►
Description
House Insurance Subcommittee - February 23, 2021 - House Hearing Room 2
A
I'm
here
we've
got
a
couple
of
folks
who
are
presenting
bills
and
other
committees
right
now,
so
we
will
have
greater
attendance
when,
as
as
the
meeting
evolves
very
pleased
to
have
before
us
today,
an
opportunity
to
hear
from
our
friends
in
TennCare
lots
of
information
coming
and
going
and
and
really
I've
asked
that
TennCare
come,
give
us
a
presentation
today
as
to
where
they
started,
where
we
are
and
where
we
envision
10
care
going
in
the
future
and
would
like
to
welcome
to
the
to
the
to
the
hot
seat.
A
Director
Stephen
Smith
feel
free
to
bring
whomever
you'd
like
with
you
as
we
get
started.
As
as
we
get
the
PowerPoint
presentation
loaded
as
I
look
around
my
committee
members.
Does
anyone
have
any
personal
orders?
Any
any
issues
need
to
take
off
your
heart
before
before
we
begin.
A
See
some
Smiles,
but
no
issues
before
so
director
Smith.
Thank
you
very
much.
We
are
glad
to
have
you
with
us
folks
who
are
watching.
We
have
this
PowerPoint
presentation
before
us
that
you'll
be
able
to
see
as
well
our
legislative
members.
It
will
be
on
your
dashboard,
as
well
as
on
the
screens
to
our
left
and
our
right
director
Smith
feel
free
to
introduce
anyone.
You
have
with
you
and
the
floor
is
yours.
Thank.
B
You
very
much
Mr
chairman
and
members,
it's
great
to
be
with
you
all
again
this
this
afternoon.
My
name
is
Steven
Smith
I
serve
as
the
Director
of
TennCare
and
with
me
today
to
my
left
is
Dr
Victor
Wu.
He
is
our
chief
medical
officer.
I
also
have
with
me
our
Chief
Operating,
Officer,
William
Aaron
and
then
our
chief
of
long-term
services
and
supports
Patty
Killingsworth,
and
so
we
may
play
some
musical
chairs
here
this
afternoon.
B
We
are
excited
we're
optimistic
about
that
future,
but
we
know
that
we
have
challenges
that
are
in
front
of
us
and
in
order
to
meet
those
challenges,
we
really
need
to
learn
from
our
from
our
past,
and
so
we'll
talk
a
little
bit
about
about
some
of
that
today.
B
Our
mission
remains
firm
and
that
is
to
improve
lives
through
high
quality,
cost-effective
care
and
I
hope
that
you
will
see
that
theme
as
we
go
through
these
slides
today
quickly.
I
want
to
do
just
a
level
set
and
just
kind
of
outline
the
fundamentals
of
our
program,
and
this
will
be
very
familiar
to
some
of
you,
but
maybe
for
others.
It
will
kind
of
be
a
refresher.
B
B
Our
current
population
is
about
1.5
million
people
that
is
higher
than
our
typical
enrollment
and
that's
due
to
the
pandemic,
and
we'll
talk
more
in
more
detail
about
that
in
some
of
the
later
slides.
As
you
can
see,
we
serve
about
20
percent
of
the
state's
population.
We
cover
half
of
all
the
births
in
Tennessee
and
we
cover
half
of
all
the
children
in
Tennessee.
So
it's
it's
a
substantial
program.
We
have
a
substantial
responsibility.
B
One
thing
that
sometimes
people
are
surprised
to
learn
is
that
we
cover
populations
Beyond
those
that
are
federally
mandated.
So,
for
example,
in
the
caretaker
relative
category,
we
cover
up
to
around
100
percent
of
poverty.
So
you
compare
that
to
Alabama,
which
is
at
18
percent.
Texas
is
at
15
percent.
Florida
is
at
28
percent.
B
In
addition,
through
our
waiver,
our
1115
waiver,
with
the
federal
government,
we
cover
additional
populations,
such
as
the
Katie
Beckett
Part
B
population,
we'll
talk
more
about
Katie
Beckett
later
in
the
program,
and
we
also
cover
What's
called
the
medically
needy
pregnant
women
and
children
categories.
So
these
are
individuals
who
would
otherwise
be
ineligible
because
of
their
income
status.
B
That's
one
of
the
reasons
why
it
was
so
important
for
us
to
maintain
this
11
15
waiver
that
we
have
with
CMS
and
and
why
securing
that
10-year
agreement
that
we
secured
last
month
with
CMS
is
really
so
important
because
it
provides
stability
for
our
program.
Stability
for
that
waiver
that
we
otherwise
wouldn't
have
in
in
sort
of
this
unstable,
Federal,
environment
Tennessee
is
a
Managed
Care
State.
We
are
a
national
leader
in
Managed
Care.
B
What
that
means
is
we
contract
with
health
plans
to
coordinate
care,
to
manage
our
services
and
to
enter
into
negotiations
and
contracts
with
our
providers
to
ensure
that
we
have
an
adequate
network
of
providers?
Today
we
contract
with
three
Managed
Care
organizations
they
operate
Statewide
later
this
year
we
will
be
procuring
new
contracts
with
our
mcos
that
is,
has
been
delayed
a
year.
We
were
actually
supposed
to
do
that
last
year,
but
that
was
delayed
so
that
we
could
focus,
and
so
our
mcos
could
focus
on
the
pandemic.
B
While
Tennessee
was
an
early
adopter
of
managed
care
and
we
were
an
innovator,
it's
really
not
new
anymore.
70
of
all
of
the
individuals
that
are
served
by
Medicaid
are
served
by
managed
care
so
that
seventy
percent
of
all
the
Medicaid
population
in
the
nation-
and
that
is
because
Managed
Care,
has
really
proven
to
be
a
a
driver
in
ensuring
that
we
provide
the
Right
Care
at
the
right
time
in
the
right
settings
and
that
improves
both
quality
and
and
also
efficiency.
B
The
last
thing
I'll
point
to
on
this
slide
is
that,
of
course,
Medicaid
is
a
it's
a
federal
program,
and
so
we
partner
with
the
federal
government
to
ensure
care,
and
so
it's
a
shared
financial
responsibility
and
in
Tennessee
we
receive
about
65
percent
of
that
of
that
payment.
That
share
is
the
federal
government
share.
We
cover
the
other
35
percent
during
the
pandemic,
and
during
this
emergency
we
are
getting
an
enhanced
Federal
match,
and
so
that
equates
to
about
6.2
percent
on
top
of
the
65
percent
Medicaid,
no,
no
secret.
B
Here
it
takes
up
a
large
portion
of
State
budgets,
and
our
budget,
of
course,
is
a
reflection
of
that.
But
but
I
would
contend
and
I'll
show
you
all
slide
in
a
bit
that
we
actually
lead
the
nation
in
terms
of
our
ability
to
limit
our
cost
growth
in
a
manner
that
is
responsible
and
reasonable,
but
that's
not
a
given
and
it
really
is
dependent
upon
our
actions
going
forward.
B
Tenncare
has
a
long
but
an
imperfect
history
today,
we're
known
as
having
one
of
the
best
managed
Medicaid
programs
in
the
country,
but
that
that
was
not
always
the
case.
