Joint Budget Committee [Mar 10, 2026 - Upon Adjournment]

Thank you, Madam Chair. Phoebe Kanagaraja, JPC staff. The summary of staff recommendations for the Department of Early Childhood figure setting starts on page one and really bleeds into page two. There are two things in that first big table that I'll note for you. One is that we have 15 items to discuss today. So there's no really downhill point where it will get easier, just so you know. I'm sorry. It kind of just cascades throughout the whole thing.

Staff recommendation results in a very negligible increase in general fund of about $95,000. Staff recommendation is $11 million less than the department requests when it comes to general fund and $10 million less than the department's request. A lot of this is driven from things related to early intervention. that we will talk about when we get to that request. To go through the summary, R1 is revisiting what we discussed during supplementals, which is reduction to appropriations for the CCDF. So that one might be a bit easier. Staff recommendation for reductions is about more of a reduction than what the department requested This is because the department requested to increase some funding for apprenticeships and teach scholarships. Staff recommends approval of that part, but is also recommending offsetting that increase with further reductions given this cliff. And so that's why it's lower than the department request. R2 is an...the department had requested an increased early intervention. The department sends to the committee updated caseload projections in March, and those caseload projections were a lot lower than what they were in the beginning of the year. So that's why staff is recommending to continue the reallocation of money that came from HICPF last year ongoing, but is also recommending a net decrease in general fund overall to align with those updated caseload projections. R3 is an increase to universal preschool. This one will be a bit more of a discussion just based on what the committee wants to do here. There's currently a cleanup bill going that is independent of the JBC that would require the inflationary increase to come from the general fund in the out years. Staff recommendation right now puts only half of that increase into the general fund and the other half of it into PPGF for budget balancing. But if the committee thinks that that cleanup bill will pass, then you might choose to put all of that inflationary increase into the general fund, and we can discuss that during R3. R4 is decreases to child care licensing services, where staff recommends a net decrease in appropriations and 19.5 additional FTE. Staff recommendation here is a little bit lower than what the department requested, just based on using our standards for legislative council staff. for salary and operational costs and not including centrally appropriate costs into the request for the first year. R5 and the next item are the only two items in this figure-setting document that require legislation. R5 is that swap of general fund and tobacco MSA funds between programs to draw down more federal funds and staff is recommending approval of that request. The statewide R6 is to discontinue the child care services and substance use disorder treatment pilot, and staff is recommending approval of that request. Staff is also recommending approval of the statewide R6 reduced child maltreatment prevention funding request for budget balancing. BA1, the Local Leads Budget Consolidation request will also have a bit more discussion. That one has some complicating factors that we will discuss. For BA2, the department requested a $250,000 decrease to its payments to OIT. Staff is recommending a $1.5 million decrease based on reversions. And then we have a whole list of staff initiated items. The first one is just like a budget neutral technical adjustment in the long bill to consolidate all of the funding that goes to family resource centers into one line item for transparency. And then the remaining items are all deductions that we can discuss when we get to those sections in figure setting. AND THEN THE LAST FEW SECTIONS OF THE SUMMARY ARE EMPLOYEE COMPENSATION, CHANGES, OPERATING COMMON POLICIES AND IMPACTS DRIVEN BY OTHER AGENCIES AND TECHNICAL ADJUSTMENTS. AS FAR AS THE COMMON POLICY ITEMS GO AND IMPACTS BY OTHER AGENCIES THOSE WILL GET UPDATED AS THE COMMITTEE CONTINUES TO MAKE THOSE DECISIONS AND WITH THAT I JUMP INTO THE DECISIONS THAT AFFECT updated as the committee continues to make those decisions And with that I jump into the decisions that affect multiple divisions which starts on page 7 And this first one is R4, the Child Care Licensing Services Decrease. The department requests to eliminate some of its child care licensing contracts and move those functions in-house. In their department's request, this results in a reduction of 428,000 total funds, including 590,000 general funds and an increase of 19.6 FTE. Staff recommends approval except that staff reductions come out to be $0.9 million in total reductions, including the same amount of general fund, but also $462,000 decrease in CCDF. and 19.5 FTE in the first year. Also note, staff recommendation has an increase of 148 reappropriate funds. It wasn't clear in my write-up, but the department also requested that, so that part doesn't deviate. The reappropriate funds are just the department has some funds from CCDF going back into the EDO for any accountant in HR position that they're requesting through this request. One thing that I'll note is that I have a technical corrections update. It's kind of, it doesn't change staff recommendation and that memo is on your desk. But what I did change is that I realized I annualized the out year cost of staff recommendation for the FTE incorrectly. The department and staff use those charts next year when we start to analyze those budget requests and so this is more of a note to the department AND MY FUTURE SELF IF THE COMMITTEE TAKES STAFF RECOMMENDATION ON THIS ITEM THAT THAT SHOULD BE THE ANNUALIZATION. SO WHAT THIS REQUEST IS DOING IS THAT IT IS BRINGING ABOUT 46% OF THE DEPARTMENT'S CURRENT CONTRACT WORK IN-HOUSE. THIS IS BECAUSE OVER THE PAST FEW YEARS CONTRACTORS HAVE TURNED OVER. THIS HAS RESULTED IN A LOT MORE WORKLOAD COMING INTO THE DEPARTMENT AND ALSO PROCESS inefficiencies for providers who are seeking to get licensed. One of the interesting facts that came out of the department's hearing was that about 93% of negative surveys that they have gotten about licensing has been because of contracted staff, not because of in-department workload or staff on licensing. And so that high contractor turnover is also resulting in process inefficiencies for providers. And this is why the department is requesting to bring this in-house. I do agree that bringing underperforming contracts in-house is a good idea and that is why I am recommending approval of that part of the department's request. However, I think in the future, as the department thinks about bringing more contracted work into the department, there needs to be more information about are those contracts actually underperforming before JBC staff can agree to bring all contracted work into the department. I'll also note that transitioning all contractors work into the department is going to be much more of an additional cost. The department estimates that it would cost an additional $1.1 million in CCDF and 44.4 FTE to bring the remaining contracting work into the department. That is not something that the committee needs to decide today. That is something that will have to be discussed in the future as the department makes a plan on bringing those contracts in-house. But I will say that if it's coming from the CCDF and there are separate requests concerned

Well, I would say that it's not a new program, that the state is doing this licensing and inspection work. And the challenge has been that from the provider angle, all of the complaints that are coming, not all, 93%, I believe, of the complaints are related to the contracted services. and the real challenges that providers have when you don't have consistent quality of folks doing that inspection work and the challenges that it is presenting. And so this is simply trying to take back in-house a certain portion of that. And the bill, Senate Bill 20, has since been amended to say, I don't remember the exact language, but it's essentially as practicable to bring licensing in-house. So it doesn't require it to be 100% in-house because perhaps there are some of those instances that A, are providing quality inspection work as well as doing it in a cost-effective way. But part of the challenge is that it's no longer cost-effective and it's not good quality, what is happening in a lot of places across the state. And that's causing a real challenge for our provider community. So I think, but to Ms. Conagharaj's point, the department will have to continue to present to us how they are going to manage, you know, the budgetary aspect of bringing more licensing staff in-house versus the contracts. And we'll have to approve, you know, new budget requests as they come forward. And so I think there's continued opportunity for us to evaluate how this is working. And my expectation is that it will work well. But if it is not, we can continue to evaluate it. But at this point, what is being presented is both a cost saving and a value add, I think, to our provider community.

THANKS, MADAM CHAIR. REPRESENTATIVE BROWN, WE HAVE AN INTERNAL POLICY WHERE IF A DEPARTMENT IS REQUESTING NEW FTE IN THAT FIRST YEAR, WE TEND NOT TO APPROPRIATE SENTURY APPROPRIATE COSTS UNLESS IT FALLS ABOVE A CERTAIN THRESHOLD, which is 20 FTE in that first year. And the thought there is that the department should have vacancy savings or other money that they can use to cover any of those expenses in that first year, and then it gets annualized in. It's very possible that a department doesn't come back requesting to include centrally appropriate costs, and they might have a good case for it because they are a new department, so they might not have as much of that money to use on this. But for now, I'm going through the typical JBC staff procedure.

Thank you.

The one thing that I'll note for here, only because it also, we'll talk about it along similar lines with this next one, is that there is a bill, SB 2620, that is going through on the other side. Technically, the fiscal note for that one did include this one, but it won't be appropriate in since it's happening through the long bill. For my conversations with the department, staff analysis is that this could happen in the long bill because the department doesn't need a statute change to start to bring contracts in-house. that's authority that they already have in a bill. When we are making the long bill, we're making it to current law, which is a bit of a complication when there are bills going through across the street that could then impact state law.

Thanks, Madam Chair. Senator Robilley, I haven't written a J amendment for that bill yet. It's been kind of held off on actually going through, like, the technical back end side of a probes. I would work with a fiscal note analyst, update the fiscal note, and then it would reflect this.

And now we are on BA1, which starts on page 9, and this one is a bit... complicated and have some things to discuss. The department in this one is requesting a budget neutral consolidation of appropriations for local coordinating organizations and early childhood councils, specifically those amounts and those line items listed below, into a new line item called local leads which would reflect, which would be an adjustment to reflect a bill that is going across the street, SB 26019, which is consolidating the functions of LCOs into early childhood councils. So there are two issues to talk about with this request and things that I have discovered as going through the analysis. The first one is that this request is predicated and dependent upon SB 26019. That has already gone through the Senate. It is scheduled to go through the House Education Committee on March 19th. It is not scheduled for House appropriations. It did not go through Senate appropriations, which is why it's being discussed here as a long bill adjustment. But it certainly would have been cleaner for the appropriations for this to go through the bill, because if the bill should fail, then it kind of leaves LCOs without a line item for their funding if the long bill reflects this The second issue which we will also talk about is that the department says that this is a budget neutral consolidation But the question across the board is if you combining functions and administration for ECCs and LCOs why is this not resulting in a reduction And it's been quite hard to parse with the department why that is so. I think what the overall story is from what I've been able to gather so far is that the department is planning to expand or take on new quality work. And those aren't necessarily required by the bill to consolidate ECCs and LCOs. But it's unclear of what of these consolidated appropriations are going to then go to ECCs for their work and what the department will use for its expanded quality work. And so staff recommendation is to try to start to parse that out. I very much expect the department to do a comeback based on staff recommendation. And if the department does do a comeback, I think it would be helpful for them to explain to the committee a breakout of how they plan to use these costs. Specifically what will go to ECCs and what they will use for quality work. And they plan on using that funding to help the committee and staff make a better recommendation.

Ms. Conagraja. Thanks Madam Chair. Representative Brian, I kind of think of ECCOs and LCOs as like the boots on the ground. And helping families get connected to child care services, helping providers get enrolled into CCAP or UPK, and helping providers know how to go through the licensing process or know what they need to do to get quality ratings with the department and things like that. So they're really there to like provide resource and navigation for families trying to navigate the early childhood system and providers who are trying to offer services. LCOs were created when the department and the universal preschool program were created specifically to take on those coordinating functions specifically for UPK, which is helping families get enrolled in UPK, helping providers become a qualified UPK provider and knowing what they need to do in terms of quality work. But there has been a lot of overlap in statute and then a lot of also functional overlap between those entities because they kind of fit the same demographic. And so that's why they're being combined. So LCOs are specific to UPK, whereas ECC is specific more towards child care. Is that it?

And there's a footnote that we're repealing because the report was done, and it was really... Or not a footnote, sorry, an RFI. It will be repealing because the report was done, but it was actually a really helpful, useful document in the process OF COMING UP WITH THIS LEGISLATION AND HOW TO MOVE FORWARD THAT WE CAN GET FOR YOU IF YOU WANT TO SPEND MORE TIME LOOKING AT THE WAYS IN WHICH THEY ARE SIMILAR AND OVERLAP AND ALL THE SORT OF QUESTIONS THAT WE HAD, THE REPORT WAS VERY HELPFUL IN EXPLAINING HOW WE MIGHT MOVE FORWARD.

