Interim Joint Committee on Health and Welfare


Minutes of the<MeetNo1> 5th Meeting

of the 2006 Interim


<MeetMDY1> November 15, 2006


The<MeetNo2> 5th meeting of the Interim Joint Committee on Health and Welfare was held on<Day> Wednesday,<MeetMDY2> November 15, 2006, at<MeetTime> 1:00 PM, in<Room> Room 154 of the Capitol Annex. Senator Julie Denton, Co-Chair, called the meeting to order at 1:07 PM, and the secretary called the roll.


Present were:


Members:<Members> Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Charlie Borders, Tom Buford, Perry B. Clark, Denise Harper Angel, Alice Forgy Kerr, Joey Pendleton, Richard "Dick" Roeding, Ernesto Scorsone, Dan Seum, Katie Stine, and Johnny Ray Turner; Representatives Scott W. Brinkman, James R. Comer Jr., Bob M DeWeese, David Floyd, Stephen R. Nunn, Darryl T. Owens, Ruth Ann Palumbo, Jon David Reinhardt, Ancel Smith, Susan Westrom, and Addia Wuchner.


Guest Legislator:  Representative Derrick Graham.


Guests:  Mark D. Birdwhistell, Secretary of the Cabinet for Health and Family Services; Steven H. Woolf, M.D., MPH, Professor, Departments of Family Medicine, Epidemiology and Community Health, Virginia Commonwealth University; Makeda Harris, Policy Analyst, Kentucky Youth Advocates; Pierce Whites, Deputy Attorney General, and Lee Wise, Investigative Agent, Office of the Attorney General; Lloyd Vest, Michael Rodman, and Danny M. Clark, M.D., Kentucky Board of Medical Licensure; John L. Warmack and Bonnie Biemer, Christian Science Committee on Publication; Chris Skidmore, Kentucky Council of Churches; Eric T. Clark, Kentucky Board of Dentistry; Daren Sink and Carolyn Chu, Pfizer; Ellen Kershaw, Alzheimer's Association; Gary Fowler, President, and Amanda Beck, Secretary, Kentucky HIV/AIDS Advocacy Group; Bob Kelley and Jonathan Ijaz, Merck & Co.; Commissioner Tom Emberton, Jr., Deputy Commissioner Mark Cornett, Elizabeth Cawood, Kelly Jackson, and Mark Washington, Department for Community Based Services, Cabinet for Health and Family Services; Rich Seckel, Office of Kentucky Legal Services Programs; Amy Berkley, TFK; Anne Joseph, Kentucky Task Force on Hunger; and Sherrall Cunningham, Mental Health Association of Kentucky.


LRC Staff:  Murray Wood, CSA; Barbara Baker, Miriam Fordham, DeeAnn Mansfield, Ben Payne, Gina Rigsby, and Michelle Woods.


The following administrative regulations were referred to the committee for review: 201 KAR 8:150 - establishes the guidelines for filing the application form for licensure with the Board of Dentistry and establishes the guidelines for the examination for licensure, 201 KAR 8:260 - establishes the guidelines for filing the application form for licensure in dental hygiene and establishes the guidelines for the examination for licensure, 201 KAR 9:041 - establishes a schedule of fees for services rendered by the Kentucky Board of Medical Licensure, 201 KAR 20:070 - establishes the requirements for the licensure of nurses by examination, 201 KAR 20:110 - establishes the requirements for licensure by endorsement and establishes the requirements for a temporary work permit for an applicant to practice nursing while the application for a license is being processed, 201 KAR 20:161 - establishes the procedures for the investigation and disposition of complaints received by the Board of Nursing, 201 KAR 20:310 establishes standards for faculty of programs of nursing which prepare graduates for licensure as registered nurses or practical nurses, 201 KAR 20:411 - establishes the requirements relating to a sexual assault nurse examiner course and the credentials of a sexual assault nurse examiner, 201 KAR 20:450 - provides procedures for the implementation of the Kentucky Alternate Recovery Effort for Nurses alternative program operated by the Board of Nursing for nurses or applicants for a credential issued by the board, 201 KAR 20:470 - establishes the requirements for dialysis technical training programs and for credentialing dialysis technicians by the Board of Nursing, 201 KAR 20:500 - requires the adoption of the administrative regulation because of the Nurse Licensure Compact, 201 KAR 22:040 - establishes the requirements and procedures for the renewal and reinstatement of credentials for a physical therapist or a physical therapist assistant, 201 KAR 22:140 - establishes the assessment fee collected by the Board of Physical Therapy as part of the licensure and certification renewal application fee, 201 KAR 33:030 - establishes continuing education requirements for dietitians and nutritionists, and 921 KAR 3:042 - establishes technical eligibility requirements used by the Cabinet for Health and Family Services in the administration of the Food Stamp Employment and Training Program. A motion to accept the administrative regulations was made by Senator Buford, seconded by Senator Roeding, and accepted by voice vote.


