Interim Joint Committee on Health and Welfare

 

Minutes of the<MeetNo1> 2nd Meeting

of the 2014 Interim

 

<MeetMDY1> July 16, 2014

 

Call to Order and Roll Call

The<MeetNo2> second meeting of the Interim Joint Committee on Health and Welfare was held on<Day> Wednesday,<MeetMDY2> July 16, 2014, at<MeetTime> 1:00 p.m., at the Owensboro Health Regional Hospital, 1201 Pleasant Valley Road, Owensboro, Kentucky<Room>. Representative Tom Burch, Co-Chair, called the meeting to order at 1:08 p.m., and the secretary called the roll.

 

Present were:

 

Members:<Members> Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Joe Bowen, Tom Buford, Perry B. Clark, David P. Givens, Denise Harper Angel, Jimmy Higdon, Alice Forgy Kerr, Katie Stine, and Reginald Thomas; Representatives Robert Benvenuti III, Bob M. DeWeese, Joni L. Jenkins, Mary Lou Marzian, Reginald Meeks, Tim Moore, Darryl T. Owens, Ruth Ann Palumbo, Ben Waide, David Watkins, Russell Webber, and Addia Wuchner.

 

Guest Legislators: Representatives Jim Glenn and Tommy Thompson.

 

Guests: Phillip Patterson, President and CEO, Owensboro Health Regional Hospital; Susan Zepeda, PhD, CEO, and Gabriela Alcalde, Foundation for a Healthy Kentucky; Gerry Stover, EVP, Kentucky Academy of Family Physicians; Khanh Nguyen, DO, Ronald A. Berry, M.D., Jennifer Roberts, Owensboro Health Medical Group; Dave Bolt, Deputy Director, Kentucky Primary Care Association; Lucy Juett, Center Director, AHEC South Central Region; Ed Heath, DSc, CEO, Muhlenberg County Community Hospital; Jessica Estes, APRN-NP, Hawesville, Kentucky and Leila Faucette, Executive Director, Kentucky Coalition of Nurse Practitioners & Nurse Midwives; Mary Begley, Commissioner, and Dr. Allen Brenzel, Medical Director, Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services; Lawrence Kissner, Commissioner, and Veronica Cecil, Chief of Staff and Director, Division of Program Integrity, Department for Medicaid Services; Rob Sprang, MBA, Director, Project Manager, Tim Bickel, Co-Project Manager, Kentucky TeleHealth Network (KTHN), University of Louisville; Mary Horsley, RN, Training Center Director, Eastern KTHN Telehealth, St. Claire Regional Medical Center; Steve Fricker, Training Center Director, West KTHN Telehealth, Baptist Health Madisonville; Russell Harper, Aetna; Kimberlee A. Richardson, LPCC, LMHC, Director, Clinical Health Services, MHNet Behavioral Health, and Fred Tolin, Chief Medical Officer, CoventryCares of Kentucky; Stephen Houghland, MD, Chief Medical Officer, Liz McKune, EdD, Director of Behavioral Health, Jill Bell, Michael Robkin, Christie Spencer, Ashlea Christiansen, and Larry Badgett, Passport Health Plan; Mike Ridenour, Senior Director, External Affairs, Lori A. Gordon, LCSW, Senior Director of Product Operations, and Tambara Nalle, WellCare of Kentucky; Lawrence Ford, Director of Government Relations, and Jennifer Ecleberry, Director, Provider Relations, Anthem Blue Cross Blue Shield Medicaid (KY); Al Mattingly, Daviess County Fiscal Court; Dana Peveler, Elizabeth Munday Center; Sarah S. Nicholson, Kentucky Hospital Association; Bob Brooks, Baptist Health Madisonville; Bev Coke, Debbie Poole, Carol Payne, Donna Ross, Debbie Nunly, Tammy Marksberry, Pam Cox, Lisa Jones, Jenny Jackson, Vickie Morris, Susie Harris, Janice Scherm, Michael Yeiser, Jeff Carpenter, Marilou Murphy, Mary Ellen, Smaley, Nick Harley, Pat Winstead, Kelly Schlachter, and Ron Taylor, MD, Owensboro Health Regional Hospital; Ashley Spalding, Kentucky Center for Economic Policy; Diana Caldwell, Bob Tarrants, and Cindy Parish, Wendell Fosterís Campus; Mario Lopez, Account Manager, Samantha Pacheco, Regional Clinical Director, and Kelli Rodman, Humana-CareSource; Darrell Higginbotham, Independence Bank/Ohio Foundation; Gail Wigginton, Deborah Fillman, Clayton Horton, Merritt Bates-Thomas, and Angel Thompson, Green River District Health Department; Virginia Gray, John Y. Brown, III Group; Donald Neel; Bill Doll, Kentucky Medical Association; Nathan Goldman and Pam Hagan, Kentucky Board of Nursing; Marie Alagia Cull, Cull & Haydon, Steve Bing, Kentucky Health Department Association; Sheila Hardy, Legislative Research Commission; Vicki Goins, Governorís Office of Policy Management; Jennifer Barnett, Anthem Medicaid; Vaughn Payne, NCS; Danny Swain, SSG; Kent Gardner, University of Louisville School of Medicine; Ben Keeton, Medical News; J. Naulty, Owensboro Municipal Utilities; Vivian McNatton, Green River Area Develop District; Mark Lord, Office of Congressman Brett Guthrie; Bonnie Brown; Bill Smith, Regional Health Care Affiliates; Jan Gould, Kentucky Retail Federation; Terry Skaggs, Wells Health Systems; Chikere Uchegbu; Nelda Barnett, AARP; Alan Braden, Braden Financial Services; Megan Mortis, Regional Health Council; S. Todd Inman, State Farm; R.R. Medleyson; Mike Mountain, River Valley Behavioral Health; Nilesh Sangoi, CFO, Owensboro Medical Practice; Libby Milligan, McCarthy Strategic Solutions; John Walker, Owensboro Medical Health System; Kathy Adams, Childrenís Alliance; and Dirck A. Curry, Primary Care Center, Owensboro Health Regional Hospital.

