The 3rd meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, September 20, 2006, at 1:00 PM, in Room 154 of the Capitol Annex. Senator Julie Denton, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Tom Buford, Perry B. Clark, Denise Harper Angel, Joey Pendleton, Richard "Dick" Roeding, Ernesto Scorsone, Dan Seum, and Katie Stine; Representatives Scott W. Brinkman, James R. Comer Jr., Robert R. Damron, Bob M. DeWeese, David Floyd, Joni L. Jenkins, Stephen R. Nunn, Darryl T. Owens, Ruth Ann Palumbo, Jon David Reinhardt, Ancel Smith, Kathy W. Stein, and Addia Wuchner.
Guest Legislator: Representative Jimmie Lee.
Guests: Mark D. Birdwhistell, Secretary, Cabinet for Health and Family Services; Joseph Toy, President and CEO, Bluegrass Regional Mental Health and Mental Retardation Board; Liana Clark, M.D., Specialist in Adolescent Medicine and Regional Medical Director, Merck Co., Inc.; Robert Kelley, Manager of Government, Merck & Co., Inc.; Herbert E. Newman, Psy.D., President, Kentucky Council on Problem Gambling; Caleb E. Cooley, Treasurer, National Council on Problem Gambling; Michael R. Stone, Executive Director, Kentucky Council on Problem Gambling; Chris Corbin, Executive Director, Office of Health Policy, Cabinet for Health and Family Services; Dr. William Hacker, M.D., FAAAP, CPE, Acting Undersecretary of Health, Cabinet for Health and Family Services; Donna Hillman, Division Director; Mental Health and Substance Abuse, Department for Mental Health and Mental Retardation Services, Cabinet for Health and Family Services; Dr. Steve Davis, Deputy Commissioner, Department for Public Health, Cabinet for Health and Family Services; Danita Reed, Lora Roberts, Susan Sullivan, Genesia Bowling, and Laura Barnard, University of Kentucky; Carrol March and Sue Williams, Northern Kentucky Area Development District; Anne Joseph, Kentucky Task Force on Hunger; Donald Putman, Martha and Jim Bazzell, Charlotte and Gayle Rees, Becky Lainhart, David Wallace, Elizabeth and Claude Farley, Parents-Relatives of Oakwood Facility (P.R.O.O.F.); Podrick Rupinen, Division of Mental Health and Substance Abuse, Department for Mental Health and Mental Retardation Services, Cabinet for Health and Family Services; Karen Hublar, Community Coordinated Child Care; Jan Gould, Kentucky Retail Federation; Debbie Ball, Division of Aging Services, Department for Human Support Services, Cabinet for Health and Family Services; Howard Beauman, Kentucky League on Alcohol & Gambling Problems; Nancy McKee, Wyeth; and Sarah S. Nicholson, Kentucky Hospital Association.
LRC Staff: Murray Wood, CSA; Barbara Baker, Miriam Fordham, DeeAnn Mansfield, Ben Payne, Gina Rigsby, Cindy Smith, and Michelle Woods.
A motion to adopt the minutes of the July 24, 2006 meeting was made by Senator Clark, seconded by Senator Stine, and adopted by voice vote.
The Families and Children Subcommittee report was given by Senator Stine. She reported that the subcommittee heard updates on the Blue Ribbon Adoption Panel, the Kentucky Youth Development Coordinating Council, and the Temporary Assistance for Needy Families (TANF) interim final regulations and possible impacts on Kentucky from Tom Emberton, Jr., Commissioner of the Department for Community Based Services, Cabinet for Health and Family Services.
The Blue Ribbon Adoption Panel reviews the processes and current practices that lead to termination of parental rights and adoption of children in the child welfare system. The panel has met twice and plans to bring recommendations to the General Assembly at the end of the year. Commissioner Emberton noted that 80 percent of child abuse and neglect investigations are related to substance abuse issues and 70 percent of child fatalities are related to substance abuse issues.
The Kentucky Youth Development Coordinating Council, established by Senate Bill 184 from the 2006 General Assembly, is charged with enhancing the collaboration of existing youth services to increase the quality, efficiency, and effectiveness of services, opportunities, and supports for young people. The council had its first meeting on August 10, 2006. The council will be conducting a statewide assessment of all youth collaborative activities, establishing subcommittees to take on specific tasks, and developing a three-year strategic plan.
