►
Description
House Finance, Ways, & Means Committee- November 16, 2021- House Hearing Room I
A
A
A
A
A
A
A
A
I
apologize
for
being
a
few
minutes
late,
but
we
and
we
have
a
number
of
members
who
are,
who
commute
and
they're
having
problem
doing
that
today,
with
the
I
think,
I-65
is
shut
down
coming
into
town
from
the
north
and
there's
a
wreck
on
24
and
perhaps
some
other
obstacles
that
are
interfering
with
people's
timely
arrival.
So
but
at
any
rate,
I
do
apologize
for
us
being
a
few
minutes
late.
We
will
try
and
make
that
time
up
today.
Madam
clerk,
would
you
please
call
the
roll
representatives.
B
F
B
A
Any
donut
is
a
good
dead
and
in
my
book,
especially
this
early
in
the
morning,
so
thank
you
before
we
get
underway.
I
would
like
to
note
that
the
hearings
are
being
live
stream
for
anyone.
That's
unable
to
attend,
including
some
of
our
members
who,
as
we
noted
yesterday,
are
not
with
us
and
the
supporting
documents
for
each
agency
are
available
on
your
dashboard
and
again
just
as
a
reminder.
A
So
we
have
three
hearings
scheduled
today.
I
will
begin
with.
If
you
need
waking
up
in
the
morning.
We
thought
about
this
and
we
put
commissioner
williams
first
on
our
agenda,
because,
if
anybody's
still
napping,
we
all
know
that
she's
enthusiastic
and
passionate
and
will
make
sure
that
we're
all
attentive.
So,
commissioner
williams
with
you
and
your
team,
please
come
forward.
C
C
So
I
look
forward
to
those
of
you
that
have
that
energy
and
enthusiasm
being
here
with
us
and
talking
through
what
we've
done
with
covid
with
us
at
the
table
with
me
to
my
right
is
deputy
commissioner
matt
yancey.
He
serves
as
our
community
behavioral
health
deputy
commissioner
to
the
left
is
todd
thornton,
who
serves
as
our
chief
of
staff
and
he's
also
over.
C
Again,
we
are
excited
to
be
here
and,
as
we
looked
at,
what
you
sent
us
to
fill
out,
what
we
wanted
to
do
was
to
first
start
with
context,
as
it
relates
to
what
sort
of
happened
in
this
state
during
coven
and
during
this
pandemic.
So
if
you
turn
to
the
first
slide,
you'll
see
part
of
the
context
really
lies
in
our
mission
and
our
vision
and
that
really
outlines
how
we
have
spent
and
utilized
the
cova
dollars
to
date.
C
First,
one
is
creating
collaborative
pathways
to
resiliency
recovery
and
independence,
and
this
is
for
tennesseans
who
are
living
with
mental
illness
and
substance
use
disorders.
If
you
look
at
our
vision,
you'll
note
a
state
of
resiliency
recovery
and
independence
in
which
tennesseans
living
with
mental
illness
and
substance
use
disorder
can
thrive.
So
those
two
things
really
guide
what
we
do
and
how
we
do.
If
you
go
to
the
next
slide,
you'll
look
at
what
we
value
in
our
department
and
what
we
value
in
the
providers
that
many
of
you
all
already
know.
C
You
have
relationships
with
across
your
districts
and
the
first
value
is
customer
focused.
We
have
an
unwavering
commitment
to
making
sure
that
the
customers
that
come
before
us
get
what
they
need.
Oftentimes,
that's
you
all.
You
will
call,
you
will
send
an
email
and
ask
for
information,
and
we
do
our
absolute
best
to
get
it
back
to
you
as
soon
as
possible
integrity.
C
You
will
note
that
we
are
honest
and
truthful
in
all
that
we
do
in
our
department
inspired
purpose
that
call
to
action
that
underlines
and
undergirds
all
that
we
do
as
we
look
at
those
people
that
we
are
blessed
to
serve
excellence,
which
is
the
highest
in
standards
for
services,
efficiency
and
conduct,
compassionate
and
effective
leadership,
which
is
something
that
I
can
tell
you.
Our
whole
leadership
team
has
as
well
as
the
providers
that
we
fund
solutions
and
outcomes
focused.
C
You
will
note
that
the
dollars
that
we
give
out
whether
their
dollars
that
you
all
allocate
to
us
or
these
covet
dollars
are
focused
on
solutions
and
outcomes,
and
we
track
all
of
that
and
then
finally
partnership,
because
we
know
without
partners
across
the
state,
we
won't
be
able
to
accomplish
anything
on
behalf
of
those
individuals.
That
again,
we
are
blessed
to
serve
going
to
the
next
slide.
I
wanted
to
point
out
to
you
the
pre-pandemic
stats,
and
I
want
to
make
sure
that's
in
your
mind.
C
A
C
A
C
When
you
look
at
the
estimated
prevalence
of
substance
use
disorder
again
that
states
among
adults
in
tennessee,
you
will
note
that
pre-pandemic
we
had
458
950
tennesseans
that
had
prevalence
data
that
seemed
that
they
had
a
substance,
addiction
we're
not
doing
so
great
there,
although
we're
doing
our
very
best
to
allocate
dollars
to
meet
that
need.
You
will
note
that
52
180
of
that
population
are
uninsured.
C
However,
with
the
funds
we've
got,
we've
only
been
able
to
serve
right
at
twenty
thousand.
As
we
go
over
the
covet
funds,
you
will
note
that
we're
really
trying
to
expand
and
really
narrow
that
gap,
because
we
know
that
if
you
do
not
have
treated
substance
addiction,
it
impacts
every
area
in
your
life.
C
This
is
very
telling,
as
we've
gone
through
the
pandemic
sources,
both
through
the
tennessee
department
of
health
and
also
sources
through
east
tennessee
state
university,
as
well
as
the
kaiser
family
foundation.
All
three
of
these
areas
stated
that
we
had
seen
a
45
increase
in
overdose
deaths
of
all
substances.
C
C
Again,
this
is
very
troubling
and
we
will
see
fallout
from
this
as
we
already
are.
We
have
seen
increases
in
anxiety
and
depression
that
have
gone
as
high
as
43.5
percent
during
the
pandemic.
It's
now
down
to
34.6,
but
that's
over
and
above
what
we've
typically
seen
in
our
state,
which
is
right
around
20
percent
of
the
population.
C
Finally,
looking
at
the
packet
that
we
sent
and
answered
the
questions
that
you
all
asked
us
to
answer,
you
will
note
that
our
funding
in
total
through
the
covet
dollars,
is
right
at
54
million,
six
hundred
and
twenty
seven
thousand
fifty
nine
dollars
and
then
that
breakout,
you
will
note
on
that.
First
page
really
goes
into
cares
funding
that
was
2
million
in
the
first
round.
C
The
paycheck
paycheck
protection
act,
funding
2
million
in
the
first
round
and
then
2
million
in
the
second
round.
The
consolidated
appropriations
for
crisis
programs
through
the
covet
funds,
which
was
2.8
million
dollars,
and
then
finally,
this
biggest
amount
of
funding
that
goes
to
our
block,
grant
that
we
get
annually,
they
actually
bumped
up
that
block
grant.
C
That
now
has
been
allocated
at
forty
five
million
seven
hundred
sixty
seven
thousand
four
hundred
and
twelve.
I
do
want
you
to
understand
that
the
low
amount
of
funding
that's
been
allocated
from
that
money
is
due
in
part
to
two
things.
We
did
not
get
approval
to
move
forward
on
this
money
for
the
mental
health
side
until
march
of
this
year,
and
then
you
have
to
go
through,
as
you
all
know,
the
whole
contracting
period
and
all
that.
So
that's
delayed
that
on
the
substance
abuse
side,
we
didn't
get
that
until
august
of
this
year.
A
Thank
you,
commissioner,
a
sobering
presentation
for
all
of
us.
It's
and
I
guess,
discouraging
in
some
ways,
because
we
were
making
such
really
positive
progress
prior
to
covet
and
just
underlines
the
need
to
make
sure
that
we're
using
these
federal
dollars
in
a
way
that
that
really
addresses
the
increased
need
and
issues.
G
Thank
you,
madam
chair
and
commissioner,
thank
you
so
much
for
your
team
and
my
questions.
We're
going
to
be
around
the
the
federal
funding
and
the
the
how
and
why
we've
not
been
able
to
invest
those
dollars
as
much
you've,
given
a
pretty
good
explanation
as
to
why
we've
not
invested
those
dollars.
Can
you
tell
me
exactly
how
we're
going
to
be
able
to
invest
those
dollars
in
the
future?
Are
these
reimbursements
to
us
or
or
how
are
these
dollars
going
to
flow
eventually
and
in
the
timing
of
that.
C
What
we
did
is
we
asked
our
providers,
because
each
provider
has
different
strengths
and
weaknesses
and
different
opportunities
in
their
community
to
come
back
to
us
within
the
rubric
of
what
these
funds
will
fund
and
tell
us.
What
can
you
do
with
this
prorated
amount
in
your
community
over
the
next
two
years,
so
each
provider
each
community
is
going
to
be
bringing
back
in,
and
some
have
already
come
in.
We've
already
started
contracting
with
to
do
projects
that
meet
those
gaps
in
need.
C
C
So
our
plans
are
to
utilize
what
the
block
grant
allows
us
to
do,
which
is
pretty
much
any
kind
of
intervention
for
individuals
that
are
seriously
persistently
mentally
ill
on
the
mental
health
side
and
then
on
the
substance,
abuse
side
for
individuals
that
are
struggling
with
addiction.
And
so
that's
that's
our
plan
to
utilize
those
funds.
G
Chairman
hawk
kept
follow-up,
yes
ma'am.
Thank
you,
madam
chair,
and
thank
you
for
that
answer
and
you
bring
up
one
of
the
most
important
facets
of
the
work
that
that
your
department
does
and
that
we
need
done
in
the
state
of
tennessee
those
those
providers,
the
work
that
they
do
and
I'll
go
back
to
slide.
Three
that
you
gave
to
us
the
last
point
of
partnerships
that
we've
got
built
or
that
we
have
built
in
and
continue
to
nurture
across
the
state
of
tennessee.
G
C
Yes,
sir,
and
I
really
appreciate
you
bringing
this
up
this
past
year,
we
joined
with
tenncare
and
I'm
so
grateful
for
deputy
commissioner
yancey's
leadership.
We
have
led
a
statewide
workforce
initiative,
work
group
that
is
finalized
with
our
draft
of
recommendations,
and
we
are
also
concerned.
Tenncare
is
concerned,
we're
concerned,
and
what
I'm
grateful
for
is
that
we're
working
in
partnership
with
one
another?
C
H
Yes,
ma'am,
so,
as
the
commissioner
said,
we
convened
a
work
group
with
tenncare
over
the
summer.
We
met
three
times
and
we
had
a
diverse
group
of
folks
work
with
us.
People
from
colleges,
universities,
provider
organizations,
other
nonprofits
advocacy
groups,
and
they
really
helped
us
better
understand
how
quite
acute
the
situation
is.
I
was
actually
on
the
phone
last
week,
chairman
with
christy
hammonds
from
frontier
health,
and
she
was
talking
about
the
the
workforce
issues
that
they're
experiencing
there.
H
Because
we
know
we
got
to
think
future
forward.
The
data
bears
out
that
there
will
continue
to
be
a
growing
need
around
mental
health
and
substance
use,
and
our
system
is
only
as
strong
as
our
provider
network
and
the
people
who
who
staff
it.
So
we
are
soon
to
release
the
report
from
the
work
group.
That's
gone
through
the
the
final
stages
of
approval
and
we'll
certainly
make
sure
that
this
this
body
has
a
copy
of
that
once
released.
F
Thank
you,
commissioner,
and
staff
for
coming
today.
I've
just
had
a
couple
questions
about
the
the
block
grant.
As
it
looks
in
the
spreadsheet
a
little
over
22
million
dollars,
we
spent
297
000
right
dollars.
Of
that
I
guess
the
question
is,
is
do
do
we
have
a
process
by
which
we
people
can
submit
for
these
grants?
F
One
of
the
common
themes
we
heard
yesterday
and
sounds
like
we're
going
to
hear
today
is
we
have
all
this
federal
printed
money
and
we
haven't
really
spent
a
whole
lot
of
it,
and,
and
so
I
guess
the
question
would
be.
What
is
the
process
for
doing
that?
And,
and
so
you
can
share
it
with
us,
so
that
others
might
be
able
to
hear
that.
C
C
Then
on
the
second
part
of
that
which
was
the
substance
abuse,
we
didn't
get
that
approval
until
august.
We're
doing
the
same
thing.
So
I'm
not
concerned
that
we
won't
be
able
to
spend
these
funds.
It
was
really
we
got
held
up
on
those
on
the
ones
above
that
you'll
know
they're
allocated
and
being
spent,
but
that
block
grant
one,
which
is
the
largest
one.
Really
we
didn't
even
get
approval
until
march
for
the
first
part
in
august.
For
the
second
part.
F
C
F
H
Yes,
sir,
so
it's
a
range
so
on
the
mental
health
block,
grant
supplement
we're
funding.
I
think
over
30
providers
with
the
substance
abuse
block,
grant
it's
well
over
a
hundred.
So
so,
when
you
think
about
our
department
and
how
we
do
our
work
in
the
community
is
through
a
wide
variety
of
local
community
organizations.
So
to
your
question
about
the
range,
it
could
be
a
grant
amount
as
small
as
twenty
thousand
dollars
all
the
way
up
to
a
million
and
a
half
based
on
the
size
of
the
organization.
H
C
B
Thank
you,
madam
chair,
and
thank
you,
commissioner,
and
your
team.
For
being
here.
I've
got
a
question
or
two
about
the
state's
use
of
the
federal
funds,
the
portion
of
them
that
we
have
spent
so
far.
What
portion
of
those
funds
have
we
spent
on
existing
programs
versus
new
programs
that
have
been
created
in
order
to
spend
those
funds
right.
C
Now
I
can't
give
you
an
actual
percentage,
but
I
can
tell
you
around
about
again
for
the
substance
abuse
side.
We
know
we
got
that
gap
that
I
talked
about
and
so
for
those
funds
we're
really
funding
what
works
that
we
have
to
expand
capacity
right.
So
you're
talking
about
detox
programs,
you're
talking
about
inpatient
programs,
you're
talking
about
residential
you're,
talking
about
aftercare.
C
C
Yes,
sir,
and
thank
you
for
asking
about
that
our
project
rural
recovery
is
a
program
that
I
wish
we
had
thought
about
a
long
time
ago.
Many
of
you
have
participated
in
conversations
and
discussions
about
the
transportation
problem
in
rural
communities
right,
and
so
we
tried
our
best
to
solve
the
transportation
problem
and
we
haven't
got
real
far
with
that.
So
what
we
did
is
we
came
together
and
wrote
a
federal
grant
really
prior
to
the
covet
funds
and
said:
hey.
Why
don't
we
go
to
the
people?
Why
don't
we
have
a
mobile
van?
C
That
goes.
That's
part
of
that
community,
where
people
can
get
the
care
and
treatment
that
they
need
versus
trying
to
figure
out
how
to
pay
people
to
go
to
a
site.
So
that
is
a
program
that
we
are
excited
about.
We've
been
able
to
expand
it
with
these
dollars,
and
I
know
deputy
commissioner,
if
you
want
to
give
an
idea
of
where
we
expanded
these
two
I'd
appreciate
it.
H
Yes
ma'am,
so
the
commissioner
mentioned
project
rule
recovery.
I
mean
I
when
I
think
about
our
department,
I
think
about
what
we're
trying
to
do
to
increase
access.
It's
all
about
going
where
people
naturally
are
so.
We've
done
a
lot
of
work
with
with
school-based
mental
health,
we're
putting
people
in
schools
to
work
with
students
we're
working
obviously
closely
with
the
justice
system,
with
our
criminal
justice
liaison
program.
I
think
project.
H
Rule
recovery
is
an
example
of
where
we're
going
to
these
hard
to
reach
communities
where
people
may
not
have
a
brick
and
mortar
mental
health
center
or
substance
use
treatment
center
there
in
their
community.
So
we're
going
there
through
these
mobile
units,
but
with
these
federal
dollars
we've
been
able
to,
I
think,
reinforce
what
we
know
that
works.
We're
using
these
monies
to
do
more
medication,
assisted
treatment,
we're
providing
more
funding
to
our
behavioral
health
safety
net
providers.
H
But,
as
the
commissioner
said,
we've
also
given
the
provider.
Some
flexibility
to
say
tell
us
what's
missing
what
are
the
gaps
in
your
community?
So
I
was
looking
at
the
list
of
things
that
we're
funding
outside
of
the
normal
and,
for
example,
volunteer.
Behavioral
health
is
doing
co-response
models
with
some
of
these
federal
dollars.
H
Helen
ross,
mcnabb
and
knoxville
is
actually
partnering
with
the
university
of
tennessee
to
bring
mental
health
services
to
the
campus.
So
it's
really
a
blend
of
doing
what
we
know
that
works
and
putting
those
dollars
behind
those
evidence-based
programs,
but
also
giving
some
flexibility
to
do
new,
innovative
things,
and
maybe
one
more.
B
C
B
B
C
Thank
you
for
asking
that.
