Call to Order and Roll Call
The 4th meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, September 15, 2010, at 1:00 PM, in Room 129 of the Capitol Annex. Senator Julie Denton, Co-Chair, called the meeting to order at 1:17 p.m., and the secretary called the roll.
Present were:
Members: Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Julian M. Carroll, Perry B. Clark, Joey Pendleton, Katie Kratz Stine, and Jack Westwood; Representatives Bob M. DeWeese, Brent Housman, Joni L. Jenkins, Tim Moore, Darryl T. Owens, and Addia Wuchner.
Guests: Jerry Malone, Vice President of State Solutions, Sandlot; Kathleen Hertzog, Vice President for Marketing and Communications, Availity; Dr. Polly Buckey, Regional Director, Kool Smiles; Sharon P. Turner, DDS, JD, Dean, University of Kentucky College of Dentistry; Ann L. Greenwell, DMD, MSD, Program Director, Pediatric Dental Residency Program, University of Louisville School of Dentistry; Dr. Beverly Largent, Past President and Michael R. Porter, Executive Director, Kentucky Dental Association; Brian K. Bishop, Executive Director, Kentucky Board of Dentistry; Dr. Bill Collins, Chairman, Kentucky Chapter of Remote Area Medical; Clifford Maesaka, DDS, President and CEO, Delta Dental of Kentucky; Julie McKee, DMD, and Steve Davis, MD, Deputy Commissioner, Department for Public Health, Cabinet for Health and Family Services; Bill Doll, Kentucky Medical Association; Jan Gould, Kentucky Retail Federation; Kymber Messersmith, 3 Click Solutions; Shirley Eldridge and Karen Cooke, Department for Aging and Independent Living, Cabinet for Health and Family Services; Jennifer Verheyden, Availity; Ben Keeton; Susan Matherly and Chet Mitchell, KALFA; Susan King, Kentucky Board of Dentistry; Don Ruley, Kentucky Dental Hygienists Association; Cheri Meadows, Kentucky Department of Education; Jodi Mitchell, Kentucky Voices for Health; and Sarah S. Nicholson, Kentucky Hospital Association.
LRC Staff: DeeAnn Mansfield, Miriam Fordham, Ben Payne, Jonathan Scott, Gina Rigsby, and Cindy Smith.
Subcommittee Report
A motion to accept the Health Issues and Aging Subcommittee report given by Senator Denton was made by Senator Denton, seconded by Representative Jenkins, and accepted by voice vote.
Consideration of Referred Administrative Regulations
The following referred administrative regulations were on the agenda for consideration: 201 KAR 9:006 – repeals 201 KAR 9:005, ethical conduct, Kentucky Board of Medical Licensure; 900 KAR 5:020 – establishes the State Health Plan for facilities and services; 900 KAR 6:020 – establishes the fee schedule for certificate of need applications; and 910 KAR 1:240 – establishes the certification process for assisted-living communities. A motion to accept the referred administrative regulations was made by Senator Pendleton, seconded by Representative Owens, and accepted by voice vote.
Approval of Minutes
A motion to approve the minutes from the June 16, 2010, July 21, 2010, and August 18, 2010 meetings was made by Senator Pendleton, seconded by Senator Carroll, and approved by voice vote.
Health Information Exchange
Jerry Malone, Vice President of State Solutions, Sandlot, stated that his company enters and receives patient data and history, orders and receives laboratory and radiologic tests, prescribes medications electronically, communicates securely with other providers, sends electronic referrals, improves diagnosis and treatment decisions with access to medical history, prevents duplication of medical tests, monitors chronic conditions better, decreases dictation and transcription costs, and provides quicker care in emergency situations. An interoperable health information exchange (HIE) takes an electronic medical record and incorporates it into the patient’s electronic health record. This information can be securely displayed in real time for providers throughout the community at the point of care. Physician-driven technology is more easily integrated into the practice increasing more efficient workflow.
Kathleen Hertzog, Vice President for Marketing and Communications, Availity, stated her company helps payers save money and providers get paid. Health information exchanges provide the capability to move clinical information electronically across organizations within a region, community, or hospital system. Availity provides the infrastructure to support the development and growth of a HIE. A HIE can provide access to real-time benefits information, deliver clinically relevant information at the point of care, and enable efficient payment processes in a physician’s office. Providers access the network through a web portal that centralizes health information from multiple sources for the provider to access in one place with a common, consistent presentation for ease of use. It enables physician offices to access the Availity network from within the software systems they use the most. Availity’s HIE allows the physician to see if the patient is covered by a commercial health plan that should be billed prior to Medicaid, reduces Medicaid efforts to recover reimbursements made that were the responsibility of another health plan, and moves Medicaid from a third party liability model to a cost avoidance model.
