normal
life.
O
Our
kiddo
here
had
CP
and
also
was
diagnosed
with
autism
spectrum
disorder
and
one
of
the
benefits
of
our
program
is.
We
have
a
robust
support
system
that
we
wrap
around
our
kids
and
one
of
those
supports
is
peer
support
specialist
and
we
assign
this
particular
member
a
peer
support,
specialist,
her
name's
Grace,
and
she
really
became
to
know
this
member
intimately
and
really
found
out
that
he
had
a
love
for
the
police
actually
was
really
interested
in.
O
You
know
tremendous
gratitude
to
the
peer
support
for
coordinating
that,
as
did
the
youth
and
KSP,
and
we
just
really
want
to
hit.
We
know
we
have
additional
resource
and
support
in
sky
and
our
sole
purpose
is
really
to
build
those
relationships
to
collaborate
with
these
different
agencies
and
to
advocate
for
all
of
our
members
that
may
be
in
these
different
and
unique
levels.
Care.
L
In
addition
to
the
nearly
30
000
children
that
we
serve
in
Sky,
we
have
220
000
members
across
the
state
of
Kentucky
who
are
in
our
traditional
Medicaid
population,
I'm
from
Madisonville
so
being
from
a
small
community
in
Western
Kentucky
has
informed
my
understanding
of
the
unique
needs
of
Medicaid
population
and
and
the
population
that
we
serve
on
a
daily
basis.
We
also
have
nearly
250
staff
spread
across
the
state
who
have
that
same
understanding
and
desire
to
serve
this
population.
L
So
moving
into
to
the
topics
I
know,
we've
heard
a
lot
about
Network
adequacy.
There
is
a
state
reporting
that
we
submit
based
on
the
the
calculations
and
the
functions
we
do
have
a
compliant
network.
With
the
parameters
of
that
report,
we
also
do
surveys
on
a
quarterly
basis,
using
a
statistically
significant
sample
of
our
our
Network
to
test
the
availability
and
appointment
access.
L
However,
we
recognize
when
we
go
to
the
next
slide,
that
that
does
not
always
tell
the
the
whole
story,
and
so
we
do
dig
a
layer
deeper
through
a
different,
a
couple
of
different
mechanisms
to
to
test
the
true
adequacy
of
our
Network.
L
Often
we
will
receive
a
request
from
a
member
to
change
their
MCO
and
the
reason
for
that
is
their
provider
doesn't
accept
Aetna
the
provider
of
choice,
and
when
we
get
that
report
from
through
our
our
grievance
system
or
through
our
member
services
team,
we
refer
that
immediately
to
Pro
to
our
provider
relations
team.
To
do
some
research
and
figure
out.
What's
happened
here.
Why
is
this
provider
in
network
with
us?
We
have
a
contract
with
them,
but
they're
not
seeing
our
members
and-
and
we
go
try
to
fix
that.
L
We
really
do
want
to
make
sure
that
we're
being
responsive
to
those
things
we
don't.
We
were
not
happy
that
it
gets
to
that
point
before
we
maybe
are
aware
of
it
and
are
addressing
it,
but
we
do
want
to
fix
it
at
that
point.
So
we
want
to
repair
that
relationship,
hopefully
bring
the
provider
back
to
a
place
where
they
feel
like
they
are
the
our
partner
and
and
support
the
members
so
that
they
can
see
their
provider
of
choice.
L
Similarly,
we
run
claims
queries
on
a
regular
basis
to
see
who
is
in
network.
Who
do
we
have
a
contract,
that's
loaded
in
our
system,
but
is
not
billing
us,
which
would
indicate
to
us
obviously
that
they're
not
seeing
Aetna
members,
and
then
we
do
the
exact
same
analysis
we
Outreach
to
those
providers
to
say
is:
is
there
something
going
on
here
that
we
can
correct
that
we
can
fix
so
that
you
would
be
willing
to
see
our
members
again?
L
Additionally,
from
having
this
guy
contract,
we
have
some
additional
opportunities
to
expand
access
for
that
particular
population.
Kelly
will
hit
on
that
pretty
quickly
here
and.
O
In
particular,
we
notice
that
there
is
a
gap
in
providers
being
willing
to
accept
Medicaid
for
members
that
have
autism
spectrum
disorder,
and
so
we
worked
to
provide
training
and
also
the
necessary
kits
for
those
providers
to
be
able
to
evaluate
children
with
autism
and
also
diagnose
them
and
then
provide
those
Services.
