SUMMARY KEYWORDS

Peter Brissette

We're recording in progress. We will have folks joining I'm sure as we go along here, but welcome everybody to today's town hall and advocacy training. I am pausing to see if Nicole's journal does but she said she's dealing with the situation so Nicole is not going to be here. I think she might join us later but welcome. And yeah, we've got Jennifer Miller with us. She is follows lobbyist and worked with us here over this last session. And it was a very busy session again. From that, what else? Last couple years have been a little bit crazy. And so it was monumental having her help us out this year. So we'll talk about some education stuff coming up and some other call of business when she gets completed, but I think we'll go ahead and turn it over to you, Jennifer, and just start with your training. If you have questions, let me know in the chat as we go. And I'll help Jennifer moderate those. And we'll try to get those answered as we go along. Alright, how are you Jennifer?

Thanks, Peter. Hi, everybody. I can't see very many of you. I wish I could see more of you. But it's nice to be here with you. Just by way of introduction. My name is Jennifer Mello. My firm is called August policy strategies. I am what they call a contract lobbyist at the state capitol. So, I have a number of clients. I do a lot of work in health care and education and just kind of some general business stuff. Obviously Kala is one of my clients. And we just started that arrangement. Gosh It's not even been a full year so I am still getting up to speed on all the issues and all the details. My role for you all is not I mean, I don't I don't know how to do your jobs and thank you all for doing your jobs. I would be terrible at them I'm sure. But my job is to kind of understand the the politics and the process and help maximize the chances of you guys getting what you need and what you want for your businesses. So and I am totally happy to be informal. So if you have questions as we go along, that works great. I will rely on Peter to tell me there's a question because otherwise I'm not I'm not great at text. We're gonna be lucky if I can get through the presentation without messing that up, let alone monitoring the chat box but you know, feel free to pop anything in chat as we go on. I'm happy to pause. So here we go. See Oh, there we go. Yay. I did it. Sorry. Not very professional, but excited. Um, I think one of the things that's really important in the work that we do together is for you all to understand the the larger context your day to day lives, or in assisted living. Again, you've heard the experts there, you know all about that. My guess is you spent a lot of time thinking about and talking to other people about assisted living. I mean, it's it's just it's what you do. That is true of about 5000 other groups of people in the state of Colorado, and I obviously made that number up. But, you know, we all come at this from a fairly narrow perspective. And those points of view really are important, but it's important to understand how they fit into the larger process. So with your patients, I am going to spend a little bit of time talking about some of that. You Colorado the point of this particular slide is that this is a very, very democratically controlled state right now. Obviously Governor Jared Polis won re election last fall. The governor is an interesting, interesting where he lies on the political spectrum. He actually is can be quite libertarian, which seems like it's conservative at times. But by and large, you know, he is a Democrat and he is a Democrat from Boulder. And he cares about and supports the things that you know, Democrats from Boulder care about. In the house, you see all those blue dots we have a huge majority of Democrats is the largest majority, certainly in my lifetime. It may be the largest majority ever. It is a two thirds majority, which matters because the Democrats if they wanted to could override a gubernatorial veto. I don't think that's going to happen right now. But that's you need two thirds to do that, which is why it's always a margin that people shoot for. And then the Senate it's a little bit closer but not much. We only have 12 Republicans in the Senate. So you don't have to count those numbers. We have 12 Republicans in the Senate and 19 in the house, which means we have a total of 33 Republicans in the building. So two thirds of the members are are Democrats. Why am I spending too much time talking about politics? Because elections matter? They really do. And when people win elections, and when they win them as decisively collectively as the Democrats did in 2022. That has implications for policy. They are more liberal they are going to push for more liberal types of policies. The Democrats, you know, their their strongest constituencies are environmental groups, unions, trial lawyers. And so it's not a surprise for those of us who do this for a living that when we see these margins of democratic control, we see a lot of proposals coming from groups like that that are successful. It is almost impossible to kill a democratic though now not impossible, but almost impossible. Because of these numbers, and it's it's challenging environment for if you're coming at it from a business community perspective, it's a pretty challenging environment. And I work with groups all over the country and all over the state and I'm belaboring this point a little bit because I think it's important understand that Colorado is just super super liberal right now. Our legislature is very, very liberal. And that influences every single thing that happens, it influences what gets produced, what gets passed, what doesn't get introduced, what doesn't get passed and all of that so and as I said Collins issues you guys are partisan in your issues. But to the extent that your issues are consistent with Democratic priorities, Great. That's good news for us. To the extent they're more consistent with Republican priorities right now, that's not such great news. So that's why I talked about the political situation. Hey, miss, oh, sorry. I probably won't get excited every time I managed to change the slide. I'll try to dial it back. Now. This is a word cloud that is taken from the titles of legislation from the 2023 session. I think it's just a helpful visual for you to see what what the legislature is really focused on right. So I mean, it's interesting to see how big the words are and so the bigger words are the ones that are more frequent and titles you know, you see right there health, tax education are really big. You see some smaller words marijuana over up in the upper left hand corner, you know, it's not huge, but the fact that even shows up on the workload tells you how many bills referenced marijuana. So again, this is just a tool to get a sense. I will note that you don't see anywhere on here assisted living. Don't think you see anything about elderly although I could I can't see the whole thing right now because of of the screen. There's the word medical shows up a little bit. In context, and and and understanding kind of where where and how we fit in the process is important. Okay, so in 2023, we were coming off with the 2022 election, which was very surprising those big margins of Democrats I talked about none of us that they were going to win them those many seats. So this was an adjustment process. But in addition to that, we had a really big amount of big number of new members in the legislature this year. There were 33 individuals who had never served in the legislature before the reason that matters is because, like anything in life, it takes time to learn how to do it, and to do it well. And a lot of those new newly elected legislators kind of acknowledged that and they're there. They're listening and they're learning and they're working to get their feet under them. Some of them would not acknowledge that they have anything to learn. Those may be the ones that are a little more challenging for us to work with. You know, but no, it's just it takes them longer to do everything takes them longer to draft their bills takes them longer to introduce their bills. Trust me it takes them longer when they present their bills. So it just it has an impact on the process overall. One of the dynamics we saw, particularly in the house this year was so again, you've got those 19 Republicans versus all those Democrats because they don't have the votes to change to change legislation very often to change the policy they use stalling tactics. We hear about the filibuster in Congress. They essentially did the equivalent of a filibuster on boy all kinds of things. I mean, even things they support it because their whole goal was just to make it take as long as possible and frankly make it as painful as possible. From their perspective being in the minority. They don't want very much to pass. And so if they can slow things down and make it so that we run out of time and things just don't pass at the end. That's exactly that's great news from their perspective. So that was kind of the House Republican tactic and I in describing that in no way, either supporting it or saying it's a bad thing. It's a legitimate tactic that the minority uses. The Democrats used it when they were in the minority. It's one of the few things you can do when you're in the minority is you can have an impact on the clock. My little cute little bullet there that says slowing it down or better way. The several Republicans I think, took a different approach. They rarely filibustered. They worked more behind the scenes to try to achieve change, and I wasn't there for those conversations, obviously. My guess is it was kind of a well, we can talk about this until four in the morning, or you guys can take these three amendments, and then we can all go home at 10. And they did a lot more of that in the Senate. And I think it was frankly more effective in terms of their policy goals and what they wanted to achieve. So two different approaches there with Republicans being in the minority.

