Legislative Joint Auditing

Our interview selected transactions of East Arkansas planning and development districts. With no additional business to discuss the meeting was adjourned the next meeting of the committee is scheduled for Thursday August eleventh two thousand twenty two Mr chairman for adoption of this report. Any questions or objections if if not the report should opted to objection. Okay standing committee on counties and municipalities represented Hillman. Thank you Mr. The Committee met the. Adopted amendments of of the may twelfth meeting you know here's the in our subcommittee meeting the Committee discussed the city of Cotton Plant and they're non compliance with the municipal council law the city was first notified that their records when substantial noncompliance. Of. In January of twenty twenty two after sixty days had passed from the initial notification staff business day on March tenth. And determine that the records remained in substantial noncompliance this report to the standing committee on counties municipalities at their meeting on April seventh. It also reported April seventh meeting that the city had hired someone to help them get their accounting records into compliance with the municipal accounting law standing committee voted white until may twelfth. to to take action at the may twelfth meeting the standing committee staff reporter that the twenty twenty one engagement would be starting soon and the committee voted to wait until June second. How to take action staff report on June second that is may thirty one twenty twenty two the city's records remain in substantial noncompliance the committee voted to notify. This city and state treasurer of the substantial noncompliance with the municipal accounting law for Arkansas Code fourteen fifty nine one seventeen upon the notification the treasure of State shall withhold fifty percent of the city's turned back the Committee reviewed that reports differed from the may twelfth meeting officials from two entities were present to address repeat findings from these reports three previously deferred reports. Or file and six for deferred. The committee voted to referred to such a county twenty twenty report to the prosecutor's office prosecutor coordination office this report has been preferred to the local prosecuting attorney and I'll add to that that they had recused from that the committee reviewed Senator Clark reports of these four reports. Referred to prosecuting attorneys an official from one entity was present to address I repeat finding in their current report the Committee file sixty nine crowd reports and deferred three so that officials can attend the August eleventh meeting to address of the findings Mister chairman a move for the option of this report. Any questions for anyone. With the objections fruit. Okay standing committee on educational institutions a representative very. Thank you Mr chairman of the standing committee on education is to remit yesterday June second. Of the committee reviewed a total of twenty. Audit reports which consist of eighteen school district reports one higher education and one educational cooperative report for the year in June thirty twenty twenty one the audit report of spring Dale school district was certified to the governmental bonding of board as well as referred to the alcohol prosecuting attorney the audit report of the Spring Hill school district board referred to the app will prosecuting attorney the Committee filed the twenty current audit reports that were brought before it. Mr chairman this time uh. Make a motion to adoption of the report. Any questions. Directions to improve standing committee on state agencies Senator Solomon. Thank you Mr chair for rule for reports without findings were on the committee's agenda yesterday during the meeting the committee adopted a motion to file before reports with that Mister chairman I moved to adopt this report. Questions well objections stand proved. Okay moving on the agenda. Of. In section the item one the financial compliance for Newton County. Of. Your own. Thank you Mr. This presentation covers the financial compliance report for Newton County for the year ended December thirty first two thousand nineteen. In counties in northwest Arkansas and maintains its county seat in Jasper and has a population of over seven thousand the county is governed by a non member quorum court indicted a operations were managed by six elected officials sixty seven full time employees and eight part time employees as of may sixteenth of this year. This slide shows banks basic financial information for the county for two thousand nineteen the general fund road fund and all other funds combine assets totaled four point eight million dollars wall liabilities totaled over nine hundred forty one thousand additionally revenues were five point six million dollars in expenditures were five point eight million dollars. Non compliance with state law and accepted accounting practices was noted in the offices of county judge District Court Clerk and share. We issued the following funding for the office of county judge the county paid over one hundred thirty two thousand dollars to to vendors to blast and crush rock at a quarry owned by private individual in the county paid over nine thousand seven hundred dollars for the purchase of the rock without a contractor for use or for gravel storage on the individual's property because the gravel is not stored on county property the county is unable to monitor access to the gravel or maintain a record of inventory further more competitive bids or not solicited for these three expenditures and noncompliance with Arkansas Code. In addition according to a county official county resources were used to haul gravel for citizens who purchased the gravel from a vendor an apparent conflict with the Arkansas constitution due to insufficient documentation the value of the services could not be determined. We noted one issue for the office of District Court Clerk the