►
From YouTube: Administrative Regulation Review Committee (10-11-22)
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
B
A
D
16
9
100
establishes
standards
for
the
option.
Seven
alternate
route
to
teacher
certification,
the
staff
suggested
Amendment
amends
various
sections
to
comply
with
KRS
chapter
13,
a
amend,
Section
5,
to
clarify
that
this
is
a
reconfiguration
process,
not
a
formal
appeal
and
amends
section
7
to
clarify
that
an
applicant
with
a
terminal
degree
shall
be
exempt
from
the
requirement
of
a
passing
score
on
the
admission
assessments.
D
A
A
Sorry
about
that,
we,
if
you
could
as
chair
I'll
kind
of
lead
discussion,
start
out
here
anyway,
but
we've
had
a
lot
of
conversation
between
members
of
the
committee
on
110.
and
if
you
could
go
into
110
in
an
in-depth
way.
If
you
could
and
I
guess,
make
the
case
of
epsb
on
that
that
particular
wreck.
E
With
this
route,
the
board
wanted
to
first
issue
an
emergency
regulation
to
be
in
effect
when
the
route
became
available,
so
that
we
could
address
those
applicants
that
may
come
in
immediately.
We
did
actually
meet
yesterday.
The
board
met
and
received
their
first
two
applications
to
provide
an
option:
nine
alternative
route
to
certification,
both
of
those
are
approved.
E
So
we
do
now
have
two
programs
that
will
be
in
operation,
but
this
regulation
sets
out
the
additional
requirements
for
that
route:
kind
of
letting
know
about
the
providers,
the
applications
that
would
need
to
be
submitted
and
then
the
requirements
to
be
met
during
that
time
around
the
residency
component
that
is
outlined
in
statute
Are.
There
specific
questions
regarding
this
that
I
may
address
I'll.
A
A
House
Bill
277,
okay,
I'll,
open
up
for
questions
I.
Believe
chairman
Hale
has
a
question.
F
E
F
Will
from
from
specifically
reading
the
reg
it
it
appeared,
it
just
appears
to
me
that
there
are.
There
are
possibilities
there
that
some
of
our
more
rural,
smaller
districts
would
have
pretty
a
pretty
stringent
would
be
pretty
stringent
on
some
of
them
meeting
some
of
the
criteria
in
the
Reg,
and
so
that
that
was
just
my
take
on
reading
that
I
think
I,
don't
know
if
any
of
the
other
members
had
a
question
on
there
and
Mr
chair
I'm,
not
jumping
in
there
but
I
think.
A
G
Yes,
I
have
several
rural
districts
and
I've
got
a
new
rural
district
and
I
will
refer
to
the
section
three.
The
field
experience.
G
Your
own
and
you've
got
you're
trying
to
recruit
teachers
to
come
from
those
districts
and
I
come
from
a
family
of
Educators
and
I
look
down
through
here
and
my
wife
talks
27
years
and
I,
don't
think
I
I
have
to
question
if
she'd
meet
all
these
regulations
to
be
able
to
qualify.
So
are
these
requirements.
E
So,
yes,
sir,
these
are
listed
as
regulatory
requirements.
This
language
was
taken
from
the
current
regulation
on
field
experience
that
our
teacher
candidates
are
required
to
meet
that
16
Kar
5040
those
requirements
and
hours
this
this
language
simply
mirrored
that
so
that
that
is
the
intention
that
they
would
have
the
opportunity
to
work
with
diverse
populations.
I
will
note
that
the
board
has
the
authority
to
waive
regulatory
requirements
under
KRS
1610281n.
You
have
given
them
the
ability
to
waive
a
requirement
in
their
regulation
in
the
case
of
extraordinary
circumstances.
E
G
G
B
G
Sir,
these
are
extenuating
circumstances
when
we're
gonna,
Short
Circuit,
educating
a
teacher
to
educate
our
students,
and
there
are
other
candidates
out
there
that
have
done
the
full
required
educational
procedures
through
the
college
means
and
I
understand.
We
got
a
shortage
and
I
want
to
meet
that
shortage.
But
to
require
these,
you
know
the
I
I
think
this
is
just
a
little
strong
and
I
I.
G
Don't
know
that
ours
in
our
rural
districts
and
Far,
West,
Kentucky
or
in
the
hills
of
Eastern
Kentucky
will
be
able
to
meet
all
these
requirements
and
I
think
they're.
You
know,
since
we
are
trying
to
expedite
this
I
think
there
should
be
some
more
leniency
on
this.
Instead
of
making
these
requirements.
C
Just
looking
through
this
as
a
contractual
read
on
it
and
I
know
that,
obviously
this
is
taken
from
elsewhere,
but
so
we
have
the
luxury
of
knowing
how
that's
already
been
previously
interpreted.
C
That
the
12
school
settings
that
allow
the
candidate
to
participate
in
the
following
and
then
it
says
it
starts
off,
engage
with
diverse
populations
of
students
that
include
any
list
of
things
that
include
so.
My
reading
wouldn't
be
a
strict
compliance
that
it
has
to
have
like,
for
instance,
students
with
disabilities
or
English
language
Learners.
C
It
seem
like
those
were
the
things
that
would
be
included
in
that
criteria
to
tally
the
circumstance
looking
for
diverse
students,
but
if
they
were
to
check
you
know
they
worked
with
students
with
disabilities
and
those
from
different
social
economic
groups.
Would
they
potentially
be
held
out
because
they
didn't
have
language
barriers
and
my
my
reading
of
it
would
say
no.
But
we
have
the
benefit
of
this
already
have
been
put
in
statute
and
already
interpreted,
and
has
that
ever
been
an
issue
before.
E
E
You
know,
especially
during
covid,
we
saw
where
people
were
not
able
to
meet
hours
just
because
of
a
lack
of
opportunity,
but
to
my
knowledge
we
have
never
received
a
request
to
way
of
the
requirement
for
diverse
populations.
You
know
we
do
have
student
teachers
and
candidates
in
our
traditional
programs
that
are
currently
in
these
districts
that
are
able
to
meet
them
and.
C
So
that
would
that's
really
a
kind
of
answer.
My
own
question:
it
look
slowly
listening
to
doubt
it's
an
it's
a
group
that
would
include
any
of
the
following
lists
in
the
event
that
you
wanted
to
make
sure
they
did
each
of
it.
It
would
be.
You
would
have
something
that
shall
do
each
of
the
following.
So
it
looks
like
you
put
a
totality
of
things
that
you're
an
ideas
that
would
include
a
economic
diversity
of
different
things,
but
not
each
individual
checklist
and
I.
Think
that
may
be.
E
That
to
my
knowledge,
that
has
not
been
an
issue
that
we
that
we
have
had.
Yes,
we
do
understand
that,
sometimes,
when
you
are
in
smaller
districts
it
may,
you
may
not
have
the
same
opportunities
to
engage
with
as
many
diverse
populations
of
students,
but
it
is
still
possible
to
engage
with
diverse
students
that
fall
under
this
section.
H
Thanks
for
being
with
us
today,
it's
very
helpful
who
who
determines
what
is
a
different
cultural
group.
E
I
A
Are
you?
Are
you
done
and
I
apologize
that
for
the
pause
I
was
going
to
call
you
representative
Frazier,
but
your
representative,
Fraser,
Gordon
and
I
couldn't
remember
the
Gordon
part
I'll
make
any
of
the
questions
from
Members.
Seeing
none
I
think
the
ultimate
goal
of
this
committee.
What
ultimate
goal
is
always
does
the
reg
carry
out
the
true
intent
of
House
Bill
277?
That's
that's.
What
we're
aiming
for
so
I
think
we've
had
a
lot
of
good
discussion.
We've
got
a
lot
of
members
with
questions
and
now
I.
A
Think
coach
air
Hale
has
a
commenter
thank.
F
You
chair,
West,
I,
appreciate
that
I
want
to
say
to
you.
I
do
thank
you
for
being
here
with
us
today
and
and
you've
you've
done
a
you've
done
a
very
good
job
in
your
explanation
when,
upon
reading
this
Reg
it
it
actually
threw
up
a
lot
of
red
flags
to
me,
I'm,
not
sure
if
it
did
anybody
else,
but
it
flew
it.
E
I
will
note
that
we
did
take
this
regulation
and
the
suggested
substitutes
before
the
education
Professional
Standards
Board
at
their
meeting
yesterday,
so
that
they
could
review
that
the
board's
intent
is
absolutely
to
carry
outs,
the
intent
of
the
the
house
bill
and
to
meet
the
needs
of
our
districts
and
our
our
providers
in
growing
the
workforce.
E
We
we
would
be
happy
to
continue
to
consider
this
feedback.
We
do
understand
with
the
new
route.
This
is
something
that
will
continue
to
to
examine
as
this
route
grows.
We
We
are
continuing
to
request
feedback
from
our
our
universities,
our
colleges
as
well
as
our
districts.
We
we
would
like
to
be
able
to
proceed,
but
are
happy
to
continue
to
consider
the
feedback.
E
Okay,
yes,
sir,
we
can
do
that.
F
A
So
so
what
I
now
we're
getting
into
my
opinion
is
chair,
a
member
of
the
committee.
The
way
I
see
the
situation.
If,
if
we
ask
you
to
defer,
then
then
we
have
an
obligation
as
a
body
to
meet
with
epsb
and
in
your
you
and
your
legal
staff
and
and
try
to
come
to
a
conclusion,
reconciliation
on
what
the
language
should
be,
so
that
I
believe
I
hope
I'm,
not.
A
Amount,
that's
that's.
The
goal
is
to
do.
If
we
don't
like
the
language,
we
just
can't
say
forget
it.
The
idea
is:
take
the
next
30
days
meet,
agree
on
some
language
come
back
in
November
and
then
hopefully,
if
there's
an
agreement,
it
rolls
on.
Yes.
A
A
J
So
start
drinks
and
finding
more
T,
you
know
certifying
more
teachers.
I
know,
there's
a
huge
teacher
shortage
throughout
the
whole
nation
and
I
think
there's
a
huge
concern,
especially
in
Jefferson
County
they're,
having
a
heck
of
a
time
finding
teachers
and
they're
doing
a
lot
of
subs
and
covering
from
the
administrative
offices.
So
that's
that's
basically.
My
question
is
that
the
goal
of
this
to
help
find
more
teachers
or
help
get
them
into
the
and
through
the
system
faster.
Yes,.
E
Representative
I
believe
that
was
the
intent
of
creating
the
route
from
the
general
assembly
was
to
have
an
additional
alternative
route
to
certification
and
the
board
is
in
agreement
with
that
and
is
working
with
our
districts.
As
I
said,
we
have
two
districts
and
a
university
that
have
partnered
to
offer
programs
to
hopefully
get
that
moving.
A
And
as
an
announcement
to
members
of
the
committee,
if
and
if
you're
at
all
worried,
we
we
allowed
to
move
forward
the
emergency
reg
on
this
rig
last
month.
So
even
if
you
defer
then
they're,
you
know
there's
language
in
place
that
allows
cpsb
and
KDE
to
move
forward
with
with
with,
in
other
words,
it
won't,
hamper
any
attempt
to
hire
new
teachers.
So
just
throwing
that
out
there.
