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EXPANSION- Medicaid expansion recognized as significant missed opportunity

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[MM Curator Summary]: Wyoming expansioners will have to try again next year.


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Bob Mathia, right, frowns in response to testimony opposing House Bill 80 during a meeting of the House Revenue Committee at the Wyoming State Capitol in Cheyenne on Jan. 19. The committee passed HB 80, titled “Medical treatment opportunity act-Medicaid reform,” to expand Medicaid eligibility, with a 6-3 vote, but it was never considered on the House floor.

Alyte Katilius/Wyoming Tribune Eagle

CHEYENNE — One-hundred and ninety-six bills passed out of the Wyoming Legislature during the general session, but that doesn’t mean nothing was left on the table.

Lawmakers recognized there were missed opportunities, while still applauding steps toward saving hundreds of millions of dollars, providing property tax relief, improving maternal health care access or securing elections. They had 500 pieces of legislation to process in a two-month period filled with chamber deadlines, and every bill couldn’t receive the attention required to move forward.

However, there was one bill that legislators on both sides of the aisle emphasized they were disappointed was left to die.

House Bill 80 would have expanded Medicaid in Wyoming, providing coverage to an anticipated 19,000 new enrollees by the end of the first biennium. The legislation was developed and sponsored by the Joint Revenue Interim Committee, as well as passed out of the House Revenue Committee in the first two weeks of the session.

Six of the nine committee members recommended it pass and be placed on general file, but the chamber was never given the chance to debate its perceived merits or downfalls. House Majority Floor Leader Chip Neiman, R-Hulett, said he wouldn’t let it onto the floor before the first Committee of the Whole deadline out of concern for the state.

House support

House Revenue Committee Chairman Steve Harshman, R-Casper, has been voting against expanding Medicaid for nearly a decade, but he became an advocate for the bill this year. He told the Wyoming Tribune Eagle it was one of the most significant losses during the session.

“When we look at experiences around the United States, and when we look at our neighboring sister states, it’s getting more and more obvious that’s part of the solution to provide health care and health insurance to people in Wyoming,” he said. “There’s no doubt.”

He said legislators need to understand it is health insurance for the poor, and that health care providers, business owners and residents want it. Harshman also pushed back against the belief that the federal government can’t be trusted.

“We just asked the federal government to come help save our cattle stranded in a blizzard,” he said.

“We’re part of the United States and part of the federal government.”

Despite the bill not making it through the legislative process, the central Wyoming representative has hope it will come back next session for consideration.

Rep. Karlee Provenza, D-Laramie, was another lawmaker hoping to vote in favor of HB 80 in the House, and she said it was the biggest issue not addressed. She noted there are more residents who are going to lose their Medicaid benefits in the next few months because of the change in federal designation for the COVID-19 emergency, and they won’t qualify.

The House Minority Whip said there will be even more uninsured people in Wyoming that can’t afford health insurance in any other way and won’t have affordable access to services. They will continue to have health issues that cost the state millions in uncompensated care, however, meaning all residents will have to pay for it in some capacity.

“And people will die. That is certain,” she told the WTE. “We’ve been beating the drum for a long time, but every year it just gets worse and worse. There’s more people impacted by it.”

Senate disappointment

While the House nearly got the chance to vote on the bill, the Senate was in no way close.

Sen. Stephan Pappas, R-Cheyenne, said it was a missed opportunity in a productive session, but that’s what it always ends up happening every year he has been in the Legislature. He has always been a supporter of expanding Medicaid, and he doesn’t share the same fears as some of his Republican colleagues about taking federal dollars.

He said leaving the money on the table will not reduce the deficit, as many of them believe, because it gets spent by other states.

Pappas was backed by a fellow Republican on his side of the Wyoming Capitol. Sen. Cale Case, R-Lander, attempted to bring an amendment to the supplemental budget bill after HB 80 gained no traction in the House, and expressed his disappointment.

