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Senate | June 19, 2014 | Committee Room | Appropriations

Full MP3 Audio File

Let me have your attention, please. We’ll go ahead and get this meeting started. Good after noon, everyone. I’d like to welcome you to the appropriations meeting. Let’s recognize our Sergeant-At-Arms. We have Ed Kessler. Ed? Thank you. We have Canton Lewis. Canton? Thank you. Isaac Walker. Thank you, Isaac. And Billy Fisher. Hey, Billy. Thank you, Billy. And we also have our pages, and pages, if you would raise your hand when I call your name. Meredith Roach. We have Quinton Beal. Quinton, where you at? We have Sophia Polatis; did I pronounce that close enough? And we have Rachel Figuard. Rachel? Thank you all for being with us today. We’re going to have a little change in the agenda and we’re going to put the Medicaid budget comparison up first. We’re not sure if someone from OSBM is planning on joining us or not, but we’ll give them the opportunity should they come in a little bit later. I do not see anyone from there at this point in time, so at this point in time we will move right into the Medicaid budget comparison with Steve Owen and Susan Jacobs. I think Steve’s going to present and I was told Susan’s answering all questions. Is that right? Thank you, Steve. [SPEAKER CHANGES] Thank you Mr. Chairman and committee. I think you all have a copy of the numbers I’m going to go through in a minute, but before I get there, I wanted to spend a little time and give you some context as you consider these numbers for the Medicaid rebase. The department, OSBM and Fiscal Research have faced data challenges this year trying to put together an estimated shortfall as well as a rebase for next year. There’s a lot of information that we do have, but there’s some critical information that we’ve never been able to get access to or don’t have at this point to do an estimate in terms of 2015. The basic areas where we’ve had challenges this year are first in enrollment. We’re not been able to get accurate or consistent enrollment data that allows us to see how many people are enrolled, which programs they’re enrolled in and present it is a consistent manner to allow us to do any analysis or evaluation. The second area is in backlogs. We’ve got two types of backlogs that we’ve been looking at. The first one is around claims. The claims backlog really results from the implementation of the new EMIS system and how that affected the processing of claims. The second one is in application or enrollment. There have been a number of things that have happened there. First the food stamp issue, in terms of its having resources diverted to take care of that at the local or the county levels; the second, they were operating two systems at the county levels for enrollment; and third, the implementation of the ACA exchange actually has shifted a number of new applicants into the system. The third area is really access to other information; information that would allow us to do some analysis of utilization and trends, to be able to look at the impact of items that are unique to 2014 like the ACA woodwork, like the presumptive eligibility, and finally our ability to understand what the impact or achievement has been for items included in the reductions for this year’s budget. So this was really where the challenge lies, or at least we think where the risk lies. The first big area of risk is, how big are these backlogs? The importance of really determining an accurate backlog for 2014 is that the 2015 rebase is really built on that 2014 expenditure level, so making sure we have an accurate or a reasonable number to build on to ensure that we have adequate funding for 2015 is vital. The second one, without that enrollment data we mentioned earlier, we really can’t assess, or truly assess, what factors such as the annualized impact of woodwork next year, presumptive eligibility, changes in utilization, to what degree we’ll achieve budget reductions. And finally, the final area of risk is how consistent will North Carolina’s growth in enrollment and changes in utilization be compared to other years or other around the country. The presentation we did earlier this year really showed that in 2003 to 2013, that if you normalize changes in mix of enrollment, neutralize the effect of legislative changes, Medicaid and North Carolina expenditures would grow like the national trends in healthcare. None of the numbers that we’re going to put out today or talk about are absolutely correct. They’re based on a series of assumptions, and the decision in large part is what degree of caution…

00:00 we wanna have in terms of a re-base for next year we've used everything that we know we've used all the actual information we have available to us we've also tried to quantify those things that we don't know trying to put a value on those so if you're making a decision about a re-base you have information at least to where we think we could be the senate chose to use fiscal researches worst case scenario the house chose to use the majority of the senate assumptions around re-base the one major variation was in the back log where they chose to use the governor's back log number with that I'll try to walk you through the sheet that you have here it's a front and back sheet and I wanna start with the medicate summary of state fiscal year 13-14 shortfall the four columns the first column is the original estimate that fiscal research made which was what was used as a basis for the senate's budget the second column which was the fiscal research [??] revised estimate utilizes information year to date