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From YouTube: Medicaid Oversight and Advisory Committee (7-7-22)
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A
A
G
G
As
I
said,
I
practice
here
in
grant
county.
I
might
give
my
apologies
for
not
being
able
to
be
there
today.
It's
always
an
honor
to
be
able
to
come
and
be
with
you
in
frankfurt,
but
today
my
patient
schedule
would
not
allow
me
to
be
there
in
person,
and
so
here
I
am
from
the
office.
But
again,
thank
you
for
having
me
I
graduated
from
the
university
of
louisville
school
of
dentistry
after
graduating.
I
moved
back
to
grant
county
here
in
northern
kentucky.
To
practice.
G
G
Many
members
of
the
kentucky
dental
association
do
provide
dental
care
to
medicaid
members.
They
serve
medicaid
members
in
both
rural
and
even
in
urban
areas,
as
you
may
have
heard,
from
local
dentists,
who
serve
the
medicaid
population
or
medicaid
providers
are
facing
tremendous
challenges
as
with
a
lot
of
other
areas
in
in
our
commonwealth.
G
There
are
staffing
shortages,
we
have
rising
labor
and
supply
costs,
and
we
couple
that,
with
in
this
case,
low
medicaid
reimbursement
rates
being
a
medicaid
dental
provider
is
is
a
struggle.
I
was
asked
to
speak
to
the
committee
today
regarding
medicaid
reimbursement
for
dental
services
for
background
kentucky.
Medicaid
dentists
have
not
had
a
fee
increase
in
over
15
years.
G
G
Like
our
counterparts
in
urban
settings,
many
of
the
challenges
are
the
same,
such
as
the
inability
to
balance
insufficient
medicaid
reimbursement
with
commercial
cash
pay.
Patients
further
was
insufficient
reimbursement.
Some
of
the
colleagues
or
my
colleagues
face
challenges
related
to
increased
costs
of
supplies,
office
technology,
rising
workforce
costs,
ppe
infection
control,
those
states,
the
cost
of
real
estate
or
leasing,
and
many
more
things.
G
Please
keep
in
mind
in
many
rural
communities.
Sometimes
the
dentist
is
the
front
line
of
health
care.
Research
has
shown
that
untreated
oral
health
conditions
negatively
affect
a
person's
overall
health
and
that
gum
disease
has
been
linked
to
diabetes,
heart
disease,
strokes,
kidney
disease,
alzheimer's
disease
and
even
mental
illness.
G
G
G
G
In
addition,
research
has
also
shown
that
good
oral
health
improves
medicaid
beneficiaries,
ability
to
obtain
and
keep
employment
employed
adults
lose
more
than
164
million
hours
of
work
each
year
due
to
dental
problems.
Also,
children
are
more
likely
to
receive
regular
dental
services
if
their
parents
have
access
to
dental
services
to
bring
the
situation
full
circle.
I
would
like
to
share
a
story
of
a
colleague
who
practices
in
eastern
kentucky.
G
He
has
a
practice
in
a
community
with
a
high
medicaid
population
due
to
low
reimbursements
and
in
order
to
make
payroll
he
has
had
to
take
out
bank
loans.
Some
might
ask
why
doesn't
he
just
stop
taking
medicaid?
Well,
the
simple
answer
to
this
question:
is
medicaid
providers
choose
to
serve
our
communities?
G
G
We
share
a
commitment
to
serving
kentuckians
the
secretary
and
commissioner.
Both
have
been
working
with
the
kentucky
dental
association
on
ways
to
tackle
reimbursement
issues,
but
also
ways
we
can
come
together
to
help
the
patients,
the
providers
and
the
medicaid
system.
I
wish
there
was
a
simple
solution
to
the
issues
that
we
are
facing.
However,
the
kentucky
dental
association
is
committed
to
working
with
the
secretary.
G
A
Thank
you
for
your
presentation,
dr
rich,
and
we
also
have.
Is
it
appropriate
to
take
this
person
out,
you
might
see
there?
Do
we
have
any
questions
or
any
comments.
A
Before
I
yield
to
my
co-chairman,
I
do
want
to
thank
you
for
your
willingness
to
take
medicaid
patients,
and
I
notice
you
use
the
phrase
medicaid
dentist,
and
so
I
guess
that
connotation
indicates
that
not
all
dentists
take
medicaid
patients.
So
what
what
percentage
of
dentists
in
kentucky
do
take
medicaid
patients,
if
you
know.
G
I
can
honestly,
I
do
not
know,
and
that
number
is
in
flux
right
now,
and
I
personally
at
this
point
within
this
last
year-
I'm
not
taking
medicaid
patients
any
longer,
and
it's
not
that
I
don't
have
that
passion.
You
know
I
still
work
through
donated
dental
services.
G
I
see
some
of
my
older
medicaid
patients
for
free.
It's
not
that
I
don't
want
to
give
back
to
the
community,
but
my
schedule
and
just
trying
to
make
my
office
work
is
so
full
at
this
point
in
time
it
it's
not
feasible
for
me
to
do
so,
and
and
that
again
is
the
greater
issue.
It's
not
that
I
don't
believe
in
the
cause.
I'm
chairman
of
the
northern
kentucky
health
board.
G
I
still
work
heavily
in
their
programs
as
far
as
the
the
medicaid
work
that
they're
able
to
do,
but
at
this
point
in
time
for
my
office,
it's
not
a
feasible,
feasible
thing.
As
far
as
the
answer
to
your
question,
what
percentage?
G
I
believe
that
that's
a
very
good
question
that
I
said
I
don't
have
an
answer
to.
We
have
a
lot
of
people
that
still
say
they
are
participating.
Dental
providers
in
the
medicaid
program,
but
we
don't
have
a
good
answer.
Nor
are
we
able
to
ascertain
that
number
and
how
many
of
them
are
actually
actively
seeing
new
patients.
G
A
G
I
again
apologize
for
not
knowing
that
exact
number
is.
That
is
a
number
that
I
should
be
able
to
acquire
and
get
back
to
you,
and
I
will
do
so,
but
we
are
starting
to
see
is
again.
This
is
starting
to
take
foot
that
many
many
states
around
us
are
starting
to
increase
these
fees
as
they
see
that
the
the
the
need
is
there,
but
I
do
not
know
exactly.
I
knew
what
I
knew.
I
do
know
that
it
is.
A
And
I
know
our
oral
health
in
kentucky
is
typically,
you
know
in
the
studies.
I
read
we're
at
the
bottom
of
the
of
the
country
in
oral
health
as
well,
so
that
is
alarming
I'll
yield
to
my
co-chairman,
senator
meredith.
H
Thank
you,
chairman
elliott,
and
thank
you,
dr
rich,
for
your
presentation
this
morning
and
also
I'd
like
to
thank
the
dental
association
for
your
engagement,
this
last
legislative
session,
and
this
was
my
sixth
one.
I
think.
Probably
we
had
more
dialogue
regarding
this
matter
and
with
you
folks
than
we
have
since
I've
been
here,
and
I
appreciate
that
because
folks
need
to
be
aware
of
the
issue,
but
what
percentage
of
your
practice
is
medicaid?
H
G
At
its
highest
would
have
been
a
few
years
back
and
I
would
probably
say
at
that
point
it
would
have
been
five
or
ten
percent
at
the
most
would
have
been
medicaid
population.
H
This
isn't
really
specific
to
medicaid,
but
it
is
kind
of
since
you're,
president
of
the
dental
association.
Can
you
kind
of
give
us
a
like
a
state
of
the
nation
overview
of
the
the
dental
industry
in
terms
of
manpower?
Do
we
have
a
shortage?
Do
we
anticipate
a
shortage?
Are
there
plans
in
place
to
address
that
if
we
do
have
shortages.
G
I
I
that's
an
excellent
question
and,
having
kind
of
looked
at
the
next
presentation
you
have,
I
know,
there's
some
information
in
that
as
far
as
more
specific
numbers,
but
I
will
say
I
don't
know
at
this
point.
You
know
their
new
dental
schools
opening
the
one
shortage
we
do
have
right
now.
It's
dental
hygienist.
G
We
have
seen
even
in
our
own
state
that
some
of
the
hygiene
schools
have
closed
due
to
covid.
There
was
a
15,
I
believe,
reduction
in
that
particular
workforce,
coming
back
to
work
either
full-time
or
part-time
hygienist,
of
course,
are
very
important
to
our
practices
as
far
as
especially
the
initial
oral
health
cleaning
teeth.
Looking
for
that
initial
disease,
the
exams
that
the
doctors
are
able
to
come
in
and
do
on
top
of
that,
so
I
do
know,
there's
a
shortage
there.
G
G
I
don't
know
that
the
issue
is
that
we're
not
having
enough
dentists
just
like
in
other
situations-
and
I
know
this
is
not
a
new
issue.
Getting
them
into
the
areas
that
need
to
be
served
is
more
of
an
issue
than
it
is
necessarily
that
the
number
that
are
out
there.
I
think
that
the
number
out
there
potentially
available
to
see
the
population
that
needs
to
be
served.
It's
not
that
they're
not
in
the
right
communities
or
places
in
which
to
to
serve
those
individuals.
G
You
know,
I,
I
think,
that's
a
great
question
and
I
don't
have
an
answer
to
that.
Personally,
I
mean
again
I'm
still
kind
of
in
a
rural
county
where
I
live
and
and
work
and
couldn't
be
happier
here.
I
think
a
lot
of
it
has
to
do
with
student
loan
debt.
G
The
the
question
of
moving
to
an
area
of
unknown,
where
there
are
more,
like,
I
said,
unknowns
in
in
issue
to
moving
to
a
city
where
they
may
be
able
to
get
into
a
group
with
a
guaranteed
salary
or
guaranteed
reimbursement
or
student
loan
forgiveness
from
the
company
they
may
be
working
for
versus,
going
out
and
to
an
area,
that's
more
rural
and
maybe
not
having
some
of
those
safety
nets,
and
even
though
I
know
there
are
some
programs
out
there
for
that.
H
I
would
certainly,
I
would
certainly
agree-
and
your
points
are
well
taken
about
the
importance
of
dental
health
in
kentucky
and
senator
alvarado,
and
I've
had
several
discussions
about
this,
and
we
understand
its
impact
upon
the
overall
health
of
our
population
and
its
specific
impact
upon
our
medicaid
population.
H
We
know
that
not
doing
something
costs
us
more
than
actually
doing
something,
so
we
hope
to
continue
to
focus
on
that,
but
appreciate
your
presentation
this
morning
and
again,
I
want
to
thank
the
dental
association
for
being
engaged
this
last
legislative
session,
look
forward
to
continuing
to
work
with
you.
Thank
you.
I
Mr
chairman,
and
thank
you
for
the
information,
I'm
not
sure
if
mr
chairman
of
mr
coleman's
gonna
be
presenting,
or
if
he's
he's
on
he's
gonna
be
presenting,
then
I'll
reserve
my
questions
at
that
time.
I
think
we're
gonna
have
a
bit
more
information
on
that
on
some
of
the
questions
that
have
been
asked,
but
thank
you
very
much.
A
J
Thank
you,
mr
chairman,
thank
you
chairman
elliott
and
chairman
meredith
and
distinguished
committee.
My
name
is
ronnie
coleman.
I
am
vice
president
of
government.
Relations
for
benevis
benavis
is
a
dental
support
organization
that
does
non-clinical
support
for
dental
offices
currently
in
13
states
and
dc,
meaning.
Basically,
we
do
everything
that
dentists
and
hygienists
and
da's
don't
go
to
school,
learn
how
to
do
I'm
responsible
for
government
relations
in
seven
states
plus
dc
currently,
and
I've
been
working
for
them
for
almost
14
years
now,
just
so,
you
have
a
sense
of
it.
J
My
responsibilities
have
included
states
as
far
away
as
washington
state
in
the
past
louisiana
mississippi.
Currently
I
have
connecticut
massachusetts
maryland
virginia
d.c,
georgia,
indiana
and
kentucky,
and
so
I've
a
good
sense
of
kind
of.
What's
going
on
out
there,
I
interact
very
regularly
with
state
dental
association,
some
dental
schools,
obviously
advocacy
communities
and
legislators
and
sort
of
medicaid
personnel
all
over
the
place.
I'm
going
to
audible
a
little
bit
just
to
address
a
couple
questions
that
were
answered
asked
a
little
bit
earlier
then
move
into
my
talk.