In response to a question by Representative Housman, Mr. Malone stated he would provide the committee with the cost savings of a HIE.
In response to a question by Representative Owens, Mr. Malone stated that Sandlot uses up-to-date formatting to ensure the patient’s medical information is correct.
In response to a question by Senator Carroll, Mr. Malone stated that there is an opt-in option for patients. There are auditing capabilities to ensure only authorized personnel have access to the medical records.
Dental Issues
Polly Buckey, Regional Dental Director, Kool Smiles, stated that Kool Smiles is dedicated to providing access to affordable, quality dental care for Kentucky families and thousands more across the nation. In 2002, Kool Smiles opened an office in Atlanta, Georgia to fulfill its mission of providing urgently needed dental care for the under-served children and their parents. Kool Smiles serves children with Medicaid in order to give them the opportunity to improve their oral health and to learn fundamental oral health care skills that will serve their overall health and wellness for the rest of their lives. If untreated, cavities and oral disease can lead to more serious and complicated issues such as poor diets, difficulty paying attention in school, poor attendance in school, and problems with sleeping. Financial limitations should not be a barrier to quality dental care, yet based on the number of dental facilities that do not accept Medicaid patients in underserved communities across the nation, this has been the case. All the dentists in the Kool Smiles’ offices have either a doctor of dental surgery (DDS) or a doctor of dental medicine (DMD) degree and must pass a rigorous screening process before joining the organization. Kool Smiles implements a vigorous compliance program and aligns clinical and billing standards to the nation’s best benchmark quality. The monthly quality report is published on the website as a matter of public record.
Representative Moore stated that the military is very serious about making sure every soldier receives the best dental care. He is grateful to Kool Smiles for its partnership with the state and the efforts being made for our children.
In response to a question by Representative Wuchner, Dr. Buckey stated that she would provide the committee with information on statistics on the number of children who have had access to dentists by age 18.
Sharon Turner, DDS, JD, Dean, University of Kentucky College of Dentistry, stated that according to the 2010 relicensure data provided by the Kentucky Board of Dentistry, there are 2,348 practicing dentists with 934 who are age 55 or older and 77 who serve pediatric patients. Western and Eastern Kentucky have the lowest dentists per population ratio throughout the state. Oral infections affect a child’s nutrition, sleep, ability to learn, attendance at school, and self image. The mission of the Kentucky Oral Health Network (KOHN) is to improve oral health literacy, reduce oral health disparities, and improve the oral and general health of families in rural Kentucky and other underserved populations of Kentucky. The outreach partners of the KOHN are public health departments, community health centers, regional health systems, regional universities, Head Start programs, public school systems, the University of Kentucky Centers for Rural Health, the University of Kentucky Medical Center colleges, and the University of Kentucky College of Dentistry Program. Senator Stine stated that bad teeth can have a negative effect on the total body.
Ann L. Greenwell, DMD, MSD, Program Director, Pediatric Dental Residency Program, University of Louisville School of Dentistry, stated that dental caries or cavities is the most common infection in children in the United States and is totally preventable. Nationally, more low-income children have cavities than non-low-income children. Untreated pain and infection cause problems with a child’s ability to eat, to speak, and to learn, and children lose the ability to focus and perform complex tasks and demonstrate disruptive behaviors because of dental pain. The solution is education and early diagnosis followed by definitive treatment. At the University of Louisville School of Dentistry Pediatric Dental Clinic, screenings are performed for free to help families with no insurance and no family dentist. Faculty from the University of Louisville and the University of Kentucky are working with the Department for Public Health’s dental director to educate dental providers in the state to help them be better able to treat more children. The program gives children a place to receive regular dental check-ups and have a place to go for care in case of trauma or emergencies without having to travel to another city. Every child in Kentucky deserves to grow up free from pain and infection.
Beverly Largent, Pediatric dentist and past President, and Mike Porter, Executive Director, Kentucky Dental Association, stated that dentists are completing the Kentucky Screening/Dental Examination Form. The association has not received information from school systems on how many children have been screened or their needs. The Kentucky Dental Association (KDA) is committed to finding a dentist for any child. There is no language in the legislation to address children who have failed to be screened, and results from screenings will not be known for one year. A dental home is a place where children can receive continuous, comprehensive, and emergency care. The dental home can best be supported by a mandatory dental examination. KDA’s concern is how children can be served on a local level.
