The 4th meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, September 21, 2005, at 1:00 PM, in Room 131 of the Capitol Annex. Senator Julie Denton, Co-Chair, called the meeting to order at 1:10 PM, and the secretary called the roll.
Present were:
Members: Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Tom Buford, Denise Harper Angel, Alice Kerr, Joey Pendleton, Ernesto Scorsone, Dan Seum, Katie Stine, and Johnny Ray Turner; Representatives Scott W Brinkman, James R. Comer Jr, Robert R Damron, Bob M. DeWeese, David Floyd, Joni L. Jenkins, Mary Lou Marzian, Stephen R. Nunn, Darryl T. Owens, Ruth Ann Palumbo, Jon David Reinhardt, Ancel Smith, Kathy W. Stein, Susan Westrom, and Addia Wuchner.
Guests: Representative Jimmie Lee; David Allgood, Jan Day, Catherine McBride, George Parsons, and Lisa Reynolds, Center for Accessible Living; Bill Harned, Alex Teper, Cathy Allgood Murphy, and Linda Kuder, American Association of Retired Persons; Sheriall Cunningham, Mental Health Association of Kentucky; Argene Jones, Kentucky River Area Development District Long Term Care Ombudsman; Irene Centers, RaeAnne Davis, and Marvin Miller, Department for Public Health, Cabinet for Health and Family Services; Terry Brooks and Tara Grieship, Kentucky Youth Advocates; Jan Gould, Kentucky Retail Federation; Mary York, Kentucky Pediatric Society, Want Knight and Vona Fuellhart, Christ Academy; Terri Leason, Advocates for Reforming Medicaid Services; Michele Blevins, Department for Mental Health, Cabinet for Health and Family Services; Garrett Adams, M.D., MPH, Physicians for a National Health Program - Kentucky; Barbara Gordon, Kentuckiana Regional Planning and Development Agency (KIPDA) Area Agency on Aging; Charles L. Smith, Kentuckiana Regional Planning and Development Agency (KIPDA) Long Term Care Ombudsman Program; Donna Brown, Kentucky Association of Health Care Facilities and Kentucky Association of Chiropractors; and Sheila Schuster, Kentucky Mental Health Coalition; Pastor Randy Hollis; Dr. William Hacker, Commissioner, Department for Public Health, Cabinet for Health and Family Services; Shannon Turner, Commissioner, Department for Medicaid Services, Cabinet for Health and Family Services; Kevin Payton, Legislative Director, Office of the Secretary, Cabinet for Health and Family Services; Steve Shannon, Director, Division of Mental Health and Substance Abuse, Department for Mental Health and Mental Retardation Services, Cabinet for Health and Family Services; and Henry A. Spiller, MS, D.ABAT, Director, Kentucky Regional Kentucky Regional Poison Center, Kosair Children's Hospital.
LRC Staff: Murray Wood, CSA; Barbara Baker, Tyler Campbell, Eric Clark, DeeAnn Mansfield, Gina Rigsby, and Cindy Smith.
A motion to approve the minutes of the August 22, 2005 was made by Representative Comer, seconded by Representative Smith, and approved by voice vote.
Senator Stine reported that the Families and Children Subcommittee met that morning and heard testimony from Steve Shannon, Director of the Division of Mental Health and Substance Abuse in Kentucky on the Recovery Kentucky Initiative that will provide ten 100-bed treatment and recovery units across the state, two per congressional district. The Kentucky Housing Corporation will build the structures and other funding will come from the Community Development Block Grant and the Department of Corrections. The adult facilities will be voluntary and based on the therapeutic community model used at the Healing Place in Louisville. The research shows that this treatment has success rates of 65% twelve months after treatment, although this is may not be enough time for complete recovery. Waiting lists are expected, and there are not enough effective treatment services for adolescents. Charlotte Wethington, an advocate for substance abuse treatment and recovery associated with the Healing Place added that voluntary outpatient treatment programs are particularly ineffective for adolescents because they may not understand that they need treatment. Mr. Shannon also discussed the current focus on Methamphetamine laboratories across the state and that there is effective treatment for methamphetamine addiction. Mr. Shannon indicated that there are five schools in three communities participating in Kentucky Encouraging Youth to Succeed (KEYS) program, a state-funded substance program in schools.
The subcommittee then heard from Jim Liles, Executive Director of the Drug Policy Task Force in Northern Kentucky. Mr. Liles said that the task force serves Boone, Kenton, Campbell, and Grant Counties, approximately 300,000 people. He said that the big problem drugs are marijuana, crack cocaine, powder cocaine, prescription drug abuse, heroin and methamphetamine. He said that with adolescents the problem drugs are marijuana, prescription drugs, and heroin. He agreed that there is not enough treatment available. Most people seek treatment when they are arrested.
