Call to Order and Roll Call
Thefifth meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, October 21, 2015, at 12:00 p.m. CDT/1:00 p.m. EDT, at the Wendell Fosterís Campus for Individuals with Developmental Disabilities, Young Meeting House, 815 Triplett Street, Owensboro, Kentucky 42303. Representative Tom Burch, Co-Chair, called the meeting to order at 1:12 p.m. EDT, and the secretary called the roll.
Members:Senator Julie Raque Adams, Co-Chair; Representative Tom Burch, Co-Chair; Senators Ralph Alvarado, Danny Carroll, Julian M. Carroll, Jimmy Higdon, and Reginald Thomas; Representatives George Brown Jr., Bob M. DeWeese, Joni L. Jenkins, Mary Lou Marzian, Reginald Meeks, Phil Moffett, Tim Moore, David Watkins, Russell Webber, and Susan Westrom.
Guest Legislators: Senator Joe Bowen; and Representatives Suzanne Miles and Tommy Thompson.
Guests: Todd Inman, Chair of the Board of Directors, and Clay Ford, Vice-Chair of the Board of Directors, Wendell Fosterís Campus for Developmental Disabilities; Diana Caldwell, Vice President, Quality and Strategic Development, Wendell Fosterís Campus for Developmental Disabilities; Mark Chumbler, CEO, and Susan Vickers, Clinical Director Hugh Edward Sandefur Training Center; Arthur Campbell, Louisville, Protection & Advocacy for Individuals with Developmental Disabilities (PADD) Advisory Board; Katherine Bowen, case manager; Kimberley Kirtley, Supported Employment Coordinator, Wendell Fosterís Campus for Developmental Disabilities; Jason Cole, Regional Program Manager and Ann Haynes, Kentucky Office of Vocational Rehabilitation; Amanda Owen, Executive Director and Founder, and Kathy Hempel, Puzzle Pieces; Jaime Rafferty, Parent; Philip Patterson, President/Chief Executive Officer, and Debbie Zuerner Johnson, Owensboro Health; Jane Stahl, NeuroRestorative; Karen Lentz, Commonwealth Alliances; Camille Collins, Jeff Edwards, and Lissette Johnson, Kentucky Protection and Advocacy; Brad Schneider and Jan Eblen, Lifeskills, Inc.; Jaqueline Smith, Humana; Robert Hobson, CoventryCares of Kentucky; Mary Reinle Begley and Tabitha Burkhart Wilson, Department for Department for Behavioral Health, Developmental and Intellectual Disabilities; Rosie McMichael, Green River District Health Department; Cindy Chapman, Innovative Support Solutions; Cuba Armstrong, Maggie Price, Karen Rednour, Scott Miller, Jeff Hagan, Carrie Blackham, Kelly Turnham, and Beth Shepherd, Wendell Fosterís Campus for Developmental Disabilities; Steve Bing, Kentucky Health Department Association and Kentucky Public Health Association; Angela Mayfield, Hospice of Western Kentucky; Michele Keel and Mike Mountain, RiverValley Behavioral Health; and Shannon McCracken, Kentucky Association of Private Providers; and Colleen Hagan, Legislative Director, Cabinet for Health and Family Services.
Todd Inman, Chair of the Board of Directors, and Clay Ford, Vice-Chair of the Board of Directors, Wendell Fosterís Campus for Developmental Disabilities, stated that the Wendell Fosterís Campus (WFC) for Developmental Disabilities, Inc. was founded in 1947 by Wendell and Edith Foster in their commitment to provide the care needed for their daughter, Louise, and other children in the Owensboro, Kentucky area. The WFC has historically specialized in serving people with severe cerebral palsy and related disorders, but now offers cutting edge services to children and adults with other disabilities ranging from autism to traumatic brain injury and muscular dystrophy. The WFCís mission is to empower people with developmental disabilities to realize their dreams and potentials. The current budget is $16,427,875 for fiscal year 2016 and there are over 300 employees. Services offered are outpatient therapies, Western Kentucky Assistive Technology Center (WKATC), Kelly Autism Program (KAP), supported employment, case management, Michelle P waiver, independent living, staffed residences, day training, and intermediate care facility for individuals with intellectual and developmental disabilities (ICF/ID).
In response to a question by Representative Burch, Mr. Inman stated that the WFC receives funding from private insurance, Medicare, Supports for Community Living (SCL) waiver, the Office of Vocational Rehabilitation KATS grant, First Steps Assistive Technology grant, training fees, private pay, Michelle P waiver, and community donations.
Approval of the Minutes
A motion to approve the minutes of the September 16, 2015 meeting was made by Senator Julian Carroll, seconded by Representative Marzian, and approved by voice vote.