J
But,
as
dr
rich
mentioned,
it's
kind
of
loosey-goosey,
because
some
of
those
dentists
might
see
one
two
patients
a
couple
families.
Many
of
them
are
dropping
out
of
the
program
and
diving
back
in,
but
generally
it's
a
fairly
low
percentage.
J
And
for
that
reason
I
think
that
that's
one
of
the
reasons
that
medicaid
dental
rates
have
been
sort
of
left
behind
over
the
years.
It's
not
necessarily
because
the
legislature
in
an
action
it's
a
lot,
because
we
haven't
done
a
good
enough
job
of
educating
you
and
letting
you
know
that
there's
need
out
there
and
sometimes
it's
because
if
70
percent
of
the
membership
population
doesn't
see
medicaid,
it's
really
not
a
priority.
J
They
have
bigger
fish
to
fry
and
not
that
they
don't
care
about
medicaid,
it's
just
that
they
have
limited
legislative
chips
and
they
choose
to
pursue,
pursue
those.
But
lately
we've
seen
a
lot
more
activism
in
the
states
and
I'll
I'll
get
to
that
in
a
little
bit.
As
far
as
the
workforce
is
concerned,
I
concur
with
dr
rich.
J
J
J
J
So
I'll
move
on-
let's
see
here
so
we
represent
and
support
ruby
dental
here
in
kentucky
ruby
dental
is
a
kid-first
family-friendly,
dental
practice
that
does
general
dentistry
orthodontia
expanded
services
like
oral
surgery
and
procedures.
Like
that
and
prior
to
the
pandemic,
we
were
responsible
for
around
six
plus
percent
of
the
medicaid
dental
population,
but
as
it
shows
on
the
slide,
we
accounted
for
way
less
than
that
in
terms
of
the
cost
to
the
state.
J
A
lot
of
it
has
to
do
with
focus
on
prevention,
focusing
on
carries
risk,
meaning
the
risk
of
dental
disease
and
treating
at
the
american
aapd
the
american
association
of
pediatric
dentistry
guidelines,
american
dental
association
guidelines,
and
so
that
mix
has
helped
us
keep
costs
low
for
the
states
that
we
serve.
J
J
You
see
that
we
have
two
offices
in
louisville,
one
in
lexington
and
one
elizabethtown
and
of
course,
there's
there's
evansville
now
I
guess
you'd
consider
them
cities
or
towns.
I
don't
know
I
can
never
figure
that
out.
Clearly
louisville
and
lexington
are
cities,
but
let's
use
lexington
as
an
example.
The
office
there
is
on
winchester
road,
it's
right
off
the
highway
and
a
pretty
significant
percentage
of
our
patients
drive
an
hour
or
more
to
go
to
the
dentist
there.
It's
the
same
with
our
office
and
on
bardstown
road
in
louisville.
J
A
lot
of
patients
drive
to
go
there.
Obviously
elizabethtown
draws
a
lot
of
rural
patients
evansville
your
patients
are
are
going
over
there
from
obviously
more
rural
areas
and,
interestingly
enough,
our
most
urban
office
in
in
louisiana,
I
should
say
in
kentucky-
is
on
broadway
in
downtown
louisville
and
we
actually
have
people
from
indiana
drive
across
the
border
to
go
to
that
office
when
we
have
an
open
patient
schedule.
J
So
I
feel,
like
the
urban
city
question,
is
kind
of
again
a
loosey-goosey
nebulous
thing
because
we're
serving
both
even
in
our
city
offices.
Now
you
ask
the
question
about
why
it's
hard
to
locate
or
find
dentists
to
locate
in
you
know
rural
areas,
we've.
J
I
live
up
in
cincinnati
and
I
tried
very
hard
to
get
our
you
know:
business
development,
people
and
the
recruiting
team
from
the
clinical
side
to
do
it.
But
the
problem
is
a
lot
of
times.
As
dr
rich
said,
you
know
the
young
dentists
who
graduate
you
know
they.
They
have
loans
that
they
have
to
repay,
so
they
need
a
stable
income.
J
Now
they're
happy
to
you
know,
to
sort
of
to
commute
to
some
degree,
but
that
we
understand
is
a
major
limiting
factor
for
our
ability
to
recruit
dentists,
to
some
rural
areas.
Not
all,
but
some
also,
the
challenge
is,
is
stable,
support
staff.
So
you
might
find
a
dentist
that
will
locate
in
some.
You
know
more
significant
rural
location,
but
can
you
assure
that
you're
going
to
be
able
to
back
them
up
with
hygienist
or
dental
assistants,
and
if
you
lose
a
hygienist?
J
J
J
But
what
I
will
say
is,
in
the
best
of
times
it's
hard
to
recruit
and
retain
dentist
and
hygienist
in
the
safety
net
environment,
because
the
patient
population
is
challenging
the
locations
that
we
locate
in
are
typically
not
very
glamorous,
mainly
because
we're
locating
where
the
patients
are
and
because
reimbursement's
a
challenge,
and
so
it's
something
that
we've
been
toiling
with
for
years
and
then
on
top
of
that
you
have
significant
cost
inflation.
J
Our
costs,
I've
been
told,
have
gone
up
like
40
percent
in
the
past
five
years.
A
number
I
hear
thrown
around
at
the
ada
level
is
that
over
the
10
10
to
15
years,
dental
practice
costs
have
gone
up
in
excess
of
60
percent
and
again,
as
dr
rich
mentioned
generally
on
a
fixed
income
for
medicaid-oriented
dentists,.
J
So,
to
show
you
a
little
bit
of
how
our
kentucky
operations
have
been
decimated,
you
can
take
a
look
at
the
slide
for
those
that
can't
see
the
slide.
As
I
mentioned,
we
have
four
offices
here
in
kentucky
pre-pandemic
we
were
employing
16
dentists,
84
employees
and
seeing
about
50
000
medicaid
patients.
I
can't
remember
that's
patience
or
patient
visits,
but
over
the
past
year
we're
down
to
four
dentists
to
serve
four
offices.
One
of
them
is
part-time
one's
an
orthodontist.
J
I
am
happy
to
say
we
have
two
more
that
will
be
starting
in
august,
I'm
not
sure
their
level
of
experience
in
which
offices,
but
that's
a
significant
drop
and
it's
not
like
we
haven't,
been
trying
to
find
them
employees
down
to
45
and
we're
down
to
serving
around
30
000
patients.
So
these
challenges
are
affecting
access
for
your
constituents.
J
Let's
start
talking
a
little
bit
about
rates,
so
I'm
not
sure
if
you've
seen
it,
but
I've
shared
with
you,
some
spreadsheets.
I
think
two
spreadsheets
the
first
one
is
a
comparison
between
commercial
payers
and
a
couple
medicaid
dental
rates.
Here
in
kentucky,
we
took
an
average
of
four
fairly
popular
large,
well-known
insurance,
dental
rates.
We
took
that
average
and
we
compared
to
your
state,
fee-for-service
schedule
and
and
that's
a
schedule
that
has
not
changed
in
15
to
20
years.
Dr
rich
said
15
I've
heard
from
various
sources
that
it's
been
more
like
20..
J
So
to
get
to
the
money
numbers
here,
we've
found
that
the
kentucky
fee
schedule
is
around
50
percent
lower
than
an
average
reimbursement
for
for
commercial
here
in
kentucky
and
then
and
that
for
us,
that's
ten
percent
of
our
patient
population.
Ten
percent
of
our
patient
population
go
to
united
healthcare,
but
the
other
ninety
percent,
for
which
we
get
reimbursed
it's
over
65
less
than
what
dr
rich
might
get
reimbursed
from
commercial
insurance.
J
J
Dentists
have
been
trying
to
encourage
commercial
debt
insurance
companies
to
increase
their
reimbursement,
and
so,
even
though
you
have
that
giant
gap,
it's
not
really
where
dr
rich
and
other
dentists
want
it
to
be
because
they
bill
at
usual
and
customary.
J
You
go
to
your
doctor
or
dentist,
and
you
come
home,
you
get
a
bill,
say
200
and
your
insurance
company
may
pay.
I
don't
know
140
150
dollars,
you're
on
the
hook,
for
the
rest,
so
that's
where
they
want
to
be
reimbursed
and
obviously
commercial
is
lower
than
that.
So,
let's,
let's
make
sure
we're
on
the
same
page.
So
you
have
usual
and
customary
where
the
doctors
and
dentists
and
all
want
to
get
reimbursed
to
meet
their
costs
and
their
expected
profitability.
J
Then
you
have
commercial
which
is
below
that
it
could
be
20
below
usual
customer.
It
could
be
40
depending
on
the
insurance
company
depending
on
the
state.
Then
you
drop
down
to
the
20
ish
year
old,
kentucky
fee
schedule,
and
then
you
drop
down
to
where
90
percent
of
our
patients
are
getting
reimbursed
for
which
is
where
again,
five
of
your
six
mcos
are
reimbursing
us.
Now
that
is
an
unsustainable
challenge
for
dentists,
especially
with
the
the
cost
increases
that
we've
talked
about
and
the
challenges
with
workforce.
J
Let's
move
on
to
states
so
yeah
commercials
higher
than
medicaid.
Well,
what
about
other
states
so,
like?
I
said,
I'm
responsible
for
a
number
of
states,
so
I've
picked
two
states
that
are
mine
that
I
know
a
lot
about.
I
could
have
picked
connecticut.
Their
rates
are
around
the
same
as
mass
health
could
have
picked,
maryland,
they're,
typically
a
little
bit
above
average.
They
were
above
virginia
and
we
had
some
success
there.
But
I
chose
these
two
states.
J
Virginia
is
a
state
that
had
neglected
dental
rates
for
a
long
time
going
back
to
2005.,
but
of
late.
We've
been
successful
at
getting
the
legislature
and
the
administrations
to
address
some
issues
with
dental
we
were
able
to
encourage
them
to
institute
or
pass
adult
medicaid
dental,
which
you
already
have
here
that
passed
in
2020
and
was
implemented
last
year,
and
then
I
am
super
happy
to
say,
especially
since
virginia
we're
the
largest
medicaid
dental
provider
in
the
state,
the
practices
that
we
support.
J
We
were
able
to
gain
bipartisan
support
and
support
of
governor
yonkin
to
increase
across
the
board
medicaid
dental
rates
by
30
percent
that
just
passed
several
weeks
ago.
It
implemented
last
week
30
on
orthodontia
30
on
general
dentistry
30
on
surgical
rates
outstanding,
so
I
picked
them
because
they
had
been
neglecting
rates.
Then
you
look
at
mass
health,
which
has
always
been
a
little
bit
above
average
governor
baker's,
been
friendly
to
the
dental
industry
as
well
as
the
physicians
there.
When
the
pandemic
hit,
I
reached
out
to
mass
health
because
we
were
struggling.
J
Our
offices
were
closed.
We
had
to
furlough
people,
we
you
know
cash
flow
was
down
and
I
reached
out
to
them
to
see
what
they
could
do
to
help,
and
I
did
that
to
all
with
all
my
states.
Well,
they
stepped
up
in
2020
and
arrange
to
advance
our
practice's
money
based
on
their
pr
2019
billing,
which
obviously
they've
had
to
pay
back,
but
also
the
fairly
new
dental
director
for
mass
health
said
she'd,
look
to
see
if
they
can
do
something
about
rates.
It
had
been
several
years
since
they'd
increased
rates.
J
Well,
she
recognized
there
was
a
mechanism
within
mass
health
that
allows
them
to
do
rate
reviews
and
seek
improvements.
So
I
remember
her
starting
that
process
in
january
of
2021
and
then
you
know
I
was
very
impatient.
Are
we
there
yet?
Are
we
there
yet?
Are
we
getting
anything
and
finally
she's,
like
I'm
working
on
it
well
out
of
the
blue?
In
early
october
of
last
year,
she
put
through
a
rate
increase
that
averaged
about
7.3
percent
across
the
board,
getting
you
to
where
they
are
now.
J
G
J
All
right,
so
there's
been
activity
going
on
out
there
of
late.
Before
I
start
on
these,
I
want
to
give
some
credit
here
in
kentucky
to
a
couple
players.
First
of
all,
I
know
that
your
medicaid
program
cares
about
dentists.
I've
heard
it
from
the
kda
they're
constantly
in
communication
with
the
commissioner
with
others
within
medicaid.