In
my
role
now
since
I've
became
director
in
in
March
I've
of
last
year,
I've
really
tried
to
spend
a
lot
of
time
learning
about
the
history
of
TennCare
and
doing
that
so
that
we
can
work
to
not
make
some
of
the
same
mistakes
and
also
learn
from
the
successes
that
we
have
achieved
over
the
last
couple
decades.
B
It
wasn't
that
long
ago,
really,
if
you
think
about
it,
that
we
were
experiencing
double-digit
growth
Trends
in
TennCare,
we
had
these
double-digit
growth
Trends.
We
had
a
very
ins
stable.
There's
a
lot
of
instability
with
our
health
plans.
We
had
a
lack
of
proper
utilization
management
and
it
threatened
the
very
existence
of
TennCare.
In
fact,
projections
showed
that
the
10-care
budget
was
going
to
eat
every
almost
every
available
new
Revenue
Dollar
by
the
year,
2008.
B
I
think
the
exact
figure
was
91
percent
of
every
new
Revenue
dollar
that
was
available
to
the
state
was
going
to
be
subsumed
by
10
care.
To
put
that
in
perspective,
if
we
continued
on
that
track
and
continued
to
experience
double-digit
growth
Trends
year
over
year
today,
our
budget
would
be
nearly
40
billion
dollars.
B
B
It
does
seem
it
seems
like
it's
made
up,
but
but
if
you
ask
the
eight
members
of
the
House
that
are
here
today
that
were
here
at
the
time,
including
chairman
Hawk
I,
think
that
he
would
confirm
that
that's
how
dire
the
situation
was
so
clearly
that
was
not
sustainable
and
so
the
executive
branch
and
the
legislative
branches
they
partnered
together
to
make
real
reforms
in
2004
and
while
the
reductions
in
the
in
the
members
that
we
served
that
kind
of
garnered
the
most
attention
that
actually
wasn't
the
main
driver
for
the
Cost
Containment.
B
So
what
that
shows
us
is
that
there
were
actually
other
reforms
that
were
made
and
more
important
reforms
that
were
made
at
that
time
and
after
among
those
things
and
perhaps
most
important,
were
effective
utilization
management
through
appropriate
medical
necessity
determinations.
We
had
stable
health
plans
that
were
operating
on
a
Statewide
basis
and
what
that
did
is
it
provided?
B
Consistency
and
stability
in
TennCare,
and
that
is
really
what
is
required
for
Success
from
a
TennCare
management
perspective,
but
also
from
a
provider
perspective
and
from
a
member
perspective,
and
so
yes,
there
were
certainly
Cost
Containment
measures,
but
I
think
that
there's
often
this
idea
that
controlling
cost
growth
must
translate
into
a
reduction
in
quality
or
access,
and
it's
actually
not
true
I.
Think
it's
exactly
the
opposite.
We've
proven
as
a
state
that
Cost
Containment
and
quality
improvements
go
hand
in
hand
and
are
actually
dependent
upon
each
other,
so
controlling
costs,
coordinating
care
properly.
C
Thank
you,
director,
Smith
and
as
Dr
Smith
mentioned,
we
take
it
very
seriously
that
quality
is
our
truly
our
number
one
mission
for
what
we
provide,
both
in
terms
of
improving
the
health
care
outcomes
of
our
members,
but
also
overall,
improving
the
health
of
the
members
we
serve
and
I
want
to
just
highlight
a
few
of
the
of
those
accomplishments.
You
know
it
is
a
never-ending
quest
to
improve
the
quality
for
our
members
and
the
quality
of
the
care
that
we
provide,
but
we
do
take
it
comprehensively
and
holistically.
C
We
look
at
every
single
one
of
those
populations
that
director
Smith
mentioned
from
infants
and
children
to
their
parents
who
take
care
of
them
to
pregnant
moms,
who
are
starting
a
family
to
our
elderly
populations
or
even
those
our
members
were
disabled,
and
so
in
each
of
those
categories.
We
continue
to
focus
on
ways
that
we
can
drive
improved
access
and
improve
quality
of
care
to
really
monitor
their
health
outcomes,
as
well
as
the
overall
health
that
they're
receiving
and
move
them
on
in
in
their
personal
journey
toward
toward
Better
Health.
C
A
couple
of
the
ones
I
highlight
from
the
the
kids
perspective,
we've
really
focused
the
last
several
years
on
well
child
business
immunizations,
our
patient-centered
medical
home,
which
many
of
you
have
heard
about
for
the
last
few
years
as
part
of
our
larger
delivery
system
transformation
and
through
that
work,
it's
really
provided
us
the
opportunity
to
partner
with
our
providers
in
a
high
quality
value-based
Care
perspective.
That's
really
driven
an
improvement
in
immunization
rates
for
our
kids.
C
As
an
example,
we
know
that
the
opioid
epidemic
has
really
hit
disproportionately
for
women,
who
have
substance
involved,
pregnancies
that
are
also
struggling
with
opioid
addiction,
and
we
know
that
as
a
lifelong
journey
of
recovery,
but
with
the
supports
and
services
that
we've
provided,
we've
seen
now
a
decrease
by
almost
30
percent
in
the
number
of
our
neonatal
abstinence
syndrome.
Births
in
the
last
three
years,
we're
the
only
state
in
the
country
to
rep
to
to
report
a
three-year
consecutive
decline
in
our
neonatal
abstinence
syndrome.
C
Birth
and
I
think
we're
really
proud
of
the
work
that
tinkerism,
but
really
what
the
entire
state
has
done
through
the
partnership
with
the
general
assembly
in
Tennessee,
together
legislation
with
the
with
both
Governor
Haslam
and
governors
leadership
in
this
area,
we
really
believe
that
we're
beginning
to
move
the
needle
in
that
space
as
well.
We've
also
seen
an
increase
in
the
number
of
postpartum
visits,
so
we
know
that
that
late
postpartum
period
is
a
really
important
time.
C
I
think
we're
really
incredibly
proud,
as
leading
the
the
country
in
that,
thanks
to
the
work
of
many
folks,
but
when
you'll
hear
from
Patty
Killingsworth
in
a
few
minutes,
but
we're
seeing
nearly
47
percent
of
all
of
our
of
all
of
our
TennCare
members
that
are
65
and
older
individually.
Choosing
to
to
receive
Services,
either
at
home
to
live
more
independently
or
to
find
ways
to
be
more
cost
effective
in
maintaining
their
autonomy
as
they
age
and
the
age
in
their
own
home
and
I.
C
C
We've
decreased
the
number
of
pills
that
we've
dismissed
by
almost
50
percent
since
27
17,
in
an
effort
to
we're
trying
to
better
use
the
evidence
and
make
sure
that
our
members
who
are
struggling
or
dealing
with
acute
injuries
or
acute
pain
really
get
access
to
high
quality,
evidence-based
treatment,
pain,
treatment,
regimens
as
well,
and
so
those
are
just
a
couple
of
the
areas
that
I
wanted
to
highlight
to
really
show
a
comprehensive
view.
C
We
take
it
very
seriously
again
to
look
at
every
one
of
our
populations
and
how
we
can
help
support
the
health
and
the
health
journey
of
those
members
and
we're
really
proud
to
see
continued
satisfaction.
Nearly
94
percent
satisfaction
for
the
last
decade
on
our
on
a
survey
that
the
University
of
Tennessee
Knoxville
does
for
us
and
I
will
say
that
again
in
kind
of
looking
at
the
past,
as
director
Smith
mentioned,
that
number
used
to
be
in
the
60
70
satisfaction
range.
