►
Description
House Finance, Ways, & Means Committee- February 22, 2022- House Hearing Room 1
A
A
A
A
A
A
A
A
Thank
you,
madam
clerk.
We
have
six
bills
on
our
calendar
today
and
two
budget
hearings.
I
think
we'd
like
to
go
ahead
and
start
with
the
bills
and
our
first
one
on
our
calendar
item
number
one
is
house
bill,
1712
by
deputy
speaker,
johnson,
speaker,
johnson,
you're
recognized.
We
have
a
motion
on
the
bill
in
a
second
recognize
for
a
brief
description.
Thank
you.
C
Is
let
me
give
you
a
little
history
in
montgomery
county
clarksville,
we're
building
a
130
million
dollar
multi-use
event
center,
which
has
generated
a
lot
of
activity,
so
this
this
is
for
a
park
and
garage
the
land.
I
did
not
explain
this
in
the
subcommittee,
but
the
land
is
being
donated
by
a
family
in
clarksville
and
the
land
value
alone
is
7
million.
So
that's
what
it
does.
A
A
C
Bill
1688
does
it
was
brought
to
me
by
the
alcohol,
the
abc
beverage
commission
and
it's
a
common
carrier
license.
So
anyone
transporting
alcoholic
beverages
is
going
to
fall
under
this
contractor
umbrella
and
the
main
purpose
of
it
is
to
sure
compliance,
and
it
ensures
it
might
that
the
alcohol
don't
get
in
the
miners
hands
because
their
signature
is
required
and
also
to
ensure
proper
taxes
is
collected.
With
that,
I
renew
my
motion.
A
If
not,
then
we
are
voting
to
send
house
bill
1688
to
calendar
and
rules
all
in
favor,
say
aye
opposed
house
bill,
1688
moves
to
calendar
and
rules.
Thank
you
chairman.
Thank
you.
Okay.
Item
number.
Three
on
our
calendar
is
house
bill.
753
by
chairman
white
chairman
white.
You've
got
a
motion
in
a
second
you're
recognized
on
the
bill.
There
is
an
amendment
I
believe
it's
drafting
code,
013415.
A
C
Our
school
districts
are
required
pursuant
to
federal
law,
to
provide
certain
health
related
or
medical
assistance
services
within
school
facilities
such
as
physical
therapy,
occupational
therapy,
behavioral
counseling
speech
therapy
and
other
services.
Now,
failure
to
provide
these
services
could
be
have
punitive
consequences
since
their
federal
law,
but
we
don't
have
in
place
where
the
leas
are
reimbursed
when
they
provide
these
services.
The
federal
government
will
reimburse
you,
but
we
didn't
have
the
the
connection.
So
what
we
have
done
working
on
this,
we
now
have
this.
C
I
had
a
fiscal
note
last
year,
which
is
why
I
didn't
go
anywhere
behind
the
budget,
but
this
year
we
have
a
signed
letter
from
commissioner
butch
ely
that
we
have
that
they
are.
The
administration
is
going
to
fund
this
491
300,
plus
the
1900
dollars
where
it
was
figured
in
a
little
bit
for
the
first
time.
So
we
have
funding,
and
this
will
save
our
school
districts,
probably
an
estimated
60
million
dollars
that
they're
not
recouping
in
the
budget,
their
budgets
right
now.
So
with
that,
mr
chairman,
I'd
renew
my
motion.
D
Thirteen
four
one,
three,
four
one,
five
are
there
any
questions.
Question
has
been
called
seeing
the
objection,
we're
voting
on
the
amendment
all
in
favor,
please
signify
by
saying
aye
any
opposed
the
eyes
have
it
amendment
013415
is
hereby
attached
to
house
bill
753,
chairman
white,
would
you
like
to
describe
the
bill
as
amended.
D
D
D
Question
has
been
called
any
objection,
seeing
none.
We
are
voting
on
house
bill
1719
all
in
favor,
please
signify
by
saying
aye
any
opposed.
You
guys
have
it
house
bill
17,
19,
moves
on
to
calendar
and
rules.
Item
number
five
on
our
calendar
house
bill
1845
by
our
very
able
and
timely
vice
chairman
bond.
Thank
you
so
much
for
getting
the
meeting
underway.
Thank.
A
D
D
E
E
D
D
That
does
complete
our
calendar.
For
today
we
are
now
going
to
continue
our
work
with
budget
hearings
and
first
step
today
is
the
division
of
tenncare
members.
You
have.
The
documentation
is
in
on
your
dashboard,
so
feel
free
to
access
it
there
and
we
are
now
out
of
session,
and
we
will
ask
our
tenncare
friends
to
come
forward.
D
F
Thank
you
very
much,
madam
chairman
and
members.
It's
a
privilege
to
be
with
you
today.
My
name
is
stephen
smith.
I
serve
as
the
ten
care
director
to
my
left
is
zane
seals.
He
is
our
chief
financial
officer
and
then
to
my
right.
We
have
dr
victor
wu.
He
is
our
chief
medical
officer
and
then
patty
killingsworth
is
our
chief
of
long-term
services
and
supports.
F
I
know
we
are
pressed
for
time,
madam
chairman,
so
I'm
going
to
jump
right
in
before
we
get
into
the
specific
line
items.
I
do
think
it's
important
to
at
least
briefly
discuss
how
we
got
here
today
how
we
managed
to
get
to
a
place
where
we
we
can
propose
the
types
of
investments
that
we
are
bringing
forward
today,
because
they
really
are
remarkable
investments
and
and
the
story
that
we
have
it's
it's
an
important
story.
It's
a
cautionary
story
and
it's
a
guide
for
our
future
success.
F
I
always
try
to
center
our
conversations,
both
internal
and
external,
on
our
mission
and
that
is
to
improve
lives
through
high
quality,
cost-effective
care,
because
as
a
state
and
as
an
agency,
a
medicaid
agency,
we
have
to
be
successful
in
both
things
that
cost-effective
piece
and
also
that
quality
piece,
sometimes
unfortunately,
in
the
medicaid
world
there
is
this
accepted
narrative
that
that
cost-effective
piece
must
come
at
the
expense
of
quality
and
access,
and
that's
actually
not
the
case.
We've
proven
as
a
state
that
the
two
actually
go
hand
in
hand.
F
I
would
argue
that
they
are
dependent
upon
one
another.
Controlling
cost
growth
through
appropriate
measures
means
that
we
can
provide
more
services
and
serve
more
people,
and
we
can
do
it
without
breaking
the
state
budget,
and
that
budget
piece
is
a
very
real
concern.
We've
come
a
long
way
in
our
medicaid
program,
but,
as
we
have
talked
about
with
this
committee
before
it
really
wasn't
that
long
ago,
when
double-digit
growth,
trends
threatened
the
very
existence
of
our
tenncare
program,
and
I
bring
that
up,
because
sometimes
people
will
say
to
me.
F
If
you
really
believed
in
your
mission,
you
would
simply
cover
more
people
and
you
would
cover
more
services
and
you
would
pay
more
for
those
services,
but
the
reality
is,
of
course
nothing.
Is
that
simple,
and
one
of
the
reasons
for
that
is
because
of
the
impact
that
the
tenncare
budget
has
on
the
overall
state
budget.
