ALC-Executive Subcommittee

Thank you members call the the executive subcommittee in Arkansas Legislative Council order. first on our agenda today we have a. DHS division medical services if you will. Come up to the table. Your. Then divide yourself. And then you're. Authorized president thank you. I thank Mr remark quite tomorrow Human Services Elizabeth Pittman Division of Medical Services. And we're here today to present an emergency rule for the administration of the coven nineteen vaccination to individuals that are in their home and those that are receiving home health services or those that maybe you're not enrolled in home health services that have difficulty getting to the doctor's office or to a pharmacist to receive the vaccine we follow the Medicare rule that was put in place for the same time type of service cover nineteen vaccination it is being paid at the same rate that we're paying having nineteen vaccinations for the first and second in the Johnson and Johnson but we are including a supplemental payments to account for travel time and the time to monitor after the shot was received. And happy to take any questions. Members are there any questions. Representative Dotson you're recognized thank you Mr chair so these. These are optional vaccines that they don't they're not mandatory right now they're not mandatory these are optional thank you. Any other questions. Not seeing any without objection the proposed emergency rule is reviewed and approved in the review and approval shall be effective at twelve oh one AM on Thursday November eleventh twenty twenty one. Thank you for being here thank you thank you members. Okay next we have the Siegel group going to present the. Draft final report of the. For health benefit study. We appreciate all your work in the the answers in a. Communication that thanks communication it's then heads and you will recognize yourself today and. Patrick Klein masego. Read it can be a single we have two people on soon today as well. We will let them recognize Senator. There was still. Matters there was still. Okay. The. Generally recognized president. I thank you. We have a small crowd today I guess everybody he's been paying attention this summer and there's no it's got a good handle on the recommendations so today like you said we're we're presenting the draft report there isn't any new recommendations and this it's really have a recap of the presentations we've made the summer and then we came in September ended a prison Tatian of all the recommendations so again this is just kind of in a different format we're gonna cover just the executive summary go over the recommendations coming aboard form and then allow time for discussion and I guess I'll be some voting on whether the recommendations move forward or not. This is takes a little longer to get in your car. Thank you just Pitsch them. So we're gonna go through the various sections wanted time The first part we have initial observation every recognized for co chair I'm sorry okay. Members just for information purposes when we when we did the procurement study the tax study all the other studies we allowed members to make a motion and they by making a motion you own that recommendations so you would on the language in the bill the future bill to go to session you and and all negotiations of that language so if if you look through here they're different subtitles yeah plan designs in contributions medical pharmacy clinical medical retiree coverage different ones we will make the motion to adopt the recommendation in its entirety from the subtitles so there are quite a few subsections under each one of those subsections will sometimes be addressed in one single bill not five bills for every subsections so So for instance plan design a contribution if I was going to carry that bill I would make a motion to carry that that recommendations so you will be clear on that for the membership so that they know when they make that motion you'll be handling that subtitle going forward. Are there any questions from membership before we move forward. Thank you are chairman rice. Thank you you're recognized proceed thank you so just get into the recommendations the first section is the plan designs and contributions you know we did a benchmarking study to kind of start things off and we figured that you know the plan designs are in a good place any reduction to plan design would really be cost shifting to the employee to save money for the planned so there isn't a lot of recommendations here but we did find a few items that we think make sense the first one is to reduce the urgent care copay from a hundred dollars to seventy five dollars in the premium plan and then or broader recommendation is to move the a public school teachers on to the of the state plan and the designs are or they have the same names are very similar in value this would be a benefit enhancement for the teachers by a slight bit no would have a small cost of the repair roughly four million dollars to the plan overall. Sauropods there. The discussion on the. Lands end and contribution. Not a take a motion I make a motion. The motion from go ahead I make a motion to adopt this recommendation that a motion and a second. Home favor I. The proposed. The doctor. continue making. Actually. So the the next section is medical we're talking medical year we're really talking about the vendor that you're with that's Blue Cross blue shield we did a discount analysis and you know we've and we looked at the admin fees those are kind of the the main ways that I. Medical