►
From YouTube: Administrative Regulation Review Subcommittee (5-9-23)
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
C
A
A
D
A
D
A
Yeah
she
didn't
look
like
cabinet
staff
or
anything
like
that.
Please
call
First
regulation.
E
A
A
A
Are
we
we're
crying
requiring
more
experience
at
a
time
where
we
need
more
teachers
in
the
classroom
or
I?
Don't
think
this
is
doing
that,
but.
F
F
Sure
so
this
regulation
relates
to
Renewal,
so
individuals
who
are
already
certified
to
be
teachers.
Renewing
that
certificate
it
actually
provides
some
expanded
opportunities
there.
With
regard
to
the
experience
that
they're
required
to
have
in
order
to
renew
the
certificate,
this
expands
a
little
bit
how
a
substitute
teacher
that
experience
could
count
toward
renewal.
So
previously
it
had
to
be
I
believe
30
hours
in
each
semester.
Instead
of
that
being
the
case,
it
can
be
60
hours,
regardless
of
which
semester
it
would
be
in.
F
A
So
it
sounds
like
this
should
do
nothing
but
enhance
the
opportunity
to
to
teach
and
and
help
with
teacher
shortage
issue.
Yes,
thank
you,
sir
appreciate
it
he's
called
the
next
regulation.
G
49010
and
emergency
and
9020
and
emergency
established
the
General
application
and
local
government
application
procedures
for
funding
from
the
Kentucky
opioid
abatement
advisory.
Commission.
The
staff
suggested
amendments
to
the
ordinary
regulations,
amend
various
sections
to
comply
with
KRS
chapter
13A.
H
Play
Christopher
senior
council
at
the
Attorney
General's
office.
A
D
Thank
you
Mr
chairman,
and
thank
you
all
for
being
here
today.
Looking
over
the
public
comments,
there
was
a
question
on:
should
a
county
or
city
misappropriate
These
funds.
What
is
the
recourse.
C
H
Right
on
the
the
type
of
misappropriation,
there
are
a
number
of
potential
things
that
could
happen
at
this
point.
There
are
methods
to
sort
of
debit
that
against
future
payments,
that's
a
possibility,
there's
a
possibility
of
having
to
pay
it
back
right.
Of
course
it
depending
on
the
situation
and
and
what
I
I
suppose
further
Evidence
would
turn
up,
there's
a
potential
that
it
could
preclude
future
payments
altogether.
But
I
don't
want
to
necessarily
comment
on
and
give
a
wide-ranging
answer
without
knowing
more
about
the
circumstances.
H
H
In
those
kinds
of
circumstances,
the
commission
is
to
refer
those
kinds
of
situations
to
the
AG's
office,
who
is
in
charge
with
investigating
and
sort
of
securing
the
Integrity
of
these
settlements
because,
as
I
understand,
probably
the
basis
of
your
question,
misappropriation
could
put
at
risk
right
the
842
million
dollars
some
odd
settlements
that
have
totaled
at
this
point,
so
I
think
it
would
just
depend
on
what
the
situations
were
and
and
also
what,
like,
what
kind
of
cooperation
we
received
about.
Moving
forward
and
correcting
the
air.
D
Sure,
thank
you.
One
follow-up,
Miss,
Truman
sure
see.
Another
portion
of
that
comment.
Section
was
also
reporting
requirements,
I
mean
there's
gonna,
be
different
dollar
amounts
and,
of
course,
some
of
your,
your,
your
bigger
governments
are
going
to
be
having
more
funds
come
in
if
you're,
a
smaller
County-
and
let's
say
you
know,
you're
getting,
maybe
14
000.
I
believe
the
reporting
requirements
required
to
be
reported
four
times
a
year.
Any
discussion
on
maybe
reducing
that
based
on
the
amount
of
money.
H
So
I
certainly
think
that's
something
the
commission
can
take
a
look
at
moving
forward
right
and
whether
it
wants
to
have
alternative
reporting
requirements
depending
on
the
size
of
the
Locale
or
the
the
amount
of
the
settlement.
I
real
I
do
want
to
note
that
part
of
that
I
think
concern
is
addressed
in
the
statute
itself.
H
And
so,
if
you're
talking
extraordinarily
law,
small
dollar
amounts
that
would
go
to
a
small
City
that
will
roll
up
to
the
county
and
the
county
will
have
the
reporting
requirement
right
at
that
point.
I
certainly
think
the
commission
can
take
a
look
at
and
I
won't
speak
for
for
the
commission
members,
but
they
can
take
a
look
at
sort
of
amending
that
in
the
future
to
make
sure
that
we're
not
being
too
obtrusive
intrusive
into
local
governments,
but
I
think.
H
A
C
H
So
I'm,
just
going
off
of
memory
off
the
last
time,
I
looked
on
our
website
I
think
it's
842
million
in
in
some
over
the
course
of
the
next.
What
15,
20
years
or
so
recall
according
to
15.291
and
293,
that's
split,
50
percent
50
will
go
directly
to
the
counties
and
cities.
The
other
50
percent
will
come
to
the
opioid
abatement
advisory
commission,
this
of
course,
or
that
amount
of
course
doesn't
come
in
and
one
Fell
Swoop.
It
comes
in
over
scheduled
payments
over
the
next
15
or
20
years.
H
A
L
A
You
there
are
staff
amendments.
Is
there
a
motion
for
approval
of
the
staff
amendments?
We
have
a
motion.
We
have
a
second
without
objectioners,
so
ordered.
What
we
have,
of
course,
is
the
reg
as
amended
any
questions
from
members
on
this
set
of
regulations
dealing
with
Dentistry.
Seeing
none,
please
call
Max
regulation.
Thank
you.
K
201
KR
2360
amends
to
authorize
the
exclusion
of
nursing
students
from
the
graduation
rate,
who
have
not
completed
the
program
of
nursing
due
to
documented
extenuating
circumstances
and
update
the
annual
report
of
the
program
of
nursing.
The
staff
suggests
an
amendment
amends
various
sections
to
comply
with
Cara's
chapter
13A.
G
201
2390
amends
Provisions
for
the
Kentucky
nursing
incentive
scholarship
fund
to
adjust
award
criteria
to
encourage
application
by
pre-license
your
students
without
a
health
care
background
and
revise
the
application
form
Incorporated
by
reference.
The
staff
suggested
a
momentum
in
various
sections
to
comply
with
KRS
chapter
13A.
O
A
P
You
Mr
chair
just
looking
through
this.
Could
you
explain
why
that
we
would
do
this?
Obviously
we
want
to
make
sure
we
have
a
clear
picture
of
you
know
who's,
completing
and
most
of
the
time,
if
you
don't
complete
it's
because
of
some
extremely
circumstance.
Why
would
this
not
give
us
kind
of
a
false.
M
The
way
that
we
had
calculated
prior
to
this
was
based
on
a
one
and
a
half
time
percent
rate,
so
what
that
meant
was
each
program
was
having
to
keep
track
of
every
name
of
every
student
each
spring
and
fall
or
now
they're
doing
quarterly
sessions.
So
it
was
really
getting
so
hard
to
accurately
get
a
true
percentage
rate.
