Interim Joint Committee on Health and Welfare


Minutes of the<MeetNo1> First Meeting

of the 2017 Session Break


<MeetMDY1> January 18, 2017


Call to Order and Roll Call

The<MeetNo2> first meeting of the Interim Joint Committee on Health and Welfare during the 2017 Session Break was held on<Day> Wednesday,<MeetMDY2> January 18, 2017, at<MeetTime> 10:00 a.m., in<Room> Room 129 of the Capitol Annex. Senator Julie Raque Adams, Co-Chair, called the meeting to order, and the secretary called the roll.


Present were:


Members:<Members> Senator Julie Raque Adams, Co-Chair; Representative Addia Wuchner, Co-Chair; Senators Danny Carroll, Denise Harper Angel, Alice Forgy Kerr, Stephen Meredith, and Reginald Thomas; Representatives Danny Bentley, Robert Benvenuti III, George Brown Jr., Larry Brown, Jim Gooch, Joni L. Jenkins, Mary Lou Marzian, Russ Meyer, Kimberly Poore Moser, Darryl T. Owens, Melinda Gibbons Prunty, and Russell Webber.


            Guests: Rosmond J. Dolen, Of Counsel, Bingham Greenebaum Doll LLP, and Executive Director, Kentucky Association of Health Plans; Vickie Yates Brown Glisson, Secretary, Eric Clark, Legislative Director, Adria Johnson, Commissioner, Department for Community Based Services, Steve Miller, Commissioner, Department for Medicaid Services, Wendy Morris, Commissioner, Department for Behavioral Health, Developmental and Intellectual Disabilities, Dr. Connie White, MD, Senior Deputy Commissioner, Department for Public Health, Deborah Anderson, Commissioner, Department for Aging and Independent Living, Robert Silverthorn, Inspector General, Office of the Inspector General, Paul Coomes, Executive Director, Office of Health Policy, John Watkins, Deputy Executive Director, Office of Health Benefit and Information Exchange, Jackie Richardson, Executive Director, Commission for Children with Special Health Care Needs, Steve Veno, Commissioner, Department for Income Support, Tim Feeley, Deputy Secretary, Cabinet for Health and Family Services;


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


Overview of Medicaid Managed Care Organizations (MCOs)

            Rosmond J. Dolen, Of Counsel, Bingham Greenebaum Doll LLP, and Executive Director, Kentucky Association of Health Plans (KAPH), stated that the KAPH has been in existence since 1985 and has provided a forum for commercial insurers to promote the common business interest of health insurers in Kentucky. Medicaid Managed Care Organizations (MCOs) joined the association providing an important voice in addressing issues impacting the sustainability of the Commonwealth’s Medicaid program while improving the quality of life and health outcomes of its members. Aetna, Anthem, Blue Cross and Blue Shield, Humana, Passport Health Plan, and WellCare contract with Kentucky as MCOs to provide Medicaid benefits to Kentuckians across the Commonwealth.


            In 1965, Medicaid was signed into law through the Social Security Act to provide health coverage for low-income people. Although the federal government establishes certain parameters for all states to follow, each state administers its own Medicaid program differently. In 2014, the Affordable Care Act (ACA) provided states the authority to expand Medicaid eligibility to individuals under age 65 in families with incomes below 138 percent of the Federal Poverty Level (FPL) and standardize the rules for determining eligibility and providing benefits through Medicaid, the Children’s Health Insurance Program (CHIP), and the health insurance market. Over 300,000 Kentuckians were added to the program during its first year. The traditional Medicaid program and CHIP are the central sources of coverage for low-income children and pregnant women, with 49 states covering children and 34 states covering pregnant women with incomes at or above 200 percent FPL as of January 2017.