Center can separate itself from from others and we we came up with that that you're with the most cost efficient vendor currently and that could change over time so we don't have a short term recommendation it's more of a long term view but we think you should continue with your normal R. F. P. cycles so whenever the contracts up conduct an RP but instead of just looking at those discounts and an admin fees should also include the ability to look at the total cost of care so you know look at metal medical management practices and it's a it's a shifting landscape so it's more than just discounts an admin fees that we should be looking at. And then the last recommendation is to try and identify areas of the contractor to be carved out so point solutions to specially vendors cemex examples or diabetes or muscular skeletal. You have a question representative dots. You're recognized unjust motion of the property. Thank you motion. I move adoption of this. A recommendation okay I have a motion to adopt the medical portion all in favor aye. Post. With medical or part is adopted. You're going to pharmacy. The next one I guess we're gonna let Nick Taylor do this. okay so um pharmacy as you know we. Had several sessions and we after our initial recommendations and and re read outs of tower we've had so discussions with you and your axe as well as the pharmacy association we had a nice discussion of those low on or recommendations as you know the the program a somewhat unique and that ET AL Boyd is both your accent impact working tenements manages program there is an aggressive form very management approach that includes reference based pricing which we know it is has been successful in obtaining a high chair dispensing rate somewhere around ninety three percent over the last several years in the use of lower cost drugs but the caller stated that is it's not a successful against benchmarks around higher costs market it is from a numbers standpoint number harsher so um just a note about that and the for Miller management process. right we fell on time focused around the rebates are part of the program and what's available through drug manufacturers our industry benchmarks and deals that we've been able to negotiate just this year you know show that read age to be twenty five to thirty five percent of gross costs your program there are currently around allowance will sign of the first class Sorek Asians are around in our of P. that is designed to the best of flexibility is desired in a program which includes a custom for Mary your custom samples process that is managed by UT R. acts today and the role of the independent pharmacies of the State Council want to do so so that you know kind of. Create that there is a wall for independent pharmacies in the US purchase recommendation The other recommendations or is around ripple required there's provided for Russell's list don't discount rebate guarantees for each year of the contract yeah clearly the final terms of the plans so this is a hundred percent passer manufacturer rebates this includes different levels or different types of rebates looting and solution protection and manufacturer of the fees. The request transparencies unserved therapeutic classes for instance of diabetes so that the P. is sharing some of the risk of managing back category the cost of that kind of those kind of words required there's proposed guaranteed rates what the independent pharmacies separate from all other pharmacies disallow a plan to have troll or basic terms pharmacies so you have separate guarantees for independence versus all other pharmacies. The reference based pricing program while it has some beneficial effect on driving increased dispensing there is some concern about the increase that number cost share in those programs and so the recommendation is if you are in our of P. is to make that program optional program that bettors can bet on. We feel at a competitive procurement would generate somewhere in this range of twenty five fifty million annually through greater rebates this to serve the same plan designed for merry that you have placed that I also know just wanna number cost share or during a war of how the form or expands to the. additionally you know we made a recommendation to route the it's not act which was act alone for I believe that spent resolved but that as the accident rate it was estimated cost about seven billion dollars in additional cost of the plan starting in twenty twenty two so that is the end of our recommendations are upon us. Is there any questions the on the pharmacy. Representative Wardlaw you're recognized. I make a motion to adopt a recommendation Mr. I have a motion to adopt. All in favor aye. Post. You're not very loud you don't seem like a yard and it. All right we'll. Open it up for discussion to intrigue. I'm I'm in favor this is only the only thing that to. I just wanna required that are supposed guaranteed rate with independent pharmacies separate from others I think we discussed that before I'd like to have just a little more information with that out I mean is that not a single run contrary with any type of price fixing or anything like that No Way bill research that for yeah and NexPoint discussed we've done this another number of other states on their performance. Any other questions neck is basically a question about doing independent separately is that causing. Problems and pricing. no no I mean it's it we've got another state send the yeah you can allow it to the to propose what they would generate as far as pricing and then