J
I
also
know
that
their
hands
are
tied
because
you're
in
these
mco
contracts
and
again
I
don't
have
anything
against
mcos
they've
done
a
great
job
of
bending
the
cost
curve
down
and
all
that,
but
also
last
year,
the
kentucky
dental
association
and
I
had
kind
of
a
contentious,
medicaid
dental
advisory
panel
call
where
the
kda
wanted
to
see
about
eight
or
ten
codes
increased
by
like
50
or
100,
because
I
think
mainly
oral
surgeons
and
other
dentists
were
losing
money
on
these
codes,
and
during
that
call,
I
even
said
why
can't
we
look
at
raising
your
all
of
the
mco
reimbursement
to
the
fee
for
service
level.
J
Like
I
said,
it
became
a
little
bit
contentious,
but
to
the
credit
of
avisas,
who
is
one
of
the
dental
benefit
administrators?
That
I
think,
supports
four
of
your
mcos.
Their
account
executive
said
hold
on
hold
on.
Let
let
us
let
us
take
a
look
at
your
your
ideas,
we'll
go
to
our
mco
clients
and
see
what
they
can
do
for
you.
So
literally
six
months
later,
they
came
forward
and
they
did
increase
about
eight
or
ten
codes
to
the
fee
for
service
level.
So
that
was
nice.
J
Basically,
they
want
to
be
at
80
percent
of
usual
and
customary,
meaning
they're,
basically
going
to
try
to
reimburse
medicaid
dentists
at
commercial
rates,
and
I
should
tell
you
they
do
that
in
michigan.
Right
now,
too,
for
their
kids
program,
their
network
of
medicaid
dentists
are
reimbursed
the
same
as
commercial
network.
J
So
on
to
the
slide,
georgia
is
a
state
that
I'm
responsible
for
that's
where
my
company's
headquartered.
We
have
a
pretty
significant
presence
there.
What's
interesting
about
them,
is
they're
very
similar
to
kentucky
in
that
the
managed
care
organizations,
control
dental
and
then
they,
you
know
sort
of.
Have
the
dental
benefit
administrators
manage
it,
but
what's
different
is
they
can
increase
reimbursement
for
certain
codes,
certain
procedures
and
that
increase
flows
through
the
providers?
J
So
what
the
georgia
legislature
and
the
georgia
dental
association
have
been
great
at
over
the
past
five
years
is
every
year
they
increase
rates
a
little
bit
even
in
2020.
In
the
midst
of
the
pandemic,
they
increased
rates
on
maybe
a
dozen
codes,
one
percent
you
can
see
on
the
slide.
We
had
15
codes,
increased
three
percent
and
then
this
year,
17
codes,
7
and
then
2
10.,
so
they're
making
incremental
improvements
all
along,
and
we
really
appreciate
that
I've
mentioned
virginia.
J
We
don't
have
offices
in
illinois
and
west
virginia,
but
we
serve
patients
from
those
states.
So
I
included
them
on
the
slide.
I
will
mention
maryland
because
we're
by
the
supportive
practices
that
we
work
with
in
maryland
are
the
largest
medicaid
practices
there.
By
far-
and
I
was
significantly
involved
in
getting
that
20
million
dollar
appropriation,
because
this
year
and
the
end
of
last
year,
the
dental
community,
the
dental
association
and
the
advocacy
community
were
focused
on
expanding
coverage
to
adults.
And
of
course
we
wanted
that
too.
J
Obviously
I
supported
that,
but
my
lobbyists
and
I
spent
time
educating
the
administration,
the
new
cabinet
secretary,
who
had
been
unaware
that
dental
rates
had
been
neglected
for
10
years
or
actually
for
them-
maybe
nine
years
and
ultimately
agreed
to
put
20
million
dollars
in
the
budget
to
help
with
rates
translating
to
about
a
nine
and
a
half
percent
increase
for
about
40
of
the
most
important
codes
that
dentist
used
there
and
then
I'm
not
going
to
hit
all
the
states.
J
You
get
grossed
up
around
18
to
20
in
a
check
that
you
receive
every
quarter,
it's
outstanding,
it's
something
that
I've
ex
mentioned
to
the
kda.
I've
talked
to
the
commissioner
about
it's
a
complicated
system.
It
requires
a
lot
of
there's
a
lot
of
moving
parts,
but
I
just
wanted
to
point
that
out
as
well.
So
let
me
try
to
shut
this
down.
J
I've
provided
a
few
recommendations
here,
they're,
probably
not
all
that
you
could
consider,
but
because
you're
in
a
managed
care
arrangement
it
limits
your
ability
to
get
things
done.
The
first
option
is
what
senator
alvarado
tried
to
do
this
past
session.
He
was
on
the
right
track
to
require
directed
payments
of
the
mcos
to
get
dentists
to
a
certain
level.
The
goal
is
to
get
them
to
the
fee
for
service
level,
but,
as
you
can
see,
that
level
is
too
low.
J
But
that
is
a
mechanism
you
can
use,
which,
unfortunately,
it's
a
administrative
burden
on
medicaid,
but
that
is
a
mechanism
you
can
use
to
get
rates
up
and
you
could
actually
maybe
say:
let's
try
to
require
directed
payments,
to
get
providers
up
to
commercial
or
up
to
80
of
commercial
or
20
above
fee
for
service.
It's
up
to
you,
but
I
do
know
that
the
fiscal
impact
statement
for
this
approach,
this
session
was
7.5
million
dollars
and
that
would
have
increased
again.
J
The
rates
from
that
managed
care
average
up
to
the
fee
for
service
level.
Next,
you
could
pass
legislation
that,
for
future
contracts
with
mcos
would
require
that
the
fee
for
service
rate
be
your
minimum
rate.
Also,
I
feel
like
you-
would
also
want
to
make
it
such
that
mco.
So
whenever
you
increase
rates,
that
rate
should
flow
through
to
the
dentist
like
in
georgia.
So
if
you
wanted
to,
you
could
pass
legislation
appropriate
money
to
increase
reimbursement,
10
percent
on
20
codes.
You
want
that
to
be
able
to
flow
through
to
the
providers.
J
You
could
also
talk
to
medicaid
or
appropriate
money
to
do
a
wholesale
fix
of
the
fee
for
service
schedule.
Make
it
a
modern
level
again.
It
wouldn't
necessarily
apply
to
us
because
of
the
way
the
mco
situation
works.
You
can't
tell
them
what
to
do
unless
you
require
directed
payments,
but
that's
another
thing
you
can
consider,
and
lastly,
I
would
encourage
you
to
ask
medicaid
to
provide
maybe
every
year
an
update
on
how
your
physician,
dentist
and
all
reimbursement
compares
to
other
states
compares
to
commercial.
What
does
access
look
like
in
rural
and
urban
areas?
J
What
network
adequacy
looks
like
get
them
to
report
that
to
you?
So
you
can
know
what
you
might
want
to
do
going
into
say
your
budget
year,
and
so
I'm
going
to
leave
it
at
that.
Just
say
that
we
could
really
use
your
help.
We
really
appreciate
you
giving
us
the
opportunity
to
present
this
information
to
you
and
remember
that
dental
is
generally
4
cents
of
the
health
care
dollar
with
medicaid
and
with
commercial,
so
we're
asking
for
some
help
to
improve
a
20
year
old
challenge
on
4
cents
of
your
health
care
dollar.
I
A
I
I
I
The
negotiations
were
done
in
1998
in
agreement
for
2002
and
that
dennis
are
being
paid
70
of
the
floor
of
2002
rates
right
now,
that's
what
I've
been
informed,
and
so
this
would
have
brought
it
up
to
the
floor
levels
what
it
would
have
done
to
at
least
get
those
payments
there
so,
like
I
said
we're
hopeful
for
there's
clearly
a
need.
I
know
that
obviously
ruby
dental
is
in
my
district.
That
provides
a
lot
of
service
to
a
lot
of
folks
there.
J
I'm
gonna
say
low
risk
for
lexington.
Honestly
evansville
was
a
challenge
for
us
and
fortunately,
we've
been
able
to
land
a
really
good
dentist
there
and
I
feel
very
good
about
evansville.
J
A
K
J
That's
my
understanding.
Yes,
they're
negotiated
rates.
As
I
said,
our
rates
might
be
a
little
bit
higher
than
some
others
only
because
we
have
more
of
a
national
presence,
but
yes,
they're
negotiated
now
united
healthcare
from
what
I
understand
they
reimburse
at
essentially
the
fee
for
service
level,
which
again
is
above
where
most
of
the
rest
are
reimbursing.
K
Most
providers,
not
necessarily
in
dental,
would
not
accept
anything
less
than
the
medicaid
rate,
and
I
also
know
that
there
are
some
private
insurances
that
try
to
pay
less
than
the
medicaid
rate
and
some
medical
services.
The
other
question
I
had
mr
chairman,
if
I
might
yes
in
in
mass
health,
you've
listed
the
epsdt
rates,
I'm
assuming
that
epsdt
rates
in
kentucky
are
higher
for
dental,
for.
J
So
what
I
meant
by
that
is
those
are
the
child
rates.
Yes,
and
then
you
have
an
adult
program
like,
for
instance,
in
connecticut.
Their
child
rates
are
very
high,
but
their
adult
rates
are
like
50
of
those.
That's
why
we
work
to
get
a
25
increase
there.
That's
what
I
was
referring
to
and
the
other
point
I'll
make
about
mass
health
was.
J
K
And
I
don't
think,
there's
any
question:
we've
got
to
do
better
for
this
commonwealth
and
what
we've
done
for
well
over
a
decade
now,
so
I
would
support
that
and
dr
alvarado.
I
hope
we
continue
those
efforts.
Thank
you.
H
H
Did
did
they
factor
in
any
at
all
and
that's
going
to
sound
rhetorical
as
well,
because
I
know
the
answer,
but
did
they
factor
in
at
all
the
impact
of
having
additional
dental
services
available?
Because
again,
we
know
that
if
you
don't
have
those,
usually
they
go
to
the
er
is
that
was
that
factored
in
offset
any
in
that
seven
and
a
half.
I
M
H
I
H
J
M
M
The
waiver
services
should
complement
other
medicaid
state
program
services,
public
programs,
family
and
community
supports
in
order
to
meet
the
individual's
specific
needs.
The
waiver
services
should
allow
the
individual
to
live
safely
in
a
community
setting
if
their
needs
exceed
what
it
can
be
safely
provided
in
the
community.
He
or
she
may
not
be
appropriate
for
waiver
services.
M
M
The
abi
acute
is
for
individuals
who
have
had
a
recent
brain
injury
and
is
focused
more
on
rehabilitation,
whereas
the
abi
long-term
care
waiver
are
for
those
who
are
going
to
require
long-term
supports.
Due
to
the
brain
injury,
we
have
the
home
and
community-based
waiver,
and
that
is
for
individuals
who
are
65
years
and
older
or
individuals
who
have
a
physical
disability.
M
M
Currently
we
are
working
collaboratively
with
cms
on
questions
they
have
about
our
abi
acute
waiver
and
then
our
seo
waiver
is
I'm
currently
in
our
public
comment
period
and
it
was
released
on
june,
the
24th
we
do
have
two
upcoming
renewals.
This
is
going
to
be
our
abi
long-term
care
and
our
michelle
p
waiver.
We
will
be
working
on
those
in
the
fall
and
winter
of
this
year.
M
M
As
you
can
see,
our
rate
study
began
in
february,
where
we
had
an
initial
meeting
with
our
work
group
in
march,
we
planned
and
implemented
stakeholder
engagement
activities.
We
reviewed
the
draft
of
the
provider
cost
and
wage
survey
and
finalize
that,
then,
in
april,
through
june,
we
sent
out
the
survey
to
be
completed
by
our
providers.
M
The
plan
is
to
obtain
dms
and
legislative
approval
on
the
rates
to
finalize
all
documentation
and
to
complete
the
public
comment
process
and
then
early
next
year
we
will
submit
waiver
amendments
to
cms
and
they
do
have
90
days
in
order
to
review
those
just
to
talk
a
little
bit
about
the
hcbs
rate
study,
the
provider
cost
and
wage
survey
was
available
for
four
weeks
from
april
the
7th
through
may,
the
6th.
We
did
have
a
total
of
188
surveys
submitted,
which
is
a
64
response
rate.
M
We
provided
support
to
our
providers
such
as
office
hours,
where
they
could
call
in.
They
could
ask
us
questions.
We
provided
written
guidelines
frequently
asked
questions,
and
we
also
even
had
a
dedicated
email
address
for
them
to
submit
any
questions
that
they
had
while
completing
the
rate
study
survey.
