Call to Order and Roll Call
The seventh meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, December 17, 2014, at 10:00 a.m., in Room 129 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order at 10:06 a.m., and the secretary called the roll.
Present were:
Members: Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Joe Bowen, Tom Buford, Julian M. Carroll, Perry B. Clark, Denise Harper Angel, Jimmy Higdon, Katie Stine, and Reginald Thomas; Representatives Julie Raque Adams, Robert Benvenuti III, Bob M. DeWeese, Mary Lou Marzian, Reginald Meeks, Darryl T. Owens, Ruth Ann Palumbo, David Watkins, Russell Webber, Susan Westrom, and Addia Wuchner.
Guests: Beth Jurek, Executive Director, Office of Policy and Budget, Cabinet for Health and Family Services; Brent Cooper, President, C-Forward, Inc.; Wayne Meriwether, MHA, Chief Executive Officer, Twin Lakes Regional Medical Center; Jonathan Rich, DMD, Board Chair, Public Health Accreditation Board; Lynne M. Saddler, MD, MPH, District Director of Health, Northern Kentucky Independent District Health Department, Accredited Health Department, Public Health Accreditation Board; Marylee Underwood, Commonwealth Council on Developmental Disabilities; Bill Doll, Kentucky Medical Association; Scott Wegenast, AARP of Kentucky; Eric Clark, Kentucky Association of Health Care Facilities; Mark R. Brengelman, Hazelrigg & Cox LLP; Sarah S. Nicholson and Pam Mullaney, Kentucky Hospital Association; Cara Stewart, Kentucky Equal Justice Center; and Steve Shannon, Kentucky Association of Regional Programs.
LRC Staff: DeeAnn Wenk, Ben Payne, Jonathan Scott, Sarah Kidder, Gina Rigsby, and Cindy Smith.
Approval of the Minutes
A motion to approve the minutes of the November 19, 2014 meeting was made by Senator Carroll, seconded by Senator Harper Angel, and approved by voice vote.
Consideration of Referred Administrative Regulations
The following referred administrative regulations were on the agenda for consideration: 201 KAR 36:060 – establishes the supervision requirements to qualify for licensure and enables the Kentucky Board of Licensed Professional Counselors to evaluate applications by establishing the supervision experience requirements for licensure; 201 KAR 36:070 – establishes the educational and examination requirements for licensed professional counselors in the state of Kentucky and specifically requires that as of January 1, 2017, applicants have degrees from programs accredited by the Council on Accreditation of Counseling and Related Programs; 201 KAR 36:080 – establishes processes by which inactive licensure status and required status can be grated to a licensee upon written request to the Kentucky Board of Licensed Professional Counselors: 902 KAR 20:008 – establishes the fee schedule and requirements for obtaining a license to operate a health facility and establishes the procedure for obtaining a variance: 902 KAR 20:430 & E - establishes minimum licensure requirements for the operation of behavioral health services organizations which provide behavioral health services necessary to treat, support, and encourage individuals with a substance use disorders, mental health disorder, or co-occurring disorder to achieve and maintain the highest possible level of health and self-sufficiency; 902 KAR 20:440 & E – establishes the minimum licensure requirements for the operation of residential crisis stabilization units which serve at-risk children or children with severe emotional disabilities, at-risk adults or adults with severe mental illness or individuals with substance use disorder or co-occurring disorders; 908 KAR 3:050 – establishes the patient cost per day for board, maintenance, and treatment for state owned facilities at frequent intervals which shall be the uniform charge for persons receiving those services; and 908 KAR 3:060 – specifies the means test and income eligibility requirements used to determine a person’s ability to pay for services at a facility owned by the state. A motion to accept the referred administrative regulations was made by Senator Buford, seconded by Senator Carroll, and accepted by voice vote.
Consideration of Executive Order 2014-906 Amending Executive Order 2014-561 relating to Establishment and Operation of Kentucky Office of Health Benefit and Health Information Exchange
Beth Jurek, Executive Director, Office of Policy and Budget, Cabinet for Health and Family Services, stated that Executive Order 2014-561 created and established the Kentucky Office of Health Benefit and Health Information Exchange along with the kynect Advisory Board which is composed of 19 members appointed by the Governor who have relevant experience in health benefits administration, health care finance, health plan purchasing, health care delivery system administration, public health, and other health policy issues related to the small group and individual markets and the uninsured. Executive Order 2014-906 would expand the kynect Advisory Board to include the Secretary of the Health and Family Services Cabinet or the Secretary’s designee and one additional consumer representative for a total membership of 21 members. The executive order names the board members appointed by the Governor. A motion to accept the executive order was made by Senator Carroll, seconded by Representative Watkins, and accepted by voice vote.
Smoke-Free Kentucky
Brent Cooper, President of C-Forward, Inc., stated that some areas of Kentucky have no smoking bans in place, like Northern Kentucky, and others do not. It has been proven that a smoking ban will not hurt businesses but in certain circumstances, help bring in more customers. Ireland is a smoke-free country. Smoke-free environments provide healthier places for non-smokers. The main reason for the smoke-free legislation is to save lives and reduce health insurance costs for Kentuckians. Smokers are a protected class in Kentucky, because an employer cannot discriminate against someone who smokes. One of the largest tobacco companies, Phillip Morris, admits that second-hand smoke causes health problems. Second-hand smoke is a danger to the workforce.