Commissioner Emberton indicated that Kentucky receives approximately $181 million in federal TANF dollars and $71 million in state dollars. Approximately $22 million was transferred to the Protection and Permanency Division in 2005. The cabinet is working to meet the new federal work requirements of 50 percent of the state caseload for work activity participation. He indicated that the cabinet is working one-on-one with individuals involved in educational activities because higher education will no longer count as a work activity.
Dr. Eugene Foster, Undersecretary for Children and Family Services, presented information on adoptions and race in Kentucky. He indicated that data show that African American children in Kentucky are disproportionately represented in the child welfare system compared to white children by a factor of 2.5. This is a national problem and Kentucky is among the states with high, but not extreme, disproportion. He stated that the cabinet is taking positive steps to address this problem, including increasing cultural diversity training for social service workers, increasing community dialogue, and engaging parent advocates to help African American parents navigate the child welfare system. He emphasized that this is not just a child welfare issue, and the cabinet is dedicated to making necessary institutional improvements to address racial disparity in child welfare.
Dr. Jeff Jones, Assistant Professor, University of College of Public Health, presented highlights from the Kentucky Youth Risk Behavior Report. His presentation focused on obesity and drugs. He indicated while there are still areas of concern, health indicators for Kentucky's youth are improving, particularly in tobacco use, although Kentucky is fourth in the nation for high school smoking. Kentucky has the highest percentage of obese high school students. Overall, 16 percent of Kentucky high school students and 17 percent of middle school students have body mass indexes at the 95th percentile or higher. The data indicate that more children in Kentucky are becoming obese at increasingly younger ages. He also reported that 25 percent of high school students in Kentucky get 60 minutes or more of physical education, compared to 54 percent nationwide. A motion to adopt the report was made by Senator Clark, seconded by Senator Stine, and adopted by voice vote.
The Aging, Disabilities, Independent Living, and Long-Term Care Subcommittee report was given by Senator Roeding. He reported that this was the first meeting of the subcommittee. Mark D. Birdwhistell, Secretary of the Cabinet for Health and Family Services, stated the subcommittee was needed and is consistent with the cabinet's initiatives and trends in Medicaid reform and flexibility. The "Long Term Living Initiative" is an effort to coordinate information and services among the Division of Aging, the Department for Mental Health and Mental Retardation Services, and the Department for Medicaid Services for people who may need long-term care in a variety of settings. Secretary Birdwhistell informed the subcommittee that Kentucky is 27th in the nation in the number of people age 65 and older, and that by 2025, it is estimated that Kentucky will rank 14th highest in the nation in the number of aged persons. The secretary also noted that Kentucky is ranked first in the nation for the number of people over age 65 with mental disorders.
Two-thirds of the aging population is obese, and Kentucky ranks first or second for the number of aged with asthma, diabetes, cancer, cardiac problems, poor oral health, percent of the population that is disabled, and smoking rates. There are approximately 10,500 individuals with mental retardation or developmental disabilities that currently live with caregivers who are over age 65. All these factors have a great impact on planning for Kentucky's future. Dr. Graham Rowles added that there are approximately 1.2 million "Baby Boomers" in Kentucky representing 30 percent of the population.
The secretary thanked the legislature for increased funding in the last budget for personal care assistants, adult day care services, the new grandparent assistant program, and dementia training for long-term care facilities. Recent changes to the state health plan and the certificate of need should make new health care services available to people closer to their homes. He reported that the cabinet's Elder Readiness Initiative involves public forums across the state to learn what local communities are doing to prepare for the new aging population. Major issues identified were transportation needs, affordable housing, and health care. Regional plans will be developed to address the current availability and future needs in the areas of health and safety, quality of life, community involvement, and local planning. The cabinet is working with the Northern Kentucky Area Development District on a pilot program to have a single point of entry for all persons who have questions or needs about long-term care or other services and assistance. The model will be operational by September 25, 2006, and will eventually be rolled out statewide. Evaluation of the pilot will be conducted by the Interdisciplinary Institute of Human Development at the University of Kentucky. Specific information and assistance to aging caregivers of persons with mental retardation will be included by the end of the year.
