►
From YouTube: Medicaid Oversight and Advisory Committee (6-22-22)
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).
A
A
Motion
passes.
Thank
you.
A
slight
deviation
from
our
agenda.
If
we
could-
and
let
me
turn
this
over
to
co-chair
elliot.
Thank
you,
mr.
C
Chairman
I
wanted
to
take
a
moment
if
we
could
to
recognize
our
former
colleague
representative
wilson,
stone
who
passed
away
over
the
weekend.
A
Thank
you.
Thank
you.
Co-Chair
elliott,
cerny
was
appropriate
and
was
a
a
great
legislator
and
a
great
individual
moved
on
to
our
agenda.
First,
an
update
on
our
medicaid
budget
and
enrollment,
and
we
had
the
commissioner
lee
scheduled
to
be
here,
but
she
decides
she'd
rather
have
kovad
than
meet
with
us.
So
she
is
in
recovering
and
quarantined.
But
we've
got
the
the
b
team
here
and
I
really
think
they're
18,
but
they
told
me
to
be
team,
but
if
you
would
identify
yourself
with
the
record
and
then
feel
free
to
proceed.
D
So
we
were
asked
to
come
and
present
today
on
on
our
budget
for
2022,
where
we
were
tracking,
where
we're
looking
at
so
just
want
to
preface
that
we
are
still
in
state
fiscal
year
2022.
So
we
still
have
some
expenditures
still
outstanding,
but
what
I
did
I'm
trying
to
illustrate
that
on
this
first
slide,
to
show
you
where
we,
what
we
were
budgeted
for
2022.
D
What
was
in
the
in
emars
as
our
appropriations
and
I
broke
it
out
by
general
fund,
restricted
agency
funds
and
federal
funds,
as
well
as
a
aggregate
total.
D
Then
I
provided
you,
the
2022,
actual
expenditures
that
were
through
may,
as
well
as
what
we
estimate
our
expenditures
to
be
for
the
month
of
june,
to
give
you
where
we're
going
to
end
up
at
the
end
of
the
state
fiscal
year.
I
will
point
out:
we
do
have
an
881
million
dollar
surplus
so
to
speak,
they're
on
the
restricted
funds,
but
that's
due
to
the
movement
of
the
6.2
percent.
F
map
has
a
lot
to
do
with
that.
D
We
did
when
we
budgeted
2022.
If
you
remember,
we
did
a
one-year
budget,
we
did
not
anticipate
the
pandemic
lasting
throughout
the
whole
year
of
2022.
So
a
large
piece
of
that,
if
you
remember,
we
did
a
current
year
appropriation
for
2022
during
this
past
budget
exercise
of
about
709
million.
So
that's
that
was
that,
but
that
709
million
was
all
federal
dollars.
If
you
recall
so.
D
So,
on
that
previous
slide,
we
we
showed
you
that
we've
spent
13.5
billion
dollars
through
may
we
kind
of
broke
it
out
on
this
pie,
chart
to
show
you
where
those
funds
went
about.
80
percent
are
going
to
our
managed
care
organizations.
Now
we'll
remind
you
that
that's
not
all
capitation
payments,
we
do
have
what
what
I
like
to
call,
but
cms
doesn't
like
to
call
it
anymore.
D
It's
pass-through
payments,
they're
now
called
directed
payments
to
where
we
direct
payments
specifically
to
targeted
provider
types
and
I'll
go
over
those
on
the
next
slide,
but
you'll
see
that
10.7
billion
was
paid
to
and
through
the
managed
care
organizations,
and
then
the
remaining
20
is
in
our
federal
in
our
fee
for
service
area.
Two
of
our
largest
pieces
of
our
of
our
federal
of
our
fee
for
service
arena
is
the
nursing
facilities
and
alternative
community
care.
D
What
we,
what
what
that
alternative
community
care
is
called
is,
is
basically
all
of
our
waivers
put
into
one.
So
those
are
our
waiver
costs,
so
you'll
see
that
those
are
the
two
highest
paid
items
in
our
fee
for
service.
I
will
point
out
the
all
other
shows
a
negative
459,
that
is
our
drug
rebates.
That's
because
our
drug
rebates
have
substantially
increased
this
year.
D
B
D
So
on
this
slide,
I
wanted
to
break
out
a
little
bit
about
the
directed
payments
that
I
mentioned,
of
the
10.7
billion
that
we've
paid
to
or
to
the
managed
care
organizations
we've
directed
them
to
pay
almost
2.5
of
that
across
three
different
directed
payments
in
2022,
the
university
directed
payments,
which
is
about
1.3
billion,
the
hospital
rate
improvement
program
which
is
based
off
of
inpatient
discharges,
that
is,
that
is
paid
about
1.15
billion.
And
then
we
had
an
ambulance
provider
assessment
program
which
was
to
the
tune
of
about
35
million.
D
We
did
break
that
out
for
you
senator
meredith.
I
know
that
this
is
very
tugs
at
your
heart
about
the
rural
hospital.
So
I
wanted
to.
I
wanted
to
identify
and
show
you
the
spin
and
what
we
did
was
we
used
the
cbsa
designations
of
urban
versus
rural
and
based
on
what
that
county
was
listed.
If
they
were
listed
as
any
hospital
in
that
county,
we
we
bucketed
them
into
the
rural
count.
D
So
you
could
see
that
I
provided
you,
the
total
paid
by
urban
and
rural,
that
we
paid
out
of
hatred
program
of
1.15
billion,
the
assessment
that
they
paid.
I
don't
want
you
thinking,
they
just
got
1.15
billion.
They
they
do
pay
the
state
match,
which
is
an
assessment
back
to
us,
so
that
was
about
199
million
and
then
the
net
paid
to
those
hospitals
was
close
to
950
million
over
state
fiscal
year.
2022.
B
We
do
have
two
other
directed
payments:
they
are
for
durable
medical
equipment
and
for
the
pharmacy
program,
the
reasons
those
don't
show
up
as
a
direct
payment
is
because
they're
incorporated
into
capitation
rate.
So
it's
included
in
that,
but
all
of
the
you
know,
all
five
of
those
programs
are
are
directed
by
statute.
D
C
Thank
you,
mr
chairman.
Yes,
I
do
on
the
non-emergency
medical
transportation
payments.
Just
can
you
just
comment
on
those?
I
know
that
that
was
a
big
conversation
piece
of
our
severe
mental
illness
task
force,
those
staying
about
the
same,
going
up
going
down
any
any
trends
in
that.
D
Well,
we
we,
this
is
a
capitated
payment
that
we
paid
to
the
transportation
cabinet
who
pays
it
to
those
brokers
in
those
areas.
We
are
seeing
an
increase
in
trips,
we're
getting
we're
not
quite
back
to
pre-pandemic
trips
just
yet,
but
we
are
seeing
a
trend
back
up
there.
Yes,.
E
You,
mr
chairman,
yeah
just
under
the
the
pie
chart
you
guys
had
there
amount
of
money
dedicated
towards
dental,
and
I
know
I
had
a
bill
filed
this
past
year
to
try
to
help
improve
a
lot
of
those
reimbursements.
E
Is
there
any
dental
costs
incorporated
into
managed
care?
I'm
at
the
larger
pie
chart
I'm
curious
how
much
about
approximately
how
much
that
is,
because
I
know
that
you
know
commonwealth
fund
just
came
out
with
kind
of
rankings.
Today
at
least
I
got
the
report
today
from
where
the
state
ranks
we're.
I
mean
horrible
on
dental
issues.
E
I
think
we're
50th,
so
anything
we
can
do
to
help
improve
that
and
for
payments
I
mean
it's
really
really
bad
we're
losing
providers
quickly
and
it's
going
to
be
tough
and
I'm
just
curious
how
much
money
do
we
have
any
idea
what
the
breakdown
would
be
in
the
larger
pie
chart
in
the
blue
part
for
dental
and
is
the
the
dental
amount?
That's
the
sliver
on
the
side
is
that
just
people
outside
of
that
managed
care.
D
To
address
your
your
question
about:
what's
in
the
pie,
chart
that's
just
for
our
fee
for
service
population
at
10
percent
of
our
population,
those
that
are
in
long-term
care
facilities.
Things
like
that,
the
children
that
are
in
the
waivers-
that's
the
dental
that
is
listed
here,
but
you're
correct.
There
is
a
piece
of
the
pie
in
the
managed
care.
I
don't
have
that
number
in
front
of
me.
I
can
get
that
for
you,
but
I
don't
have
that
amount.
E
I'd
be
curious,
how
much
that
is!
I
mean
at
your
leisure
to
get
that
so
that
2.2
for
children
that
are
outside
of
that
and
then
people
and,
like
I
said,
skill,
nursing
facilities,
long-term
care,
that
kind
of
thing.
Okay,
I
was
just
curious,
that's
something
we
have
to.
I
think
try
to
focus
on
as
much
as
we
can
add.
B
B
I
think
this
provider
type
like
several
other
provider
types,
is
struggling
with
workforce,
and
so
then
we
have
an
access
issue
which
we're
obviously
concerned
about,
but
we
have
been
in
communication
with
them
and
we
are
talking
through
what?
What?
What
are
the
levers
that
we
have
available
to
us
to
be
able
to
try
to
help
out.
D
And
if
I
may
say
a
little
more
on
that
on
the
in
2020,
the
american
dental
association
did
a
an
analysis
on
rates
and
the
fee
for
service
rates,
in
particular
we're
number
one
in
the
nation
on
our
fee-for-service
rates
for
children,
and
I
think
we're
number
three
on
fifa
service
rates
on
adults.
D
E
And-
and
I
and
I
thank
you,
mr
chairman-
I
know-
there's
been
I've
had
some
recent
discussions
with
people
nationally
that
have
mentioned
that
we
rank
very
well
on
fee-for-service
rates
right
from
a
medicaid
angle,
at
least
as
a
percentage
of
what
we
pay
for
commercial.
The
hard
part
is
there's
practices
that
are
purely
on
dental
and
and
they
use
the
the.
I
think,
the
larger
blue.
E
You
know
whatever's
in
that
managed
care
lump
and
that
isn't
very
good,
obviously
we're
dealing
with
very
old
rates
and
then
percentages
of
that
and
below
that
amount.
So
I
I
just
be
curious,
I'm
you
know
we
rank.
I
mean
the
rankings
came
out
today,
really
poorly.
That's
why
I
look
at
that.
I
go
man,
we
gotta.
We
have
to
do
something
to
improve
that.
So
that
was
my
curiosity,
but
if
you
can
give
me
those
numbers
when
you
get
a
chance
to
be
great
thanks.
A
F
Carol,
thank
you,
mr
chairman,
just
quickly
and
remind
me
on
the
the
10
billion
that
was
appropriated
or
spent
on
managed
care.
How,
when
is
that
distributed?
Is
it
done
quarterly
or.
D
F
Are
there
limitations
on
what
they
can
do
with
that
money,
while
they
are
waiting
to
disperse
that
those
funds,
as
far
as
how
it
is
it's,
just
in
a
obviously
can't
be
invested
in
stock
market
or.
B
B
So
you
know
once
the
payment
goes
to
them.
The
only
requirement
that
we
have
is
they
have
to
spend
90
percent
as
part
of
the
medical
loss
ratio.
They
have
to
spend
90
percent
of
the
dollars
they
receive
on
health
care
services.
So
you
know
during
the
time
between
when
they
receive
the
payment
and
when
they
expend
the
money,
you
know
I'm
not
sure
what
they
do
with
it,
but
they
do
have
just
to
make
payments
timely
payments,
so
they
do
have
to
pay
claims
within
30
days.
D
I
will
tell
you
on
the
directed
payments:
we
have
a.
We
have
a
time
frame
of
like
a
week
for
them
to
turn
around
make
those
payments.
So
the
2.5
that
I
mentioned
to
you
earlier
that
goes
to
the
hospitals,
universities
and
the
ambulance.
We
do
require
them
to
that's
paid
outside
the
capitation
payment
that
that
deputy
commissioner
cecil
is
talking
about.