            In 1995, the Commonwealth of Kentucky sought to develop eight regional Medicaid Managed Care Partnerships to help control increasing Medicaid costs. The two state medical schools at the University of Louisville and the University of Kentucky were asked to provide leadership in the development of these partnerships. Only Region 3 was successful and resulted in the single source waiver approved for Louisville and the surrounding sixteen counties while the rest of the state continued to operate under the fee-for-service model. In 2011, the Cabinet for Health and Family Services (CHFS) privatized the Medicaid administration through a competitive bid process and was able to save approximately $1.3 billion. Three companies were awarded contracts to administer the Medicaid benefits across the state, except in Region 3 which continued to operate under a single source waiver utilizing the partnership model. Initially, the three MCOs were given 90 days to build a network and eventually another 30 days to build provider networks and put in place systems that could successfully administer Medicaid benefits for both providers and members. On November 1, 2011, the three MCOs began providing benefits to low-income children and pregnant women, the aged, blind, and disabled, and foster care. Individuals in nursing homes and other waiver programs, such as the Home and Community Based Service (HCBS) waivers, are not included in Kentucky’s Medicaid managed care program but under the previous fee-for-service program. Today, over 1.3 million Kentuckians receive their health care benefits through five MCOs.


            MCOs administer Medicaid benefits on behalf of the Department for Medicaid Services (DMS) and in accordance with the State Plan. MCOs contract with providers or provider groups that meet the guidelines of participation with Kentucky Medicaid to create networks of providers. All MCOs allow members to see any provider participating in its network in accordance with plan rules, although some may require prior authorizations. Under the terms and conditions of Medicaid participation, providers are prohibited from balance billing patients. Participating providers in Kentucky Medicaid may not balance bill patients or collect cash payments from Medicaid beneficiaries for Medicaid covered services. MCOs are required to provide all benefits that Kentucky Medicaid fee-for-service offers. Each MCO determines and operates its own utilization requirements which are similar to programs utilized by commercial insurers. MCOs pay providers directly from the money received from the cabinet.


            In 2016, the General Assembly passed Senate Bill 20 that established the right and path for providers to an independent, external third party review of the MCOs decision that denied, in whole or in part, a health care service to an enrollee or a claim for reimbursement to a provider for a health care service rendered by the provider. The Medicaid Managed Care Final Rules released by the Centers for Medicare and Medicaid Services (CMS) in May 2016, contain significant new requirements for actuarial soundness and actuarial certification of rates. Among the requirements is that MCOs report to the state Medical Loss Ratios (MLR) which essentially is the percent of premium or revenue used to pay claims and provide care. In July 2016, Kentucky imposed a MLR for MCOs at 90 percent which exceeds the federal minimum MLR of 85 percent. In the event an MCO does not spend the required 90 cent of revenue to provide care for Medicaid beneficiaries, a portion of the money is returned to the Commonwealth.


            All MCOs are contractually required within three years to be accredited by the National Committee for Quality Assurance (NCQA). NCQA accreditation provides a comprehensive evaluation including clinical performance and consumer experience. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. HEDIS consists of 81 measures across 5 domains of care. HEDIS measures demonstrate the MCOs effort to improve health outcomes.


            The MCO footprint varies by each plan. The DMS provides the MCOs weekly membership counts for each county. Each of the MCOs have hired and developed a workforce to administer the Medicaid benefits across the Commonwealth of Kentucky. Aetna has more than 30 years of experience managing the care of the most medically vulnerable using innovative approaches to achieve both the successful health care results and effective cost outcomes. For over 75 years, Anthem Blue Cross and Blue Shield has provided health care benefits in both the commercial and government-sponsored programs to more than 1.6 million Kentuckians. For over 50 years, Humana has served Kentucky’s healthcare needs through Medicaid, Medicare, commercial, and government lines of business. Passport Health Plan is a provider sponsored, non-profit, community-based health plan administering Medicaid benefits in all 120 Kentucky counties since 1997. WellCare was founded in Tampa, Florida 32 years ago by a group of physicians and focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage, and Medicaid prescription drugs plans to families, children, seniors, and individuals with complex medical needs. WellCare has served the Commonwealth since November 1, 2011.