F
As
you
all
are
well
aware,
tank
care
makes
up
a
third
of
the
overall
state
budget.
So
what
that
means,
then,
is
that
if
we
are
unable
to
control
costs
to
a
reasonable
level,
there
won't
be
any
funds
left
over
for
other
state
priorities
and
the
record
k
through
12
education,
improvements
that
are
in
this
proposed
budget.
F
When
we
think
about
our
improvements
for
this
next
fiscal
year,
we
group
them
into
three
categories:
people
benefits
and
providers.
So
I'll
start
with
people,
this
budget
will
increase
the
number
of
individuals
that
are
served
by
tenncare
in
a
targeted
and
responsible
manner.
It
recommends
nearly
100
million
dollars,
combined
state
and
federal
funding
to
serve
more
than
2
000
people
in
additional
people
in
our
employment
and
community
first
choices
program
that
reduces
the
waiting
list
by
more
than
half.
F
F
This
increase
will
specifically
focus
on
providing
services
in
the
home
for
those
at
risk
of
institutional
care,
allowing
these
enrollees
to
live
as
independently
as
possible,
and
the
second
piece
is
part
of
our
medicaid
alternative
pathways
or
maps
program,
which
is
something
the
governor
highlighted
in
his
state
of
the
state,
something
that
we
are
really
excited
about.
I
said
earlier
we're
targeting
our
resources
in
a
responsible
manner.
F
Next,
I'm
going
to
shift
to
benefits
this
budget
will
provide
greater
benefits
and
services
to
tenncare
members.
Most
notably,
we
are
proposing
a
historic
enhancement
that
will
provide
a
dental
benefit
to
all
adults
on
tenncare,
that's
more
than
600
000
adults
who
will
now
be
eligible
for
dental
services.
F
For
example,
in
the
most
recent
completed
year,
where
we
have
data,
we
spent
more
than
10
million
dollars
on
emergency
room
costs
related
to
dental
and
oral
health
issues.
So
we
would
expect
those
expenses
to
come
down
once
we
implement
this
benefit,
and
then
I
want
to
be
sure
to
highlight
our
health
starts
initiative,
which
is
a
25
million
dollar
investment
to
address
non-medical
risk
factors
that
have
an
outsized
impact
on
driving
poor
health
outcomes.
F
This
budget
increases
payments
to
providers
in
a
in
a
big
way,
and
I
I
really
can't
say
enough
about
our
10
care
providers.
They
have
been
under
tremendous
stress
and
strain,
as
you
all
know,
and
they
have
remained
committed
to
our
tenncare
population
in
the
state
of
tennessee.
When
we
talk
about
access
and
quality,
it's
our
providers
that
deserve
the
credit
recognizing
the
workforce
challenges
that
many
of
our
providers
are
facing
and
also
the
previously
mentioned
investments
to
serve
more
people
and
to
add
services.
F
This
budget
provides
nearly
100
million
dollars
to
support
wage
increases
for
our
front
line,
direct
service
professionals
working
in
our
home
and
community-based
services
programs
that
will
bring
up
that
wage
to
the
1375
which
you
all
have
talked
about.
I
know
there's
a
lot
of
discussion
last
year
with
the
department
of
intellectual
and
developmental
disabilities.
F
And
then
we
will
reinvest
those
funds
back
into
the
tenncare
program
and
the
benefits
and
services
that
we
provide
to
ten
care
members.
So
the
very
kinds
of
investments
that
we
just
talked
about.
This
is
how
we
are
able
to
do
that.
As
we
said
all
along
ten
care,
three
is
about
more,
it's
not
about
less,
so
I'm
convinced
more
than
I
ever
have
been
that
this
waiver
is
good
for
tennessee.
It's
good
for
the
people
that
we
serve
at
the
end
of
the
day.
F
It's
about
improving
health
which
drives
down
healthcare
costs
which
results
in
shared
savings
which
results
in
a
reinvestment
of
those
savings
back
into
the
program
which
improves
health,
and
so
the
cycle
starts
all
over
again
with
that.
I'm
chairman
that
completes
my
prepared
remarks
again
very
happy
to
be
here
and
we're
happy
to
stand
for
questions
or
comments.
D
G
I
appreciate
all
the
work
that
you
do
and
you
know
you
and
I
have
had
long
conversations
about
the
choices
program
and
if
we
could
go
down
the
road
there,
I'm
gonna
refer
back
to
slide
three
that
you've
been
showing
to
us,
and
I
guess
I
want
to
know
the
differences
at
the
moment
between
ecf
choices,
and
I
don't
know
if
there's
a
more
traditional
choices
program
and
are,
is
everything
ecf
or
or
are
there
two
different
buckets
of
money
that
we're
looking
at
there?
First.
F
H
Thank
you,
madam
chair.
Patty
killings,
our
chief
of
long-term
services,
and
supports
with
ten
care
I
apologize.
The
choices
program
is
the
program
that
serves
older
adults
and
adults
with
physical
disabilities.
It
is
delivered
through
our
managed
care
program
and
then
the
employment
and
community
first
choices
program
serves
individuals
with
intellectual
and
developmental
disabilities.
H
There
are
some
benefits
that
are
the
same
between
those
programs,
but
there's
also
differences
which
really
recognize
the
fact
that
different
populations
sometimes
need
different
types
of
services.
Same
for
the
provider
network.
We
have
some
providers
who
participate
in
both
programs
and
some
who
only
participate
in
in
one
or
the
other.
Are
there
specific
other
questions
that
you
have
about
that?
That
might
be
helpful
chairman.
D
G
We've
got
some
folks,
some
some
businesses
that
have
set
up
across
the
state
of
tennessee
and
are
trying
to
provide
services
to
our
older
adults,
who
may
not
essentially
trying
to
keep
them
out
of
a
nursing
home
type
setting,
and
there
have
been
wage
concerns
much
like
in
other
areas
where
we
have
done
some.
Some
good
work
chair,
lady
hazelwood,
in
particular,
with
with
our
direct
service
providers
in
in
areas
there
and
we're
at
a
similar
challenge
with
our
companies
that
are
providing
these
services
and
the
wages
that
they're.
G
H
H
You
may
recall
that
this
body
appropriated
funding
to
raise
that
frontline
wage
to
an
hour
the
recurring
funds
to
do
the
same
thing
in
choices
and
employment
and
community
first
choices
is
the
first
50
million
dollars
of
that
100
million
that
director
smith
spoke
of.
We
have
actually
already
made
those
rate
increases
using
federal,
arp
funding
that
was
targeted
specifically
for
home
and
community-based
services.
They
were
retroactive
effective
to
july
1
of
2021..
D
D
H
Thank
you,
madam
chair,
another
really
good
point,
and
we
have
again
tried
to
follow
the
good
path
laid
out
by
this
body
in
terms
of
requiring
both
an
attestation
from
the
provider
that
they
will
in
fact
make
sure
that
those
funds
are
passed
through
the
front
line
workforce
and
we've
established
audit
processes.
To
also
monitor
that,
on
an
ongoing
basis.
D
And
one
follow-up
other
follow-up
on
choices
when
you
were
with
us
earlier
last
year,
but
earlier
in
this
cycle
we
had
a
question
about
wait,
lists
and
choices,
and
I
believe
we
were
told
that
there
was
no
one.