D
We
do
have
a
monthly
capitated
process,
but
the
the
directed
payments
are
paid
outside
that
directed
outside
that
capitated
process,
but
we
do
put
a
little
bit
closer
time
frames
or
more
string
time
frames
on
them
to
get
those
payments
issued,
because
it's
so
important
to
get
it
into
the
hands
of
the
hospitals
into
the
ambulances
so
that
they
can
do
what
they
need
to
do
with
it.
B
You
know
senator,
I
think
it
might
be
really
difficult
to
try
to
to
tie
how
long
they
keep
the
funds
before
they
pay
it
out,
because
they're
paying
claims.
You
know
every
some
every
day,
some
every
week,
so
I'm
not
sure
we'd
be
able
to
demonstrate.
B
We
try
to
provide
oversight
on
both
the
timeliness
of
their
claim
payment
and
their
denial
rate,
so
we
do
they
have
to
report
to
that
us
to
medicaid
regularly.
With
that
we
do.
We
do
track
that
to
make
sure
that
they're
within
the
contract
and
then
again,
you
know
when
providers
complain
to
us
about
something
going
on.
We
definitely
want
to
look
into
it
because
we
want
to
hold
them
accountable
to
the
contract.
A
Speaking
of
the
contract,
where
are
we
with
the
rfp
process?
It
seems
like
it's
been
hanging
out
there
since
the
beginning
of
time.
A
A
Last
interim
I
mentioned
when
we
had
presentations
from
our
mcos
that
rural
providers
on
their
average
are
being
paid
75
to
80
percent
less
than
their
urban
counterparts,
and
so
I
posed
the
question
it
wasn't
rhetorical.
I
think
it
was
taking
the
rhetorical
that
why
would
anybody
choose
to
practice
in
a
rural
community
knowing
they're
going
to
be
making
substantially
less
in
their
urban
counterparts
with
a
more
critical
ill
patients
less
compliant
patients?
And
the
answer
was
we
don't
know?
A
Some
of
us
attended
a
conference
back
in
april
with
csg,
and
we
heard
a
presentation
where
they
talked
about
cms,
formulating
a
payment
policy
that
would
reflect
the
the
issues
specific
to
rural
communities
and
those
payments
would
be
adjusted
to
reflect.
It
have
y'all
heard
anything
about
that
said
anything
about
that
studied
any
of
that.
B
No,
we
are
aware
that
medicaid
is
creating
a
new
provider
type
for
rural
health
so
that
they
can
maybe
adjust
their
business
model
to
not
do
inpatient
so
we're
closely
monitoring
that
one.
But
I'm
not
aware
of
any
right
now
any
guidance
on
or
any
grumblings
around
extra
payments
to
roles
and.
A
D
A
Certainly
looks
like
a
last-ditch
effort
to
try
to
salvage
some
of
these
rural
hospitals,
but
again
it
goes
back
to
the
payment
methodology
and
how
it's
reflected
and
right
the
specific
issues.
So
that's
something
we
can
talk
about
in
the
future
meeting,
but
I
found
that
subject
to
be
very
very,
very
interesting
because
I
think
it
can
improve
the
health
of
our
population,
which
saves
us
money.
A
B
D
Yes,
in
terms
of
budget,
no,
I'm
I'm
trying
to
get
through
2022,
but
but
we
will
be
doing
a
deep
dive.
We
wanted
to
wait
until
at
least
one
quarter
goes
by
of
2023
and
see
how
it
aligns
with
our
projections
just
so
that
we
can
get
some
data
to
use
to,
because
we're
trying
to
make
data
decisions
based
off
of
data,
and
so
we
just
want
to
make
sure
that
we
give
enough
time
for
that
month,
because
rates
change
on
7-1
for
nursing
facilities
rates,
change
for
for
other
provider
types
as
well.
D
So
we
want
to
make
sure
that
our
projections
incorporated
that
allow
some
extra
times
for
some
of
these
visits.
Some
of
these
days,
the
days
in
nursing
facilities,
we're
down
right
now
in
in
the
number
of
days
day
beds,
so
we're
trying
to
see
if
that
comes
back
up
to
pre-pandemic
levels
anytime
soon.
So
we
just
want
to
make
sure
that
we're
we're
looking
at
that
from
all
angles.
A
D
In
fact,
that's
our
next
portion
of
the
of
the
presentation,
but
before
we,
if
we
may,
on
the
on
the
a
trip
on
back
to
the
rural
versus
urban,
I
know
it's
a
little
disappointing
to
you,
probably
to
see.
37
percent
is
going
to
rural
counties,
but
it
is
driven
based
solely
off
of
discharges,
whatever
the
inpa,
everyone
gets
the
same
add-on,
but
it's
based
off
of
those
inpatient
discharges.
So
I
just
didn't
want
you
to
think
we
were
paying
less
to
the
to
the
rules.
D
They're
getting
the
paid,
the
same
add-on
amount,
it's
just.
They
have
less
discharges.
Well.
Thank
you.
B
Yes,
as
you
can
see,
we
do
we
have
grown
from
the
right
before
the
pandemic
right
around
the
start
of
the
pandemic.
To
now
we
do
have
over
1.6
million
medicaid
members
as
of
right
now,
our
presumptive
eligibility.
B
You
know
we
did
increase
quite
a
bit
during
the
pandemic
for
to
ensure
coverage.
I
think
to
kentuckians
that
were
needing
to
have
access
to
treatments
for
coven.
B
Just
as
a
reminder,
presumptive
eligibility
is
temporary
and
you
have
to
be
a
qualified
entity
to
grant
that
that
eligibility
and
what
what
we're
hoping
is
that
when
people
do
apply
for
eligibility
they're
going
forward
and
move
and
moving
to
file
a
full
application,
so
we
can
see
if
they
are
actually
qualified
and
meet
all
the
eligibility
qualifications
oops
by
the
way.
B
So
this
is
just
a
slide
that
kind
of
compares
our
total
enrollment,
which
is
the
blue
line
up
above
to
our
presumptive
eligibility.
Enrollment
and,
as
you
can
see,
we
had
quite
a
quite
a
quite
an
increase
during
the
height
of
the
covid.
The
point
you
see
on
jul
right
around
july,
2nd,
which
might
be
hard
to
see,
but
it's
where
it
goes.
Where
there's
a
kind
of
a
big
dip,
that's
where
in
2021
we
saw
a
significant
population
drop
off
of
presumptive
eligibility
because
you
they
reached
their
maximum
coverage.
B
So
sorry
I
keep
going
the
wrong
way.
So
this
this
really
kind
of,
I
think,
is
a
better
grab
to
show
that
cliff
that
happened
once
people
met
their
or
or
maximize,
you
know
mac.
They
reached
their
maximum
presumptive
eligibility
period,
so
we
had
an
enormous
drop
off.
We
are
now
right
now
our
presumptive
eligibility
enrollments
around
1700,
so
we're
very
much
back
to
pre-pandemic.
B
Okay,
so
you
asked
about
waiver
enrollment.
This
slide
shows
what
our
funded
slots
are.
What
our
field
slots
are
and
keep
in
mind.
That
field
means
individuals
who
are
actively
participating
in
the
waiver
and
those
who
might
have
vacated
by
vacated.
I
mean
they're
no
longer
accessing
services
to
be
qualified
for
the
waiver
and
to
maintain
that
waiver
slot.
You
have
to
actually
access
services.
We
cannot
allocate
that
slot
until
the
end
of
the
year,
so
unfortunately
that
just
remains
as
a
field
slot.
B
The
reserved
as
it
notes
is
those
are
the
ones
that
we
we
know,
somebody's
applying
for
that
slot
and
we're
just
going
through
all
of
the
application
process
to
make
sure
they're
fully
qualified
and
can
fill
that
slot
and
then
the
the
available
is
listed
there.
I,
I
will
note
that,
so
you
know
it
changes
on
a
daily
basis.
So
this
is
a
snapshot
as
of
may
31st,
so
every
day
we're
allocating
or
filling
slots.
So
that's
kind
of
an
important
piece
to
note
here
is
that
this
is
just
a
slot.
B
B
You
asked
about
the
wait
list,
so
michelle
p,
this
reflects.
We
have
a
total
of
7
794
individuals
on
the
wait
list.
We
wanted
to
show
that
some
of
those
are
accessing
services
through
another
waiver.
Most
of
them
are
through
the
hcb
waiver
and
then
you
know
some
of
those
individuals
do
have
access
to
services
through
a
third
party
liability,
so
they
have
insurance
through
some
other
source.
B
F
Mr
chairman,
please
feel
free
to
cut
me
off
whenever
you
need
to
with
with
the
waiver
slots.
F
You
know,
nothing
ever
seems
to
change
with
that,
but
but,
as
from
the
provider
perspective,
what
we're
seeing
is,
is
you
have
class
after
class
graduating
from
high
school?
None
of
these
kids
have
a
waiver,
none
of
them
are
getting
services
and-
and
we
don't
we're
not
making
any
dent
in
that,
and
what
we're
seeing
is.
Our
population
is
aging
within
our
center
and
there's
no.
F
F
Families
can't
afford
to
pay
that
every
day,
so
that
that's
an
ongoing
problem
within
this
state
and
what
is
does
the
cabinet
have
long-term
plans
to
to
to
resolve
this
issue
once
and
for
all
I
mean
there
there's
just
thousands
of
families
that
kids
get
out
of
high
school.
It
just
disrupts
their
entire
family
because
someone's
got
to
take
care
of
their
child
and
it
they
pull
away
from
the
workforce.
B
So
senator
we're
undergoing
a
redesign
right
now.
We've
done
some
needs
assessment
and
right
now
we're
just
doing
the
deep
dive
and
to
see
what
we
can
do
to
help
solve
that
problem.
You
know
you
all
allocated
50
slots
for
michelle
p
and
for
scl
we're
right
now
getting
those
approved
through
cms,
so
we
haven't
we're
not
able
to
add
them
yet
to
the
available
slots,
but
I
think
some
of
the
other
things
is
that
we're
just
going
to
have
to
innovate
and
find
other
ways
to
provide
services
to
our
individuals.
B
One
is
an
smi
waiver,
we're
very,
very
interested
in
also
including
sed
as
part
of
that,
so
that
we
can
also
cover
children.
You
know,
I
think
I
think
we
just
have
to
continue
to
work
to
to
solve
those
problems
and-
and
we
do
try
to
do
it
with
the
providers.
Your
perspective
is,
is
very
helpful
to
us.
B
You
know
we
we
want
and
appreciate
that
that
information
to
help
guide
what
what
we
need
to
do,
but
there
there
is
a
need-
and
you
know
one
of
our
concerns
right
now
is:
are
there
resources
available?
So
we
could?
We
could
have
as
many
slots
as
we
want,
but
if
we
don't
have
provide
enough
providers
to
provide
the
services,
then
you
know
that.
B
F
B
B
F
And
I
know
during
the
the
session,
the
senate
had
actually
asked
for
250
350
slots
on
one
of
the
two,
and
I
know
that
the
issue
about
not
having
the
services
came
up
and
I
don't
know
where
that
came
from.
I
wasn't
asked,
but
but
it
is
a
problem
in
a
lot
of
providers
where
you
know
you
have
families
calling
every
day,
but
nobody
has
a
waiver
and
we
we
have
something.
We've
got
to
address
and
it's
got
to.
F
It's
got
to
be
made
more
of
a
priority
for
these
families,
and
it
just
doesn't
seem
to
be
moving
forward
at
all
that
we're
just
just
a
small
step
forward
and
it's
not
accomplishing
anything,
and
it
gets
very
frustrating
that
we're
not
taking
bigger
steps
and-
and
we
have
again,
we
have
to
have
more
clients,
more
individuals
with
waivers
for
the
providers
to
grow
their
services.
F
You
know,
we've
invested
a
couple
million
dollars
in
a
renovated
facility
and
nobody
to
use
it
we're
waiting
to
open
a
senior
program
adult
day
health
care.
You
know
where
are
they
going
to
come
from?
So
so
that's
from
the
provider
perspective.
That's
a
concern,
and
one
other
thing
I
want
to
ask
mr
chairman,
if
I
might
please,
with
the
the
increased
rates
that
we
approved,
where
do
we
stand
with
that
and
will
that
go
into
effect
with
the
new
fiscal
year.
B
So
I
can,
I
can
do
a
little
piece
of
this.
We
have
we,
the
budget
required
us
to
use
the
fmap
funds
for
that.
