[BLANK_AUDIO] We're gonna get under way. The program evaluation Division oversight committee meeting will begin. It is 1:06 PM. Before we begin, we want to remind everyone to do what I just did, to make sure all their noise-making devices are put in Into non-noise making mode and I did do that, Senator Gunn just to let you know. I'd like to introduce of course our Sergeant-At-Arms from the House, Mr. Reggie Seals, to my left David Lighton, right behind him, Terry McCRaw. Terry McCraw is not here. And Randy Wall. There he is. From the Senate, Terry Bernhardt, there he is. Sorry. Francis Patterson. Hello, Francis and And Hal Roach. Thank you. Do we have pages? >> No. >> No pages. So to begin with, I wanna recognize my esteemed Co-Chair, Senator Hartsell With nothing to bring to our attention. And I'm gonna ask Mr. Turkott/g to introduce his new PED program evaluator. Mr. Turkott/g.>> Yes, Mr. Chairman and members. We're very pleased to have on our staff Emily McArthur. Emily, stand up Emily is now a homeowner in Riley. She's working on her doctorate in public administration in North Carolina state. She has a masters degree and a Bachelor's degree from LBJ School in Austin, Texas. We're very excited about her. She She has expertise and education. Education finance, number of things and she won a sweepstakes of one of the two openings that we had. We have another one starting next week. Patrick Mayday and he'll be joining us So welcome Emily. >> Welcome Emily, thank you for joining us. Buckle your seat belt, it's always an interesting ride around here. With that done, we have minuted to approve. Take a look at those minutes Minutes and any corrections and additions, subtractions or various other manipulations, all those in favor of approving the minutes say I, all those oppose no. The I's have it. Thank you very much. And now we're pleased to welcome our State Auditor Hon Beth Woods. Good morning, oh afternoon. >> Good afternoon. [BLANK_AUDIO] Thank you Mr. Chair . I'm here this afternoon to present up a couple of items. The first one is The results of an audit we did and released in August of 2014 and this had to do with Medicaid provider eligibility. And we were looking at department of health and human services processes, what they look like in order to enroll only qualified providers in North Carolina medicaid program. So of two handouts that I gave out today, one of them is labelled executive summary and that's the one I'll start with today. This is the summary of the audit results for the Medicaid provider eligibility. One of the reasons that we looked at this system, a couple of things. First, obviously because North Carolina is Is a pay and chase state. We pay out Medicaid benefits if you will and we pay them out, and then hoping that we did it right , that we paid the right people and for the right people.But we do that a lot without documentation to support those payments. So obviously on the front end making sure that we are paying the providers only those who have been approved to be a provider in the medicate system and receive, provide services to patients and receive payments for those services is important aspect. So under the background we'll sort of give you a quick summary Of how this works, the screening and enrollment of Medicaid providers required by federal laws and regulations.
However the federal laws do not set standards or criteria to determine providers enrollment qualifications. So that decision is left to the State's Medicaid Agency. So I would say the criteria by which a provider is allowed into the system is set by the agency and that we did not audit. So the department of health and human services are responsible for setting those criteria. They then outsourced this Provider application approval to CSC and as a contractor to approve those applications. They set forth this criteria and once they do that the criteria may be used to approve or reject a provider From providing services of being paid with medicate monies. However when they ran into some situations, that raised red flags about a provider, then the agency had those what we call higher risk providers, they had them sent over to DHSS for For a section of their staff to take a look at what the red flags were and decide whether or not they were going to be approved. So the four areas of rectification and I've got those listed and bolded, here before you, so there are several things four to be exact that and Application applicant is supposed to be put through. he first one is a database that maintains a list of penalties and sanctions that are levied against providers. The second one is a list of providers that are excluded from any Federal health care programs. The third one is a Background check for identifying criminal convictions misdemeanors or felonies and the fourth one has to do with licencing of this providers. And then just a side note just to let you know that the contract for the provider enrollment application reviews we spend 4.6 million Million dollars in 2012 and 5.3 million dollars in 2013, and the contractors CSC is paid based on the number of applications that they approve. So on the second page we get into the key findings and there were two, but we Some sub bullets under each one of them, and in our audits we will list we think the most important, the highest priority, the most egregious tight findings if you will first, so in this case we talked about how CSC will get the initial application and if everything was Was fine then they would approve the provider. If they have some clear cut criteria for rejecting, they could reject it before the most part if they run into some red flags or spook the saying, this providers over to DHSS and they will take a second look. So what we found were deficiencies in this Second review that was being done by DHHS. They lacked DHHS, the division of DMA, lacked documentation needed to review this higher risk approvals. A lot of times this provider application files did not have Have information in them that we really would document why these providers, even though they were high risk, were allowed to be approved. Information about the criteria that were used, to go ahead and evaluate these providers, and say that they could be approved The information was not present. The criteria, and how it was considered was not present. And then how the final approval decision was made was not present. Secondly, the division liked reviews for higher risk provider process. So there were no reviews performed By the division. In other words, when a high risk provider, one that had had some red flags through those four databases that we looked at, there were no real reviews to go back and say, okay you had this high risk provider, you approved them. And we found that there were 800 and 43 high risk providers sent to DHHS in 2012. 548 of these did not have the sufficient documentation, for anybody to go back and say, yes you considered the red flags. And yes you made the appropriate decision about letting them be Be an approved provider. So there were no reviews to go back and anybody to review what the initial secondary review as done and did the right decisions get