There's a bit we make a big deal at the Capitol about steak holding such a big deal. We've turned it into a verb, right. And that basically means talking to the people that are going to be impacted by a piece of legislation. Your policy committee can tell you that there was not a very robust steak holding process this year on a couple of different bills. And I'm gonna get into the specific legislation in a minute. But, you know, it was very common this year that bills just got introduced and you know, hadn't talked to anybody that they would impact. We're pushing back against that just from a process perspective. That's it's really challenging, you know, our legislature moves really fast. They have to be done in 120 days. They'll tell you when you get 100 page bill and it's in committee two days later, it is really hard to have a good policy conversation about it. So one of the challenges we face this session, and I think this didn't impact call in particular was just less commitment to doing adequate stakeholder offering before introduction and even as bills were working through the process. I'm sure you all are very smart people who are very engaged so you probably have seen some of the bigger issues. In this. The legislature spent a lot of time talking about guns this year. A lot of time talking about reproductive rights, criminal justice, Environment, Energy and housing. Note that not healthcare is not on that list, again, in assisted living issues that impact elderly folks not on that list. This is what the legislature is primarily focused on right now.

Okay, I'm gonna, I promise I'm not gonna spend a bunch of time boring you with budget and budget numbers. I want to just remind you all that we have something in our state called the taxpayers Bill of Rights are Tabor it's part of our Constitution. And what it says is that the government can only keep so much money. So tax rate is whatever the tax rate is, and has to be 5% right now and income tax in Colorado. I think it's 5%. Don't quote me on that. What it you know, so that's the tax rate. We all pay our taxes, they add up the number. If that number is above a certain threshold that's determined based on population growth and inflation. The government doesn't keep that money, they give it back to all of us. And over the years, the legislature has found a whole bunch of different ways to return it to taxpayers. Most of you probably got that $700 check last year. That was your Tabor refund. That was money that the state government had to send back to taxpayers that wasn't able to be spent on any government programs. The budget right now is tight and it's getting tighter. I'm not going to read this quote out loud, but this is a quote from the sorry, the Chair of the Joint Budget Committee Senator Rachel's enzinger Who by the way has been a great friend to kala and really gets and supports our issues. Basically morning, it's gonna get harder. We are at the end of the enhanced federal match formatic Medicaid, the pandemic money hasn't necessarily all been spent, but it's all been allocated. There are not pots of federal money sitting around waiting for people to figure out what to do with them. And there are lots of pressures on the state budget. Again context right so like getting a little bit out of our bubble and understanding where other folks are coming from. I tell you, every single person who works in K 12 thinks that that system is underfunded, so does every person who works in the higher education system. You know, and we have a lot of conversations in higher ed about how much money is the state going to contribute? Because whatever they don't contribute essentially gets made up in tuition. So when tuition goes up at our in state institutions, it's related to the size of the investment the legislature has either been able to or has decided to make transportation. I've lived in Colorado almost my whole life. I've seen a lot of the growth. I don't know many of you may be the same but it's it's hard out there sometimes. I mean, we have a problem with our roads. We don't have enough of them and traffic is terrible and there's potholes everywhere. Housing and particularly affordable housing is a huge challenge in this state. You lots and lots of people cannot afford if we're in a place where they would want to please, you know, when you give state employees a modiface I think, you know, two or 3%, which in this inflationary climate is really not even keeping pace with inflation. That has a big impact on the budget. You know, you want it out across every state employee amount has an impact. Our retirement system for our public employees is desperately underfunded. It's a big looming problem. Sothose issues impact the budget. And then finally, when it comes to Medicaid, which I know is more, many of you not I know not all of you, but many of you work with Medicaid. You know, the number of people in Medicaid certainly has a big impact and that number has gone up and up and up. Now with some of the changes because of the COVID emergency. expiring. It'll be interesting to see what happens with our Medicaid population. Essentially, the state was prohibited from dis unrolling anybody since COVID. Hit. Now they have to go through and figure out if people are still eligible or not. Regardless of what it does to the size of the Medicaid population and how that impacts the budget, I can tell you it's going to be a pretty chaotic process. I have zero faith that the department of health care policy and finance will do this smoothly or well. So if you do have Medicaid residents, just you might want to be aware that there are there's a real redetermination of eligibility coming down the pike and it may be complicated. Um, you know, we talk a lot about why can't I hear this a lot. Why can't the state just you know, subsidize assisted living or we just need to raise Medicaid rates or we just need to, we shouldn't have to pay licensing fees you know, that should be under the state budget. I get where those those desires are coming from. The reason why it's really hard to achieve those almost impossible in some cases is because of everything I just went through, which is why I wanted to share that information with you. Let me pause there real quick. And Peter, is there anything because I'm gonna go no more to some of the specific legislation but I just wanna see if there's any questions about the general stuff I've talked about?