M
The
other
thing
is
this
puts
us
in
line
with
the
National
Council
of
state
boards
and
how
other
states
actually
calculate
that
graduation
rate,
and
now
it
is
just
a
snapshot
for
us,
because
we
can
only
use
this
as
a
benchmark
as
a
reason
why
we
might
need
to
go
in
and
do
a
site
visit.
As
you
recall
the
last
legislative
session,
we
only
now
can
like
what
was
perceived
as
a
cap,
but
they
can
increase
enrollment
it
doesn't.
It
doesn't
pertain
to
this
Factor
anymore.
M
A
Any
other
questions
seeing
none
if
you,
if
you
could
just
further
comment
on
that,
how
is
that
going
the
implementation
of
the
bill
that
that
we
passed
have
we
removed
the
cap?
Oh.
M
A
B
G
301-2222-301-4110
amidst
procedures
to
administer
drugs
to
Native
Wildlife,
to
clarify
three
definitions
and
other
Provisions,
add
to
the
detailed
plan
and
timeline
for
administration,
anesthetic,
monitoring,
withdrawal,
time
data
and
potential
human
consumption
risks
and
add
to
waiver
criteria
the
possibility
of
biological
or
chemical
emergencies.
The
staff
suggested
amendments
for
301-2015
and
4110
am
in
various
sections
to
comply
with
KRS
chapter
13A.
A
L
A
Yeah,
nice,
so
yeah
I
know
turkey
season
ended
yesterday,
I
think
day.
A
I'm
sorry
day
before
yesterday,
yes,
always
nice
having
you
any
further
questions,
seeing
none!
Please
call
next
regulation.
A
E
A
There
is
a
staff
amendment.
Is
there
a
motion
for
approval
of
the
staff
Amendment?
We
have
a
motion
in
a
second
without
objection.
It
is
so
ordered
any
questions
for
members
whenever
I
deal
with
workers,
comp
I
have
a
little
flag.
That
goes
up
in
my
mind,
I'm
an
attorney
but
I
know
enough
to
be
dangerous
when
it
comes
to
workers
comp
law,
especially
when
we
talk
about
the
calculation
methodology.
A
So
my
question
is:
is
this
a
huge
change
that
will
affect
a
client?
A
claim
comment
on
that?
If
you
would.
R
What
this
is
is
to
clarify
the
calculation
of
assessment,
so
insurance
companies
are
required
to
pay
assessment
on
all
their
insurance
policies
that
route
workers
comp
in
the
state
of
Kentucky.
They
may
pass
it
on
to
their
insurance
if
they
want
to
do
that,
but
it
is
not.
This
does
not
have
to
do
with
the
payment
of
the
claims,
and
the
calculations
here
are
not
new.
What
we're
trying
to
do
is
be
transparent
and
open
as
to
what's
going
on.
It's
not
been
done
in
the
past,
and
it's
just
good.
A
R
To
measure
yes
sure
of
right:
yes,
they
pay
in
quarterly
and
it
is
on
a
a
voluntary
basis.
The
companies
do
and
we
work
directly
with
insurance
companies
to
collect
this
employer.
R
B
G
808
1170
amend
requirements
for
licensing
and
registration
of
consumer
loan
companies
check,
cashing
and
deferred
deposit
service
businesses
and
mortgage
loan
companies,
Brokers
branches
and
Originators
to
establish
the
process
to
calculate
the
annual
assessment
fee
for
a
renewed
mortgage
loan
company
or
broker
the
staff
suggested.
A
momentum
is
various
sections
to
comply
with
KRS
chapter
13,
a
amends
Section
5
to
clarify
that
branches
do
not
have
to
pay
the
registration
renewal
fee
individually
and
amend
section
11
to
insert
a
reference
to
KRS
12.357
which
exempts
military
spouses
from
licensure
fees.
Under
certain
circumstances.
G
A
There's
a
staff
amendment:
is
there
a
motion
for
approval,
the
staff
Amendment?
We
have
a
motion.
We
have
a
second
without
objection
is
so
ordered,
there's
also
an
agency
Amendment.
Are
there
any
questions
or
discussion
on
the
agency
Amendment,
seeing
none
as
their
motion
for
approval
of
the
agency
Amendment.
We
have
a
motion.
We
have
a
second
without
objection,
so
ordered
so
you
have
before
you
the
regulation
with
as
many
by
staff,
Amendment
and
agency
Amendment.
Any
questions
for
members.
A
N
So
I
guess
before
the
this
statute
was
changed,
there
was
a
initial
application,
a
fee,
an
examination
fee.
Every
time
we
went
on
an
exam
and
then
a
renewal
fee
based
on
the
office
locations
that
that
broker
would
have
going
forward.
It's
going
to
be
based
off
of
loan
volume,
so
there's
a
multiplier
in
statute
that
is
used
to
calculate
the
fee
with
a
Min
and
a
Max
that
has
taken
the
place
of
the
renewal
fee
and
Branch
or
exam
fee.
N
A
N
G
Management
Services
clarifies
Provisions
if
a
resident
refuses.
Medication
management
allows
certified
medication,
aides
to
administer
pre-loaded
insulin,
in
addition
to
other
medications
and
revises
Incorporated
material.
The
staff
suggested
Amendment
amends
various
sections
to
comply
with
KRS
chapter
13
a
and
amends
section
15
7
to
comply
with
new
credentialing
requirements
and
Senate
bills.
110
and
111.
G
902
2490
establishes
minimum
standards
for
licensure
as
a
rural
emergency
hospital.
The
amended
after
Commons
version
amends
section
2
to
clarify
that
a
rural
emergency
hospital
shall
obtain
licensure
priorities
prior
to
certification
by
CMS
and
delete
the
requirements
to
obtain
certificate
of
need
approval
prior
to
converting
back
to
a
critical
access
or
acute
care
hospital.
A
Thank
you.
There
are
staff
amendments
we
have
do.
We
have
motion
approval
staff
amendments.
We
have
a
motion.
We
have
a
second
without
objection,
is
so
ordered,
so
we
have
before
us
what
appears
to
be
a
complex
regulation
before
I
open
for
questions
from
Members
representative.
Did
you
want
to
speak?
Yes,.
S
In
favor,
just
assuming
yes,
sir
Justin,
thank
you
Senator.
Yes,
sir
I'm,
in
favor
of
this,
we
are
when
we
passed
last
legislative
session
with
the
one
before
Senate
Bill
11,
basically
re-codified
the
Assisted
Living
organizations
and
put
them
into
different
categories.
It
was
kind
of
unclear
in
the
regulation
how
many
categories
there
would
be
I
think
there
was
originally
two.
This
makes
sure
that
there's
three
categories
it
includes
Alzheimer's
and
Dementia
as
one
category
the
medical
models.
Another
category
in
the
community
model
is
another
category.
S
S
It
also
changed
the
allowed
CMAs,
which
is
certified
medication
aids
to
administer
from
a
pre-loaded
injections
for
insulin,
so
40
percent
of
the
people
in
assisted
livings
and
nursing
homes
now
or
have
insulin
requirements
which
would
normally
required
a
nurse
to
be
on
site,
but
from
a
preloaded
injectable
syringe.
We
were
allowing
them
to
do
it
themselves,
which
people
with
Alzheimer's
and
Dementia
or
Parkinson's
disease
have
a
just.
If
you
can
imagine
the
difficulty
doing
that.
