Video & Transcript Research : 'nursing facilities'
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ND
North Dakota 2025-2026 Regular Session
Senate Appropriations - Human Resources Division Apr 15th, 2025 at 09:00 am
Appropriations - Human Resources Division
Bills:
HB1012
Keywords:
health and human services, DHHS, appropriations, biennial budget, behavioral health, substance use disorder, opioid settlement, medical assistance expansion, Medicaid, basic care, long-term care, child care assistance, early childhood care, child care provider payments, guardianship, conservatorship, housing loan fund, disability services, extraordinary medical needs, community health trust fund
Summary:
The Senate Appropriations Human Services Division met to consider House Bill 1012, the Department of Human Services budget, and reviewed three previously made amendments: correcting a reference to $30 million underfunding, changing “human service centers” to “behavioral health clinics,” and revising section 31 language so the department would review medical assistance services and report findings and recommendations rather than directly implement adjustments. The committee also discussed whether to include funding related to two other bills with fiscal impacts, House Bill 1485 (personal needs allowance) and House Bill 2399 (PRTF reimbursement), noting those measures may go to conference committee and that appropriations could be added there instead of in HB 1012. The committee agreed to proceed with HB 1012 and members noted provider inflation questions would be raised later in full committee.
The division then approved a due pass recommendation on the amendments to HB 1012 and, after a roll call vote, approved HB 1012 as amended on a 4-1 vote, with Senator Mathern voting no. Senator Davison was named as carrier. Members also discussed House Bill 1577, involving wastewater project financing and possible amendments related to a line of credit from the Bank of North Dakota for specific projects, and House Bill 1619, for which additional amendments were expected before full committee action. The meeting ended with general thanks and adjournment.
MN
Minnesota 2025-2026 Regular Session
House Health Finance and Policy Committee 3/11/26
Health Finance and Policy
Transcript Highlights:
- If you're in a skilled nursing facility, where I spent a lot of my clinical practice, you might go through
- If you're in a skilled nursing facility, where I spent a lot of my clinical practice, you might go through
- not, I'll work through the other nurses not, I'll work through the other nurses or<00:59:14.079>
- of Clinical Nurse Specialists.
- This transition to practice limits where certified nurse specialists and nurse practitioners can work
Keywords:
hospital moratorium, hospital construction, bed capacity, hospital expansion, health care facilities, hospital licensing, safety-net hospital, level I trauma center, Ramsey County, Minnesota health law, hospital beds, new hospital exception, certificate of need, inpatient capacity, emergency care, trauma services, health system regulation, state moratorium, hospital modernization, health infrastructure
AZ
Transcript Highlights:
- We output four-year degree BSN nurses now. We output four-year degree BSN nurses now.
- So the Board of Nursing doesn't have the authority since it doesn't mention, like nurse practitioners
- Ajene, if you could explain House Bill 2195, nursing facilities, records, surveys, and timeliness.
- It's a simple idea to align skilled nursing facility inspections and complaint investigations with federal
- Skilled nursing facilities are subject to both federal certification surveys and state licensure surveys
Keywords:
radiation therapy, particle accelerator, critical access hospitals, patient care, rural healthcare, radiologic technologist, radiologist assistant, radiology, imaging, x-ray, diagnostic x-ray, fluoroscopy, mammography, computed tomography, CT technologist, nuclear medicine technologist, bone densitometry, radiation safety, radiation licensing, scope of practice
MN
Minnesota 2025-2026 Regular Session
House Health Finance and Policy Committee 3/2/26
Health Finance and Policy
Transcript Highlights:
- When facilities are purchased using leverage buyouts, the nursing home is immediately saddled with debt
- Staffing in nursing homes, especially among certified nursing assistants and licensed practical nurses
- Minnesota has a facility collapse.