Madam Chair and Representative Targis, it's on the top... Representative Targis talking about the numbers on the top of page 10. Yes. There are six FTE who oversee the LCOs. My understanding is that they are overseeing all 32 of the LCOs, but that they should be coordinating with the department's internal staff, which are 4.0 FTE, that also work with the ECCs on areas where they overlap. But it is a good question on, like, why there's, like, this, what those FTE are actually doing when there is this functional overlap. I think the question when it comes to, like, post-consolidation, WHAT ARE THOSE FTE DOING AFTER LCOs ARE CONSOLIDATED INTO ECCS? THAT IS WHAT STAFF ANALYSIS GETS TO AND THAT IS WHY STAFF IS RECOMMENDING A CUT FOR FTE BECAUSE FROM THE DEPARTMENT'S RESPONSES TO QUESTIONS, THERE IS A CHART THAT STARTS ON PAGE 11 THAT DETAILS HOW STAFF POSITIONS WILL STAY THE SAME OR CHANGE AFTER CONSOLIDATION. FTE will still manage ECCs and LCOs and continue the work that the department has been doing. Four FTE will be taking what looks to be like new and expanded quality work. And those are the FTE that staff is recommending to eliminate post-consolidation. Again, that brings up the questions. I was able to parse out what is happening on the FTE side of what staff will take on new quality work, but in terms of the remaining appropriations, I have not been able to parse out and have not been able to get a clear answer from the department on how much of their existing funding will go to consolidated ECCs and LCOs and how much the department will use internally for quality work, which is also why staff is recommending a footnote in the ECC line item that specifies that those appropriations cannot be used for departmental internal expenses, almost like a forcing mechanism for the department to provide some more information to the committee on what it is planning to do with these appropriations.

Ms. Conagorasha. Madam Chair, Senator Kierkemaier, it's been hard for me to know. It's like a combination of UPK and CCAP as far as I know, but this is what the department needs to clarify. The bullet points in the middle of page 11 kind of detail what that is. It's developing and maintaining a resource bank for UPK providers, designing and implementing a child outcome monitoring system. I don't have more details on what that means. And then doing things like assuring quality standards. Also what's interesting in how the department's talking about this is that it sounds like they're also planning to take on more work that was formerly housed by LCOs when it comes to UPK enrollment and helping families with UPK issues. WHICH ALSO SEEMS TO BE A BIT OF AN OVERREACH BECAUSE THAT SHOULD BE WORK IN STATUTE THAT IS GIVEN TO LCOs AND ECCs. BUT WE ARE REDUCING THE MONEY THAT WOULD BE GOING OUT, ARE WE REDUCING THE MONEY THAT WOULD BE GOING OUT THE DOOR TO THE COMBINED ECC-LCO NOW? AT ALL?

Madam Chair, I don't know. The department has not been clear about what they're doing with this money.

I would just recommend that this be a department come back instead of a staff come back.

THE NEXT ITEM IS STAFF INITIATED ONE. IT STARTS ON THE BOTTOM OF PAGE 12. THIS IS JUST A TECHNICAL ADJUSTMENT TO THE FAMILY RESOURCE CENTERS APPROPRIATIONS. MORE STAFF RECOMMENDS TO COMBINE FUNDING FOR FAMILY RESOURCE CENTERS. THEY'RE CURRENTLY SPLIT INTO TWO LINEMS. ONE IS THE FAMILY RESOURCE CENTERS LINE ITEM. THERE'S ALSO SOME GENERAL FUND IN THE CHILD MALTREATMENT prevention line item and staff recommendation is to move what's in the child maltreatment prevention line item for FRC's into the Family Resource Centers line item for transparency. The analysis goes into some history about why those were split up it was just because one of the programs that the department was operating they stopped operating it they use those appropriations for FRC's instead when FRC's receive this money it's kind of like one block grant that they get they don't see a difference in the funding and so that's why staff is recommending to consolidate those line items. There's a separate reduction to the impacted

Page 13 is just an informational summary of the recommended budget reductions in this document. We will discuss them as we get to those requests. I really found it helpful to include a consolidated memo. The one item that is more informational but it doesn't need the committee's action is something that I think the committee could add to its assumptions for budget balancing, which is that first item of the ARPA money that the department doesn think that it will spend by December 2026 and that is million The bottom of page 14 goes more into where that money is coming from This is the money the department is thinking will be unspent and could be returned to the general fund by the end of December of 2026. That I'm providing to you more for awareness, but if you would like to revert that money early for fiscal year 25-26, it's an option that would require a bill.

I think that is the recommendation, but... but if it's included in the vote for 2526, then that is.

The department requested a reduction of $250,000 general fund. Staff is recommending a reduction of $1.5 million general fund based on prior reversions, and this would be an ongoing reduction to the payments to OIT line item. The chart in the middle of page 16 shows what those reversions have been in the past. It certainly is an option for the committee to revert more, to have that be $2.3 million. I just, I try to, the department, I just try to keep this modest, but you could definitely sweep more.

That is the bottom. I don't know. Is there anything the department has had to say that would put us at a, I don't know, that we would risk then having to make a greater appropriation next year? Madam Chair, I think payments to OIT has always been a bit unclear, where the department does think it needs this funding, which is why I went for 1.5 million as kind of a halfway point.

Madam Chair, Mr. McLear, who has the OIT budget, is making sure to work with staff on if staff, like in this case, is recommending reductions to payments to OIT to coordinate that, so we're not kind of double-hitting the departments.

The fiscal note doesn talk about it for 1364 So it possible that this FTE is separate from that and this appropriation does not cut that work um the reason so the statewide launch new data system will start to connect cde and cd le data into the system next year and a first report will be submitted to the general assembly in september of next year and then it seems like oit and the departments are focused on building a minimum kind of viable product for SLDS and then to increase other data systems from there as they get like a first phase of it built. And so the Department of Early Childhood's data is more scheduled for the second phase of the SLDS build than what will happen in the next year or so. Aside from like what other data work that the department is doing, I don't know honestly if this FTE does that. It certainly wasn't included in the fiscal note or the appropriation for the bill. Okay.

We're on page 32.

THE DEPARTMENT'S R1 REQUEST ON C-CAP, BUT THEY DON'T CHANGE STAFF RECOMMENDATION AT THIS POINT. LAST WEEK, THE DEPARTMENT SENT ME A MEMO ON OPERATIONAL ADJUSTMENTS AND ADMINISTRATIVE UPDATES. IT'S MAKING A C-CAP. THAT MEMO IS ATTACHED. IT'S APPENDIX THREE, SO AT THE END OF THIS FIGURE-SETTING DOCUMENT, IF THE COMMITTEE WOULD LIKE TO READ IT. BUT THIS IS A ONE-PAGE SUMMARY OF KIND OF SOME ADJUSTMENTS THAT THE DEPARTMENT IS MAKING IN C-CAP. The first are short-term actions. They will start to move El Paso Douglas and Montrose County from freezes to wait lists. The difference there is that a freeze means that the county is not taking or enrolling any new family in a wait list means that the county will start to enroll new families as it makes determinations about its ability to sustain them with funding. And those three counties will move on to wait lists because it looks like they're underspending their 25-26 allocation. The department's medium-term actions are that they're drafting a rule that will make a few different changes in how it's administering CCAP and that rule might take effect in August. I think the biggest thing to mention for the committee is that we had talked about earlier that counties have optional policies that they could implement for CCAP. The rule would make it so that counties would have to put this in their plan with the department. The department would have to approve it within 30 days for counties to take up an optional policy. This would give the department more visibility and kind of some more control over those optional policies that could increase costs. The second thing is clarifying that the state is a decision-maker for the allocation closeout process. I think what this one is trying to get to is that in the past counties have sometimes traded their funds. Like if a county has under appropriated that year for CCAP they might trade some of their funds with counties that have overexpended and this kind of puts a limitation on counties doing that in part to give the department more visibility on how counties are actually expending their money.

Madam Chair, I'll let the department defend it more, but my understanding is that counties that have historically underspent are doing so less now, and they actually are starting to use more of their full appropriation, which does kind of put the state or those counties that overspend it in a hard position where, like, there is no longer as much money to trade as there used to be before. And so I think this is why the department is trying to get to a position of having more visibility and oversight into that process, especially as it tries to control CCDF expenditure.

you have a question no okay and the long-term action for the committee to be aware of is that the CCAP allocation committee, that committee is composed of 11 members, eight of which are county representatives and three are department representatives. That allocation committee is considering your proposal right now to allocate less than the full CCDF appropriation in fiscal year 26-27 to counties in an effort to kind of postpone the funding cliff and ensure long-term sustainability of the CCDF. However, that final decision won't be made until May after long bill decisions have been made and the long bill is passed. The department on its end is still analyzing the impact of what that proposal would be on the fiscal cliff and the impact that it could have on families and providers, but it's still just a proposal being considered and I don't have additional details on what that would actually look like.

So R1 is the department's request to start to decrease appropriations for the CCDF to start to address the fiscal cliff that it is anticipating will come up in the future. We had discussed this request when it came to supplementals because this was also the department's S1 request. So I'll focus on the parts that have really changed since we discussed this during supplementals. The chart in the middle of page 40 there hasn't changed from supplementals. It's still the best data that I have right now, but given that some counties might start to move from freezes to wait lists, that number will change. And so I do want to highlight where the committee is kind of trying to balance an actively moving target with the CCDF. The assumptions on the cliff in terms of the federal rule being repealed, that repeal hasn't been finalized yet. As far as I know, the department still hasn't heard on whether its last provider rate increase can be delayed or not, but the department is still hoping and assuming that it will be able to.

This request is decreasing appropriations from the CCDF to some of those quality initiatives, and they are outlined in this analysis because the department has outlined what those decreases will be. But yes, on BA1 with the local leads where it seems like they are going to take on more quality work, it is unclear on where those will be appropriated to. But not these cuts.

Ms. Conagraja. Thanks, Madam Chair. Representative Tugger, I'm sorry. That's an editing error on my part. My first draft of this had a table that had all of those broken out and then I took it out, but I forgot to edit that sentence to be clearer. I think when the department estimates that it's 9.1 million off, it's doing it based on its annual award, but there is some flexibility in terms of it has three years to spend its awards. And so I think that might be part of the disjoint between its table on page 44 that shows its total quality and its estimate that it's 9.1 million over. It's just how is the department calculating what it can spend and what it is spending on quality based on the flexibility it gets in timeline to spend its federal award. And I think the department has had a hard time in being able to explain that clearly.

share because I feel like we started cutting you off before you actually through this just a couple of things that have changed since we last discussed this. Okay. No, no. Sorry. Whenever we did supplementals January, which was not very long ago. The one update is in the middle of page 41. So House Bill 26-12-60 is going through across the street and make some updates to the 2024 bill that had that would have resulted in increased cost to see cap. The main thing to highlight with that bill is that it delays what would have happened in in 2026 was that family copay caps would decrease from 10% to 7% and so this bill proposes to delay that until 2028 and so that is a general fund cost avoidance. to the program. And that is just the thing to highlight. That's what's in the bill? That is what's in the bill. And I only highlight it because it's something that has come up during the hearing with the department on who would run that bill and what is the status of that bill and, thank you, it's running across the street. Most of these reductions for quality have been discussed during supplementals. So I won't necessarily go through them. I'm on page 41. I'm going through the table that says R1 requests and staff recommendation. So most of these cuts were discussed during supplementals. The two new additions are an increase to teach scholarships and apprenticeships, which is an increase in appropriations and staff is recommending approving both of those For the teach scholarships staff IS RECOMMENDING APPROVING it based on the evidence of how it improves workforce retention and also because the entity that actually administers this program told me that they would use the CCDF investment to get a match in philanthropic funds. So for every $1 of CCDF, they would get $2 in philanthropic funds.

It doesn't seem like we're focused on that with the not you, not us, the department. It doesn't seem like the department is focused on how do we get off of the wait list or off of the freeze, maybe at least maybe move to a wait list.

Yeah. Senator Kirkmire, it's a good question. I think the department is really looking at how the fund is going to go negative, and there are not enough federal funds to be able to serve all the children that the department would like to. AND I THINK IT IS LIKE AN ONGOING QUESTION OF HOW DO WE DECREASE EXPENDITURES TO THESE THINGS TO SERVE MORE CHILDREN. WHAT THE DEPARTMENT IS TRYING TO DO IS ALSO NOT, IS ALSO MAKE SURE THAT THERE IS A WORKFORCE THAT CAN PROVIDE SERVICES TO CHILDREN, WHICH IS ALSO WHAT THE CCDF DOES, IS TO DO PROGRAMS THAT HELP WITH WORKFORCE RECRUITMENT AND RETENTION.

I don't think that there's anything that the department can do to increase the federal award. I think the problem is how do you administer this program within the confines of what is APPROPRIATED OR GRANTED TO THE DEPARTMENT FROM THE FEDERAL GOVERNMENT. AND THAT IS THE TRICKY THING.

On the apprenticeship side, I do also recommend that because my research into how apprenticeships are funded is that there is not a lot of federal funding for early childhood education apprenticeships. But for both of those increases, I recommend offsets to what the department is putting into the professional development information system. For any kind of a quality appropriation increase that the department would like to put in, I would recommend that there's something else that comes out. That's all.

