Administrative Regulation Review Subcommittee

 

Minutes of the February Meeting

 

February 9, 2015

 

Call to Order and Roll Call

 

The meeting of the Administrative Regulation Review Subcommittee was held on Monday, February 9, 2015, at 2:30 PM, in Room 149 of the Capitol Annex. Senator Ernie Harris, Chair, called the meeting to order, and the secretary called the roll.

 

Present were:

 

Members: Senator Ernie Harris, Co-Chair; Representative Mary Lou Marzian, Co-Chair; Senators Julie Raque Adams, Perry B. Clark, and Alice Forgy Kerr; Representatives Denver Butler, Will Coursey, and Tommy Turner.

 

Guests: Donna Brockman, Professional Learning and Assessment; Doug Hendrix, Pete McDonald, Troy Robinson, Finance and Administration Cabinet; Leanne Diakov, Mark Jorrisch, M.D., Michael Rodman, Board of Medical Licensure; Matt James, Board of Licensed Diabetes Educators; Gerald Ross, Department of Criminal Justice Training; Laura Begin, Troi Cunningham, R.N., C. Darrell Jennings, M.D., Department of Public Health, Newborn Screening; Leslie Hoffmann, Natalie Kelly, Stuart Owen, Department of Medicaid Services; Phyllis Sosa, Tonia Wells, Department of Aging and Independent Living; Mary Sparrow, Steve Veno, Child Support Enforcement; Elizabeth Caywood, Jason Dunn, Mary Beth Jackson, Beth Jurek, Department for Community Based Support; Dr. Larry Suess.

 

LRC Staff: Donna Little, Emily Caudill, Sarah Amburgey, Carrie Klaber, Karen Howard, Emily Harkenrider, Ange Bertholf, and Betsy Cupp.

 

Administrative Regulations Reviewed by the Subcommittee:

 

EDUCATION PROFESSIONAL STANDARDS BOARD: Assessment

 

16 KAR 6:010. Examination prerequisites for teacher certification. Donna Brockman, director of professional learning and assessment, represented the board.

 

A motion was made and seconded to approve the following amendments: (1) to amend the NECESSITY, FUNCTION, AND CONFORMITY paragraph to make a technical correction; and (2) to amend Section 2 to correct dates for consistency. Without objection, and with agreement of the agency, the amendments were approved.

 

FINANCE AND ADMINISTRATION CABINET: Office of the Secretary: Fleet Management

 

200 KAR 40:010. Motor pool procedure. Doug Hendrix, deputy general counsel; Pete McDonald, director of fleet management; and Troy Robinson, executive director, represented the office.

 

In response to a question by Co-Chair Marzian, Mr. McDonald stated that the office sought energy-efficient, "green" vehicles for the fleet.

 

In response to a question by Co-Chair Harris, Mr. Robinson stated that the incorporated guides were revised to update information regarding texting prohibitions, Web site addresses, and mileage reimbursement tables.

 

A motion was made and seconded to approve the following amendments: to amend the NECESSITY, FUNCTION, AND CONFORMITY paragraph, Sections 1 and 3, and the material incorporated by reference to comply with the drafting requirements of KRS Chapter 13A. Without objection, and with agreement of the agency, the amendments were approved.

 

200 KAR 40:020. Purchase, use, lease, maintenance, and disposal of state-owned motor vehicles.

 

A motion was made and seconded to approve the following amendments: to amend Sections 2, 5, and 6 to comply with the drafting requirements of KRS Chapter 13A. Without objection, and with agreement of the agency, the amendments were approved.

 

GENERAL GOVERNMENT CABINET: Board of Medical Licensure: Board

 

201 KAR 9:270. Professional standards for prescribing or dispensing Buprenorphine-Mono-Product or Buprenorphine-Combined-with-Naloxone. Leanne K. Diakov, general counsel; Mark Jorrisch, M.D.; and Michael Rodman, executive director, represented the board. Dr. Larry Suess, child psychiatrist, appeared in opposition to this administrative regulation.