S
So
these
the
Board
of
Nursing
supported
this
and
has
put
together
regulations
to
ensure
that
the
CMAs
can
administer
this
medication
without
a
nurse
being
on
site
but
being
available,
so
that
pretty
much
in
summary,
is
our
two
biggest
changes.
A
G
910
1180
amends
Provisions
for
the
Home
Care
Program
to
add
definitions,
revised
case
manager,
qualifications,
add
service,
appropriateness
and
safety,
monitoring,
establish
Provisions
to
prevent
reduction
or
termination
of
services
without
cause
add
service
planning,
including
involving
the
client
in
planning,
and
update
the
appeal
process
to
include
an
informal
dispute
process.
The
staff
suggested
Amendment
amends
very
various
sections
to
comply
with
KRS
chapter
13A.
T
T
A
G
907
1038
emergency
amends
Kentucky,
Medicaid
Program
hearing
Provisions
to
implement
estate
plan
amendment
that
allows
adults
to
receive
Hearing
Services
establish
Audiology
service
limits
through
the
Incorporated
fee
schedule,
increase
the
amount
that
can
be
charged
per
year.
Each
36
months
from
800
to
1200
clarify
how
hearing
and
batteries
may
be
provided
clarify
how
hearing
aid
batteries
may
be
provided
clarify
that
new
or
improved
technology
may
be
a
reason
to
reimburse
for
hearing
aid
replacement,
establish
that
service
and
instrument
limits
may
be
exceeded
for
children
under
21
if
medically
necessary
and
update
the
fee
schedule.
G
G
907-1632
emergency
amends
Kentucky,
Medicaid,
Program
Vision
Provisions
to
make
technical
Corrections,
including
for
consistency
with
907
3005
Implement.
A
state
plan
amendment
that
allows
for
adults
to
receive
Vision
Services,
clarify
costs,
save
cost
sharing
requirements
in
order
for
providers
to
deliver
a
service
to
deliver
services
on
a
non-medical
basis,
clarify
vision,
service
limits
require
a
higher
quality
of
frames.
Lenses
and
lens
enhancements
shall
be
available,
clarify
that
contact
lenses
are
covered
and
shall
be
available
and
update.
The
vision
fee
schedule.
A
Any
questions
from
Members
as
we
get
into
this
important
set
of
Rec
Center.
There.
W
Thank
you,
Mr
chairman
half
expected
Bill
Murray
to
come
to
the
table
today,
because
I
feel
like
this
is
Groundhog
Day
for
those
of
you
who
aren't
as
old
as
I
am
that
was
a
movie
starring,
Bill
Murray,
where
the
same
thing
kept
happening
over
and
over
and
over
again
so
I've
been
back
on
this
committee
for
just
a
couple
of
months,
but
I
think
every
month
since
I've
been
back
on
this
committee,
you've
been
before
trying
to
push
through
these
regulations,
which
seemed
to
me
to
fly
in
the
face
of
the
other
branch
of
government,
the
one
that
we
are
members
of
elected
by
the
people
to
implement
policy
to
pass
policy
that
you
are
supposed
to
implement.
W
So
with
that
in
mind,
I'm
going
to
ask
quite
specifically,
do
these
regulations
comply
with
the
provisions
of
the
Chairman's
bill,
Senate,
Bill,
65,
relating
to
Medicaid
coverage
for
dental
vision
and
hearing
services.
That's
part,
one
part
two
is
how
were
these
different
from
the
previous
set
of
regulations
found
deficient
by
this
committee,
and
please
do
not
avoid
the
question,
because
if
you
do,
I
will
ask
it
again.
Thank
you.
Mr
chairman.
V
Well,
I'll
take
the
first
part
of
that
question
and
maybe
segue
into
two
in
regard
to
Senate
Bill
65.
It's
our
position
that
this
that
these
regulations
before
the
committee
here
today
are
substantially
different,
and
that
was
and
once
again
that's
in
compliance
with
Senate
Bill
65..
They
are
different
as
far
as
each
service
provided
dental
vision
and
hearing
and
as
we
say,
we
think
they're
substantially
different
in
regard
to
fee
schedule
in
regard
to
Services
provided
in
regards
to
services
covered
and
in
regard
to
rules
about
the
provision
of
sales
services.
V
U
U
Simulations,
for
example,
our
Dental
regulation
is
definitely
significantly
different
in
that
the
adult
fee
schedule
has
been
changed.
Kentucky
has
two
different
fee
schedules
for
our
Dental
population.
We
have
a
fee
schedule
for
children
and
a
fee
schedule
for
adults.
The
adult
fee
schedule
is
slightly
lower
than
the
children's
fee
schedule,
based
on
studies
conducted
by
the
American
Dental
Association
air
child
fee
schedule
is
at
104
percent
of
the
commercial
rate.
U
U
Their
smile
and
the
vision
regulations
are
different
in
that
we've
increased
the
quality
of
frames,
we've
updated
the
Medicaid
vision
fee
schedule
in
several
places,
we've
removed
language
that
would
allow
providers
to
balance
Bill
a
member,
because
that
is
not
allowed
under
federal
statute,
so
we
want
definitely
to
be
in
compliance
with
federal
laws.
Our
hearing
regulation
is
different
in
that
our
Audiology
Services
limits
us
hit
by
or
set
by
the
fee
schedule.
U
V
And
I
like
I,
just
like
to
add
to
that
all
these
changes
that
that
we
just
that
we
were
just
mentioned
and
there's-
and
there
are
more
we're
done-
we're
done
in
conjunction
with
our
technical
advisory
committees
in
regard
to
these
service
provider
types.
So
the
similarity
with
this
is
only
this
Vision,
dental
and
hearing
services.
The
actual
regulations
are
substantially
different
and
it's
our
understanding.
It's
our
understanding.
It's
our
position
that
that's
in
full
compliance
with
Senate
bill,
65.
W
A
A
The
main
change
to
be
in
compliance
on
Senate,
Bill,
65
and
Senate
bill
2.
you
have
to
have
you
know
there
has
to
be
substantial
change,
but
the
change
has
been
to
increase
the
fees
in
most
cases.
A
Now
you
talked
about
this
was
done
after
consultation
with
the
your
technical
Review
Committee.
Did
you
at
any
time
act
in
conjunction
with
the
Senate,
Health
and
Welfare
committee
on
this?
Did
you
consult
with
them
before
you
proceeded
with
the
change.
P
Thank
you,
Mr,
chair,
I
was
trying
to
take
a
couple
notes.
Was
it
said
that
that
this
was
necessary?
These
changes
to
comply
with
federal
law
is
written
right
now.
U
Some
of
the
changes
that
we
did
Implement
were
designed
to
comply
with
with
federal
law.
Specifically
there's
no
balance
billing
to
a
Medicaid
member.
So
providers,
for
example,
could
not
provide
a
pair
of
glasses
and
I'm
just
going
to
throw
out
numbers
for
a
hundred
dollars
and
only
Bill
Medicaid
for
50
and
try
to
balance
Bill
the
member
for
the
other
50..
That's
not
allowed
in
Medicaid
Billing
at
all.
P
One
of
the
talks
and
worries
that
in
and
I
think
I'm
in
agreement
with
is
that
we
didn't
have
enough
providers
willing
to
provide
the
services
out
there.