Senator Stine, Co-Chair, Families and Children Subcommittee, reported that the subcommittee met that morning and heard a presentation by Eric Friedlander, Executive Director of the Commission for Children with Special Health Care Needs. The commission serves approximately 8,000 to 10,000 children per year. An excellent film was shown depicting the commission's services that are provided to children up to age 21 who have a variety of special health care needs. They have served children from across the state since 1924. Mr. Friendlander discussed the medically fragile foster care initiative, a joint venture with the Department for Community Based Services (DCBS), that began as a pilot project in Owensboro and has just expanded to statewide coverge. The initiative pairs social workers with nurses on monthly visits to medically fragile foster care children. Another pilot program in Prestonsburg, Northern Kentucky, and Paducah pairs nurses with social workers to better serve the health care needs of all foster children. Mr. Friedlander indicated that the recent merger of the Cabinet for Health and Family Services has been beneficial to improving the commission's ability to meet the diverse needs of the children it serves.


The, Marvin Miller, Assistant Director, Division of Adult and Child Health Improvement, and Wendy Carlin, Program Coordinator of the Obesity Prevention Program, presented an overview of the Cabinet for Health and Family Services' wellness and physical activity initiatives. They discussed the Centers for Disease and Prevention (CDC) Obesity Prevention Grant which provided the ground work for five areas of action: schools, worksites, healthcare, built environment, and families and communities. The current CDC grant is $420,000, but this is less than previous grants because of reduced federal funding to the CDC.


Several activities related to schools were discussed including school wellness policy training, nutrition training, and the Youth Risk Behavior Survey. One program noted was the "Take 10! Program" that focuses on integrating physical activity in the classroom setting. Also, pilot programs across the state offer after-school structured physical activity programs to engage children in more activity rather than just physical education. These pilots are funded with grants. Save the Children has similar programs in 33 schools in the south eastern part of the state that offer after-school activities four days per week; however, seven of the schools there have moderate to vigorous activity in structured recess five days a week. Some research has shown that physical activity increases academic performance and research at the University of Kentucky has shown there are no negative effects on school test scores.


Also gaining popularity are farm-to-school programs that encourage learning by studying where food comes from and from students growing fruits and vegetables. Worksite wellness programs include building regional coalitions with local chambers of commerce and business liaisons for worksites. One focus of worksite wellness is increasing health nutrition choices in the workplace. Health care initiatives involve the Kentucky Medical Association, the Women, Infants, and Children (WIC) program, and promoting breatfeeding to help address obesity.


The built environment initiatives include the creation of safe walking routes to school, a walkability conference, and a study on the economic and health impacts of bicycle and pedestrian activity programs, as required by 2006 Senate Concurrent Resolution 98. One study showed that the risk of obesity declines by 30 percent when people live in a neighborhood where they can walk or bike. The Transportation Cabinet can be encouraged to make more connections between parks, schools, and homes, and take more initiative in creating bike and walking paths where feasible and cost effective.


The families and communities initiatives include the VERB Scorecard, getting children physically active, eating five fruits and vegetables a day, choosing one percent milk or less, and improving nutrition in the WIC program as well as several initiatives through the local health departments. One initiative, "We Can", focuses on encouraging family and nutrition activities. A parent guide suggests ways for parents to cook, eat, and exercise with their children.


Tobacco prevention and cessation initiatives were also discussed.  Creating smoke-free environments, including smoke-free school campuses, is becoming more popular. The presenters emphasized that tobacco pricing is an important deterrent to tobacco use.