The subcommittee then heard a presentation from T.J. Delahanty, with the 4-H Youth Development Cooperative Extension Service. He presented results on the Youth Policy Assessment which identified the statewide resources and supports for Kentucky's young people. The goal was to find ways to coordinate the existing programs in order to improve youth services for young people ages 8 to 24 years in Kentucky. The total number of programs studied was 61 with $855,155,557 allocated in fiscal year 2004. The study assessed the degree to which the programs met the "Five America Promises to Youth", a research project that indicates the best predictors of positive outcomes for youth programs. The assessment revealed a major deficiency in existing programs with Kentucky is the finding that 83% of the programs meet only two of the five promises, and 94% meet only three of the promises. The largest deficiency was in the programs that offer youth opportunities to be involved with program administration. Out of the 61 programs, 28 have advisory councils and only a small number have youth involved.
Glenda Taylor, Association of Retared Citizens of Kentucky, reported that there is training a program for parents on the problems for children associated with methamphetamine labs. A motion to accept the subcommittee report was made by Representative Smith, seconded by Representative Burch, and approved by voice vote.
Next was a report on the Kentucky Commission on Autism Spectrum Disorders given by Representative Scott Brinkman. Representative Brinkman stated that House Bill 296 passed during the 2005 Regular Session established the commission to develop and monitor the implementation of a comprehensive state plan for an integrated system of training, treatment, and services for individuals of all ages with an autism spectrum disorder (ASD) and to establish a timeline for implementing the plan in all geographic regions of the state.
Representative Brinkman said that statistics show that one out of every 160 children born in this country are diagnosed at some point with ASD. Currently, there are 24,000 Kentuckians that have been diagnosed with ASD. He stated that it is a profound problem that has the potential to overwhelm the resources of the state. The Governor appointed members to the commission and became it was established July 1, 2005. The commission met for the first time on August 22, 2005, and is an excellent group of individuals who are representative of the Commonwealth and of those who deal with ASD on a regular basis. He stated that four subcommittees were formed: 1) Identification and Intervention; 2) Best Practices and Training; 3) Services and Transition; and 4) Funding Source.
Representative Brinkman stated that the over the next several months the subcommittees will hold regional forums asking input from individuals interested in ASD, Each subcommittee is expected to prepare a comprehensive report to be submitted to the commission. He stated that the commission will meet every six weeks for updates from each subcommittee. The report is due to the Legislative Research Commission and the Governor by October 1, 2006. After the report has been completed, the commission will cease to exist as a statutory commission and become a subcommittee of the Kentucky Council on Developmental Disabilities. The subcommittee will submit a report to the Council that will be submitted to the Legislative Research Commission and the Governor biennially until October 1, 2015.
Next was a report on the Kentucky KIDS Count Data by Tara Grieshop, KIDS Count Coordinator, and Terry Brooks, Executive Director, Kentucky Youth Advocates. Ms. Grieshop said that Kids Count is an effort funded by the Annie E. Casey Foundation that is focused on data relating to child well-being in an effort to inform the decisions by service providers, community leaders, and policymakers. The KIDS Count data book compares and ranks states on ten indicators of child well-being such as child deaths, teen births, and teen without a high school diploma. In the report released in July, Kentucky fell to 42nd in the nation, which is the lowest rank Kentucky has received in the 16 years the report has been released.
Mr. Brooks stated that Kentucky fell from 37th the previous year to 42nd this year. Positive indicators are that Kentucky joined Wyoming as the only two states that did not experience an increase in infant mortality rates, the rate of teen pregnancy declined by seven percent, and a ten percent decline in high school drop-out rates. However, in the 15 prior years, Kentucky had improved in 80 percent in the measures in the report, but in this report, Kentucky declined in 60 percent of the measures. The mortality rate for every Kentuckian between the ages of one and 19 increased. In 2003, approximately 81,000 children lived in homes where neither parent had secure employment, which ranked Kentucky 46th. Child poverty worsened by nine percent. Kentucky is one of ten states in the nation without a graduated driver's license. Every state that borders Kentucky has a graduated driver's license.
Representative Burch asked how many deaths could be prevented by extending a driver's permit for six months. Mr. Brooks stated that a 16-year old is three times more likely to die in an automobile fatality than a 17-year old and five times more than an 18-year old and twice as likely as an 85 year old. He said that 16-year olds need more experience driving. The national opinion is there will be a decline in deaths if more focus is put on 16-year olds. Representative Burch asked why there was such a dramatic decline in Kentucky's ranking. Mr. Brooks stated that economic conditions of families are a major cause in the decline.