As
you
know,
this
is
not
broken
down
into
capital
funds,
so
I
want
to
ask
gene
wood,
our
budget
director.
Are
you
aware
or
deputy
commissioner
yancey,
how
much
of
this
went
to
capital?
The
majority
of
it's
really
gone
to
staffing
and
services,
and
and
bringing
in
like,
like
the
vans
for
the
project,
rural
recovery,
but
as
far
as
bricks
and
mortar
capital,
I'm
not
sure.
H
Yes,
sir,
so
so
with
these
funds,
specifically,
the
mental
health
and
substance
abuse
block
grant
supplemental
dollars.
There
hasn't
been
a
lot
of
investment
in
capital
projects,
primarily
because
there
are
some
exclusions
around
that
set
forth
by
the
federal
funder
gene.
I
don't
know
if
you
want
to
you're,
saying:
okay,
good.
B
C
J
B
C
Thank
you
for
asking
that
there
are
multiple
reasons
number
one
they
may
not
seek
service.
So
if
you
look
at
prevalence,
this
is
what
we
know
across
the
state,
but
not
everybody
who
has
a
serious
mental
illness
seeks
service.
So
that's
part
of
the
gap.
The
other
part
is
if
they're
over
138
percent
of
federal
poverty
level
or
higher.
Although
this
is
really
focused
on
low-income
individuals,
that
group
may
not
be
able
to
be
served
because
the
dollars
that
we're
using
are
really
for
138
percent
of
federal
poverty
level
or
below.
B
C
C
C
But
as
long
as
you
have
that
big
of
a
gap
there,
it's
going
to
be
hard
to
get
service
and
that's
not
just
for
the
uninsured,
that's
for
the
insured
individual.
So
all
I
can
say
to
you
is
as
we
get
dollars,
we
expand
the
services.
If
you
look
at
our
overhead
in
our
department,
we
only
have
six
percent
overhead
94
of
these
funds
go
to
the
community.
They
don't
stay
with
us.
B
Sorry,
one
more
question
and
and
a
theme
that
we've
been
asking
on
this
this
panel,
this
whole
time
is
what
what
are
you
doing
to
be
proactive
to
notify
tennesseans
of
the
additional
programs.
I
understand
the
the
the
reason
you
gave
for
not
ex
expending
the
the
federal
dollars
that
we've
received,
but
how
are
we
being
proactive
to
make
sure
that
we
close
that
gap?
Yes,
not
just
there,
but
on
mental
health
and
and
all
these
other
programs
that
we're
we're
rolling
out.
C
We're
doing
multiple
things,
one
is
an
unbelievable
commercial
that
our
director
of
communications
has
put
together
with
news
channel
five.
That
really
makes
you
stop
and
think
related
to
how
to
call
and
where
to
call
when
you
have
a
crisis,
because
that's
your
portal,
if
you've,
never
accessed
services
and
you're
in
a
crisis
or
a
family
members
in
a
crisis
that
ability
to
call
so
we
like
blanketed
the
market
during
the
highest
points
of
covet
in
the
pandemic.
C
The
second
thing
that
we've
done
is
our
provider
network
is
very
responsible
for
within
their
communities,
letting
people
know
about
the
services
that
are
funded,
and
I
know
that
they've
done
a
lot
of
outreach
over
this
pandemic
to
let
people
know
what's
available,
we've
also
enhanced.
Our
website
cannot
even
begin
to
tell
you
the
work
that
this
team
did
related
to
making
sure
people
went
to
our
website.
C
They
knew
where
to
get
services,
so
they
could
geographically
look-
and
I
can
tell
you-
I
am
a
website
challenged
and
I
literally
can
get
on
here
and
find
where
I
need
to
go
to
get
help.
We
expanded
our
24
hour
seven
day
a
week
resource
with
substance
abuse.
It's
called
the
red
line
when
we
first
funded
it,
it
was
like
a
person
would
call
and
they
would
read
you
35
questions,
and
we
said
this
doesn't
make
a
lot
of
sense.
I
mean
this
person's
in
a
crisis.
C
A
You,
sir,
and
I
I
think
it's
worth
noting-
that
one
of
the
challenges
here,
to
my
mind
at
least
is
this-
is
not
a
stable
population
that
we're
able
to
work
against
that
population
is
growing
all
the
time.
So,
even
as
we
increase
services
and
do
things
more
efficiently
and
hopefully
more
effectively,
it's
it's
still
a
tsunami.
That's
coming
at
you
just
because
of
the
increased
numbers
of
people
who
are
involved.
So
it's
a
very
difficult
situation.
Obviously,
chairman
faison.
K
I
have
noticed,
and
there
are
a
few
counties
who
have
some
pilot
projects
when
it
comes
to
mental
health
courts
like
we
do.
Our
drug
courts
have
special
courts.
We
have
military
courts
and
it's
not
publicly
known,
but
this
is
something
that
I've
been
passionate
about
for
years.
My
dad
struggled
with
bipolar
depression.
K
So
my
question
is:
is
this
possible
for
the
the
money
that's
come
in
to
help
us
get
around
the
state
of
tennessee?
I
I
was
just
talking
to
the
vice
chair
here
and
they're
they're,
doing
something
with
mental
court.
Mental
health
courts
in
rutherford
county,
but
there's
no
standardization
at
all,
and
I'm
just
wondering
is:
is
it
possible
that
we
could
use
this
to
to
maybe
increase
our
our
ability
in
our
court
systems
around
tennessee?
To
do
something?
Could
you
speak
to
that
it
it
something
we
could
use
this
money
for.
C
I
really
appreciate
you
asking
that,
as
you
know,
since
we
took
over
the
recovery
courts,
substance
abuse
courts,
mental
health
courts,
we've
actually
expanded
those
by
like
70
percent,
since
they
came
to
us
and
one
of
the
areas
that
we
really
do
focus
on.
In
addition
to
the
substance,
use
recovery
court
is
mental
health
because
oftentimes
the
two
are
together
right.
So,
even
if
you
have
a
substance
abuse
court,
that's
a
recovery
court,
it's
not
just
for
substance,
addiction,
you're,
dealing
with
people
with
mental
health
issues,
so
e.
C
C
H
We'll
have
to
check
representative,
but
I
do
know
with
some
of
the
block
grant
funds,
that
the
plan
is
to
expand
treatment
for
the
criminal
justice
population.
So
folks,
who
are
coming
through
the
recovery
course,
we
want
to
make
sure
those
providers
have
access
to
the
funding
to
ensure
that
they
get
the
treatment
they
need.
That
also
includes
using
some
of
these
funds
for
medication-assisted
treatment,
knowing
that
that
is
the
evidence-based
modality
for
folks
living
with
with
opioid
use
disorder.
H
K
H
H
C
Absolutely
there's
potential
for
that
to
be
applied
for
if
we
haven't
already
gotten
the
application
from
the
provider,
I
was
telling
you
earlier.
We
have
allocated
funds
based
upon
all
that
research
for
a
particular
provider
in
region
area,
and
so
yes,
there's
the
opportunity
if
they
have
not
already
applied
and
been
allocated.
Okay.
D
Thank
you
chair,
lady,
good
morning,
good
morning.
I
apologize
for
my
tardiness.
That's
fine
I
wanted
to,
and
I
don't
know
if
this
culvert
related,
but
I
know
there's
a
lot
of
more
cases
of
youth
under
18
experiencing
mental
distress
because
of
virtual
school
being
at
home,
not
getting
meals
because
they
have
to
be
at
home.
Parents
can't
afford
it.
Is
there
some
sort
of
initiative,
collaboration
or
anything
going
on
uses
copic
funds
to
provide
mental
health
counseling
in
the
schools
for
our
children,
yeah.
C
C
I
can't
tell
you
how
important
that
is,
because
so
often
schools
don't
know
what
they
can
access
for
help
for
their
kids,
especially
kids,
that
are
poor,
and
so
we've
already
got
that
person
helping
in
each
county
and
when
you
ask
about
the
funds
allocated,
we've
got
the
safety
net,
the
behavioral
health
safety
net
for
kids.
That
provides
the
full
array
of
services
for
any
uninsured
kid
in
this
state
and
so
we're
utilizing
those
dollars
to
meet
that
need,
but
also
utilizing
the
school-based
behavioral
health
liaison
position.
C
D
C
D
L
C
A
D
C
We're
looking
at
kids
yeah
we're
looking
at
number
of
kids
in
each
county,
but
I
also
want
to
say
it's
not
just
that
only
one
person
does
help
for
the
kids,
it's
that
liaison
that
hooks
them
up
to
the
services
and
people
that
are
already
funded
in
the
county,
so
that
one
person
is
not
the
only
person
working
with
kids
in
shelby
county
you've
got
a
case.
Management,
inc
and
you've
got
alliance
and
you've
got
some
other
providers
that
are
actually
funded
and
have
case
managers
and
therapists
that
work
with
kids.
D
C
D
C
C
H
Yeah
representative,
this
is
a
timely
question,
we're
actually
meeting
with
the
council
of
family
and
juvenile
court
judges.
I
think
this
friday
we're
doing
a
couple
of
things
related
to
the
juvenile
justice
population,
one
of
which
is,
I
think,
with
six
or
seven
providers
across
the
state
to
work
children
and
youth
prior
to
adjudication.
H
So
once
they
refer
to
the
court,
the
judge
will
say:
hey
this.
This
charge
may
not
necessitate
it
going
formal.
Let's
refer
to
this
provider
who's
doing
an
evidence-based
program.
We've
had
a
lot
of
success
with
that
we've
seen
data
that
supports
that
the
majority
of
these
children
are
not
going
forward
in
the
court
process
they're
staying
at
home
with
their
parents,
which
is
really
really
important.
H
The
other
thing
with
the
juvenile
courts
that
we're
doing
is
around
safe
baby
courts
in
partnership
with
the
department
of
children,
services
and
the
aoc,
and
we're
continuing
to
expand
safe
baby
courts.
That
also
is
seen
are
producing
similar
outcomes
related
to
permanency
and
stability
within
the
home
for
that
early
that
early
childhood
population.
So
I
know
beyond
those
two
programs
that
many
of
our
providers
have
long-standing
partnerships
with
local
juvenile
courts.
They
work
closely
with
the
judges.
Many
of
them
have
staff
housed
at
the
juvenile
courts.
A
I
You
manager,
thank
you,
commissioner,
going
back
to
2019
pre-pandemic,
like
everything
we
talked
about
across
multiple
departments
was
opioid
epidemic
like
over
and
over.
The
only
word
I
heard
up
here,
more
than
opioid
was
recidivism,
which
I
can
finally
say
what's
what's
happened
with
that?
Are
we
still
having
an
epidemic
so
much
of
our
programming?
So
much
of
our
funding?
I
So
much
of
what
I
heard
you
talk
about
and
multiple
other
commissioners
talk
about
were
involved
with
opioids
over
prescription
of
those
the
programming,
the
reimbursement
rates
that
doctors
were
telling
me
that
they
had
to
provide
these
during
treatment
at
facilities,
because
if,
if
they
got
a
bad
score
on
somebody's
experience,
it
would
hurt
the
reimbursement,
so
they
were
actually
being
coached
and
told
you
know
they
have
to
be
happy
when
they
leave
well.
How
do
you
make
somebody
happy?
Well,
you
give
them
a
pill,
so
there
was
a
kind
of
problem
across
the
board.
I
I
Are
we
going
to
over
prescribe
something
to
treat
anxiety
and
depression
and
then
are
we
going
to
come
back
in
two
and
three
years
and
say:
we've
got
a
new
epidemic
because
everybody
was
depressed.
We
over
prescribed
this
pill,
and
now
we've
got
a
whole
nother
group
that
we're
going
to
spend
the
next
five
years,
trying
to
treat
and
wing
off
over
prescribed
medications.
C
Those
are
two
really
major
big
questions:
the
first
one,
the
opioid
epidemic
and
where
we
are,
we
really
have
done
a
great
job
in
this
state
related
to
lowering
prescribed,
opioids,
so
pain
pills,
and
you
can
see
that
in
the
department
of
health
data,
it's
really
really
gone
down
low.
So
you
ask
yourself:
why,
then
are
we
having
more
overdoses?
Why
did
we
get
a
45
increase
in
overdoses,
and
that
goes
to
the
second
part
of
this
response?
C
C
It's
not
just
a
straight
pain
pill
that
you're
taking
it
looks
like
the
pain
pill
that
you're
taking
so
we're
urging
citizens
to
not
take
a
drug
off
the
street.
You
do
not
know
what
it
is,
even
if
it
looks
exactly
like
what
your
pain
pill
looked
like.
So
I
can
tell
you
that
is
what
we're
seeing
right
now
to
your
first
question.
Does
that
respond
appropriately
to
your
second
question?
Are
we
going
to
over
prescribe
because
of
the
increase
in
anxiety
and
depression.
C
I
don't
have
the
data
and
I'm
sure
my
pharmacy
director
can
get
this
about
how
prescriptions
are
going
around
anti-anxieties
and
antidepressants
your
question's
a
really
good
one.
So
I'd
like
to
do
like
a
trend
which
I
don't
have
with
me
and
sort
of
see,
what's
happening,
it's
it's
a
very
great
question.
Thank
you.
A
D
Camper.
Thank
you,
madam
chair.
Thank
you
for
your
presentation,
I'll,
be
short
because
I
was
really
concerned
about
the
rural
recovery
and
you
already
talked
about
that.
I
wanted
to
learn
more
about
that,
but,
secondly,
I
did
a
session
with
some
college-age
students
in
the
student
government
and
they
were
concerned
about
their
access
to
mental
health
and
substance
abuse
and
what
they
were
dealing
with
during
kovitz.
So
can
you
talk
to
any
programs
or
support
that
you're
doing
for
that
college
age
group.
C
Yes,
ma'am,
it
is
something
that's
near
and
dear
to
my
heart.
We
have
started
a
collegiate
recovery
program
under
dr
bonnie
burks,
who
many
of
y'all
know
he's
our
director
of
faith-based
initiatives,
and
we
have
a
member
of
our
team
he's
a
lifeliner
that
works
out
in
the
community.
His
name
is
nathan
payne,
and
he
really
is
our
point
person
on
this
and
we
have
done
trainings
with
colleges
across
the
state
deputy
commissioner.
C
Yancey
has
been
at
those
trainings
and
spoken
at
those
trainings,
we're
also
creating
collegiate
groups
on
campus
for
students
to
be
able
to
talk
to
other
students
who
are
in
recovery
and
to
give
that
support
to
maintaining
that
recovery.
I
mean
I'm
just
real,
I'm
very
excited
about
this
and
matt.
Do
you
want
to
add
anything
to
this.
H
This
veterans
day,
I
was
actually
at
motlow
state
they've
started
a
collegiate
recovery
program.
We
also
have
other
kind
of
ancillary
programs
related
to
the
young
adult
population.
We
have
a
first
episode
psychosis
program
across
the
state
for
young
adults
that
may
be
experiencing
their
first
psychotic
break.
H
So
we
know
it's
a
population
that
we
have
to
keep
our
focus
on,
just
because
there's
such
an
immense
need
and-
and
we
do
look
forward
to
doing
more
with
all
colleges
and
universities,
I
think
we
have
an
event
at
university
of
tennessee
knoxville
next
month.
We'd
love
to
partner,
with
every
college
and
university
in
the
state,
around
collegiate
recovery
and
connecting
their
students
to
treatment
and
recovery
support
services.
D
Leader,
camper
follow
up
yes,
ma'am.
Thank
you
very
much.
I
appreciate
that.
I
think
we
need
to
probably
increase
our
funding
outside
of
our
cover
dollars
and
really
put
some
funding
into
those
programs.
I
think,
is
much
needed,
but
also
for
young
people
who
have
aged
out
of
foster
care,
and
you
know
some
of
the
programming
that
they
may
need,
and
this
whole
group
of
young
people
that
we've
categorized
as
disconnected
you
they're
not
connected
to
a
college
they're
not
connected
to
something
that
we
can
track.
D
But
you
know
if
we're
able
to
assess
where
they
may
be
and
try
to
bring
them
in,
maybe
do
some
marketing
toward
that
group.
So
they'll
know
that
there's
a
place
for
them
to.
I
think
we
should
maybe
consider
that
or
maybe
you
all
are
and
can
just
brief
us
on
it,
but
I
can
I
can
get
the
answer
later.
Thank.
N
Real
quick
chairman,
I
just
want
to
thank
this
committee
and
and
your
leadership
for
for
the
passion
and
conviction.
You
know
this
isn't
a
democrat
issue
or
republican
issue.
I
heard
chairman
faison
opened
up
about
his
father.
I've
had
him
on
our
radio
show
back
home,
but
he's
talked
about
it
and
appreciate
representative
freeman
open
it
up.
Last
year
I
had
to
carry
a
woman
to
to
identify
her
daughter
who
had
overdosed.
They
think
it
was
fentanyl,
and
you
know
I've
seen
this
in
my
own
family,
the
hurts
and
hang-ups.
N
But
if
I
could
chairman
about
two
years
ago,
we
put
an
event
together
in
my
in
my
community.
I've
shared
this
at
education.
We
had
the
drug
court,
judge,
judge
tidwell
there
monty
burks.