Glenn Jennings, Commissioner for the Department for Medicaid Services, Cabinet for Health and Family Services, provided an update on the consumer directed option (CDO) for persons in the Medicaid home and community based waiver program. The program will begin on September 29, 2006 and will allow individuals to choose to have an individual budget and hire or fire their service providers for non-medical services, instead of the state making payments to providers. The area development districts across the state will serve as the fiscal intermediary for CDO and the area agencies on aging will serve as support brokers to help the person develop their budget and arrange their services. People may hire family members, excluding spouses. The cabinet plans to pilot this program with a few persons with mental retardation and acquired brain injuries. As requested by Representative Nunn, the cabinet agreed to provide monthly information on the number of individuals enrolled in the CDO, the number rejected for the program, and the type and number of services involved per different populations. The cabinet acknowledged that adjustments may be needed as the program gets underway. A motion to adopt the report was made by Senator Stine, seconded by Senator Scorsone, and adopted by voice vote.
The Women's Health Subcommittee reported was given by Senator Denton. She reported that the subcommittee heard testimony from Dr. Liana Clark, a specialist in adolescent medicine, and the Regional Medical Director for Merck & Co., Inc. Dr. Clark provided a presentation on the relationship between human papillomavirus (HPV) and cancer. Over 10,000 cases of cervical cancer are diagnosed every year in the United States. All cervical cancers are caused by HPV and four (types 6, 11, 16, and 18) are responsible for 70 percent of all cervical cancers.
Dr. Clark stated that clinical trials have concluded that a new vaccine, Gardasil, is highly effective in preventing cervical cancer caused by HPV types 6, 11, 16, and 18 in 16 to 26 year old females. Also, females ages 10 to 15 had a successful immune response to the vaccine. This vaccine could prevent approximately 70 percent of cervical cancers. She stated that the vaccine includes a series of three injections, and that insurance companies have indicated an interest in covering the vaccine. Dr. Steve Davis, Deputy Commissioner of the Department for Public Health, Cabinet for Health and Family Services, stated that the department is working on a business plan for coverage of uninsured and Medicaid recipients who are not covered under the Vaccine for Children's Program with a projected cost of up to $3 million. However, the cost to treat cervical cancer in Kentucky exceeds $25 million per year. A motion to adopt the report was made by Senator Roeding, seconded by Representative Palumbo and adopted by voice vote.
Next was an update on Oakwood by Mark D. Birdwhistell, Secretary, Cabinet for Health and Family Services, and Joseph Toy, President and CEO, Bluegrass Regional Mental Health and Mental Retardation Board. Secretary Birdwhistell stated that the contract with Liberty Healthcare will end October 31, 2006, and the contract with Bluegrass Regional Mental Health and Mental Retardation Board will start on November 1, 2006. He said that approximately 640 employees will be transitioned to Bluegrass and can stay in the retirement system. The cabinet had extensive discussions with family members and have updated the Oakwood Task Force, and the Kentucky Commission on Mental Retardation and Other Developmental Disorders. Secretary Birdwhistell said that he went to Washington to talk with officials from the Centers for Medicare and Medicaid Services and the Department of Justice, and the cabinet will submit a strategic action plan to the federal government on September 22, 2006. He said that Bluegrass has the best clinical expertise and is the right for one for the job.
Mr. Toy stated that everyone at Bluegrass cares deeply about the residents and wants to make Oakwood a place to be proud of and a place where residents can live a good quality of life with good quality staff. Another goal is to pay attention to the needs of family members and staff. It is important for family members to be involved in decisions that will affect their loved ones, and a happy workforce does a better job. He stated that every employee that works at Oakwood would have to work for Bluegrass. Bluegrass is also reviewing the settlement agreement between the cabinet and the United States Department of Justice (DOJ). The settlement agreement gives the United States District Court jurisdiction over Oakwood improvement plans.
Representative Nunn stated that his father's administration, former Governor Louie B. Nunn, was responsible for opening Oakwood 38 years ago and hopes it can be turned around. He was frustrated working with Liberty and not being able to get anything accomplished, and he looks forward to working with Bluegrass.
Senator Scorsone asked if the cabinet had any long-term plans to dismantle Oakwood. Secretary Birdwhistell stated that the first order of business is to stabilize conditions for the 250 residents remaining at Oakwood. In the future, if there are community placements, the residents and parents will have the choice to leave or stay. Mr. Toy stated that the General Assembly was better equipped to answer that question. Senator Scorsone asked if the cabinet would come to the General Assembly before closing Oakwood, and Secretary Birdwhistell said yes.