made once they considered the criteria and then there were no supervisory controls over this process to ensure That those doing the second review of these higher risk providers that it was done appropriately and in accordance with division policies and procedures. And the third bullet under that finding the division likes efficient written procedures for documenting approvals. Their was somewhere between 6 and 10 reviewers Of these higher risk providers. And again without written policies and procedures their is no real insurance that their is any consistencies being done by all of these reviewers of these higher risk providers. And again their was no documentation of how they reached those decisions. So then finding number two basically With the contractor them self. And overall application on reviews at the vendor. So under this finding number two, we found that some contractor files were missing documentation which indicates that the risk that some of the applicant verification checks were even Performed, so we've got those four verification checks that have to be done,whether it was licencing, whether it was criminal background, whether it was provision by the federal government that this providers could even provide medical care or medicate recipients, there was no documentation to support Held that this checks were even done. Now you are worried about where the checks you've been done are particularly when you look at the fact that CST was being paid on a per approved application is how they got paid. Not saying anybody did anything wrong, just saying And the door is wide open because there're in an incentive for more applications approved, the more money CSC will take in. And so there's a risk there. And so if you don't have documentation that those verifications were done, you do run the risk that some of them were not even done. Some verification checks were performed by the contract Using incorrect provider data. We found that the providers maybe misspelled the wrong name would be used I think more importantly we found a number where the wrong social security number was being put in to do this verification checks. So if you are not again, Some kind o review process and make sure that things are being done as they should, these kinds of errors can o and be undetected and then you're not necessarily sure that the provider that was approved should have been approved. The third [UNKNOWN], the contractor and the decision monitoring procedures were inadequate. They really weren't going back and following Up to make sure those who were processing these applications were doing it in accordance with the policies and procedures and again documenting that they even did the procedures. And then the fourth bullet, the Medicaid contract that was in place at the time of the audit did not contain performance measures to hold the Or the contract accountable for accuracy and reliability can. Nobody from DHSS was going in and taking a look at those that were approved to be providers in this system and then again making sure that they were truly everything was done as it should have been done And that the providers were certainly eligible to be providers in the medicate process. And we talked about this reviews. We go back to the first finding and during the audit we had covered of course DHHS new about this but by not having this reviews in place, by not making sure that everybody Is doing thing consistently was found that one of this reviewers of a higher risk provider was rubber stamping every one of them and not performing anything, not going back and doing any kind of review that higher risk provider, they were just rubber stamping of course that Employee was terminated, they had just rubber stamped the eight months. The agency was not aware of it. It was a vendor, a physician, a provider that complained about it, that the applications were not being turned around timely and so it was from that point they discovered the reviewer Really wasn't doing any of the verification, any of the checks that he should have been doing. He was just rubber stamping and sending everything through. Also note that of the 848 higher risk providers that went from CSC to DHHS for the secondary Review because of red flags, almost if not all of them I think it was close to 100% of all of those that had red flags high risk providers DHHS approve them to be providers within the system.
[BLANK_AUDIO] So some of the recommendations that we made are that specific evidence requirements for determining and documenting provider eligibility should be added to the enrollment process procedures . The contract between the state and the contract that should establish documentation requirements and performance measures for accuracy And reliability again there's no evidence to support in a lot of cases where the verification process was even done. And so if there is some sort of performance matrix in the contract and then the agency is going behind CSC on the sampling basis and determining that they're meeting those performance matrix , we possibly save the state money as well as making sure that only eligible providers are getting into the system. And then of course systematic quality assurance reviews of the enrollment processes should be conducted. So for that With that provider eligibility Mr. Chairman, those are our findings. >> Great, thank you very much Madam Auditor. Before we take questions or comments from committee, we have with us Mr. Dave Richard, our deputy secretary for medical systems for DHHS To provide a response and then we'll involve the committee in questions, comments or for either before we move on to a second part with our auditor. So with that, I just wanna say thank you very much. Let's call up Oh, he is in the back, so all set to go. Mr. Richard, you are recognized. [INAUDIBLE] You are not on. >> there you go, sorry. Determinate favor to with DHSS and the main thing we wanted to be here is that if we have to respond to any questions I wanna say we respect the auditors work on this, we have taken those recommendations Recommendation very seriously. We have a correct of action plan that we have put into place. We have our office of internal audit which is reviewing that plan and we will have a final report for us on September to make that we have here all the complaints areas but again we appreciate the recommendations and recognize the changes that had to be made. You Mr. Richard from the committee, Senator Brigham. >> [SOUND] >> Thank you Mr.Chairman. I certainly appreciate this report, every time you come, you surprise us with all the things you find.We appreciate you very much.I mean it You had indicated the 843 high risk. Can we get that information? The committee? Can the committee be informed of who Who these high risk and the ones that's being charged with felonies and other things just for our information. >> Mr. Chairman, you could say the high risk, I guess we could. >> Is there a confidentiality issue? >> Dave may have to help Have to help with that and in every case for instance if someone was in contempt of court, it may show up in one of those background checks but it may not be prohibitive to allow somebody to serve He Medicaid recipients but Mr. Richards would have to help me whether or not we could turn that because it's confidential as we speak now because it's part of our work papers. >> Dave Richard again from DHHS and truthfully I don't know the answer about what our ability is to turn over information. I'm certain that we will go back and check And make sure that if that's possible we can. But obviously with the [UNKNOWN] everybody who shows up on that list would not mean they were ineligible to be part of the Medicaid program. >> Right, I understand. I just think it would be helpful and especially identifies criminal convictions. We could certainly get that, couldn't we? Wouldn't that be Have knowledge that anybody could access but it be helpful to this committee. >> Again Dave Richards. Senator, the only reason I'm not answering directly is because I'm not a lawyer and I wanna make sure we overthink our legal provisions of the Medicaid program. I'm assuming we can but I just wanna make sure that I'm correct. >> Would you look Into that and if it's allowable, provide the information and if not provide us a statement. >> Yes sir. >> Mr. Chairman. >> Oh, I'm sorry. >> I was just gonna say one thing and just recognize this is a 2012 audit.