- My first job as a new provider was at a medical campus, including a skilled nursing facility, assisted
- >
and nursing facility, assisted living, and nursing facility, assisted living, and recently<01
Keywords:
gun violence, public health, Department of Health, prevention, criminal justice, health care transparency, ownership disclosure, control reporting, health care consolidation, private equity, management services organization, MSO, provider organization, health insurer, pharmacy benefit manager, hospital system, affiliate reporting, financial disclosure, public reporting, market concentration
Summary:
The House Finance and Policy Committee met on March 2 with a quorum present and heard House File 3668, which would create a state Office of Gun Violence Prevention. The bill author argued the office would treat gun violence as a public health crisis, improve research and coordination, and help reduce deaths and trauma, especially among children. Several supporters testified, including representatives from the Minnesota Medical Association, Protect Minnesota, family medicine, public health, and obstetrics/gynecology, all emphasizing firearm injury and suicide as major public health problems and urging a coordinated, data-driven response. Multiple testifiers shared personal accounts of shootings and their effects on children and families, including the Annunciation shooting, and said the office could help align prevention efforts across health care, law enforcement, and community organizations.
Opposition came from the Minnesota Gun Owners Caucus, which argued the bill would create a permanent taxpayer-funded bureaucracy that could be used to shape firearm policy and restrict a constitutional right. The group said Minnesota should focus instead on enforcing existing laws, prosecuting violent offenders, and providing direct victim services. During committee discussion, Vice Chair Nadeau offered an A2 amendment to move the proposed office from the Department of Health to the Department of Public Safety, citing data-sharing, accountability, and examples from other cities and states; after discussion with the bill author, he withdrew the amendment. Chair Becker then noted existing state and local spending on violence prevention and public safety programs and raised concerns about duplication of effort.
HI
Transcript Highlights:
- Representatives from H-Power, Honolulu's energy facility that processes most of Oahu's waste, shared
- that in 2024 the facility experienced 158 fires, and 44 of which were lithium-related.
Keywords:
cannabis, marijuana, Hawaii Cannabis Law, legalization, decriminalization, adult use, hemp, taxation, social equity, public health, primary care, health insurance, health carrier, insurance commissioner, Med-QUEST, Medicaid managed care, provider reimbursement, downcoding, prior authorization, utilization review
Summary:
The committee heard testimony on several health-related bills. HB 1864, which would require health insurance coverage for standard fertility preservation services for people undergoing medically necessary treatment, drew broad support from SHIPA, the Department of Health, HMSA, the Hawaii Association of Health Plans, and others. Testifiers emphasized that fertility preservation is routine coverage on the mainland and important for patients facing infertility from cancer or other treatment; one patient described incurring more than $20,000 in costs. The Insurance Division flagged possible Affordable Care Act issues, a potential conflict in the bill’s language about using patient history to determine limits, and a mismatch with state medical-necessity standards. Committee discussion also focused on whether the bill should apply to all women of childbearing age rather than a narrower age-based category.
HB 2305 would require nutrition and metabolic education as part of physicians’ continuing medical education. The Hawaii Medical Board opposed the measure, arguing that CME should remain flexible and tailored to each physician’s specialty and warning that topic-specific mandates can expand over time. The Office of the Governor supported the bill, saying it would help the state’s rural health transformation application and could improve federal funding prospects, though the exact impact was unclear. Members questioned whether nutrition is already covered in medical training and whether the requirement should be limited to primary care physicians; the board said Hawaii currently has no topic-specific CME mandates and that physicians can already choose relevant courses.
The committee also heard strong support for HB 1597, which would establish an Alzheimer’s disease research center at the University of Hawaii. Supporters from the university, the Alzheimer’s Association, AARP, and others said the center could attract federal research dollars, expand clinical trials, and help address the state’s high Alzheimer’s-related health costs. HB 2159, which appropriates funds for health care workforce development, also received broad support from the University of Hawaii, health systems, and advocacy groups, with no opposition noted. Finally, HB 2121, which would prohibit the sale and distribution of disposable electronic smoking devices, drew support from the Department of Health, youth advocates, and public health groups citing youth addiction, environmental waste, and fire hazards; the department said a separate bill, HB 1573, would be more comprehensive and better defined for enforcement and penalties. The committee ended with HB 1913, creating a veteran services mental health coordinator position at Tripler Army Medical Center, which was supported by veteran services officials and others who said veterans need better navigation and coordination for behavioral health care.
MN
Minnesota 2025-2026 Regular Session
House Workforce, Labor, and Economic Development Finance and Policy Committee 3/18/26
Workforce, Labor, and Economic Development Finance and Policy
Transcript Highlights:
- <01:14:09.520>
shortage a nursing shortage a nursing shortage that<01:14:11.160>matches - The CNEE is Minnesota's nursing The CNEE is Minnesota's nursing workforce<01:15:32.480>
center - Nurses make up half of Minnesota's licensed healthcare workforce, and Minnesota is facing serious nursing
- $1.4 million to launch the pre-licensure nurse apprenticeship program.