We
started
this
in
2022.
It's
been
successful,
we're
continuing
to
put
investment
into
this
area
in
2023.
O
In
addition
to
that,
we
are
also
interested
in
equipping
our
network
with
the
experience
to
be
able
to
serve
these
youth
in
sky,
but
also
for
our
traditional
population
and
an
example
of
that
was
our
investment
to
create
some
access
to
evidence-based
behavioral
health
therapy
and
in
2022
we
partnered
with
The
Healing
Tree,
which
is
a
local
non-profit
organization.
That's
dedicated
to
training
clinicians
and
becoming
certified
in
EMDR,
which
is
a
particular
evidence-based,
behavioral
health
treatment
that
helps
people
heal
from
trauma.
We
were
able
to
train
181
therapists
throughout
the
Commonwealth.
O
We
collected
quite
a
few
testimonials
as
you
see
one
here
on
the
screen,
and
we
in
in
this
coming
year,
going
to
be
contracting
with
those
providers
to
collect
outcomes,
measures
for
our
Aetna
members
and
engage
in
some
pay
for
Quality
agreements.
So
we
can
maximize
their
reimbursement
with
us,
and
you
know
we
want
to
highlight
this.
Certain
Lee
is
an
intervention
that
is
near
and
dear
to
our
heart
for
our
Sky
members,
but
is
something
that
is
applicable
to
the
entire
population
and
the
Commonwealth
who
suffer
from
the
devastating
effects
of
trauma.
R
Now
we'll
discuss
some
of
the
specific
initiatives
that
we
have
put
forth
in
the
population
to
improve
health
outcomes,
I'm
appreciative
of
the
opportunity
to
share
our
story
today.
I'm,
a
clinician
with
my
roots
in
public
health
and
I,
just
feel
very
fortunate
to
have
a
career
that
allows
me
to
elevate
the
health
of
the
community
that
I
live
in.
So
let's
give
a
little
bit
of
context
to
how
we
evaluate
outcomes
as
a
Managed
Care
Organization.
We
evaluate
ourselves
using
a
standardized
set
of
measures
that
are
put
forth
nationally
through
an
accreditation
body.
R
So
it's
the
same
set
of
standards
that
every
Managed
Care
organization
within
the
state
and
nationally
are
evaluated
on.
So
we
are
looking
at
those
very
critically
year
over
year
to
understand.
Where
are
we
succeeding?
Where
are
we
stagnating
and,
most
importantly,
where
do
we
need
to
direct
more
resource
to
improve
so,
in
addition
to
benchmarking
ourselves
year
over
year,
we're
looking
at
our
national
performance?
So
how
do
we
compare
nationally
for
those
specific
set
of
measures?
And
you
can
see
that
here
where
we
are
outperforming
national
average?
R
So
as
an
incumbent,
MBA
MCO
we've
been
in
the
market
since
Managed
Care
Inception
over
a
decade
ago.
We've
got
plenty
of
data
over
time,
and
one
of
the
areas
that
has
been
and
will
continue
to
be,
a
focus
for
us
is
diabetes.
We
know
it's
costly,
it's
also
a
quality
of
life
burden
for
our
members,
who
are
trying
to
manage
a
complicated
condition
among
the
other
social
needs
that
they
have.
R
So
we
looked
at
our
data
to
see
how
are
we
performing
in
making
sure
that
our
members
with
diabetes
are
getting
the
necessary
testing
and
treatment
that
they
need
to
understand
the
progression
of
their
disease?
A
few
of
the
lovers
that
we
have
as
a
Managed
Care
Organization
are
value-based
contracts
that
we
have
with
our
providers,
trying
to
make
it
very
easy
for
our
providers
to
understand
which
of
our
members
are
in
need
of
these
necessary
services.
R
So
we're
sharing
monthly
providers
in
addition
to
having
quarterly
jocs
where
we
sit
at
the
table
and
strategize
around
you
know,
how
can
we
make
the
Healthy
Choice
the
easy
choice
for
these
members?
In
addition
to
that,
we
have
quite
a
few
value-added,
Services
non-covered
benefits
that
that
we
provide
to
our
members,
because
it's
the
right
thing
to
do
things
like
medically
tailored
home,
delivered
meals,
post
discharge.