You
know
there
was
no
wait
list
for
choices,
but
in
subsequent
conversation
I
found
out
that
while
there
might
not
be
a
wait
list,
people
were
in
the
choices
program,
but
they
were
not
getting
services
and
that
had
to
do
with
you
know:
personnel
shortages
and
all
those
things.
H
H
D
B
Thank
you,
madam
chair
director,
good
to
see
you
thank
you
to
you
and
your
team.
Actually
actually
ashley
was
helping
with
the
issue
this
morning.
You
guys
are
always
extremely
responsive.
We
appreciate
that
question.
We've
been
talking
about
esf,
ecf
choices
and
the
wait
list,
so
I
believe
you
guys
are
gonna,
receive
roughly
146
million
dollars
in
art
funds
to
address
the
ecf
choices.
Wait
list
also
with
some
workforce
development
issues.
Those
funds
are
only
available
until
march
of
24,
I
believe,
which
will
create
a
49
million
dollar
nugget
to
cover.
B
F
Thank
you
for
the
for
the
question
and
the
the
comments
about
our
about
our
team,
so
this
budget
actually
commits
state
funding
to
pick
up
those
federal
dollars
once
the
arp
dollars
expire.
So,
for
example,
on
on
line
item
number
eight
you
see
the
workforce
development
initiative,
that's
that
first
50
million
that
we
actually
have
already
implemented
through
the
arp
dollars
that
were
specifically
designated
for
home
and
community
based
service
programs.
F
So
we
had
to
use
them
for
these
types
of
programs,
but
you
see
the
zero
on
the
state
because
we've
got
those
arp
dollars
it
then,
but
the
state
dollars
are
committed
so
that
once
they
run
out
the
state
dollars
will
pick
up
the
the
federal
portion.
That
is
right
now
covering
the
state
share.
So
that's
accounted
for
in
the
budget.
E
E
E
E
F
F
E
E
F
Well,
if
I
mean
I
guess,
there
is
a
scenario
where
the
protest
committee
could
rule
in
favor
of
the
protester
and
we
may
have
to
do
another
procurement.
I
don't
believe
we
would
have
to
come
forward
depending
on
the
it's
hard
it's
hard
for
me
to
predict.
I
don't
think
we'd
have
to
come
forward
and
ask
for
additional
dollars.
E
F
Well,
I
think
right
do
you
want
to.
I
may
defer
to
our
cfo
here
because
there's
a
maximum
liability
question
on
these
contracts
and
I
think
we're
within
our
our
range.
So
I
don't
see
a
scenario
where
we
would
have
to
where
we
would
have
to
come
back
to
this
body
and
ask
for
additional
dollars
in
the
immediate
future.
But.
G
F
G
Sills,
I'm
the
chief
financial
officer
at
tenncare.
I,
the
money
that
flows
through
the
mco
contracts
is
part
of
our
managed
care
line
item
in
our
budget.
You
see
that
represented
in
our
trend.
Ask
that
we
bring
before
you
every
single
year
and
it's
here
in
the
list
of
cost
increases
as
well.
I
don't
really
see
a
scenario
in
which
switching
one
mco
out
for
another
would
really
impact
that
trend
we've
already.
G
F
E
E
F
In
in
recent
years-
and
they
have
been
the
same
three
mcos-
there
was
a
period
in
tenncare's
past
where
we
had
many
more
mcos,
and
when
I
was
talking
earlier
about
how
the
tenncare
story
is
a
cautionary
story,
we've
learned
a
lot.
Tennessee
was
a
leader
in
managed
care,
one
of
the
first
states
to
to
go
all
in
on
managed
care.
So
we
made
a
lot
of
mistakes,
and-
and
one
of
those
mistakes
was
having
many
many
mcos
operating
in
certain
pockets
of
the
state
inexperienced
volatile.
F
It
created
a
lot
of
volatility,
so
we've
learned
from
those
mistakes.
Other
states
have
followed
that
the
trend
is
actually
going
from
more
mcos
to
to
fewer
mcos.
So
we
feel
very
comfortable
about
about
the
three
we've
had
three
for
a
very
long
time.
When
you
look
at
our
most
successful
period
in
tenncare,
it
would
be
the
period
of
time
in
which
we
had
three
mcos.
E
Well-
and
that
was
kind
of
followed
to
my
final
question
and
my
understanding-
there
are
several
states
that
have
four
mcos
and-
and
I
wouldn't
that
was
my
question-
what
it
what
it
prohibits
tennessee.
Is
there
legislation,
it's
your
own
internal
policy,
what
prohibits
us
from
going
to
four
mcos
and
and-
and
that
gives
tennesseans
that
are
on
medicaid
some
more
options.
So
why?
What
is
the
downside
in.
F
D
F
Well,
they
they
should
not
have
to
change
providers.
The
only
way
that
the
only
situation
where
they
would
be
in
where
they
would
have
to
they
be
forced
to
change
providers
is
if
the
provider
did
not
enter
into
a
contract
with
one
of
the
the
managed
care
organizations.
One
of
the
medicaid
managed
care
organizations
which.
F
F
F
I
know
that
the
main
concern
from
you
and
the
members
of
the
committee
is
that
it's
not
the
it's,
not
the
institution,
it's
not
the
provider
of
the
insurance,
it's
the
member,
and
we
want
to
make
sure
that
there's
continuity
of
care,
so
that
should
still
occur
because
again
those
providers
should
still
have
contracts
with
the
medicaid
managed
care
organizations,
and
then
we're
also
going
to
do
a
lot
of
communication
with
any
individual
member.
That
would
be
impacted.
D
But
it's
my
understanding
and
maybe
I'm
wrong
again
anecdotally,
but
because
I
have
a
in
my
district,
I
have
some
folks
who
are
in
a
facility
that
doesn't
currently
contract
with
one
of
the
mcos
that
your
rfp
now
says.
You
know
this
is
who
you
need
to
contract
with
if
you're
going
to
provide
services
to
this
person,
so
their
choices
seem
to
be
either
their
the
facility
is
going
to
have
to
add
their
mco
to
their
repertoire
or
my
constituent
is
going
to
have
to
look
at
changing
facilities
and
we're
talking
long-term
care
health.
D
You
know
nursing
homes,
that
kind
of
thing
which
that's
a
really
difficult
disruption.
So
I
guess
I'm
still
I'm
having
a
hard
time
understanding
the
rationale
betw.
You
know
why
make
this
dual
population?
It
seem
to
be
working
well,
they're,
very
satisfied
with
their
provider.
So
why
do
we
make
this
change.
F
Yeah,
that's
that's
a
great
question.
It's
it's!
Really.
It
comes
down
to
aligned
incentives
between
the
medicaid
program
and
the
the
medicare
benefits.
It's
really
important
to
us,
because
we
have
to
pick
up
the
costs
for
the
this.
We're
talking
about
dual
dual
members,
who
have
a
medicare
benefit
and
a
medicaid
benefit,
and
so
this
is
actually
we're
not
alone
in
this,
actually
something
that
they're
looking
at
at
the
federal
level.