through May of this year to update all the assumptions and all the calculations that we did the major difference between what we used in preparation of the senate budget and where we are right now in terms of our estimate is in the back logs when we did the original estimate we had a back log of about 407 million dollars a 157 million dollars of that was in claims about 250 million dollars was in application or enrollment back log at the end of May where we think we are right now is about 25.6 million dollars in total requirements for the claims back log about a 187 million dollars in terms of the application enrollment back log we also in this sheet represented some of the key components in terms of where we factored into the estimate as example we start with where we think claims and utilization will be we've indicated how much of the back or how much of the shortfall in this year will be at trivial to not achieving budget reductions the presumptive eligibility etc so we're giving you the pieces in parts in terms of medicate where we expect the end of the year from on a cash basis is with a cash surplus of about 43.2 million dollars this year when you had the health choice cash surplus of 9.4 million we expect in this year for medicate in health choice with a cash surplus of about 52.6 million then comes in the back logs these are liabilities that we're all into next year under the revised scenario we're resuming about a 112 million worth of liabilities that we'll roll into next year so from a budget prospective this year when you recognize that a 112 million dollars you'll have almost a 60 million dollars shortfall in terms of what's in the revised budget again the senate's budget originally used original estimate and the house used the for the most part the senate assumptions with the exception of back log they also did not include presumptive eligibility also did not include a expected change in use patterns in utilization rights in terms of response towards rate reductions so their back log we're assuming their shortfall from a budget perspective in 2013-14 was [??] at 25.3 million dollars if you flip the page over I'll go into state fiscal year 14-15 again using the 2014 as our base to build our 15 obviously as we will do start back log from 407 then we go down to 312 million dollars we see on 2014-15 revised estimate will come down as well in terms of where we ended up from medicate perspective we moved from 206 million dollars in terms of additional re-base needed next year down to a hundred just under a 185 million dollars again this compares to the house original position of a 117.8 million dollars the health choice surplus in 2015 is also expected to increase from 14.5 to 14.8 approximately so in terms of a net bottom line re-base needed for next year using May information where we think we'll be right now is we'll go from a 191.5 million in the worst case scenario down to 169.9 million again that's the worst case scenario at this point I'd be happy to take any questions. [SPEAKER CHANGES] Okay thank you Mr [??] any questions from the committee members senator [??] 05:00

I'm a little off because I was on the wrong side the whole time. I can't believe I did that but it's just not my day. OK. And Brock is not much help over here. Anyway, my main question is really where you got started, and I'm not on HHS so some of you may all know some of this stuff and I'm just a lot behind. In terms of the, you were saying some things, none of it is exactly right because some things we just don't know, so where are we with knowing our data, the enrollment data, what part do we know and what part is it we don't know and will we ever know what we need to know? I don't know of another way. And is there a timeframe on that? I'mm not trying to be funny, but I hope that makes sense. [SPEAKER CHANGES] Senator Bryant, what we do know is in terms of total spending through the end of May we know actually what we have spent. So we have confidence that the spending is accurate. We're probably between 95 and 98% confident when you get down below the total in terms of how that spending breaks down between the various programs, categories of service like hospitals, physicians etc. So those two we're pretty confident about. The things we don't know and we still don't have a date when we think we will know is enrollment. We've not known all year how many people are actually enrolled in Medicaid. We've gotten information that changes from time to time. We don't know how it brakes down between aged, blind, disabled, children, etc. and that's important because a child, for instance, in Medicaid, spends about $208 a month, a disabled individual, about $1400 a month, so knowing how those things break down is really important. At this point we don't have any idea. That's probably the biggest one. There are some other pieces of data that are important that we don't have as well. [SPEAKER CHANGES] Follow up, Mr. Chair. [SPEAKER CHANGES] Follow up. [SPEAKER CHANGES] OK. Is it knowable? And is it knowable and we just don't have the money to pay the people to count the files or find the papers or is it just something that we will never know for ever and ever. I mean, it's just not knowable. [SPEAKER CHANGES] Susan [SPEAKER CHANGES] Senator Jackson, members of the committee, this year is different. In the past we have had that information, so it's not information that has not been available, but this year they implemented two new systems as you're aware of, NC Fast Eligibility system and the NC Track system so both of those systems for Medicaid will take quite a bit of time for us to be able to get accurate