It
looks
like
because
of
the
increased
rates
that
you
added
about
close
to
another
thousand
dentists
that
are
willing
to
provide
services.
Is
that
correct.
P
U
U
390
individuals
had
dentures
and
if
I
could
just
read
a
very
small
email-
and
this
is
one
of
many
that
we
received
from
an
individual,
she
states
her
name
and
I'm,
not
going
to
say
that,
of
course,
for
HIPAA
reasons,
I
have
several
dental
problems
and
was
scheduled
to
get
all
teeth,
extracted
and
Dentures
for
both
top
and
bottom
I've
done.
All
x-rays
on
April,
21st
and
I
was
going
to
begin
Impressions
and
have
my
new
teeth
by
the
end
of
May.
I
am
two
years
clean
and
sober
and
am
applying
for
a
new
state.
U
Job
in
July
I
have
worked
so
hard
to
get
where
I
am
and
I
feel
great
about
myself,
except
for
my
appearance
due
to
my
teeth
or
lack
thereof.
This
is
a
perfect
example
of
why
we
need
these
services.
In
Kentucky.
We
currently
rank
49th
in
the
state
in
oral
health
care.
We
can't
continue
to
pay
for
the
same
Services
more
and
more
and
expect
different
results.
We
have
to
do
something
different.
U
Our
neighbors
to
the
east
of
Us
Virginia
has
dramatically
changed
their
adult
Dental
benefit
and
they,
their
services
went
into
effect
July
1st
of
2021.
They
provide
a
full
array
of
services
to
their
to
their
adult
population,
including
three
cleanings
per
year,
ours,
current
population.
We
only
provide
two
prior
to
these
changes.
P
My
and
I
appreciate
that
my
final
question
is
when
we
have
different
come
before
us.
You
said
that
was
done
with
the
technical
advisory
committee
on
there
that
kind
of
looking
at
Best,
Practices
or
whatnot,
who
would
that
make
up?
Who
would
be
part
of
that
of
the
advisory
committee?.
U
The
technical
advisory
committee,
we
have
several
technical
advisory
committees,
we
have
a
dental
technical
advisory
committee,
that's
made
up
of
dentists
around
the
state,
same
thing
with
vision
and
hearing
made
up
of
different
individuals
and
those
those
tax
report
up
to
the
Medicaid
advisory
Council,
and
so
they
make
recommendations
to
the
mac
and
then
the
Mac
brings
those
recommendations
to
the
department.
Thank.
A
You
Central
items
before
you
start
I
got
a
quick
question
that
I'll
hand
it
over.
Last
time
we
had
the
regs
before
the
committee.
The
price
tag
I
think
we
had
it
set
at
like
38
million
I,
believe
most
of
that
coming
from
the
savings
from
Senate
bill
50.
go
ahead.
Correct
me
if
I'm
wrong
there
is
that.
Does
that
sound,
accurate?
A
U
We
we
do
have
some
savings
from
Senate
bill
50.
Therefore,
we
did
not
need
an
appropriation
we
feel
like
this
is
in
our
current
appropriation
we
have
30.
The
total
is
36
million
dollars,
31
million
of
that
coming
from
the
federal
government
good,
you
know
great
return
on
investment
and
5.6
coming
from
State
State
dollars.
So.
A
With
the
increase
and
then
the
new
rates
in
this
version,
what
was
the
initial
price
tag
and
then
what?
What
are
we
at
now
with
this
new
expansion.
A
You
so
so
you
gave
us
a
price
tag
last
time
you
were
here.
This
is
what
it's
going
to
cost
and
now
you're
telling
us
what
the
changes
here
this
is
expanding
services
and
increasing
rates,
so
I
would
assume
that's
going
to
be
a
higher
cost.
So
what
was
the
cost
last
time
compared
to
what
the
cost
is
now.
V
And
I
think
it's
well
I,
don't
think
we
have
the
exact
number
here
for
as
far
as
this
as
far
as
the
regs
are
here
today,
however,
I
don't
think,
there's
any
concern
that
it
will
fall
outside
of
what
the
savings
are
already
being
generated.
They
will
be
able
to
absorb
it
without
any
additional
appropriation
and.
U
Most
of
that
is
because
the
Managed
Care
organizations
serve
90
of
our
population,
Managed
Care
organizations
per
month,
capitation
payment,
and
they
have
to
provide
all
the
services
that
are
outlined
in
our
benefit
package.
So
the
mcos
will
be
using
that
PM
pm
to
the
per
member
per
month
to
pay
for
these
services,
and
it
should
not
be
an
increase
as
we
go
forward.
X
I
was
a
question
on
the
same
lines.
Is
it
that
you
did,
and
that
is
cost
I
mean
we
are
if
we
are
increasing
the
rates
in
order
to
expand
these
Services
you're,
saying
that
this
additional
expansion
is
not
going
to
create
additional
costs.
Is
that
your
testimony
that
we.
U
U
Medicare-Based
Medicaid
bases
a
lot
of
error
rates
on
Medicare
Medicare
did
reduce
some
rates
in
our
Behavioral
Health
Pro
in
the
behavioral
health
program,
so
our
Behavioral
Health
Services.
We
used
to
have
an
inpatient
and
an
outpatient
fee
schedule.
It
was
a
little
bit
confusing.
We
combined
those
into
one
Behavioral
Health
fee
schedule
and
if
the
rate
on
one
fee
schedule
was
higher,
we
chose
the
higher
rate.
We
did
not
reduce
any
rates.
U
X
U
X
And
now
let
me
ask
you
this,
so
you
are
basing
your
rate
cut
for
Behavioral
Health
Services
on
the
fact
that
Medicare
required
it,
but
don't
we
set
regulation
for
behavioral
health
Medicaid
rates
through
our
own
regulatory
process.
This
is
not
a
from
my
understanding.
This
is
not
a
federal
government
requirement
that
we
did
not
have
to
cut
those
Behavioral
Health
rates
if
we
took
care
of
it
within
our
own
regulatory
framework,
correct.
U
Our
regulation
that
covers
Behavioral
Health,
specifically
references
the
Medicare
fee
schedule,
so
it
is
in
our
regulation.
Cms
requires
that
our
rate
methodology
be
based
on
some
sound
methodology,
and
one
of
those
methodologies
is
tying
to
the
Medicare
fee
schedule.
So
our
rates
because
our
rates
are
in
stat
in
our
regulations,
outlined
that
we
tie
ours
to
Medicare.
We
have
to
to
be
in
compliance
with
state
law.
We
would
have
to
adjust
our
rates
whenever
Medicare
adjusts
their
rates,
so.
X
U
X
Look
forward
to
seeing
the
the
reg
that
raises
back
those
Behavioral
Health
fee
schedules.
So
I
look
forward
to
seeing
that
in
the
interim
I'm
assuming
you're
working
on
that.
U
Too,
we
are
definitely
working
on
a
behavioral
health
rate
study,
particularly
around
children's
services.
For
example,
I
am
in
routine
meetings
with
other
Medicaid
directors.
Across,
the
Nation
there's
a
huge
issue.
Right
now,
with
prtfs.
Several
of
our
states
surrounding
states
are
changing
their
prtf
rates.
They
are
looking
at
some
of
their
policies
because
some
of
the
state,
some
prtfs,
are
taking
out-of-state
children.
