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From YouTube: House Finance, Ways, & Means Committee- March 9, 2021
Description
House Finance, Ways, & Means Committee- March 9, 2021
A
C
B
I'd
like
to
call
the
finance
ways
and
means
committee
to
order
for
march
9th
2021..
Mr
clerk,
would
you
please
call
the
roll.
B
B
All
right
sting
none.
We
have
seven
bills
on
our
calendar
today
following
that
we'll
be
hearing
doing
a
budget
hearing
from
the
division
of
tenncare.
So
we
do
have
a
full
afternoon
and
we
get
started
a
few
minutes
late.
So
we'll
try
to
move
as
expeditiously
as
possible
and
we're
first
going
to
take
up
the
calendar
item
number
one
on
our
calendar
is
house
bill.
1042
chairman
kiesling,
chairman
keisling,
you're
recognized.
E
B
Motion
in
a
second
on
the
amendment,
would
you
like
to
I'll
briefly.
E
E
So
this
amendment
will
allow
the
bill
that
passed
last
year
to
now
be
effective
now.
Actually,
the
amendment
applies
to
to
the
same
counties,
though,
as
as
last
year's
and
anyone,
anyone
that
passed
a
resolution
or
other
official
action
prior
to
that
that
magic
date
of
january
121
is
is
is
eligible,
but
with
that
that
is
a
that
is
an
explanation
of
the
amendment
chair,
lady.
B
F
F
B
All
right
we
have,
the
amendment
is
before
us
amendment
4393
any
questions,
seeing
none
all
in
favor
of
adding
amendment
4393
to
house
bill
1042,
please
signify
by
saying
aye
any
opposed.
You
guys
have
it.
The
amendment
4393
is
now
with
the
bill
and
jeremy
kiesling.
Would
you
like
to
take
a
moment
to
explain
the
bill
as
amended.
E
Yeah,
I
I
can
wrap
it
up
with
with
this
statement
house
bill
1042.
Now
it
has
introduced
and
as
amended,
it
revises
provisions
governing
the
allocation
of
sales
and
use
tax
revenues
to
certain
commercial
development
districts.
Now,
in
this
case
members,
this
is
this
is
regarding
cumberland
county
we've
got
a
33-acre
site
up
there
that
that
that
can
be
financed
with
with
these
tif
with
tiff
funding.
E
So
if
it
will
really
be
a
boost
to
that
area
and
with
the
passage
of
this
that
will
give
them
the
green
light
to
proceed
so
I'll,
entertain
a
chair,
lady
I'll,
entertain
any
questions
then,
at
this
point
in
time,.
B
The
question
has
been
called
on
the
bill.
Are
there
any
objections
to
calling
the
question
seeing
none
we're
now
voting
on
house
bill
1042
as
amended
all
in
favor,
please
signify
by
saying
aye
any
opposed
guys
have
it
house
bill
1042
moves
on
to
calendar
and
rules?
Thank
you,
chairman
kiesling,
and
we're.
E
E
Well,
that's
fine
and
and
chair
lady,
if,
if
I
may,
if
you
give
me
permission,
I
just
like
to
acknowledge
the
the
effort
and
assistance
by
by
our
stat
legal
staff,
joel
hayes
and
anastasia
campbell.
Thank
you
all
very
much
for
for
your
help
and
assistance
and
again
thank
you,
chair
lady
and
members.
B
Thank
you
item
number
two
on
our
calendar
house
bill
913
has
been
taking
taken
off
notice,
so
we
move
to
item
number
three
house
bill
515
by
leader.
Again
we
have
motion.
We
have
a
second
leader,
gant
you're
recognized.
Thank.
E
You
chairman
this
bill,
exempts
smokeless
nicotine
products
from
the
tobacco
wholesale
tax.
This
simply
still
simply
clarifies
that
any
nicotine
product
that
has
no
tobacco
in
its
composition
is
not
subject
to
the
tennessee
6.6
otp
tax,
which
is
other
tobacco
products,
and
this
bill
passed
obviously
last
year,
if
you
remember
on
the
house
floor
and
was
not
calendared
due
to
the
coveted
pandemic.
B
B
C
Thank
you,
chairman
of
members
house,
bill
367,
clearly
defines
what
the
term
micro
market
means,
as
it
relates
to
unmanned
facilities
for
the
usually
located
industrial
commercial
facilities
where
an
employee
could
purchase
goods
or
services
from
a
kiosk,
that's
unmanned
there.
This
bill
also
goes
further
to
allow
for
those
industries
that
are
micro
markets
to
be
able
to
file
one
report
with
the
department
of
revenue
for
all
those
facilities
at
those
locations
in
lieu
of
filing
one
for
each
address,
in
which
they're
located.
C
Madam
chair
lady,
we
passed
this
bill
last
year
and
the
senate
chose
not
to
move
it,
and
so
the
exact
same
language
from
last
year.
I'm
happy
to
answer
any
questions
you
might
have.
B
All
right
wait:
the
bill
has
is
before
us,
it's
been
properly
motioned
and
seconded.
Are
there
any
questions
on
the
bill?
B
As
the
chairman
pointed
out,
we
we
completed
our
work
on
this
issue
last
year,
so
now
we
will
complete
it
again
and
hopefully
this
time
we'll
have
companion
work
that
will
be
done.
You're
now
voting
on
house
bill,
367,
moving
on
to
calendar
and
rules
all
in
favor,
please
signify
by
saying
aye
any
opposed
eyes.
Have
it
house
bill
367
moves
on
to
calendar
and
rules.
B
We're
now
at
number
item
item
number:
five
on
our
calendar.
Also
by
chairman
williams.
We
have
a
motion
in
a
second
chairman
williams.
You
recognize.
C
Thank
you
chair,
lady
members.
This
bill
is
a
transparency
and
controls
bill
for
the
entertainment,
tax
and
exemption
tax
credit.
Currently,
the
ecd
has,
in
the
past,
spent
monies
and
grants
towards
film
and
movie
industries
and
and
mini
series
across
the
state.
C
What
this
bill,
instead
of
being
a
first
dollar
investment,
would
be
a
reimbursement
of
of
expenditures
that
these
industries
do,
the
the
fiscal
note
wouldn't,
or
the
fiscal
impact
wouldn't
be
until
2023,
because
as
sales
tax
revenue
is
reimbursed
for
that
for
the
sales
tax,
as
well
as
labor
costs
associated
with
it.
These
incentives
are
capped
based
on
the
half
of
the
of
those
labor
expenditures
and
capped
at
the
duration
based
upon
how
long
those
incentives
are
applied
for
this
is
an
administration
bill.
A
Thank
you,
madam
chair
lady,
mr
chairman,
as
I
read
the
summary,
it
creates
a
sales
and
use
tax
exemption
and
a
franchise
and
excise
tax
credit
for
film
productions
that
would
be
approved
by
commissioners
of
the
department
of
revenue,
as
well
as
the
department
of
economic
and
community
development.
C
Thank
you,
chair
lady.
The
ecd
will
still
determine
which
film
industry
incentives
through
those
departments
much
like
they
do
their
current
grants,
except
they
have
before
they
can
be
approved.
They
have
to
meet
these
criteria
for
sales
tax
through
the
department
of
revenue
and
these
excise
tax
credits.
The
reporting
is
done
in
both
departments,
one
annually
and
one
every
four
years,
based
upon
those
those
tax
credits.
