The 3rd meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, September 19, 2007, at 1:00 PM, in Louisville at Our Lady of Peace, 2020 Newburg Road. Representative Tom Burch, Co-Chair, called the meeting to order at 1:02 PM, 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, Ernesto Scorsone, Katie Stine, and Johnny Ray Turner; Representatives Scott W. Brinkman, James R. Comer Jr, Robert R. Damron, Bob M. DeWeese, Joni L. Jenkins, Mary Lou Marzian, Reginald Meeks, Darryl T. Owens, Ruth Ann Palumbo, Kathy W. Stein, David Watkins, Susan Westrom, and Addia Wuchner.
Guests: Jan Day, Center for Accessible Living; Eric T. Clark, Executive Director, Kentucky Board of Dentistry; Michele Blevins, Department for Mental Health and Mental Retardation Services, Cabinet for Health and Family Services; Reylene Medina, Pam Helms, M.A., President, and Michael J. Kapfhammer, Board Member, Family Place; Meghan McGee, Kaleidoscope; William J. Wells, Mental Health; Kayla Rose, Area Health Education Center; Glenda Stanley, West Area Health Education Center; Evelyn Tackett, North Central Area Health Education Center; Michael W. Gayheart, Southeast Kentucky Area Health Education Center; Margaret Mahaffey and Jim Ballard, Kentucky Area Health Education Center Program; Loretta Maldaner, Purchase Area Health Education Center; Lucy Juett, South Central Area Health Education Center; Dwain Harris, Southern Area Health Education Center; Patty Dempsey, Doug Riddell, Ann Smits, and Linda Wainscott, The Arc of Kentucky; Beth, Holly, and Pat Evans Kaleidoscope Arc; Sherry and James Sanders, Somerset; Shelley Spratt, Congressman John Yarmuth's Office; Donna Brown; Ruby Jo Labarsky, Kentucky Association of Health Care Facilities; Sean M. Cutter, McBrayer, McGinnis, Leslie, and Kirkland; Sarah S. Nicholson, Kentucky Hospital Association; Karen Lentz, Johnson & Johnson; Marty White, Kentucky Medical Association; Melissa L. Currie, MD, Assistant Professor of Pediatrics and Director, Division of Forensic Medicine, University of Louisville; Brenda Fitzpatrick, North West Area Health Education Center; JoAnne DeLorenzo Maamry, President & CEO, Our Lady of Peace; Bob Shircliff, President & CEO, Jewish Hospital & St. Mary's Healthcare; Donna Litrell, parent; Leslie Lederer, Louisville; and William Hacker, Commissioner, Department for Public Health, Cabinet for Health and Family Services.
LRC Staff: Murray Wood, CSA; Barbara Baker, Miriam Fordham, DeeAnn Mansfield, Ben Payne, Gina Rigsby, and Cindy Smith.
A motion to approve the minutes of the August 15, 2007 meeting was made by Senator Buford, seconded by Representative Stein, and approved by voice vote.
JoAnne DeLorenzo Maamry, President & CEO, Our Lady of Peace; Bob Shircliff, President & CEO, Jewish Hospital & St. Mary's Healthcare gave an overview of services offered to patients and future plans. The array of services provided for children and seniors at Our Lady of Peace include 24-hour access, outpatient counseling, intensive outpatient, partial hospital, inpatient, and specialty programs. Eighty percent of the patient served are children, 95 percent are medically indigent, approximately 50 percent are in state custody, and 90 percent have a history of abuse. She said that challenges are to renovate the Access Center in 2008-2009 at a cost of $6 million and to increase child and adolescent beds. Approximately $1.2 million state funds will be needed for two additional specialty programs in 2008.
Donna Litrell said that her experiences at Our Lady of Peace for her 16-year old autistic sons have been wonderful. Her sons were at the hospital for six weeks and received the highest level of care. She said that everyone at the hospital cares about the people that they serve.
Representative Burch asked who sexually abuses children. Ms. Maamry stated that it is predominately a family member, foster parents, or friends of the family. Representative Burch asked about abuse of children by gay parents. Ms. Maamry said that she did not see any trend that there would be any more abuse in children with gay parents as children in heterosexual families.