District Court collected probation fees for certain offenses an apparent conflict with Arkansas Code five four three twenty two as interpreted by the Attorney General and opinions two thousand three dash forty one two thousand three dash eighty five as requested the county judge and District Court Clerk attended meetings of the standing committee on counties municipalities to respond to the these findings. The remaining slides discuss findings for the county sheriff. On June eleventh two thousand nineteen the county sure so one hundred three seize firearms to gun dealer for just over twelve thousand dollars the dealer issued payment to a car dealership rather than the county and the county's sheriff's office subsequently purchased the vehicle from the dealership using the gun so it sales proceeds as credits. As a group. We know the following areas of noncompliance Arkansas Code regarding these transactions the sheriff did not sell selling claim seize property at public auction. Proceeds from the farm sale we're not remitted to the county treasurer. The vehicle purchase was not budgeted by the quorum court approved by the county judge and paid by the county treasurer. Documentation of the origin could not be provided for sixty one farm sold. Authorization of disposal was not available for eighty three of the farm so. Legislative audit presented the Newton County report that the November two thousand twenty one meeting of the standing committee on counties municipalities and the committee voted to the for the report to the December meeting so that the sheriff could tend to respond to questions related to findings. The December meeting was canceled I'm sure for subsequently sent certified letters requesting his attendance at the standing committee meetings held in January February April and may of this year the sheriff did not attend these meetings. The full Legislative Joint Arjun Committee voted at its meeting last month to request that the legislative auditor issue a subpoena requiring the shares attendance at today's meeting. Mister chair this concludes my presentation the county sheriff is present to respond to committee questions. Sure if you would would you please come to the table. If you would please turn your microphone for the record yes Sir okay the state your name your for your position I'm sure Flynn winner from Newton County. Well would you please stand and raise your right hand absolutely. do you solemnly swear or affirm that the testimony you're about to give will be the truth the whole truth and nothing but the truth yes Sir thank you for you turn your microphone and to introduce yourself please. As Kevin Thomas the evidence custodian and to the county sheriff's office okay would you please stand. Raise your right hand. Do you solemnly swear to a farmer the the excuse me do you solemnly swear or affirm that the testimony you're about to give will be the truth the whole truth and nothing but the truth I think thank you please be seated sure for my phone off if you all would leave the microphone don't live alone is a legal loan yeah for. Okay. represent very thank you Mr chairman larger more so typically the legislative audit so we don't send out subpoenas to for a elected officials but unfortunately after about four opportunities to appear in front of of the committee we have no choice to other than to subpoenas I'm a few questions for you when you disposed of those guns did you have a disposal order signed by a judge as required by law we did did you provide that to of the auditors well I I thought we did a apparently I don't an amount not distorting and ensure that can can I answer that four million better answer form. The farms we could identify the case numbers We were submitted and signed by judge Kirkpatrick. And I believe that the auditors had a copy of that sent sent by computers crash so I can't pull those. Using a different computer but there was. Trashing always have a team seem to be a a good way but not so of the ones that you could not identify case files or anything you so those also right I'm sure you didn't have a disposal order for the ones that you didn't have case files on your you're correct but. You would have to understand the circumstances with their small evidence room. Well I I I go by what the law says losses that you have to have order signed by the judge and you didn't have a job only going to the the question so we can save a little bit of time warmer the hundred three guns not sold at auction that's to read required by law instead of being sold to a a private party. I was operating under the impression under 5-73-113 part P. one that we can sell them to federal law arms dealer and then apply that escorted towards a purchase of a law enforcement equipment so that it doesn't allow you to sell undocumented guns to federal firearms dealer doesn't know now okay another question of a committee chairman. Thank you so one the wrist the responses that you gave the in the audit said that the. Steps have been taken to ensure this doesn't happen again I'll be curious what those steps are because there are procedures in place just and follow well I'm talking about internal steps or agency some of the guns that were what what were they I'm a. We update our computer system we we use a new evidence tracking system that we didn't have before some of the guns in question had been in the evidence room since the eighties and there just was no. Paper trail for those guns and what we sense but to put one in place where. For the remainder while I'm in office in the future share says has a very good. Very good easily track paper system so it shouldn't does undocumented guns that you don't know where they came from should they not have been destroyed instead of being sold you have to have a court order to destroy them to up. And you didn't have one for either because so that's all my questions thank you Mr chairman. Representive Hillman. Thank you Mr chairman of each out what was the date you sold these these weapons I'm sorry