M
M
M
What
we'll
do
is
we
will
make
that
through
appendix
k,
while
the
rate
study
is
being
completed
once
the
rate
studies
completed
and
we
get
everything
finalized
and
approved,
we
will
submit
those
long
term
changes
through
waiver
regulation
and
application
modifications
once
that
rate
studies
completed
and
then
the
remaining
initiatives
in
the
original
spending
plan
are
not
going
to
advance
at
this
time.
D
D
Our
current
kentucky
1115
authority
is
our
umbrella
authority
that
allows
us
to
be
creative
and
flexible
in
kentucky
and
to
waive
some
of
those
medicaid
requirements
when
needed.
The
current
kentucky,
11
15
demonstration
authority
is
set
to
expire
on
september.
The
30th
of
2023
cms
requires
us
to
send
an
extension
request,
one
year
prior
to
the
end
of
the
demonstration,
so
that
makes
our
extension
due
september,
the
30th
of
2022,
which
is
right
around
the
corner.
D
I
do
want
to
mention
here.
If
I
may,
under
the
kentucky
1115
authority,
we
are
required
to
meet
cms
milestones,
and
one
of
those
milestones
that
are
under
the
umbrella
is
the
sud
component.
The
sud
component
has
to
meet
utilization
management
processes
to
ensure
that
residential
treatment
is
at
the
appropriate
level
of
care.
D
So
with
that
said,
and
with
our
upcoming
demonstration
request
for
an
extension
in
may,
we
we
sent
out
a
notification
letter
to
distribute
communicating
that
dms
would
reinstate
pas
only
for
sud,
residential
and
inpatient
treatment,
and
we
sent
that
out
in
may
and
it'll
be
effective
or
it
was
effective
july.
1.,
so
I
just
wanted
to
mention
that,
while
we
were
talking
about
the
milestones
we
do
have
a
pending
sud
1115
incarceration
amendment,
which
is
very
exciting.
D
We
submitted
that
in
november
of
2020.
it
is
still
with
cms.
We
managed
to
keep
it
every
month
on
our
agenda
with
them
to
ensure
that
it
would
be
addressed,
and
so
in
january
of
2021.
They
finally
were
ready
to
talk
to
us
about
that,
and
we
were
very
excited
again.
We
are
discussing
our
current
budget
neutrality
configuration
and
we
do
feel
like
this
is
a
positive
step
towards
approval
for
this
amendment
so
again,
very
exciting
about
that
work.
D
Next
step
on
this
particular
amendment
is
to
continue
our
work
with
cms
regarding
state
options
and
best
approaches.
We
are
currently
working
with
our
contractor
to
assist
with
developing
a
budget
neutrality
workbook
we
meet
with
them
next
week
and
then
we
will
be
able
to
submit
the
budget
neutrality
workbook
sometime
in
july,
so
that's
moving
along,
and
I
can
give
you
more
information
about
that
later.
D
We
began
research
and
initial
inquiries
with
cms
to
get
started
on
this
initiative
in
2021
we
hired
a
lead
staff
person
and
they
were
employed
in
september
we
completed
technical
assistance
collaborative
with
state
health,
state
health
values,
strategy
and
man
it,
and
we
held
meetings
with
multiple
smi,
sed
stakeholders
across
the
state
to
gauge
in
needs
and
click
feedback
and
folks
that
are
providing
those
services.
D
We
wanted
to
hear
from
them
and
find
out
what
was
working
and
what
was
not
working,
ongoing
waiver
research
to
compare
other
states
and
waivers,
including
the
authority
which
would
be
the
type
of
waiver
that
they
are
providing
it
under
and
the
implementation
strategies.
So
how
they
plan
to
implement
in
each
state
is
a
little
bit
different.
We
also
established
a
health
and
housing
supported,
housing
collaborative
with
khc
and
k
and
chfs,
and
the
reason
why
I
include
chfs
is
because
we
have
multiple
partners
in
that
collaboration
from
the
cabinet.
It's
not
just
dms.
D
Our
smi
sed
waiver
in
2022
began
our
expanded
collaboratives
we've
been
providing
participation
in
supported
employment
consultations
and
learning
collaboratives
and
voc
rehab,
and
finding
out
more
information
related
to
individual
placement
and
supports,
which
is
the
ips
program.
We
continue
our
discussion
with
our
stake,
stakeholders
and
advocacy
groups
and
learning
more
about
the
medical
respite
providers
and
what
other
states
are
doing
as
a
possible
service.
D
Also
in
2022
we
had
senate
joint
resolution
72
that
was
passed
in
our
next
steps.
We
want
to
create
a
service
enhancement
model
and
what
I
mean
by
that
is
to
develop
what
I
would
call
a
matrix
or
a
grid
of
what
we
currently
have
in
the
state
plan
and
if
it
needs
to
be
modified
or
expanded
to
meet
the
needs.
What
needs
to
go
into
a
waiver
that
cms
would
allow
us
to
put
into
an
1115
and
what
can
be
added
to
a
state
plan.
D
D
K
K
How
does
that
relate
to
what
will
happen
with
the
the
rate
study
and
the
results
of
that,
and
also
what
is
currently
the
the
the
rates
for
appendix
k
when
all
that
shakes
out
when
appendix
k
goes
away
and
the
the
study
is
done?
What
what's
that
going
to
look
like
how?
How
do
those
three
sets
of
rules
relate
to
each
other.
M
The
so
the
rate
study
will
continue
and
it
will
be
completed.
The
appendix
k,
through
the
federal
public
health
emergency,
allows
us
to
go
ahead
and
get
those
rates
in
providers
hands
quicker,
but
then
once
so
we're
going
ahead.
Renewing
our
waivers,
but
then
once
that's
done,
then
we
will
set
the
rates
once
we
get
approval
and
submit
that
through
the
amendments
to
each
of
the
waiver
applications
and
get
approval
from
cms,
because.
K
Gms
we
have
to
have
so
the
rates
will
be
from
from
the
study.
K
In
relation
to
the
10
that
we
have
already
approved,
will
that
be
the
base
that
those
rates
go
by
the
from
the
rate
study?
If
there's
a
percentage
increase
or
how
will
that
work.
M
So
you
all
have
mandated
the
increases,
but
we
will
take
that
into
consideration,
but
looking
at
it
overall
because
it's
possible
that
they
might,
some
of
them
might
need
to
be
increased
more.
We
just
have
to
figure
all
that
out.
Okay,.
K
But
it
wouldn't
be
any
less
than
the
10
percent
that
we
mandated
correct
no
okay
and,
with
with
the
model
k,
the
rates
that
we
approved
are
the
appendix
k.
I'm
sorry,
the
rates
that
we
approved
will
appendix
k
be
on
top
of
that
additional
10
or
50
once
that
goes
through.
M
So
the
appendix
k
is
just
temporary;
it
just
allows
us
to
you
know,
get
the
money
in
the
provider's
hands
quickly
once
the
federal
heart
federal
health
emergency
ends,
then
that.
M
Yes,
after
so
then
that
kind
of
goes
away
at
that
point.
So
then,
we'll
have
to
you
know,
do
the
amendments
and
then
what's
put
into
the
applications,
will
be
the
rates.
K
K
M
So
the
projection
on
the
rates-
initially,
I
mean
they're,
looking
at
60
or
more
over
the
current
rates,
so
you've
got
your
base,
but
we're
looking
at
even
higher
rates
on
that
through
the
rate
study.
B
Thank
you,
mr
chairman,
thank
you
for
your
presentation.
B
I'm
interested
in
hearing
a
little
bit
more
about
the
supportive
housing
for
people
with
smi
in
particular,
and
I
wonder
if
you
could
talk
more
about
the
supportive
housing
collaborative
and
also
specifically,
if
you
could
address,
if
24
7,
supportive
housing
is
going
to
be
part
of
this
waiver
request.
Sure.
D
D
It
will
offer
all
the
surroundings
of
services
without
the
paying
for
the
room
and
board,
while
kentucky
health
corporation
has
agreed
in
our
collaboration
to
work
together
to
assist
with
those
pieces
so
and
we're
looking
at,
maybe
a
third
party
administrator
to
administer
that
program
now
I
know,
there's
concerns
about
the
other
populations
that
are
similar
to
our
1915
c
residential
components.
They
actually
pay
for
supervision,
not
the
room
and
board.
So
we
are
also
looking
at
other
options
through
the
1915
see
related
to
housing
as
well.
D
D
With
that
so
there's
some
concern
related
to
the
individuals
that
might
need
a
three-person
staff
residence
type
of
setting,
as
well
as
those
who
may
just
need
a
little
bit
of
housing,
supports
to
get
established
to
obtain
and
maintain,
and
maybe
check-ins
and
things
like
that.
So
it's
like
supportive
services,
so
it
may
require
us
to
look
at
research
and
requesting
two
types
of
waivers.
C
Thank
you,
I'm
just
trying
to
get
my
arms
around
this
and
you
talk.
We've
talked
about
a
bunch
of
different
programs
and
and
increases.
Can
you
give
me
an
example
of
a
rate
and
a
potential
increase
in?
In
that
rate,
what
we're
looking
at
we're
talking
about
60
increases
in
in
rates
just
like
to
have
some
examples
of
what
we.
What
we're
talking
about.
M
Just
for
an
example
of
just
between
waivers,
we
have
a
disparity
between
like
our
home
and
community-based
waiver,
whereas
one
service
allows
11
in
that
waiver,
but
the
same
service
in
another
waiver
allows
like
24.
So
like
personal
care,
it's
just
the
disparity
amongst
our
waiver
populations.
Even
so
personal
care
would
be
one
of
those.
C
M
Oh
absolutely,
we
will
provide
everything
to
you
all.
We
also
any
of
the
work
group
minutes
and
meetings.
We
are
putting
those
on
our
website
as
well,
but
anything
that
you
need
we'll
absolutely
get
it
to
you.
I
Senator
alvarado,
thank
you,
mr
chairman.
I
know
I
know
that
whole
process
is
causing
a
lot
of
banks
and
obviously
it's
been
a
long
process
in
terms
of
trying
to
get
a
lot
of
that
done.
My
question
is
more
about
the
1915s.
I
got
calls
yesterday
about
current
waitlist.
Can
you
give
us
an
idea
what
the
weightlifts
are
in
our
1915
waivers?
Currently,
I
know
that
michelle
p
waivers
always
got
a
long
wait
list
and
maybe
just
for
the
public
that
are
watching
in
education,
how
people
ascend
up
on
that
wait
list.
I
I
got
someone
saying:
hey,
I'm
number
3000,
so
is
there
any
way
to
move
up,
and
my
understanding
is
no
you
just
your
first
come
first
serve
and
as
people
either
come
off
that
list
or
the
things
happen
or
spots
open
up
or
they're
allocated
by
the
general
assembly.
That's
how
they
move
up.
So
maybe,
if
you
could
just
very
briefly
give
us
an
idea
of
what
the
wait
lists
are
like
on
the
1915s
and
how
people
can.
How
can
they
expect
to
move
up
on
those
lists.
M
So
we
do
have
waitlists
for
the
michelle
p
waiver
and
the
seo
waiver
right
now
with
the
seo
waiver.
We
do
not
have
any
emergency
waiting
list
for
that,
but
we
do
have
future,
and
so
that
means
that
they're
going
to
need
services
sometime
in
the
future.
The
majority
of
those
people
are
already
receiving
services
on
another
waiver,
but
the
michelle
p
waiver.
You
are
correct.
The
list
is
quite
lengthy.
M
I
don't
have
the
exact
numbers,
but
I
know
it's
over
7
000
and
we
are
looking
at
ways
in
the
future
when
we
go
through
and
rewrite
our
regulations
and
the
waiver
applications
and
what
we
can
do.
But
right
now,
it's
dictated
by
the
regulations
that
it
is
kind
of
like
a
first
come
first
serve
and
in
order
to
serve
more
people,
we
would
have
to
have
more
money
from
the
legislator,
along
with
getting
those
spots
approved
through
cms.
M
So
right
now
we
have
10
500
members,
so
if
they
fall
off
and
some
of
them
might
move
to
another
waiver,
some
of
them,
unfortunately,
might
be
deceased
or
sometimes
we've
had
some
individuals
and
had
some
really
good
success.
Stories.