you can you have control to adjust that it is too aggressive or not aggressive enough for however you want to get a sheet within our. We go on the idea is that you have more control the plan sponsored Senate negotiate that rather than rely on an issue that was a pharmacist in the guarantees of the independence are usually lower rate they're like more more favorable to the pharmacy is correct. Absolutely the other they will propose what we saying one that made proposals is that they are more favorable Both in distressing Garrett discount guarantees as well as this time. As low. In our time here and what it what he say about the guaranteed thirteen this because of the guarantees of the independence aren't as aggressive as they are furnishings Senate actually get paid a higher price than the chains all right thank you. Thank you Mr at and that's exactly what we ask you guys to do is to ensure that the independents are not left out of this pie the last thing we want is some big chain nationwide mail in pharmacy taken over all the pharmacy for state employees sorry we're clear on that right correct thank you I think this Senator Hickey does that answer some of your questions. It does again I'm I'm fine with it I understand what we're doing as long as the the state run contrary with any type of As long as we're for sure that when we've researched any type of. trade practice or anything like that then that I'm okay with it again that's my that's my concern. Thank you salary structure that are of PC can customize its weight one. Which is that's the most important part correct. Do we understand that I think I think we do. Yes Sir thank you. Okay any other questions on that. But we we will let the motion that was approved stand. next we have Medicare retiree coverage okay so we we look at the Medicare retiree program then we compared to our other states and have plenty of documentation explaining about the group Medicare advantage programs in other states and what they've done so we actually went up to bed got some pricing on that all came back favorable of actually from a conservative numbers I think it ended up showing about a forty million dollar savings through lower premiums so we recommend that you put a bit of for that making this on one roll means people would default into the MA planned at open enrollment they can change and go back to their of the plan it would be side by side next to the current program. the contributions would be recommend they be lower kind of proportional to the rates if they come through so is a lower premium for the member a lower lower price for the state. We also recommend that the ANC and the P. plan design is similar to the current plan design. And the PSC we recommend that you we need to reinstitute the pharmacy program so for those public school employees they would have a pharmacy benefit that they currently do not have. the both the programs a CMP issue would be equal plan designs And I think that's it and then in general the other piece of to be to have a big communications campaign around that to make sure that you can educate early retirees about the different program. Okay any questions on wrecker retiree coverage. The representative Dotson you're recognized. Thank you Mr chair I move. To address recommendations. I have a motion the second adopt all in favor aye. Just a minute. Good discussion I haven't accepted. I just wanna make it clear that this recommendation to me is one the most important ones because we're able to give back some of those benefits to teachers that they have lost since two thousand seven so as will make that known that this is the recommendation were able to give that pharmacy benefit back to those retirees thank you Mr thank you for pointing that out I have a motion the second all favor I. Posed. Thank you. Next we have clinical yes. Unfortunately Joanna who's presenting a couple times she is unable to attend Evan for the surgery but so I'm gonna be the clinician today Intellia Arden general recommendations we have not with Blue Cross and went to the different programs trying to look at the data the health of the population and in general there is short term recommendations and long term recommendations the short term recommendations are really to do a targeted diabetes management program that's as far as financially that's the where the savings is coming through we recommended that gives you about a ten to fourteen million dollar savings. So that can either be if the research whether it's you know through Blue Cross sort of organization or the targeted specialty diabetes management firm that would be some native to the figure that next piece out but that's when the recommendations the other one is the roll and roll out a less because musculoskeletal program and that's a virtual program. and both of those were mainly due to the data analysis that you did and saw that the prevalence and the issues in the opportunity for you guys one more longer term ones are well the the bariatric one she also recommends that you remove the limit on that after conversations with both Blue Cross in our review it looks like there's a positive ROI and then it's been successful so we don't see a really reasonable cap on that. And then the longer term ones are to shift the wellness plan design to more of a a results based program which would have a more impact on behavior change so it both requirements on your wellness vendor to have some clinical performance metrics that would show population health improvement and then as well as if you're gonna give credits back