the date what date did you sell on June of twenty nineteen I'm not sure the exact day. And this law you referred to Order of five seven three one oh three. One three zero okay one three zero of what what is what is that law actually say. Bear with me one moment here I'm work. This section I was referring to the. Section P. one one fourth legen which a farmers forfeited may trade the farm a federal license firemen's courted towards purchase future purchases by the law enforcement agency okay what was the effective date of that law operated this on the twenty nineteen persons no Sir what was the effective date of that law that you're referring to I don't see that here source on the paper. It was my understanding was in fact when I did this okay because could staff answer the questions for police. We're looking. You're you're recognized. Thank you Mr chairman of. To Mr Holmes question that law was enacted if I remember correctly during the. Twenty nineteen session but it the existing law five seventy three one thirty did not have a subsection piece subsection P. was enacted. During the twenty nineteen session it did not have an emergency clause and it did not have an effective date so according to the AG it became effective on July twenty fourth twenty nineteen about six weeks after the sale if I could with the chairs permission. As we read the lawn is secondary authority we found reach the law it applies to forfeitures involving juveniles of course without any court orders and without background records you know we don't know if these guns involved juveniles so it in there other procedures in the law that were not followed so we have a little bit of an issue with that law applied quite apart from the effective date being after the date of the sale. So sorry it seems to me is if you applied a law that was not in effect at the time that you get it okay. Okay. I don't have an answer for that. I read this law I was I was I thought I was in the right area was. I wanted you holder public auction like it says in the law it's already in effect Sir. I thought I was within my rights to this apparently I wasn't and and I apologize for that however the reasoning behind not having an option when I thought this was legal and applicable was because of the the the man man hours and stuff involved in auction an agency my size is just almost impossible to the and and so you just decided take upon yourself to take these guys down to a pawn shop or a gun dealer in Salem well it what exactly like that no Sir okay well how was. I used a vendor who come to the sheriff's association and has done this throughout the state I thought it was legal. And. I thought I was within one means of doing that. And and they made the check out to someone besides accounting that it. You thought that was legal to I did based on this I thought it was I thought we can apply that as credit towards the purchase of something else I misinterpreted. So you sold on your own. You decide how the money was gonna be spent you took them you didn't get a check to the county you want to give it to a Hey automobile dealer and bought a vehicle from them without the approval of the county judge or anyone that's correct and you thought all that would legal I did this thank you Mr chairman. Representative makes. Thank you Mr I have just the two two questions first one you said your computer had crashed do you have proper back up for that those records or those records is gone. Yes I don't have. I gave them to the sheriff The chief deputy at the time. Not on my computer anymore and paper copies exist the paper okay I do not know where they're at okay so I mean are you doing proper you know but the part of the law code requires the county to have a back up for all that I just wanna make sure that you're properly doing that so that you have access to those records I understand I wish of and I understand the way these things work I answer the questions of the I asked I wish I could make a brief statement about these guns and what we've done since then correct this problem. I'm okay with you don't have the with the chairs I I began working for the sheriff's office and two thousand eight as a full time investigator part of my job at that time was. Evidence control however I've spent twenty eight years with the game and fish work in close contact with with the sheriff's office and at that time there was no evidence room or evidence custodian I recognize some of these guns from being there back in the nineteen eighties In two thousand nine I believe approached prosecutor about how to. Go about getting rid of these guns get a court order. He said I had to. Look up the dispositions on none of these guns were marked there was no case number of no name attached to them I didn't know if they are confiscated found property Turned in all of those that we've been working around them for. Well at least twenty years I left the sheriff's office came back in late two thousand eighteen You could not even get to the shelves and some of the. Evidence shows to to retrieve stuff because their stuff piled on the floor. Then I'm gonna take up for the sheriff here I did get I spent three weeks documenting all of my could but without a name or a case number it was impossible another was no way to know where it came from and I was asked about a court or. Nobody would sign a court order without. Without the. The history on the sayings. honestly I could of taken to a pawn shop or a gun dealer in pocketed the money and nobody would known any different I try to do it. As correctly as I could there was no intent to defraud anybody They're all registered by serial number owner on the receipt so I'm sure the order still has at sent to me I I spoke with the order now. Since then we use of the program called our PS. That we do all reports with they have a it has a place for the officer to enter the evidence He puts in a locker I'm the one with the key locker. I take it log into the computer print a label and put on and anything that would