Peter Brissette

Yeah, just one kind of general question. Do you think a more liberal government is less favorable to small business? Or is that just stereotype?

I think yes. Is the answer. I'll make it simple. Yes. I mean, that and that is based on my own experience. Now, you know, listen, this is politics. And so there are no, everybody gets their own opinion. You might get a different answer from a different person. But I think that liberal policies, which are the policies most often embraced by Democrats, are not great for small businesses frequently. Alright, so keep going, Peter, just watching your face. To tell me yes. Okay, great. Great. Um, so there were five bills that we tracked pretty carefully for color this year. We're gonna work through those real quick just so you can see some of the specific you know, I've talked a lot about generalities and concepts. This is where the rubber really meets the road. Hospital 2310 30 We supported this bill, it did pass. Many of you probably had experience with these health care staffing agencies during COVID right they they really came into their own and became quite important during the COVID pandemic. But they often came with conditions that said, you know, you couldn't hire their people. That is no longer allowed for certain types of employees. So it's not for all employees. It's for anybody who has a nursing type of license. So that includes a CNA includes a nurse, but it doesn't include oh, now I'm not going to come up with a good example. doesn't include anybody who's not somehow in that nursing, licensure change. So if you're working with a temporary company, and they're trying to say you can't hire one of the people in that area, you can now I see Janet came off mute. Did you have an example for me to share?

Janet

We had talked about this and I was confused. It does not include cubemap employees and that's the term you were looking for. Thank you.

Okay, thank you. So that's a great

Janet

example I would like to recruit as cubemaps but it did not include them because they don't have a professional license. They have a certificate. So thanks, Janet. That's really, really helpful. So and, you know, the bill is introduced would have included all of those employees. This is an example of, you know, sometimes to get stuck through you've got to compromise. We did not initiate this piece of legislation. But again, we did support it and we testified on behalf of it and work to pass as strong of a bill as it possibly could. Senate Bill 40 staffing agency caps checks, it was really a pretty small bill we supported it just essentially ensures that those caps checks are happening. I'll spend a little more time talking about Senate Bill 63, assisted living residences, referrals. Again, we did not initiate this bill. I want to be really clear about that. This bill was initiated by some of the national placement companies, a place for mom being the most prominent amongst them, and what they were in their words, they were looking to kind of create a more even playing field between national and local referral agencies. I'm not I'm just telling you how they described it. I'm not taking a position on whether or not that's what it did. We got engaged they came to us and they really wanted. This is an example of stakeholders where they did come to us and they came to us before the bill was introduced, and they said, you know, we'd like you guys to be okay with this. Can you read it and tell us if you want changes? We did negotiate for a number of changes that I think had the bill passed would have been really good for consumers, including that they weren't allowed to send a referral on without your permission. And clarifying so that if you got one referral for one individual from two different entities, making it clear that you only had to pay one of those not both, my understanding is there's sometimes pressure to pay both. So we were clarifying that the bill actually did not pass. So none of the great changes that we negotiated, became law. And I think it didn't pass in large part because the opposition of some of the more locally oriented referral agencies and some of you may may work in that business or may be really familiar with it. They were able to basically count enough votes to make sure the bill wasn't going to get through so it died in its first committee. Senate Bill 155 Sunset continuing nursing home administrators. I think I won't go into the detail of what a sunset means, but if someone really cares, you can put it in the chat. Why do I have a bill on here about nursing home administrators? Well, because the same license for nursing home administrators applies to some assisted living administrators. And in one of its versions, this bill would have increased the training requirements for those folks, I think many of you may be those folks. That would have required some specific training around Alzheimer's and memory care and dementia. Senators enzinger really went to bat for the industry and got that language taken out of the bill. So you don't need to worry about that. That's not changing as a result of this bill. But that's an example of you know, sometimes there's bills that we don't think directly impact us but we always have to be it's it's part of my job for you all is to have that broader view and be able to see across all the different things that are happening and saying, I get that this is about nursing homes, but this actually does impact us. And, you know, here's my concern, and then we talk as a group. Do we share this concern? Yes. And so then we go try to do something about it. I'll spend the most time talking about Senate Bill 261, the direct care workforce stabilization board. This bill did pass again, we were heavily engaged in this bill. We had an amend position. Which amend is kind of between support and opposition. It's kind of neutral depends on a min can mean a couple of different things. What we meant is we really wanted changes to this bill and we got some of them. We didn't get everything we wanted. what the bill does is create this direct care workforce stabilization board within the Department of Labor and Employment. And it's super specific about who's going to serve on this board. And this board is essentially tasked with doing research into the conditions for the direct care workforce and making recommendations about how to improve those, including recommendations about what people should be paid. It's not a requirement about what people should be paid. But I think when you have a quasi governmental entity like this, when they get to the end of their work, which will be two or three years issuing, you know, people should be paid XY and Z. I think that's going to put pressure on the wage market and on the labor market, which is the intention of the proponents. Part of why we took it a min position on this bill is you know, and again, your representatives that I work with made it really clear that most of you wish you could pay your direct care folks more that these people are really important to your business and the work that you do you really value what they do. And it would be great if if the economics of the business were such that they that you could pay them more. So we didn't want to come out in opposition because we didn't want to oppose it, trying collectively to do better by by the folks who work in these really important jobs. We did however, work hard to one of the things we tried to do that we were not successful and was limited the amount of data collection that this entity was able to do. As passed. It's got broad authority to collect information from directly from workers. You guys don't have any requirements about what you have to provide. You may get asked for data but nothing's mandated. But I think in some ways, this was really the heart of the bill because part of this bill was the main proponent was the Service Employees International Union. A huge national goal to unionize this workforce. They have struggled to do that because it's kind of a diffuse workforce, right? It's not like an Amazon warehouse where there's 500 People at the Amazon warehouse. This is spread across much more, much more sparsely, sparsely across a variety of businesses. Once they have their contact information, they will absolutely use that to try and unionize them. Whether that's a good or a bad thing, I think depends on where you where you start in the equation. I think from your policy committees perspective, they are concerned about that long term goal. One of the things we did was make sure that there was adequate industry representation on this direct care stabilization board. So the industry voice was there and could really provide some of the balancing information. You know, I think, I mean, I don't know I'd love for there to be a board that said lobbyists should get paid more. You all would probably love that too. There's reasons why we all get paid what we do and I don't know some of them may be fair, some of them may not be but you know, the economics of the business. We thought it was really important that this this board understand at least have to consider as part of their work, what the economics of the industry are and how it operates and why these folks don't get paid more than right now and what it would mean if they did get paid more and how we might go about doing that. Are there other ways we could support this workforce that aren't necessarily wage increases? You know, Medicaid eligibility, things like that.