A
E
B
State
Board
of
Elections
31k
or
3031
emergency
and
ordinary
31kar,
4071
emergency
and
ordinary,
the
131
emergency
and
ordinary
141
emergency
and
ordinary
170
196
emergency
and
ordinary
201
emergency
and
ordinary
210
emergency
and
ordinary
31
Kar,
5,
0,
11
emergency
and
ordinary
in
o26,
emergency
and
ordinary.
The
all
of
the
ordinary
regulations
have
amendments.
K
This
package
of
Regulation
establishes
procedures
and
requirements
for
oversea
voters,
recanvassing
consolidation
of
precincts
and
election
officers
chain
of
custody
for
records
in
an
election
contest,
a
risk
limiting
audit
pilot
program,
absentee
ballots
and
exceptions
to
electioneering.
The
staff
suggested
Amendment
amends
4196
to
clarify
when
the
board
May
request
resubmission
of
a
consolidation
petition
and
amends
5026
to
use
statutory
terminology
to
cross-reference
relevant
statutes
and
to
align
with
statutory
requirements.
They
also
amend
various
sections
throughout
to
comply
with
a
drafting
and
formatting
requirements
of
KRS
chapter
13A.
A
A
My
question
I'll
start
us
out,
I,
don't
know
if
we
have
other
questions
or
not,
but
could
you
describe
to
us
where
these
regs
did
these
come
out
of
a
specific
bill
that
was
passed
this
session,
or
is
it
just
housekeeping
in
internal.
H
A
B
D
106
1141-31
371
established
local
Emergency
Management
Services
Provisions,
including
funding
and
fund
allocations,
reporting
project
applications,
reimbursement
planning,
training,
director
appointments
workers,
compensation
for
local
personnel
and
alternative
affiliation
requests
for
specialized
Rescue
Services.
The
staff
suggested
a
momentum
in
various
sections
to
comply
with
KRS
chapter
13.
A
the
staff
suggested
Amendment
for
106-1201
also
amends
Section
3.
D
To
clarify
that
the
plan
draft
and
adopted
local
plan
shall
be
due
annually
and
add
section
4
to
incorporate
material
106
2021
establishes
Provisions
for
the
military,
family
assistance,
trust
fund
and
106
2031
establishes
requirements
for
the
Kentucky
National
Guard
employee
adoption
program.
The
staff
suggested
amendments
amend
various
sections
to
comply
with
KRS
chapter
13A.
A
A
A
F
Thank
you,
Mr
chair,
exactly
what
what
requirements
are
you
proposing
that
they
have
to
to
do
I
mean
when
it
says
additional
requirements?
What
explain
that,
if
you
could
please
actually.
H
It's
not
additional
requirements.
The
regulation
has
always
been
that
athletic
trainers
have
to
complete
six
continuing
education
units
per
three-year
cycle.
So
that's
about
20
hours
of
continuing
education
every
year
and
then
over
the
course
of
three
years
at
60.
by
Statute,
we
were
required
to
specify
that
they
had
to
have
two
of
those
hours
specific
to
HIV
AIDS
training
in
2021.
The
legislature
took
out
that
requirement
from
statute.
So
we
are
taking
out
the
specification
of
those
two
hours
here,
but
it
doesn't
change
the
overall
continuing
education
hours.
H
A
H
201
12030
is
being
amended
to
remove
forms
and
details
duplicated
in
other
administrative
regulations
and
incorporate
the
requirements
of
Senate
Bill
113.
From
the
regular
session
of
the
20.
Kentucky
general
assembly,
12060
is
being
amended
to
outline
additional
terms
to
protect
the
public
from
unlicensed
and
unsafe
practices.
H
12082
is
being
amended
to
provide
adjusted
hours,
requirements
for
a
license
and
clarify
the
registration
process
for
furnace
instructors.
12
190
and
emergency
are
being
amended
to
clarify
complaint
processes
and
investigative
details.
12
230
is
being
admitted
to
clarify
a
necessary
statement.
12
260
is
being
amended
to
increase
exam
fees,
to
maintain
balance
on
the
new
contract
for
exams
and
establish
a
fee
structure
for
new
permits.
12
290
establishes
the
requirements
and
processes
necessary
to
receive
a
KBC
permit.
A
Would
you
please
identify
yourself
for
the
record
good
afternoon?
My
name
is
Christopher
hunt
I
Am,
The,
General
Counsel
for
the
Board
of
Cosmetology.
Thank
you
so
much
there
are
staff
amendments.
Do
we
have
a
motion
for
approval
of
Staff
amendments
Motion
in
a
second
without
objection
is
so
ordered,
so
we
have
before
us
these
cosmetology
regs
with
staff
amendments.
Any
questions
from
members
on
these
regs.
Seeing
none,
please
call
the
next
regulation.
Thank
you.
L
201
car
2260
amends
for
consistency
with
Senate
Bill
10
from
the
2022
regular
session,
including
to
delete
inconsistent
Provisions
conform
to
the
new
requirements
for
the
number
of
students
enrolled
in
a
program
of
Nursing
and
set
requirements
for
new
programs
of
nursing
that
opened
During
the
period
the
emergency
regulation
was
in
effect,
201
care
2310
amends
to
reference.
The
new
requirements
for
didactic
faculty
required
by
Senate
Bill
10
from
the
2022
regular
session,
and
delete
inconsistent
Provisions
201
KR
2490
amends
to
update
material
Incorporated
by
reference.
L
201
KR
2620
amends
to
make
changes
for
clarity,
including
to
state
that
all
other
fees
will
be
contained
in
the
general
fee
regulation
and
indicate
the
name
that
an
lcpm
shall
use
for
practice
purposes.
201
KR
2650
amends
to
add
several
tests
to
the
list
and
several
new
medications
to
the
formulary,
as
recommended
by
the
lcpm
advisory
Council
and
approved
by
the
board.
E
A
Of
the
Board
of
Nursing,
thank
you.
There
are
staff
amendments.
Do
we
have
a
motion
for
approval
staff
amendments?
We
have
a
motion
in
a
second
without
objection,
so
ordered
any
questions
from
members
on
these
Rags
I
have
one
question
but
open
it
up
for
seeing
none.
Mine
is
just
a
general
question.
You
know
the
the
overarching
goal
of
Senate
Bill
10
was
you
know
we
got
this
nursing
shortage,
which
is
very
serious
to
the
state.
We
felt
there
were
some
artificial
barriers
there
in
the
number
of
nursing
students
and
allowed
do
you
feel?
H
Right
now,
we're
still
at
about
14
500
that
are
in
what
we
call
the
pipeline
and
the
pipeline
means
that
they've
been
admitted
to
a
nursing
program,
so
whether
they're
in
the
first
semester
or
the
last
semester.
That's
what
we
consider
our
Pipeline
and
that's
really
about
the
same
as
what
we
had
at
this
time
last
year.
But,
like
I,
said
we
just
enrolled
about
400
more.
So
we
do
our
annual
reports.
You
know
it's
always
kind
of
like
a
lag
time,
so
I
suspect
that
we
will
have
closer
to
15.
A
L
In
the
Commonwealth.
The
agency
Amendment
means
section
2
on
the
supplemental
procedures
and
EMT
is
eligible
to
perform
to
delete
under
the
identification
of
the
correct
placement
of
an
indiotracheal
tube
placed
by
a
licensed
paramedic.
The
reference
to
the
use
of
end-title,
CO2
monitoring
and
add
a
reference
to
quantitative
and
qualitative
capnography
and
kepnometry
and
amends
section
11
to
comply
with
Keras
chapter
13A.
A
D
306-011
establishes
the
application
process
to
determine
a
Fair's
eligibility
to
claim
a
certified
historic
structure.
Rehabilitation
tax
credit,
the
amended
after
Commons
version,
adds
Incorporated
material
and
clarifies
photo
documentation
requirements
as
being
necessary
prior
to
Rehabilitation,
because
at
the
time
of
purchase
is
not
always
applicable.
The
staff
suggested
a
momentum
in
section
2
to
comply
with
KRS
chapter
13A.
N
A
D
301-1410
amends
Provisions
for
sport
and
rough
fishing
by
means
such
as
archery
and
other
non-traditional
methods
to
make
technical,
Corrections
add
shovelnose
sturgeon
to
the
list
of
fish
that
shall
not
continue
to
be
snagged
after
the
creole
limit
has
been
reached
and
have
additional
requirements.
If
archery
is
used,
clarify
that
there
is
no
size
limit
for
sport,
fish
snagged
in
parts
of
the
Tennessee
River
delete
the
exception
for
daily
Creole
limits
on
rough
fish
from
the
Cumberland
River.
D
Add
pallid
sturge
into
the
list
of
fish
that
shall
be
released,
establish
prohibitions
against
taking
shovelnose
sergeant
from
the
Mississippi
River
and
requiring
any
taken
to
be
released.
Add
a
portion
of
the
Cumberland
River
to
the
list
of
waters
where
snagging
is
prohibited,
clarify
that
there
is
no
creel
limit
for
Asian.
Carp,
establish
separate
creel
limits
for
paddlefish
and
shovelnose
sturgeon
and
established
daily
Creole
and
size
limits
for
fish
taken
by
non-traditional
methods.
The
staff
suggested
a
momentum
is
various
sections
to
comply
with
KRS
chapter
13A.
L
A
A
We
have
a
motion,
a
second
without
objection,
so
ordered
any
questions
from
members
on
this
set
of
regs.
B
D
H
Good
afternoon
my
name
is
Bethany.
Fields
I
was
a
summer
intern
at
the
Department
of
Agriculture
Clint
Quarles
counsel
for
the
Department
Ms
Fields
was
the
author
of
these
repealers
and
will
be
running
for
National
FFA
office
in
a
couple
of
weeks
and
I
thought
this
would
be
a
neat
experience
for
her
to
come
and
testify
nice.
A
Nice
and
it's
you
know
the
beauty
of
that
is
you're
learning
and
instead
of
writing
regulations,
you're
repealing
regulations,
it's
a
great
thing,
but
welcome
to
this
exciting
committee,
any
questions
from
members
on
these
regs,
seeing
none
good
luck
in
your
future
endeavors
thank.
B
H
A
A
I'll
have
start
us
out
with
a
question,
so
you
know
whenever
we
hear
concealed,
carry
or
anything
like
that,
you
know
a
red
flag
can
go
up
either
way,
whether
you're,
you
know
100,
Sacramento
or
vice
versa.
So
could
you
briefly
describe
you
know
what
we
had
before
and
then
after
this
red
goes
into
effect?
How
will
this
affect
concealed?
Carry
like
a
normal
citizen,
attempting
to
get
their
concealed,
carry
or
who
or
one
who
has
concealed
carry?
How
will
this
affect
them?.
H
It
would
not
this
is.
These
regulations
are
only
on
the
law
enforcement
officer,
safety
act,
which
is
basically
the
federal
law
that
allows
peace,
officers
and
retired
peace
officers
to
carry
a
concealed
weapon
Nationwide,
and
what
we've
done
in
Kentucky
is
just
facilitate
that
this
allows
them
to
get
the
the
range
qualification
and
things
that
are
necessary
to
comply
with
the
federal
law.
So
it
doesn't
affect
a
civilian
concealed,
carry.
H
They
did
this
is
this
is
mainly
housekeeping
stuff
that
we've
done
here,
okay
gotcha,
so
this
has
been
around
for
several
years.
But
even
if
we
had
not
enacted
a
law,
they
would
still
have
the
ability
under
federal
law
to
carry
so.