A
C
A
And
I'm
looking
at
the
estimated
impact
foregone
state
revenue-
and
I
think
you
said
it
starts
in
fy
2223,
which
looks
at
1.3
million
and
in
subsequent
years
for
2728.
It's
15.7
million
dollars
is.
Is
that
correct?.
G
C
Thank
you,
chair,
lady.
The
answer
to
your
first
question
is
the
nature
of
this
revenue
is
foregone
revenue.
The
definition
foregone
revenue
means
that
if
these
industries
didn't
come
here,
then
their
sales
tax
revenue
wouldn't
be
generated,
which
is
why
they
would
receive
a
tax
credit
if
the
department
of
revenue
recognized
this
as
a
acceptable
entity
for
that
reimbursement,
as
it
relates
to
the
the
term
hollywood.
I
I
can't.
I
can't
really
comment
as
to
what
what
that
definition
of
hollywood
is.
C
G
G
So,
as
I
said,
I
appreciate
the
work
that
ec
does,
but
there
ought
to
be
some
claws
in
there
that
they
could
not
hold
us
hostage
if
we
did
not
comply
with
their
radical
agendas
that
they're
putting
forth
all
across
our
nation
today
and
that's
all
I
have
to
say.
C
F
It
is
a
very
conservative
approach
in
a
very
different
way,
and
you
have
fought
for
these
type
of
issues
for
years
to
not
give
companies
on
the
front
end
taxpayer
dollars,
but
to
make
them
prove
that
they're
actually
going
to
invest
in
tennessee
and
then
have
some
benefit
on
the
back
end,
and
this
may
help
with
some
of
my
friends
and
members
that
share
my
dislike
for
some
of
the
hollywood
values
that
have
tried
to
been
inserted
in
other
states
and
tried
to
hold
those
states
hostage.
F
The
only
group
that
I
have
met
with
that
is
a
big
fan
of
this
is
the
folks
that
do
veggietales.
So
literally,
that's
the
group.
We
met
with
right
afterwards,
they
reached
out,
because
these
are
smaller.
These
are
smaller
grants.
These
are
smaller
opportunities,
and
so
it's
actually
the
opposite
of
hollywood.
F
It
is
designed
specifically
for
those
folks
that
do
shows
like
veggietales,
that
are
that
are
not
very
costly,
but
it
does
encourage
them
to
come
to
tennessee
and
if
they
actually
invest
here,
it
allows
folks
like
that
to
be
able
to
show
larry
the
cucumber
and
and
to
a
whole
new
generation
of
folks,
and
so
I
only
bring
that
up,
because
it
I
had
some
of
the
same
concerns
when
we
first
saw
the
bill-
and
I
appreciate
you,
chairman,
carrying
it,
because
again
very
conservative
way
to
help
small
business
owners
and
specifically
small
small
production
companies
that
currently
it's
all
hollywood
and
the
big
guys.
B
And
I
might
just
take
a
moment
of
privilege
to
tack
onto
that
a
bit
to
say
that
this
would
give
an
opportunity
for
our
young
people
who
are
interested
in
the
film
industry
to
be
able
to
work
in
that
industry
in
this
state
and
not
have
to
go
to
california
and
some
of
those
more
liberal
areas
to
to
find
the
kind
of
work
that
they're
interested
in
doing
so.
From
that
perspective,
I
think
it
too
lends
itself
to
keeping
our
our
kids
at
home
and
representative
sexton.
I
believe
you
had
a
follow-up.
G
Yes-
and
I
like
veggie
tales
too,
and
also
like
mr
potato
head,
but
he's
dead,
and
it's
it's
a
it's
a
change
of
culture
that
we're
inviting
in-
and
I
appreciate
my
conservative
friends
and
and
they
fight
for
conservative
values
all
the
time.
G
We
just
have
a
difference
of
opinion
here
about
what
monies
are
used
and
again,
let
me
say
if
mom
and
pop
comes
here
and
brings
a
furniture
store
or
convenience
stores
we're
not
going
to
give
them
the
sales
tax
back,
and
I
think
it's
a
double
standard
when
we
try
to
bring
in
these
companies
like
this
and
the
sports
authority
and
everything
else
when
these
little
mom-and-pops
we've
got
so
many
conglomerates
today
that
are
taking
over,
we
need
our
neighborhood
stores.
We
need
mr
potato
head
back.
D
Thank
you,
madam
chair
lady,
and
I
would
ask
the
sponsor
of
this.
A
a
few
years
ago,
when
we
had
the
tv
show
here,
nashville
the
series
we
were
provided
some
data
and
at
that
time
for
every
dollar
we
spent
toward
this
entertainment
grants,
or
with
ecd
and
and
stuff
to
bring
in
these
things,
we
were
receiving
four
dollars
back
on
our
investment.
C
Thank
you,
chairman,
crawford
you're,
exactly
right.
That
was
the
case.
The
only
difference
was
then
we
were
funding
it
with
our
state
appropriated
dollars.
So
we
were
investing
dollars
in
trying
to
get
a
return.
What
this
is
it's
a
reimbursement
of
their
dollars
back
to
them
that
they
actually
invest
in
our
communities,
which
is
really
good.
I
just
wanted
to
chair
lady
hazelwood's
comments
reminded
me.
C
One
of
our
institutions
of
higher
learning
here
in
nashville
has
a
program
in
which,
where
they
do
animation,
you
can
receive
a
degree
in
animation
those
those
young
men
and
women
in
that
department
have
to
go
outside
the
state
of
tennessee
to
be
able
to
work
and
so
and
and
do
animation
similar
to
what
leader
lamberth
was
just
talking
about.
So
not
only
does
this
create
an
incentive,
it
creates
an
opportunity
for
tennessee
and
to
stay
in
tennessee
to
do
these
jobs,
and
so
for
that
I'm
also
pretty
excited,
but
thank
you.
Cheerleading.
D
Thank
you.
Thank
you,
madam
chair,
and
let
me
let
me
thank
the
chairman
for
the
legislation,
because
from
what
I
understand
we're
clearing
up
some
issues
that
we've
been
duped
on
before
and
to
me.
I
think
this
is
going
to
put
things
in
order
where
we
won't
suffer
some
of
the
issues
that
are
being
brought
up
now.
So
I
want
to
thank
you
for
bringing
legislation,
and
I
I
personally
think
it's
it's
a
good
piece
of
legislation
and.
E
I
just
want
to
thank
you
for
that
leader
gant.
Thank
you,
madam
chair.
Just
to
give
you
an
example.
Mississippi
did
this
same
exact
thing
and
it
actually,
if
anybody
watches
hdtv
the
show
my
hometown
was
created
because
of
this
piece
of
legislation
and
it
targets
laurel
mississippi,
and
so
it
puts
the
target
on
the
state
municipality
in
that
state
and
that
that
is
the
direction
of
the
governor
under
this
administration
is
to
draw
more
attention
to
tennessee
through
this
piece
of
legislation
like
that.
So
just
want
to
give
you
that
example.
H
Thank
you,
chair
lady.
I
just
wanted
to
say
that
I
really
appreciate
this
bill
as
someone
with
several
friends
who
are
filmmakers
in
the
film
industry,
they're
all
trying
to
leave
memphis
they're
all
trying
to
leave
because
there's
no
incentive-
they
can't
stay
here,
so
I'm
so
thankful
for
this
legislation
for
us
to
bring
support
for
them.