 

LRC Staff: DeeAnn Wenk, Sarah Kidder, Ben Payne, Jonathan Scott, Gina Rigsby, and Cindy Smith.

 

Minutes

††††††††††† A motion to adopt the minutes of the June 18, 2014 meeting was made by Representative Jenkins, seconded by Representative Jenkins, and adopted by voice vote.

 

Consideration of Referred Administrative Regulation

The following administrative regulation was available for consideration and placed on the agenda, having been referred to the Committee on June 6, 2014, pursuant to KRS 13A.290(6): 201 KAR 20:057 Ė establishes the scope and standards of practice for an advanced practice registered nurse. A motion to adopt the administrative regulation was made by Senator Clark, seconded by Representative Owens, and adopted by voice vote.

 

Access to Primary Care

††††††††††† Susan Zepeda, Ph.D., President and CEO, Foundation for a Healthy Kentucky, stated that the Johns Hopkins Primary Care Policy Center defines primary care as an entry point into a health services system for all new needs and problems, person focused not disease oriented, provides care for all but uncommon or unusual conditions, coordinates or integrates care regardless of where it is provided, and assures optimized care use and health status equity. A 2012 Deloitte Consulting study stated that to meet the Affordable Care Act (ACA), Kentucky would need an additional 3,790 physicians, 612 dentists, 5,635 registered nurses, 296 physician assistants, and 269 optometrists. As of April 21, 2014, there were 413,410 Kentucky enrolled in new health coverage through Kynect, the stateís health benefit exchange. Physician-led teams can provide coordinated, patient-centered, cost-effective quality care.