Representative Burch asked if Bluegrass would become a party to the U.S. Department of Justice settlement agreement, and Secretary Birdwhistell said no. Representative Burch asked what the expectations were for the other contracted employees at Oakwood. Mr. Toy stated that all employees need to work for one employer and he insists that all employees work for Bluegrass. Representative Burch asked about the approval and timeline of the new Supports for Community Living slots. Secretary Birdwhistell stated that the federal government has approved all of the slots and funds have been appropriated in the state budget. Representative Burch asked about the cabinet's responsibilities for monitoring the community placement of Oakwood residents. Secretary Birdwhistell stated the Office of the Inspector General is responsible for individuals when they are in state-owned facilities and the Department for Mental Health and Mental Retardation are responsible for individuals in community placements.
Senator Denton asked how many individuals at Oakwood are waiting to move elsewhere. Secretary Birdwhistell said 80. She asked about the average time it takes for some to transition to another placement. Secretary Birdwhistell stated that because transitioning someone can be a traumatic experience, it could take up to six months, which is the standard amount of time. She asked if the General Assembly had provided adequate funding for all of the slots, and he said yes.
Representative Brinkman asked about the strategies to get trained staff in place quickly. Mr. Toy stated he planned to recruit individuals at community job fairs, to utilize staff from Bluegrass on a short-term basis, and Adanta Regional Mental Health and mental Retardation Board to get help from the community colleges.
Representative Nunn stated that Governor Fletcher should visit Oakwood and give his support on a regular basis to raise morale for workers.
Next was a discussion on cervical cancer given by Liana Clark, M.D., Specialist in Adolescent Medicine, and Regional Medical Director of Merck & Co., Inc. Dr. Clark stated that 15 to 20 types of human papillomavirus (HPV) have been identified as cancer-inducing viruses with four types accounting for 70 percent of all cervical cancers. She stated that you have to have HPV to have cervical cancer and Gardasil is the only cervical cancer vaccine. Statistics have shown that by age 50, 80 percent of women have been infected with HPV. There are approximately one million new cases of genital warts per year, approximately 1.4 million cases of low grade abnormalities, and approximately 3,700 deaths per year due to cervical cancer. Young people are very vulnerable to HPV, and 9 to 26 year olds need to be vaccinated with a three-dose regimen of Gardasil. She stated that the best time to be vaccinated is prior to a person's sexual debut, and Gardasil works well for five years and then the immune memory in the body keeps the vaccination effective.
Representative Burch stated that mass production of Gardasil should make it cheaper. Dr. Clark stated the vaccine is a cost-saving measure because there are not as many abnormalities in pap tests.
Representative Stein asked if there had been a parallel study done with males, and Dr. Clark stated yes, but the Food and Drug Administration wanted more outcomes reported. She said it is more difficult to collect samples from males to get a detailed analysis.
Representative Wuchner stated that abstinence and the vaccine both should be used together. While someone might abstain from sex before marriage, a partner may not. Dr. Clark stated that you can get HPV by close skin contact not just sexual intercourse.
Senator Denton stated that Gardasil had been researched in Kentucky.
Gayle H. Rees, President, Parents-Relatives of Oakwood Facility (P.R.O.O.F.), stated that P.R.O.O.F. supports the identification and discipline of any and all direct care staff members who are involved in abuse and neglect of mentally retarded and medically fragile citizens. He stated that during the past three years, the operation of Oakwood has experienced continuing changes in management and daily operations that have strained the quality and continuity of services. The current state merit system has precluded positive and firm action when a resident has not been properly cared for. He stated that the current merit system should be revised to correct the deficiencies that precludes immediate disciplinary action when providing care for the mentally ill or the mentally challenged. He suggested that revised conduct requirements for merit employees could provide management with the ability to immediately act on any improper conduct.
Mr. Rees stated that of the a significant number of the 22 citations issued to Oakwood involve residents who have been placed there by court order in the past two years. He stated that there is very little information published on the failure of efforts to transition from a facility to a community setting. The infrastructure at Oakwood needs to be preserved and the services must not be reduced or destroyed. He recommended that House Bill 449, concerning downsizing or closure of facilities, remain intact. The action that would be most beneficial to the citizens of the Commonwealth, would be to ensure in the future that facilities are managed and staffed by state-recruited directors and staff.