I know of the CCDF that PDIS receives what would have been the FY26-27 appropriation before staff recommendation would have been about $500,000 and then staff recommendation decreases that to $360,000. The department did see my recommendation for this prior and they didn't explicitly say what would be cut with this. So if the department is concerned then I would recommend that they do a comeback but I would still also affirm that if there's going to be an increase in quality appropriations somewhere there has to be a mirroring decrease.

Thanks, Madam Chair. The next item is on UPK, which starts on page 44. So in this one, the department is requesting an appropriation increase to UPK based on projected enrollment and inflation increases. The main driver in the increase this year is the inflation increase. The department is also requesting to drop the reserve target for the preschool program crash fund or the PPGM from 15% to 10%. And this results in an increase of 14.3 million total funds, which includes 3.8 million general fund and 10.5 million, an increased spending authority from that cash fund. The out-year impact for the department is a lot bigger, mainly coming from an increase in general fund. This is because the department is annualizing next year's inflationary increase into this budget request. Staff has a modification, and then this is a unique one where staff has a modified recommendation because there is a bill going through and across the street that would impact this. And so it's up for committee discussion.

What I want to emphasize here is that there are two staff recommendations because I do not recommend the department's request on the out-year costs. I think it is getting ahead of ourselves to try to put in the inflationary increase for next year, this year, and that decision should be made next year and on an annual basis as we know what inflation is, actually. So staff recommendation is for the total increase of $14.3 million, but it puts half of the inflationary increase into the general fund, and then half of it into the cash fund. And this would drop the cash funds reserve to 8.9% under the OSPB's forecast, or 11.3% under LCS's forecast. aside from not recommending the out year inflationary increase I am also recommending to split between the general fund and PPGM just because of the general fund pressure that the state is under and this does align with current law however the modified staff recommendation takes into account House Bill 26-1259 which is the cleanup bill of statute for the department if that bill was your pass it does require that the UPK inflationary increase come from the general fund or state education fund. And so if it does become law, then the full 3.8 million inflationary increase would have to come from general fund. So I think it is a conversation for the committee of if you would rather assume that the bill passes to make that increase now.

It's a conversation for the General Assembly to essentially rectify something.

SHOULD COME FROM THE PRESCHOOL CASH FUND. AND THE RESULT OF DOING IT THE WAY IT WAS DONE LAST YEAR IS THAT FEWER DOLLARS ARE AVAILABLE FOR LOW-INCOME KIDS, FEWER DOLLARS THAN SORT OF WERE PROMISED WHEN THE PROGRAM STARTED. THAT SAID, I VERY MUCH UNDERSTAND THE CHALLENGES WE ARE FACING IN OUR BUDGET, BUT MY PREFERENCE WOULD BE TO PUT THE ORIGINAL LANGUAGE back into statute and then it can be the decision of this committee as to whether or not we are in a position to be able to fund that inflationary increase out of the general fund and we are certainly capable of running a bill to change that in a year that we needed to.

I think. I will also look to Director Harper for this. But I think if the committee were to vote on staff recommendation today, THE APPROPRIATION Clause for the bill would kind of have to reverse staff rec a bit and add back in the general fund and take away some of that cash fund that staff used to offset the increase. Unless we change that implementation date until later.

Okay. Okay.

Representative Brown, I don't know that, but I'll include it for the department as like an informational comeback. Thank you.

I think I would have to take back what the implementation date should be. Because if the goal is to minimize the fiscal year 26-27 impact, then I think the implementation date would have to take effect for just the year 27-28, so July 1st of 2027. Okay.

I DO, THAT THE DEPARTMENT THOUGHT THAT THEY COULD SAVE ABOUT $3 MILLION ON THE SUBJECT OF STACKING AND THEN REVISED IT DOWN, I BELIEVE, TO A MILLION. YES. AND I BELIEVE THAT WAS STRICTLY FOR 25-26, IF I RECALL. BUT I DON'T SEE ANYTHING IN YOUR WRITE-UP, UNLESS I MISSED IT, ABOUT STACKING.

Representative Tiger, it's still happening. It's still. So I think what, and I'm sorry that it figure setting didn't discuss it. I'm trying to make my document shorter, but then it does result in me cutting out things that would have been helpful. For 26 the department is projecting about 3 million of CCDF savings from stacking And this is from implementing stacking for the entire cohort of kids who have both UPK and CCAP And what happened and why they're not accounted for in figure setting is that that pool of money that is now available in CCDF would go to fund theoretically more families in CCAP. But that's still, for 26, 27, an updated projection. IT'S NOT ACTUALLY REALIZED. STAFF RECOMMENDATION FOR RFIs. FOR THE RFI THAT DISCUSSED STACKING FOR UPK AND CCAP, STAFF RECOMMENDATIONS TO KEEP IT WITH SOME MODIFICATIONS TO KEEP UP TO DATE ON HOW STACKING IS ACTUALLY PERFORMING. WAYS THAT THE DEPARTMENT CAN INCREASE EFFICIENCIES WITH STACKING AND GET MORE CCDS SAVINGS FROM IT. AND OTHER POLICY OR PROGRAMMATIC AREAS TO LOOK AT EFFICIENCIES FOR UPK AND CCAP.

I really appreciate that. All right.

Staff recommendation, Staff Initiated 6, which is, so, starts on page 747. It is a contract reduction to a WEDIT. Staff is recommending eliminating this contract, which would result in an ongoing general fund reduction of $188,000 almost. This is something that the committee approved during fiscal year 2425 for the fiscal year 2425 long bill in the department. This had been supported by stimulus funds but as stimulus funds expired the department or the committee chose to replace this with general fund. The contract provides business training courses and consultation including one on one advising to existing or prospective child care providers through the small business development center. And they offer a variety of formats for those courses, virtual and in person. And so this reduction would result in eliminating provision of those business training courses and consultation to providers. I do not have metrics on how that program has performed since fiscal year 24-25. The metrics that I got from the department are from January 2023 to June 2024. So a one and a half year period back in 2023-24, probably from when they requested this. And in that one and a half year period, the SBDC offered 33 trainings and 702 hours of one-on-one consultation. At the time...

retained and 64 jobs were created. I don't quite know how that information is gathered.

And that finishes decision items for the Division of Early Learning Access and Quality.

The Division of Community and Family Support starts on page 55. This one has the most decision items, but then it's smooth sailing after that. The first one is R2 on early intervention, which starts on page 56. And I'll just preface for the committee that there might be a lot of whiplash on this one as we're going through EI this year. So back in November, the department had requested an increase of 2.2 general fund and a reduction of 4 million reappropriate funds. Of this amount, 2 million general fund would have been taken from what had been appropriate to the Department of Health Care Policy and Financing and instead directly appropriate to the department a continuation of decisions that the committee made last year to provide more funding to EI. staff recommendation has substantially changed from that staff does recommend to continue that two million dollars that had been appropriated to HICPF and instead of appropriating it into the department ongoing which then also does result in a reduction of four million reappropriate funds however staff is also recommending a 7.4 million general fund decrease so the net impact of this is a 5.4 million general fund decrease to early intervention. And this is because of how caseload projections have changed since November. And you can see that on the chart on the bottom of page 56. It shows a lot of dotted lines, but it essentially just shows how the forecast for caseload has changed since 2025. So that uppermost gray line is what the forecast was in 2025. The orange middle line is what the department was balancing off for their request in November. And then the lower line is the updated forecast in March. And so there has been a big swing downward in terms of the projected caseload. The department has decreased that projection since November based on how fiscal year 2526 is currently performing. And that is at the top of page 57. So again, that gray line that's dotted shows the November projection for 2526. The dark blue line shows what has what actual enrollment has been monthly. so far in the fiscal year up until December. And based on that blue line, the department is updating its projection to the orange dotted line for November. And then that has also revised downwards 26-27. What is confusing and kind of conflicting here, aside from just like how caseload projections have swung downwards, is while the department has revised its caseload projection down for it has also increased its projection for service utilization very slightly by 0.5 percent. But the story on EI seems to keep evolving. Caseload I guess is decreasing but kids are using services and kids are using more services than anticipated or originally projected. And then the final thing that is just really confounds things is that the department still doesn't have a way to estimate cost per child. Ideally, there should be a way to see how caseload and service utilization projections then net out to what the department is requesting in terms of cost and forecasted state costs going forwards. That is the way that one would hope a projection would work. But the department is missing information that would let it be able to do this. Namely, it does not seem to have visibility into brokers fixed and variable costs. Also because those could vary by broker. So fixed costs are things like administrative staff, internal department provider staff, supplies, things like that. Variable costs are subcontracts staff and the rate for service that subcontract staff could get paid for. And then finally, there are a lot of costs that are just outside of the state and the department's control, like private insurance, that could offset state costs that we don't know and don't have visibility into. And so I know all that to say that, one, it does seem that the department is making a lot of strides in trying to update and make its caseload modeling more accurate, which is seen by the changes that are happening in caseload. But it's not automatically translating or very clearly translating into cost forecasting for this program. And so in this write-up, staff is making recommendations based on that updated forecast, and then staff has an informational item following this for conversation with the committee on how to proceed on this more long-term. But to just talk about R2.

Maybe.

I talk about R2 and staff recommendation for R2 first and then we can talk about more long for EI afterwards So for 26 with that downward revision of projections the department is projecting that it will underspend its current 25 appropriation after considering supplemental reductions by an additional $1.4 million. I think given the state of general fund deficit the state has, Staff is recommending to reduce the 2526 appropriation by 1 million general fund through a long bill add-on. If the performance indicates that the department has not accurately projected as under expenditure, I would encourage them to submit a 1331 request over the summer to make sure that they could pay for children. But given the general fund needs and also thinking about maintenance of effort for this program moving forward, Staff is recommending taking the $1 million now. And then for 26-27, the Office of State Planning and Budgeting and the Department communicated an updated request to me, and staff is recommending approval of that request. And that is essentially to maintain the same amount of funding as FY25-26 after supplemental actions. This would be $69.6 million general fund, inclusive of the $2 million general fund that the Department would get from what had been appropriate to HIGPUF. This is net 5.5, that number is wrong in my write-up. A net 5.5 million dollars lower than the department's original request when it comes to the general fund. Yeah, I made a math error there. Not included in this is it has been an ongoing conversation with the department on their cost containment strategy. They are moving forward with their cost containment strategy to require providers to determine eligibility annually. And during their hearing they projected that this would save about 1 million general funds starting in 26-27. And they still aim to implement it starting in 26-27. However, I don't recommend decreasing general fund by that estimated amount quite yet, just to see how EI performs in the start of 26-27. If it does seem like those savings are being realized, I would encourage the department to submit a supplemental request next year with that reduction. Thank you, Madam Chair.