What
we're
doing
is
giving
them
the
opportunity
to
qualify
on
the
Range
and
the
other
things
that
their
own
Department
may
not
do
for
a
retired
officer
and
and
that.
A
K
A
A
A
B
L
820Kr1001
amends
to
Define
primary
office
location
and
prohibit
the
primary
location
from
sharing
a
space
with
a
bar
restaurant
convenience
store
or
other
commercial
retail
business.
A20
KR
1032
amends
to
allow
charitable
organizations
to
conduct
gaming
at
the
same
time
for
a
raffle
require
that
the
flare
or
seal
card
for
paper
pull
tabs
is
in
view
of
the
players.
L
While
the
deal
is
in
play
and
after
all,
tickets
have
been
sold
until
all
prices
have
been
claimed
or
time
has
expired,
require
the
holder
of
the
winning
pull
tab
to
be
paid
in
full
no
later
than
five
days
from
the
Redemption
date.
Allow
the
purchase
of
electronic
pull
tabs
to
occur
by
inserting
the
currency
into
the
device
require
users
of
the
electronic
pull
tab
system
to
have
a
personal
identification
number
prohibit
a
point
of
sale
station
from
accepting
payment
via
credit
or
debit
card.
L
Allow
a
device
to
be
activated
for
the
purchase
of
electronic
pull
ties
for
the
insertion
of
currency
or
credit
ticket
prohibit
the
electronic
pull
tab
device
from
dispensing
coins,
cash
tokens
or
anything
of
value
other
than
a
credit
ticket.
Allow
a
fixed-based
electronic
pull
tab
device
to
have
attached
bill
validator,
which
can
only
accept
U.S
paper,
currency
or
a
valid
credit
ticket
and
to
comply
with
industry
standards,
prohibits
a
fixed-based
electronic
pull
tab
device
from
accepting
payment
via
credit
or
debit
card,
establish
that
a
player
shall
win.
L
If
the
pull
tab
reveals
how
much
has
been
won,
prohibit
an
electronic
pull
tab
game
from
containing
a
pull,
handle
or
mimicking
a
slot
machine,
such
as
coins
falling
into
a
tray
or
Hopper.
Remove
restrictions
on
animation
and
sound
rules
concerning
gameplay
software
require
a
game
that
uses
symbols
to
indicate
those
symbols
on
the
winning
ticket
require
a
disclaimer
for
a
bonus
round
to
be
displayed
in
the
player
interface
or
on
the
flare.
Help
screen
restrict
the
cost
of
the
individual
electronic
pull
tab.
L
Ticket
from
exceeding
five
dollars
require
an
organization
to
State
the
authorized
location
for
electronic
pull.
Tab
games
on
the
charitable
gaming
license.
Allow
a
distributor
to
install
an
electronic
pull
tab
system
or
device
in
an
unlicensed
location
for
demonstration
purposes
and
require
an
authorized
chairperson
to
be
present
on
the
premises
at
all
times
that
electronic
pull
tab
devices
are
available
to
the
public.
The
staff
suggested
amendments
for
these
regulations
amend
various
sections
to
comply
with
care
as
chapter
13A.
A
C
Thank
you,
Mr
chair,
no
hurry,
but
as
I'm
reading
through
some
of
the
changes
one
would
be
under
section.
One
lays
out
the
definitions
gets
down
to
subsection
15.
It
describes
the
primary
office,
there's
a
change
on
subsection
15b.
It
says
well
and
it
really
I,
don't
know
if
it
changes
the
the
10
of
it.
But
I
worry
about
one
particular
non-profit
in
my
district,
it
says,
does
not
include
any
physical
space.
C
A
charitable
organization
shares
with
a
bar
restaurant
convenience,
store
or
other
commercial
retail
business
is
that
that's
already
been
in
place
for
some
time.
It's
a
that
they
can
the
charitable
organization
whether
to
save
its
charitable
slots
or
those
things
they
can.
Are
you
saying
they
cannot
share
a
space
with
another
bar.
N
The
we
didn't
really
have
any
standards
for
what
constitute
a
primary
office
location,
so
we
needed
to
have
that
in
the
definitions,
because
that
was
something
that
was
kind
of
left
of
our
interpretation
for
a
long
time.
We
wanted
to
set
to
spell
that
out
in
law
there,
it
wouldn't
prohibit
an
organization
from
having
gaming
devices
at
those
types
of
locations.
It's
just
that
those
locations
would
have
to
be
licensed
charitable
Gaming
facilities,
as
opposed
to
the
Charities
primary
office
location.
A
Thank
you.
My
question
is
in
the
same
section
as
Center,
Yates
and
I.
Don't
know
what's
happening
here,
so
I'm,
trying
to
figure
out
what's
currently
happening
in
the
state,
ideally
I'm
trying
not
to
we're
trying
not
to
upset
the
apple
card
of
what
is
currently
happening
in
the
state,
because
this
can
get
pretty
serious
in
some
parts
of
the
state.
A
You
know
these
charitable
events
and
gaming,
so
so
primary
I'm,
just
going
to
read
it
primary
office
location
means
the
land
and
building
in
upon
which
a
charitable
organization
conducts
the
majority
of
its
charitable
business
and
organization's
primary
office
location
shall
not
include
any
physical
space
shared
with
a
bar
restaurant
convenience
store
or
other
commercial
retail
business.
A
N
N
that
lists
the
locations
where
and
that
this
isn't
anything
new.
This
is
existing
regulation
that
lists
the
locations
where
a
licensed
shared
organization,
May
install
electronic
pull
tab
devices.
One
of
those
is
primary
office
location.
N
The
definition
we
added
is
just
to
Define
what
a
primary
office
location
has
to
be
so
that,
for
example,
a
charity
couldn't
just
say
well,
the
broom
closet
in
the
back
of
the
bar
is
our
office
and
we're
going
to
install
the
machines
here.
They
could
still
install
the
machines
at
the
bar,
the
restaurant,
the
gas
station,
wherever
as
long
as
it,
it
wouldn't
be
their
primary
office
location
that
commercial
establishment
would
have
to
have
a
charitable
gaming
facility
license.
A
Gotcha
Okay
so.
A
There
was
a
lot
of
talk
in
this
past
session
about
gray
machines,
so
how
does
how
would
this
regulation
affect
gray
machines.
N
B
N
Normally
not
depends
on
if
the
application
is
complete.
If
there
are
any
deficiencies
in
it,
we
there's
a
regulation
that
encourages
organizations
to
get
those
applications
in
60
days
before
they
expire
or
before
they
intend
to
start
our
licensing
staff
almost
never
has
any
trouble
getting
it
done
in
that
60-day
time
frame.
Are
you
sure
about
that?
N
B
A
B
Cabinet
for
Health
and
Family
Services
office
of
Inspector
General
900
Kar
12005,
without
an
additional
Amendment.
A
K
L
902
kr2020
amends
to
remove
the
requirement
for
Health
Care
Facilities
to
submit
covid-19
antigen
test
results
and
antibody
test
results.
Add
a
requirement
to
report
positive
test
results
for
covid-19
viral
detection
using
antigen
immunoassays
and
allow
submission
of
case
reporting
through
the
Kentucky
Health
Information
Exchange.
H
F
Thank
you
Mr
chair,
my
quit
just
my
question
is:
does
this
regulation
requiring
anything
more
than
House
Bill
3
requires
or
required
in
the
language
of
House
Bill
3?
Is
there
anything,
that's
add
that's
being
added
through
this
regulation
as
far
as
data
any
any
other
information
in
this
wreck,
yeah.
O
D
H
F
B
D
907-1104
men's
Medicaid
reimbursement
Provisions
for
recipients
not
enrolled
with
an
MCO
to
add
coverage
for
anesthesia
at
100
reimbursement
to
a
participating
position
for
the
same
service.
907
4020
emergency
amends
to
include
all
k-chip
children
under
this
regulation
clarify
how
a
5
income
disregard
is
to
be
calculated
and
delete.
Outdated
references,
907
4030
emergency
amends
to
add
an
option
for
pregnant
recipients
to
receive
k-chip
Services
up
to
the
limits
of
k-chip
phase
3
eligibility
and
expand
the
key
chip
phase
3
program
to
218
percent
of
the
federal
poverty
level.
L
907
KR,
20020e
and
100e
meant
to
implement
Implement
a
state
plan
amendment
to
extend
Medicaid
coverage
to
new
mothers
for
one
year
following
the
birth
of
a
child
in
accordance
with
Senate
Bill
178
from
the
2022
regular
session.
Additionally,
907
KR
2100e
amends
to
clarify
language
related
to
household
size
of
the
pregnant
person.
A
A
Could
you
give
us
and
my
questions
will
relate
to
104.
the
reimbursement
schedule,
and
so
could
you
just
briefly
describe
what
that
does
in
30
SEC
30
seconds
to
a
minute?
But
my
question
is
going
to
be:
does
the
cabinet
have
statutory
authority
to
make
this
decision
which
I
you're
basically
purporting
that
it
does,
or
you
wouldn't
be
here,
but
explain
to
us
how
the
reimbursement
rates
are
set
by
by
the
feds
but
the
cabinet?
M
I'll
I'll
try
my
best,
so
we
we
base
our
statutory
Authority
for
the
most
part
when
we're
implementing
the
the
the
the
administrative
regulations
and
the
and
the
fee
schedules
that
we
have,
we
are
basing
that
off
205.5203,
which
is,
which
is
our
most
our
kind
of
our
Bedrock
statutory
Authority,
and
but
we
also
negotiate
with
the
federal
government,
the
state
plan
that
we
develop
and
and
we
we
have
to
adhere
to
that
in
order
to
pull
down
federal
financial
participation
for
all
for
the
entire
Medicaid
Program.
M
M
They
are
present
to
a
high
degree
in
rural
hospitals
and
in
more
underserved
areas
in
our
Healthcare
ecosystem
in
the
Commonwealth,
and
so
that's
why
we're
making
that
change
to
to
ensure
that
we
have
a
a
wide
Continuum
of
Care
for
our
Medicaid
beneficiaries.
Thank.
A
You
so
we've
got
that
KRS
and
just
a
little
further.
If
for
the
committee,
if
you
could
and
just
kind
of
tee
up
and
set
up
further
discussion,
it
sounds
easy,
but
I
don't
think
it
is
so
explain
to
us
how
what
code,
what
the
codes
are,
the
difference
between
the
codes
and
so
so
we're
adding
another
code,
which
means
a
higher
reimbursement
for
the
hospital
or
the
or
the
entity
if
they,
if
they
provide
that
service.
But.
M
Getting
ready
we're
removing
an
edit
on
a
code
so
that
this
is
a
specific
type
of
this
is
Services
provided
by
crnas,
which
are
an
APRN
with
a
an
additional
level
of
training.
On
top
of
that,
and
previously
we
had
limited
them
to
75
of
anesthesiology
rate,
so
we've
removed
an
edit
on
the
code
that
we
have
I'll,
pull
that
Michael's
closure.
We
have
removed
that
edit
on
the
code.
So
now
it
will
be
paid
at
100
of
the
of
the
physician
rate.
M
A
Now
you're,
ultimately
you're
you're,
saying
your
goal
was
to
for
the
state
pull
down
more
funds,
maybe
not
even
that
maybe
make
the
code
more
applicable
to
what's
actually
happening
in
the
field.
Is
that
a.
A
A
P
To
answer
your
question,
thank
you
Mr
chairman.