The Governor's initiatives, Get Healthy Kentucky Board and the Council on Wellness and Physical Activity were discussed. The presenters indicated the hope is that the Governor's Council on Wellness and Physical Activity, formed by 2006 House Bill 646, will establish and support a centralized location for information on programs and program outcomes. A follow-up of the Get Healthy Kentucky forums shows that communities across the state have prioritized improving nutrition, increasing physical activity in schools, and increasing worksite physical activity for wellness initiatives. The presenters suggested that rather than talking about the obesity epidemic, the focus should shift to physical inactivity and poor nutrition choices.  It should be easy to be healthy. A motion to accept the report was made by Senator Buford, seconded by Senator Roeding, and accepted by voice vote.


Sen. Roeding, Co-Chair, Aging, Disabilities, Independent Living, and Long-Term Care Subcommittee, reported that the subcommittee met that morning and heard recommendations for legislative action from two of the five subcommittees of the Special Advisory Commission of Senior Citizens. The Health and Human Services Subcommittee recommends legislation: (1) to establish a "Golden Alert System", similar to the Amber Alert system, to alert citizens when a mentally, physically, or cognitively impaired adult is reporting missing from his or her home, from a facility, or from the care of another person. It was suggested that the Golden Alert system be coordinated with the existing Amber Alert system to keep costs at a minimum; (2) to mandate 24 hours of required training in geriatrics, including dementia care, for employees of licensed or certified facilities that provides care to seniors; and (3) to prohibit the use of cell phones while operating a motor vehicle, with exceptions for emergency vehicles.


The Taxation Subcommittee recommends legislation to establish an income tax credit for persons who provide in-home care for an elderly person. They suggest a sliding scale for the tax credit based on income.


The subcommittee also heard testimony from professors of the University of Kentucky Graduate School of Social Work about "Project Age", funded by the Hartford Foundation and administered by the New York Academy of Medicine. The University of Kentucky will receive $150,000 for a three-year grant period to provide stipends to students to specialize in geriatrics, and support part-time faculty positions. They hope to recruit 24 students and help build aging coalitions in southeastern Kentucky and the Morehead area. Another objective is to sustain this program and obtain on-going funding for geriatric specialty stipends that would be similar to stipends for master's level students in the child welfare programs. The subcommittee discussed the future needs of elders, recruitment and retention in the field of social work, and inclusion of wellness and health promotion services to seniors. A motion to accept the report was made by Senator Buford, seconded by Senator Harper Angel, and accepted by voice vote.


A motion to adopt the minutes of the October 18, 2006 meeting was made by Senator Buford, seconded by Senator Kerr, and adopted by voice vote.


An update on welfare fraud was given by Secretary Mark D. Birdwhistell and Commissioner Tom Emberton, Jr., Department for Community Based Services, Cabinet for Health and Family Services, and Pierce Whites, Deputy Attorney General, and Lee Wise, Kentucky Bureau of Investigations agent, Office of the Attorney General. Secretary Birdwhistell stated that the biggest challenge that the cabinet faces is upgrading the computer systems that have been in place since 1981. Commissioner Emberton said that the DCBS family support eligibility workers are responsible for administering approximately $4.5 billion in food stamps, Medicaid, and TANF cash benefits annually. In response to the Auditor of Public Account's 2005 Annual Single Statewide Audit of Kentucky and the 2006 follow-up, the cabinet initiated the following control procedures: (1) data match between program benefits and death certificates; (2) incorporated "real time" verification of Social Security numbers into Kentucky Automated Management and Eligibility System (KAMES); (3) system edits to limit expenditures to benefit limitations; (4) monthly review of special circumstance payment listings; (5) strengthened oversight procedures when benefits are mailed to local offices; (6) strengthened policies for payments that require supervisory approval; (7) automated the two-level approval process for the Family Alternative Diversion program; and (8) strengthened security of the automated systems. The Kentucky Access Accuracy and Accountability Project (KAAAP) was created to integrate and update the KAMES and its dependent systems.