So
I
will
be
voting
an
affirmative
for
this
bill
and
I
appreciate
this
legislation.
D
Thank
you,
madam
chair.
I
just
wanted
to
kind
of
echo
some
of
my
colleagues
statements.
D
There
are
so
there
have
been
so
many
opportunities
in
memphis
and
shelby
county
where
there
have
been
films,
large
and
small,
that
have
not
taken
place
that
are
based
off
of
people
that
are
from
memphis
live
in
memphis
that
have
been
passed
over
and
put
in
other
states,
and
I
I
don't
want
to
keep
seeing
that
happen.
So
thank
you.
B
B
I
B
Have
it
if
anyone
would
like
their
navy
codified?
Please
see
the
clerk
item
number
six
on
our
agenda
has
been
rolled
for
two
weeks
and
that
brings
us
to
item
seven.
D
B
Thank
you,
mr
chairman.
This
bill
simply
codifies
what
has
been
the
practice
in
tennessee
for
many
years
in
terms
of
underground
utility
and
energy
companies
that
construct
new
pipeline
infrastructure
in
the
state.
B
The
these
companies
have
long
treated
in
installation
of
the
pipeline,
the
contract,
labor
services
as
exempt
from
sales
and
use
tax.
They
pay
the
tax
on
the
materials,
but
these
are
put
in
by
third-party
contractors,
and
we
have
never
collected
sales
and
use
tax
on
our
I'm
sorry.
Sales
tax
on
that
before
and
actually
could
provide
an
impediment
to
growth
and
economic
development
in
terms
of
just
getting
infrastructure,
new
infrastructure
out
for
areas
for
development.
B
So
all
this
bill
does
is
codify
the
practice
that
has
been
maintained
in
the
state,
and
that
is
that
these
these
services
will
not
be
the
installation
of
these
services
will
not
be
taxed.
So
with
that,
mr
chairman,
I
would
stand
ready
for
questions.
D
B
B
B
Mr
commissioner,
if
you
would
just
introduce
yourself-
and
I
would
ask
if,
if
other
members
of
your
team
is,
if
they
speak
as
part
of
the
presentation
or
doing
the
q
a
if
they
would
just
identify
themselves
in
their
titles
before
they
speak,
so
we
folks
at
home
will
know
who
you
are
so
with
that.
I
would
just
I
invite
you
to
proceed
with
your
budget
presentation.
J
Thank
you
very
much,
madam
chairman
and
members.
It's
good
to
be
with
you
all
again
this
afternoon.
My
name
is
stephen
smith.
I
serve
as
the
director
of
tenncare
and
we
have
members
of
our
team
here
and
and
as
you
requested,
they
will
introduce
themselves
as
as
they
as
they
speak.
We
have
just
a
few
slides
to
go
through
out
of
respect
for
your
time.
Members
we're
going
to
go
through
these
very
quickly
and
we'll
leave
plenty
of
time
for
questions
and
comments.
J
We've
already
spent
some
time
this
session.
Talking
about
the
this
theme
of
the
past
present
and
future
of
tenncare.
J
J
In
fact,
back
in
2004
prior
to
2004,
the
the
tenncare
budget
was
projected
to
to
take
up
every
single
available
revenue
dollar
or
about
91
percent
of
every
available
new
revenue
dollar
to
the
state
by
the
year
2008,
and
so
clearly
this
was
not
sustainable
and
so
the
executive
branch.
At
the
time,
the
legislative
branch
worked
together
to
make
some
major
reforms
in
2004
and
often
the
what
people
look
to
when
they
look
at
those
reforms.
J
In
fact,
if
you
look
prior
to
the
decade
prior
to
2004,
what
you'll
see
is
that
the
10
care
enrollment
grew
by
about
22
percent.
Over
that
same
time,
period.
Tenncare
expenses
grew
by
224
percent.
So
what
that
confirms
to
us
is
that
there
were
other
equally
important,
if
not
more
important,
reforms
that
were
made
at
that
time,
and
you
can
see
some
of
those
reforms
on
the
screen.
J
We've
proven
as
a
state
that
curbing
the
rising
cost
of
health
care
and
quality
improvements
go
hand
in
hand,
they're
actually
dependent
upon
one
another,
so
controlling
cost
growth,
coordinating
care
properly.
Managing
utilization
means
that
you
can
provide
more
services
more
benefits
and
you
can
do
that
without
breaking
the
state
budget,
and
I
believe
that
our
budget
is
a
reflection
of
that
philosophy.
J
So
moving
into
our
proposed
cost
increases
questions
that
you
all
have.
First,
as
you
all
are
accustomed
to
seeing
every
year
we
have
our
medical
inflation
and
utilization
increase.
So
this
is
our
anticipated
trend.
It's
it's
always
our
largest
recurring
item
each
year
and
I'll
note
that
this
represents
a
1.42
percent
growth
rate,
controlling
those,
the
rising
cost
of
health
care,
and
why
it's
so
important
for
our
state
as
a
whole,
and
this
is
where
that
shows
up.
It
shows
up
in
this
medical,
inflation
and
utilization.
J
To
put
this
in
better
perspective,
if
our
trend
rate
has
simply
been
at
the
medicaid
state
average
over
the
past
decade,
we
would
have
spent
two
billion
more
dollars
in
our
program.
I
don't
think
it's
a
coincidence
to
know
that
that's
about
the
same
amount
that
this
state
has
invested
in
k-12
education
over
that
same
time,
so
the
the
cost
of
tenncare
being
average.
It's
substantial
and
it's
real.
J
We
don't.
We
don't
want
to
be
average
at
10k
and
we
don't
have
the
luxury
of
being
average
if
we
rest
on
our
laurels,
if
we
go
back,
if
we
loosen
the
cost
controls
that
we
put
in
place,
then
the
state
is
impacted
and
when
the
state
is
impacted,
considering
10
care
makes
up
such
a
large
portion
of
the
budget.
It's
inevitable
that
that
will
result
in
cuts
to
the
10
care
program,
and
that
is
something
that
we
work
very
hard
to
try
to
avoid.
J
I
want
to
point
out
a
couple
of
really
important
maternal
health
initiatives,
and
you
may
recall
these
from
last
year
they
were
actually
funded
and
approved,
and
then,
when
the
pandemic
hit,
we
had
to
we
had
to
take
those
out.
The
first
is
a
dental
pregnancy
program.
This
will
extend
dental
coverage
to
pregnant
women
21
and
over.
J
The
second
would
extend
postpartum
coverage
for
10
care
members
from
60
days
to
12
months.
We
know
that
maternal
mortality
is
an
issue
nationwide.
It's
an
issue
in
this
state.
The
late
postpartum
period
remains
critically
important.
It's
a
vulnerable
period
for
both
the
the
mother
and
the
child.
This
initiative
is
about
it.
It's
as
much
about
the
the
health
of
the
child
as
it
is
the
mother.
We
want
to
set
that
child
up
for
success.
J
Presently
we
have
a
number
of
dcs
children
and
adoptions
where
the
children
do
not
qualify
for
adoption
assistance,
and
this
can
create
a
coverage
gap
and
it
results
in
a
scenario
where
the
child
has
to
has
to
rely
on
the
adopting
parents
insurance
and
that
could
make
the
adoption
process
more
difficult.