B
So
it
just
takes
basic
math
to
understand
that
10K
plays
a
very
large
role
in
our
overall
state
budget.
If
we
are
unable
to
reasonably
contain
cost,
it
impacts
everything
else
that
we
do
as
a
state,
and
that
means
less
funding
available
for
other
state
priorities,
whether
that
be
education,
Economic,
Development,
safety,
local
government,
you
name
it.
B
So
we
take
this
responsibility
very
seriously,
and
you
will
note
on
this
slide
that
since
the
year
2000
Tennessee
has
outperformed
every
single
state
in
the
country
when
it
comes
to
limiting
the
growth
of
this
of
the
share
of
the
state
budget
supporting
Medicaid.
So
in
the
proposed
FY
22
budget,
the
10
care
percentage
of
the
overall
State
portion
of
the
budget
is
19.7
percent,
which
is
actually
a
decrease
from
last
year.
B
Now
we're
able
to
do
this,
of
course,
by
limiting
our
year
over
year,
growth,
Trend
and
that
translated
translates
into
real
dollars.
So,
for
example,
if
our
Trend
rate
has
simply
been
at
the
state
average
for
Medicaid
programs
since
2012.,
we
would
have
spent
an
additional
two
billion
dollars
to
run
our
program.
So
not,
coincidentally,
that
is
very
close
to
the
same
record
amount
that
Tennessee
has
invested
in
public
education
over
that
same
time,
so
the
cost
of
10
Caribbean
average.
Is
it's
substantial
and
it's
real?
We
don't
have
the
luxury
of
being
average.
B
We
talk
about
that
as
a
as
a
staff.
Often
if
we,
if
we
turn
our
back
or
we
rest
on
our
Laurels,
if
we
loosen
the
reins
on
what
we've
done
to
control,
these
Healthcare
cost
growths.
If
we
do
that,
our
state
is
impacted
and
when
the
state
is
impacted,
considering
TennCare
makes
up
such
a
large
portion
of
the
budget.
There's
just
no
way
around
the
fact
that
TennCare
would
be
impacted
and
we
would
face
actual
Cuts
in
the
TennCare
program
and
that's
something
that
we
want
to
avoid.
B
B
A
perfect
example
of
this
is
the
Katie
Beckett
program
and
I'm,
going
to
ask
Patty
to
come
up
for
an
update
on
this
program.
I
know
it's
a
program,
that's
very
important
to
the
general
assembly.
It's
very
important
to
you
all.
It
was
actually
a
legislative
initiative.
We
wanted
to
be
sure
to
give
you
an
update
on
where
we
are
with
Katie
Beckett
and
then
also
give
you
all
an
update
on
a
very
another,
very
important
initiative
that
we
are
working
on
relative
to
individuals
with
intellectual
and
developmental
disabilities.
A
Thank
you
very
much
and
Dr
Wu.
Forgive
me.
I
should
have
asked
you
to
introduce
yourself
into
the
microphone
and
I'll.
Ask
you
next
time.
Thank
you,
Miss
Killingsworth.
If
you
could
state
your
name
in
your
position
with
TennCare,
as
just
for
the
record
as
we
go
forward.
Thank.
D
You
Mr
chairman
members
of
the
committee,
I'm
Patty,
Killingsworth
I'm,
the
chief
of
long-term
services
and
supports,
and
it's
a
pleasure
to
speak
with
you
for
just
a
couple
of
minutes
today,
as
Stephen
pointed
out
just
a
couple
of
slides
ago.
Managing
our
program
well
really
does
allow
the
state
to
focus
on
other
important
priorities,
and
when
we
talk
about
the
Katie
Beckett
program,
those
priorities
have
names
and
faces,
and
they
have
dedicated
families
that
those
of
you
who
were
here
in
2019,
along
with
we,
who
were
here
in
2019,
will
never
forget.
D
Most
of
you
will
recall-
and
in
fact
many
of
you
really
helped
lead
and
support
the
passage
of
the
Katie
Beckett
legislation.
The
approval
of
the
27
million
dollars
in
state
funding,
77
million
dollars
total
to
establish
a
new
Standalone
Katie
Beckett
program
that
serves
children
with
complex
medical
needs
and
disabilities
who
otherwise
wouldn't
qualify
for
Medicaid
because
of
their
parents,
income
or
assets.
D
Turning
to
the
next
slide,
we'll
talk
a
little
bit
more,
as
Stephen
mentioned
about
our
continued
efforts
to
innovate
and
also
to
improve
the
efficiency
and
effectiveness
of
our
programs.
We
think
there's
another
opportunity
that
will
provide
us
to
position
us
to
be
able
to
offer
services
to
more
people
with
intellectual
and
developmental
disabilities
who
need
them
by
integrating
all
of
the
programs
and
benefits
that
serve
that
population
into
our
Managed
Care
program.
That
includes
Home
and
community-based
Services
in
the
waiver
programs
that
are
operated
by
didd.
D
The
department
of
intellectual
and
developmental
disabilities
as
well
as
ICF
IID
Services
Intermediate
Care
facilities
for
individuals
with
intellectual
disabilities
really
important
to
understand
that
the
people
who
receive
those
Services
have
been
in
Managed
Care
since
1994..
So
they
are
in
managed
care
today
for
their
physical
and
behavioral
health
services,
beginning
July
1
their
same
Health
Plan
will
begin
to
also
pay
for
their
long-term
services
and
supports
with
direct
oversight
by
didd,
as
well
as
by
TennCare.
D
We
can
leverage
those
increased
efficiencies,
then
to
be
able
to
serve
more
people,
including
people
from
the
waiting
list,
subject,
of
course,
to
the
budget
process
and
take
advantage
of
an
increased
Revenue
opportunity
via
the
HMO
premium
tax.
That
will
help
us
to
avoid
reductions
that
might
otherwise
have
been
necessary
during
difficult
budget
times.
D
Also
really
important,
especially
to
the
people
that
we
serve
and
to
their
families
is
even
though
these
benefits
will
become
part
of
Managed
Care.
On
July
1st,
we're
really
approaching
this
integration.
In
a
very
incremental
way,
with
a
focus
on
ensuring
continuity
of
the
services
that
people
receive,
making
sure
that
they
will
keep
the
same
entity
responsible
for
their
case
management,
the
same
providers
available
to
deliver
their
services.
While
we
also
provide
new
and
exciting
opportunities
for
them
to
increase
their
independence
and
really
live
their
best
lives
in
the
community.
B
So
last
month,
this
Committee
in
the
general
assembly
discussed
and
approved
our
10
care,
3
waiver,
otherwise
known
as
the
shared
savings
waiver
and-
and
this
was
a
first
of
its
kind
Medicaid
financing
model.
So
this
this
offered
an
unprecedented
opportunity
for
Tennessee
to
be
rewarded
for
its
efficiency
and
to
bring
in
additional
federal
dollars
to
our
state
that
that
we
could
then
reinvest
into
our
program
and
enhance
benefits
and
services
to
our
members
and
I
won't
spend
much
time
on
this
because
we've
we've
talked
about
it.