Was
there
tennessee
mental
health
cooperative?
Was
there
dr
brian
terry,
both
school
superintendents,
here's.
What
came
out
of
that
that
whole
event
we
had
about
110
folks
in
attendance.
I
want
to
read
this
letter
from
the
late.
Dr
gilbert.
I've
shared
this
before
education.
N
I
want
to
share
it
before
this
committee.
Here's
what
she
said
she
said
mike.
I
apologize
for
the
delay
in
responsing
in
responding.
She
says.
Thank
you
for
reaching
out.
Yes,
more
funding
for
counselors
would
certainly
help
with
the
social
emotional
issues
we're
seeing
another
area
of
social
workers
that
are
vital
and
many
school
districts
are
not
able
to
fund
them.
She's
also
think
it'd
be
helpful
for
him
and
other
legislators
to
talk
with
school
superintendents
about
the
issues
we're
seeing
in
very
young
children
to
be.
This
is
what's
important
right
here.
N
The
behaviors
of
our
six
to
nine
year
olds
are
like
nothing
we
have
ever
seen
before.
This
is
a
50-year
educator.
That's
saying
this.
The
behavior
of
our
six
nine-year-olds
are
like
nothing
we've
ever
seen
before.
They
are
inordinately
disruptive
and
aggressive,
and
while
we're
bringing
all
of
our
resources
into
play,
there's
no
place
for
these
children
to
go
to
be
assessed
and
treated.
N
I
feel
very
good
about
what
the
department
of
education
is
trying
to
accomplish
in
this
area,
with
emphasis
on
the
whole
child,
and
I'm
helpful
that
I'm
hopeful
that
department
of
mental
health
and
substance
abuse
will
work
alongside
them
to
help
address
the
upper
tier
children
who
there
seems
to
be
no
answers,
sadly,
that
that
school
superintendent
that
50-year
educator
passed
away
about
three
months
later.
I
know
that
this
committee
and
the
governor
has
put
more
resources
into
play.
55
of
our
inmates
are
on
psychotropic
drugs.
N
Our
prison
budget,
I'm
seeing
with
the
request,
is
going
to
be
an
additional
60
million.
1.3
billion
is
what
we
spend
on
our
prisons.
So
to
me,
any
investment
in
the
in
in
this
area,
especially
with
the
young
folks,
the
young,
whether
it's
counselors
nurses,
social
workers
to
me,
is
an
investment,
and
I
appreciate
the
passion
that
chairman
hawk
and
scotty
campbell
and
others
that
have
been
fighting
for
these
issues
for
a
long,
a
long
time
and
the
whole
committee
in
general.
But
how
do
we
do
I
mean
how?
N
C
I'll
shut
up,
listen!
Thank
you!
Yes,
sir.
I
want
to
say
to
you.
I
had
the
privilege
to
meet
dr
gilbert
right
after
she
had
that
larger
meeting
she
reached
out
and
chief
of
staff
thornton,
and
I
went
and
met
with
her
in
murfreesboro
at
trust
point
with
beth
goodner
and
we
put
together
some
incredible
plans
which
really
are
being
enacted
right
now
and
just
to
give
you
an
idea,
here's
one
of
the
enacted
enacted
plans
that
has
occurred.
C
And
then
we
went
on
he's
still
having
sessions,
but
not
there,
but
anyway
he
knows
I'm
joking
with
him,
but
but
now
I
I
so
resonate
with
this.
I
was
one
of
those
kids
at
a
school
that
when
I
was
growing
up
really
poor
with
an
issue
with
my
mom,
I
would
have
given
anything
if
somebody
had
been
there
and
paid
attention
to
what
was
happening
in
my
life
and
had
reached
out.
C
So
this
is
very
close
to
my
heart
that
any
kid
that
we
can
help
that
we
can
save
not
just
them
but
their
family,
because
y'all
have
created
a
system
even
though
we
don't
have
medicaid
expansion.
What
you've
done
allows
us
to
take
adult
funds
for
that
family,
like,
in
my
case,
my
mom.
She
could
have
gotten
help
and
the
kid
itself
the
kid
that's
there
and
I
didn't
mean
itself,
but
the
kid
themself
would
have
been
welcome.
C
I
would
have
gone
into
that
room
as
a
young
person
and
sat
down
and
told
that
counselor
here's
what's
happening
so
the
more
that
we
can
partner
going
back
to
that
word
that
we
talked
about
that
we
can
partner
with
the
local
schools
and
they
allow
our
people
that
are
funded
through
those
local
providers
to
set
up
shop.
The
more
difference
in
change,
we're
going
to
see
we're
going
to
see
major
change
and
difference
there.
A
O
I
O
M
O
Is
so
important
that
we
don't
add
to
their
trauma
and
and
do
have
someone
who's
trained
when
they're
taking
them
in
and
then
my
next
question
is
statement.
First,
we
really
don't
have
enough
psychiatrists
in
the
state
or
therapist,
and
what
I'd
like
to
know
is:
are
we
doing
anything
to
try
to
encourage
and
incentivize
people
to
go
into
these
practices?
O
O
E
O
Say
you
know
what
I
I
I
don't
take
that
health
insurance
and
I
just
want
you
to
pay
and
that's
a
curiosity
to
me.
I
I
think
the
economics
of
it
just
needs
to
be
looked
at
what
is
going
on
and
why
are
they
doing
that
and
there's
definitely
reasons
for
that?
Maybe
that's
for
commerce
and
insurance
or
some
other
department,
but
I
I'm
interested
in
learning
more
about
the
economics
of
that.
So
come
talk
to
me
and
if
you
want
to
address
anything
here,
I'd
appreciate
it
just.
C
Real
quickly,
cit
absolutely
we're
expanding
it.
Not
only
are
we
expanding
it,
we're
looking
at
working
with
madison
county
to
expand.
They
already
have
a
simulated
classroom
where
they
can
train
any
sheriff
any
staff
member
out
of
the
sheriff's
office
to
know
how
to
respond,
and
we
have
worked
and
continue
to
work
with
nami
to
expand
it.
That's
expanding.
I
can
tell
you
that,
as
it
relates
to
the
shortage,
we
talked
a
little
bit
earlier
about
that.
C
We've
co-wrote
with
our
partners
at
tenncare,
a
plan,
that's
based
on
statewide
input
from
providers
and
and
other
individuals
to
address
the
workforce
shortage
psychiatrists
are
a
huge,
huge,
huge
gap,
not
just
in
this
state.
It's
nationwide,
the
average
age
of
a
psychiatrist.
Right
now
is
around
80.,
and
so
I
mean
it
tells
you
we
need
help,
and
so,
when
you're
looking
at
that,
one
thing
to
look
at
is:
are
there
other
ways
that
we
could
provide
psychiatric
services
and
expand
scopes
around
other
professions?
C
O
I
just
wanted
to
say
that
I
I
do
a
lot
of
study
on
this
and
what
I've
seen
is
that
physicians,
they
they're
often
attracted
to
psychiatry.
But
it's
you
know.
They
don't
feel
that
there's
a
lot
of
benefit
to
the
practice,
because
there's
not
a
lot
of
satisfaction.
You
don't
always
cure
someone.
You
don't
always
see
the
results
like
a
surgeon
who
sees
results
and
that's
very,
very
satisfying.
So
it
is
hard,
and
so
we
do
need
to
incentivize
people
to
go
into
psychiatry
because
it
is.
O
C
A
Commissioner,
thank
you
again
and
your
staff
for
not
only
for
joining
us
here
today,
but
for
the
work
that
you
do
every
day
for
tennesseans
in
a
field
that
is
as
has
been
referenced
here.
Many
of
us
have
a
strong
interest
in
and
recognize
that
there's
a
there's
a
lot
of
unmet
needs,
but
we
appreciate
what
is
being
done
to
close
those
gaps
and
recognizing
that
we're
never
going
to
live
in
a
perfect
world
where
everybody
can
get
all
of
the
services
that
they
need.
A
A
A
Thank
you.
I
think
it
goes
without
saying
we're
appreciative
of
the
time
that
you
all
are
taking
to
be
here
with
us
today.
We
know
it's.
There
doesn't
seem
to
be
much
down
time
anytime
anymore,
but
we
know
this
is
an
incredibly
busy
time,
even
more
so
than
usual,
with
budgets
being
prepared
and
all
of
those
things.
A
So
we
we
thank
you
for
being
here
to
bring
us
up
to
date
again
a
reminder
we're
focusing
on
federal
funding
dollars
that
have
come
in
that
we
would
not
have
you
know
known
about
when
we
did
our
previous,
when
we
did
the
budget
for
this
current
year.
So
with
that,
we'll
ask
you
to
get
underway
with
your
presentation.
A
P
Thank
you
very
much
chairman
hazelwood
members.
It's
good
to
be
with
you
this
morning.
My
name
is
steven
smith.
I
serve
as
the
director
of
tenncare
and
with
me
today.
I
have
william
aaron,
our
chief
operating
officer
and
zane
seals
is
our
chief
financial
officer.
We
very
much
appreciate
the
opportunity
to
be
with
you
this
morning
to
give
you
all
a
status,
update
and
offer
some
clarity
on
the
federal
funding
that
we
have
received
throughout
the
pandemic,
and
we
do
have
some
slides
to
help
with
that.
P
We're
going
to
go
through
these
very
quickly,
because
we
want
to
leave
plenty
of
time
for
questions
and
comments
that
that
you
all
have
so.
At
the
beginning
of
the
pandemic,
the
federal
government
enacted
legislation
that
provided
an
additional
6.2
percent
match
for
all
medicaid
programs
so
that
increased
tennessee's
match
from
about
65
to
71
and
unlike
a
lot
of
the
or
actually
most
of
the
federal
relief
that
you
all
have
been
talking
about
and
will
talk
about.
P
This
was
not
provided
to
us
in
the
form
of
a
grant
or
for
any
one
specific
purpose
within
medicaid.
Rather,
it's
designed
primarily
to
address
the
increased
costs
that
the
medicaid
programs
are
facing
throughout
the
country,
and
that
is
due
primarily
to
increased
enrollment
and
also
testing
and
treatment
due
to
covid.
P
But
it
also
is
designed
to
help
states
that
have
severe
budget
issues,
and
that
makes
sense,
because
if
a
state
has
to
make
drastic
budget
cuts,
it's
almost
inevitable
that
those
cuts
will
have
to
come
from
the
medicaid
program.
Because
since
that
makes
up
such
a
large
portion
of
the
state
budget,
we
know
that
the
enhanced
federal
funding
will
continue
through
any
quarter
in
which
the
public
health
emergency
is
in
effect.
P
So
this
next
slide
gives
you
all
a
picture
of
where
the
overwhelming
majority
of
the
increased
costs
come
from,
and
that
is
due
to
the
increased
enrollment
and
the
enrollment
increase
is
due
primarily
to
the
fact
that
during
the
emergency,
there
is
a
maintenance
of
effort
provision
that
has
been
put
in
place
by
the
federal
government
and
what
that
means
is.
We
are
not
able
to
remove
anyone
from
the
medicaid
roles,
regardless
of
their
their
eligibility,
and
you
can
see
the
result
of
that
on
the
screen.
P
So
to
date
we
have
increased
our
10
care
enrollment
by
about
200
000
people,
that's
about
14.
Our
latest
projections
show
the
well
our
best
projections.
We
believe
that
the
federal
emergency
will
end
in
march
of
2022,
so
you
can
see
that
we
will
peak
in
enrollment
in
march
of
2022
and
then
you'll
see
a
gradual
decline
as
we
go
through
that
redetermination
process,
and
that
is
a
process
that
is
required
by
both
federal
and
state
law.
P
Now,
there's
a
caveat
to
this,
of
course,
and
that
is
the
the
federal
legislation
that's
being
discussed
right
now.
A
portion
of
that
discussion
revolves
around
medicaid,
revolves
around
the
maintenance
of
effort
provision
and
also
the
enhanced
federal
funding.
So
we're
closely
monitoring
all
of
that.
But
it's
very
possible.
We
are
going
to
have
to
revise
our
projections
based
on
whatever,
whatever
it
is,
that
they
do
at
the
federal
level.
P
So
when
we
think
about
the
estimated
cost
from
this,
we
really
look
at
it
over
the
course
of
the
entire
pandemic,
the
entire
emergency,
and
that's
because
these
costs-
they
don't
come
in
neat
little
packages
around
the
fiscal
years.
So
here
you
can
see
our
estimated
cost
from
enrollment
broken
down
by
fiscal
year,
and
you
will
note
that
our
largest
cost
estimates
are
incurred
in
in
fy
22.
P
So
that
is
this
current
fiscal
year
next
you'll
see
our
estimated
cost
for
testing
and
treatment
so
about
a
total
of
500
million
dollars
through
fy22,
and
one
note
here
for
fy23
and
beyond,
we
are
incorporating
our
testing
and
treatment
costs
into
our
normal
recurring
budget.
So
you
won't
see
a
carve
out
for
that
going
forward
here.
You
will
see
the
estimated
impact
of
the
enhanced
federal
matching
dollars,
so
these
are
our
best
estimates.
With
the
information
that
we
have
today.
P
You
will
note
that,
based
on
our
projection
of
the
emergency
going
through
march
of
2022,
we
believe
that
we
will
have
an
estimated
total
of
about
1.22
billion
dollars
from
the
enhanced
federal
match
and
then
on
this
slide
from
a
fiscal
responsibility
and
budget
perspective.
This
is
the
side
you
probably
want
to
pay
close
attention
to
because
it
estimates
our
total
increase
cost
from
this
emergency,
as
well
as
the
increased
federal
funding
to
account
for
those
costs,
and
what
you
will
see
here.
P
A
Thank
you
so
much
director
and
just
quickly
before
we
get
into
our
other
questions.
If
on
slide
five,
if
you
could
go
back,
I
think
I
you
talked
about
the
fact
that
these
ongoing
costs
would
be
incorporated
into
future
budgets.
There
would
not
be
a
line
item
so
to
speak,
and
can
you
tell
me
when
that
begins
again.
P
A
J
Thank
you,
chair
lady.
I
appreciate
you
being
here
and
thank
you
for
what
you
do
for
those
in
our
communities
that
that
need
it.
The
most
I
understand
that
tenncare
has
provided
about
4.3
million
dollars
in
relief.
Payments
to
dentists
throughout
the
state
has
tenncare
provided
similar
relief
payments
to
other
service
providers,
other
than
dentists.
P
P
Those
are
direct
service
providers,
behavioral
health
providers,
primary
care
and
then,
as
you
mentioned,
a
dentist-
and
there
were
also
dollars
that
were
tied
to
the
nursing
facility
assessment
that
went
to
nursing,
nursing
facilities
went
directly
to
them,
and
then
there
are
also
dollars
that
are
tied
to
the
hospital
assessment
that
are
currently
sitting
in
the
hospital
assessment
trust
fund.
We
are
working
with
the
hospital
association
to
to
distribute
those
funds.
J
P
P
J
Okay,
during
the
pandemic,
I
think
tenncare
renegotiated
capitation
rates
for
the
mcos
due
to
the
limited
services
and
the
types
of
services
enrollees
were
receiving
during
that
time
was
10
care
able
to
do
something
similar
with
dent
quest
and
if
so,
what
were?
The
savings
realized
from
that
procedure?.
P
P
I
think
we've
made
two
adjustments
now
and
william
can
talk
about
that
on
the
dental.
The
dental
manager
works
differently
from
our
mcos
in
that
it's
not
really
an
at-risk
arrangement,
and
so
we
didn't
do.
We
didn't
do
something
similar
with
the
the
dental
benefits
manager.
But
william,
do
you
want
to
speak
more
specifically
to
that.
Q
Yep,
thank
you.
Thank
you,
director
yeah,
and
it's
an
excellent
question.
It
goes
to
as,
as
you
just
heard,
the
director
mention
that
we
pay
our
big
mcos
differently
than
we
pay
dentaquest.
For
example.
I
don't
know
about
you
all,
but
because
during
the
pandemic
I
wasn't
driving
as
much
my
car
insurance
company
sent
me
a
refund
check
right,
which
was
a
nice
surprise
right.
I
wasn't
expecting
that.
I
didn't
ask
for
it,
but
I
didn't.
I
didn't
drive
nearly
as
many
miles
and
apparently
that
was
wasn't
just
about
me.
Q
It
was
the
folks
they
were
covering.
Similarly,
with
our
mcos
we
paid
when
we
set
the
captivation
rates,
as
you
mentioned,
sir,
you
know
that
there
are
a
certain
level
of
service
that
we
expect
is
going
to
be
delivered.
Well,
obviously
that
didn't
happen
and,
as
you
heard
stephen
mentioned,
we
wanted
to
make
sure
that
the
mcos
basically
didn't
make
inappropriate
levels
of
profit,
because
we
were
paying
them
for
this
level
of
service
and
what
was
actually
being
delivered
in
the
pandemic.
Was
this
level
of
service
right?
Q
It's
like
an
insurance
premium
that
we
all
pay.
That's
what
those
cap
rates
are
the
dental
dental
benefits
manager
is
structured
differently,
and
that
is
more
fee
for
service.
So
the
only
way
that
those
dollars
get
paid
is
if
a
tenncare
member
goes
to
the
dentist
gets
a
service,
and
then
that
comes
back
and
we
pay
that.