information out of those systems, so. And then you've got local, the counties who've had to deal with the food stamp issue. I mean there's just been a whole host of things that have gone on that makes getting data, accurate data, challenging. But I do think, we have had it before, accurate data before, and I'm hoping that once these systems get resolved, completed, that we'll get that accurate information again. [SPEAKER CHANGES] OK. One more follow up. [SPEAKER CHANGES] Can I hold you to that, Senator? [SPEAKER CHANGES] Yes, you can. [SPEAKER CHANGES] OK, thanks. [SPEAKER CHANGES] Is there an outside date of us, fairly comfortable that we will have the data we need to know what our numbers are in terms of enrollment? You know, what our liabilities and responsibilities are. Is there like a outside possible date? [SPEAKER CHANGES] Generally, Senator Bryant, you know closeout by the middle of August what your actual expenditures were. The reason this year is different is because of backlog in claims payments and backlog in eligibility and the fact that the state has to go back three years prior to the application date and pay those bills. This year I don't know when we're going to know, I think someone from the department will have to respond to that or someone from state budget, but we think it will be sometime probably late next year before we even know what our accurate total expenditures were for Medicaid because they'll have cash on the bottom line but they'll have outstanding liabilities. We just won't, it'll take a little while to reconcile all of that I think, but I don't have a timeframe for you. [SPEAKER CHANGES] OK, thank you Susan, thank you Senator Bryant. Senator Robinson. [SPEAKER CHANGES] Thank you, Mr. Chair and thank you Steven, Susan. My question here gets back to what we had looked at earlier when we had projected what the backlog would be and what the Medicaid shortfall would be and were saying in terms of claims and growth $114 million here. Does that take into account the numbers of providers or are you estimating the numbers of providers that we still have outstanding because they're still having difficulty with the North Carolina Track system? I know in my area we have quite a few who call all the time. So what are you including and are you including that, or how close do you think you are in estimating what that particular backlog is? And then I had one

… question, Mr. Chair. [SPEAKER CHANGES] Steve? [SPEAKER CHANGES] Senator Robinson, in terms of the original forecast, there was about 157 million dollars of claims that we estimated at that time. At the end of May, we’ve seen claim payments actually accelerate to some extent. At this point, we see about 25.6 million dollars worth of claims that we think are in that bucket that you’re talking about, and that number is in here. [SPEAKER CHANGES] If I could just add to that Senator Robinson, let me tell you a little bit of how we ended up with this estimate. So you passed the budget last year for both years of the biennium for 13-14, 14-15. Based on the rebase we did and the continuation budget, the certified budget that you passed, we know where we should be in expenditures, so Steve modeled it out to say this is how, based on historical data, we should have spent this much money by this point in time. If you hadn’t done that because other policy changes haven’t happened, that’s how we try to figure out where you should be in expenditures, so to the extent that the budget was accurate, we can project how much providers should have been paid by this point, and if not then there’s something wrong, potentially a claims backlog or eligibility backlog. [SPEAKER CHANGES] Just follow-up. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] And I’m assuming that means that you’ve included that in here, but the presumptive eligibility in terms of the woodwork group, does this take in or does this factor in the numbers that we had estimated would be in the woodwork already, or is there an increase in here or a decrease? [SPEAKER CHANGES] In terms of the original, the estimate in the Senate budget in both the original and the revised, we’re assuming the same level of activity for woodwork. Presumptive eligibility was actually not in the original budget, so what we’ve done is estimated based on another set of scenarios, what we think the presumptive eligibility impact would be if there was a ten percent error rate, and again, the only way presumptive eligibility costs the state is if ultimately we have people that are presumed eligible and well they’re not, so we’ve assumed a ten percent error rate in that factor. [SPEAKER CHANGES] Senator Ford. [SPEAKER CHANGES] Thank you, Mr. Chairman. Can you share with us the percentage rate of growth for Medicaid? [SPEAKER CHANGES] In terms of the 2014-15, we assumed a 1.1 percent growth in enrollment and a 4.2 percent growth in utilization. We also assumed that we would continue to see a shift in mix of enrollment to a higher, if you will, cost recipient, so those three things went into the enrollment numbers. [SPEAKER CHANGES] Follow-up, Mr. Chair? [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] I’m asking for the percentage rate in growth in overall spending by the state. [SPEAKER CHANGES] You mean historical spending, Senator Ford? [SPEAKER CHANGES] Yes. Mr. Chair, may I follow up? [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] Just hoping to clarify my question. What I’m looking for is based upon the historical data that you have, based upon what the state has spent from budget to budget as that increase, what is that percentage increase over