- Nurses make up half of Minnesota's licensed healthcare workforce, and Minnesota is facing serious nursing
Keywords:
workforce development, appropriations, nonprofit organizations, employment services, state funding, paid leave, S corporations, employment law, exemptions, Minnesota Statutes, cancer, healthcare, appropriation, Rural Cancer Institute, Minnesota clinicians, pilot program, nursing, education, University of Minnesota, equity
MN
Minnesota 2025-2026 Regular Session
House Health Finance and Policy Committee 2/18/26
Health Finance and Policy
Transcript Highlights:
- First as an employee health nurse and now as a nurse leader.
- First as an employee health nurse and now as a nurse leader.
- nurse lure compact. nurse lure compact.
- health nurse and now as a nurse employee health nurse and now as a nurse leader.<01:37:51.360>
The - c> at the nursing as a nursing practice and at the nursing as a nursing practice and education<01:43:
Bills:
HF1925
AZ
Transcript Highlights:
- SESHA, which is the Semiconductor Environmental Safety and Health Association, as well as Ultra Facility
- A fab is a facility that makes semiconductors.
- And, of course, you folks know that there are many of these facilities in the world, many of them centered
- There are many of these facilities in the world, many of them centered in Arizona.
- And where the customer does not have enough staff to actually operate the facilities, we can provide
Bills:
SB1041
Keywords:
electronic monitoring, nursing care, assisted living, resident rights, privacy, consent, surveillance, 1182, all
MN
Minnesota 2025-2026 Regular Session
House Human Services Finance and Policy Committee 3/20/25
Human Services Finance and Policy
Transcript Highlights:
- >
to <00:03:29.599>provide assisted living facilities to provide assisted living facilities - As someone who has worked in a nursing home and assisted living facilities, I have firsthand witnessed
- :15:04.920>
facilities. - And sometimes we attach that angst to the nursing home or to the assisted living facility.
- And sometimes we attach that angst to the nursing home or to the assisted living facility.
TX
Bills:
SB2972, SB1909, SB2815, SB735, SB2233, SB800, SB1069, SB2683, SB2986, SB2058, SB2310, SB2055, SB1032
Keywords:
expressive activities, freedom of speech, public forum, higher education, protests, student rights, antisemitism, public institutions, disciplinary policy, student organizations, compliance, institutional policy, disciplinary sanctions, diploma designation, institution merger, academic records, student options, Holocaust education, Holocaust Remembrance Week, genocide education
TX
Transcript Highlights:
- Texas continues to face a serious nursing shortage.
- This information will be easy to find on the board of. nursing website.
- As using an example, when a nursing program submits to the board of nursing for final approval, the board
- in the nursing program survey, but in a very general form and not annually.
- partners for all areas of concentration for nursing students.
Bills:
SB2972, SB1909, SB2815, SB735, SB2233, SB800, SB1069, SB2683, SB2986, SB2058, SB2310, SB2055, SB1032
Keywords:
expressive activities, freedom of speech, public forum, higher education, protests, student rights, antisemitism, public institutions, disciplinary policy, student organizations, compliance, institutional policy, disciplinary sanctions, diploma designation, institution merger, academic records, student options, Holocaust education, Holocaust Remembrance Week, genocide education
FL
Florida 2026 Regular Session
Appropriations Committee on Health and Human Services Feb 25th, 2026
Appropriations Committee on Health and Human Services
Transcript Highlights:
- In a survey of Florida OR nurses last fall, 95% reported their facility already has the equipment, yet
- And the supervising nurse must have been a registered nurse.
- The Florida Nurses Association supports the Board of Nursing in its critical role in ensuring that nursing
- nursing programs must meet.
- I'm a registered nurse of 45 years. We've been hearing a lot from nursing this morning.