happen. In the future I'll have a paper trail on it's these weapons that had been there for years and years that we just did not know what to do I mean I guess we could take them to the doll we go to crest on the And I realize it. It would take up for the sheriff here. Of told we did have a court order. Specifically on the others but I'm not sure you not understood where the other ones came from that one's on me not not to share. But to assure you my intentions were. Ramis because like I said I could I could take them all home and nobody would've known the difference and we we obviously we appreciate that it sounds like your intentions were in the right place it was just maybe they're it was absolutely everywhere I mean so my my other question this is going to be for that for the sheriff can you explain to us why you are able to attend those last four five meetings I know sometimes on a small office there can be complex issues there but obviously you understand the importance of coming down and visiting with us and addressing these issues I do understand and respect this process thoroughly I don't understand it thoroughly and respected early the first one I was just unable to attend subsequently and and enhance a good or bad I don't know but I I reached out to A legal counsel so what I need to do on this and he said. Hold off for now. So that that's one. Also I think I would be finding some different legal counsel on at them no problem thank you thank you Mr chairman. Hammer. Thank you Mr would have a concert probably be a good time to find different legal counsel if they gave you that advice was that legal counsel your county attorney no Sir okay when I understood you Sir that you had been with the sheriff's department left and then came back in two thousand eighteen sacrifice. worked in left several times I retired from the game and say issue okay in the. Insure one did you take duty twenty nineteen twenty nineteen so you're taking duty about the time the law change was taking place that's correct yes okay did you consult with your county attorney or did you just make this decision on your own I honestly don't remember when it or not I don't I don't know that. I mean I just don't know what internal. Okay then we would conclude that you didn't which probably yes Arkansas for my part I can tell you I did not okay which I would've been a good thing to do because hopefully your county attorney would be able to give you direction and that's for the future the federal firearms purchaser that purchase them to did he or she have a free of purchasing fire arms from the Department and was he or she related to anybody with the Department. No history with our department he is he does have mixed with other agents state of Arkansas has no relation anyone in the department now he's actually out of Kansas okay and the. I'm sorry that were Kansas okay was he familiar with the with our laws at all or a I would have expected him to be but I wish that I would I would have thought it was because again he he works for several agencies that work so and then the auto dealer that the money was taken to and my I understand your testimony is that you felt that you are within your rights to do that based on the way that you interpreted the law is that correct that's correct all right the auto dealer related to anyone in the department or your family or not okay at which it is it a independent dealership or is it a we're all kind of dealership was it's a Toyota dealership and here's okay all right I'll hold for now thank you Mister you. Representative very. Yes thank you Mr so just one quick question is the county attorney does that county attorney also to your knowledge represent the car dealership not that I'm aware of no okay and thank you. You have just a few minutes staff is trying to get a question answered force. Anyone else have a question. What we're. Thank. Hammer you have questions please thank you Mr what was your county judge and all this I mean. Your county judge was elected when prior to your efforts to me yes it I'm not sure when but he's been in office for years did you consult with the county judge on this is on. Okay. Thank you yes. Okay. No other questions should share for created come thank you will filed this report thanks very much thank you. We've got a. Special report on Arkansas state public school employees health benefits. The. So. So you're recognized. Thank you Mr chair. Thanks. Okay thank you Mr chair. Arkansas Code requires legislative audit to conduct an annual review of the employee benefits division and the performance of the health benefit plans. The primary objective of this report was to analyze the fund balances of both the state and public school employee health benefit plans and Joan thirty twenty twenty one this year's report contains no findings. Ibidi administers the health and benefit plans for both state and public school employees benefits are provided through self funding a method by which the state takes in contributions from both the employee and the employer. Separate funds are set up for each plan to pay health and pharmacy claims and to serve as reservoirs to prevent dramatic rate increases for subscribers. This exhibit which is found on page two of the report shows the plan enrollment for both subscribers and members for each plan the term subscribers refers to both employees and retirees who are enrolled in the plans why the term members refers to subscribers and their qualifying dependents who are enrolled in the plans. As detailed in this exhibit from fiscal year twenty twenty to twenty twenty one the number of subscribers decreased by one thousand ninety three for the Arkansas state employee plan and increased by seven hundred and seventy six with the public school employee plan creating a net decrease of three hundred and seventeen for both plans. The first plan discussed is the Arkansas state employee plan. As shown in the exhibit on the slide and on page three of the report the ANC plan had just over two hundred and