B
But
it
is
a
it's
a
it's
a
perfect
example
of
the
kinds
of
things
that
we
can
do
because
of
the
successes
that
we've
achieved
over
the
last
10
20
years,
and
because
of
the
reforms
that
had
been
made,
it's
dependent
upon
successful
management
and
if
we
are
average
I'll
go
back
to
that.
B
If
we
are
an
average
Medicaid
Program,
then
this
shared
savings
opportunity
and
this
waiver
is
just
not
a
possibility
and
if
we
don't
maintain
our
success,
if
we
don't
continue
to
do
the
things
that
got
us
here,
then
we
won't
have
shared
savings
and
we
will
have
missed
an
opportunity
again.
Managing
the
the
growth
of
health
care
costs
leads
to
improvements
in
quality
and
access
and
shared
savings
will
lead
to
enhanced
benefits
and
services,
and
that's
really
the
whole
point
of
10
care.
3..
B
Also
I
just
want
to
point
out
before
I
leave
this
slide
that,
despite
what
you
may
be
seeing
on
Twitter
or
other
social
media
10
care
3
is
Alive
and
Well.
It
has
not
been
rescinded.
We
are
moving
forward
and
I'll
be
happy
to
answer
any
questions
about
that.
But
there
is
no
change.
There
has
been
no
change
in
status
of
our
10
care.
3
waiver
I
want
to
Pivot
to
covid
in
our
response
to
the
pandemic.
B
It
certainly
won't
come
as
a
surprise
to
anyone
to
to
know
that
the
the
work
of
our
agency
was
really
focused
on
the
kobit
19
and
the
pandemic,
particularly
particularly
our
response
over
the
last
year.
This
has
really
been
a
focus
of
ours
and
during
this
time
we've
had
one
overriding
priority
and
that
is
to
ensure
that
our
members
have
access
to
care.
B
So
this
involved
providing
a
number
of
flexibilities.
Some
of
those
related
to
the
method
in
which
we
deliver
Health
Care
Services
Telehealth,
of
course,
is
the
is
the
most
notable
example
there.
We
expanded
access
to
nearly
all
of
our
Professional
Services
via
Telehealth,
and
that
was
a
real,
a
real
life
saver
for
our
members
and
also
for
our
providers.
B
I
mentioned
earlier
our
priority
of
ensuring
that
we
have
an
adequate
network
of
providers
and
clearly
we
can't
provide
access
to
care
unless
we
have
providers
that
are
available
for
those
members
to
to
receive
care
and
no
question.
Our
providers
experienced
some
some
really
dire
challenges
and
circumstances
during
this
time.
So
utilization
has
been
impacted.
B
It
continues
to
be
impacted
in
many
cases
and
therefore
Revenue
was
impacted
and
in
some
cases
it
wasn't
low
utilization,
but
it
was
just
the
increased
cost
of
providing
care
so
that,
whether
that
be
PPE
or
Staffing
or
overtime,
all
of
those
things.
So
we
did
several
things
to
assist
our
providers
First.
We
allowed
a
number
of
administrative
flexibilities
to
allow
our
hospitals
and
our
nursing
homes
to
focus
on
care
and
then
second,
we
provided
direct
assistance
with
Revenue
through
accelerated
payments
and
through
direct
provider
relief
payments
to
our
heavily
Medicaid
dependent
providers.
B
I
should
also
point
out
that
we
distributed
118
million
dollars
to
our
nursing
facilities
through
the
nursing
home
assessment,
which
greatly
assisted
our
nursing
homes
and
facilities,
and
we
appreciate
the
partnership
with
thca
on
that
front.
On
the
subject
of
testing,
TennCare
and
Medicaid
programs
throughout
the
country
have
a
big
role
to
play.
We've
worked
to
ensure
that
all
of
our
TennCare
members
have
access
to
testing.
To
date,
we've
paid
for
more
than
360
000
tests
Statewide,
but
we
know
that
we
have
our
10
care
members
that
are
also
receiving
tests
through
the
drive-through
site.
B
So
that
includes
Transportation,
supports
care
coordination
and
then
paying
for
the
administration
costs
I
just
want
to
before
I
leave.
This
slide
I
want
to
just
once
again
publicly
thank
our
providers
for
all
of
their
efforts.
During
this
time,
I
can't
say
enough
about
their
efforts,
their
resiliency,
their
flexibility.
They
have
been
true
partners
with
us
and
we
just
cannot
be
successful
as
an
agency
in
serving
our
members
without
the
partnership
with
our
providers
and
and
I
didn't
want
to
leave
this
without
publicly
thanking
them.
B
Once
again,
we
thought
it
would
be
useful
for
you
all
to
get
a
snapshot
of
what
utilization
has
looked
like
during
this
time,
and
so
to
talk
more
about
that
I'm,
going
to
turn
this
back
over
to
to
Dr
Wu.
A
C
Yes,
absolutely
thank
you,
chairman
Hawkins
members
of
the
committee
for
the
record,
I'm
Victor
woo,
the
chief
medical
officer
at
TennCare.
As
director
Smith
mentioned,
we've
often
been
asked.
You
know
how
does
utilization
look?
How
is
the
healthcare
industry
been
responding
to
coven,
and
this
is
just
a
snapshot
I'm
not
going
to
kind
of
go
reach
line
item
for
those
of
you
that
are
interested
to
kind
of
see
how
the
pandemic
has
impacted.
C
Our
the
big
categories
of
care
that
we
tend
to
track
and
you'll
see
kind
of
the
early
pandemic
period
is
on
the
First
Column
march
to
May,
when
our
state
was
in
a
in
a
different
kind
of
approach
around
the
lockdown
and
then
in
June
through
October,
seeing
how
some
of
that
is
rebounded
over
time
and
and
overall,
the
change
and
so
in
some
categories.
You're.
Seeing
that
we're
starting
to
near
pre-pandemic
utilization
in
some
areas
still
remain
a
little
depressed.
C
I
think
one
of
the
areas
that
I
do
want
to
highlight
is
that
in
both
in
Partnership
and
under
the
leadership
of
TennCare,
but
with
our
health
plans,
we've
really
focused
on
some
of
the
major.
Your
categories
that
we
know
that
the
pandemic
is
going
to
hit
that
we
will
have
long-term
Health
consequences.
Things
like
preventative
care
things
like
well
child
visits,
immunizations
those
things
tend
to
kind
of
have
been
reduced
significantly
with
just
with
the
decreased
utilization.
C
Yet
we
know
that
those
are
long-term
Investments
for
the
health
of
the
population
and
you'll
notice
that
our
well-child
business
we've
made
some
even
though
we're
down
for
the
entire
year,
we've
made
some
real
gains,
we're
actually
higher
than
we
were
last
year's
we're
playing
catch-up,
and
we
will
continue
to
to
really
use
the
types
of
investments
in
care.
Coordination
supports
that
our
health
plans
offer
to
really
Drive
some
of
those
preventative
Services.
The
other
piece
I'll
mention
is
just
that.
Telehealth
has
been
a
tremendous
benefit
to
our
members.
During
the
pandemic.
C
In
in
the
to
kind
of
fill
in
that
Gap,
when,
when
in
person,
some
visits
weren't
really
as
as
accessible
as
they
were
in
the
past,
and
maybe
the
best
way
to
tell
the
story-
is
honestly
I'd
like
to
share
with
you.