 

Gerry Stover, MS, Executive Vice-President, Kentucky Academy of Family Physicians, stated that patients with a family physician as a source of care receive more preventive services, use the emergency rooms less often, and spend less on care. Health Resources and Services Administration (HRSA) data shows that 95 percent of graduates from family medicine residencies practice primary care five years after graduation from medical school compared to 21 percent of internal medicine residency graduates. Approximately 56 percent of family medicine residents stay within 100 miles of where they graduate from residency. More needs to be done to address the shortage of primary care physicians in Kentucky. Approximately 44 percent of rural counties experience a shortage of primary care physicians. A positive early experience in rural health increases the probability that graduates will choose to work in rural health. A recent study by the Robert Graham Center for Policy Studies evaluated the impact of family physicians on a state-by-state basis. The study found that in Kentucky, family physicians have an economic impact of $878,642 per doctor, per year. The total impact of family physicians in Kentucky is estimated to be $955,962,533 per year.

 

The FY 2014 Loan Repayment Program is currently closed. This program is open to licensed primary care medical, dental, and mental and behavioral health providers who are employed or have accepted an offer of employment at an NHSC-approved site and will begin working by July 15, 2014. Awardees receive up to $50,000 in exchange for two years of service if they practice in a Health Professional Shortage Area (HPSA) of 14 and above (Tier I). Awardees can also receive up to $30,000 in exchange for two years of service if they practice in a HPSA of 13 and below. In FY 2013, all of the NHSCís loan repayment awards were made to providers located in a Tier 1 HPSA. There were a total of 4,505 awards made (2,106 new and 2,399 continuations) totaling $169.7 million. Mary Takach, Senior Program Director at the National Academy for State Health Policy, stated that establishing medical homes is the driving innovation model in the Medicaid system. Even commercial payers are partnering with public payers and supporting this model because it makes sense. States also are working to better coordinate Medicare and Medicaid services. Nine states are receiving federal funding to begin to coordinate services to vulnerable seniors and individuals with disabilities provided by these two major health funding sources.

 

††††††††††† Lucy Juett, Director, South Central AHEC, stated that over 12,000 health professionals have enhanced clinical skills through Area Health Education Centersí (AHECs) continuing education and retraining programs. Over 46,500 citizens have received free dental, medical, and health education services through the Kentucky AHEC. One challenge is a shortage of clinical training sites. Other challenges are that students only receive an $80 stipend per week to pay for housing costs and essentials and there is a disparity of medical student graduates to number of residency positions.

 

††††††††††† David Bolt, Deputy Director, Kentucky Primary Care Association, stated that the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) reported that 65 percent of Kentucky counties are considered Health Professions Shortage Areas for primary care. According to the 2013 County Health Rankings and Roadmaps published by Robert Wood Johnson and the University of Wisconsin, individuals in the healthiest counties are 1.4 times more likely to have access to a primary care physician. According to 2013 research by the University of Kentucky Office of Rural and Community Health, 21.2 percent of physicians were above the age of 61 in 2012, 680 physicians need to be replaced due to retirements, and Kentucky had a 1,287 to 1 primary care physician (PCPs) to citizen ration, 557 below the United States average. Current family practice (FP) residency programs provide 57 FPs annually. Approximately 163 FPs are needed per year to get the ratio of 1,500 to 1 by 2025. A healthy, well educated workforce is Kentuckyís future and needs to be approached from an investment perspective just like economic development. More community-based medical residency programs need state support for rural health programs. Kentucky needs a greater use and support for Telehealth, expanded loan repayment programs, tax credits or other incentives for health care professionals, and state funds for expansion of the physician assistant (PA) and nurse practitioner (NP) programs.

 

††††††††††† Ed Heath, D.Sc, Chief Executive Officer, Muhlenberg Community Hospital (MCH), stated that the MCH is a 135 bed acute care hospital with over 450 employees that has four employed primary care practices, two specialist clinics, and an ambulatory surgery center. There is a need to decrease non-critical use of the emergency department (ED) and provide access to care, especially after hours and on weekends. Benefits of primary care are comprehensive care, preventative exams, lower costs in primary care setting, and population management. There is a small candidate pool of family practice and internal medicine physicians. There need to be more training programs for physicians, physician assistants, and advanced practice registered nurses. Access to and delivery of services is needed to reduce the need for patients to travel to receive services.

