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Senate | July 16, 2014 | Committee Room | Rules

Full MP3 Audio File

I need a sergeant at arms up front please, now. One like to welcome you to day two of the rules committee on this beautiful Thursday in Raleigh. First I’d like to introduce our pages. We have Richard Perago from Roxboro. Richard, welcome. Jamario Williams from Henderson. Welcome. Looks like Carly Robertson from Kerry, Carly welcome. Autumn Fulton from Pleasant Garden, welcome. Is it Makayla Smith, is that correct? Welcome. Candice Brown, welcome. Ruth Parsons, welcome. And last but not least, Erin Ray, welcome. Thank you for your service this week. Ya’ll have been, by far, the best group of pages I’ve seen this whole session. It’s true every week, Senator Brown, thank you. It just keeps getting better. I wish I could say the same about the members. OK. We’re going to start off… If anyone wants to speak on any of these bills, I guess mainly the medicaid bill, sign up sheet’s in the back. I ask you to please go ahead and sign up. Representative Hager, you still with us? Let’s talk a little bit about Lake Lure. That is HB1056. Welcome, always good to have you here. [SPEAKER CHANGES] Thank you, Mr. Chair. Mr. Rules Chair, I just wanted everyone to know you are my favorite Rules Chair, thank you. [SPEAKER CHANGES] Well I don’t have a lot of competition, but I do appreciate the compliment. Representative Moore, agrees. [SPEAKER CHANGES] Lake Lure map, guys, is self-explanatory. I’ll stand to ask any questions on budget. [SPEAKER CHANGES] Senator Hise over there and I got all kind of whirlybirds going around here for favorable report on House Bill 1056. Lake Lure Official Map. I didn’t know Lake Lure needed a map. It’s not that big. But anyway, any questions or debate on this? Hearing none,all those in favor of the passage or the favorable report to 1056 say aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] Sounds pretty good. It passes. [SPEAKER CHANGES] Thank you, Mr. Chairman. [SPEAKER CHANGES] Thank you. Who will run this. Senator Hise? Andrew, you ready? Ok. You want to start with 883? OK. We’re going to do Senate Bill 883. We have a PCS that Senator Brown moves we bring before us for consideration. All those in favor say aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] All right, it is so before us. Senator Brock. [SPEAKER CHANGES] Thank you, Mr. Chairman. This could technically classify as an agency bill. This bill was requested by DENR. It establishes a state group to address objections to the rules that will include representatives from environmental engineering firms, stream mitigation firms, industry, DOT and DENR. In 2004, the stakeholder group unanimously approved a new set of rules that are both supported by industry and environmental groups. What the bill will do is direct EMC to adopt a new consensus language developed by broad stakeholder group through temporary rule-making by October 1st of this year. If the construction has occurred under a federal permit and follow federal stream and buffer mitigation guidelines and two, the pipe stream is now underground in a stream buffer, is not longer relevant, adjacent to the pipe stream. DENR has signed off on this and let’s say it was requested by them part of the rule-making process. Of getting... [SPEAKER CHANGES] Thank you Senator Brock. Senator Meredith moves unfavorable on the original bill, favorable to the proposed committee substitute on Senate Bill 883. Any further discussion or debate? Hearing none, all those in favor say aye. [SPEAKER CHANGES] ‘ Aye. [SPEAKER CHANGES] Opposed nay. Ayes seem to have it. Let’s go to House Bill 201. Senator Brown moves that we bring the PCS for House Bill 201 before us for consideration. All those in favor say aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] Any opposed, no. It is now before us. Senator Brock. [SPEAKER CHANGES] Thank you Mr. Chair, members of the committee, this is a bill that started out as good bill over in the House and we’ve tried to make it a little bit better by making some changes. Just as a brief overview that last year in North Carolina, there were over 2500 naked buildings representing over 153,000,000 square feet of unutilized space. Meaning industrial and commercial industries considering locating in North Carolina or expanding in North Carolina, have stated that the energy code and environmental regulation has prohibited them...