Representative Owens that the need for services for adults is increasing, and asked if there were other facilities that serve the senior population. Ms. Maamry stated the units in general hospitals are predominately adult units.
Representative Brinkman asked how Our Lady of Peace had managed when the Medicaid reimbursement has been frozen for seven years. Ms. Maamry stated Jewish Hospital has helped with capital needs and efficiency. She said that even with all the other help, it has not been enough to make up for the Medicaid rate of 70 percent of the cost for the last seven years. She said that the extended care rate has been frozen for eleven years. Mr. Shircliff stated the hospital is in need of restoration and needs the help of the General Assembly. Ms. Maamry said that the hospital cannot continue to take care of Medicaid children if the reimbursement rate is not changed. Representative Brinkman asked about the percentage increase needed, and she stated they need approximately $8 million per year more in reimbursement.
Representative Stein asked about the number of KCHIP children were served, and Ms. Maamry said under five percent. Representative Stein asked if the children that are screened and unable to receive services are referred to another facility, and Ms. Maamry stated yes. Representative Stein asked if the federal legislation on Children's Health Insurance Program would help, and Ms. Maamry stated if Medicaid eligibility tightens up or changes, or families no longer eligible for Medicaid and unable to afford private insurance, it would have a critical impact on the hospital.
Senator Scorsone asked if the facility wanted a grant or loan to help with capital expenditures. She said an appropriation of $7.2 million over the next five years was needed from the General Assembly. He asked if the state would have any ownership in the facility if state funds are allocated, and she said no.
Senator Denton stated that a high percentage of patients served are on Medicaid, and keeping the facility open helps save the state money.
Representative Westrom asked if the $7.2 million would be needed for capital expenditures or to expand programs. Ms. Maamry stated the money would be for two new programs and expansion of the Access Center. Representative Westrom asked if this would be enough funds, and Ms. Maamry stated it would depend on whether the Medicaid reimbursement rates change. Representative Westrom asked how pregnancy issues are handled. Ms. Maamry stated that they work with other agencies to help provide services to the mother and child. Representative Westrom asked what happens when a patient ages out of programs. Ms. Maamry said that the hospital's specialty units serves children through the age of 21 years, and the hope is that someday they would be able to offer a full continuum of care.
Senator Stine, Co-Chair, reported that the Families and Children Subcommittee met that morning and heard an overview of the Mayor's Health Hometown Movement by Dr. Adewale Troutman, Director of the Louisville Metro Department of Public Health and Wellness. Tonya Chang, Advocacy Director, American Heart Association testified on the promotion of physical activity in schools. Tiffani Jackson, Bicycle and Pedestrian Coordinator, Office of Special Programs, Transportation Cabinet discussed programs and initiatives in Kentucky to promote the development of bike and walking paths. A motion to adopt the report was made by Senator Buford, seconded by Senator Stine, and adopted by voice vote.
Representative Stein, Co-Chair, reported that the Aging, Disabilities, Independent Living, and Long-Term Care Subcommittee met that morning and heard testimony from General Maxwell Bailey, Director, Kentucky Division of Emergency Management, on emergency management for vulnerable populations. Dr. William Hacker, Commissioner, Department for Public Health, Cabinet for Health and Family Services, gave a presentation on disaster preparedness for senior citizens. Deborah Anderson, Commissioner, Department for Aging and Independent Living, reported on the Excellence in Nursing Homes Initiative. Marnie Mountjoy, Department for Aging and Independent Living, provided a an update on 2007 Senate Joint Resolution. Dr. Carla Mahan, Department for Aging and Independent Living, reported on the status of the dementia care pilot project. A motion to adopt the report was made by Representative Stein, seconded by Representative Jenkins, and adopted by voice vote.