F
In
fact,
in
back
in
the
the
trump
administration,
not
the
current
administration,
the
previous
administration-
this
was
part
of
the
one
of
the
strategic
initiatives
of
cms-
was
to
address
this
issue
and
they
cited
fragmentation
and
overpayments,
because
the
medicare
incentives
are
not
aligned
with
the
medicaid
incentives,
medicaid
incentives
and
the
reason
congress
cared,
and
then
congress
passed
a
law
in
2018
which
actually
requires
cms
to
work
with
states
on
this
type
of
integration.
The
very
thing
that
we
are
that
we
are
attempting
to
do
so.
F
We
know
that
members
or
ten
care
members
prefer
to
be
served
in
the
home
rather
than
institutional
care,
and
that's
typically,
the
most
cost
effective.
So
a
non-medicaid
d-snip
does
not
have
the
same
incentive
to
help.
These
dual
eligible
members
receive
more
cost-effective
care
in
the
home,
and
the
reason
for
that
is
because
the
short-term
medical,
medic
medicare
skilled
nursing
facility
benefit
once
that
is
exhausted.
F
F
If
the
person
receives
care
at
home,
however,
then
the
non-medicaid
d-snip
is
responsible
for
the
medicare
home
health
as
needed,
so
medicare
still
has
to
pick
up
a
portion
of
the
in-home
care,
whereas
if
this,
if
the
individual
stays
in
the
institution
medicaid
has
to
pick
it
up
once
the
medicare
benefit
is
exhausted,
it
gets
really
really
complicated,
but
these
are
major
dollars
that
we
have
to
spend
in
our
state
budget
to
account
for
it.
And
so
that's
that's
the
reason
why
it's
one
of
the
reasons
why
we're
bringing
this?
F
H
That's
one
helpful
14,
000
total
full
benefit.
Dual
eligible
individuals
is
what
we're
talking
about,
and
and
just
for
for
clarification.
Madam
chair,
if
I
may
I
understand
your
concern
is
about
beneficiary
choice
and
it's
really
important
to
understand
that,
there's
a
pathway
to
beneficiary
choice.
Even
with
this
policy
decision,
this
policy
decision
is
being
made
primarily
in
the
best
interest
of
beneficiaries,
because
we
know
that
better
quality
and
more
appropriate
utilization
results
from
more
integrated
care.
H
We
know
that
from
evidence
at
that
point
at
this
point,
but
even
with
that
dual
eligible
individuals
will
have
a
choice,
they
will
have
a
choice
of
original
medicare.
They
will
have
a
choice
of
of
the
three
existing
mcos
medicaid
mcos,
who
will
operate
d-snips,
but
they
also
have
a
choice
of
every
other
medicare
advantage
plan
on
the
market,
so
it's
not
as
if
they
wouldn't
have
a
choice
of
either
another
health
plan
or
or
original
medicare
if
they
want
to
stay
in
a
facility
for
the
time
limited
benefit.
H
That's
really
important
to
understand
is
that
if
a
facility
is
not
contracted
with
medicaid,
once
that
medicare
sniff
benefit
expires
and
it
will
expire
in
no
more
than
100
days,
medicare
is
done
with
long-term
care
and
all
of
the
burden
shifts
to
medicaid
over
90
percent
of
people
who
receive
long-term
care
in
the
choices
programs
are
full
benefit.
Dual
eligible
individuals
and
there's
a
well-worn
pathway
from
from
a
hospital
bed
to
a
skilled
nursing
facility
to
a
medicaid
nursing
facility
benefit.
It
drives
a
huge
portion
of
long-term
care
costs.
H
So
if
we
can
have
a
single
entity
who
is
coordinating
that
care
and
really
helps
make
sure
that
people
receive
services
in
the
most
integrated
setting
where
they
want
to
it,
not
only
aligns
with
people's
choices,
it
also
is
more
cost
effective
for
the
state,
but
bottom
line
is
people
will
still
have
a
choice
and
they
would
not
be
forced
to
move
if
they
wanted
to
stay
in
the
facility
where
they
are,
and
that
facility
refused
to
contract
with
the
medicaid
plan
and
their
choice
would
be
their
choices.
Would.
H
They
could
choose
another
medicare
advantage
plan.
For
example,
humana
has
a
dsnip.
Humana
also
has
a
medicare
advantage
plan.
They
could
choose
the
other
humana
plan
if
they
wanted
to
do
that
or
they
could
choose
any
of
a
number
of
other
medicare
advantage
products
or
they
could
choose
original
medicare.
D
Again,
I
think
I'm
sure
this
is
very
complex
issue,
but
I
have
constituents
who's
going
to
be
impacted,
others
do
as
well
and
and
there's
just
there's
a
lot
of
uncertainty
about
it.
So
I
guess
one
of
my
other
questions
would
be.
How
are
people
notified
about
these
changes?
How
are
what
sort
of
communications
are
you
having
and
were
there
communications
with
providers
prior
to
the
rfp
going
out.
H
So
if
I
respond
madam
chair
in
terms
of
communications
prior
to
the
rfp,
when
we
are
preparing
to
start
a
procurement
process,
we
don't
communicate
with
potential
bidders
in
advance,
as
that
might
actually
jeopardize
the
procurement
process.
So
we
don't
talk
about.
What's
going
to
be
in
the
procurement
document,
it
was
clearly
a
part
of
the
procurement
document
and
two
of
the
three
non-medicare
non-medicaid
dsnips
did
ask
questions,
so
they
were
well
aware
of
that.
It
was
included
in
the
procurement
process
in
terms
of
beneficiaries.
H
We
haven't
had
conversations
with
them,
yet
we
are
in
a
bid
protest,
so
these
these
contracts
have
not
been
awarded.
Yet
there
are
medicare
regulations
which
require
a
dsnip
that
is
leaving
the
market
to
provide
advanced
notice
to
the
beneficiaries
that
they
serve,
and
they
will
do
that
no
earlier
than
october.
1St
is
the
medicare
requirement.
D
D
Advantage,
thank
you
the
advantage
plan.
How
would
that,
if
you're,
if
we're
talking
about
coordinating
benefits
here
this,
I
I
think
that
we're
doing
this,
I'm
hearing
you
say
so
that
we
can
better
coordinate,
benefits
and
coordinate
care.
How
will
you
coordinate
if,
for
that
person
who
chooses
to
move
to
the
humana
advantage
plan.
H
So
we
will
educate
people
about
all
the
reasons
why
they
might
want
to
consider
choosing
an
aligned
arrangement
having
the
same
health
plan
for
medicare
and
medicaid
and
the
advantage
of
doing
that,
which
is
why
this
policy
decision
is
being
made
at
the
end
of
the
day.
It
will
be
their
choice
and
they
can
choose
an
unaligned
plan
as
they
have
chosen
today
to
be
in
an
unaligned
plan.
D
C
Thank
you,
madam
chair.
The
questions
that
I
have
is
concerning
the
provider's
rate
increases
and
there's
been
a
proposed
of
95
million
in
the
budget
for
the
workforce
initiative
on
these
dsps
and
certain
of
the
ecf
choices,
homes
and
community-based
services.
Can
you
tell
us
how
that
money
is
going
to
be
distributed.
F
I'll
I'll
defer
to
patty
for
details.