We
have
remote
patient
monitoring
tools,
we
talked
a
lot
about
Telehealth
and
how
that
can
close
that
access
Gap.
R
So
our
members
are,
are
they
have
a
blood
pressure,
cuff,
a
glucometer,
a
weight
scale
at
home
and
those
those
measurements
and
readings
are
being
shared
with
our
clinicians
and
back
with
their
providers
that
we
can
intervene
at
those
important
time
points
we
do.
We
have
seen
some
decrease
in
Ed
and
inpatient
costs
related
to
those
programs
and
we're
seeing
clinically
relevant
outcomes
in
terms
of
a
decrease
in
chronic
kidney
disease.
R
I
think
it's
important,
obviously
for
us
to
help
those
who
have
diabetes,
but
we've
got
a
large
population
in
the
state
who
have
pre-diabetes
and
that
precursor
to
diabetes,
which
we
know
is
preventable.
So
we
do
Focus
efforts
again
value-based
Contracting,
Care
Management
Outreach
to
making
sure
that
our
youth
are
getting
the
well-child
visits
that
they
need
so
that
they
can
have
those
conversations
with
their
providers
around
weight,
nutrition
and
physical
activity.
R
There
you
go
emergency
department
utilization,
so
some
of
the
initiatives
that
we
have
to
improve
the
appropriate
utilization
of
services
and
make
sure
that
our
members
are
are
not
ending
up
in
a
crisis
situation
needing
the
emergency
room.
We've
parsed
this
data
out
by
physical
and
behavioral
health
because
we
are
seeing
two
different
Trends
physical
health
related
visits
are
on
the
decline,
we're
seeing
a
shift
towards
higher
Acuity,
which
would
suggest
that
our
members
are
having
more
appropriate
Ed
utilization.
R
Obviously,
there's
an
impact
of
covet
in
here
we
haven't
rebounded
to
that
level
of
pre-pandemic
Ed
utilization.
One
of
the
keys
here
is
using
the
near
real-time
data
that
we
have
access
to
things
like
the
Kentucky
Health
Information
exchange,
the
homeless
management
information
system.
So
we
can
see
where
our
members
are
in
the
universe
and
intervene
when
it's
appropriate.
R
We'll
talk
a
lot
about
the
really
Innovative
and
fun
things
that
we
do
in
Sky,
it's
sort
of
an
incubator
for
us
where
we
can
test
these
ideas
in
a
high
Touch
model,
and
then
we
borrow
those
best
practices
in
our
traditional
line
of
business
and
that's
exactly
what
we're
doing
with
some
of
the
interventions
with
Ed.
Unfortunately,
our
Behavioral
Health
visits
for
emergency
room
use
are
are
going
the
opposite
direction.
This
tracks
nationally.
R
We
take
very
seriously
the
fact
that
we're
seeing
an
increase
in
suicidal
ideation
diagnoses,
presenting
to
the
Ed
we've
got
campaigns
out
to
parents
of
of
Youth
on
our
programs
to
understand
the
signs
and
symptoms
of
depression
and
suicidal
ideations.
We
also
have
some
mobile,
apps
and
Tech
tools
for
our
members
to
interact
with
that.
Do
depression
and
loneliness
screenings
we're
onboarding
about
100
members
a
month
for
those
programs
and
we
are
seeing
a
decrease
in
those
depression
and
loneliness
scores.
O
And
so
one
of
the
data
points
that
you
see
in
BH
right
is
the
rise
in
Acuity
and
we
do
have
the
sky
membership.
So
we
know
that
that
is
a
factor
in
that
data
and
I
just
like
to
ground
folks
and
who
is
a
sky
member
with
Aetna.
We've
got
about
28
000
children
and
young
adults
that
we're
serving
in
Sky
about
a
third
of
those
are
children
who
are
presently
committed
to
the
department
for
community-based
services
and
in
foster
care.
O
But
we
do
have
a
large
portion
of
our
membership
that
have
been
formally
adopted
and
we
serve
former
Foster
youth
up
to
the
age
of
26,
as
well
as
children
who
are
involved
with
the
department
for
Juvenile
Justice.
We
see
through
our
claims
data
that
62
percent
of
our
Sky
members
have
a
claim
for
Behavioral
Health
diagnoses,
but
that
percentage
we
believe,
is
much
higher.