Of
individuals
not
needing
the
waiver
services
anymore,
so
that's
always
exciting,
but
as
those
individuals
do
fall
off
the
waiver,
we
are
constantly
reallocating.
Those
spots
in
order
to
you
know,
provide
care
to
as
many
people
as.
A
M
That
is
an
interpretation,
but
we
are
looking
at
the
possibility
of
those
rates
even
being
higher,
depending
the
outcome
of
the
rate
study.
A
Okay,
representative
wilner
again
you're
recognizing.
B
Thank
you
again
and
I
wanted
to
follow
up
from
senator
alvarado's
question
about
the
the
wait
lists
and
I'm
just
wondering
if
there
are
barriers
aside
from
money,
if
the
general
assembly
were
to
say
here's
all
the
money,
you
need
to
make
those
you
know
weightless
spots,
go
away.
M
One
thing
is,
you
know
again
money
and
funding,
because
you
know,
for
instance,
I
know
senator
higdon
had
asked
the
question
about
the
disparities
and
the
rates
for
hcb.
We
pay
case
managers
100,
whereas
for
abi
it's
over
400,
so
they
need
equitable
reimbursement
in
order
to
get
more
providers
to
come
in
and
then
get
the
slots
so
that
we
can
serve
our
members.
K
M
L
Hello,
I'm
lisa
liam
the
commissioner
for
the
department
for
medicaid
services.
Now
our
budgets
are
created,
of
course,
on
a
biennium
budget
and
we
have
our
funding
based
on
our
current
and
projected
expenditures.
So
no,
there
is
not
enough
money
in
the
budget.
I
think
at
one
time
when
I
testified,
I
said
we
would
need
at
least
35
million
dollars,
and
that
was
just
to
make
the
some
of
the
rates
equitable
across
and
serve
some
of
the
populations
that
we
have.
L
So
no,
we
do
not
currently
have
enough
money
in
the
budget
to
fund
all
of
those
individuals
on
the
waiting
list,
and
I
would
like
to
point
out
too
that
a
lot
of
those
individuals
on
the
waiting
list,
the
last
time
that
we
we
examined
those
individuals
on
the
list
for
michelle
p.
For
example,
a
lot
of
those
individuals,
almost
half
are
children,
and
so
it's
important
to
note
that
the
eligibility
for
the
medicaid
waiver
programs
is
based
on
the
individual
income.
L
So
if
a
child
is
not
in
medicaid
and
they're
on
a
waiting
list,
they're
not
receiving
services,
but
they
make
too
much
money
for
medicaid.
So
at
some
point,
when
we
look
at
the
issues
surrounding
some
of
the
services
that
our
children
need,
I
think
that
we
need
to
look
at
our
commercial
carriers
and
hold
them
a
little
bit
more
accountable
for
some
of
the
services.
As
you
know,
senator
carroll,
a
lot
of
the
individuals
that
come
the
children
that
come
into
these
waiver
programs,
some
of
the
services
that
they
use,
are
mainly
therapy
services.
L
So
I
think
that
it's,
it's
really
important
to
take
a
really
big
picture
of
how
we
are
serving
our
children,
particularly
those
that
qualify
for
waiver
programs.
Because
again,
as
you
know,
in
order
to
qualify
for
a
waiver,
an
individual
has
to
meet
facility
level
of
care.
So
I
think
taking
a
really
good
look,
not
only
at
the
rates,
but
at
on-air
assessments
for
the
individuals,
particularly
children,
to
get
into
the
waiver
programs
is
very
important.
K
L
So
you
know
the
waiver
redesign
was
actually
started
in
the
previous
administration
and
we
do
agree
definitely
that
that
waiver
redesign
needs
to
go
forward,
but
we
did
put
a
halt
on
the
waiver
redesign
based
on
some
concerns
from
some
of
their
stakeholders,
particularly
some
of
our
waiver
providers,
based
on
conversations
that
we
have
had
with
stakeholders.
We
did
start
the
waiver
redesign
back
up.
One
of
the
largest
components
of
the
waiver
redesign
is
going
to
be
that
rate
study
because
cms
has
said
we
can't
just
arbitrarily
determine
rates
for
our
waiver
programs.
L
We
have
to
base
that
methodology
on
some
or
have
to
have
a
sound
methodology
for
which
to
base
their
rates.
So
the
rate
study
is
going
to
drive
the
rest
of
that
waiver
redesign.
So,
as
I
think,
as
the
assistant
director,
ms
clark
testified,
we'll
have
that
done
later.
This
fall
and
then
we'll
know
more
about
specific
timelines
on
when
we
can
implement
those
rates
and
get
the
complete
waiver
redesign
implemented.
Okay,.
L
K
Okay
and
I
apologize
I'm
trying
to
understand
and
pull
all
this
together,
going
back
to
to
the
the
rates.
I
know
we
have
to
get
cms
approval
for
the
mandated
increases
that
the
legislature
passed,
correct,
correct
and
that's
likely
not
going
to
occur
before
the
end
of
this
month
or
mid
mid
july
when
that
goes
into
effect.
Correct.
L
I
really
can't
speculate
on
a
timeline
right
now.
A
lot
of
it
is
dependent
on
on
cms
and
some
of
the
questions
they
have
and
when
we
get
how
we
can
respond,
how
quickly
we
can
respond
to
their
their
questions.
K
So
so,
let's
assume
that
it
that
it
is
approved
and
when,
when
the
the
budget
goes
into
effect,
that
those
those
rates,
the
10
and
then
the
50
on
the
residential
that
that
goes
into
effect
and
so
those
that
becomes
the
new
rates
at
that
point
and
I'm
getting
back
to
the
appendix
k.
Does
the
50
appendix
k
rate
would
that
be
on
top
of
that
new
base?
And
I'm
sorry
to
keep
asking
this,
because
I'm
not
it's
not
connecting
with
me.
L
K
L
Let
me
make
sure
I
understand
your
question,
so
your
question
is
right:
now
we
have
appendix
k
that
gives
that
gives
money
into
the
hands
of
the
providers,
which
is
a
50
increase.
So
your
question
is
once
we
develop
new
rate
methodology
and
then
based
on
the
the
budget
bill,
are
we
going
to
increase,
keep
that
50
percent
and
add
another
10
and
50?
On
top
of
that,.
L
I
think
the
appendix
I
think
the
way
to
look
at
this
is
the
appendix
k
is
separate.
If
we
can,
just
just
the
appendix
k
is
something
that
it's
a
flexibility
that
is
allowed
during
the
public
health
emergency.
That
is
separate
from
the
rate
increases
that
we're
talking
about.
K
M
So
the
appendix
k
we
are
taking
what
is
in
the
bill
that
was
mandated
by
the
legislator
and
we
are
going
ahead
and
putting
that
in
the
appendix
k
so
that
we
can
get
the
money
out
to
the
providers
quicker.
K
M
K
M
K
K
L
K
And
I'm
sorry
this
this
gets
confusing
and
I'm
I'm
looking
at
it
from
the
provider
perspective,
because
it's
appendix
k
implementing
appendix
k
has
been
a
nightmare
because
we
implemented
and
the
rules
changed
a
week
later,
we'd
already
done
contracts
we
had
to
go.
We
had
to
pay
certain
staff
members,
not
pay
other
certain
staff
members,
so
it
was
very
frustrating
dealing
with
that
and
but
it's
been
great,
don't
get
me
wrong
and
our
our
especially
our
contract
people
and
throughout
the
state.
Many
have
benefited
from
that.
So
it's
been
worth
the
effort.
K
M
Yes-
and
we
actually
can
request
an
extension
and
for
like
up
to
another
six
months:
okay,.
G
G
K
I
understand
I'm
just
trying
to
put
it
all
the
components
together,
but
it
has
been
a
huge
benefit
and
for
the
providers
and
and
with
some
of
the
questions
that
were
asked.
This
is
kind
of
a
all
of
these
things
kind
of
work
together
to
to
move
us
forward.
K
We,
I
think
we
messed
up
in
the
budget,
because
the
senate
had
proposed
more
slots
as
either
250
or
350
for
michelle
p
and
scl,
and
my
understanding
is
when
it
got
to
a
conference
committee
that
apparently
there
was
one
of
the
leaders
that
made
the
comment.
There's
no
need
in
passing.
All
these
there
aren't
enough
providers
to
provide
the
services
which
is
completely
inaccurate
and
if
we
do
not
open
up
more
waiver
slots
to
support
the
providers,
we're
going
to
see
more
providers
closing
down.
K
In
my
case
we
are
one
of
the
largest
providers
in
western
kentucky,
we're
getting
to
the
point
that
there
are
there's
there
are
no
people
getting
the
waiver
so
we're
having
to
look
at
private
pay.
Individuals
coming
in-
and
it's
you
know
in
the
past-
we've
done
that,
based
on
that
person's
income,
which
is
very,
very
low,
so
it's
it's
very
difficult
for
providers
to
survive
when,
when
the
numbers
of
people
getting
the
waiver
there
just
aren't
that
many
of
them
to
sustain
these
businesses
so
to
grow
businesses.
K
We've
got
to
have
increased
rates,
we've
got
to
have
more
waiver
slots
opened
up
and
in
return
there
will
be
more
providers
in
the
commonwealth.
But-
and
I
wish
that
during
the
budget
during
conference
committee,
there
had
been
more
discussion
on
that
because
that
the
what
was
stated
than
that
was
just
completely
inaccurate.
In
my
opinion,
and
we
have
got
to
see
the
growth
of
providers,
we
have
got
to
work
on
this
waiting
list.
You've
got
kids
coming
out
of
high
school.
K
It's
kind
of
the
same
thing
and
if
we
don't
have
the
waiver
slots
and
we
don't
have
providers
expanding
and
growing
throughout
the
state,
this
problem
is
going
to
keep
getting
worse
and
worse
and
not
you
all
have
done
an
outstanding
job
over
the
years
on
this
and-
and
we
have
got
to
step
up
as
a
legislature
to
make
this
happen
and
to
support
these
families
in
the
commonwealth.
You
know
think
about
it.
You're,
the
parent
of
a
high
school
kid
coming
out.
K
You
know
the
kid
cannot
stay
alone,
you
don't
have
waiver
services,
you
can't
afford
private
care.
What
are
you
going
to
do?
You're
going
to
quit
your
job
and
you're,
going
to
stay
home
with
your
kid
and
our
workforce
is
going
to
suffer
because
of
that,
and
so
that's
where
we
are
and
there's
again
there's
just
a
lot
of
components
to
this.
It
gets
very
complicated.
I've
been
doing
it
12
years
now,
and
I
still
when
I
think
I
understand
it.
K
I
don't
and
but
but
I
do
know
that
on
the
basis
where
we
are
right
now,
those
are
the
things
that
we
need
to
address
and
I'm
hoping
with
the
next
budget
cycle
that
we
can
step
up
and
and
make
a
big
dent
into
these
waiver
slots
and
get
these
folks
the
services
that
that
they
deserve
it's.
What
medicaid
is
for,
and
we
need
to
take
care
of
these
folks
first.
Thank
you,
mr
chairman.
Thank
you
all
thank.
A
Am
I
interpreting
that
correct
that
we
will
have
to
approve
again
the
legislature
I
see
where
you
have
once
cms
has
a
or
has
approved
or
dms
is
approved.
Then.
A
Okay,
okay
and-
and
I
guess
by
approval-
you
don't
mean
another
legislative
action
during
the
session.
No.
A
A
N
N
Today
I
have
with
me
liz
steerman,
our
behavioral
health
director,
as
well
as
kristin
mauter,
our
director
of
population
health
we've
been
provided,
20
minutes
to
cover
five
topics,
and
I
know
we're
a
little
behind
on
the
agenda,
so
we'll
try
to
move
quickly
and
allow
some
opportunity
for
comments
and
questions,
but
we
are
proud
to
be
here
and
to
represent
our
health
plan.
The
first
topic
we
picked
today
was
a
discussion
related
to
network
adequacy.
N
We've
done
a
lot
of
hard
work
to
ensure
that
we're
offering
broad
access
across
these
services,
but
also,
if
you
look
at
other
services
like
primary
care,
we've
contracted
with
over
6000
pcps,
we've
contracted
with
over
700
obgyns,
and
we've
done
a
lot
of
study,
understanding
our
competitiveness
and
the
broadness
of
our
network.
By
looking
at
the
rfp
submissions,
but
also
looking
at
current
submissions
of
other
mcos,
we
offer
a
broad
access
to
specialty
care
as
well.
