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Description
House Health Committee- February 16, 2022- House Hearing Room 1
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B
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A
Are
there
any
questions
on
the
bill?
Okay,
seeing
none
can
you
just
clarify?
This
was
something
I
can't
guess
came
up
after
last
committee.
There
is
a
good-sized
fiscal
note,
but
being
the
chair
of
fiscal
review
may
or
of
the
finance
committee,
you
may
have
a
little
input
on
this,
but
you
think
it's
a
little
bit
broader
than
what
it
should
be.
B
A
B
You,
mr
chairman,
thank
you
committee
today.
I
have
house
bill
1956
before
you.
This
is
the
ambulance,
emt
training
facilities
or
training
centers
bill.
Basically,
what
we're
doing
is
we're
increasing
the
amount
of
students
that
can
take
the
class
from
10
to
20
and
we're
also
extending
instead
of
two
times
a
year.
They
can
do
three
times
a
year
as
far
as
their
classes.
B
The
reason
we
brought
this
bill
is,
we
are
heavily
understaffed
throughout
the
state
with
ambulance
drivers,
we
have
ambulances
sitting
there
and
nobody
to
drive
them
or
work,
and
so
our
citizens
are
not
as
safe
as
they
could
be.
So
hopefully,
what
I'm
doing
is
I'm
going
to
get
some
more
of
these
guys
trained,
so
gary
can
give
them
800
when
they
train.
So
this
this,
hopefully,
will
fix
the
problem.
We
did
it
as
a
pilot
program
in
east
tennessee
and
it's
worked
out
great
so
far,
so
I
think
this.
B
B
Thank
you
chairman.
No,
no
questions
just
wanted
to
thank
the
sponsor
for
this
bill.
I
remember
when
he
came
to
finance
and
was
asking
for
a
little
bit
of
money
for
a
pilot
program,
and
it
seemed
like
a
a
a
great
idea
at
the
time,
but
we
weren't
really
sure
he's
here
before
us
today,
because
it
is
working
really
well,
and
so
these
are.
This
is
a
job,
that's
very
difficult
to
fill
in
our
communities
and
by
multiplying
the
number
and
the
opportunities
for
them
to
do
it.
B
A
All
right,
thank
you.
Any
further
questions
again.
I'd
like
to
thank
the
sponsor,
I
think
I
said
something
in
subcommittee
on
this
and
for
those
at
home
or
those
that
are
in
the
audience,
sometimes
getting
to
a
point
like
where
we're
at
here.
It's
a
process,
and
sometimes
the
discussion
where
we
think
we
need
to
go
and
we
end
up.
We
eventually
end
up
there.
A
I
think
a
former
speaker
pro
tem
bill
dunn
had
said
the
sometimes
the
slower
you
go,
the
faster
you
get
there,
but
you
have
worked
on
this
and
I
really
do
appreciate
you're
working
on
this
issue.
Without
any
objection,
we
are
voting
on
house
bill,
1956,
all
those
in
favor
say
aye
opposed
eyes.
Have
it
bill
goes
on
to
calendar
roles.
Thank.
A
C
This
legislation
will
codify
the
use
of
non-licensed
and
entry-level
personnel
to
operate
an
ambulance.
These
non-licensed
and
entry-level
operators
will
have
no
medical
contact
with
patients
above
their
scope.
They
will
be
a
company
accompanied
by
a
licensed
personnel
with
appropriate
medical
training,
and
they
will
be
required
to
enter
further
training
within
12
months.
C
C
This
category
of
personnel
is
licensed
at
a
level
below
mt
and
emr
can
perform
basic
life
support
skills
such
as
cpr
oxygen
administration,
limited
medication,
administer
medication,
administration,
splinting,
immobile
immobilization
and
patient
assessment
upon
employment
as
an
emsa
or
emr,
or
licensed
as
an
emr.
The
employee
has
12
months
to
enter
into
a
higher
level
of
training.
With
that.
Mr
chairman
I'll
answer,
any
questions.
Okay,.
D
C
Thank
you,
mr
chairman.
I'm
very
confident
in
this
I've
had
all
kinds
of
folks
come
in
the
office
talking
about
how
good
this
has
worked
out
and
also
the
tennessee
ambulance.
Service
association
has
worked
with
the
emergency
medical
service
board
and
the
department
of
safety
to
remove
this
unnecessary
endorsement,
so
they're
all
on
board
with
doing
this.
So
I
think
it's
a
really
good
program.
D
A
Additionally,
I
did
want
to
point
out
that,
if
somebody,
this
is
something
that
this
body
passed,
this
committee
passed
the
tanf
opportunity
act
and
the
apprenticeship
program
on
this.
If
they
they
qualify
for
tanf,
then
they
could
get
support
through
that
apprenticeship
program.
So
this
goes
in
line
with
something
that
this
committee
has
already
done
so
appreciate
you
for
bringing
this
bill.
Thank
you.
Without
any
further
questions,
we
will
be
voting
on
house
bill.
1981.,
all
those
in
favor
say
aye
aye
opposed
eyes.
Have
it
bill
goes
on
to
finance
ways
and
means
all
right.
A
A
E
You,
mr
chairman,
thank
you
committee
for
having
us
happy
to
present
our
budget
to
you
today.
I'm
lisa
pearcy,
the
commissioner
of
the
department
to
my
right
is
dr
morgan,
mcdonald,
our
deputy
commissioner
of
population
health,
and
to
my
left,
is
our
money.
Man,
john
webb.
He
is
the
deputy
of
operations
and
oh
excuse
me
and
to
his
left.