to members that would need to do some sort of health management aspect to get the reward. So there's that and the other piece would be looking at possibly on site clinics nonstate clinics there's like the next generation of on site clinic which is not necessarily of brick and mortar so you may have a brick and mortar in a certain location but there's now hubs and rituals and all this other stuff that the next generations doing which would allow you access to all the rural communities so I think research and that looks like it's almost just coming out now so it's it's fairly new but that might be something that would really help you gain access in the rural communities so it's like a longer term approach. I think those are the main objectives of the missile. A question from S. the pressure button. There will get you Senator Irvin you're recognized. So there is concern about the independent pharmacists and how the independent pharmacists would be affected this recommendation carries with that concern about how independent healthcare providers particularly that are located in rural Arkansas we continue to be able to be located there and so does this recommendation follow along with the same concerns it not replace scene your clinical healthcare providers within the state of Arkansas with an outside center of excellence as replacing that and how that would be in conflict with any willing provider legislation that we have because that's been an issue that's been brought up before when you go down this path and so I for you know just as we want to support our independent pharmacists in the state of Arkansas we also want to and support our health care providers in the state of Arkansas two in their clinical studies and clinical locations that provide jobs well paying jobs for all areas of the state of Arkansas so what would be your response to that yeah I guess which which recommendation talking about that that would have that or talk about the COE piece that one. The communication by college and that the on site the clinics that you were discussing answer clinics are really like The new model the kind that that the that I'm talking about which is really just and this is just a feasibility deceive it's impractical rates really talking a lot of providers to come in and the almost all the ones that are doing the next Gen stuff for doing partnerships in the community so they're trying to do a clinic that encompasses all the different clinicians in the rural areas so that's like that's part of this month and next agenda trying to wink at all and so that you can get everywhere and get more access for those members of the not really looking to cut that back to looking to expand it if anything and make more partnerships some question on a and and I'm on the bariatric program and I'm not I'd support it I'm a supportive person of that that I find it interesting because when we've actually tried to do other types of preventive type measures with you know different procedures and things like that we've been met with resistance and a huge cost to the taxpayer fund to taxpayers with the for instance lowering the cancer screening age for for Kali rectal cancer from the age of fifty down to forty five you know I received a letter stating that that was going to cost the benefit plans a ton of money so I don't understand how I can square you know of a diagnosis diagnostic test of lowering the age for colon cancer to get a a colonoscopy from fifty to forty five is actually gonna cost a ton of money for taxpayers because of the benefits that that would increase but then bury attic surgery. Is going to actually save money. Those two things don't swear to me so how is the insurance company saying in both of those things at the same time. A well I guess. I guess I'll have a couple comments on it first the they're totally different things rate and then we talk. So the one you're recognized as a bariatric which already has a proven record of having our lives so that's been that's a whole separate thing right so just analysis of why are you cap noted are many people yet capita so that dollar amount that's spent on which you haven't had anyways so that's one thing the other thing is all Joanna said was which is the recommendation here is to do age gender specific cancer screens we instead spend the we decided to age gender specific right and the reason she did that is because you said during COVID there's a huge drop in screening rates so she said relation one the re communicate to make sure that people are getting their cancer screens right I don't think she recommend anywhere to lower or raise it or any of that so what I'm and I am not referring to your report I'm referring to legislation that passed back in the session and the response from the insurance company's website so you understand you know you get one response saying what your legislation is going to increase costs but and then here I see you know we're going to do this and that's going to decrease costs or create savings so those two things just don't seem to I mean I support both yeah right I mean I or both I'm just trying to understand how they do things part of it you know very a concert is a major operations of somebody's you know their whole bodies changing and so we've seen the before and after and it's instant there's a big you know decreasing costs on on their claims and you know what you guys already have the program in place so it's nice we can see the the data on it showing a positive ROI I think you know if you lower the screaming screening from fifty to