If
you
don't
mind
a
short
patient
story,
we
think
about
this
oftentimes
in
terms
of
our
members
and
and
there's
countless
numbers
of
stories
we
could
tell,
but
one
of
them
I
think
just
emblematic
of
the
types
of
supports
and
services.
Our
our
health
plans
provide.
C
There
was
a
nine-year-old
patient
of
ours
who
I
call
them
patients
that
hard
for
me
not
to
think
of
those
patients
as
a
physician.
But
a
nine-year-old
member
will
call
her
Anne
but
she's
had
a
complicated
medical
history.
History
of
breast
cancer,
history
of
heart
disease,
arthritis,
as
well
as
severe
asthma,
and
she
was
living
at
home,
fairly
functional
able
to
move
around
most
for
the
most
part
on
her
own.
But
she
does
have
a
caregiver
who
came
in
to
visit
her
three
four
times
a
week
for
a
couple
of
hours
to
support
her.
C
That
caregiver,
unfortunately
received
kovid
I,
got
covid
and
was
unable
to
come
in
and
had
been
in
her
home,
but
then
had
to
stop
and
during
those
few
days
where
the
caregiver
wasn't
checking
in
on
her
as
regularly
and
had
a
fall
at
her
home
and
had
a
serious
injury
to
her
foot.
She
actually,
our
MCO
care
coordinator
is
one
of
our
health
plants
who
regularly
checks
on
our
heart.
C
Our
high
risk
members
who
have
these
chronic
conditions
kind
of
connected
with
Ann
and
and
told
her
a
story
and
immediately
set
up
a
home
visit
the
very
next
day.
So
our
MCO
care
coordinator,
went
into
her
home,
was
able
to
set
up
a
Telehealth
visit
with
a
physician,
orthopedic
surgeon
who
was
able
to
look
at
her
ankle
over
Telehealth
with
some
pictures.
Do
a
couple
of
tests
with
the
help
of
the
MCO
care
coordinator
and
that
allowed
the
physician
to
diagnose
and
say,
look
you're
going
to
be
okay.
C
You
need
some
supports,
but
you
don't
need
to
come
into
the
ER.
You
don't
need
X-rays
and
that
Anne
was
able
to
stay
at
home,
receive
the
care
coordinator,
etc.
For
physical
therapy
services
for
Rehab
Services
and
got
her
in-home
test,
because
she
was
also
worried
about
being
exposed
to
covid
through
the
previous
worker.
C
This
is
the
type
of
levels
of
supports
and
care
that
our
mcos
are
going
above
and
beyond
during
the
pandemic,
in
order
to
really
provide
the
care
for
our
members
and
that
story
of
Anne
I
think
is
just
emblematic
of
of
how
our
healthcare
industry,
or
how
our
providers
and
how
our
health
plans
have
really
tried
to
increase
the
level
of
supports
and
really
rally
around
the
needs
during
the
pandemic.
And
so
hopefully,
that
gives
you
a
flavor
of
the
type
of
services
that
we're
doing
and
we're
trying
to
to
work
on.
B
All
right,
Mr
chairman,
to
wrap
up
here,
I'm,
going
to
ask
William
to
come
up
and
we're
going
to
give
you
all
an
update
on
where
we
are
with
our
enrollment
and
and
also
walk
through
how
the
enhanced
federal
dollars
have
have
impacted.
10
care.
E
Thank
you,
chairman
Mr
chairman
members
of
the
committee.
My
name
is
William
Aaron
and
I
have
the
privilege
of
serving
as
the
Chief
Operating
Officer
for
TennCare
wanted
to
talk,
just
as
director
Smith
said
just
a
moment
about
enrollment
and
about
some
special
financing
that
we
are
currently
receiving
from
the
federal
government,
so
I
think
most
folks,
who
are
familiar
with
the
fact
that
the
the
federal
government
has
passed
a
series
of
coveted
relief
bills
over
both
the
Trump
Administration
and
now
working
through
the
bite.
Administration.
E
The
second
through
the
Trump
Administration,
included
a
temporary
provision
that
essentially,
as
long
as
the
public
health
emergency,
was
in
effect,
All
State.
Medicaid
programs
would
receive
a
higher
level,
a
higher
share
of
federal
funding
than
they
would
otherwise
get,
and
that
is
an
increase,
as
you
heard
director
Smith
mentioned
previously
of
6.2
percent
right.
So
if
you
assume
that
our
normal
share
of
federal
funding
is
about
65,
66
percent
well,
now
we're
at
71
72
percent
right.
This
was
a
mechanism
that
was
used
back
during
the
Great
Recession.
E
One
of
the
requirements
that
the
federal
government
put
in
this
coronavirus
relief
bill,
however,
was
that
for
states
to
be
able
to
receive
those
enhanced
federal
dollars,
and
it
is
significant
dollars
as
we'll
see
in
just
a
moment
that
they
would
have
to
suspend
all
re-verification
activity
of
members
right
and
just
so
that
members
of
the
committee
are
clear.
We
are
required
by
the
federal
government
to
at
least
once
every
12
months,
reach
out
to
every
member
in
the
program
and
ask
them
for
information
to
ensure
that
they
are
still
eligible
for
membership.
E
For
us
to
receive
this
enhanced
Federal
match.
We
had
to
cease
all
of
that
activity
so
effectively.
We've
stopped
that
activity
completely.
As
of
last
March,
now
I
will
say:
there's
nothing
unique
to
Tennessee
about
this.
Every
state
and
every
State
Medicaid
Program
has
made
this
choice
right
so
that
we
are
very
much
in
good
company
on
this
front.
But
if
you
look
at
the
slide,
what
we
want
to
do
is
to
highlight
the
impact
that
that
has
now,
certainly
because
in
tough
times
economically
more
people
are
eligible
for
Medicaid
because
they
lose
jobs.
E
They
have
to
take
jobs
that
pay
less
Etc
family
circumstances
change,
and
we
know
that
you
know
there
has
been
some
portion
of
enrollment
that
comes
from
basically
the
state
of
the
economy,
but
particularly
here
in
Tennessee,
where
the
economy
has
bounced
back
well
and
we
have,
as
a
government,
managed
effectively
through
it.
What
we're
seeing
the
majority
of
our
enrollment
increase
comes
from
the
suspension
of
our
re-verification
activities.
Right
and
again,
as
long
as
we
receive
those
enhanced
Federal
matching
dollars,
we
will
continue
to
suspend
the
re-verification
of
members.
E
E
E
So,
as
long
as
on
January
1st
of
this
year,
we
were
still
in
public
health
emergency,
even
if
it
was
just
that
one
day
we
would
get
dollars
for
the
full
quarter.
Come
let's
see,
January
March
April
1st
right.
If
we're
still
in
the
public
health
emergency,
we
will
get
Public
Health.
We
will
get
those
matching
enhanced
federal
dollars
for
the
full
quarter
right.
Well,
so,
the
broadly
speaking,
the
enrollment
constraints
and
the
the
the
constraints
on
re-verification
the
maintenance
of
effort
requirement
is
what
it's
called
follows
those
dollars.
E
So
what
we
know
right
now,
sitting
here
in
in
late
February,
is
that
we
are
good
through
the
end
of
March
right.
We
will
continue
to
receive
those
enhanced
federal
dollars
through
the
end
of
March,
and
we
will
continue
to
have
our
re-verification
suspended
through
the
end
of
March
in
concordance
with
that
right.