 

††††††††††† Khanh Nguyen, DO, Family Medicine, Owensboro Health Medical Group, stated that the total number of office visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in 2025. By 2025, the demand for primary care physicians nationally will grow by 52,000. A 2013 report by the Robert Graham Center states that to maintain current rates of utilization Kentucky will need to add an additional 624 primary care physicians by 2030. Potential solutions are physician reimbursement reform, dedicated funding for primary care Graduate Medical Education (GME), increased funding for primary care training, and medical school student debt relief.

 

††††††††††† Jessica Estes, APRN-NP, stated that she is the only prescribing mental health provider in Hancock County. While mental health would be seen by some as a specialty, it is actually considered to be a primary care service. There is a need to gain access to high quality, consistent health care. The focus is not just on treatment of a range of conditions, but on early and periodic screenings, follow-through, and patient education. Nursing education and training puts the emphasis on prevention, ongoing care, and communication making the patient a partner in the process. The patient-centered approach includes participation of the patient, caregivers, and providers to assure a minimal intrusion into the patientís functioning everyday life. Only a comprehensive, patient-centered approach of primary care services is going to reverse Kentuckyís poor rankings of health conditions. With the implementation of the ACA, nearly 400,000 Kentuckians now have health care coverage, many for the first time. These individuals need access to quality healthcare to address current problems, education to prepare them for healthier choices, a better understanding of their condition, and the steps that can be taken to secure a healthier future for themselves and their families. APRNs are grounded in this comprehensive, patient-focused primary care approach and stand ready to be a strong factor in the primary care workforce and strong influence in delivering services that include education, care management, and prevention.

 

††††††††††† Leila Faucette, Executive Director, Kentucky Coalition of Nurse Practitioners and Nurse Midwives, stated that the term APRN includes Nurse Practitioners, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists. According to the Kentucky Board of Nursing, there are currently 4,032 nurse practitioners and nurse midwives licensed in Kentucky which is an increase of 54 percent since 2010. In 2010, legislation was enacted for regional universities across the Commonwealth to begin offering the Doctorate of Nursing Practice (DNP) degree. Each of the regional universities now offers the program. Approximately 2,500 APRNs have completed the required four-year prescribing period and will have the option to prescribe non-scheduled, legend drugs without a collaborative prescribing agreement. This will give APRNs more choices and options about how and where they practice, increasing access for more Kentuckians to NP services, particularly those who are Medicaid eligible.

 

IMPACT Plus Services: Medicaid Managed Care

††††††††††† Mary Begley, Commissioner, and Dr. Allen Brenzel, Medical Director, Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, stated that the July 1, 2014 transition has been moved to August 1, 2014 and all parties will be ready. There will be a greater opportunity to expand access to high quality, evidence based, and community based services for children with intensive behavioral health needs and their families. This opportunity allows the cabinet to implement the legislatively mandated transition of previous Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) subproviders from the IMPACT Plus funding stream to direct contracting with the managed care organizations (MCOs). All IMPACT Plus services will still be available, but are not being limited to 48 groups of providers. Service duplication by the DBHDID and the MCOs is eliminated. The providers have to become familiar with the claim submission process for each MCO. The MCOs and the providers need the ability to negotiate contracts with each other and do not need to go through the DBHDID. The goal is to make sure the transition is successful and children continue to have access to critical behavioral health services.

 

††††††††††† In response to a question by Senator Denton, Dr. Brenzel stated that each MCO has a contingency plan for when a provider has not been credentialed but is still providing IMPACT Plus services so there is not any interruption of services.