Yes,
so
the
way
this
works
with
modifiers
is
a
set
code
for
anesthesia
Services
right
now.
If
a
nurse
practitioner
offers
those
Services
there's
a
modifier
and
they
receive
a
portion
of
that,
only
not
the
full
amount.
What
we're
doing
is
removing
the
modifier
and
saying
nurse
practitioner
work
is
equal
to
physician
work
when
it
comes
to
Anesthesia.
The
paper
will
be
equal
essentially.
Is
that
correct?
A
Questions
I'm
going
to
put
you
in
line
Central
Alvarado
I'll,
get
to
you,
representative,
co-chair
Hale.
He.
A
F
M
Pay
rate
will
be
equal
between
the
two,
the
two
providers.
Yes,.
A
J
Thank
you,
Mr,
chair
and
I.
Think
you
touched
on
what
I
wanted
to
ask,
but
what
we're
equalizing
is
anesthesia
service,
so
I've
been
put
to
sleep
at
least
three
times
by
CRNA,
who
did
a
fabulous
job?
I
thought
you
were
going
to
say
this
committee.
Well,
this
too,
that
that's
happened
a
few
times.
J
Hence
I
didn't
expect
it.
You
know,
but
you're
looking
at
the
service
provided
rather
than
who
provides
it
and
I
think
that's
what's
important,
that
we
have
a
shortage
of
anesthesiologists
and
a
crnas
across
the
whole
state,
probably
in
service
in
urban
areas
as
well.
J
But
I
just
want
to
take
us
down
a
little
history
back
in
when
I
was
first
elected
in
96,
I
sat
next
to
Dr
Ernie
Fletcher,
who
became
governor
Republican,
and
we
got
together
with
Representative,
Bob,
De
Wiese
to
Dr
Republicans
and
a
nurse
Democrat
and
passed
the
first
bill
in
Kentucky
to
allow
nurse
practitioners
to
write
prescriptions
of
Legend
drugs.
J
J
P
You
Mr
chairman
I'm,
in
complete
opposition
of
that
opinion.
I,
don't
think
this
is
a
good
idea.
So
let
me
ask
a
few
questions
for
you.
Jonathan
I
know
this
is
you're
kind
of
in
a
tenant,
maybe
not
the
person
to
make
the
policy
here
to
explain
the
policy,
but
you
just
answered
yes
to
the
question
that
basically
we're
recognizing
Physician,
Services
and
nurse
practitioners
to
be
equal
with
this
is
what
we're
doing
effectively
because
we're
paying
it
the
same.
P
P
P
I
mean
it's
clear,
but
I
just
want
to
make
sure
that
the
cabinet
recognizes
that
sure,
okay,
very
good,
if
you
can
look
it
up
online
and
find
it
and
some
will
argue,
there's
also
a
shortage
of
anesthesia
Services
across
the
and
I've
heard
that
the
comment
for
this
is
that
it's
going
to
help
in
rural
communities,
but
when
I'm
reading
the
reg
there
is
no
distinction
between
urban
or
rural
communities
on
the
reimbursement.
P
If
we
wanted
to
drive
people
into
certain
areas
and
you
offered
enhanced
payments,
people
would
probably
say:
hey
look
I'm
going
to
get
paid
more
to
go
to
a
rural
area.
I
might
understand
it.
If
there's
a
clause
in
here
that
says
we're
willing
to
offer
this
in
underserved
areas
or
areas
that
are
considered
rural
by
nature
and
need
providers.
We
don't
have
them
we're
willing
to
do
that,
but
that
there's
no
distinction
here
that
I
can
read
when
I'm.
Looking
at
this
regulation,
there's
no
difference.
M
M
P
P
Sure,
and
that
may
be,
for
primary
care,
but
in
terms
of
providing
Services,
we
have
certain
lots
of
hospitals
in
urban
areas,
provide
surgeries
for
individuals
where
you're
going
to
have
these
anesthesia.
You
know
anesthesia,
Services
being
provided.
The
comment
has
always
been
that
it's
needed
for
rural
areas
and
again
my
point
is
that
we
see
no
distinction
between
either
one
of
these.
P
How
does
how
does
this
regulation?
How
does
this
change?
Maybe
you
can
answer
this
for
me,
how
does
this
attract
more
people
to
become
a
physician,
anesthesiologist.
P
P
P
To
do
the
same
thing,
so
one's
going
to
take
you
12
to
14
years
and
probably
cost
you
300
000
bucks
with
no
income
along
the
whole
way
because
you're,
basically
a
slave
to
a
system
while
you're
doing
it
or
you
can
go
through
a
system.
That's
going
to
take
you
six
to
seven
years
with
a
lot
less
clinical
hours
and
a
lot
of
those
things
and
get
paid
the
same.
P
Knowing
how
much
time
and
effort
goes
into
this.
This
is
going
to
detract
from
people
wanting
to
go
into
anesthesia,
at
least
for
Physicians
you're
not
going
to
have
those
Physicians
doing
these
Services
now
some
might
say
big
deal.
Some
on
this
committee
might
think
it's
not
a
big
deal.
We
don't
think
there's
any
difference
between
the
two
I
would
argue
that
there
is,
and
if
you
have
a
very,
very
complicated
case,
and
you
have
an
option
I
think
a
lot
of
patients
would
choose
one
over
the
other,
if
they'd
like
to
have
that.
P
This
detracts
from
that.
This
is
not
good
policy
for
this.
If
you
want
to
enhance
it
for
rural
areas
and
underserved
areas
put
the
stipulation
that
we're
going
to
offer
these
higher
amounts
for
those
areas
where
maybe
you
can
attract
a
doc
and
you
might
have
a
CRNA
doing
it.
Okay
I
can
get
that
I
could
probably
understand
and
that,
but
this
doesn't
do
this.
P
C
M
I
believe
that
we
have
experts
here
who
could
who
could
who
are
crnas?
Who
could
speak
to
the
the
actual
practice
realities,
I
I
would
I,
don't
think
I
I
should
speak.
C
Okay,
so
that'll
be
one
of
my
questions.
We
could
kind
of
finish
because
I
want
to
know
that
and
then
it
seemed
like
based
on
what
my
colleagues
said,
that
there
would
be
sometimes,
if
there's
not
normal
differences,
there
would
be
sometimes
that
it
would
be
on
certain
cases.
So
the
necessity
of
it
and
the
reason
I
ask
is
I,
know
in
this
committee.
We
know
where
we
have
shortage
we've.
We
spent
some
time.
You
know
speed
up
the
process
for
the
CCD
to
get
truck
drivers.
C
We
knew
we
needed
more
different
route
than
some
of
you
know.
People
in
my
district
may
have
taken.
We
sped
up
the
route
through
just
talked
about
through
education,
making
sure
we
got
teachers
in
place
other
ways
to
do
that,
because
it's
about
reducing
making
sure
that
you
have
that
available
to
the
people.
C
So
to
me,
I
want
to
make
sure
that
the
service
is
provided
in
my
law
office
I
build
a
different
rate
than
the
paralegals
bill,
but
also
make
sure
that
I'm
not
doing
paralegal
work
and
building
at
attorney
rates,
because,
ultimately
it's
about
the
services
provided
to
my
clients.
So
if
there's
something
that
I
believe
a
paralegal
can
do
at
a
quarter
of
the
rate,
then
I'll,
let
the
barely
go-
do
that.
C
Of
course
they
have
my
oversight
and
whatnot,
but
the
attorney
work
is
something
different
and
so
I
know
that
as
we're
trying
to
make
things
more
affordable,
you
know.
Sometimes
we've
got
to
watch
that
whole
protectionism
thing
driving
the
best
price,
but
again
I
am
I.
Don't
want
to
do
anything
that
would
make
people
less
safe.
So
I
would
like
to
know
what
services
are
different,
because
if
you
have
your
doctorates
or
if
you've
gone
through
this
degree
and
when
we
would
need
the
doctor
as
opposed
to
nurses,
thanks.
M
Just
from
my
perspective,
I
would
mention
that
we
last
year
put
through
a
reg
that
allowed
for
medical
Direction,
which
does
allow
for
an
anesthesiologist
to
supervise
up
to
four
at
a
at
a
time
for
crnas
at
a
time.
So.
C
A
I
have
other
questions,
but
just
for
FYI
I'm,
going
to
here
in
just
a
second
I'm
going
to
allow
the
people
to
speak
for
it
and
then
we'll
take
questions
there
and
the
people
to
speak
against
it
and
we'll
take
questions
there.
So
Central
Adams,
I
think
had
a
question.
Do
you
have
a
question
now
Senator
Adams.
B
A
K
A
Thank
you
so
much
proceed,
we'll
allow
you
to
make
your
case
and
then
we'll
have
questions
after
you're
done.
Yes,.
O
Sir,
like
you
mentioned,
we
are
here
today
in
support
of
this
regulation,
just
to
give
everyone
a
quick
background.
This
regulation
has
been
a
long
time
in
the
making
we've
been
working
on
this
for
over
18
months
now.
This
originally
started
at
the
suggestion
of
the
hospital
Tech
committee.
That's
where
all
of
this
talk
started:
Kentucky,
Medicaid
regulations
at
that
time
offered
two
anesthesia
billing
codes.
One
was
personally
performed
by
an
anesthesiologist
and
one
was
personally
performed
by
a
nurse
an
ethicist.
O
Those
were
the
only
two
codes
that
Kentucky
Medicaid
regulations
allowed
to
be
billed
for
Medicaid.
When
this
came
to
the
hospital
attack.
What
we
were
finding
out
is
some
of
our
Medicaid
patients,
who
were
going
across
state
lines
to
facilities
in
our
border
states,
where
they
Implement
different
anesthesia
models
than
we
do
here
in
Kentucky,
and
they
use
some
different
codes.
O
We
needed
to
broaden
the
way
that
our
Medicaid
allowed
for
billing
of
anesthesia
services
for
those
patients,
because
some
of
the
people
providing
care
to
them
were
not
able
to
bill
for
the
services
being
provided.
So
when
all
of
this
came
about
at
the
discretion
of
the
governor,
we
had
a
meeting
that
meeting
was
back
on
Tuesday
April
13
2021
I
was
there
April?
Was
there
Hospital
administrators?
Were
there
people
from
the
Department
of
Medicaid
Hospital
legal
teams,
several
hospitals
from
out
of
state
who
are
personally
dealing
with
this?
The
hospital
tax
chairman?
O
Was
there
the
Kentucky
Society
of
anesthesiologists?
Was
there
the
American
Society
of
anesthesiologists?
Was
there
every
anesthesia
stakeholder
in
this
state
as
well
as
Hospital
admins
legal
teams?
We
were
all
there
and
while
we
all
did
not
agree
on
every
aspect,
the
way
that
that
meeting
concluded
was
that
the
best
thing
for
clarity
and
for
our
Medicaid
patient
population
was
to
implement
the
same
billing
codes
and
reimbursement
as
Medicare
here
in
Kentucky
Medicaid.
That's
all
this
is
doing
to
say
this
is
about
pay
equality.
It's
not
about
pay.
O
Jen
Wiseman
is
not
going
to
be
making
any
more
money
after
this
regulation
goes
through.
Physician
anesthesiologists
are
not
going
to
be
making
any
less
money
after
this
goes
through
this,
isn't
about
pay
or
bringing
money
home
or
who
makes
what
and
making
things
equal.