from even considering a vacant space. Let me tell you what this means personally. We lost a thousand jobs in Davie County. A thousand jobs went to another state and that state’s other press release said thank goodness for North Carolina’s regulations. My people need some work and this will help do it and we can utilize our empty meals without using any type of...they have a choice to either use the new energy code or use the other energy code which will allow them to use the existing code that was in 2009. [SPEAKER CHANGES] Senator Brock, I’ve got a couple of favorable motions. You want me to go ahead and roll with those. [SPEAKER CHANGES] Please. [SPEAKER CHANGES] I’d be happy to let you talk a little longer if you’d like. [SPEAKER CHANGES] I’m good. [SPEAKER CHANGES] All right. Senator Jenkins moves for a unfavorable to the original bill, favorable to the proposed committee substitute for House Bill 201. Any discussion or debate amongst the members? [SPEAKER CHANGES] There is an amendment. [SPEAKER CHANGES] Ah. [SPEAKER CHANGES] I’d like to send forth an amendment. It’s just clarifying language. [SPEAKER CHANGES] Senator Brock send forth an amendment. Senator Brock. [SPEAKER CHANGES] This would actually change language in the bill, more of a technical change of using building area instead of floor area. So it’s footprint. We talked with insurance agency, it’s what we already have in the statute. [SPEAKER CHANGES] Discussion or debate? Senator Meredith. Discussion or debate on the amendment. Hearing none, all those in favor of the amendment presented by Senator Brock to 201 say aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] So passes. We’re back to the proposed committee substitute as amended. Senator Meredith are still holding with that motion, unfavorable to the original but favorable to the proposed committee substitute as amended. Any further discussion or debate? Hearing none, all those in favor say aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] Any opposed, nay. It barely passes. Senator Stein, you all right with it? Senator Wade, you OK with it? I didn’t want to rush you. OK, thank you. Let’s go back. Senator Harrington moves that we bring House Bill 1181, a new proposed committee substitute before us for discussion purposes. All those in favor say aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] Any opposed, no. All right. We have the new PCS for 1181. Senator Hise, can you tell us what’s different with this one than the one we had yesterday? [SPEAKER CHANGES] As far as I’m aware, all the PCS changes are the technical changes that came in regard to number others that were identified yesterday that were coming in, that’s what I have at this point. [SPEAKER CHANGES] Senator Pate , you agree with that? [SPEAKER CHANGES] Yes sir. [SPEAKER CHANGES] Mr. Chair. [SPEAKER CHANGES] Yes. [SPEAKER CHANGES] Ryan Black, legislative drafting. [SPEAKER CHANGES] Oh there you are, Ryan, good to see you. [SPEAKER CHANGES] Just to clarify, there were two additional clarifications. These were included in the email I sent out to the committee yesterday. There were a lot of questions about whether or not the board would be employees of the state so I added language to clarify that they are not employees, they are indeed board members just like other board members within the state. Also made...see if there were additional… There were a lot of questions about how they would relate to the state ethics act so I added some language to explicitly say that they would indeed be public servants under the state ethics acts, operations state ethics acts would make them subject to it, but I just add basically cross-reference clarifying language with that. [SPEAKER CHANGES] Let’s go to the committee first. Any further discussions, any further questions from the committee? We’ll back down from the committee to other members of the Senate. Any questions for those? All right. We’ll go to members of the House. Anyone from the House? Representative Dollar, would you like to ask any questions about this fine piece of legislation? Or Representative Hager?