That's
what
we
know
for
sure
all
right
and
that's
what's
represented
in
the
blue
line-
obviously
win
the
requirement,
and
again
this
is
not
unique
to
Tennessee.
This
is
all
this
is
every
Medicaid
Program.
E
When
that
requirement
is
lifted
and
the
enhanced
federal
dollars
are
no
longer
available,
we
will
begin
re-verification
activities
and
that's
why
you
see
the
the
membership
line
starting
to
come
down
after
March.
Now,
that's
what
we
know
for
sure
right
and
as
I
always
tell
the
hooks
I
work
with
you
know:
I
will
wake
up
like
1201
a.m.
On
the
very
first
day
of
the
first
day
of
the
quarter
like
are
we
still
in?
Yes
we're
good
right?
We
don't
know
for
sure
until
we
get
there.
E
However,
it
is
interesting
members
that
the
Biden
Administration
has,
although
they
have
not
formally
put
a
policy
in
place
for
this,
yet
they
have
communicated
that
their
intent,
or
at
least
they
believe
that
the
likelihood
is
is
probably
a
better
way
to
put
it
that
the
public
health
emergency
will
be
in
place
through
the
rest
of
this
calendar
year.
E
As
we
began
to
ask
members,
are
you
still
eligible
and
would
find
that
just
the
normal
turn
that
comes
with
Medicaid
is
nothing
unusual
about
it?
Every
state
experience
is
it
that
enrollment
would
begin
to
come
down
so
with
those
additional
folks.
That
means
that
there
are
additional
costs
and
members
of
the
committee
we
wanted
to
share
with
you
all
that
we
feel
very,
very
comfortable
that,
yes,
we
will
have
those
additional
costs,
but
that
we
will
have
the
dollars
available
to
pay
for
that
right.
E
If
you
look
at
the
the
impact
and
again
remember
what
happens
here,
is
that,
instead
of
getting
our
normal
65
66
cents
on
the
dollar,
from
the
federal
government,
we're
getting
71
to
72
cents
from
the
federal
government
for
every
dollar
right,
what
that
means
is
that
we've
got
these
levels
of
State
funding
that
are
freed
up.
If
you
look
at
say
the
first
six
months
of
calendar
year,
2020
so
January
through
June
of
2020,
we
had
243
million
dollars
in
state
funding
that
was
freed
up
right.
E
That
Again
part
of
that
has
gone
to
our
reserves
to
enable
us
to
help
pay
for
these
expenses,
which,
let's
be
clear,
we're
getting
all
the
revenue.
Now
the
expenses
are
going
to
stretch
out
over
time.
So
we
have
to
be
prudent
and
plan
for
that
part
of
that
also
went
to
help
stabilize
state
government
in
a
very
challenging
time
right
and
we're
proud
to
be
able
to
to
be
a
part
of
that
solution
for
the
state
government
as
well.
But
you
can
see
what
our
projections
are
as
we
move
through
here.
E
You
know
we're
looking
at
approximately
140
million
for
this
quarter
again
and
that's
what
we
know
right
now.
Right
again,
we
will
see
if
there
is
some
official
action
by
the
Biden
Administration
that
extends
that
through
the
rest
of
the
calendar
year,
but
all
that
to
say
you
know,
members
of
the
committee.
Yes,
we
are
seeing
an
increase
in
enrollment.
B
Foreign
members
that
completes
our
prepared
remarks.
We
appreciate
your
attention
to
those
and
again
appreciate
the
opportunity
to
to
be
here
with
you
and
happy
to
answer
any
questions
or
listen
to
any
concerns
that
you
all
have.
A
F
B
B
That
is
great.
We've
received
a
letter.
I
think,
that's
that,
maybe
that's
some
of
the
confusion.
Maybe
I
should
just
talk
about
what
this
letter
is.
So
at
the
end
of
the
Trump
Administration,
the
CMS
administrator
at
the
time
provided
a
letter
to
every
State
Medicaid
director
that
has
an
1115
waiver.
We
have
an
1115
waiver
and
what
that
did
is
it
set
out
some
procedures,
some
some
additional
due
process
rights?
That
states
would
have
in
the
event
that
the
federal
government
chose
to
take
an
action
on
the
1115
waiver.
B
So
we
signed
that,
as
did
every
state
that
has
an
1115
waiver.
We
submitted
that
back.
The
Biden
Administration
came
in.
They
issued
their
own
letter
recently
that
rescinded
that
previous
letter,
but
I
want
to
be
very
clear.
That
letter
is
not
specific
to
the
10K
or
three
waiver.
It
relates
to
11
15
waivers
in
general,
and
it
just
speaks
to
the
process
that
the
federal
government
would
go
through
if
they
are
to
to
take
action
on
a
waiver,
but
it
doesn't
change
the
status
of
our
waiver
at
all.
F
And
and
my
my
only
other
thing
and
yeah
I
remember
when
the
breast
administration
had
to
make
some
tough
choices
and
it
was
tough
Financial
Times,
we
didn't
have
a
billion
dollars
laying
around
or
another
300
million.
We
could
stick
in
the
rainy
day
fund
at
that
time.
We're
trying
to
keep
the
lights
on.
Keep
the
state
employees
paid,
keep
government
working
for
the
people,
so
I'm
hearing
a
lot
of
saving
money,
saving
money.
Well,
TennCare
wasn't
created
to
save
money.
F
F
There's
350
000
tennesseans,
who
need
health
care
and
and
I
hope
we
don't
lose
fact
the
focus
that
you
know
our
goal
should
be
to
help
provide
as
much
health
care
to
as
many
tennesseans
as
we
possibly
can,
especially
in
time
when
we're
sticking
money
in
the
rainy
day
fund,
because
I
can
guarantee
you,
those
300
and
some
thousand
tennesseans,
it's
raining
on
them.
You
know
it's
a
rainy
day
in
their
household.
So
that
being
said,
let's
just
think
about
that.
A
Thank
you,
Riverside
Mitchell
and
I
appreciate
that
and
we'll
refer
folks
back
to
slide
number
two,
as
well
as
we're
looking
at
the
the
Tinker
enrollment
numbers
and
and
the
percentage
of
in
when
you
and
I
had
some
discussions
early
early
on
back
in
the
bredesen
days
where,
where
we
are
in
terms
of
numbers
right
now
as
well.
So
thank
you
very
much
for
your
for
your
comments.
Representative
Mitchell,
chair
lady
Smith,
you
are
recognized.
Thank.
G
You
Mr
chairman
and
congratulations
director
on
keeping
that
10
care
3
intact,
we're
cheering
you
on,
because
we
know
that
more
tennesseans
could
potentially
receive
coverage.
G
My
question,
if
you
wouldn't
mind
going
back
director
to
one
of
the
more
recent
slides
about
the
fmap
and
how
it
was
broken
down
quarterly
just
for
click
that
was
it
right
there
just
so
that
I'll
understand
there
was
a
moment
at
which
there
were
243
million
dollars
was
awarded
from
the
federal
government
to
our
state,
and
you
mentioned
that
was
that
reflects
a
6.2
percent
increase
from
that,
the
that
which
would
have
been
typical
for
fmap
and
and
I
understand,
going
to
stabilize
other
parts
of
the
government.