This
is
simply
implementing
the
Medicare
model
that
we've
used
for
a
long
long
time
into
Kentucky
Medicaid,
so
there's
Clarity
in
our
Medicaid
patients
can
get
care
where
they
need
care.
O
There's
billing
codes
available
for
providers
to
bill
for,
and
it
limits
the
ability
to
build
fraudulently
using
modifiers
that
we
just
recently
implemented
last
October.
So
this
has
been
a
three-part
process.
The
first
two
parts
have
already
gone
through
I'm
gonna.
Look
at
my
notes,
because
I
was
trying
to
answer
questions
when
you
were
asking
about
adding
a
code
just
to
clarify
this
is
one
of
the
original
codes.
This
is
not
one
of
the
codes
that
is
being
added
to
Medicaid
regulation.
O
The
two
codes
that
were
being
added,
which
referred
to
Medical
Direction,
were
added
and
took
effect
last
October.
So
this
isn't
adding.
This
is
adjusting
the
rate
for
one
code
And
to
clarify
this
isn't
a
CRNA
only
code.
This
is
the
code
that
is
used
when
medical
Direction
guidelines
cannot
be
met.
That's
all
it
is.
I've
worked
around
this
state
in
many
scenarios
with
Physicians
without
Physicians.
We
all
do
what
our
facility
needs,
but
this
code
does
not
mean
that
a
CRNA
is
by
themselves.
O
That's
all
this
means
and
to
turn
it
into
anything
other
than
a
reimbursement
code
is
pretty
distracting
from
the
point,
and
that
I
mean
that's
the
clearest
way.
I
can
make
it
without
going
into
leads
of
anesthesia
billing,
which
can
get
really
complicated,
but
any
opposition
to
this.
Let
me
let
you
know
this
has
come
in
the
final
hour
of
this
happening.
There
was
Zero
opposition
with
adding
the
two
new
codes
last
year
when
this
went
through
this
committee.
No
one
was
opposing
anything
at
that
point.
A
Things
happen
here,
a
lot
of
times,
there's
no,
no
opposition
until
you
get
to
committee,
so
Senator
Yates
is
in
front
and
then
we
got
Center
Alvarado
well.
C
First
of
all,
thank
you
for
the
clarification
and
also
for
my
colleague
from
Jefferson,
pointed
that
out
too,
because
I
was
going
down
that
red
herring
on
looking
at
the
reimbursement.
So
just
to
be
abundantly
clear
previously.
If
the
reimbursement
rate
would
have
been
the
same
amount
if
it
would
have
been
billed
by
a
doctor,
as
opposed
to
the
nurse.
O
No,
the
way
that
medical
Direction
billing
codes
were
up
until
all
this
started.
The
billing
code
for
a
personally
provided
service
by
an
anesthesiologist
was
at
a
hundred
percent
of
the
physician
fee
schedule
a
service
provided
by
a
nurse.
An
ethicist
was
at
the
75
percent
rate
of
the
physician
fee
schedule.
That's
what
it
was
prior
to
any
of
this
work
on
on
these
regulations.
So.
C
C
O
Certain
scenarios
where
we
obviously
work
as
a
team
with
many
people
to
provide
care
a
lot
of
our
University
Hospitals.
We
are
working
side
by
side
anesthesiologists.
This
isn't
a
Turf
War
about
who
wants
to
work
with
who
and
who
can
do
what
this
is
simply
going
back
to
just
the
billing
model.
There's,
never,
whether
I
give
you
a
little
bit
of
sedation
for
something
or
whether
I
put
you
to
sleep
for
a
nine
hour
surgery.
That's
the
same
code.
O
Do
you
see
what
I'm
saying
there's
not
a
discrepancy
amongst
like
levels
of
anesthesia,
the
codes
come
from
the
way
that
the
involvement
of
providers
are
dispersed.
So
this
was
never
an
issue
at
the
100
and
75
percent
to
original
billing
codes.
What
makes
this,
what
makes
this
a
requirement,
and
what
makes
this
important
is
the
fact
that
last
fall.
P
Yeah
I'm,
looking
at
the
regulation
here,
it's
pretty
simple.
The
only
addition
it
says
is
for
anesthesia
and
related
Services,
delivered
by
a
certified
registered
nurse
anesthetist
at
100
percent
of
the
amount
reimbursable
to
a
Medicaid
participating
position
for
the
same
service
or
procedure
pursuant
to
907
KR
3010
I've
gone
to
3010
and
I'm,
taking
a
look
at,
they
have
a
long
list
of
stuff,
but
that's
basically
what
it
says
just
getting
paid.
Equally,
it's
the
same.
P
So
again,
my
question
still
stands
is
if
you're,
a
young
person
with
you
know,
good
brain,
you
want
to
say:
hey
I
want
to
do
anesthesia
at
some
point,
there's
going
to
be
a
complete
disincentive
to
want
to
go
into
medical
school
and
become
an
anesthesiologist
for
this
purpose.
If
the
argument's
going
to
be,
we
can
do
the
same
things.
P
It
doesn't
matter,
okay,
just
as
long
as
this
committee
and
the
people
that
are
doing
this
understand
that
we're
going
to
be
basically
driving
people
into
saying,
don't
choose
med
school,
don't
choose
medicine,
it
doesn't
matter.
You
know,
and
I
would
argue
that
it
does,
because
the
amount
of
clinical
hours
that
are
there
is
exceeding
the
amount
that
you
all
get
trained
in.
You
guys
do
a
good
job
and
you're.
P
So
if
you
would
have
brought
it
before
me,
you
would
have
heard
me
break
out
about
that
too,
and
we've
got
someone
here:
who's
going
to
speak
on
behalf
of
Physicians
as
well
to
see
what
anesthesiologists
think
about
this,
but
that's
the
reality
of
what
it's
going
to
do
to
Senator
yates's
point.
If
Government
came
out
and
said,
hey
paralegals
can
practice
law
and
they're
going
to
be
able
to
Bill
exactly
what
lawyers
can
I
suspect.
P
We
probably
hear
a
breakout
from
the
lawyers
saying
whoa
whoa
whoa
whoa
hold
on
a
second,
you
know,
and
the
paralegals
do
a
lot
of
good
work.
You
talk
to
a
lot
of
lawyers.
Those
guys
know
the
law
as
well
as
a
lot
of
lawyers
do,
but
the
argument
going
to
be
hey.
There's.
Do
they
go
to
the
schooling
that
lawyers
do?
No,
they
don't
do
they
have
all
that
other
train.
No,
they
don't,
but
if
suddenly
government
said
hey,
you
can
build
exactly
the
same
and
be
independent
for
it.
P
There'd
be
a
different
cry
out
from
certain
groups
out
here.
That's
my
concern
here
is:
there
is
a
discrepancy
in
training
and
amount
of
clinical
hours
that
it
takes
to
achieve
these
degrees,
and
I
would
think
that
if
you're
going
to
reimburse
that
should
be
consummate
to
that
not
to
say
it
doesn't
matter
about
your
training
and
background
as
long
as
the
service
is
being
provided,
it's
okay,
what
we're
going
to
do
is
we're
going
to
drive
people
out
of
one
profession
and
into
another
that's
going
to
wind
up
happening.
That's
the
reality
of
it.
P
Folks
here
are
okay.
With
that
just
know
that
when
the
time
comes
in
the
future,
there'll
be
a
lot
less
people
and
the
anesthesiologist
in
the
state.
That's
what's
going
to
wind
up
happening,
you're
not
going
to
have
them
around
and
some
may
not
care.
Okay,
but
I'm,
just
making
sure
people
are
aware.
That's
that's
the
end
result
of
this.
This
is
going
to
do.
O
Can
yes,
so
thank
you
for
your
comment.
I
would
like
to
just
note
that
this
isn't
about
anyone's
education.
It's
not
about
anyone's
training.
This
is
a
billing
model
that
has
been
in
place.
It
is
being
updated
from
2014.
That's
simply
an
update,
but
this
is.
This
is
a
model
that
CMS
uses
daily.
This
is
a
model
that
CMS
and
private
insurers
already
use
and
pay
on
so
to
extrapolate.
What
this
is
doing
and
put
it
in
a
form
that
it's
gonna,
you
know
disincentivize
people
from
going
to
medical
school.
O
If
that's
the
case,
it's
not
going
to
be
this
reg.
That
does
that,
because
we
are
only
mirroring
what
Medicare
and
private
insurers
are
already
doing.
P
36
of
our
population
receives
Medicaid
services,
so
this
is
going
to
cover
36
percent
of
the
state
right
now
for
medical
services.
That's
the
case
that
isn't
the
case
right
now
when
this
passes
through
it
changes
it
from
whatever
we
got
from
Medicare,
and
it's
going
to
go
to
36
more
percent
of
the
people,
the
population
of
the
state
will
fall
underneath
this
and
shortly
after
that
will
probably
be
commercial
stuff
as
well.
P
I,
don't
know
that
much
has
changed
in
terms
of
training
in
terms
of
ability
to
do
these
procedures
from
seven
or
eight
years
ago,
when
it
was
when
it's
been
like
this.
This
is
how
it's
been
built
for
a
long
time.
Nothing
has
changed
in
terms
of
the
training,
the
services
provided,
all
those
sorts
of
things
the
shortages
existed.
Then
they
still
exist.
Now.
This
is
the
trend
that
we're
seeing
I'm,
just
letting
everybody
know
I'm.
Not
supportive
of
this
it'll
be
a
different
public
discussion
when
it
comes
to
Health
and
Welfare.
P
I
can
assure
you,
but
that's
the
concern
when
it
comes
to
this.
Is
this
not
gonna?
This
is
not
going
to
help
in
certain
aspects.
You're
gonna
have
people
that
are
going
to
be
saying,
we'll,
take
less
training
and
less
hours
to
do
the
same
services
for
some
that
might
be
okay,
it
isn't
for
me
as
a
doc.
That's
it!
Thank
you.
Mr
representative.
A
O
Because
this
is,
this
has
been
an
issue
in
some
of
the
facilities
in
our
bordering
states
without
getting
into
the
weeds
of
anesthesia
prior
to
the
implementation
of
the
two
new
codes.
Last
year
there
was
just
two
codes
and
it
was
very
simple:
the
two
new
codes
that
we
added
were
medical
Direction
billing
codes,
one
of
which
gets
tagged
on
to
the
physician
and
one
of
which
gets
tagged
on
to
the
nurse
and
ethicist.
So
when
we
are
both
working
together
providing
care,
okay,
medical
Direction
guidelines,
tefra
guidelines-
this
is
CMS.
O
If
the
requirements
are
met
to
build
that
code,
the
bill
gets
submitted
and
the
two
codes
are
divvied
up.
50
50.
50
is
reimbursed,
Under,
The,
Physician,
modifier
and
fifty
percent
is
reimbursed
under
the
nurse
and
ethicist
modifier.
Does
that
make
sense?
100
bucks
call
it
50
50
each
way.
If
those
tefra
guidelines
are
not
met,
it
must
be
billed
if
the
CRNA
is
involved
as
the
qz
modifier,
which
is
what
we
are
discussing
today,
which
means
that
the
reimbursement
is
now
seventy
five
dollars.
That
doesn't
mean
a
physician
wasn't
involved
in
the
case.
O
O
You
know
medically
directing
four
crnas
with
start
times
at
the
same
time,
and
you
know
what
the
suggestion
is,
so
that
you
can
Bill
appropriately
stagger
start
your
surgeries
and
delay
the
cases.