So those names are two years old. >> Well it doesn't matter to be if they're They're still corrupt. I just like to see who they are. >> Okay, okay good. >> The other question I got. You're paying I think you said or you indicated that they're being paid by the number of applications or something. Why don't we pay them by the convictions As we find rather than just, what happened is [INAUDIBLE] improve the system. Or is that something we can do? >> And that's why the recommendations in here is that they should be some performance matrix and then a quality review process, in other words we say that they have to be 95% or 98% accurate Accurate of everybody they provide say is they have approved that they truly are eligible and then if the agency will perform a sampling of everybody they approve and then hold them to that but the contract doesn't provide for anything like that at the time we did this audit and I don't believe in new contract provider for that either That would be certainly the way to go is making sure because if they are skipping steps to get the applications done faster, we had some statistics I think it's was like 65% of the 65% showed either they didn't have a, let me go back to the first one. It's 25%, that's what it was Was missing at least. It was 25% was missing at least one documentation for at least one of those four mandatory verifications, either the criminal background check or the licensing issue or not being able to be paid with federal money. So We looked at 200 out of 14,000 and 20% of those was lacking documentation where at least one of those checks hadn't been done. And so you're saying number one, we don't even know if they did them and number two, how accurate were they even if they did do them? So some kind of performance metric in the contract would be important. >> Thank you, thank you Mr. Chairman. >> Senator Hise. >> Thank you, Madam Auditor. Just to kind of add one under this. I believe your recent audit at the department I believe found that providers were getting paid even though they weren't approved as providers through the Through this process. Is that accurate as I remember that documentation didn't match up at all and hadn't gone through the process yet payments were still being made. >> The issue with that, Senator, was that they were in the system as not being approved and yet we paid them anyway because that edit check had been turned off. But when the agency went back and looked at all 40 of those, I think they found only one that shouldn't have been paid. So it was really more of a problem with the system. >> Follow up? >> Follow up. Kind of specifically for the department and I know this goes back with this auditor with report. I guess knew this in 2012 for this process. It was my understanding that since then we also entered into a new contract with CSC that was coming in after we got through the whole process and evaluation so I would assume that since we've changed contracts, since this sort of finding that the new contract does not pay providers on the basis of approval of this, is that correct? >> Senator I am gonna go back and check, I pointed out cuz I have gone through the [UNKNOWN] plan and well it's part of the plan. i will go back and check But you don't think it was changed at the previous contract negotiations. >> I am not sure if it was, I wish I, yes sir. >> And let us know. >> Yes sir. >> And just comment I think probably of everything in this what I found, the biggest problem is that we create a system to where we reward the contractor for not funding something, so how we wound up in a payment plan it would seem much more logical to me that we would pay them on the number of applications they process versus trying to say we will pay you on the number you approve in the process and I assume if the department takes over approval even if they can't get into the department, the department approves it, I remember that I paid for that either, so we might be missing them at the partial. >> Why neither it's an economical intensive to say yes when I would say much more form the contract purpose of the state, it would
mean much better to say we contact you for all the applications that were sent to you, the individuals that apply and that's only about a number of 600 different and that as much as we could under federal law we create an incentive for denials. So if they find the reason and that holds up to the end they save the state a lot of money by keeping providers out and I couldn't begin to imagine that someone was on the after so inspector general exclusion database, so we can't pay them with federal money, whatever be someone we would openly say yes to in this stay, thanks for coming in and that's one of the four commentaries that's coming << Mr. Richard point well taken. Thank you, representative Harley. >> Thank you Mr. Chairman. Is there a penalty on the contract in case one of the providers is turns out to be in trouble or whatever is their county in contract? >> I don't believe so Mr. Reece could probably answer that question better and again that was probably one of the issues that wee no real penalties and penalty clauses in that contract the initial one we looked at. >> Mr. Richard I am gonna give the same answer again I will go back and actually you have any information, I don't wanna quote something wrong. >> Thank you follow up? >> Yes, I need to ask Mr. Richard a question. On this office of the internal auditors that you have there, how many internal auditors do you have? >> I don't know this is within the DHSS internal audit section, I think there's' about 40, 60 excuse me. >> 60? >> 40 sorry. >> Either way I know it's a big department, however this things looks like it could have been checked when they started so I just wonder what exactly do they do? >> May I respond. That is an increase that has happened over the past two to thee years in terms of those number of people in the audit, one of the things that we have recognized in DHSS is we did not have that function at a level that we needed to have in an internal audit, so it's a very important part of our transition that we are going through. >> Mr. Chairman may I just. >> Please. >> Comment I was gonna say I think initially when I became state auditor they were six internal auditors and over a course of a couple of years they went to 40 and even at that it was a huge undertaking to bring that many people and get them geared up for DHSS, so that I will have to say from that perspective they are trying cuz they were only six in the whole department at the time I became state auditor. [BLANK_AUDIO] Thank you. >> Senator, I'm sorry. >> Wardell/g. Thank you Mr. Chair and thank you for this report. I see a lot of the things that we discussed earlier at the last meeting are contained in this report and I think that's very good and we've had someone to talk about those counties that were experiencing difficulty and the help they will be provided that would be very, very helpful and just wanted to know the counties were aware and I've seen some other reports that related to what they were involved with. >> This really was about the providers that are allowed across the state to be a provider, doctor, dentist and home healthcare provider, doctors within a hospital. So this was really about eligibility for those people to render services to participants. This really didn't have anything to do with the participants themselves. >> Thank you. >> Representative Dollar >. Thank you, Mr. Chairman Madam Auditor and it may be in there and I just missed it. But is there a particular type of provider or a particular type of setting which was ore problematic than others? In other words was there any particular pattern along those two factors or not. >> I don't believe that we looked at it from that perspective but certainly I will check on that and get back to you on that because it makes sense when you're looking at hospitals versus sole practitioners and you're looking at clinics versus sole practitioners, you're looking dentist versus Opticians and that kind of thing. So it would be interesting to note if there was an industry that was having more problems than another. >> Thank you. >> Seeing no further questions, do you have a final comment, Madam
Auditor. >> No. Pointing to Mr. Holmes to get that question so we get back to Representative Dollar. >> Okay. Let's then move on to the status of the audit required under section law 2017-7, accuracy in determining Medicaid eligibility. I assume that's the status report a sheet that you also had handed out? >> Yes it is Mr.Chair. >> Thank you, please continue. >> So we have this particular audit the General Assembly asked us to look at Medicaid eligibility determination at the county level and to look in to see if it was to determine if it's being done timely and accurately. And it was the initial application as well as the re-enrollment in addition to the Medicaid presumptive eligibility determinations. And I just wanna say that we looked at it from the perspective I did that. The federal government considers Medicaid a state administered program. So we own the computer, we own the system, we pay the bills, the eligibility determination while its done at the county level. This is considered a state administered program.And so the counties are just acting as that arm if you will to determine locally those that can participate in the program. So on March 26th is when the legislation was passed and I was approved for us to do this audit. So from June 2015 to January 2016, we came up with our sample of counties that we were gonna take a look at. So initially when you say let's look at Medicaid eligibility determination across the state of North Carolina, we determined earlier on that that was gonna be impossible for us to make a statement about eligibility determination across the state of North Carolina and the reason being is that every county has the ability in some way or another to do things differently at each county, so to say this way across this whole state will not be a way that we could do that, so after some discussion we've selected 10 counties and you'll see see that criteria here under the second paragraph, so we looked at population and number of medicaid applications