forty five they just see it as a cost where in a long term you probably are saving you're catching it earlier and some some instances but that's harder to quantify because it's just less of a you know immediate thing well yeah I mean I'm I mean I'm thank you for the latitude Mister chair but I mean I agree that those Clause copies are saving lives and that's not. A huge cost at the on site which could prevents you know huge cost on the backend it just doesn't seem like we're looking at at things the same way we're kind of picking and choosing what we want to support or not support or whatever and so I just I think that they're both good measures to take for people's health outcomes and so no I just wanna make sure I understand Howard figuring the announcmenet on the dollar amounts on this versus that. The thing is returned. Thank you senator Bledsoe you're recognized. Thank you Mr chair it's my understanding that with a eighty percent of those who have type two diabetes when they have bariatric surgery even before their they leave the hospital they are due is that correct. That's what your doctor said when he presented. All your doctors that we presented I mean I was the first time I heard that but then I was like I guess it makes sense I mean. To me that was you know one of the original things that was put out by the diabetes association of this was several years ago that it's amazing it was you know of people were shouting it from the rooftops that to with Dalby is sending expense here if they had bariatric surgery of and of course they're very conscious about the ones that they select for that surgery but that eighty percent work matured before they left the hospital yeah and you know diabetes is something that can be reversed so used to her used to hear about managing diabetes and mansion insulin but it's actually something that can be reversed not everybody but there's a high percentage that can be reversed a type two all right thank you. Thank you Is Senator Hammond St eighty. You're recognized thank you Mr on your on your page five presentation under clinical. It says our clinicians met with Blue Cross blue shield reviewed protocols in place for number programs who controls those protocols ultimately as far as how those look and the measurements as to whether they are being successful as they are currently being utilized I'm not sure if I have a great answer because I'm not Joanna but I mean I think in general she met with them and Blue Cross controls the protocols but in partnership I'm sure you can modify your protocols as the state and when you actually put your procurement out you can put in place with your our of peas and put a protocols you want for the state. Follow Mr. Was there any responsibility on the part of the carrier to bring forward recommended changes to the protocols because we're we've hired you to bring us these recommendations why would we have had to hire you to do this and should they have been doing this all along and would have had significant changes on the outcomes that would have affected the the the price of the policy we pay. I don't have the exact around the exact answer for what's exactly in their semi typically administrative administrators. You'll have quarterly and annual meetings with them and they're typically trying to bring you information and opportunities my guess is they probably have brought opportunities and protocols and things they should be doing till we and then provide all those meetings What else was. Okay we'll let me let me ask this last one then the the proposed amount of ten to fourteen million that you're estimating that just doing this would help create the savings these. These are modeled somewhere else in some other state where they're doing this to support your claim that it would save us ten to fourteen million dollars yeah we model that by the number of diabetics you had and with the participation expectation for the program and then the net savings that we can get from each of those what what data did you used to do that with to to determine that we used your own data for the diabetes people on the cost that you're having and then I'm not exactly sure who they are yeah there's like a national having national numbers on what can you flip somebody from a diabetic and they. So I think you know national numbers. Okay thank you thank you Mr. Thank you of Richmond Dotson you're recognized. motion from time. I have nobody else thank you would you motion. Motion to adopt the recommendation that a motion and a second adopt recommendation or clinical on favor I. Most clinical is adopted. Proceed with the reserving under strategy. All right so you know and I think the reason we are brought in is that we all recognize there's been some financial issues in the past and you know kind of coming up on another one if if changes are made so That's just come out quick intro but you know the recommendation is is really to build a multi year projection model so whatever the actuary is you're projecting out the current year and three additional years so you have Capitolina side of a potential shortfalls and you can see what the revenue and and claims all that is expected to be down the road he also we also recommend that you issued for a target reserve and we came up with the range of twelve to sixteen percent that's based off eight percent I'd be in our and then the four to forty eight percent on the claims fluctuation so that's our reserve are gonna be aiming for the the mid point of the reserve so fourteen percent target and then the twelve of the