He said Wyoming is losing the ability to have a healthier and more vibrant population, as well as the chance to keep rural hospitals from losing millions of dollars.

“It affects so many people; it’s so far reaching,” added Sen. Mike Gierau, D-Jackson, who said it was the top missed opportunity. “Even the most anti-government people will tell you that, in some form or fashion, health care for the citizenry isn’t something that the government should be too far away from.”

Other priorities

Expanding the federal program was on the minds of many who left their desks at the end of the session on March 3, but it wasn’t the only legislation or issue weighing on lawmakers.

Some were frustrated with a lack of focus on Wyoming solutions, time that escaped the House chamber or failing to find multiple ways to provide immediate tax relief for residents. Even those who focused on the significance of Medicaid expansion failing pointed out a need for sustainable transportation funding, investments in capital construction or placing more funding in the Wyoming Outdoor Trust Fund.

Sen. Brian Boner, R-Douglas, said he was disappointed that a bill addressing severance taxes for oil and gas companies was voted down in the House Appropriations Committee. He said it was a direct response to President Joe Biden’s administration increasing the royalty rate on federal lands for oil and gas development.

“The proposal was to make a proportional reduction to what they pay on severance taxes in a way that would be net-neutral to state and local government,” he told the WTE. “I look forward to bringing that back next year.”

Another missed opportunity was creating a film incentive program in the state, according to House Majority Whip Cyrus Western, R-Big Horn. He said it died on general file due to an extensive amount of debate taking up time in the weeks preceding the deadline.

It was a program he believed would have been impactful, as shows such as “Yellowstone” and “Joe Pickett” aren’t being filmed in the state.

“That series is filmed in Alberta. And while Alberta is certainly a beautiful place, great mountains, it’s set in Wyoming,” Western said of the series based on C.J. Box’s Pickett character. “And so, those are a couple of pretty glaring examples where we want that money to be invested here in our community.”

Although the session has come to an end, lawmakers are still preparing for work throughout the interim. Any missed opportunities or legislation they felt needed deeper dives will spend months under the microscope in interim committees or can be developed privately by stakeholders and individual sponsors.

The Legislature’s Management Council will meet March 23 to assign interim topics, and the first round of committee meetings begins in April. This will spur a year-long effort to get organized before the 2024 budget session next February.

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PHE- Google search update aims to ease Medicaid redeterminations

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Google is building out its Medicaid operations suite.


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Google is helping people navigate Medicaid redeterminations with the latest update to its search product, the tech giant said Tuesday morning. 

Google announced several new healthcare initiatives at its annual Check Up event on Tuesday. The updates were related to search, artificial intelligence and interoperability. 

Related: Health industry groups to assist Medicaid enrollees losing coverage

The company is adding a feature to search to provide specific information for users seeking to re-enroll in Medicaid by the end of March. Google said it plans to include state specific information in these searches.

During the public health emergency, people were not required to re-enroll in Medicaid. At the end of March up to 14 million people will no longer be eligible for Medicaid once states start re-checking individual eligibility, according to HHS. States will begin the process of clearing their rolls April 1.

Google has applied its conversational artificial intelligence technology Duplex to verify healthcare providers’ information and whether they accept certain Medicaid plans. Duplex is a voice-enabled technology tool that has called hundreds of thousands of physicians to get this information, Google said.

The search tools will also provide information to users on community health centers near them that offer free or low-cost care. 

Updates to AI projects 

During the event, Google also provided an update on its AI cancer research projects with Mayo Clinic and other health system partners. With Mayo, the company tested whether it was possible to use AI to automatically contour organs by reading CT scans. The process is typically completed manually. 

Results from this research will be published soon but Google said it is extending the research efforts with Mayo. While each individual project can vary, Google said it is broadly looking for partners to co-develop and test solutions.