and came up with three categories large, mid size and small. The General Assembly had asked us to make sure that we include urban and rural and when we went through that process we found out we have urban, suburban counties and rural, and then we decided that it would be appropriate if the geographic location they we went East West and Central. So the counties that we came up with for the ten we picked Wake, Macklenburg and Billford. They are the largest, they are urban and they are centrally located. Relin was the suburban mid sized, and then the smaller counties were [UNKNOWN] Madison, Rockford, Washington and Wilkes, so in the first face our staff of auditors visit each one of these ten counties to determine how it is that these counties are determining eligibility. We have Incey/g tracks, incey/g fast which ones you get the information into the computer, the computer will determine whether they're eligible or not. But it's that intake, it's determining the information that's necessary then, it's getting it into the computer and then, it's making sure that the computer, I mean you still have to test that occasionally to make sure that the eligibility determinations, what's going on within the computer it was done correctly. So we've gotten through that part of what we're attempting to do under our phase one. So under phase two we will start testing the accuracy. and timeliness of eligibility determinations .We contracted with Vanguard Professional Staffing. They will go into each county and they will look at two populations. One for the applications, is one population, and then the re-enrollment another population. They'll be 250. A minimum of 250 in each of those populations They've already submitted to us for our review.The first quarter of applications that have been done . In quarter two, they are now working on testing. And what they're doing is their re-determining manually eligibility and then the final audit report will be finished in December of
2016.We approach this from the perspective of a couple things.One of them being what would it take to make sure that eligibility terminations are being done appropriately.So we thought qualified staff, we thought controls in place to make sure that what goes. That the applications are being taken down or the manual work if you will or the intake is being done properly by qualified people. And then making sure that once, that once information goes into the computer, what you had on paper ended up in the computer accurately and then on the back end, if as these people are determined to be eligible then the to have some sampling process to go behind and say yes this makes sense, that came out of the computer turned out to be eligible, now will re-perform it manually, yes it makes sense. Once we go tin there and started doing this initial gaining and understanding,l we ran into some issues that appeared to be IT related. We had some accountee or two to say that, once we got in to put the information in the computer it didn't determine it correctly. We had a couple of counties to say, that they would put the information in, it wouldn't take it, they would put the information again, it wouldn't take it, put the information in a third time, finally it would take it, or you put it in it wouldn't take it, you shut the computer down, turn it back on, put it in then it would take it So because of some of the It related issues, we have initiated an It audit to run alongside with the issues we're finding that might be IT related within this process, so that we will deliver both reports at the same time. So, if there are any IT related issues that the committee needs to know about, they will. The other thing we looked at is that, we know that the counties no longer have to pay anything, there is a state portion of MedicAid that has to be paid into the federal portion it's a 65- 35 split, and the 35 being state monies and at one time the counties had to pay that and so it made it, it was more important to them to make sure that only those that are eligible were determined to be eligible, well now the state pays a 35% totally And so the counties, there's not as much incentive as you will to make sure that the eligibility of termination is being done accurately and plus the salaries for those case workers, those intake people are being paid by the counties cuz we were thinking initially that that's all coming out of federal monies so the salary should be the same, you paying for talent to people to conduct this interviews and take down all this information and give it to a computer properly and that really is on individual counties to pay the salaries of those people so a lot of different issues rolling into this process and so we are taking all of that into consideration and those types of things will be in our report in 2016, December, 2016. >> Great thank you very much, questions of. >> Mr. Chairman may I just say when we issue our report, what you are gonna see is here were the results for Wake county, here were the results for Macklenburg county, here were the results for Guilford, you will not see a here what's going on in the state of North Carolina as far as eligibility determination because it goes county by county by county as far as there's this too much flexibility and then another thing that I guess we ran into is that while this is a state administered program, not sure that DHSS has all the teeth that it needs to make things be more consistent across all counties. From the implementation of the NC fast to making sure there are policies and procedures in place. To ensure that only the eligible participants are being allowed into the program. I'm sorry Mr. Chairman. >> No it's fine. Any question from the committee, Senator Hise and Senator [INAUDIBLE]. Senator Hise? >> Thank you Mr. Chairman, I don't think your gonna find a lot of shocked people that have an IT problem within roma/g we've heard from our DSS for a long time. Although we are here from another [INAUDIBLE],
so that's trying to get it on and others. But the two questions I really want to dive into is the re-enrollment eligibility and the presumptive eligibility requirements. For all of this counties, I guess first the re-enrollment eligibility were out of the whole auto-enroll eligibility process cuz I think for a long time, particularly last year we just had seasons everyone was automatically re-enrolled in the process. And for some other benefits we still have that, so I was just making sure that for these counties we're out of the auto-enroll for re-enrollment Enrollment were everyone is determined eligible. >> Am not sure that we know that. I have Cynthia Hefren with me she is the supervisor on this particular audit. She's heading up this audit. >> Press and pope/s please. >> Okay, identify yourself. >> Good afternoon, am Cynthia Hefren supervisor with auditor wood for the medicate eligibility audit. Actually as the vanguard staff we determine the eligibility we have an indicator. If you will, if it's been auto extended am not quite sure how that works. I think I've heard that maybe there are a few more counties that are maybe the bigger counties that are still involved in this, but that is something that we'll be looking at as we test throughout this fiscal year. >> Okay. Follow-up? And then and I think I can get a list of who we still have on that for coming in for the present abilities. These are original determination isn't necessarily made by the department at DSS. This is more likely someone presented in the hospital and seemed to meet all the criteria of being a Medicaid recipient. But it's I think from the new federal policies coming out, they have the risk of providing those services of never getting paid by not being determined as eligible as for coming. And I think some hospitals are worried about losing those funds and might not be doing any predetermination cases as policy because they don't wanna run the risk of losing those funds in the future. And the better question is as most of these aren't done with DSS until after they've already occurred, that's with coming in, how are you determining with the DSS their procedure? That's with coming in or are you actually going to the hospitals and doctors and others to see if they're making the correct determinations. >> Identify yourself again please. >> Yeah this is Cynthia Hafrun/g. Actually when we determined that the eligibility was not being actually determined at the county, we decided or we have talked about looking at it in another way because it looks like it's pregnant women basically. So what we are trying to do is some analysis to provide basically to see if in fact the people that have been determined presumptively eligible if in fact they come back at some point and get full Medicaid or what that really looks like. So we're gonna try to approach it in that manner. >> Mr. Chairman. >> Yes. >> But I think you've hinted on Senator Hise/g that I mean it's a risk when somebody walks into a hospital and they give out the information that seems like they're Medicaid eligible and they're really not. Then the hospital is gonna run the risk that they won't be aid. >> They can just [INAUDIBLE] It's also with pregnant women also you see that most present at delivery [INAUDIBLE] for coming in and after presumptive/g and they have no reason to come back in and present some other point to be eligible for Medicaid. So it's a different criteria area and I was just trying to ask some of those questions see if we can get a sense before we dive in to all those because there are so many problems, I'm not sure that they are within the county and that kind of area when it comes to presumability/g. >> I would agree. >> [UNKNOWN] >> Thank you Mr. Chairman. [COUGH] excuse me. This is extremely confusing and [INAUDIBLE] probably understands this better than anybody in here. Did I understand you just say that, this is, first off this is a state, so far as federal funds are concern this is a state administered program. >> Yes sir. >> And there seems to be some some discrepancies in the payment. You indicated that counties, each county pays the salaries for this folks. Most counties, the salary is different according to the county of that can afford it or how does that work?