As
I
noted
earlier.
There
is
complexity
in
terms
of
billing
practices
and
children
who
are
actually
placed
in
dcbs,
residential
or
Therapeutic
Foster
Care
are
receiving
services
from
those
agencies.
O
We
don't
necessarily
get
a
claim
for
that
to
be
able
to
represent
their
behavioral
health
Acuity.
So
I
just
wanted
to
point
that
out.
I
think
that
percentage
is
much
higher
and
eight
percent
of
our
Sky
members
are
hospitalized
each
year
for
a
behavioral
health
condition,
but
I'd
like
to
note
that
the
bulk
of
those
60
of
those
are
actually
children
who
are
in
out
of
home
care,
so
those
kids
who
are
in
foster
care.
O
Presently
we
see
that
five
percent
of
our
members
are
visiting
the
Ed
for
a
behavioral
health
condition
each
year
and
presently
we
have
.046
percent
of
members
placed
out
of
state
that
actually
equates
to
14
kids
presently
today
and
in
terms
of
our
program,
I
could
spend
hours
talking
about
sky
and
all
of
the
work
that
we
have
going
on
on
the
ground.
But
I'll
highlight
a
couple
of
things.
We
have
that
high
touch
approach
to
Care
Management
we've
got
over
200
staff
dedicated
to
this
line
of
business.
O
The
bulk
of
those
individuals
are
actually
care
managers
that
have
experience
with
children
who
are
system
involved
and
they
reside
throughout
the
nine
different
dcbs
service
regions
in
the
state,
and
they
are
providing
a
more
integrated,
Care,
Management,
Service
and
I
think
you
would
traditionally
see
with
the
Managed
Care
entity,
they're
actually
doing
face-to-face
visits
in
the
home
or
in
the
facilities
that
they're
placed
in
and
they've
got
really
robust
requirements
around
weekly
contacts
and
are
really
helping
to
coordinate
care
for
those
members.
As
a
result,
you'll
see
on
the
next
slide.
O
We
do
have
a
lot
of
positive
outcomes
to
show
in
this
program
due
to
that
dedicated
resource.
But
in
addition
to
Care
Management
I
mentioned,
we
have
a
really
robust
training
collaborative
that
is
increasing
access
to
evidence-based
trainings
and
treatments.
So
we
can
help
equip
our
providers
and
really
bolster
their
expertise
to
serve
this
acute
population.
O
In
addition
to
that,
we
have
a
really
robust
stakeholder
engagement
platform,
where
we
have
really
deep
collaboration
with
the
cabinet
and
with
our
providers,
we're
sitting
around
the
table
frequently
and
having
those
difficult
conversations
of
where
their
gaps
in
the
Continuum.
And
what
can
we
all
do
from
our
Vantage
points?
To
really
enhance
our
Continuum
of
Care
in
Kentucky
for
these
youth,
and
so
here
are
a
couple
of
key
outcomes
that
are
on
the
screen,
certainly
not
all
inclusive
but
wanted
to
call
out
in.
O
We
are
almost
two
years
into
the
sky
contract
and
we
are
beating
the
the
hedis
rates
for
several
measures,
but
wanted
to
point
out
that
our
care
managers
are
really
working
to
get
kids
into
those
preventative
Services.
So
we're
beating
hedis
rates
in
well-child
visits
and
getting
them
to
dental
services,
which
we
know
are,
are
really
needed.
O
And
then
we
have
a
really
robust
collaboration
with
Dr
Lore
at
the
department
for
community-based
services
to
reduce
again
children
who
are
prescribed
multiple
psychotropic
medications
and
as
a
result
of
that
initiative
are
also
beating
at
the
national
average.
At
a
hedis
measure
pertaining
to
ensuring
kids
are
getting
metabolic
monitoring
when
they're
prescribed
those
medications,
because
we
know
there
are
adverse
Health
outcomes
from
being
on
those
we're
really
passionate
about
too
addressing
social
determinants
of
Health
with
this
population.
O
You
all
know
our
ZIP
code
now
is
becoming
more
of
an
indicator
of
our
long-term
Health
outcomes,
rather
than
our
genetics,
and
certainly
with
our
children
in
Sky
they've
experienced
trauma,
and
so
we
want
to
ensure
we're
assessing
them
and
linking
them
to
those
necessary
supports
and
services
that
may
not
be
Medicaid
covered
benefits
and
we're
happy
to
say:
we've
screened
almost
26
000
of
our
members
and
are
actively
making
those
referrals
to
close
the
loop.