Commissioner Emberton stated that the cabinet has responded to the findings of the report of the 2006 Franklin County Special Grand Jury. The average number of cases per worker is now approximately 445, and many do not require monthly contact. Currently, there are approximately 1,430 frontline staff, however, within 60 days there will be approximately 1,500 frontline staff. The cabinet uses a weighted methodology to determine caseloads. Through reorganization efforts, the cabinet continues to reduce caseloads and improve access and accuracy. A case review summary sheet is used to assess claims processing by new workers. Cases are held until a supervisor has reviewed them. All case review summaries are reviewed by supervisors or other senior staff. All new employees are informed of security and confidentiality rules and are required to sign a security agreement. The number of public assistance worker fraud referrals to the Office of the Inspector General has increased. Photo identification is required when applying for benefits, but retailers have the option of requesting photo identification when the benefits are used. A face-to-face interview is required for food stamp applications and recertification, with exceptions as approved by the United States Drug Administration/Food and Nutrition Services. Current procedures for removing food stamp benefits from a client's account are provided by the USDA/Food and Nutrition Services and approved by the Legislative Research Commission.


In 2005, the Office of Inspector General (OIG) implemented the Determining Eligibility Through Extensive Review (DETER) and expanded its staff of two to one investigator in 14 counties. The OIG established a Medicaid Provider Fraud Unit, increased investigative staff from 12 to 38, increased the number of counties where cases have been prosecuted to 58, increased the number of cases submitted for prosecution, and completed or initiated 52 internal audits in less than three years.


Commissioner Emberton stated that the KAAAP was created to integrate and update the KAMES and its dependent systems. The goals of KAAAP include improved and updated accessibility to services, improved data integrity, improved accuracy rates for eligibility, improved processing efficiency, improved human resource utilization, and modernized and integrated systems.


Senator Roeding asked about staff retention and new hires. Commissioner Emberton said the cabinet does lose caseworkers to private entities. Senator Roeding said that higher pay scales are needed in some areas of the state. Commissioner Emberton stated that the turnover rate is higher in urban areas. Senator Roeding asked if there are adequate numbers of supervisors for all the caseworkers. Commissioner Emberton said that the cabinet's goal is to make sure the supervisors are accessible and visible, but some counties, such as Jefferson County, will require additional staff.


Representative Burch asked how often the cabinet's accounts are audited. Commissioner Emberton stated that state and federal agencies provide different types of oversight throughout the year. Representative Burch asked how the cabinet finds fraud in the food stamp program. Commissioner Emberton stated that they look for timeliness of applications and high error rates, and look for potential problems. Secretary Birdwhistell said that the cabinet also has numerous internal audits. Commissioner Emberton said that the cabinet is responsible for administration and eligibility of the food stamp program, but not enforcement. Deputy Commissioner Cornett stated that the amount of food stamps issued to an individual is placed on an EBT or debit card and any eligible member of a household can use the card if they know the pin number. Representative Burch asked how many caseworkers have been charged with food stamp fraud. Mr. Cornett said seven of the ten indicted persons were current or past employees.


Senator Scorsone asked why the cabinet did not ask for additional funds for social workers in the last budget to reduce caseloads. Commissioner Emberton said that the cabinet can reduce the number of caseloads through technology enhancements and realignment. Senator Scorsone asked what the optimum number of cases per worker would be, and Commissioner Emberton said 700 based on case weight. Senator Scorsone asked how many more caseworkers are needed to reach 700 cases per worker, and Deputy Commissioner Cornett said 1,500 additional staff. Secretary Birdwhistell said that with current resources, the cabinet has been able to reduce the number of regions, cut out some middle management, and deploy more caseworkers to the frontline. With the recent death of a caseworker, worker safety has been pushed to the forefront, and the cabinet has to reassess modernization initiatives to see what did or did not work. Senator Scorsone said that caseloads and safety issues should be viewed at as the same issue.


Senator Stine asked if the cabinet would be permitted under the federal guidelines to require photo identification and limit the access to the EBT card to the person identified. Commissioner Emberton said that a photo identification is one of the requirements for eligibility, but its use is an option of the retail merchant.


Senator Buford stated that unless the General Assembly makes changes to the retirement eligibility in 2007, a large number of employees would be retiring in 2008. He asked if there is enough money in the budget to hire social workers in anticipation of the large number who could retire. Secretary Birdwhistell stated that the cabinet has computer printouts for people who could potentially retire, and those have been incorporated into the staffing plan for offices along with the safety issues. Senator Buford stated that while safety is an important concern, the issue is to have enough workers to take care of all the individuals who need help.