The next item is more of a memo and discussion for the committee on what to do with early intervention moving forward. and that starts on page 59. The reason that this is not a staff recommendation at this point is, one, I want to have the conversation with the committee to gauge interest, but two, there's also information that I would need and I don't have yet in order to make this an actual recommendation for the committee. And so if the committee is interested in this, I think the next step forward is to have the department provide some of that information and an informational comeback. BUT WHAT STAFF IS KIND OF PROPOSING OR LOOKING INTO HERE IS DOING A PERFORMANCE AUDIT OR EVALUATION OF THE EARLY INTERVENTION PROGRAM. AND THIS WOULD, STAFF ESTIMATES THAT THIS WOULD COST ABOUT 500,000 GENERAL FUND ONE TIME TO THE OFFICE OF THE STATE AUDITOR BASED ON HOW OTHER AUDITS OF THIS SCOPE HAVE COST BEFORE AND MY CONVERSATIONS WITH THE STATE AUDITOR'S OFFICE AS WELL. This would also be a bill to do a performance audit or evaluation of the department's EI program. I do want to make sure that it's clear for the committee that an audit would not result in immediate cost savings to EI. What it would do is provide information to help the department and help the committee and help stakeholders at large understand where exactly costs for this program are coming from and then how to contain costs moving forward. My hope is that it would recommend improvements to the state budgeting financial management and funding for EI moving forward as allowable under Tabor and our constitutional landscape So what this audit is trying to solve for are two core issues. Also, my numbering got off in trying to combine documents, but eight and nine should be one and two. One is the department's inability to actually forecast its EI budget. BASED ON INACCURACY IN FORECASTING CASE LOAD AND SERVICE UTILIZATION, WHICH IS IT IS WORKING TO IMPROVE, BUT ALSO HOW THOSE DIRECTLY RELATE TO COSTS. AND TWO IS A LACK OF INFORMATION ON HOW TO BEST DEPLOY LIMITED FINANCIAL RESOURCES TO SERVE ALL ELIGIBLE FAMILIES. THE COMPLICATING FACTOR WITH EI IS THAT IF THE STATE IS OFFERING EARLY INTERVENTION AND A FAMILY IS ELIGIBLE, IT CANNOT HAVE A WAIT LIST. it has to serve all children that are eligible for EI. So that is not a way to control costs in the program. But a performance audit could look into other ways that the department could try to contain costs. What is missing in terms of how the department can calculate cost per child or relate to costs is that the department may not have visibility into the rates that brokers pay their subcontractors, the types of services that are used, how payment for services could vary between services and between brokers, and what each broker gets when it comes to Medicaid and other insurance. In addition, there may be other models of how to build private insurance or otherwise ensure equitable administration of EI from how other states implement this. That could be applicable to Colorado. And I have stated applicable to Colorado as a core kind of caveat to all of things when I talk about what other states are doing because Colorado does have a very unique constitutional landscape that makes it hard for us to do what other states are doing. Page 60 goes into more detail about what this performance audit could look into. I call it a solution, not the solution, because it might not be a perfect solution. But the list of things would be essentially for the state auditor contract WITH AN INDEPENDENT AUDITOR OR EVALUATOR. AND I KNOW THAT AS A CONTRACT TO AN INDEPENDENT ENTITY, MOSTLY FOR TRUST AMONG STAKEHOLDERS IN THE FINDINGS, AND THAT THERE'S A THIRD PARTY WHO'S LOOKING INTO ALL OF THIS INFORMATION AND COMING TO THE STATE AND THE DEPARTMENT WITH RECOMMENDATIONS. THE AUDIT, AS THIS INFORMATION IS AVAILABLE TO THE DEPARTMENT, AND THAT IS THE CAVEAT AND THE THING THAT I DO NOT KNOW, is which of these items of information are currently available to the department. The audit would look into broker's financial records, including reimbursements to subcontractors, services provided in cost per service, how many service units are provided by in-house staff versus subcontractors, and a break out of reimbursements by funding source. It would also look into the department's financial and operational records for administering early intervention. The department's contracts and agreements with brokers as well as when evaluators contracts are separate from brokers, those evaluators financial records too. And then as applicable and as other states are willing to discuss with an independent auditor what other states are doing that could be implemented in Colorado. And again as detailed in this last section of unknowns impacting this proposal, I don't know if the department's current contractual agreements with brokers gives them access TO THIS INFORMATION. AND THE STATE AUDITOR WOULD NOT BE ABLE TO ACCESS IT OR WHOEVER THEY CONTRACT WITH IF THE DEPARTMENT DOESN'T ALREADY RECEIVE IT. receive them. An avenue here, there is a path of if there is any information the department does not currently have, the committee could include as part of the audit bill a requirement that brokers provide that information to the department as part of their contracts in order to receive state funding. However, that does kind of push out the timeline of when findings from an audit would be available to the committee. And it may have an impact on cost, but I don't quite know that yet either. The audit would start if all this information was already available to the department and the department brokers would not need to make additional information available, the audit could start in 26-27 and take one year to complete with the information available to inform the 28-29 budget request. So this is definitely more of a long-term strategy and something that will not have an immediate impact. And that's a caveat.

Not. I'm not quite sure how things on the auditing committee work. It could be lower, but I think that is also if the auditor has a long docket of things to audit, and so having an independent contractor kind of speeds things up, too.

If the information is already available to the department because the department is entering contracts with these brokers, then the audit would be able to access the information that the department has.

It could also be a conversation just to start understanding with the department what information they do and don't have out of this list right now. And then keep having the conversation.

SO START WITH AN RFI? IT COULD ALSO BE AN INFORMATIONAL COMEBACK AND THEN THE COMMITTEE COULD DECIDE IF THAT ISN'T ENOUGH INFORMATION TO DO AN RFI. THANK YOU, MADAM CHAIR. I MOVE FOR AN INFORMATIONAL COMEBACK ALONG THE LINES OF STAFF REC UNDER I INFORMATIONAL EARLY INTERVENTION AUDIT. AUDIT. WE DON'T VOTE ON THAT. WE JUST WANT TO MAKE SURE IT HAPPENS. WE WANT THEM TO COME BACK. AND WE'RE GOING TO MAKE THEM BY VOTING ON IT. RIGHT?

I see. So the question in the information to come back is do you already have this information? And the RFI would then be for them to provide it to the committee.

DEPARTMENT UNLESS THEY COME BACK. I THINK THEY'LL PROBABLY SHARE THE INFORMATION WE'RE ASKING FOR WITHOUT THAT. I MEAN, WITH ALACRITY. AND MAYBE WE HOLD ON THE LINE ITEM DETAIL FOR THIS DEPARTMENT. LET'S JUST DO THAT. I'M NOT GETTING ANY NODS OF AGREEMENT TO SHARE THIS INFORMATION FROM THE

All right. Are we on R5? We're on R5, which starts on page 61. So the department here is requesting a net neutral swap of general fund and tobacco master agreement or MSA funds between Safe Care and the Nurse Home Visitor Program to draw down about 1 million more in federal funds Staff is recommending approval of the request except I have some modifications to the request of legislative changes that the department has requested. And then if the committee does approve staff recommendation, I also request drafting authority for a bill to enable this fund swap in coordination with OLLS, LCS, and the executive branch. A quick overview about SafeCare and Nurse Home Visitor Program and what the department is trying to do here. So SafeCare is an evidence-based and voluntary home visiting program that helps make homes physically safer for children and educates parents on child health. It receives an annual appropriation of 5.1 million general fund, which is used as the maintenance of effort requirement for a different source of federal funds, MCHV. The Nurse Home Visitor Program is another evidence-based and voluntary home visiting program that sends nurses to the homes of first-time pregnant parents and their newborns. And it's mainly funded through tobacco MSA appropriations and MIECHV grant funds. The federal source that the department is trying to draw down more money from is coming from the Federal Family First Prevention Services Act. The act permits the use of federal funding for timely prevention services for mental health SUBSTANCE USE AND IN-HOME PARENT SKILL BUILDING PROGRAMS WITH THE INTENT TO KIND OF PREVENT THE CHILDREN OR YOUTH GOING INTO FOSTER CARE OR CASES OF CHILD WELFARE. ONLY PROGRAMS THAT ALIGN WITH REQUIRED EVIDENCE DESIGNATIONS THAT ARE ESTABLISHED BY THE FEDERAL GOVERNMENT IN THAT ACT AND THEN ARE ALSO LISTED IN THE FEDERAL PREVENTION SERVICE clearinghouse are eligible to receive that federal match or reimbursement. Programs must also be listed in the state's five-year family first prevention services plan to be eligible to receive drawdown. And so the list on the bottom of page 61 lists those programs that are eligible for the drawdown. They include Safe Care and Nurse Family Partnership, aka the Nurse Home Visiting Program. I'll note here that while Safe Care has been in the a list of programs that can receive more, receive federal drawdown. It hasn't been used for matching for this federal fund source because it's already being used for matching with a different federal funding source, which we'll talk about next, which is MIECHV. And the same program can't be used twice for federal matching, essentially.

Over the last three years the department has drawn down about 489,000 in federal FFSA reimbursements. This amount is so low because right now the state can only claim it on families that are going through an open child welfare case. And the reimbursement rate is 50% for state investment into eligible direct services. The expansion of the department is trying to do here is listed under maximizing FFPSA reimbursements and explains the swap. My one note on page 62 before moving on is that any money that comes in through FFPSA will get deposited into the COCAP trust fund. There's a bill going through across the street right now that will continue the COCAP trust fund indefinitely. It was set to sunset. And it would also only, the trust fund moving forward if that bill passes would only include reimbursements received from the Department of Early Childhood. into the trust fund as well as other existing funds fees that go into that. Before this bill the Department of Human Services also got FFPSA drawdown If that bill passes then what the Department of Human Services gets from drawdown would be directly allocated to counties for child welfare services What that does mean is that if the department is successful in drawing down more federal funds, the trust fund is annually appropriated. So the department would have to come to the committee to request more funding and report on how much more it has been able to draw down in order to actually be able to use that funding. So the expansion here is the department is trying to try this community pathways approach, which was approved by the federal government, and the department did get it approved for safe care. It's a pilot that's approached to maximize its federal reimbursement. And what it's expanding here is that the department would now be able to draw down more federal funds for populations that don't have an active child welfare case but will refer to child welfare. And so that is why the department is requesting this swap because it can't use safe care for both MIECHV and FFPSA. The legislation changes, I'll just focus on what staff recommendation is for those, is in the middle of page 63. The legislation would need to allow an annual transfer of 5.1 million from the Nurse Home Visitor Program Cash Fund, which is funded by the Tobacco MSA, to the CoCAP Trust Fund for 26-27. And this is different from the request. Staff recommends limiting it to 28-30. This is to align with the department's five-year strategic plan on how it's trying to improve drawdown of FFPSA. The intent here is that if this pilot to draw down more funding is successful, then this annual transfer can continue and the department can request it to continue indefinitely. But if it's not successful, then the committee should know and this should sunset. I also am recommending statutory change to allow the nurse home visitor program to use general fund as well as the request of statutory change to include primary and secondary child maltreatment services as an allowable use of that cash fund. And then finally, this is in addition to the request staff is recommending that the bill includes that the Joint Budget Committee receive a report from the department no later than November 1st, 2029, on how much funds have actually been drawn down as a result of this pilot.

UNDER THE WAY THAT THIS BILL WOULD BE WRITTEN, IT WOULD KIND OF JUST, I THINK THE INTENT WOULD BE LIKE IT JUST REVERTS. THIS IS ESSENTIALLY NET NEUTRAL, AND SO IT WOULDN'T LOOK LIKE A NEW APPROPRIATION OF GENERAL FUND. ACTUALLY, I MIGHT NEED TO THINK ABOUT THAT.

I think the one protective factor as I think about this for the general fund that would go to the nurse home visitor program is that it is the exact amount that is needed to match for MCHV funds. And so that would decrease any likelihood of that funding being cut. It could be moved back to safe care, but if there was a cut then it jeopardizes drawdown of federal MCHV funds. Okay. Any other questions? Vice Chair Bridges.

It does make some changes to the COCAP trust fund that just changes how money is deposited into it. It doesn't have an appropriation, this bill.

Have you seen it?

The bill, but that part of the bill is separate from what is happening in this list.

That was part of the staff rec.

The department had two state wide requests, so the first one starts on page 64. This is to discontinue the child care services and substance use disorder treatment pilot. This would require legislation to end this pilot program two years early than what it was scheduled to sunset at, and it would result in a reduction of 500,000 general fund for the next two years. Staff recommends approval of the request as well as drafting authority to eliminate the program working with OLS, LCS and the executive branch. The analysis just includes some background about this pilot program and first started in 2019 through House Bill 19-11-93 and then was extended to House Bill 22-12-95. The program is currently set to repeal on July 1st of 2028 and so the legislative change would be to repeal it two years early. Finally the grant funding goes to illuminating child care which provides mobile child care for parents and SUD treatment programs. And the picture on the bottom of page 64 is what one of those mobile child care units look like. The program does seem to be based on a need and some evidence. Nationwide SUD treatment service data indicates that only about 16% of treatment facilities that serve pregnant or postpartum women offer child care. And so this program was trying to address a need. In 2425, the program served 148 children, letting 104 caregivers attend SUD treatment. About 11% of those caregivers were pregnant. And 74% of those caregivers indicated that the program's child care helped them be able to participate in SUD treatment. Qualitative interviews of people who have been in this program have noted improvements in caregivers ability to focus on their treatment and be able to make long goals And in that qualitative interview of the 27 caregivers studied 17 had either completed or were still in their treatment program afterwards. The reduction that is proposed here would eliminate child care for all three of those sites. The program is trying, has applied for opioid settlement funds to try to sustain some of, at least one of the Denver sites that it operates, but it won't know whether it will get that funding until May or June.

Yeah, that's correct.

I don't think that alternative funding requires a match from the state. But it is an unknown of if the committee cuts this, I think the assumption is that it's cutting all the sites unless the program that operates it is able to find additional funds. The one thing that I wanted to note is, one, there are no similar programs offered in the state. This is something that I have in additional balancing options. But House Bill 24-12-23, which expanded some of the factors for CCAP, made participation for SUD treatment an eligible qualification to receive CCAP services. And the fiscal note for that bill did appropriate the department about 500,000 general fund in order to do that. However, those families would not be eligible right now to jump freezes and wait lists. So that general fund would kind of go into a pool to generally serve families. that wouldn't be dedicated specifically for families going through an SUD treatment program, which is why I listed it as an additional balancing option, but I'm just mentioning it here for the committee's awareness.