>> You are exactly right. Different salaries for different counties. You are right. >> Okay. So is a large turnover in this, that does also create part of this problem? >> We haven't been able to determine that yet as far as the turnover. Mr. Chairman? >> Identify yourself each time, I'm sorry. >> Yeah. This is Cynthia [UNKNOWN], actually when we were out in phase one, that was something that the counties, talked a about a lot. There has been a huge turnover. Loss of institutional knowledge and yes. The counties, larger counties pay, can pay better, if you will. So there is that issue. [BLANK_AUDIO] >> Yes, Thank you Mr. Chairman, so that being said, that there is a large turnover and of course the salaries being paid by the counties and it varies county to county according to what is conveyed, do you have any stance for how much difference we're talking about. Are talking about double salaries to go to the larger counties or is that something you all haven't had an opportunity to look into yet? >> Mr. Chair, Cynthia Hafrun/g again. Yes we actually did get some of that information when we surveyed. We actually surveyed 300 counties and at times it can double between the rural counties and the larger counties. The salaries double. >> Okay if I must - >> The IT issues that Senator Hise/g mentioned and you as well, is there something or anyone that seems like this been a serious problem in state government for many, many years and I know we've talked about it and talked about it, and then the millions of dollars that's been lost because of it. Is there any movement or any thought in how we could consistently come up with something that would work and assist some of these smaller counties and some of these problems or you've identified the problems but do you have recommendations along this lines as well? We thinking this particular instant because one of the things that we have been hearing , the computer, you put the information in it won't take it, you put it in again it won't take it, you put it in a third time fine it takes it or you search for computer down. Some of the issues that the department has said that the counties didn't build the system memoriam/g according to spec. And so the agency would put out the spec that should be build but then no body went around to make sure that every county built to spec. So now you got this going on The counties blame it on the state but the state saying you never build the system to spec. The bandwidth is not big enough and so that's what we are trying to hope sort of figure out with the IT auditors. Moving along with this but again am not sure that the DHHS has had all the teeth it needed for this to be a state administered program they are responsible for it but it sought of been like the counties have done their thing and the state let him. >> Well, [SOUND] It just appears to me that this would be one of the first things we should, because I don't know that this ever going to improve if we have [INAUDIBLE] if you put it in. Two times God knows who, I won't quit too. I think I want to go somewhere with the system worked >> [LAUGH] >> but anyway, but may be you are right to think that way, but anyway that seems to be very important in a, anyway. Thank you. Thank you madam. >> Chairman Hudsel.>> Mr Chairman, I would like to ask Senator [UNKNOWN] a question. >> I would be happy to answer. Go right ahead. >> Have you ever responded to any of the hundreds of thousands of emails that you've ever received in your office? >> I have received. I have responded to three. [LAUGH] I'm not going to tell you how many I didn't respond to but it it were constituent, I would respond it but if they were not, I got [SOUND] as far as I am concerned. [SOUND] >> Additional questions from the committee. Seeing none I do, you did make a point that this audits were county specific but I'm hopeful that in your final report you will of course give us some recommendations that we can may be and observations that would apply state wide. I appreciate that very much. Any additional questions? Yes, Representative Dollar. >> Just along on that line [INAUDIBLE] also is part of the audit or depending on where the conclusions lead the audit to there will be an exploration of what those individuals who are responsible for those, for eligibility are also being tasked to do. Because I know we can be variation among the counties in terms of what any individual employee or group of employees is actually
tasked to do in addition to medicaid eligibility. And Mr. Chairman I would say for any of the errors the Vangod/g finds for somebody was determined to be eligible and they really were not or the timeliness of we will work on what caused it. What was the reason so we'll once we have the errors will work towards what were the courses. Because the courses could be different among these ten counties but apply to a lot of different counties the other 90 so. So we will be looking at what you call the root cause of why you have an error. >> Right terrific. Madam Honor thank you as always for your complete presentation and your hard work, greatly appreciated. Next I'm gonna recognize senator Hacksaw. >> With some intrapedation I would like to forward the results. of the study of incense of the work group that we had. But let me do a little back up on this if I might. You may recall that the work plan adopted by this committee about this time last year included among other things a study of the pay and allowances for members of the general assembly and actually was one of the top two or three items on that work plan. As a result of that we determined that we would contact the a national conference state legislators and asked them to provide us with information nationwide with regard to the methods of compensation with other allowances for four members of the legislature. Members of the national conference and state legislators attended a committee here as you may recall about five or six months ago and gave us their report which was based upon 2014 data and, we had an extensive discussion relating to all these matters at the time. I believe the session after that, Mr.Tarcon also made a presentation on some other data that he had located.I believe out of the state of Alabama, looking at the pay side of this and, the methodology the state of Alabama had adopted by Zara Core.A constitution memo relating to pay. About two to three weeks ago we received from the national conference for state legislators a national survey on the 2015 data relating to pay and allowances. That data is on my [UNKNOWN ]in your package. In your package you will see three items or several items. One is a draft piece of legislation. It's associated solely with allowances. The second item is just a memo from Mr.Tucker out of the office relating to various states that have in some form or fashion adopted the Per diem with regard to travel, payments or allowances adopted the essential referenced to the federal provisions. There were in that if you'll note their are 26 states who have done so in some form or fashion. Next to that you will find a national survey provided to us by the National Conference of State Legislators. Relating to all of the above, we'd looked at some other things and frankly for timing purposes, really didn't have the opportunity to look seriously at the pay question, you will notice that there are tremendous disparities, differences among the state relating both to pay and to allowances but there is at least some reasonable consistency associated with for allowances the sums associated with the internal revenue code. What the draft legislation in the recommendation of this rather informal working group was consisted of Sandra Bengum, Senator Clark, Representative Harley and Representative Carny and myself actually volunteers in wanting to address this in a bypartisan way. What you will see from this is we have solely looked at the issue of allowances to go to the national consist at lea something that