 

In response to a question by Senator Clark, Ms. Diakov stated that a patient who had tested positive for THC was not automatically rejected from the program. The patient would be counseled by the physician, and the physician would determine if there was a need for a change to the treatment plan.

 

Dr. Suess stated that Kentucky was experiencing a high rate of heroin abuse. This administrative regulation's standard for treatment with Buprenorphine-Mono-Product or Buprenorphine-Combined-with-Naloxone separated dependence treatment from the medical care system, which limited access to care and contributed to the stigma of getting treatment. The requirement to report information to the Kentucky Health Information Exchange was redundant because the information was already reported to the KASPER system. Additionally, the information was subject to security threats, such as hacking. Naloxone should be administered only with great caution to pregnant women, newborns, or women who are nursing. These medications were prohibited for patients taking certain other medications unless prescribed by an addition specialist. Because of the small number of addiction specialists, this may create an access problem for many patients. Dr. Suess requested that the board withdraw this administrative regulation or that the subcommittee find this administrative regulation deficient.

 

Ms. Diakov stated that the Cabinet for Health and Family Services requested that the information be reported to the Kentucky Health Information Exchange in order to promote information sharing for comprehensive care, and the security risk was no greater than any other threat to information in that system. Dr. Jorrisch stated that the standard of care established for treatment during pregnancy was shown as not harmful to mother or baby if administered orally. There was still a risk of misuse, which would then possibly have a harmful effect.

 

In response, Dr. Suess stated that the information required for the Kentucky Health Information Exchange was already available through the KASPER system and thus was redundant, doubling the risk to the security of the information. Additionally, the information may result in refusal of the insurance company to pay for the medication.

 

Co-Chair Harris requested that Dr. Suess continue to work with the board in the development of this administrative regulation.

 

A motion was made and seconded to approve the following amendments: to amend Section 2 to: (1) use the term "prescribing or dispensing physician" rather than "physician"; (2) include generic forms of the treatment medications; (3) establish procedures if a patient is transferred from a previous treatment provider; and (4) specify that, after the second month of treatment, if the patient is progressing, the physician shall ensure that the patient shall be seen at least once monthly thereafter. Without objection, and with agreement of the agency, the amendments were approved.

 

Board of Licensed Diabetes Educators: Board

 

201 KAR 45:110. Supervision and work experience. Matt James, assistant attorney general, represented the board.

 

201 KAR 45:120. Renewal, reinstatement, and inactive status.

 

A motion was made and seconded to approve the following amendments: (1) to amend Sections 1 through 3 to comply with the drafting requirements of KRS Chapter 13A; and (2) to amend Section 5 to revise the form incorporated by reference. Without objection, and with agreement of the agency, the amendments were approved.

 

JUSTICE AND PUBLIC SAFETY CABINET: Kentucky Law Enforcement Council: Council

 

503 KAR 1:090. Approval of course curriculums. Gerald Ross, assistant general counsel, represented the council.

 

A motion was made and seconded to approve the following amendments: (1) to amend the RELATES TO and STATUTORY AUTHORITY paragraphs to correct citations; (2) to amend the NECESSITY, FUNCTION, AND CONFORMITY paragraph to clearly state the necessity for and function served by this administrative regulation, as required by KRS 13A.220; (3) to amend Sections 1, 2, and 4 to specify curriculum submission requirements and approval procedures; and (4) to amend Sections 3, 5, and 6 to comply with the drafting and formatting requirements of KRS Chapter 13A. Without objection, and with agreement of the agency, the amendments were approved.

 

CABINET FOR HEALTH AND FAMILY SERVICES: Department for Public Health: Division of Maternal and Child Health: Maternal and Child Health

 

902 KAR 4:030. Newborn screening program. Laura Begin, regulation coordinator; Troi Cunningham, RN, nurse administrator; and C. Darrel Jennings, M.D., associate director, represented the cabinet.