 

Lawrence Ford, Director of Government Relations, and Jennifer Ecleberry, Anthem Blue Cross Blue Shield Medicaid (KY), stated that the Medicaid provider network was built by amending the Anthem commercial network agreements to add the Medicaid product and plan requirements. Of the 16,000 providers in the Anthem network, there are 1,000 behavioral health providers. Participation requirements include an active Medicaid ID number, National Provider Identifier (NPI) number, Council for Affordable Quality Healthcare (CAQH) application for Anthem credentialing. Medicare participation is not required. The Anthem credentialing process typically takes 30-45 days, but is averaging around 24 days. Anthem has completed 100 percent outreach to IMPACT Plus agencies. Twelve agencies have already contracted with Anthem Medicaid and three more contracts from Community Mental Health Centers (CMHCs) are awaiting signature. Three Medicaid eligible children receive IMPACT Plus services. Anthemís outpatient services are very accessible through a broad network with no copays and a streamlined authorization process with many services not requiring prior authorization. If services are needed prior to a providerís completion of contracting or credentialing, a single case agreement can be utilized, but the provider must have an active Medicaid ID in order to be reimbursed.

 

Mario Lopez, Account Manager and Samantha Pacheco, Regional Clinical Director, Humana-CareSource, stated that since the Kentucky General Assembly passed legislation informing the Cabinet for Health and Family Services (CHFS) to transition the administration of the IMPACT Plus program from the DBHDID to MCOs contracted by Kentucky, Humana-Caresource has actively outreached to begin that transition. To date, Humana-Caresource has contracted with 28 of the 47 IMPACT Plus entities. Of the 28 contracted agencies, 20 are fully contracted and credentialed and are currently able to provide the full array and continuum of expansion services. Of the remaining eight contracted providers, most are agencies or groups that have obtained, or applied for, their Multi-Specialty Group (MSG) Medicaid designation. Five of those agencies are currently awaiting their MSG Medicaid numbers. The majority of contracted providers have submitted their credentialing documentation, some of which have already been completed for the licensed individuals working within the agency. There are 144 individuals and 61 of those are on the IMPACT Plus list, and 20 agencies fully contracted or credentialed. Of the remaining 19 non-contracted providers, 16 will have or have had contracts sent to them by July 18, 2014, as well as have either submitted credentialing documents or are currently in the process of gathering the necessary credentialing information. Three of the nineteen non-contracted providers have not responded to multiple outreach efforts. Overall, Humana-Caresource is committed to ensuring all agencies interested in contracting will be in contract negotiations and in the credentialing process by August 1, 2014. Of those agencies not fully contracted and credentialed effective August 1, 2014, Humana-Caresource will ensure children and families can be seen and the agency can bill via Letters of Intent (LOIs) while contracting or credentialing is completed. Humana-Caresource currently has 49 members engaged in IMPACT Plus services. Each of those members are actively involved with our case management services to ensure the fluidity of their transition plan and to work actively with the IMPACT Plus Provider on that plan. We initially began outreaching the nine IMPACT Plus providers involved with the 49 Humana-Caresource members. Six of the nine IMPACT Plus providers are contracted and the other three are actively working on submitting their credentialing packet. Humana-Caresource expects to have the majority of IMPACT Plus providers contracted or actively in-process of credentialing for final contracting by August 1, 2014.

 

Stephen Houghland, MD, Chief Medical Officer, and Liz McKune, EdD, Director of Behavioral Health, Passport Health Plan, stated that in addition to looking at the prioritized list of providers that was provided by DMS and DBHDID, Passport looked at where members were receiving services to further prioritize. The analysis demonstrated that 98 percent of members received services from seven providers all inside Medicaidís Region 3. Of the seven, six are contracted at the group level, and one is still in contract negotiations with Passport. On a statewide basis, 13 IMPACT Plus providers are contracted at the group level with 157 individual practitioners. Ten are fully credentialed and in the system and 94 are in the process of being credentialed. Currently 570 children receive IMPACT Plus services, and 60 new children are added monthly. The IMPACT Plus program change starting August 8, 2014 only effects new children entering the program, all other children will transition on October 1, 2014. Passportís primary contingency plan is completing single case agreements with the requested provider if they are not currently participating in Passportís network. In addition, Passport will employ whatever creativity is feasible to make certain that children are receiving the services that are needed.