So
it's
not
about
the
money,
because
when
a
state
sends
a
child
to
another
state,
they
pay
more,
they
negotiate
rates
and
they
pay
more
than
the
state
fee
schedule.
U
We're
not
seeing
children
from
out
of
state
coming
into
Kentucky,
which
is
a
little
bit
of
a
concern
because
it
means
we
don't
have
the
array
of
services
needed
for
it.
So
states
are
not
targeting
us
to
bring
their
children
in
so
we're
very
concerned
about
that.
We
are
looking
at
it.
We
have
talked
to
other
states,
they
are
making
changes.
U
X
And
Mr
chairman
I
promise
I'm
not
getting
too
far
off
Vision
dental
and
hearing,
but
the
commissioner
just
brought
up
something
that
I
think
needs
to
be
just
vetted
for
a
moment,
and
that
is
how
many
children
are.
We
sending
out
of
state
with
the
exact
same
I,
know
we're
not
receiving
children,
but
we
are
sending
children
out
of
state.
How
many
kids
do
we
have
out
of
state
right
now
when
we
have
empty
beds.
U
Prior
to
2011,
when
we
expanded,
medicaid
managed
care,
we
had
over
200
children
in
out
of
state
facilities.
We
brought
on
Managed
Care
organizations
and
one
of
their
charges
was
to
decrease
that
number.
We
got
it
down
to
zero
at
one
point,
and
then
we
have
one
Managed
Care
Organization,
which
is
Aetna
Sky
to
serve
our
foster
child
population.
That
has
helped
reduce
and
I
think.
At
the
last
time
it
was
under
30,
but
getting
close
to
30
individuals.
So.
X
Okay
and
then
my
final
question
is
back
to
Dental
how
many
providers
do
we
have
in
the
dental
program
in
our
rural
areas,
I.
X
Be
more
happy
to
send
that
I'd
love
to
know
that,
thank
you,
Mr
chairman.
D
You
Mr
chairman
two
questions
when
these
regulations
were
before
us
last
time,
they
were
also
emergency
regulations
with
them
and
with
that
the
basis
was
a
press
release
from
the
governor's
office
from
September
I
believe
the
emergency
regulation
was
filed,
December
29th
or
emergency
regulations
here
before
us
today.
What's
the
basis
where
it
was
it
an
emergency.
U
We
know,
for
example,
that
Dental
Services
oral
health
services
are
have
a
direct
impact
on
an
individual's
overall
health
care.
We
know
that
poor
oral
health
leads
to
heart
disease
diabetes.
Those
are
diseases
that
are
very
rampant
in
Kentucky
also
leads
to
pre-term
deliveries.
These
services
are
very
vital
to
it
for
individuals
to
improve
their
health
care,
also
and
very
vital
to
get
them
back
in
the
workforce.
The
email
that
I
read
that
was
a
very
specific
example
of
individuals
who
have
got
to
get
their
smiles
back.
U
They
have
got
to
get
their
confidence
back
in
order
to
go
and
and
and
have
an
interview
and
be
productive
in
the
workforce,
and
so
we
believe
that
these
are
very
vital
services
to
improving
the
health
status
of
this
state
in
2014
or
2011.
We
ranked
no
it's
2014
Kentucky,
ranked
47th
in
the
nation
in
overall
health
care
2014
we
ranked
47.
2022.
We
now
rank
43rd,
so
we
have
increase
increased
our
overall
health
care
status,
but
we
remain
49th
in
oral
health
care.
We
have
got
to
get
something
done
here.
V
And
I
would
also
like
to
kind
of
add
to
that
Senate
Bill
65
had
a
provision.
It
came
in
late
that
allowed
us
to
pay
for
services
that
had
already
been
initiated
and
which
was
a
wonderful
thing,
and
that
was
great.
I.
Think
that
just
accentuated
the
emergency
that
there
were
services
that
were
being
utilized
and
to
to
stop
any
Gap
that
might
have
happened
between
those
that
have
been
initiated
and.
D
The
second
time
it's
mentioned
that
you
know
doing
the
same
thing
over
and
over
and
expecting
different
results.
As
you
pointed
out,
we
are
49th
and
when
this
originally
came
up,
you
know
I
spoke
to
the
providers
in
my
district.
In
the
course
I
do
see
that
you
have
made
some
changes
to
the
regs
fee
schedule
increases,
making
sure
that
they
are
accepting
willing
to
accept
and
and
perform.
These
Services
is
a
big
one.
D
The
contact
lenses,
that's
another
big
one.
I,
don't
I
can
only
speak
for
myself.
I
mean
I'm,
not
necessarily
opposed
for
doing
this.
I
I
think
there's
a
lot
of
great
things
and
there's
a
lot
of
people
in
my
district
that
could
benefit
from
this,
but
the
process
matters
but
I
am
curious,
though
you
mentioned
earlier
that
through
the
Medicaid
technical
advisory
committees
that
these
suggestions
were
made
to
you
all
correct.
Yes,
could
you
provide
us
with
the
meeting
minutes
for
those
meetings?
Yes,.
D
A
You
going
to
jump
into
a
couple
questions
real,
quick
and
then
representative,
Fraser
Gordon
I'll,
come
to
you
my
question.
My
next
line
of
questioning
will
be
other
areas,
other
Medicaid
areas
that
you
serve
okay,
and
so,
if
you
could
comment
what
is
the
process
for
rebasing
the
Medicaid
rates
for
nursing
facilities?
U
U
A
U
I'll
start
and
Jonathan
may
have
to,
but
I
believe
that
we
have
we.
There
is
a
an
ambulance
tax.
The
ambulance
providers
are
actually
paying
the
state
match
on
those
those
increases,
but
we
have
increased
the
ambulance
provider
reimbursement
and
we
are
currently
based
on
the
Emergency
Medical
Services
Task
Force.
We
are
currently
looking
at
and
preparing
state
plan,
Amendment
or
waiver
to
treat
triage
and
transport
individuals.
You
know
currently
our
ambulance
transportation.
We
only
pay
if
they
go
to
a
hospital
or
to
a
facility.
A
This
comes
up
every
year
and
and
if
you
notice
the
floor,
discussion
senate
floor
discussion
on
Senate
Bill,
65.,
Senator
Carroll
specifically
spoke
on.
We
need
to
pull
down
more
waiver
funds,
so
there's
a
there's.
A
pretty
hefty
Federal
match
there.
So
just
just
a
little
bit
more
investment,
we
could
pull
down
quite
a
few
more
waiver
slots.
Is
that
something
that
you
all
have
looked
at?
We.
U
Continue
to
love
monies.
Yes,
we
continue
to
look
at
our
1915
sea
waivers.
As
you
know,
these
waivers
serve
some
of
their
most
vulnerable
populations.
Those
are
individuals
who
need
assistance
in
living
in
the
community
and
who
would
otherwise
be
in
a
long-term
care
facility.
We
are
doing
rate
studies
again
for
the
waiver
population
and
looking
at
at
a
variety
of
things,
to
help
assist
those
individuals
in
the
waivers
and
not
only
the
waiver
members,
but
the
providers
as
well.
A
So
we've
talked
a
lot
about
priorities
today
and
clearly,
Dental
Care
is
very
important.