G
Clearly
it
was
raining
on
all
of
us
at
one
point,
but
of
those
funds
have
those
all
been
spent
allocated
expended
or
their
monies
that
are
continuing
to
be
put
forward
in
other
programs.
Do
you
have
things
allocated
for
with
that
sum
of
money
in
in
anything,
that's
going
to
fall
in
quarter,
one
or
two
of
this
year
or
or
you
know,
let
us
know
how
that
those
6.2
percent
that
increase
is
being
utilized
outside
of
stabilizing
government
through
some
sort
of
an
accounting
opportunity.
B
Thank
you,
Mr
I'll
appreciate
that
question
I'm,
going
to
kick
it
over
to
William
to
talk
specifics
about
what
I
would
just
reiterate,
though,
is
we
we
really
think
about
these
expenses,
these
pandemic
expenses,
the
covid-19
related
expenses,
as
not
just
one
fiscal
year,
because
we
know
it
started
in
FY
20
and
it's
going
to
extend
past
FY
22,
and
so,
when
we
think
about
the
expenses
and
this
Revenue
that's
coming
in,
we
kind
of
think
about
it
collectively
expand.
You
know
going
through
those
multiple
fiscal
years,
but
William
I'll.
E
Yeah,
no,
it's
an
excellent
question:
Madam
chair
and
I'll,
just
Echo
what
what
director
Smith
said.
It
is
the
situation.
I
think
this
is
part
of
your
point
as
well,
where
you
know
essentially
we're
getting
this
sort
of
bolus
of
dollars
up
front,
and
so
we
need
to
make
sure
that
we're
being
good
stewards
of
that
for
the
full
duration
of
our
costs
right
so
yeah.
It's
absolutely
part
of
what
we
do
is
you
know
we
iterate
our
projections
and
our
models
for
enrollment,
as
well
as
for
testing
and
treatment
costs.
E
We've
done
so
many
versions
of
these
I've
almost
lost
count,
as
our
data
improves
and
we've
gotten
much
better
about
it,
as
you
would
hope
that
we
would
right
over
the
course
of
this
pandemic,
and
we
are
in
very
frequent
conversation
with
the
budget
office
in
FNA
about
what
our
dollars
look
like
and
what
we
project
our
expenses
are
going
to
be
so
part
of
the
the
challenging
nature
of
this
Madam
chair.
Is
that
again,
I
can't
promise
you
that
we're
going
to
have
any
enhanced
fmap
dollar
is
past
March
30th.
E
This
has
been
one
of
the
main
sources
of
concern
and
complaint
from
states
to
both
the
Trump
Administration
and
now
continuing
to
divide
Administration
right
is
that
it
it.
You
know
it's
hard
to
plan
right,
if
you
don't
know
whether
you're
going
to
get
those
dollars
or
not
so
we're
hopeful.
Given
recent
Communications
again,
there's
going
to
be
some
more
certainty
around
that
going
forward.
E
The
the
overwhelming
majority
of
these
dollars
Madam
chair
are
going
to
be
necessary
for
us
for
several
years
to
pay
for
the
impacts
of
this
pandemic
on
the
TennCare
program,
for
example,
the
enrollment
model
that
you
saw
you'll
notice
the
lines
start
coming
down,
but
we
only
showed
you
through
State
fiscal
year,
22
right,
which
is
the
budget
that
is
before
the
legislature.
At
this
point
we
have
cost
going
all
the
way
out
projected
into
State
fiscal
year,
24.
E
E
B
So
the
word
of
caution
there
is
that
some
may
look
at
our
fund
balance
and
and
think
that
it's
inflated,
but
the
reality
is
we're
going
to
have
to
use
very
likely
going
to
have
to
use
those
dollars
to
account
for
those
costs
after
the
emergency
goes
away.
Does
that
answer
your
question.
A
Any
other
members
I
do
have
a
few
questions
and
some
comments
myself.
If
we
could
go
back
to
slide
number
four
as
you
presenting
the
the
populations
that
we're
serving,
we
definitely
have
an
aging
population
in
our
state.
Now,
look
at
the
third,
the
third
segment
of
the
slide
that
you
have
there
we're
seeing
some
increases
in
needs
of
our
elderly
population.
A
B
Yeah
I'll
ask
Patty
to
come
about
defer
to
the
expert
here.
A
D
Thank
you,
Mr
chairman,
happy
to
talk
about
that
and
really
appreciate
you
raising
the
issue.
One
of
the
things
that
the
pandemic
has
done
is
really
shine.
A
light
on
the
critical
importance
of
long-term
services
and
supports
and
how
fragile
the
nature
of
that
service
system
can
be.
D
The
good
news
is
that
this
body
now
over
a
decade
ago,
took
some
really
definitive
steps
to
vastly
improve
our
position
relative
to
planning
for
the
future
needs
of
an
aging
population.
By
creating
the
choices
program,
and
since
that
program
launched
in
in
2010,
we
have
been
able
to
significantly
expand
access
to
Home
and
community-based
Services.
D
We
have
when
we
start
it
out
the
choices
program
we
had
18
percent
of
our
population
who
were
receiving
services
in
the
community,
the
rest
of
the
individuals
were
receiving
their
services
in
nursing
homes
and
now
we're
at
46
and
a
half
percent
of
people,
as
you
saw
on
the
slide,
who
are
receiving
services
in
their
home
and
community.
So
we've
gone
from
a
little
over
4
000
to
over
12
000.
D
That
really
is
I
think
our
future
is
continuing
to
find
ways
to
honor
the
choices
that
people
want
to
make
about
where
they
receive
services
and
to
support
them
and
receiving
those
services
in
their
home
in
cost-effective
ways.
Whenever
we
can
that's
a
part
of
our
reason
for
really
moving
forward
with
idd
integration.
That
too,
by
the
way,
is
an
aging
population.
D
There
is
among
that
population,
a
group
of
individuals
who
are
who
are
becoming
older
and
there's
also
a
group
of
people
who
are
coming
out
of
school
and
they're
young
and
they
want
opportunities
to
live
lives
that
we
live.
They
want
jobs
and
they
want
lives,
and
we
need
to
begin
to
provide
supports
in
ways
that
enable
them
to
really
achieve
their
maximum
level
of
function
and
Independence
and
success
in
everyday
life
and
then
wrap
supports
around
them,
where
necessary.
A
Thank
you
very
much
and
I'll
jump
on
my
soapbox
a
little
bit
here
as
director
Smith
was
talking
about
the
the
value
and
the
thanks
for
our
provider
Community
out
there,
and
they
have
they've
had
a
tough
time.
It's
been
a
challenging
year
to
to
say
the
least
and
I
want
to
ensure
that
we
continue
provider
sustainability,
that
the
population
that
we're
serving
with
this
with
these
choices
dollars
and
these
choices
program
that
the
providers
are
able
to
continue
and
I
know
that
there
are
some
concerns.
A
Several
of
us
have
had
meetings
and
conversations
about
about
a
rate
and
a
three-tiered
rate
right
now
we
can
talk
dollars
and
cents
all
day
long
and
how
we
justify
those
dollars.
But
there
are
certain
pools
and
and
tugs
on
us
right
now
as
a
legislative
body
that
we
ensure
that
I
think
there
was
a
conversation
I
had
with
someone
earlier,
we
don't
know,
there's
a
a
provider
crisis
until
there's
a
provider
crisis
and
just
to
ensure
that
that
the
folks
that
are
providing
these
in-home
services
are
able
to
continue.