time? [SPEAKER CHANGES] I can get… I don’t have it with me but I can… When you look at history in terms of growth, you have to make sure that… because in past years we’ve had legislatively-approved reductions that would tend to lower or dampen the rate of growth in prior years. What we try to do, in terms of the analysis we did earlier this year, is try to extract or normalize the data so as if those things had not gone into place. In that case, Medicaid base spending grew at about 5 to 5.4 percent. [SPEAKER CHANGES] Senator Rucho. [SPEAKER CHANGES] Thank you Mr. Chairman, and I’m going to… First of all, I’m glad Senator Robinson allowed me to share her microphone. She doesn’t usually give me a chance, so… but maybe to you, Mr. Chairman, this Medicaid portion of the budget is the lynchpin to getting this problem solved, and would someone explain to me why we don’t have OMB or staff people from DHHS here to help us get to an answer so that we can move this budget forwards? [SPEAKER CHANGES] Well I’ll attempt to answer that for you, Senator Rucho. We had spoken earlier with our budget director, and he has informed us that he’s almost to the point of having numbers he’s ready to put out to public, but he does not have them as of this meeting. Senator Brown, would you like to follow-up on that? [SPEAKER CHANGES] Mr. Chair, it’s my understanding that they’re having the same problems we’ve been having with getting numbers to present anything different to us, so they felt like they had no new information, and I think that’s why they’re not here today. [SPEAKER CHANGES] Follow-up, Senator Rucho? Senator Tucker.

[Speaker Change] Thank you Mr. Chairman, in my short time around here, you started by saying out that the numbers are not accurate and you said we don’t know seven or eight times, have you as far as claims and backlog have you checked with the hospital ?? Carolina in UNC, to see if they have any backlog claims that are outstanding? That is owed to them by Medicaid? [Speaker Change] We have not surveyed ??. The department as provided us information where they have surveyed the providers in terms of claims they’ve also given us information about the enrollment backlog and we’ve tried to work through some of that we have not directly surveyed the providers. Follow up sir [Speaker Change] Yes sir, that would certainly be fiscal knew that if those numbers were real would be indicative of kind of what we’re looking at and how it may or may not skew your number. You know also too, Medicaid enrollment they said, was about 65,000 and is that a good number. From the HHS. [Speaker Change] I’m not sure I understand when said 65,000. [Speaker Change] Yeah roughly 65,000 is the Medicaid enrollment increased by rather than aggregate number of 27,000 that they had before which is a considerable growth. Is that number correct, [Speaker Change] We’ve received information, have received information this week that shows that enrollment grew by about when you take out the effective children being shifted from health choice to Medicaid that the other Medicaid enrollment has grown by 65,000 before you add in the backlog. This issue as we look at the data, there very wide variations as an example in April according to the data we received, enrollment dropped by 97,000 people. So we’re trying to reconcile, we jumped by 50,000 in July down by 97,000 in april so we can’t reconcile it doesn’t line up with prior years or months. [Speaker Change] Just one more comment the 60 million dollar hiccup that we have for next year because it was disallowed by the feds all the money we were supposed to save, we’re already in the hole now is that not correct?. [Speaker Change] Sen. Tucker it’s our understanding that communication from CMS the federal government and HHS indicated that it is not an allowable assessment as this point so the house did not include that item, the senate included it, but it’s our understanding you can’t move forward with that as proposed in the governments budget. [Speaker Change] Senator ??, [Speaker Change] First kind of looking at these, some information coming in on what the county backlog, when we’re looking at a backlog number. We have one number that’s in the system and then we have another potential number of backlog claims that aren’t in the system and I know that we were dealing with food stamps earlier this year we had a sudden appearance several thousand applications conveniently stored under someone’s desk. That appeared near the last day of that. What kind of ?? that the counties might be holding that aren’t reported in the system. [Speaker Change] Senator Heist, what we have, the recent information that we have is there’s 104,000 applications that are beyond what’s called the standard time for processing. Last year this time around this time there was about 1600. So there’s about 102,000 more than normal. If you can consider that normal, the other factor is that about 44,000 applications pending that have come through in the exchange about facilities that 50,000 applications that would have come through the DSS. We have extra information about the applications that you are talking about those that either have not come into the system or not in the system as of this day. Have not received any information about those. [Speaker Change] Let me clarify, we have received some information yesterday or day before yesterday on what they think the paper application that they haven’t made any action on. We’re still reviewing that data and asking questions on counties. We want to contact some counties to see what their response actually is, but it’s bigger than the number that is pinged.