We
Kentucky
does
not
want
to
be
49th,
that's
for
sure
and
that
that
should
be
a
significant
priority,
but
there
are
other,
as
we've
listed
here
and
outlined,
there
are
other.
You
know
things
we
could
look
at
when
it
pertains
to
Medicaid
the
Emergency
Services
nursing
home
rates,
these
Michelle
P
waivers
Therapy
Services.
U
I
think
it
has
to
be
a
joint
effort.
We
are
all
here
for
the
same
reason.
We
are
here
to
improve
the
health
status
of
those
we
serve.
Unfortunately,
1.7
million
people
in
Kentucky
currently
live
at
or
below
the
federal
poverty
level,
nothing
to
boast
about,
because
that
means
that
1.7
million
people
live
at
or
below
the
federal
poverty
level
and
the
average
life
the
average
cost
of
living
in
Kentucky
is
about
forty
three
thousand
dollars
a
year.
U
A
family
of
four
can
only
make
forty
one
thousand
dollars
a
year
before
taxes
to
qualify
for
Medicaid,
so
I
believe
this
definitely
has
to
be
a
joint
effort
for
us
to
discuss
some
of
our
priorities
and
I
would
definitely
welcome
any
Senator
any
representative
to
the
Medicaid
advisory
Council
to
meetings
to
see
how
those
go
to
talk
to
listen
to
the
process
and
I
think
that
that
would
be
one
area
that
we
could
use
to
get
everybody
at
the
table
and
listen
and
get
information
and
find
out
what
we
need
to
do
to
move
the
health
care
needle
in
this
state.
A
We
met
in
the
hallway
out
here
and-
and
you
asked
me,
you
know:
what
can
we
do
to
work
together?
What
can
we
do
to
get
these
regs
further
down
the
line
and
and
I
stated
specifically
that
the
first
thing
you
need
to
do
is
to
speak
with
Senator
Meredith
as
chair
of
the
Health
and
Welfare
committee.
Did
you
all
during
session
or
any
time
pass
that?
Did
you
go
into
his
office?
Did
you
reach
out
to
Senator
mayor
or
any
other
legislator
on
these
regulations?
I.
V
Check
yeah
I
mean
I
think
we
need
to
confirm
that,
but
it's
my
understanding
is
that
Senator
Meredith
was
contacted
about
this,
but
I
will
confirm
that
I'm
not
gonna
I'm
gonna,
say
that
for
sure,
but
I
am
I
feel
fairly
confident
that
he
was
and
what
did
he
say-
I'm
not
privy
to
what
what
the
but
the
details
of
the
conversation
were.
I
apologize
for
that.
A
So
what
wouldn't
a
good
person
if
you're,
trying
to
to
have
a
team
effort
and
work
together
on
an
issue,
would
I
would
think
that
the
chair
of
the
Senate,
Health
and
Welfare
committee
would
be
a
very
important
person
to
talk
to
about
this
and
good
or
bad.
You
should
probably
know
what
they
have
to
say:
I'm
gonna
I'm
gonna
hand
it
over
to
Senator
Thayer.
For
now,.
W
W
Now,
I
don't
profess
to
know
a
lot
about
it.
It's
not
in
my
wheelhouse
I
think
we
probably
you're
jumping
the
gun
here
when
the
current
programs
we
have
are
underfunded,
but
I'm
also
sitting
up
here
in
the
top
row
and
looking
at
the
back
of
the
head
of
someone
who
used
to
chair
the
Health
and
Welfare
committee,
Senator
Rocky
Adams,
who
has
probably
sponsored
more
bills
in
the
Health
and
Welfare
and
Medicaid
space
during
her
time
here
than
any
other
member
of
the
house
or
the
Senate.
W
W
A
X
Thanks
and
I
I
need
to
just
speak
up
talking
about
collegiality
and
working
together.
I
respect
you
I
respect,
you
have
a
very
difficult
job,
I
respect
secretary
friedlander,
but
in
the
spirit
of
collegiality
and
working
together,
I
sent
the
secretary
a
letter
weeks
ago
asking
about
the
cut
to
the
bhso
rates
weeks
ago.
X
P
Y
Y
I'm
relatively
new
to
the
game,
both
in
terms
of
this
committee
and
to
being
a
legislator,
and
it's
clear
to
me
that
there's
a
lot
going
on
that
is
subtext,
isn't
quite
being
said,
but
some
some
discomfort
between
both
the
general
assembly
and
the
cabinet
in
this
case.
But
that
said,
having
sat
through
the
previous
meeting
in
which
the
regulations
were
found,
deficient,
I've,
seen
substantial
change
and
you
know
words
that
don't
ring
Hollow
to
me
in
today's
statement
are
that
what
is
being
proposed
today
is
not
a
policy
change.
Y
But
if
we
want
to
take
a
30,
000
foot
View
nearly
90
percent,
as
Senator
Yates
said,
86
percent
of
the
cost
is
going
to
be
absorbed
by
the
federal
government
with
only
14
percent
by
us.
So
we
get
36
million
dollars
at
an
expense
of
only
5.8
million
and
let's
listen
to
what
we've
gotten
so
far.
We've
gotten
60
000
Medicaid
members
who
have
received
glasses,
who
would
not
have
otherwise
received
glasses.
Y
932
dentists
have
received
reimbursements
for
crowns
on
more
than
5
600
individual
members
who
would
not
have
otherwise
been
reimbursed
or
received
crowns.
We
have
nearly
1200
members
who
have
received
Dentures,
who
would
not
otherwise
receive
dentures,
and
providers
have
received
over
11
million
dollars.
They
would
have
not
otherwise
yet
received
and
in
a
state
where,
let's
just
take
Dentistry
alone,
we
rank
49th
something's
got
to
change,
we
may
be
having
an
element
of
Groundhog
Day
and
I'm
a
few
years
younger
than
Senator
Thayer,
but
I.
Remember
the
movie
as
a
kid.
Y
Thank
you
thank
you
Senator,
but
but
I
do
remember
and
I
thought
it
was
a
horror
movie
at
the
time,
but
but
we're
living
it
over,
because
neither
side's
willing
to
give-
and
it's
clear
to
me
that
at
some
point,
these
meetings
that
the
Senators
have
spoken
up
need
to
take
place
and
other
changes
need
to
take
place.
Y
But
at
this
point
I
think
that
we
need
to
allow
these
regulations
to
pass
through.
If,
for
no
other
reason,
then
the
dental
regulations
Dental
changes
not
only
someone's
oral
health,
but
their
economic
health
and
Economic
Opportunity,
the
first
thing
you
see
when
you
shake
someone's
hand,
is
their
smile
and
it
can
make
the
difference
to
whether
or
not
someone
gets
a
job.
If
you
talk
to
any
cardiologist
or
any
neurosurgeon
they'll
tell
you
that
the
leading
causes
of
heart
disease
and
vascular
disease
in
the
brain
are
directly
correlated
to
dental
health.
Y
If
these
people
had
preventative,
dentistry
and
corrective
Dentistry,
I
can't
give
you
the
exact
numbers,
perhaps
the
people
on
the
panel
could,
but
we
would
save
those
addictions,
save
those
lives
and
the
countless
lives
that
each
of
those
people
impacts
so
I'm
not
going
to
defend
the
actions
that
took
place
before
I
was
on
this
committee.