What
I?
What
I'll?
I
will
reiterate,
though,
that
those
are
specifically
directed
for
those
direct
service
providers,
so
it
will
have
to
result
in
wage
increases
for
those
those
frontline
workers
and
that's
a
message
that
we
heard
loud
and
clear
from
from
this
body,
and
I
know
that
there
are
some
providers
that
are
not
happy
about
that.
They
would
prefer
to
have
the
money
just
flow
to
them
and
they
decide
what
to
do
with
it.
F
But
again,
the
message
that
we've
that
we've
received
loud
and
clear
is
that
those
dollars
need
to
end
up
in
the
the
hands
of
the
direct
service
providers.
So
that's
that's
what
we're
going
to
do
and
it
makes
sense
because
when
we
hear
from
providers
the
number
one
reason
that
they
give
us
for
needing
additional
money
is
to
address
the
workforce
shortage,
and
so
we
think
it.
C
H
It's
a
great
question:
let
me
start
with
your
first
question,
if
I
may
so
the
way,
oops
sorry,
the
way
that
it
is
distributed
is,
through
rate
increases,
so
increases
in
the
medicaid
rate
of
reimbursement
to
the
agency
for
services
that
include
a
direct
care
component,
so
this
is
targeted
to
the
frontline
worker,
who
is
in
the
home
or
in
the
community,
actually
delivering
hands-on
or
supportive
care
to
to
a
person
with
a
disability.
Regardless
of
the
program.
H
The
the
funding
is
not
targeted
to
every
employee.
It
is
targeted
to
that
frontline
workforce
and
it
is
intended
to
account
for
the
first
workforce
development
item,
which
is
the
recurring
funds
for
the
rate
increases
that
have
already
been
put
into
place,
account
for
a
wage,
an
hourly
wage
of
12.50
cents,
an
hour
to
that
frontline
workforce.
H
The
additional
funding
that's
being
requested
to
align
with
didd's
request
for
the
1915
sea
waivers
comparable
services,
comparable
workforce
will
bring
that
frontline
wage
up
to
13.75
cents
an
hour.
I
can't
tell
you
what
percentage
increase
that
is
by
agency,
because
I
don't
know
how
how
every
agency
pays
their
staff,
but
we
are
requiring
that
the
funding
is
passed
through
to
that
frontline
workforce,
no
matter
sort
of
where
the
starting
point
is.
C
You
gave
me
better
than
percentage.
You
gave
me
actual
figures,
so
I
appreciate
that.
The
other
question
is
how
does
tin
care
ensuring
that
the
rates
have
increased
will
be
used
as
intended?
Is
there
any
chance
that,
as
you
said,
you
know
they
really
would
rather
have
come
to
them
and
let
them
to
decide?
C
H
A
Thank
you,
madam
chair.
It
sounds
like
there
are
some
providers
who
are
opposed,
or
at
least
concerned
about
some
of
the
changes
to
this
dual
eligible
medicare
medicaid
population,
and
I
know
from
some
of
my
conversations
with
other
legislators
that
there's
some
concerns
there
too.
Would
your
office
be
doing
anything
to
help
someone
who's
got
a.
I
guess,
one
of
the
the
different
mcos
with
medicaid.
F
Well,
once
I
think
I
understand
the
question
once
we
kind
of
complete
this
process
and
we
move
to
the
aligned
mcos
where
the
the
medicare
and
the
medicaid
is
aligned
with
the
three
mcos
we
would
be.
We
would
be
communicating
and
working
with
our
tenncare
members
to
kind
of
educate
them
so
that
if
they
were
in
a
situation
again,
we
think
it's
very
unlikely,
but
if
they
were
in
a
situation
where
their
provider
said
hey,
I
can't
I
can
no
longer
serve
you
because
I'm
not
accepting.
F
I
don't
have
a
contract
with
one
of
the
managed
care
organizations.
Then
we
would
work
with
them
and
we
would
outline
the
benefits
that
they
would
have
available
to
them
through
one
of
the
aligned
mcos
and
then
we
would
also
talk
to
them
about
the
providers
that
were
available
in
that
network.
So
hopefully
they
would
feel
good
about
the
present
state
of
things
and
then,
if
they
decided
that
that
didn't
work
for
them,
then
they
would
have
the
other
choices
that
that
patty
outlined.
F
D
Again,
I
think
one
of
the
issues
I've
seen
some
quality
surveys
and
satisfaction
surveys.
I
think,
with
a
very
high
percentage
rate,
those
folks
who
are
on
the
dual
enrollment
plan
with
other
providers,
not
an
mco
or
very
satisfied
with
their
service.
So
I
think
if,
if
someone
talks
speaks
to
them
and
say
well,
you
can
keep
that,
but
you'll
just
have
to
change
to
a
different
medicare
advantage
plan.
D
Then
you
know
if
I'm
really
happy
with
my
provider-
and
I
don't
want
to
change
my
facility
or
anything
else,
then
I
think
people
are
going
to
be
maybe
more
receptive
than
you
believe
to
changing
to
a
medicare
advantage
plan
and
then
again
you
you've
lost
that
continuity,
you've
lost
whatever
that
you
would
have
gained
with
the
you
know
by
forcing
that
alignment.
So
I'm
just
struggling
with
what
we're
actually
gaining
here.
Chairman
todd.
C
F
F
F
C
F
F
C
The
committee
know
I
know
there
was
some
savings
realized
in
the
ef
map
program
and
those
savings
were
being
held
in
the
tenncare
reserve
to
hopefully
offset
some
increasing
cost
expected.
How
much
is
currently
held
in
reserve
and
does
tenncare
feel
that
this
is
sufficient
to
cover
those
future
costs.
F
So
right
now
we're
still
getting
that
enhanced
match
once
the
federal
emergency
ends,
though
it's
going
to
be
there's
12
months,
where
we'll
go
through
that
redetermination
process.
So
what
that
means
then
is
we
need
to
have
a
healthy
fund
reserve
because
those
costs
are
going
to
continue
and
we
will
no
longer
be
getting
the
increased
federal
match.
H
F
I
think
it's
probably
I
mean
we
still
have
some.
I
can't
I
can't
imagine
a
scenario
where
this
federal
emergency
continues
beyond
that
point,
where
it's
no
longer
it
no
longer
works
for
us.
Other
states
are
already
in
that
position.
We've
we've
done
really
well
here,
where
we're
still
in
good
shape.
G
C
F
F
We
just
completed
our
first
year,
so
we're
now
having
discussions
and
well,
I
think,
we'll
settle
on
the
shared
savings
from
year,
one
probably
in
in
late
spring
at
least
we
hope
it'll
be
it'll
be
late
spring,
and
at
that
point
we
could
then
claim
the
dollars
draw
the
dollars
down
and
but
before
we
did
anything
with
those
dollars,
it
would
have
to
come
before
this
this
body.
Thank
you
director.
Thank
you,
madam
chair.
D
A
Thank
you,
madam
chair.
I
had
a
question
or
two
about
medical
price
inflation
in
the
current
budget.
I
believe
we're
projecting
it
to
be
1.12,
but
in
prior
budgets,
we've
been
projecting
a
higher
rate
of
medical
price
inflation.