Because federal policy requires, even for recertifications, that you can’t take someone off the Medicaid roll until they have been determined ineligible, so to the extent that counties are backlogged on recertifications or even new applications, a person remains eligible until they are determined ineligible, and so our backlog number hopefully will anticipate both backlog and potentially some of those other expenses that haven’t been built into our rebase for people who will receive Medicaid services who should not be receiving services, but because of these issues at the local level will remain eligible until they catch up at the county. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] Thank you. One of the assumptions that the OSBM and the Governor’s budget as well as the House in accepting those numbers and operations made was that a large majority of those pending applications would be significantly denied, that they were ineligible. I believe all calculations, somewhere about 75 to 80 percent of them would be thrown out for various reasons. What type of estimates or calculations are you using for the assumptions as to how many of those are coming through, and what’s the difference in those two numbers? [SPEAKER CHANGES] Senator Hise, I’ll respond to the first part of the question, then Steve can tell you what he’s actually done in his model that he’s presented, and that is we’ve seen that information from the department where I think it’s about an 8 percent approval rate, but without knowing whether that’s just a really random sample or whether it came all from just a few counties, it’s hard for me to know whether that’s a real 8 percent or whether it’s been skewed in some way, so I don’t know whether the 8 percent is a valid 8 percent or if it’s just because of the sample that they actually used, so we I think have gone back to our original ACA projections for our worst-case scenario, so Steve can talk about what he’s actually included. [SPEAKER CHANGES] We’re trying to parse the applications between those that are coming from the exchange and those that are coming through the DSS. The information we’ve got from the counties are that about 62 percent of the applications that come through the county process ultimately get approved, so as a parse, I’m using 62 percent on that side. We’re using 22 percent on the exchange side, partly… that’s one of the numbers that we’ve also seen from the department. Based on some of the research I’ve done in terms of the exchange processing, that seems to be fairly reasonable, but those are the two numbers and we’ve also added in a little extra on top of that. [SPEAKER CHANGES] Follow-up? [SPEAKER CHANGES] Just for a final follow-up, if we had gone to this… if we, based on your estimate right now, if looking at your estimate, if we were instead to accept the House position or OSBM’s position on the budget, what would be your total estimated shortfall we would be looking at coming into next year? [SPEAKER CHANGES] I think for the House budget, ?? here, the House’s number would be 103.3 million in 14-15. Their current year shortfall number based on our revised numbers would be 25.4 for 13-14. [SPEAKER CHANGES] So about 130 million just for that calculation. [SPEAKER CHANGES] Senator Tillman? [SPEAKER CHANGES] I’m going to try to take off a little bit ??. I think you’re getting to what I was wanting to get at, and we’ve been working with Senate and House budgets and trying to reconcile them over the last several years. Now we all start off knowing what the problem is, and we come up with assumptions, and based on those assumptions, if you look at the bottom line on 2014-15 budget, we can see a 90 to 100, who knows? It could be 150 million, but we’ve got a huge difference there with two groups trying to come up with an answer to this problem, and everything else that we’re going to do down here with the budget cannot move unless we fix this problem that we’re looking at. Now it’s like nailing jell-o on a tree. You ever try that? What I want to know is whose numbers are we going to trust, and over the years, whose numbers have been close to right and whose numbers have not. Somewhere you’ve got to say this is the set of numbers that we think is best at estimating what the shortfall will be. Tell us what’s the history and what do you…