So
we
are
in
the
process
of
you
know
we
have
to
get
cms
approval,
so
we
have
prepared
that
request
and
are
working
with
cms
on
getting
the
getting
the
approval
for
that
plan.
That's
where
we
are
as
far
as
it
when
it's
effective.
B
I
believe
I
mean
it'll
go
back
to
july
one.
I
think.
B
So
it'll
be
effective
now
the
other
thing
we're
looking
at
just
to
be
you
know,
open
and
and
transparent,
is
that
we
are
looking
at.
You
know
utilizing
appendix
k
for
some
additional
increases.
That's
on
the
table
right
now,
we're
you
know
we're
looking
for
ways
to
increase
provider
payments
for
our
waiver
providers.
D
And
we
have
to
do
it
through
an
appendix
k
to
get
it
right
away,
because
cms
requires
a
rate
study
to
be
done
and
our
rate
study
will
not
be
done
until
late.
This
fall,
so
we
didn't
want
to
wait
until
late.
This
fall
so
we're
looking
at
doing
it
through
an
appendix
k
at
first,
but
we
will
be
doing
the
rate
study
for
2023
and
2024.
F
B
No
it
well
it
it's
a
good
question:
it
expires
six
months
after
the
end
of
the
public
health
emergency.
So
as
of
right
now,
we've
already
we're
pretty
certain
it's.
The
phe
will
be
extended
past
july,
that'll
bring
us
into
october,
and
then
you
know,
the
secretary
for
health
and
human
services
will
make
the
decision
again
as
to
whether
or
not
to
extend
the
phe
another
time.
B
So
you
know
we're
pretty
certain
that
we
at
least
have
to
october
and
it'll
be
six
months
after
that,
okay,
and-
and
let
me
add
to
that,
is
that's
why
we
think
we
can
maybe
get
through
these
increased
payments
through
the
appendix
k
to
have
the
rate
study
done
and
have
all
that
ready
to
go
so
there's
no
gap.
A
Certainly,
no
funding
is
an
issue,
I'm
not
surprised
by
the
enrollment
numbers.
I
would
hope
that,
since
our
economy
is
on
fire,
that
we've
seen
more
people
going
to
traditional
commercial
insurance
and
moving
away
from
medicaid,
but
that
hasn't
materialized
yet,
but
I
think
if
that
were
to
happen,
then
that
makes
funding
available
for
other
services,
but
I'm
curious
as
to
what
the
proposed
basic
health
program
could
potentially
do
to
the
medicaid
program.
B
Sure,
well,
you
know,
funding
for
providers
or
payments
to
providers
through
a
qualified
health
plan
or
through
a
basic
health
program
would
be
different
than
medicaid
rates.
I
don't
know,
I
can't
tell
you
right
now
what
that
would
mean
to
provider
the
provider
community,
but
that
that
you
know
it's
not
the
same
as
medicaid.
A
If
not,
let
me
go
back
to
agenda.
I
missed
an
item.
That's
approval
of
the
minutes
that
you
had
those
previously
from
our
march
30th
of
last
year.
Is
there
a
motion
to
prove,
though
center
alvarado
seconded,
by
co-chair
elliott,
all
this
favor
say:
aye
aye,
any
opposition.
All
right.
Thank
you.
Motion
passes
next
agenda
item.
Is
our
medicaid
managed
care
organizations
and
I'll
give
you
a
little
history
on
this
as
we're
putting
our
agendas
together.
A
I
requested
that
we
would
hear
from
each
of
our
mcos
during
this
interim
session
and
very
specific
in
what
we
were
attempting
to
do.
I
asked
them
specifically
to
tell
us
how
they're
ensuring
network
adequacy,
what
specific
initiatives
they
are
undertaking
to
improve
the
health
of
our
medicaid
population,
what
their
tools
are
for:
measuring
the
effectiveness
and
efficacy
of
substance,
abuse,
treatment,
programs
and
what
their
strategies
are
for
ensuring
health
delivery,
equity
and
what
their
strategies
are
for.
A
You
we
appreciate
you
being
here
this
morning
and
obviously
anthem
is
the
first
one
in
the
queue
here.
So
if
you
want
to
introduce
yourself
for
the
record
feel
free
to
proceed
for.
G
Well,
chairman
meredith
and
chairman
elliott,
members
of
the
committee,
it's
a
pleasure
to
be
here
with
you
today.
We
just
introduced
ourselves,
but
I
have
david
here
by
my
side,
because
we
anticipate
a
lot
of
questions
on
the
substance
use
disorder
topic.
The
the
committee
requested
that
we
address
five
areas
in
our
presentation.
G
I've
reordered
them
because
I
think
it
makes
a
little
better
story,
but
we
do
intend
to
be
able
to
answer
all
of
those
questions.
G
Recognize
anthem
has
been
in
serving
the
commonwealth
for
83
years,
but
we've
only
been
serving
medicaid
since
2014,
and
since
the
introduction
in
2014
anthem
has
grown
to
become
the
fourth
largest
mco
in
kentucky
with
173
000
lives.
One
thing:
that's
a
little
different
about
our
population.
You'll
notice
in
the
the
very
right
hand,
or
the
left-hand
side
is
that
49.1
percent
of
our
lives
are
childless
adults,
and
so
that's
a
result
of
when
we
came
into
the
marketplace.
G
So
just
if
you
reference
the
the
top
left
up
here,
the
average
time
that
it
takes
anthem,
medicaid
to
pay
a
claim
is
8.2
days.
You
can
also
see
the
total
number
of
claims
paid,
the
total
spend
the
encounter
acceptance
rate,
etc
in
the
top
right.
The
average
speed
of
answer
for
the
provider
community
is
13
seconds
and
for
our
members
is
12
seconds
in
the
in
the
box
on
the
bottom
left
outlines
the
top
prescriptions
that
anthem
pays
and
you
can
also
see
the
total
dollars
spent
on
each
of
those
prescriptions.
G
The
bottom
on
the
box
right
illustrates
the
top
diagnoses
that
are
paid,
and
I
want
to
point
out
look
at
the
the
orange
box
on
the
left
of
the
two
orange
boxes.
Anthem's
top
one
two
and
three
are
all
related
to
substance.
Use
disorder.
Opioid
dependence
is
number
one.
Other
stimulant
dependence
is
number
two
and
alcohol
dependence
is
number
three.
This
is
an
area
that
we
absolutely
have
to
own,
and
so
this
is
where
we
spend
a
significant
amount
of
time.
That's
why
we
anticipate
the
questions
to
be
there
primarily
for
our
audience,
the
box.
G
So
as
we
look
in
the
center
of
the
dashboard
are
examples
of
key
hedis
quality
measures
comparing
two
years
2021
and
2022,
and
you
can
see
in
every
one
of
those
instances.
Those
some
of
the
most
common
are
definitely
trending
upward
compared
to
prior
year
levels.
G
Just
right
of
center
are
some
key
utilization
statistics
like
admits
per
thousand
days
per
thousand
that's
hospital
days
per
thousand
er
visits
per
thousand,
and
one
highlight
is
the
2051
telehealth
visits
per
thousand
members,
which
is
compared
to
1293
per
thousand
just
a
year
ago,
slide
five
addresses
your
question
about
met.
What
medicaid
is
doing
to
improve
health
to
the
medicaid
population,
and
we
refer
to
this
strategic
planning
process
as
the
elevate
planning
model.
G
We
take
a
look
at
data,
starting
at
the
12
o'clock
hour
here
on
this
visual
start
with
specific
data,
we
identify
health
disparities.
We
then
turn
our
attention
to
seeking
stakeholder
input.
We
define
metrics
of
success,
we
develop
and
deploy
strategies
we
collect
and
analyze
data
and
then
adjust
those
strategies
as
we're
able.
I
want
you
to
think
of
this
as
we
started
with
population
health
kind
of
strategic
plans.
We
then
turned
our
attention.
G
G
Now,
on
the
right-hand
side
of
this
screen,
you
can
see
what
we
have
documented
as
the
key
metrics
of
success.
How
will
we
know
what
we're
doing
is
making
a
difference?
Now,
let's
turn
to
the
attention
to
the
details.
Okay,
on
the
next
slide,
this
is
actually
one
of
our
strategic
planning
documents
and
I
apologize
that
it
is
so
dense.
G
You
may
have
to
reference
your
materials
and
I
can't
get
into
all
the
details,
but
let
me
take
one
example:
maternal
child
and
health
prenatal
care
we
wanted
to
address.
We
saw
an
instance
where
the
number
of
women
seeking
prenatal
care
within
the
first
14
weeks
of
of
pregnancy
was
below
where
we
wanted
it
to
be.
We
identified
a
goal.
We
wanted
to
increase
that
rate
by
5
percent.
G
We
identified
several
strategies
to
try
and
address
that,
namely
we
made
an
investment
in
three
different
doula
organizations
so
that
they
could
expand
services,
we're
offering
focus
groups
to
learn
more
about
the
members
and
what
are
the
issues
that
they're
facing?
And
then
we
targeted
member
outreach
to
educate
members
on
prenatal
care,
introducing
them
to
the
benefits
available
from
anthem.
We
have
a
variety
of
programs
and
services
both
from
in
the
terms
of
both
in
terms
of
value-added
benefits
and
the
healthy
rewards
that
we
that
we
align
for
our
members.
G
G
There
were
24
new
doulas
that
were
trained
of
that
10
were
persons
of
color,
14
were
caucasian,
six
were
in
rural
communities,
two
were
hispanic
and
able
to
to
speak
multiple
languages,
and
one
was
american
sign
language
certified
and
so
we're
able
to
try
and
track
and
monitor,
although
there
have
only
been
the
28
births
so
far
in
this
program.
G
All
but
one
was
a
very
a
successful
birth.
We
only
had
most
all
were
vaginal
deliveries
and
all
of
these
women
are
breastfeeding,
the
the
children
that
have
come
into
the
world
and
so
as
we
think
about
the
the
both
the
the
hard
numbers,
as
well
as
the
softer
numbers.
This
is
one
particular
example,
and
I've
got
many
listed
here.
I
just
chose
to
go
through.
G
You
know
the
the
prenatal
care,
we've
got
issues
on
diabetes
and
you
could
go
through
that
dental
visits,
I'm
going
to
use
that
as
our
our
health
equity
strategy
here
in
just
a
moment,
but
before
moving,
are
there
any
questions
about
the
general?
This
is
the
general
health
population
strategies
that
anthem,
folk
and
and
I'll
I'll
tell
you.
There
are
hundreds
of
strategies
we're
working
on.
I
chose
to
list
these
for
this
committee
questions.
A
Selection
slide,
I
appreciate
that,
and
you
know
one
of
the
things
that
that
drove
this
question
was
testimony
we
had
last
summer.
I
believe
health
and
welfare.
Dr
alvarado,
was
cheering
that
day
we
dealt
with
a
hepatitis
c
screening
and
folks
were
advocating.
We
need
to
do
more
of
that.
Well,
why?
Wouldn't
because
there's
tremendous
savings,
but
I've
made
the
comment
at
that
time
as
why
are
we
even
talking
about
that
looks
like
the
mcos
would
be
developing
a
program
for
this.
G
So
yeah
and
it
leads
to
so
many
complications
right
and
so
yeah,
that's
the
kind
of
thinking
the
data
drives,
the
decision
in
the
intervention,
and
so
just
as
as
you
can
see
the
many
many
strategies
here
now.
Imagine
if
you
will
turning
this
on
its
head
for
just
a
minute
and
now
we
start
looking
through
help
equity
strategies.
So
here's
one
of
the
most
tangible
examples.
G
In
fact,
if
you
look
at
the
identified
disparity
I'll
just
use
a
couple
of
examples,
diabetes,
so
black
members,
77.0
percent
white
members,
80.9
percent-
are
getting
those
baseline
measures,
so
we're
able
to
track
the
the
information
and
then
by
that
information
is
when
we
turn
our
attention
to
the
strategic
plan.
Let's
look
at
the
dental
visit
since
dental
came
up
just
a
little
bit
earlier.
G
Adults
in
rural
areas
had
lower
rates
and
on
annual
dental
visits
and
baseline
dental
visits.
Then
so
we,
the
the
baseline
period,
was
november
of
2021..