N
We
utilize
our
commercial
and
our
medicare
relationships
to
create
unique
provider
relationships.
A
good
example
of
that
is
lexington
clinic
lexington
clinic
offers
humana
only
medicaid
access,
so
we're
the
only
mco
in
the
state.
If
you're
a
medicaid
member
in
lexington,
you
can
go
to
lexington
clinic
over
the
last
couple
years.
They
provide
access
over
three
thousand
members
for
pcps.
N
We
have
quite
a
few
tools.
We
utilize
to
ensure
that
we're
continuing
to
expand
our
networks,
and
the
first
of
that
is,
is
utilizing
geo-access
reports.
So
we
look
at
our
members.
We
plot
them
across
the
state
and
we
ensure
that
we're
meeting
the
contractual
obligations
of
time
and
distance
that
are
required
within
our
contracts
with
dms.
N
That
information
is
critical
so
that
we
can
follow
up
for
providers
to
understand
that
experience
and
address
it
when
it
occurs.
We
also
have
a
lot
of
neat
tools
like
quest
analytics
that
gives
us
provider
targets
to
go
out
and
contract
for
additional
access
for
our
members.
And
finally,
we
review
our
member
experience
for
our
network
providers.
So
when
we're
signing
letters
of
agreement
with
providers
that
are
out
of
network,
we
work
with
our
provider
contracting
team
to
bring
those
providers
into
our
networks.
N
Our
second
topic
here
is
an
important
one
and
we
understand
the
importance
of
rural
health
in
kentucky.
As
we
look
at
our
membership,
52
percent
of
our
members
live
in
rural
counties.
If
we
look
at
our
experience
on
how
we
spend
funds
for
our
members
that
live
in
rural
communities,
what
we
find
is
that
we
spend
a
higher
percentage
of
our
premium
for
members
who
live
in
rural
communities
as
compared
to
urban
communities.
N
If
we
look
at
our
contracts
and
contracts
that
are
non-standard
contracts,
we're
paying
above
the
fee
schedule,
on
average,
we
pay
rural
providers
more
than
we
do
urban
providers
with
those
non-standard
contracts,
but
we
also
recognize
that
dynamic
of
how
members
are
served
in
urban
versus
rural
communities.
If
we
look
at
the
revenue
we
receive
from
the
state,
while
we
pay
more
for
members
who
live
in
rural
communities,
a
higher
percent
of
the
actual
providers
who
are
paid
live
our
work
in
urban
communities.
N
The
reason
that
is
is
is
the
specialization
of
services
and
what
our
critical
hospitals
do
for
members
who
have
high
needs
and
chronic
conditions
that
are
served
through
the
that
centralization
of
services
within
our
urban
communities.
N
If
we
think
about
house
bill
320
and
how
that's,
including
quarterly
enhanced
payments,
we
think
about
what
we've
done
in
the
last
two
years
for
ambulance
providers
for
draw
down
payments
from
the
federal
government
for
direct
payments.
We
also
think
about
the
supplemental
payments
that
we're
receiving
through
our
capitations
or
dms
that
are
flowing
through
to
both
urban
and
rural
communities.
I
think
we've
taken
the
recommendations,
the
hospital
association
we've
taken
it
seriously.
We've
passed
good
legislation,
it's
helped
support
providers
from
a
managed
care
perspective.
N
We
do
quite
a
bit
to
try
to
pay
for
value
and
that's
one
of
our
focuses
at
humana.
When
we
first
implemented
our
contract,
we
provided
supplement
supplemental
payments,
a
lot
of
our
pcps
that
allowed
them
to
coordinate
care
and
conduct
outreach.
If
we
look
at
our
program
today,
we
have
over
4
000
providers
who
live
in
rural
communities
and
over
90
percent
of
our
member,
for
those
providers
have
the
ability
to
receive
quality
payments.
N
So
if
they
meet
the
standards
that
are
being
dictated
to
us
from
the
department
of
medicaid
services,
we
provide
incremental
payments
in
the
future.
We
want
to
continue
to
work
with
those
providers
to
what
we
call
full
base
risk
arrangements,
meaning
they
share
in
the
financial
risk,
but
they
also
share
in
the
value
of
when
they
reduce
cost
that
cost
that
savings
is
returned
back
to
those
providers.
N
Another
topic
we're
asked
to
cover
it's
one,
I'm
probably
the
most
proud
of
it's
it's.
What
is
humana
doing
to
address
health
equity
in
kentucky
today.
First,
I
think
it's
important
that
we
define
health
equity.
The
way
we
define
health
equity
is
the
removal
of
unjust
avoidable
and
unnecessary
barriers
to
both
health
and
health
care.
Over
the
last
two
years,
humana
has
made
the
most
significant
investment
in
the
history
of
managed
care
related
to
health
equity,
and
that
means
both
investments
and
are
urban
in
our
community
are
in
our
rural
communities.
N
If
we
think
back
the
last
two
years
as
well,
we've
made
a
six
million
dollar
commitment
to
building
the
health
and
learning
complex
in
west
louisville.
The
completion
of
that
building
allows
for
a
community
space
where
in
it
where
community
members
can
come
together
and
learn
about
health,
but
also
it
creates
a
safe
place
for
sporting
events,
and
it
creates
a
way
for
kentucky
to
recognize
the
full
community
in
a
feeling
of
belonging
and
we're
excited
about
what
that
partnership
can
do
for
all
of
louisville.
N
But
what
I
mentioned
is
it's
not
just
our
commitment
in
louisville
humana's
commitment
statewide.
If
we
think
about
what
we're
doing
in
pike
county,
we're
partnering
with
commissioner
quarles
and
we're
in
the
no
kids
hungry,
so
that
families
that
have
food
insecurities
can
be
fed.
If
we
think
about
clay
county
in
jefferson,
county
we're
working
with
senator
stivers
and
jennifer
hancock
for
the
voa.
N
What
we're
doing
there
is
we're
helping
expand
access
to
pregnant
women
who
have
substance
abuse
issues,
but
we're
also
providing
significant
for
funding
for
them
to
design
new
payments
for
behavioral
health
and
we're
also
funding
community
health
workers
through
voa,
so
that
we
can
coordinate
our
care
if
we
think
about
lions
lion
county,
we're
partnering,
with
the
county
judge
executive
to
to
close
the
the
gap
for
connectivity
to
the
internet.
N
N
We're
also
providing
three
touchdown
points
in
lyons
county
so
that
within
15
minutes
in
that
county,
any
citizen
can
drive
and
have
free
access
to
the
internet
through
humana
we're
also
developing
a
telehealth
hub
within
the
county,
so
that
we
can
have
access
to
local
specialty
providers
with
partnership
with
both
baptists
and
the
university
of
kentucky.
If
we
go
further
west
and
we
think
about
hopkins
county,
we're
partnering
with
the
ymca
to
build
housing,
so
we
can
recover
from
the
tornadoes
we're
partnering
with
the
local
friskies
to
do
micro.
N
N
The
point
I'm
making
is
is
humana
is
committed
in
the
medicaid
space
to
addressing
health
equity,
we're
committed
to
our
medicaid
plan
and
we're
showing
that
through
significant
inactionable
funding
throughout
our
state,
kristin
mounter
is
going
to
cover
some
of
our
population
health
programming
and
then
liz
is
going
to
cover
behavioral
health.
F
Thank
you
jeb,
so
you
just
heard
about
all
the
community
investments
that
we've
done
to
increase
overall
population.
So
now
we're
going
to
talk
about
how
do
we
identify
individual
member
need
so
the
core
of
what
we
do
as
a
health
plan
is
take
all
the
different
data
sources
and
then
we
take
that
to
create
risk
stratification
models.
F
So
through
that
identification
we
attempt
to
help
the
member
focus
on
making
healthier
decisions
participating
with
their
health
care
providers.
We
promote
preventative
services,
we
address
the
sdh
needs
and
then
we
reward
our
members
for
those
healthy
behaviors
through
our
humana
go
365
program
in
that
program.
F
Not
only
do
we
reward
things
for
our
quality
and
preventative
things
so,
like
prenatal
visits,
postnatal
visits,
well,
child
visits
getting
your
diabetic
screening.
We
also
have
some
sdoh
support
activities
that
go
along
with
that.
Some
of
those
are.
We
have
a
workforce
development
program
that
is
statewide.
F
We
have
housing
specialists
that
provo
pro
that
assist
with
housing
assistance
statewide,
and
then
we
also
offer
things
like
back
to
school
haircuts
for
kids.
If
you
want
to
go
to
the
next
slide
on
this
slide,
we're
going
to
talk
about
you
know
just
a
few
of
the
initiatives
that
we
have.
F
I'd
also
like
to
mention
that
our
initiatives
that
we
provide
at
humana
are
all
statewide
and
what
I'm
going
to
focus
on
today
are
two
of
those
initiatives
that
are
digital
initiatives
that
we
use
in
conjunction
with
some
of
our
other
programs,
like
our
chronic
condition
program,
our
mom's
first
case
management,
so
they
they
utilize
those
tools
to
also
help
the
members,
along
with
those
programs
that
we
have
so
first
we'll
talk
about
pacify,
so
pacify,
is
an
initiative
or
a
digital
program
that
focuses
on
pregnant
or
parenting
members.
F
What
it
does
is,
it
gives
a
library
of
education,
the
member
can
access,
but
it
also
provides
24
7
access
to
lactation,
lactation,
consultants,
physicians
and
nurses
to
be
able
to
answer
any
questions
that
they
may
have,
and
what
we've
seen
so
far
as
far
as
outcomes
related
to
that
program
is,
we've
seen
a
12
increase
in
our
prenatal
visits
and
a
15
increase
in
our
postnatal
visits.
The
second
program
I'm
going
to
talk
about
is
called
vita.
F
It's
another
digital
program
that
we
have
and
that
program
is
directed
towards
members
who
are
diagnosed
as
pre-diabetic
or
members
who
have
type
2
diabetes,
and
that
program
also
has
a
digital
library
of
education
that
they
can
go
through
for
self-education,
but
it
all
we
also
offer
one-on-one
in
group
health.
Coaching
with
that
program
and
some
of
the
outcomes
we've
seen
with
that
program
is
medication.
Adherence
is
up
by
50
percent
and
our
pcp
visits
are
up
by
29
percent.
F
F
We
all
have
also
seen
year
over
year,
increases
in
our
a1c
control
less
than
eight
and
then
from
our
er
diversion
programs
that
we
have
where
we
look
at
non-emergent,
urgent,
non-emergent,
er
visits
and
converting
those
to
lower
appropriate
levels
of
care,
such
as
urgent
treatment.
We've
seen
a
nine
percent
increase
in
that
as
well.
So
that's
some
of
the
outcomes
and
some
of
the
programs
that
we
have
that.
I
want
to
highlight
today
and
then
I'll
turn
it
over
to
liz
to
talk
about
behavioral
health.
E
In
kentucky,
we
have
the
largest
percentage
of
members
with
a
substance
use
disorder,
diagnosis
covered
by
our
plan
versus
the
other
managed
care
organizations
within
the
state,
because
we
know
we
have
this
very
high
number
of
member
vulnerable
members.
We
have
a
lot
of
different
mechanisms,
both
from
the
clinical
perspective,
as
well
as
from
the
operational
standpoint,
to
make
sure
that
we
are
providing
the
appropriate
oversight
and
connecting
our
members
with
the
care.
That's
actually
going
to
get
them
on
that
road
to
recovery.
E
We've.
We
have
a
slide
here
that
shows
some
of
those
for
you
guys
from
our
clinical
supports,
which
include
our
actual
clinicians,
either
in
the
care
management,
space
or
utilization
management
space
working
directly
with
providers
to
ensure
that
our
members,
when
they
are
leaving
an
inpatient
or
residential
facility,
that
they
have
the
proper
discharge
plan.
So
when
they
walk
out
those
doors
to
return
to
their
community,
they
know
exactly
who's
going
to
give
them
services.
E
E
Additionally,
we
have
a
lot
of
key
metrics
that
we
are
monitoring
over
time
through
claims
data
working
collaboratively
with
the
department
on
any
any
suspected
fraud,
waste
or
abuse,
and
also
monitoring
some
of
our
metrics,
like
average
length
of
stay
and
readmission
rates
for
those
specific
levels
of
care.
E
We
also
wanted
to
be
able
to
demonstrate
some
outcomes
that
that
are
that
come
from
this
population
and
all
the
efforts
that
we
have
here,
we've
got
a
slide
a
chart
here
that
shows
kind
of
that.