This
is
the
first
time
this
budget
has
been
presented
with
dr
tim
jones.
He
was
out
with
a
family
emergency
last
week.
Dr
tim
jones
is
our
chief
medical
officer.
E
So
I
wanted
to
first
bring
to
you
our
cost
increases
they
in
total,
come
to
about
30.8
million
dollars,
and
so
I'll
give
you
a
line.
Item
breakdown
of
that
one
of
our
largest
items
is
something
that
you've
probably
heard
us
talk
about
either
in
our
budget
presentations
or
in
multiple
other
conversations.
We're
really
excited
about
is
our
dental
services
pilot
project.
E
E
Both
this
year's
line
item
requested
line
item
and
the
entire
proposal
are
broken
down
into
three
primary
components
so
about
two-thirds
of
the
dollars
go
to
dental
schools
to
help
increase
the
class
size.
Let
me
take
a
little
side
step
here
to
give
you
some
situational
awareness
in
our
county
statewide
in
all
of
our
counties.
Statewide,
there
are
only
a
handful
two
three
four,
maybe
that
have
adequate
number
of
dentists.
Every
other
county
in
the
state
is
considered
a
health
professional
shortage
area
when
it
comes
to
dentists.
E
Yet
so
ut
puts
out
or
ut
has
about
a
hundred
slots
a
year,
30
of
which
have
to
go
to
arkansas
residents,
because
arkansas
does
not
have
a
dental
school.
So
that
leaves
70
spots
in
the
ut
school
that
are
eligible
for
tennessee
dentists,
and
we
know
people
from
here
are
more
likely
to
stay
here
and
practice,
although
that
doesn't
always
hold
true.
So
ut
has
a
hundred
slots,
mahari
has
plus
or
minus
60
slots.
Neither
of
them
have
expanded
class
size
in
a
very
long
time.
E
In
fact,
ut,
one
of
the
reasons
we're
in
sort
of
this
I'll
call
it
gray,
wave
upcoming
retirement
wave
of
dentist
is
because
ut
used
to
put
out
two
classes
a
year
and
then
at
some
point,
maybe
in
the
80s
or
in
the
90s.
They
dropped
back
to
one
class
a
year.
So
this
state
is
only
putting
out
right
now
about
160
dentists
per
year
and
there's
no
guarantee
that
they'll
stay
in
the
state.
Obviously,
lmu
is
coming
online.
They
are
scheduled
to
start
their
first
class
in
august.
Their
applications
are
currently
open.
E
E
So
two-thirds
of
this
overall
dental
package
proposal,
including
this
first
year,
has
to
go
to
or
is
going
to,
dental
schools
to
increase
class
size,
and
so
that's
the
bulk
of
that
there's,
a
lot
of
costs
associated
with
faculty
and
and
all
flies
needed.
So
that's
the
major
component
of
the
program,
the
other
third
of
the
funds,
are
going
to
a
couple
of
different
things.
E
One
is
the
prosthodontics,
so
all
of
the
dentures
for
the
under
served
elderly
case
management
for
those
who
are
65
plus
trying
to
navigate
the
dental
system,
but
another
really
big
component
of
that
is
recruitment
and
retention
to
underserved
areas.
This
is
the
immediate
piece
that
can
help
immediately,
because
even
if
you
expand
dental
class
size
today,
it's
going
to
be
at
least
four
years
before
you
recognize
that
investment.
E
So
when
you
start
so
so
this
whole
approach
and
if
you
haven't
seen
the
report
that
the
work
group
put
out
in
october,
I
encourage
you
to
do
that.
We're
happy
to
provide
that
to
you,
but
this
is
a
multi-faceted
approach
where
we
have
more
short-term
solutions
and
then
longer-term
solutions,
because
in
that,
in
that
mismatch
of
supply
and
demand
that
I
described,
you
can
imagine
if
you're
a
new
grad
coming
out
of
dental
school
with
what
is
on
average
about
380
000
worth
of
debt.
Just
from
dental
school,
not
undergrad.
E
Dental
school
is
quite
expensive
when
you
have
that
kind
of
debt,
and
you
have
the
demand
in
the
market.
It's
pretty
attractive
to
go
to
a
suburban,
heavily
commercially
insured
area,
because
that
you
can
recoup
your
investment
from
dental
school,
much
quicker
and
and
can
have
some
of
the
lifestyle
that
you
want.
So
there
is
a
pretty
easy
path
to
the
areas
that
may
not
need
the
dentist
as
much,
and
so
it's
really
important
for
us
to
be
able
to
incentivize
new
dentists
and
even
existing
dentists
to
go
into
these
underserved
areas.
E
I'm
sorry,
I'm
taking
a
lot
of
time
on
this.
I
just
get
pretty
passionate
about
it
because
it
you
just
really
can't
fathom
all
of
the
trickle
out
effects
from
this.
So
it's
pretty
easy
to
make
the
connection
between
oral
health
and
physical
health.
You
know
if
you
have
poor
dentition,
it
oftentimes
bleeds
over
into
poor
physical
health
or
those
kind
of
go
together.
E
It
might
be
a
little
more
of
a
stretch,
but
you
can
understand
that
poor
dental
health
can
lead
to
poor
economic
health.
If
you
don't
have
a
presentable
smile,
a
good
face
to
the
world,
if
you
will
not
only,
you
might
not
feel
well,
but
you
not
might
not
feel
confident
enough
to
work
in
an
environment
or,
frankly,
might
not
be
hired
in
an
environment
to
where
you
can
economically
prosper.