Mr. Chairmen, I would have ?? questions. I’ll try a couple just for size. What is the plan for the management of state dollars that are currently managed with the LME/MCOs. Because you know LME/MCOs manage both Medicaid dollars in the provision of behavioral health services as well as state dollars. How will state dollars be managed and who will manage them. [SPEAKER CHANGES] As it stands right now, the state dollars that were outside of Medicaid, unless the discussion was to transfer them to board, would continue to be administered by the Department of Health and Human Services under the contracts as they exist. [SPEAKER CHANGES] Follow up on that. [SPEAKER CHANGES] Please. [SPEAKER CHANGES] What would happen if the, if I’m understanding it correctly, the plan is, at least on paper, saying that the LME/MCOs would still exist or could exist, but if they went under, if they’re asked...what exactly are the LME/MCOs going be asked to do? [SPEAKER CHANGES] The choices for the LME/MCOs, they may choose to become providers and actually bid for one of these plans, in which case they would take over other individual into their plans and provide for both physical and mental health for those individuals. What I believe is more likely is they may contract with either type of plan that is in here to be the mental health provider for those organizations as they try to put together a network of benefits that covers the whole person. Especially given the timeline, that would be the most likely path in which provider led networks and outside organizations would put together a network that was coming forward. As they choose to continue or move on they will make those business decisions on their own. [SPEAKER CHANGES] Follow up on that. [SPEAKER CHANGES] Please. [SPEAKER CHANGES] Thank you Mr. Chairman. They’re not providers so how would they be providing services when the LME/MCOs are not providers at all. Why would you have several, in that instance, multiple layers of care management and management of the dollars in the system because they’re not providers. [SPEAKER CHANGES] No, but they are establishing contractual relationships and they are a capitative organization which would already have a lot of that framework in place to build toward an ACO or MCO that’s coming into a particular region. Most importantly, the value they hold is they hold a network of providers already established and covering a region. [SPEAKER CHANGES] Let me ask… [SPEAKER CHANGES] Go ahead. [SPEAKER CHANGES] Some other questions. Is there any state in which there are zero carve outs, because the way I read the plan, there’s no carve outs with regard to any of the specialized populations. There’s obviously no carve outs for dental or pharmacy or long term care, so any entity would have to cover all of the behavioral health, all of the specialized populations, all of the dental, all the long term care services that an individual might need, or might be covered under some program within Medicaid. [SPEAKER CHANGES] I guess my answer to that is, I’ll probably start with because we’re one of the only states I know that has their IDD population under capitation for that operation. I would say that it is probably unlikely that other states have all this, unless, of course they’re a service in which its still run by the state and the department of Medicaid or whatever their equivalent is in which the state running it provides all those services to all individuals as we currently do. [SPEAKER CHANGES] OK. Thank you. Let’s go to the audience now. Who’s up on the list. Jeff Meyers is number one. Please step up to the mic, identify yourself.

Press the button. [SPEAKER CHANGE] There you go, I hope you can hear me OK. My name is Jeff Meyers I'm the President and Chief Executive Officer of the Medicaid Health plans of America. We're the largest trade association of managed Medicaid plans. Our members operate in 34 of the 37 states that have [capitated] risk plans. Our members insure about 20 million beneficiaries which is about half of the covered lives in the united states for Medicaid that are under some form of coordinated care program. And our plans are as large as United and Aetna, to about 30 percent of our plans are based solely in 1 state and of those most of them are nonprofit. So we have a general overview and opinion of how a managed medicaid works and I'm happy to answer any questions or provide any data that you may need as you consider it. There are 2 issues that I wanted to address today that I've seen in the press and have been raised by our members. The first is a general concern that as states move to managed care, money flows out of the states. That managed care organizations do not put significant resources into the states in which they participate. That's not, that's not correct. 