And
then
the
last
thing
I'll
hit
on
in
terms
of
outcomes
is
really
placement
stability.
O
We
want
to
make
sure
that
kids
can
get
treatment
in
Kentucky
and
can
live
in
their
communities
and
be
close
to
their
natural
support
systems.
And
since
we
went
live
in
January
of
2021,
with
our
partnership
with
the
cabinet.
59
of
our
members,
who
get
referred
to
out-of-state
placements
have
been
able
to
be
maintained
here
in
the
state
of
Kentucky,
and
we're
really
proud
of
that
collaboration
that
we
have
with
the
state
and
looking
forward
to
continuing
the
work
with
them.
R
Let's
address
a
very
important
topic:
how
we
are
measuring
and
evaluating
the
efficacy
of
our
substance,
use
treatment,
so
in
2017,
as
an
organization
Aetna
committed
to
a
Five-Year
Plan
of
improving
opioid
outcomes
among
our
members
fast
forward
five
years,
we've
exceeded
all
benchmarks
and
it's
around
things
like
increasing
access
to
medication-assisted
treatment,
Alternatives,
increasing
alternatives
to
pain
management
use
among
our
population,
decreasing
opioid
scripts.
R
For
those
who
already
have
an
oud
diagnosis-
and
you
can
see
that
reflected
in
our
data
here
so
going
back
again
from
2013
to
present,
you
see
an
acceleration
in
2017
for
our
members,
both
initiating
and
continuing
treatment
for
sud.
We
rank
pretty
highly
from
a
national
benchmarking
perspective
in
that
initiation
and
continuation
also
following
up
with
providers
after
an
edu,
an
ed
visit
for
sud.
R
R
Paige
will
address
some
value-based
Contracting
that
we
do
in
this
space
as
well.
I
think
this
is
not
an
Aetna.
Clearly,
not
an
Aetna
only
concern,
and
it's
going
to
take
that
cross-industry
collaboration
for
us
to
solve,
and
we
welcome
those
collaborations
slide.
One
of
the
important
initiatives
that
we've
seen
yield
some
benefit
building
on
the
great
work
that
the
assembly
put
forth
in
terms
of
overhauling
regulation
in
2017
for
over
prescribing
and
prescribing
behaviors
for
opioids.
We
took
that
a
step
further.
R
We
looked
at
our
data,
particularly
for
our
Dental
prescribers,
knowing
that
the
dentist
is
usually
the
first
one
of
the
first
exposure
to
opioids
for
young
people,
and
we
saw
how
many
providers
are
writing
scripts
outside
that
three-day
Supply
and
how
many
prescriptions
do
we
have
falling
into
that
category?
We
mailed
and
called
providers,
along
with
our
Dental
vendor,
to
share
results
of
recent
research
that
connect
that
opioid
over
prescribing,
particularly
by
dentists
with
long-term
opioid
use.
This
was
not
punitive
in
any
way.
R
L
So,
as
Jennifer
mentioned,
we
do
view
value-based
payment
arrangements
as
an
important
opportunity
to
to
drive
improved
outcomes,
specifically
in
the
sud
population.
We
think
it's
really
important
to
get
the
providers
that
we're
working
with
at
the
table
very
early
in
that
contract
development
to
share
data
so
that
we
can
compare
what
are
we
seeing
in
our
population
and
what
services
are
they
offering
so
that
we
can
wrap
an
arrangement
around
that
that
is
beneficial
to
the
provider
and
beneficial
to
the
members
they're
producing
outcomes?
L
Let's
make
sure
that
we
are
focusing
on
the
right
outcomes
and
then
reimbursing
accordingly.
We
think
it's
really
important
to
have
have
that
perspective
of
what
you
know,
what
the
providers
are
doing
real
time
with
those
members,
and
we
want
to
make
sure
that
we
are
wrapping
agreements
around
that
that
that
further
those
efforts,
we
do
have
several
deals
in
place
currently
that
focus
on
outcomes
such
as
retention
and
treatment,
timely,
follow
up
after
Ed
reduction
in
Ed
visits
and
then
we're
also
working
with
several
provider
groups.