Dr. Bill Collins, Chairman, Kentucky Chapter of Remote Area Medical (RAM), stated that RAM’s mission is to provide medical, dental, and vision care to the underserved who cannot afford co-pays and deductibles. The organization operates solely on donations from the private sector, and no government grants or monies have been applied for or taken, 100 percent of all RAM Kentucky money goes back into the treatment of the patient. Just because someone is poor, it does not mean they deserve poor or incompetent care. The newest attempt to address Kentucky’s dental problems is the screenings required for school-age children. These are only screenings and not complete examinations and are not always performed by a dentist or a hygienist. Parents need to be made aware that this is not a complete examination and a follow-up is needed to ensure treatment is sought for identified problems. The problem is not that providers will not accept Medicaid, but because of the low Medicaid reimbursement fee schedule. The Kentucky Board of Dentistry has been involved in every charity clinic to ensure the delivery of the highest standards of care to the public and have been instrumental in easing the regulatory process to allow out-of-state dental professionals to participate with minimal paperwork. The Kentucky Board of Dentistry and the Kentucky Dental Association along with others have recently rewritten the Dental Practice Act. In response to a question by Representative Wuchner, Dr. Collins and Brian Bishop, Executive Director, Kentucky Board of Dentistry, stated that all money for RAM’s clinics are private donations and are not reimbursed by Medicaid.
Clifford Maesaka, DDS, President and CEO, Delta Dental of Kentucky, stated that his company is the largest single provider of dental benefits in the Commonwealth serving over 550,000 individual residents of Kentucky or employees of Kentucky-based companies. Delta Dental is licensed by the Kentucky Department of Insurance as a not-for-profit dental service corporation and is committed to oral health of Kentuckians. It supports and funds many oral health initiatives throughout the state including the University of Kentucky and the Western Kentucky University mobile dental vans and elementary school education projects. Delta Dental has also granted over $1.5 million dollars to fund research centers at the University of Kentucky and the University of Louisville dental schools.
Julie McKee, DMD, Dental Director, and Steve Davis, MD, Deputy Commissioner, Department for Public Health, Cabinet for Health and Family Services, stated that the department’s oral health program builds access, supports assurance, improves assessment, and creates and supports policy development to improve oral health status. Fluoride is delivered into a municipal system through specialized equipment to create the optimal concentration. It reduces smooth surface decay by strengthening developing teeth and repairing beginning decay lesions in erupted teeth. Kentucky has a municipal system participation rate of 99.7 percent, the highest state in the nation next to DC at 100 percent participation. Kentucky’s Community Fluoridation Program conducts regular annual inspections of the 205 systems for effectiveness and compliance. The Health Resources and Services Administration (HRSA) and the Appalachian Regional Commission (ARC) help fund a plan that has been developed to train dentists to have the competency to effectively assess, manage, and treat a patient who is under six years of age. Through support from HRSA and ARC, the department is assisting communities to come together, establish themselves as an oral health coalition, and work on dental issues in their community.
Kentucky’s new Dental Practice Act builds access to care through the establishment of the public health dental hygienist licensure category. Although the law is not specific, its intent is to place public health dental hygienists in the school systems through health departments and their contractors to be able to do assessments, preventive services, and effective referral into the dental care system to address active disease such as cavities. The department’s desired outcome is to design and implement a model that will reduce the number of school-aged children that miss school because of dental disease and create a seamless continuum of care into the dentist’s office. Through allocation of state general funds, the Kentucky Oral Health Program has a contract with the University of Kentucky College of Dentistry to assist in underwriting costs for their outreach to improve access in areas of the state that have demonstrated oral health needs in underserved populations. The desired outcome is to continue designing and establishing the Kentucky Oral Health Plan Network to create a seamless care system that moves people from the state of perceived need into a dental home that can offer comprehensive dental services.
The Kentucky Oral Health Program also supports assurance through its involvement in the new unfunded dental law that requires an oral screening for every five- or six-year old entering into the public school system. Follow-up legislation allowed dental hygienists to provide the screening without the supervision of a dentist. All screenings are recorded on one form and provided to the school upon the student’s admission to the school, and are reported by January 1 to the Department of Education.
In response to questions by Representative Housman, Dr. McKee stated that although the legislation that requires a child to have a dental examination, which must be kept on file, before entering school passed several years ago, it was only enforced this school year.
In response to questions by Representative Burch, Dr. McKee stated that there are approximately 80 pediatric dentists and a small percentage of the 1,945 general dentists see children under age six. While Kentucky has a 99.7 percent municipal fluoridation system participation rate, there are some individuals who experience problems because of bad personal oral hygiene. A doctor does check a child’s teeth as part of the school physical, but not a dentist. Bad oral health can not only affect a child’s school performance, but it can be lethal.
A motion to adjourn at 3:11 p.m. was made by Senator Pendleton, seconded by Representative Burch, and approved by voice vote.