So
this
is
an
attempt
to
remove
one
of
the
barriers
that
may
exist
and
we
think
it
will
have
a
really
positive
impact.
J
Moving
on
to
the
reductions,
I'll
highlight
just
a
couple
of
points.
First,
we're
proud
once
again
at
10
care
to
be
a
major
player
in
the
necessary
reductions
in
the
overall
state
budget.
This
year
or
for
fy22
10k
represents
57
percent
of
the
total
general
general
fund
reductions
in
the
budget,
and
then
second,
we've
been
able
to
propose
these
reductions
with
minimal
impact
to
our
10
care.
Members,
for
example,
you'll
see
the
pretty
large
reduction
in
our
pharmacy
trend.
That
is
a
reflection
of
our
actual
expenditures.
J
Over
the
last
few
years,
trends
have
moderated
substantially
we're
also
just
doing
a
better
job
of
managing
that
program.
Our
rebate
collections
have
stabilized,
and
so
this
is
a
large
reduction
that
we
can
put
forward
that
will
have
no
impact
on
our
members
and
no
impact
on
our
providers.
J
The
the
f
map
rate
change.
That's
our
federal
matching
percentage
this
year
that
works
to
our
advantage.
This
is
strictly
a
federal
calculation
that
is
based
on
our
relative
position
to
other
states
and
for
the
second
year
in
a
row
it
works
to
our
advantage.
What
that
means
is
we're
going
to
get
a
higher
matching
percentage
than
we
than
we
had
the
previous
year.
J
The
90-day
refill
item
this
makes
permanent
a
policy
that
has
been
put
in
place
since
the
pandemic
started.
This
will
allow
providers
the
option
to
write
90-day
scripts
for
our
tenncare
members
for
maintenance
medications.
So
that
means,
of
course,
that
it
will
decrease
the
number
of
trips
that
the
ten
care
members
have
to
make
to
the
pharmacy.
J
It
also
improves
drug
adherence,
which,
of
course,
is
a
really
good
thing
and
then
I'll
wrap
up
by
speaking
to
the
340b
item,
the
340b
program.
It's
a
federal
program,
it's
extremely
complex.
It's
gotten
a
lot
of
attention
at
the
federal
level
here
recently,
we
know
from
our
oig
auditors
that
hhs
at
the
federal
level
they're
taking
a
really
close
look
at
the
340b
program
and
state
medicaid
programs
and
how
that's
implemented,
but
at
its
core.
J
It's
effectively
negating
the
the
benefit
of
the
medicaid
rebate
program
and
again
this
gets
really
complex.
I'm
happy
to
answer
more
questions
about
that,
but
I
will
stop
there
and
then
just
one
more
slide.
Madam
chairman,
I
want
revisiting
care,
did
play
a
large
role
in
the
overall
vacancy
reductions
that
were
included
by
the
general
assembly
in
the
budget
and
so
you'll
see
on
the
screen
there
that
that
resulted
in
34
positions
for
10
care.
J
B
K
Thank
you,
madam
chair
and
director
smith,
and
your
whole
team.
Thank
you.
So
much
and
I've
heard
bits
and
pieces
of
this
previously
and
really
appreciate
the
work
that
you
do.
It
is
a
daunting
task
when
you
look
at
the
substantial
portion
of
the
budget
that
tenncare
makes
up-
and
I
appreciate
all
the
all
the
time
and
effort
and
and
as
we've
had
the
conversations
before
I
I
have
expressed-
concerns
previously
about
about
provider
rates,
provider,
provider,
care
and
and
there's
a
healthy
tension
that
occurs
between
our
entity
and
providers.
K
That
I
feel
is
good
and,
as
we've
mentioned
several
times
in
in
terms
of
legislation
and
in
policy
and
budgets
they're
you
know,
sometimes
the
best
policy
is
is
a
is
an
issue
that
no
one
is
ecstatic
about,
but
everybody
can
live
with
and
that's
where
the
tensions
are
coming
from
providers
as
well
as
as
entities
of
tenncare.
K
So
I
appreciate
you
listening
to
me
over
the
years,
madam
sheriff
I
could
a
couple
of
questions
and
director
smith
talked
about
the
f
map,
the
federal
medicaid
assistance
percentages
and
as
we're
looking
at
the
the
37
million
dollar
reduction
in
state
investments.
Is
that
related
to
covet
or
how
is
how
is
that
related?
Or
is
it
just
a
an
organic.
J
Thank
you.
Thank
you
for
the
question
so
that
that
item
is
actually
not
related
to
kobe,
so
that
that
this
is
something
that
happens
every
single
year,
where
the
federal
government
sets
our
matching
percentage
and
again
it's
it's
just
based
on.
I
don't
know
william
likes
to
say
they
go
into
a
room,
a
dark
room
and
they
do
the
calculator
and
they
figure
it
out.
J
But
and
then
they
just
tell
us
what
it
is
some
years
it
works
to
our
advantage
and
some
years
it
doesn't
the
second
year
in
a
row
it's
working
to
our
advantage,
which
is
kind
of
surprising,
but
you
know
we'll
take
it.
K
You,
madam
chair,
appreciate
it
and-
and
you
did
as
well
addressed
the
340b
program
in
the
reductions
they're
in.
K
I
just
want
to
get
some
assurances,
and
I
know
what
your
answer
will
be,
but
I
just
want
to
make
sure
that,
as
we're
looking
to
to
have
some
alterations
and
potential
cuts
to
the
340b
reimbursement
plan,
I
want
to
make
sure
that
ensure
that
patients
are
still
receiving
the
medications
that
they
need.
I
know
what
the
answers
will
be,
but
I
just
want
to
get
have
that
conversation
with
you
as
we
talk
about
this
program.
J
Yes,
absolutely
so
we
we
will
continue
to
provide
the
medications,
of
course,
we're
responsible
for
the
ten
care
membership,
and
you
know
by
law.
We
we
have
to
provide
those
medications,
those
medically
necessary
medications.
We
will
continue
to
do
that.
D
Thank
you,
madam
chair
good
afternoon.
Thank
you
all
for
being
here
today.
My
question
centers
around
fraud,
waste
and
abuse.
I
noticed
in
y'all's
budget
1.7
million
dollars
in
reductions
from
savings
that
were
related
to
limiting
over
utilization
and
reducing
fraud,
waste
and
abuse,
and
I
was
curious
how
you
do
you
track
and
measure
the
amount
of
fraud,
waste
and
abuse,
and
what
policies
did
you
implement
to
generate
these
savings.
J
L
Madam
chair
members
of
the
committee,
my
name
is
william
aaron.
I
have
the
privilege
of
serving
as
the
chief
operating
officer
for
the
division
of
tenncare.
It's
good
to
be
with
you
today,
so
happy
to
talk
about
fraud,
waste
and
abuse,
so
we
have
as
a
state
a
very
good
infrastructure
to
address
and
investigate
and
identify
and
root
out
right
fraud.
Waste
and
abuse
are
part
of
that.
We
don't
own,
all
of
it
right
and
elsewhere
in
the
department
of
finance
administration.
L
There's
the
office
of
the
inspector
general
right
who
that
focuses
on
individual
members
and
their.
You
know:
potential
fraud,
waste
interviews
in
the
program.