Senator Seum asked if any states required anyone to be age 18 to drive. Ms. Grieshop stated she did not know of any. Senator Seum asked if no states require an age limit of 18 to drive, where do the statistics come from. Ms. Grieshop stated from the National Highway Transportation Safety Administration. Mr. Brooks stated that they compared 16-year olds in accidents to the total population of 16 year olds.
Representative Owens asked what steps should be taken to increase enrollment in KCHIP. Mr. Brooks stated that we should begin to look at the access families have to services. Representative Owens stated that one way to increase the participation of children in KCHIP would be to revert back to the mail-in application process and a more meaningful outreach.
Representative Westrom asked if the KYA was prepared for such a dramatic decline. Mr. Brooks said no, and while rankings are a concern, change of the trendline from improvement to decline is of more concern. He said that the biggest concern that is that instead of improving in 80 percent of the areas, Kentucky declined in 60 percent of the areas.
Representative Palumbo stated that once Kentucky improves in the education area, it should automatically cause changes in other areas. Mr. Brooks stated that the KYA hopes to address achievement gaps based on socio-economic gaps.
Next was a report on responses to Hurricane Katrina by Pastor Randy Hollis. Pastor Hollis stated that Louisiana could not absorb everyone who need to relocate, so there was a need to help on a national level. One goal of The Joseph Project is to help find missing family members of evacuees. He said that evacuees complete a screening application, and law enforcement officials have located several sex offenders and criminals through this process. To date approximately 134 evacuees have arrived in Louisville with more expected toward the end of September. He said that he would wok with the Red Cross to for evacuees to use vouchers for hotel rooms until housing could be located. More housing, jobs, and vehicles are need. He stated that because of the large volunteer effort approximately $2,000 had been spent on helping evacuees through The Joseph Project.
Senator Denton stated that the project was meeting needs that no one else was meeting by relocating the evacuees. She said that evacuees are matched up with a host family that helps with whatever they need. Medical and psychological needs are being met, and children are being enrolled in schools. She stated that some of the evacuees want to relocate to Louisville permanently.
Representative Burch stated that he wanted to applaud everyone who was a part of The Joseph Project and commend the legislators that went to New Orleans. He asked if the Red Cross and FEMA had helped, and Pastor Hollis answered that the Red Cross has helped but not FEMA. He stated that the project is only three weeks old, and the federal government is apprehensive of new projects because of their concerns relating to fraud. Vouchers are needed from the Red Cross to help get things in place.
Senator Seum stated that the legislator most involved with starting the project was Senator Denton. He said that much has been accomplished with the guidance of Pastor Hollis. The project was not looking for government help because it did not want any bureaucratic red tape involved. He said that he appreciated Pastor Hollis and his efforts.
Representative Palumbo asked for a description of a typical family the project worked with on a daily basis. Mr. Ekbundit, administrator of the project, stated that they work with anyone who needs help. Representative Palumbo stated that she was glad the project was working across political, economic, and racial lines. She asked for a copy of the screening application used by the project, and Pastor Hollis stated that it can be downloaded from their web site.
Representative Wuchner stated that public health is an on-going need. Some centers will be maintained through the first of the year. She said that some families were reluctant to relocate at first but now have realized they have to.
Representative Nunn asked for the phone number to contact the Joseph Project. Pastor Hollis stated they are 502-966-LIFE (5433) or 866-44-JOSEPH.
Senator Pendleton asked if health departments and local physicians are taking care of medical needs. Pastor Hollis stated that health screening is completed immediately upon arrival and needs are assessed. Senator Denton stated that the needs vary from family to family. Some still have insurance from previous employers, some are Medicaid eligible, and some do not have any coverage, and the community has stepped up to help address needs.
Representative Marzian asked if mental health issues were identified and services provided. Pastor Hollis stated that the evacuees have been very traumatized and the project relies on medical health professionals to help meet needs. She asked if any initial screening is done to identify medications a person had already been prescribed, and Pastor Hollis said yes. Senator Denton stated that allot of therapy and counseling are being done for free, but people have been so traumatized and in shock, they have not seemed ready for these services. Senator Denton said the project takes care of the needs that evacuees say they have. Pastor Hollis stated that each family has a mentor group for help and support.
Representative Westrom stated that because some of the evacuees lived in rural areas, it could be a big adjustment moving to an urban city such as Louisville. She asked Pastor Hollis if his organization had contacted the Department of Tourism and asked if the state park cottages could be used for housing for the evacuees. Pastor Hollis stated that he would contact the department.