is comparable on national basis relating to that, that is to say the travel and the per diems, the travel allowance which I might add in the legislation self tracks the last time this General Assembly ever looked at this which is in 1994. I think I am the only person here who was around in 1994 and frankly in my age I am beginning to have trouble remembering what took place in 1994 But none of those things have changed since that time. As you will see what in the second chart on you actually shows the difference in the travel payment and the allowances between 1994 and today, I believe if I am not mistaken the travel has actually reduced a little bit from last year based upon the, and that's no doubt because of the reduction of gas prices. What we do not in this legislation adopt a proposal associated with the specific federal allowances, the references from the code for one reason as you will know we have on annual basis we do in finance and I should come to the General Assembly. We actually make specific modifications as to whether or not we accept or do not accept certain changes in the internal revenue code to apply to ours. There's a reason for that and there's a reason for why we do not do that in this particular circumstance and that is as Mrs. [UNKNOWN] Smith is matching to me, is recently has about two hours ago and I believe I saw [UNKNOWN] walked in but I guess he left. The state constitution does not permit us to make reference to an action outside of what we control to time, pay and allowances too. Absent a constitution amendment is what was used in State of Alabama to modify their circumstances. We do not have that in North Carolina. So what we have done in this proposal by way of full, is simply to change the provisions and which would only go into a fact next year. It would not affect a single person in this room with regard to the current time frame because we cannot do so constitutionally in that we cannot change our own pay or allowances, we can make a change for a future General Assembly. >> I will not be here, so it doesn't affect me in any fashion. I don't believe Senator [UNKNOWN] was gonna be here either, >> [UNKNOWN] >> [LAUGH] He may answer an email or two in the meantime but I'm not sure that's necessarily the case, but what we're doing here is simply recommending that we change the allowances for the next General Assembly to be consistent with what is actually almost a national standard, certainly a majority of off states associated with the provisions in the internal Revenue code associated with paying allowances for state like [UNKNOWN] I will be glad to try and answer any further questions. >> Thank you. Senator [UNKNOWN] So we begin with Sir Hayes. >> Thank you [UNKNOWN] It kind of nerving into this and to mileage and others, I am kind of getting into this catch 22 on either side because right now let's say they set the mileage rate at 54 CN and in a future legislature the feds reduced that number, gas prices continue to drop and it gets to 50 cents. Well the IRS then contain with that four cent a mile is in come to the individual or to the legislature yet you have our income already set in statutes to what it must be And so how do you deal with that if you don't fluctuate the rate and the federal rate drop below the rate that we are currently paying,how do you balance that income with this statutory requirement of what legislative income must be. >> Well under those circumstances I think it would apply similar to what we do in the IRC update,
the general Assembly if it chose to would have to treat,adopt a separate piece of legislation identifying a new. The same thing is true if in fact the expense increases. The general assembly would have to do the same sort of thing. I might add, to the extend if it increases obviously that provides potential for a deduction if it is if it decreases, that element that you are paid in excess of that I would assume treated as income. I might add for any legislature he leaves within 50 miles of general assembly, this particular slot it will be treated as income whether or not it would be. [BLANK_AUDIO] >> There is no questions, comments? Senator [UNKNOWN] >> Thank you Mr. Chairman. I know we've discussed this at length but is there any way that we could let, say for example, cost of living increase, that something is out of the question, is that true? [BLANK_AUDIO] >> It is possible I suppose if it is defined in accordance with a state, adopted provision that this general assembly adopts with specific specifications. It is not, if in fact, if what we are tracking is the federal requirement. Absent frankly, I think a constitutional amendment. I want to differ to Miss Goldsmith/g on that. I think that is a fair statement. If I may I. Mr. Chairman. >> Miss Goldsmith/g please re introduce yourself. I know you are not >> Goldsmith/g sir director of the bill drafting division. That's correct. He can't have a [INAUDIBLE] is something that floats with an external measure you have to set it specifically you can cite to something specifically the way this IRS. IRS flags are sited to specifically but you can't sought of say it floats with inflation, or the cost of living or the consumer price index those sort of measures will not be permissable/g. >> Follow up. >> Well in that case it seems, that seems to be the solution because anytime this comes up, whoever brings it up, won't be here. And we have to learn that and here is the example but so if we in somehow could resolve this so that [INAUDIBLE] wouldn't have to vote on it, because it is going to be a black [INAUDIBLE] I don't care who it is. But if they vote for a pay increase or etc but what would be the chances of a [INAUDIBLE] if we just follow the guidelines as the federal gas, wherever they pay cuz I know it is certainly double or more so than what we do and then the state employees get a cost of living increase every other year. Is the legislature fallen? >> Let me say with regards to allowances that is not the bill is about It was about the pay requirements cuz I thought allowances. Frankly what we are doing here is adopting something pretty close to what the state employees get anyway as far as allowances are concerned. We are not talking about pay we are not about these other standards. The question is whether you use an external standard that is external from what the general assembly controls or directs to create these changes. What we are doing here is we have a fixed number. And it is has obviously been fixed for 22 years now. And we are simply changing that fixed number which regard to those allowances for travel and such. Obviously within the last few years that differential has increased rather dramatically largely on the travel side. >> There is no questions. I think we would all agree that it is pretty much a dead net loser income wise to be in a legislator and if we are going to be able and attract and retain good people and we all want good people serving the needs of the state. It's not that they need to necessarily turn this to a profitable venture but it certainly shouldn't be a deficit. Recognize if we don't allow a bill to forward at point nothing happens for two more years and it's already been over 20 years.