A
That's
important
to
us
and
I
know
that
as
we're
looking
with
with
Mr
Aaron,
who
was
speaking
earlier
to
sharpen
that
pencil
as
we
have
those
discussions
going
forward,
that's
that's
important
that
that
we
achieve
that
balance
going
forward.
I
will
mention,
as
as
we're
having
this
conversation.
A
I
know
that
the
senate
committee
on
health
met
recently
on
on
behavioral
health
issues
and
some
concerns
coming
from
the
Behavioral
Health
Community
in
terms
of
providers
once
again,
I
want
to
ensure
that
we
have
a
stable
provider
Network
in
order
to
continue
the
levels
of
care
that
we've
got
and
and
what
that
looks
like
finding
that
balance
I
we're
going
to
be
charged
with
that
as
a
legislative
body
as
we
work
through
the
budget
document
over
the
next
eight
weeks
as
well
as
this
committee
and
and
you
are
going
to
be
charged
with
that.
A
So
my
my
encouragement
is
to
you
is
to
have
an
open
ear
as
we
work
with
our
mcos
as
we
work
with
our
provider
organizations
to
ensure
that
that
we
achieve
that
happy
happy
medium,
as
the
old
saying
goes,
where
no
one's
in
love.
A
With
with
the
presentation,
but
they
can
live
with
it
to
where
we're
we're
all
going
to
have
a
little
bit
of
something
we
wish
we
could
change,
but
but
we
can
live
with
it
and
and
continue
that
stability
within
our
provider
Community
as
well
as
within
our
our
mcos.
So
thank
you
thanks
for
allowing
me
on
my
soapbox
there,
representative,
Smith
I,
think
you
had
a
follow-up.
Your
recognize
representative
Smith.
G
I
did
and
blame
the
chairman
because
he
provoked
a
thought
early
early
in
the
covid
response.
I
know:
I
had
several
conversations
with
different
people
about
the
how
PPE
is
treated
in
the
world
of
reimbursement
and
and
I
know
that
you
all
have
eloquently
spoke
about
new
costs
that
have
come
up.
It's
kind
of
like
the
woodwork
effect
of
this
covid
response
and
how
they're
going
to
be
long
lasting.
G
You
know,
another
cost
of
doing
business
of
a
provider
is
an
enormous
amount
of
PPE
and
those
are
costs
that
are,
though,
are
those
now
being
reimbursed
in
any
capacity
or
reflecting
in
the
cost
of
treating
patients.
Is
that
something
that
is
incorporated
into
a
billing
code?
Is
that
something
that's
being
included
in
an
upcharge
in
any
capacity
when
you're
dealing
with
a
coveted
patient
so
that
that's
not
a
cost,
that's
being
eaten
by
a
provider?
G
And
instead
it's
viewed
as
part
of
an
episode
where
there's
going
to
be
increased
cost
when
you're
dealing
with
any
sort
of
like
an
infection,
whether
it
be
communicable
covid
viral?
But
is
that
something
that
you
all
have
changed
and
and
are
now
providing
an
accommodation
for
PPE?
Thank
you.
Mr
chairman
I.
B
May
need
some
help
from
William
and
Patty.
You
may
be
able
to
speak
to
the
nursing
facilities.
I
I
can
point
to
the
the
one-time
investment
that
we
made.
You
know
early
on
to
those
heavily
Medicaid
dependent
providers,
the
HCBS
providers
in
particular,
where
we
did
address
the
PPE
cost,
but
for
nursing
facilities.
I
do
believe
that
that's
part
of
their
cost
reports
but
I
may
need
to
defer
to
to
William
I.
Have
him
come
up
here.
E
Thank
you,
Mr
chairman
William
Aaron
Chief,
Operating
Officer
of
tincare
yeah.
It
sorry
is
that
Mickey
no
hear
me
okay,
great
yeah,
so
we
have
addressed
this
in
several
ways:
Adam
chair,
so
one
of
which,
as
as
you
heard
director
Smith
mentioned,
was
you
know
when
we-
and
this
was
you
know,
60
days
into
the
the
covid-19
crisis
right?
E
If
then,
but
probably
not
even
that
far
end,
we
saw
that
there
were
certain
classes
of
providers
who
were
you
know,
extraordinarily
heavily
unusually
dependent
right
proportionally
on
Medicaid
dollars
and
knew
that
they
were
in
particularly
Dire
Straits.
And
so,
as
you
heard
the
director
mentioned,
did
you
know
more
than
40
million
dollars
worth
of
sort
of
immediate
provider
payments
to
those
folks,
a
large
part
of
what
was
driving
some
of
those
was
PPE.
E
For
example,
you
know
we
have
built
a
you
know:
world-class
network
of
pediatric
pediatric,
dentistry
and
dentists.
That
will
see
our
members
right
because
again
we
have
half
of
all
the
kids
in
the
state.
E
So
that
means
we're
responsible
for
half
of
all
the
children
into
dental
work
in
the
state,
and
you
know,
dental
work
in
particular
is
one
of
those
places
where
PPE
is
critical,
because
you
were
a
close
up
constantly
right
up
against
an
open
mouth
right,
so
we
actually
for
them
put
in
place
a
rate
increase
that
reflects,
among
other
things,
PPE
considerations,
that's
in
place
for
for
a
good
period.
You
know
you
also
heard
director
Smith
mentioned
nursing
homes.
You
know
we've
again
we're
we're
grateful
for
our
partnership.
E
You
know
we
have
great
Partnerships
with
our
providers
thca,
certainly
absolutely
up
there.
You
know
we've
pushed
out
significant
additional
dollars
to
them
to
cover,
because
of
goodness
for
them,
it's
PPE.
It's
Staffing,
there's
just
a
ton
of
additional
costs
to
help
them
be
stable
through
that
as
well,
and
in
addition,
where
we
do
have
certain
providers
who,
for
whom
cost
reports
Drive
what
we
pay
right,
it's
not
all
providers,
but
certain
ones.
We
do
nursing
homes
that
can
factor
in
our
ICF
provide
writers,
for
example.
A
I
want
to
thank
you
all
very
much.
As
you
know,
it's
it's
an
issue
with
great
depth
and
it's.
It
is
not
an
easy
discussion
to
have
it's
a
very
critically
important
discussion,
as
it
is
a
substantial
part
of
our
budget,
as
it
was
mentioned
before
you
know,
one
in
five
tennesseans
are
affected
by
our
the
program
and
it
it
means
a
lot
in.
The
fact
that
we
are
engaging
in
these
conversations
is
is,
is
very
important,
going
forward.
A
I
think
that
you've
heard
us
loudly
and
clearly
where,
where
we,
where
we
feel
like,
we
need
to
go
as
a
as
a
legislature
and
as
a
as
a
state
I.
Thank
you
for
the
work
that
you
do
in
it
being
thankless
I'm
going
to
say
thank
you
that
that
you
folks
have
have
really
done
a
great
job
of
informing
us
of
managing
and
and
I'm
very
proud
to
proud
that
you're
tennesseans.
So,
thank
you
so
much
seeing
no
further
business
before
this
committee,
we
will
be
adjourned.