G
One
of
the
strategies
we
used
was
to
take
mobile,
dent
mobile
clinics
into
communities
to
promote
that
we
were
going
to
be
there
and
people
come
to
those
mobile
clinics.
Look
at
the
look
at
the
results
over
on
the
far
side
of
the
page.
Now
remember
in
region,
1
measurement
year,
2021
region,
one.
We
had
25
adults
that
had
gotten
their
dental
visit
in
that
in
that
entire
year,
look
over
on
the
outcomes,
column
region,
one
in
january
28.
G
G
Now
those
may
be,
you
know
we're
talking
about
the
ones
here,
but
that's
how
this
game
is
fought
and
won
it's
one
at
a
time
it's
doing
the
hard
lifting,
and
so
you
know,
if
we
talk
about
you,
know
colorectal
cancer
screenings
what's
taking
place
there.
This
is
an
example
where
we're
working
with
the
university
of
kentucky
in
their
center
of
research
to
find
out.
What
do
we
need
to
do
to
make
colorectal
cancer
screenings?
G
Be
equitable
for
the
caucasians
and
the
black
community
and
the
hypothesis
is
that
not
only
is
the
message
important,
but
the
messenger
is
equally
as
important,
and
so
what
we're
going
to
be
doing
is
doing
this
within
local
churches
to
be
able
to
work
with
some
of
the
church,
the
churches
and
have
them
now.
This
will
be
a
research
study
published
by
uk
to
be
able
to
see
if
we're
able
to
move
that
needle
either
altering
the
message,
altering
the
messenger
or
altering
the
the
medium
under
which
that
message
is
given.
G
So
those
are
just
a
few
examples.
My
competitors
have
seen
now
all
of
some
of
our
secret
sauce.
Obviously
this
is
we've
given
some
examples
of
of
some
of
these,
but
any
questions
from
anyone
here
at
the
at
the
table
around
any
of
these
others
that
you
would
like
to
hear
or
learn
about.
A
C
So
senator
meredith,
one
of
the
things
that's
important
about
to
think
about
about
managed
care,
is
that
the
insurers
assume
the
risk
for
the
state
we
get
that
per
member
per
month
allocation
and
it's
our
job
to
make
sure
that
the
cost
doesn't
go
above
that
amount
and
if
it
does
we're
on
the
hook.
For
that
and
the
state
is
not
so
that's.
Our
financial
incentive
is
to
make
sure
we're
getting
healthier
members
over
time.
So
we
continue
to
stay
under
that
per
member
per
month.
Allocation.
G
G
G
G
That's
what's
in
it
for
us
now,
as
as
was
mentioned,
there
is
a
financial
incentive
right.
If
we
do
well
the
better,
our
members
are
the
healthier.
Our
members
become
the
more
well.
We
can
be
the
better,
the
the
cost
structure
can
be,
but
there's
there's
many
levels
to
your
question,
and
I
appreciate
you
asking
it
and
I
apologize
that
I
got
emotional,
but
one
thing
you'll
know
we
are
passionate
about
what
we
do.
A
I
think
some
of
my
colleagues
will
agree
that
we
spend
enough
on
health
care
in
america
already,
but
we
focus
too
much
on
taking
care
of
sick
people
rather
than
keeping
our
population
healthy
right,
and
I
understand
that
you've
got
your
return
on
an
investment
that
you've
got
to
show
to
your
stockholders,
and
I
don't
see
that
the
payment
methodology
really
rewards
you
sufficiently
to
improve
the
health
of
the
population.
A
Sure
your
your
risk
and
that's
kind
of
a
financial
disincentive,
but
I
like
to
take
it
to
a
different
level
where
you
know
if
you
truly
commit
the
resources
to
it
and
that's
what
we
need
as
a
resources
to
improve
the
health
population,
there'll
be
dramatic
savings.
You
should
be
able
to
share
in
that
beyond.
The
10
percent
and
providers
should
as
well.
But
I
don't
see
that
we're
structured
to
do
that
presently,
and
so
I
guess
I'm
exploring.
Are
there
opportunities
to
do
this
differently
and
do
it
better
and
work
together?
A
G
G
Agreed
couldn't
agree
more
we're
doing
things
with
the
provider
community
now
that
involve
value-based
payments.
In
fact,
as
we
think
about
one
of
your
second
questions,
was
that
of
what
are
we
doing
about
provider
access
right?
Well,
part
of
that
is
introducing
a
value-based
payment
arrangement
with
the
providers,
where
they're
getting
rewarded
for
doing
the
right
things.
Maybe
there's
a
variant
to
that
between
managed
care
firms
as
well.
G
That
we'd
be
more
than
happy
to
talk
about
in
many
states,
I've
been
a
part
of
there's
a
quality
component
and
there's
a
a
payment
for
quality
in
being
able
to
achieve
those,
certainly
happy
to
try
and
address
with
this
audience
or
all
other
audiences,
what
we
can
do
yeah.
I.
A
Admit
I've
got
a
little
bit
of
bias
against
value-based
type
of
payments,
understood
just
based
on
on
past
history.
You
know
one
time
my
medicare
payments
for
providers
was
based
on
how
well
we
control
pain.
What
happened
there
didn't
work
at
all
right.
Then
providers
are
penalized
because
patients
are
emitted
within
48
hours.
Well
in
a
rural
community.
If
you
don't
have
a
home
to
go
to,
and
you
don't
have
food
to
put
on
your
table
yeah,
where
are
you
going
to
go
you're
going
to
come
back
in
the
hospital?
A
Why
should
providers
be
penalized
for
that?
We're
not
addressing
the
real
problems?
That's
the
core
of
the
issue
I'm
trying
to
get
to
is:
how
do
we
do
this
collectively
using
the
resources
that
we
have
at
hand?
That's
two
to
three
times
more
than
other
industrialized
nations,
to
address
these
issues
in
in
and
do
it
now,
rather
than
in
the
future
agree.
I
agree.
G
So
when
you
asked
about
ample
access
to
availability,
what
are
we
doing?
Well,
there
are
contractual
standards
I
wanted
to
just
kind
of
illustrate.
Some
of
this.
G
Our
contractual
standard
is
that
we
need
to
have
95
percent
of
our
population
zip
code
by
zip
code,
that
is
able
to
see
a
provider,
and
there
are
a
variety
I've
just
listed
some
of
the
most
common
within
a
30
mile
radius
or
a
50
mile
radius
in
rural
communities-
and
you
can
see
over
here
on
the
fourth
column
over
anthem-
significantly
exceeds
those
standards
you
can
see
in
the
third
column
over
the
actual
number
of
providers
that
are
in
each
of
these
levels
of
service.
G
One
thing
to
point
out
so
like:
let's
look
at
the
the
number
completely
on
the
right,
the
average
distance
to
one
provider
in
the
anthem
world
is
to
primary
care,
for
instance,
2.45
miles
so
people.
Our
our
network
is
built
on
our
commercial
platform.
It's
a
derivative
of
the
commercial
network,
and
so
we
have
typically
it's
a
it's
a
competitive
advantage
for
anthem
to
be
able
to
have
fairly
large
and
substantial
networks,
and
I'm
grateful
for
for
being
able
to
borrow
from
that.
G
But
there's
more
so
we
have
a
second
contractual
requirement
and
that
is
a
ratio
standard,
and
you
can
see
the
ratios
on
the
fourth
column,
over
availability
standards
for
a
pcp,
for
instance,
one
provider
for
every
1500
members.
Well,
look
at
anthem's
ratios
one
provider
for
every
12
members
for
family
practice,
one
provider
for
every
14
members
for
or
let's
see,
11
members,
13
members
or
pediatricians
one
for
every
39.
So
we
you
know
being
a
little
boastful.
I
guess
we
crush
the
ratio
standards,
but
there's
still
need
to
continue
to
develop
networks.
G
We
report
to
dms
every
quarter,
a
report
that
demonstrates
in
the
very
same
maps
that
I'm
describing
here
with
this
one
example
on
44
different
specialty
types.
You
can
look
here
what
this
map
represents.
In
essence,
is
you
know
the
there
you
can't
tell
on
this
map,
but
the
square
boxes
are
group
locations,
individual
dots
or
individual
locations,
etc.
But
the
bottom
line
here
is:
is
we
have
3
42
adult
pcps
in
2600
locations
and
92
percent
of
them
are
open
to
medicaid
patients.
G
8
percent
have
closed
to
only
existing
patients,
but
this
is
just
one
example
of
the
things
that
we
do
we're
constantly.
Looking.
Are
there
other
providers
that
we
need
to
be
bringing
into
the
network
and
what
are
we
doing
to
help
construct?
The
financial
relationships
with
them
is
what,
in
part
on
the
next
slide?
Not
only
do
we
have
this
the
standard
for
pins
on
the
map
or
ratios,
but
we
also
have
to
test.
We
make
outbound
calls
try
to
schedule
appointments
with
our
provider
community
and
the
access
or
availability
standard.
G
The
next
slide
talks
about
the
variety
of
now
value-based
payments.
I
I
use
that
term
generally
to
represent
a
number
of
different
quality
incentive
programs
that
we
have,
some
of
which
are
targeting
different
types
of
providers.
We've
got
quality
based
programs
for
behavioral
health;
we've
got
quality
based
programs
for
substance
use,
we've
got
quality-based,
programs
for
primary
care,
etc
and
they're
kind
of
outlined
in
these
different
four
types
of
buckets.
G
To
do
the
things
that
medical
practice
and
industry
accepts
as
high
quality,
so
we're
trying
to
do
the
right
thing
with
our
provider
community
to
educate
them
to
train
them
to
get
member
attribution
so
that
they
know
who
they're
supposed
to
be
treating
and
compensating
them
for
so
doing
next
slide,
please,
just
as
we
won't
spend
a
ton
of
time
here,
but
hedis
is
one
of
the
measures
that
health
plans
use
to
track
our
our
performance,
I'll,
just
direct
your
attention
to
the
bottom
right
hand.
Side
of
this
slide.
G
Anthem
is
tied
for
first
place
with
three
and
a
half
stars.
Frankly,
three
and
a
half
stars
is
embarrassing
to
me.
Personally,
I
want
to
be
the
first
health
plan
at
four
stars
and
I've
already
been
the
leader
of
a
health
plan,
a
five-star
health
plan
twice
in
my
career.
I
want
to
achieve
that
again
here
in
kentucky
five-star
health
plan
a
nice
part.
Now
this
is
the
consumer
satisfaction.
Through
our
cap
survey,
anthem
last
year
was
able
to
move
up
to
4.5
stars,
so
the
members
themselves
are
beginning
to
reward
us.
G
I
think
that's
why
we
are
among
the
fastest
growing
mcos
in
the
state.
That's
why
we've
gone
from
123
000
to
174
000
in
the
last
three
years.
Our
our
best
performing
quality
domain
is
maternal
and
infant
health
and,
quite
frankly,
that's
right
where
it
should
be
and
we're
a
medicaid
program.
We
give
birth
to
60
of
the
state's
children.
G
Biggest
improvement
in
rates
were
in
maternal
and
infant
health,
followed
by
chronic
conditions.
But
again
these
numbers
move
very
very
slowly
and
there
are
hundreds
of
them.
I
tried
to
spare
you
from
an
even
worse
eye
chart
than
the
one
that
I
that
I
had
before,
but
we're
happy
to
sit
down
with
you
and
show
you
what
we're
doing
and
the
strategic
planning
that
we're
doing
to
be
able
to
affect
each
and
every
one
of
these
next
slide.
G
H
Sure,
thank
you
leon
substance
use
disorder
has
and
will
continue
to
be,
our
top
priority
at
anthem,
medicaid
and
we've
developed
a
focused
three-prong
strategy
to
to
best
meet
the
the
member
and
provider
needs
in
in
the
commonwealth.
That
first
prong
is
our
post-discharge
management
program.
H
I
won't
go
into
detail
what
that
involves,
but
it's
really
a
high
intensity
outreach
to
members
that
are
in
an
inpatient
or
residential
substance
use
disorder
facility
trying
to
contact
that
member
pre-discharge
and
then
continuing
to
outreach
the
member
24,
48
and
72
hours
post
discharge,
and
we
really
want
to
focus
on
securing
an
after-care
appointment,
making
sure
that
the
members,
following
their
their
discharge,
planning
their
recommendations
and
also
to
build
a
plan
of
care.