Representative Marzian, Co-Chair, reported that the Women's Health Subcommittee met that morning and heard testimony from Helen Kinton, Executive Director, Sanctuary Domestic Violence Program on concerns about staff salaries and lack of health insurance benefits. Darlene Thomas, Executive Director of the Bluegrass Domestic Violence Program, discussed concerns affecting battered women and perpetrator accountability. Dr. Leslie Crofford, Director, Center for the Advancement of Women's Health, provided testimony on the Women's Health Registry.
The following administrative regulations were referred to the committee for review: 201 KAR 8:450 - establishes requirements for dental hygienists to provide dental hygiene services when the supervising dentist is not present; 900 KAR 6:050 - establishes the requirements necessary for the orderly administration of the Certificate of Need (CON) Program with amendment (deferred from August meeting); 922 KAR 1:300 - establishes basic standards of care and service for child-caring facilities; and 922 KAR 1:310 - establishes basic standards for child-placing agencies.
Senator Buford asked for an explanation for 900 KAR 6:050. Marie Alagia Cull, attorney and legislative agent, stated that currently nursing facilities can move beds among facilities in counties where their occupancy rate is 95 percent and over from facilities that have an occupancy rate of 95 percent. The amendment would permit nursing facilities to move up to 15 beds instead of 10 beds. She said that it is a mechanism to relocate beds without adding beds to the inventory.
Representative Damron asked why the proposed amendments were not made in the Administrative Regulations Review Subcommittee. Ms. Cull stated that the issue did not arise at that time. He asked about expanding beds, and she stated there is a time limited period of one in May 2008 and one in November 2008, and then the provision would expire. He asked which counties would gain or lose by the changes. Ms. Cull stated that it is equally split, that a facility willing to sells beds would find a facility that can accommodate the beds. He asked if they were Medicaid beds, and she stated that the beds are nursing facility beds and Medicaid certified nursing home beds. He asked if a facility without Medicaid beds would be able to buy Medicaid beds, and she said that they would have to be a licensed nursing facility. He asked if licensed Continuing Care Retirement Community (CCRC) facility could buy Medicaid beds and convert some non-Medicaid beds into Medicaid beds, and she stated the cabinet said that the facility would have the option to buy the beds. He asked if a facility closed, are the beds still being counted in the state. She said that the cabinet stated the facility would not be able to sell any beds at this time. He asked if it was 15 beds per county, and she said it is limited to 15 beds per facility to receive or sell. He asked if there was a requirement in the administrative regulation that would require the beds to be filled, sold, or put back to those who have applied for them within a certain period of time. Rob Edwards, Cabinet for Health and Family Services, stated that the cabinet has not made a ruling one way or other, but if it is done, it would be done in the State Health Plan administrative regulation. Representative Damron asked if there was any opposition to the administrative regulation, and she said no.
Senator Buford asked about the price range for selling a bed, and Ms. Cull said she had no idea. He asked if a facility wants to sell a bed, do they have to establish a period of time the beds have not been used or could they ask someone to vacate the premises so the bed could be sold. She said that would require a notice of transfer discharge, and there is a 30-day timeframe between the time the notice between the time a notice is provided and the time a person is discharged. She stated that it is not an easy process.
Dr. Ruth Ann Shepherd, Department for Public Health, Cabinet for Health and Family Services, gave an overview of the Maternal and Child Health Block Grant. Lisa Walls, Department for Mental Health and Mental Retardation Services, Cabinet for Health and Family Services, gave an overview of the Substance Abuse Prevention and Treatment Block Grant. Michele Blevins, Department for Mental Health and Mental Retardation Services, Cabinet for Health and Family Services, gave an overview of the Community Mental Health Block Grant.
An update on Family Place was given by Pam Helms, MA, President, and Mike Kapfhammer, Board member. Mr. Kapfhammer stated that abuse and violence occur everyday for children. The cost to treat a sexually abused child is $4,000 per year, and the cost to treat an abuser is $18,000 per year. The Visitation Center provides visits for children with their parents in a safe, secure family friendly environment. Referrals are accepted from Jefferson County Family Court from the divorce, domestic violence, paternity and custody dockets and from the Cabinet for Health and Family Services. Visitation services for a family cost $1,200 per year. He stated that the Family Place model can be replicated.