Don Putnam, President Elect, Parents-Relatives of Oakwood Facility (P.R.O.O.F.), stated that the group's policy priorities for the coming year include: 1) providing management stability and positive leadership; 2) preserving infrastructure; 3) protecting health, safety, and welfare of the residents of Oakwood; and 4) providing and defending true choice, including providing a full range of supports and services based on the needs of the individual served. He asked the General Assembly consider PROOF's policy priorities in the next legislative session. He also asked that the General Assembly review the recent actions by the cabinet that may violate the intent of House Bill 449 that could result in the downsizing of Kentucky's ICF/MR programs without appropriate public review and legislative action. Both the increased funding incentives offered to community providers willing to accept current Oakwood residents into the Supports for Community Living waiver program, and the recent federal settlement that prohibits backfilling vacant ICF/MR slots at Oakwood may be in conflict with existing law. He suggested that the committee evaluate the establishment of an independent Quality Review Commission to provide leadership and oversight to ensure that the current management change undertaken by the cabinet and Bluegrass Mental Health and Mental Retardation Board achieves success.
Mrs. Charlotte Rees stated that 42 years ago she and her husband fought to keep their daughter in the community. In 1974, they won a lawsuit that allowed their daughter to attend Bluegrass School because they wanted her to be able to reach her full potential. Their daughter was 22 years old before she started living at Oakwood. Mrs. Rees said that she believed in quality and choice.
Becky Lainhart and her brother, David Wallace, stated that their 47-year old brother had been at Oakwood since July 9, 1980. Ms. Lainhart stated that not all residents are abused, but she did want the abuse of any resident stopped. Mr. Wallace thanked everyone for the support given to Oakwood.
Next a presentation on problem gambling and responsible gaming was given by Herbert E. Newman, Psy.D., President, Kentucky Council on Problem Gambling, Caleb E. Cooley, Treasurer, National Council on Problem Gambling, and Michael R. Stone, Executive Director, Kentucky Council on Problem Gambling. Mr. Cooley stated that more money needs to be put into the awareness, education, and treatment of problem gambling. Dr. Newman stated that the 2003 Legislative Research Commission Report #316, Compulsive Gambling in Kentucky, identified there were approximately 15,000 compulsive gamblers and approximately 20,000 problem gamblers. The report noted an absence of clinicians trained to treat compulsive gamblers in most of the state. The University of Illinois professor Earl L. Grisnols and others estimate the annual social cost of each compulsive gambler at $13,585, from crime and criminal justice activity, lost business productivity, unemployment, unemployment insurance, bankruptcy, illness, social services including counseling and treatment, and family costs from divorce and separation. Based on the LRC estimate of compulsive gamblers in Kentucky, the social cost of compulsive gambling in Kentucky is $195 million per year.
Dr. Newman reported that the 1995 Harvard University Medical School, Division on Addictions metastudy estimated approximately one percent of the population gambles compulsively, and approximately three percent of the population has a gambling problem. Kentucky's four million population equates to 40,000 compulsive gamblers and 120,000 problem gamblers with an annual social cost of $540 million. Gaming industry market surveys indicate more than three-fourths of adult Kentuckians gamble in any given year. Using the Harvard estimates, which were substantiated by the National Opinion Research Center for the 1999 National Gambling Impact Study Commission, the Kentucky Council on Problem Gambling believes there are at least 25,000 compulsive gamblers in the state with an annual social cost of $325 million. He stated that spending at Kentucky's three legal gaming activities, lottery, pari-mutuel horse racing, and charitable gaming, amounts to approximately $2 billion annually. Kentucky residents spend approximately $500 million annually at out-of-state casinos. Dr. Newman stated that Kentucky receives approximately $200 million annually in revenue from legal gambling activities, yet dedicates no funding for compulsive gambling education, awareness, prevention, identification, treatment, or research.
Representative Comer asked how much funds should be appropriated for a gambling awareness program and what would it be used for, and Dr. Newman stated approximately $1 million is needed for prevention programs, awareness, training people to treat others, and a treatment fund.
Representative Burch said that compulsive gambling is an addiction and Kentucky needs to treat its citizens for this addiction.
Mr. Stone stated that funds from unclaimed prize money from lotteries could be used for gambling programs, but Representative Burch stated these funds are in a reserve fund for education and other programs.
Representative Owens asked if other states have other mechanisms other than the lotteries and the race tracks that fund gambling awareness programs. Dr. Newman stated that most funds come from the gambling entities and one or two percent of the handle goes toward treatment, education, prevention.