2 of our largest plans that operate currently in North Carolina have a combined 5500 employees. It is also been our experience as states move to managed care, like Florida, Louisiana, or Oregon, the plans that are members of ours invest both financial resources and personnel resources in those states to managed Medicaid beneficiaries. And that can be as large as five to seven hundred new employees right at the start. The other issue that I've heard that I'd like to provide some thoughts on is, excuse me, excuse me, that providers generally are very concerned when states start to consider a move to managed care. What we know about managed care particularly in the Medicaid space is that beneficiaries receive better care with higher quality outcomes at lower cost in every state in which managed Medicaid begins to appear. And what we've seen is that while providers are obviously very concerned, it turns out that over time, as they integrate into the system, they become more and more comfortable with it. In several states our member plans have actually increased payment rates to primary care physicians and others as they've built the network that the state has outlined for them that they would like to do as part of the contractual requirement. So I, I know you all have a lot to do today, I don't want to spend a lot of time in prepared remarks, but I did want to layout those two issues because it is apparent to us, as the 37 states that have moved to managed Medicaid and several more that are considering it, they do it not just for the savings of money, which is absolutely true, but because we've seen a noticeable increase in quality metrics for the poorest and sickest in those states. And so I'm happy to answer any questions MHPA is providing the information to the members as you all consider this and I will stop here. [SPEAKER CHANGE] Thank you Mr. Meyers. Appreciate it. Let's go next to Greg Griggs. Welcome. [SPEAKER CHANGE] Thank you. I have not stood here before which should tell you how important this is to us. I'm Greg Griggs Executive Vice President of North Carolina Academy of Physicians. The Medicaid reform plan before you will impost major burdens on North Carolina's family physicians. Over 90 percent of our states primary care physicians currently accept Medicaid. They do so in part because of the efficient delivery system we've built. States relying on managed care approaches are struggling with physician participation in part because their systems are confusing and complex. For example, in Florida, which has been touted here, only about half of the primary care physicians accept Medicaid. And that's because of the complexity and confusion in that state and it limits access to care. We've applauded the legislatures move to lessen the regulatory and administrative burden on small businesses. Yet the proposal that you're considering will bury small private physician practices under a mountain of new administrative and regulatory requirements that will be imposed by multiple managed care plans

In each region. Rather than one set of pharmacy formularies, one set of traditional requirements, one set of prior authorization procedures, and one set of billing programs, practices would be faced with four or more sets of requirements in each of these areas. The, the proposal is a significant blow to physicians who own small businesses, providing care across our state. This proposal also takes much needed healthcare dollars and ships them out of state for the administrative cost of multiple corporate manage care plans, rather than leaving the dollars with healthcare providers in North Carolina who have a vested interest in our state and its citizens. Healthcare providers who have been here for a long time and will continue to be here caring for your citizens. The current proposal ignores sixteen months of hard work and compromise to design a reform plan that is good for tax payers, good for our most vulnerable citizens who receive the care, and good for the physicians and hospitals that provide the care. And it ignores the improved quality and cost savings we worked to achieve through community care of North Carolina over the last decade. And if you want to look at the quality metrics, look at the quality metrics that CCNC has achieved, and it is better than Medicaid managed care plans in other states. North Carolina's family physicians recognize Medicaid reforms are needed and are prepared to embrace change, and we've worked to compromise, but this plan creates unknown problems in an unproven infrastructure that will provide no input for those actually providing the care. On behalf of our thirty six hundred members on the front line of healthcare throughout our state, we urge you to vote no on this proposal. Thank you. [SPEAKER CHANGES] Thank you Mr. Griggs. Next, Pam Kilpatrick. [SPEAKER CHANGES] Good morning Mister Chairman, members of the committee. My name is Pam Kilpatrick. I'm here from the Office of State Budget and Management. I appreciate having just a couple of minutes to speak to this committee about implementing the Medicaid modernization legislation. We've had an opportunity to do just an initial review of this with a mind towards how we would carry it out, how we would actually put it in place. So with that caveat, that we are not lawyers, I'm not a lawyer, looking at it in terms of being able to get a new department up and running, I would like to share a few considerations. There are some immediate time lines that have to be fulfilled in this legislation, for example, creating the new department by October, by August first, establishing an entity for it as a new state agency by September first, identifying and compensating essential personnel, which certainly will involve working with the beacon systems to get