sixteen ACT is guard rails so um. Thanks. So as you you know drop if we do a projection and we see that the fund is going to be beneath twelve percent then that will because a trigger to take place and that's going to be immediate funding through the employees that need to be made up to get back to the twelve percent on the other on the flip side if you're above sixteen percent then you know the plan has some leeway on whether they need to you you know they can make benefit enhancements that could reduce what the finding the scheduled funding so really that twelve to sixteen a reserve ranges a recommendation. Skip the couple things okay ma'am up they said I yes. So then the the other piece is once we get the the Revenue shored up and we're on a level playing field the recommendation is that we hi future funding increases to some kind of health care CPI so say that's around four percent I think that's where it currently sets so you would have that as your target that EBT would be managing to So that's a recommendation and then. The last one is. You know we see opportunity to combine the esee in PSE programs so that's gonna help maximize stability and can reduce minimize the future increases required so you know we on we're not sure if there's a political political barrier there but you know if if that's something that's possible we think it makes sense to combine those for more stability. German Wardlaw recognized for a question thank you Mr. Senator Hickey now spoke earlier today when you get to the reserve that S. the guts of this whole thing because that's how you determine your premium pricing and everything going forward so instead of having a range and I know we need a range to find a mid point fine or said is is that having a range would have triggers a twelve percent that you would have to raise premiums to get it back to that fourteen also when you get to that sixteen percent you could actually lower premiums to give the members a little bit more that money in their pocket right until that goes back down below the fourteen percent and you have to start building up so I'm I guess it just wanna paint that picture to make sure you guys agree that that is what we're looking to do with these we're calling triggers that right exactly SO you're solving for the mid point but to your point yeah if you're been below that range then something needs to happen in centennial in any in need of a shot of funding instantaneously to get back within that range and then if you're outside of it on the high and then you can give that money back you know you don't have to raise premiums or you know benefit design enhancement whatever whatever's decided on and and it might mean that you're doing the three year production and two years out you know you're gonna get the eleven with everything happens okay when you next one percent funding and there's either we make it up through you know a step funding where you raise up percent we we put it on J. to try to figure out where we can get another percent somewhere or you know last resort if you need to get that you have to which was the the last by progress to be would be if we mourn by plan design changes are down to the number level C. hope you don't get to that level that has to do that but in the sequence has to make mention make sure that it's funded at minimum level S. S. right and and you need the reserves in case you have a catastrophic of the so that's the whole point. Thank you Mr I have a motion and proper to. Senator Hammer you're recognized for a question. Thank you Mr on your last point on on page six about combining the ASC in the PS funds to maximize stability. Per. It seems like forever we've been told that because the two different because the populations. Are really two different types of needs teachers usually cost more than the public school Irma I mean in the public sector but yet you're proposing to combine that can you can just help me understand how it is that that's going to help strengthen things or what's the rationale behind that. I mean historically the the ASC Fund has been. Funded better from the state persons the PSE Fund which is why it had to these infusions in the PSE Fund. but by putting together it basically takes the the stability of the ASC and helps the PSE get more stable we don't think you have to do it because both funds are a good side we think by putting together you can you have less very ability you could actually lower that you know the the guard rail if you want to lower the guard will slightly gives you a little more flexibility in design thinking overall we're trying to make an approach where you know the Medicare retirees of a similar look similar plan designs the benefit levels are the same so. Let's let's make it be the same you know and putting together I mean you can't change contributions I know that because the the district level but as far as the rest of the the game to the same vendors in a call on the same plan designs so. I guess my question is if we can't change. If we can change the funding how is it not disproportionately going to affect everyone population over the other. By combining it together if the funding announcmenet our coequal as to what we do for both of them. They're definitely not equal exactly out of the gate so the ANC would subsidize the PSC out of the gate a little bit because they have access funding even after the so for example you put in the Medicare advantage plan right you save forty million dollars on the the ANC side you're not saving on the PSC side because you're adding back the