… think? [SPEAKER CHANGES] Either one of you two want to jump at that? [SPEAKER CHANGES] I don’t think I can handle that. I will tell you that last year in the various budgets that the same rebase was used from in the House and the Senate and also in the conference process, and those were fiscal research rebase numbers. So starting last year, you changed what you had been doing, and that is you used a national growth rate. You didn’t use flexible cuts; you used cuts that were tied to specific policy changes. I do believe, and I can verify for you, that all three budgets had the same rebase, and the cuts may have varied but the rebase was the same. In this instance with the House going with the Governor’s backlog number, that’s a number that can be debated. We’ll tell you that we have our methodology for trying to figure out what’s at the local level. It’s not probably much better than what the Governor’s using; it’s just that we are using a worst-case scenario. We were asked by the Senate to prepare a worst-case scenario, and that’s what this is. So the decision by the Senate was to use a worst-case. The House’s decision was to use sort of a hybrid. [SPEAKER CHANGES] Follow-up? [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] My point is if we don’t choose the worst-case scenario, we’re going to be back where we’ve been every year. A billion, billion and a half, two billion dollars that we’ve had to make up. [SPEAKER CHANGES] Last year, Senator Tillman, you had a structural problem of over 200 million and you had the growth, so a growth rate, if you look at 5.3 percent, hopefully you’ve made some progress there. It shouldn’t be 500 million again unless something goes really wrong. Part of the problem is that there are budget reductions that haven’t been achieved this year, or else you wouldn’t be looking at 200 million dollars. 90 million dollars is associated with cuts that were not implemented by the Division of Medical Assistance. But moving forward, we would be hopeful that the worst case is really the worst case, and however you decide to fund it, you’d have funds available that would cover that and you wouldn’t have to have a shortfall bill, but given the fact that we don’t even know how many people are enrolled in Medicaid, I can’t give you an answer on that. I can tell you we’ve tried to think of everything possible and put a number to it, but I can’t… we don’t know what the ?? would be. [SPEAKER CHANGES] Well… [SPEAKER CHANGES] Senator Tillman, let Senator Brown. He hasn’t… [SPEAKER CHANGES] I just thought I’d ask Susan maybe to respond to this. This is a totally different budget just because of information, compared to what we’ve been dealing with in the past, and that’s one of the reason you have to take worst-case scenario, is because you don’t have the information that we’ve had to deal with before, and even at worst-case scenario, I’m sure Susan would tell you that she’s real skeptical about these numbers dealing with worst-case scenario because there’s so much uncertainty out there, and I think that’s important to make sure everyone understands that. [SPEAKER CHANGES] Senator Berger. [SPEAKER CHANGES] Thank you Mr. Chairman, and I’m kind of new to this process, but what information is it that we’re missing, and have we asked for that information? [SPEAKER CHANGES] Steve? [SPEAKER CHANGES] Senator Berger, the information we’ve asked for relates… is around enrollment; how many people at what program and category, numbers of recipients. We’ve asked for… we’ve tried to get information about the applications that are pending in process, the number of applications that are in the DSSs that haven’t been put into the system. Those are the three, and we have… enrollment is probably the most significant one. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] Yes sir. [SPEAKER CHANGES] And you’ve asked for this information from the department. [SPEAKER CHANGES] Yes sir. [SPEAKER CHANGES] And what if any response have you received? [SPEAKER CHANGES] We’ve received multiple iterations of the information. It changes every time and when we get it and ask questions, we never can get a satisfactory answer that we have real information. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] I think everybody knows the answer to this question, but what impact would we expect to see on the budget if we don’t have that information and, I’m going to call it “guesses” that are being made, are incorrect? [SPEAKER CHANGES] We think, Senator Berger, that if we had the same enrollment data we had last year, the worst case would probably look better. So that would be… we would hope that that additional information would help us be able to get better per member per month utilization data and help us firm up our numbers, and some of these risk factors that we’ve had to put a dollar sign to wouldn’t necessarily be as high. So I think that would be the impact of the additional data, but… [SPEAKER CHANGES] Follow-up? [SPEAKER CHANGES] Well just a statement, Mr. Chairman. I think that’s the reason the committee…