That's
individualized
that's
best
going
to
meet
the
member
needs
for
a
positive
prognosis.
H
H
H
H
H
I
don't
want
to
dehumanize
the
the
impact
here,
because
every
single
tick,
up
and
and
down
has
has
an
impact
on
someone's
family
friend
and
loved
one,
but
that's
really
our
primary
indicator
and
our
lead
indicator
to
say
how
good
of
a
job
are
we
doing
and
our
providers
doing
as
well.
It's
the
most
traumatic,
it's
critical.
It's
a
life
or
death
instance
and,
as
you
can
see,
we've
showed
a
a
decreased
trend
of
47,
comparing
q4
2017
to
q4
2021..
H
We
did
see
a
significant
increase
in
overdose
rates
around
the
june
and
july
time
frame
of
2020,
which
was
really
in
the
heart
of
or
the
initiation
phases
of,
covet
restrictions
and
and
that
nature,
our
second
rate
would
be
reducing
30-day
readmissions,
and
I
know
the
committee
asked
specifically
to
recidivism
rates
where
recidivism
is
extremely
difficult
to
capture
from
from
a
claim
space
you
have
to
get
down
into
into
the
weeds,
and
it's
often
under
reported,
so
one
factor
we
use
are
30
day
readmissions.
H
H
The
third
indicator
to
measure
efficacy
and
outcomes
are
increasing.
Our
percent
of
detox
incidents
that
receive
residential
sud
treatment
within
0
to
14
and
0
to
60
days
post
discharge.
H
Inpatient
detox
can
be
a
critical
time
over
the
disease
state
of
substance
use
disorder.
You
can
really
find
an
opportunity
and
window
for
intervention
during
that
time,
however,
successful
discharge
doesn't
mean
to
the
streets.
We
want
folks
to
get
treatment
post-discharge.
So
this
is
that's
why
this
is
one
of
our
key
indicators.
Are
our
members
or
patients
receiving
treatment
at
a
residential
sud
program
after
they've
completed
an
inpatient
detox?
H
H
H
This
measure
will
show
you
that
in
in
march
2017,
roughly
a
quarter
of
our
members
receiving
medication,
assisted
treatment
also
had
a
supportive
service
claim.
Two
supportive
service
claims
within
a
30-day
receipt
of
the
prescription
a
quarter
now
march
2022
66.3
percent
are
receiving
mat
services
with
the
appropriate
supportive
treatment.
H
So
before
I
pass
the
mic
over
to
leon
to
discuss
rural
health
a
little
bit
more
and
to
wrap
up
the
presentation,
are
there
any
questions
from
from
the
committee?
And
I
hope
I
I
addressed
your
endpoints.
A
I
don't
see
any
other
than,
and
maybe
it's
a
conversation
we
need
to
have
at
a
different
time
and
we'll
be
glad
to
have
that
with
you.
As
I
know,
our
own
justice
cabinet
is
using
a
program
that
is
a
six-month
residential
program,
social
model
and
I'm
not
sure
many
insurance
companies
will
embrace
the
social
model,
but
apparently
they
have
some
great
outcomes,
and
I'd
just
be
curious
to
have
some
conversation
with
you,
folks
is
to
do.
Do
you
look
at
that
is
there's.
A
Or?
Do
you
shy
away
from
those.
H
We
look
to
what
works
if
you
know
standing
on
your
head
and
and
counting
slowly,
ten
to
one
works,
for
you
then,
albeit
have
at
it
and
and
social
aspects
are
integral
to
substance,
use
disorder,
treatment,
getting
folks
reintegrated
to
the
community
with
their
their
new
identity.
That's
not
attached
to
anything
else
is
extremely
critical,
so
we
would
love
to
have
those
conversations.
A
G
All
right
so
we're
we're
conscious
of
the
communities
and
members
that
we
serve
as
well
as
providers
we
work
with
across
the
across
kentucky,
so
we
wanted
to
touch
on
some
rural
strategies
we
have
already
implemented
and
some
of
the
things
that
we're
working
on
and
discussing
in
the
pipeline,
just
kind
of
referencing
here
everything
from
workforce
type
programs
to
things
that
we
know
like.
For
instance,
we
worked
with
eastern
kentucky
university
and
the
local
other,
the
hazard
community
technical
college
and
helped
to
fund
some
some
programs
for
nurses
and
medical
assistants.
G
We've
also
done
a
lot
of
work
with
the
digital
technologies,
recognizing
that
not
everyone
has
access
to
providers
in
their
area.
The
the
things
that
we've
done
in
the
rural
care
is
everything
from
you
know:
making
investments
in
like
the
freedom
house
to
time
and
and
taking
services
specifically
to
those
communities.
Specific
examples
were
in
like
our
vaccines,
the
covet
vaccinations
where
we
made
physical
arrangements
to
take
vaccine
clinics
into
those
communities
or
the
dental
programs
that
we've
got
in
in
mobile
kinds
of
things.
G
When
we
look
at
some
some
real
specific
things
that
we're
doing
right
now,
we're
in
conversations
with
two
different
hospital
systems
on
a
hospital
at
home
type
program
and
as
you're
probably
aware,
one
of
those
the
the
the
arh
just
received
a
grant
from
harvard
to
work
on
the
hospital
at
home
model
and
think
of
this
as
basically
being
able
to
now
manage
a
care
with
assistive
devices
in
a
member's
home
and
have
that
observed
at
the
hospital
location
so
that
we
can
dramatically
expand
those
type
of
services.
G
It
was
interesting
that
steve
mentioned
the
directed
payments,
so
managed
care
enables
the
fact
that
we're
able
to
then
pay
additional
types
of
services
and
for
state
physical
year
21
anthem
in
in
part
of
that
participation,
we
paid
out
124
million
dollars
to
the
different
providers.
To
do
that.
We're
collaborating
with
dms
to
ensure
that
wrap
payments.
G
This
is
something
that
really
is
important
to
the
cmhcs,
the
fqhcs
and
the
regional
health
centers,
because
these
are
additional
monies
that
can
come
as
we
work
together
to
make
sure
that
each
of
these
entities
are
able
to
to
to
get
you
know
full
reimbursement
for
their
services
based
on
cost.
We
do
not
discount
below
the
medicaid
fee
schedule,
so
you
know
there
isn't
an
85
reduction
if
you're
in
a
a
rural
community,
we
do
pay
and
do
not
discount
below
the
medicaid
fee
schedule
in
in
that
regard.
G
G
You
know
I
I
know
we
could
probably
go
on
much
longer.
We
need
to
to
be
able
to
reserve
time
for
for
the
other
speakers
on
today's
agenda,
but
I
really
wanted
to
thank
you
for
the
time
and
attention
today.
This
gave
us
an
opportunity.
G
We,
we
chose
to
come
here
in
a
full
disclosure
to
be
completely
transparent,
recognizing
that
I
think,
if
you
know
what
we're
doing
and
our
intention
and
the
activities
that
we're
engaged
in
many
of
which
are
you
know,
dry
or
boring,
but
some
of
which
are
really
exciting
about
what
we're
doing
to
try
and
work
with
the
local
providers
that
you
would
see
that
we
are
part
of
the
healthcare
economy,
a
vital
part.
In
fact,
I
think
of
it.
As
the
I.
G
I
grew
up
in
the
high
rocky
mountain
desert,
and
if
you
want
a
green
lawn,
you
have
to
factor
for
the
overspray
of
your
sprinkling
system.
Well
managed
care
in
a
way.
Is
the
overspray
of
a
sprinkling
system
to
keep
the
lawn
green
or
to
keep
people
healthy?
It
takes
doctors,
hospitals,
health
plans,
all
working
together
to
be
able
to
make
that
happen.
So
thank
you
for
the
opportunity
to
serve
the
commonwealth
and
thank
you
for
your
service
to
the
commonwealth.
A
Thank
you
for
your
presentation,
wealth
of
information,
good
information
and
I
had
said
I
didn't-
want
a
commercial
you
folks
have
not
given
me
a
commercial.
I
appreciate
that
you've
given
me
some
very
solid
information-
and
I
think
probably
our
committee
wants
to
take
a
harder
look
at
this
and
may
have
you
back
at
a
future
moat
meeting
to
maybe
getting
some
more
in
the
minutia,
the
detail,
but
good
presentation.
I
appreciate
it
greatly
any
parting
question
committee
members.
C
Thank
you.
I
you
you
referenced.
I
can't
find
the
page
at
the
beginning
of
your
presentation
you
referenced.
I
think
it
was
on
the
third
slide
about
childless
adults.
C
G
G
Right
and
so
many
of
those
are
employed,
they
continue
to
be
employed
but
recognize
that
even
if
you're
working
at
target
40
hours
a
week
you're
you
still
probably
don't
have
enough
and
qualify
for
medicaid,
and
so
these
are
those
that
are
just
what
what
I
was
trying
to
illustrate
is
many
medicaid
plans
are
like
70
percent
moms
and
babies
right
because
of
the
time
that
anthem
came
into
the
market
during
the
expansion
we
don't
have
the
same
member
mix
and
the
reason
that
that's
important
is
we
don't
have
the
same
illness
burden.
G
C
Thank
you
and
then
just
a
comment
on
it.
Your
your
scholarships,
rural
scholarships,
don't
forget
western
kentucky.
We.
A
E
Disappointed
if
you
didn't,
I
know
we
hate
to
put
away
blank
on
the
presentation.
I
appreciate
y'all
coming
today,
but
a
lot
of
your
numbers,
just
don't
jive
for
me,
so
I
want
to
start
by
saying:
we've
all
got
a
lot
of
passion.
This
is
a
committee
of
passion.
If
anything
in
health
and
welfare,
all
of
us
are
have
been
providers
in
one
way
or
another.
So
I
appreciate
your
story
and
I'm
very
sorry
about
your
family's
circumstances,
but
I've
heard
a
lot
of
those
I've
taken
care
of
a
lot
of
people
in
that
regard.
E
So
I
have
a
lot
of
passion
in
this
space.
Your
organization's
been
the
one.
That's
been
the
toughest
for
me
to
work
with
over
the
years
that
I've
been
here
in
eight
years.
Every
time
I
try
to
file
a
bill
to
get
things
done,
who's
fought
me
on
stuff
has
been
anthem
repeatedly
over
and
over
and
over
again.
E
E
E
E
To
system
correct,
so
I
take
a
look
also
when
you
you
give
me
your
presentation
on
ratios
of
providers,
and
you
say:
you've
got
a
1
to
13
ratio
across
the
state
of
pcp's
to
members
correct
correct,
and
that
means
it's
across
the
board
and
I
take
a
look
at
your
total
membership
is
173
901.
roughly
how
many
of
those
are
adults
do
we
know.
E
Of
your
members
are
children.
Is
that
correct,
yeah,
okay,
so
you're
looking
at
around
86
000
people.
So
when
I
take
a
look
at
that
and
try
to
go
backwards,
I
look
at
you
have
two
different
presentations
and
how
many
people
the
unique
count
of
providers
you
have
on
ample
access
and
availability
to
providers.
You've
got
that
list.
You
show
there
are
5
586
primary
care
providers
total.
If
I
multiply
that
out
to
1
to
13,
it
comes
at
about
72
000..
E
If
I
take
a
look
at
two
slides
down,
access
for
adult
pcp
you've
got
unique
providers-
thirty,
four
hundred
and
twenty
two,
but
imagine
those
are
pcps.
You
multiply
that
out
by
the
one
to
thirteen
ratio,
it's
forty
four
thousand
four
hundred
and
eighty
six.
It
doesn't
drive
to
that.
Eighty
somewhat
thousand
folks,
so
I
question
that
when
I
try
to
compare
the
numbers,
you've
got
a
lot
and
this
looks
very
professional
and
that's
all
great,
but
I
come
down
to
nitty
gritty.
It
doesn't
add
up
to
the
ratios
that
you
present
there.
E
I
also
wonder
in
terms
of
access:
I'm
a
provider,
I'm
an
internal
medicine
provider.
I'm
contracted
with
you
all
to
see
folks,
you
know
if
somebody
says
hey
we're
listing
you
as
a
primary
care
provider
within
30
miles
radius.