Senator Denton asked if the cabinet had to follow the USDA/Food and Nutrition Services guidelines to freeze a food stamp account after someone's death, and Commissioner Emberton said yes, because the food stamp program is 100 percent funded by federal allocations. Deputy Commissioner Cornett said that DCBS works with the Department for Vital Statistics to verify a death. Names of the deceased are sent to J.P. Morgan, the vendor who authorizes the EBT card. She asked that if the cabinet only administers the food stamp program, who enforces the program, and he said the USDA/Food and Nutrition Services office targets retailer fraud cases. Deputy Commissioner Cornett stated that the OIG and the OAG can prosecute fraud cases. Deputy Commissioner Cornett stated that the cabinet will pursue tips received from the OIG hotline and caseworkers.


Senator Kerr stated that due to the closing of the Lexington USDA/Food and Nutrition Services office, Kentuckians will have to contact one of nine other states in the region for services. She asked if the cabinet had a plan to stop the Lexington USDA/Food and Nutrition Services office from being closed. Secretary Birdwhistell said that the cabinet could not prohibit the closure, but a letter conveying concerns is being drafted by the cabinet and the Lexington USDA/FNS office and will be sent seeking reconsideration of the decision to close the office.


Mr. Whites stated that the OAG and the Office of the Auditor of Public Accounts (APA) partnered together to look at records from an expanded audit of the Annual Single Statewide Audit of Kentucky conducted by the APA on CHFS. Mr. Whites said that the 2006 Franklin County Grand Jury Investigative Report on Welfare Fraud  revealed  KTAP and food stamp payments were being made to dead individuals, payments were mailed to addresses of cabinet employees, and some were even mailed outside of Kentucky. As of November 9, 2006, six of the ten individuals indicted on 136 felony counts  have plead guilty. The other four cases will be tried in the Franklin County circuit court. He said that the data is troubling on many accounts, particularly because there is nothing more important than for families in need to receive benefits. During fiscal year 2004-2005, $2.2 million was adjudicated, and for 2005-2006 the amount was $791,000. Mr. Whites stated that the discrepancies in the amounts reported by the OAG and the OIG are due to the fact that most of the cases referred from the OIG have not been through the court system and adjudicated like the cases handled by the OAG's office. It is very difficult for any bureau to effectively police itself. There needs to be a professional, external law enforcement agency to serve as a check upon the system. While the cabinet may have new policies, the goal is to make sure they are enforced.


Representative Floyd asked if the OAG thought the cabinet was trying to gain something by being a larger cabinet. Mr. Whites said that there is always an inherent institutional bias or tendency to down play the number of problems within any bureaucracy.


Representative Owens asked how much of the $2.2 million judgments have been collected. Mr. Whites stated that once a case of fraud has been handled by the court system, all money recovered goes directly to the cabinet. The OAG does not receive any further information about the case. Representative Owens asked if only welfare fraud cases were investigated, and Mr. Whites said the OAG's office only had a contract with the cabinet to investigate welfare fraud, but there are many other kinds of fraud. While the OAG can still investigate welfare fraud cases that are reported to them, it is difficult because investigator positions were lost when the $1.4 million contract with the cabinet was not renewed. Representative Owens asked what the OIG has done about the suspicious fraud cases. Secretary Birdwhistell said that they have increased the number of investigators and have one in 14 counties, and increased the counties where cases can be prosecuted. The cabinet also has a contract with the Kentucky State Police to help investigate cases.


Senator Denton asked why the OAG has not followed up legally on suspicious fraud cases found from the APA's audit and the grand jury report. Mr. Whites said that the data collected shows suspicious activities. A thorough investigation would have to be conducted on each case to conclude if fraud has been committed. She asked if the cabinet has to report to the OAG if they did any follow-up on suspected fraud cases. Mr. Whites said that there is no statutory duty to report back to OAG.


Representative Brinkman asked if the OAG had requested more funds for investigators, and Mr. Whites said that the OAG requested, but did not receive, a budget increase. The budget increase request was not just for investigators. Representative Brinkman asked if the OAG has the authority to empanel a grand jury if allegations of fraud by workers and/or recipients are reported and investigated, and Mr. Whites said yes.