Person-Centered Thinking and Planning
Diana Caldwell, Vice President, Quality and Strategic Development, Wendell Fosterís Campus for Developmental Disabilities, stated that individuals with disabilities need to be recognized for their contributions. Every person has a gift that can be used, they just need encouragement and empowerment. A case manager helps individuals find and utilize available services.
Bryan Stone answered questions from his case manager, Amy Staves, saying that he liked living on his own and his job at the Bingo Hall. Bryan lives in one of Wendell Fosterís independent living homes where staff visit him twice a week. He loves to bowl and currently competes with three different leagues.
The Value of Sheltered Workshops within the Medicaid Waiver System
Mark Chumbler, CEO, and Susan Vickers, Clinical Director Hugh Edward Sandefur Training Center, stated that the concept for sheltered workshops has been around for 50 years. The Hugh Edward Sandefur Training Center is involved in sheltered workshops and integrated employment. Medicaid waivers provide opportunities for individuals with disabilities to be integrated into the community.
In response to a question by Senator Julian Carroll, Mr. Chumbler stated that one-third of the centerís funding comes from community partnerships, two-thirds from Medicaid, and some private funds. The center wants to be able to provide services even if state funds are unavailable.
In response to question by Senator Alvarado, Mr. Chumbler stated that some individuals in the sheltered workshops are paid $4 per hour. If an individual is paid less than minimum wage, the rate is determined by a piece rate worked hourly or time settings worked monthly. Individuals who participate are required to pay taxes. Sheltered workshops in other states have survived because of private funds. Person-centered thinking and planning must allow individuals to pursue their own goals. Ms. Vickers stated that case managers provide options that are available for individuals to choose.
Living Wages in Sheltered Workshops
Arthur Campbell, Louisville, Protection & Advocacy for Individuals with Developmental Disabilities (PADD) Advisory Board, translated by his case manager, Katherine Bowen, stated that he is philosophically opposed to sheltered workshops. Most people think that individuals with severe disabilities should not be allowed to live out in the community. He has lived in the community in his own apartment for 31 years and is able to lead a full life. Individuals with disabilities are not patients. Families need good and dependable respite. Nationally there is talk about raising the minimum wage, but individuals with disabilities in Kentucky are still paid $4 per hour. He questioned what that says about that personís time and worth. Individuals with disabilities do not want to be disrespected or discriminated against because of their disabilities. In 1999, Kentucky received a federal Medicaid grant to study how to best implement the Olmsted decision and make recommendations on how to desegregate the disabled population from the institution, nursing home, and workshop setting. In his opinion, the current workshop model is in violation of the Olmsted decision for many individuals. The goal of individuals with disabilities is to be paid a living wage without segregation.
Senator Danny Carroll stated that some individuals with disabilities cannot work in the community and need to have other options available to them. Employment programs are needed. There is a place for individuals with disabilities in the work place. Fair working standards and equitable pay is needed for these individuals. It is about equality for individuals with disabilities not just what they get paid. Individuals with disabilities deserve to get paid the same amount for the same job as individuals without disabilities.
Representative Watkins stated that workshops build self-esteem and confidence.
Jason Cole, Regional Program Manager, Kentucky Office of Vocational Rehabilitation, stated that the Office of Vocational Rehabilitation receives state and federal funds. An individual has to have a disability to be eligible to receive vocational rehabilitation services. Approximately 4,000 individuals are placed in the workforce yearly. Their employment provides millions of dollars in taxes and helps the individual be less dependent on state benefits. Individuals are physically and mentally better when employed. Because there are different disabilities, there is no one solution.
Kimberley Kirtley, Supported Employment Coordinator, Wendell Fosterís Campus for Developmental Disabilities, stated that supported employment started two and a half months ago at WFC and receives referrals from the Office of Vocational Rehabilitation. The program helps individuals with disabilities learn social skills and helps bring out the talents of these individuals. The program is helping to prepare individuals to live on their own. Individualsí skills need to stop being minimized.
In response to questions by Senator Thomas, Ms. Kirtley stated that currently there are no certificate programs, but programs are needed to help individuals learn how to improve their skills. Mr. Cole stated that the Office of Vocational Rehabilitation has excellent partnerships with educational facilities. To look at some individuals, no one could tell the individual has a disability.
In response to a question by Representative Marzian, Mr. Cole stated that employers are willing to hire individuals with disabilities, but there is not a list of companies to choose from that are willing to hire them. There needs to be alternatives for individuals with disabilities.
Amanda Owen, Executive Director and Founder of Puzzle Pieces, stated that there should not be a cookie cutter aspect for person-centered programs. The person-centered approach is different for every individual. Employers need to be shown the benefits of hiring individuals with disabilities. Autism is on the rise, and an array of services needs to be available for autistic children and their families.