 

Mike Ridenour, Senior Director, External Affairs and Lori A. Gordon, LCSW, Senior Director of Product Operations, WellCare of Kentucky, stated that 872 children receive IMPACT Plus services from 27 agencies. Approximately 33 percent of the providers are fully in the system, and 77 percent of them have signed a contract with an effective date. Three providers have not submitted applications for contracting and two agencies are still in contract negotiations. WellCare is currently using DMSí credentialing, but will recredential the provider after they are in WellCareís system. There are 597 behavioral health providers credentialed and in the system that are not part of the IMPACT Plus program.

 

††††††††††† Kimberlee A. Richardson, LPCC, LMHC, Director, Clinical Health Services, MHNet Behavioral Health, and Fred Tolin, Chief Medical Officer, CoventryCares of Kentucky, stated that 40 of the 48 agencies are under contract, and discussions are being held with the remaining 8 providers. Approximately 130 independently licensed clinicians that are employed by these agencies have submitted credentialing packets, and 71 percent of these providers are on track to be through the process by July 25, 2014. Of these providers, 23 percent had missing information in CAQH and have been asked to complete the needed information. Non-licensed staff is not required to be credentialed. Single Case Agreements will be considered for members that need care when the provider has not completed the credentialing process. Currently there are approximately 1,500 children who require Impact Plus services, and Coventry is very confident it is well-positioned to support the transition with little to no disruption to the members who are receiving these services.

 

In response to a question by Senator Stine, Dr. Zepeda stated that in order to come up with savings to permit the Medicaid expansion under the Affordable Care Act, Medicare and the residency programs experienced a decrease in funding. Mr. Bolt stated that it costs $150,000 to $200,000 per year to train a family practice resident. The larger problem is the cap on existing residency programs.

 

In response to questions by Senator Thomas, Ms. Estes stated that there is a fine line between a patient who can and cannot adequately make mental health decisions for themselves.

 

In response to questions by Representative Benvenuti, Dr. Zepeda stated that some studies that conclude that tort reform is one way to attract and retain skilled healthcare providers, but it is not the complete answer. The Foundation has not conducted research or studies on medical review panels. Mr. Stover stated that tort reform and debt issues keep a lot of providers from opening up private practices.

 

In response to questions by Representative Moore, Mr. Stover stated that rural family medicine practice, including APRNs, will choose services that pay well. Currently, the payment system is not focused on preventive care. Family physicians are not encouraged to spend a lot of time with a patient and focus on preventive care and coordination of services because of the current payment system. Dr. Zepeda stated that multidisciplinary teams are needed to control costs. Dr. Nguyen stated that preventive care prevents more catastrophic illnesses. Kentucky has a shortage of doctors. Ms. Estes stated that APRNs are limited to where they can practice because it depends on a collaborative agreement with a physician to prescribe medications. Mental health providers get a reduction on top of a low Medicaid reimbursement rate. There are a limited number of Medicaid providers willing to provide care. Dr. Zepeda stated that the earlier the prevention the less it will cost in the long run.

 

In response to a question from Senator Givens, Dr. Heath stated that recruiting PCPs in rural areas is a challenge. Rural communities need to seek providers who want to practice in rural areas.

 

In response to questions by Representative Wuchner, Dr. Heath stated that there is a need to look at populations to demonstrate the need that there are enough physicians and clinical manpower available to provide care. There is a need to have hours available after school, after work, and on weekends for individuals to see a provider.

 

In response to a question by Representative Waide, Ms. Estes stated that one of the challenges with the implementation of managed care is that in a provision in the contract for outpatient providers is to see a discharged patient within seven days of discharge and referral. There is a need for more access to care at different times other than office hours. Mr. Stover stated that the physician has to find what motivates a patient to seek preventive care.