Are
you
all
projecting
that
rate
of
inflation
to
go
down
be
going
down
this
year
next
year?.
F
Appreciate
the
question
so
that
that
number
that
you're
looking
at
that's
our
trend
number.
So
it's
not
it's
not
just
inflation,
it
is
the
cost
of
medical
services,
but
it
also
represents
utilization
enrollment,
and
some
of
that
is
offset
by
the
fact
that
we
continue
to
have
a
decrease
in
utilization.
We
haven't,
we
haven't,
come
back
up
to
pre-pandemic
levels
and
a
big
driver
of
that
is
nursing.
Home
utilization
still
is
not
where
it
was
and
then
also
even
our
outpatient
utilization
is
not
where
it
was.
F
So
that
means
that
part
of
the
adjustment
has
already
been
accounted
for,
because
last
year's
trend
number
you
all
adopted
that
in
the
budget,
but
it
hasn't
completely
materialized.
So
some
of
it's
already
built
in
where
we
could
come
forward
this
year
with
a
lower
with
a
lower
number
and
then
also
when
you
look
when
you
think
about
medical
cost,
it's
it's
much
more
than
than
just
cpi,
and
so
that
kind
of
that
kind
of
weighs
in
into
it
as
well.
A
F
Is
that
the
cpe
yeah?
That's
a
that's
a
great
catch?
It
is
a
little
higher
this
year
in
terms
of
the
state
percentage,
and
that
is
because
of
we
are
decreasing
our
dependence
on
certified
public
expenditures,
and
when
I
talked
about
that
public
hospital
item
earlier,
what
we're
doing
there
is
since
the
inception
of
tenncare,
we
have
been
the
public
hospitals
have
been
supporting
part
of
the
tenncare
overall
operating
budget,
and
so
what
we
do
is
we
claim
the
uncompensated
care
dollars
for
the
public
hospitals.
F
If
this
budget
passes,
what
that
will
mean
is
for
the
first
time
those
federal
dollars
that
we
draw
down
will
go
back
to
where
they
should
go,
which
is
to
the
public
hospitals
that
provided
the
uncompensated
care
there's
about
31
of
those
hospitals,
16
of
those
are
in
rural
communities.
So
we
think
we're
really
excited
about
that
and
then
part
and
then
also
to
your
specific
question
within
the
trend
number
we're
decreasing
our
dependence
on
cpe,
because
we've
seen
a
decrease
over
time.
F
There's
lagging
data
there,
we're
usually
like
two
or
three
years
behind
before
we
get
the
actual
data
and
we've
seen
a
decrease
in
overall
cpe,
and
so
we're
decreasing
our
dependence
on
that.
But
what
that
means,
though,
is
we
have
to?
We
have
to
fill
that
the
gap
that
it
creates
in
the
state
budget.
So
that's,
why
that's
a
long
answer,
but
that
that's
that's
why
it's
higher
this
year.
A
F
F
A
Mixed
up
in
in
that
yeah,
okay,
I
guess
my
final
comment
would
just
be
I
I
just.
I
just
want
to
make
sure
that
we
do
everything
we
can
to
to
attempt
to
honor
the
selections
of
of
those
dual
enrollees
who
have
chosen
a.
I
guess,
a
different
mco
than
maybe
the
ones
that
that
are
that
are
possibly
going
to
be,
I
don't
know,
recommended
or
restricted
to
them
thanks.
I
understood.
D
G
So
if
this
budget
passes,
those
funds
would
be
effective
july
1st
the
dollars
probably
wouldn't
flow
on
july
1st.
What
they
would
do
is
they
would
go
out
and
quarterly
installments,
like
our
other
hospital
supplemental
payments
so
beginning
in
fiscal
year,
23
we'd
make
quarterly
installment
payments
to
the
public
hospitals.
G
B
Thank
you,
madam
chairman,
just
a
kind
of
quick
question
on
this,
and
I
know
that
we
have
discussed
in
the
past
the
reader
retermination
process.
So
I
know
you
requested,
but
did
not
receive
a
cost
increase
for
about
three
million
dollars
to
cover
19
additional
positions
to
help
with
redetermination
process
post
public
health
emergency.
B
So
I
mean
I,
I
know:
we've
been
frozen
on
that
for
a
while
and
and
hopefully
at
some
juncture,
we'll
be
getting
back
into
what
is
a
healthy
process
of
folks
coming
into
and
out
of
the
program
so
with
without
these
additional
staff
being
provided
in
the
budget.
What's
what's
your
plan
for
handling
the
redetermination
process
that
again,
hopefully
at
some
juncture,
the
feds
will
allow
us
to
embark
on
again.
F
Yeah,
thank
you
for
the
question.
I'm
gonna
I'm
gonna
defer
to
zane.
What
I
will
say
is
we're
the
reason
why
you
don't
see
it
in
the
budget
is
because
these
are.
These
are
non-recurring
costs,
and
so,
when
we
had
discussions
with
with
fna
about
this,
the
decision
was
made
that,
because
these
are
non-recurring,
we
can
cover
it
with
our
enhanced
federal
matching
dollars,
because
this
is
certainly
related
to
the
pandemic.
G
That's
basically
it
since
it's
a
non-recurring
need.
We
did
not
want
to
create
permanent,
recurring
state
positions
for
work
that
wasn't
permanent
and
recurring
in
nature,
and
so
we
can
run
those
positions
temporarily
as
overlaps,
and
we
have
the
non-recurring
ef
map
funding
from
the
federal
government
to
be
able
to
pay
for
that.
D
Thank
you
and
I
want
to
go
back.
I
apologize
for
this
ping-ponging,
but
on
the
public
hospitals.
If
you
have
projections
of
what
the
different
or,
if
you
can
just
say,
if
we
had
been
had
this
process
in
place
in
our
current
budget
year,
what
difference
would
that
have
made
in
payments
to
public
hospitals?
If
you
could
get
something
on
that
to
me
and
I'll
share
that
I'd
appreciate
it
sure.
Thank
you,
chairman
hicks.
C
C
G
We
are
going
to
have
to
fill
those
positions
either
with
contracted
resources
or,
if
we're
able
to
identify
vacant
positions
within
10
care,
which
we
don't
have
very
many
we'll
have
to
to
borrow
from
there
to
be
able
to
address
those
data.
Security
is
really
important.
So
it's
not
something
we're
going
to
let
fall
by
the
wayside,
but
we're
currently
working
with
our
chief
information
officer
to
determine
what's
the
best
way
to
deploy
the
resources
that
are
available
to
us
to
still
meet
those
data.
Security
needs.
Okay,.
B
F
Yeah,
thank
you
for
the
question
so
right
now
we
have
I'll
kind
of
give
you
the
overall
and
then
I'll
break
it
down
by
part
and
part
b.
So
right
now
we
have
about
1
600
that
are
either
enrolled
or
they
are
awaiting
eligibility
determinations
that
would
be
170
in
part
a
and
then
1442
in
part
b.
We
have
had
to
date,
2100
applicants.
F
I
don't
have
the
breakdown
of
applicants
between
part,
a
and
part
b,
but
we
can
get
that
to
you.
I
will
say
that
the
the
demand
has
not
been
as
high
as
we
projected
and
that's
that's,
not
a
bad
thing.