Representative Burch stated that while it is a great thing helping the victims of Katrina, he asked if as much help is being provided for Kentucky's citizens in need. Pastor Hollis stated that he hopes every church will step up and do what Christ has called them to do.
William Hacker, MD, FAAP, CPE, Commissioner of the Department for Public Health, Cabinet for Health and Family Services, stated that the cabinet created blanket policies on eligibility for all programs and relaxed requirements to serve displaced persons. A web site was created to register and to conduct needs assessment for displaced persons, and to register health professionals to volunteer. Currently, over 1,200 health professionals and over 1,000 Katrina evacuees have been registered. The department has used the Health Alert Network (HAN) and EM Systems for data and information dissemination and is using telemedicine technology in 42 locations to present public health, medical, mental health, social, and Medicaid information. An environmental strike team was deployed to inspect food and water supplies in the Mississippi area, and a public health administrative strike team was deployed to operate local health departments in six Mississippi Gulf Coast counties for 30 days. Also deployed were six public health nurses to work in a Red Cross shelter in Mississippi to relieve other teams.
Commissioner Hacker stated that according to FEMA records, Kentucky has 6,800 evacuees located in 94 counties. Local health departments, local social service offices, local private physicians, and local private hospitals are working together in each of the counties. While the department is taking care of the effects of Katrina, there are still other public health needs that need attention. Public health professionals have been and continue to do a wonderful job in Kentucky.
Representative Westrom asked if disaster training was required for volunteers. Commissioner Hacker stated that the federal system operated by FEMA is the Emergency Management Assistance Compact (EMAC) that is a state-to-state agreement that if a state needs assistance, other states will send help and if only applies to governmental, health departments, and state employees. He recommended that people get disaster training if they plan to go to a disaster area because people do not realize the impact it will have on their own emotional state of being. The Citizen Corps, coordinated through the Office of Homeland Security, has a training program in place and there is a medical reserve corps team component for clinical or medical professionals. She asked if licensure for individuals in the healthcare field who have come to Kentucky could be waived or temporary credentials obtained. Commissioner Hacker said that currently in statute is a 30-day instant licensure in an emergency situation, but the statute does not provide the ability to extend beyond the 30 day period. A proposal has been drafted and is ready to be sent to the Governor's office for an executive order to be issued to extend licensure beyond 30 days. Senator Denton stated that the same thing is being done for CNAs and LPNs.
Senator Pendleton stated that if evacuees are unable to get medical coverage, it puts all Kentuckians at risk because there is no way to know what diseases each of them were exposed to before relocating to Kentucky. Commissioner Hacker said that for presumptive eligibility for Medicaid is an option for individuals who have been displaced who want to remain. For individuals who do not want to remain in Kentucky, the federal government has set up a program a system where physicians in Kentucky can automatically become a provider for the Louisiana Medicaid Program. For individuals who want to remain in Kentucky, those individuals can receive instant approval at a local Department for Community Based office so they will not do without health care. Senator Pendleton stated that we need to treat the people first, then find out if they want to stay in Kentucky.
Commissioner Hacker stated the Kentucky Physician Care Program will provide physicians for free of charge who are economically challenged, and there is also a pharmaceutical benefit program that will provide them drugs. Representative Wuchner said that the evacuees need guidance in spending the $2,000 received from FEMA.
Representative Palumbo asked if there would be a follow-up to make sure that all immunization records are up-to-date for school children. Commissioner Hacker stated that the local health department works with the school systems to determine compliance with state laws. He said that it would be a challenge because some children's records are lost, but groups are being monitored for signs of illness, there has not been any significant increase in illnesses.
Senator Denton thanked Dr. Steve Davis for his help and participation in the Joseph Project.
A motion to approve Executive Order 2005-779 was made by Senator Seum, seconded by Representative Brinkman, and approved by voice vote.
A motion to approve the Community Mental Health Services Performance Partnership Block Grant was made by Senator Seum, seconded by Representative Comer, and approved by voice vote.
Next was a presentation on elderly and disabled issues by Bill Harned, State President, American Association of Retired Persons, and David Allgood, Advocate, Center for Accessible Living. Mr. Harned stated that the Advocates for Reforming Medicaid Services (ARMS) is a large coalition of family members, advocates, and providers of services concerned about changes in Kentucky's Medicaid program. These groups have joined together to seek changes in the Medicaid program that will ensure that beneficiaries have reasonable, high quality and cost effective choices of long-term care services, and to help inform consumers of changes in Medicaid. ARMS represents approximately 1.5 million people throughout the Commonwealth. ARMS was created in response to the Medicaid crisis in 2003 when budget shortfalls prompted the administration to deny services to thousands of Kentuckians who relied on the various Medicaid programs for their health and well being.