pharmacy benefit so that's kinda like they were disproportionately impacted by removal of the pharmacy benefits so we're putting it back but the issue would be getting all the funding advantage so it's kind of like we're trying to. Squared up a little bit in funding so like I said you can keep them separate but I think overall it's easier to manage a larger fund and it doesn't matter if there's different funding announcmenet coming through and you can still you know provider funding rates appropriately it doesn't matter if they're different contribution rates I mean the coffee managed in one particular fund I don't know if technically if if it's not able to merge the funds and you know from our perspective it's not a. It's not a game changer if you don't want to put together but we think in general it would be easier to manage a large fund. Our thank you. Senator Hickey recognized. Thank you of and I believe you all the back and forth with this on this part that it was just a little bit more because we've been trying to draft as part of the bill the timing is the part that we're or leased I'm struggling with a little bit okay so this is what we're going vision that J. E. B. day currently he's going to give us some projection is going to show that we're going to be will be twelve fourteen what whatever percent. So he's gonna give us that projection. And then if it's a if it's below it's going to come to a see for us to look at and discuss and debate were read and why. And then. If it's below at that point we're going to have to make a decision on whether or not we're going to put more money into the plan out of funds that we have parked in an account somewhere or if we're just going to allow the employees To you know have to pick up part of that or maybe maybe both maybe we put in part maybe they have to put in depending on you know where we're at with things. So as far as just the timing belt when when do we need when do employees that need to be notified. Of that increase increase if there were word to be an increase so does that need to be by. September thirtieth. But I guess the thing is I'm I'm wondering about the projections are the projections going to line up so that if we do June thirtieth that he has June thirtieth give him a couple weeks to figure out where we're at then July it's referred Dale C. use or in August we've got to make a decision. It could be that we have to have a special session in here you know if it depending on what the what the money was if we didn't have it parked in an account trying to do something different I'm almost munis When you do this process like sametime I think you're doing it I think it's not going to be for one one of this year yeah I mean so I think you've got time rates I think it's going to be for a year I would like you know like right now if the when you which will go the initial everything he did everything where you be at financially you know you're okay for a couple years right but as you get more experience and you get more time in the project are you gonna say maybe in your two thousand twenty four or three MS for having some issues so we have to do it by the time we got to that yours it's not like you're doing right now it's immediate right which is kind of like what you've been deal with the pass rate we're short this year we need to get the money and so I can be like them to be like we're gonna be short in a year and a half ago because you planned all this out you always have it out there so you're you're really looking at down the future now you could have some of us would draw down a little bit but you shouldn't get below that point first year you can be thinking more about I think you got time to not do it I think we need to in that cycle you're thinking about the following year for the employee contributions not the immediate one right of course we are we operate a political reality down here that three quarters of us may be grown in the. A not understand what's going on so I guess just just to kind of a allow are coming date for that for that factor. When when with the employees when would you think when would we if there had been an increase on the employees I'm not saying you know at some point fifteen years down the road. Would they need to be and what they need to be notified. By. October September what what's kind of the one thousand and that you want to notify them before the open enrollment which would which such as I'm blanking on the exact probably October two okay October. Okay so we want to figure that out by you know right when I understand what for the I understand what you're saying for the multi year but by the same token for the for the final year like that we're going to put a date within the draft legislation so that there is a drop dead date on one of action has to be taken and then there's compliance rules related to me if you had if you try to do something mid year you'd have to open it up and allow an open enrollment like all kinds of stuff like that so few gotten real fiscal crisis little beer and you have to do something which when I think you would be a time and that would be you know you have to give them probably thirty days never have open enrollment like all others but that's what we're trying to avoid sure okay I appreciate that yeah I mean with our typical clients you know usually the spring I mean for one one clients typically it's the spring that you know you're establishing baselines and figure out budget and then you're working through scenarios in the summer and then you make your decisions at all communicated