 

In response to a question by Co-Chair Harris, Ms. Cunningham stated that hospitals paid the fee for the newborn screening program and were billed monthly in a standard bundle. The fee was not charged for repeat screening.

 

Department for Medicaid Services: Division of Policy and Operations: Behavioral Health

 

907 KAR 15:040 & E. Coverage provisions and requirements regarding targeted case management for individuals with a substance use disorder. Leslie Hoffmann, director of behavioral health; Natalie Kelly, division director; and Stuart Owen, regulation coordinator, represented the cabinet.

 

A motion was made and seconded to approve the following amendments: (1) to amend Section 3 to expand the types of Medicaid providers authorized to provide targeted case management services to include Levels I and II psychiatric residential treatment facilities for recipients under twenty-one (21), chemical dependency treatment centers for individuals with a substance use disorder, outpatient hospitals, and psychiatric hospitals; (2) to amend Section 4 to create an exemption to the targeted case manager educational requirements by waiving requirements for anyone who has provided or supervised targeted case management services any time from April 1, 2014 until the administrative regulationís effective date; (3) to amend Section 8 to: (a) remove the restriction that an individual who provides targeted case management services cannot provide any other services but establishes that the individual cannot provide any other services to the recipient to whom the individual is providing targeted case management services; and (b) establish an overall caseload cap for targeted case managers of twenty-five (25) recipients at one (1) time beginning October 1, 2015; (4) to amend Section 9 to correct citations to federal law; (5) to amend Section 10 to clarify that: (a) the timeframe for providing requested information to the department or a managed care organization shall be reasonable given the nature of the request and circumstances surrounding the request and shall be a minimum of one (1) business day; and (b) a targeted case management services provider may request a longer timeframe; and (6) to amend the NECESSITY, FUNCTION, AND CONFORMITY paragraph and Sections 2, 4, 9, and 10 to comply with the drafting and formatting requirements of KRS Chapter 13A. Without objection, and with agreement of the agency, the amendments were approved.

 

907 KAR 15:045 & E. Reimbursement provisions and requirements for targeted case management services for individuals with a substance use disorder.

 

907 KAR 15:050 & E. Coverage provisions and requirements regarding targeted case management for individuals with co-occurring mental health or substance use disorders and chronic or complex physical health issues.

 

A motion was made and seconded to approve the following amendments: (1) to amend Section 3 to expand the types of Medicaid providers authorized to provide targeted case management services to include Levels I and II psychiatric residential treatment facilities for recipients under age twenty-one (21), chemical dependency treatment centers for individuals with a substance use disorder, outpatient hospitals, and psychiatric hospitals; (2) to amend Section 4 to create an exemption to the targeted case manager educational requirements by waiving requirements for anyone who has provided or supervised targeted case management services any time from April 1, 2014 until the effective date of the administrative regulation; (3) to amend Section 8 to: (a) remove the restriction that an individual who provides targeted case management services cannot provide any other services but establishes that the individual cannot provide any other services to the recipient to whom the individual is providing targeted case management services; and (b) establish an overall caseload cap for targeted case managers of twenty-five (25) recipients at one (1) time beginning October 1, 2015; (4) to amend Section 9 to correct citations to federal law; (5) to amend Section 10 to clarify that: (a) the timeframe for providing requested information to the department or a managed care organization shall be reasonable given the nature of the request and the circumstances surrounding the request and shall be a minimum of one (1) business day; and (b) a targeted case management services provider may request a longer timeframe if necessary; and (6) to amend the NECESSITY, FUNCTION, AND CONFORMITY paragraph and Sections 4, 9, and 10 to comply with the drafting and formatting requirements of KRS Chapter 13A. Without objection, and with agreement of the agency, the amendments were approved.

 

907 KAR 15:055 & E. Reimbursement provisions and requirements regarding targeted case management for individuals with co-occurring mental health or substance use disorders and chronic or complex physical health issues.