Mr. Harned stated that statistics show Kentuckians are older, poorer, and sicker than most Americans. He reported the following Kentucky statistics: 1) Kentucky is the fourth most impoverished state in the nation; 2) approximately 700,000 Kentuckians qualify for Medicaid coverage one half are of them children and almost one fourth are adults; 3) the elderly population will increase by 79 percent by the year 2030; 4) 24 percent of Kentucky Medicaid recipients are blind or disabled which is higher than the national average of 13 percent; 5) 36 percent of the elderly and disabled are enrolled in Medicaid; and 6) 71 percent of Medicaid funds are spent on the elderly and disabled.
He stated that there needs to be a separate and distinct forum to address the legislature with ideas and concerns regarding the elderly and disabled and requested that the Interim Joint Committee on Health and Welfare form a subcommittee on aging, disability, and independent living.
Mr. Allgood stated also stated that there needs to be an arena where voices and concerns of the elderly and disabled can be heard. He stated that these populations want to work with legislators and offer their expertise and knowledge. As of six years ago, there were 874,000 Kentuckians with disabilities not counting children under the age of five years. Approximately 435,000 of the 874,000 were fifty years of age or older. He said that a person should have the option to remain in a nursing home or receive services in the community.
Representative Palumbo stated that she thought the subcommittee was a great idea but suggested that long-term care be added to the end of the name of the recommended subcommittee.
A motion to request an Aging, Disabilities, Independent Living, and Long-Term Care Subcommittee for the 2006 interim was made by Representative Jenkins, seconded by Senator Pendleton, and approved by voice vote. Bernie Vonderheide, advocate of nursing home reform, gave his support of the subcommittee.
Next Representative Burch noted the problems at Oakwood and Central State Hospital ICF/MR and said the recent violations led to the decision of the federal Centers for Medicare and Medicaid Services to end Medicaid reimbursement at Oakwood within 30 days. He stated a letter would be sent to the congressional delegation asking them to support the state's request for more than 30 days to allow the cabinet to find suitable placement of residents who will be relocated from these facilities. He said that he had met with Undersecretary Birdwhistell, and given sufficient time, the cabinet can resolve the problems with these facilities. Representative Burch said he would continue to meet with cabinet officials.
Representative Burch announced that the next committee meeting would be in Louisville on October 19, 2005.
Next was a report on the Kentucky Regional Poison Center by Henry A. Spiller, MS, D.ABAT, Director of the Kentucky Regional Poison Center at Kosair Children's Hospital. Dr. Spiller stated that in 2004 there were 77,212 calls made to the Kentucky Regional Poison Center with an average of 210 to 215 per day. The center is open 24 hours a day, seven days a week, 365 days a year and provided in all 120 counties. He said that 75 percent of patients are treated outside of the hospital and that saves between $8-12 million per year by reducing unnecessary emergency room use. In Louisiana and Illinois funding was cut and centers were closed, and both states re-opened their centers within two years. He stated that in the 25 percent of poisoning cases treated in a hospital, Kentucky Regional Poison Center reduced the length of stay by 46 percent and saved between $2-4 million per year.
Dr. Spiller stated that the Department for Public Health has designated the Kentucky Regional Poison Center as the primary contact for health professionals, emergency service providers, hospitals, and the general public during the first six days after a biological or chemical terrorist attack in the state. He stated that the annual call volume from 2000 to 2004 increased 21 percent. During the last eight consecutive years there has been no change or increase in state support for the center. In order to retain experienced nurses due to a nursing shortage, salaries have rise 27.2 percent, and personnel cost are over 93 percent of the operating budget. He stated that the annual budget is $2,118,000 - $1,000,000 state general funds, $254,980 federal funds, and $863,020 Norton Healthcare funds. The proposed funding for fiscal year 2006-2007 annual budget would be $2,118,000 with an increase in state funds to $1,150,000, federal funds remaining at $254,980, and a decrease in Norton Healthcare to $713,020. Dr. Spiller noted that the center serves all 120 counties but Norton Healthcare is the only medical provider that contributes any funding.
Representative DeWeese stated that the demands on the center have increased, and the legislature should respond favorably.
Representative Marzian stated that the staff of the center do a great job with the small amount of allocated funds. She emphasized that the center serves all counties not just Jefferson County, and additional funds should be allocated to the center in the 2006 budget.
Representative Wuchner stated that she gave her support and that the funding is just a little more than $1,000 more per county of extended funding.
There being no further business, a motion to adjourn at 3:24 p.m. was made by Representative Marzian, seconded by Senator Denton, and approved by voice vote.