Jaime Rafferty stated that autism is a life altering event for not just the child, but also the family. Her son, Beau, had to be taken out-of-state to get a diagnosis. There are not enough mental health providers available for autism. A comprehensive team approach is needed. Resources need to be put into programs for autism. She was told that her son was very smart and has the capability to go to college and earn a degree. He just needs help with his social skills.
In response to a question by Senator Danny Carroll, Ms. Owen stated that individuals can access services from the Michelle P waiver. Health care providers are needed who understand autism and which medications to prescribe. Unfortunately, the medications are expensive and some parents cannot afford them. Puzzle Pieces opened because of a grant received from a local hospital in Owensboro. Donations from the community are needed to be able to sustain autism programs. There needs to be more support available for child care services to help parents and caregivers of autistic children.
Representative Burch stated that more research needs to be conducted to find out what causes autism.
Discussion of 900 KAR 5:020
Philip Patterson, President/Chief Executive Officer, Owensboro Health, stated that comments were submitted to the Cabinet for Health and Family Services opposing the cabinetís proposed Ambulatory Surgical Center Review Criteria 5 and 6 in the 2015-2017 Kentucky State Health Plan found 900 KAR 5:020. These criteria create potentially very broad exceptions to the legislative mandated need methodology for ASCs. Changes could lead to proliferation of unneeded ASCs and could lower the quality and raise the cost of outpatient surgery services. If there is a need for additional ASCs in particular locations, the cabinet should adopt a reasonable need methodology addressing those needs. The Kentucky Hospital Association (KHA) stated there should be no change made to the review criteria for ASCs. If the changes are implemented, there is the potential for extremely damaging consequences for community hospitals.
In 2014, the General Assembly enacted the biennial state budget that included a requirement that all applications proposing to establish an ASC be reviewed against the utilization based need criteria contained in the State Health Plan. However, the cabinet has proposed four exceptions to the need criteria that conflict with the state budget. Under the changes being made to the State Health Plan, surgery centers can be established by any entity including entities from out of state. The applicant would only need to argue that a particular surgical procedure was not sufficiently available and they could be granted a CON for a surgery center. The surgery center would have an unrestricted license to perform any type of surgical procedure. The new surgery center could be approved regardless of whether there is an existing local hospital that has available capacity to serve additional patients.
The cabinet creates an exception to the need criteria to allow any physicianís office to establish a surgery center if the physicianís office has been operating in the state for ten years. The physician only needs to acknowledge the same procedures will be performed in the surgery center as those already performed in the physicianís office. The proposed changes would give the physicians an unrestricted surgery center allowing any type of procedure to be performed in the facility. Another change allows ophthalmologists who have practiced in the state for ten years to be eligible to open a surgery center if $300,000 is spent on laser equipment by March 31, 2016. Only ophthalmic surgery would be allowed to be performed.
The fourth exception is to allow surgery centers to be built anywhere in the state if the facility is owned by a Kentucky hospital. The surgery center could be built in either the county of the hospital or any surrounding county, regardless of whether there was any other hospital in the county or a surrounding county with available outpatient surgical capacity. This exception also treats hospitals differently based on whether or not quality data is reported to a Medicare data base, HospitalCompare. The cabinetís own data shows there is no need for additional surgery services.
The proposed changes to the State Health Plan need criteria will result in an explosion of surgery centers throughout the entire state of Kentucky, movement of the most profitable surgeries and patients out of hospitals, and ultimately threaten the financial viability of many community hospitals. The changes would be devastating to rural and safety net hospitals which are already struggling.
The cabinet also proposed to create a number of exceptions to the review criteria for Megasvolt Radion Equipment. An application for a new radiation oncology program by any hospital or entity that falls within one of these exceptions would automatically be consistent with the State Health Plan, even if it is inconsistent with the need methodology. Approval of additional radiation oncology programs should be tied to a need for such programs and the availability of existing programs in an area.
The Legislative Research Commissionís Administrative Regulation Review Subcommittee (ARRS) reviewed the State Health Plan at its September meeting and found 900 KAR 5:020 deficient. CON applications can still be filed, but many applicants will never be required to show a need for their project if they fall into a State Health Plan exception and then are deemed to meet the separate need and access review criteria.
Senator Raque Adams stated that the cabinet was trying to usurp the General Assemblyís authority. Everyone needs to take a step back and find the regulation deficient or defer it to be able to get more information about concerns and receive more public comments. A letter from Secretary Audrey Tayse Haynes of the Cabinet for Health and Family Services, was distributed to members of the Interim Joint Committee on Health and Welfare that outlined the background and overview of the process for the State Health Plan updates. Also attached was the letter from Governor Beshear that overrode the finding of deficiency by the ARRS.
Senator Bowen stated that at the September 8, 2015 meeting, the ARRS voted 8 yes votes to 0 no votes to find 900 KAR 5:020 deficient. It was not a partisan issue.
There being no further business, the meeting was adjourned.