Some treatment centers do provide child care. This program was meant to fill a gap in providers that don't. Assistance use treatment providers also do get some federal block grants. They can choose to use that to help fund child care, but that going to be at that provider kind of discretion on how they use that funding Red Brown Yeah thank you Madam Chair and thank you Ms Conagraja

Oh, okay. And so the principle behind here is that the van, I guess, pulls up at a treatment center,

The next one is the second statewide R6 request that starts on page 66. This is to reduce child maltreatment prevention funding, specifically funding that's going to family resource centers. And the department requests to cut 480,000 general funds for the child maltreatment prevention line item ongoing. And staff recommends approving this reduction. connection. Family resource centers serve as resource hubs for families. They help connect families to services throughout the state as well as can provide food and nutrition services, parenting classes, housing assistance. The services that it offers to its community kind of vary by what their specific community needs In fiscal year 25 the family resource Centers received 3 million general fund in this line item and they also received 1 million in the Family Resource Centers line item. These are the line items that I am proposing to consolidate. The center's total fiscal year 26-27 funding with this reduction would be 4.1 million. This request reduction could impact about 236 families and children. Overall staff is recommending this budget balancing even though FRCs have been effective because of the state's general fund constraints. FRCs have indicated that this may eliminate or reduce the staffing position to absorb this cut.

It is more of a reduction to FRCs, yes. although it has been clear to me how FRCs have currently been impacted by last year's reduction. I think across the board, the department did award more grants to FRCs, but those grants are likely to have been in a smaller dollar amount than what they were in the past. But I don't know what FRCs did after receiving smaller grant awards.

STAFF IS RECOMMENDING A 10% REDUCTION TO EARLY CHILD MENTAL HEALTH SERVICES, WHICH IS ABOUT 135,000 GENERAL FUND ONGOING. THIS IS SOMETHING THAT STAFF PROPOSED LAST YEAR DURING FIGURE SETTING, BUT THE COMMUNITY DIDN'T TAKE, AND SO STAFF IS REVISITING IT AGAIN THIS YEAR. The Early Child Mental Health Consultation Program aims to increase mental health consultation services to children from ages 0 to 5 and coach and train families and providers. The goal is to identify early concerns in social and emotional development. The department estimates that this reduction would reduce two service providers resulting in about 60 fewer cases served statewide. In fiscal year 24-25, there were 26.9 service providers helping about 569 children. I'll also say that this program also receives about $2 million in CCDF.

Staff is recommending a 50% reduction to the general fund appropriated to Healthy Steps for a savings of $314,000 general fund ongoing. Staff is also recommending as part of this to create a new line item for the remaining 50% of appropriations that go to Healthy Steps for transparency. Right now, those appropriations are in the line item that mostly goes to fund the nurse home visiting program. Healthy Steps is an evidence program that supports pediatric primary care for children ages 0 It places a Healthy Steps specialist in the family primary care setting so that as they go to visit a primary care doctor they also have another specialist who can sit down and spend more time with them to talk about their child's development. And as the family has more needs, help connect that family to additional resources. In 2024, the program served about 38,000 children and is estimated to return about $3 for every $1 invested. The general fund supports six out of the program's total of 33 sites statewide. Those three sites served about 13,000 children total. And so a 50% reduction would cut three-site staff and reduce services to about 6,700 children per year. THE PROGRAM ALSO GETS MEDICAID AND PHILANTHROPIC FUNDING, WHICH IS HOW THEY HAVE A LOT MORE SITES THAT ARE NOT SUPPORTED BY STATE GENERAL FUND.

And now it's line item detail and base appropriations for the division of community and family support.

Decision items for this were impacted in the decision items for multiple divisions. And so this one is also a line item and base appropriation.

Footnotes start on page 80. Staff recommends continuing a footnote that provides the department flexibility to collect indirect costs as it working to streamline its indirect cost plan Staff is also recommending the new footnote that was related to that local leads request, which is requiring that amounts appropriate in the Early Childhood Council's line item not be used for the department's internal expenses.

Yeah, I can tell you about RFIs. THERE IS ONE RFI FROM MULTIPLE DEPARTMENTS THAT STAFF IS RECOMMENDING TO CONTINUE AND MODIFY. THIS WAS ON THE CONNECTION BETWEEN C-CAP TENF AND CHILD WELFARE. AND THE STAFF MODIFICATION IS IN THAT THE RFI SUMMITED THIS YEAR. THE DEPARTMENTS WERE SUPPOSED TO REPORT ON BUDGET PRACTICES TO IMPLOMENT COST CONTAINMENT STRATEGIES. AND SO THE MODIFICATION IS JUST TO CONTINUE KNOWING ABOUT HOW IMPLEMENTATION OF THOSE STRATEGIES HAVE BEEN GOING AND HOW THE DEPARTMENTS ARE STILL STRATEGIZING ON THAT. Staff recommends eliminating two RFIs from the Department of Early Childhood. The first one is the one on ECCs and LCOs because the department has already answered that one and that is what created its local leads request. And the second one is an RFI related to the department's IT infrastructure and spending. The RFI was originally put in as the department was getting a lot of like big time investments into its IT infrastructure. And the last RFI the department has been reporting on how it's maintaining and doing modifications to that IT infrastructure. But given the amount of RFIs that the department has to respond to that are continuing or new, staff is recommending eliminating that one. Staff is recommending a new RFI discussed with the local leads related on what the department is doing with the quality initiatives. That's in the middle of page 82. And then the staff is recommending continuing and modifying a number of existing RFIs. The one that has the biggest modification is the RFI that had that big research request for early intervention cost containment strategies. Staff modification starts on page 84 and goes to page 85, but the modification on that one is that instead of researching cost containment strategies to keep the committee updated on on how implementation of cost containment strategies is going. And then the other big modification is on page 85, the RFI on stacking, just to continue updates on how stacking is going and other ways to improve efficiencies.

What else for us, Ms. Kanagarasha? The only thing to make the committee aware of is page 88 has the additional balancing options.

Yeah, really could have, and it might get there. I already, the one on the top of staff's ongoing expenditure reduction list is the appropriation from HB 24-12-23 for SUD treatment. JUST BECAUSE THAT GENERAL BOUND APPROPRIATION IS NOT GOING DIRECTLY TO FAMILIES GOING THROUGH SUD TREATMENT PROGRAMS FOR CCAP BUT it would go into serving additional families under CCAP If there are any of these that the committee would like to discuss further we can

Correct. The fiscal note assumes and appropriates the department that 557 general fund in its annualization because it's fiscal year 26-27 is when families become eligible based on being in an SUD treatment program. And it was to offer services to those families.

26-27.

So the committee could choose to not annualize that

Do we vote to take it to somewhere between 8.9% and 11% depending on the forecast? Yeah. So the committee right now there's about $42 million in the reserve and then the committee's vote would, depending on LCX,

it would probably go down to about $18.3 million at the end of fiscal year 26-27. At the end of 26-27, you said, right?

Thank you.

EMILY POPE, JBC STAFF. TECHNICALLY, TODAY WE'RE TALKING ABOUT BEHAVIORAL HEALTH COMMUNITY PROGRAMS, BUT IN ACTUALITY, WE'RE GOING TO BE TALKING ABOUT, WELL, MOST OF WHAT WE'RE TALKING ABOUT ACTUALLY HITS OTHER DIVISIONS OUTSIDE OF BEHAVIORAL HEALTH. WE'RE TALKING ABOUT 11 REQUESTS AND ONE INFORMATIONAL ITEM. Seven of those requests are repeats from the supplementals, so they should look familiar. And then four of those are new. I think I will start on page four. Our first request is a reduction for the SBIRT training grants. This is a repeat from the supplemental, but I am recommending that you do something a little different. So the department is asking for a reduction of $500,000 from the marijuana tax cash fund for SBIRT and using that marijuana tax cash fund appropriation to support MSP, the medical services premiums line, which is the largest line in the department, and then reducing general fund to MSP by $500,000. I'm recommending that you simply take a $1 million reduction from the MTCF for SBIRT without the general fund refinance to support marijuana tax cash fund balancing. So to start, the department has a $1.5 million appropriation from MTCF to support and contract for SBIRT training. The current appropriation is expected to support 150 trainings a year, or an average about three trainings per week. There are also free federal resources available for SBIRT training, but the federal trainings do not offer in-person and state-specific technical assistance that is available through the state-funded trainings. For example, state training support schools, and they also provide provider support with specific Medicaid billing requirements. The program initially was appropriated $500,000 from the Marijuana Tax Cash Fund, and that was increased to $1.5 million in 2018. It was reduced back down to $500,000 in 2020 for budget balancing and has gradually increased over the last several years. The committee denied a staff recommendation to completely eliminate funding for the grants last year. And I think the SBIRT trainings do show some value to support substance use providers. So that's why I'm not recommending a full elimination of the program. However, I do think that you need to make marijuana tax cash fund balancing decisions based on the LCS December forecast. So that is why I'm recommending a reduction of $1 million rather than a full elimination of the appropriation. You can see how the department request is working on the table in the middle of page 5 where it a net zero change to MTCF a net zero change for MSP but an overall reduction of in general fund Again, I'm not recommending that you take that general fund reduction so that we can focus on the MTCF balancing. I also wanted to note that I think the SBIRT providers recognize that budget balancing decisions are necessary, but this is a larger reduction than they are comfortable with. They'd prefer to see a $500,000 reduction. So what I'm recommending to you today is $1 million, but you can certainly choose to reduce that further or not as severely depending on the March forecast and the forecast that you choose to balance to.

Okay, next up is the request to reinstate the PARs for outpatient psychotherapy. You denied that request as part of the supplementals. I'm still recommending denial as it seemed like it was something the committee was not willing to take up. I will say I agree with the department that this is probably the largest reduction you can take in the least painful way for behavioral health. as meaning that it's a lower impact reduction than some alternatives. not been able to identify a better alternative and I think we're pretty concerned about where you stand for balancing so it may be something you want to reconsider but I did find articles with evidence that PARs reduce access to services beyond medical necessity so I found the request

Ms. Pope. Thank you, Madam Chair. I think I agree with what both of you have just noted. I think the concern is along the lines of what Senator Immobile is raising. I think some people have noted that the increase in utilization might have a lot to do with the way that the network has expanded overall. And it's hard to, there's certainly been an increase in utilization, and that's not up for debate. but whether or not that utilization has been problematic is a little up for debate. And it seems like people will lose access to services, and that loss in access to services may be simply due to administrative burden and not medical necessity. But that being said, that is less severe of a cut than maybe other options that are being brought to you. Okay.

Yes I just have a question So did they increase or did the rate increase or are we decreasing the rate so that this request assumes a savings of million including million of general fund I don know where that coming from because I looked at the fiscal note and they had nothing in there Nothing Paperwork So I understand about the utilization, but did the rates go up a lot, or did they cut the rates in this year's budget? Thank you, Madam Chair. So the original bill assumed that this would simply be an administrative change and there wouldn't be any change in utilization because most PARs were being approved. However, the department saw a sharp increase in utilization after the bill was passed, so they conducted a third-party analysis that found some of the utilization changes that you see in the table on page 7, where, for example, the utilization in sessions over 56 per year increased by 98%. So they're attributing that change in utilization to this bill, and they're assuming that there's $30 million associated with that change in utilization.

I will just say that we expanded the network on purpose and expanded access and contracted with a bunch more providers through the raise and did all these things because we had a big problem of people not having access. So I don't know how you strike a middle ground because I might be willing to do that, but I don't know what the right number of visits is. Is it 26? Is it 52? Is it like I just don't know. So I'm not sure I feel qualified to run a bill to address the issue.

Well, thank you. I was just, I'm just basing that number based on the conversations that I've had with the department, that there appears to be this sort of break point in the data where, you know, there's folks who are above 26. And I think that the data that Ms. Pope pulled is somewhat, gives me some hope that that isn't the worst idea in the world because it is the data that you pulled. but I think Ms. Pope talked about how when you set the par limit between like 5 and 10, that that's when you get into these situations of denying based on medical necessity. I'm not necessarily pushing for a bill here. I'm just sort of trying to give the committee an understanding of sort of like if we would like to pursue legislation, these are the conditions under which I would be willing to do that. And again, I would not want to require the Rays to do this. I would only want to allow them in very limited circumstances for people who are utilizing services above 26 in a given year. Because I think it's entirely possible that Senator Modell is right in that none of this would save us any money. And I think the Rays probably know that best. Thank you, Madam Chair. The more than 26 seems like the number, right? Like if we're just looking purely at most people are below the 26, but the most expensive people are above the 26, it is entirely possible that those folks really do need it. And I think in that case they would be given it. But if, you know, this is the classic 10% of people account for 90% of the cost, then we could be having, we could dramatically reduce costs without really reducing the impact on most people and without eliminating the ability to provide that care for folks who really need it if we set that 26 number And so I am inclined to move forward I inclined to move forward because we have to make cuts this year that we don't love to make, and this seems like a way to do it, that will have the least impact on people who need services. Even if we, I mean, just putting a par on services above 26, I mean, this is essentially saying this is a paperwork problem that will slow people down. It's not that because people still are entitled to parity. So if there's a medical necessity for more sessions, then they will be approved for said sessions and that they used to always approve them. And so I don't, I would like to be able to find savings here too. I just don't, I'm not quite clear on how we,

I'm not quite clear on how we get there either or if that, if this is, I think if you said you're limited to 26 and then you have to have prior authorization, what we're doing is, and I don't mean any disrespect for anybody who's listening, but that is, you know, the worried wealth, the people who are doing pretty good but want and need and use therapy, but aren't going all the time because they don't need that and they don't want that. And they don't have medical necessity for that. And if we limit the people who are the sickest by saying, you, the person who is doing the worst, can't get what you need, and they're also the people who are the sickest are also the least able to actually advocate for themselves to get what they need. and the least able to do any paperwork or make any phone calls or do any of the things that they might need to get past this paperwork hurdle. So I just feel like we're going to not even save any money on the backs of the people who are the sickest. And there might be a way to figure this out, but I don't know exactly what it is.