You wanted to have somebody from OSMB be here today to help us answer these kinds of questions. [SPEAKER] I would agree. Senator Tillman, did you get all your questions answered? [SPEAKER] No, but I'm gonna stop. [SPEAKER] Okay, Senator Rucho. [SPEAKER] Thank you. Mr. Chairman and again along the line and I appreciate trying to canvas the counties and the providers since we have a challenge in getting that information. But, along the line of what Senator Burger was talking about, without that information as to how OSMB actually came to their numbers and they're not even here to defend their numbers. Then a prudent business person, and I ask a prudent would take worse case scenario to put some certainty in the budget. Would you agree? [SPEAKER] We believe if you do not want to be facing a potential shortfall when you come in here next year, that's your goal, then you would go with that scenario. [SPEAKER] Okay, Senator Bryant. [SPEAKER] I wanted to follow up, to some respect, on the line of questioning that President Pro Tempore Berger was on which was similar to mine about what's knowable and non-knowable. And I was only going to ask, are we completely or do we have to be completely at the mercy of the executive branch agencies on an issue like this that is so critical to what we do. And this is more of a going forward question since we know we're in this transition according to staff it's not even predicted that maybe by the end of 2015, if I'm correct? We really know the answers to some of these questions. Do we have the capability to somehow implement something that gives us more control over the numbers or the process or can somebody go into the account files or do we have to go back to some old fashioned process or something and get people to do that. I don't know what needs to be done, but I just cannot believe it's un-doable. And I wonder to my question to the chair and perhaps even to President Pro Tempore, or whoever might know; is there anything we can do? [SPEAKER] Okay, before l give you my opinion Susan would you like to. [SPEAKER] Sir, Senator Bryant this past year, we want to let you know that HHS has given us access to their data warehouse. So fiscal research will have the capability now and can go and look at their data. The problem that we are facing and they are facing is the actual data. Because these are new systems and they are still having issues with the systems, the data is not as good as reliable as it should be. Now we're hopeful that will change moving forward. And when it does, we will have access to the raw data that we need and can run any kind of scenario or analysis that we need to. So that is coming, it's just that we don't have that for you unfortunately right now. [SPEAKER] Okay. Senator Ford. [SPEAKER] Thank you Mr. Chair. Based upon the uncertainty and the lack of data, how can we say for certain that people are not being overpaid or underpaid? [SPEAKER] Susan. [SPEAKER] We probably can't say that. [SPEAKER] Follow up? [SPEAKER] Follow up. [SPEAKER] To me, that is a very disturbing scenario where we are taking tax payer money with good intentions but with no verification that we're doing th right thing by it because of a broken system. Mr. Chair, I encourage this body to take some actions so that we can bring some correction to this situation. [SPEAKER] So noted sir, thank you. Any other questions or comments from the members? Did anyone by chance from OSMB show up? If not. Senator Page, excuse me. [SPEAKER] Just one statement Mr. Chair. I do believe that this shows the critical necessity for reorganization of MEDICARE, MEDICAID excuse me. Let me pick my terms out. It really shows that we need to reorganize MEDICAID so that we will have accurate data and do the best we can for the citizens of our state. [SPEAKER] Thank you. Any other questions or comments. If not. Senator Brown. [SPEAKER] Can we vote on that? [SPEAKER] Thank you Mr. Chairman. I just regret that OSMB isn't here to make their presentation. I think you know as a body we try to put together the best budget we can. These are are difficult budgets, but you got to have as accurate numbers as you can have to put these together and.

And I think, I hope, I hope you see that using worst-case scenario in this situation is probably the only way to go because of the uncertainty we are dealing with trying to put this budget together. And, before you can continue on with a budget process you’ve got to have good numbers and I think the numbers we presented today are probably the best numbers to move forward with. And I hope that we can get our House counterparts on board with that. [SPEAKER CHANGES] Senator Apodaca [SPEAKER CHANGES] Thank you Mr. Chairman, we’re sitting here and what is it June 19th, I believe? And we still don't have numbers. If push comes to shove, we can always issue subpoenas, and have the numbers come to us. So, let’s don't take that off the table. I mean we need to get moving here and get out of here. Thank you Mr.Chairman [SPEAKER CHANGES] You’re certainly welcome. Any other comments or questions? If not , thank y’all this meeting is adjourned.