So
it's
not
prepaid
in
the
same
way
and
the.
Q
B
P
To
hospitals,
yeah,
thank
you
for
the
questions
I
I
believe
you're
referring
to.
We
worked
with
the
tha
early
on
to
submit
an
emergency
waiver
request
to
cms
that
would
have
driven
some
dollars
out
to
the
hospitals
and
it
was
related
to
quality
plans
and
well.
It
was
related
to
preparation
and
all
the
work
the
hospitals
were
doing
around
the
pandemic.
P
Unfortunately,
after
many
many
months,
cms
declined
to
approve
that,
and
so
now
we're
pivoting
and
we're
working
with
the
hospitals
to
try
to
come
up
with
another
plan
that
we
could
submit
to
to
cms
and
that
would
be
tied
to
a
directed
payment
and
we
think
that
our
chances
will
be
better
with
this
particular
proposal.
We
haven't
finalized
that
yet,
but
we're
in
discussions
with
the
hospital
association
to
push
those
dollars
out.
A
And
I
guess
just
a
sort
of
a
follow-up
to
that.
While
you
know
cms
declined
the
the
first
proposal,
we're
hopeful
that
they
will
approve.
The
second
will
that
those
dollars
be
retroactive
and
assuming
the
worst
case
scenario.
If
those
dollars
are
not
approved,
then
what
plans
do
we
have
to?
Because
I
know
hospitals
have
taken
a
very
long
and
very
direct
hit
during
all
of
this
covered,
not
only
because
of
the
coded
patients,
but
because
having
a
number
of
coded
patients
has
deterred
them
from
being
able
to
provide
services.
A
P
Q
Right
so
chairman,
the
way
that
this
would
work
if
it's
approved
is
that
once
approved,
we
could
pay
dollars
out
and
it's
not
retroactive
in
the
sense
of
it's,
not
the
rate
increase.
That
would
go
back
into
effect,
but
it
would
just
be
dollars
that
move
out
to
hospitals
once
it's
in
effect,
the
hospital
thing
is
a
little
a
little
different
right
because
nothing's
easy
with
medicaid
and
the
dollars
that
would
fund
that
are
in
the
hospital
assessment
trust
fund
that
have
built
up
because
of
the
enhanced
death
map.
Q
Q
A
P
The
the
worst,
the
very
worst
case
scenario
there.
If,
for
some
reason,
the
federal
government
just
refused
to
approve
those
directed
payments
at
the
very
worst,
there
would
be
about
right
now,
there's
about
180
million
in
that
trust
fund
that
could
be
dispersed
to
the
hospitals.
But,
of
course,
that's
not
the
ideal
situation
because
we
want
to
draw.
We
want
to
draw
down
the
federal
dollars.
A
K
Thank
you,
madam
chair
good
morning,
y'all
good
to
see
you
during
the
ten
cares
budget
here
and
for
the
first
week
of
november.
It
was
mentioned
that
the
hospital
assessment
was
started
during
the
great
recession.
It
was
news
for
a
lot
of
us
just
a
couple
questions
on
that.
How
long?
If
I
can,
madam
chair
lady,
just
a
couple
questions.
How
long
does
tenncare
foresee
the
hospital
nursing
home
ems
assessments
continuing.
P
K
P
We
have
not
had
any
conversations
with
the
nursing
facilities
or
ems
on
reducing
or
eliminating
those
assessments.
There
certainly
have
been
conversations
about
opportunities
for
increased
funding
for
those
particular
groups,
but
there
have
not
been
any
substantive
conversations
about
reducing
or
eliminating
those
assessments.
P
N
N
You
talk
briefly
about
cost
increase
costs
and
hospitalization
in
your
plan.
I
have
two
a
few
questions,
dealing
with
nursing
home
assessments
and
and
also
increase
cost
to
the
hospitals,
particularly
when
it
comes
to
the
impact
of
uncompensated
care
to
our
hospitals
during
the
pandemic,
and-
and
you
mentioned
your
plan-
are
you
all
addressing
that?
Also
for
the
uncompensated
care.
P
Uncompensated
care
is
a
is
always
an
issue
that
we
that
we
deal
with
whether
it's
pre-pandemic
or
post
pandemic,
and
there
actually
are
some
discussions
right
now
happening
at
the
federal
level,
which
could
have
a
big
impact
on
uncompensated
care
and
the
dollars
that
we
could
pay
to
hospitals
for
uncompensated
care.
So
we're
we're
very
concerned
about
that
and
we're
working
with
the
hospitals
to
try
to
better
understand
that
provision.
P
We're
working
with
our
federal
representatives
as
well
to
and
a
lot
of
states
are
to
kind
of
push
back
against
that
particular
provision,
because
it
would,
it
would
result
in
a
hit
to
our
to
our
hospitals,
because
it
would
decrease
the
amount
of
dollars
that
we
could
claim
for
uncompensated
care.
So
it's
certainly
something
that's
on
our
radar.
N
P
But
we
have
to
go
through
a
process,
and
I've
always
said
that
there's
a
dual
responsibility
here:
there's
a
responsibility
on
the
tenncare
member
to
ensure
that
he
or
she
provides
us
all
the
information
that
we
request
and
that
we
need
to
ensure
that
that
individual
is
in
fact
eligible
and
and
then
there
is
a
responsibility
on
the
part
of
tenncare
to
make
sure
that
that
process
is
as
user
friendly
and
easy
as
possible.
And
so
that's
what
we
are
really
working
on
and
we've
got
a
new
state
of
the
art
eligibility
system.
P
That
is
in
place
today
that
wasn't
in
place
prior,
and
so
that
does
make
it
a
lot
easier
for
our
members
to
stay
up
to
date
and
to
get
information
and
to
respond,
and
we're
also
going
to
have
an
all-out
effort
to
get
awareness
out
there
that
when
the
emergency
ends,
when
redetermination
starts,
we
will
work
with
our
sister
agencies.
We
will
work
with
our
advocacy
partners
to
get
that
word
out
there,
so
that
people
know
that
they
need
to
respond
to
their
mail.
P
We
want
to
make
sure
that
we
get
that
word
out
and
that
they
respond
so
that
we
can
maintain
that
eligibility.
If,
if
the
member
is
eligible
in
terms
of
members
that
go
through
that
eligible
eligibility
process,
and
then
it's
determined
that
they
are
not
eligible,
I
do
have
our
director
of
member
services
that
it
that
is
here.
That
can
probably
speak
better
to
this.
But
there
are.
There
are
things
that
we
have
to
do
to
determine
if
they
are
eligible
for
other
services.
P
D
N
P
N
One
more
chairman,
okay,
thank
you,
and
I
know
you
went
into
the
cost
increase
associated
with
the
pandemic.
My
specific
question
is
to
to
what
extent
does
tenncare
estimate
increase
covet
related
costs
is
due
to
the
suspension
of
re
verifications
versus
the
increased
costs
associated
specifically
with
covet
related
care,
such
as
longer
hospital
stays
more
expensive
equipment
and
supplies.
P
Yes,
well,
we
we
would.
We
would
estimate
and
project
that
the
overwhelming
majority
of
the
increased
cost
is
due
to
the
increased
enrollment.
It's
not
it's
not
due
to
the
testing
and
treatment
that
is
a
that
is
a
portion
of
the
cost,
but
the
overwhelming
increase
is
is
due
to
the
increased
enrollment.
A
And
as
a
follow-up
to
that,
the
more
I
read
about
the
long-term
effects
of
covid,
the
more
frightening
that
it
gets
with
things
that
we
aren't
even
aware
of
that,
you
know
organ
damage
and
things
that
might
not
show
up
for
some
period
of
time.
So
are
we,
I
guess,
making
any
sort
of
allowances
for
the
ongoing
long-term
effects
of
covet
on
our
health
care
costs
going
forward.
P
Well,
one
thing
we
are
doing,
as
I
mentioned
before,
is
we
are
incorporating
the
what
we
believe
the
testing
and
treatment
costs
will
be
we're
incorporating
that
into
our
into
our
normal
budget.
So
that'll
show
up
in
trend
and
then
every
year
we
monitor,
we
monitor
that
we
monitor
the
costs
and
so
we're
going
to
see
in
the
out
years.
P
If
that
impact
does
occur,
and
then
we
will
have
to
come
back
and
make
adjustments
based
on
that.
But
it's
certainly
true
that
we
we
could
see
that,
but
also,
I
think
we
will.
It's
also
true,
that
we
will
see
some
some
decrease
in
the
overall
testing
and
treatment
cost
as
we
get
through
this
pandemic.
So
potentially
it
kind
of
offsets.
G
Thank
you,
madam
chair
and
dr
smith.
Thank
you
and
your
team
for
for
being
here
as
well.
I
appreciate
that
in
our
in
our
prior
budget
hearing
with
mental
health
and
substance
abuse
services,
we
discussed
the
the
partnership
between
our
mcos
tenncare
and
our
provider
networks
out
there
and
I'm
glad
that
they
deem
it
as
a
partnership.
Sometimes
I
see
it
as
a
tense
partnership
and
there
is
a
push
and
pull
and
tugging
whatever
adjectives.
P
In
place,
yeah
absolutely
thank
you
for
the
comments
and
and
the
question.
So,
as
you
mentioned
through
the
federal
arp
dollars,
we
are,
we
are
able
to
kind
of
kick
start
some
of
the
priorities
that
we
actually
put
in
place
for
the
fy
21
budget
and
then,
of
course,
the
pandemic
kit,
and
we
had
to
make
reductions
so
that
the
the
big
piece
of
that
two
big
pieces
one
was
to
remove
2000
people
off
of
our
waiting
list.
People
seeking
services
through
to
through
the
ecf
choices
program.
P
You
will
see
that
we
are
asking
for
dollars
that
would
address
the
10
care
providers
in
the
same
way
and
also
address
the
waiting
list,
but
the
good
thing,
and
so
that
will
fund
it
on
a
recurring
basis.
The
good
thing,
though,
about
the
federal
dollars
that
are
available
is
it
allows
us
to
kind
of
kick
start
that
immediately
and
we
can
in
effect,
buy
back
the
state
dollars
with
the
federal
dollars
and
so,
but
we
want
to
make.
G
G
It
could
have
been
stated
in
our
prior
budget
hearing
as
well,
but,
but
I
think
it
it
bears
to
think
outside
the
box
and
talk
about
getting
folks
into
these
workforce
into
this
particular
workforce
and
the
opportunities
that
we've
got
for
training
through
our
tcats,
our
technology
centers
and
our
community
colleges
and
anything
that
we
can
do
to
partner
and
again,
if
we
can
come
together
as
as
mcos
or
tenncare
and
our
provider
networks
to
to
work
and
partner
on
getting
folks
into
the
workforce
to
stabilize.
I
think,
there's
great
value
in
that
yeah.
P
I
absolutely
agree,
and-
and
that's
one
of
the
really
exciting
things
about
the
going
back
to
the
ecf
choices
program-
is
that
we
have
a
large
percentage
of
those
individuals
that
are
able
to
fully
participate
in
the
community
and
and
also
have
full
employment,
and
that's
that's
really
exciting.
We
exceed
the
national
average.
We've
seen
great
success
with
that
program.
G
G
P
So
I'll
give
high
level
and
then
patty
killingsworth
is
here.
If
you
want
more
detail
and
she
can
speak
to
it,
but
in
general
terms
we
have
about
a
4
000
person
wait
list
for
the
ecf
choices
program,
but
not
all
of
those
are
currently
seeking
services
so
of
those
seeking
services.
I
think
it's
about
3,
700,
and
so
with
this
plan
through
the
arp
dollars,
and
then
what
you'll
see
us
propose
in
our
budget
that
will
take
about
2
000
off
of
that
list.
So
that's
really
exciting.
P
There
is
a,
I
believe
there
is
a
wait
list
for
the
options
program.
We
don't
run
the
options
program.
As
you
mentioned,
there
is
a
wait
list
for
the
options
program,
we're
fully
supportive
of
the
options
program,
because
we
can
actually
serve
people
through
the
options
program
and
potentially
those
individuals
will
not
need
to
come
into
the
medicaid
program
which,
which
is
a
benefit
for
that
individual.
It's
also
a
benefit
to
the
state.
A
And
again,
on
the
choices
program
and
director,
you
and
I've
had
some
conversation.
I've
had
some
conversation
with
other
members
of
your
staff
because-
and
I
know,
there's
complex,
there's
different
choices.
Programs
and
I
may,
in
my
ignorance,
be
getting
some
of
these
things
confused
and
convoluted,
but
I
know
that
we
have
people
in
nursing
homes
who
are
you
know
some
are
seeking
to
get
out
of
that
kind
of
environment,
covid,
driven
or
otherwise
back
in
their
homes.
A
A
A
They
some
of
them
are
feeling
a
little
bit
pushed
and
that
they
may
or
may
not
have
adequate
home
care,
but
be
that
as
it
may,
if
you
have
someone
in
the
nursing
home
who
is
you're
looking
to
move
out
of
there
to
the
choices
program
at
home
or
you
have
somebody
wait
listed
to
be
on
the
program
to
avoid
entry
into
the
nursing
home?
Is
there
a
priority
given
to
one
or
the
other.
P
A
E
Thank
you,
oops.
Thank
you,
madam
chair
patty,
kellingsworth,
I'm,
the
chief
of
long-term
services
and
supports
with
10
care,
really
appreciate
this
line
of
discussion,
because
it
is
incredibly
important
if
a
person
is
in
a
nursing
home
and
wants
to
move
to
the
community,
we
will
absolutely
work
with
them
to
help
make
that
happen
just
for
a
little
bit
of
clarification
as
it
relates
to
the
multiple
choices
program.
So
the
original
choices
program
which
launched
in
2010
is
for
older
adults
and
adults
with
physical
disabilities,
employment
and
community
first
choices.
E
The
second
choices
program
is
for
individuals
with
intellectual
and
developmental
disabilities.
The
original
choices
program
does
not
have
a
waiting
list
and
has
not
with
a
with
a
minor
exception
shortly
after
its
implementation.
It
is
waiting
list
free
and
we've
been
able
to
serve
all
of
the
people
who
need
services
in
that
program.
So
anyone
who
wants
to
move
out
of
an
institution
we
can
work
with
them
to
help
them
get
community-based
services
in
place
in
their
own
home
in
other
kinds
of
alternative
community
living
arrangements.
E
There's
an
array
of
services
available
in
the
employment
and
community
first
choices
program,
as
director
smith
talked
about.
There
is
a
waiting
list
of
about
4
000
people
and
in
the
with
the
2000
slots
that
we
are
going
to
begin
filling
using
the
arp
dollars
that
are
specifically
for
home
and
community
based
services.
E
We
are
going
to
prioritize
those
people
who
have
been
on
the
waiting
list,
the
longest.
We
do
believe
those
are
the
people
who
are
most
at
risk
of
being
placed
in
an
institution
just
by
virtue
of
how
long
they've
waited
for
supports.
Some
of
them
actually
were
on
the
waiting
list
that
the
department
of
intellectual
and
developmental
disabilities
maintained
before
the
choices
program
launched.
So
we
want
to
serve
those
individuals
first,
but
we
certainly
would
and
and
do
prioritize
opportunities
to
help
keep
people
out
of
institutions
and
in
community.
A
A
F
Thank
you.
Thank
you,
gentlemen,
for
coming
today.
Just
we,
we
talking
a
lot
about
obviously
funding,
but
one
of
the
challenges
that
was
discussed
earlier,
that
I'm
a
little
bit
concerned
about
and
wondered
just
for.
You
expound
on
a
little
bit
more,
but
what
we
found
is
is
that
some
some
people
are
having
lingering
effects.
F
If
we
go
to
fast
forward
to
march
22
21
next
year,
when
the
cliff
falls
off,
and
then
we
start
to
remove
two
to
four
hundred
thousand
people
from
ten
care
rolls,
and
yet
they
have
lingering
effects
as
it
relates
to
covet
symptoms
or
treatments.
Or
even
you
know,
we
have
colleagues
that
have
issues
because
of
vaccination.
So
I
guess
the
question
is:
is:
is
there
a
mechanism
in
place
where
we
can
continue
to
recruit
those
dollars
even
or
do
we
have
to
leave
or
do
we
leave
those
people
on
the
rolls.
P
Thank
you
for
the
question
so
the
way
that
the
redetermination
process
works
ultimately
there's
a
determination.
If
that
member
is
eligible
for
medicaid
or
not
so,
if
the
member's
not
eligible,
then
then
we
cannot
maintain
enrollment
in
medicaid
for
that
individual
there
may
be,
depending
on
what
the
federal
government
is
going
to
do.
P
There
may
be
some
opportunities
for
the
providers
to
be
directly
reimbursed
by
the
federal
government
for
that
treatment,
but
we
don't
know
at
this
point
if
that
will,
if
that
will
be
the
case,
but
from
a
medicaid
perspective
our
our
hands
are
going
to
be
tied
once
it's
determined
that
that
member's
not
is
no
longer
eligible
for
medicaid.
Well,.
F
So
my
I
have
a
really
big
concern
this
time
next
year,
we're
going
to
be
still
long
after
the
money's
dried
up
at
the
federal
level
that
tennesseans
are
still
going
to
be
trying
to
figure
out
how
to
provide
health
care
to
people
that
we've
that
we've
taken
off
the
rolls
yeah.