Our
focus
is
on
providers
right,
and
so
we
have
actually
two
teams
that
work
together
in
our
organization,
one
that
basically
just
looks
at
the
data
and
the
other
that
actually
goes
in
and
does
the
heavy
lifting
and
does
the
work
to
put
the
evidence
together.
Those
two
work
very
closely
together
to
identify
items
where
again,
we've
got
significant
potential
for
fraud,
waste
and
abuse.
L
L
This
isn't
all
of
it
right,
but
certainly
the
kinds
of
things
that
we're
talking
about
we're
seeing
for
orthotics
that
there
are
there
are
patterns
of
overpayments
right,
so
we're
moving
to
actually
look
at
invoice
costs
and
actually
pay
invoice
costs
so
that
we're
not
overpaying
for
orthotics
kind
of
a
similar
issue
around
breast
pumps
right.
L
We
want
to
make
sure
that
what
we're
paying
is
fair
and
appropriate,
but
not
inappropriate,
and
where
we
see
instances
of
that,
we
can
identify
that
deal
with
those
controls
and
remove
that
cost
from
our
budget
on
recurring
basis.
In
past
years,
we've
had
similar
examinations
that
have
looked
at.
For
example,
if
you
walk
into
a
walgreens
or
any
drug
store,
not
not
pushing
walgreens
right,
you
can
find
what's
called
a
tens
unit.
Some
of
you
may
have
used
them.
L
They
just
stimulate
little
electrical
stimulant
pads.
You
can
buy
them
over
the
counter.
We
were
paying
multiples
of
that
cost
through
tenncare
and
put
a
policy
in
place
that
that
was
not
what
we
wanted
to
do
right
that
wasn't
appropriate,
given
the
fact
that
it's
widely
available
on
the
market
for
the
identical
product.
So
it's
something
that
you
know
we
we
pursue.
I
mean
we're
doing
every
day
of
the
year
that
we're
working
looking
at
fraud,
waste
and
abuse
and
identifying
that
and
very
pleased
to
be
able
to
bring
an
item
like
this.
G
Thank
you,
madam
chairman,
and
director
smith,
good,
seeing
you
and
your
team
and
one
of
my
favorite
constituents
out
there
miss
gillinsworth
and
mr
aaron
good,
seeing
you
and
I
just
want
to
com.
First
of
all,
I
want
to
compliment
you
and
your
team
for
being
proactive
on
making
sure
that
kate,
the
katie
beckett
waiver
was
ready
to
hit
the
ground
running
when
approved
by
the
federal
government.
G
You
all
did
a
great
job,
you
and
your
entire
team,
and
I
just
really
want
to
tell
you
how
much
that
is
meant
to
so
many
families
across
tennessee,
y'all
y'all
hit
a
home
run
on
that
one,
okay
and
but
my
question.
It
has
to
do
with
ecf
choices
in
this
year's
budget.
11
million
dollars
to
enable
tenncare
to
enroll
additional
300
individuals
into
the
ecf
choices
program
the
last
year
and
it
didn't
get
it
was
requested,
but
I
don't
think
it
was
fun
or
it
was
not
fun.
G
It
was
35
million
for
a
100
slots
for
those
individuals
in
the
greater
levels
of
need.
You
know
levels
or
excuse
me,
group,
seven
and
eight
and
200
slots
for
people
on
the
waiting
list,
and
I
have
three
questions.
The
first
one,
mr
director,
is
how
many
people
in
groups
seven
and
eight,
are
currently
being
served
in
this
program.
G
J
Fine,
I
do
think
the
the
crisis
slots,
though
last
year
those
those
did
stay
in
the
in
the
budget,
didn't
they
yeah
yeah.
So
the
crisis,
thoughts
that
you
mentioned
in
last
year's
budget.
We
were
able
to
keep
those,
so
we
we
did,
those
were
funded
and
then
every
year
we
have
additional
slots
where
these
individuals
are
deemed
in
crisis
and
we
we
bring
them,
we
bring
them
on,
and
but
patty
can
speak
more
to
that
specifically.
I
Thank
you,
representative
whitson
patty
killingsworth,
I'm
the
chief
of
long-term
services
and
supports,
and
it's
good
to
see
you
and
I
appreciate
the
question
groups,
seven
and
eight,
which
you
referred
to,
and
I
sure
you
know
this,
but
just
for
the
benefit
of
folks
who
may
not
are
groups
that
are
targeted
to
serve
people
who
have
intellectual
and
developmental
disabilities
and
very
significant
or
complex
behavioral
health
needs.
I
Those
groups
currently
can
serve
up
to
50
people
each.
I
believe
group
8
is
almost
full.
I
think
it
has
around
45
people.
Group
7
is
maybe
around
35
people,
so
not
a
lot
of
people,
but
we
we
intended
that
the
populations
in
those
groups
would
be
really
small.
This
is
really
targeting
a
very
small
subset
of
the
population
that
has
really
challenging
needs.
G
Thank
you.
What
would
the
remaining
wait
list
look
like
if
this
11
million
dollars
increase
that
is
funded
and
what
is
the
remaining
need
for
this.
J
I
I
think
representative
you
may
be
referring,
so
I
think
we're
talking
about.
Maybe
two
different
groups:
we've
got
these
crisis
lots,
but
but
then
last
year
in
the
budget
we
also
were
very
excited
because
we
had.
We
have
a
waiting
list
of
about
4
000
individuals
that
are
awaiting
services
and
we
were
able
to
initially
fund
about
2
000
of
that
waiting
list
and
then,
when
the
pandemic
hit.
G
And
has
the
as
the
katie
beckett
program
enrollment
impacted
any
of
these
categories
or.
I
It's
a
great
question,
representative
whitson.
We
did
send
letters
to
any
children
under
age
18
who
didn't
have
medicaid,
who
were
on
the
waiting
list
for
employment
and
community
first
choices,
so
there
were
some
of
those
children
who
were
actually
able
to
enroll
in
the
katie
beckett
program
that
that
waiting
list
has
gone
down
a
little
bit
as
a
result
of
that
program.
Opening
up
many
of
the
people
on
the
waiting
list
are
actually
adults,
though.
B
And
just
to
follow
up
to
that,
we
have
this.
You
know
fairly
enormous
waiting
list.
B
What
kind
of
funding
would
it
require
to
take
move
those
people
from
waiting
list
of
funding,
and
is
it
even
possible
to
do,
and
just
in
light
of
the
resources
and
the
people
that
would
have
to
be
added.
I
B
The
neighborhood
of
75
million
we'll
do
the
math
and
that
would
be
recurring
expense,
okay,
correct,
so
it's
a
significant
held
to
climb.
I
just
want
to
make
that
point,
but
we
do
have
4
000
tennesseans,
who
are
both
in
need
of
the
services
and
qualified
for
the
services
that
we
are
not
currently
serving.
So
all
right.
Next,
on
the
list
representative
lamar.
H
H
What
metrics
would
you
use
to
determine
if
the
pilot
is
successful
and
if
so,
do
you
anticipate
and
requesting
that
this
is
reoccurring?
Funds
for
the
program,
yeah.
J
So
I
I'll
just
start
out
and
then
I'll
turn
it
over
to
doctor
who
can
speak
about
the
the
the
medical
evidence
related
to
this?
I
would
say
I
mean
we
we're
very
confident
this
is
this.
Is
we
think
that
there
is
a
need
we're
looking
initially
at
what?
But
I'll
I'll
turn
this
over
to
victor,
and
he
can
speak
more
to
this.