 

A motion was made and seconded to approve the following amendments: to amend the TITLE and NECESSITY, FUNCTION, AND CONFORMITY paragraph to use terminology that is similar to the provisions of the administrative regulation. Without objection, and with agreement of the agency, the amendments were approved.

 

907 KAR 15:060 & E. Coverage provisions and requirements regarding targeted case management for individuals with a severe mental illness and children with a severe emotional disability.

 

A motion was made and seconded to approve the following amendments: (1) to amend Section 3 to expand the types of Medicaid providers authorized to provide targeted case management services to include Levels I and II psychiatric residential treatment facilities for recipients under age twenty-one (21), chemical dependency treatment centers for individuals with a substance use disorder, outpatient hospitals, and psychiatric hospitals; (2) to amend Section 4 to create an exemption to the targeted case manager educational requirements by waiting requirements for anyone who has provided or supervised targeted case management services any time from April 1, 2014 until the effective date of the administrative regulation; (3) to amend Section 8 to: (a) remove the restriction that an individuals who provides targeted case management services cannot provide any other services but establishes that the individual cannot provide any other services to the recipient to whom the individual is providing targeted case management services; and (b) establish an overall caseload cap for targeted case managers of twenty-five recipients at one time beginning October 1, 2015; (4) to amend Section 9 to correct citations to federal law; (5) to amend Section 10 to clarify that: (a) the timeframe for providing requested information to the department or a managed care organization shall be reasonable given the nature of the request and the circumstances surrounding the request and shall be a minimum of one (1) business day; and (b) a targeted case management services provider may request a longer timeframe if necessary; and (6) to amend the NECESSITY, FUNCTION, AND CONFORMITY paragraph and Sections 2, 4, 6, 9, and 10 to comply with the drafting and formatting requirements of KRS Chapter 13A. Without objection, and with agreement of the agency, the amendments were approved.

 

907 KAR 15:065 & E. Reimbursement provisions and requirements regarding targeted case management for individuals with a severe mental illness and children with a severe emotional disability.

 

Department for Aging and Independent Living: Division of Quality Living: Brain Injury

 

910 KAR 3:030. Traumatic brain injury trust fund operations program. Phyllis Sosa, staff assistant, and Tonia Wells, fund director, represented the cabinet.

 

A motion was made and seconded to approve the following amendments: (1) to amend Section 1 to specify a definition; (2) to amend Section 10 to correct an inadvertent error and for consistency; (3) to amend Section 14 to clarify that a recipient discharge from the fund program shall be required if both the recipient and the provider have had a substantiation of fraud related to the program, rather than a recipient discharge if only the provider has had a substantiation of fraud; and (4) to amend the RELATES TO paragraph and Sections 4, 7, 13, and 14 to comply with the drafting and formatting requirements of KRS Chapter 13A. Without objection, and with agreement of the agency, the amendments were approved.

 

Department for Income Support: Child Support Enforcement: Family Support

 

921 KAR 1:410. Child support collection and distribution. Mary Sparrow, policy analyst, and Steve Veno, commissioner, represented the cabinet.

 

A motion was made and seconded to approve the following amendments: (1) to amend the RELATES TO and STATUTORY AUTHORITY paragraphs to update citations; (2) to amend Sections 4 and 5 to correct form names and edition dates; and (3) to amend the RELATES TO and STATUTORY AUTHORITY paragraphs and Sections 1 through 4 to comply with the drafting requirements of KRS Chapter 13A. Without objection, and with agreement of the agency, the amendments were approved.

 

Department for Community Based Services: Division of Family Support: Supplemental Nutrition Assistance Program

 

921 KAR 3:030. Application process. Elizabeth Caywood, policy analyst, and Jason Dunn, director, represented the cabinet.

 

In response to a question by Co-Chair Harris, Mr. Dunn stated that this administrative regulation included voter provisions as part of the federal Motor Voter Act.

 

Division of Child Care: Day Care

 

922 KAR 2:160 & E. Child Care Assistance Program. Elizabeth Caywood, policy analyst; Mary Beth Jackson, division director; and Beth Jurek, executive director, represented the cabinet.