            Managed care focuses on improving health outcomes through coordinated care, preventive services, and by offering disease management for individuals with chronic conditions. It also focuses on reducing the unnecessary use of services such as emergency room visits for non-emergencies or duplicate tests. MCOs are focused on providing the right care at the right time in the right setting. The most effective way to control costs in Kentucky’s Medicaid program is to make members healthier. The proposed 1115 Medicaid waiver focuses on how to provide a new framework designed to increase Medicaid member engagement that encourages cost-conscious healthcare decisions. In January 2014, the ACA mandated coverage of substance use disorder treatment allowing states to expand provider types and add billing codes for additional therapies and treatment. This allowed MCOs to not only pay for substance abuse medications but expand access to care and provide coverage for additional treatment options enhancing the likelihood of success. The proposed 1115 waiver would make changes to allow Medicaid payment for inpatient psychiatric care for individuals 21 to 64 years of age in institutions for mental diseases (IMDs) with more than 16 beds. The proposed waiver includes a demonstration project in 10 to 20 high-risk counties to cover short-term inpatient psychiatric treatment for substance use disorders in the 26 facilities identified by the cabinet. Expanding treatment options for addiction services empowers MCOs to contract with new providers while working with the Commonwealth to address the public health crisis of addiction.


            In response to a question by Senator Adams, Ms. Dolen stated that the 10 to 20 high-risk counties have not been identified.


            In response to questions by Senator Danny Carroll, Ms. Dolen stated that she was not aware of any systematic approaches to deny or defer services or claims in an effort to manage corporate cash flow. In 2016, approximately 25 million claims were processed by the MCOs within the required percentages allowed by the Department of Insurance (DOI). MCOs try to work with providers to address claims issues in terms of payment. Providers will receive statutorily required interest based on the length of time it takes to pay a claim. MCOs are heavily regulated and monitored by the DMS and DOI and regulated by federal compliance requirements.


            Representative Benvenuti stated that Medicaid is very expensive to operate and manage because there are too many people on the rolls. The fundamental core issue is when a handout is provided, people are unmotivated to take care of themselves. There should be an aggressive effort to reduce the Medicaid population.


            In response to questions by Senator Meredith, Mike Ridenour, Vice President of Government Affairs, WellCare of Kentucky, stated that the $1.3 billion savings achieved included state and federal dollars. The state’s strategy was contracting with providers who could offer different rates, different contract structures in order to achieve a level of savings without slashing needed services across the board. The state contracted with MCOs instead of cutting reimbursement rates by $438 million. The state ended up saving $1.3 billion and this savings immediately went back into the state budget for education, infrastructure development, and other areas that would not be able to be funded without the additional funds. Ms. Dolen stated the 10 percent of funds left after the 90 percent MLR expenses are paid is used for administrative functions to expand programs, quality initiatives, case management services, and profits. Provider reimbursement rates negotiated with the individual MCOs are typically proprietary and not something an MCO can talk about, but initiating a contract with a provider is something that can be addressed from each individual MCOs perspective. It is up to each MCO to decide how to use and divide funds from the state, so for the MCOs, it is a business decision. She did not know the percentage of cost Medicaid providers are being reimbursed. Senator Adams requested that Ms. Dolen provide members information to questions that she was not able to provide at the meeting.


            Representative Gooch stated that the number on the Medicaid rolls is unstainable. The state should never provide benefits to Medicaid recipients for free that are better benefits than what the taxpayers can purchase.


            In response to questions by Representative Moser, Mr. Ridenour stated that MCOs partner with the cabinet and other groups to identify ways to achieve better quality and better care for the Medicaid membership. Medicaid benefits are identified in the State Plan that is approved by CMS. CMS set the 16-bed limit policy. The 1115 waiver would allow Kentucky to expand the 16-bed limitation in 10 to 20 counties. The counties for the pilot project have not been identified yet. After 2014, MCOs could contract for therapy services and interventions to ensure successful treatment of addiction. MCOs, the state, and the General Assembly need to partner to find creative ways to address the problem of substance abuse. Ms. Dolen stated that she did not know how long the short-term treatment option for addiction services would last under the proposed 1115 waiver. Representative Moser asked that when the counties are identified that Ms. Dolen provide the information to the committee.