I
have
one
other
questions
and
it
regards
to
other
challenges
other
than
the
denial
of
the
waiver.
Do
you
have
any
other
concerns
about
funding
going
forward?
F
I
I
guess
one
of
the
concerns
I
have
is
we're
printing
at
the
federal
level,
we're
just
printing
money
right,
there's
no
way
to
return
it,
and
so
we
have
to
consume
it.
Are
you
concerned
at
all
other
than
the
denial
of
that
waiver,
or
is
there
anything
in
the
future
that
that
gives
you
pause
or
concern
challenges.
P
P
B
Yes,
thank
you
for
the
question.
We
are
working
very
closely
with
our
actuarial
consultants
to
look
at
this
question.
There's
a
variety
of
different
things
going
on
certain
costs
in
health
care
are
going
up
and
we
are
seeing
inflationary
increases,
especially
in
some
of
the
institutionalization
type
costs,
but
there
are
other
areas
where
the
ongoing
impacts
of
covid
have
really
depressed
trends
longer
term
than
anybody
expected
and
we're
still
seeing
some
kind
of
sluggish
rebounding
of
those
trends.
B
A
B
P
Thank
you
for
the
question
I
I
want
to.
I
want
to
make
sure
that
I'm
careful,
because
that
is
that
is
part
of
our
managed
care
organization,
procurement
process
and
and
we
we
are
currently
under
a
protest.
So
I
got
to
be
very
careful
about
what
I
say.
What
I
will
say
about
that
particular
provision.
Is
it's
all
about
coordination
of
care,
and
this
isn't?
This
isn't
just
a
tenncare
issue.
It's
really
a
nationwide
issue
where
you've
seen
a
lot
of
groups
out
there.
P
Macpac
is
one
which
advises
the
federal
government
in
states
on
medicaid
policy.
One
of
the
things
that
is
really
stressed
is
is
continuity,
continuity
of
care
and
coordination
of
care
and
the
way
that
it
works
is
we
have
some
individuals
who
are
duly
eligible
for
medicare
and
medicaid,
and
in
some
cases
you
have
those
individuals
that
are
being
served
that
are
medicare
eligible
that
are
being
served
by
providers
working
with
plans
that
are
not
they're
they're,
not
also
medicaid
plans,
and
so
what
we're
trying
to
do
there
is.
P
We
really
want
to
coordinate
that
care,
because
what
we've
seen
when
we
talk
about
the
evolution
and
the
history
of
10
care,
we've
seen
all
the
successes
that
we've
had.
One
of
the
main
drivers
of
that
success
is
that
coordination
of
care-
and
I
probably
have
jumbled
that
and
and
patty's
really
the
person
that
can
speak
more
directly
to
this.
But
again,
I
want
to
be
careful
about
specifics,
because
we're
kind
of
in
this
odd
position
now
with
the
procurement,
but
that's
kind
of
a
high
level
overview.
B
Chairman
baum,
okay,
and
thank
you
for
that.
I
guess
individuals
who
are
eligible
for
both
medicare
and
medicaid,
we'll
say
medicare
and
tenncare.
Those
individuals
would
receive
the
primate
their
primary
health
care
through
medicare.
So
to
what
extent
would
it
be
wise
to
limit
those
individuals,
medicare
choices.
P
It
is
true
that
they're
covered
by
medicare,
but
it's
also
true
that,
to
the
extent
medicare
doesn't
cover
a
particular
service
or
is
capped,
then
medicaid
would
pick
up
those
costs
and
it
it
really
results
in
a
in
a
large
cost
to
the
medicaid
programs
and,
of
course,
the
states
in
tennessee.
We
we
pay
for
that.
So
that's
why
it's
really
important
for
us
that
we
have
that
care
coordination
piece,
because
we
know
when
we
look
at
our
our
the
history
of
our
trends
over
time
and
we've
been
very
successful
there.
B
K
Thank
you
for
the
indulgence,
but
this
sparked
a
question
for
me
and,
and
I
know
you
don't
want
to
drill
down.
Maybe
we
need
to
get
mrs
killingsworth
back
up
here,
but
the
truth
is
my
district
people
I
represent.
I
have
a
high
number
of
people
who
are
medicaid,
medicare
recipients
and
and
and
they
have
the
dual
eligibility
plan.
K
I'm
they
and
my
people
are
comfortable
with
that
and
all
of
a
sudden
we're
making
this
decision
to
sit
a
couple
questions.
How
are
we
going
to
make
sure
that
they
get
the
same
care
that
that
they're
currently
getting,
which
is
what
I
want
to
see
and
number
one
if
they're
not
comfortable
going
with
the
mco
and
they
do
have
medicare,
do
they
not
have
the
option
say?
No?
No
we're
not
going
with
the
mco.
We
want
to
stick
with
what
we've
got.
Do
they
have
that
option
with
you
guys.
P
Yes,
okay,
our
go
ahead.
Yeah,
the
10
care
member
is,
is
working
with
a
provider
they're
receiving
services
from
a
provider
and
that
provider
is
contracted
with
the
entity
right
and
so
under.
Under
what
we
are
talking
about
now
is
they
could
still
work
with
those
providers
and
there
there's.
Actually
we
have
a
requirement
that
those
that
the
mcos,
whatever
those
whoever
those
mcos
are.
K
K
P
P
I
believe
it's
in
the
rfp.
There
are
provisions
that
one
provide
for
a
transition
period
where
there
is
continuity
of
care
with
that
same
provider
for
a
certain
amount
of
time,
and
then
there
are
provisions
in
place
where
we
direct
those
mcos
to
work
with
those
providers
in
an
attempt
to
have
to
negotiate
a
contract
with
those
providers.
P
K
K
P
Yeah,
well,
there
would
be
the
transition
period.
There's
a
guaranteed
amount
of
time
where
that
tenncare
member
would
be
able
to
continue,
as
is,
and
then
during
that
time,
that
the
we
direct
the
mcos
to
work
with
those
providers
in
an
attempt
to
negotiate
a
contract
so
that
those
services
would
continue
and
there
would
be
no
interruption.
K
So
who's
walking
my
constituents
through
this,
you
gotta
understand
I
I
I
represent
appalachia
they're,
already
they're,
already
a
little
bit
nervous
about
anything
like
this
going
on.
They
don't
like
change
and
and
you're
you're
talking
way
up
here
on
all
this
level.
At
the
government
level,
my
people
specifically
who's
holding
their
hand,
we're
talking
senior
citizens
who
who
have
an
expectation
that
they
get
up
tomorrow
and
they're,
provided
certain
services
because
of
what
they've
given
in
over
their
life
for
medicare
all
right,
and
it
feels
like
to
me
over
the
next
year.
K
P
Yeah,
ultimately,
it's
our
responsibility
as
the
ten
care
agency
to
work
with
the
10k
member
to
make
sure
that
his
or
her
care
is
addressed
and
taken
care
of
that.
That
is
our
responsibility
and
we
we
have
to
work
with
our
managed
care
organizations
and
our
providers
to
make
sure
that
happens,
but
we
have
to
have
network
adequacy
and
we
have
to
ensure
that
by
federal
law
by
state
law
that
we
are
providing
services
to
our
members.
So,
ultimately
that
is
that's
going
to
be
on
us.
P
K
This
is
pass-through
dollars
that
come
from
the
federal
government
as
it
deals
with
the
medicare
recipients
of
my
constituents.
It's
it's
not!
It's
not
10
care
that
we
put
up
for
a
match
for
certain
money
to
draw
down
from
the
federal
government.
This
is
this
is
pass-through
money
that
the
federal
government
through
medicare
for
people
who
paid
into
medicare
or
their
life.
E
E
With
regard
to
medicare,
it
is
a
federal
insurance
program,
but
there
are
costs
that
the
state
pays
for
those
for
those
federal
insurance
benefits.
So
we
pay
for
people
who
are
dually
eligible
who
have
medicaid.
We
pay
their
premiums,
we
pay
their
their
co-insurance
for
services
and
and
then
we
pay
for
all
of
the
wraparound
benefits
that
we
provide
that
medicare
does
not
the
biggest
one
being
long-term
care
services
right.
E
So
that's
the
biggest
expenditure
94
of
the
people
who
are
in
nursing
homes
today
in
tennessee
that
we
10
care
are
paying
for
are
dually
eligible.
How
medicare
administers
its
benefits
matters
a
lot
to
the
state
medicaid
program
and
it
certainly
matters
a
lot
to
people
who
receive
medicaid
and
medicare.
E
If
you
go
to
the
hospital,
because
you've
had
an
acute
event
and
you
automatically
almost
leave
that
hospital
and
go
to
a
skilled
nursing
facility
because
you
have
medicare,
you
will
end
up
in
all
likelihood
on
the
medicaid
rolls
for
medicaid
nursing
facility
services
once
that
hundred
day
benefit
is
exhausted
and
by
the
way,
we'll
help
pay
for
the
hundred
days.
So
it
matters
a
lot
to
the
medicaid
program
and
it
matters
to
those
people
as
a
dual
eligible
individual.
You
always
have
a
choice
of
how
your
medicare
benefits
are
administered.
E
E
You
can
also
choose
from
any
medicare
advantage,
which
is
a
managed
care
company
who
administers
medicaid.
I'm
sorry
medicare
benefits
you
can
also
choose
from
any
of
those
that
you
want
and
as
as
a
dual
eligible,
you
can
choose
any
time
you
don't
just
get
to
choose
once
a
year.
You
could
literally
every
month.
E
They
were
created
under
federal
law,
with
the
explicit
intent
that
those
plans
would
coordinate
both
the
medicare
and
the
medicaid
benefits
for
this
really
chronically
ill
and
very
vulnerable
population
who
are
who
are
disproportionately
high
utilizers
of
services
in
both
medicare
and
medicaid,
high
cost,
high
need,
and
and
and
really
not
the
quality
that
we
would
expect
because
of
the
lack
of
coordination
that
often
exists.
That's
why
d-snips
were
created
in
practice.
E
They
don't
administer
the
medicaid
benefit,
there's
nothing
for
them
to
coordinate
they're,
just
administering
the
medicare
benefit.
It
really
is
a
state's
choice
in
terms
of
who
they're
going
to
enter
into
a
dsnip
agreement
with,
and
if
you
don't
have
a
state
contract
with
with
the
state,
you
can't
be
a
d-snip
to
administer
benefits
to
dual
eligibles.
E
What
that
does
is
it
creates
again
this
sort
of
fragmented
health
care
delivery
system
for
very
vulnerable
people
and
leaves
them
trying
to
figure
out
how
to
put
medicare
and
medicaid
together
and
oftentimes
leads
them
with
poor
quality
in
places
that
they
really
don't
want
to
receive
care,
because
there
wasn't
somebody
to
help
them
figure
out
how
to
get
the
care
that
they
needed
when
they
needed
it.
This
is
a
policy
decision
that
is
ultimately
about
better
quality
for
people,
better
coordination
for
people
and,
quite
frankly,
better
costs
for
the
state
right
too.
E
So
it's
a
win-win
when
somebody
gets
better
care
in
the
setting
where
they
want
to
receive
it
and
it
costs
the
state
less
money.
We
are
not
the
only
state
to
do
this.
We
are
following
federal
policy
recommendations
around
integrated
care
for
this
population
and
really
how
best
to
align
systems
in
order
to
support
better
outcomes,
better
quality
and
greater
cost
efficiency
for
this
population.
E
E
And
so,
and
the
medicare
benefit
is
the
medicare
benefit
right?
So
no
matter
who
administers
your
medicare
benefit.
That's
the
benefit
that
you
have.
It's
spelled
out
in
federal
regulation
really
important
that
that,
even
if,
even
depending
on
what
the
outcome
of
the
procurement
is,
even
if
that
means
that
a
plan
that
is
a
d
snip
today
is
not
a
d
snip
tomorrow
there
will
be
choice
available
to
those
people
about
whether
they
want
original
medicare
or
what
d
snip
they
want,
or
if
they
want
to
choose
a
medicare
advantage
plan.
E
E
They
get
to
keep
their
same
providers
for
a
period
of
time,
and
then
there
is
an
expectation
that
that
period
of
time
is
really
to
allow
time
to
hopefully
bring
that
provider
into
the
network
to
continue
seamlessly
on
beyond
so,
and
we
see
that
we
actually
monitor
that
right.
So
when
people
come
into
a
dsnip,
we
look
at
how
many
of
them
have
to
change
their
primary
care
providers.
E
A
I
don't
think
I'm
you
know,
sharing
any
secrets
when
I
say
tenncare
doesn't
pay
very
well
in
terms
of
of
providers.
If
you
ask
most
most
providers
out
there,
tenncare
patients
or
not
their
revenue
source.
So
that's
an
issue,
and
I
also
from
what
I've
seen
about
the
plans
that
people
are
currently
involved
in
they're,
very
highly
rated
they're.
A
Their
plans
are
not
rated
as
well,
and
I
think
the
big
issue.
I
appreciate
the
fact
that
their
people
will
be
given
time
to
transition,
but
I've
got
a
letter
from
a
provider
who,
I
said,
as
I
said,
are
very
concerned
about
whether
or
not
they
would
be
able
to
even
continue
to
financially
be
feasible
for
them
to
provide,
and
so
these
people
would
ultimately
have
to
transition
their
primary
care.
And,
as
you
said,
these
are
the
folks
who
are
most
vulnerable.
D
Thank
you,
madam
chair.
Thank
you,
commissioner.
Good
morning
it's
been
reported
that
the
federal
government
is
saying
that
tennicare
owes
them
money
due
to
an
audit
that
was
recently
released
and
I'd
be
interested
to
hear-
and
I
know
you've
disputed
it.
I
understand
that,
but
I'm
interested
to
know
your
thoughts
on
it,
but
secondly,
you
mentioned
something
about
the
2023
budget,
and
so
I'm
concerned
as
to
whether
this
could
impact
that
budget.
Would
we
have
to
put
funding
aside
earmark
to
repay
or
have
you
established
some
mechanism
to
repay?
P
Sure
thank
you
for
the
question
so
I'll
start
off
and
so
you're
speaking
to
an
audit
that
came
out
from
oig
at
the
federal
level.
Yes,
sir,
and
this
relates
to
certified
public
expenditures,
claims
for
certified
public
expenditures
that
were
made
by
the
state
of
tennessee
almost
13
years
ago.
Now
so
2009-2014.
P
So
we're
going
back
to
governor's
administrations.
I
just
point
that
out,
because
that's
a
that's
a
very
frustrating
point
for
me,
because
I
don't
think
from
a
state
perspective
that
our
own
comptroller
would
ever
audit
a
local
government
and
look
back
12
or
13
years.
It's
it's
baffling
to
me,
but,
as
you
said,
we
we
completely
dispute
the
findings.
P
Over
half
of
the
findings
relate
to
claims
made
by
institutions
for
mental
disease
and
just
to
just
to
kind
of
give
you
an
example
of
how
egregious
these
findings
are.
According
to
oig,
they
are
essentially
saying
that
our
institutions,
our
public
institutions
of
mental
disease,
had
zero
claims
for
uncompensated
care,
they're,
giving
us
zero
credit
that
defies
all
logic.
It
defies
all
reason
and
we
have
provided
more
than
adequate
documentation
to
show
that
we've
had
hundreds
of
millions
of
dollars
of
acceptable
claims.
P
P
They
submit
that
to
cms,
and
then
we
engage
with
cms
about
any
potential
payback.
We
feel
much
better
about
our
conversations
with
cms
than
we
do
with
our
conversations
with
oig,
because
cms
actually
understands
these
issues,
but
that's
why
we
weren't
we
weren't,
avoiding
it
it's
just
it's
not
going
to
have
an
impact
on
our
fy
23
budget.
D
Yes,
thank
you,
madam
chair.
Thank
you
for
that
answer.
I
appreciate
you
know.
You
know
how
this
may
make
you
feel
with
respect
to
them
reaching
back
that
far
and
the
claims
that
you,
you
believe
that
our
state
comptroller
woulda
wouldn't
do.
But
I
do
believe
that
there
is
a
reason
and
purpose
for
auditing
and
that's
just
something
that
we
do
and
in
state
government.
I
believe
that
our
constituency
expect
us
to
have
these
audits
and
expect
us
to
respond
to
these
audits.
D
So
I
I
don't
think
that
you're
taking
it
lightly
or
anything
like
that,
but
I
do
feel
that
should
should
it
prevail.
After
your
continued
dialogue
and
discussion,
and
back
and
forth
with
cms
that
the
state
need
to
have
a
plan
to
repay
the
funds-
and
I
know
we
have
a
healthy
reserve
account-
and
I'm
just
wondering
I
was
just
wondering-
were
you
thinking
through
that
part
of
it
so
that
we're
prepared
for
it?
Should
we
have
to
refun
return
or
or
whatever
the
agreed
upon
amount
might
be?
D
It
may
not
be
the
700
million
in
millions
of
men,
300
million,
but
we
would
still
owe
that
back,
which
means
there
will
be
an
impact
somewhere.
Some
other
place
down
the
line,
maybe
with
services.
You
know
I
don't
know.