“What we want to do is look for opportunities where there’s clear space to demonstrate the value-add of artificial intelligence in that particular application space,” said Greg Corrado, lead of the health AI group at Google.  “A partner who’s keen and is capable to realize those benefits in a co-development setting, or in a technology transfer setting [are also important].” 

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The company is also developing AI tools on its own that demonstrate capabilities in language understanding and generation. Google said the tools need more work as the AI displayed “significant gaps” when it came to answering medical questions. These developments come as ChatGPT and conversational AI tools have become more popular for potential medical uses.

At the event, Google also rolled out a series of components called Open Health Stack that allows developers to build digital health apps on an interoperable data standard.

In August 2021, Google unwound its Google Health division and opted instead to redistribute its health efforts across its research, search and device divisions.

This story first appeared in Digital Health Business & Technology.

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PHE- Arizona House’s Health Committee approves bill to shorten Medicaid redeterminations by three months, despite concerns over condensed timeline

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: AZ wants to stop paying $5M in state funds each month that it shouldn’t as soon as it can.



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Hannah Saunders | Feb 28, 2023 | Arizona

The Arizona House’s Health and Human Services Committee met on Feb. 16th to discuss House Bill 2624 as it relates to Medicaid redeterminations. The bill would require the Arizona Health Care Cost Containment System (AHCCCS) to complete Medicaid redeterminations for all members by Dec. 31st, 2023, and remove individuals who were not determined to be eligible. 

This spring, Medicaid redeterminations will take place in Arizona for the first time in three years. Since the onset of the COVID-19 pandemic, the federal public health emergency’s continuous coverage provision has kept members from being dropped from Medicaid—even if they became ineligible due to changes in income.  



Bill sponsor Rep. Leo Biasiucci (R – Gilbert) stated that about 600,000 individuals on AHCCCS will no longer qualify, and that ineligible members need to be removed swiftly as their continued Medicaid coverage costs the state about $5 million per month.

Sam Adolfson, a visiting fellow at the Opportunity Solutions Project, brought up how he has worked with other states across the country, some of which are completing redeterminations in shorter time frames, such as three to six months. He noted there has been no change to Medicaid eligibility criteria, but that this process will disenroll ineligible members from the program. 

Willa Murphy of AHCCCS provided some context, stating that over 2.4 million members will undergo a redetermination, with disenrollment prepared to start on April 1st. She noted the potential consequences of shortening the 12-month redetermination window in Arizona.

“By condensing the redetermination window from 12 months, as currently planned, to nine months—this would require additional eligibility staff in order to meet the deadline,” Murphy said. “There is a potential ongoing impact because of the annual redeterminations cycle, so it may create a redetermination surge moving forward as a result of this window narrowing.”

The estimated preliminary increase in staffing levels needed for AHCCCS eligibility redeterminations is 33%, which would cost approximately $16,700,000 from the general fund, and $47,700,000 from the total fund, according to Murphy. 

Jennifer Carusetta, vice president of public affairs and advocacy for Phoenix Children’s Hospital, provided public testimony in opposition to this bill. Her greatest concern is having children with complex medical needs and children experiencing crises undergo a lapse in care due to redeterminations being conducted on a condensed timeline.

“Time matters for these kids. Time matters for these families,” Carusetta said. “When you are going through a redetermination process, you are going to be notified that you owe AHCCCS information. We want to make sure that these families get AHCCCS that information.” 

Carusetta said she is supportive of the original redeterminations timeline, and that she is concerned about potential confusion with mixed deadlines, and the potential for individuals to be dropped from coverage due to a rushed process. 

“We are concerned about families who do not have adequate time to identify a network of providers to meet children’s complex medical needs,” Carusetta said. 

Drew Schaffer of the William E. Morris Institute for Justice, a nonprofit organization dedicated to protecting the rights of low-income Arizonans, also testified in opposition and stated that AHCCCS has never attempted something of this magnitude before. 