M
Hello:
everyone,
my
name,
is
victor
wu,
I'm
the
chief
medical
officer
at
tencare
thanks
so
much
for
the
question.
This
is
certainly
something
we
are
really
passionate
about
at
ten
care,
given
the
fact
that
we
serve
nearly
fifty
percent
of
all
pregnant
mothers
in
the
state,
we
know
we
have
a
really
outsized
role
in
making
sure
that
our
moms
have
good
health
care
and
have
good
access
to
health
care
and
they
have
good
health
outcomes.
M
So,
in
terms
of
evaluation,
we
certainly
believe
strongly
that
this
would
be
beneficial
to
the
mom
and
to
the
infant.
We
know
that
infants,
where
their
mothers
have
health
insurance
oftentimes
end
up
coming
in
for
their
well
child
visits
or
screening
more
frequently,
and
so
we
definitely
think
we
look
outcomes
for
both
the
mom
and
the
baby.
Some
of
those
outcomes
are
exactly
what
I
just
said
on
the
baby
side.
We
want
to
see,
you
know,
are
they
coming
for
screening?
Are
we
detecting
potential
issues
for
them
early?
Are
they
getting
their
vaccinations?
M
Are
they
getting
their
well-child
visits
and
for
the
mother's
side
we
want
to
look
at.
You
know
continuous
coverage.
We
want
to
look
to
see
if
they're,
following
up
for
their
postpartum
visit,
we
want
to
look
to
see
if
they're
getting
screened
for
depression,
a
lot
of
the
services.
We
know
that
some
of
our
vulnerable
mothers
can
experience
in
the
year
after
delivery.
H
J
H
J
Let
me
turn
this
over.
To
victor
I
mean,
I
think
the
answer
would
be
that
first,
we
would
have
to
choose
as
a
as
a
tent
care
entity
to
cover
that
service
and
then,
if
we
did
potentially
that
could
be
covered
as
part
of
this
12
months.
But
victor
you
want
to
add
anything
to
that.
Yeah.
M
Thanks
for
that,
we
certainly
have
been
tracking
and
looking
at
the
research
around
doulas
for
our
programs.
All
of
our
health
plans
are
always
interested
in
finding
opportunities
to
help
support
our
mothers
and
several
of
our
our
mcos
have
started
to
partner
with
community
health
worker
organizations
and
and
those
types
of
opportunities.
So
I
think
at
this
time
the
the
dollars
and
the
way
that
the
bills
are
in.
We
know
there
will
be
health
care
services
first
and
foremost
that
we
must
meet.
M
We
need
to
make
sure
that
our
mothers
who
are
screened
for
depression
can
go
see
a
mental
health
provider.
We
know
that
our
mothers
who
choose
contraception
afterwards
need
to
go,
get
access
to
the
contraceptive,
that's
what
they
decide
after
they
have
a
pregnancy.
So
our
first
priority
is,
of
course,
to
serve
and
make
sure
that
the
medical
needs
of
the
of
the
mothers
met
in
the
postpartum
period
and,
as
we
continue
to
evaluate
other
potentially
promising
opportunities
like
doulas
in
the
future.
J
Well,
we
would
have
the
ability
to
to
add
that
service
if
we
did
add
it.
Of
course,
there
would
be
a
cost
to
that
and
that
would
have
to
be
part
of
the
budget.
M
One
other
thing
I'll
add
to
that
just
kind
of
as
the
the
the
opportunities
and
the
roles
of
doulas
are
still
being
kind
of
evolving
the
community.
There
are
federal
regulations
around
what
a
provider
medicaid
provider
can
be
can
be
enrolled
in
the
program.
They
have
to
be
screened,
they
have
to
be
licensed.
B
C
Yes,
thank
you
chair,
lady
commissioner.
I
just
wanted
to
say
I
think
it's
it
goes
without
saying,
but
but
I
feel
like
it's
necessary
to
say
it
here
today.
I
just
want
to
thank
the
governor
administration
for
spending
this
6.5
million
dollars.
I
know
it
was
in
the
budget
last
year
for
us
to
do
and
because
of
code
we
weren't
able
to
do
it.
C
Our
maternal
mortality
rate
and
state
is
one
that
we
don't
like
to
talk
about
it,
because
it's
not
that
good,
and
so
I'm
hopeful
that
not
only
this
five-year
pilot
will
improve
outcomes
from
others
across
the
state.
I
think
it's
really
important
for
us
to
do
that.
We
want.
We
all
want
to
care
for
our
mothers.
C
None
of
us
will
be
here
without
them
so
anyways.
We.
We
appreciate
the
hard
work
that
you're
doing
here.
I
I
would
ask
you,
though,
as
a
follow-up,
though
I
know
that
this
is
not
new
across
the
states.
I
know
a
couple
of
states
have
also
implemented
these
extensions
of
postpartum
or
services,
and
I
guess
the
question
for
me
is:
if
you
guys,
could
give
us
any
direction
as
to
what
other
states
are
doing
and
how
those
changes
have
impacted
their
states.
C
I
think
it
would
be
good
for
us
to
use
as
a
barometer
going
forward,
but
I
just
want
to
thank
you
guys
and
the
governor
for
what
you're
doing
here.
This
is
in
the
whole
scheme
of
40
some
odd
billion
dollars
6.5.
This
is
probably
one
of
the
most
important
places
we're
going
to
spend
some
money
this
year,
and
so
I
just
want
to
say
that
and
congratulate
you
and
thank
you
for
your
hard
work.
There.
Thank.
M
D
Thank
you,
madam
chair.
Thank
you,
commissioner,
for
being
here
today,
fy
2122,
the
projected
enrollment
for
access
tennessee
is
projected
at
about
88.
D
J
That
thank
you
yeah.
That's
that's
a
great
question.
I'll
have
william
jump
in
here.
If
I,
if
I
say
anything
incorrect,
but
the
way
that
that
program
works
currently
is
those
dollars
have
to
remain
in
the
access
xstn
program,
and
so
it
actually,
it
would
require
legislation
to
do
something
different
with
those
dollars.
J
You
may
recall
that,
early
on,
when
that
pandemic
hit,
we
actually
submitted
a
waiver
to
cms
to
be
able
to
utilize
state
dollars
and
get
federal
matching
dollars
to
serve
the
uninsured
population
for
treatment
and
testing
and
treatment
for
covid,
and
we
were
we
were
going
to
to
use
available
dollars
that
were
in
the
access
tn
program
for
that
purpose.
Ultimately,
a
cms
did
not
approve
that
waiver
request
and
they
set
up
another
means
by
which
uninsured
individuals
could
receive
that
testing
and
treatment,
and
so
we
didn't
need
it.
L
So
it's
I
understand
the
question
about
savings,
but
this
one
is
funded
a
little
differently
right,
and
so
it's
just
a
matter
of
spending
less
from
that
fund
every
year,
as
enrollment
declines
over
time.
F
Thank
you,
madam
chairman.
I
know
I've
seen
some
recent
news
articles
insinuating
that
somehow
another
the
shared
savings
plan
that
we
passed
and
approved
the
first
week
of
the
session
had
had
issues
somewhere
under
the
federal
government.
It
was
my
understanding
that
we're
still
the
tenncare
three
is
still
alive
and
well
we're
still
operating
under
that
and
we're
still
in
open
and
good
faith
negotiations
with
our
federal
counterparts
to
make
sure
those
those
shared
savings
are
utilized
for
tennesseans.