O
For
sake
of
time,
I'm
really
more
saying
this
for
my
colleagues
I'm
going
to
skip
to
the
last
question.
I
know
we're
under
tight
time
frame
to
evacuate
the
room.
R
Are
we
going
to
do
Health
Equity
as
well?
Okay,
we'll
run
through
Health
Equity
quickly,
we'll
give
you
we
can
go
to.
The
next
slide.
Talk
about
a
few
of
our
initiatives,
a
very
important
topic
and
imperative.
If
we
want
to
improve
outcomes,
we
have
to
address
Health
Equity,
so
I'll
touch
on
our
dual
partnership.
We
know
that
the
United
States
as
Senator
Meredith
referred
to
earlier.
We
don't.
We
spend
a
lot
on
health
care,
we're
also
at
the
bottom
when
it
comes
to
maternal
Health
outcomes.
R
R
So
we
partnered
with
Norton
Healthcare
to
create
a
doula
program,
so
they
they're
practicing
in
a
doula
and
Midwifery
capacity,
where
they're
going
into
homes
addressing
those
social
determinive
needs
making
sure
that
they
are
understanding
what
is
being
discussed
with
their
provider,
attending
those
prenatal
and
postpartum
appointments
and
we're
seeing
some
some
success
in
those
areas.
If
you
want
to
see
us
in
action,
we
are
co-hosting
in
Louisville
this
weekend,
a
community
baby
shower.
So
if
you're
in
the
Louisville
area,
you'll
be
able
to
see
us
in
action.
L
And
finally,
I
know
this
is
very
important
topic
and
I
apologize
that
we
don't
have
as
much
time
to
spend
on
it
as
as
we
had
intended.
But
you
know
how
do
we
impact
the
the
financial
position
of
role
providers
and
Senator
Matthew
hid
on
it
earlier,
and
it's
exactly
what
we
intended
to
to
talk
about
here
and
highlight
it's
it's
reduction
of
administrative
burden.
L
We
know
that
administrative
burden
impacts
cash
flow
and
we've
created
a
council
made
up
of
four
work
groups
that
consist
of
providers
that
we've
brought
to
the
table
to
say:
look.
Sometimes
we
don't
know
what
we
don't
know
or
policy
seems
good
when
it
comes
out
of
our
conference
room,
but
when
it
hits
your
mailbox
and
in
your
billing
processes
it
it
doesn't
work
and
it
it's
adding
a
whole
bunch
of
steps
to
the
process
that
don't
make
any
sense.
Please,
let's
talk
about
what
those
things
look
like.
L
We've
had
a
lot
of
great
feedback
from
the
providers
that
we've
involved.
We've
tried
to
use
a
really
nice
cross
section
of
Specialties
and
the
way
a
provider
makes
it
onto
that.
Council
often
is
they've
called
us
and
said
we
are
really
upset
about
this
and
we
want
to
talk
about
it
and
we
try
to
fix
what
what
that
immediate
issue
is,
and
then
we
also
say
will
you
join
our
Council?
This
is
the
type
of
feedback
we
are
looking
for.
L
We
also
recognize
that
for
federally
qualified
Health,
Centers
and
rhcs,
the
payment
of
wrap
payments
is
incumbent
upon
the
MCO,
getting
the
encounter
data
right
and
we've
done
a
lot
of
work
there.
If
we're.
If
we're
wrong
and
we're
submitting
bad
encounter
data,
it's
having
a
revenue
impact
on
providers,
so
we've
done
a
lot
of
work
with
kpca
with
the
Department
to
try
to
make
sure
that
we're
passing
that
data
cleanly
and
that
that
Revenue,
that
wrap
payment
is
making
it
to
Providers
and
then.
L
L
We
want
them
to
keep
their
doors
open,
so
we
paid
bonuses
into
a
lot
of
programs
that
do
support
our
most
acute
children
again,
I
apologize
that
we
did
not
spend
more
time
on
that
I
would
I
would
love
to
come
talk
with
you
about
it
more,
but
we
we
appreciate
the
opportunity
to
be
here
today
and
are
happy
to
take
questions
if
we'd
like
to
go.
A
There
thank
you
very
much.
Do
you
have
any
final
comments,
Mr
co-chair
or
any
okay?
Well,
thank
you.
So
much
for
your
presentation
and
the
Medicaid
oversight
advisory
committee
will
stand
adjourned
for
the
final
time.