I
can't
defend
meetings
that
didn't
take
place
that
probably
should
have,
but
I
can
defend
the
regulations
that
I
see
in
front
of
me
and
I
have
no
reservations
in
finding
them
not
deficient.
Thank
you.
Mr
chairman
thank.
T
Fine,
thank
you
chairman,
yeah,
I'm
agreed
I
just
wanted
to
speak
in
regards
to
the
hearing
regulations.
Of
course,
that's
no
surprise.
I
did
want
to
thank
you
for
the
work
that
you've
done,
because
the
fee
schedule
was
vastly
improved
and
I
think
it
will
help
with
coverage.
I
know
there
has
been
a
lack
of
audiologists
in
general,
but
especially
those
that
that
accept
Medicaid
for
payment,
so
I
just
wanted
to
appreciate
that
and
I
had
submitted
some
questions
and
you
very
graciously
provided
those
answers.
T
So
thank
you
for
that
as
well,
but
I
did
want
to
bring
out
two
points,
one
in
regards
to
the
medical
referral
that
is
necessary
when
submitting
for
approval,
because,
as
you
stated,
the
DMS
amended
to
remove
the
mandatory
physician
and
I
just
you
know
wanted
to
reiterate
we're
a
doctoring
profession
and
we
are
the
ones
that
are
specifically
counseled
and
trained
and
educated
and
testing
evaluating
and
recognizing
diseases
of
the
ear,
and
so
with
audiologists
and
hearing
aid
dispensers.
T
That's
two
groups
of
people,
so
I
would
really
advocate
for
the
removal
of
that,
because
that
is
one
thing
that
slows
down
the
process.
If
we're
trying
to
look
at
at
providing
this
service,
the
other
thing
is
because
of
that
we
have
to
send
a
copy
of
manufacturer's
invoice,
we're
not
a
label,
we
can't
submit
claims
electronically,
so
we
have
to
do
those
by
hand,
and
so
those
are
just
two
things
that
I
would
like
to
see
moving
forward
if
they
could
be
considered.
Please.
Z
Thank
you,
Mr
chair,
I,
sit
here
and
listen
to
all
this
and
I
just
want
to
go
back
and
possibly
look
at
some
dates
because
you
said
you
want
to
work
together.
We
look
at
December
29
2022,
when
these
regulations
were
found
deficient
and
we
can
wobble
on
identical
they're,
definitely
not
identical,
but
for
a
substantial
difference.
Z
Z
We
want
to
bring
Health
Care
to
all
kentuckians
but
of
your
own
numbers,
and
we
talk
about
the
Michelle
P
waivers.
We
talk
about
the
scls
as
of
October
22
numbers
from
your
group.
We've
got
10
000
individuals
about
8
000,
with
Michelle
P
waivers.
We
got
3
000
with
the
scl
Core
Medical
Services
that
are
not
being
serviced
and
you
put
them
on
the
back
burner.
Z
Z
You've
been
requested
to
contact
Health
and
Family
Services
work
with
them.
I
think
we
did,
we
could
I
have
to
get
back
with
you.
That's
everything.
We've
said
here
and
heard
every
day,
I'm,
not
for
sure
chairman
I'm,
going
to
have
to
get
back
with
you
I
think,
there's
a
blatant
move
against
the
legislative
intent.
Our
intent
has
been
loud
and
clear
for
several
months
now
and
yet
blatantly
ignored
it
and
try
to
work
around
it
and
that's
inexcusable.
A
Thank
you
quick
question
on
the
the
waiver
slots.
What
is
the
federal
match
on
those
waiver
slots,
Michelle,
P
and
others.
U
A
U
Typically,
services
in
the
Medicaid
Program,
the
match
rate
varies,
for
example,
if
we
are
serving
the
general
Medicaid
population
is
about
70
75
percent
chip,
children,
children
are
enrolled
in
our
children's
health
insurance
program.
Federal
government
pays
80
percent
for
those,
and
anybody
in
the
Medicaid
expansion
program
is
90
percent.
Federally
reimbursed
reimbursement
rates
are
very
complex,
but,
yes,
the
the
nursing
facilities
are
typically
around
70
percent.
I.
Believe.
A
Was
75
or
80.
I'm
sorry
I
missed
that
you're
pulling
that
we're
pulling
down
a
significant
Federal
match,
but
it's
safe
to
say.
There
are
clearly
other
areas
that
if
we
were
gonna,
we
could
take
this
money,
put
it
into
other
areas
and
also
pull
down
a
federal
match
like,
for
instance,
if
we
want
to
invest
this
money,
this
five
or
six
million
that
we're
spending
on
this
expansion.
If
we
wanted
to
apply
it
to
Michelle
P,
we
could
pull
down
a
75
or
70
75
percent
match.
A
We
could
pull
down
a
nursing
home
match.
We
could
pull
down
other
matches
if
we
wanted
to.
Is
that
safe
to
say
well.
U
The
services
we
believe
that
we're
being
very
strategic,
the
services
that
we're
providing
today,
we
know,
for
example,
that
we
spend
nine
million
dollars
per
year
in
ER
services,
for
children
or
for
adults
with
dental
pain.
We
hope
to
offset
that
cost
and
have
Services
delivered
in
the
right
area
at
the
right
time.
So
we
believe
that
we're
making
a
return
on
our
investment
by
investing
this
money
in
areas
where
we
can
see
a
reduction
in
Services
cost
of
Health
Care
Services
in
the
future.
A
I
think
that's
where
the
the
breakdown
is,
that
you
feel
you're
being
strategic
and
I
get
that
and
you
should
be,
but
members
of
the
general
assembly
I
think
they
feel
they
are,
would
be
strategic
as
well
pushing
it
towards
more
core
Services
emergency
service,
getting
people
to
the
hospital
nursing
home
care,
Michelle
P
slots,
things
of
that
nature,
really
core
services,
so
aren't
that
isn't
that
being
strategic?
Also.
U
W
Thank
you,
Mr
chairman.
First
of
all,
representative
grossberg,
you
are
way
years
younger
than
me,
but
I
am
impressed
with
the
fact
that
you
remember
the
movie.
Groundhog
Day
and
I
find
it
interesting
that
you
would
equate
it
to
a
horror
show,
because
that
opens
up
a
lot
of
statements
for
me
to
make
in
this
meeting
here
today,
but
I'll
refrain.
W
You
know
we
have
1.7
million
people
in
this
Commonwealth
on
Medicaid
and
one
of
the
worst
Workforce
participation
rates
in
the
country.
It's
embarrassing
frankly,
you
know
Medicaid
should
be
for
those
who
truly
need
help
with
their
health
care
and
a
transitional
phase
for
those
who
are
trying
to
get
back
into
the
workforce.
W
But
we
can't
afford
the
Medicaid
program
that
we
currently
have
expanding.
Services
right
now
is
flat
out
irresponsible
when
we
can't
afford
to
pay
for
the
programs
we
currently
have.
But
I
I
know
it's
an
election
year,
but
I
think
it's
irresponsible
to
play
politics
with
People's,
Health,
Care
and
so
Mr.
Chairman
I
would
like
to
make
a
motion
that
these
three
regulations
discussed
here
today
be
found
deficient
by
this
committee.
A
Y
P
I
think
being
in
a
poor
State
come
with
Kentucky.