I
know
that
we
we're
operating
under
the
block
grant
now
and
so
there's
this
belief
that
under
that
system,
we're
gonna
save
some
money
and
we
were
believing
that
the
savings
would
go
back
into
the
programming.
D
D
P
P
So
there
would
not
be
an
expectation
from
the
federal
government
that
we
would,
you
know,
do
a
lump
sum
it
would
be.
It
would
have
to
be
spread
out
over
time,
but
I
I
do
just
I
got
to
reiterate
that
we
do
we
do
dispute
the
findings.
We
do
take
it
very
seriously
and
that's
why
we
provided
a
very,
very,
very
detailed
response
to
the
oig
audit,
which
you
can
actually
find
in
the
audit,
and
we
look
forward
to
making
our
case
with
with
cms.
J
As
you
guys
know,
over
the
over
the
last
decade,
what
I've
seen
I
mean
it
continues
to
increase
then
kind
of
in
good
times
when
there's
lots
of
jobs
out
there.
It
decreases
so
here's
my
question:
we
constantly
try
to
get
away
from
siloing
within
state
government,
the
department
of
labor
wages
that
can
provide
for
their
families.
J
How
much
do
you
guys
work
with
the
department
of
labor
and
businesses
out
there
so
that
these
folks
that
are
coming
off
the
tenncare
roles
can
get
into
a
job
that
has
full
benefits
full
health
endurance
and
can
actually
thrive?
Is
there
any
communication
between
you,
guys
and
other
departments
within
state
government
or
with
private
employers,
to
again
truly
get
these
folks
to
a
point
where
they
can
thrive
without
government.
P
Assistance,
yeah,
that's
that's
a
great
point
and
it's
something.
That's
been
a
priority
for
this
governor
and
this
administration,
encouraging
departments
to
to
work
together
and
to
collaborate
and
to
and
the
point
that
you
just
made
is
a
perfect
one,
because
there
are.
We
do
know
that
we
have
a
lot
of
tremendous
opportunities
out
there
available
for
individuals
to
take
advantage
of,
and
so
that's
something
that
we
are
looking
to
increase
increase.
That
communication
increase
that
collaboration.
J
Thank
you
chairman.
Thank
you
director.
I
mean
that's
just
something
the
more
you
all
can
work
towards
that.
I
think
the
more
benefit
would
be
to
several
of
the
comments
here
today
when
we
talk
about
making
sure
that
folks
have
health
insurance,
the
the
best
place
that
an
able-bodied
individual
who
can
seek
full
employment
can
get
that
health
insurance
is
through
an
employer
that
provides
it.
J
I
mean
we
are
in
my
district
at
least
I
mean
literally
we
it's
very
difficult
for
us
to
find
bus
drivers
and
folks
that
work
in
manufacturing
and
folks
that
work
that
jobs
that
pay
well,
but
also
have
full
benefits,
and
so
for
able-bodied
tennesseans.
Anything
we
can
do
to
try
to
help
them
match
up
with
those
jobs
that
they
might
be
appropriate,
for,
I
think,
would
be
very
beneficial.
So
thank
you.
D
Thank
you,
chair,
lady.
My
question
probably
isn't
in
line
with
anybody
else's
concerns,
but
mine
is
during
this
covert.
19
pandemic
did
10k,
see
an
increase
of
reproductive
service
from
tin
care
patients
or
an
increase
of
need
for
ob
gyn
other
services.
Did
you
see
an
increase
of
deaths
or
sickness
from
cover
19
and
pregnant
patients?
Can
you
elaborate
on
that.
P
B
Great
good
morning,
everyone
victor
wu
chief
medical
officer,
thanks
for
the
question
representative
lamar
at
this,
an
area
where
we
certainly
have
been
really
focused
on
maternal
health
and
the
maternal
health
outcomes.
For
our
members,
I'll
say
from
a
data
perspective,
it's
still
a
little
bit
early
to
see
long-term
impacts
of
kova's
specific.
If
there
are
have
been
any,
we
haven't
seen
any
significant
decreases,
for
example
in
the
in
the
overall
birth
rate.
I
think
our
our
mothers
are
able
to
access
care
the
way
they
normally
would.
B
Our
ob
gyns
have
been
able
to
meet
those
needs
in
the
state.
We're
certainly
going
to
look
for
and
see
some
of
the
other
markers
but
of
maternal
health.
The
department
of
health
does
measure
a
lot
of
the
the
maternal
outcomes
for
the
state
as
a
whole.
We
continue
to
know
that
some
of
the
areas
of
greatest
opportunity
are
unrelated
to
covin
maternal
health.
Mental
health
is
an
area
where
there
needs
to
be
continued
emphasis,
an
area
where
we
really
begin
to
help
support
and
continue
to
reinvest.
B
We're
really
grateful
and
excited
about
having
the
option
for
postpartum
care
to
be
extended.
That
will
begin
for
all
pregnant
women
in
in
april
of
this
year
as
part
of
our
and
the
investment
from
the
governor
and
and
in
our
tinker
program,
and
so
overall
we
can
report
back
to
you
as
we
continue
to
look
at
it.
But
I
think
from
a
need
perspective,
we've
been
able
to
support
a
lot
of
our
moms
during
this
period.
D
Representative
lamar,
thank
you.
Thank
you
for
your
answer.
Can
any
of
these
coping
money
be
used
for
doula
services
or
to
create
a
training
program
for
certification
or
a
licensing
program
so
that
doulas
can
receive
tenncare
coverage?
Because
what
we
do
know
is
through
this
covit.
They
provide
mental
emotional,
physical
and
informational
support
for
mothers
and
what
we've
seen
from
the
programs
that
have
been
funded.
They
have
100
self-rate
us
success
rates
with
no
deaths
and
mothers,
no
deaths
of
children.
So
can
we
use
this
coving
money
to
do
something
like
that?.
B
B
A
Thank
you.
Thank
you
all.
I
think
I
apologize
that
we
have
kept
you
over
and
kept
our
next
presenters
waiting,
but,
as
I
think
you
can
see,
there's
a
lot
of
interest
in
what
you
all
do
for
tennesseans
and
as
later
lambert
mentioned,
it
is
the
single
largest
budget
item
and
we
are
the
finance
committee.
So
I
think
it
is
incumbent
upon
us
to
try
and
better
understand
what
you
all
do
and
how
you
do
it
and
how
our
tennesseans
are
being
served
through
those
services
that
you
oversee.
A
L
You,
madam
chair
committee,
members,
we
are
proud
to
be
here
today
and
with
me
to
my
right,
is
john
webb.
Our
deputy
of
operations
to
my
left
is
dr
morgan,
mcdonald,
who
is
our
deputy
of
population
health
and
because
I
know
I'm
oh
excuse
me,
and
over
here
on,
the
other
table
is
our
chief
medical
officer,
dr
tim
jones,
and
because
I
know
I'm
between
you
and
lunch,
I
will
make
it
snappy,
but
in
all
seriousness,
happy
to
answer
any
questions
for
as
long
as
you
need
me
to
so.
L
This
first
slide
is
just
a
pie
chart
of
all
of
the
different
buckets.
If
you
will
we'll
go
through
those
in
more
detail,
so
don't
strain
your
eyes.
Looking
at
that,
we
have
received
a
total
of
44
federal
awards,
totaling
over
1
billion
dollars,
and
that
is
to
be
spent
through
fiscal
24.,
so
we'll
focus
more
on
21
and
22,
but
I
want
you
to
know
that
this
has
a
long
off
ramp,
and
so
we
will
be
stretching
those
out.
L
This
slide
is
the
funding
available
to
us.
I
apologize
for
a
little
bit
of
a
typo
there
in
the
column.
This
is
actually
amount
available,
not
amount
spent,
but
the
total
amount
available
to
the
department
is
1.173
billion.
Now
we
categorize
that
in
two
different
buckets,
the
top
half
of
that
slide
is
the
direct
funds
sent
directly
to
the
department,
which
totals
just
shy
of
850
million.
L
L
I
will
note
that
we
have
spent
about
467
million
of
the
1.2
billion,
which
is
about
40
percent,
but
I
want
to
clarify
why
why
that
may
look
low
to
you
number
one?
This
does
not
include
things
that
we
are
awaiting
federal
guidance
on.
There
are
some
of
these
federal
funds
that
are
relatively
recent
awaiting
federal
guidance
on
that
another
one
of
these.
This
is
through
september
30th.
It
does
not
include
funds
that
are
awaiting
program
budgets
and
are
are
supposed
to
be
coming
soon.
L
This
also
doesn't
include
those
that
are
pending
the
expansion
process.
So
don't
don't
fear,
we
don't
lose
it
if
we
don't
use
it
immediately.
We
do
have
some
no-cost
extensions
available
to
us
and
a
big
chunk
of
this
about
300
million
is
arp,
which
you
know
just
came
out
in
maybe
may
or
june.
So
those
are
relatively
recent.
L
One
of
the
questions
that
this
committee
asked
that
is
really
important
for
us
is
how
do
you
prioritize
this?
I
mean
you
know
just
to
be
honest:
we've
we've
joked
a
lot
like
well,
that's
a
good
problem
to
have
is
to
have
a
lot
of
money,
but
then
it
gets
really
serious
really
quickly
like.
That
is
a
problem.
L
We
need
to
be
good
stewards
of
this
and
we
need
to
use
the
resources
available
to
us,
and
so
we
want
to
come
up
or
we
want
to
execute
a
methodology
to
where
we
prioritize
these
things
in
an
order,
so
we
can
use
them
most
efficiently.
First
and
foremost
is
what
are
the
rules?
What
do
we
have
to
do?
What
are
we
told
to
do?
That's
always
the
first
priority,
but
the
second
big
bucket
you'll
see
there
is
the
urgent
public
health
needs.
L
So
if
the
first
category
is
what
we
have
to
do,
the
second
category
would
be
is
what
we
need
to
do
and
it's
what
the
department
needs
to
do
so,
first
and
foremost,
there's
a
there's,
a
sub
prioritization
within
that
category
and
the
first
one
of
that
being
what
are
the
immediate
needs
of
our
citizens,
things
like
testing
vaccine.
Those
are
the
things
that
we
needed,
first
and
foremost,
and-
and
so
that
was
first
in
that
bucket.
The
second
one
is:
what
is
the
infrastructure
that
we
need
to
respond
to
those
immediate
needs?
L
Do
we
need
newer,
faster,
better
lab
equipment?
Do
we
need
to
set
up
new
vaccine
or
testing
sites?
Do
we
need
to
purchase
a
software
program
that
will
make
our
patient
flow
more
efficient,
so
that
second
big
bucket
is
what
do
we
need
to
serve
the
constituents
and
the
citizens
of
tennessee
and
then
the
third
bucket
is:
what
do
our
partners
need,
and
so
we'll
talk
more
about
that
in
a
minute,
but
partners
like
hospitals
and
nursing
homes
in
our
metro
health
department?
L
So
this
hospital
staffing
assistance
grant
was
pretty
much
a
no-brainer
to
to
all
of
us
and
it's
been
sort
of
in
two
phases
or
it
will
be
in
two
phases,
and
so
I
will
describe
to
you
what
phase
one
was
phase,
one
which
we're
just
tailing
off
on
the
end
of
now.
We
were
able
to
provide
staffing
assistance,
reimbursement
to
about
80
hospitals,
statewide,
and
so
now
this
is
separate
than
actually
sending
national
guard
personnel.
This
was
a
reimbursement
based
program
on
staffing
and,
as
I'm
sure,
every
single
one
of
you
is
very
familiar.
L
Not
only
did
we
have
workforce
issues
before
this
exacerbated
it
and
the
workforce
that
they
had
sometimes
left
to
go
what
they
do,
what
they
call
travel
nursing
because
of
this
very
exorbitant
rates
that
they're
getting
so
some
of
them.
In
fact,
most
of
them
actually
have
less
staff
than
they
did
pre-pandemic
because
of
retirements
illnesses.
Saying
hey!
This
is
hard.
L
I
can
go,
do
something
else
or
because
they've
been
lured
away
because
of
this
very
high
travel
pay,
so
the
cost
to
hospitals
to
staff.
It's
not
like,
they
can
just
say,
oh
well,
we
just
don't
have
enough
staff
today
they
have
to
staff
at
certain
levels
to
keep
the
doors
open,
and
so
what
that
forces
them
to
do
is
enter
into
these
very
costly
contracts,
and
you
know
commensurately
their
reimbursement
didn't
change,
so
we
helped.
We
used
a
lot
of
these
federal
funds
to
offset
that
staffing
need
for
hospitals.
L
So
in
the
first
round
we
have
already
paid
out
about
93
million.
By
the
time
we
run
out
what
is
already
committed.
That
will
be
about
114
million
in
that
first
phase.
I'll
touch
on
this
second
phase
in
just
a
minute,
but
those
of
you
familiar
with
the
conversations
with
financial
stimulus,
accountability
group.
There
is
a
second
phase
of
this
that
has
been
requested.
L
I
want
to
remind
you
that
tennessee
was
one
of
the
very
first
states
and
maybe
the
first
state
to
have
widespread
available
testing
for
everyone,
and
we
still
have
one
of
the
most
robust
testing
programs
in
the
nation.
That
was
a
long
time
ago,
and
so
we
forget
about
those
things.
But
testing
is
one
of
the
very
key
components
of
knowing
who's
infected
and
how
to
reduce
the
spread.
L
We
have
done
almost
a
million
tests
just
at
the
health
departments
alone,
and
that
certainly
doesn't
include
everywhere
in
other
medical
settings.
But
a
lot
of
our
funds
were
spent
on
sort
of
what
we
call
special
testing.
You
remember
the
prison
testing,
you
remember
the
nursing
home
testing.
We
did
some
widespread
testing
with
the
didd
population.
L
Again,
one
of
the
leading
states
in
the
nation
to
do
that
and
then
smaller
scale
things
like
housing
authorities
and
just
different
special
groups,
particularly
vulnerable
groups,
we'll
talk
more
about
that
in
a
minute
to
provide
tests
in
the
past.
Well
now,
what
we're
doing
is
ramping
up
the
at-home
testing
capacity,
because
the
days
of
needing
to
go
and
waiting
a
long
drive
through
to
get
a
traditional
pcr
test
are
kind
of
behind
us.
So
now
we're
using
our
funds
to
give
testing
kits
out
our
health
departments.
L
Another
one
again
that
was
big
early
on
was
contact
tracing.
This
is
sort
of
a
key
component
to
all
public
health.
When
you're
talking
about
infectious
disease
again
you'll
remember
very
early
on
people
were
super
super
frightened
about
who
they
had
been
in
contact
with,
who
may
have
been
exposed
or
or
have
come
into
contact
with
someone
who's
been
infected,
and
this
is
was
one
of
the
early
big
buckets
of
funding
when
we
used
contract
personnel
for
about
700
000
cases
for
contact
raising.
L
L
We
call
that
the
safety
net
population,
so
just
because
you
don't
have
access
to
health
insurance
or
because
you
don't
have
a
regular
doctor,
you
don't
need
to
have
a
lower
level
of
services
so
early
on,
particularly
but
continuing
now
supporting
safety,
net
clinics
and
safety
net
clinics
are
ones
that
you'll
sometimes
hear
us
call
community
and
faith-based
clinics
and
so
supporting
covet-related
costs
in
safety
net
clinics.
Also
in
fqhcs.
Those
are
a
more
comprehensive
approach
to
the
underserved
population
and
supported
them
early
on
until
they
got
their
own
direct
federal
funding.
L
L
And
then
one
that's
been
more
recent
top
of
mind
for
a
lot
of
folks
is
our
vaccination
efforts.
We
have
delivered
more
than
1.3
million
vaccinations
and
have
had
to
put
in
all
of
the
infrastructure
to
do
that.
One
of
the
things
that
helped
us
get
out
of
the
gate
a
little
bit
faster
is
because
we
had
been
preparing
and
practicing
pandemic
vaccination
efforts
for
years.
We've
been
doing
that
for
four
or
five
years
now
through
what
we
call
our
fight
flu
tennessee,
so
we're
all
across
the
state,
and
we
just
did
this.
L
I
think
it
was
last
tuesday
because
that's
when
I
got
my
flu
shot,
we
practiced
doing
this
all
at
once,
and
so
that
helped
us
get
out
of
the
gate
faster
as
far
as
making
sure
we
know
where
our
sights
are
and
what
the
logistics
are.
But,
as
we
all
know,
covet
vaccine
is
not
the
same
as
the
flu
vaccine.
In
many
many
respects
you
have
to
have
multiple
doses.
L
In
the
beginning
you
had
to
have,
there
was
a
triage
or
a
prioritization
system,
there's
certain
timing
between
the
doses,
so
things
like
online
scheduling
and
computer
software
programs
to
help
us
manage
the
logistics
of
that
and
then
my
last
slide
is
about
future
funding.
I
referenced
a
minute
ago,
the
second
phase
of
the
hospital
staffing
assistance
grants.
L
You
probably
heard
fsag
talk
about
that
just
yesterday,
that
is
on
target
to
be
about
plus
or
minus
another
100
million
dollars
in
essentially
the
same
format
related
to
their
covet
occupancy
and
the
burden
that
that
placed
on
them.