E
Well,
then,
when
you
take
another
layer
out,
if
you
don't
have
adequate
dental
care,
you're
still
going
to
have
dental
problems,
and
if
you
don't
have
a
dentist
to
go
to
the
only
place
to
go
to
is
an
emergency
department
and
er
oftentimes
in
rural
areas,
rural
eds,
don't
have
dental
expertise
on
staff,
full-time,
most
likely
and
so
about
about
the
best
they
can
do.
Many
times
is
stop
their
pain
until
they
can
get
them
in
somewhere.
E
So
you've
got
the
excess
cost
of
an
emergency
room
visit
that
was
unnecessary
in
the
first
place
and
then
even
potentially
some
opioid
issues
if
there
are,
if
there's
extreme
pain
and
there's
really
not
else,
much
much
else
to
do
about
it,
so
there's
a
whole
lot
more
effects
than
just
saying.
Oh,
your
smile
looks
pretty
or
your
teeth
look
nice
there's
a
lot
bigger
health
and
public
health
and
economic
health
ramifications
of
this.
I
apologize
chairman.
That
was
a
long-winded
explanation.
E
E
We
had
a
stakeholder
group
of
about
22
or
24
folks,
almost
all
from
the
private
sector,
with
the
exception
of
our
department
and
tenncare,
we
had
payers,
we
had
private
dentists,
we
had
the
dental
schools
all
come
together
and
and
lay
out
this
multifaceted
approach
over
five
years.
I
encourage
you
to
look
at
that
report.
If
you
haven't
seen
it
called
the
healthy
smiles
initiative.
E
Number
two
on
our
list
is
a
provider
rate
increase
for
our
safety
net
providers
and
just
as
a
quick
reminder
when
we
say
safetynet,
that's
a
term
to
use
that
we
use
to
mean
providing
for
the
uninsured.
So
we
administer
the
safety
net
fund
and
this
would
be
a
provider
rate
increase
in
the
amount
of
just
shy
of
2.2
million
dollars.
E
The
number
three
line
item
is
for
four
new
ftes
for
environmental
health
specialists.
These
are
essentially
restaurant
inspectors,
so
we
have
had
significant,
but
when
you
have
more
restaurants,
you
need
more
restaurant
inspectors
and
we've
sort
of
maxed
out
the
ones
that
we
have.
They
each
are
carrying
a
caseload
of
between
a
thousand
and
twelve
hundred
restaurants,
each,
whereas
they
need
to
be
around
the
800
mark.
So
this
would
be
adding
four
new
positions
in
order
to
account
for
that
increase
in
volume.
E
Similarly,
we
are
requesting
two
fte
positions
for
administrative
positions
in
our
board
of
nursing.
These
are
positions
that
are
actually
filled
right
now,
but
they're
filled
with
contract
employees
and
we're
having
to
use
them
so
much
that
the
finances
have
gone
upside
down
and
it
would
be
more
advantageous
to
put
those
on
the
payroll
numbers.
E
Our
licensees
and
their
processes.
Number
seven
is
one
that
is
extraordinarily
impactful
and
important,
and
that's
our
suicide
prevention
director
position.
That
position
is
currently
filled,
but
the
short-term
funding
does
expire
this
year.
So
we
certainly
want
to
continue
that
and
are
requesting
sustainable
funding.
For
that
position.
E
If
you
aren't
familiar
with
that
term,
those
are
the
folks
who
do
the
genomic
sequencing
of
variants,
I'm
pretty
sure,
you're
familiar
with
what
a
variant
is
and
just
for
the
record.
There
are
variants
in
things
way
more
than
just
covet
and
in
all
seriousness,
as
our
technology
evolves,
and
we
have
the
ability
to
do
sequencing
and
more
specific
identification
of
these
viral
variants
or
or
genomic
variants.
This
is
something
we
can
do
to
that.
Our
industry
can
do
to
target
therapy
so
very
important
position.
There,
both
number
eight
and
number
nine.
E
Number
10
is
our
largest
line
item
this
year,
which
is
15
million
dollars
for
an
upgrade
to
our
lars
system,
which
is
the
licensing
system.
This
does
come
out
of
the
dedicated
board
reserve
fund,
so
it's
not
state
dollars
and
just
as
a
reminder,
our
board
fund
is
populated
by
the
fees
from
all
of
the
different
boards
and
it
is
prorated
based
on
how
many
licensees
are
in
each
one
of
those
boards,
so
our
licensing
system
is
online.
I
believe
this
was
the
the
current
product
was
when
we
went
from
paper
to
electronic.
E
For
those
of
you
who
are
in
the
medical
field.
You
kind
of
know
how
difficult
that
transition
is
to
begin
with,
but
now
this
is
taking
our
current
electronic
system
and
making
it
much
more
user-friendly
with
the
mobile
app
and
one
that
can
be
supported.
The
customer
support
and
tech
support
of
our
current
system
is
already
on
the
wind
down,
and
so
we
are
going
to
be
putting
this
out,
obviously
competitively
for
a
new
system
using
dedicated
board
reserves.
E
We
do
a
tremendous
amount
of
data
collection
and
analysis
across
the
department,
even
though
the
oia
office
primarily
puts
out
a
lot
of
our
substance,
use
and
overdose
data,
which
is
exceedingly
important,
and
they
need
some
additional
software
capabilities
to
do
that.
Data
analysis
number
12
is
one
that
is
in
addition
to
last
year.
So
this
works
up
our
routine
equipment
replacement
cycle
in
our
lab.