Thank you, Madam Chair. I certainly don't have a solution, but my concern here is that there are some trends in this department from the standpoint of when we open up a larger provider network, which is needed to reach a broader number of people, that's when things seem to explode. And then when we go to try to cut back on it, it ends up being on the patient. And what concerns me is, is this being driven by patient need, or is it being driven by providers that, and I won't finish the sentence, but there's a troubling trend. This isn't the only area within this department where we've expanded providers and we see the dollars going up exponentially. Well it not any EMT quality bed No We hope We hope Well Brett Brown I was just going to say that I think it is actually true in mental health, or sorry, in physical health, too, that a lot of times the sickest or the most serious procedures require prior authorization. I totally understand what Senator Mobile is saying. It does, I think I was trying to come up with a way to manage this with the least burden for the most amount of people, but I understand what you're saying about the consequences for folks that might need this kind of therapy ongoing for a long period of time at more than once every two weeks, basically. And so, I mean, again, I'm not exactly pushing for this, but I am trying to come up with a solution to what I think is the utilization problem that we are dealing with. And it is true that in health insurance and in health care, putting up red tape is one way to control utilization, and PARs are essentially that, and it sucks. So, anyway.

I mean, I'd be curious to know what the department thinks they would save if we said if you're over 55 visits. What does that save us? Because that 56, over the 56 plus is where you get the biggest percent change. And, you know, once a week if you're somebody who has schizophrenia or schizoaffective disorder, Like, that's not, that doesn't feel like you're somehow cheating the system. I would also, I mean, I think if you could do, if the department is willing to come back and say, we'd save so much for 55, it might also be willing, it just might be nice to know what the range is. Like, if you were to say, because I think what the department's request did not really contemplate is that we would do anything other than just like allow PARs, period. And now we're talking about sort of a guardrail on that. And if they have some sort of understanding of like what the savings would be if you were to set that requirement either at 55 or 26 or maybe something else, that would be helpful. They have the 24. Oh, they have 24 in there? Sorry, did I miss that? Well, that's what the 30 million is, is 24 visits. Oh, I'm sorry. Okay.

Because if somebody is going to object to even ever doing that, then... I don't mind us drafting a bill, but I'll just say that I'm not going to approve a bill that caps it at 24 visits. I mean, again, because I feel like that's just a completely arbitrary number, and I see that, oh, people started using it more because it became more available, and it was easier to get, and I'm like, good. All right. Well, moving on then, I guess. I'll just say. I deny it.

Let's draft a bill and let's start at 55. Okay. Over 55, they would have to get a par. Yeah. And tell the department to give us the fiscal note. See what it is.

Start. See if we can get anywhere. Thank you, Madam Chair. I guess I agree with starting the bill, but I think Representative Brown was heading down a path that I also was comfortable with in terms of, if I heard you right, is 55 the magic number any more than 24 is the magic number? If they could tell us how that 30 million breaks down on those four distinct levels, that would help me a great deal in whatever decision making. Because we could have picked 52. Well, the reason I said 55 is because they say that the utilization for 56 plus visits went up by 98%. That's a lot more than any other utilization, like the utilization for 26 to 35 visits went up by 61%. So if we're sort of trying to compare this to, like, long-term services and supports and we're saying, oh, these people who are 56 plus are costing us the most because they've, you know, doubled their utilization, well, maybe that's the place where we start to evaluate, do these people need that many visits? I don't know. That's why I said that number. Just because of this one chart.

And I'd like to know what the fiscal year 24-25 numbers are. Did we keep seeing big jumps, or was it just after that first year? Yeah, that would be good, too. It's kind of suspect that it's not there.

Thank you, Madam Chair. I move to go to drafting for a bill regarding R6.09 outpatient psychotherapy. initially at a number of 55. 50. 50. 52, because that's one per week. 52. 52.

Just as a starting place. Okay. We're going to get a tier from them. Okay, so long as we get the tier, I'm okay with it. Okay.

or not. Let me go pull another two things. Clarify what you...

Well, let's start with require and see what the fiscal note is.

allowing it would...

Make it higher.

I would.

Yes.

So required.

Okay.

We'll start.

Well, wouldn't the same estimate be present in the fiscal note based on whatever par level we set,

Yeah, allowing is fine.

All right.

So this was a request we also discussed during the supplementals. The request was assuming savings of $20 million in total funds, including $10 million general fund, based on a federal audit that was ongoing at the time the request was submitted. During the supplementals, I discussed that we were concerned that this request was double counting an amount that you had already assumed during figure setting last year, and the department has confirmed that, in fact, this is a double count. So I'm recommending denial since these savings have already been recognized as of last year. I did want to, well, I should clarify that the department also confirmed that their most current savings assumed for PBT pre- and post-payment reviews are reflected in their budget amendment request that was submitted in January and that I believe you approved yesterday. So you are assuming savings for PBT, just not from this specific request. The federal audit was released last week, so I did want to spend some time going through some of the findings. Before I do that, to level set some facts that were presented to you from the Manat presentation in January. They indicated that spending for PBT was $287 million in fiscal year 24-25, and expenditures for PBT have increased 436% from fiscal year 2018-19 to fiscal year 24-25. Spending on PBT makes up approximately 2% of total Medicaid spending, and the growth in expenditures has significantly outpaced the growth or the change in utilization of individual members. The audit from the Office of the Inspector General, my discussion of it begins on page 11. It makes five recommendations to HICPF, including refunding $42.6 million to the federal government, providing additional guidance to ABA facilities on documentation billing and credentialing requirements, periodically performing statewide post-payment reviews, periodically reviewing prior authorization procedures, and exercising reasonable diligence to review whether an additional estimated $112.5 million in potentially improper payments complied with federal and state requirements. The department does not agree with the methodology that was used to calculate the amount that's owed to the federal government, but the report indicates that the audit was completed in accordance with generally accepted government auditing standards. The department did indicate to you in their hearing that they expect negotiations around the exact amount that they will pay back to the federal government to go on for the next five to 10 years as we comb through the actual payments. What the federal audit did was look at payments that were made by the department from January 2022 to December of 2023 and selected a random sample of about $600,000 in payments from 47 facilities for 96 enrollees. If you look at the chart on page 12, the audit found that of those in payments only was allowable All other payments made by the department were found to be improper or potentially improper wow 862 dollars payments were found to be improper when federal or state guidelines were clearly violated and they were potentially improper when the documentation or guidelines were unclear to to providers. The audit makes the following statement, the state agency made improper or potentially improper payments because it did not provide effective oversight of fee-for-service Medicaid ABA payments, and specifically states that HICPF has not performed a statewide post-payment review, did not provide sufficient guidance to providers, and did not review its prior authorization contractors' procedures for verifying compliance with state and federal requirements. For some specific examples, starting with documentation, the audit could not determine if many documentation errors were improper or potentially improper because HICPUF does not have clear documentation standards for providers. Some examples of what they saw were they state that most session notes were found to be insufficient because basic information about the location, type, and duration of treatment used was omitted from the session notes. Many samples included session notes with text that appeared to be from standard templates or copied from another session. Some notes showed the wrong child's name, the wrong therapist's name, or incorrect dates and times. Moving on to some examples on page 13, the audit found that HICPF paid for services when the session notes did not match the billing code. HICPF paid for time that was not supported by the session notes, which may mean that the notes indicated less time than was billed for. or the bill time included non-billable services. HICPF paid for services that did not have notes with required signatures, and HICPF paid for services on one or more dates of service where the facilities were unable to provide documentation to the auditor at all. When it comes to prior authorizations, the audit again states that HICPF has never reviewed prior authorization procedures, and the audit found that the contractor approved requests even though required documentation such as a diagnostic evaluation was not provided. The audit indicates that some facilities were not aware that they were not submitting correct documentation because their prior authorizations were always being approved. When it comes to credentialing, the audit indicates that some billing codes require that services are provided by, provided by or supervised by a graduate level or certified paraprofessional, but the audit found that HICPF paid claims for services billed by non-credentialed technicians. The audit also says that HICPF told the auditor that credentials were required but there was not actually documentation that that was a requirement. So all of the payments in this category were found to be potentially improper because HICPF's guidance was unclear. When it comes to the additional findings from Manat, they found that PBT spending has increased 650% since fiscal year 17-18. Utilization is not evenly distributed across providers, raising concerns about consistency and medical necessity, and PBT spending is driven by increased rates and the average number of hours utilized per week. So I have concerns listed out on page 14 that are probably pretty obvious, but I'm concerned that the audit identified a lack of oversight at HICPF for PBT and what that means for services beyond PBT Many of the findings indicate that HCPF has provided insufficient guidance to providers Poor documentation may be the result of facilities not assuring appropriate training for their staff but it also indicates that some providers acting in good faith may not know that they're providing insufficient documentation because HCPF has never told them that. Staff is concerned about the department's capacity overall to identify risk and growth trends in free-for-service programs and the impact that a lack of review has had on vulnerable children. I, again, expect that the department will continue to negotiate refunds with the federal government for many years, and exactly what that means for the general fund I think is a little unknown to me at the time. I think this request assumes that the department will be recouping payments from providers. Half of that would go to the federal government and half of that would be general fund savings. But at some point we will owe the federal government a certain amount, and if they aren't able to recoup that from providers, that will be a general fund cost. I also assume that it will be a general fund cost to go through this entire negotiation process and figure out the exact amount that is owed to the federal government. I think there's also a significant risk that the department may not be able to recoup payments from providers that have already closed down, but will be able to recoup payments from providers who are operating in good faith and didn't know that they weren't meeting guidelines because those guidelines were never specified. Senator Kirkmeyer.

And I'm sorry, Emily, I don't have your cell phone number. I would have texted this to you as well. But I literally just got, and I've been talking to the autism folks, the PBT folks, about what could actually be done here. And they understand the issue. Appreciate, Emily, your comments with regard to staff concerns, because I read through the audit as well and had the same concerns. And it seemed to me like HICPF wants to try and blame everybody else when they were pretty lacking in what they should have been doing here. Anyways, they have a proposal that would require legislation from, again, this is from the PBT folks. that actually would end up with some savings, and it could actually maybe even be more savings. They're saying in their proposal, using a tiered approach and putting through some different legislation, and they welcome audits, quite frankly, because they've been trying to do what they were told to do, and now they're getting called out by HICPF for doing what HICPF told them to do. So, but they have, to start with, net savings of $10.2 million in total funds, which would equate to about $5.1 million in general fund savings. And they think maybe they could find more. So I think we should start here. And, again, I have not read this proposal. I just sent it to you all. I haven't read it. I think we need to do something here. We can't just keep having an increase. We can't just keep saying that, you know, I mean, the staff concerns are exactly what was in that audit. And it's not like we haven't seen audits like this before of HICPUF. I mean, I'm going to take you all back to the RAC audit that we had to go pay for and have done, and it was dismal. I mean, there were 18 recommendations that just said pretty much the same thing, that it's pretty dismal. So I think we've got to try something, and I think we've got to go find some savings. I THINK THE PBT FOLKS ARE TRYING TO HELP US FIND THE SAVINGS, AND I WOULD HOPE THAT WE COULD FIND MORE. BUT I HAVEN'T READ THROUGH THIS, AND I KNOW I JUST SENT IT TO ALL OF YOU AS WELL. I READ IT, AND I THINK THERE ARE SOME THINGS IN THERE THAT I JUST, WE ARE NOT IN THE POSITION TO MAKE A DECISION ON. NOW, ONE THING THAT MAY BE APPROPRIATE. be to have some kind of working group that is going to figure out the steps that need to be taken.