those folks their five percent bonus, and do all the requisite planning. By March first, the new board, the new entity, has a report due on initial reform planning to the general assembly, so as we look at it from state budget we would expect what we need to do is get some staff in place so that this board is well supported. Some fiscal management staff to be able to do the processing of the reimbursements, and again some policy staff if it's the desire of the board so that it can meet those initial planning and reporting dates that are just several months down the road. In terms of how this takes place, from an administrative perspective, there are a number of moving parts. Typically, when the state budget office has had to be involved in implementing, either creating a new entity or reorganizing entities that exist into a new structure, we would partner with the Office of State Controller to coordinate your state level management agencies so that we can get those systems in place, the structures in place, a new banking account, a new checking account, staff set up and in support of that. Logistics would include working on space, setting up securities, IT, and administrative support. What would the time line be? Again, there are some fairly immediate deliverables and some long term deliverables in this legislation. The time line would, would vary depending on the complexity of the agency. The size of, of, of the budgets, the complexity of the program. Certainly Medicaid is, is complex. So how that would be carried out, we would hope that there could be time to plan a transition

working with our state partners, working with the affected parties. We'd be more than welcome, Mr. Chairman and members of the Committee, if we could assist the Legislature in developing a timeline, if that would be appropriate. And again, how ever the legislation is enacted, we're committed to making sure that it's an orderly process. Thank you so much. [SPEAKER CHANGES] Thank you. Next, we have Mary Hooper? Is that correct? [SPEAKER CHANGES] Good morning, thank you. It's Hooper, so it's close. [SPEAKER CHANGES] Thank you. [SPEAKER CHANGES] My name is Mary Hooper, I'm the Executive Director of the NC Council of Community Programs, excuse me, and I represent the LME/MCOs across the state. I do want to thank the Chairs and the members of the committees for their work regarding improvements in the Medicaid system. We know that your goal is to improve Medicaid services to the citizens our state, and we appreciate that and we support your goals. We request that in your process of making these improvements, that you not destabilize parts of a system that are currently functioning. As you know, the LME/MCOs are using managed-care principles; they are capitated, they are not causing cost overruns, and they are fiscally responsible. Over the course of the past year, the Medicaid Reform Advisory Group spent a great deal of time hearing from stakeholders across the state. One of the consistent themes that you heard was the theme and the request that you not destabilize that which is working in this state. I'm here to tell you that as you look at Medicaid reform, and as you struggle to embrace principles of managed care, the LME/MCOs are actively involved in managed-care activities. They are an example of successful public behavioral managed care. We respectfully request that you not take that part of the system apart in your efforts to improve others parts of the system. Your LME/MCOs, at the community level, are actively working with providers, stakeholders, and consumers in your communities, to ensure that your constituents are receiving the services they need. I am not here primarily and only to represent MCOs. The role of the MCO is to ensure that consumers get what they need, and I would respectfully request that we keep consumers at the top of this conversation. Thank you. [SPEAKER CHANGES] Thank you. Adam, you're up. [SPEAKER CHANGES] Thank you, Mr. Chairman, good morning. My name is Adam Sholar and I'm the legislative liaison for the Department of Health and Human Services, and I appreciate the opportunity to address the committee this morning. I just have a couple points I'd like to make. First, I'd like to begin as I did yesterday, by saying the Department appreciates the Senate's recognition that Medicaid reform is an important issue. While the current Medicaid program is in better shape today than it has been over the past four or five years, and while we're on a path to making it even better, we still must move to a value-driven Medicaid program, which will make it a better system for those who receive care, for those who provide care, and for our taxpayers. We're thankful that both the Senate and the House share this commitment to reform. We're concerned, however, with some changes that were made to the reform plan in this version of the bill. We spent more than a year working with stakeholders, including the Reform Advisory Group, to come up with a provider-led Medicaid reform plan that built upon the investments North Carolina made in its Medicaid program that has broad stakeholder support. The provider-led plan was embodied in the bill that passed House and we think it's the best plan for North Carolina and we'd like to see that plan given a chance to