It
takes
it
from
500.
000
a
year
adds
this
500
000
to
make
it
a
million
for
routine
replacement
of
our
lab
equipment.
E
If
you've
never
been
to
our
state
public
health
lab,
I
would
love
to
give
you
a
personal
tour.
It
is
a
super
interesting
impressive
place.
I
had
the
privilege
of
taking
chairman
watson
out
there
a
couple
of
mondays
ago
and-
and
I
think
he
was
also
pleasantly
surprised
at
the
very
vast
amount
of
work
that
they
do
out
there.
They
were
pretty
hard
on
that
equipment
because
they
use
it
a
whole
lot
and
so
in
our
10-year
replacement
cycle
of
equipment.
E
This
will
take
us
from
500
000
to
a
million
dollars,
which
is
where
they
think
they
need
to
be
for
routine
equipment
replacement
and
then
the
last
one
is
a
payroll
realignment
in
oia
that
data
analysis
office
that
I
referenced
a
minute
ago.
This
is
a
realignment
from
federal
sources
to
state
sources.
We
have
federal
funding
now,
but
many
of
the
federal
grants
that
we
use
to
pay
for
payroll
are
restrictive
in
what
those
personnel
can
do
under
that
grant
funding.
E
So
we're
going
to
retain
that
grant
funding
but
use
it
for
a
different
purpose
other
than
payroll
to
free
up
the
restrictions
on
those
on
those
employees
and
requesting
state
funding
to
backfill
that
payroll
expense.
So
again,
the
total
is
30.8
million,
with
16
right
just
over
16
million
of
that
coming
from
dedicated
state
funds.
E
When
we
were
in
house
finance
a
week
or
so
ago,
and
they
asked
us
to
present
the
big
buckets
of
non-recurring
funding
that
we're
going
that's
going
to
expire
this
year,
so
on
the
state
side,
we
did
get
an
an
additional
three
million
dollars
in
safety
net
funding.
That's
going
to
expire
this
year
and,
as
I
told
them,
we
are
exceedingly
grateful
for
any
amount
of
money
put
in
the
safety
net,
because
this
is
how
we
care
for
our
uninsured
and
most
vulnerable
population.
E
But
I
will
admit
that,
while
we're
glad
to
have
money
in
that
fund
in
any
shape,
form
or
fashion,
it's
pretty
difficult
to
have
it
in
a
non-recurring
way,
because
that
forces
us
to
do
one
of
a
couple
of
different
things,
neither
of
which
are
palatable.
One
of
them
is.
We
can
bump
up
rates
for
the
providers
that
are
in
the
safety
net
for
a
temporary
time,
and
then
they
adjust
their
business
cycle
based
on
that
additional
rate
increase.
E
And
then,
when
that
non-recurring
funding
goes
away,
they
have
to
go
back
to
the
lower
rates,
that's
difficult
for
somebody
in
operations.
Likewise,
the
other
alternative.
We
can
do
for
one-time
non-recurring
funding
is
we
can
bring
new
safety
net
providers
onto
the
rolls
if
you
will
to
expand
access?
That's
great
more
providers,
but
when
that
non-recurring
funding
goes
away,
those
providers
are
there
without
funding
or
they
potentially
have
to
stop
seeing
those
patients.
Because
of
that
so
safetynet
funding
is
a
double-edged
sword.
We
really
can.
E
It
goes
a
long
way
and
we're
good
stewards
of
it
and
we
appreciate
any
dollar
we
can
get,
but
we
we
do
much
more
appreciate.
Non-Recur.
Excuse
me
recurring
funding
because
of
what
I've
just
described,
the
other
non-recurring
state
level
funding
that's
going
to
be
expiring.
This
year
is
2.4
million
dollars
in
direct
appropriations.
E
Many
of
those
were,
interestingly
dental
initiatives
where
we
had
several
one-offs
on
oral
health
things
and-
and
we
just
didn't-
wake
up
one
day
this
year
and
decided
to
start
working
on
on
dental
initiatives.
We've
been
trying
to
do
this
over
several
years
because
we
recognized
the
need,
but
it
has
been
in
somewhat
of
a
piecemeal
fashion,
which
is
why
I
so
much
appreciated
the
governor
asking
back
in
the
spring
of
last
year
to
convene
all
of
the
stakeholders
to
get
this
comprehensive
approach.
E
Fortunately,
this
is
able
to
be
carried
forward,
some
of
it
even
as
far
as
25
and
26,
if
needed,
and
so
we're
not
particularly
concerned
about
that.
It
takes
quite
some
time
to
process
and
spend
that
amount
of
money,
but
we're
well
on
our
way
there
and
then
the
other
one
is
just
a
very
small
bucket
of
interdepartmental
grants,
the
biggest
of
which
was
a
criminal
justice
program.
E
House
finance
also
asked
us
to
kind
of
cover
a
few
of
the
big
buckets
that
we
have.
We
have
done
with
our
coveted
relief
money,
the
federal
funding
and-
and
certainly
this
is
not
an
exhaustive
list,
but
probably
the
three
biggest
buckets
you
may
have
heard
of-
but
I
wanted
to
highlight
here
so
one
of
them
is
what
we
used
to
call
hospital
staffing
assistance.
Grant.
E
So
I'm
I
won't
go
into
a
long
monologue
about
why
staffing
has
become
so
expensive
and
difficult
health
care.
Some
of
the
reasons
are
the
same
reasons
that
all
industries
are
having
workforce
issues
right
now,
but
one
of
the
things
that's
particularly
particularly
unique
and
difficult
in
healthcare,
as
you've
probably
heard
of
of
the
contract
agency.