But
something
else
modeled
after
that
program
that
is
scheduled
for
the
remaining
funds
is
a
similar
program
in
nursing
homes
and
long-term
care
facilities.
L
I've
got
four
bullet
points
here.
The
first
two
would
be
through
the
state's
arp,
that
is,
the
new
public
health
lab,
as
well
as
support
of
construction
or
renovation
of
our
health
department
buildings.
We
do
have
health
department
buildings
in
all
95
counties.
It
is
statutorily
dictated
that
these
are
owned
by
the
county
in
many
places
and
I'm
sure
you've
seen
it
in
your
home
county.
These
are
40
50
plus
year
old
buildings.
L
Many
of
them
are
falling
into
disrepair
and
the
counties
themselves
are
just
not
able
to
sustain
the
price
tag
that
it
would
cost
to
fix
that.
So
those
are
the
two
from
the
infrastructure
side
that
we're
pursuing
through
the
state
arp
funds
and
then
for
the
department's
arp
funds,
we're
looking
at
workforce
development
just
like
just
like
everybody
else
in
pretty
much
every
sector.
We
also
need
to
bolster
our
workforce
and
then
modernize
our
data
systems.
L
A
lot
of
our
systems
did
fine
on
a
sunny
day,
but
when
they
were
really
stressed
and
strained,
they
had
difficulty
performing
so
modernizing
that
for
the
future
and
then,
as
you
know,
this
is
not
going
anywhere
anytime
soon,
so
just
making
sure
we're
prepared,
not
only
for
the
next
year
but
the
next
few
years
as
we
predict
and
deal
with
future
searches.
Madam
chair,
that
closes
my
formal
presentation.
Any
of
us
are
happy
to
answer
any
questions
you
may
have.
A
Thank
you,
commissioner.
I
know
it's
been
a
very
difficult
and
very
busy
year
for
your
department
and
again
we
would
be
remiss
if
we
didn't
thank
you
and
all
of
those
who
work
with
you
and
with
your
departments
across
the
state
for
all
the
work
that
you've
done
to
to
move
us
forward
during
this
crisis,
and
hopefully
I'm
not
going
to
jinx
it
by
saying
any
anything
about
ends
of
tunnels,
or
any
of
that.
Thank
you.
L
B
Thank
you,
madam
chair,
and
thank
you,
commissioner
piercy
and
your
team
for
being
here.
At
one
time,
the
department
requested
29
positions
for
the
disease
and
emergency
preparedness
program,
but
my
understanding
is
that
those
were
not
filled
is.
Are
those
positions
still
needed
or
are
contractors
doing
that
work.
M
B
A
I
think
in
just
a
bit
of
a
follow-up
to
that
in
the
questionnaire
that
you
provided
and
when
we're
talking
about
federal
funding.
Here,
of
course,
there
were,
I
believe,
25
million
dollars
in
state
funds
that
were
replu.
We
were
able
to
utilize
federal
funds
rather
than
the
state
monies.
So
can
you
just
help
me
understand
what
programs
the
federal
dollars
funded
and
then
what
happened
to
that
25
million
dollars
formally
allocated
to
those
same
programs
by
the
state?
Have
we
used
that
in
some
other
way?
Are
we
holding
that
you
know?
A
M
Yes,
ma'am
the
25
million
dollars
really
was
payroll
related.
As
you
know,
we
operate
out
of
the
local
health
departments,
part
of
our
folks
that
work
there.
Their
salaries
are
supported
by
state
funds,
and
so
we
basically
traded
out
our
federal
sources
for
what
they
normally
do
and
that's
where
we
captured
the
majority
of
our
state
dollar
savings,
so
payroll
that
normally
would
have
been
paid
out
in
state
funds
was
paid
out
with
federal
sources
as
a
side
effect
of
the
covid
crisis.
M
We
didn't
have
as
many
people
coming
into
health
departments,
there's
a
lot
of
revenue
that
we
generate
through
the
health
departments
through
billing,
third
parties,
small
sliding
scale,
insurances
or
sliding
sale
fees,
and
we
didn't
collect
that
revenue.
So
we
saved
25
million
in
payroll,
there's
a
slight
offset,
probably
from
where
we
didn't
collect
as
much
in
revenue
as
we
normally
would
and
whatever
was
remaining
reverted
to
the
general
fund
at
the
end
of
fiscal
year.
21.
M
M
M
I
Thank
you,
madam
chair
good
morning,
commissioner
good
to
see
you
and
your
team.
You
had
referenced
the
department's
use,
spending
down
the
40
percent
of
the
funds
and
really
not
having
much
issue
with
that.
Do
you
anticipate
needing
more
full-time
or
contractors
to
spend
the
rest
of
that?
The
allocation
of
that
money.
M
I
I
They
have
referenced
that
the
cms
rule
would
significantly
the
ability
to
provide
quality
health
care,
they're
already
understaffed.
Covenant,
for
example,
I
think
30
of
their
staff
is
not
vaccinated.
Many
of
them
are
nurses.
If
the
cms
rule
has
not
stayed
this
week
and
we
move
toward
december
5th
they're
going
to
lose
a
significant
number
of
nurses,
not
to
mention
doctors
and
others,
has
the
department
evaluated
what
that
will
look
like
if
the
cms
rule
has
not
stayed
like
the
osha
rule
was
if
the
cms
rule
has
not
stayed.
L
Thank
you
for
that
very
salient
question
chairman,
because
it's
something
that's
weighing
heavy
on
a
lot
of
our
providers.
I
did
a
call
with
the
executive
team
of
one
of
our
large
long-term
care
chains
on
friday
on
this
very
topic
and
have
a
call
this
afternoon
with
one
of
our
east
tennessee
hospital
ceos
again
same
topic,
the
the
difficult
part
to
your
question
about
projections.
L
Each
facility
is
a
little
bit
different.
This
nursing
home
chain
may
have
as
much
as
15
percent
attrition
that
they
are
concerned
that
they
have
may
have
as
much.
We
also
know
from
president
from
other
states
and
other
entities
that
it's
probably
going
to
be
less
than
that,
but
still
even
if
it's
five
percent
that
is
going
to
entail
closing
some
wings,
maybe
even
closing
facilities,
disrupting
patients,
same
kind
of
thing
with
the
hospital
that
I'm
talking
to
this
afternoon,
so
I
I
think,
you're
very
familiar.
We
have
significant
concerns
about
that
mandate.
L
F
Thank
you,
commissioner.
Thank
you
for
coming
today.
I
I
would
be
remiss
if
I
didn't
follow
up
with
chairman
zachary's
comments.
I've
in
the
last
five
days
I
hear
from
constituents
quite
a
bit,
but
none
like
I've
heard
in
the
last
10
years
of
service,
like
I've
heard
in
the
last
week
from
health
care
providers.
My
and,
as
you
know,
my
community
serves
eight
counties
with
its
small
regional
hospital
there
and
37
percent
of
the
staff.
F
There
is
not
vaccinated
currently,
which
means,
if,
if
half
of
them
choose
to
take
a
vaccine
without
in
order
to
keep
their
jobs
and
provide
for
their
families,
the
other
half
would
drastically
impact
eight
counties
in
the
state
and
the
ability
to
provide
health
care,
and
so
this
rule
is
one
that
is
of
of
great
concern
to
to
all
all
those
tennesseans
who
are
seeking
health
care
in
our
state,
whether
they're
teen
care
patients
or
or
not.
So
I
guess
my
thoughts
or
questions
regarding
that
is.
F
Do
we
we
say
that
we're
doing
a
great
job
with
vaccination,
because
we've
been
practicing
what
it
looks
like
for
five
years.
Have
we
done
anything
remediation
plans?
Do
we
have
any
idea
what
the
the
the
future
might
look
like
in
five
weeks
if
we
lose
15
of
our
health
care
providers
across
the
state.
L
Thank
you,
sir.
That's
a
very
fair
question
and
one
that
waves
weighs
heavily
on
us,
so
I
want
to.
I
want
to
clarify,
because
I
don't
want
to
be
too
self-congratulatory
here.
We
did
a
great
job
of
rolling
it
out,
providing
it
making
it
available,
but
what
you're
describing
and
what
we're
dealing
with
is
vaccine
hesitancy
and
we've
got
a
lot
of
that
and
there's
it's
very
apparent
in
just
like
everywhere
are
more
rural
areas
and
with
our
lower
income
workers.
Well,
our
lower
lower
wage
workers.
L
L
If
that
happens,
part
of
me
would
like
to
believe
that
that
we'll
figure
something
out,
there's
going
to
be
there's
going
to
be
an
alternative,
whether
they
will
allow
testing
for
that
and
then
the
other
part
of
me
says
well
what
do
you
do
if
they
don't,
and
so
we're
tossing
around
some
ideas
and
in
fact,
on
our
agenda
internally
tomorrow
to
talk
about
what
does
staffing
assistance
look
like,
but
then
you
come
to
this
thing.
All
the
money
in
the
world
can't
buy
humans,
so
it's
a
real
pickle.
F
F
You've
only
been
able
to
spend
the
the
deadline
ended.
Obviously,
before
we
were
able
to
spend
all
that
money,
I
think
you
spend
about
700
million
dollars
of
it.
So
we've
heard
time
after
time,
every
time
during
these
hearings,
I
got
this
money.
I
don't
know
what
to
do
with
it
or
I
can't
spend
it.
Is
there
any
pot?
M
We
have
the
opportunity
and
a
lot
of
those
cases
do
get
a
one-year
extension,
a
no-cost
extension
so
that
we
can
buy
a
little
bit
more
time
to
spend
the
money
and
then
we've
been
coordinating
with
fna.
You
know
all
these
are
estimates
right.
We
estimate
what
we're
gonna
spend,
what
we're
gonna
collect
and
we've
been
working
with
fna
to
make
sure
we
have
the
right
amount
in
the
budget
at
each
time
we
want
to.
M
We
want
to
make
a
balance,
because
we
don't
want
to
put
too
much
authority
in
because
we
would
spend
it
and
we
don't
put
too
little
in
because
we
want
our
programs
to
to
have
what
they
need
so
we're
trying
to
strike
that
right
balance.
So
I
think
right
now
we're
in
a
good
position
just
to
continue
support
as
we
kind
of
work
through
expansion
processes
or
anything
like
that.
You
know
the
normal
day-to-day
of
of
adding
money
to
our
budget.
L
I
wasn't
going
to
bring
it
up,
but
you
did
ask
the
expansion
process
has
been
the
the
slowness
of
that
has
hurt
some
of
our
vendors
and
I've
gotten
personal
outreach
from
friends
and
providers.
Saying
hey,
we've
waited
for
this
long.
So
if
you're
asking
what
you
can
do
to
help,
that
would
be
one
thing.
B
Thank
you,
madam
chair.
So
I'm
gonna
ask
the
same
question.
I've
asked
most
people,
and-
and
that
is
what
are
you
doing-
to
be
proactive
to
notify
the
people
of
tennessee
of
the
additional
programs
from
this
1.7
billion
dollars?
You
know,
I
know
we.
We
recently
expanded
vaccine
availability
to
five
to
11
year
olds
and
I
couldn't
have
been
more
excited
to
take
my
children,
but
but
I'm
I'm
sad
to
say,
I've
not
seen
anything
from
the
state
notifying
the
residents
of
our
state
of
this
availability.
What
are
we
doing?
L
L
We
are
making
these
types
of
programs
known
on
our
social
media
channels
and
and
through
our
typical,
more
traditional
media,
but
going
forward
when
you're
talking
about
big
things,
big
new
programs,
if
we've
learned
anything
during
all
of
this
is
that
government
is
probably
the
worst
messenger
there
is,
and
so
we
need
to
rely
on
our
partners
that
doesn't
mean
we're
off
the
hook
and
that
we
shouldn't
do
it.
In
fact,
we've
got
the
rfp
just
finished
for
our
second
round
of
market
research
on
vaccine
hesitancy.
So
you
you
reference
the
big.
L
You
know
ad
campaign
for
vaccine
hesitancy
that
we
did
early
on
we're
going
to
be
looking
at
that
again
we're
polling,
not
not
the
same
people
but
the
same
types
of
people
and
saying:
okay,
now
that
essentially
a
year
has
passed.
How
is
your
attitude
related
to
vaccine
changed
and
what
are
your
reasons
for
continued
hesitancy?
And
how
can
we
overcome
that?
So
I
think
you'll
be
seeing
that
in
the
coming
months,
but
the
the
key
answer
to
your
question
is
leveraging
our
partners
and
supporting
them.
L
The
other
thing
that
we've
learned
through
this
is
it's
not
enough
to
say
here.
Xyz
clinic
use
this
money,
here's
some
money
go
tell
they
don't
have
the
expertise
and
the
tools
to
do
that,
so
packaging
up
tool
kits
giving
them
talking
points
giving
them
content
that
they
can
use
to
promote.
Those
programs
is
going
to
extend
our
reach.
Much
further
than
we
could
do
is
just
a
state
government.
B
L
L
This
is
something
we're
going
to
have
to
operationalize
and
put
in
our
normal
system
what
that's
one
of
the
reasons
behind
what
I
was
referencing
earlier
about
those
self
test
kits
so,
instead
of
having
you
come
in
and
us
have
to
segregate
you
over
here,
because
you
might
be
infected
and
go,
do
your
test
and
then
still
do
everything
else.
You
can
come
to
us
for
a
resource.
We
can
hand
you
a
test
kit.
You
can
go
home
and
do
it
yourself,
likewise
providing
testing
and
other
resources
to
community
providers.
L
J
Thank
you,
commissioner.
I
don't
have
a
question.
I
just
have
a
comment
I
want
to
thank
you
and
your
team
for
the
hard
work
you've
put
in
over
the
last
two
years.
This
has
been
a
constantly
moving
ball
as
far
as
how
to
obtain
victory
on
this
pandemic
and
we've
all
struggled
with
exactly
how
that
is,
I
think
every
tennessean
has.
But
when
you
agreed
to
be
commissioner,
I
I
don't
know
that
you
anticipated,
or
your
team
did
either
one
that
you
would
be
fighting
a
global
pandemic.
L
J
Thank
you,
chairman
baum,
commissioner.
I
I
too
applaud
what
you
guys
have
done
and
and
what
you've
been
thrown
into
and
you've
been
very
responsive
to
me
when
I've
called
with
individual
questions
related
to
constituents
of
mine
and
and
friends
of
yours,
even
and
and
even
your
assistant,
commissioner,
who
I
think
it
was
just
thrown
into
the
fire
very
recently
he's
been
very
responsive
as
well,
but
I'm
concerned
about
strings
that
are
attached
to
federal
money
and
it's
always
a
concern.
J
L
B
J
L
J
But
for
the
flu
or
other
diseases
like
that
other
illnesses,
like
that,
it's
it's
unprecedented,
but
I'm
understanding
now
that
that
cms
is
requiring
this
and
they're
they're,
actually
finding
labs
that
don't
comply.
Now.
A
year
ago
we
had
this
discussion
about
this,
and,
and
it
became
apparent
that
there
was
a
mistake
on
the
portal,
as
I
understood
you
to
tell
me
that
certain
information
was
required
and
certain
was
optional
and
you
realize
that
and
I
believe
it
got
changed.
J
But
now
it's
changed
back
all
this
information
personally
identifiable
information
is
required
now
on
the
state
website.
The
portal
that
that
clinics
have
to
submit
test
results
in
these.
These
are
required
for
negative,
coveted
tests,
and
I
guess
my
question
is:
is
that
a
very
strict
requirement
and
I'm
talking
about
the
fine
details
of
here
from
cms,
because
I've
read
what
the
assistant
commissioner
sent
me.
It
makes
references
to
some
things
that
aren't
in
this
document.
J
I
don't
know
where
to
find
them,
and
so
I
want
to
make
sure
that
that
the
state
of
tennessee
department
of
health
has
not
over
interpreted
and
asked
for
more
information.
That
is
very
minimally
required
and
I
can
understand
wanting
a
zip
code,
the
sex,
maybe
age
of
someone,
but
to
know
their
exact
name.
Their
phone
number,
their
address
to
me
is
beyond
the
pale.
J
There
is
absolutely
no
reason
that
I
can
come
up
with,
and
you
and
I
have
discussed
this
and
I
wasn't
convinced
there
was
a
legitimate
reason
out
there
for
knowing
negative
coveted
tests.
So
it
is,
have
we
interpreted?
Has
your
department
interpreted
the
cms
intentions,
liberally
or
very
conservatively.
L
L
There
does
have
to
be
personally
identifiable
information
in
there
for
deduplication
purposes,
because
there
are
a
lot
of
us
that
live
in
38305,
for
example,
zip
code.
There
are
a
lot
of
us
with
the
same
birth
year
or
maybe
even
birth
date
in
the
same
zip
code,
so
we
are
complying
with
cms
at
their
minimally
required
standard.
But
I'm
happy
to
send
you
all
the
detail
on
that.
Okay,.
J
J
We've
got
an
outbreak
here
that,
to
me,
is
scientific,
but
knowing
specific
names
addresses
phone
numbers,
if
you
have
them
in
our
every
clinic
is
going
to
have
those
bits
of
information,
and
that
goes
into
a
database
in
our
federal
government
which
practically
nobody
in
my
district
trust,
anymore
whatsoever
for
very
good
reason.