work. ?? the concepts, albeit in a more aggressive timeframe, remains in this bill. It's now joined at this stage by several new concepts, including changes to our behavioral health care system. We have ?? about making this change at this point in time and we respectfully ask the Reform Plan, based on the work and embodied in the previous version bill, be adopted. The other new addition to the Medicaid Reform Bill is the creation of a new department to administer the Medicaid program. And about this provision we have serious objections. First, the Department of Health and Human Services believes that Medicaid is an integral part to its operations. It's intertwined with our Division of Mental Health, our Division of Aging, our Division of Social Services, our Division of Public Health, and our Division of Public Health among others. It's intertwined with county Departments of Social Services, over which we have supervisory authority, and we do not believe unwinding these functions in this bill will serve the people of our state the best. Second, as Mrs. Kilpatrick mentioned, there are many practical concerns that I won't elaborate on as she

Representative: …a great addressing those but we have those concerns as well. Finally, the government’s new Medicaid department raises serious constitutional questions. This is an executive branch agency that will now have a 7 member board responsible for its administration, but 4 of the 7 members are appointed by, and serve at the pleasure of, the general assembly. With legislative control over executive branch agency, it raises constitutional questions, and I think, given the size and importance of this program, right to a challenge in the future that could hamper the operation of the program and those that serve in the state. So the decision to grant a new Medicaid agency is one that hasn’t received the same public study that the model to reform the healthcare system did. For all of these reasons we would ask that the decision be given the same consideration, and we would be happy to help with that study in the interim. Thank you Mr. Chairman for letting me speak this morning. Speaker: Thank you Adam. Okay, Ardis where are you? Come on up - we need to work on that penmanship. Lisa will be in town this weekend maybe she can help you on the third grade level. It’s all yours. [laughter] Speaker: I wish I could use the excuse that I am a physician, but that wouldn’t be true. I am Ardis Watkins, which is apparently not legible, with the state employee association of NC, and I appreciate the chance to have two minutes with you today. I wanted to say that scenic shares Representative Dollard’s concerns about the lack of a carve out for behavioral health centers, and clients skilled nursing and psychiatric and developmental disabilities institutions, or places where state employees can now provide those services. Many of these are long term clients with multiple medical and cognitive impairments, and that requires specialized care. It includes those needing innovative treatment and other methodologies that we believe, firmly, are best provided at these current facilities. Our state developmental disabilities center not only provide active care but also conduct research, which is a very important component. A few weeks ago, some legislation of this type was floating around where you all were going to look at these types of facilities and come back, and now it feels like things are getting pushed through on the 11th hour that would turn all of that on its head. So, we do want to share Representative Dollard’s concerns there. The other portion of the bill, under 143B14-15, the changes there, variations from certain state laws, that would take the employment rights of certain state employees under the state personnel act, and that will do nothing but have a chilling effect to employees who, right now, if they have state employee protections might otherwise feel compelled to report things such as waste, fraud or abuse that can happen in the system. We feel it is more imperative than ever with the issues we have had concerning the Medicaid system and DHHS, that it come before you as a body, that these employees feel free to be the good employees they want to be and point out where they can see there are problems and do that on behalf of the taxpayers and the clients they serve through DHHS. That is all that I have to say. I thank you for your time. Speaker: Senators Page and Heist, would you like to add some comments? Representative: Thank you Mr. Chairman. We have been listening to everyone and asking questions and drilling down into Medicaid for the past year. We think we have come up with a bill thanks to our staff and the input of hundreds of people that will meet the challenges that medicaid offer this state. I, for one, thank everyone that had input. You had spoken today. I think it is time to move on and get this procedure over with. Mr. Chairman, I am grateful for the opportunity to have one small piece in getting this legislation before you. Representative: Thank you Mr. Chairman. A few things I wanted to address that kind of have been said in the comments. First, looking at carve outs. Since we have began this process, it was the stated legislative goal, that we would have whole person care. I have talked to providers that even work