ninety seven million dollars in fund revenue for fiscal year twenty twenty one. Stay contributions provided sixty percent of total revenue subscriber monthly premiums made up thirty five percent while other revenues accounted for five percent other revenues include performance guarantees penalties investment income pharmacy rebates Medicare part D. subsidies if I could tax savings. Exhibit three on page for the report and on this slide shows how the ASC Fund balance was affected throughout the year. This state contributed over a hundred and seventy six million dollars and subscribers paid a hundred and five million dollars in monthly premiums the reimbursement of claims expense amounted to two hundred and twelve million dollars for providers in almost ninety four million dollars for pharmacy claims administrative costs of the plan decreased slightly to just under nineteen million dollars. Subscribers paid an additional thirty five million dollars to health care providers in nineteen million dollars to pharmacies for copays coinsurance and deductibles. S. shown on exhibit five on page five and on this slide the S. C. fund balance decreased to seventeen point eight million dollars at the end of the fiscal year the fund had a declining rate of fourteen percent in fiscal year twenty twenty compared to the seventy three seventy three percent declining rate in fiscal year twenty twenty one the decline in the fund's growth was primarily the result of plan expenditures exceeding revenues by twenty seven point three million dollars and eleven point five million dollar increase in the actuarial incurred but not reported claims help in pharmacy claims and accounting adjustments. This exhibit which is provided on page five of the report shows the changes in claims an administrative costs as well as the premiums and other revenues for the S. C. plan for the past five years. Schedule three Page thirteen shows help informs the claims by plan type shown on this slide is the portion of schedule of the schedule related to the S. C. plan for fiscal year twenty twenty one health and pharmacy claims paid from the fund total two hundred and twelve million dollars and ninety four million dollars respectively. Factors contributing to increases from the print previous fiscal year included the rebounded deferred elective care postponed due to COVID nineteen coverage of what COVID nineteen testing and vaccinations an increase of five million dollars in claims over two hundred and fifty thousand dollars. Next few slides will contain information regarding the public school employee plan. The exhibit on the slide in on page six of the report shows that the PSC plan had over three hundred and sixty million dollars in funding revenue for fiscal year twenty twenty one. Legislative funding provided thirty percent of the total contributions from school districts amounted to twenty nine percent subscriber's monthly premiums made up thirty seven percent what other revenues delivered four percent. Other revenues include performance guarantees penalties investment income. Pharmacy rebates if I could tax savings. Exhibit seven on page eight of the report and on this slide shows how the PSE Fund parents was affected throughout the year. This state contributed just over a hundred and eight million dollars premiums from school districts provided over a hundred and five million dollars as described as paid over a hundred and thirty three million dollars in monthly premiums the reimbursement of claims expense amounted to over two hundred and eighty two million dollars to providers and seventy three million dollars for pharmacy claims administrative costs decreased slightly from the prior year two thirty point four million dollars. Subscribers also pay an additional seventy three million dollars to health care providers in twenty four million dollars to pharmacies for copays coinsurance and deductibles. As shown on exhibit nine on page nine and on this flight the PSC Fund balance decreased to eighty five point six million dollars at the end of the fiscal year the fund had a declining rate of eighteen point seven percent in fiscal year twenty twenty and compared to the compared to the twenty eight point six percent declining rate in fiscal year twenty twenty one this decline was primarily the result of thirty one million dollar increase in health in pharmacy claims due to an increase in plan membership and expenditures related to COVID nineteen. This exhibit which is provided on page seven of the report shows the changes in the claims and administrative costs as well as the premiums and other revenues for the PS the plan for the past five years. Shown on this slide is the PSE portion of schedule three for the current fiscal year help the pharmacy claims paid from the fund totaled two hundred and eighty three million dollars and seventy three million dollars respectively factors contributing to increases from the previous fiscal year included an increase of over seventeen hundred covered members the rebound of deferred elective care postponed due to COVID nineteen and the coverage of COVID nineteen testing and vaccinations. Schedule for on page fourteen provides a list of the individual health claims exceeding two hundred and fifty thousand dollars during fiscal year twenty twenty one for both plan. That is the plan had fifteen members with claims totaling nine point six million dollars approximately double the amount of the prior fiscal year the PSC plan had twenty two members with claims totaling ten point four million dollars a decrease of over three million dollars from fiscal year twenty twenty. We tested these claims for accuracy and timeliness and eligibility covered procedures payment amounts and case management services and noted no discrepancies. We also reviewed the nineteen members of the ANC planned and twenty one members of the PSC plan with cumulative claims exceeding five hundred thousand dollars. We tested these claims for accuracy and timeliness of case management services