            In response to a statement by Representative Wuchner, Ms. Dolen stated that she provide the HEDIS reports to the committee.


            In response to a question by Senator Meredith, Ms. Dolen stated that Kentucky’s any willing provider law also applies to Medicaid providers just as it does to providers who contract with commercial payers. If a provider accepts the same or similar terms and conditions being provided to everyone else, that is a provider’s individual choice.


            The committee recessed for lunch at 11:05 a.m. and reconvened at 1:03 p.m.


Legislative Agenda and Overview of the Cabinet for Health and Family Service

            Vickie Yates Brown Glisson, Secretary, stated that the cabinet is the primary state agency responsible for protecting and promoting the well-being of Kentuckians through the delivery of health and human services. From birth certificates to death certificate and everything in between, someone in Kentucky utilizes a service provided by the cabinet. The cabinet has 7,200 full-time employees in 400 locations and 2,500 contractors. There is a local DCBS office and local health department in each county. The CHFS budget is $13 billion of the total state operating budget of $43 billion. In 2016, the cabinet’s expenditures were $12,264,178,400 with $10,045,561,800 used for Medicaid expenses. Most of the cabinet funds are spent on grants, loans, and benefits. Major cabinet initiatives are transforming Medicaid, transforming adoption and foster care programs in Kentucky, and developing ways to combat Kentucky’s substance abuse problem. Twice as many babies will be born to a Kentucky mother with an opioid addiction than in any other state.


            Adria Johnson, Commissioner, Department for Community Based Services (DCBS), stated that the mission of the DCBS is to build an effective and efficient system of care with Kentucky’s citizens and communities to reduce poverty, adult and child maltreatment, and the effects; advance personal and family self-sufficiency, recovery, and resiliency; assure all children have safe and nurturing homes and communities; and recruit and retain a workforce and partners that operate with integrity and transparency. The department also processes Medicaid eligibility applications and administers 30 programs and grants such as the Supplemental Nutrition Assistance Program (SNAP) State Supplementation Program for persons who are aged, blind, or have a disability, Temporary Assistance for Needy Family Block Grant, Child Care Assistance Program, Low Income Home Energy Assistance Program (LIHEAP), and others. DCBS serves approximately 4.4 million Kentuckians. The SFY revenue of $1,025,695,674 is funded through federal funds, general funds, restricted and/or agency funds, and tobacco settlement funds. High caseloads cause huge worker turnover rates. Kentucky law mandates that a parent or guardian authorizes and signs for a minor child to get a driver’s license. There needs to be a law that allows a foster parent to be able to sign for a foster child’s driver’s license. The department wants the ability to place a child with a fictive kin. Currently, the cabinet cannot recommend placement of a child with someone who is not a family member.


            Steve Miller, Commissioner, Department for Medicaid Services, stated that the Medicaid budget is $11 billion annually and covers approximately 1.4 million Kentuckians. Due to the decrease in federal match for the cost of the Medicaid expansion, the Medicaid expenses will increase to $750 million by state fiscal year (SFY) 2021-2022. Approximately $7 billion is spent on the MCO population. Kentucky ranks highest in the nation for Medicaid managed care profits. In January 2017, the MCOs negotiated a six-month contract with the cabinet. The MLR was raised to a minimum of 90 percent which means 90 cents of every premium given to an MCO has to be spent on Medicaid expenses. Some of the Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) goals are to encourage individuals to become active participants and consumers of healthcare, transition people to seek employment and transition to commercial health insurance coverage, and ensure fiscal sustainability of Medicaid.