They were some of the organizations that spoke. They talk about working with mental health patients and trying to get their medications right when they can't control their blood sugars cause that has to be another doctor in another area, because they are separated. I appreciate the House's new concerns about carve outs but I would take everybody back to the house bill also had no carve outs for any areas for LMENCO's or for other areas of providers. Provider led plans, I understand the statements made about provider led plans. That is why the only priority given in the bill is that each region shall have a provider led plan. We also talk about CC and C and their quality matrix and how they are hired, that's why we brought CC and C onto the table to develop the quality matrix for all the plans within the state so that we continue to grow on what we have in North Carolina. Provider led plans have the opportunity now to compete in the state of North Carolina and how us in this development how they provide better care for better cost, and have a priority in doing so. I would also say that I too am shocked at the bureaucracy required in the state of North Carolina to create a new department. It is something I think we do have to look at when we get it together but I would also say I think it is a process that is unacceptable that it takes that much to move and create a new agency in the state in moving forward, specially when we are trying to simplify the process. No business, as we are trying to create a business model, would make a process that complicated in order for it to occur and I think there's a lot we need to do in those areas as well. So I thank you all, there have been a lot of individuals that have put a lot of work into getting this bill before you today. This is the next step in the process, moving forward, and I look forward to this being completed in the short session. [SPEAKER CHANGES] Ok I'm going to let Senator Robinson have her question cause she is my favorite, please. [SPEAKER CHANGES] Thank you mister chair and I apologize, I came in a little late after you had asked those other questions. I do have several concerns of this and one and then I have questions other times. One is that I notice in Florida that 63% or more of the people who are enrolled in the one particular area, mostly low income etc. and we know that in North Carolina those will be the majority of the people who will be involved in this plan as well and are in Medicaid. And so there was a medical advisory committee. My concern here is that a board led mostly by corporate people who don't have experience in Medicaid, folk who may be appointed other places we won't have providers in, and people who corporately provide Medicaid services, that the interest and the needs of Medicaid recipients will not be or might not be represented. And so, my question is is this medical advisory did include consumers, specifically consumers who are Medicaid recipients. Is there any opportunity to hear for those people to b represented on that board. And we know that the best model to make sure that services are available to the recipient is to make sure that consumers are represented on those boards, so there would be an opportunity for consumers to be represented on the board. I know your plan doesn't have it but I'm asking. [SPEAKER CHANGES] I think I would start by saying the biggest distinction in what you are saying between Florida and here is by name. The Florida board is an advisory board. There is nothing that would prohibit this board from creating advisory, they have the ability to do sub committees. The conflict we are trying to avoid with providers is trying to have the individuals who profit, or their business dependent upon the rate set and the patients received from Medicaid being the ones making the decisions about what those rates should be. That would be a conflict we probably wouldn't accept anywhere else in state government and wouldn't accept in this legislature for individuals coming in. So what we are trying to do is put a wall of separation between the actual decision making and those who will receive

...leave the benefit from the decisions, but I don’t think there’s any opposition or anything that would prohibit this board from creating other things that would be advisory to the board in that concept. [SPEAKER CHANGES] Just one follow up, Mr. Chair. [SPEAKER CHANGES] Yes, ma’am. [SPEAKER CHANGES] I think it would be a novel approach to add a couple of consumers in some of those positions at this great salary, we’d move them out of poverty and into another strata. [SPEAKER CHANGES] And General Assembly Members first, right. OK Senator Wade. [SPEAKER CHANGES] Yes, Mr. Chair, at the appropriate time, I’d like to move for a favorable report to the PCS. [SPEAKER CHANGES] I think it’s very appropriate. Senator Wade moves unfavorable to the original bill and to the first proposed the first committee substitute and favorable to the last committee substitute we had before. All those in favor say aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] Opposed say no. [SPEAKER CHANGES] No. [SPEAKER CHANGES] So passes. Thank you. Keep an eye on the computer. I’m going to be in town this weekend, we may meet tomorrow, why knows?