I
don't
have
a
clinic
anymore
that
people
can
call
up
and
just
come
in
and
see
patients.
So
I'm
curious
about
how
many
of
those
providers
you've
got
out
there
that
you're
claiming
are
in
our
system
that
are
there
that
can
see.
You
know
you've
got
them
listed,
but
probably
are
not
accepting
patients.
E
I
know
my
doctor
when
I
call
him
and
say
hey
it's
time
for
me
yeah.
I
do
just
call
me
personally
because
we
call
our
location
it's
about
a
two-year,
wait
to
see
the
doc
that
I've
got
and
he's
a
provider
that
I'm
sure
his
contract
with
you
all
through
a
major
hospital
system.
It's
not
as
easy
as
it
presents.
So
I
know
the
numbers
look
great
and
you
can
put
data
and
put
that
out
there
in
practical
reality.
E
That's
not
what's
happening
on
the
ground
level
for
folks
people
to
see
folks
that
are
out
there.
I
know
you
said
the
word:
do
the
right
thing
so
many
times
the
things
we
talk
about
in
these
committees
by
doing
the
right
thing
and
our
mco
partners
have
not
been
doing
the
right
thing
for
years
in
this
state.
We've
exposed
a
lot
of
that
in
this
committee
repeatedly
for
the
last
eight
years.
E
It
really
has
not
been
the
case
when
you
talk
about
value
base,
and
I
know
you've
got
a
lot
of
that's
a
nice
term
to
say
that
and
you
base
it
off
of
again
doing
the
right
thing.
An
algorithm
that
you
might
have
to
say
this
is
what's
scientifically
based.
I
would
argue
you
want
to
look
at
outcomes
is
what
you
want
to
look
at.
Providers
can
do
a
lot
of
the
things
we
talk
about
sud
treatment
and
you
say
we
want
to
do
all
the
above.
E
Whatever
works
as
a
doctor,
I
would
apply
that
same
systematic
approach
for
suds.
I
would
for
hypertension,
stroke
heart
disease
diabetes,
whatever
works,
and
the
person
often
who
knows
what's
best
and
whatever
works
for
that
patient
is
the
doctor
who
takes
care
of
that
person
every
day,
not
an
algorithm
that
you
have
on
the
right
on
the
side.
E
But
you
say
this
is
what's
the
right
thing
to
do,
because
someone
has
we've
relied
on
some
system
that
you
guys
have
for
your
qm
management
for
quality
management
and
a
doctor
who
says,
I
think
you
can
do
this
treatment
or
not
do
this
treatment
today.
You
guys
base
the
right
thing
on
that
and
I've
had
patients,
people
that
I
think,
need
to
do
the
right
thing
and
say
this
person
needs
to
be
in
rehab
for
another
week.
They
can't
walk,
they
can't
go
at
home.
Well,
my
little
computer
program
qm
says
this.
E
So
we're
going
to
deny
you
and
I
got
to
send
that
person
in
only
to
be
readmitted.
The
right
thing
was
to
listen
to
me
or
to
the
doctor
at
hand
to
say
I'm
seeing
this
person
regularly.
This
is
what
they
need.
So
a
lot
of
our
quality
assurance
measures
that
you
guys
have
in
place
don't
work
a
lot
of
our
prior
authorization
systems,
don't
work
and
the
amount
of
time
that's
spent
in
blocking
that
kind
of
treatment.
I
think,
if
you
want
to
do
the
right
thing
is
listen
to
your
providers.
E
Take
a
look
at
maybe
there's
gonna
be
people
that
can
be
higher
cost.
You
can
put
them
in
a
different
category,
but
the
vast
majority
of
doctors
and
providers
and
nurse
practitioners
want
to
do
the
right
thing
and
often
the
block,
for
that
is
an
organization
like
your
own.
That
is
saying
no
you've
got
to
go
through
a
prior
authorization
fill
out.
Ten
thousand
forms
to.
E
Let
us
do
the
right
thing
and
then
repeat
that
whole
process
again
in
three
months,
really
really
frustrating,
but
your
numbers,
don't
don't
come
together
on
this
as
far
as
unique
providers.
In
one
slide,
you
have
a
different
number
of
unique
providers
on
another
slide
for
pcps.
The
ratios
don't
match
up
for
how
many
doctors
you
have
in
your
whole
system.
As
far
as
how
that
comes
down.
E
E
If
the
trend
is
already
up,
which
would
be
encouraging,
that
would
be
pretty
rapid
because
we
just
passed
that
law
in
the
last
year
year
and
a
half
something
along
those
lines
to
be
upwards
of
six.
Seventy
percent,
I'm
wondering
if
we're
seeing
any
trending
on
that,
if
the
doctors
and
providers
that
are
doing
sud
are
they
doing
mental
health
stuff
on
the
side?
Is
that
reflected
in
this
mat
trend
that
you
have
there.
H
E
Okay-
and
that's
that's-
that
was
the
question,
so
that's
basically
saying
you
can
you're
doing
counseling
that
we
can
bill
and
we
can
track
based
on
billable
amounts.
Correct.
I
was
told
that
it
was
upwards
of
60
were
not
doing
that.
That
was
just
a
year
year
and
a
half
ago
so,
and
I
heard
it
from
multiple
mcos,
which
was
surprising,
because
I
I
practiced
somewhat
in
that
space
as
well
for
folks,
so
the
curiosity
is
going
to
be.
E
I
mean
you're
supposed
to
be
collecting
that
data
now
you're
obligated
by
a
law
to
collect
that
and
report
it
to
the
licensing
board,
so
I'll
be
curious
to
see.
If
again,
that
looks
like
that
trend
is
increasing,
that
people
either
doing
a
better
job
of
reporting
it
or
billing,
for
it
perhaps
or
doing
it.
I
know
telehealth
is
going
to
help
in
a
lot
of
those
that
space
as
well.
That's
it,
mr
chairman,
I
won't
go
on.
E
I
just
I
wanted
to
make
those
points,
but,
like
I
said
I
don't
know
if
the
the
data
you
provided
jives
I
mean,
if
those
ratios
don't
match
up,
is
the
concern.
C
We
have
a
lot
of
things
that
we
track
and
report
and
wanted
to
be
sure
that
you
were
seeing
those
as
well,
and
so
what
we'll
do
is
we'll
go
back,
senator
alvarado
and
we'll
see
if
it's
something
with
the
way
the
reports
were
pulled
timing
or
something
like
that
and
we'll
see
what
goes
into
them.
So
we
can
then
explain
to
you
what
has
come
out
on
these
slides
and
give
you
an
explanation.
E
Just
if
you're
going
to
brag
about
saying
we
have
a
1
to
11
1
to
13,
that's
tremendous
right.
It
sounds
great,
but
you
have
one
slide.
That
shows
this
is
the
axis
for
adult
pcp,
here's,
how
many
unique
providers
and
all
the
locations
we've
got.
I
would
argue
that
a
lot
of
those
folks
are
not
seeing
new
folks,
don't
have
a
clinic
setting
you've
got
them
under
a
contract.
They
fit
under
a
category
of
family
practice,
internal
medicine
pediatrics,
I'm
probably
one
of
those.
E
C
So
so
something
that
your
comments
just
kind
of
triggered
my
brain,
this
particular
map
shows
both
the
provider
groups
and
the
individual
providers
it's
kind
of
hard
to
see,
because
the
dots
are
all
the
same.
Color
the
dots
and
the
boxes
are
the
same
color.
So
that
may
be
some
of
the
the
differential
here
is
that
we're
talking
about
provider
groups
versus
individuals
on
the
different
reports?
So
I
apologize
for
the
confusion
for
that,
but
we'll
clear
that
up
and
bring
you
back
some
answers
on
that.
A
A
It
seems
to
be
a
hassle
for
all
providers,
but
one
that
I'm
most
interested
in
which
we're
going
to
talk
about
later
is
pin
legislation
we
passed
a
couple
years
ago
with
single
source
credentialing,
and
I
thought
that
that's
such
a
great
dream
to
have
one
source
to
credential
all
of
our
health
care
providers,
but
even
with
passive
legislation,
we're
not
there
yet
you
folks
don't
participate
in
that.
So
can
you
give
me
a
little
history
background
on
why.
G
Yeah
I'll
take
a
shot
at
that,
so
recognize
that
anthem
in
particular,
we,
the
medicaid
network,
is
a
derivative
of
the
commercial
network,
and
so
when
our
our
providers
go
through
the
credentialing
process
from
the
commercial
network,
and
then
it
is
basically
the
opt-in
through
the
contract
for
the
medicaid
network,
so
to
be
able
to
actually
we
would
be
placing
our
providers
at
a
double
credentialing
process,
because
we
don't
we,
we
do
our
own
for
the
commercial
and
didn't
want
to
put
our
providers
to
a
second
process
to
to
put
them
basically
in
a
double
process.
A
A
D
F
Mr
chairman,
I
wanted
to
take
just
a
moment
before
we
leave
the
mco
conversation
and
I've
been
as
critical
of
mcos
as
anyone,
because
I
do
see
it
every
day.
But
there
are
some
good
people
within
these
organizations,
and
I
want
to
recognize
mike
redenauer
it's
in
here
with
well
care.
I
had
constituents
in
my
district,
a
single
mother,
two
young,
severely
disabled
children,
mom
disabled
diabetic,
had
lost
a
leg
and
had
since
passed
away.
F
We
had
problems
getting
a
formula
for
those
kids
called
mike
for
help
he
stepped
up
and-
and
they
made
sure
that
those
kids
had
a
system
in
place.
So
so
mom
could
get
what
she
needed,
and
I
just
want
him
to
know
how
much
I
appreciate
that
and
and
that
direct
service,
and
that
that
taking
care
of
of
our
our
constituents
and
of
our
people
in
kentucky.
That's
what
it's
all
about,
and
I
just
wish
that
we
could
get
past
all
this
other
stuff
and
dealing
with
providers
and
get
things
more
standardized
streamline
things.
F
So
we
can
focus
on
those
good
things
and
make
a
difference
in
this
state
and
move
those
numbers
that
the
chairman's
talking
about,
because
the
reality
of
it
is
we're
not
this
state
is
not
getting
any
healthier
we're
failing
and
we've
got
to
get
that
fixed.
Thank
you,
mr
chairman.
A
I
So
I
want
to
thank
you
so
much
chairman
meredith,
chairman
elliott
and
members
of
the
committee
for
having
us
today.
We
would
like
to
give
you
an
update
on
the
status
of
our
hospitals
and,
unfortunately,
it's
a
time
when
there
are
gathering
economic
storm
clouds,
but
we
do
have
a
potential
silver
lining
at
the
end
of
our
presentation.
I
So
first
I'd
like
to
start
by
thanking
you
for
your
support
of
hospitals
during
the
pandemic.
I
The
general
assembly
backed
our
hospital
rate
improvement
program
at
a
very
crucial
time,
and
that
made
it
possible
for
our
hospitals
to
receive
more
federal
funding
for
medicaid,
just
when
it
was
needed
most
and
as
mr
bechtel's
you
know
talked
about
that
was
a
very
critical
program,
and
so
really
without
the
funds
from
a
trip
there
would
have
been
likely
a
large
number
of
hospital
closers
and
causing
access
to
care
and
a
loss
of
jobs
and
revenue
for
the
communities
where
hospitals
were
located
and
I've
just
recently
had
some
of
our
ceo
say.
I
You
know
where
the
status
that
they're
in
now,
which
we're
going
to
get
into
is
almost
really
worse
than
covid,
because
at
least
during
covet
there
were
some
federal
relief
funds.
But
now
you
know
those
funds
are
long
gone
and
there
are
a
lot
of
losses
and
a
lot
of
issues
that
our
hospitals
are
dealing
with,
so
just
kind
of
getting
back
to
a
trip.
A
trip
was
a
godsend
to
our
hospitals
and
that
program
doesn't
use
any
state
funds.
I
I
I
Our
constant
guiding
star
is
serving
our
patients
doing
all
that
we
can
to
preserve
life
and
restore
health,
and
we
want
to
thank
you
for
being
our
partner
in
this
work.