So
you
know
staffing
problems
in
healthcare
settings
didn't
start
two
years
ago.
They
started
a
long
time
ago,
particularly
the
nursing
shortage,
but
certainly
exacerbated
by
the
pandemic.
Well,
what
did
we
do
with
nursing
shortages
before
the
pandemic?
E
E
Whereas
when
I
was
running
hospitals,
we
might
pay
60
or
70
an
hour
for
a
nurse
which
was
more
than
the
typical
rate
of
35
or
40
for
an
employed
nurse.
So
there's
a
premium
on
that,
but
at
the
height
of
the
pandemic,
at
the
height
of
that
competition,
those
fees
could
be
upwards
of
200
and
250
dollars
an
hour
for
nurses.
E
It
doesn't
take
a
healthcare
finance
expert
to
understand
how
unsustainable
that
is,
for
hospitals.
They
are
faced
with
having
to
find
staff,
but
yet,
at
this
super
expensive
rate,
and
so
our
our
hospital
and
now
healthcare
staffing
assistance
program
helps
to
offset
that
and
you'll
see
the
amount
here
of
120
million,
that's
out
of
the
arp
funds.
E
So
local
health
departments,
generally
speaking,
are
owned
by
the
counties,
and
many
of
them
are
quite
old
and
quite
in
disrepair.
But
if
public
health
does
anything
well,
it
is
due
a
lot
with
a
little,
and
so
I
hardly
ever
hear
complaints.
They
are
they're,
fine,
where
they're
working,
but
not
only
our
employees,
and
certainly
our
constituents
deserve
better.
They
deserve
a
good
place
to
go
and
in
some
instances,
a
safe
place
to
go,
because
some
of
them
are
quite
old.
E
So
this
about
129
million
dollars
allows
for
a
minimum
of
450
000
for
renovation.
At
all
89
rural
health
departments,
so
if
you
haven't
heard
from
your
local
mayors
about
this,
you
probably
will
I've
heard
from
many
of
them.
They
are
super
grateful
for
that,
because
particularly
some
of
these
smaller
counties
do
not
have
those
types
of
funds.
This
does
leverage
a
small
match
with
the
county,
arp
funds
and
sort
of
us
both
having
skin
in
the
game
to
invest
in
those
health
departments.
E
The
final
one
is
another
replacement
of
our
state
public
health
lab
the
one
that
I
was
bragging
about
a
few
minutes
ago.
It
is
a
great
service
and
has
a
lot
of
fabulous
programs,
but
it
is
in
a
1950
tuberculosis
hospital.
It
is
not
the
most
efficient
design
for
a
highly
technological
or
technologically
advanced
lab
and
sort
of
outgrown
the
space.
The
space
is
is
older
and
in
disrepair,
and
so
this
would
be
using
the
one-time
federal
funds
to
replace
that
capital.
E
And
then,
before
I
leave
you,
I
want
to
make
sure
you
know
that
we
do
more
than
covet
at
the
department
of
health.
Sometimes
it
feels
like
that's
all
we
do,
but
we
are
super
excited
about
getting
back
to
non-coded
work,
it's
important
work
and
we're
going
to
continue
doing
it,
but
we've
got
much
bigger
and
broader
priorities,
just
something
to
maybe
reference.
E
Some
comments
I
made
earlier
actually
in
our
department
in
our
mission
of
the
department
is
not
only
what
you
would
expect
to
protect
and
promote
and
improve
the
health
of
people
in
tennessee,
but
also
their
prosperity,
because
we
know
that
if
they
are
not
healthy
in
every
sense
of
the
word,
physically
healthy,
emotionally
mentally
healthy
that
they
are
not
going
to
reach
their
full
economic
prosperity
potential.
And
so
we
wanted
goals
of
prevention
and
access
is
something
that
is
just
the
bread
and
butter
of
public
health
anywhere.
E
And
it's
the
things
that
you
think
of
when
you
think
of
public
health.
But
specifically,
we
have
detailed
out
in
our
four-year
strategic
plan
about
the
different
metrics
that
we
want
to
try
to
improve.
One
of
those
is
local
health
metrics,
using
a
locally
driven
process
through
county
health
councils
and
county
health
assessments.
E
We
recognize
as
I
that
what
works
in
sullivan
county
is
not
necessarily
what
works
in
lawrence
county
and
all
different
types
of
scenarios
across
the
state.
We
have
a
very
diverse
state
and
diverse
healthcare
needs
so
using
the
local
level
and
the
local
folks
to
do
those
health
assessments
and
help
them
target
interventions.
E
One
of
the
primary
causes
of
morbidity
and
mortality
in
our
state
is
obesity,
and
we
know
that
children
who
are
obese
are
much
higher
risk
to
be
adults
who
are
obese
and
so
targeting
that
youth
obesity
in
children,
one
of
the
most
evidence-based
ways
to
do
that
is
through
wic
participation
and
wic,
is
the
women,
infants
and
children.
The
food
program
for
pregnant
mothers
and
young
children,
and
driving
that
participation
and
maximization
of
that
program,
as
well
as
through
our
office
of
primary
prevention
and
the
built
environment.
E
So
access
to
greenways
and
playgrounds
and
spaces
where
particularly
children.
But
all
individuals
can
move
and
get
physical
activity
and
I'm
sure
it
comes
as
no
surprise
that
one
of
our
primary
goals
is
to
decrease
tobacco
use.