We
had
never
done
this
before
and
so
when
this
legislation
was
going
through
a
couple
of
years
ago,
we
worked
with
the
disability
coalition
to
try
to
come
up
with
our
best
projections,
but
we
didn't
we
didn't
know
so.
F
The
original
projection
was
that
we
would
have
3
000
individuals
served
300
in
part
a
and
2
700
in
part
b,
but
as
again
as
of
today,
we've
we've
had
2
100,
total
applicants
and
we're
at
about
that
are
either
enrolled
or
awaiting
eligibility
determination.
So
it's
a
pretty
pretty
high
percentage
of
those
that
have
applied
have
got
have
gotten
in
at
our
current
rate
for
part
a
because
we
do
have.
F
F
F
What
can
we
do
to
get
more
people
enrolled
right
now,
and
there
are
some
decisions
that
we
could
make.
We
could
we
could
lower
the
level
of
care
or
the
eligibility
requirements.
We
don't
think
that's
the
right
way
to
go,
because
we
could
end
up
in
a
situation
where
you
have
someone
coming
in
with
really
complex
needs
and
they
can
no
longer
get
into
the
program
because
we've
filled
all
of
the
space
and
that
those
are
discussions
we
were
having
with
the
technical
advisory
group,
which
was
established
specifically
for
katie
beckett,
but
we've
overall.
F
I
Thank
you,
cheerleader.
Thank
you
for
coming
today,
director.
I
one
of
the
things
I
was
most
excited
about
last
year
was
the
extension
of
postpartum
care
for
two
maternal
mothers
that
the
governor
put
in
the
budget.
The
legislature
supported
that
10
months
we
felt
like
was
going
to
be
a
really
huge
impact
to
our
mothers,
and
particularly
since
our
the
results
resulting
data
surrounding
mothers
on
teen
care
was
was
abysmal.
I
guess
the
question
is:
is
how's
that
process
working
it?
F
Well,
a
couple
of
things
there:
one
because
they're
the
federal
government
there's
a
law
in
place
that
allows
states
to
begin
that
in
eight,
it's
actually
april,
first
of
this
year.
So
technically
we
can't
start
that
program
until
april
1st
and
we're
on
we're
on
track
to
do
that.
But
the
reality
is
no
pregnant
mother
is
losing
that
coverage
during
the
public
health
emergency,
because
we
we
can't.
We
can't
change
benefits
during
that
time.
So
that's
that
would
be.
I
Well,
one
of
the
things
I
liked
about
this
is
two
year
pilot
project,
see
if
it
was
going
to
work.
What
we're
saying
is
it's
a
it's
a
three-month
pilot
project
with
another
year's
funding
to
make
the
second
year?
I
guess
the
question
is:
if
we
put
another
six
million
dollars
in
to
fund
this
project,
going
forward,
does
the
two
years
start
april
first,
or
did
it
start
july,
and
why
do
we?
Why
do
we
need
additional
revenues
when
we've
only
spent
20.
F
I
Okay,
so
we
didn't
spend
but
twenty
we
only
did
it
for
we're.
Only
gonna
do
it
for
three
months
this
fiscal
year,
we're
gonna,
do
it
for
12
months
next
year,
but
we
need
two
24
months
to
do
it.
I
guess
the
question
is:
is
that
you
mentioned
earlier
that
the
money
was
going
to
go
into
reversion
and
then
you
said
in
the
fund
balance.
So
I
guess
my
can.
I
F
I
guess
in
the
last
couple
of
years
we
felt
like
that
500
million
was
kind
of
the
healthy
reserve
and
then
we've
got
the
other
500
million
to
take
care
of
the
the
pandemic
cost.
So
you
know,
if
you're
asking
me,
do
I
want
to
pull
money
out
of
the
reserves.
The
answer
is
going
to
be.
No,
but
ultimately
you
all
have
control
over
that.
I
F
I
I
get
it
I
mean
there
were.
There
were
a
couple
of
ways
we
could
have
gone
about
this.
We
could
have
filed
a
waiver
amendment
and
that
would
have
been
a
very
long,
drawn-out
process.
We.
We
have
two
amendments
right
now
that
are
waiting
to
be
approved
by
cms,
or
we
could
go
the
route
of
this
new
federal
law
which
allows
us
just
to
do
it
quickly.
F
B
F
Oh,
I
think
you're
referring
to
the
the
audit
related
to
certified
public
expenditures.
That
was
the
the
one
that
came
out
several
months
ago
and
we
we
very
we.
We
completely
dispute
the
findings,
and
so
I
guess
the
the
the
main
answer
to
your
question
is
we
haven't
because
we
don't
agree
and
we
intend
to
fight
those
findings
all
the
way
we
haven't
really
made
any
changes,
because
oig
is
just
wrong
and
fortunately,
oig
doesn't
make
the
decision.
F
They
report
their
its
findings
to
cms,
and
then
we
enter
into
conversations
with
cms
and
we
feel
like
we're
going
to
be
able
to
make
our
case
with
cms
in
a
way
that
we
weren't
with
oig,
because
cms
actually
has
people
that
understand
the
medicaid
program
in
oig
doesn't
have
that
that
expertise.
So
these
things
take
a
long
time
to
to
settle.
F
D
F
D
D
F
D
D
All
right,
I
don't
have
anyone
else
on
my
list.
Are
there
other
questions?
Any
members,
I'm
not
seeing
all
right?
Well,
we
thank
you
for
your
time,
as
I
think
you
can
tell
there's
a
lot
of
interest.
You
all
are
obviously
a
huge
part
of
state
government
and
provide
take
care
of
a
lot
of
tennesseans.
So
we
thank
you
for
that,
but
I
I
think
it's
it
behooves
us
and
it
is
our
responsibility
to
try
and
make
sure
that
all
of
us
are
on
the
same
page
about
how
that
care
is
being
provided.
F
D
J
Good
afternoon,
everyone,
my
name,
is
logan,
grant
I'm
the
executive
director
of
the
health
services
and
development
agency.
I
hope
to
be
brief
and
succinct
today,
I'll
just
go
ahead
and
get
into
our
budget
our
budget
this
year,
you
will
notice,
is
slightly
elevated
from
last
year,
and
the
increase
in
expenditures
resulted
from
the
cost
of
implementing
the
certificate
of
need
reform
bill,
which
I'm
sure
you
all
remember
from
last
year.
J
That
resulted
in
two
additional
new
or
excuse
me,
four
full-time
positions,
three
of
which
are
filled,
one
of
which
is
we're
in
the
process
of
hiring
for
that
fourth
position.
So
we
should
be
fully
staffed
here
shortly,
just
to
point
out
the
eight
part-time
positions.
Those
are
actually
board
members,
not
not
traditional
part-time
employees,
just
to
talk
a
little
bit
about
our
agency
priorities.
Obviously,
since
last
year
our
priority
has
been
implementing
public
chapter
557,
which
has
been
a
really
big
success.
J
We've
been
able
to
reduce
the
size
of
the
co
application
by
more
than
50
we've
been
able
to
reduce
the
amount
of
time
it
takes
to
go
through
the
process
by
more
than
50
percent
and
reduce
the
application
fees
by
more
than
50
percent.