We
have
to
make
a
lot
of
tough
decisions
a
lot
of
times
that
we
make
decisions
based
on
moral
reasons.
Some
are
economic
reasons,
but
I
think
one
of
the
primary
tenets
of
our
government
would
be
Public,
Safety
and
Public
Health.
We
know
that
we're
embarrassed
to
where
we
rank
from
a
public
health
standpoint,
and
that
should
be
a
very,
very
top
priority.
Our
moral
compass
is
our
budget,
it's
our
it's!
P
But
if
we're
up
here
upset
about
the
process,
I
get
it
I,
get
it
I
as
a
legislature,
you
know
I
want
to
make
sure
that
that
I
protect
my
Lane,
but
not
to
the
extent
that
I'm
going
to
hurt
my
constituents.
Z
I'd
just
like
to
end
on
this:
we,
you
know
the
general
assembly
expanded
services
for
community
health
workers,
for
example,
and
in
doing
that
we
used
real-time
kentucky-based
data.
They
showed
the
return
on
investments
and
the
quality
improvement
metrics.
We
did
that
a
lot
of
this
up
here
is
you
think
you
may
you've
you
you're
being
strategic,
but
do
you
have
any
Kentucky
specific
data
that
shows
these
regulations
will
increase
Workforce
Development
since
we
brought
Workforce
Development
up.
U
There
are
several
studies
that
show
that
services
will
increase
Workforce
participation
and
we
can.
We
have
some
in
our
this
discoveries.
So
we
can
get
you
surveys.
We
can
get
you
information
that
shows
that
individuals
with
a
confident
smile
are
more
employable.
There
have
been
several
studies
that
link
participation
in
particularly
Medicaid
dental
services
to
increased
Workforce.
Q
Z
X
Yeah
I
guess
I'd
just
like
to
end
on
this.
You
know
we
we
hear
that
this
is
something
that
we
have
to
do
so
we're
expanding
we're
expanding
this
program
when,
at
the
same
time
we
are
watching
in
real
time
the
b-h-o-s-o
rates
being
cut.
We
are
watching
the
fact
that
we
are
not
getting
money
from
kids
coming
in
from
out
of
state,
which
raises
those
dollars.
We
are
sending
kids
out
of
state
to
receive
care
which
costs
a
whole
lot
more
than
keeping
them
here
in
beds
that
we
have
open.
X
We
haven't
taken
care
of
our
nursing
facilities,
so
every
here's.
What
we're
doing
today
is
we
are
pitting
all
of
these
various
groups
against
each
other,
and
that's
not
the
right
thing
to
do.
What
we
should
be
doing
is
having
a
holistic
conversation
about.
How
do
we
appropriately
raise
rates
to
take
care
of
our
most
vulnerable
population
so
that
we
don't
just
have
one
winner
that
we
can
have
a
lot
of
different
winners,
and
so
with
that,
that's
all
I
have
to
say.
D
Thank
you
Mr
chairman,
so
I
went
back
and
and
looked
on
the
basis
of
emergency.
There
are
eight
different
reports
that
were
submitted
again.
The
prior
emergency
basis
for
emergency
was
from
a
press.
Release
from
the
governor's
office
in
September
of
2022.
well
has
been
submitted.
Now
is
three
reports
from
2018
setting
it's
an
emergency
and
then
three
reports
between
2011
and
2015
when
Steve
this
year
was
in
office.
I
would
arc
on
an
emergency.
That
being
said,
I
mean
I,
believe
in
procedure.
D
I
believe
the
the
funds
being
appropriated
are
not
being
appropriated
by
us.
I
I
take
issues
with
that.
I
agree
with
a
lot
of
what
you're
doing,
I
do
and
I
think
it's
a
matter
of
us
working
together,
and
so
the
past
two
months
I've
been
working
with
chair,
a
r
chairman
Petrie.
He
is,
and
he
is
immensely
interested
in
this
going
forward
and
that's
next
budget
year
I've
talked
to
chair,
Moser
I
know
she
has
extreme
interest.
In
this,
I've
talked
to
my
co-chair.
I've
talked
to
Senate
leadership,
I've
talked
to
house
leadership.
D
A
Any
other
members
seeping
seeking
to
add
discussion
points
I'll
just
make
one
final
comment
before
we
vote.
In
my
opinion,
this
is
my
opinion
as
a
member.
Now,
this
deficiency
vote
has
nothing
to
do
with
the
regulation
itself.
As
far
as
expanded
Dental,
Services
I.
Think
every
single
person
up
here
on
this
committee
would
be
in
support
of
expanded
dental
services.
I,
don't
think,
there's
any
question
about
that.
A
I,
don't
think
we
would
be
here
if
there
was
some
level
of
effort
from
the
cabinet
to
meet
us
halfway,
to
discuss
it
to
to
show
up
in
our
office
and
and
and
and
work
through
this
thing
together,
but
in
our
in
my
case
personally,
there's
been
none
of
that
and
since
we're
talking
about
emergencies
today
we
have
a
mental
health
emergency.
A
A
W
P
I
am
hoping,
though,
that
I'll
take
my
colleagues
at
the
word
that
we
will
be
working
on
a
holistic
conversation
to
be
able
to
raise
the
rates
to
address
all
this
and
I
will
trade
cell
phone
so
numbers
when
we
leave
and
hope
we'll
get
everybody
to
the
ground
and
work
on
this
stuff,
because
if
we
don't
there's
been
a
lot
of
there's
going
to
be
a
whole
lot
of
people
hurting
my
votes.
No.
Z
Z
Z
Y
Permission
to
explain
my
vote
please
proceed.
We
are
being
told
that
this
vote
has
nothing
to
do
with
the
regulations,
but
rather
has
to
do
with
process.
I
can't
Overlook
the
consequences
of
finding
these
regulations
to
fish,
and
because
it's
going
to
impact
millions
of
people,
so
I
am
a
hard.
Y
No,
but
like
Senator
Yates
I
can
see
the
writing
on
the
wall
and
I
truly
hope
that
both
sides
are
sincere,
that
we
can
work
together,
that
the
meetings
that
should
have
taken
place
do
take
place,
that
there's
a
more
open
dialogue
and
that
politics
can
be
put
aside
for
the
betterment
of
literally
millions
of
kentuckians
and
I
vote.
No.
Thank
you.
D
A
A
The
some
of
the
confusion
is
some
folks
say
they
signed
up
to
speak,
but
we
did
not
receive
that
up
here.
So
we're
not
going
to
allow
that
this
time
we're
too
far
down
the
road
with
this
vote
and
with
this
process
so
I
apologize,
but
we
had
no
notice
that
that
you
were
signed
up
to
speak.
That's
my
understanding.
A
A
A
The
legislature
also
voiced
their
opinion
with
Senate
Bill
65,
the
house
and
the
senate
senate
Bill
65
went
through
committees
in
the
house
in
the
Senate,
so
the
legislature
has
made
it
very
clear
where
we
stand
on
this
issue
very
clear,
and
we
have
again
today
if
this
carries
I'm
going
to
make
this
statement
as
the
chair.
If
the
cabinet
chooses
to
move
forward
with
this
and
implement
this
regulation,
they
have
the
power
to
pull
back
to
pause.
B
We
have
FPA
votes,
the
motion
carries.
B
Our
next
meeting
is
the
13th
of
June
at
1
pm.