So,
instead
of
incentivizing
that
to
happen,
putting
medicare's
billing
framework
into
Kentucky
Medicaid
regulation
is
a
very
simple
answer.
It
makes
it
very
clear
for
anyone
providing
services
to
our
Medicaid
patient
population,
what
the
guidelines
are
and
how
to
bill
and
allows
them
the
codes
to
do
so
according
to
how
their
facility
chooses
to
run
their
anesthesia
Department.
O
J
Thank
you.
Thank
you.
I
just
wanted
to
point
out
that
lawyers
and
paralegals
don't
Bill
Medicaid,
so
paralegal
could
bill
whatever
they
want.
They
just
have
to
get
paid
so
they're
not
involved
in
that
system.
So
I
appreciate
your
answers
and,
yes,
I
hope
we
can
move
forward
with
this
any.
A
Other
questions
from
members
in
this
section
moving
on
to
the
next
section,
if
you
guys
don't
mind,
if
you
could
step
back
and
we've
got
people
signed
up
to
speak
against,
we
have
I
think
one
in
person.
Yes,
we
have
Caitlin
Williams
and
we
have
jaiping
Wang
on
Zoom.
A
Q
H
R
Q
Sure
I'm
Japanese
yard,
at
the
University
of
Louisville
I'm,
a
professor
here
I,
also
serve
as
a
Kentucky
director
for
American
society
and
physiologists
and
I
also
serve
as
a
treasurer
for
Kentucky
Medical
Association
kma.
Thank
you.
R
Dr
Wong
fits
everything
in
I'm,
not
sure
so.
I'll
go
ahead
and
start
us
off
here,
as
you
guys
have
heard
to
be
a
physician.
Anesthesiologist
requires
much
more
training
than
a
nurse
anesthetist
I
want
to
make
it
clear
that
I'm
very
pro-crna
at
uofl.
We
do
work
in
teams
of
medical
directions,
so
we
can
oversee
up
to
four
crnas
at
a
time
or
we
can
see
our
training
over.
We
can
oversee
two
of
our
resident
doctors
that
are
training
in
anesthesiology,
so
we
very
much
value
our
team
model
at
uofl.
R
R
But
there
is
a
difference
between
the
education
and
the
training
and
nurse
anesthetists
and
physician
anesthesiologists,
as
Dr
Alvarado
was
discussing.
We
do
have
to
go
through
medical
school,
at
least
four
years
of
training
in
anesthesiology
before
we
can
practice
and
yes,
we
are
both
providing
anesthetics,
however,
just
because
we're
providing
the
same
service
does
not
mean
that
every
service,
so
every
anesthetic
is
the
same.
R
A
very
healthy
patient
is
very
different
to
put
to
sleep
than
a
patient
with
many
medical
comorbidities.
As
you
can
imagine,
many
of
our
constituents
here
in
Kentucky
do
have
a
fair
amount
of
medical
comorbidities,
whether
they're
from
an
urban
area
in
Louisville
or
a
rural
area
in
Eastern
or
Western
Kentucky.
R
So
it's
when
we
get
these
very
complicated
patients
that
have
extreme
medical
comorbidities
and
it's
literally
a
matter
of
life
and
death
as
we're
putting
them
to
sleep
that
it's
important
to
to
understand
the
value
of
having
a
physician
anesthesiologist
and
to
reimburse
these
rates.
At
the
same.
A
nurse
anesthetist
versus
an
physician
anesthesiologist
is
sending
a
signal
that
you
think
that
it
doesn't
matter
that
extra
training
and
education
can
go
into
taking
care
of
patients.
R
I
think
that's
one
important
Point
and
what
we
were
talking
about
earlier
with
the
medical
Direction
and
your
question.
Senator
Yates
Kentucky,
actually
is
what
we
call
an
opt-out
state
in
the
anesthesia
community,
so
Governor
Steve
beshear
had
made
an
executive
order
years
back
that
allows
nurse
anesthetists
to
practice
without
an
anesthesiologist
overseeing
them,
so
that
was
written
as
a
way
to
get
more
access
to
these
rural
hospitals
and
these
medically
underserved
or
medical
deserts,
as
was
referred
to
in
the
the
language
earlier.
R
However,
that
has
clearly
not
been
effective
because
we're
still
facing
those
same
shortages
of
providers,
whether
that
be
physician,
anesthesiologist
or
nurse
anesthetist
over
10
years
later.
Excuse
me
sorry.
This
is
my
first
time
talking
in
front
of
you
guys
and
it's
a
little
bit
nerve-wracking
guys
so.
R
It's
important
to
to
understand
that
with
this,
this
medical
direction
is
that
we're
going
to
be
reimbursing
the
same
amount
to
a
nurse
anesthetist
who
does
not
have
the
same
amount
of
training
as
to
if
they
are
practicing
under
an
anesthesiologist
I,
also
serve
on
the
admissions
committee
at
the
University
of
Louisville
school
of
medicine
this
year
and
each
admissions
meeting
which
we've
had
about
eight
of
so
far
this
year.
R
For
the
the
upcoming
class,
we
go
over
statistics
of
how
many
students
are
applying
to
medical
school
from
the
state
of
Kentucky
and
from
the
rest
of
the
country,
and
our
applications
from
our
in-state
applicants
are
down
this
year
and
I
know.
It
may
seem
like
a
small
thing,
such
as
this
resolution,
to
say
that
that's
dissuading
people,
but
it's
these
things
that
are
built
up
over
time
in
different
Specialties,
that
culminate
in
students
being
not
as
motivated
to
go,
get
their
medical
degree
and
stay
here
and
can
Kentucky
to
practice.
R
So
resolutions
such
as
this
that's
going
to
reimburse
providers
that
have
less
training
and
expertise
less
debt
when
they
get
out
after
having
gone
through
the
rigors
of
medical
school
residency,
not
making
much
money
enough
to
start
paying
back
loans
at
all,
as
opposed
to
a
less
intensive
and
time-invasive
Route
is,
is
not
exciting
for
these
students
that
are
that,
are
you
know,
22
years
old,
trying
to
make
this
decision
about
their
future
careers?
Dr,
Wong
I'll?
Let
you
take
it
from
here.
Q
Foreign,
thank
you.
Mr,
chairman
committee
members
is
a
great
honor
to
be
here
to
speak
on
this.
So
let
me
clarify
so
on
behalf
of
the
American
society
and
enthusi
artists
and
on
behalf
of
the
Kentucky
Society
physiology
restaurant
against
this
regulation,
and
here
here
why
I
think
Dr,
Alvarado
Dr
William
talks
extensive
about
the
20
differences
between
the
CR
and
MD,
just
like
Dr,
Williams
I
work,
this
year's
every
day,
I,
love
them
and
I.
Think
they're,
great
and
they're
really
really
important
force
in
healthcare.
Q
I
think
to
really
to
you
know,
I
think
if
we
want
to
improve
the
care
in
Kentucky,
especially
for
rural
areas,
the
solution
is
not
to
increase
the
pay
for
the
CRS.
The
solution
increase
pay
for
all
of
us,
for
the
enthusiasts
and
for
the
cras.
So
right
now
there's
a
severe
shortage
of
CRS
and
enthusiasts
in
Kentucky.
If
we're
going
to
make
this
change,
you
will
see
less
and
less
anything
she
already
want
to
see
in
Kentucky
and
yeah
I
already
talked
to
several
people.
Q
They
say
if
I
stay
in
California
I
can
get
all
the
respect
as
a
physician.
Why
do
I
do
I
want
to
come
to
Kentucky
one,
the
one
the
Canadian
member
asked
the
question:
do
we
do
different
things
between
any
physiologists
and
Cris?
Yes,
we
do
so
if
you
survey
the
country
right,
so
the
insurance
is
of
the
echocardiography.
All
trans
thoracic,
echocardiography
they're
hard
long
ultrasound
is
pretty
much
only
done
by
any
physiologists,
not
done
by
the
nursing,
nephitis
and
I
think
the
second
difference,
the
anesthesia.
Q
We
actually
make
a
diagnosis
if
we
see
some
things
going
wrong
or
misdiagnosis
and
treat
the
patient,
we
don't
just
follow
simple
protocols
and
for
in
many
practices,
if
you
look
at
you
know
it
doesn't
matter.
It's
the
urban
area
or
rural
area
for
the
big
cases
for
cardiac
surgery,
for
neural
surgery,
for
big
sponsors,
V1,
the
anesthesiology
care
for
them,
and
we
as
I
said
as
a
physician.
Not
only
we
do
anesthesia,
we
actually
diagnose
people,
diagnose
disease
and
treat
the
disease.
The
the
the
other
point
I
have
is.
Q
When
we
talk
about.
You
know
young
healthy
patients
coming
in
for
a
small
surgery
right.
We
have
old,
singing
anesthesia,
there's
only
small
surgery,
there's,
never
a
small
anesthesia,
and
if
you
read
the
newspaper
you
will
know
those
are
the
cases
that
will
be
on
the
newspaper
right,
somebody
pretty
healthy,
come
in
for
simple
surgery,
they
had
a
big
stroke
or
they
die
in
the
Outpatient
Center.
The
reason
for
that
is
surgery
and
anesthesia
fear
a
non-easy
thing
to
do:
there's
no
in
complication
from
anesthesia
such
as
molecular
hypothermia.
Q
So
if
you
have
anesthesia,
a
small
group
of
people
will
develop
high
fever
and
many
of
them
died
down
on
the
table
and
the
other
thing
you
have
is
a
cardiac
arrest
and
a
year
years,
over
years,
we're
doing
better
but
still
they're
a
young,
healthy
patients
come
for
surgery
and
anesthesia.
They
will
die
on
the
aura
table.
The
question
before
the
committee
is:
do
you
want
that
happen
to
your
family
member?
Do
you
want
that
happen
to
your
members
in
Kentucky?
Again
answer
you
don't
right!
Q
So
that's
why
we
want
to
Prior
why
the
highest
possible
level
here
not
reduce
the
level
so
I
think
our
sharing
colleague
mentioned
that
the
increases
it
cannot
be.
The
requirement
for
medical
Direction,
so
meaning
one
efficiology
is
only
can
supervise
four
crnas.
That's
the
reason
that
root
came
right
for
any
possible
any
physiologist.
That's
the
maximum
we
can
do
is
to
supervise
for
cras
and
there's
a
reason
behind
the
regulation
right.
So
what
we're
doing
right
now
is
we're
really
telling
people
don't
worry
about
it?
You
don't
need
to
supervise.
Q
You
know
only
for
a
room.
You
can
see
probably
40
rooms
right
and
you
still
get
paid
the
same
one,
a
message
that
I
was
sending.
Are
we
seeing
our
Kentucky
patients
less
whatever
than
others
right?
We
are
putting
our
Kentucky
patients
into
danger
by
relying
on
these
Regulators
to
go
through
sorry,
I
I
could
not
be
there
in
person
and
I
apologize.
I
I
talk
a
lot
but
I'm
very
passionate
about
this.
Thank
you.
A
No
worries,
thank
you
so
much.
We
have
some
questions,
I'm
going
to
start
us
out
really
quickly.
Just
for
for
my
clarification,
I
think
I
know
the
answer
to
this,
but
in
in
the
doctor's
comments
he
mentioned
reimbursement
rates.