Keywords:
surgical smoke, health standards, hospital safety, patient protection, medical regulations, nursing education, licensure, remedial courses, temporary license, graduate nursing preceptorship, Agency for Persons with Disabilities, background screening, support coordination services, developmental disabilities, Tatton-Brown-Rahman syndrome, public hearings, orthotics, prosthetics, healthcare, Medicaid
Summary:
The Appropriations Committee on Health and Human Services met with a quorum present and took up several health-related bills. CS/SB 1110 on Medicaid and insurance coverage for orthotics and prosthetics was heard first. The bill would require coverage for medically necessary orthotics and prosthetics without lifetime or continuous-use caps, direct AHCA to seek federal approval and update contracts, and require annual reporting. Testimony from a child using prosthetic “gymnastics blades,” his mother, and another young person with a prosthetic leg emphasized the high cost of activity-specific devices and the impact on children’s mobility, sports participation, and quality of life. Senators voiced strong support, and the bill was reported favorably.
The committee then approved SB 1574, “Maddie’s Law,” which adds newborn screening for biliary atresia using the existing blood specimen collected at birth. The sponsor and the child’s father described the condition as time-sensitive and potentially fatal without early detection, and argued the screening could prevent transplants and save money. The bill was reported favorably. The committee also considered CS/SB 794 on background screening for employees of residential facilities and day training programs for people with developmental disabilities, plus a review of waiver support coordination quality, training, and access issues. Parents and a support coordinator testified that strong support coordination is essential for families and that the bill would help standardize expectations and improve services. An amendment aligning the bill with the House companion was adopted, and the bill was reported favorably.
Members next heard SB 162, which requires hospitals and ambulatory surgical centers to adopt policies using smoke evacuation systems during procedures that generate surgical smoke. Supporters, including nurses and the Florida Nurses Association, described surgical smoke as a workplace hazard with toxic chemicals and potential cancer risks; hospital representatives said they support the intent but argued existing federal and state standards already regulate the issue and the bill is too prescriptive. A late-filed amendment clarifying the smoke must be “effectively captured and filtered” was adopted, and the bill passed favorably. The committee also approved CS/SB 254, a major nursing education bill that tightens oversight of low-performing nursing programs, creates a temporary provisional license and preceptorship pathway for graduates awaiting NCLEX results, requires remediation for delayed testing, and increases transparency by posting passage rates. Nursing groups supported stronger standards, while private nursing schools warned the bill could reduce capacity and discourage program directors; the amended bill was reported favorably.
Finally, the committee heard SB 688, which would reestablish licensure and regulation of naturopathic doctors in Florida, create a board of naturopathic medicine, set licensure and renewal requirements, and define the scope of practice while excluding most prescription authority. Supporters said it would expand health care choices and allow naturopathic doctors to practice openly, while opponents from the medical community warned the bill could authorize diagnosis and treatment without sufficient training and rely on unproven therapies. The bill was reported favorably. The committee then adjourned after members thanked staff for their work.
AL
Alabama 2025 Regular Session
Alabama House Ways and Means General Fund Committee Apr 1st, 2025
Ways and Means General Fund
Transcript Highlights:
- On our rural healthcare and our nursing homes and our providers, so just really trying to understand
- HB 405 by Representative Blackshare, concerning nursing facilities' privilege assessments and surcharge
- on each nursing home bed.
- The extension of the current supplemental privilege assessment on each nursing home facility is set to
Keywords:
Alabama budget, general fund appropriations, fiscal year 2026, state budget, appropriations act, HB186, executive branch funding, legislative branch funding, judicial branch funding, debt service, capital outlay, corrections, Medicaid, public health, mental health, transportation, education, law enforcement, tourism, veterans affairs
TX
Transcript Highlights:
- And the Texas Board of Nursing rules allow nurses to delegate nursing tests to unlicensed persons, including
- Their facilities were short staffed. Some, there were no staff.
- So hospitals, nursing homes do have the regulation.
- Some of these facilities are charging us upwards of $6000 to $10,000.
- So my mother is in an assisted living facility right now.
Bills:
HB 660, HB 4845, HB 3902, HB 5396, HB 4615, HB 1825, HB 1403, HB 4336, HB 4585, HB 4371, HB 863, SB 1589, HB 5223, HB 3195, HB 2734
Keywords:
child protective services, adult protective services, caseload limits, call processing goals, child-care licensing, employee workload, reporting requirements, employee caseload limits, protective services, workload management, accountability, Department of Family and Protective Services, employee goals, call processing, child care, human resources, government accountability, Medicaid, provider enrollment, revalidation
TX
Transcript Highlights:
- Duty nursing through Medicaid, but as you all know, we have a nursing shortage in this state.