How
is
how
is
that?
F
J
J
As
I
said
when
we
discussed
this
back
in
january,
there
was
there's
really
nothing
that
we
had
to
do
from
a
day-to-day
perspective
to
get
going
on
this.
So
once
it
was
approved,
we're
go,
we're
we're
a
go
and
there's
nothing.
That's
happened
at
the
federal
level
that
has
changed
that
in
any
way,
there's
been
a
lot
of
misinformation
about
this
letter
that
came
from
the
new
administration,
that's
related
to
1115
waivers,
which
we
have
an
1115
waiver,
but
it
has
no
impact
on
tenncare
3
or
our
shared
savings.
L
D
J
M
Thanks
thanks
for
the
question,
I
I
something
that
I
think
the
state
has
taken
very
seriously
ever
since
in
in
across
multiple
seas
and
in
partnership
with
this
body
as
well.
As
you
know,
starting
the
tennessee
together
legislation
we've
seen.
Finally,
some
really
positive
trends.
We've
seen
as
director
smith
mentioned,
decreases
in
our
our
neonatal
abstinence
syndrome.
Babies
nas
from
those
of
you,
may
not
be
familiar.
M
Those
are
children
who
have
been
exposed
to
opioids
during
the
pregnancy
and
are
exhibiting
signs
of
withdrawal
when
they're
born
and
we've
seen
tremendous
decreases
over
the
last
three
years,
tinker
hasn't
hasn't
in
this
place
as
well.
In
outsized
role,
we
cover
nearly
95
of
all
the
birds
that
end
up
being
born
babies
being
born
of
nass
after
they're
delivered,
and
so
we
know
we
have
a
really
important
role
to
play.
We're
I
do
think
the
pandemic
is
something
that
we
are
watching
very
closely.
M
We
started
to
see
the
opioid
overdose
numbers
start
to
flatline
and
actually
increase
in
the
last
year,
and
you
know
diseases
of
isolation,
diseases
that
despair
as
people
call
them
have
really
been
exacerbated
as
part
of
the
pandemic,
and
so
we
know
that
this
coming
year,
there
may
be
some
kind
of
flattening
of
that
curve,
or
hopefully
we're
not
going
to
see
an
increase.
But
I
think
that
is
a
reality
of
what
happens
when
the
our
state
is
going
through
such
a
public
health
crisis
and
so
we're
keeping
a
close
eye.
M
We
continue
all
the
efforts
we've
done
around
increasing
access
to
treatment
to
evidence-based
medication,
assisted
therapy.
We
make
sure
that
our
women
get
outreach
early
on
to
get
the
supports,
that
they
need
to
see
their
primary
care
providers
and
we're
really
proud
of
the
work
that
we've
done,
but
the
the
race
is
not
over
yet
we're
still
doing
as
much
as
we
can.
Thank
you,
representative,.
J
William
is
telling
me
that
the
cost
for
nas
births
is
three
and
a
half
times
the
typical
birth,
so
it's
substantial.
Okay!
Thank
you.
D
Thank
you,
madam
chairman,
hello,
director.
How
are
you
hi?
I
wanted
to
ask
you
a
question
to
federal
funding
sources
on
the
questions
that
we
sent
you.
I
was
just
curious.
It
says
here
that
we.
D
And
then
in
20
I
guess
we
received
113
million,
that's
quite
a
difference
and
I
was
just
wondering
why
the
difference.
I
know
we
pull
these
questions
out,
but
I
was
just
wondering
why
there
was
such
a
lesser
amount
spent.
L
Yeah
representative,
it's
good
to
see
you
so
the
part
of
what
is
going
on
there
is
changes
in
the
federal
match
rate.
You
know
as
one
of
the
part
one
of
the
provisions
of
the
affordable
care
act,
which
was
seems
like
a
long
time
ago
now,
right
back
in
in
2013
it
it
changed
the
and
enhanced
the
the
rate,
and
then
that
got
extended,
and
so
that
has
moved
those
numbers
around
in
terms
of
what
we've
anticipated
part
of.
L
It
also
is
just
that,
as
we
have,
you
know,
brought
re-verification
back
in
to
ensure
that
we're
meeting
federal
requirements
in
both
medicaid
and
chip
and
only
those
people
who
are
supposed
to
be
on
the
program
or
on
the
program
that
you
know
we
have
been
actually
spending
less
in
some
areas.
So
it's
a
combination
of
those
two.
H
Thank
you,
madam
chair.
Thank
you,
commissioner
question
about
tenncare
doing
the
covet
19
responses
last
year.
Were
we
able
to
adapt
our
services
telehealth
telemedicine
and
how
well
did
we
perform?
You
know
from
you
know
our
staff
maybe
going
to
alternative
workstations,
and
could
you
just
kind
of
tell
us
a
little
bit
about
you
know
how
tenncare
was
able
to
adapt
to
the
changes
during
covert
19.
J
Sure,
but
thank
you
for
the
question
we.
I
don't
think
it
would
come
as
a
surprise
to
anyone
to
to
know
that
we've
really
focused
on
our
response
to
the
pandemic.
Over
the
last
year,
it's
been
such
a
big
part
of
the
work
that
we've
done
so
part
of
that
was.
It
relates
to
flexibilities
that
we
have
provided.
Telehealth
is
a
really
good
example.
There
we
expanded
almost
all
of
our
professional
services
via
telehealth,
so
that
members
could
receive
that
care
via
telehealth
in
their
homes.
J
J
We
know
that
utilization
was
was
down,
especially
when
the
pandemic
hit,
and
so
what
you
see
on
the
screen
there.
It's
it's
comparing
two
points
in
time:
19
or
2020
versus
2019,
and
so
the
first
column
there.
J
You
see
what
happened
initially
when
the
pandemic
hit,
and
you
see
some
pretty
sharp
decreases
in
utilization
and
then
in
the
later
months
you
see
the
progress
that
has
been
made
and
that's
due
to
some
pretty
significant
efforts
on
the
part
of
our
managed
care
organizations
and
our
providers
to
coordinate
care
for
our
members
and
the
one
that
I'll
point
to
is
the
pediatric
well
child
visits.
H
Thank
you
for
that.
I
guess
that
was
going
to
be
my
question
about
whether
the
participants
were
utilizing
the
services
more,
but
I
think
this
answers
that
question
so
thank
you,
mr
commissioner
and
madam
chair.
B
Thank
you,
leader,
kemper
director,
we
have
had
a
a
number
of
questions
and
I've
just
started
getting
those.
Today
from
some,
I
have
a
safety
net
hospital
that
serves
my
region.
There
are
number
of
rural
hospitals
in
the
state
and
there's
some
changes.
B
So
there's,
as
I
said,
there
are
a
number
of
questions
and
we
might
talk
about
a
couple
of
them
today,
as
we
begin
to
hear
more
from
our
friends
in
the
our
providers
and
how
this
impact
is
because
they
seem
to
think
they're
looking
at
a
significant
shortfall,
we
may
want
to
have
a
deeper
dive
with
in
our
appropriations
subcommittee
or
at
some
other
point,
but
the
language
in
the
budget
for
the
340b
program
says
that
there's
a
reduction
in
the
program's
expenditures
and
it
states
that
the
change
is
being
made
to
recognize
savings
and
ensure
federal
compliance.