That
is
not
only
initiation
in
young
people,
particularly
as
it
pertains
to
electronic
products,
but
also
cessation
services
for
adults.
One
of
the
programs
that
you
effective
is
the
baby
and
me
tobacco-free
program,
which
allows
for
diaper
vouchers
for
pregnant
moms
who
stop
smoking
or
their
and
or
their
partners
in
the
home.
E
So
if
you've
ever
bought,
diapers
lately
they're
quite
expensive
and
they
are
not
covered
through
any
of
the
other
governmental
programs,
and
so
this
not
only
improves
health
outcomes
for
mom
and
baby
and
partner
in
the
home,
but
also
incentivizes
that
through
diaper
vouchers,
another
one
of
our
prevention
objectives
is
to
decrease
substance
misuse.
A
very
important
component
of
that
is
the
data
analysis
and
the
overdose
surveillance
that
I
mentioned
earlier.
Unfortunately,
our
overdose
trends
have
gone
in
the
exact
wrong
direction
during
the
pandemic.
I'm
sure
you
can
understand
why
that
is.
E
So
childhood
trauma
trying
to
prevent
that
and
in
situations
where
it
already
exists,
trying
to
mitigate
the
effects
of
that
through
things
like
evidence-based
home,
visiting
care
coordination
and
supporting
young
families,
and
then
finally,
is
our
second
piece
of
our
strategic
goals,
which
is
access
and
I'll,
remind
you
that
we're
in
a
bit
of
an
unusual
situation,
actually
a
very
unusual
situation
in
this
state.
In
so
much
as
the
state
department
of
health
serves
as
the
primary
care
provider
for
a
large
portion
of
the
uninsured
in
tennessee.
E
So
different
patient
throughput,
different
patient
needs,
and
so
it
forces
us
sometimes
to
pick
well.
Are
we
a
public
health
clinic,
that's
doing
primary
care?
Are
we
a
primary
care
clinic?
That's
doing
some
public
health.
We
tend
to
lean
towards
the
former,
but
knowing
that
we
have
to
balance
both
of
those-
that's
been
frankly
a
challenge
in
choosing
an
electronic
health
record,
because
nobody
else
is
doing
both
of
these
things.
E
So
it's
hard
to
kind
of
get
that
it's
also
hard
to
get
your
throughput
processes
efficient,
because
you're
dealing
with
two
simultaneous
processes
happening
concurrently
in
one
location.
So
one
of
our
big
access
initiatives
is
to
improve
our
clinical
efficiency,
that's
basically
being
able
to
serve
more
patients
without
additional
resources.
Just
doing
I
hate
to
use
a
cliche
doing
it
smarter,
not
you
know
doing
it
better
through
doing
it
smarter,
not
working
harder
or
adding
more
to
it,
then.
E
Likewise,
for
those
who
don't
see
care
in
our
primary
care
clinics,
we
want
to
improve
the
health
care
access
for
those
in
the
community,
using
primarily
our
safety
net
providers.
We
have
an
excellent
group
of
safety
net
providers
across
the
state
and
just
like
public
health.
They
are
very
accustomed
to
doing
a
lot
with
a
little,
and
so
we
want
to
do
what
we
can
to
help
support
that
and
support
them,
not
only
in
their
efficiency
and
their
sustainability,
but
also
in
their
outcomes.
E
So
underserved
and
uninsured
patients
absolutely
deserve
the
same
outcomes
that
commercially
insured
patients
do,
and
so
we
want
to
be
able
to
help
our
safety
net
providers.
Support
those
good
outcomes
in
this.
This
also
includes
our
provider,
recruitment
and
retention
to
rural
areas.
You've
probably
heard
of
our
tennessee
state
loan
repayment
program,
which
is
very
unfortunately
called
t
slurp,
sometimes,
and
I
try
not
to
say
it,
but
that
is
the
state
loan
repayment
program
where
we
do
incentivize
providers
to
go
to
underserved
areas.
E
D
E
F
Hey
good
afternoon,
so
approximately
162
000
adults
were
served
by
the
primary,
the
adult
primary
care
safety
net
through
what
we
call
primary
care
plus
services.
So
that's
actually
primary
care
mental
health
and
dental.
And
then
we
also
fund
some
specialist
care
coordination
and
I'm
going
to
get
that
number
for
you
as
well.
But
it
was
a
similar
number
of
individuals.
D
E
D
F
The
current
recurring
budget
for
the
adult,
uninsured
safety
net
fund
is
21.9
million.
There
was
three
million
that
was
non-recurring
in
last
well,
the
current
year
budget.
There
is
this
provider
rate
increase
which
was
designated
to
safetynet
and
we
do
have
a
pediatric
different
safety
net.
So
there's
there's
some
determination
that
needs
to
be
made
there,
but
the
non-recurring
piece
is
three
million
for
this
fiscal
year
that
we
don't
have
for
next
fiscal
year.
F
E
C
D
E
They
are
currently
they.
They
are
not
charging
the
patient.
Anything
right
now
and
dr
mcdonald
can
correct
me
if
I'm
misremembering
these
numbers
most
primary
care
visits,
get
reimbursed
about
23
a
visit.
I
bet
you
can
imagine
that
that
doesn't
cover
cost,
and
so
this
would
increase
that
it's
still
not
going
to
cover
costs
for
them
and
under
no
circumstance
will
they
have
a
margin
on
that,
but
it
will
help
offset
some
of
the
cost
a
little
bit
better.