            In response to questions by Senator Meredith, Commissioner Miller stated that the fee-for-service provider reimbursement rate for a combination of inpatient and outpatient care is 80 percent. The cabinet is not privy to the MCOs contractual arrangements with providers. Each MCO has to have an adequate provider network in each county. Some counties do not contract with all the MCOs which makes having an adequate provider network challenging. The Red Tape Reduction initiative is an in-house effort but outside feedback is welcome. Senator Meredith stated that there needs to be one clearinghouse for all five MCOs.


            Eric Clark, Legislative Director, stated that as part of Governor Bevin’s Red Tape Reduction, many of the 669 administrative regulations that have to be promulgated by the cabinet are required by statute. The goal is to identify which administrative regulations are or are not still relevant to run the cabinet efficiently. Approximately 60 percent of the administrative regulations have been reviewed. Information on the Red Tape Reduction initiative can be found at Anyone can submit comments or ideas on how to reduce red tape within the cabinet. All submissions are reviewed and responded to by the cabinet.


            In response to questions by Senator Danny Carroll, Commissioner Johnson stated that the cabinet is analyzing what are the appropriate number of regions. A permanent eligibility team has been established in Frankfort to deal with special cases that need more time and attention than standard processing that takes place in a call center. Secretary Glisson stated the cabinet is looking at workflow issues and establishing consistent regions throughout the cabinet and state. Deck Decker, Executive Director, Office of Administrative and Technology Services, Cabinet for Health and Family Services, stated that the cabinet is working on identifying why a recipient is being assigned from Medicaid to a MCO during recertification through Benefind. The cabinet is also working on issues with the 1915(c) and 1115(c) waiver populations. Secretary Glisson stated that the 1915(c) waiver population includes at-risk populations in the Home and Community Based Services (HCBS) waiver, the Acquired Brain Injury (ABI) waiver, the Michelle P waiver (MPW), and the Supports for Community Living (SCL) waiver. These waivers need approval by the federal government. Executive Director Decker stated that the cabinet is trying to find solutions to help the Medicaid Management Information Systems (MMIS) and Benefind work in together. Benefind cannot process a claim without all the fields having information. Commissioner Johnson stated that a rapid response team has been put in place to address the Benefind issues. Representative Wuchner clarified that the Home and Community Based Services, Acquired Brain Injury, Michelle P, and the Supports for Community Living waivers have a fee-for-service reimbursement and are not part of the MCOs.


            In response to questions by Representative George Brown, Commissioner Miller stated that able-bodied adults need to be active in their care, engaged in the community, and transition to commercial insurance (federal health plans). An individual would stay on Medicaid until they have the skills set and abilities and are no longer qualified for Medicaid and can move to a qualified health plan. If they are unable to make the transition, they will still have the Medicaid benefits through Kentucky HEALTH. Qualified health plans have protections for pre-existing conditions and unlimited lifetime limits. The goal of the 1115(c) waiver is to help individuals transition over to qualified health plans that are in place today and mirror the policies in the commercial market.


            Wendy Morris, Commissioner, Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID), stated that the department is responsible for the administration of state and federally funded mental health, substance use disorder, developmental and intellectual disability programs and services through the Commonwealth. Its mission is to provide leadership, in partnership with others, to prevent disability, to build resilience in individuals and their communities, and to facilitate recovery for people whose lives have been affected by mental illness, substance abuse, intellectual disability, or developmental disability. The department contracts with the 14 Community Mental Health Centers (CMHCs) located throughout the state and provides oversight for the Supports for Community Living (SCL) waiver. In January 2017, a Release for Information (RFI) from the Substance Abuse and Mental Health Services Administration (SAMSHA) was released for a grant application for $10.5 million to help address the opioid epidemic. The department leads the cabinet’s Opioid Response Workgroup, promotes efforts to decriminalize mental illness by diverting and transitioning people from the criminal justice system and into treatment, and supporting implementation of evidence-based behavioral health practices for adults and children through funding, technical assistance, and performance based contracts.


            In response to a question by Senator Adams, Commissioner Morris stated that the department is watching legislation dealing with assertive outpatient treatment and there is always a need for funding to transition from institutions to a robust system of care in the community.