We wanted to make sure all of those were part of the conversation and making sure that Medicaid rates were part of it was another one of our big issues. We did succeed in that. For those of you who take Medicaid, you know, the reimbursement rates are woefully inadequate and that's part of the problem. It's part of the challenge. To ignore that to have a state entity studying this issue and ignore that just seemed ludicrous to us and and frankly, not helpful in the long run to anybody, the workers or the businesses. You just you can't just pretend that that reality doesn't exist that we have really low Medicaid reimbursement rates, and that that has an impact on how all of this works and comes together. We never switched positions because well, we did make some change. We did get some changes. They weren't enough we thought to go to a support position or even a neutral position on the bill. Our next steps are I'm watching the formation of this board very carefully. We will work to get an assisted living voice on that stabilization board to keep us at the table through those conversations. There's a couple of things going on right now that some of you may be familiar with. And we can talk more in detail about any of these things. Your Government Affairs is not just the legislature. There's also the regulatory process, right and I know you all I'm sure you work closely with cdphp and I'm sure you value your partnerships with the agency. But they have a lot of power, frankly over different aspects of your business. There's a conversation happening right now about licensing fees, the department feels like they need to increase those fees in order to be able to continue the work they do. We have said, we're not so sure the work you do right now is the work you're supposed to be doing and we're not so sure you're doing it the most efficient way and we're not super excited about paying more money so that you can just keep doing things, not really the greatest way. So that's kind of the position we've taken in that I know there's a lot of concern about Medicaid reimbursements. I wish I wish we could do more about that. I will tell you I think that's the hardest needle to move on this particular chart.

And then and this is a little bit related to the licensing fee. There has been an increase this we know this anecdotally. I'm not sure what data we have but the use of i j's which are immediate jeopardy CDs, I would did not know anything about ij six months ago. I do learn as I go and apparently surveyors from cdphp are have dramatically increased their use of IGA is which has lots of implications for you all in your businesses when they're out there doing their surveys. So those are things that call us aware of and we're working on in different ways, kind of as we speak. And I think those are the issues that we'll be carrying forward into the next legislative session for us. Again, Peter, let me let me pause there, because I'm going to talk a little bit more about it what we can do about this and advocacy next, let me see if there's any questions about what I've just shared.

Peter Brissette

Um, yeah, nothing right now. Any questions folks?

Can we ask it just ask the question. I'm sorry, I haven't. I just got brand new glasses. My name is Chris. I'm going to be a new administrator. But I've been a healthcare professional for a long time. I've been involved legislatively. indirectly. I'm the I was the Park County rep for the Area Agency on Aging reasonable that Advisory Committee for several years, and then I was their chair for the funding. So  what's happening with Medicaid is a serious concern for me because that's the avenue I want to go into as an administrator. And we automatically stumbled across the state wanting to our have paid and consulting firm to introduce a possible three tier Medicaid reimbursement system with all kinds of questions around that so I personally am very concerned about what's going to happen with the Medicaid pathway. We know that there are not enough beds for the people in need. They seem to be it seems to me that more favorable support is running towards the large box, box house, the community where I've seen your buys in instead of it being on the other end where the population is growing. There's people over the age of 65 not changing and then we have to deal with the fact that yes, right now the most of the cash in our countries are with people over the age of 55. That is quickly changing. So I have a deep concern for Medicaid issues with this and the only way that I know of how to change it is to approach it legislatively. And if there is a law called the Older Americans Act, and a big part of that is supportive of rural locations and aging in place. And if indeed that is a part of how our government's supposed to operate in the state then approaching it legislatively even as a law as a lobbyist. There is already a foundation for that. Even if there isn't it's not their prime baby for this some this session. It still has a lot of strong base to support it. And so I guess my question is, yes, we understand that it's a concern. Clearly we're seeing in what you're presenting universe, that it's not a favorite topic. But the concern is there. In the end, they the law, there are laws behind it to support it. So my concern is the next step for that.