F
B
Yeah
representative
clements,
this
is,
I
think
this
is
part
of
the
administration's
effort
to
do
pooled
provided
rate
increases.
I
think
you'll
see
one
from
dcs
for
for
didd
for
some
of
the
other
third
party
providers
that
that
I
guess
help
the
agencies
fulfill
their
roles
to
the
people
of
tennessee.
D
D
This
is
a
population
that
has
to
be
served
one
way
or
another
and
we're
choosing
to
do
it
through
a
safety
net
more
money
every
year,
rather
than
taking
other
alternative
funds
out
there
that
tennessee
taxpayers
have
already
paid.
So
I
really
want
us
to
consider
that
and
think
through
that,
as
we
appropriate
funds
and
continue
this
same
model
year
after
year.
Thank
you,
mr
chairman.
B
And-
and
thank
you
thank
you,
mr
chairman,
and
I
want
to
say
how
much
I
appreciate
dr
piercy
and
her
leadership
over
the
last
period
of
time.
None
of
us
knew
two
years
ago
when
we
showed
up
for
work.
What
we
were
going
to
face.
You've
done
a
great
job
and
we
appreciate
it
and-
and
I
do
appreciate
so
much
your
emphasis
on
adult
dental
care.
B
Since
I
came
up
here
in
2009,
we've
been
trying
different
methods
of
rural
health
departments
and
different
things
to
assure
the
care,
because
it's
such
a
burden
on
an
emergency
medical
service
and
a
financial
burden
to
tenncare.
So
I
appreciate
that
and
I
believe
any
help
I
can
as
you
folks
move
forward.
Thank
you.
Thank.
B
Thank
you,
mr
chairman.
I
too
would
like
to
thank
you,
dr
piercy,
for
and
your
staff
for
the
good
work
that
you've
given
us
here
in
the
state
of
tennessee.
I
have
two
or
three
questions.
One.
You
spoke
earlier
about
young
persons.
I
say
coming
out
of
dental
school
with
a
debt
load
of
380
k,
a
thousand
dollars,
and
you
spoke
of
incentives.
I
I
may
have
missed
it,
but
we
talked
about.
I
heard
incentives
for
new
and
existing
providers.
E
Sure
I'm
glad
you
asked,
because
I'm
remiss
for
not
mentioning
that
earlier,
that's
primarily
through
the
mechanism
of
loan
repayment,
and
so
that
would
be
not
only
new
grads
coming
out.
They
have
all
the
loans
right
there,
but
many
of
us
have
been
out
for
20
years
and
are
still
paying
our
loans,
our
student
loans,
and
so
you
know
when
you
have
that
big
of
a
bill
coming
out
of
professional
school.
It
takes
quite
some
time,
so
it's
perfectly
plausible
for
someone
who's
even
been
in
practice
for
a
long
time
to
sort
of
done.
E
Their
thing
they've
served
their
community,
they
like
where
they
are,
but
they're
ready
to
do
something,
a
little
more
service
oriented
and
then
they
can
be
incentivized
through
loan
repayment
there's
also
a
little
bit
of
like
sign-on
bonuses
and
other
types
of
short-term
bonus
type
incentives.
But
probably
the
primary
mechanism
is
loan
repayment.
All.
B
E
Great
question,
so
that
is
a
replacement
of
our
current
lab.
I
believe
they
have
done
the
assessment
and
it
will
be
replaced
on
that
same
similar
campus,
maybe
not
in
the
exact
location,
but
on
that
campus
and
all
of
the
equipment
and
viable
furnishings
from
there
will
be
moved
over.
So
it
does
not
we're
not
going
to
need
all
new
equipment,
as
we
do
that
routine
equipment
replacement
that
I
talked
about,
we'll
just
move
that
right
into
the
new
building.
Okay,.
B
Thank
you,
dr
percy,
and
thank
you
all
for
all
being
here.
You
mentioned
that
we
would
do
some
prevention
efforts
in
youth
obesity,
that's
very
near
and
dear
to
my
heart,
because
I
own
a
funeral
home
the
children
that
we
buried
were
all
obese,
and
I
just
think
I'm
just
curious
to
know
how
you
all
plan
on
doing
that.
E
Children
eating
the
right
way:
yes
ma'am,
if
it
if
it
sounds
like
a
tall
task
it
because
it
really
is,
and
if
there
were
a
quick
fix
or
a
silver
bullet,
somebody
would
have
done
it
right
now,
but
it's
a
whole
and
it's
not
just
targeting
the
child.
It's
the
whole
family
and
it's
the
it's
food
deserts
and
which
food
comes
into
the
home
and
which
food
the
children
are
exposed
to
and
the
amount
of
physical
activity
they
get.
But
there
are,
there
are
some
evidence-based
programs.
E
So
I
always
dr
mcdonald
to
tell
you
a
little
bit
about
that
because,
to
be
quite
honest,
even
as
a
pediatrician
really
didn't
resonate
with
me
until
I
came
on
this
side
of
healthcare
into
public
health
to
to
to
recognize
the
importance
of
wic,
but
when
you
think
about
it,
when
mom
and
young
children
at
home
start
to
have
those
good
healthy
eating
habits,
that
does
tend
to
continue
throughout
life.
So
I'll.
Let
dr
mcdonald
taste
some
more.
F
Happy
too,
and
can't
reiterate
enough
the
complexity
of
that
problem,
because
and
when
we
think
about
pediatric
obesity,
we
do
think
about
it
holistically
and
certainly
mom's
prenatal
nutrition,
the
food
that
she's
able
to
buy
the
food.