The
prevalence
of
the
diagnoses
under
that
substance
use
disorder
bucket
for
our
our
population.
E
You
can
see
here
that
we
we
have.
I
don't
think
anyone
will
be
surprised.
The
the
biggest
piece
of
the
pie
here
is
clearly
opioids
and
then
second
right
after
that
is
going
to
be
poly
substance,
abuse
of
which
the
vast
majority
of
the
folks
in
that
bucket
also
have
some
sort
of
opioid
dependence
in
addition
to
another
substance.
E
What
I'd
really
like
to
call
out
on
this
slide?
There
we've
got
a
lot
of
different
measures
here
to
kind
of
show
you
guys
trending
on
things
that
we
watch,
but
one
of
the
things
that's
really
been
most
significant.
We
know
that
during
the
pandemic
that
we
have
seen
in
our
state
that
was
already
really
hit
hard
by
the
opioid
crisis
that
we've
continued
to
see.
We
were
kind
of
crack
out
all
doing
really
well,
we
were
cresting
sort
of
plateauing
on
on
outcomes
for
that
population.
E
E
We
do
continue
to
see
overdose
numbers
increase,
we're
taking
a
harm,
reduc
reduction
approach
to
ensure
that,
even
if
we
have
members
who
are
continuing
to
struggle
with
their
road
to
recovery
that
if
they
have
those
overdose
incidents
that
they
have
that
they
do
not
become
fatal.
E
We
have
a
program
where,
if
a
member
admits
to
an
emergency
room
in
kentucky
with
an
opioid
use,
disorder
related
overdose,
we
get
a
real-time
notification
to
our
case
management
team
that
we
can
actually
engage
with
that
member
if
they
have
their
cell
phone
while
they're
in
the
er,
but
immediately
after
leaving
the
emergency
room.
So
we
can
ensure
that
they
have
access
to
an
mat
provider
and
that
they
know
where
to
go
to
get
services
once
they
leave
that
that
urgent
setting
all
right.
A
H
Thank
you
for
presentation,
and
I
appreciate
you
being
very
concise
with
this
I'm
looking
at
slide.
Five,
you
have
that
ninety
percent
mlrs
among
rural
community
among
rural
community
enrollees,
have
exceeded
ninety
percent.
Is
that
a
long-term
trend,
a
recent
trend,
if
it
is
how
how
much
has
it
exceeded
90
percent.
N
N
If
we
look
across
the
last
three
years,
I
would
last
year
was
probably
our
best
year,
as
we
think
about
financial
performance.
Two
years
ago
was
probably
our
worst
year
and
this
this
year
is
still
developing,
but
we're
committed
to
continue
to
invest
and
partner
with
providers.
But
it's
not
it's
not
a
decision
or
related
to.
Are
we
going
to
invest
with
urban?
Are
we
going
to
invest
with
rule
it's
it's
the
contracted
rates
that
we
have
to
ensure
that
we
have
access
for
our
members
and
that's
what
we're
continuing
to
develop.
H
N
I
think
it's
a
rate
development
related
to
cohorts.
I
think
you
know
we're
following
trend
and
we're
following
the
injury
of
new
mcos.
I
think
there's
a
dynamic
on
how
that
is
settling
within
the
market
and
as
the
market
continues
to
settle
from
that
new
entry
of
a
new
health
plan
you'll
see
an
equalization
of
region
a
versus
region
b.
N
If
you
recall
back,
I
think
it
was
two
or
three
years
ago
we
went
from
eight
regions
to
two
regions
from
a
rate
setting
perspective,
so
you
kind
of
have
your
super
region
around
louisville,
with
cholera
counties,
and
then
you
have
everything
else:
that's
impacted
kind
of
the
flow
of
revenue
between
those
two
regions
and
it's
probably
led
to.
If
you
look
at
the
county
level,
mlr
performance
between
urban
versus
rule,
but
it's
not
a
decision-making
process.
It's
what
I'm
suggesting
senator
meredith.
N
It
is
what
it
is
related
to
our
experience
with
our
providers
and
claims.
Ultimately,
we
work
to
improve
quality,
to
reduce
costs,
but
also
to
meet
our
commitments
to
providers
that
they
can
stay
whole
to
serve.
Our
members.
H
N
So
we
work
through
our
averaging
to
to
get
to
a
a
rate
and
our
members
are
sicker,
so
we're
paying
more
claims
and
but
we're
still
committed
to
growth
in
the
state.
What
I'd
say
from
humana's
perspective,
we
spend
the
most
on
our
quality
programs
over
the
last
three
years,
we've
spent
the
most
on
our
claims
and
what
we
hope
to
do
is
grow
in
in
kentucky
and
to
serve
more
members,
and
it's
through
that
growth
that
ultimately,
the
mlrs
will
come
down.
A
B
B
N
I'd
say
there
was
some
real
valid
points.
As
we
talk
about
dental
access,
we
supported
senator
alvarado
your
bill
last
session.
You
know,
I
think
the
represent
representative
who
spoke
earlier
had
a
lot
of
good
things
to
say,
but
we
do
need
to
ensure
that,
when
we're
paying
to
increase
the
fee
schedules,
especially
from
a
dental
perspective,
that's
providing
incremental
access.
What
we've
really
struggled
with
is
to
convert
commercial
dental
providers
to
medicaid.
N
N
We
have
to
find
a
way
to
to
get
to
the
point
where
we're
actually
converting
providers
who
are
really
focused
on
commercial
to
come
over
to
the
medicaid
space,
so
I
do
think
there's
a
collaboration
that
needs
to
continue
both
on
the
legislative
perspective
and
with
the
administration
on
how
we
push
increases
to
some
of
these
providers,
and
we
do
pay
just
to
be
clear.
On
the
dental
side,
there
are
fee
schedules
that
pay
above.
N
B
So
just
I
I
was
not
asking
thank
you
for
the
answer.
I
was
not
asking
specifically
about
dental
I'm
thinking
about
you
know
general
physical
health,
behavioral
health.
Certainly
we've
heard
you
know:
behavioral
health
provider
shortages
at
crisis
level
in
the
state
and-
and
I
didn't
hear
any
of
that
in
your
presentation.
E
Yeah,
absolutely
and
from
that
earlier
slide
we
are
contracted
with.
You
know:
100
percent
of
the
the
psychiatric
residential
facilities,
the
psych
hospitals,
community,
mental
health
centers,
but
quite
honestly,
you're
right.
You
know
there
are
definitely
parts
of
the
state
that,
if
you
need
to
find
a
pediatric
psychiatrist,
one
just
does
not
exist
anywhere,
whether
it's
for
medicaid
or
any
other
line
of
business.
You
know
during
the
the
pandemic,
having
the
the
capability
to
really
expand.
Telehealth
offerings
has
definitely
helped
ease.
E
Some
of
that,
which
is
why
you
know
humana,
has
invested
so
strongly
in
internet
accessibility
in
some
of
those
more
rural
communities,
because
it
promotes
access
to
actual
care
for
those
folks
as
well.
Ideally,
obviously
we
want.
We
would
like
folks
that
prefer
to
see
someone
face
to
face,
be
able
to
to
drive
across
town
or
or
get
on
to
public
transportation
and
see
their
provider
right
there.
E
That
is
definitely
something
that
when
we
look
at
contracting
and
creative
contracting
in
in
for
those
specialties
where
there
is
a
shortage,
that's
always
part
of
those
negotiations,
but
you're
absolutely
right.
Additionally,
the
the
the
community
mental
health
centers
have
been
really
integra,
integral
in
making
sure
that
they
can
reach
outside
of
their
their
regions.
E
They've
been
getting
into
to
new
ground
right,
making
sure
that
more
and
more
of
them
are
able
to
provide
crisis
services,
and
we
we've
been
very
active
in
that
the
crisis
initiatives
that
are
happening
within
the
state
to
expand
mobile
crisis
and
and
really
draw
down
federal
funding
to
be
able
to
increase
the
access
there.
But
you're
right.
It's
it's.
It's
very
challenging
in
some
of
those
spaces.
K
Thank
you,
mr
chairman.
Just
a
couple
quick
questions
on
the
sud
slide
that
you
had
here.
What
treatment
does
humana
covered
faith-based
treatment?
What
what
variations
do
you
all
cover.
E
Sure
absolutely
well.
First
off
the
provider
has
to
be,
you
know
enrolled
with
kentucky
medicaid
in
order
for
us
to
be
able
to
to
reimburse
them
for
any
kind
of
services
and
within
the
service
array.
We
we
cover
everything
from
inpatient
and
detox,
which
is
you
know,
really
the
most
acute
care
in
the
substance,
use
disorder,
space
down
to
residential
care
outpatient.
We
cover
medication,
assisted
treatments
for
folks
that
where
that
is
indicated
as
well.
As
you
know,
we
do
peer
support,
iop,
sorry,
intensive,
outpatient,
partial
hospitalization.
E
All
every
single
level
of
service
is
covered
by
us
and
as
long
as
the
provider
is,
is
enrolled
with
kentucky
medicaid
and
is
demonstrating
that
they
can
provide
quality
care,
then
they
can
come
into
network
with
us
that
there
is
not
a
designation
between
a
faith-based
non-faith-based
prop
for-profit
non-profit.
K
K
A
K
Can
remember
in
my
district
talking
to
a
provider
a
few
years
ago
and
they
were
struggling.
I
think
they
eventually
became
a
provider,
but
they
were
face
faith-based
and
I
wasn't
sure
how
that
worked.
L
That's
not
a
that's,
not
a
qualifier
for
enrollment
in
the
medicaid
program.
They
just
have
to
meet
criteria
established
in
our
regulations,
and
that
is
not
a
criteria
for
enrollment
and
medicaid
program.
Okay,.
K
Very
good-
and
I
you
know,
some
of
those
programs
are
some
of
the
most
successful
that
you
can
have.
Mr
chairman,
my
final
question
has
to
do
with
the
providers
the
process
on
negotiating
rates.
How
does
that
work
and
what
does
humana
base
their
their
offer?
I
guess
on
rates,
how
does
that
work.
N
Senator
carroll
we
negotiate
according
to
the
market,
so
we
determine
market
rates
and
that's
what
we
negotiate
against
by
far
the
standard
for
most
services
in
kentucky
is
the
fee
schedule.
So
that's
really
usually
the
the
baseline
for
for
negotiations,
there's
very,
very
few
services
that
pay
below
the
medicaid
fee
schedule
and
for
every
other
services
the
standard
is
usually,
but
if
there's
an
access,
concern
or
there's
a
value,
that's
created
with
a
specific
provider,
we
consider
going
above
the
fee
schedule.
K
Okay,
as
you
know,
as
we
look
towards
needing
as
many
providers
as
we
can
have
within
the
commonwealth,
I
think
that
is
a
critical
component
is
the
negotiation
of
rates
and
you
know
because
the
provider
has
to
survive
and
new
providers
coming
in.
K
Sometimes
it's
it's
illegal
to
ask
in
most
cases
other
providers
what
their
rates
are
or
improper,
or
you
know
it's
in
some
cases
that
that
is
the
way
it
is,
and
I
you
know-
and
I
think
that
is
a
component
we
don't
ever
talk
about,
but
I
think
it
is
important
that
you
know
that
we
kind
of
know
what
what
the
standard
is
across
the
state,
because
if
we
find
that
providers
aren't
surviving,
it
could
be
because
maybe
the
the
owners
of
this
business,
they
don't
know
how
to
negotiate.
K
They
don't
know
what
proper
rates
are
and
therefore
they
price
themselves
out
of
business.
So
and
I'm
finding
this
out,
because
the
provider
that
I
work
for
is
getting
into
the
private
market.
We've
never
negotiated
private
rates
before
and
it's
very
intimidating
when
some
of
the
private
carriers
want
to
pay
you
less
than
medicaid
rates.
K
So
it's
very
difficult
to
know
for
people
coming
in
and
wanting
to
start
these
services
up
what
what
is
proper
and
what's
it
gonna
take
for
me
to
survive
and,
and
so
that
you
know
just
as
a
legislature
and
dr
alvarado.
C
Higdon,
thank
you,
mr
chairman,
and,
of
course,
some
of
the
statistics
you
had.
I
just
wanted
to.