It's a great question and a great point. And I want to be really clear, we're very concerned about Medicaid, that some of the information I presented before demonstrated that Medicaid was not a big issue for the legislature this year. Right and, and that that does change over time as the other thing, right. So some years they are more focused on healthcare and Medicaid. Unintentionally, I think you provided me the perfect segue into this last slide which this is how we start to do something about it right. So yes, the reimbursement rates are a problem all kinds of things in Medicaid are challenging. We care about that. Here's how we start being able to do something about that. And you're right, the legislature is ultimately the place where that happens. So all of this builds up to that. So I will talk a little bit about that and tell you that honestly, the best thing you can do. If you care about these issues you care about the industry you want to get involved is develop relationships with the State Senator and the state representative from from where you live and where you work. Those may be different places and that can be a good thing because then you can talk to more people. You may have more than one location and you can talk to more people that way. The goal is when I'm up at the capitol in April, and all of a sudden a terrible bill has gotten dropped. You have enough of a relationship with your state senator, you can call that person and that person knows who you are. They're gonna say, oh, Janet, yes, Jenna always gives me great information about assisted living issues. I'm gonna listen to her I'm going to talk to her. That doesn't mean we can persuade everybody. But it's that ability to get through I think is is the end goal. And the other key part of that I'm going to go back and talk in more detail, but is telling us what you're doing or you're keeping us in that loop. Because we can't use it as part of our larger strategy to achieve all these goals if we don't know what's happening, right. So it's both developing those relationships and then making sure we were working together on that we've got good communication loops. I'm seeing a couple of hands raised right now. So maybe we can call on those folks. And then I'll talk more about some ways to build relationship. Janet

Janet

Yeah, you know, I'm, I think I'm still muted. Um, I was, I didn't know in the beginning when I was involved in all this sometimes in a min position is the best solution, you know, because my personalities want to kill them all, you know, any bill that mentioned assisted living, just get in there and kill them, you know? And I learned from working with you, Jennifer, sometimes that's not your smartest way to go about it. Because one of those was the bill has such strong backing. Your chances of getting it killed are slim to none. And then one other one you said sometimes you can add things to the bill there or your are favorable to you. So I just thought maybe you can elaborate so other people understand why sometimes Cal was not going to run in there and try to kill Bill even though that's what we want, really, but it's not realistic, you know?

Yeah, I'm happy to talk about that. And there are times when we oppose legislation. I want to be clear about that. It's not I'm not saying we can't oppose things. I think we take every bill on its own merits, right. We look at the policy, how much of an impact it's going to have. And then I have to look at the politics on your behalf and give you my best advice as to what's achievable. The challenge with if you have if there is a bill that's backed by a major constituency that has a ton of support in the Democratic caucus, it's gonna be really hard to get it to go away. And if you just come out oppose what happens they don't talk to you. So it's this trade off between you know, we wish this would go away because we don't say, I mean, we're playing the odds here, maybe it goes away, but the odds are, it's not going to go away. So how do we make it better? And that amend position allows us to get in there and have those conversations. I really believe in the power of relationships and developing relationships and a men strategy helps us with that because we've got to be able to say, look, we don't like your bill, we really don't like your bill. Here's the things we'd like to talk to you about in it and here's why. And it just allows for you to engage in a conversation and that's the beginning of building relationship. That then helps because it's all the same people next year, just a different set of bills, but it's the same people you're talking to. And so when you've developed that report, it's really helpful to do that. Help Jana?

Janet

Yeah, that was perfect. Because, um, you know, and I didn't know that the beginning that once you oppose the bill, you're out of the conversation. You know, you don't want to speak to you and if you if you become real heavy handed, pretty soon you're kind of out of the game in a lot of different avenues. Yeah. Yeah.

Again, it depends on the bill and the dynamics of every given built right. So I want to be really I don't want you all to think we're a bunch of wimps who are scared to oppose bills. That's not it at all. And there are times when I think a straight up post strategy is right it's we got to continue to consider what's happening with every single piece of legislation and then make that decision. Somebody named Janelle

Peter Brissette

I think, yeah, Janelle.

Hey guys, how you doing? Well, nuggets. Yay. That's a good thing for today. I just had to put that in there. So one of my we're talking about some of the stuff that you had said that, you know, that IGS the surveys, trying to increase the license fees. So my concern is and I don't know how we do this is a lot of these things aren't going to be able to change for years. I mean, we're already going to get they're going to talk about the license increase, it's already going to hit before we can get legislation. We know in 2024 from the bill from last year. The $10,000 fines and above are going to go in before we you know that already passed in legislation. And I think that the frustrating part of that was like Janet said, we really didn't know what was going on, you know, as far as the billing being being amended. Some of the amendments, you know, we went back and they amended the bill. It's like, oh, shoot, we didn't want them to do that. You know, they amended it and that made it worse instead of better. So I guess, my position is, our question is the timing. A lot of these things are gonna go through before we even get to legislation and what can we do? I mean, I know there's maybe not a lot we can do, but maybe some guidance on what we all can do because a CDP he seems to be able to make their own rules and their own requests and do how and when they whatever they want, no matter you know, no matter what, so I'm trying to figure out, you know, a way that we can work with them or around it. To be honest, we've already tried working with them. And that didn't go I mean, it just went for a while it didn't go good but just a little guidance of what we can do because you're right CDP he does have a lot of power. And even though we're doing legislation, they are still able to set these give i j's. So just just some thought on that. I guess just putting it out there and maybe some guidance. Yeah. They're tired of taking care of you and they have to