 

In response to questions by Co-Chair Harris, Ms. Jurek stated that there were 2,000 licensed childcare centers. One (1) or two (2) percent of those centers experienced a change of ownership transfer each year. A new owner had six (6) months before a STAR rating was given; however, it was necessary to provide some exceptions. A parent may request an exemption of the six (6) month waiting period so that the center may retain funding until the new STAR rating is established. The cabinet may reconsider the exemption if there were problems with the center after the transfer. Funding was provided to the center, not the recipient. Funding was based on 2011 federal poverty guidelines. Revising to the 2014 federal poverty guidelines would not result in helping more families because the funding itself was finite and was based on the 2011 federal poverty guidelines. Revising to the 2014 federal poverty guidelines would result in the need to reduce funding, which would mean the same number of families would receive assistance. The cabinet was considering changing the economic standards to a fixed amount that was not based directly on federal poverty guidelines in order to alleviate misunderstandings pertaining to the year of the federal poverty guideline standard.

 

A motion was made and seconded to approve the following amendments: (1) to amend Section 1 to correct a citation; (2) to amend Sections 1 and 13 to make technical corrections; and (3) to amend Sections 3, 12, and 20 to comply with the drafting requirements of KRS Chapter 13A. Without objection, and with agreement of the agency, the amendments were approved.

 

Other Business: Co-Chairs Harris and Marzian stated that the date of the March 2015 meeting would be set for either Monday, March 9, or Tuesday, March 10. The date and time would depend on the General Assemblyís schedule for the Regular Session. The co-chairsí preference was to meet on Monday, March 9, at a time convenient for all members given that dayís session schedule and other committee meetings. Subcommittee staff will discuss the meeting time with Senate and House leadership and Subcommittee members and will announce the scheduled date as soon as it is known.

 

The following administrative regulations were deferred to the March 2015, meeting of the Subcommittee:

 

GENERAL GOVERNMENT CABINET: Board of Licensure for Occupational Therapy: Board

 

201 KAR 28:010. Definitions and abbreviations.

 

201 KAR 28:020. General provisions.

 

201 KAR 28:030. Short-term practice of occupational therapy for persons practicing under KRS 319A.090(1)(e).

 

201 KAR 28:060. Requirements for licensure.

 

201 KAR 28:070. Examination.

 

201 KAR 28:090. Renewals.

 

201 KAR 28:110. Fees.

 

201 KAR 28:130. Supervision of occupational therapy assistants, occupational therapy aides, occupational therapy students, and temporary permit holders.

 

201 KAR 28:140. Code of ethics and unprofessional conduct.

 

201 KAR 28:170. Deep physical agent modalities.

 

201 KAR 28:180. Temporary permits.

 

201 KAR 28:200. Continuing competence.

 

201 KAR 28:220. Per diem of board members.

 

TRANSPORTATION CABINET: Office of the Secretary: Kentucky Bicycle and Bikeways Commission: Motorcycle and Bicycle Safety

 

601 KAR 14:020. Bicycle safety standards.

 

Department of Highways: Division of Maintenance: Billboards

 

603 KAR 10:001. Definitions.

 

603 KAR 10:010. Static advertising devices.

 

603 KAR 10:020. Electronic advertising devices.

 

603 KAR 10:030. Removal of vegetation related to advertising devices.

 

EDUCATION AND WORKFORCE DEVELOPMENT CABINET: Board of Education: Department of Education: Instructional Programs

 

705 KAR 4:250. Energy technology engineering career pathway.

 

CABINET FOR HEALTH AND FAMILY SERVICES: Department for Medicaid Services: Division of Policy and Operations: Hospital Service Coverage and Reimbursement

 

907 KAR 10:825. Diagnosis-related group (DRG) inpatient hospital reimbursement.

 

The Subcommittee adjourned at 3:10 p.m. until March 2015.