“What we see here with House Bill 2624 is an unnecessary acceleration of a plan that has been thoughtfully put in place for a long time,” Schaffer said. 

Schaffer’s concerns included the 600,000 estimate of individuals who do not qualify is only an estimate, and mentioned how there is still a large portion of individuals who have no contact with AHCCCS and cannot ascertain eligibility. 

The committee approved the bill by a narrow vote of 5-4. The Arizona House’s Rules Committee is hearing the bill on Feb. 27th for further determination. 

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REFORM- CMS Proposes to Implement Changes to Medicaid DSH Calculations

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: The annual pretending that we will reform the cash cow that is DSH.



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The proposed rule would implement changes to Medicaid’s hospital-specific Disproportionate Share Hospital (DSH) cap calculations from the Consolidated Appropriations Act of 2021.


Source: Centers for Medicare & Medicaid Services/Xtelligent Healthcare Media


By Jacqueline LaPointe

February 24, 2023 – CMS has proposed a rule to update the regulatory requirements of the Disproportionate Share Hospital (DSH) program in response to the Consolidated Appropriations Act of 2021, including implementing provisions related to including third-party payments for calculating Medicaid hospital-specific DSH caps.

The proposed rule would also clarify regulatory language for the DSH program, including payment and financing definitions, refine administrative procedures for state compliance with federal regulations, and remove regulatory requirements that CMS said have been “difficult to administer and do not further the program’s objectives.”

States must provide DSH payments to qualifying hospitals that serve a disproportionate share of uninsured and Medicaid patients. Which hospitals receive the payments and how much depends on state Medicaid program rules. However, federal law requires hospital-specific limits on DSH payments.

Overall, a hospital cannot receive DSH payments beyond the costs it incurred for providing inpatient and outpatient hospital services during the year to certain Medicaid and uninsured patients, less other payments it received from uninsured patients and under the Social Security Act.

The Consolidated Appropriations Act of 2021 modified the Medicaid portion of the hospital-specific DSH limit calculation to include only costs and payments for services delivered to patients for whom Medicaid is the primary payer for such services.

“Accordingly, the limit excludes costs and payments for services provided to Medicaid beneficiaries with other sources of coverage, including Medicare and commercial insurance),” the proposed rule states.

The updated hospital-specific DSH cap calculation applies to all qualifying hospitals except those in the 97th percentile of all hospitals for inpatient days made up of patients who, for such days, were entitled to benefits from Medicare Part A and supplemental security income. These hospitals will receive a higher hospital-specific limit.

The federal law enacted the changes to the Medicaid DSH program on Oct. 1, 2021. However, CMS said in the proposed rule that data limitations prevented the agency from clarifying which hospitals qualify for the exception for the 97th percentile.

“This rule proposes how CMS would determine which hospitals qualify for this exception,” the proposed rule says.

Hospitals are expecting a significant cut to their Medicaid DSH payments by Oct. 1st if lawmakers do not address it. The Affordable Care Act included an $18 billion reduction to Medicaid DSH payments to be phased in over a couple of years. The cut is to account for policies like Medicaid expansion that were expected to lower uncompensated care for hospitals.

However, 11 states have not expanded Medicaid under the provisions of the ACA. Additionally, one state has adopted Medicaid expansion but has not implemented it.

Congress has delayed the massive cut to the Medicaid DSH program nine times. Without more intervention, the government will reduce Medicaid DSH payments to hospitals by $8 billion between 2024 and 2027.

The proposed rule addresses the cuts by defining the methodology for determining the annual, state-by-state DSH allotment reduction amounts. The amounts will be based on five factors—uninsured factor, Medicaid volume factor, uncompensated care factor, low DSH State factor,  and the budget neutrality factor (BNF)—which are defined in the rule.

The proposed rule also removes administrative inefficiencies from publishing preliminary and final annual DSH allotments and national expenditure targets in the Federal Register.

Comments on the proposed rule are due by April 24th.