I know their is a never a good time for legislators to talk about improving their lot but it's not about us it's about attracting and retaining just like we wanna attract and retain high quality teachers, we wanna attract and retain high quality legislators and they shouldn't have to. the fact is they wont be able to continue to loose money in order to come here and be away from their families for the lengths of time that we are. With that we have a recommendation for a bill I can assume Hurt's/g will tell us what the process is from here. [BLANK_AUDIO] I need you to repeat that [UNKNOWN] with the mic on. >> To authorize the introduction of this bill on part of the committee [UNKNOWN] >> Representative [UNKNOWN] >> Thank you Mr. Chairman and thank you Mr. Chairman for bring this forward. I've been here 14 years and every time it comes up for pay increase, it goes nowhere. I mean it really doesn't even make the floor. I think this is an approach as Chairman Horn said for other people that might be considering running for this seat to know that your compensation for living, your gas mileage here, etc, is within the realm of what some state employees get and the federal government am I correct? That's what the state employees get, the federal rate. I think the time has come for us to put it out there. I view this embedded up or down but I view this as an opportunity for the public, for us to help educate them. I can tell you and I''m sure you have too the emails that I have gotten since I've been here, about you sit up there and make $100,000 a year and you're gonna do this to me? I don't think we as a political body has done a good enough job educating the community. And I can tell you this had we had compensation in this, that would have absolutely been the headline tom morrow, contrary to what's going on right now elsewhere. But I think the time has come that we put this to a vote. Up or down. And I'm sure we'll hear from people. But if we understand what it does then I think it is our responsibility to educate the public on what it is. [BLANK_AUDIO] >> Further comments or questions from the members of committee? Senator Wardell. >> Thank you Mr. Chair.[COUGH] I think I've come from a farther distance than a lot of other people coming from Mecklenburg County, and it's greatly needed because the subsistence that we get now, the reimbursement does not cover the expenses. When you stay in a hotel, the hotels are continually going up, food is continuing to go up, it really costs to be here be here. So this is an increase and it does help and it's greatly needed. >> Thank you.[UNKNOWN] >> Thank you Mr.Chair I was gonna ask Senator Hartsell he knows in his vast length of time here, if this proposal has ever been recommended or studied by independent agency, that we could be hands off or at least arms length distance away from them as they do their deliberations and let them take a look and see what they feel like adequate per diem and travel allowance might be. >> I know there have been suggestions for the formation of an extended pay commission outside for pay, outside the general assembly. I'm not aware of anything with regard to allowances although I'm not all knowing and all that.I would say that this is here because this general assembly it's members is part of our work, is our draft. This is actually was one of the top two or three issues in it to begin with and again I would reiterate that the allowances that are identified here are specifically consistent with A federal laws and pretty close to what they are for current state employees. [BLANK_AUDIO]
And that's what they're designed to be. It's not designed to address the pay issue. The pay issue could still be addressed by this committee or someone else, but it would not, unless there were a recommendation or something filed by tomorrow it wouldn't be considered for the next two years. This cannot go into effect until under a general assembly, under any circumstances. >> We at present do not have a fiscal note on this but we can get one in a couple of days and get that to all members of the committee. >> It is my understanding that the cost in the effective date of this I believe is our is cost, January 1. My understanding is the cost is around 1.3 million. >> So it would not be in this, the budget we're working on right now, but it would - >> It would be in the second half of the year. >> Second, okay. >> Yeah. >> So it would have an impact. >> It's possible to of course amend this to reflect the effective date of July 1, of next year so it would affect that. But that would be part of the process. >> So this would be an agency it was eligible for introduction, be assigned a committee, some work would be done and get it to the floor So I'm gonna assume we have a motion before the committee to, I won't assume anything. I'll let Senator Fletcher Hartsell - >> I'll make the motion. I'm eligible to do that. >> Yeah. And would you want to state that so we all understand what we're voting on. >> Motion is to prove the draft legislation for introduction as pat of the committee's adjustment. Further discussion for the debate. Seeing none, all those in favor say aye. >> Aye. >> Those opposed no. The ayes have it and we will move forward on this issue. Coming down to the end, here we just need to keep an eye on the time. Next issue is the Medicaid determination of bill recommended from PED, I'm gonna ask Carol Shaw/g to briefly review and comment. >> You all had from our report last week and the bill that you all are getting and Jennifer is getting ready to review for you. It is based on the recommendations of our report and it also takes in to consideration what the chair of the committee ask for us to assure that it had an appropriate appeal process and we worked closely with both the County Commissioners Association, The association for the county DSS departments and the department of health and human services and I believe we've come up with a bill that everyone is comfortable with. That will allow correction action to take place if absolutely necessary, temporary assumption of medicated administration by the state but it has an appropriate appeal process. It ensures that there are all parties are notified and know what is going on in standards are clearly stated in the law. I think we met everything we had from the committee plus what was PED, recommendations and just wanted to let you all know that before you hear about the bill. >> Okay with that? Someone. >> Thank you Mr. Chair, members of the committee. My name is Jennifer Hellman/g, I'm with the legislative analysis division. The bill draft that is before you is the one that is on the blue paper and has a summary on the front and the bill structure right behind that. As Carol mentioned this bill draft is based on the PED reports that you all had at the last meeting and section one of the bill draft corresponds with the recommendations one within the report and that was to require the DHHSS to report on the timeliness of medicaid eligibility determinations performed by county departments of social services for the next two fiscal years. Section one lists the specific information that DHHS must include in the report and specifies that it will be due to Medicaid oversight committee and the AHHS oversight committee, November 1st of 2016 and November 1st in 2017. Section two of the bill draft corresponds with recommendation two of the PED report which was at the General Assembly should enact state law authorizing DHHS to intervene and take over county administration of Medicaid eligibility determinations when necessary. Section two creates the new part ten in article two of chapter 108 A of the General statues [UNKNOWN] a framework [INAUDIBLE] to temporarily assume [UNKNOWN] eligibility administration for a county, when a county is not meeting timely standards and one corrective action effort have been unsuccessful.