            Dr. Connie White, MD, Senior Deputy Commissioner, Department for Public Health (DPH), stated that there are 61 health departments in Kentucky, some independent. The department’s budget is $36 million and employs 2,500 workers. The goal is to improve the health and safety of the citizens of Kentucky by using high quality data. The department is working on an electronic health records and early childhood development initiatives. There are 179 administrative regulations promulgated by the department. There are 144 programs administered by the department covering a broad range of areas. Kentucky has the highest number of cases of hepatitis C.


            Representative Wuchner stated that awareness needs to be increased about adolescent and young adults considering and making a plan to commit suicide. Dr. White stated that the DPH wants to make sure a newborn goes into a nurturing environment where they will be able to take care of themselves appropriately.


            Deborah Anderson, Commissioner, Department for Aging and Independent Living, stated that the populations served are older adults and individuals of all ages with disabilities and wards of the state. The department receives federal and state funding. The Aging and Disability Resource center receives approximately 32,000 phones calls annually. The state Long Term Care Ombudsman makes 49,000 visits annually to visit approximately 49,000 residents. Meals are provided to homebound individuals as well as senior citizen centers. Supportive services are provided to help keep people in their homes longer. Assisted living facilities are not Medicaid funded and cost $2,500 to $5,000 per month. There are 100 to 110 assisted living communities statewide. The number of active clients has increased from 2,100 to 4,309 over the past 8 years and continues to trend upward, and budget constraints limit the ability to continue to cover the trend. Caseload sizes for state guardians is 60 to 80 with the national recommendation being 20. Approximately 10 to 12 percent of clients have a history of violence and/or substance abuse. In 2016, 4,700 grandparents were served in the Kentucky Caregiver Program. Out-of-state placements remains necessary because Kentucky does not have a secure setting for traumatic brain injury patients. Approximately 2,700 traumatic brain injury patients are served per year. Nearly all programs for aging services currently have waiting lists.


            Robert Silverthorn, Inspector General, Office of the Inspector General (OIG), stated that the OIG licenses and regulates health care and child care providers, long-term care facilities, and child adoption and placement agencies. It investigates fraud, waste, abuse, mismanagement or misconduct by CHFS clients, employees, vendors, providers, and contractors. The office coordinates enforcement of federal law as state survey agency for the CMS and operates the Kentucky All Schedule Prescription Electronic Reporting (KASPER) Program and enforces applicable laws. Goals of the office are to sync state and federal drug schedules for consistency, include toxicology reports within KASPER, and house KASPER in the Kentucky Office of Benefit and Information Exchange.


            Paul Coomes, Executive Director, Office of Health Policy (OHP), stated that OHP administers the Certificate of Need (CON) Program, maintains and publishes data on health care facilities and uses, seeks and administers many federal grants, manages several external contracts, and coordinates and develops health policy within the cabinet. A health plan on data needs to be developed. OIG receives $455,000 in general funds, $572,000 for CON application fees, and $1.5 million in federal funds.


            John Watkins, Deputy Executive Director, Office of Health Benefit and Information Exchange, stated that in October 2016, Kentucky received approval from CMS to transition from kynect to the federal The office is still responsible for outreach, training, and education to consumers during transition. The office anticipates the same number of enrollees on the federal exchange as the state exchange has had in past years. The Kentucky Health Information Exchange (KHIE) is a statewide secure electronic network for patient electronic medical records to be shared among all providers. KHIE compiles a common patient record from disparate provider electronic medical records (EMRs) for the purpose of improving coordination and curtailing costs by reducing duplicative tests and exams. KHIE acts as a data intermediary for the DPH by routing data from provider EMRs to DPH for population health purposes.