Representative Burch asked about the number of professionals currently certified for problem gambling in Kentucky. Dr. Newman stated there were 12. Representative Burch asked how other states pay for treatment. Dr. Newman stated from a gambling fund.
Representative Damron asking if the Kentucky Council on Problem Gambling was taking a position on expanded gambling. Dr. Newman said no, but if legislation is enacted to expand gambling, the council would want funds for awareness, treatment, prevention, and research. Representative Damron asked if there was concern that expanded gambling would increase the number of people needing treatment services. Dr. Newman stated yes, but that does not mean there is a causal relationship, but the availability of more gambling venues would bring pathological gamblers to the surface.
Next was a discussion on consumer access to health data by Chris Corbin, Executive Director, Office of Health Policy, Cabinet for Health and Family Services. Mr. Corbin stated that health care continues to take a large percentage of an individual's income, as well as an increasing percentage of the expenditures of local state and federal governments. Consumers, researchers, and others have little or no access to information on cost, quality, and outcomes and this is due in small part to its subjective nature. He stated that it is unfair to compare a health care service to another commodities or goods.
Mr. Corbin stated that the cabinet collects de-identified inpatient facility records quarterly from facilities statewide. Beginning November 2006, the cabinet will make the following information available, primarily through a web site but also a paper-based access product: 1) billed/charged data - cost, volume, and average length of stay for the top 25 elective procedures by facility, comparable by facility and by state median and average; and 2) quality of health care services - data filtered by the Agency for Healthcare Research and Quality (AHRQ) that allows comparable information based on inpatient quality, prevention quality, and patient indicators.
Next was a legislative review of the FFY 2007 Substance Abuse Prevention and Treatment (SAPT) Block Grant by Donna Hillman, Division Director, Mental Health and Substance Abuse, Department for Mental Health and Mental Retardation Services, Cabinet for Health and Family Services. Ms. Hillman stated that the state has been receiving the SAPT block grant since the early 1980's. An application has to be completed and submitted each year, but because the instruction did not arrive until May, the application is not complete. The anticipated amount for FFY 2007 is approximately $20,602. In September 2005, the Office of Drug Control Policy was established by Executive Order. The office is responsible for reviewing, approving, and coordinating all matters related to drug usage, abuse prevention, treatment, and enforcement conducted by and funded through agencies of the executive branch. The Kentucky Agency for Substance Abuse Policy (KY-ASAP) now resides in the Office of Drug Control Policy. The SAPT Block Grant supports local efforts through the involvement of regional prevention centers and other staff of the community mental health centers.
Kentucky will continue to provide treatment services that will include primary prevention, adult residential, outpatient, intensive outpatient, non-hospital detoxification, transitional living, adolescent residential, outpatient, intensive outpatient, transitional living, methadone maintenance, and any others to meet the needs of the affected population. The Division of Mental Health and Mental Substance Abuse will work in collaboration with the Department for Public Health to provide tobacco use prevention initiatives aimed at increasing the health of all Kentuckians. The division will also work with the Administrative Office of the Courts to support Drug Court treatment programs.
Next was a legislative review of the FFY 2007 Title V Maternal and Child Health Block Grant by Dr. Steve Davis, Deputy Commissioner, Department for Public Health, Cabinet for Health and Family Services. Dr. Davis stated that the block grant is federal legislation dedicated to providing and improving the health of our nation's mothers and children. It is a federal and state partnership to direct money to identified maternal and child health needs unique to each state. For every $4 received from the federal government, the state must allocate $3 of state and local funds. The block grant budget is $11.5 million with 30 percent used to support services for mothers and children, 30 percent used to provide preventive and primary care services for children, 30 percent used to support services for children with special health care needs, and 10 percent used for administrative costs.
The following administrative regulations were referred to the committee for review: 908 KAR 3:190 & E - establishes the procedures for the drug testing of employees and contractors of state-operated institutions for persons with mental illness or mental retardation; 921 KAR 1:410 - establishes procedures for the collection and enforcement of child support payments; 921 KAR 3:035 - establishes the certification process used by the cabinet in the administration of the Food Stamp Program; and 922 KAR 2:160 - enables the Cabinet for Health and Family Services to qualify for federal funds under the Child Care and Development Fund, and establishes procedures for the implementation of the Child Care Assistance Program to the extent that funding is available.