- And so private duty nursing is one of those services.
- And these people are in these facilities.
- There are facilities with short staff, some that were...
- I have examples where facilities shipped their residents to the hospital. Who paid for it?
Bills:
HB660, HB4845, HB3902, HB5396, HB4615, HB1825, HB1403, HB4336, HB4585, HB4371, HB863, SB1589, HB5223, HB3195, HB2734
Keywords:
child protective services, adult protective services, caseload limits, call processing goals, child-care licensing, employee workload, reporting requirements, employee caseload limits, protective services, workload management, accountability, Department of Family and Protective Services, employee goals, call processing, child care, human resources, government accountability, Medicaid, provider enrollment, revalidation
TX
Transcript Highlights:
- This prolonged lack of reimbursement strains nursing facilities and can jeopardize the care provided
- The agreement ensures integrity in the child process and that nursing facilities don't manipulate the
- Process more efficient while also creating accountability for nursing facilities.
- It repeals the nursing facility direct care staff rate enhancement program.
- However, one statistic that stands out to me is the 52%. turnover rate of Texas' nursing facility nurse
Bills:
HB660, HB4845, HB3902, HB5396, HB4615, HB1825, HB1403, HB4336, HB4585, HB4371, HB863, SB1589, HB5223, HB3195, HB2734
Keywords:
child protective services, adult protective services, caseload limits, call processing goals, child-care licensing, employee workload, reporting requirements, employee caseload limits, protective services, workload management, accountability, Department of Family and Protective Services, employee goals, call processing, child care, human resources, government accountability, Medicaid, provider enrollment, revalidation
TX
Transcript Highlights:
- And diminishing the need for board meetings to be conducted outside of a CAC facility.
- The construction and request one final survey of their completed facility.
- Touchstone manages or operates 34 skilled nursing facilities in all in the state of Texas, and it is
- As you know, HHSC is charged with inspecting nursing facilities and other providers.
- And so it really discourages facilities, our members to take the time to challenge one.
Bills:
HB 2510, HB 3589, HB 4611, HB 4655, HB 4665, HB 4666, HB 4670, HB 4700, HB 4730, HB 4798, HB 4838, HB 5136, HB 5243, HB 5302, HB 5539
Keywords:
assisted living, healthcare, licensing, criminal offense, personal assistance, group home, regulation, health and safety, inspections, resident care, criminal background checks, adoption, parental rights, registry, vital statistics, disclosure, counseling, foster care, independent living, financial literacy
TX
Transcript Highlights:
- So, what does it take to shut down a facility?
- So, what does it take to shut down a facility?
- and must comply with the regulations as an assisted living facility. ...living facility by going through
- Medicaid does not cover these facilities.
- that has 24-hour nursing and has doctors that come to the facility.
Bills:
HB2510, HB3589, HB4611, HB4655, HB4665, HB4666, HB4670, HB4700, HB4730, HB4798, HB4838, HB5136, HB5243, HB5302, HB5539
Keywords:
assisted living, healthcare, licensing, criminal offense, personal assistance, group home, regulation, health and safety, inspections, resident care, criminal background checks, adoption, parental rights, registry, vital statistics, disclosure, counseling, foster care, independent living, financial literacy
TX
Transcript Highlights:
- These facilities are regulated by both the federal government, CMS, and the state government.
- Touchstone manages or operates 34 skilled nursing facilities, all in the state of Texas.
- HHSC is charged with inspecting nursing facilities and other providers.
- On this new journey of going here, that you're seeing you can help them and other facilities.
- If MPRO has a finding and rules in favor of the facility, that's a state law claim that they have.
Bills:
HB2510, HB3589, HB4611, HB4655, HB4665, HB4666, HB4670, HB4700, HB4730, HB4798, HB4838, HB5136, HB5243, HB5302, HB5539
Keywords:
assisted living, healthcare, licensing, criminal offense, personal assistance, group home, regulation, health and safety, inspections, resident care, criminal background checks, adoption, parental rights, registry, vital statistics, disclosure, counseling, foster care, independent living, financial literacy
KY
Kentucky 2026 Regular Session
Administrative Regulation Review Subcommittee (6-9-26)
Transcript Highlights:
- KAR<00:07:33.440>
2472 Board of Nursing, 201 KAR 2472 Board of Nursing, 201 KAR 2472 and< - Board of Nursing. Good afternoon. Board of Nursing. Good afternoon.