The three basic components for the statutes which I will walk through. The first is setting standards for determining timeliness. The second one is collective action procedures and the third is temporary assumption process. First the new statute address the standards for timely processing of individual cases as well as standards for timely processing cases overall by DSS and also sets forth the DHSS monitoring requirements. GS108-70.32 requires the county DSS's to adhere to timely decision standards which are required by federal regulations. 108A-70.33 through 70.35 to find the timely processing standards that DHHS would use to monitor timeliness. The timely processing standards are average processing time and percentage processing timely and new standards are calculated on a monthly bases. This timely processing standards are based on standards that are currently in rule or DHHS policy. The new statute next addresses the collective action procedures. Collective action is triggered at the county DHHS just not meet the average processing time standards or the percentage process timely standard. For any three consecutive months or any five out of twelve consecutive months. This trigger for collective action is currently in the rule. When the trigger has occurred DHHS and the county DHHs must enter in to a joint collective action plan to improve the timely processing of applications. The joint collective action plan must have the following components, an initial period that cannot exceed twelve months but may be extended by an additional six months if the county DHHS shows measurable progress during the initial period. The plan must describe the actions to be taken by both the county DHHS and DHSS. The plan must specify the performance requirements that constitutes the successive completion of the plan and the plan must include an acknowledgement that failure to successfully complete the plan will result in DHHS temporary assuming Medicaid eligibility administration. And then finally in 108A-70.37, the new statute says sets fourth procedures for DHSS to temporary assume medicaid eligibility administration. Temporary assumption will be triggered if the county DSS fails to successfully complete the joint corrective action plan. The DHHS must give at least 90 days notice of it's intent to temporarily assume medicaid eligibility administration and that notice must state the date of intended assumption. It must identify the performance requirements in the joint corrective action plan that the county DSS failed to meet and it must advice of the right to appeal the decision to the office of administration hearing. And during a period of temporary assumption the following things will happen, DHHS who administered the medicaid function in the county. The county DSS will be divested of it's administration authority. DHSS will direct and oversee the expenditure of funding from medicaid eligibility administration. The county will continue to pay the non federal share f medicaid eligibility administration, including additional cost encouraged timely processing of applications. DHSS will work with the county DSS to develop a plan for the county DSS to resume medicaid eligibility administration. And DHSS must keep the county stakeholders informed about key activities in ongoing concerns. The temporary assumptions would be terminated when DHSS determines that the county DSF can make timely eligibility decisions based on the performance standards set out and statute and upon notice to the county DSS. This new statutes in section two of the bill draft will become effective January 1st 2017. And finally section three of the bill draft corresponds with recommendation three from the PED report and it would appropriate funds to DHHS for seven new positions to support better utilization of NC fast data for performance measurement and evaluation of medicaid eligibility determination performed by the county DSSs. Mr. Chair that concludes my review of the draft legislation. I'll be happy to answer any questions. >> Questions comments from the committee? >> The question I have for you is on the $300,000 to be expended effective January 1, 2017 so that's in the coming physical year. Do you know if that's been presented their appropriations committee and where that money is online, inline, about to be in line?
>> It would have to be appropriated the session of the general assembly but we have verified that if that money is appropriated then it would be eligible for the 50% match from the federal government. So that's why it's only $300,000. >> Right, but we need to formally communicate that to health and humans services appropriation and say DHHS appropriation committee so they include that in their elaborations going on at the moment. >> Mr. Chairman the Senate sides away. >> Okay. Right we'll let you guys got more money than we do so that will be terrific. Sorry but appropriations are really at the top of my mind today. >> Any other comments or questions? Action to be accomplished now is to move this to a bill. Mr. Chairman may I ask a question please. >> Yes sir. [CROSSTALK] Senator Hise [INAUDIBLE]. So I'll assume the county commissioner associations remain with this and they have endorsed it, is that fairly sorry? >> They are here and can speak for themselves but we were closely with their lawyers and lawyers from all the associations and also with the department on this. >> Okay. Anyone from the county commissioners wanna speak on this? I see a gentleman has risen. Yes sir, identify yourself for the record. >> Thank you representative. Hue Johnson with the county commissioners association. Michelle is correct,she resat us with the draft version of the bill which had solicited feedback from county experts.Provided that feedback and worked on the draft.And don't see any concerns. >> Okay.Thank you. Senator Hise you look like you're ready to speak. >> Move may we prepare the bill for introduction through the session but I'd also like to be a sponsor on the bill [INAUDIBLE] >> Great. Senator Wardell. >> Second. >> Second. Motion who made the second to prepare this bill for introduction, Senator Hise already volunteered to be a sponsor. Great. Any further comments or questions saying none. All those in favor say aye. >> Aye. >> Those no opposed no. >> The aye's have it. Thank you very much. Last item on the agenda we're actually gonna ask representative Davis to briefly comment on the elimination of the use of development tiers. Bill draft in yellow. >> Thank you Mr. Chairman. If the members of the committee will look at the yellow documents in your packet which consist of a a bill summary as well as the bill for eliminating the use of development tiers. Last leading we discussed this bill, but nothing has changed in it except if you look at page two of the bill summary, at the last sentence of the second bullet, and then page two of the actual bill, which is section two [INAUDIBLE] this contains the recommendation made at the last meeting by Senator Ralph Hise to include the rate of employment in the economic distress index . So that has been included once again to my knowledge there is nothing different other than that from the last bill that we vetted in our last meeting therefore I would move to authorize the introduction of this bill during the 26th session of the general assembly and if there are any questions Erica Churchill/g from research in [UNKNOWN] from PED are here. >> Before I accept the motion any questions. Senator [UNKNOWN] >> [INAUDIBLE] [INAUDIBLE] I'm just curios because I would hate to find out later that they, cuz I ain't got any calls from anyone. I'm just curious. >> That is an excellent question and I do not know the answer. >> Okay. Sir by any chance do Senator Hudssel. >> I said I may be able to answer that. Actually I had some discussions with representative indirectly of the league who didn't express an opinion one way or another, with regards to it. There are two things. Let me add to this. One is I wanna thank Representative Davis for working really hard to come up with a compromised bill from this committee. Two, the edge committee has also, has an independent bill which
is inconstant in someway with this bill. And we've have had at least one meeting to try to pull this together with some fashion. We have not achieved that. But in order to perceive with what we were proposing to do and that's what I had discussions with some. Representative [INAUDIBLE] is the metropolitan mayor in that case. That we are trying to look at some other ways to perceive because I think the goal is to do what this committee wants in particular [INAUDIBLE] what my good friend senator Miccsick wants and that's to get on with this game and try to get something done as soon as we can. And we've had several suggestions about how to put some of these together and move in the short and long term. >> Thank you further comments and questions seeing none representative Davis has moved that this bill be prepared for introduction. All those in favor say Aye. >> Aye. >> Those opposed No, the Aye's have it. And we will move this for introduction. Our next meeting will be Monday June 13th. Monday June 13. Do we have an idea of what it would be on that meeting? >> [INAUDIBLE] >> Say that again? >> [INAUDIBLE] >> The bills that Senator Hise was on one of them. The bills that we moved to introduce please contact staff if you are going to or the chairs if you wanna be one of the sponsors. Actually and do it before you leave today, now. And then we will get out to you soon as possible what would be on next agenda. With that being said it is 2:34 and the meeting is adjourned.