thank you for meeting. Yeah. Janelle. Really good. Good questions. I. We start by with the legislation and the $10,000 fines. That is statute. And you're right. We can't do anything to change that. We wouldn't be able to do anything to change that until January of next year at the earliest. And And honestly, I don't know that we could change it at the legislature. And I know that's frustrating, but I'm just it's my job to kind of tell you I think that would be really challenging. Fight doesn't mean we can't have it. I do think it's up to 10,000 I think that's probably important to note. I'm not as familiar with the the latest kind of day to day on that. But the legislation was not a 10,000 fine. It was up to 10,000. So, you know, I don't know if that's any comfort at all? Probably not. But in terms of the licensing fees, you're right, that CDBG does have the statutory authority to set those fees. However, luckily, there is a component of statute that says they cannot raise them more than the cost of living has gone up without legislative approval. And so that's really where we have our leverage, frankly, um, and we're just, you know, we just finished session. We're just getting started kind of thinking through our strategy and our priorities for next year, but I don't think the legislature also has to approve. It's kind of weird. They don't approve the specific fees, but they have to prove the spending authority for the agency. There's a couple of different legislative levers I think we have where we can go in and say, Look, we get it. The way that Colorado works, partly because some of the things I talked about before is that the people being regulated pay for that regulation. We understand that. However, you know, we don't we're not sure that they're doing this the right and best way and we don't want to be funding something that's frankly not the right and best way. And I don't mean to sound vague. It's just that we're like literally in the midst of trying to figure some of this out. But I think where we're headed is trying to figure out what what levers do we have at the General Assembly, where legislators have to be involved in this feed increase thing, and how do we use those to get what we need, and either delay the fee increase, have some work done to some independent work to say how many surveyors we really need and how they should be funded, what they should be doing what they shouldn't be doing. Those are the kinds of things that we're considering are heading in that direction. Is that helpful?

I think it is, but I also think that my concern is the damage is already going to be done before you know we get it there. I mean, they're already talking about the increasing licensing fees because they need more surveyors. And they said that the surveyors have to be able to be they have to be able to compete with other nurses in the industry. And if you look at their hiring criteria does not require you to have a nursing degree. So there's some of these things that are going on that, you know, like it falls down and bottom line falls down to the residents because small homes closed down and they have nowhere to go. Right and I believe we have to do something about the power that cdphp has in regard to the surveyors and they are able to make or break a person. I did copy the part of the legislation where it talks about the fines and I did put it in the link, so they can go over $10,000 If they figure it's egregious enough, and the fines will be turned be determined by cdphp. So another part of legislation, you know, we should have some more input in that. I know these are all things that are problems now and I know they're things that we're looking to fix in the future. My concern is the future. We've got to do something in this next session. We can't wait another year and another year and another year. So I think it's good that we email and communicate. But I think we also need to know what are we which what's our battle, which one is our biggest battle? What do we want to go after? What is the one that we want to put all of our energies into so I just think that going forward, that's something that we need to discuss as a group and figure out, you know, where are we going to put that energy in which one of these situations?