This is absolutely a mess. It is a mess in other states. It's not just here. This is reflective of activity that's happening across the country. And I will say that I do remember Director Bim Steffer sitting in here when we were being proposed with these, you know, very large increases to the rates and saying, don't do that. There is a lot of private equity that is engaged in this activity, and what we see happen when a lot of money is funneled into a sector, people find a way to tap into that money and extract it. I think that is part of what's going on. Clearly, we do not have our house in order here in terms of what is going on in the department in terms of clarity of guidance. And I absolutely agree that there's a lot that needs to be done. I think what's in that proposal is not something I feel like I can get on board with right now. I'm happy to have more conversations about, I don't know, what steps this committee ought to be taking. But we're not in a position to be increasing rates right now. And I think, you know, the committee, the working group that they're putting forward, I'm not thinking it's going to be so helpful to have industry and family utilizers driving the train here. I think everybody, yes, needs to be at the table, but I don't know where everyone else is at in next steps forward.

Thank you, Madam Chair. I will say that I think I agree with you on thank you for pointing out the challenge that this particular service line is facing across the country and that the audits that have occurred in other states have basically had very similar findings. And our finding is not unique. and I think it's also important to note that improper payments really mean that there was missing documentation. They don't necessarily mean that there was fraud, although I agree with you that this is a real challenge here. This is not the way that we should be running a program. So I do think that I can't speak to the proposal that we've been given today. Other than it would have to, I think it was going to take a lot of, I think a working group or something along the lines to think about the best way for us to move forward here is appropriate. But I think you have highlighted a key problem, which is that the more money that is to be made in these services, the more that there will be disreputable activists that take advantage of that. And that is not to say that everyone who is working in the space is a disreputable actor. but it will ultimately if we don get a handle on this it will affect kids and it will affect the legitimate actors who are trying to provide services in this space So that why I think it important for us to think about what the right approach is And I don't know that I know enough at this point to know what it is.

I mean, I just want to comment on, I wasn't here then. Maybe Kim Steffer did come in and say don't do this because of private equity. But it was still on the department to not let this become completely full of fraud. Like, that's, you don't get a pass just because you knew maybe, I mean, just because you're private equity doesn't mean you're bad. But it turns out there were a lot of bad actors here. And the department should have been paying attention. I mean, we just heard that there was a 90% increase among one group in behavioral health, and they're all, you know, we should cut that out and make them not get service anymore. But here we let 600% growth happen without raising the alarm until the auditor came in and exposed that. That seems like a different thing. And that's neither here nor there about this proposal about a working group. I mean, I do think we need to figure out what is the answer, and if that's a working group or I don't know. I just, you know, I'm just seeing it for the first time too, so I don't know what that looks like, but maybe we could table this. I mean, we don't have a decision, right? There's no savings. We've already realized it. We already took it.

I think you do need to take a vote to not take the department request. But I think to your point, yeah, there's not. I did maybe to be clear, I did also receive some outreach that may be different or the same as what you're seeing. And I think to me there's a lot of things that I have seen proposed are things to address in rule that you could take up in statute. But I think the department has a lot of work to figure out what guidelines they need to be giving providers. because I think to Rep Brown's point, I agree that a lot of what the audit found may indicate fraud in some places, but it's not fraudulent behavior. It's more unclear guidelines that the department needs to work out. So I think it was a little premature to me to assume savings from certain rule changes that are still to be determined.

Thank you, Madam Chair. I would support the working group, but I also want to say, even though I haven't been able to absorb everything here, the group that put this together really, really care. And I don't know about you folks, but I get hit every day. We all get hit with, we know you've got a budget problem, but the but's coming. And when I talked with this group, and I think everybody did, I said, take the time to give us some ideas, some advice, something that we can work around. And I may not agree with everything that's here, but I want to acknowledge the good actors put this together, and I sincerely appreciate them doing it.

Thank you, Madam Chair. I mean, I hear all of that, and I think when the rules are unclear and the oversight is not as strong as it perhaps needs to be, that that is when bad actors step in. I think we saw that with NAMT. I think we seeing that here And I move to reject department requests for R6 PBT reviews And do you want to do this working group thing At the moment, I think we're just, let's do this separately.

Thank you, Madam Chair. I'd love a staff come back on this because I think that something is called for here and maybe the staff come back is great news, HICPF's all over it, the rules are changing and clarity will be provided. I don't expect that that will be the case. So, but I would love to get a little bit of a deeper dive on where we go from here.

I appreciate that, and I do think that we need to figure out how to get to somewhere, and there are a lot of people that wish to work with you on this, good people who understand the issues facing children with autism and the lack of funding. And when we increased the JBC supplemental that we increased, and in that year following, we went from being underutilized of general fund at the Department of Health Care Policy and Finance by about $160 million to being overutilized by about $150 to $60 million. A $300 million shift in one year. And no one can ever explain that, how that happened either. So it wasn't just PBT. But let's face it, I read through that audit because I'm thinking what the hell did happen? And it's a lack of oversight that led us here. That audit wasn't about all the influx of money and granted there was things, but when you get things about lack of oversight, insufficient guidance, no training, insufficient because they haven't conducted reviews and clarified guidance accordingly. I mean, I'm not willing to let, I mean, hick puff off the hook here. and the confidence, my confidence in the department was low to begin with after reading through that audit, it went even lower. That's just not acceptable either. So we do have to do something. The folks that helped put together this proposal are saying, yep, we know cuts are coming. Let's figure out how we get there.

The department has implemented a reduced rate for PBT to 95% of a new benchmark that includes reduced rates that Nebraska implemented last year. You approved this request as part of the supplemental, and I'm recommending approval of the request on an ongoing basis.

Thank you, Madam Chair. I move staff rec R6.15.

You may recall the department originally requested a reduction for movement therapy in November that they retracted in January, so I'm recommending you take no action on that, which would have the same effect as approving both. So after that we on to new requests The first is at the bottom of page 16 The department is asking to continue a term program that conducts chronic pain training for providers on an ongoing basis I'm recommending denial of that request for budget balancing. It would be almost $300,000 in total funds, but only $94,000 in general fund to continue one FTE. The chronic pain centers of excellence was initiated by the department in fiscal year 21-22 using federal stimulus funding from ARPA. That was not from a bill. I believe it was just a program initiated by the department. It was continued for two years using general fund from a budget request in 2024. And the purpose of that request was to allow for some additional data collection to determine whether or not this program should be continued on an ongoing basis. This request continues the program on an ongoing basis even though that program effectiveness has not yet been determined. The center offers accredited education for providers, patient consults, and care coordination and the department indicates that the center has offered live and on-demand educational sessions for over 100 providers and connected dozens of patients to resources since it was implemented four years ago. When it comes to program effectiveness, the request indicates that it's difficult to gather conclusive data because intervention for chronic pain may occur at different times for each Medicaid member and it's difficult to measure the prescribing habits of hundreds of individual providers. So they have conducted some provider surveys that indicate that 76 percent of providers surveyed were comfortable incorporating skills learned into their everyday work and 96 percent found the information useful. The department hopes that if this funding is continued they will evaluate claims one year prior to intervention and one year after intervention. This analysis hasn't been possible in the four years that the program has operated because medical claims may be submitted 12 months after the date of service. So they hope that by extending the timeline they'll be able to collect more data to determine the effectiveness and are asking to continue with the program on an ongoing basis before that effectiveness has been determined. I'm recommending denial of the request for budget balancing since program effectiveness has not been demonstrated. If you would like to approve the request, I would recommend that you only do it on a two-year term limited basis to have the department report back to you on effectiveness before establishing the program on an ongoing basis. The department has indicated that if the request is not approved, members suffering from chronic pain would be more likely to receive inadequate care and providers would have no state-funded resources available to them, but there are some federal resources available for free through the CDC and FDA.

Are we talking about MD providers or like, I know there are pain clinics, I'm not trying to minimize what happens to somebody who has chronic pain, but I feel like there's been a lot of study of this problem. There's been a lot of innovation that's happened. There's a lot of new therapies out there. So I'm just not sure what this particular, who is this training for?

So it was originally the intent of the program to create a network of specialists, but the department was not able to do that. So instead they pivoted and the program trains primary care providers now.

Thank you, Madam Chair. I move staff recommendation for R14.1.

Thank you, Madam Chair. Can you tell me how they just pivoted? I mean, if we passed a bill to do something and they're like, well, we couldn't do it, so we're just going to do this other thing instead. Like, how's that happen?

You did not pass a bill to tell them to do this. They just started doing it. And then it didn't work, so they did something else.

All right. The next request starts on the bottom of page 18.

Senator Bradley.

Vice Chair Bridges.

Are there any objections? That passes on a vote of 6-0. Okay, next on page 20, the department

Director Harper.

Okay. Ms. Pope with the good ideas. Vice Chair Bridges.

Are there any objections? That passes on a vote of 6-0.

I will note that my chart on the top of page 24 is similar to what I presented in supplementals,

Thank you, Madam Chair.

Okay and the raise on the capitated side do we know what their medical loss ratio is like is that the thing that's 85-15 and do we know that that's is that what we're actually seeing and I'll just say on the physical health side we should know what that looks like too. I know I know it's not the same thing, it's not the medical loss ratio, but like we have eyes on that. Do we know what makes up the medical loss ratio? Like what things are they including, what things are they not including? Like there was a question about case management and.

We do have an RFI that includes information about the MLR, so I can see what level of detail is in there. it is a federal requirement that it be below 85 percent. So I can get more information on exactly what's included in there, but we do proactively receive that every November.

Thank you, Madam Chair. I just want to apologize to all of you colleagues. I should not have made this an issue on the mic to call out that these folks were significantly lower than everyone else Maybe it was the one person that was listening that day and said Taggart just gave us an opening I'm guessing they noticed.

Thank you, Madam Chair. I move staff rec on R2.

So the department is asking for a reduction in the behavioral health incentive payments to raise of 12.6 million total funds, including 3 million general fund. I'm recommending a reduction that's an estimated 30% reduction, which is what the department was assuming they were doing in the request. But based on follow-up information, it seems like the reduction that they requested is a little bit more aggressive than what they intended. So I recommended a $1.5 million decrease as part of the supplementals, and that's what you approved. This is a slightly higher reduction, again, trying to align with what the department's intent was. So RAIS are eligible to earn incentive payments based on performance metrics, and those payments can be up to an additional 5% of their capitation rate. Those payments are typically distributed, 66 to 90% of those awards pass through to providers. Rays often indicate that costs are not covered without their incentive payments, so I assume that the impact of the reduction could be passed on to providers, decreased provider and rate performance, or simply result in Rays negotiating higher rates in future years. The request states that it's based on an assumed reduction of 31%, but their hearing documents indicate that it's more like a reduction of 55%. Based on my concerns about what the impact of this reduction could be, I'm recommending that you align with that 31% rather than the request, which again is a reduction of $1.9 million in general fund.

Thank you, Madam Chair. I move Staff Rec R6.02.

The department is requesting some funding adjustments related to implementing the CCBHC demonstration grant. So you may recall that the committee sponsored legislation in 2024 to require the department to apply for a CCBHC planning grant, which is the certified community behavioral health clinic model. The department was awarded that grant in December of 2024 and has been going through the planning process. The next stage is to apply for a demonstration grant in April that's expected to be awarded in June. So the department is asking for additional staff and contracts to implement that demonstration grant. I agree that there's likely additional resources needed to meet the requirements of the grant, and that was part of the original assumption of implementing the CCBHC model, that the department would require additional resources. In addition to those resources, the department is also assuming federal fund savings because the CCBHC model results in a higher federal funds reimbursement rate. So overall, the request is an increase of 2.2 million total funds, but a decrease in 6 million general fund to recognize those additional federal funds I recommending approval of some of the requested resources but not recommending that we recognize the federal fund savings before that grant award is actually made One of the reasons for that is that the department has applied for CCBHC grants in the past and they were not awarded. and it just seems like a more cautious position to not assume the savings before they're awarded but you could come in during the supplemental or figure setting process next year once that decision is actually made and recognize the savings then. On the other hand, I do think that hopefully the department and state is in a much better position to be awarded a grant than we have been in prior years because our comprehensive provider system was set up with the intention of aligning with the CCBHC model. So when I look at what is required of the state, really, I think the primary difference is just some of the reporting requirements, which are extensive and which are the center of the requested resources from the department. So again, it seems like we're in a better position, but a more cautious take would be to not assume those savings until next year. When it comes to...

Well, you and I talked about this, but this isn't the BASOs. and these aren't when we are we talking about it says here you have to do these things to be a CCBHC but who is it that has to do these things is it the comprehensive providers is it the e-SNPs or the c-SNPs because I think we're not doing these things is that why we got turned down or because they'd like to She said we got turned down twice for this CCBHC. Twice? Oh, once a long time ago and once recently.