All
those
reimbursement
rates
are
federally
set
correct,
so
the
state
has
nothing
to
do
with
setting
any
of
these
rates.
Is
that
correct.
R
Yes,
those
Federal
rates
are
set
and
that's
actually
another
one
of
our
points
when
we
go
and
talk
to
DC
with
our
legislators,
there
is
that
the
system
is
broken.
I,
don't
think
there
are
very
few
people
that
are
happy
with
the
totality
of
Medicare
and
Medicaid
and
that's
something
that
definitely
does
need
to
be
looked
at
on
a
federal
level.
R
So,
as
Dr
Wong
was
saying,
that's
one
of
our
points.
If
the
pro
the
problem
is
getting
these
providers
out
to
those
points.
Yes,
let's,
let's
raise
those
reimbursements
so
that
we
can
get
providers
out
into
those
underserved
hospitals
and
communities.
But
let's
do
it
based
on
expertise
and
training
and
clinical
training.
C
Thank
you,
Mr
chair
and
for
my
question.
You
kind
of
got
me
that
I
think
I
was
thinking
the
same
line
that
obviously,
if
it's
already
set,
we
want
to
capture
as
much
money
as
we
can
for
Kentucky
for
Kentucky
workers.
So
never
we
want
to
turn
that
down.
We'd
always
want
to
put
it
in
a
way
that
would
capture
as
much
again
so
if
there
needs
to
be
something
to
increase
it.
C
You
know
for
some
other
reason
at
the
federal
level,
but
as
I'm
sitting
here
anytime
I
can
snatch
money
and
bring
it
back
to
poor
Kentucky
I'm
going
I'm
fighting
for
that.
But
the
doctor
put
it.
He
said
part
of
the
treatment
that
that
you
do
as
a
physician
would
also
be
diagnosed
and
treat
patients-
yes,
sir,
and
and
so
I
think
that's
a
really
important
part,
because
we've
had
the
testimony
that
ship
sell.
C
We
know
that,
and
this
is
the
anus
assist
I'm
going
to
say
it
three
times
bad,
but
that
can
we've
said
look.
They
can
do
that
job.
We
know
that
we
want
to
have
some
oversight,
but
it
seems
like
would
there
be
another
billing
code
that,
in
the
event,
as
opposed
to
just
given
the
putting
someone
to
sleep
in
as
opposed
to
doing
that,
if
you're
also
diagnosing
and
treating
some
condition?
Wouldn't
you
also
bill
for
that
as
well?.
R
There
are
certain
modifiers
that
we
use
in
our
billing
systems
like
Dr
Wong
was
talking
about
using
trans-esophageal
Geo
Echo.
So
that's
when,
if
a
patient
is
asleep,
you
can
put
that
Echo
probe
down
a
patient's
throat
and
look
at
the
heart
from
the
inside
and
that's
something
that
we
do
on
pretty
much
every
cardiac
case
in
the
cardiac
physician
anesthesiologist
is
the
one
performing
and
reading
that
there
are
additional
reimbursements
for
that,
and
we
know
that
all
of
those
are
high
risk,
I.
R
Think
to
Dr
Wong's
point
the
important
part
of
of
valuing
the
anesthesiologist's
role
in
the
field
of
anesthesiology.
Is
that
you
don't
know
when
things
are
going
to
go
wrong.
You
don't
know
when
a
patient's
going
to
have
a
difficult
Airway
and
it's
almost
impossible
to
put
a
breathing
tube
in
you.
Don't
know
when
a
patient
has
an
un.
A
seemingly
healthy
patient
has
an
undiagnosed
condition
that
comes
to
fruition
on
the
Opera
operating
table,
and
it
is
quite
literally
seconds
that
determine
that
can
determine
a
patient's
outcome.
R
It's
important
to
place
value
on
that
training
that
we
have
as
physician,
anesthesiologist
to
act
and
diagnose
and
treat
in
those
moments
that
deserves
the
difference
in
the
pay
and
I
think.
As
we've
kind
of
said,
it
sends
the
wrong
message
to
put
us
on
a
pay
Equity
scale
when
our
training
is
so
different
again.
C
You
touched
my
point
and
that's
what
I
was
looking
at.
So
in
the
event,
that's
why
you
have
the
oversight.
Then
it
was
said
that
was
necessary
that
there
should
be
the
oversight.
So
in
the
event
that
there's
something
going
wrong,
there's
a
complication.
We
need
you,
that's
where
the
doctor
comes
in,
but
that
billing
is
done
separate.
So,
in
the
event,
there's
not
that's.
Why
I
keep
going
back
to
my
practice
sure
if
it's
something
that
the
paralegal
does
it
gets
on
a
bill
sends
it
out.
That's
how
my
office
does
it.
C
This
was
built
with
attorney
great.
This
is
built
a
paralegal
rate
sent
out,
but
but
in
your
situation
in
the
event
that
it's
something
that's
routine,
it's
gone
through
and
the
service
costs
x
amount
of
dollars,
but
if
you're
there
as
a
doctor-
and
you
have
to
diagnose
or
treat
or
do
something
else-
you
you're
going
to
build
above
and
beyond
that
correct.
No,
that's.
R
R
Unfortunately,
with
Medicare,
if
they
increase
our
anesthesiology
reimbursement,
they
have
to
take
it
from
somewhere
else.
So
that's
kind
of
the
root
of
the
problem
is
we're
not
trying
to
take
money
from
everyone
else.
We
just
it
hasn't
been
overhauled
in
years,
which
is
you
know
its
own
separate
issue,
but
I
can
tell
you
working
at
a
high
Acuity
Center
like
uofl,
like
Dr,
Wong
and
I,
do,
and
the
Jewish
Heart
Hospital
just
down
the
street,
that
we
also
staff
as
part
of
our
group
when
things
go
wrong.
R
The
nurse
anesthetists
are
not
calling
their
fellow
nurse
anesthetists
they're,
calling
the
physician
anesthesiologist
into
the
room
and
I
think
it's
that
speaks
volumes
and
it's
important
to
place
value
on
that
and
reflect
that
in
the
reimbursements.
Otherwise,
it's
sending
the
wrong
message
to
patients,
thinking
that
we
provide
the
exact
same
care,
sending
the
wrong
message
to
hospitals
and
sending
the
wrong
message
to
the
medical
community
in
future.
Physicians.
Q
And
to
answer
it
to
Senator
ease
to
answer
your
questions.
That's
really
not!
So
that's
really!
No
I
mean
those
are
like
a
full
Echo.
They
will
pay
about
fifty
dollars
for
30
minutes
to
50
minutes
Physicians
work.
So
there's
really
no
code
to
accomplish
some
of
the
Physicians
for
more
work
to
be
done
and
I
think
you
know
that
we
I
look
at
it
and
pretty
much
every
hospital
look
at
that.
They
view
the
any
physiologist
as
a
fire,
firefighters
right.
Q
If
there's
emergency
we're
ready,
we
will
go
there
and
take
care
of
the
patient
and
it's
very
hard
to
justify
to
see
well
just
because
there's
no
fire
in
this
District
today,
I'm
not
going
to
pay
for
firefighter
so
I
would
say
for
patient
safety.
We
want
to
fight
fighter
there,
whether
that's
fire
or
not,
just
just
to
protect
the
possible
complication,
and
we
all
know-
and
if
this
is
Mercy
for
now,
but
still
there's
a
significant
significant
complication.
People
can
die
from
what
again
hypothermia
can
die
from
Cardiac
Arrest
can
die
from
fail.
B
Thank
you,
Mr
chairman
I
kind
of
just
want
to
get
us
back
on
track
because
it
seems
as
if
we're
talking
about
scope
of
practice,
and
this
is
not
a
scope
of
practice-
we're
not
trying
to
expand
what
nurse
and
necess
are
doing
we're
not
trying
to
decrease
what
docs
are
doing.
This
is
about
a
billing
code
that
apparently
hospitals
are
quite
comfortable
with
allowing
to
have
increased
rates.
It's
a
it's
a
symmetry
between
Medicaid
and
Medicare
I.
B
Don't
know
why
we're
getting
off
on
this
scope
of
practice
and
who's
more
qualified
and
who's,
not
more
qualified.
It's
currently
happening
and
from
my
understanding
is
that
everybody
was
at
the
table
at
the
same
time,
and
everyone
agreed
that
this
was
an
appropriate
way
to
go
and
all
the
hospitals
were
represented
and
the
anesthesiology
community,
so
Mr,
chairman
I,
don't
know
if
this
is
the
appropriate
time,
but
I
just
think
we're
kind
of
off
track
with
a
billing
code.
For
that
a
facility
is
allowed
to
submit.
Q
Senator
Adams,
let
me
clarify
on
behalf
of
the
American
society,
anesthesia
artist.
We
are
strongly
against
this
regulation.
R
Yes,
thank
you
for
Senator,
Adams
I
agree
with
you.
This
is
not
a
scope
of
practice
issue
at
all.
I
think
our
issue
with
this
stems
from
the
fact
that.
R
J
J
I
have
been
put
to
sleep
for
brain
surgery
by
CRNA,
so
crnas
can
can
do
a
lot
you're
acting
like
they're,
totally
unqualified,
but
the
concern
I
have-
and
maybe
this
was
not
stated
correctly
or
whatever,
but
the
incentive
was
to
increase
pay
in
the
underserved
area,
but
if
you're
saying
they're
not
qualified
so
there
it
makes
no
sense
at
all.
This
is
a
billing
code
issue
and
that's
it
period
and
I
hope
we
can
move
forward.
Thank
you.
P
Yeah,
just
I
want
to
clarify
the
state,
does
set
rates
so
I
think
that
was
stated
earlier,
that
they
don't
Medicare
sets
their
rates.
God
knows:
Medicaid
pays
a
lot
less
than
Medicare
has
over
the
years,
I
think
every
provider
out.
There
knows
that,
so
the
state
does
set
their
own
they're
wanting
to
mirror
assume
that
CMS
has
done.
But
again
this
Miss
markedly
expands.
This
36
percent
of
the
population
of
this
state
is
under
Medicaid.
This
is
again
expanding
this
to
that.
P
What
I'm
saying
is
it's
going
to
disincentivize
and
people
may
say:
no,
it's
not
I'm
we're
already
seeing
that
in
our
medical
schools.
We're
seeing
that
already
for
anesthesiologist,
if
you're
a
hospital
employer
and
you're
going
to
get
paid
the
same
and
you're
going
to
say,
I
can
either
hire
an
MD
or
I
can
hire
a
CR,
a
nurse
anesthetist
for
this
and
one
I'm
going
to
be
paying
less
for
right.
Now,
you're
going
to
go
with
the
cheaper
stuff
to
maximize
your
profit
margins
and
do
away
with
less
stocks.
P
Less
stocks
means
less
people
going
into
the
profession
I'm.
Just
letting
everybody
know
here.
Everybody
acts
like
it's
no
big
deal
and
they
have
their
little
folks
that
they
like
to
hang
out
with
I'm
telling
you
from
a
policy
perspective.
This
is
not
the
proper
approach,
we'll
be
regretting
this
in
years
to
come
in
the
future.
Thank
you,
Mr
chairman,
that.
A
Will
be
it
for
this
subject,
I
think
we've
covered
it
I
think
everyone's
had
ample
opportunity
to
make
their
case
before
we
move
on
to
the
next
regulation.
Do
we
have
any
motions
on
this
regulation.