Um, yeah, a couple of comments in response. One, you're right, we do have to prioritize because we can't do everything and that's you know, unfortunate. I mean, you know, Excel Energy spends a million dollars a year on lobbying. If you have that budget. Yeah, you probably can do lots of things. That's not call us budget. That's okay. But it does mean that we have to be strategic and be smart about how we prioritize. I know that cdphp is putting a lot of pressure on you all from a timing perspective. That is because they are responsible to the governor's office, and that's the governor's office budget timelines. I don't believe that statutorily they can raise those fees higher than the cost of living until after the legislative session. Next year. And I could be wrong about that. And we can all look into this. I understand that the time sensitivity there, but I don't think they have the statutory ability to raise the fees as much as they want to before we go through another session. And that's what gives us leverage and it gives us leverage not just over the fees, and what those are going to be, but also around some of these survey and these ij issues, they're related. So that's kind of a short version of it. Let me just talk a little bit go back to the advocacy and what and how we go about doing that. You know, I started with kind of point number one and then I went on to the bottom to the last point. Getting to know your folks one on one is the most important thing and keeping us in that loop so that we're aware of what's going on is critical to that how do you go about developing a relationship with the legislature First, don't be scared. Really. They are people just like you. Some of them are nice. Some of them are mean some of them are smart. Some of them are dumb. You know, some of them have little kids. Some of them are retired. I mean, you know, they're like they're people just like them. It's like when you go to the grocery store, right? See all kinds of different people. That's the same thing with the legislature. And I think you treat them like people both from the sense of don't be intimidated, but also in the sense of kind of showing up some respect. So I guarantee that not a single one of you would call me tomorrow and say we are meeting at 10 o'clock and you have no choice about it. And I don't care what you have going on, and I don't care if your kiddo has a doctor's appointment. That's what's happening. We don't talk to other people that way. Typically, maybe our spouses maybe we shouldn't I don't that's a whole other thing. But um, you know, so when you call your legislator, they're a human being too, right. Maybe they're on vacation, maybe they have a childcare, emergency. All of those things can happen and just just be human about it. Just be a real human person like you would with anybody else right? So understand that they've got realities, they've got pressures that they're dealing with, as do you. And the goal is to find that the place where you you can fit together. I don't know any legislator who's going to say no to a request for a one on one meeting this time of year. I'm sure there's probably a few unfortunately, but but I think it's going to be very rare and to say, Hey, I'd love to go have a cup of coffee with you and talk about the challenges that I'm having as a small assisted living provider. And this is a really important service in our community. And I'm really worried and here's the things I'm worried about. I think I would be surprised if it was difficult to have those conversations. So that's my first suggestion. And if you need help getting in touch with your legislators, let us know we can certainly help you with that. The other and so that's kind of step one. But then it's about developing relationship, right. So the other thing is, we'll have what we call Christmas Card friends, right? So there's those people that we don't really talk to very much and you know, we just exchange Christmas cards once a year. Don't think Christmas Card friends. Don't be the person who calls them once a year and and is saying here's what I want from you or here's what's not working. It's got to be more than that. In order to keep that to be a real relationship, ways you can do that. You can go to their town halls and their events. Trust me. They love having people at their town halls. Get on their mailing list, they all have one. And then you'll get more emails than you want probably about all the different opportunities where you can go interact with them. You can offer to give a tour of your facility. I think that's a really powerful. We've done that. A couple places in the Metro Denver area in the last few years and it's it's memorable to people it's when they can see it and put the visual on it and, you know, depending on circumstances, meet some of the residents and it's really powerful and it sticks with them in a different way than a cup of coffee which is also important, but you know, how many cups of coffee do we have with people right? So it just becomes more memorable. You have to stay in touch by email, you know, every so often, Hey, I saw this article, I thought this might be interesting to you or just want to let you know, you know, you were worried about so and so and I wanted to let you know we got that situation resolved or, you know, whatever, whatever. It's a little bit you can make stuff up a little bit. But the point is just to keep that continual communication. There's probably a million other ways you can do that. I don't have any of them or they're listed. I would say think about it as how would you do if if you go to church and there's somebody at your church that you want to become friends with? What would you do? How would you do that? Or you know, if you have kids in school and you want to be friends with one or the other moms, how would you go about doing that? Those are the same types of tools and techniques you can bring to the table in terms of building those relationships with legislators. When you all are able to do that work, then we're able to roll it up, right? part of us being more effective, which would have been I know really wonderful for you all back in 2022 and that really particular challenging piece of legislation was going through is, you know, having lots of people we can go to and having those effective relationships and being that trusted source. And we need to build that component of our work in order to be more successful. So I think that's part of why your policy committee was really wanting to and your board really wanted to make sure I emphasize this particular point about advocacy and your role in that and that we really do need your help. And that is actually my last slide. So I'm happy to you to do any questions.

Peter Brissette

Other questions, thoughts, things you'd like to see us doing from a legislative standpoint?

Yeah, this is Janelle. Sorry. I'm going to chime in again. We were told in the last legislative session, not the last one, but last year. Democrats are not going to go against Democrats and Republicans aren't going to go against Republicans. So if you have a bill that is presented by a Democrat and you have a vote, you know, the day we've got more Democrats than Republicans, pretty much it's going to win. I you know, that is a little bit concerning to me. And also in the 2022 when we had people that were on the board that we're voting, and they were asking the question, what is the difference between an assisted living in a nursing home? You know, that's pretty scary when these people are voting for the party, rather than voting on what the facts are and how is how is a way that we can work around that. I mean, we can meet with people I understand we can get to know them. But if you know if they're not going to go against their own party, how, what do we do about that? We just go for the amendment of a bill. How would that work?

Peter Brissette

Well, let me I know General Angeles, we have to get them in your facilities. If you have facility run one, manage one, get them in there. If you got to say I'm going to donate $200 to your campaign or $500 for your campaign, come see my facility. They have to see the difference and see what we're doing. And the kind of work that we do. We have to educate them. So that's our job, right? Yeah, that's right. We do have and that's when we when I say building our presence, part of that is educating them. Sure, right. They don't know the difference. You know, legislators vote have to consider about 700 different issues in a given day and they cannot be experts on everything. And so we have to get out there, help them understand that give them those visuals as part of our work together. In terms of the party dynamics, I guess what I would say is generalities, which I use quite a bit of in this can be unhelpful at times. Every situation is different. And it is not the case that on every bill every Democrat is going to vote for a Democratic bill or vice versa. It is much more challenging when you have a Democratic bill that has a bunch of democratic co sponsors on it that has a constituency like the unions or the trial lawyers who give the Democrats a bunch of money that's going to make it harder not impossible. There was a bill that got killed in the house this year. And its first committee which was remarkable that had to do with scheduling and how they said it was about workers in the restaurant industry. I think it might have applied more broadly and and we we had eyes on that for kala to you know, just in terms of like how you schedule your employees and their rights and that this that the other that they'll died, so it's not impossible, but it is certain circumstances make it more or less challenging. We don't have a lot of political power we just and I don't mean to be discouraging and saying that because we can build it but we don't have it right now. And that's the work we need to do. That's how we're going to, over time become more successful.

Peter Brissette

Janet, did you have another question?