 

††††††††††† In response by questions from Senator Higdon, Commissioner Begley stated that providers have a relationship with a managed care organization (MCO) and will work with them on being credentialed.

 

Medicaid Expansion Overview

††††††††††† Lawrence Kissner, Commissioner, and Veronica Cecil, Chief of Staff and Director, Division of Program Integrity, Department for Medicaid Services, Cabinet for Health and Family Services stated that the national quality strategy is better care for individuals, better health for populations, and financial stewardship. Medicaid is now the largest payer of healthcare services for Kentucky residents. An independent study found that expanding Medicaid is beneficial for Kentucky because it creates 17,000 new jobs, provides $11 billion in funding to providers and $800 million savings in FY 2014-2021. Medicaid eligibility was limited to the elderly and persons with disabilities, children, and pregnant women. The program has been expanded to include adults who are below 138 percent of the federal poverty level (FPL). The ACA requires that services be covered for the expansion population in each of the ten Essential Health Benefits (EHBs) that include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, behavioral health including substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care. Since August 2013, the department has filed and had approved 27 unique state plan amendments (SPA) to the Centers for Medicare and Medicaid Services (CMS) with six pending CMS approval and has filed 48 administrative regulations. While Kentucky has consistent enrollment figures, the individuals that make up that enrollment are constantly changing. Only 81 percent of individuals enrolled in June 2012 were still enrolled in June 2013. Medicaid expansion enrollment outpaced the enrollment anticipated in the whitepaper in every county. Whitepaper participation rates prepared by PricewaterhouseCoopers were based on estimates from the Congressional Budget Office (CBO) and anticipated 55 percent of eligible persons enrolling in the first year and eventually 70 percent. The woodwork enrollment should be at or below the whitepaper estimates.

 

††††††††††† In response to questions by Representative Benvenuti, Commissioner Kissner stated that Medicaid is not the highest paying plan. The department only has Medicaid data and does not know if there has been a financial detriment to hospitals. Approximately 80 percent of emergency room use is for mental health and substance abuse services. There is no data available on the estimated cost to Kentucky in FY 2017-2020 due to the Medicaid expansion.

 

Kentucky Telehealth Network

††††††††††† Rob Sprang, MBA, Director, Project Manager, University of Kentucky, and Tim Bickel, Co-Project Manager, University of Louisville, Kentucky Telehealth Network (KTHN), Mary Horsley, RN, Training Center Director, Eastern KTHN Telehealth, St. Claire Regional Medical Center, Steve Fricker, Training Center Director, West KTHN Telehealth, Baptist Health Madisonville, stated that stated that the Kentucky Telehealth Board is housed in the Cabinet for Health and Family Services, and is the governance structure for statewide Telehealth policy and operational standards. The board contracts with four training centers for oversight and management of the statewide Kentucky Telehealth Network (KTHN). There are four resources centers with telemedicine and Telehealth development expertise located at the University of Kentucky, University of Louisville, St. Claire Regional Medical Center, and Baptist Health Madisonville. The Telehealth centers provide statewide leadership focusing on collaborative efforts and public and privet partnerships to increase the use of Telehealth to ensure quality of care and positive health outcomes. Telehealth benefits reduce barriers to access, increase efficiency for providers, reduce overall health care costs, reduce delays in care, increase quality of care, improve health outcomes, and have virtual accessibility. Kentuckyís statewide Telehealth network permits healthcare providers and systems to deploy Telehealth technology on their own, but creates a structured environment that coordinates the infrastructure and service delivery so no Kentuckian is isolated from needed healthcare services.

 

††††††††††† In response to questions by Senator Denton, Mr. Fricker stated that the Telehealth Network Board is funded by the Cabinet for Health and Family Services. Regulations state that any site that wants to provide Medicaid services has to be an approved Telehealth site.

 

††††††††††† In response to a question by Senator Thomas, Mr. Sprang stated that it would be very beneficial to have a consolidated high speed network.

 

Adjournment

††††††††††† There being no further business, the meeting was adjourned at 4:00 p.m.