So
really
we're
really
excited
to
be
able
to
implement
such
great
legislation.
J
So
that's
what
we're
working
towards
now,
and
so,
when
we
we've
been
meeting
with
stakeholders
across
the
state
and
what
we've
found
is
that,
in
terms
of
taking
the
board
for
licensing
healthcare
facilities
and
their
support
staff
and
transferring
it
from
the
department
of
health
of
h
to
hsda,
there
is
a
great
deal
of
support
for
that.
That
would
really
make
it
easier
for
the
industry,
who
is
regulated
to
be
able
to
call
one
organization
instead
of
two,
for
example.
Let's
say
somebody
wants
to
open
up
a
home
health
agency.
J
They
often
call
us
and
say:
oh
if
I
want
to
do
this,
do
I
need
to
get
a
con.
We
say
well,
actually,
department
health
deter
actually
interprets
its
own
licensure
statute
and
determines
what
requires
the
license
and
what
requires
a
license
requires
con.
So
by
bringing
all
that
stuff
in-house,
we
can
be
a
lot
more
responsive
to
the
industry
and,
we
think
be
a
lot
more
efficient.
J
So
that's
what
we've
been
working
towards
and
that
plan
will
that's
supposed
to
be
submitted
in
2023,
will
essentially
contain
three
elements:
one
is
merging
the
staffs
another
is
taking
the
two
boards
and
making
consolidating
them
into
a
single
board,
and
then,
thirdly,
we
want
to
take
the
con
process
and
make
it
a
part
of
the
licensure
process.
So
rather
than
two
consecutive
processes,
somebody
would
just
file
a
single
application
and
go
all
the
way
through.
J
We
think
that,
since
there
is
a
lot
of
support
for
merging
the
staffs
together,
we've
been
discussions
with
members
of
the
con
working
group
to
look
into
legislation
to
go
ahead
and
accomplish
the
staff
element
of
the
merger,
and
that
could
also
really
set
us
up
for
success.
When
we
go
towards
consolidating
the
board
and
integrating
the
processes,
because
we'll
already
have
their
expertise
in-house
and
that's
and
that's
essentially,
what
we're
working
on.
I'm
happy
to
answer
any
questions
about
our
budget
or
what
we're
working
towards
on
the
merger.
D
C
J
Yes,
sir,
we
that
is
not
ready
yet.
So
what
that
I
want
to
say
five
years
ago
I
was
I
wasn't
with
the
agency
at
that
time,
but
I
think
it
was
about.
Five
years
ago
there
was
a
quarter
million
dollars
appropriated
to
the
agency
for
the
implementation
of
online
application
system
that
was
to
be
worked
on
with
sts.
J
So
what
we've
been
doing
now
is
we've
been
reaching
out
to
some
other
vendors
to
see
what
our
alternatives
were
and
we're
in
the
process
of
looking
to
a
a
new
platform
which
would
allow
us
to
not
only
create
a
web-based
application
system
for
con,
but
one
that
could
be
easily
modified
and
expanded
to
include
licensure
as
well.
Since
that's
what
we're
looking
at
doing
so
we're
in
the
process
of
looking
into
that,
and
that's
something
that
we're
also
contemplating
as
at
including
in
the
legislation.
C
C
000
was
went
to
this
project,
so
I
three
years
is
a
long
time
to
complete
a
project
must
much
less
to
get
off
the
ground
to
get
started.
So
I
hope
by
this
time
next
year.
I
hope
we
can
hear
that
it's
well
on
its
way,
not
necessarily
completed,
but
it's
well
on
its
way
to
getting
at
least
off
the
ground,
and
hopefully
we
can
at
least
see
the
end
somewhere.
Yes,
sir,
thank
you.
D
J
Not
for
not
for
ongoing
costs,
the
quarter
mill,
the
quarter
million
dollars
was
a
non-recurring
appropriation
that
has
since
reverted
to
our
reserves,
and
so
we
plan
to
use
that
for
the
startup
cost
for
the
development
of
the
platform,
but
as
far
we're
still
working
on
what
the
ongoing
cost
for
that
would
be.
But
it
would
be
a
recurring
expense.
J
B
J
And
then
it's
gonna
be
just
coordinating
with
you
know:
fines
and
administration
general
services,
things
like
that
to
make
sure
that
nothing's
lost
in
transition
and,
of
course
the
leadership
of
health
has
been
really
helpful
in
working
with
us
to
make
sure
that
we
want
to
minimize
disruption
to
the
industry.
That's
the
absolute
priority,
but
we
all
want
to
make
sure.
I
also
want
to
make
sure
that
the
staff
involved
see
this,
as
you
know,
potentially
an
improvement.
J
So
so
far
we've
reached
out
to
several
you
know
some
large
regional
health
systems,
some
of
the
industry
associations
we've
reached.
Of
course,
we've
addressed
the
board
for
licensing
healthcare
facilities
at
its
meetings
we've
with
the
legislation
still
pending.
You
know
we
don't
want
to
say
it's
100
gonna
happen,
but
you
know
once
the
legislation
passes
we
plan
on.
There
will
be
a
gap
between
that
date
and
when
it's
effective,
so
we
do
plan
to
let
everybody
know
that
really
we're
not
planning
any
immediate
changes.
J
So
everybody,
you
know
the
same
phone
numbers,
hopefully
we'll
we'll.
If
we
do
our
job
right,
everything
will
be
the
same
on
july
1
as
it
is
june
30th,
but
it'll
at
least
position
us
to
be
able
to
start
looking
for
efficiencies
in
ways
that
we
can
be
more
responsive
to
the
industry
and
of
the
legislature.
B
J
But
there
wasn't
an
immediate
decline
or
sudden
or
steep
decline
in
c1
applications
and
think
of
that,
a
lot
of
the
reason
is
that
is
these
applications
sometimes
are
well
thought
out
in
advance,
and
so
they
want
to
go
want
to
go
ahead
and
pursue
it
while
they
had
the
application
prepared.
So
I
anticipate
a
sort
of
delayed
decline
because
I
think
that-
and
I
think
that's
what
we've
seen
for-
maybe
the
first
couple
months
of
implementation
of
the
new
process
from
october
to
december.
J
J
So
ongoing
there
have
been,
we
anticipated
a
reduction
of
certificate
of
need
applications
somewhat
because
of
the
cert,
the
reform
legislation
that
was
passed
last
year
because
we
reduced
the
number
of
things
for
which
you
require
a
con.
I
wouldn't
say
that
we've
really
observed
a
steep
decline
that
we
would
attribute
to
covet
yet,
like
I
said
what
we've
noticed
mostly
is
just
people
needing
extensions
for
implementing
what
they've
got.
D
All
right,
I
don't
have
any
further
questions
on
my
list,
so
mr
grant,
thank
you
for
being
with
us
and
we
wish
you
luck
in
getting
that
online
system
up
and
running,
hopefully
soon
and
also
with
the
merger
that
will,
I
think,
make
it
easier
and
less
frustrating
for
the
industry
to
deal
with
the
state
and
do
the
work
that
they
need
to
do.
So.
Thank
you
for
your
time
today,
members
without
objection.
We
are
back
in
session
and
I
would
entertain
a
motion
to
adjourn.