Janet

Do you know what I had? To jump in the car and kind of over schedule myself today but I just need to make a plug for my own little committee here. I'm head of the government where like regulations committee and we could also make a difference and you can join us because it is hard and it's a huge learning opportunity of how this all works. Things don't happen overnight. It's over time. And I went to a different meeting here recently and our national arms of assisted living also were challenged with the with the legislators on a national level to get people to understand the difference between skilled care nursing and assisted living. They they can get the year of the US senators, the US House of Representatives there have the same challenge. So I was encouraged that just little Colorado was an epic challenge. It's a lot of people, but I would I would hope that some of you if you're interested in just you know, contact Kalin come on the committee and because you know, lots of how's it saying? Lots of hands make the workplace here you know what that is you can enhance make the work light I don't know I don't have the right obviously, but that we would love to hear from you and your voice versus delivering in the next couple of years. If we were where we were now in 2022. That bill may have not passed. We are we're miles ahead of where we were two years ago. So in the education of our members, everything so I invite you people that want to be involved get on our committee, I would love to have you.

Peter Brissette

Yeah, and it goes to you know, Jennifer loves what she does, I think and she would love to do it for free, but it's not practical. And which right now we're in the process of renewing dues. So if you are not a member, please join because it takes funds and we're not a big Association. It's not like we got tons of money just laying around for this kind of stuff, but it takes money to have the staff and to have the people and to have professionals like Jennifer available to help us do this. So renew your dues. Why do we charge for education and events? And things? We have to cover those costs like and it's desperate we need, we need a voice. And part of that voice is everybody's participation and the more we're involved and the more that we need people's pocketbooks to sorry to help with that, like it's just a fact. And so that's my pitch for that. And I think I think we're transmitting a little bit here but still open to whatever questions or comments. We have a couple of educational events coming up. The main one right now is an emergency preparedness workshop is going to be a four hour workshop that we're doing online here at the end of the month. We've been working on this for probably at least the last year and to get this put together so we could have a more in depth workshop that's very interactive, where you can, you know, have your whole plan right there and work on it and get a lot of work accomplished in that workshop so that you've got all the key things that you need in there and how to avoid, you know, getting tags when you get surveyed, and all those things. So really look out for that. And then thanks to Jana we recently added for this trigger course that we've started offering, so she's right in the middle of the first one that we're doing, and we'll do those, you know, probably a couple times a year or more as demand is is needed on that. So we're trying to provide the education that you guys need, and we need your ideas if there's education that you guys want to see us doing that we haven't done, or you want to see again, please let us know that. We want to make sure we're giving you guys what's most, what is the most relevant support and education that you need. Currently right now. In your day to day operations. And we talked about dues renewal, so I think I've covered was anything anything else for Jennifer, anything else for Colin in general? How can we help you guys support you? Were we missing the mark?

Janet

Thank you, Jennifer. I think that was wonderful. I think it really gave people a chance to see especially your little blue and red dots in the arena and was that like simple? That was awesome. I really liked that and you have so helped me and you're working with you to understand this process. Because it is a process you know, so

it is I mean I often say I think it's a shame that the groups like yours need people like me to do this work right. I actually don't think that's good for democracy. It would be better if if you all if the system worked in a way where your voices and your expertise were sufficient. Unfortunately, it doesn't really work that way. And, and so I think there's a lot of work we can do together to make things better. It's probably not going as fast as everyone likes. But I'm really excited to keep doing that work with you guys. It's been it's been a fun six or seven months, whatever it's been. And I learned more and I do think that we've got a lot of capacity to build and do more over time.

Peter Brissette

Well, I think as we talked about to having you, we brought you on fairly late in the year last year, and it was kind of a rush leading up to the legislative session. So now that we've kind of got a lay of the land, then we can be much more starting now. Like let's start talking about what we need to be doing for next year. And yeah, you're absolutely right in that theater early in that process now to be able to do that better and you know, be able to get to the next session and again, like you said, Paradise, what can we really go for? What do we need to do? And I make that happen? And by the way I just sent you. There was a bill that we ran in 2010. That was for tiered rates Medicare's it, it got passed and it needed some funding but it never went anywhere because of the regulatory side of things just didn't make anything happen. So we have some precedents there. At least of of looking at different levels of Medicaid rates for assisted living. So I say that I don't know if that will be helpful or not in some of the discussions that you can have. It's like, Hey, we've asked the bill like this before, was supposed to be a pilot program and never

Yeah, that's great. I think. I do think the long term solution on Medicaid rates starts with pilot programs. So I'll take a close look at that. Yeah,

Peter Brissette

let's see if that's helpful. And I think that's it. Thank you all for being here today. Appreciate it. appreciate all your support, and we'll see you down the road.

Have a great day, everyone. Thank you.

Peter Brissette

Thank you recording stopped

Alright, Peter, thanks that window and good she did a great job.

Peter Brissette

Yeah, yeah, that was awesome. I love that cool. Are you there?

Yes, I'm here sorry guys.

Peter Brissette

I was How's what's happening? Well, I mean,

Nicole S

I just have an admission that's having a tough time transitioning so I had to go down there and do another didn't see visit. You know, we need to call the ambulance and just you know, things that can happen.

That's really hard.

Nicole S

But it happens especially in my in my industry with my residents because they just any change is upsetting to people with brain injuries.

Yeah. Yeah. Yeah.

Nicole S

So that happened. I mean, at least that was today's excitement. But other than that, we have contracts, holes and sprinkler systems. We have hail, causing roof leaks. It's been just about everything in the past three weeks.

Peter Brissette

So you're saying it's another Tuesday?

Janet

The other day in paradise. That's what she's saying. Exactly. Hey, you guys are going to be surprised and we need to do a Tidbit Tuesday I am doing someone's plan of correction. They really did get tagged with not providing protective oversight.