You
talked
about
waste
fraud
and
abuse,
one
of
the
things
that
I've
heard
repeatedly
over
the
years
that
our
neighbors
to
the
south,
that
that
don't
participate
in
expanded
medicaid,
that
we
have
a
lot
of
out
of
state
participants
that
are
participating
in
kentucky
medicaid
that
actually
don't
live
in
the
state.
Do
you
do
you
see
that
or
have
you
detected
that.
E
If,
if
through
any
of
those
metrics,
where
we're
doing
monitoring,
we
do
notice
that
there
is,
is
a
concern
such
that,
maybe
they
have
a
and
you
know
a
brick
and
mortar,
maybe
in
kentucky,
but
the
real
clinical
treatment
is
maybe
being
conducted
outside
of
the
state
or
it's
minimal
staffing
in
the
state.
Those
immediately
get
r,
and
usually
we
find
that
out
either
because
some
of
our
members
have
called
us
and
said
hey.
This
doesn't
seem
quite
right
or
I
don't
feel
like
I'm
getting
good
treatment.
E
So
sometimes
we
we're
getting
that
feedback
directly
from
members,
but
also
we
can
do
that
through
monitoring
of
medical
records
and
claims,
and
things
like
that.
We
have
an
internal
special
investigations
unit
that
works
very
closely
with
the
department's
program,
integrity
office,
and
we
share
information
immediately
when
something
like
that
happens,
and
that
way
each
mco
can
also
be
made
aware
of
that.
So
if
the
department
finds
that
there
are,
you
know,
concerns
there.
E
They
may
step
in
and
take
over
that
investigation,
because
it
really
has
to
do
more
with
that
medicaid
enrollment
and
that's
you
know,
should
that
provider
be
enrolled
in
medicaid,
but
even
while
the
department
is
is
doing
their
due
diligence
there.
We
have
the
opportunity
to
assess.
Should
this,
this
provider
still
be
a
part
of
our
network
and
participating
in
for
our
humana
medicaid
members.
So
we
may
assess
you
know
how
many
folks
are
seeing
that
provider.
E
Could
we
get
them
to
a
provider
where
we
actually
see
good
outcomes
where
we
can
tell
the
quality
of
service
that's
being
delivered
through
our
reviews
and
attempt
to
potentially,
you
know
see
if
members
are
willing
to
make
a
move
and
even
have
that
provider
leave
our
network.
While
we
wait
for
the
investigation
to
end
well.
C
N
The
department
of
medicaid
services
determines
eligibility
for
our
programs.
If
we
do
find
or
suspect
we
can
open
an
siu
case
to
investigate,
but
that
hasn't
been
a
trend
that
we've
seen.
I
do
think
during
the
pandemic.
We've
seen
continuous
enrollment,
so
so
there
could
be
cases
of
that
that,
as
we
move
outside
of
the
phe
that
we
need
to
investigate,
but
it
hasn't
been
something
that's
been
discussed
within
managed
care
as
a
trending
issue.
C
C
And
we
talk
about,
you
know
the
digital
services
that
you
have.
What
percentage
of
your
participants
would
you
say,
are
internet
savvy
that
can
actually
communicate
to
have
email,
addresses
and
participate,
digitally.
F
So
what
we've
seen
is
we
get
reports
on
some
of
those
digital
applications
and
on
the
reports.
It'll
it'll
talk
about
how
they're
getting
accessed
and
a
large
portion
of
what
we
see
is
most
of
the
the
members
do
have
smartphones
and
so
they're
they're
getting
on
those
applications
via
their
smartphone
or
they're,
going
to
our
websites,
and
things
like
that.
So
we
do
see
a
high
percentage
of
our
membership
that
are
being
able
to
access
our
our
different
internet
type
services,
either
through
a
smartphone
or
some
other
type
of
you
know,
device.
N
I
think
it's
probably
depend
on
the
clinical
program.
Some
of
our
clinical
programs
on
the
digital
side
are
focused
around
pregnant
women.
I
think
there
is
a
lot
of
consistency
with
digital
savviness.
From
from
that
cohort,
the
others
are
targeting
things
like
diabetes.
You
know
you
get
a
spectrum
there,
depending
on
the
age
of
the
member.
N
C
And
and
one
last
question,
mr
chairman,
politics
aside,
we
talk
about
covert
vaccinations.
I
know
I
saw
a
report
that
medicaid
population,
the
the
percentage
of
vaccinated
vaccination,
was
very
low.
I
saw
one
pers
one
one
step.
One
report
said
27
of
medicaid
recipients
were
vaccinated
and
I
think
I.
M
N
N
We
have
done
rewards
programs
to
allow
our
members
to
get
gift
cards
if
they're
willing
to
be
vaccinated.
We've
done
communication
partnerships
with
our
health
plan
association,
we've
partnered
with
providers,
it's
been
a
struggle,
but
we
need
to
continue
to
message
the
importance
of
vaccination
as
we
exit
the
public
health
emergency
because,
as
we
move
away
from
the
pandemic,
it's
still
important
that
we
control
trending
from
spikes
from
from
covid.
N
I
I
don't
have
it
right
in
front
of
me,
but
I
could
provide
it
probably
five
minutes
after
this
committee.
C
That'd,
be
fine,
I'm
just
curious.
Thank
you.
Thank
you,
mr
chairman
representative
sheldon.
Thank
you
chairman,
mr
duke.
Thank
you
a
great
presentation.
It
was
a
lot
of
interesting
information,
the
provider.
You
know
angle
that
we've
all
been
talking
about
here,
just
making
sure
people
have
access.
I
really
just
want
to
follow.
Ask
this
and
you
can
actually
get
back
to
the
chair
on
this
or
send
it
back
to
me
or
the
chair,
but
we
passed
the
law
in
here
march,
2021
house,
bill
48..
C
I
just
need
an
update
from
you,
where
you're
at
and
implementing
that
law,
since
we
did
pass
it
there.
I
understand
there's
not
been
any
movement,
but
you
know
you
can
hear
a
lot
of
things
so
I'd
just
rather
ask
you
and
let
you
tell
us.
N
Is
you
know
absolutely
from
a
dispensing
fee
perspective,
the
single
pbm
programming
we've
had
significant
shifts
in
programming
in
the
implementation
of
the
single
pbm,
and
I
think
that
the
state
has
also
developed
programming
specific
to
brand
drugs
versus
generics.
So
we've
had
a
lot
of
shifts,
but
I
do
think
we've
done
a
lot
to
support
independent
pharmacies
over
the
last
two
to
three
years.
I'll.
Look
at
that
specific
legislation
to
let
you
know
where
we
are.
C
I
appreciate
the
support
and
I
will
tell
you
that
you
know
that
particular
legislation
was
about
recognizing
pharmacists.
C
As
for
things
they've
been
doing
for
for
decades
and
saying
you
are
a
healthcare
provider,
we're
recognizing
that
in
our
insurance
code,
so
they're
doing
services
like
vaccines,
which
came
were
quite
critical
in
the
last
couple
years
and
and
weren't
getting
paid
for
the
services
they
provide
when,
when
a
physician
assistant
can
do
the
same
thing,
so
it's
spelled
out
in
house
bill
48
I'd
just
like
for
you
to
to
give
us
some
type
of
implementation.
A
Thank
you,
mr
duke,
and
for
your
presentation,
each
of
you
and
we
appreciate
it
and
our
last
presentation
will
be
about
medicaid,
presumptive
eligibility
and
I'll
invite
commissioner
lee
to
the
desk
and
she
can
introduce
herself.
I
think
she's
already
introduced
herself,
maybe
once
or
twice
today,
but
she
can
introduce
herself
again
and
proceed.
L
So
first,
I
think
just
you
know
just
a
little
high
level
overview
for
what
presumptive
eligibility
is.
It
is
temporary
enrollment
for
individuals
who
appear
to
be
eligible
for
medicaid,
based
on
some
information.
They
provide
related
to
their
household
size
and
income.
Presumptive
eligibility
has
been
around
for
quite
some
time,
particularly
with
pregnant
women.
L
We
implemented
pregnant
women,
presumptive
eligibility
or
pe
in
the
early
2000s.
L
Basically,
what
this
does
is
it
allows
providers
to
get
paid
for
that
service
on
that
date,
and
I'd
like
to
note
that
the
providers
themselves
don't
actually
determine
if
an
individual
is
presumptively
eligible
that
is
determined
in
our
system.
A
provider
enters
information
based
on
what
a
member
tells
them
that
information
is
in
goes
into
the
medicaid
system.
L
The
system
looks
at
information
such
as
household
size,
income,
that
sort
of
thing
and
says:
okay,
this
individual
does
appear
to
be
presumptively
eligible
for
medicaid,
and
then
the
provider
gets
an
authorization
number
and
the
member
gets
a
temporary
card
that
they
can
use
to
receive
services
until
they
complete
a
full
application.
L
In
this
instance,
hospitals
are
the
providers
that
determine
if
an
individual
should
be
screened
for
presumptive
eligibility
in
the
pregnant
peps,
for
example,
we
have
fqhcs
local
health
departments.
Ob
gyns
can
screen
individuals
for
presumptive
eligibility.
So
again
it
allows
members
to
receive
services
while
they
are.
While
we
are
processing
their
full
application
providers
do
receive
payment
we
did
have
during
the
pandemic.
We
did
expand
the
role
of
the
cabinet
to
be
allowed
to
take
presumptive
eligibility
applications.
L
L
L
So
again
the
numbers
are
dropping
and
again,
as
you
can
see
during
the
period
of
march
2020
to
may
2022,
we
had
over
243
000
individuals
who
did
receive
medicaid
pe
of
those
63
000
or
so,
or
26
qualified
for
the
traditional
medicaid
program
after
they
completed
or
we
processed
their
applications
again,
just
a
little
bit
of
a
trend
line
to
show
you
that
our
medicaid
enrollment
did
increase
during
the
public
health
emergency,
but
we
did
see
a
slight
decrease
when
some
of
the
individuals
who
were
in
presumptive
eligibility
no
longer
qualified.
L
Medicaid
had
to
ensure
continuous
enrollment
for
current
enrollees
at
the
beginning
of
the
public
health
emergency,
and
due
to
that
that
mandate,
cms
is
providing
6.2
percent
increase
in
our
federal
share
of
medicaid
spending,
which
helps
us
reduce
some
of
our
state
spending.
That
means
that
we
have
to
have
our
eligibility
standards
no
more
restrictive
than
what
they
were
in
place
in
january
2020.
L
We
cannot
disenroll
individuals
during
the
public
health
emergency.
We
cannot
disenroll
individuals
from
the
medicaid
program
for
administrative
or
procedural
reasons.
For
example,
they
fail
to
return
documentation.
However,
we
can
disenroll
individuals
if
they,
if
they
pass
away
if
they
move
out
of
state
or
they
make
a
request
to
disenroll
from
the
program.
The
maintenance
of
effort
requirements
is
does
not
apply
to
presumptive
eligibility.
That
is
why
we
are
allowed
to
disenroll
those
individuals
from
the
program
once
they
no
longer
qualify
or
they
do
not
complete
an
application
house
bill.
L
7
has
information
in
it
or
mandates
any
requirements
related
to
presumptive
eligibility.
For
example,
cf
the
cabinet
for
health
and
family
services
was
considered
a
qualified
entity
for
the
purpose
of
making
pe
determinations.
We
had
approval
through
an
emergency
state
plan.
Amendment
house
bill
7,
specifically
section
8,
prohibits
the
cabinet
from
being
a
pe
entity,
so
the
form
that
we
created
that
was
online
with
easy
access
for
individuals
to
complete
a
presumptive
eligibility
application
is
will
be
removed
from
the
website
july
14th,
and
that
process
will
no
longer
be
in
place.
L
Section
9
of
house
bill
7
related
to
hospital
presumptive
eligibility
again
hospital
presumptive
eligibility
has
been
around
since
about
2014..
We
are
in
compliance
with
most
of
those
provisions
in
section
9..
The
hospitals
currently
do
not
assist
individuals
with
completing
a
full
medicaid
application.
So
we
are
updating
our
regulations
to
make
that
requirement
for
the
hospitals
to
assist
with
that
application.
L
Section
32
of
house
bill
7
requires
the
cabinet
to
contract
with
a
third
party,
to
review
pe
determinations
made
by
hospitals
between
january
1,
2020
and
now,
and
the
effective
date
of
house
bill
7,
which
will
be
july
14th.
So
the
cabinet
is
working
to
be
in
compliance
with
that
provision
of
house
bill
7.