I believe, so the department has been turned down, successfully applied for a planning grant, I believe in 2016. And then I don't recall if they were denied the demonstration grant or if they just didn't apply. But then on the next round of planning grants, they applied and were denied. And then this was the third round that they applied for successfully. So the department and the BHA have partnered to align our system much more closely with the CCBHC model in hopes of having a successful application. I think to me, so there's requirements for the providers that to me look very similar to what we already asked of comprehensive providers. but maybe to your point that maybe it's happening, maybe it isn't. My main concern is there's very robust reporting requirements that would require a lot of database work for providers that some providers already have in place, but I think a lot of them don't, and that's what a lot of the contracting that the department is asking for will support. So they're asking for $800,000 to help clinics align their internal data systems with state and federal requirements to implement the demonstration grant, an additional $286,000 for cost reporting and reviews, and then almost $100,000 for quality and fidelity reporting required by the grant. So to me, that's the big gap that we will need to fill in order to have a successful demonstration and, again, part of what was assumed the department would need to implement CCBHC on an ongoing basis. It might be more of an outstanding question about whether our comprehensive providers are actually doing what is required.

Thank you, Madam Chair.

Senator Kirkman?

Senator Mobley?

So right now I think there are seven providers who are receiving CCBHC grants and have implemented all these requirements independently. But if the state is successful in their application, we receive an enhanced federal match. So the idea is that everyone benefits from that enhanced match rate. Senator Kirkmeyer? The providers are saying that they'll bring down the federal funds,

Senator Mobley.

Senator Kirkware?

pushing the department who left federal funds on the table for years in this program as well. That's frustrating too. I don't disagree with you. So maybe if the CCBHCs had more confidence in working with the department, maybe there would be more willingness to assist with some other things.

That's mostly based on an assumption that you probably want to recognize savings around FTE. I do think what they're requesting is in line with what we normally see around their request for new benefits. So that's just where that recommendation is coming from.

Thank you, Madam Chair. I move department request to accept one FTE instead of four.

I'm happy with the request. I like department rec. I would like to recognize the savings now as opposed to waiting until later. I think that's dangerous.

I wanted to point out there's only two line items in this subdivision. So it's $1.8 billion for capitation and $12.3 for fee for service. As I think you discussed yesterday, the staffing associated with behavioral health is in the executive director's office, so I don't have transparency into how many FTE or the amount of money that's attached to that office without asking, but you did ask during the hearing, and they indicated that they have 31.3 FTE for their behavioral health office, which is $6.89 million in total funds and $2.3 million general fund.

Thank you, Madam Chair, and thank you, Ms. Polk, for that. I appreciate that additional detail. One of the things that I was struck by yesterday, especially when we were talking about MPRAC and the importation program, it's just it doesn't seem like there's a ton of detail in the HICPF budget, in the line item detail, right? Like other departments that we get, it's like this program and this program and this program within the individual departments, and that isn't the way HICPF operates. I know this is probably a bigger project than we have time for, that anybody has capacity for right now, but I do think that working with Mr. Kurtz and Mr. Dermody in the future on giving the committee a little bit more sense of the individual line items and restructuring the long bill, I guess is what I'm asking for, related to HICPF, because it does seem like it's just a big bucket of money, and we just keep throwing stuff in there and having a little more sense of what individual divisions, individual offices, individual programs cost would be helpful. Yes. But not for today. But not for today. No, I'm just throwing that out. I'm putting it on the record in the future. Okay.

Thank you, Madam Chair. I move line item detail and base appropriation for behavioral health community programs. Community programs.

Thank you, Madam Chair. I was just bringing information to the committee, so no action initiated by me at this time.

Thank you, Madam Chair. As I recall, this high fidelity wraparound service that was presented to us last year or the year before. Anybody remember? Last year. Last year? Had very significant savings down the road. And maybe I didn't hear that right because you're giving me, Ms. Pope, you're giving me the eyes. Like, wasn't this the program that either Ohio or North Carolina, one of the two of them, were doing this very successfully? and we were mirroring our program after them?

So I guess my question is, and could the department come back to us? I know they're planting the seeds right now. I understand that from your write-up of when they believe this program will be operational so we can start to get some of that information of its evidence-based success. MS. SEN. KERRY. SEN. KERRY. SEN. It doesn't necessarily translate to savings for us or for this program, but even worse, it doesn't necessarily translate to care for these children. Doing a medical necessity by paper, not really even going and interviewing the child or know what's going on kind of thing, is just wrong. Leaving children in hospitals or in other placements or not finding placement or step-down placements is just wrong. I mean, the fact that it just seems ME THAT THEY DON'T CARE ABOUT THE CHILD AND WHAT KIND OF SURFACES THEY'RE RECEIVING AND HOW THEY'RE GOING TO PROGRESS IN ANY POSITIVE WAY IS JUST WRONG TO ME. SO FOR THEM TO JUST SAY WE'RE GOING TO DO A MEDICAL NECESSITY, WE TOLD THEM TO PAUSE, PUT SOME STUFF IN GUIDANCE, PUT SOME STUFF WHERE THEY'RE GOING TO COORDINATE THIS WITH THE COUNTIES, WITH THE HOSPITALS, WITH WHOMEVER THEY NEED TO, AND THEY DON'T DO THAT, AND THEY BLEW US OFF AND THEN STARTED IT in November, haven't really done anything except for one case that I heard of, and I think it's your county, Mesa County, and then just to say, well, you know what, we're just trying to cut our costs and screw the child welfare services side of things. Costs will go up there and forget about what we're doing that's in the best interest of the kid, of the child. I just think all of that is wrong. So that's why I would like for us to at least pause it for another year or tell HICPUF no completely to this policy. but I don't know that I have the votes to get there, but I do think we should pause it for another year and put in dates this time.

Vice Chair Bridges. I think if I could clarify. So what happened with the bill last year, there was a definite date about when these payments could move to behavioral health capitation, which was fiscal year 2627. We did not address medical necessity. So I think the issue would be, would you want a bill that says, I don't know, specifies how we're working with medical necessity for child welfare youth? Because that's what was implemented in November.

Did you have a comment? I don't have any more comments. Well, I don't know the answer to that question.

Thank you, Madam Chair. So last year there was no assumed savings. savings. I do think I would wonder if that would be the case this year, if the department would assume that it would be, if there would be costs with delaying it another year. I think they have been working on implementing this into the RAE contracts and whether or or not they would say it's net neutral again. We can find out.

ARE THERE ANY OBJECTIONS? THAT PASSES ON A VOTE OF 6-0 FOR TODAY. OKAY. I THINK THEN WE HAVE THE LINE ITEM DETAIL FOR THE TRANSFERS TO HUMAN SERVICES SECTION.

Are there any objections? That passes on a vote of 60. Okay, that brings us to footnotes and RFIs. There are no footnotes, but there are three RFIs. One is the RFI I was noting earlier that does break down some of the expenditures for behavioral health and has been long-standing. I'm only recommending technical changes around dates basically for these. The other two were added last year around the youth system of care issue. So the first is specific to what the department is implementing related to the system of care, and the next is around this issue of how many placements are available for child welfare youth. For that one, RFI 3, you asked for that to be provided to you in June of last year so that you would have it before your June meeting. I'm recommending that we bump that to November so that it's aligned with our regular budget process, but if you would prefer to receive it in the summer again, we can certainly keep it in June.

That's it. Anything to point out on the additional balancing options? You would elevate at this moment.

Okay. Let's do it. Let's just keep working. Okay. I feel like the challenge for us though is we have identified the recent things but I really hate to bring back the soup analogy No please It a great analogy No no it not Don't cut it all started. But here it comes. And croutons. We're going to talk about croutons. This conversation around zero-based budgeting, and it gets to Rep Brown's point of us having lack of transparency, especially in HICPUF. You've got to drive the soup. But just, you know, we can start with the most recent. But for me, it's also almost a question of what are all the things that we have done in the past that maybe aren't even being done anymore? Well, I'm very interested not if we're just going to focus on behavioral health, but if we're going to focus on the whole department. I don't want to pick, I don't want to isolate behavioral health. I'm not suggesting that. Okay. It's the whole state budget. Yeah. I agree. That's a frustration for me as well, that we don't know what we don't know. All right. Well, thank you, Ms. Pope. You've done an excellent job as always and appreciate your recommendations.

Because I don't know, Director Harper, is there a standard method that everybody used? because they were tables in all of our briefing documents, but I don't know if there's a certain length of time look back, or is it only the prior year actions that have some sort of budgetary shift in that particular year? Thank you, Madam Chair. The only things that show up in the standard tables below the summary would be bills that have a change that's driving in the budget year. So if there's an annualization, often, I mean, Department of Corrections, you may see annualizations from several years before, and occasionally those will pop up in other departments as well. But the only ones that will show up in those tables will be things that are actually driving a change in the budget. As an office we tried to go back and look for significant changes going back to at least 2020 and highlight things which is kind of where Ms Pope is going with these balancing options This happens to have been a policy area with a lot of robust legislative action over that period Not all departments have had that, but we've tried to go back and look back to at least kind of 1920, trying to get pre-COVID and look at the major changes that have happened since then. I don't think we've been, we have not brought in every bill that has been passed since then with a fiscal impact, that's for sure. But that was the lens that we were trying to bring to it, was go back several years and highlight the things that were having a significant impact.

Thank you, Madam Chair. I'm not trying to dump a big load on the department and the director, but one of the things I go home each night wondering about is where are we so far? And I really don't know what level of a dent we've put into this at all. and it scares me because if we haven't put a significant den into it, the last week that we're going to get together is going to be really horrible.

I don't know when Director Harper would be, maybe the forecast is, maybe after the forecast is where we'll see because by that point in time, We will have made a lot of decisions, but we have delayed certain items that are large, like the provider rate cut in HICPF and compensation policies and things like that. So there are some sort of big rocks out there. I would say on the whole, we've taken most of what the administration put forward, some not and then we've taken other cuts that our analysts have suggested so I don't I I think we'll probably need to wait until after the forecast unless Director Harper plans to update us any time sooner than that just knowing though that we still have some big outstanding items that we haven't decided upon and then of course the very large outstanding questions of Pinnacle and and the Tabor overrefund. Director Harper. Thank you, Madam Chair. Representative Taggart and Senator Kirkmeyer has had similar questions. My goal and my intention is to have an overview to you after you finish the IT capital, capital construction, IT common policies figure setting. I will have an overview for you before you receive the forecast that will show you where you are. I have been, and I'll just, if the committee wants to change this process going forward, then we can discuss that. I've been reluctant to give you anything that resembled a play-by-play because you have, A, we really aren't equipped for it. It takes time for the analysts to get the decisions that you've made into our database and then me to be able to pull those numbers. you're also approving bills every day that will be outside that database and will show up in an entirely different place in the overview the other piece that always concerns me about these conversations is I think that our process as a collective is based on you all trying to give a similar look to every department and I'd be hesitant to give you an overview today before the Department of Higher Education presentation tomorrow which will be a large general fund discussion. You have Mr. Dermody coming in on Thursday with the Office of Community Living which is obviously an incredibly hot topic this year and a much more prominent place for reductions than it has ever been, at least in my time here. And from talking to folks that have been here longer than me, that applies to them as well. And then you have the entire judicial branch on Friday. So if we can get through all those departmental conversations, and then we will have, you have large items outstanding. Employee compensation common policies, which obviously continue to come up, but are almost always a balancing decision late in the process. You have IT common policies that you'll hear on Monday. You still have at least one operating common policy that's outstanding. Those are relatively small potatoes statewide, but will be relatively important. And then as the chair mentioned, you have Pinnacle and the Tabor over refund to deal with as well, or Tabor over refund proposal. But my plan is to get you an overview before the forecast so that you'll have some idea where you are going into the forecast. And then the forecast is likely to change dramatically in one direction or the other, or who knows what we're going to see. I think if anything, it's becoming more uncertain by the week. So anyway, my plan, this should have been a very short answer is to have an overview for you early next week. But again, trying not to put information in front of you that would cause a significant change in the committee's reaction to the departments that you're about to hear from.

Thank you, Madam Chair. And Senator Kirkmeyer, again, it's taking time. Most of the biggest reductions that you're taking are coming now. This week has packed a punch for everyone in the room, I think. It's going to take time. It's going to take time for those actions to get reflected. I think Mr. Kurtz is getting his in now. Ms. Pope and Ms. Kanagiraja will have theirs in as soon as they can. I can pull data from the other departments and give you an idea of what you've cut and what you've approved. Let me talk to my folks first thing in the morning and we get there You also approved a lot of one actions that will help with the near situation but obviously not necessarily the structural issues So I can split those out as well. Those would be the long list of cash fund transfers and ARPA recaptures that you've approved.