Senator Roeding said that the OIG and the OAG should work together. Mr. Whites said that the OAG employs experienced Kentucky Bureau of Investigations agents, and his office wants to work with everyone who wants to stop welfare fraud.


Representative DeWeese asked of the approximate 7,400 payments made to dead individuals, how many people were involved. Mr. Wise said approximately 1,000 to 2,000 cases. Representative DeWeese asked how the cases were chosen, and Mr. Wise said randomly. Mr. Whites stated that it is a massive task, but the OAG cannot devote enough investigators to welfare fraud cases only.


Representative Owens asked what the OIG has done about the suspicious cases reported by the APA and grand jury. Secretary Birdwhistell said that the cabinet wants to work collaboratively on fraud and abuse, and want to report to the committee all fraud and abuse activities identified. He said that they welcome close scrutiny by everybody. The cabinet has a contract with the Kentucky State Police and have hired additional OIG investigators. Representative Owens asked about cost avoidance. Secretary Birdwhistell agreed this is an opportunity to save money rather than to spend money on fraud investigations.


A presentation on social worker safety as given by Secretary Mark Birdwhistell, and Commissioner Tom Emberton, Jr., Department for Community Based Services, Cabinet for Health and Family Services. Commissioner Emberton stated that four priority issues had been identified for the department: worker safety, substance abuse prevention, leadership, and supervisory training. A position paper on creating a culture of safety was developed and has served as the foundation for the cabinet's workgroup activities. In October social service consultants met and began outlining how the cabinet can best respond to the immediate needs of staff and develop short- and long-term plans to improve policy and procedures. Department staff were notified that an on-line system has been established to provide staff with the opportunity to submit recommendations to the workgroup to improve policies and procedures related to employee safety. The workgroup has started on the development of a strategic plan to comprehensively address employee safety.


Some concerns identified by staff were: the office environment, employing safety officers for regional and central offices, establishing visitation centers, developing an on-going advisory group, implementing first alert technology, having on-line instant access to criminal records, maintaining an incident tracking database, coordinating safety training for workers, establishing judicial branch liaison and judicial training, and decreasing caseloads for workers. The department will be implementing an automated incident reporting system, appointing department safety officers and regional safety officers, assessing high-risk offices, having DCBS field staff prioritize safety issues identified by the workgroup, and will be continuing workgroup activities.  Commissioner Emberton stated that the department would work with members of the General Assembly in the 2007 Regular Session to enact the "Boni Bill" - legislation to improve worker safety.


Representative Graham stated he hoped it would be an on-going process, even after this administration, to address staff concerns, and to keep staff involved. Secretary Birdwhistell stated that an advisory group is being formed, and hopefully, it will continue long after this administration.


Representative Westrom asked if hazardous duty pay had been discussed and if  it would be requested, and if there is any compensation to families after the death of a frontline caseworker. Commissioner Emberton said that there have been discussions on hazardous duty retirement, and the cabinet wants to know what the greatest impact would be for workers. There is a statute that provides death benefits if state employees lose their life while carrying out their job duties. The cabinet will be considering this and other options.


A presentation on Medicaid coverage for smoking cessation was given by Steven H. Woolf, M.D., MPH, Professor, Departments of Family Medicine, Epidemiology and Community Health, Virginia Commonwealth University, Makeda Harris, Policy Analyst, Kentucky Youth Advocates, and Chris Skidmore, Kentucky Council of Churches, Kentucky Faith United to Reduce Tobacco Use. Mr. Woolf said that U.S. Public Health Service guidelines developed in 1996 established an expectation that all doctors screen all adult patients for tobacco use and urge them to quit, and provide intensive counseling, medications, and referrals to community programs. A major hindrance to the guidelines for both doctors and patients is lack of reimbursement for these services. He stated that tobacco cessation counseling is the most important health benefit that can save lives and money for Kentucky. National experts say that tobacco use screening and treatment, childhood immunizations, and advising high-risk adults to take aspirin have the greatest health benefit and highest cost savings.  Tobacco use is the leading cause of death in this country. He stated that tobacco counseling saves money because it prevents diseases that account for a large part of the health care budget, including Medicaid. He added that there is no logical reason for Kentucky's Medicaid program to not cover tobacco use screening and treatment. Tobacco use screening and treatment is a benchmark of a quality health system. The National Committee on Quality Assurance tracks the performance of health plans through a measurement set called HEDIS. One of the first measures adopted by HEDIS in 1998 was counseling smokers to quit. In March 2005, the Medicare program issued a rare national coverage decision requiring all Medicare carriers to pay for tobacco use screening and treatment for the aged and disabled beneficiaries. He recommended that Kentucky's coverage should include not only counseling by clinicians, but also the prescription and non-prescription medications that smokers and doctors rely  on to support counseling.