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STATE NEWS- State plan to shift Medicaid expenses would cost St. Lawrence County taxpayers $3.8 million

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[MM Curator Summary]: The fight between the state Medicaid money financing masters and the local counties just trying to survive continues. Shorthand – NYC vs Albany.




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North Country This Week

CANTON –A proposal by Gov. Kathy Hochul could push $3.8 million in Medicaid expenses back to St. Lawrence County taxpayers, but legislators across the state are rallying to halt the move.

Offsetting the cost in St. Lawrence County would require a 6% hike in county taxes, which would push the county well over the state-imposed 2% cap.

A resolution passed by the St. Lawrence County Finance Committee calls on state officials and the governor to reconsider the plan.

“St. Lawrence County strongly disagrees with the need to cut county funding so deeply when the executive budget proposes to fully fund its own reserves two years ahead of schedule by depositing $5.4 billion into reserves before the end of state fiscal year 2023, while also projecting a general fund surplus of $35 billion by the end of state fiscal year 2024,” the resolution reads.

The “budget proposal would end the Affordable Care Act enhanced Federal Medical Assistance Percentage federal pass-thru to counties and New York City,” the resolution says.

The Governor is proposing to keep all of these federal savings going forward and use them to cover further expansion of Medicaid eligibility and benefits and to increase payments to health care providers, according to the resolution.

The county estimates the shift will cost the state’s 57 counties to spend an additional $280 million and approximately $1 billion when New York City is included.

The figures shared by the county match estimates my by the New York State Association of Counties.

New York State is one of the few states that pushes Medicaid expenses on to local taxpayers, in most states the expense isn’t passed down.

“It’s been a long held understanding that Congress intended these federal savings to be shared with counties promotion to the amount they contribute toward non federal Medicaid match,” the resolution. “Since 2003 New York State has shared the funds proportionally based on analysis of savings received during periods when an enhanced federal Medicaid match was enacted by congress.”

County legislators aren’t alone in their calls. Similar concerns have been raised by county legislators across the state including a unified call from NYSAC.

“In 2011, the State made a deal with local governments that said, ‘You can’t raise property taxes more than 2% a year, but to make that possible, we’ll cover any increases in the cost of Medicaid,’” said NYSAC Executive Director Stephen Acquario. “Counties kept our end of the bargain and held property tax increases in check, but now the state is shifting billions of dollars of new Medicaid costs onto counties over the next several years. New York taxpayers are already grappling with increasing costs to rent, housing, food, and utilities and can’t afford to bear the burden of rising Medicaid costs.”

State lawmakers representing the North Country are also opposing the plan.

On Tuesday Assemblyman Scott Gray (R-Watertown) joined members of The New York State Association of Counties to push against Gov. Hochul’s proposal within the Executive Budget that would withhold federal Medicaid funding from counties.

“After serving 21 years in the Jefferson County Legislature, I understand the importance of federal fund allocations,” said Gray.

Gray said that with Medicaid coverage expanding since the passage of the Affordable Care Act, counties have been setting their budgets with the funding in mind.

“New York state has increasingly relied on county revenue intercepts to disguise and support its wayward spending habits. The state has previously intercepted sales tax revenue, aid meant for distressed hospitals, passed AIM payment responsibilities onto the counties and now wants to intercept Medicaid payments intended for county-level services,” he said. “Gov. Hochul must recognize the seriousness of this issue and release these Medicaid funds to the counties as the U.S. Congress intended.”

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REFORM (SD) – Work requirement resolution for expanded Medicaid recipients killed in committee

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[MM Curator Summary]: SD work requirements proposal lose an early key battle in committee.


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A proposal that would have paved the way to work requirements for expanded Medicaid recipients died in the Senate Health and Human Services Committee Friday.

While House Joint Resolution 5004 wouldn’t have made such work requirements law, it would have put the question to voters on a future ballot.

Voters approved Medicaid expansion in South Dakota last November.