- <00:20:06.280>
and to confirm appropriate facilities and to confirm appropriate facilities - These children would be in psychiatric facilities, ICF/IIDs, which is your intermediate care facilities
- , would be in psychiatric facilities, would be in psychiatric facilities, ICF/IIDs,<00:37:33.200>
Keywords:
0:06 - Roll Call
0:30 - Approval of Minutes
0:45 - OFFICE OF THE ATTORNEY GENERAL
2:08 - FINANCE AND ADMINISTRATION CABINET - OFFICE OF THE CONTROLLER
2:55 - BOARD OF DENTISTRY
5:30 - BOARD OF OPHTHALMIC DISPENSERS
7:30 - BOARD OF NURSING
8:32 - BOARD OF EMERGENCY MEDICAL SERVICES
9:30 - EDUCATION AND LABOR CABINET - DEPARTMENT OF EDUCATION, OFFICE OF DISTRICT SUPPORT SERVICES
15:35 - CABINET FOR HEALTH AND FAMILY SERVICES, DEPARTMENT FOR PUBLIC HEALTH
18:44 - CABINET FOR HEALTH AND FAMILY SERVICES, OFFICE OF THE INSPECTOR GENERAL, HEALTH SERVICES AND FACILITIES
23:39 - CABINET FOR HEALTH AND FAMILY SERVICES, DEPARTMENT FOR MEDICAID SERVICES
1:01:46 - CABINET FOR HEALTH AND FAMILY SERVICES, DEPARTMENT FOR PUBLIC HEALTH, OFFICE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
1:03:46 - Next meeting/adjournment, 958, all
Summary:
The committee first approved the minutes and then took up a series of administrative regulations from several agencies. Early items included Attorney General consumer protection rules on removal sales, health spas, liquidation sales, and nonresident sellers of visual aid glasses; Finance and Administration Controller rules on clearinghouse validation and fraud prevention; and Board of Dentistry rules updating exam requirements, controlled substance prescribing, training for neuromodulators and dermal fillers, infection control, sedation/anesthesia continuing education, and required education on pediatric abusive head trauma and controlled substance ingestion prevention. The committee also approved staff amendments on these items, generally to conform to KRS Chapter 13A, and members asked a brief question about the dentistry controlled-substances changes, which was answered as an alignment with statute.
The committee next approved regulations for the Board of Ophthalmic Dispensers, Board of Nursing, and Board of Emergency Medical Services. The ophthalmic dispensers package would revise meeting and recordkeeping language, raise renewal fees, set reinstatement and apprentice-license rules, add complaint and hearing procedures, and repeal a duplicative regulation. The nursing regulations would streamline approval of training programs and require notice and documentation of site visits and deficiencies. EMS rules would create five EMS medical director certifications, set expiration and renewal requirements, require publication of disciplinary sanctions, and exempt currently approved directors before October 1, 2026. Staff amendments were adopted without objection on each set.
The Education and Labor Cabinet’s school transportation regulation drew extended discussion. The agency explained the changes were intended to implement Senate Bill 46 and update references affected by later legislation, including an oral amendment to delete a subsection reference tied to KRS 160.380. The committee adopted both the agency and oral amendments without objection after brief questions about the scope of the bill changes and van transportation for students.
The committee then heard a lengthy package from the Department for Public Health on WIC and related nutrition program regulations, including updates to infant and child certification periods, documentation requirements, vendor criteria, sanctions, hearing procedures, and high-risk vendor standards. Staff amendments were adopted without objection. Finally, the committee considered the Inspector General’s regulation for freestanding birthing centers, which included both staff and agency amendments. The agency changes would require two neonatal resuscitation program-certified staff, set rules for medical director vacancies and appeals, revise facility and staffing terminology, adjust transfer-agreement requirements, and allow waivers when agreements cannot be secured. Mary Katherine DeLodder of the Kentucky Birth Coalition testified in support, saying the parties had worked through concerns and were ready to move forward. The committee then moved on to Medicaid’s 1915C child waiver regulations, where staff amendments were adopted, but Lucy Heskins of Kentucky Protection and Advocacy testified against the package because it did not include person-directed services, which she said are required by Kentucky law and important for families using the waiver.