A
That
that's
seeing
none,
there
are
no
emotions
on
this
on
this
set
of
regulations
and,
in
particular
the
one
that
we
have
just
been
discussing
104
for
the
proponents
of
104..
The
good
news
is
it's
getting
out
of
this
committee.
The
bad
news
is
it's
going
to
Health
and
Welfare,
which
is
chaired
by
Senator
Alvarado,
so
we,
this
will
be
discussed
again
and
that's
what
frankfurt's
all
about
you
know
delving
into
issues
looking
at
the
minutia
and
making
sure
we
have
good
policy
in
the
end.
B
H
C
Joe
Barnett
branch
manager,
policy
and
training
at
Division
of
Child
Support.
A
Are
there
any
questions
on
this
particular
regulation?
400
921
KR,
zero,
zero
one,
four
hundred
seeing
none,
please
call
the
next
regulation.
Thank
you.
L
Incentivizing
providers
considered
to
to
consider
operating
during
non-traditional
hours,
effective,
September,
1
of
2022
the
transition
period
during
which
a
household
still
receives
child
care
assistance
program.
Assistance
after
becoming
ineligible
due
to
exceeding
income
guidelines,
will
be
extended
from
three
to
six
months,
effective
after
October
24th
of
2022.
L
I
A
Thank
you
so
much.
There
are
our
agency
amendments.
Is
there
any
discussion
on
the
agency
amendments?
Seeing
none
is
their
motion
for
approval
of
the
agency
amendments.
We
have
a
motion
in
a
second
without
objection,
it
is
so
ordered.
I
have
a
few
I
think
there
are
a
few
questions
and
I'll
warn
you
in
advance.
I
have
a
question
on
this
subject
and
I
have
a
question
on
a
totally
different
topic
not
related
to
this
regulation,
but
basically,
what
we're
doing
is
providing
an
increase
in
reimbursements
using
arpa
dollars.
A
Could
you
tell
us
quickly,
you
know
we
see
the
per
the
smaller
numbers.
What
would
what
do
you
expect?
The
total
number
to
be
once
these
increases
go
into
effect.
I
Well,
some
of
these
increases
have
already
gone
into
effect
and
we
have
been
tracking
the
expenditures
of
increasing
eligibility,
so
we
initially
increased
eligibility
on
January
1st
and
then
we
increased
that
eligibility
again
on
July
1st.
So
we
do
have
the
expenditure
total.
So
you
know
we're
continuously
monitoring
how
much
these
changes
are
costing
us.
A
To
clarify
my
question:
so
what
are
we
currently
paying
roughly?
What
do
you
once
the
increase
goes
into
total
effect?
What
do
you,
what
do
we
will
be?
What
will
the
state
be
paying
in
the
future
and
I
know?
That's
a
guesstimate!
That's
a
that's
a
total
hypothetical,
but
we
have
to
kind
of
plan
right.
I
Well,
there
are
many
parts
to
this
regulation,
but
the
the
largest
and
the
part
that
I
think
you're,
most
speaking
to
the
most
costly,
has
been
the
increase
in
eligibility
from
January
through
June.
The
increase
in
eligibility
from
160
percent
federal
poverty
level
to
200
federal
poverty
level,
cost
us
about
1.7
million
dollars.
I
So
that
was
just
looking
at
families
that
were
eligible
just
because
of
that
increase
and
from
through
the
month
of
July,
when
we
increased
eligibility
from
the
200
percent
federal
poverty
level
to
85
percent
State
median
income
level
for
one
month
that
additional
eligibility
increase,
cost
us
about
thirty.
Four
thousand
dollars.
A
A
So
the
total
for
for
a
year
would
be
5.4,
two
point:
I'm
sorry,
3.4
million
I'm,
an
attorney
I'm,
not
good.
E
A
Math,
3.4
million,
so
in
our
buying
annual
budget,
it's
approximately
a
six
or
seven
million
dollar
increase
Okay.
So
we've
we've
set
that
we've
set
the
table.
We
know
what
the
increase
will
be
so
once
these
arpa
dollars
are
gone,
the
way
this
regular
way,
I
read
this
regulation
is
that
Baseline
will
still
be
in
effect,
it'll
go
in
it's
a
we're
forming
a
new
Baseline,
correct.
I
I
Well,
we
have
this
Federal
funding
through
September
30th
2024,
so
we
have
some
time.
Advocates
are
calling
on
Congress
to
invest
more
money
in
child
care,
so
it
may
be
ongoing.
So,
as
I
said,
we're
continually
monitoring
so
that
we
can
estimate
costs.
There
is
some
fluidity,
quite
a
bit
of
fluidity
in
child
care
assistance
program,
but
at
least
we'll
be
able
to
provide
estimates.
If
Congress
chooses
not
to
do
that,
there
will
be,
of
course,
another
budget
session
2024.
I
If
the
general
assembly
chooses
to
fund
any
parts
of
this,
as
I
said,
there's
quite
a
few
changes
through
this
Federal
funding.
But
ultimately,
if
the,
if
there
is
no
additional
federal
or
state
funding,
we
would
have
to
consider
stepping
eligibility
or
possibly
other
increases
that
we've
made
back
down
are.
A
Care,
that's
right.
I've
got
another
question,
but
it's
on
a
different
topic
and
I'll
Circle
back.
Do
we
have
any
other
questions?
P
It
was
just
to
that
same
issue.
It's
you
know,
I
want
to
make
sure
we
have
a
long-term
plan
for
this.
Ultimately,
because
this
sounds
great,
this
will
be
wonderful.
People
get
increased,
Services
they'll
have
increased
eligibility
and
more
reimbursement
for
providers,
but
if
it
gets
dried
up,
you
know
I'm
going
to
see
it
we're
going
to
hear
it.
We
have
a
budget
description.
Well,
it's
a
general
assembly
who
wants
to
cut
you
that's
going
to
be
the
argument.
That's
what
I
don't
want
to
have
happen
for
us.
So
right
is
this
wonderful.
P
We
need
to
have
a
long-term
plan
if
it's
seven
million
dollars
we're
using
at
least
again
I've
said
this
many
a
Time
seven
million
dollars
in
advertising
for
Medicaid
services.
I
would
encourage
you
all
to
take
a
look
at
the
advertising
dollars,
bring
that
in
and
offer
this,
which
probably
go
to
better
use
in
my
opinion,
since
we're
at
an
all-time
high
for
Medicaid
signups,
so
consider
there's
funds
out
there
that
we
can
use
for
this
I.
Just
don't
want
it
to
be
thrown
in.
P
A
Would
Echo
Central
Alvarado's
comments
that
were
you're
drawing
the
line
here
today
that
that
we've
stated
it
and
but
sure
enough?
When
we
come
back
in
2024,
the
message
will
be
you
cut
us?
You
know
you
cut
us
so
anyway,
that's
my
problem.
Any
other
questions
for
members
on
this
rag.
Okay,
Switching
gears
a
little
bit
so
you
know
we're
currently
providing
arpa
dollars
to
Providers
we're
providing
those
to
private
providers.
Non-Profits
and
I.
Think
those
rates
are
pretty
are
the
same.
Is
that
correct?
A
I
I
Those
are
tiered,
so
I
will
turn.
Oh,
there
are
three
tiers
to
the
those
funds.
Tier
one
is
base
level.
You
know
they're
meeting
health
and
safety
requirements,
tier
two
they're
meeting
health
and
safety
requirements,
but
all
their
employees
are
paid
at
least
ten
dollars
per
hour
and
tier
three
again
they're
meeting
the
the
health
and
safety
standards
and
the
floor
for
all
employees
is
13
per
hour,
so
it
really
incentivizes
them
to
try
to
pay
their
employees
more,
but.
I
No
they're,
as
long
as
those
are
meeting
those
three
guidelines,
the
the
contract
and
the
application
that
we
had
for
this
process.
It
was
any
regulated,
Child,
Care,
Program
across
the
state.
It
doesn't
matter
if
your
profit
government,
whatever
it
doesn't
matter
what
you
are
as
long
as
you're
regulated.
I
Then
you
could
apply
for
this,
and
it
was
based
on
your
capacity
that
was
listed
in
our
system,
which
is
the
Conte
kicks,
which
is
Kentucky,
integrated
child
care
system
and
shows
how
many
kids
you
can
have
at
your
highest
capacity
and
that's
what
we
based
it
on.
We
allocated
49.6
million
for
each
payment,
which
is
nine
payments,
total
there's
a
rolling
application
for
that.
So
that,
let's
say
someone
was
closed
for
the
summer
and
they're
not
going
to
be
eligible
because
they
weren't
providing
services
to
children,
but
then
they
reopened.
I
They
could
get
that
next
payment,
but
part
of
the
contract
was
also.
We
are
federally
mandated
to
report
out
on
how
these
funds
are
being
spent.
So
one
of
the
items
in
our
contract
was
a
monthly
data
sheet
showing
how
providers
were
using
that
money
and
for
those
to
be
turned
in
every
month.
And
if
there's
one
that's
missed,
they
won't
be
eligible
for
the
pay
payment
because
they
didn't
fulfill
the
part
of
their
contract
that
they
were
supposed
to,
but
they
could
as
if
they
turned
them
in
get
the
next
payment.
A
You
know
we
were
a
little
bit
late
on
the
questionnaire.
Therefore,
we
lost
the
whole
quarter
of
payment.
Is
the
questionnaire
easy
to
do
or.
I
It
is,
it
is
it's
the
same
questions
every
month
and
we
ask
for
those
to
be
done
monthly,
even
though
we
are
required
to
do
quarterly
reporting.
We
ask
for
those
monthly
to
make
it
easier
on
the
providers
that
way
they
weren't
rushing
every
quarter
like
oh
I,
need
to
go
back
and
find
X,
Y
and
Z
if
they
got
in
the
habit
of
doing
it.
Now
we
contract
with
a
third
party
vendor
to
distribute
These
funds.
They
send
an
email
reminder
out
to
folks.
I
Every
month
they
follow
up
with
phone
calls
asking
for
it
and
the
date
is
outlined
in
the
contract.
That
is
due
by
the
5th
of
every
month.
We
have
had
some
folks,
unfortunately,
that
have
missed
that
deadline.
We
have
been
very
consistent
with
applying
the
contract
says
if
you
don't
follow
this
you're
not
going
to
get
this
payment,
but
you
can
get
the
next
one.
B
A
November
9th
and
do
we
have
any
announcements
for
members
I
have
announcement
if,
okay,
this
is
an
announcement
mainly
for
lobbyist
cabinet
members,
whoever
that's
listening,
still
listening,
I
guess,
if
you
want
to
do,
we
have
a
general
rule
that
you
need
to
be
in
person
that
we
don't
allow
Zoom,
unless
it's
extenuating
circumstances
just
for
clarification,
that
that
rule
was
never
meant
to
prevent
people
or
make
people
fly
in
from
out
of
state.
A
So
if
you'll,
just
let
the
committee
know
that
you
have
a
speaker,
that's
in
California
or
or
another
state
wanting
to
speak.
It's
not
the
intent
of
the
leadership
of
the
committee
that
they
fly
into
our
committee
that
we
we're
more
than
happy
to
do,
take
them
by
Zoom.
But
if
you
live
in
the
general
area,
it's
our
wish
that
you
would
would
be
here
for
the
in
person.
I
just
want
to
make
that
announcement
for
clarification,
any
other
business
to
come
for
the
committee,
seeing.