Mr. Skidmore stated that tobacco use is higher among the poorest, most vulnerable people, many who are on Medicaid. He recommended more comprehensive policies that include counseling and treatment to help tobacco users who want to quit. Many  Medicaid recipients do not have phones and cannot call the cabinet's Quitline.


Representative Burch stated that Medicaid and health insurance should cover smoking cessation, just like any other addiction. Hopefully, if children can be educated and encouraged to quit smoking  now, there will not be as many smokers in the future.


Senator Roeding said that the cabinet should utilize all the available medications and not just tobacco replacement therapy. Dr. Woolf stated that smokers need more choices, and products should not be limited to only Quitline users. He said that 38 states have comprehensive smoking cessation Medicaid coverage.


Ms. Harris reported the following statistics: (1) 7,700 tobacco-related deaths are reported annually; (2) 24,100 children try their first cigarette each year; (3) 6,800 additional children become daily smokers every year; (4) 107,000 children alive today will die from tobacco use; (5) 26.2 percent of Kentucky high school students are current smokers;  (6) 28.7 percent of Kentucky adults are current smokers; (7) $1.5 billion in annual health care costs are related to tobacco use; (8) $19.1 million in health care costs are attributable to smoking during pregnancy; (9) $602 per household is paid by Kentucky taxpayers to treat tobacco-related diseases; (10) $487 million in Medicaid costs because of smoking; and (11) Medicaid beneficiaries are disproportionately affected by tobacco-related disease and disability.


Gary Fowler, President, and Amanda Beck, Secretary, Kentucky HIV/AIDS Advocacy Action Group provided an update on their activities. Mr. Fowler stated that he directs the CDC Prevention Grant for HIV/AIDS in Henderson and western Kentucky that focuses on preventing the spread of the HIV virus. The advocacy group consists of care coordinators, social workers, patients, and concerned citizens who want to increase awareness about the plight of HIV/AIDS patients in Kentucky. The goals are to create good public policy and to increase funding for supportive programs. They expressed appreciation for the recent budget increases for the Kentucky Drug Assistance Program (KADP).


Representative Burch asked how many cases of AIDS and HIV are currently reported in Kentucky. Ms. Beck stated that there are no HIV numbers currently available due to the 2004 mandate for confidential name reporting for HIV. Data is being collected and should be available by early 2007. She said that since 1993, there have been 4,321 cases reported, and approximately 2,422 are reported as living. Representative Burch asked about the cost of maintaining an AIDS patient per year. Ms. Beck said that the KADP spends $10,000 per year for prescriptions per HIV individuals. An average life expectancy of someone living with HIV is 24 years, and the average annual cost of care is approximately $25,200 per year. Representative Burch asked if a comparison had been made between the costs of care between the United States and Europe, and Ms. Beck said no. One study reported that the projected lifetime cost to treat someone with HIV, including prescriptions and medical costs, is $618,000.


Ms. Beck stated that, the General Assembly allocated $250,000 for the KADP in the last budget, but the majority of money for the program comes from federal funds. Kentucky is no longer leading the nation for its HIV waiting list mainly because of the new Medicare Part D program and pharmacy rebate programs. Twenty-three clients are added to the KADP waiting list each month. Ms. Beck stated that KADP has served 915 clients this year. The $250,000 covers approximately ten clients. The amount of federal funding is based on the number of AIDS cases, and the amount has decreased from prior years.


There being no further business, a motion to adjourn at 3:55 p.m. was made by Representative DeWeese, seconded by Representative Brinkman, and adopted by voice vote.