This
is
this
is
a
tremendous
overreach
and
they're
doing
it
a
lot
of
times
with
the
carrot
that
okay,
we've
got
this
money,
but
you
have
to
comply
with
this.
J
So
I
have
a
lot
of
folks
upset
over
that
and
very
concerned
about
that,
and
I
would
just
request
that
the
department
keep
this
and
I'm
sure
you
are
to
the
very
minimum
whatever
they
require.
Don't
do
anything
else,
and
that's
about
all.
We
can
request
at
this
point,
but
it's
very
concerning
and-
and
I
think
that,
along
with
so
many
other
things
go
to
the
concern
you
had
about
the
hesitancy
for
the
vaccine,
there's
so
much
about
this
push
this
force
of
a
vaccine
to
people
that
don't
even
need
it.
J
I
don't
need
it.
I
have
natural
antibodies
and
cdc
is
now
admitting
they
know
of
absolutely
no
transmission
from
a
person
with
natural
antibodies.
Yet
I
know
personally,
of
transmission
from
vaccinated
people,
so
those
are
facts
that
they're
now
finally
sharing
reluctantly,
I'm
sure,
but
that
all
those
things
create
such
a
cloud
over
this,
that
it
creates
the
hesitancy
and
neither
of
us
like
that,
but
that's
where
we
are-
and
so
I
just
ask
for
the
department
to
continue
fighting
for
the
people
of
tennessee
and
their
personal
liberties
and
their
rights.
D
Thank
you,
chairman,
hey
mines
is
cover
related,
but
not
along
the
lines,
and
we
talked
about
this
in
the
hallway,
but
I
just
want
to
get
on
the
record.
What
are
the
federal
funds
that
we
can
use
for
doula
services
and
kind
of
talked
about
some
of
the
struggles
or
successes
that
you've
had
around
maternal
health
and
infant
mortality
during
the
kobe
19
pandemic?.
B
Thank
you,
commissioner.
I
don't
acknowledge
that,
but
thank
you
so
a
couple
of
questions.
I
think
there
that
I
want
to
make
sure
that
we
address
so
certainly
in
regards
to
doulas
and
community
health
workers.
Broadly,
we
as
a
department
absolutely
can't
recognize
enough:
the
value
of
community
health
workers
and
also
doulas,
both
in
the
maternal
and
child
health
space,
as
well
as
with
covet
response
and
having
someone
who
is
from
a
community
who
knows
a
community
who
can
then
really
relate.
B
As
dr
piercy
said,
the
government
is
the
least
trusted
source
of
information
oftentimes
within
communities
and
so
to
have
trusted.
Resources
in
community
health
workers
and
doulas
has
been
a
tremendous
asset
from
a
cobit
response
perspective,
but
also
in
larger
maternal
and
child
health
initiatives.
B
We
have
invested
some
of
our
funding,
particularly
in
our
health
disparities,
grant
funding
we
received
about
38
million
dollars
from
cdc
to
address
health
disparities,
particularly
covert
related.
This
did
have
to
be
cova-directed,
but
we
have
used
that
to
really
develop
some
of
our
workforce
infrastructure
and
particularly
thinking
about
training
for
community
health
workers
and
funding
community
health
workers,
and
we
had
an
rfa
release
not
very
long
ago
to
fund
community
health
workers.
B
We've
got
ongoing
meetings
with
several
doula
entities
across
the
state,
both
to
think
about
training
for
doulas,
as
well
as
to
think
about
sustainability
plans
for
doulas
and
recognize,
as
we've
addressed
already
with
an
influx
of
federal
funds.
Now,
how
do
we
use
that
in
a
way
that
is
sustainable
in
the
future,
so
that
then,
if
we
hire
trade
doulas
now
making
sure
that
they
have
employment
reimbursement
going
forward,
go
ahead.
D
Thank
you,
mr
chairman,
thank
you
for
your
answer.
I'm
so
in
clarity.
Could
we
potentially
do
use
those
federal
funds,
because
I
don't
have
the
licensing
restrictions
that
we
have
to
maybe
create
a
pilot
program
to
provide
the
proof
that
they
work.
So
we
can
continue
their
process
of
creating
a
licensing
program
for
them
here
in
the
state.
So
we
can
do
even
more
than
what
we're
doing
now.
B
D
B
N
Thank
you,
commissioner,
just
wanted
to.
I
appreciate
your
choice
by
the
way
I
like
that
I've
got
a
new
daughter-in-law
that
started
as
a
traveling
nurse
at
vanderbilt
recently,
but
when
you,
I
think
you
use
the
word
sustainability.
Is
this
whole
model?
Sustainable,
I
mean,
do
you
have
a
fear
of
where
things
are
going
in
the
future?
I
know
I
do
and
with
the
debt
and
the
printing
of
money,
like
chairman
williams,
had
mentioned,
but
going
back
on
all
these
myriad
of
issues
that
we're
facing
the
the
nursing
shortages.
N
What
else
can
we
do?
What
what
advice
would
you
give
us
to
what
we
do
to
maybe
fast
track
this
or
lure
people
into
the
industry,
because
I've
got
I've
got
a
sister
in
a
nursing
home
that
that
literally
lost
everything
and
it's
heartbreaking
to
go
see
her?
I
got
a
mom
and
a
nursing
home.
I
get
her
ready
every
night
get
her
something
to
eat
the
turnover.
N
It's
something
somebody
knew
all
the
time
and
you
know
it
bothers
me
when
I
see
my
sister
lose
everything
in
her
name,
everything
you
know
and
she's
in
there
with
three
other
patients
at
200,
something
dollars
a
day
and
I'm
like
man,
I'm
a
lawmaker.
What
can
I
do
probably
not
much,
but
you
know
I'd
like
to
use
some
choice
words,
but
but
I'm
not
going
to
do
that,
but
it
really
just
it
burdens
me
burns
my
heart.
Hopefully
I
can
make
an
impact
and
I
know
you're
I've
seen
it.
N
L
Thank
you,
sir,
for
that
and
and
as
much
as
I
hate
to
hear
about
the
situation
of
your
sister
there's
so
many
tennesseans
in
that
very
same
boat
and
with
an
aging
population,
I'm
not
sure
the
trajectory
is
going
to
get
any
better
related
to
nursing
workforce
or
just
health
care
workforce
in
general.
I
really
think
this
is
a
moment
of
reckoning
for
us
and
it
should
inform
us
not
only
in
the
short
term,
but
in
the
long
term
and
one
of
the
things
that
I
joked
earlier,
I'm
a
recovering
hospital
administrator.
L
One
of
the
things
that
I
dealt
with
all
the
time
was
nursing
shortages.
This
is
not
a
new
thing.
This
was
a
thing
that
we
hobbled
through
when
we
limped
along
and
we
made
it
work,
but
we
didn't
invest
the
time,
the
money,
frankly,
the
political
capital,
to
set
up
the
structure
to
where
we
could
mitigate
this
long
term.
So
I
think
that
gives
us
two
lessons
going
forward.
Number
one.
There
are
no
quick
fixes.
There
are
no
band-aids,
I
mean
there
are
some
but
they're
not
worth
putting
money
into
because
they're,
not
long-term
solutions.
L
We
do
what
we
have
to
in
the
short
term,
but
there
aren't
any
quick
fixes.
Trust
me.
If
there
were,
we
would
have
done
them.
Somebody
would
have
found
them.
The
second
lesson
I
think
it
brings
is
we
have
to
stop
ignoring
the
problems
that
are
today
just
because
we
can
fix
them
today
or
we
can
get
by
today
and
was
talking
to
some
folks
yesterday,
things
like
respiratory
therapy,
things
like
ems,
maybe
even
primary
care
doctors.
There
are
a
lot
of
things
that
are
kind
of
pain,
points
right
now,
but
we're
hobbling
along.
I
Thank
you,
mom
chair,
thank
you,
commissioner,
and
thank
you
for
all
the
work
you'll
do.
I
know
it's
been
a
long
road
we've
been
on.
It
seems
now
earlier
you
spoke
that
you
were
talking
to
hospital
administrators
and
giving
guidance.
I'm
concerned
a
little
bit
in
some
of
your
messaging.
You
said
vaccine
hesitancy,
understand
that,
but
there's
a
specific
group
within
the
health
care
world
workers
they're
not
hesitant.
They
just
flat,
do
not
want
to
take
the
vaccination,
and
I
got
a
call
earlier.
I
There's
a
group
of
doctors
and
nurses
that
are
banding
together
and
they've
asked
for
a
religious
exemption
and
they're
not
getting
good
guidance.
I'm
hearing
about
a
system,
that's
discombobulated
around
the
state
where
there's
being
boards
set
up
questionnaires,
going
out
two-part
question
and
then
I'll
I'll
make
a
statement
first.
But
what
recommendation
is
your
department
giving
to
those
administrators
for
one
and
is
that
documented?
Is
that
something
we
have
access,
because
I
would
like
to
see
that
and
two.
I
What
is
the
state
done
to
take
up
the
issue
and
what
lawyers
I'm
sure
we
have
some
lawyers
in
the
room?
The
the
question
that's
posed
to
me
is
this
is
a
direct
title.
Seven
conflict
and
these
doctors
and
nurses
are
going
to
end
up
in
federal
court
suing
the
individual
cms
hospitals
that
take
funding
because
they
feel
like
their
civil
rights,
are
being
violated,
they're
being
discriminated
against
and
if
they're
ultimately
terminated
they're
going
to
seek
recourse.
I
L
This
is
a
choice
and
there
are
some
people
who
are
an
absolute
no
and
it's
not
hesitancy,
and
we
want
to
protect
that
choice,
even
if
it's
an
absolute,
no
and
even
if
we
disagree
with
it
as
public
health
and
medical
professionals.
That
is
their
right
to
do
that,
and
we
want
to
protect
that
related
to
guidance
to
hospitals.
It's
not
related
to
it
doesn't
pertain
to
how
to
coax
a
few
more
employees
to
get
vaccinated.
It
is
how
can
I
help
you
if
you
suddenly
have
10
of
your
workforce
walk
out?
L
It
is
more
of
a
of
an
operational
support.
It's
not
and
there's
nothing
formal.
This
is
these
questions
that
are
coming
up
to
say,
we're
sitting
around
the
table
and
we're
worried
about
this.
For
example,
one
of
them
asked:
do
you
continue
to?
Are
you
going
to
continue
to
have
national
guard?
If
I
need
those
those
types
of
questions
related
to
your
title
vii
question,
I
totally
defer
to
the
attorneys
on
that,
but
you're
exactly
right.
There
will
be
lots
of
lawsuits
pending.
I
Thank
you
ma'am,
chair
to
that
statement.
I
don't
know
that
they're
going
to
walk
out,
I
think
they're
going
to
be
removed
and
if
they're
removed
or
if
we
intimidate
them
or
force
them
to
walk
out.
That
in
itself,
I
believe,
is
discrimination
for
the
record
and
I
believe,
they've
got
recourse.
We
should
not
be
intimidating
employees
forcing
them
to
do
something.
That's
so
quickly
derived,
and
these
are
healthcare
professionals.
This
is
their
livelihood.
They
work
there.
I
L
Yes,
sir,
and
your
your
comment
reminds
me
of
something
that
chairman
todd
said,
which
is
when
you
attach
so
many
monetary
strings
to
it.
It
essentially
becomes
it
saying
it
a
different
way:
a
hospital
or
nursing
home
can't
survive
without
cms
funding,
and
so
when
that
is
what's
on
the
line
here
and
they
have
to
choose
between
sustainability,
it
puts
our
hospitals
in
in
long-term
care
facilities
in
very,
very
precarious
situations.
O
Lynn,
thank
you
very
much,
madam
chairman,
commissioner.
I
I
just
so
appreciate
my
colleagues
statements
down
here
and
there's
one
other
thing
that
I
have
been
extremely
concerned
about
since
this
pandemic
began,
and
that
is
people
when
they're
diagnosed,
especially
when
they're
diagnosed
with
their
doctor,
they
are
not
given
any
sort
of
at-home
self-care
protocol
in
the
state.
O
O
I
asked
what
did
your
doctor
tell
you
to
do
as
you
about
this
go
home.
They
gave
me
a
little
oxygen
meter
and
if
my
blood
oxygen
reaches
92,
I
should
go
to
the
hospital
okay.
What
else
did
your
doctor
tell
you
to
do?
What
did
your
doctor
give
you
provide
to
you
nothing,
nothing
at
all,
one
woman
who
was
so
concerned
about
herself.
She
insisted
to
the
doctor.
O
There
has
to
be
something
there
has
to
be
something
I
can
do,
and
the
doctor
said
well,
if
you
want
to,
you,
can
go
to
hendersonville
medical
center
and
get
them
monoclonal
antibodies.
Well,
she
very
sick
drove
herself
over
to
hendersonville
medical
center.
They
told
her.
We
only
treat
15
people
a
day
with
the
antibodies
and
we've
already
treated
the
15..
O
I
was
alarmed
and
she
she
had
already
called
someone
else
who
she
knew
had
coveted.
They
had
actually
been
together
the
prior
weekend.
She
feels
that
she
probably
got
it
from
that
person
and
they
said
well.
We
found
out
that
in
trousdale
county
they
will
give
you
the
antibodies
any
time
you
get
there
and
it
doesn't
matter
what
time
you
get
there
just
bring
your
positive
kobe
test.
O
O
Well,
she
did
get
the
antibodies
and
in
a
few
days
she
turned
the
corner.
I
did
go
online
and
I
found
from
two
reputable
sources:
some
protocols
for
at-home
care
for
yourself
if
you
have
been
diagnosed
and
very
good
common
sense
things
to
do,
but
I'm
just
alarmed
that
doctors
in
tennessee-
because
I
heard
this
from
several
people-
we're
not
routinely
giving
out
a
protocol
for
at
home
care
and
and
especially
for
people
who
have
those
comorbidities
that
are
so
dangerous
and
really
we're.
O
I
mean
we're
just
going
to
drive
them
to
the
hospital
commissioner.
What
is
going
on
in
medical
care
that
this
was
occurring?
Why
were
people
not
given
better
care,
and
what
can
the
department
of
health
do
about
that,
because
this
is
a
major
concern
and
I'm
utterly
shocked,
and
just
recently
on
national
news
shows?
I
heard
the
discussion
there
too,
that
doctors
were
not
giving
a
protocol
for
at-home
care
for
yourself.
All
they
said
was
if
your
blood
oxygen
gets
to
92
go
to
the
emergency
room.
O
L
Thank
you,
representative,
two
or
three
quick
thoughts
and
I'll
try
to
be
brief,
madam
chair,
so
the
state
itself,
we
don't
no
pun
intended.
We
don't
prescribe
a
protocol
for
medical
providers
that
is
left
to
the
discretion
of
each
individual
practitioner
and
admittedly,
they
heretofore
have
not
had
a
lot
of
tools
in
their
toolbox.
One
of
the
tools-
that's
very
very
important
and
impactful
you've
mentioned-
is
monoclonal
antibody.
The
really
good
news
is,
we
continue
to
have
very
ample
supply
across
220
locations.
I
just
got
this
week's
allocation.
L
Yesterday
got
another
2,
300
doses
in
the
state.
You
shouldn't
have
any
trouble
anywhere
in
the
state
getting
same
day
or
next
day.
Now
I
can't
speak
to
individual
facility
staffing
patterns
and
and
when
and
where
they're
able
to
provide
that,
but
as
far
as
the
supply,
that's
not
the
issue.
The
other
tool
that's
coming
very
quickly,
probably
in
the
next
two
to
four
weeks
that
physicians
will
have
at
their
disposal
is
the
oral
antiviral
pill
so
essentially
the
equivalent
of
tamiflu
for
flu.
L
The
first
one
will
be
malnupiravir
from
merck,
and
then
there
will
be
another
one
from
pfizer
that
probably
come
out
in
january.
That
will
become
much
more
of
a
routine
thing.
Here's
your
positive
test!
Here's
your
prescription
supply
will
be
a
big
issue
at
first,
but
it's
another
tool
that
we're
looking
forward
to.
A
Thank
you,
commissioner,
and,
as
I
think
one
thing
we've
learned
through
this
crisis
in
this
process,
is
that
it's
it
definitely
evolves
on
a
daily,
if
not
hourly
basis
and
the
rules
change,
because
the
information
that
we
gather
leads
us
to
new
conclusions
from
time
to
time.
So
I'm
grateful
to
know
that
there
are
at
least
on
the
horizon,
other
treatments
for
those
who
do
contract
the
disease.
We
thank
you
again.
I
think
leader
lamberth
said
it
for
all
of
us.
We
appreciate,
we
know
you
it's
a
very
difficult
job
that
you
have.
A
It's
been
a
difficult
position
for
you
and,
and
us
frankly
to
be
in
so
I
thank
you
for
the
work
that
you've
done
and
again.
Thank
you
for
being
here
today.
I
apologize
one
more
time
for
making
you
late
and
making
you
tardy
for
your
whatever
lunch
plans
you
might
have
had
probably
at
your
desk,
but
with
that
we
will
conclude
our
hearings
at
this
time.
I
want
to
thank
the
members,
those
of
the
stalwarts
who
have
remained
with
us
here
for
for
spending
your
time.