B
You
mentioned
that
the
feds
have
maybe
changed
some
of
the
rules
or
were
looking
at
things
a
bit
differently
with
this
340
b
drug
program.
So
can
you
help
us
understand
what
these
savings
are
and
then
you
know
the
changes
that
you're
looking
at
making
that
perhaps
may
adversely
affect
our
hospitals?
B
Are
they
which
ones
are
required
by
the
federal
changes
and
which
are
those
that
tenncare
is
just
choosing
to
make
in
your
view,
is
the
best
interest
for
the
state,
but
we
may
have
a
different
viewpoint
on
that,
but
if
you
could
just
share
that
with
us,.
J
Sure
glad
glad
to
do
that
appreciate
the
question
and
340b
is.
It
is
very
complex
and
I've
spent
I've
spent
an
inordinate
amount
of
time
trying
to
trying
to
learn
about
340b
over
the
past
several
months.
So
the
the
savings
are
they
they
they
come
in
two
buckets,
so
the
first
bucket
is
it
results
from
rebates
that
we
are
able
to
collect
through
the
medicaid
rebate
program.
J
The
the
challenge
that
we've
had
is:
we
have
been
unable
to
collect
the
information
to
know
when
a
340b
entity
has
been
has
been
supplying
a
340b
drug
to
a
medicaid
member
and
because
there's
a
prohibition
on
duplicate
discounts.
What
that
means
is
we've
just
we
haven't
been
able
to
submit
rebates
for
any
340b
or
any
three
any
drugs
provided
to
medicaid
members
from
a
340b
entity.
J
So
what
we're
proposing
to
do
here
is
one
we're
just
going
to
collect
the
information
from
the
providers
so
that
they
will
have
to
document
to
us
when
they
are
providing
a
340b
drug
to
a
medicaid
member.
What
that
will
allow
us
to
do
is
if
it's
not
a
340,
if
they,
if
it's
not
a
340b
drug,
then
it's
easy.
J
We
just
collect
the
rebate
and
there's
no
impact
on
the
provider,
no
financial
impact
on
the
provider
if
it
is
a
340b
drug,
what
we're
proposing
to
do
is
to
pay
no
higher
than
the
ceiling
price
for
that
drug.
That's
been
negotiated
at
the
federal
level
and
the
reason
that
we
want
to
do
that
is
because,
if,
if
we're
paying
higher
than
the
340b
ceiling
price,
then
we
are
not
getting
a
discount
because
we
can't
collect
the
rebate
under
the
medicaid
rebate
program.
J
So
it's
negating
the
very
benefit
that
we
are
supposed
to
achieve
through
the
medicaid
rebate
program,
and
also
just
you
know,
thinking
about
it.
Philosophically
we
are
a
state
taxpayer-funded
insurance
entity
and
for
us
to
pay
higher
than
a
price.
That's
been
negotiated
by
another
taxpayer
funded
government
entity,
it
just
seems
it
seems
counterintuitive,
so
I
don't
think
there
was
ever
any
intent
at
least
from
what
we
can
tell.
J
There
was
never
any
intent
when
congress
created
the
340b
program
to
negate
the
benefit
of
the
of
the
medicaid
rebate
program,
because
both
of
those
programs
are
supposed
to
represent
the
manufacturer's
best
price,
the
pharmaceutical
company's
best
price
for
the
drug.
I
know
that
gets
really
complicated
to
your
question
about
what
is
required,
what's
required
federally
and
what
is
not
so
it
is
required
that
we
collect
all
the
rebates.
So
at
a
minimum,
we've
got
to
collect
the
information
so
that
we
can
collect
the
rebates.
If
it's
not
a
340b
drug.
J
The
other
piece
is
more
complicated
for
the
ceiling
price.
So
at
the
federal
level,
fee-for-service
medicaid
programs
are
prohibited
from
paying
higher
than
the
ceiling
price.
That's
not
the
case
yet
for
managed
care
programs.
We
are
a
managed
care
program,
so
it's
not
a
federal
requirement
for
us
yet
that
we
pay
no
higher
than
the
ceiling
price
for
the
340b
drug.
We
just
think
it's
the
right.
It's
the
right
policy,
because
if
we
do
pay
higher,
then
we
are
not
getting.
We
are
not
getting
the
discount
as
the
medicaid
program.
B
And
I
won't
pretend
that
unders
to
say
that
I
understand
all
that,
but
I
do
think
I
hear
you
saying
that
these
rules
don't
currently
apply
to
us
because
it's
managed
care
environment
and
I
also
hear
what
you're
saying
about
you
know.
We
want
to
be
good
stewards
and
we
want
to
get
the
best
prices
that
we
can
and
that's
great.
In
theory.
B
I
think
my
concern
is
the
the
practical
implementation,
because
a
lot
of
our
rural
hospitals,
I
think,
are
depending
on
these
340b
dollars
that
they
have
been
collecting
and
then
they've
been
using
that
to
provide
services
for
the
folks
who
come
into
them.
That,
don't
you
know,
are
indigent,
do
not
have
insurance,
don't
have
a
means
of
payment.
So
if
we
take
away
that
mechanism,
it's
going
to
be
a
big
hole
for
a
safety
net
hospital
like
the
one
in
my
region,
but
in
a
big
number.
B
It's
not
going
to
be
such
a
big
number
for
some
of
these
rural
hospitals,
but
it
is
going
to
be
a
big
part
of
their
budget,
and
you
know
they're
already
under
stress
in
in
many
ways
a
lot
of
those
rural
hospitals
are
keeping
their
doors
open
just
almost
on
a
day-to-day
basis.
So
I
would
you
know
we
it's
raining
money,
as
we
all
know
from
the
federal
government
at
this
time,
and
we,
I
just
think
maybe
it
might
be
a
time
for
us
to
before
we
take
this
action.
B
We
might
step
back
and
take
a
look
at
what
the
impact
is
going
to
be
the
full
impact
on
our
hospitals
and
our
providers
across
the
state.
So
I'm
just
throwing
it
out
there.
We
can
certainly
have
further
conversation
about
that,
and
I
know
I
think
the
providers
are
just
finding
out
about
this
and
are
just
in
the
process
of
trying
to
really
see
how
it's
going
to
impact.
B
But
if
the
impact
is
going
to
be
as
negative
as
it
appears
to
be
on
the
front
end,
then
I
I
think
that
we
may
have
an
issue
that
that
we'll
have
to
deal
with
and
one
way
the
other.
These
patients
still
have
to
be
served,
and
you
know
we
are
required
to
do
that.
So
it's
pay
here
or
pay
there
pay
now
or
pay
later,
but
the
state
is
going
to
pay
and
I
think
we
just
maybe
need
to
have
some
more
conversation
about
the
best
way
to
do
that.
B
L
B
I'm
think
we
can
be
proudest
tennesseans
of
the
work
that
your
department
does,
but
for
all
of
us
we
can
always
do
more
and
do
better,
and
so
that's
that's
all
that
we
are
concerned
about
doing
because
we
still
have.
Unfortunately,
we
still
have
citizens
in
the
state
who
need
services
that
we're
not
able
to
provide
so
we're
just
we're
just
trying
to
get
there
and
get
them
those
services.
But
thank
you
for
all
that
you
do
and
with
that
we're
back
in
session
and
we
will
stand
adjourned.