            Jackie Richardson, Executive Director, Commission for Children with Special Health Care Needs, stated that the functions of the commission are being a one-stop shop for children with complex health needs, seeing patients in a multidisciplinary setting, filling the gaps in services for children and youth with special health care needs, and enhancing services not duplicating them. There are 11 offices and 7 satellite locations statewide. Every child is within a 1.5 hour drive from a commission office. The goal is to expand and reach out to touch as many children with special healthcare needs by continuing collaborations with providers, state partners, school systems, universities, and telehealth services.


            In response to a question by Representative Wuchner, Executive Director Richardson stated that the commission provides a parent in a federally qualified health center (FQHC) in Louisville to be a support to other parents.


            Steve Veno, Commissioner, Department for Income Support, stated that the Disability Determination Services (DDS) program determines medical eligibility for Kentucky residents who apply for Social Security or SSI Disability benefits set by the Social Security Administration. SSA contracts with states to administer determinations process. Kentucky is the only state in the region piloting the use of telework for the Medical Consultants staff. The goal is to expand this to other DDS staff. The Child Support Enforcement (CSE) program establishes paternity, child and medical support, modifies support obligations, and enforces and collects child and medical support for individuals who request child support services or are receiving public assistance. State funding is needed to replace the 26-year old Kentucky Automated Support Enforcement System (KASES).


            In response to questions by Senator Danny Carroll, Deputy Secretary Feeley stated that the waiting list for the Michelle P Waiver (MPW) is long, and if someone becomes ineligible, it would take a long time to get back on the waiver. There is currently no determination of need for individuals on the waiting list. Secretary Glisson stated that the 1915(c) waivers are being reviewed by the cabinet.


            In response to a comment by Representative Wuchner, Secretary Glisson stated that there are only a certain amount of funds available, and the cabinet wants to make sure the funds are being used as wisely as possible. If an able-bodied individual with no dependents can transition off Medicaid, the funds could possibly be used to increase services for the 1915(c) waivers.


            Tim Feeley, Deputy Secretary, stated that the cabinet also has an Office of Legal Services, Office of Ombudsman, and Office of Hearings and Appeals. The cabinet provides oversight of the Family Resource and Youth Services Centers (FRYSCs) and AmeriCorp & Volunteer Services. The cabinet wants to be open and transparent and work with legislators on issues.


Consideration of Referred Administrative Regulations

The following administrative regulations were referred for consideration: 10 KAR 6:010 – establishes procedures for the governance of the Early Childhood Advisory Council and procedures for disbursement of funds, in accordance with KRS 200.700(1), from the Early Childhood Development Fund to programs that support and promote early childhood development; 201 KAR 21:025 – establishes the duties of the officers, field personnel, and administrative staff, establishes the terms and procedure for election of officers, and establishes compensation of the Kentucky Board of Chiropractic Examiners;

201 KAR 21:041 – establishes the procedures relating to application for licensure, license renewal, and fees for practitioners of chiropractic in Kentucky; 908 KAR 2:040 - establishes hospital district assignments and updates the forensic psychiatry evaluation process; 908 KAR 3:081 – repeals 908 KAR 3:080, 3:090, 3:100, 3:120, 3:130, 3:140, 3:150, 3:160, and 3:180 for consistency with other cabinet regulations, to eliminate redundancy, and to remove antiquated policy; 921 KAR 3:030 – establishes the application and the voter registration processes used by the cabinet in the administration of the Supplemental Nutrition Assistance Program (SNAP); 921 KAR 3:050 – establishes the criteria for recipient claims, collections provisions, and additional provisions used by the cabinet in the administration of SNAP; and 922 KAR 1:360 & E – establishes five levels of care based upon the needs of a child for whom the cabinet has legal responsibility, a payment rate for each level, gatekeeper responsibilities, provider requirements, procedures for classification of the appropriate level of care, and procedures for determination of components of the model program cost analysis. An ordinary administrative regulation would not allow the agency sufficient time to increase payment rates for residential child-caring facilities to better meet the actual costs in providing care, thereby jeopardizing placement capacity and service provision to vulnerable children in state custody.



There being no further business, the meeting was adjourned at 2:45 p.m.