and noted no discrepancies the twenty twenty one total cumulative health and pharmacy claims exceeding five hundred thousand dollars increased three point one million dollars to thirty three point seven million dollars for fiscal year twenty twenty. It be D. entered into various contracts with outside vendors to assist in providing insurance benefits for plan participants schedule five on page fifteen of the report on this slide shows administrative costs by a vendor and a prefix a brief description of the services provided administrative costs totaled almost nineteen million dollars for a S. C. participants in over thirty million dollars for PSP participant. Finally scheduled to on page twelve of the report provides the monthly premiums for each plan available to subscribers shown on this slide is the portion of the schedule related to the agency plans. Monthly premiums again increased five percent for the twenty twenty one plan year wellness program participants experienced a twenty five dollar reduction in the wellness discount from seventy five dollars to fifty dollars per month the net effect of the premium increase and the wellness discount reduction was an increase in subscribers out of pocket monthly premium payments ranging from ten percent to eighty seven percent of plan year twenty twenty one. This like contains the portion of schedule to that shows per premiums for the PS plan why premium rates did not increase for active or retiree subscribers the wellness discount degrees twenty five dollars per month from seventy five dollars to fifty dollars increasing the out of pocket contributions of wellness program participants by anywhere from three percent to two hundred and twenty two percent additionally cobra rates increase. This concludes my presentation agency representatives are here to answer committee questions. Centerfield pollution table. If you would please introduce yourself Jake pleaded with the employee benefits division of the Department transformation church service. If you would please stand raise your right hand. You Sullivan swear or affirm that the testimony back to give will be the truth the whole truth and nothing but truth I do thank you the city. Senator Hammer. Thank you morning governing do you have a copy of the report yes Page fourteen. Would you excuse me Senator with the church permission I'd like the auditor or the accounting in our office who work on this report and can answer in far more detail than I can bring County please come to the table. Thank you Sir. Senator. Yes Page fourteen ma'am thank you would please turn your microphone in addition if tell us your position Jennifer cost controller of employee benefits division would you please stand raise your right hand. Do you solemnly swear or affirm that the testimony rescue bees truth whole truth and nothing but truth leave me some. Sure would you like to ask a question yes Sir thank you just want to get done thank you up on page fourteen. On the PC E. health claims it has for cancers listed do you happen to are those individual type of cancers and so do you have what they are. We can certainly get those those are all going to be pulled out of our claims costs so the cancers are right we pay as you can imagine claims on a variety of different cancers right they're very different how we categorize them in terms of costs and breakdowns sometimes the reason treatment sometimes varies on and how they're presented at how they present in in the populations but we can certainly get you that information about alleged that non the ASC also the the two types of what kind of cancers are represented in those numbers if we could And then the second thing is sepsis the those are on both of them they're they're pretty good size claim amounts do you know is that originating after hospitalizations are deep does the data reveal the source of where it occurs we would probably have to go down into a claim by claim analysis to make that determination okay we rely on and contract with health advantage Blue Cross blue shield for medical management so we're really dependent on them to be able to help identify these claims as an insurance provider will work we're late to the game we don't Noel that such a one of our members is in the hospital or has sepsis and is treated for that sepsis do we get the bill. A month or two later so from a medical management standpoint we're really relying on the the doctors the hospitals and and R. T. P. A. R. third party administrator to handle that up front hopefully and I think I understand the direction you're going hopefully don't get sepsis and that were able to avoid those situations but I agree if if you are concerned with that that is something we should look at but I mean that's a pretty good chunk and I'm I'm just wondering if it originates on the hospital's hospital liability for why are we paying for that would be that bill legal questions but I think that's an excellent question given the given the high numbers that are represented in this and and I'm thing but all the other meetings that we sit in it on a B. D. and all this other stuff but to to what you just said coming in late to the game. Are we dependent then upon the cross BlueShield to provide that information as far as as the the causes the treatments and that are the the provider of that information or is it some other entity we have our own claims data and we do our own auditing internally we're very limited staff however as you can imagine so we do contract out with Blue Cross for medical management for claims management one of the things we've looked at doing going forward as may be separating that out having a separate vendor to look at those things but those high cost claims what we can do to get ahead of avoidable things certainly something that we're looking at. Okay and given what we're paying us on here somewhere on page fifteen what we're paying health advantage for the. Benefits that is not covered in those fees at all right that that item you just mentioned you