in early fall when you're ready for open enrollment and I mean you're actually doing the work isn't going to be more than one or two points plus or minus so I would suspect that your you have way off numbers for the year I don't know when you go out to three four years then you start seeing more variability because of the longer term projection. So that's why we recommend using conservative assumptions in your project and out you know if you do you will see a gap to some you're looking two or three years out there looking at how we manage it maybe there's something we can do with their network with Blue Cross or maybe there's something with the pharmacy program or you know it's under it's under they're looking at all kinds of triggers that they could pull up to hold it down to. In thank you. Thank you okay take a motion from culture Wardlaw on the reserve in funding strategy I make a motion for adoption. Rose motion the second all in favor aye opposed. This is. So under the other if you are seeing okay. The settlement. The less so just a couple miscellaneous ones that we had one was actually. Have an actuarial note when you have an impact statements though and when you guys pass the I know that impacts the plant there's an actual know if there is a companion to that and I know you I think probably the on the pension side already so it's something that you can do on the health side. That way if you know the like the diabetes bill or thing like that the would have you would know financial impact of that that would affect the program. That's one of the things and the other one was just we did do a a cursory review of the website which recommended the updated that and noted Jake said that you guys are in the process of doing that currently so. I think that was the. Game any questions. It. Who you're with. Okay in any discussion. Go ahead Senator. I make a motion for those additional to Recommendations second I have a motion second all in favor aye. Posted. Section passes. Wardlaw. The the addition legislative recommendations members you would follow me to the additional legislative recommendations these are outside the scope of the. Okay so I'm just going splaine this you guys I don't think you'll have copies of it this is outside the scope of the consultants so the first topic here is governing board structure you guys member during session we put that over at the finance board we will have a bill that will put that back with representation from our public employees and our state teachers so it'll go back to a similar board as it was before with some guard rails that keep from happening what happening before there also be some legislative oversight so some different reports that will come to council throughout the year so that we can keep an eye and on the reserve funding and funding models going forward of we talked about in here at length I think it was in the July meeting on teacher of PSE funding changes moving some of those monies that go to the schools and come back the BT and moving that two of two a categorical fund and that is in this of recommendation as well and then one thing that was brought up by Mr Jake blade was minimum participation for members to receive the retirees benefits and that is also been brought up into this recommendation so maybe a five year participation while they're on the state job before they can receive retiree benefits just protection from the high cost side of it so with that I'd be glad to take any questions from members and I have a motion of proper time for these recommendations. Any questions. One thing I think we discuss some of when we can talk about that later in the legislative oversight of. One of the thoughts was with Michael Moore on the front end. As the saying kinda gets rolled out is is that going to be a flexibility in legislation that we could do that. And then. Later on such as a ninety day then go to six months or something to be flexibility and okay yes Jean no questions ready for your motion a motion for adoption of the additional legislative recommendations. I have a motion. Second. And all in favor aye. Opposed. Motion passes on the additional legislative recommendations. It members that is completed or any other business discuss. If not we will. One minute. Okay we are we will be meeting at one PM tomorrow Richmond Wardlaw you're recognized I just want sincerely from the membership to thank you guys from Siegel and all the hard work and also want to use this time to give a law announcmenet we look to maybe adopt the final report of the recommendations in the November council meeting hopefully we'll have bills ready for public release by the December council meeting so all members may motions represent Dotson Senator Hickey if one's and center in Irvine we want to try to work with staff and Siegel's promised me they'd be available for conference calls soon as for members to work through language so that by the December meeting we have these bills ironed out so they can be filed and out there for the public view for long enough before the fiscal session or the next time we come round for session to get the stuff enacted so with that I just want to you guys thank you and members of please work hard to get this stuff done on time so we can get it get it done it members your homework the big binders to take with you but be sure and bring back to our. Hello thank you to for would create the working of Louis police met your expectations. Thank you gentlemen we appreciate that and of the I. the clarify that or if the binder for Tomar. We are Jr.