That's
in
her
neighborhood,
her
ability
to
walk
or
exercise
safely
and
that
continuing
through
early
childhood
policies,
and
certainly
we
have
a
collaboration
with
dhs
around
the
gold
sneaker
program
and
really
promoting
and
incentivizing
those
healthy
policies,
even
in
early
daycare
and
and
teaching
parents
through
that
venue.
B
B
B
A
E
E
Now
now
that
does
turn
in
I
mean
that
that
does
look
turn
back
the
clock.
There
were
some
difficulties
initially,
which
feeds
into
some
of
the
overdose
issues
that
we
had
I'll
talk
about
in
just
a
second
right
now,
I'm
unfamiliar
commissioner
williams.
Marie
williams
might
have
better
information
on
that,
but
none
of
that
has
trickled
my
way,
I
think
we're
pretty
good
as
far
as
accessing
mat
right
now,
even
from
telehealth
and
other
mechanisms.
E
So
in
all
seriousness,
the
quick
overview
of
what
substance
use
has
done
over
the
last
really
not
that
long.
Five,
eight
ten
years
at
most,
you
had
the
prescription
opioid
epidemic.
Everybody
was
pretty
familiar
with
that
and
and
this
committee,
in
fact,
I
think
I
testified
back
at
the
beginning
of
session
about
some
of
the
tn
together
legislation
and
how
that
prescribing
has
gone
down.
It's
become
much
shorter.
E
In
duration,
which
really
helps
cut
down
on
the
risk
of
dependence
on
particularly
opioid
naive
patients,
I
wish
well,
I
was
going
to
say
I
wish
that
were
still
the
problem.
I
wish
it
were
never
a
problem,
but
in
some
respects
that's
easier
to
deal
with
than
what
we're
dealing
with
now,
which
is
fentanyl
and
fentanyl,
is
an
opioid.
It's
a
synthetic
opioid
that
that
can't
it
does
have
legitimate
pharmacologic
use
pharmaceutical
use,
but
what
it
has
done
it.
It
has
replaced.
E
Prescription
opioids
as
as
the
drug
of
abuse-
and
I
feel
like
this
has
been
an
economic
seminar,
because
it's
all
about
price
and
it's
all
about
demand.
So
the
demand
was
pretty
high
and
then,
when
they
couldn't
get
prescription
opioids.
Well,
the
demand
didn't
change,
so
the
demand's
still
there
and
the
searching
for
a
different
thing.
In
times
past
it
might
have
been
heroin,
they
could
have
gone
back
to
heroin.
But
what
came
on
the
market?
E
So
that's
what
you've
got
when
it
comes
to
fentanyl,
so
your
overdose
potential
is
extraordinarily
high
to
begin
with
and
then
when
the
pandemic
started
kind
of
this
combination
of
things
that
happened
so
you've
already
mentioned.
There
was
a
temporary
drop
in
the
ability
to
access
mat,
and
so
people
in
active
addiction
have
to
get
that
somewhere
and
if
they're
not
being
treated
with
their
mit,
then
they
could
go
back
to
the
street.
E
Well,
then,
because
of
all
of
the
lockdowns
and
the
different
travel
methods,
if
you
will
the
supply
chain
for
those
products
was
interrupted.
So
what
the
person
was
used
to
buying
off
the
street
no
longer
they
were
able
to
get,
and
so
they
had
to
get
something
else.
And
then
you
combined
the
stress
of
the
pandemic
and
the
increased
demand.
E
Because
of
that
stress,
you
saw
our
overdoses
skyrocket
in
the
first
few
months
of
the
pandemic,
and
they
have
come
down
some,
but
they
have
continued
to
remain
very
high,
likewise
with
methamphetamine,
even
not
that
long
ago,
five
to
ten
years
ago,
the
primary
mechanism
of
methamphetamine
were
these
home-based
labs.
You've
heard
of
the
shaken
baked
method.
All
of
that
again
we're
dealing
with
supply
and
demand.
E
Methamphetamine
is
another
one
that
has
some
significant
overdose
potential
and
is
oftentimes
combined
with
opioids
and
particularly
fentanyl,
which
becomes
a
particularly
dangerous
situation.
If
memory
serves
me
correctly,
over
70
percent
of
our
overdose
deaths
have
more
than
one
substance
on
board
I'll.
Stop
there.
Mr
chairman,
I'm
sorry,
but
it's
a
it's
an
issue
that
is
certainly
one
that
we
need
to
get
back
to
full
force.
A
B
E
E
If
you
can
get
at
least
three
years,
there's
a
good
bit
of
data
about
how
much
more
likely
they
are
to
stay
permanently
so
that
it
if
we
can
incentivize
folks
to
go
to
those
under
areas
and
in
the
span
of
three
to
four
years,
which
is
the
commitment
to
pay
that
off
they've
established
friendships
and
churches
and
neighbors
and
schools
they're
much
more
likely
to
stay
in
those
communities.
Some
of
them
do
leave
after
three
years,
but
trying
to
use
an
evidence-based
approach
to
get
people
to
go
to
that
area.
A
Thank
you.
Thank
you
all
right.
Thank
you.
All
right
sing,
no
further
questions.
I
want
to
thank
you
guys
for
coming
and
giving
us
your
presentation,
always
a
pleasure
to
have
you
before
the
the
committee
and
I'd
like
to
commit
to
know
that
you
know
in
your
discussions
about
access
and
rural
provider
recruitment.
It's
not
just
here.
I've
had
you
guys
in
my
office,
I'm
trying
to
think
outside
the
box.