talk about beef up your so what we paid a health advantage is to kind of categories once the claims costs so and that's a direct payment to us to the providers they work through the Blue Cross network so we're dependent on their reimbursement schedules the health of blue crosses but then we also pay an administrative fee to health advantage that's included in that that medical management is included in that it's about twenty one dollars per member per month okay and like what the my last question like what the Municipal League does as far as how they handle their payments is it just the sheer volume of the number of bodies that you're dealing with as opposed like what the Municipal League does thank maybe operated a lower cost in that area or I was the municipales does not rely on Blue Cross they have their own in house shop so they have their own employees that they paid to do this right of having those folks on the pay roll here we we contract with Blue Cross to do that yeah look at that yes Sir okay we'll talk thanks. With the excuse me Sir with the terms permission I might have to step up on the board of finance meeting here at ten o'clock but we will certainly do our best to answer the questions. Represent ringer. Hey good morning thank you Mr chair I guess my question is for this staff person to provide the report I was attempting to follow along as you provided the report and I noticed that there were several slides that are not a part of this report with respect to the large claim pay outs am I correct you pulled the road like right before the and they were like two or three slides that talked about certain claims. I think it was like nineteen and twenty one. Numbers that not that were a part of the slide presentation that this in this report and I was just I found that to be interesting because it made up a large part of the. Report is that correct this. It will follow just won't we will continue with other questions into the this report seems to have that in there will fall of music but not the one that I have okay retain may very. Thank you. I don't know if this is been analyzed or if it can be analyzed but I'd be interested in your perspective so it it says one of the reasons why we've had such higher cost on page three it says rebounded deferred elective care postponed due to COVID nineteen. And so I know during twenty twenty some of that elective care wasn't really I mean we're not talking plastic surgery I'm gonna get my nose fixed or something a lot of that elective care was actually needed care and I'm wondering how much of that contributed to some of those higher cost in other words when we look at what you know that the graph on page fourteen when we look at cancer and heart disease heart defect how many of those people if they had gotten care a little bit earlier might not have been in as bad of a situation is there is there any yet now what she can share on that that's something that we have looked at in our actuaries have tried to build into their cost projections but it's very difficult to project out okay if somebody has cancer right if we have a one of the high cost claims cancer claims that senator Hammer as identified to what extent would have prevented screening that was avoided in twenty twenty have identified that risk and mitigated the cost it's very hard to do but it's something we're looking at and COVID generally created a lot of challenges for us trying to figure out. What's going to happen with our claims expense okay I I'd be interested in just whatever research you can provide on that because I do know some very important surgeries were considered elective and I would not have considered any of them to be elective and a lot of you know mammograms and and things like that that maybe were put off sure and then just seeing moving forward how do we make sure that doesn't happen again so thank you good point. You know the questions. You're not senator Elliots wouldn't. It representative flowers we will recognize you. Thank you so share I was just wondering if any of the costs have been in any way impacted by prescription drug um costs absolutely prescription drug costs for one of our larger cost drivers if you look at overall costs right in the assumptions that we used to project costs or prescription drug expenses are rising faster than our medical claims expenses in a particular specialty drugs are particularly expensive part of our cost riders. And has there been any specific of information derived from the assessment behind this report like our keep you. Has anyone been able to point to why that Increase in costs has been escalating at the rate that it has we're not alone this is a national issue it's an issue that is. Parents all over the country Medicare Medicaid and cheese challenge by the Siegel consultants that were hired by L. C. legislative counsel to review this had a lot of thoughts on what we can do and we're trying to incorporate those proposals within a contract for pharmacy benefits management which is now on the street were soliciting bids for. All. I so I know in the end just because I've been marginally aware but still aware of some of the reasons behind cost increases. Lands in different parts of the state in different parts of the country it varies even though we are seeing a national spike and I'm just wondering if we're if we're going to entertain doing something different I would suspect that we would have some idea as to why the cost is escalating at a higher rate you know where where it's coming from especially if we're seeing a difference over time and I'm just wondering if if we've been able to isolate that is a multi trillion dollar question that you know the single team that came in and looked at it they have some thoughts on why that's going on one of the realities is is that although we are paying more for the medicines were getting we are also getting better medicine the code vaccine is a good example of that so he there's a lot going on in the pharmaceutical space I think our