Unfortunately,
after
being
badly
beaten
up
by
the
pandemic,
the
hospitals
are
now
facing
the
challenges
associated
with
skyrocketing
costs,
from
both
inflation
and
growing
labor
shortages.
I
The
prognosis
is
likely
is
that
both
are
likely
to
get
worse
before
they
get
better,
and
so
the
slide
that
we
have
up
right
now
shows
the
components
of
what
make
up
a
hospital's
operating
costs.
And
what
you're
going
to
see
is
that
about.
75
percent
of
the
costs
are
going
to
fall
into
three
categories
and
that's
labor
drugs
and
supplies
over
one
half
of
a
hospital's
costs
are
going
to
be
for
labor,
and
those
costs
are
continuing
to
rise.
I
I
Inflation
raises
the
cost
of
nearly
everything
that
the
hospitals
use
its
medications,
salaries,
ppe,
food
and
utility
costs,
and
no
doubt
everyone
here
sees
and
feels
the
pinch
and
sometimes
the
punch
of
inflation.
The
purchasing
power
of
the
dollar
has
dropped
and
continues
to
erode,
and
that
means
rising
costs.
I
U.S
energy
production
has
been
curtailed
and
we
have
all
felt
the
pain
at
the
gas
pump,
but
the
increasing
cost
of
petroleum
isn't
just
felt
at
the
gas
pump.
It's
also
felt
in
the
hospital
just,
for
instance,
the
cost
of
treatment
gloves
has
risen.
247
percent
in
the
last
year
multiply
that
over
scores
of
items
that
hospitals
use
constantly
to
treat
our
patients.
I
Everything
in
the
hospital
that
has
a
petroleum
base
is
becoming
more
expensive,
just
as
you
have
seen
the
cost
of
the
gas
pump
hitting
all
sorts
of
new
records.
The
same
thing
applies
to
petroleum-based
products
used
in
hospitals,
the
cost
for
electricity
to
run
vital
machinery,
in
addition
to
just
keeping
the
lights
on,
and
the
elevators
working
has
risen
dramatically.
I
I
Hospitals
are
constrained
by
federal
laws
and
regulations,
and
we
must
take
what
medicare
and
medicaid
pay
based
on
what
those
federal
laws
and
regulations
allow.
There
is
no
negotiation
here.
The
majority
of
patients
in
our
hospitals
are
either
medicare
or
medicaid
patients
in
some
hospitals,
government
paid
patients
make
up
nearly
80
percent
of
the
patient
census.
I
Neither
of
those
programs
cover
the
full
cost
of
treatment,
much
less
the
full
charge.
The
losses
simply
can't
be
passed
on
to
commercially
insured
patients.
Not
only
aren't
there
enough
of
them,
but
having
only
two
commercial
plans
that
cover
80
percent
of
all
commercial
enrollees
gives
insurers
significant
leverage
in
setting
provider
rates.
I
The
options
then
become
grim
with
the
community,
facing
either
a
loss
of
services
or
outright
closure
of
a
hospital.
Either
scenario
is
devastating
for
a
community,
both
from
a
loss
of
access
to
care
and
a
loss
of
the
economic
engine
of
a
hospital
that
provides
employment
and
revenue
in
the
community.
I
Your
colleagues,
representatives,
bentley
and
coke
have
both
seen
what
happens
when
a
hospital
closes.
Access
to
care
becomes
a
struggle.
Hundreds
of
well-paying
jobs,
disappear,
revenue
for
local
governments
fall,
and
it
becomes
more
difficult
to
draw
new
businesses
into
the
community
because
of
the
lack
of
access
to
care.
This
isn't
a
good
scenario
for
anyone.
I
I
Hospitals
must
be
able
to
do
well
financially
in
order
to
do
good
and
fulfill
the
mission
of
providing
compassionate
care
to
our
patients.
So
where
does
this
leave
us
once
again?
Kentucky
hospitals
are
calling
on
the
general
assembly
to
be
our
partner
to
ensure
the
delivery
of
care
to
our
patients
and
your
constituents.
I
The
hospitals
seek
to
expand
the
current
a
trip
program
and,
as
you
may
recall,
the
current
a
trip
program
applies
to
medicaid
inpatient
admissions.
The
program
allows
us
to
draw
down
additional
federal
dollars
to
increase
medicaid
payment
almost
to
the
same
level
as
the
average
commercial
payment
rate.
The
hrip
program
has
been
innovative
and
while
valuable
to
our
hospitals,
both
rural
and
urban,
as
mr
bechtel
showed
you,
urban
hospitals
right
now
tend
to
have
significantly
more
inpatient
admissions
and
so
they're
getting
more
of
the
revenue.
I
I
I
As
a
reminder,
the
way
the
program
works,
the
hospitals
pay
an
assessment
to
fund
the
state's
share
of
supplemental
payments
as
an
add-on
to
a
medicaid
claim.
Hospitals
must
meet
certain
quality
metrics
to
continue
to
receive
the
enhanced
federal
payments.
The
program
must
be
approved
annually
by
cms.
I
I
Like
you,
the
kha
wants
to
make
sure
that
all
of
our
people,
urban
and
rural,
wealthy
or
needy
have
access
to
quality
health
care
when
they
need
it.
We
strongly
urge
you
to
take
up
the
necessary
legislation
to
make
this
a
trip,
expansion
possible,
and
so
again,
thank
you
for
having
us
today
and
we're
happy
to
answer
any
questions.
A
I
No,
the
cabinet
secretary
and
I
have
talked
on
several
occasions
and
he
is
totally
supportive
of
us
moving
forward.
A
A
I
We
agree
with
you
senator
meredith.
We
see
it
as
a
last-ditch
effort
when
a
hospital
just
has
no
other
choice,
and
it
might
be
better
than
closing.
We
have
really
only
known
two
hospitals
that
are
have
expressed
an
interest
to
us,
and
so
we
do
think
we
should
put
a
program
in
place
so
that
that
is
at
least
available
for
those
that
might
need
that
option.
C
I
We
actually,
I
think,
have
paved
the
way
for
other
states.
We,
as
I
said
this,
was
an
innovative
program.
When
we
passed
our
hrip
program,
we
have
a
lot
of
other
states
calling
us
wanting
to
know
how
we
did
it.
So
a
lot
of
states
are
copying
us,
but
some
of
those
other
states
have
gone
beyond
just
inpatient
and
have
received
approval
from
cms
for
an
outpatient
program.
So
we
are
optimistic,
cautiously,
optimistic
that
we
would
be
able
to
expand
our
program
and
have
it
approved.
F
Thank
you,
mr
chairman
nancy,
as
we
have
gone
through
covet
and
all
the
issues
with
especially
nursing
staff
and
the
high
cost
are
y'all
doing
anything
to
track
the
the
additional
cost
salary
cost
with
what
has
happened
with
the
increased
rates,
especially
with
nurses.
We
all
have
statistics
on
that.
At
the
end
of
the
year.
I
Yes,
well
we're
going
to
have
several
reports
so,
first
of
all
we're
in
the
final
stages
of
collecting
some
data
that
will
give
you
an
idea
of
the
vacancy
rates
in
hospitals
across
the
state,
not
just
for
nurses
but
for
other
health
professionals
and
we're
also
going
to
be
surveying
our
members
on
what
they're
having
to
to
pay
around
contract.
Nursing
costs
premium
pay.
So,
yes,
we
will
have
that
information
for
you.
I
I
So
it's
come
down
some,
but
the
hospitals
are
still
haven't
really
they're
still
having
to
use
travel
nurses
about
the
same
level
as
before
so
and
also
the
other
thing
is
they're
having
to
make
a
lot
of
premium
pay
to
just
retain
the
employees
that
they
have
and
those
are
ongoing
costs.
So
what
the
ceos
are
saying
to
me
is
you
know
we
can
never
take
that
back
now.
The
cost
of
care
has
now
gone
up.
F
Do
you
think
that
some
of
the
changes
we
made
in
an
effort
to
get
more
nurses
through
the
system
through
our
schools
and
recruit
students
out
of
high
school?
Do
you
think,
ultimately,
that's
going
to
be
the
the
answer?
Is
a
supply
and
demand,
obviously
with
workforce
availability?
Do
you
think
that
will
possibly
help
in
the
future
if
we
can
get
more
nurses.
I
I
We
definitely
want
to
work
with
the
high
schools
and
you
know
incentivize
and
excite
people
to
move
into
health
careers
and
have
that
career
ladder.
You
know,
maybe
even
looking
at
how
we
can
credential
people
within
high
school
that
then
they
can
move.
You
know
into
nursing,
you
know,
maybe
you
start
with
an
lpn,
and
then
you
move
to
a
two-year
nurse
or
whatever.
But
you
know
we.
We
need
some
immediate
relief
and
solutions.
F
How
do
these
higher
costs
play
into
negotiations
for
reimbursement
rates
with
insurance
companies,
I'm
just
now
getting
into
that
world?
I've
always
dealt
with
medicaid
we're
opening
an
autism
center,
we're
negotiating
negotiating
with
private
insurance
now
and
it's
a
whole
different
world
in
a
very
frustrating
world,
I'm
finding
already.
So
how?
How
does?
How
does
that
factor
in
will
hospitals
be
able
to
reopen
negotiations
to
to
account
for
some
of
the
additional
cost.
I
Yeah,
our
hospitals,
I
believe,
are
starting
to
approach
the
commercial
insurers.
With
this
data
and
saying
you
know
we,
we
need
to
look
at
what
our
rates
are.
So
I
don't
know
what
reaction
they're
getting
from
that,
but
there's
there
was
a
lot
of
discussion
among
our
board
recently
that
you
know
we
that
that
discussion
has
to
occur.
Okay,.
A
Last
question
I
referenced
earlier
with
the
medicaid
folks
about
the
basic
health
program,
that's
being
pursued,
how
much
discussion
within
your
industry
has
there
been
on
this
program.
I
Well,
obviously,
we
want
to
see
people
covered
and
we
don't
want
to
see
people
dropped
off
of
medicaid.
So
from
that
standpoint
you
know
we
certainly
want
to
be
a
partner
in
assuring
coverage.
I
think
the
concern
that
we
had
with
what
we
were
hearing
about
the
program
was
that
the
rates
were
going
to
be
set
at
medicaid
rates,
and
yet
that's
the
basic
health
plan
wasn't
going
to
be
a
medicaid
plan.
I
It
wouldn't
have
had
the
directed
a
trip
component
to
it,
and
so
I
think
people
were
very
concerned
that
that
you
know
was
was
going
to
be
a
problem,
but
you
know
we've
talked
to
the
cabinet
secretary.
I
think
they're,
maybe
not
married
to
that,
and
I
think
you
know
what
he
told
our
folks
was
that
there
would
be
additional
work
groups.
There
would
be
additional
discussion
as
we
also
looked
at
other
states.
You
know
when
we
talked
to
some
other
states
that
had
the
program.
I
New
york,
that
was
paying
medicaid
rates
had
realized
that
that
had
been
a
mistake
and
had
gone
in
with
a
20
rate
increase,
but
they
were.
They
gave
the
money
to
the
plans
and
then
that
what
we
heard
was
that
it
wasn't
passed
along
because
the
plans
weren't
losing
money.
So
I
think
we
have
to
really
understand
how
we're
setting
this
thing
up
and
make
sure
that
it's
going
to
be
successful.
A
A
And
we've
asked
them
to
give
us
an
update
on
the
limitation
of
three
bills
that
are
hanging
out
there:
incendiville
50
house
bill
438,
which
the
credentialing
bill
we
already
made
reference
to
in
legislation
past
this.
Is
this
last
time
house
bill
188.
So
please
again
just
for
the
record.
We
know
who
you
are,
but
please
identify
yourself
for
the
record
and
feel
free
to
just
kick
it
right
off.
B
I
think,
for
the
most
part,
it's
been
fairly
successful.
I
know
the
the
providers
have
been
very
happy
with
a
single
entity
to
deal
with,
so
they
don't
have
to
worry
about
what
the
certainly
what
the
pdl
is
among
the
different
plans
and
or
prior
authorizations.
B
We
are
in
the
process
of
reviewing
the
program,
we're
doing
a
deep
dive
into
the
program,
so
that's
to
be
completed
by
the
end
of
june.