Ms. Helms stated that for child abuse usually starts early in life and that one-third of abused children will grow up to be abusers. One in three girls and one in seven boys will be abused before they are 18 years old. Family Place helps families learn to stop sexual abuse and provides a safe place for visitation. Children are served that have been refused services elsewhere or thrown out of other facilities and Family Place is their last chance. The Family Treatment Program provides long-term, intensive services to families where a child has been sexually abused by an adult family member. The Juvenile Program provides long-term, intensive services to families where a child between the ages of ten and seventeen has sexually abused another child in the context of an existing relationship. She stated that the Children's Program provides specialized early childhood services for children from birth to age five who have been abused or exposed to other forms of family violence. The program is the only nationally accredited and state-licensed program in Kentucky specifically designed for children who have had these experiences. The program holds a four-star rating from KIDS NOW Initiative for Early Childhood Development. She stated that Family Place serves approximately 1,000 children and family members from Jefferson County and Southern Indiana with a budget of $1.4 million.
Representative Palumbo asked about the Family Place's deficit. Ms. Helms stated that the handout showed the most consistent funding sources from year to year. Ms. Helms said that they also raise money through fundraisers and other events. Representative Palumbo asked that Ms. Helms provide the committee with a breakdown of $1.4 million expenditures. Ms. Helms stated that 77 percent of each dollar goes back into programs. Representative Palumbo asked about the number of staff, and Ms. Helms said there are 28 full time and three part time employees.
Representative Burch asked about the types of cases. Ms. Helms said programs are provided for sexually abused children, children who abuse others, early childhood and visitation services. He asked who the children were abused by, and she said 83 percent by family members or someone they know.
Representative Clark asked about the projected deficit, and Ms. Helms said it is only for operating expenses. He asked if about studies on prison and if inmates had been abused. She stated that a large number of inmates had been abused.
Representative Meeks asked about other agencies available to children. She stated that their Children's Program that provides children up to age five who have been abused or exposed to family violence is the only program of its kind in Kentucky.
Testimony on living in the community was given by Leslie Lederer and Sherry Sanders. Ms. Lederer told about experiences she has had with her son, Danny. She said that is scary to know that if anything happens to her and her husband, there is not a support circle in place at this time for her son.
Ms. Sanders stated that she had lived Oakwood, Central State Hospital, other institutions since she was nine years old until she moved into a community setting in 1999. She said that there are other people at Oakwood that could live with a home provider or their own home. She wants everyone to know that people with disabilities can live and work in the community, instead of being told what they cannot do. People with disabilities need a chance to live and work in their communities. Dr. Hacker stated that the cabinet supports anyone who chooses a community setting.
Testimony on the University of Louisville's Pediatric Forensic Department was given by Melissa L. Currie, MD, Assistant Professor of Pediatrics and Director, Division of Forensic Medicine, University of Louisville. She stated that a new Division of Forensic Medicine has been created which will serve as a resource to community physicians, child protection personnel, law enforcement, and the judicial system for the medical assessment of potential cases of child abuse and neglect. The university will work with local, regional, and state resources to prevent duplication of services and to ensure a seamless and accurate assessment of children who may be victims of child abuse or neglect. The mission is divided into three areas: clinical service, education, and research. She stated that the university will seek state funding to expand services to the entire state, with the goal to incorporate the Living Forensics Program currently with the Medical Examiner's Office into the new division. She stated that funding would be necessary to make it a statewide program.
Testimony on Area Health Education Centers (AHEC) was given by Karkie Tackett, Center Director, North Central AHEC, and Brenda Fitzpatrick, Center Director, North West AHEC. Ms. Fitzpatrick stated that each center is structured for each area's specific needs. Each center is attached to a regional host that has strong ties in the community. Ms. Tackett said that all eight AHECs perform the same services and are able to work closely with universities. The AHECs are involved in community education and are working to improve the health of the people in the community.
Senator Denton announced that the committee would meet Monday, November 19 because our regularly scheduled meeting falls the day before Thanksgiving. There being no further business, the committee adjourned at 3:36 p.m.