Speaking during proponent testimony to committee, Rep. Tony Venhuizen said despite his initial opposition to Medicaid expansion, this bill is not designed to undo that vote.

“I can tell you that we are working very hard with the administration, that’s working very hard, to make sure Medicaid expansion is implemented faithfully,” Venhuizen said. “The issue of a work requirement as a possibility for Medicaid expansion was not really central to the issue of the expansion ballot last year, and I’m not so sure it’s been fully addressed by the voters.”

While framed as a solution to workforce issues, there was opposition to the proposal. Sister Kathleen Bierne, speaking on behalf of the Presentation Sisters in Aberdeen, questioned who this bill could affect.

“This resolution would result in nullifying the purpose of expanding Medicaid for some of the very people who are most in need,” Bierne said. “This resolution uses the term ‘able-bodied’ in its work requirement. ‘Able-bodied’ in its work requirement would have a lot of different meanings.”

That could include people like cancer patients, according to Matthew McLarty with the American Cancer Society.

“We see this resolution as potentially creating undue barriers for low-income South Dakotans who are cancer patients and those who will be diagnosed with cancer,” McLarty said. “Many cancer patients in active treatment are unable to work, or require significant work modifications, due to their treatment.”

The resolution was moved to the 41st legislative day on a 5-2 vote, killing it for this session.

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REFORM- Medicaid Buy In, Other Health Legislation Advances During Saturday Session

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[MM Curator Summary]: Another Buy-in program is up for discussion. Its been a hot minute.



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Legislation focused on West Virginia health issues was a topic of debate and lawmaking during Saturday’s legislative session with many bills being passed through both chambers.West Virginia Legislative Photography/Photo by Will Price

Legislation focused on West Virginia health issues was a topic of debate and lawmaking during Saturday’s legislative session with many bills being passed through both chambers.

HB 3274 – Affordable Medicaid Buy-In Program Passed the House

Affordable Medicaid Buy-In Programs were a topic for debate in the House of Delegates.

House Bill 3274 would create the Affordable Medicaid Buy-in Program to help alleviate financial strain on recipients of Medicaid who start a job that disqualifies them from receiving their benefits.

Medicaid buy-in programs soften the “cliff effect” for recipients who lose their coverage when starting a new job that pays too much for Medicaid eligibility, until they can earn enough to afford other health insurance plans.

According to 2023 data from the U.S. Department of Health and Human Services, an individual would lose their Medicaid benefits in West Virginia when they earn more than $20,120 annually. The Affordable Medicaid Buy-in Program would allow that threshold to rise to 200 percent, or $29,160 annually.

Del. Evan Worrell, R-Cabell, explained the bill on the house floor.

“The idea behind this legislation is an attempt to mitigate the cliff effect for those individuals on Medicaid,” Worrell said. “The cliff effect occurs when wages from a new employment opportunity do not make up for a family’s loss of state benefits, putting the family in a worse financial situation.”

Del. Riley Keaton, R-Roane, asked Worrell questions and spoke in opposition to the bill on the House floor.

“So, we’re actually going to see is the public payer mix of patients grow pretty substantially for our health care providers,” Keaton said. “And then we’ll be faced with politically complicated decisions about how to make that program make sense.”

Jordan Maynor, R-Raleigh, spoke in support of the bill.

“I think my friend from the 15th (Keaton) brings up a great point. And it did get me thinking, but I think the intent of the bill is to move people off of Medicaid, keep a job, keep climbing that ladder of economic success, if they get off Medicaid completely eventually,” Maynor said. “And right now, it seems to be if we don’t do this, we’re incentivizing them to not keep their job, not take that pay raise and just be on Medicaid completely, which means no buy in from the patient.”

The bill passed the House with a vote of 73 yays, 19 nays and 8 absent, or not voting. The Senate will decide whether or not the bill makes it to the governor’s desk for his signature.