We're
almost
there
so
I'd
be
happy
to
come
back
or
share
that
report
with
the
committee
once
that's
been
completed,
so
we
can
actually
bring
some
data
to
you
all.
That's
what
we're
looking
at
right
now.
B
So
we're
working
on
that
again
right
now,
but
you
know
I
I
think
the
intent
certainly
was
served
with
the
implementation,
and
you
know
where
we
work
through
issues
as
they're
identified.
B
I
think
our
biggest
issue
we're
working
on
right
now,
just
to
be
transparent,
is
about
the
dispense
fee
and
and
how
often
a
provider
can
get
a
dispense
fee.
We
align
with
the
fee
for
service
methodology
and-
and
that
was
a
little
different
than
the
way
the
mcos
were
paying.
But
we
are
looking
at
specifically
with
suboxone
and
in
creating
additional
dispense
fees
for
providers
in
that
area,
because
we
don't
want
that
to
be
a
barrier
to
individuals
receiving
medication-assisted
treatments.
So
we're
looking
at
that
right
now.
B
All
right
house
bill,
188,
passed
earlier
this
year,
made
some
changes
to
what
are
to
be
the
telehealth
regulations.
The
department
has
already
implemented
those
you
all
saw
that
and
and
in
fact
the
health
and
welfare
committee
passed
that
through
recently,
it's
907
kr
3170,
and
so
we
have
reflected
the
changes
in
house
bill.
188
in
that
and
just
very
at
a
high
level.
It
talked
about
people
being
temporary
located
and
not
being
able
to
have
prohibitions
for
whether
or
not
people
were
kentucky
residents
that
were
outside
the
state.
B
And
you
know
we
can't
prohibit
the
use
of
telehealth
for
those
individuals
and
non-kentucky
residents
being
in
state.
We
can't
prohibit
a
licensing
or
board
can't
prohibit
telehealth
to
those
individuals
when
they're
in
the
states.
So
again
all
that's
been
incorporated
in
in
medicaid's
telehealth
regulation.
B
Legislation
was
house
bill,
140
passed
last
year
again
our
regulation.
Our
current
regulation,
reflects
all
the
changes
that
were
required
as
part
of
that
one
of
those
included
the
need
to
submit
an
annual
report,
and
we
have
done
that
and
I
just
wanted
to
address
a
couple
of
the
key
takeaways
from
that
report.
B
One
is
that
we
did
see.
You
know
there
was
a
significant
increase
in
the
use
of
telehealth
during
the
pandemic,
and
we
were
great.
You
know
I
think,
that's
great
to
see
it
created
more
access
for
our
members.
B
B
One
of
the
areas
this
did
identify
is
a
concern
around
mental
health
services
and
whether
or
not
you
know
we're
really
utilizing
or
leveraging
telehealth
for
mental
health
services
at
the
beginning
of
the
pandemic.
There
was
a
little
bit
of
a
challenge
because
the
licensing
boards
had
to
do
some
things
to
allow
providers
to
provide
certain
services
via
telehealth,
but
I
think
it
still
continues
to
be
an
area
that
we
want
to
to
to
track
and
and
make
sure
that
we're
increasing
access
there
if
needed.
B
The
other
is
that
you
know
we
are
seeing
the
unit
costs
for
telehealth
increase.
But
again
you
know
we're
just
tracking
that,
and
in
this
day
and
age
I
think
it's
just
what's
expected.
E
Just
really
briefly,
it
would
be
good,
probably
to
track-
and
I
know
we're
looking
at
this
thing.
Okay,
it's
being
utilized.
What
are
our
er
visits?
Doing
I'd
be
curious.
I
know.
E
Anthem's
report
showed
a
slight
uptick,
but
the
hospitalizations
went
down,
and
so
I
can't
help
but
think
that
if
you
know
if
people
and
again
we're
a
very
litigious
state
when
it
comes
to
health
care,
I
fight
for
that
all
the
time
people
get
admitted
to
the
hospital
almost
as
a
cya
thing
for
providers
well
just
send
them
to
the
er
and
if
they
admit
in
the
er
says
I
better
just
admit
him
to
be
safe,
because
we're
worried
about
the
ramifications.
E
If
I
don't
do
something,
I'm
going
to
get
sued,
I'm
telling
you
that's
real
and
that
exists
so
we're
ranked
the
worst
in
the
country
when
it
comes
to.
You
know,
pre-hospital
or
not
worse.
I
think
bottom,
five
for
re-hospitalizations
we're
not
doing
very
well
I'd,
be
curious,
as
telehealth
hopefully
increases.
If
we
see
a
reduction
in
that
that'd
be
that'd,
be
a
good
trend
because
for
every
you
know
our
telehealth
visit
we're
paying
for.
E
E
How
many
hospitalizations
we've
reduced
as
a
result
of
these,
and
I
still
think
a
good
option
would
be
to
put
kiosks
in
and
talk
to
our
hospital
partners
put
a
kiosk
in
their
er
and,
as
somebody
shows
up,
I
want
to
be
seen,
for
I
have
a
cold,
you
know.
Well,
you
can
wait
and
some
people
will
wait
hours
to
be
seen
in
an
er
visit
and
say,
but
if
you
want
to
be
seen
right
away,
here's
a
kiosk
right
here
and
you
can
log
in
and
see
somebody
on
a
television
screen
and
get
paid.
E
You
know
they
get
paid
a
lot
less.
It
would
alleviate
the
burden
from
people
that
really
are
sick.
Coming
into
the
er.
I
think
that
still
would
be
an
opportunity
to
have
a
telehealth
visit
not
to
pay
for
er
charges
and
it
would
help
cut
costs
down.
So
just
some
thoughts
and
I
thought
maybe
we
could
track
those
and
compare
to
see
if
we
see
a
trend
as
telehealth
stays
up.
Do
we
see
a
reduction
in
those
it
might
be
worth
a
while?
Thank.
F
Thank
you,
mr
chairman,
just
quickly,
if
you
can't
answer
this
quickly,
I'll
get
with
you
later
recently,
a
physician
down
in
paducah
admitted
to
medicare
fraud
through
telehealth
hundreds
of
thousands
of
dollars.
What
do
we
have
in
place
within
kentucky
as
far
as
medicaid,
to
to
oversee,
reducing
or
preventing
fraud
within
telehealth
system.
B
Thank
you
for
that
question.
It
is
a
concern.
I
think
it's
been
a
concern
across
the
country
in
terms
of
you
know,
by
ramping
up
telehealth
services.
Are
we
ensuring
that
our
our
members
are
receiving
quality
care?
That
way,
and
just
like
in
person,
certainly
there's
fraud,
waste
and
abuse
a
couple
of
things?
One
is
that
we
are
monitoring
it.
B
We
are
auditing
against
it.
So
you
know
I
know
providers
don't
like
the
word
audit,
but
it
really
is
the
mechanism
for
us
to
when
we
identify
a
trend
to
really
dig
in
and
see
what's
going
on,
and
it
is
really
the
only
way
to
identify
if
there
is
a
true
issue,
so
you
know
I
I
think
we
are
always
looking
for
better
ways
to
monitor
and
we
certainly
utilize
those
types
of
cases
to
find
out.
You
know
what
can
we
do
better.
B
Practice,
thank
you.
It's
very
much
evolving
still
and
then
you
know
we
have
tried
to
put
into
our
regulations
some
standards
that
you
know,
providers
have
to
meet
because
we
need
to
do
that.
We
want
to.
We
do
have
to
protect
our
members.
For
that
very
reason.
So
you
know
one
of
the
concern
is
well
what
happens
if
they're
doing
a
telehealth
visit
and
there's
an
emergency
going
on?
If
that
person
was
in
person,
you
could
be
dealing
with
it,
but
you're
they're.
B
Not
so
you
know
those
are
some
of
the
things
we're
having
to
work
through
and
and
definitely
learn.
I
think,
as
as
we
move
forward
in
this
arena,
is
you
know
what
are
the
steps
we
need
to
take
to
make
sure
that
we're
protecting
the
patient.
B
And
then
the
last
piece
of
legislation
house
bill
438.
So,
as
you
all
know,
in
2018
legislation
was
passed
to
mandate
that
the
department
procure
a
credentialing
verification
organization
in
2019
that
was
slightly
tweaked,
some
additional
language.
There
were
some
minor
changes
to
that.
So,
following
that
the
department
did
start
down
the
road
procuring
a
vendor
that
was
released
in
september
of
2019
a
contract
was
awarded
in
july
of
2020..
B
You
know
just
to
be
candid,
I
think
there
were
some
challenges
with
it,
and
one
was
the
fact
that
there
were
delegated
credentialing
organizations
out
there.
Kha
is
one
the
kentucky
primary
carrier
association
is
another
universities
have
their
own.
Delegating
a
lot
of
universities
have
their
own
delegating
credentialing
with
each
of
the
managed
care
organizations.
So
when
we
started
to
dig
into
it
and
see
that
it's
we
if
we
created
one
with
the
state,
we're
not
solving
the
problem
that
there
would
still
be
all
these
different
avenues
for
providers
to
have
to
go
through.
B
So
at
the
time
we
you
know,
the
mandate
was
removed
from
the
statute.
There
was
a
provision
that
if
there
were
60
percent
of
the
mcos
that
had
some
type
of
credentialing
alliance,
then
or
contract
with
the
credential
alliance,
then
we
were
to
cancel
the
contract.
So
we
were
sort
of
in
this
position
that
we
had
a
contract.
B
We
hadn't
gone
live
yet,
but
we
did
know
that
at
the
time
over
60
percent
of
the
mcos
did
have
contracts
with
kpca
the
primary
care
association,
and
there
were
all
these
other
delegated
credentialing
contracts
that
we
did
instead
of
going
live,
we
did
go
ahead
and
cancel
the
contract.
The
protest
was
still
pending.
B
B
We
also
monitor,
through
reports
that
you
know
the
mcos
have
to
meet
certain
credentialing
timelines,
and
so
you
know
we
we
look
at
those
reports
on
a
quarterly
basis
and
we
ensure
that
they
are
meeting
those
credentialing
timelines
and
if
they're
not,
then
we
do
a
letter
of
concern
or
if
it's
you
know
serious,
then
we'll
we'll
increase
that
to
a
corrective
action
plan
and
and
assess
penalties.
B
But
the
reality
is
is
on
paper
we're
not
seeing
the
problem.
That
doesn't
mean
it's
not
out
there,
but
we're
just.
We
don't
have
the
evidence
of
it
so
for
medicaid
enrollment,
which
enrollment
and
medicaid
is
different
than
credentialing.
There
are
two
different
processes
that
have
to
happen.
B
Our
our
online
system
is,
has
gotten
more
and
more
sophisticated
to
help
the
provider
understand,
what's
needed
to
get
that
information
and
to
get
the
application
moving
along.
So
there
are
outliers,
I'm
not
going
to
tell
you
that
it's
a
hundred
percent.
There
are
definitely
outliers
as
there
are
with
everything.
But
that's
that's
the
current
situation.
E
B
Yeah,
let
me
send
that
to
you,
so
you
can
send
it
on
just.
B
E
Yeah
and
also
on
the
on
the
telehealth,
if
we
could
empower
the
patients
somehow
either
either
if
they've
had
a
telehealth
visit.
Maybe
a
follow-up
to
say
you
know
was
everything:
okay,
I
I've
heard
from
people
that
have
you
know,
had
a
follow-up
for
a
sleep
study
and
wound
up.
They
said
okay,
here
for
your
follow-up.
E
It
made
the
patient
watch
a
video
on
their
telehealth
screen
after
it
was
done
any
questions,
and
that
was
the
telehealth
visit,
which
wasn't
really
any
kind
of
an
examination,
no
back
and
forth,
but
I'm
sure
it
was
billed
that
way,
and
so
I
try
to
channel
those
when
I
get
them.
But
if
we
can
empower
patients
to
report
those
kinds
of
encounters.
E
A
A
That
folks,
just
to
note
that
our
next
meeting
is
just
two
weeks
away,
it'll
be
thursday
july
7th
at
9
00
a.m.
In
the
morning
we'll
be
in
this
room
so
be
prepared
and
we'll
send
out
the
agenda
once
we
get
that
finalized,
no
other
business
coming
for
us.
This
meeting
stands
a
term
thanks.
Everyone.