Wayne Meriwether, MHA, Chief Executive Officer, Twin Lakes Regional Medical Center, stated that 130 healthcare facilities in Kentucky support a smoke-free statewide smoking ban. Hospitals are now leading by example with tobacco-free campuses. The Kentucky Hospital Association supports smoke-free legislation. Knowledge and tolerance has changed as more is learned about the dangers of smoking. As part of the Affordable Care Act, hospitals conduct a community needs assessment to help improve health problems. Approximately 26.5 percent of Kentuckians smoke. Kentucky leads the nation in cancer-related deaths due to smoking and is the forth-seventh unhealthiest state. 27 percent of Kentuckians are exposed to second-hand smoke at work. There are 7,000 chemicals in second-hand smoke and 69 cause cancer. Approximately 950 Kentuckians die from second-hand smoke complications yearly. Sixty-five percent of Kentuckians favor a smoking ban law. Annual expenditures for smoking-related healthcare are $1.92 billion and $106 million for second-hand exposure. Smoke-free environments can change the attitude of youth about smoking. The goal of smoke-free legislation is to help Kentuckians become healthier and reduce healthcare costs. Smoke-free legislation does not take away someone’s privilege to smoke, but it just says they have to do it outside.
Representative Westrom stated that smoke-free legislation will be introduced during the 2015 Regular Session. She asked that legislators keep an open mind about the legislation. The best way to have public support for a smoke-free law is to educate them about the benefits of not smoking.
Representative Adams stated that some legislators think local communities should decide about smoke-free ordinances. Unfortunately, it is a statewide problem and needs to be addressed at the state level. Smoke-free legislation will save healthcare costs for Kentuckians.
Representative Watkins stated that the smoke-free legislation will improve the health of Kentuckians, because smoking and second-hand smoke lead to huge healthcare costs.
Representative Burch stated that smoke-free laws did not hurt businesses in Rhode Island after a smoke-free law was passed. It is time to have a statewide smoking ban in Kentucky.
Senator Thomas stated that there is a better chance of not having heart-related problems if someone does not smoke. Passing a smoke-free law is not a partisan issue but an issue about doing what is best for the health of Kentuckians in order to live productive lives.
Senator Bowen stated that local communities should have the option to enforce smoke-free ordinances. Mr. Cooper stated is a statewide problem, therefore, there needs to be a statewide smoke-free law. Representative Westrom stated that not everything can be solved at the local level.
Senator Carroll stated that Kentucky spends $8 billion, approximately 50 percent, of the budget on healthcare. Funds used on unnecessary and/or preventable health issues could be used to help Kentucky’s education system. Passing a statewide smoke-free law is a legislative responsibility.
Representative DeWeese stated that smoke-free legislation has been passed out of the House Standing Committee on Health and Welfare for several years, but has not been called for a vote in the House chamber. Representative Westrom stated that legislators need to ask the House leadership to make smoke-free legislation a number one priority of the 2015 Regular Session.
Senator Denton stated that it is not fair for non-smoking state government employees to be responsible for the higher healthcare costs of smokers. When a company is in the process of deciding to locate in Kentucky, a healthy workforce is one of the factors in the decision. Companies that decide to open businesses in Kentucky will provide new revenues for the Commonwealth. It is irresponsible not to pass a smoke-free law in Kentucky.
Senator Higdon stated that while second-hand smoke is a contributing factor for someone being diagnosed with lung cancer, exposure to radon is a bigger factor. Representative Westrom stated radon testing legislation has already passed the General Assembly. Now it is time for the General Assembly to pass smoke-free legislation.
Northern Kentucky Board of Health
Jonathan Rich, DMD, Board Chair, Public Health Accreditation Board, stated that the Northern Kentucky Board of Health is in the process of drafting a bill for the 2015 Regular Session that will amend KRS 212.786 pertaining to the size and make-up of independent health boards. Currently, the there is no cap on either in Northern Kentucky. The change in the statute would reduce the size of the board from 32 to 23 to enable the board to have a more manageable membership.
Lynne M. Saddler, MD, MPH, District Director of Health, Northern Kentucky Independent District Health Department, Accredited Health Department, Public Health Accreditation Board, stated that amending KRS 212.786 would reduce the size and growth of the board. Currently there are 32 board members and membership will continue to grow based on population size. The legislation would also broaden the professions of someone who can serve on the board.
Representative Wuchner stated that there are no hidden agendas in amending the statute. In response to a question by Representative Wuchner, Dr. Saddler stated there will still be a consumer on the board. Amending the statute would create more flexibility.
In response to questions by Representative Burch, Dr. Saddler stated that the make-up of the board depends on who gets nominated and approved to serve on the board. Having 23 members would allow the board to be able to get a quorum and make it easier to conduct business.
In response to a question by Representative Marzian, Dr. Saddler stated that amending the statute would not affect Title X federal funding that helps provide healthcare services to children and families.
In response to question by Senator Carroll, Dr. Saddler stated that the average attendance at a board meeting is between 21-30 members. Senator Carroll stated that the current membership should not be changed but a management board should be created. All other members would be on an advisory board. All counties could be represented.
There being no further business, the meeting was adjourned at 11:40 a.m.